Substance related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of the present study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring due to substance-related impairment, in order to develop better mechanisms of prevention and intervention.
A total of 55 physicians (94.5% male) who were being monitored by their State professional health program due to substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from nine separate focus groups, lasting 60–90 minutes each. Qualitative analyses were conducted to examine themes.
All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented five primary reasons for prescription drug misuse: 1) to manage physical pain, 2) to manage emotional/psychiatric distress, 3) to manage stressful situations, 4) for recreational purposes, and 5) to avoid withdrawal symptoms.
Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, though recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education occurring throughout the physicians’ careers.
prescription drug misuse; impaired physicians; addiction; physician health
The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision-makers as they seek to develop preventive. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program (PHP) were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs.
This article describes the goals and current practice of school-based random student drug testing (RSDT) as part of an overall drug prevention strategy, briefly explores the available literature evaluating its effectiveness, and discusses the controversies related to RSDT.
Authors describe the rationale for RSDT programs and the prevalence of RSDT and other drug testing programs in schools. Eight major criticisms and controversies in RSDT are discussed including those related to acceptance of RSDT, program effectiveness, costs, legality, and effects of drug testing on students. The limitations of the current literature are explored.
Although there is limited empirical evidence to support or refute the efficacy of RSDT in schools, there remains substantial opposition to such programs, which may contribute to the paucity of empirical studies of RSDT.
Rigorous long-term evaluations are needed to evaluate the effectiveness of various versions of RSDT programs to prevent drug use and identify students in need of assistance to become and stay drug-free.
prevention; drug tests; adolescents; school-based programs; students
The prevalence of substance abuse and other psychiatric disorders among physicians is not well-established. We determined differences in lifetime substance use, and abuse/dependence as well as other psychiatric disorders, comparing physicians undergoing monitoring with a general population that had sought treatment for substance use.
Participants were 99 physicians referred to a Physician's Health Program (PHP) due to suspected impairment, who were administered the Computerized Diagnostic Interview Schedule Version IV (CDIS-IV) to assess the presence of psychiatric disorders. Referred physicians were compared to an age, gender, and education status-matched comparison group from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave 1, in a 1:1 ratio.
While referred physicians did not differ from their counterparts on lifetime use of alcohol, opiates, or sedatives, they did have significantly higher conditional odds of meeting criteria for alcohol, opiate, and sedative DSM-IV abuse/dependence disorders. Physicians referred to the PHP had significantly lower odds of obsessive compulsive disorder, major depression, and specific phobia compared to their counterparts.
Physicians referred to a PHP have significantly higher odds of abuse/dependence disorders for cannabinoids, and cocaine/crack, compared to a matched general population sample that had ever sought treatment for substance use, even though physicians were less likely to report use of those substances. Although the rate of alcohol use was similar between the two populations, physicians had higher odds of abuse/dependence for opiates, sedatives, and alcohol. More research is needed to understand patterns of use, abuse/dependence and psychiatric morbidity among physicians.
Physician impairment; psychopathology; substance abuse; epidemiology; MDs; drug abuse
Young people represent the largest number of new HIV infections, thus youth living with HIV (YLH) are likely to be the largest group to initiate antiretroviral treatment (ART). Adherence patterns for behaviorally infected YLH are not adequate to effectively manage the disease; therefore, novel interventions are needed to improve medication adherence. The purpose of the current study, which will precede a randomized controlled trial, was to assess the initial feasibility of an individually tailored computer-based two-session interactive motivational interviewing (MI) intervention for YLH newly recommended to start ART. Intervention development occurred in collaboration with three youth advisory groups. Ten youth (ages 18–24) were recruited to participate in this study. Participants completed the intervention online. Intervention components focused on medication adherence (rating perceived importance and confidence, and goal setting). Retention was 100% for both intervention sessions. All participants (n = 10) felt medication adherence was important, but 80% felt confident they could manage their adherence to HIV medications. Ninety percent of participants set the goal of taking their HIV medications exactly as prescribed and reported success achieving this goal at follow-up. Additionally, participants were satisfied with the quality of the sessions and the amount of assistance they received for managing their adherence to HIV medications (90% participants for Session 1; 89% for Session 2). Per exit interview responses, participants felt that the intervention made them think more about their health and was a motivator for them to take better care of their health. In conclusion, the intervention was feasible for YLH enrolled in the study.
