Having a coexisting psychiatric illness or family history of a substance use disorder or having used a major opioid are key factors that can increase the likelihood of a substance use disorder relapse among health care professionals, according to a study in the March 23/30 issue of JAMA.
The prevalence of chemical dependency (excluding nicotine) among physicians has been estimated to be 10 percent to 15 percent, similar to that in the general population, according to background information in the article. Following completion of primary treatment, recovery is best achieved through continuing group therapy and regular attendance at mutual help groups. Data on the incidence of relapse and risk factors contributing to the likelihood of relapse after initial treatment for substance use are lacking.
Karen B. Domino, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to identify factors that might predispose individuals to relapse. The study included 292 health care professionals enrolled in the Washington Physicians Health Program, an independent post-treatment monitoring program. The participants were followed up between January 1, 1991, and December 31, 2001.
Twenty-five percent (74 of 292 individuals) had at least 1 relapse. The researchers found that a family history of a substance use disorder increased the risk of relapse (2.3 times greater risk). The use of a major opioid (e.g., fentanyl, sufentanil, morphine, meperidine) increased the risk of relapse significantly in the presence of a coexisting psychiatric disorder (5.8 times increased risk) but not in the absence of a coexisting psychiatric disorder. The presence of all 3 factors--major opioid use, dual diagnosis (presence of a coexisting psychiatric disorder), and family history--markedly increased the risk of relapse (13.3 times). The risk of subsequent relapses increased after the first relapse (1.7 times increased risk).
"In health care professionals with a substance use disorder, the presence of a coexisting psychiatric illness or a family history of substance use disorder significantly increased the likelihood of relapse, as did the presence of prior relapse," the authors write. "Use of major opioids also increased risk of relapse in the presence of family history and even more dramatically in those with a dual diagnosis, and the combination of all 3 risk factors further magnified the likelihood of relapse. State physician health programs might wish to consider managing substance-using professionals who have one or more of these 3 risk factors and those with prior relapse with more intensive and more prolonged monitoring."
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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