Professional Well Being Programs
Author: David E. Smith, MD, FASAM, FAACT
Licensed professionals are often in positions of great responsibility, with their actions affecting large numbers of the public, their employees, and, of course, their families. The pressures of their jobs lead some to abuse of drugs, illicit or otherwise, while the prestige and economic benefits of their licenses provide an avenue to denial of the risks they present to those they serve. State licensing boards are usually the bodies that conduct investigations of addictive behavior, hold hearings and make decisions regarding disciplinary actions such as suspension or revocation of licenses.
An intermediate course between identification of an addicted physician and subsequent loss of license is often a well-being committee or physician health program (PHP) located in a hospital or county/state medical society. These bodies offer early intervention to professionals, and make efforts to direct them to treatment for their illness. International Doctors in Alcoholics Anonymous (IDAA) conducts annual meetings with educational programs and lectures to support physicians, dentists, and other practitioners in their recovery. Healthcare professionals, in particular, usually have greater access to addictive prescription medications, as well as greater knowledge of the subtleties of their administration and side effects.
In the 1970s airline pilots developed a program known as Human Intervention Motivation Study (HIMS) as an occupational substance abuse treatment program. In California, The Other Bar offers support through a network of legal professionals in recovery, while the International Lawyers in Alcoholics Anonymous has annual meetings and other services. Accountants have also established similar educational and support groups in several states. The California Board of Registered Nursing has a diversion program that allows nurses to maintain their licenses and continue working while in a monitored treatment program and under regular review.
Programs for physicians typically set the standard for treatment programs. The concept was established in the 1970s by the late Douglas Talbott, MD, who created the first treatment program designed especially for addicted physicians. The key elements of physician treatment typically consist of an evaluation, an intervention, intensive treatment, often in a residential facility, and post-treatment monitoring, including drug testing, which may last as long as 5 years (Skipper & DuPont, 2011). Because physicians may be using prescription medications, their drug tests usually include more sophisticated drug assays than the so-called “NIDA-5,” which test only for illicit heroin, cocaine, marijuana, amphetamines, and PCP. They are expensive.
Physicians are often referred to treatment by the well-being committee of their hospital or local medical society, often after a complaint is lodged by a co-worker. Physicians have an ethical responsibility to address possible addiction issues with their colleagues, which can be awkward due to long-standing friendships and/or professional relationships. The California-based Medical Insurance Exchange of California (MIEC) recommends that physicians first discuss their concerns with the co-worker and if the individual continues his or her destructive behavior, that the appropriate well-being committee be contacted for a more authoritative addressing of the issue.
Substance abuse disorder is a major public health problem, affecting all social, economic, and occupational strata to the same approximate degree. Post-treatment supportive recovery care is often more available to licensed professionals in various disciplines through associations of their peers and is crucial to the continuing care model of managing addictive disease as a chronic illness for all afflicted populations.
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