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Why Drug-Abusing Doctors Relapse After Treatment

Family history, psychiatric problems the big risk factors, study finds

TUESDAY, March 22, 2005 (HealthDay News) -- Findings that surprised researchers may lead to a deeper understanding of why some doctors relapse back into drug abuse despite treatment.

Investigators behind a study into drug-abusing physicians assumed that anesthesiologists would be more likely to relapse because they have such easy access to commonly abused medications.

That assumption turned out to be wrong.

Researchers at the University of Washington, Seattle, found that a physician's risk of relapse had nothing to do with his or her specialty. Instead, the most important factors were a family history of drug abuse or having a psychiatric illness, such as depression.

"Things are more complicated than we thought," said lead researcher Dr. Karen B. Domino, herself an anesthesiologist. "The thought was that since anesthesiologists can give patients these potent drugs without writing prescriptions, they might have more of a predilection to take these opiods. It wasn't so, except in the presence of the other risk factors, such as having a family history or a concurrent psychiatric disorder."

The findings are reported in the March 23/30 issue of the Journal of the American Medical Association.

When it comes to abuse of drugs -- starting with alcohol and running through to hard drugs such as heroin -- doctors are pretty much like everyone else, Domino noted. About 10 percent to 15 percent of both doctors and non-doctors become alcoholics or drug abusers at one time or another, she said.

Treatment can help addicted physicians kick their habit, while continuing group therapy and support groups can keep them that way. But, of course, relapse often occurs.

Until now, the percentage of addiction relapse among physicians has not been known. Domino's study, which included 292 health-care professions enrolled in a Washington state monitoring program, found that 74 of them -- about one in four -- had at least one relapse over the decade beginning in 1991.

A physician's particular specialty didn't play a role in relapse, the study found. Instead, a family history of a substance abuse disorder, including alcoholism, was associated with a 2.3 times greater risk of relapse after treatment, while the presence of a psychiatric disorder increased the risk 5.8-fold.

The presence of three risk factors -- history of hard drug use, family history of substance abuse, and psychiatric disorder -- increased the risk of relapse more than 13-fold compared to individuals without these factors, the study found.

The study results can help guide treatment of drug-abusing physicians, said Dr. David R. Gastfriend, who wrote an accompanying editorial while he was at Harvard Medical School. He is now is vice president of medical affairs for a pharmaceutical company, Alkermes Inc.

"It tells us that it is not enough to assume that physicians in certain specialties with access to more dangerous drugs are the ones at higher risk," he said. "It tells us we have to study each individual physician more carefully. If we do, we can tailor treatment to that person's needs and probably increase our success rate."

And what is true for doctors probably holds true for individuals from every walk of life who are trying to kick a drug habit, Gastfriend added.

"We can begin individual therapy for everyone else," he said. "This study tells us that there is an opportunity to help everybody."

More information

A guide to treatment of drug abuse is provided by the National Institute on Drug Abuse.

SOURCES: Karen B. Domino, M.D., professor, anesthesiology, University of Washington, Seattle; David R. Gastfriend, M.D., vice president, medical affairs, Alkermes, Inc., Cambridge, Mass; March 23/30, 2005, Journal of the American Medical Association
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