Book contents
- The Cambridge Handbook of Substance and Behavioral Addictions
- The Cambridge Handbook of Substance and Behavioral Addictions
- Copyright page
- Contents
- Figures
- Tables
- Contributors
- Foreword
- Preface
- Acknowledgements
- Part I Concepts of Addiction
- Part II Clinical and Research Methods in the Addictions
- Part III Levels of Analysis and Etiology
- Part IV Prevention and Treatment
- Part V Ongoing and Future Research Directions
- 24 Precision Behavioral Management (PBM): A Novel Genetically Guided Therapy to Combat Reward Deficiency Syndrome (RDS) Relevant to the Opiate Crisis
- 25 Novel Psychoactive Substances: A New Challenge for Prevention and Treatment
- 26 Impaired Physicians
- 27 Feedback Models for Gambling Control: The Use and Efficacy of Online Responsible Gambling Tools
- 28 Food versus Eating Addictions
- 29 Measurement, Prevention, and Treatment of Exercise Addiction
- 30 Tanning as an Addiction: The State of the Research and Implications for Intervention
- 31 Considering the Overlap and Nonoverlap of Compulsivity, Impulsivity, and Addiction
- 32 Anhedonia in Addictive Behaviors
- 33 Mindfulness-Based Interventions Applied to Addiction Treatments
- 34 American Legal Issues in Addiction Treatment and Research
- Index
- References
26 - Impaired Physicians
from Part V - Ongoing and Future Research Directions
Published online by Cambridge University Press: 13 July 2020
Edited by
Book contents
- The Cambridge Handbook of Substance and Behavioral Addictions
- The Cambridge Handbook of Substance and Behavioral Addictions
- Copyright page
- Contents
- Figures
- Tables
- Contributors
- Foreword
- Preface
- Acknowledgements
- Part I Concepts of Addiction
- Part II Clinical and Research Methods in the Addictions
- Part III Levels of Analysis and Etiology
- Part IV Prevention and Treatment
- Part V Ongoing and Future Research Directions
- 24 Precision Behavioral Management (PBM): A Novel Genetically Guided Therapy to Combat Reward Deficiency Syndrome (RDS) Relevant to the Opiate Crisis
- 25 Novel Psychoactive Substances: A New Challenge for Prevention and Treatment
- 26 Impaired Physicians
- 27 Feedback Models for Gambling Control: The Use and Efficacy of Online Responsible Gambling Tools
- 28 Food versus Eating Addictions
- 29 Measurement, Prevention, and Treatment of Exercise Addiction
- 30 Tanning as an Addiction: The State of the Research and Implications for Intervention
- 31 Considering the Overlap and Nonoverlap of Compulsivity, Impulsivity, and Addiction
- 32 Anhedonia in Addictive Behaviors
- 33 Mindfulness-Based Interventions Applied to Addiction Treatments
- 34 American Legal Issues in Addiction Treatment and Research
- Index
- References
Summary
Substance use disorders affect physicians at a prevalence like the general population, yet they are difficult to detect and are inextricably linked to job dissatisfaction and burnout. Often physicians develop complex denial strategies and rationalizations, and shame and stigma prevent them from seeking help. However, when engaged in treatment and monitored through state-level Physicians Health Programs (PHPs), including long term monitoring and systems of accountability, approximately 80 percent will stay sober for and return to work in five years. This continuing care model with long-term monitoring and follow up, if adopted for the general population, may provide a paradigm shifting approach for the treatment of substance addictions, and might be extended to behavioral addictions.
