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Jullian B, Deltour M, Franchitto N. The consumption of psychoactive substances among French physicians: how do they perceive the creation of a dedicated healthcare system? Front Psychiatry 2023; 14:1249434. [PMID: 38156325 PMCID: PMC10752955 DOI: 10.3389/fpsyt.2023.1249434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Substance use among physicians can have negative impacts on their health, quality of life, and patient care. While Physician Health Programs (PHPs) have proven effective, many physicians with substance use disorders (SUDs) still face obstacles in seeking help. Our study explores the expectations, attitudes, and experiences of French physicians regarding the implementation of a specialized healthcare system (SHS) for addiction, and their opinions on the factors that could improve the effectiveness of such a service, with a focus on substance use disorders (SUDs). Methods We conducted a web-based survey from April 15 to July 15, 2021, which included questions about sociodemographic characteristics, substance use, and attitudes toward a specialized healthcare system (SHS) for physicians with SUDs. Results Of the 1,093 respondents (62.5% female), 921 consumed alcohol (84.2%), and 336 (36.4%) were categorized as hazardous drinkers (AUDIT-C ≥ 4 for women and ≥ 5 for men). The mean AUDIT-C score was 3.5 (±1.7 SD), with a range from 1 to 12. Factors associated with hazardous alcohol consumption included coffee consumption [OR 1.53 (1.11-2.12)], psychotropic drug use [OR 1.61 (1.14-2.26)], cannabis use [OR 2.96 (1.58-5.55)], and other drug use [OR 5.25 (1.92-14.35)]. On the other hand, having children was associated with non-hazardous alcohol consumption [OR 0.62 (0.46-0.83)]. Only 27 physicians (2.9%) had consulted a specialist in addiction medicine, while 520 (56.4%) expressed interest in such a consultation. The main barriers to accessing a dedicated consultation were denial (16.3%), physician self-medication (14.3%), fear of judgment (12.8%), and confidentiality concerns (10.2%). Conclusion A specialized consultation with trained professionals in a neutral location can improve access to care for healthcare workers and maintain patient confidentiality and anonymity. Prevention and awareness can reduce addiction stigma and help peers in need. The improvement of healthcare workers' addiction culture and detection of addictive behavior in peers depends on academic addiction medicine.
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Affiliation(s)
- Bénédicte Jullian
- Centre Hospitalier de Toulouse-Purpan, Service d’Addictologie Universitaire, Toulouse, France
| | - Marine Deltour
- Centre Hospitalier de Toulouse-Purpan, Service d’Addictologie Universitaire, Toulouse, France
| | - Nicolas Franchitto
- Centre Hospitalier de Toulouse-Purpan, Service d’Addictologie Universitaire, Toulouse, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
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Mark Anderson D, Diris R, Montizaan R, Rees DI. The effects of becoming a physician on prescription drug use and mental health treatment. JOURNAL OF HEALTH ECONOMICS 2023; 91:102774. [PMID: 37451143 DOI: 10.1016/j.jhealeco.2023.102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
There is evidence that physicians disproportionately suffer from substance use disorder and mental health problems. It is not clear, however, whether these phenomena are causal. We use data on Dutch medical school applicants to examine the effects of becoming a physician on prescription drug use and the receipt of treatment from a mental health facility. Leveraging variation from lottery outcomes that determine admission into medical schools, we find that becoming a physician increases the use of antidepressants, anxiolytics, opioids, and sedatives. Increases in the use of antidepressants, anxiolytics, and sedatives are larger among female physicians than among their male counterparts.
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Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics, Montana State University, NBER, United States; IZA - Institute of Labor Economics, Bonn, Germany.