HIV; youth; motivational interviewing; medication adherence; computer intervention
This study aimed to develop and assess the psychometric properties of an English language measure of problematic mobile phone use. Participants were recruited from a university campus, health science center, and other public locations. The sample included 244 individuals (68.4% female) aged 18–75. Results supported a unidimensional factor structure for the 20-item self-report Problematic Use of Mobile Phones (PUMP) Scale. Internal consistency was excellent (α = 0.94). Strong correlations (r = .76, P < .001) were found between the PUMP Scale and an existing scale of cellular phone dependency that was validated in Asia, as well as items assessing frequency and intensity of mobile phone use. Results provide preliminary support for the use of the PUMP Scale to measure problematic use of mobile phones.
Substance misuse, abuse, and dependence are serious problems among a minority of pharmacists. Though various environmental risk factors have been implicated, few data are available describing the underlying mechanisms or the extent to which the environmental risk factors actually contribute to the problem. In the present study, 32 pharmacists (72.7% male), under contract with a State impaired healthcare provider monitoring program, were recruited to participate in one of 6 guided group discussions regarding substance use among healthcare providers. These groups included 4-6 pharmacists, on average, and lasted approximately 60-90 minutes each. Participants anonymously contributed to the group discussions, providing in-depth commentary and describing their substance-related experiences. The discussions were digitally audio-recorded and transcribed for analysis using the Grounded Theory method. Results indicated that several occupational hazards unique to the pharmacy profession might contribute to the problem of substance use disorders among some members of this population, including: increased access to potent drugs of abuse, a stressful/unpleasant working environment, a culture that unofficially condones medication diversion, lack of education related to addiction, and lack of support for individuals seeking treatment. These results have important implications for the education of pharmacy students, the continuing education of licensed pharmacists, and the management of pharmacies in which these individuals work.
Sexual addiction is estimated to afflict up to 3-6% of the population. However, many clinicians lack clear criteria for detecting potential cases.
The present studies were conducted to assess the effectiveness of a brief sexual addiction screening instrument (i.e., PATHOS Questionnaire) to correctly classify patients being treated for sex addiction and healthy volunteers.
In Study One, a six-item questionnaire which utilizes the mnemonic “PATHOS” was examined in regard to sensitivity and specificity using a sample combining patients being treated for sex addiction and healthy volunteers (970 men/80.2% patients; 938 women/63.8% patients). In Study Two, a cross-validation sample of 672 men (93%patients) and 241 women (35.3% patients) completed the PATHOS screener.
Results of ROC analyses in Study One demonstrated that the PATHOS captured 92.6% of the area under the curve, and achieved 88.3% sensitivity and 81.6% specificity for classifying the male sample (n = 963) as patients and healthy subjects using a cut-off score of 3. Similarly, the PATHOS captured 90.2% of the area under the curve and, with a cut-off of 3, achieved 80.9% sensitivity and 87.2% specificity for the female sample (n = 808). In Study Two, results of ROC analyses indicated that the PATHOS captured 85.1% of the area under the curve, with sensitivity of 70.7% and specificity of 86.9% for men (cut-off of 3). For women, the PATHOS captured 80.9% of the area under the curve and achieved 69.7% sensitivity and 85.1% specificity with the cut-off of 3.
These studies provide support for the use of the PATHOS as a screening instrument to detect potential sexual addiction cases in clinical settings.
Sexual Addiction; Sexual Compulsivity; Screening; Assessment; Psychometrics
Anesthesiologists with opioid use disorders are at high-risk for relapse. In 2005, the State of Florida impaired professionals monitoring program (PRN) implemented a policy whereby anesthesiologists referred for opiate use disorders were contractually obligated to take naltrexone for 2 years. Naltrexone ingestion was witnessed and verified via random urine drugs screens or administered via IM injection.
Charts were reviewed for the 11 anesthesiologists who underwent mandated pharmacotherapy with naltrexone, as well as 11 anesthesiologists who began monitoring immediately prior to implementation of this policy.
