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Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
Substance Use in Anesthesiology Residents

Substance Use in Anesthesiology Residents

Substance use disorders are a serious public health issue, and physicians are not immune to these problems. “Anesthesiologists have long been considered at risk for substance use disorders because of their access to potent drugs, such as opioids,” explains David O. Warner, MD. Few studies, however, have explored the epidemiology of these disorders in physicians in general and anesthesiologists in particular. Current estimates have been based on surveys and reports from clinicians as well as physician health programs, but these data have limitations. “The long-term outcomes of substance use disorders in physicians are not known,” says Dr. Warner. “Gathering more data on substance use disorders can help educate us about preventing and managing these problems.” Compelling New Data on Outcomes of Substance Use In a retrospective study published in JAMA, Dr. Warner and colleagues described the incidence and outcomes of substance use disorders among anesthesiology residents in the United States who entered training between 1975 and 2009. The study included 44,612 residents who contributed 177,848 resident-years for analysis. “One important goal was to inform residency program directors and others about the long-term outcomes for anesthesiology residents who experience substance use disorders. We also wanted to better inform both individual treatment decisions and overall policies,” Dr. Warner says. According to the results, the incidence of substance use disorders increased over the study period, and relapse rates did not appear to improve. Overall, 0.86% of anesthesiology residents entering primary training from 1975 to 2009 had evidence of substance use disorders during their training. Of the residents involved in the study, 384 experienced substance use disorders during training, with an overall incidence...
Binge Drinking & Fatalities: EDs at the Forefront

Binge Drinking & Fatalities: EDs at the Forefront

Substantial progress has been made over the last 20 years in the United States to curb drinking and driving among teenagers. Since 1991, there has been about a 54% decrease in the prevalence of drinking and driving among high school students aged 16 and older. However, about 10% of adolescents in this age range report that they have driven after consuming an alcoholic beverage (Figure 1). Although progress has been made, the overall prevalence of drinking and driving still affects about 950,000 high school students, killing more than 800 each year. National data have illustrated significant differences in drinking and driving among genders, races, ages, and patterns of binge drinking. Male students are more likely than female students to drink and drive. Hispanics have the highest prevalence of drinking and driving when compared with Caucasians and African Americans. Drinking and driving rates increase with age throughout the teenage years. These rates are more than three times higher among students who report binge drinking when compared with those reporting they use alcohol but do not binge drink. The prevalence of drinking and driving per state also varies significantly, ranging from a low of about 5% in Utah to a high of nearly 15% in North Dakota (Figure 2). Making Efforts: Alcohol Screening & Intervention To reduce the prevalence of alcohol-related injuries, the CDC has worked with EDs and trauma centers to implement alcohol screening and brief intervention (SBI) programs. “Currently, major trauma centers are required by the American College of Surgeons to use SBI programs to screen all incoming patients for alcohol use in an effort to identify risky drinking...
Substance & Alcohol Use After Weight Loss Surgery

Substance & Alcohol Use After Weight Loss Surgery

Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data. The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population. A Closer Look At Substance Use After Weight Loss Surgery My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery. Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2...
Taking Aim at Physician Impairment

Taking Aim at Physician Impairment

When a critical event occurs in professions other than medicine, detailed investigations are conducted to examine systematic and individual factors that caused or contributed to the event. While these policies are the norm in many high-risk industries, they are not in place for medicine. Mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine, but research shows that alcohol, narcotic, and sedative addiction is as common among physicians as the general population. Furthermore, about one-third of all hospital admissions experience a medical error, meaning it’s possible that physician impairment can contribute to patient harm. Learning From Other High-Risk Industries To improve patient safety, medical institutions should take a cue from other high-risk industries and put policies in place that mandate employee testing for drug or alcohol impairment immediately after an unexpected or significant event occurs. Hospitals can take steps to address this overlooked patient safety issue. One such step is to have physicians participate in mandatory physical exams, drug testing, or both before medical staff appointments to a hospital can be made. This already occurs in some hospitals and has been successful in other industries. Hospitals should also consider random alcohol-drug testing and a policy of routine drug-alcohol testing for all physicians involved with a sentinel event leading to patient death.   An important component to addressing physician impairment is the establishment of testing standards by a national hospital regulatory or accrediting body. Medicine is under-regulated when compared with other industries. Hospitals can take the lead by capitalizing on their infrastructure to conduct adverse event analyses and drug testing and by governing...
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