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PHYSICIAN’S IMPAIRMENT DUE TO DRUG OR ALCOHOL ADDICTION

Impairment of a healthcare professional is the inability or impending inability to practice according to accepted standards as a result of substance use, abuse, or dependency (addiction).

The term substance use disorder can be divided into substance abuse and dependence (addiction). Substance abuse results in adverse social and professional consequences. Addiction manifests as physiologic and behavioral symptoms related to a maladaptive pattern of substance use.  

Physician impairment by substance abuse represents a significant challenge to physicians, patients, and society as a whole. Although data is sparse, the prevalence of alcohol and illicit drug abuse among physicians is probably similar to that of the general population, while abuse of prescription drugs may be more prevalent.

From a medicolegal standpoint, these issues are managed mostly at the state level and substance abuse is of increasing interest to credentialing organizations such as hospitals and managed care organizations.    A variety of concrete steps can be taken to identify physicians with substance abuse problems and treatment approaches have been designed specifically for impaired physicians.

With improved attention to the problem of physician impairment by substance abuse, the well-being of both physicians and their patients can be enhanced.   It is estimated that approximately 10% to 15% of all healthcare professionals will misuse drugs or alcohol at some time during their career.

Although the rates of substance abuse and dependence are similar to those of the general population, the prevalence is disturbing because healthcare professionals are the caregivers responsible for the general health and well-being of the general population.

Healthcare professionals have higher rates of abuse with benzodiazepines and opiates.   Specialties such as anesthesia, emergency medicine, and psychiatry have higher rates of drug abuse, probably related to the high-risk environment associated with these specialties, the baseline personalities of these healthcare providers, and easy access to drugs in these areas.

Drugs and alcohol are mostly used for "recreational" purposes by medical students. Residents and attending physicians use drugs of abuse for performance enhancement and as self-treatment for various reasons, such as, pain, anxiety, or depression.

Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the medical or healthcare workplace, and outcomes have not appreciably changed.  

Although alcoholism and other forms of impairment, such as addiction to other substances and mental illness, impact medical or healthcare at rates similar to those in other professions, as recently as 2013.  the drug of choice for medical or healthcare workers was still an opioid. 

There exists a considerable association between chemical dependence and other psychopathology, and successful treatment for addiction is less likely when comorbid psychopathology is not treated. Individuals under evaluation or treatment for substance abuse should have an evaluation with subsequent management of comorbid psychiatric conditions.

Participation in self-help groups is still considered a vital component in the therapy of the impaired physician, along with regular monitoring if the physician or other healthcare worker wishes to attempt reentry into clinical practice.
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