Physician substance use by medical specialty.

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

Changes in personality characteristics in women treated in a therapeutic community.

We examined changes in mood and personality characteristics in a sample of cocaine-dependent women being treated in a therapeutic community (TC). Forty-six women completed the Beck Depression Inventory (BDI), the Hamilton Anxiety Scale (HAM-A), and the Millon Clinical Multiaxial Inventory-II (MCMI-II) on admission and 12 months after discharge from the TC. On admission, the group was characterized by clinically significant scores on the BDI, HAM-A, and the MCMI-II Avoidant, Dependent, Antisocial, Passive-aggressive, Self-defeating, and Borderline scales. On follow-up, significant improvement in functioning was suggested by decreases in scale scores on the BDI, HAM-A, and MCMI-II Avoidant, Dependent, Self-Defeating, and Borderline Scales, but not for the MCMI-II Antisocial and Passive-Aggressive scales. These results suggest substantial positive effects of TC treatment on personality characteristics and functioning, but also indicate that TC treatment may not habilitate all critical personality deficits.

Substance use by surgical residents and students entering surgery.

We studied the use of alcohol, tobacco, and nine unprescribed or illegal substances by surgical residents and medical students accepted into surgical programs. With the exception of alcohol, surgical residents had less lifetime experience and used less than other residents or nonmedical college graduates. Students entering surgery had used these substances more frequently and were more likely to be using them regularly than were residents. Residency directors need to be aware of the change in attitude and use patterns of present residents as compared with those of the past.

Retaining cocaine-abusing women in a therapeutic community: the effect of a child live-in program.

A clinical trial examined whether retention of cocaine-abusing women in a therapeutic community can be improved by permitting their children to live with them during treatment. Fifty-three women were randomly assigned to either the standard community condition (n = 22), in which children were placed with the best available caretaker, or the demonstration condition (n = 31), in which one or two of the children lived with their mother in the community. Survival analysis distributions indicated that demonstration women remained in treatment significantly longer than standard treatment women. (Mean length of stay was 300.4 days vs 101.9 days, respectively.)

PAR Village for chemically dependent women. Philosophy and program elements.

The authors present a description of PAR Village, a demonstration project designed to examine the question of whether mothers in residential treatment accompanied by their children have better outcomes than those who enter treatment without their children. Issues related to the treatment of women in substance abuse programs are discussed as an introduction to the structure and purposes of the program. Details of the setting, client selection process, and program philosophy are provided. The workings of program services and treatment elements are described and illustrated by a case example.

Heroin epidemics revisited.

This paper reviewed heroin use data from the US government's epidemiologic monitoring system for substance abuse. The monitoring system has multiple components, i.e., the Drug Abuse Warning Network of reporting emergency rooms (9), annual surveys of high school and post-high school youth (3, 4), annual National Household Surveys of Substance Abuse (7, 8, 50), Drug Use Forecasting (51), the Community Epidemiology Work Group (52), and law enforcement systems not reviewed here. These monitoring systems should identify any major increase in heroin incidence in this country relatively early. This is important, because the early stages of heroin epidemics are often hidden from society, and the epidemics are already full-blown by the time health and other agencies become aware of the size of the affected population and are required to respond. The hidden or underground nature of heroin epidemics is caused by 1) the need of each user to hide an illegal activity and 2) the delay between the time when heroin is first used and the onset of physical dependence and other adverse consequences, which bring new heroin addicts to the attention of treatment and enforcement systems. Despite an epidemiologic surveillance system which should rapidly identify large-scale heroin spread in this country, our treatment and law enforcement systems are not organized to respond rapidly to contain an epidemic. Substance abuse treatment services are not structured for rapid expansion and contraction based on fluctuating need. Apart from HIV prevention programs, we do not have outreach teams attached to treatment programs that could quickly identify local outbreaks and involve new heroin abusers in treatment (10).(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of drug involvement: applications to a sample of physicians in training.

