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Treatment Programs Designed for Physicians and other Health Professionals

Treatment Programs Designed for Physicians and other Health Professionals

All substance use disorder treatment programs should be excellent, unfortunately standards are often lax, in part because funding is inadequate. Every program should be licensed and accredited and have a physician involved with expertise in addiction medicine. Counseling staff should be licensed. Every program should have excellent evaluation services for assessing the severity of the substance use disorder but also evaluating for co-occurring psychiatric disorders, trauma, cognitive disorders, family dysfunction, and medical issues. Treatment plans should be individualized, and treatment services should be evidence based. Family and couples therapy should be included when appropriate. All programs should develop aftercare plans that are realistic and comprehensive and long-term monitoring for every patient, particularly for professionals, should be emphasized. Unfortunately, most of the >13,000 treatment programs in the USA do not meet these standards. Staff turnover is high. Most treatment programs have little input from physicians or doctorate level staff. Most counselors are unlicensed.

Programs designed for professionals, particularly for health professionals, meet all the above standards plus they offer unique characteristics that can make them more effective. These characteristics include:

  • Having experienced staff who have become accustomed to treatment of physicians and one or more physicians are on the staff and conduct groups and give lectures to professionals
  • Having a peer group of other physicians and health professionals in treatment
  • Including a specialized curriculum to assist physicians and other health professionals to deal with their unique issues (see list below).

Staff Experienced with Treatment of Physicians

Having staff experienced in treating physicians is particularly important.

“General medical and psychotherapeutic treatment of physicians and other health professionals, as patients, can be difficult and expertise is beneficial. A physician who undertakes the challenge of treating other physicians, for any disorder, must have firm boundaries, and must be willing to provide extra time and patience. Denial of symptoms, countertransference and other pitfalls have been cited. Physicians tend to seek general medical check-ups and consultation visits less often than controls and tend to wait longer before seeking consultation for serious symptoms. Complex factors including the tendency to diagnose and treat one’s self, the obtaining of “hallway” medical consultations regarding personal symptoms, treatment by close professional friends, difficulty in accepting the role of the patient, and the receiving of less than objective medical treatment may inhibit an ill or impaired physician from seeking and obtaining timely and effective treatment. Furthermore, physicians fear the potential or real loss of status and authority associated with becoming a patient. Physicians often have a false sense that having medical knowledge somehow protects them from illness.”

Having more involvement of medical staff, meeting with professional patients regularly, giving lectures and conducting groups is very important.

Peer Group

It is very important that when a physician or other health professional enters treatment there are professional peers. This is very important to prevent the celebrity effect of a physician in treatment. It is important that physicians in treatment hold each other accountable to avoid diagnosis and treatment of themselves or others in treatment. It is important that professional peers confront each other regarding rationalization or other defenses to avoid seeing their situation clearly. Much is gained by having peers in treatment.

Topics to be covered with licensed health professionals

The following are a list of topics typically covered in groups or lectures in a professionals program.

  1. Shame and the cognitive dissonance inherent in being a professional and being addicted to alcohol and/or drugs.
  2. When returning home what does one say and to whom regarding where one has been when in treatment? What if they ask? (Practicing and role-playing are important.)
  3. Meeting with the Regulatory Board, Professional Health Program, employers, hospital wellbeing committee, medical executive committee or others. What does one tell them? (Role-playing frequently utilized as an exercise.)
  4. Questionnaires? Such as License renewal, Hospital privileges, Insurance companies, Malpractice insurance, Driver’s license renewal, Life insurance applications, etc. Is it ever appropriate to lie on these forms? Would you lie and why? Patients develop a statement and read it to peers and accept feedback regarding their explanation of a Yes answer. (Patients are encouraged to keep a copy of their account for future use and/or to always share an intended response to an appropriate person or group to help avoid “accidental denial.”)
  5. DEA certification – Is it helpful to have a restricted DEA Certificate? For how long? Should you ever surrender your DEA? How to answer the DEA renewal questions etc.
  6. Prescribing controlled substances – risks and procedures to follow. Can you practice medicine without prescribing controlled substances? If so, how?
  7. Disability insurance – when to use it, how to use it, who to get to help you, etc.
  8. Medical Board and other regulatory board procedures, structure, function, purpose, etc. How to work with the board.
  9. Professional boundaries: Dual relationships, gifts from clients or patients, hugging, risk factors and vulnerability (professional and patient) for intimacy with patients or clients, prescribing to self, family or friends, etc.
  10. Use and risks of social media, texting, cell phones, websites, etc.
  11. History of Medical (and other regulatory) Boards, purpose, function, structure, national organizations (e.g., FSMB.org), newsletters, procedures, etc.
  12. History of Physician (and other Professionals) Health Programs, purpose, function, structure, national organizations (e.g. FSPHP.org), newsletters, procedures, etc.
  13. Going to 12-step meetings or other support groups and seeing clients or patients…What do you do, say, think, or feel?
  14. The optimal work/life balance…Write out your average schedule for your weekday and/or weekend then write your optimal schedule. How are they different? What are the barriers to working the optimal schedule? How can you overcome the obstacles? How important is it?
  15. How to apply for a new job. When to mention your history of psychiatric issues? How much do you tell? How to mitigate the damage?
  16. The importance of being vulnerable and honest in recovery and what are the barriers, risks, etc.

Conclusion

The high success rates for physicians treated for substance use disorders have been associated with thorough evaluation, adequate treatment and long-term monitoring that all begins in specially designed treatment programs for professionals. It is not only a public safety issue that physicians receive the best treatment possible, but it is also a matter of great importance for the physician as they often do not get a second chance. A relapse can mean the end of their career.

1 Skipper, GE. Treating the Chemically Dependent Health Professional, Journal of Addictive Diseases, Vol 16(3) 1997, pg. 67-74
2 McLellan AT, Skipper GE, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008 Nov 4;a2038, doi:10.1136.a2038.

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