Magazine article Clinical Psychiatry News

Zero Tolerance Is Effective for Physician Addicts: Monitoring, Testing, and Consequences for Relapse Could Be Extended to Abusers in Other Settings

Magazine article Clinical Psychiatry News

Zero Tolerance Is Effective for Physician Addicts: Monitoring, Testing, and Consequences for Relapse Could Be Extended to Abusers in Other Settings

Article excerpt

SAN FRANCISCO -- Zero tolerance for substance abuse and random testing have been the keys to successful rehabilitation of addicted doctors in physicians' health programs--and might help nonphysician populations of addicts.

Some of the program elements that have worked well for addicted physicians are beginning to be applied with surprisingly good results in other settings, especially the criminal justice system, Dr. Robert L. DuPont said. "If it's good enough for physicians, why not for everyone else?" he asked.

Intensive monitoring with frequent, random drug and alcohol testing backed by swift and certain consequences for a single relapse appear to keep a large majority of addicts substance free during monitoring periods of up to 5-7 years in recent studies.

That kind of zero-tolerance intensive monitoring differs markedly from competing theories of "harm reduction" and "compassion" for addicts that often amount to "enabling" the addiction, DuPont said.

"If the environment is tolerant of the drug use, then the drug use is more prevalent and it persists. If the environment is intolerant, the use stops, whether it's in physicians or convicted felons," said Dr. DuPont, who was the first director of the National Institute on Drug Abuse 37 years ago and now is head of the Institute for Behavior and Health, a drug policy nonprofit in Rockville, Md. "If you expect and tolerate relapse, you'll see more of it."

He and his associates studied 904 consecutive admissions to 16 state physicians' health programs and found that 72% of the physicians were still licensed and practicing with no sign of substance abuse in 5-7 years of monitoring. Twelve percent had their license suspended or dropped, 6% were licensed but not practicing, 4% had retired or left practice, 4% had died, and the outcomes of the rest were unknown (J. Subst. Abuse Treat. 2009;36:159-71).

"It's striking how many of them go through successfully," he said.

The physicians' health programs start with a careful initial evaluation followed by referral to intensive, high-quality treatment, which usually lasts for 1-3 months and is mostly in residential facilities. After treatment, the physicians undergo frequent, random drug and alcohol testing for 5 years or longer. Each work day, the physician must call a phone number to find out whether he or she will be tested that day.

The programs are closely tied to community support, mainly the 12-step groups of Alcoholics Anonymous and Narcotics Anonymous.

Participants who leave the program or have a single positive test for drugs or alcohol are removed from practice and sent to more intensive treatment. In addition, they risk losing their medical license after a repeat relapse. …

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