UF Study: Physicians Addicted To Drugs Or Alcohol Do Well In Long-Term Treatment

November 14, 2001

GAINESVILLE, Fla. — Physicians who battle drug and alcohol addiction by participating in ongoing treatment and monitoring programs have excellent odds of being employed and drug-free after five years, according to a new University of Florida study.

The findings, which showed successful rehabilitation for 22 of 24 Florida doctors who began treatment in a variety of programs in 1995, were presented this week at the Society for Neuroscience’s annual meeting in San Diego.

“Addiction is a serious medical condition, but it can be successfully treated and studied as any other medical disease,” said Dr. Mark S. Gold, the study’s lead author and chief of addiction medicine for the UF College of Medicine’s psychiatry department. “Studying success rates over the course of five years is a widely utilized standard of treatment outcome and evaluation research.”

Dr. Raymond Pomm, a study co-author and clinician who follows the day-by-day progress of Florida physicians with addiction problems under a contract with the state, said the research shows that the particular treatment setting or treating clinician appears to be less important than access to long-term rehabilitation services.

“We work with hospitals, medical groups and agencies to make sure physicians are tightly monitored. We make sure the doctors sign a treatment contract, detoxify, get to their recovery meetings and do whatever they need to do to get well,” said Pomm, medical director of Florida’s Physician Recovery Network. “And there is always the potential threat to the doctor that there will be further consequences if they don’t comply. Physician addicts recover whether they come in to treatment when they have had enough or when someone other than themselves forces the issue. ”

About 3.5 million Americans are thought to be dependent on illicit drugs, with an additional 8.2 million dependent on alcohol, according to the National Institute on Drug Abuse, a component of the National Institutes of Health. Physicians have alcoholism rates similar to those of the general population. But physicians who become addicts-especially those addicted to intravenous narcotics-tend to cluster among certain medical specialties, such as anesthesiology and neurosurgery.

Because of their patient-care responsibilities and access to powerful prescription drugs and narcotics, doctors impaired by addictions raise special public-health concerns. Though specific requirements vary from state to state, physicians known to be addicted to drugs or alcohol typically must agree to undergo detoxification, treatment and counseling, and submit to random drug tests for many years-or face the possible suspension or revocation of their medical licenses. In Florida, monitoring is required for a minimum of five years.

For the UF study, Gold and his colleagues analyzed data collected by the Florida Physician Recovery Network. The researchers randomly selected the case files for 24 doctors who began treatment for drug or alcohol addiction in 1995. The physicians received care through a wide variety of inpatient and outpatient settings and from providers across the state.

The doctors ranged in age from 30 to 63, and all but one were men. Almost 40 percent had a history of intravenous drug abuse. Recovery was documented in their case files by reports from counselors, evaluations from psychiatrists or physicians, records of returning to work and results from random urinalysis tests conducted at least weekly over the years.

“The five-year recovery rate among physicians is remarkable, with more than nine out of 10 drug-free and returned to work,” said Gold, a distinguished service professor affiliated with the Evelyn F. and William L. McKnight Brain Institute of UF. “Physicians may have chosen to leave the state or give up their license to practice, but once they signed their contract with the Physician Recovery Network, treatment was effective.”

It’s not known how the physician success rates compare with other types of patients in recovery because few studies have evaluated long-term outcomes. Still, Gold said, it’s becoming evident that access to long-term treatment is critical. “It appears that people can often do well if they’re not treated simply with detoxification and a ‘see-you’ attitude,” he said.

Gold said some people have suggested that doctors do well in recovery because they have so much to lose. But Gold doesn’t think that’s the case. “By the time doctors enter a recovery program, they’ve typically lost everything-their health, their marriage and family, and their practice,” Gold said. “We have evaluated physicians who were selling cars or providing day labor and landscape services. If they were successfully treated because they had so much to lose, then why had they already lost everything before intervention and treatment? Treatment works when it is applied over the long term with proof of abstinence available to confirm clinical findings and behavior.”

Gold hypothesizes that age at which substance abuse begins is the major determinant of drug-free recovery, with those who start young most likely to do poorly in treatment.

“We know from studies of tobacco addiction that people who began smoking in their teen years seem to have a harder time breaking the habit than those who started smoking later,” Gold said. “We also know from their professional history and past successes that doctors were very high-functioning in their teens and early 20s. Abuse and addiction in the physicians started after their brains were fully developed. This may play a part in why they do well in recovery.”