The prevalence of chemical dependency (excluding nicotine) among physicians has been estimated to be 10 percent to 15 percent, similar to that in the general population, according to background information in the article. Following completion of primary treatment, recovery is best achieved through continuing group therapy and regular attendance at mutual help groups. Data on the incidence of relapse and risk factors contributing to the likelihood of relapse after initial treatment for substance use are lacking.
Karen B. Domino, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to identify factors that might predispose individuals to relapse. The study included 292 health care professionals enrolled in the Washington Physicians Health Program, an independent post-treatment monitoring program. The participants were followed up between January 1, 1991, and December 31, 2001.
Twenty-five percent (74 of 292 individuals) had at least 1 relapse. The researchers found that a family history of a substance use disorder increased the risk of relapse (2.3 times greater risk). The use of a major opioid (e.g., fentanyl, sufentanil, morphine, meperidine) increased the risk of relapse significantly in the presence of a coexisting psychiatric disorder (5.8 times increased risk) but not in the absence of a coexisting psychiatric disorder. The presence of all 3 factors--major opioid use, dual diagnosis (presence of a coexisting psychiatric disorder), and family history--markedly increased the risk of relapse (13.3 times). The risk of subsequent relapses increased after the first relapse (1.7 times increased risk).
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