Keywords
- Type
- Chapter
- Information
- The Cambridge Handbook of Substance and Behavioral Addictions , pp. 326 - 332Publisher: Cambridge University PressPrint publication year: 2020
References
Alexander, B. H., Checkoway, H., Nagahama, S. I. & Domino, K. B. (2000). Cause-specific mortality risks of anesthesiologists. Anesthesiology, 93(4), 922–930.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Arlington, VA: American Psychiatric Publishing.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). Arlington, VA: American Psychiatric Publishing.Google Scholar
Angres, D. H. (2010). The temperament and character inventory in addiction treatment. Focus, 8(2), 187–198. doi:10.1176/foc.8.2.foc187Google Scholar
Angres, D. H. & Nielsen, A. K. (2007). The role of the TCI-R (Temperament Character Inventory) in individualized treatment plannning in a population of addicted professionals. Journal of Addictive Diseases, 26 (Supplement 1), 51–64. doi:10.1300/J069v26S01_06Google Scholar
Boisaubin, E. V. & Levine, R. E. (2001). Identifying and assisting the impaired physician. American Journal of Medical Sciences, 322(1), 31–36.Google Scholar
Boyd, J. W. (2015a). A call for national standards and oversight of state physician health programs. Journal of Addiction Medicine, 9(6), 431–432. doi:10.1097/adm.0000000000000174CrossRefGoogle Scholar
Boyd, J. W. (2015b). Deciding whether to refer a colleague to a physician health program. AMA Journal of Ethics, 17(10), 888–893. doi:10.1001/journalofethics.2015.17.10.spec1-1510Google Scholar
Boyd, J. W. & Knight, J. R. (2012). Ethical and managerial considerations regarding state physician health programs. Journal of Addiction Medicine, 6(4), 243–246. doi:10.1097/ADM.0b013e318262ab09Google Scholar
Brewster, J. M. (1986). Prevalence of alcohol and other drug problems among physicians. JAMA, 255(14), 1913–1920. doi:10.1001/jama.1986.03370140111034Google Scholar
Candilis, P. J. (2016). Physician health programs and the social contract. AMA Journal of Ethics, 18(1), 77–81. doi:10.1001/journalofethics.2016.18.1.corr1-1601Google Scholar
Cloninger, C. R., Svrakic, D. M. & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50(12), 975–990.CrossRefGoogle ScholarPubMed
Cloninger, C. R., Zohar, A. H. & Cloninger, K. M. (2010). Promotion of well-being in person-centered mental health care. Focus, 8(2), 165–179. doi:10.1176/foc.8.2.foc165Google Scholar
Cottler, L. B., Ajinkya, S., Merlo, L. J., et al. (2013). Lifetime psychiatric and substance use disorders among impaired physicians in a physicians health program: Comparison to a general treatment population: Psychopathology of impaired physicians. Journal of Addiction Medicine, 7(2), 108–112. doi:10.1097/ADM.0b013e31827fadc9Google Scholar
Dewa, C. S., Loong, D., Bonato, S. & Trojanowski, L. (2017). The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: A systematic review. BMJ Open, 7.Google Scholar
Dorr, D. (1981). MMPI profiles of emotionally impaired physicians. Journal of Clinical Psychology, 37(2), 451–455.Google Scholar
Drummond, D. (2015). Physician burnout: Its origin, symptoms, and five main causes. Family Practice Management, 22(5), 42–47.Google Scholar
DuPont, R. L., Compton, W. M. & McLellan, A. T. (2015). Five-year recovery: A new standard for assessing effectiveness of substance use disorder treatment. Journal of Substance Abuse Treatment, 58, 1–5. doi:10.1016/j.jsat.2015.06.024Google Scholar
DuPont, R. L., McLellan, A. T., Carr, G., Gendel, M. & Skipper, G. E. (2009a). How are addicted physicians treated? A national survey of Physician Health Programs. Journal of Substance Abuse Treatment, 37(1), 1–7. doi:10.1016/j.jsat.2009.03.010Google Scholar
DuPont, R. L., McLellan, A. T., White, W. L., Merlo, L. J. & Gold, M. S. (2009b). Setting the standard for recovery: Physicians' Health Programs. Journal of Substance Abuse Treatment, 36(2), 159–171. doi:10.1016/j.jsat.2008.01.004Google Scholar