| | - Ron Diris
- Department of Economics, Leiden University, the Netherlands; IZA - Institute of Labor Economics, Bonn, Germany
| | - Raymond Montizaan
- Research Centre for Education and the Labour Market, Maastricht University, the Netherlands; IZA - Institute of Labor Economics, Bonn, Germany
| | - Daniel I Rees
- Department of Economics, Universidad Carlos III de Madrid, Spain
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Ojonuba HS, Abdul Rahman H, Zaremohzzabieh Z, Mohd Zulkefli NA. The Effectiveness of an Empowerment Education Intervention for Substance Use Reduction among Inner-City Adolescents in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3731. [PMID: 36834427 PMCID: PMC9963347 DOI: 10.3390/ijerph20043731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Substance use among inner-city adolescents is at an alarming rate in Nigeria. Despite their high exposure to this risk, limited experimental tests have been conducted on prevention programs. (2) Methods: This study investigates the effectiveness of an empowerment education intervention in reducing the risk of substance use in Abuja's inner-city adolescents. Random selection placed adolescents into intervention and control conditions, and assessment was conducted at baseline, post-test, and 3-months follow-up intervention. After pre-test, the intervention group engaged in an empowerment education intervention of 11 sessions. (3) Results: In a post-test of three months, results show significant and positive changes among adolescents in substance use, including a notable reduction in positive attitudes toward drugs. In other words, the results showed adolescents reported less depression and substance use as well as higher peer support, parental support, social competence, and self-esteem at post-test and 3-month follow-ups as compared to the pre-intervention period. In addition, at both post-test and the 3-month follow-up, the intervention group performed better than the control group on peer support, parental support, social competence, and self-esteem. (4) Conclusions: This study presents a new indication that the empowerment education intervention effectively reduces substance use among Nigeria's inner-city adolescents.
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Affiliation(s)
| | - Haliza Abdul Rahman
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Institute for Social Science Studies, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Zeinab Zaremohzzabieh
- Institute for Social Science Studies, Universiti Putra Malaysia, Serdang 43400, Malaysia
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Geuijen P, Schellekens A, Schene A, Atsma F. Substance use disorder and alcohol consumption patterns among Dutch physicians: a nationwide register-based study. Addict Sci Clin Pract 2023; 18:4. [PMID: 36639645 PMCID: PMC9837897 DOI: 10.1186/s13722-022-00356-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Problematic substance use and Substance Use Disorders (SUD) are common in all layers of the population. Several studies suggest higher prevalence rates of problematic substance use among physicians compared to the general population, which is harmful for themselves and potentially impairs quality of care. However, nationwide comparison with a highly educated reference group is lacking. Using nationwide register data, this study compared the prevalence of clinical SUD diagnoses and alcohol consumption patterns between physicians and a highly educated reference population. METHODS A retrospective study was performed using registry data from 2011 up to and including 2019, provided by Statistics Netherlands. From the data, a highly educated reference group was selected and those with an active medical doctor registration were identified as "physicians". Clinical SUD diagnoses were identified by DSM-IV codes in mental healthcare registries. Benchmark analyses were performed, without statistical testing, to compare the prevalence of SUD diagnoses and alcohol consumption patterns between physicians and the reference population. RESULTS Clinical SUD diagnoses were found among 0.3% of the physicians and 0.5% of the reference population, with higher proportions of sedative use disorder among physician patients. Among drinkers, the prevalence rates of heavy and excessive drinking were respectively 4.0% and 4.3% for physicians and 7.7% and 6.4% for the reference population. CONCLUSION Prevalence rates of SUD diagnoses were fairly comparable between physicians and the highly educated reference population, but physicians displayed more favorable alcohol consumption patterns. The use of sedatives by physicians might deserve attention, given the relatively higher prevalence of sedative use disorder among physicians. Overall, we observed relatively low prevalence rates of SUD diagnoses and problematic alcohol use, which may reflect a treatment gap and social desirable answers.
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Affiliation(s)
- Pauline Geuijen
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Arnt Schellekens
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Aart Schene
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Femke Atsma
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Salani D, Goldin D, Valdes B, McKay M. The Impaired Nurse. Am J Nurs 2022; 122:32-40. [PMID: 36083031 DOI: 10.1097/01.naj.0000884568.95085.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Substance use disorders (SUDs) do not discriminate. Anyone can be affected regardless of age, sex, ethnicity, socioeconomic status, or profession. Nurses with SUDs present serious risks to both their patients and the nursing profession. Frontline nurses' responsibility to provide patients with safe, high-quality care may be too great a challenge for those with SUDs, resulting in adverse consequences. Early recognition and treatment of nurses with SUDs promotes patient safety and retention in the profession. For this reason, all nurses and other health care professionals should be able to recognize behaviors associated with SUDs and should be familiar with the available treatment modalities.