The investigators examined survey data of lifetime and recent drug use in national samples of 2036 senior medical students and 1772 resident physicians to test whether patterns of lifetime drug use could be characterized adequately by a single underlying dimension of 'drug involvement'. The data analysis was based on a two parameter normal item response theory (IRT) model using the marginal maximum likelihood estimation method. The results showed that a single latent dimension of 'drug involvement' characterized individual drug use differences on the following measures: substances ever used, substances used in the previous year or previous month, and the sequential order of first use for each substance. The dimension was equivalent for students and resident physicians, and for both genders. Those who professed 'no religion' tended to be more drug involved. Physicians-in-training with a higher drug involvement score based on lifetime use were more likely: (a) to have used higher-ranking drugs (such as LSD and prescription opiates) in the past year; and (b) to have used a greater number of different drugs during the past month. Subjects first began to use each of the substances in a relatively invariant sequence corresponding to that predicted by the model. The implications of this model for evaluating the drug use histories of physicians-in-training, for identifying subgroups at greater risk for continued drug involvement after the beginning of medical training, and for further psychological, biological, and sociocultural research on the nature of 'drug involvement' are discussed.

Resident physician substance use, by specialty.

OBJECTIVE: This study compares substance use by medical specialty among resident physicians. METHOD: The authors estimated the prevalence of substance use of 11 medical specialties from a national sample of 1,754 U.S. resident physicians. RESULTS: Emergency medicine and psychiatry residents showed higher rates of substance use than residents in other specialties. Emergency medicine residents reported more current use of cocaine and marijuana, and psychiatry residents reported more current use of benzodiazepines and marijuana. Contrary to recent concerns, anesthesiology residents did not have high rates of substance use. Family/general practice, internal medicine, and obstetrics/gynecology were not among the higher or lower use groups for most substances. Surgeons had lower rates of substance use except for alcohol. Pediatric and pathology residents were least likely to be substance users. CONCLUSIONS: The authors' previous research indicates that residents overall have lower rates of substance use than their age peers in society. Yet resident substance use patterns do differ by specialty. Residents in some specialties are more likely to use specific classes of drugs, to use a greater number of drug classes, and to be daily users of alcohol or cigarettes.

PAR village. Specialized intervention for cocaine abusing women and their children.

Operation PAR in St. Petersburg received National Institute on Drug Abuse support in 1989 and state and local appropriations to establish PAR Village, a research demonstration program for treatment of cocaine abusing women with young children. Adjacent to PAR's residential therapeutic community, it includes 14 housing units and a day-care center for infants and children. Women live with their children while receiving long-term residential care. The program is being systematically evaluated by researchers from the University of South Florida Department of Psychiatry and Behavioral Medicine. Retention in treatment and post-discharge outcomes of the women are compared with those involved in the standard program where children remain in the community with relatives or are placed in foster care. Preliminary results suggest the demonstration program increases retention in treatment.

The stresses of the surgical residency.

UNLABELLED: Concern over resident work hours prompted us to study the stress of surgical residencies and determine if the experience might be associated with an increased use of alcohol and drugs. Two hundred fifty-seven surgery residents were selected from a stratified, randomized sample of residents (n = 1728) from the AMA files and were given an eight-page self-administered questionnaire. RESULTS: Surgical residents reported very long hours and heavy duties and complained of loss of sleep and exhaustion, both of which correlated with nights on call. Despite the heavier work load, surgical residents showed no more emotional stress than other residents. Surgery residents were more likely to have used alcohol in the last month than other residents (P less than .05) but 70% had used it fewer than 10 times in the month. All surgical residents were less likely to have used marijuana, cocaine, or other drugs than were other residents. Surgical residents seem to cope well with the extreme stresses of surgery training programs; however, more research needs to be done if we are to fully understand the process for training surgeons.

Prevalence of substance use among US physicians.

OBJECTIVE: To estimate the prevalence of substance use among US physicians. DESIGN: A mailed, anonymous, self-report survey that assessed use of 13 substances and permitted comparison with results of the National Household Survey on Drug Abuse. Rates of physician substance use were weighted to provide national prevalence estimates. PARTICIPANTS: A national sample of 9600 physicians, stratified by specialty and career stage, and randomly selected from the American Medical Association master file. The response rate after three mailings was 59%. Demographic characteristics of respondents closely reflected those of the US physician population. MAIN OUTCOME MEASURES: Subjects' self-reported use of 13 substances in their lifetime, the past year, and the past month; reasons for use; self-admitted substance abuse or dependence; and whether treatment was received. For controlled prescription substances, respondents were asked to report only use "not prescribed by another physician for a legitimate medical or psychiatric condition." RESULTS: Physicians were less likely to have used cigarettes and illicit substances, such as marijuana, cocaine, and heroin, in the past year than their age and gender counterparts in the National Household Survey on Drug Abuse. They were more likely to have used alcohol and two types of prescription medications--minor opiates and benzodiazepine tranquilizers. Prescription substances were used primarily for self-treatment, whereas illicit substances and alcohol were used primarily for recreation. Current daily use of illicit or controlled substances was rare. CONCLUSIONS: Although physicians were as likely to have experimented with illicit substances in their lifetime as their age and gender peers in society, they were far less likely to be current users of illicit substances. The higher prevalence of alcohol use among respondents may be more a characteristic of their socioeconomic class than of their profession. A unique concern for physicians, however, is their high rate of self-treatment with controlled medications--a practice that could increase their risk of drug abuse or dependence. Uniform national guidelines are needed to sensitize medical students and physicians to the dangers of self-treatment with controlled prescription substances.

