Regular article How are addicted physicians …

1 Regular articleHow are addicted physicians treated?A national survey of physician health programsRobert L. DuPont, ( )a, A. Thomas McLellan, ( )b, , Gary Carr, ( )c,Michael Gendel, ( )c, Gregory E. Skipper, ( )caInstitute for Behavior and Health (IBH), Philadelphia, PA, 19106bThe Treatment Research Institute, Philadelphia, PA, 19106cFederation of State physician Health Programs (FSPHP), Philadelphia, PA, 19106 Received 23 March 2009; accepted 25 March 2009 AbstractIntroduction: physicians with substance use disorders receive care that is qualitatively different from and reputedly more effective thanthat offered to the general population, yet there has been no national study of this distinctive approach.

2 To learn more about the nationalsystem of physician Health Programs (PHPs) that manage the care of addicted physicians , we surveyed all 49 state PHP medical directors(86% responded) to characterize their treatment, support, and monitoring :PHPs do not provide substance abuse authority from state licensing boards, state laws, and contractual agreements, they promote early detection, assessment, evaluation, andreferral to abstinence-oriented (usually) residential treatment for 60 to 90 days. This is followed by 12-step oriented outpatient then receive randomly scheduled urine monitoring, with status reports issued to employers, insurers, and state licensing boards for(usually) 5 or more years.

3 Outcomes are very positive, with only 22% of physicians testing positive at any time during the 5 years and 71%still licensed and employed at the 5-year : addicted physicians receive an intensity, duration, and quality of care that israrely available in most standard addiction treatments: (a) intensive and prolonged residential and outpatient treatment, (b) 5 years ofextended support and monitoring with significant consequences, and (c) involvement of family, colleagues, and employers in support andmonitoring.

4 Although not available to the general public now, several aspects of this continuing care model could be adapted and used for thegeneral population. 2009 Elsevier Inc. All rights :Addiction treatment; Substance use disorders; physicians ' health programs1. IntroductionAmong physicians , there is a lifetime prevalence ofsubstance use disorders (SUDs) of approximately 10% to12%, very similar to the general population rate (Flaherty &Richman, 1993; SAMHSA, 2006). Specialty care andsupervision for addicted physicians were initially proposedand initiated in 1973 by the American Medical Associationto help physicians and to protect the public with thepublication of The Sick physician : Impairment by Psychia-tric Disorders, Including Alcoholism and Drug Depen-dence.

5 That document encouraged the growth ofspecialized, state physician Health Programs (PHPs) in 49states, managed via authority typically granted under charterfrom the state Licensing Boards, ..to provide advocacy forphysicians protect the public ( ; White, DuPont, & Skipper, in press).Given the potential public health and safety issuesassociated with addiction among physicians , it is surprisingthat despite the many studies of single-state PHPs ( ,Bohigan, Croughan, & Bondurant, 2002; Domino et al.)

6 ,Journal of Substance Abuse Treatment 37 (2009) 1 7 The Robert Wood Johnson Foundation supported this study but had norole in the design, conduct, analyses or even in the decision to submit thestudy for publication. Corresponding author. Treatment Research Institute, 600 PublicLedger Bld., 150 S. Independence Mall, Philadelphia, PA, McLellan).0740-5472/09/$ see front matter 2009 Elsevier Inc. All rights ; Fletcher, 2001; Reading, 1992; Selander & Epstein,1983), there has been no study describing the nationalprogram of PHPs or the nature of treatment and monitoringprovided.

7 In this regard, it might be expected that physicianswith a SUD receive essentially the same type and duration oftreatment that other addicted individuals receive. This isgenerally the case in all other areas of health care. If so, thereis reason for concern because studies of addiction treatmentin the general population have consistently shown relapserates of 40% to 60% following treatment (Finney, Ouimette,Humphreys, & Moos, 2001; Institute of Medicine, 2006;McLellan, O'Brien, Lewis, & Kleber, 2000; ProjectMATCH, 1997; Simpson, Joe, & Brown, 1997).

8 However, it appears that the care and management ofaddicted physicians , as coordinated through these PHPs,may be qualitatively and quantitatively different from thecare available to the lay public (seeDomino et al., 2005;Gold, Pomm, Kennedy, Jacobs, & Frost-Pineda, 2002;Skipper, 1997). Moreover, the available outcome studies ofPHP-managed addicted physicians have reported remarkableresults much superior to those found in other populationsof addicted patients or from other forms of addictiontreatment.

9 Specifically, one outcome study reported absti-nence rates of 78% over 11 years (Domino et al., 2005),whereas another reported a 90+% success rate over 5 years(Shore, 1987).Indications of qualitative differences in the way care isprovided, coupled with indications of substantially betterresults, led us to several evaluation questions. How do theseprograms operate? What is their structure? Are the programssimilar across states? and What are the factors potentiallyresponsible for the widely reported better outcomes?

10 Withthese questions in mind, we approached the Federation ofState physician Health Programs (FSPHP) to undertake acomprehensive, nationally representative evaluation of thestructure and function of these PHPs. Here, we characterizethe legal, financial, administrative, and clinical structure of42 PHPs nationwide, with a description of the course of care,support, and monitoring provided by these programs. Wereport some of the more salient 5-year results here, but asecond article (McLellan, DuPont, & Skipper, 2008)isdevoted to a full report of the 5-year outcomes on aconsecutive sample of more than 900 addicted physiciansfrom 16 state Involvement of the FSPHPThe FSPHP was approached with a request for assistance incompleting a descriptive survey of all state PHPs.