Five year outcomes in a cohort study of physicians treated for substance use disorders in the United StatesBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2038 (Published 04 November 2008) Cite this as: BMJ 2008;337:a2038
- A Thomas McLellan, chief executive officer1,
- Gregory S Skipper, medical director2,
- Michael Campbell, research scientist3,
- Robert L DuPont, president3
- 1Treatment Research Institute, 600 Public Ledger Building, 150 S Independence Mall, Philadelphia, PA 19106, USA
- 2Alabama Physician Assistance Program, Montgomery, AL, USA
- 3Institute for Behavior and Health, Rockville, MD, USA
- Correspondence to: A T McLellan
- Accepted 28 August 2008
Objective To evaluate the effectiveness of US state physician health programmes in treating physicians with substance use disorders.
Design Five year, longitudinal, cohort study.
Setting Purposive sample of 16 state physician health programmes in the United States.
Participants 904 physicians consecutively admitted to one of the 16 programmes from September 1995 to September 2001.
Main outcome measures Completion of the programme, continued alcohol and drug misuse (regular urine tests), and occupational status at five years.
Results 155 of 802 physicians (19.3%) with known outcomes failed the programme, usually early during treatment. Of the 647 (80.7%) who completed treatment and resumed practice under supervision and monitoring, alcohol or drug misuse was detected by urine testing in 126 (19%) over five years; 33 (26%) of these had a repeat positive test result. At five year follow-up, 631 (78.7%) physicians were licensed and working, 87 (10.8%) had their licences revoked, 28 (3.5%) had retired, 30 (3.7%) had died, and 26 (3.2%) had unknown status.
Conclusion About three quarters of US physicians with substance use disorders managed in this subset of physician health programmes had favourable outcomes at five years. Such programmes seem to provide an appropriate combination of treatment, support, and sanctions to manage addiction among physicians effectively.
We thank the Robert Wood Johnson Foundation for unrestricted career award funds and the Federation of State Physician Health Programs for its cooperation and access to the data.
Contributors: ATMcL oversaw data collection and audits, participated in the analyses and writing of the paper, and is guarantor. ATMcL and RLDuP designed the study and secured funding. GSS designed the study and data collection, supervised data collection, and participated in the analyses and writing of the paper. GSS and RLDuP liaised and communicated with the Federation of State Physician Health Programs. MC was responsible for the preparation and storage of the data and analyses and participated in the writing of the paper. RLDuP assisted in the design of the data collection instrument, oversaw audits of data, and participated in the analyses and writing of the paper.
Funding: This study was supported by the Robert Wood Johnson Foundation.
Competing interests: GSS is the director of the Alabama State Physician Health Program. His contribution to the work was invaluable in securing cooperation from the Federation of State Physician Health Programs and in providing guidance as we structured the data collection survey. GSS did not direct or influence the data analyses.
Ethical approval: This study was approved by the institutional review board of the Treatment Research Institute, Philadelphia.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.