A Comparative Analysis of Substance Use Disorder Programs Between Three Safety Sensitive Professions.

The prevalence rate of addiction among physicians is similar to the general population, with approximately 10% to 12% of U.S.-based physicians developing substance use disorders (SUDs) during their lifetimes. To address this public health concern, physician health programs (PHPs) have been created to facilitate the early identification, evaluation, treatment, and monitoring of physicians. Although a number of published studies provide outcome information from PHPs, there has been no comprehensive review of the related literature. The objective of this narrative review is to summarize the treatment outcomes, including treatment types, rates of relapse, rates of contract completion or extension, as well as licensure and work status rates of a nationally representative physician cohort and related subpopulations from a single dataset. Based on the studies included in this review, our findings reveal that physicians who completed their PHP contracts have more favorable treatment outcomes than members of the general population who receive mainstream treatment. In addition, our review describes unique features of physician rehabilitation facilitated by PHPs. However, further prospective research is needed to ensure a standardized and comparable dataset and facilitate performance improvement.

State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

Overall their lifetimes, 10-12% of physicians will develop a substance use disorder [1]. This rate is comparable to that of the general public. Physicians who are suspected of having substance use disorders or other mental health issues are often referred to their state physician health program (PHP) for evaluation. These referrals might come from chief medical officers, boards of medicine, or colleagues in a group practice. PHPs meet with, assess, and monitor physicians who have been referred to them for substance use or other mental and behavioral health problems. Once referred, physicians often have little choice but to comply with any and all recommendations by the PHP in order to continue practicing medicine, because they have often been told by the referral source that failure to comply with any and all recommendations of the PHP will result in termination of their ability to practice medicine. In most states, for example, boards of medicine rely completely on the PHPs for guidance about how to deal with impaired physicians. So even though PHPs don’t directly have the ability to prevent physicians from practicing medicine, since PHPs can’t themselves revoke medical licenses or hospital privileges, their determinations of physician compliance with their recommendations often result in exactly those actions. PHPs are therefore extremely powerful.

Many physicians are referred to state physician health programs (PHPs) for evaluation, monitoring, and treatment of mental health and substance use disorders. If the physician agrees to cooperate with the PHP and adhere to any recommendations it might make, the physician often can avoid disciplinary action and remain in practice. Despite their considerable power, many PHPs operate with little oversight. I review recommendations that a co-author and I previously made regarding oversight of PHPs and then review some of the findings from a recent performance audit of the North Carolina Physicians Health Program by the North Carolina Auditor's Office. Physicians who might object to the conclusions and recommendations of PHPs in many states do not have the ability to appeal and lack due process. Additionally, given that many of the evaluation and treatment centers to which PHPs refer their clients also sponsor meetings of PHPs, there is significant potential for conflict of interest in the standard operations of PHPs. National standards should be put in place for the day-to-day operation of PHPs and include avenues for appealing decisions and recommendations by them. Also, PHPs should be routinely audited to ensure the soundness and fairness of their practice.

