Issues in the recovery of physicians from addictive illnesses.

The issues discussed in this article introduce and examine topics related to physicians' health which are salient in their clinical usefulness or their heuristic value in planning future research. Physicians in general possess physical, emotional and intellectual strengths that are needed to face high stress and low social support. Physicians are also less likely to seek routine medical care. With many illnesses physicians are inherently resistant but have higher risk factors. It is postulated that the opposing tendencies cancel each other. Physicians have better intrinsic physical and mental health but live under higher stress and get less routine preventive care. Physicians also may have a tendency to live healthy lives without addiction but have high risk factors for addiction. Adults who have grown up in families with addiction have a tendency to choose health care professions. Genetic composition may predispose to alcoholism and other chemical addictions. Taking into consideration inherent health and risk it is thought that physicians have a similar prevalence of alcoholism and drug dependence as compared to the general population. Physicians have higher access to pharmaceutical drugs but are less inclined to use street drugs. In the New York State Physicians' Health Program, 88% of the participants used alcohol or prescription drugs and only 12 percent used marihuana or Cocaine. Additional risk factors for Substance Use Disorders in Physicians have been postulated to be pharmaco-logical optimism, intellectual strength, strong will, love of challenges, instrumental use of medications and a daily need for denial. These factors require rigorous investigation to establish their role. Clinical approaches and techniques discussed include the incubation period for a Substance Use Disorder, initial high tolerance, state dependent learning, and the signal properties of drugs. As recovery progresses it is postulated that it becomes increasingly important to deal with substitute addictions and family of origin issues.

Reminiscence of an addictionologist: thoughts of a researcher and clinician.

The changes in the field of addiction are discussed from the prospective of twenty-two years of work as a researcher and clinician. The growing importance and relevance of twelve step programs to clinical practice is explored as is the changing experiences of working with early stage alcoholics. This is followed by a discussion of the interaction the research and clinical aspects of chemical dependency. Behavioral and learning theory in relationship to chemical dependency, the disease concept and the importance of the incubation period, withdrawal syndromes, and hereditary aspects of chemical dependency are all discussed.

Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Report of the NIMH Collaborative Study Group comparing lithium carbonate, imipramine, and a lithium carbonate-imipramine combination.

In a double-blind, long-term follow-up study, 117 bipolar patients received lithium carbonate, imipramine hydrochloride, or both and 150 unipolar patients received lithium carbonate, imipramine, both lithium carbonate and imipramine, or placebo. With bipolar patients, lithium carbonate and the combination treatment were superior to imipramine in preventing manic recurrences and were as effective as imipramine in preventing manic recurrences and were as effective as imipramine in preventing depressive episodes. The combination treatment provided no advantage over lithium carbonate alone. With unipolar patients, imipramine and the combination treatment were more effective than lithium carbonate and placebo in preventing depressive recurrences. The combination treatment provided no advantage over imipramine alone. The lithium carbonate-treated group had fewer manic episodes than the other groups. Treatment outcome, which was evaluated primarily in terms of the occurrence of major depression or manic episodes, was significantly related to characteristics of the index episode, ie, the episode that brought the patient into the study.