Eight out of 11 anesthesiologists who did not take naltrexone experienced a relapse on opiates. Only 1 out of 11 anesthesiologists experienced a relapse on opiates after taking naltrexone, while another relapsed on an inhalant (nitrous oxide). It is noteworthy that 5 of the 11 anesthesiologists who took naltrexone had relapsed prior to naltrexone treatment, and 7 of the 11 anesthesiologists who did not take naltrexone experienced multiple documented relapses. Only 1 of the 11 anesthesiologists who did not take naltrexone successfully returned to the practice of anesthesiology. This individual suffered primarily from alcohol dependence, and suspected opiate abuse was never verified. Others who attempted return to anesthesiology (n = 7) suffered a relapse. In comparison, 9 of the 11 anesthesiologists who took naltrexone have returned to the practice of anesthesiology without a relapse (as verified by continued random urine and hair testing).
Mandatory naltrexone treatment may provide anesthesiologists with an additional safeguard to successfully return to work.
Impaired physician; Naltrexone; Relapse; Anesthesiologists; Opioid Dependence
Internationally, sporting events represent a specific context in which heavy episodic drinking is common. The current study assessed determinants of heavy episodic drinking among tailgaters (i.e., individuals engaging in pre-game social festivities) prior to American football games at two large universities. A total of 466 individuals at two universities completed a short interview and provided a breathalyzer sample to estimate breath alcohol content (BrAC) during the tailgating window (150 minutes prior to and 10 minutes after the start of the game). The plurality of participants, 48.5% at the Southeastern University (School1) and 58.8% at the Midwestern University (School2), engaged in heavy episodic drinking. Only 54 individuals (11.6%) from the combined sample at both universities abstained from alcohol (confirmed via BrAC). In total, 40.2% of participants at School1 and 31.9% at School2 produced breath samples over the legal limit for driving (i.e., BrAC = 0.08 or higher). In site-specific regression analyses, younger ages, males, and non-students at School1, and younger ages and non-game attendance at School2 were associated with self-reported heavy episodic drinking and higher levels of estimated BrAC (p<0.05). Given the widespread participation in heavy episodic drinking among both students and non-students in this sample, public health interventions should be implemented both on- and off-campus to promote safety and to discourage heavy episodic drinking at American football games and other high-profile sporting events.
Tailgating; Heavy Episodic Drinking; College Football; Alcohol; Sporting Events
Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for substance use-related problems completed an anonymous online survey regarding their experiences in the program. Results indicated that 78.1% of program completers had a 5-year contract, with 100% including random drug screening. In addition, 84.8% continued participation in 12-step fellowships after the required monitoring period. Participants were generally satisfied with the program, and 92.5% indicated that they would recommend it to others. They provided suggestions to increase the acceptability and efficacy of PHPs for physicians.
Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and non-medical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students’ attitudes and experiences related to psychiatric medications, as well as correlates of psychiatric medication misuse (i.e., attitudes towards mental illness and beliefs about the efficacy of psychiatric medications).
Data were collected anonymously via self-report questionnaires from April 2008 to February 2009. Measures included the Michigan Alcohol Screening Test, Drug Abuse Screening Test, Day’s Mental Illness Stigma Scale, Attitudes Toward Psychiatric Medication Scale, and the Psychiatric Medication Attitudes Scale. Participants included 383 university students (59.2% female), recruited on campus or through online classes.
Results showed high rates of psychiatric medication misuse when compared to rates of medical use. Participants reported believing that the majority of students who use prescription psychotropics do so non-medically. In addition, less-stigmatized attitudes toward mental illness were correlated with both increased beliefs about the treatability of mental illness and increased misuse of psychiatric medications. Conversely, more stigmatized beliefs were associated with negative views toward psychiatric medication, as well as decreased likelihood of abuse.
Results suggest the need for improved education regarding the nature of mental illness, the appropriate use of psychiatric medications, and the potential consequences associated with abuse of these potent drugs.