The Evidence for SBIRT in Adolescents

Back to table of contents Previous article Next article Education & TrainingFull AccessResource Document Calls for Improved Residency Training on SUDsMark MoranMark MoranSearch for more papers by this authorPublished Online:26 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.23AbstractTrainees need to see patients in a wide variety of settings, over time, with supervisory training that focuses on a patient’s addiction.When trainees are exposed to patients who recover from a substance use disorder, it is humanizing, destigmatizing, and unforgettable, said Shelly F. Greenfield, M.D., M.P.H., a member of APA’s Council on Addiction Psychiatry, at the virtual meeting of the American Association of Directors of Psychiatric Residency Training (AADPRT).“When trainees have that opportunity to work with a patient with a substance use disorder over time and see the patient get better in a real-world setting, it is incredibly gratifying,” says Shelly F. Greenfield, M.D., M.P.H.Residents and fellows need more of those experiences. Greenfield cited data from surveys of program directors and from an October 2020 APA Resource Document on Education and Training for Substance Use Disorders (see section below) indicating that trainees generally do not receive sufficient training in the treatment of substance use disorders (SUDs), including faculty supervision focused specifically on treatment of SUD patients over time. Additionally, too few residents receive training in prescribing buprenorphine and other medications approved for treating SUDs.“When trainees graduate as early career psychiatrists—no matter where they practice—they will see a very high proportion of patients with an SUD either alone or co-occurring with another psychiatric disorder,” Greenfield said. “Yet they have very little training in their four years overall. There have been some positive changes in addiction training in residency, but most studies and the APA resource document demonstrate that training for diagnosing and treating patients with substance use disorders is inadequate for graduating residents in 2021.”She noted that the requirement of the Accreditation Council for Graduate Medical Education for just four weeks of dedicated training in addiction has not been changed since 2001. A 2012 survey of 104 program directors supported by the APA Council on Addiction Psychiatry found that only 19% of program directors reported that trainees were paired with supervisors for addiction, and 68% said patients with SUDs were sent elsewhere for treatment. Most did not provide opportunity for long-term treatment for patients with SUDs.In comments to Psychiatric News after the meeting, Greenfield emphasized four areas in which training in addiction falls short:Lack of supervision that is specifically focused on treatment of patients with SUD. Greenfield cited a 2018 survey of 84 program directors by the Addiction Task Force of AADPRT that found that in many programs addiction training takes place only on general psychiatry units in which co-occurring disorders are evaluated and treated, but the extent to which addiction-trained supervisors are available or addiction is the focus of the training is unclear. In that survey, 41.6% of program directors indicated there was a limited number of faculty with expertise in co-occurring conditions to provide trainee supervision.Greenfield said one approach for programs that lack faculty expertise in addiction is collaboration with other programs, an opportunity made possible by the widespread use of video technology in medicine and psychiatry during the pandemic.Failure to see patients over time. Trainees need to see the progress and recovery of patients with SUD over time. “Longitudinal experience with patients having SUD usually happens in outpatient settings where the trainee can treat patients with SUD, receive supervision, and be able to follow them beyond just a four-week experience on an inpatient unit,” Greenfield said.Lack of training in using buprenorphine and other medications approved for addiction and SUD. “If residents have eight-hour waiver training in buprenorphine, they learn a lot about the medication and about opioid use disorder,” Greenfield said. “Data show that if you get just eight hours of training in residency, you are much more likely to prescribe this medication in your practice after residency. And yet we don’t have a requirement to complete that training.”The tendency of residents to see patients with SUD only in the emergency department. “If you mostly expose trainees to patients who present to the emergency department with SUD, this can contribute to stigma and therapeutic nihilism—the belief that this condition never gets better,” Greenfield told Psychiatric News. “Most patients with SUDs are never seen in emergency departments.”Psychiatrists should learn how to care for patients presenting in the emergency department with acute withdrawal or intoxication, she said, but most will graduate to practice in other settings—outpatient practices, community health settings, inpatient services, and residential and partial hospital settings. “Psychiatrists will routinely encounter patients in these settings who have substance use disorders including those with co-occurring psychiatric disorders, and it is imperative that they feel competent in providing that care.”In addition to the APA resource document, Greenfield cited a number of resources for trainees and training programs. They include the Opioid Response Network and the Providers Clinical Support System, of which APA is a partner. This program offers training and mentoring in evidence-based prevention and treatment of opioid use disorders and treatment of chronic pain.When trainees are expose to patients who recover from an SUD, it can be an experience the trainee will never forget.“We have an apprentice system of learning in graduate medical education—as a resident you have a supervisor, but you are treating the patient yourself,” she said. “What we know is that when trainees have that opportunity to work with a patient with a substance use disorder over time and see the patient get better in a real-world setting—it’s incredibly gratifying.” ■The APA Resource Document on Education and Training for Substance Use Disorders is posted here.APA Resource Document Offers Recommendations for Medical Students, Residents, and Lifelong Learners“Medical schools, physician training (residency) programs, and continuing education programs for physicians in practice provide limited training in the treatment of SUDs,” according to the APA Resource Document on Education and Training in Substance Use Disorders. “The scope of training on SUDs is disproportionate to the population health need to address these problems, and many with SUDs go undiagnosed and untreated.”The resource document is a product of APA’s Council on Addiction Psychiatry, the Council on Medical Education and Lifelong Learning, and the Council on Healthcare Systems and Financing. The document offers recommendations for medical schools, residencies, and continuing medical education for physicians in practice, as well as strategies for change.Recommendations for medical student rotations and residency programs include the following:Addiction and co-occurring disorders should be incorporated into all aspects of psychiatry residency training since patients with SUD are seen at all levels of care.Supervision and discussion of SUD cases should occur at inpatient and outpatient levels of care and should include an addiction psychiatrist.Programs should ensure they have access to resources to help them incorporate enhanced training in SUD with the goal of bolstering resident competencies in assessing and treating patients for these conditions.All psychiatry residents should complete the buprenorphine waiver training or its equivalent.Residents should be trained to treat patients with alcohol use disorder, stimulant use disorder, opioid use disorder, sedative/hypnotic use disorder, cannabis use disorder, tobacco use disorder, and other substances.Training experience should include various levels of patient acuity and corresponding care including outpatient and residential treatment.Residents should receive training in the use of FDA-approved medications for opioid, alcohol, and tobacco use disorder (and others as developed and approved by the FDA).Training on SUD treatments should include knowledge of the range of evidence-based behavioral therapies and competency to practice at least one. This might include, but is not limited to, the ability to integrate motivational interviewing concepts and techniques into patient assessments and sessions. ISSUES NewArchived

The link between bipolarity and substance use: A controlled clinic based study.

