Tuesday, November 22, 2011

Substance Abuse Treatment Programs for Physicians: Are These Programs the Best Possible Treatment for Everyone?

Last week, I was asked to speak to a group of Physicians, Nurse Practitioners, and Nurses on the subject of Substance Abuse in Health Care Professionals. It is a subject near and dear to my heart, and it was a pleasure sharing my knowledge and experience with this group. They were bright and eager to learn and share their experiences.

As I researched the topic, I came across some recent research that is very illuminating. The research reviewed, not just how we treat physicians, but the research also gives us information on some of the principles that we can use to treat anyone who has a substance abuse problem.

The research was reported in The Journal of Substance Abuse Treatment, and was written by Robert DuPont MD and his colleagues. Dr DuPont decided to study how we identify, and treat, addicted physicians. Most states in the US have programs called Physician Health Programs (PHP’s), to help physicians with substance abuse problems. The programs are usually set up under the authority of the State Licensing Board with the intention of both protecting the public from impaired physicians, and helping those doctors heal from their addiction.

Dr DuPont and his colleagues were able to survey all 49 of the state PHP’s and then get outcome data on many of the physicians who were followed by these PHP’s. The features of the PHP programs usually included: (a) intensive and prolonged initial treatment – either inpatient, residential, or outpatient treatment (typically 30 to 90 days), (b) treatment that was almost always abstinence based and usually included strong 12 step support, (c) 5 years of extended support and monitoring with significant consequences for any relapses, (d) involvement of family, colleagues, and employers.
The treatment outcomes for these physicians were remarkable. The researchers were able to review the records of 904 physicians and remarkably 78% of these doctors had no positive drug screens for alcohol or drugs over a 5 year period. In other words, 78% of these physicians were able to get detoxed off their drugs, complete their treatment program and not have a single relapse on alcohol or any drug for at least five years. Many of these physicians were highly addicted to very potent drugs and many went back into practice where they had access to the drugs, but they still did not relapse. The results are actually even more impressive - of the physicians who had one positive test, 74% had only one positive test – they were able to get back on track and then maintain their sobriety.

I find this research very interesting and very informative because it supports what I was taught back in 1984 when I went to my own treatment. I had a serious problem with drugs and alcohol and was forced to go to a program for impaired professionals. The treatment program I went to was supported by the Virginia Impaired Physicians Program. It had all of the features that were described in the research article. The initial treatment lasted 4 months. It was definitely abstinence based. It was followed up by aftercare and 12 step involvement. It included drug screening and I knew that there were serious consequences for any relapses. In 1984, while I was in treatment, I was told that if I surrender to the program and do what I was told, that lifelong recovery was virtually guaranteed. I remember feeling very reassured that the path out of my problems was clear. I have now been clean and sober for over 27 years and I am so grateful that I was able to get the treatment that I did. It is also nice for me to see that the other people I was in treatment with are also doing well.

The success rates that are described in this research are very impressive. When I was in treatment, I was very aware that most patients who came to treatment only stayed for one month. I was told that their long term success rate was about 60% - good, but not as good as the success rates that can be achieved if patients stay for 3 – 4 months of initial treatment. The main reason why the physicians were able to achieve such high recovery rates seems to be the length and intensity of their initial treatment.

Since that time I have done what I can to design programs that help all of our patients achieve the best recovery rates. Our treatment protocols at the Coleman Institute recommend a rapid detox, to quickly get the drugs out of their systems. We then do what we can to have the patients to opt for 12 months of Naltrexone implants, and intensive counseling for at least 3 months. We know that it takes time for patients to physically recover, and it takes time for them to fully accept their illness, and learn the skills needed for lifelong recovery.

- Peter R. Coleman, M.D.

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