Attitudes; Students; Psychiatric medication; Drug abuse; Mental illness stigma
Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. This paper presents a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6–17 who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation sessions. Results indicated that after 4 sessions, the mean CY-BOCS score for the CBT+MI group was significantly lower than for the CBT+psychoeducation group (t(14) = 2.51, p < .03, Cohen’s d = 1.34). In addition, the degree of reduction in CY-BOCS scores was significantly greater (t(14) = 2.14, p = .05, Cohen’s d = 1.02) for the CBT+MI group (mean change = 16.75, SD = 9.66) than for the CBT+psychoeducation group (mean change = 8.13, SD = 6.01). This effect decreased over time, and scores at post-treatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.
Children; Anxiety; Treatment outcome; Psychotherapy
Binge drinking has been tied to specific occasions, such as certain holidays and sporting events. However, previous research has relied almost exclusively upon self-reports of university students to document these associations. In order to address this limitation, the present study examined patterns of alcohol-related offenses occurring within the context of holidays and collegiate football games. Public arrest records from a university town with a successful NCAA Division I football program were examined for 30 days: 10 holidays, 10 college football “home game” days, and 10 control days. In total, 944 arrests were associated with the 30 study days. Results indicated football game days were associated with the highest number of arrests (F= 24.76, 2/27 df, p < .001). Specifically, on average there were 70.3 (SD = 35.4) arrests on each football game day, compared to 12.3 (SD = 8.8) arrests on non-game “control Saturdays,” and 11.8 (SD = 6.3) arrests on holidays. Offenses committed on game days generally occurred closer to the football stadium than crimes committed on holidays or control days (F = 165.05, 2/941 df, p < .001). Though efforts have been made to combat excessive drinking on holidays, more effort is needed to address the significant binge drinking among students and other spectators that is associated with high profile collegiate sporting events.
Alcohol; Substance abuse; Crime prevention; Sporting events; Binge drinking
Current methods of selecting future residents for anesthesiology training programs do not adequately distinguish those who will succeed from the pool of seemingly well-qualified applicants. Some residents, despite high exam scores, may struggle in the OR in stressful situations.
This study examined whether specific neuropsychological and personality measures can distinguish high competency residents from low competency residents to aid in resident selection.
25 residents enrolled in an anesthesiology program at a major academic institution were identified for participation. 13 were evaluated identified as “high competency” residents and 12 as “low competency ” by the department's clinical competency committee. Groups were evaluated on measures of fine motor dexterity, executive functioning, processing speed, attention, and personality using IPIP-NEO.
There were no significant differences between groups on measures of fine-motor dexterity, executive functioning, processing speed, or attention. High competency residents scored significantly higher than low competency residents on measures of cooperation, self-efficacy, and adventurousness, and lower on measures of neuroticism, anxiety, anger, and vulnerability.
Although measures of fine-motor dexterity, executive functioning, processing speed, and attention do not appear to distinguish between high- and low competency residents in anesthesiology, specific personality characteristics may be associated with future success in an anesthesiology training program.
Management of type 1 diabetes (T1D) involves balancing several components including diet, exercise, and medication. Peer involvement in management tasks is an important, but understudied, issue in T1D. This study presents results of a preliminary examination of perceptions of disease management in youth with T1D and their peers. Data were collected using a mixed methods (qualitative and quantitative data) approach during medical education time at a camp for youth with T1D and their peers. Results suggest that both youth with T1D and their peers believe that peers need more information about medical consequences of having diabetes. Further, youth with T1D and their peers would like coaching on how peers may help the child with T1D manage their illness better. Results provide preliminary ideas for intervention (i.e., including peers, assessing social support) in the medical setting as well as ideas for future research (i.e., examining relationships among perceptions and gender, time since diagnosis).
Type 1 Diabetes; Adolescents; Peers
This pilot study assessed the quality of life and psychosocial functioning of pediatric patients with Barth Syndrome. Thirty-four boys with Barth Syndrome and 22 healthy male controls were administered a measure of verbal ability and completed measures of quality of life, loneliness, perceived peer support, and sibling relationship quality. Parents completed measures of parental distress, parenting stress, child academic functioning, child adaptive behavior, and child emotional and behavioral functioning. Quality of life ratings were consistently lower in youth with Barth Syndrome relative to both healthy controls and a previously reported sample of youth with cardiac disease. Compared to healthy controls, children with Barth Syndrome were rated as having more internalizing and externalizing symptoms, social problems, loneliness, and lower independent functioning. Parents of boys with Barth Syndrome reported greater distress and parenting stress relative to healthy controls. In addition, parents reported a significant need for academic accommodations, given their son’s illness and associated impairments. Boys with Barth Syndrome and their parents appear to be affected by the presence of the illness in numerous ways. Results suggest the need for interventions aimed at helping children and families cope with illness-related stressors to enhance quality of life and overall functioning.