BackgroundThe COVID-19 pandemic is creating severe issues for healthcare and broad social structures, exposing societal vulnerabilities. Among the populations affected by COVID-19 are people engaged in substance use, such as people who smoke; vape (e-cigarette use); use opioids, cannabis, alcohol, or psychoactive prescription drugs; or have a substance use disorder (SUD). Monitoring substance use and SUD during the pandemic is essential, as people who engage in substance use or present with SUD are at greater risk for COVID-19, and the economic and social changes resulting from the pandemic may aggravate SUD. There have been several reviews focused on COVID-19 in relation to substance use and SUD. Reviews generally did not consider on a large range of substance use variants or SUDs. We plan a scoping review that seeks to fill gaps in our current understanding of substance use and SUD, in the COVID-19 era.MethodsA scoping review focused on substance use and SUD, in relation to COVID-19, will be conducted. We will search (from January 2020 onwards) Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Web of Science Core Collection, Embase, Global Health, WHO Global Literature on Coronavirus Disease Database, WHO Global Index Medicus, PsycINFO, PubMed, Middle Eastern Central Asian Studies, CINAHL Complete, and Sociological s. Grey literature will be identified using Disaster Lit, Google Scholar, HSRProj, governmental websites, and clinical trials registries (e.g., ClinicalTrial.gov, World Health Organization, International Clinical Trials Registry Platform and International Standard Randomized Con-trolled Trial Number registry). Study selection will conform to Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. Only English language, original studies investigating substance use and SUD, in relation to COVID-19 in all populations and settings, will be considered for inclusion. Two reviewers will independently screen all citations, full-text articles, and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods.DiscussionOriginal research is urgently needed to mitigate the risks of COVID-19 on substance use and SUD. The planned scoping review will help to address this gap.Systematic review registrationOpen Science Framework (osf/io/tzgm5).

Background: Although a growing body of evidence supported that substance use disorder (SUD) patients are considered a group of population at risk for the development of Addictive Behaviors such as Gambling disorder (GA) and Internet Addiction (IG), only very few studies have been carried out on the Addictive Behaviors among substance use disorder (SUD) patients.Aim of the work: The current study conducted to investigate the prevalence of addictive behaviors in a sample of patients with substance use disorder and comparison in socio-demographic, clinical variables and legal factors in substance dependent individuals with and without addictive behaviors. Patients and methods:100 substance use disorder (SUD) patients were included in the study. Full neuropsychiatric history for patients with substance use disorder (SUD)using psychiatric sheet, SCID-I for diagnosis of substance use disorder, Addiction Severity Index (ASI) to assess the severity of substance use disorder, Gambling Addiction Test (GAT) to assess the severity of gambling Addiction and Internet Addiction Test (IAT) to assess the severity of internet addiction.Results: The prevalence of Addictive Behaviors (Gambling disorder and Internet Addiction) among substance use disorder (SUD) patients was 33%. Conclusion: These findings demonstrated the high prevalence of Addictive Behaviors among substance use disorder (SUD) patients. Consequently, Addictive Behaviors management should be included in all treatment programs dealing with substance of abuse.

AMA to Work With APA, Other Groups on Integrated Care

The objective of this study was to compare outcomes of psychiatrists and nonpsychiatrist physicians enrolled in state physician health programs for substance use disorders. The study used the data set from a five-year, longitudinal cohort study of 904 physicians, including 55 psychiatrists, with diagnoses of substance abuse or dependence consecutively admitted to one of 16 state physician health programs between 1995 and 2001. There was a higher proportion of women among psychiatrists than among other physicians, but there were no other significant differences between the cohorts. Five-year outcomes were similar between psychiatrists and the other physicians, with at least 75% of psychiatrists continuing their medical practice after five years of monitoring and treatment. Psychiatrists were not overrepresented compared with other physician groups and had similar clinical outcomes at the five-year follow-up. Physician health programs appeared to be effective treatment programs for psychiatrists with substance use disorders.