Federation of State Medical Boards (2006). Addressing Sexual Boundaries: Guidelines for State Medical Boards. Retrieved from Federation of State Physician Health Programs State Programs. Retrieved from www.fsphp.org/state-programsGoogle Scholar
Gold, M. S., Melker, R. J., Dennis, D. M., et al. (2006). Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis. Journal of Addictive Diseases, 25(1), 15–21. doi:10.1300/J069v25n01_04Google Scholar
Grant, J. E., Potenza, M. N., Weinstein, A. & Gorelick, D. A. (2010). Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241. doi:10.3109/00952990.2010.491884Google Scholar
Higgins, S. T., Heil, S. H. & Lussier, J. P. (2004). Clinical implications of reinforcement as a determinant of substance use disorders. Annual Review of Psychology, 55, 431–461. doi:10.1146/annurev.psych.55.090902.142033Google Scholar
Hloch, K., Mladenka, P., Dosedel, M., Adriani, W. & Zoratto, F. (2017). The current clinical knowledge on the treatment of gambling disorder: A summary. Synapse, 71(8). doi:10.1002/syn.21976CrossRefGoogle ScholarPubMed
Hughes, P. H., Brandenburg, N., Baldwin, D. C. Jr., et al. (1992). Prevalence of substance use among US physicians. JAMA, 267(17), 2333–2339.Google Scholar
Hughes, P. H., Storr, C. L., Brandenburg, N. A., et al. (1999). Physician substance use by medical specialty. Journal of Addictive Diseases, 18(2), 23–37. doi:10.1300/J069v18n02_03Google Scholar
Kessler, R. C., Hwang, I., LaBrie, R., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351–1360. doi:10.1017/s0033291708002900CrossRefGoogle ScholarPubMed
Kraus, S. W., Voon, V. & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111(12), 2097–2106. doi:10.1111/add.13297CrossRefGoogle ScholarPubMed
Lenzer, J. (2016). Physician health programs under fire. BMJ, 353, i3568. doi:10.1136/bmj.i3568Google Scholar
Markel, H. (2012). An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine. New York, NY: Vintage Books, Random House, Inc.Google Scholar
McLellan, A. T., Skipper, G. S., Campbell, M. & DuPont, R. L. (2008). Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ, 337, a2038. doi:10.1136/bmj.a2038Google Scholar
Merlo, L. J. & Gold, M. S. (2008). Prescription opioid abuse and dependence among physicians: Hypotheses and treatment. Harvard Review of Psychiatry, 16(3), 181–194. doi:10.1080/10673220802160316Google Scholar
Merlo, L. J. & Greene, W. M. (2010). Physician views regarding substance use-related participation in a state physician health program. American Journal on Addictions, 19(6), 529–533. doi:10.1111/j.1521-0391.2010.00088.xGoogle Scholar
Merlo, L. J., Campbell, M. D., Skipper, G. E., Shea, C. L. & DuPont, R. L. (2016). Outcomes for physicians with opioid dependence treated without agonist pharmacotherapy in physician health programs. Journal of Substance Abuse Treatment, 64, 47–54. doi:10.1016/j.jsat.2016.02.004Google Scholar
Merlo, L. J., Goldberger, B. A., Kolodner, D., Fitzgerald, K. & Gold, M. S. (2008). Fentanyl and propofol exposure in the operating room: Sensitization hypotheses and further data. Journal of Addictive Diseases, 27(3), 67–76. doi:10.1080/10550880802122661Google Scholar
Merlo, L. J., Greene, W. M. & Pomm, R. (2011). Mandatory naltrexone treatment prevents relapse among opiate-dependent anesthesiologists returning to practice. Journal of Addiction Medicine, 5(4), 279–283. doi:10.1097/ADM.0b013e31821852a0CrossRefGoogle ScholarPubMed
Merlo, L. J., Singhakant, S., Cummings, S. M. & Cottler, L. B. (2013a). Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program. Journal of Addiction Medicine, 7(5), 349–353. doi:10.1097/ADM.0b013e31829da074Google Scholar
Merlo, L. J., Trejo-Lopez, J., Conwell, T. & Rivenbark, J. (2013b). Patterns of substance use initiation among healthcare professionals in recovery. American Journal on Addictions, 22(6), 605–612. doi:10.1111/j.1521-0391.2013.12017.xGoogle Scholar
