Robert DuPont, MD
Physicians’ Health Programs, which combine addiction treatment with long-term monitoring and support, should be used as a model for the nation’s addiction treatment programs, said Dr. Robert L. DuPont of the Institute for Behavior and Health during a recent presentation at Positive Sobriety Institute. These comprehensive approaches to Substance Use Disorder Treatment highlight the importance of integrating continuous care and support for effective recovery outcomes.
Physicians’ Health Programs
A highly-cited study from 2009 that included 904 physicians struggling with alcohol or drug addiction found that those who participated in Physicians’ Health Programs showed remarkable success in achieving long-term sobriety. Physicians’ Health Programs are state-based programs for physicians with substance abuse or mental health issues.
Over a five-year period, 78 percent of physicians had no positive tests for drugs or alcohol, 14 percent had one and only 8 percent had two or more positive tests. Three in four – 72 percent – were able to continuing practicing medicine.
What accounted for their success? Some would argue that physicians are highly motivated, unique individuals. But that doesn’t fully explain it, Dr. DuPont said.
As part of the program, physicians had to undergo frequent drug and alcohol tests, and participate in 12-step meetings. Those found to be using were subject to swift consequences, including the suspension or loss of their medical license.
Other addiction treatment programs with groups ranging from pilots to felons that have used similar strategies of frequent testing, ongoing support and rapid consequences for relapse have also shown high rates of success in helping participants achieve long-term sobriety.
One groundbreaking program known as HOPE (Hawaii’s Opportunity Probation with Enforcement) included felons with an average of seven prior arrests, who were high school drop outs, mostly unemployed and typically methamphetamine users. As a condition of probation, participants had to undergo frequent drug testing. Those who didn’t show up, or who failed, were sent to jail immediately.
A randomized controlled trial found that those participating in HOPE were 55 percent less likely to be arrested for a new crime within one year, and 72 percent less likely to have a positive drug test.
Like the physicians, they faced immediate consequences, Dr. DuPont said. “That approach changes the behavior of the physicians, as well as the convicts,” he said.
Instead of seeing physicians as unique, Physicians’ Health Programs should be used a model for addiction treatment for all, with five years of sobriety the measure of success by which addiction treatment programs are judged.
“The result of my nearly 50 years in this field, of caring about addicted people… is that this model that is pioneered for more than 40 years in the Physicians’ Health Program movement sets the standard, and from that everybody can learn about what they need to do to make treatment better,” said Dr. DuPont, former Director of the National Institute on Drug Abuse and a clinical professor of psychiatry at Georgetown University School of Medicine.
“All drug treatment should be evaluated on the treatment’s ability to produce stable, five-year recovery,” he added.
Yet addiction treatment, and insurance coverage, has a long way to go before that standard is adopted. Despite the evidence that long-term care, follow-up and monitoring is effective, most treatment programs last from one to three months at most. “It is very odd that addiction is a lifetime disease. It is not something you get like a cold and it’s gone,” Dr. DuPont said. “Yet the treatments are all short-term. That doesn’t add up.”
The Physicians Health Programs study was published in the Journal of Substance Abuse Treatment. Dr. DuPont was lead author. Mark Gold, MD, chairman of RiverMend Health’s Scientific Advisory Boards, was senior author.
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Read the full transcript of Dr. DuPont’s presentation