Patterns of substance use in the medical profession.

National drug use surveys of medical students and resident physicians in 1987 found that medical school was not a time when students began to use drugs, nor was it a time when they engaged in heavy use. Medical students and resident physicians reported lower rates of illicit drug use than their age and gender counterparts. Although males generally were more likely to use substances than females, young male and female physicians resembled one another in their current rates of substance use more than they resembled their gender counterparts in society.

Resident physician substance use in the United States.

A national survey was conducted to determine patterns of drug use among 3000 American resident physicians. Sixty percent (1785) of the residents surveyed responded. This report evaluates the prevalence of drug use among the respondents, when they initiated drug use, and their reasons for current use. Substance use rates are compared with other studies of resident physicians and with a sample of their nonphysician age peers surveyed the same year. Heavy substance use patterns were not observed among resident physicians. They had significantly lower rates of use for most psychoactive substances than their peers in the general population but did report higher rates of past-month use of alcohol and benzodiazepines. A sizable minority began using benzodiazepines and prescription opiates during their residency years-the stage in physicians' training when they first receive prescribing privileges. Current users of benzodiazepines and opiates used these drugs primarily for self-treatment rather than recreation. These two substances are often associated with impairment at later stages in the physician's career.

Substance use among senior medical students. A survey of 23 medical schools.

Senior students at 23 regionally distributed medical schools received an anonymous questionnaire designed to examine current and prior use of tobacco, alcohol, and nine other drugs. The overall response rate was 67% (N = 2046). Substance use prevalence rates during the 30 days preceding the survey included alcohol, 87.5%; marijuana, 10.0%; cigarettes, 10.0%; cocaine, 2.8%; tranquilizers, 2.3%; opiates other than heroin, 1.1%; psychedelics other than LSD (lysergic acid diethylamide), 0.6%; amphetamines, 0.3%; barbiturates, 0.2%; LSD, 0.1%; and heroin, 0.0%. Compared with national, age-related comparison groups, senior medical students reported less use of all substances during the past 30 days and the past 12 months, except for alcohol, tranquilizers, and psychedelics other than LSD. Substantial new drug use after entry into medical school was reported only for tranquilizers. Seven students (0.2%) admitted to current dependence on a substance other than tobacco, four of these implicating marijuana. Thirty-three students (1.6%) believed that they currently needed help for substance abuse. Only 25.7% were aware of any policy on substance abuse at their own school.

La Pharmacodépendance : méthodes pour l' évaluation du traitement et de la réhabilitation / A. Arif ... [et al.]

Décrit une méthodologie simple, pratique et aisément adaptable pour l'évaluation des progrès réalisés dans le traitement et la réadaptation des sujets pharmacodépendants. Cette méthodologie, qui est l'aboutissement d'un projet de recherche et d'évaluation sur l'épidémiologie de la pharmacodépendance doit servir à mesurer les résultats du traitement pour différents types d'utilisateurs de drogues recevant différents types de traitement dans différents environnements socio-culturels. La majeure partie de l'ouvrage est constituée par le commentaire détaillé de quatre séries de formulaires d'enregistrement. Les formulaires sont reproduits intégralement, avec des instructions pour leur utilisation, des informations sur le traitement des données et une analyse des problèmes rencontrés dans la conception et l'exécution d'études réalisées à l'aide de ces instruments

Drug dependence : a methodology for evaluating treatment and rehabilitation / A. Arif ... [et al.]

Describes a simple, practical, and adaptable methodology for monitoring progress in the treatment and rehabilitation of drug-dependent persons. The methodology, which stems from a research and reporting project on the epidemiology of drug dependence, is designed for use in measuring treatment outcome for different types of drug users receiving different types of treatment in different sociocultural environments. The main part of the book consists of detailed information on four sets of data recording forms. The forms are reproduced in full detail, together with instructions for their use, information on data processing, and an analytical description of issues encountered in the design and implementation of studies using these instruments