With results that show recovery—not relapse—is the expected outcome, state physician health programs are a model for a new paradigm in addiction treatment, Robert L. DuPont, MD, president of the Institute for Behavior and Health and a clinical professor of psychiatry at the Georgetown University School of Medicine, told National Conference on Addiction Disorders attendees in a session that was presented on Thursday.
DuPont, the first director of the National Institute on Drug Abuse from 1973-78, said that in his career spanning more than 50 years, his best teachers have been his own patients. Because of their high rates of successful outcomes, he was particularly intrigued by the physicians being treated for substance use disorder and who were participating in state physician health programs as part of their recovery.
DuPont and a colleague conducted a longitudinal study of the programs to see what was working. DuPont noted to attendees that the physician health programs themselves do not penalize participating physicians who use drugs or alcohol or drop out, but that state medical boards can revoke licenses of those who are not compliant with the programs. The PHPs have zero tolerance for any substance use and conduct frequent, random and highly sophisticated tests over the duration of their five-year contract. Physicians engage in brief residential treatment (usually 30 days), followed by sustained immersion in community support, such as 12-Step meetings at least three days per week for five years, and long-term monitoring and support. Physicians who have one positive screening during their contract fail the program, but are welcome to start a new five-year contract.
In the study of 904 physicians in 16 PHPs that DuPont conducted with his colleague:
- 64% of participants completed 5-year contract
- 16% voluntarily extended their contract
- 19% failed to complete their contract, although many who failed one contract came back for subsequent contracts and succeeded
Five years after the physicians completed their five-year program, a follow-up study found:
- 89% had no relapse
- 96% considered themselves in recovery
- 88% continued attending 12-Step meetings after completing their contract, including 69% within the past year
- 96% were licensed to practice currently (and none had lost their license due to substance use)
Program participants said in the study that their brief treatment episodes and long-term fellowship were the most impactful elements in their recovery. Many physicians who strenuously resisted treatment initially were grateful for the coercion to enter the program once they were in recovery, he added.
Ultimately, DuPont said, sustained recovery is an achievable goal if recovery programs adhere to high standards.
“If you accept substance use, it continues,” he said. “If you identify it, intervene immediately while guiding the individual to recovery, and the use stops. It’s pretty simple, but not easy. Hold strong to the standard of no use and make it consequential, and you’ll get a better outcome.”