Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States

OBJECTIVE: To evaluate the effectiveness of US state physician health programmes in treating physicians with substance use disorders. DESIGN: Five year, longitudinal, cohort study. SETTING: Purposive sample of 16 state physician health programmes in the United States. PARTICIPANTS: 904 physicians consecutively admitted to one of the 16 programmes from September 1995 to September 2001. MAIN OUTCOME MEASURES: Completion of the programme, continued alcohol and drug misuse (regular urine tests), and occupational status at five years. RESULTS: 155 of 802 physicians (19.3%) with known outcomes failed the programme, usually early during treatment. Of the 647 (80.7%) who completed treatment and resumed practice under supervision and monitoring, alcohol or drug misuse was detected by urine testing in 126 (19%) over five years; 33 (26%) of these had a repeat positive test result. At five year follow-up, 631 (78.7%) physicians were licensed and working, 87 (10.8%) had their licences revoked, 28 (3.5%) had retired, 30 (3.7%) had died, and 26 (3.2%) had unknown status. CONCLUSION: About three quarters of US physicians with substance use disorders managed in this subset of physician health programmes had favourable outcomes at five years. Such programmes seem to provide an appropriate combination of treatment, support, and sanctions to manage addiction among physicians effectively.