Nace, E. P., Birkmayer, F., Sullivan, M. A., et al. (2007). Socially sanctioned coercion mechanisms for addiction treatment. American Journal on Addictions, 16(1), 15–23. doi:10.1080/10550490601077783Google Scholar
Nelson, H. D., Matthews, A. M., Girard, D. E. & Bloom, J. D. (1996). Substance-impaired physicians probationary and voluntary treatment programs compared. Western Journal of Medicine, 165(1–2), 31–36.Google Scholar
Oreskovich, M. R., Shanafelt, T., Dyrbye, L. N., et al. (2015). The prevalence of substance use disorders in American physicians. American Journal on Addictions, 24(1), 30–38. doi:10.1111/ajad.12173CrossRefGoogle ScholarPubMed
Rash, C. J., Stitzer, M. & Weinstock, J. (2017). Contingency management: New directions and remaining challenges for an evidence-based intervention. Journal of Substance Abuse Treatment, 72, 10–18. doi:10.1016/j.jsat.2016.09.008Google Scholar
Rezvani, A., Bouju, G., Keriven-Dessomme, B., Moret, L. & Grall-Bronnec, M. (2014). Workaholism: Are physicians at risk? Occupational Medicine (London), 64(6), 410–416. doi:10.1093/occmed/kqu081CrossRefGoogle ScholarPubMed
Rush, B. (1823). An Inquiry into the Effect of Ardent Spirits upon the Human Body and Mind, with an Account of the Means of Preventing and of the Remedies for Curing Them (8th edition). Boston: James Loring.Google Scholar
Shaffer, H. (1984). Uber coca: Freud's cocaine discoveries. Journal of Substance Abuse Treatment, 1(3), 205–217. doi:http://dx.doi.org/10.1016/0740-5472(84)90023-0CrossRefGoogle Scholar
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., et al. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings, 90(12), 1600–1613. doi:10.1016/j.mayocp.2015.08.023Google Scholar
Shanafelt, T. D., Sloan, J. A. & Habermann, T. M. (2003). The well-being of physicians. American Journal of Medicine, 114(6), 513–519.Google Scholar
Sinsky, C. A., Dyrbye, L. N., West, C. P., et al. (2017). Professional satisfaction and the career plans of US physicians. Mayo Clinic Proceedings, 92(11), 1625–1635. doi:10.1016/j.mayocp.2017.08.017Google Scholar
US Department of Health and Human Services (HHS) & Office of the Surgeon General. (November 2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS.Google Scholar
Vaillant, G. E., Brighton, J. R. & McArthur, C. (1970). Physicians' use of mood-altering drugs. A 20-year follow-up report. New England Journal of Medicine, 282(7), 365–370. doi:10.1056/nejm197002122820705CrossRefGoogle ScholarPubMed
Warner, D. O., Berge, K., Sun, H., et al. (2013). Substance use disorder among anesthesiology residents, 1975-2009. JAMA, 310(21), 2289–2296. doi:10.1001/jama.2013.281954CrossRefGoogle ScholarPubMed
Washton, A. M., Gold, M. S. & Pottash, A. C. (1984). Naltrexone in addicted physicians and business executives. NIDA Research Monographs, 55, 185–190.Google Scholar
White, W. L. (1998). Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Normal, IL: Chestnut Health Systems/Lighthouse Institute.Google Scholar
White, W. L., DuPont, R. L. & Skipper, G.E. (2007). Physicians health programs: What counselors can learn from these remarkable programs. Counselor, 8(2), 42–47.Google Scholar
Xiong, W. (2017). Physician burnout: An epidemic or the new norm? American Journal of Psychiatry Residents' Journal, 12(4), 2. doi:10.1176/appi.ajp-rj.2017.120401Google Scholar
Williams, B. W., Flanders, P., Welindt, D. & Williams, M. V. (2018). Importance of neuropsychological screening in physicians referred for performance concerns. PloS ONE, 13(11), e0207874–e0207874. doi:10.1371/journal.pone.0207874Google Scholar
Wood, B. A. (2014). Performance audit: North Carolina physicians health program. North Carolina Office of the State Health Auditor.Google Scholar
Yip, S. W. & Potenza, M. N. (2014). Treatment of gambling disorders. Current Treatment Options in Psychiatry, 1(2), 189–203. doi:10.1007/s40501-014-0014-5Google Scholar