Prevalence of alcohol and drug use in a highly educated workforce.

This study examined alcohol and licit and illicit drug use in a highly educated medical related workforce.

A comprehensive health survey of a 10% random sample of a workforce (n = 8,567) yielded a 60% response rate (n = 504) after accounting for 15 undeliverable surveys.

• Many respondents reported past-year use of alcohol (87%).
• Thirteen percent of respondents consumed three or more drinks daily; 15% were binge drinkers.
• Twelve percent of the workforce was assessed as having a high likelihood of lifetime alcohol dependence;
• 5% of respondents met criteria for current problem drinking.
• Overall, 42% reported using mood-altering prescription drugs (analgesics, antidepressants, sedatives, or tranquilizers).
• Eleven percent reported using illicit drugs (cocaine, hallucinogens, heroin, or marijuana) in the past year.

Significant relationships were found between gender, age, ethnicity, and occupation with some measures of alcohol consumption and use of mood-altering drugs.

These results indicate prevention and early intervention programs need to address use of mood-altering substances (including alcohol) in highly educated workforces.

Research; J Behav Health Serv Res. ;29(1):30-44. Prevalence of alcohol and drug use in a highly educated workforce. Matano RA, Wanat SF, Westrup D, Koopman C, Whitsell SD.

See also;

• Brief-TSF is designed to address these issues.

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Help set the ghosts of alcoholism free

Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination.

PURPOSE: To determine knowledge of a national sample of medical students about substance withdrawal, screening and early intervention, medical and psychiatric complications of addiction, and treatment options.

METHODS: Based on learning objectives developed by medical faculty, twenty-two questions on addictions were included in the 1998 Canadian licensing examination.

RESULTS: The exam was written by 858 medical students. The average score on the addiction questions was 64%.

• Students showed strong knowledge of the clinical features of medical complications.

Specific knowledge gaps were identified for

• withdrawal treatment protocols,
• low-risk drinking guidelines,
• taking an alcohol history,
• substance-induced psychiatric disorders, and
• Alcoholics Anonymous.

CONCLUSION: Medical students are knowledge-deficient around key learning objectives in addictions. The deficiencies were in areas of basic knowledge that could be learnt with little difficulty.

Research report; Kahan M, Midmer D, Wilson L, Borsoi D. Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination. Subst Abus. 2006 Dec;27(4):1-7.

Brief-TSF includes training, as well as other matters, in taking an alcohol inventory and knowledge of Alcoholics Anonymous.

Stricter Sobriety Standards for California Health Professionals November 30, 2009

Nurses, doctors, dentists and other health professionals in California who are in treatment for alcohol and other drug problems will now be subject to stricter oversight and could be immediately removed from practice should they relapse, the Los Angeles Times reported.

Health workers will now be required to take more than 100 drug tests during their first year in treatment. One positive drug test result will be enough to have a health professional be temporarily suspended from practice.

All restrictions to licenses will be posted online for public access.

The new standards were created by the state legislature last year to address the way recovery programs for doctors were being handled. The Medical Board of California ended its diversion program in 2008 after several audits found that doctors were not monitored properly and those who relapsed were not being fired.

The new standards will apply to the seven boards that oversee diversion programs, which allow licensed health professionals with addiction problems to undergo drug tests and group therapy to address their illness.

Licensed health professionals who are on probation for abusing substances will also be subject to the new rules.

Critics of the new standards include Ellen Brickman, president of the National Organization of Alternative Programs, which advocates for treatment rather than punishment for impaired healthcare professionals. “I’m listening to this and I’m cringing,” said Brickman. “I’m not optimistic that this is going to work the way they want it to. It won’t keep people from abusing substances. It will keep them out of the system, where they’ll be sicker before anybody can do anything about it.”

Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings.

Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known.

This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies.

The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD

This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings.

It seems logical to assume similar results could be achieved in community treatment programs.

Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.

Reference: Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009;28(3):301–323.

From; Join Together Online

Query Patients About Past Drug Problems to Prevent Prescription Misuse, Docs Told

Diversion and misuse of prescription drugs is a growing problem, but one that physicians can help prevent by asking patients about their addiction history before prescribing drugs with high abuse potential, experts say.

AMANews reported March 17 that doctors who want to prescribe adequate medication to treat pain can take a number of precautions to avoid running afoul of law enforcement or unwittingly contributing to an addiction problem. “Because so many patient problems have fallen at the feet of primary care, we need to look at ways primary care can be part of the solution and not part of the problem,” said Michael M. Miller, M.D., president of the American Society of Addiction Medicine.