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Affiliation(s)
- Deborah Salani
- Deborah Salani is an associate professor of clinical in the University of Miami School of Nursing and Health Studies, Coral Gables, FL, where Beatriz Valdes is an associate professor of clinical and Mary McKay is a professor of clinical. Deana Goldin is a clinical associate professor at the Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami. Contact author: Deborah Salani, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Wong RXY, Farrell M, Degenhardt L, Memedovic S, Harvey SB, Petrie K. Substance use among vocational trainees in Australia: differences between medical specialties. Intern Med J 2022. [PMID: 35257451 DOI: 10.1111/imj.15729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/06/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There have been few large-scale nationally representative studies on the prevalence of substance use among doctors. Additionally, the association of different medical specialties with the use of different substances requires further research. AIMS This study aimed to investigate how the use of alcohol, tobacco and illicit drugs varied between junior doctors enrolled in different specialty training programmes. METHODS A secondary analysis was conducted on a national survey of 12,252 Australian doctors. The population of interest was junior doctors currently enrolled in a specialty training programme, termed Vocational Trainees (VTs) (n=1890, 15.4% overall sample). Self-report prevalence of current alcohol, tobacco and illicit drug use were assessed, and hazardous alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine the association between specialty and substance use, adjusting for demographic characteristics when required. RESULTS One in six VTs reported hazardous levels of alcohol use (n=268, 17.3%). After adjusting for confounders, the association between the prevalence of alcohol use and the specialties of emergency medicine/ICU (OR=2.15, 95% CI:1.40-3.32, p<0.001), anaesthetics (OR=2.53, 95% CI:1.35-4.76, p=0.004) and obstetrics/gynaecology (OR=1.89, 95% CI:1.19-3.02, p=0.007) remained significant. No significant associations were found between tobacco use/illicit drug use/hazardous alcohol use and medical specialty. CONCLUSIONS While rates of substance use and hazardous alcohol use in VTs are similar, if not lower, to the general population, it poses a concern that there are higher rates of alcohol use in certain medical specialties. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of Sydney, Sydney, Australia
| | - Sonja Memedovic
- National Drug and Alcohol Research Centre (NDARC), University of Sydney, Sydney, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Katherine Petrie
- Black Dog Institute, University of New South Wales, Randwick, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
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Geuijen PM, Pars E, Kuppens JM, Schene AH, de Haan HA, de Jong CAJ, Atsma F, Schellekens AFA. Barriers and Facilitators to Seek Help for Substance Use Disorder among Dutch Physicians: A Qualitative Study. Eur Addict Res 2022; 28:23-32. [PMID: 34192705 DOI: 10.1159/000517043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) among physicians affect their health, quality of life, but potentially also their quality of care. Despite the availability of effective specific Physician Health Programs (PHPs), physicians with SUD often experience barriers when seeking professional help. Therefore, we studied barriers and facilitators when seeking help for SUD among physicians from a multiple perspective approach. METHODS A qualitative design was adopted for 2 sub-studies. First, answers of 2 open-ended questions (about anticipated barriers and facilitators) of an existing questionnaire were analyzed. This questionnaire was filled out by 1,685 general physicians (response rate = 47%). The answers of these open-ended questions were coded inductively. Second, 21 semi-structured interviews (about experienced barriers and facilitators) were performed with physician SUD-patients, significant others, and PHP employees. Themes identified in the first sub-study were used to deductively code the interview transcripts. Results were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Barriers were found at the level of the individual physician (negative feelings and lack of disease awareness), whereas facilitators were found at the level of social relationships (confrontation with SUD and social support) and health services (supportive approach, good accessibility, and positive image of services). The interviews emphasized the importance of nonjudgmental confrontation by social relationships in the process of seeking help for SUD. CONCLUSION Physicians with SUD face barriers when seeking help for SUD mostly at the level of the individual physician. Health services and people around physicians with SUD could facilitate the help-seeking process by offering confidential and nonpunitive support. Future studies should explore whether the barriers and facilitators identified in this study also hold for other mental health issues.
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Affiliation(s)
- Pauline M Geuijen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Esther Pars
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Joanneke M Kuppens
- Physician Health Program ABS-Doctors, Royal Dutch Medical Association (RDMA), Utrecht, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein A de Haan
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Tactus Addiction Treatment, Deventer, The Netherlands
| | - Cornelis A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
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