eview question / Objective What is the prevalence of substance use and changes in the consumption of psychoactive substances during the COVOD-19 pandemic in people with a previous diagnosis of Substance Use Disorder undergoing treatment? RationaleThe COVID-19 pandemic brought a series of challenges to society and affected different layers of the population in different ways.People with more vulnerable conditions may have been more impacted, such as those with Substance Use Disorder (SUD).For these people, the effects of the pandemic are not limited to concerns about the spread of the disease, but also extend to mental health in general, as well as possible changes in the consumption of psychoactive substances.Thus, the need to study the impacts of COVID-19 on these population , considering they will require public policies and guidance for specific clinical decisions to formulate treatment interventions.Although the number of articles on this topic is increasing day by day, there are still few studies aimed at this population.In this way, our study is a systematic, comprehensive and methodologically adequate review that aims to indicate the prevalence of results on the use of material in the period of the COVID-19 pandemic. Condition being studiedWe pretende analyse prevalence of psychoactive substance use and changes in consumption during the pandemic in individuals with pr-existing Substance Use Disorder in tratment. METHODSSearch strategy ("COVID-19" AND "Substance-Related Disorders"), ("COVID-19" AND "Substance Use Disorders"), ("COVID-19" AND "addiction"), ("COVID-19" AND "Chemical dependency"), ("COVID-19" AND "Alcoholism"); ("Coronavirus" A N D " S u b s t a n c e -R e l a t e d D i s o r d e r s " ) , ("Coronavirus" AND "Substance Use Disorders"), INPLASY

Substance use disorder is very prevalent in nursing home (NH) residents due to aging, the number of prescription drugs that are being used to manage their physical and psychological pain, and several discharges with the diagnosis of substance use disorder from hospitals to NH for aftercare support. However, many nursing homes are not equipped to provide adequate care for residents with a diagnosis of substance use. The staff is not well-trained to care for this type of population, which is becoming a challenge for the staff to manage residents in-house, leading to overdose, recurrent hospitalization, and unsuccessful discharges to communities due to relapses and an increase in the number of frequent flyers. Substance use disorder has become a significant public health concern in the United States, especially in the older population from the past couple of decades, which tends to increase. Discharging older adults with substance use disorders into nursing homes without ensuring established resources in the long-term care setting raises safety and quality concerns, emphasizing a pressing need for innovative preventive and management approaches for substance use disorders to meet unique needs of older adults in nursing homes. Purpose: The purpose of the study is to explore and identify the interventions, treatments and care models to effectively manage substance use disorders in older residents who are living in nursing homes. The study further focuses on the unique challenges that are faced by older adults and staff in nursing homes to understand the need for integrating addiction treatments in Long-term care settings to assess the need to enhance care strategies to improve resident outcomes, which includes handling overdose emergencies, prevention, rehabilitation and relapse management of substance use disorders (SUDs). Scope: Provides valuable insights for future researchers and points out the need for collaborative models among the rehabilitation, addiction centers, and LTC and the need for virtual health platforms to improve access to care, interdisciplinary approaches, and policy innovation on resident retention and optimum resource allocation to reduce the health care cost of frequent flyers or unnecessary hospitalizations, therefore, improve patient outcomes.

To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. Retrospective national cohort study of Veterans diagnosed with OUD (n=65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD+1 SUD) and with multiple SUDs (OUD+≥2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD+1 SUD and 35.9% had OUD+≥2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD+1 SUD [adjusted odds ratio (aOR)=0.87, 95% confidence interval (CI)=0.82-0.93] and patients with OUD+≥2SUDs (aOR=0.65, 95% CI=0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD+1 SUD (aOR=0.91, 95% CI=0.86-0.97)and for those with OUD+≥2SUDs (aOR=0.79, 95% CI=0.74-0.84). Patients with OUD+1 SUD (aOR=1.85, 95% CI=1.77-1.93) and patients with OUD+≥2SUDs (aOR=3.25, 95% CI=3.103.41) were much more likely to have a SUD clinic visit. The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.

Historically, recovery from substance use disorders (SUD) has focused exclusively on the use or non-use of the addictive substance(s). More recently, SAMSHA [1] has defined recovery in a more holistic way, using quality of life (QoL) as a measure of recovery for individuals with substance use and mental health disorders. However, little is known about the myriad experiences that inform and affect QoL for individuals with substance use disorders. Using an attachment informed stress-buffering framework, the purpose of this study was to examine the contribution of parental warmth and recovery support to QoL among women in substance abuse treatment. Linear regression and bootstrapping were used to examine direct and mediated effects of parental warmth and recovery support on QoL among 318 women recruited from three inner-city women-only addiction treatment programs. Relationships were assessed across three domains of quality of life: physical, psychological, and social. Parental warmth and recovery support were directly associated with psychological and social QoL, when controlling for the influence of trauma symptoms. Recovery support mediated the relationship between parental warmth and QoL across psychological and social QoL domains. Findings suggest that interventions that focus on attachment-related constructs to enhance recovery support may improve quality of life among women with SUD.