Miller advises doctors to start by asking about the patient’s past history with alcohol and other drug addiction as well as past problems controlling prescription medication use. Prescribing only as much medication as the patient will reasonably need also can prevent diversion or misuse, such as kids or others taking unused pills from a parent’s medicine cabinet.

“We hate to see somebody in pain run out of medicine, so sometimes we may be a little too generous,” said Kyle Kampman, M.D., medical director of the Charles O’Brien Center for Addiction Treatment at the University of Pennsylvania. “Patients tell me they worked as a maid at the height of their addiction and they would go through people’s medicine cabinets. I had a patient who was a roofer tell me, ‘If you ever let a roofer in your house and in the bathroom, chances are they are looking through your medicine cabinet.’”

Patients returning early to seek a refill of their prescription also should raise a red flag with physicians. “It’s a joke among addiction providers that sinks and toilets seem to be magnets for people’s medications,” said Kampman. “That’s an excuse you often hear: ‘I dumped my medicine down the sink or down the toilet.’ So that should ring alarm bells.”

If a problem is suspected, doctors should question patients directly, said Kampman. Some will admit an addiction problem and can be referred to treatment, while others may need stronger medications for their pain and should be referred to a pain specialist.

Doctors also should be careful to adhere to rules requiring them to conduct a physician exam before prescribing medication, and inform patients that sharing prescription drugs with others is illegal and that leftover medicine should be destroyed.

Finally, doctors can now check prescription-drug databases to find out if patients are “doctor shopping” — visiting multiple physicians for prescriptions to feed their addiction or illicit sales. “It takes about 30 seconds to check to see if patients are filling other prescriptions,” said family physician Terry Haffner, M.D., of Kokomo, Ind., where such a tracking system is now in place.  

From Join Together Online

Older Adults Often Exceed Alcohol Consumption Limits

Guidelines for “safe” alcohol use among older adults recommend daily limits no more than 2 drinks for men and 1 drink for women, weekly limits no more than 14 drinks for men and 7 drinks for women or a combination no more than 1 drink per day, 7 drinks per week, or 3 drinks per drinking session, regardless of sex.

The proportion of older adults who actually exceed each of these limits (i.e., engage in risky drinking) and experience associated alcohol-related problems is unknown.

To explore these issues, researchers surveyed 1291 non-abstinent, community-dwelling older adults at baseline and 10 years later.

The prevalence of risky drinking differed across guidelines, ranging from 23 percent to 50 percent among women and from 29 percent to 45 percent among men.

Both men and women who exceeded consumption limits were more likely to have alcohol-related problems (e.g., difficulties with relationships and functioning) both at study entry and follow-up. These problems were more prevalent in men.

In this community-based sample, risky drinking (defined by specific consumption levels) was prevalent among older adults, and guideline cut-offs were associated with alcohol-related problems.

Research Reference: Moos RH, Brennan PL, Schutte KK, et al. High-risk alcohol consumption and late-life alcohol use problems. Am J Public Health. 2004; 94(11):1985-1991. From Join Together

• See also;
• Elderly substance abuse

Self-reported mental illness in a dental school clinic population

The purpose of this study is to assess the prevalence of mental illness in a university-based dental clinic population. Dentists routinely review the patient’s medical history to identify any physical disease or condition that may impact dental treatment.

Mental illness may also affect dental treatment and patient management.

This study examined the degree to which patients seeking routine dental care report these diagnoses.

Data was gathered from records of 508 consecutive new patients whose treatment plans were submitted for faculty approval.

The patient’s self-reported mental illness was obtained from the patient questionnaire and physical evaluation forms of the dental record.

• One hundred thirty-six patients (27%) reported at least one mental illness.
• Of all diseases and disorders recorded in the medical history, self-reported depression was second only to hypertension in frequency.
• Substance abuse (alcoholism, addiction, medication), anxiety, anorexia, bulimia, insomnia, bipolar disorder, and post-traumatic stress disorder (PTSD) were also common findings.

This study establishes the need for training of dental students to recognize and manage psychologically compromised patients. The dental curriculum must address these issues.

J Dent Educ. 2003 May;67(5):500-4. Self-reported mental illness in a dental school clinic population. Woods CD.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation
• Subscribe to Twelve Step Facilitation by e-Mail

Relapse Prevention Counseling Workbook: Managing High-Risk Situations by Terence T. Gorski Read more about this title…