Barth Syndrome; Children; Chronic Illness; Quality of life; Psychosocial functioning
The use of methamphetamine (METH) is a growing public health problem because its abuse is associated with long-term biochemical and structural effects on the human brain. Neurodegeneration is often observed in humans as a result of mechanical injuries (e.g. traumatic brain injury, TBI) and ischemic damage (strokes). In this review, we discuss recent findings documenting the fact that the psychostimulant drug, METH, can cause neuronal damage in several brain regions. The accumulated evidence from our laboratories and those of other investigators indicates that acute administration of METH leads to activation of calpain and caspase proteolytic systems. These systems are also involved in causing neuronal damage secondary to traumatic and ischemic brain injuries. Protease activation is accompanied by proteolysis of endogenous neuronal structural proteins (αII-spectrin and MAP-tau protein) evidenced by the appearance of their breakdown products after these injuries. When taken together, these observations suggest that METH exposure, like TBI, can cause substantial damage to the brain by causing both apoptotic and necrotic cell death in the brains of METH addicts who use large doses of the drug during their lifetimes. Finally, because METH abuse is accompanied by functional and structural changes in the brain similar to those in TBI, METH addicts might experience greater benefit if their treatment involved greater emphasis on rehabilitation in conjunction with the use of potential neuroprotective pharmacological agents such as calpain and caspase inhibitors similar to those used in TBI.
neurotoxicity; methamphetamine; psychoproteomics; proteolysis; calpain; caspase; αII-spectrin; neuroproteomics; brain injury
Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitive-behavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to examine whether the amount of family accommodation provided to pediatric OCD patients is associated with treatment outcome, and whether decreases in accommodation are associated with improved outcome. The sample consisted of 50 youth (aged 6-18 years) who participated in 14 sessions of family-based cognitive-behavioral therapy for OCD, and their parents. Participants completed measures at pre-treatment and post-treatment. Results indicated that family accommodation was prevalent among families of pediatric OCD patients and that such accommodation was associated with symptom severity at pre-treatment. In addition, decreases in family accommodation during treatment predicted treatment outcome, even when controlling for pre-treatment OCD severity/impairment. Results suggest that the level of accommodation provided by the family may indicate an important obstacle to, or predictor of, treatment outcome in pediatric OCD. Directions for future research are discussed.
Family Accommodation; Children; Treatment Predictors; Obsessive-compulsive disorder; Cognitive-Behavioral Therapy
The goals of the present study were to explore the possibility that symptoms of food addiction may exist for some children and to identify factors that may be associated with pediatric food addiction.
Participants were 50 children (aged 8-19), recruited from the Pediatric Lipid Clinic at a large southeastern teaching hospital, and their parent/guardian. Participants completed questionnaires to assess food- and eating-related attitudes and behaviors, as well as symptoms of food addiction.
Parent- and child-reported behaviors and attitudes demonstrated similar patterns. Child BMI ratings were significantly correlated with overeating (r = .42, p = .02) and emotional eating (r = .33, p = .04). Of note, 15.2% of children indicated that they “Often,” “Usually,” or “Always” think that they are addicted to food, and an additional 17.4% reported that they “Sometimes” feel that way. Food addiction symptoms were significantly correlated with child overeating (r = .64, p < .001), uncontrolled eating (r = .60, p < .001), emotionol eating (r = .62, p < .001), food preoccupation (r = .58, p < .001), overconcern with body size (r = .54, p < .001), and caloric awareness and control (r = −.31, p = .04).
Results of the present study suggest that “food addiction” may be a real problem for a subset of children who suffer from overweight/obesity. Identification of food addiction may improve obesity treatment efforts for this subset of patients.
Food addiction; Obesity; Children; Adolescents