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Am Fam Physician. 2005;72(9):1878

The prevalence of drug dependence among physicians is similar to that in the general population. Treatment consists of continuing group therapy and mutual help groups. Little is known about relapse after treatment because most follow-up data refer to short-term recovery. Domino and colleagues reviewed 11 years of outcome data from a post-treatment program that monitors physicians recovering from substance abuse.

The Washington Physicians Health Program database provides demographic information and detailed information about drug use. Information about family history of drug use, medical specialty, and concomitant psychiatric disorders also was collected. Analysis attempted to identify risk factors for relapse using calculation of relapse rate. The study also attempted to account for multiple relapses.

Of the 292 participants, 84 percent were men, almost three fourths had a family history of substance abuse in a first-degree relative, and 37 percent had concomitant psychiatric disorders. More than one half indicated alcohol as their drug of choice, and 14 percent abused opioids, including fentanyl (Duragesic). At least one fourth of participants had one relapse, 5 percent had two relapses, and 3 percent had three or more relapses, with most returning to their initial drug of choice. In most cases, relapses were uncovered through monitoring within the first two years of treatment, and relapses decreased over time. All participants without relapse in five years successfully returned to medical practice; of those who had one relapse in the same period, 61 percent returned to practice. Risk of relapse was higher when the drug of choice was a major opioid, with a 35 percent relapse risk compared with a 25 percent relapse risk for other drugs. Having a concomitant psychiatric diagnosis or a family history of substance use disorder approximately doubled the risk. Risk was higher in nonphysician health professionals compared with physicians and anesthesiologists. In multivariate analysis, having a concomitant diagnosis coupled with opioid use entailed a significant risk of relapse, whereas the relapse risk in opioid users without a comorbid psychiatric condition had a relapse risk similar to nonopioid users. Number of relapses increased the likelihood of subsequent relapses, but there were no characteristic differences between one-time relapsers and multiple relapsers.

The authors conclude that there is a marked association between risk of relapsing substance use and opioid use, a concomitant psychiatric diagnosis, and a family history of substance use. Opioid use alone did not entail higher risk for relapse than other users if no comorbid psychiatric diagnosis was present. Substance-using physicians with the multiple risk factors identified in this study might require more intensive monitoring and treatment to prevent relapse.

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