DoctorFinder | Join/Renew | MyAMA | Site Map | Contact Us

Substance abuse among physicians

Note: This report represents information and AMA policy on this subject as of June 1995.

Full text

Resolution 401, adopted, at the 1994 Annual Meeting, called for a report on substance abuse and dependency among physicians. This report addresses those and related issues and provides an update of the Council on Mental Health's 1972 report on  The Sick Physician,1  which is often credited as being responsible for the rapid spread of physician health programs sponsored by state medical societies.

Existing American Medical Association (AMA) policy clearly recognizes that physicians may develop substance abuse problems. Moreover, AMA policy is clear on the ethical responsibilities of physicians who are aware of colleagues with such problems. Policy 275.952 (AMA Policy Compendium) states "Physicians have an ethical obligation to report impaired, incompetent, and unethical colleagues. Physicians should be familiar with the reporting requirements of their own state and comply accordingly."

While acknowledging that physicians are subject to this illness, the AMA is clearly supportive of efforts to prevent substance abuse and to treat physicians who have become impaired by substance abuse in order to facilitate their return to practice. Policy 275.964, for example, encourages state medical societies to maintain effective physician health programs, and Policy 235.977 encourages hospital medical staffs to address issues of physician health in the medical staff by-laws. Other policies advocate educational efforts to ensure that physicians are knowledgeable about substance abuse problems (e.g., Policies 295.979 and 295.987). 

More recent policies express concern over discrimination against physicians with a history of substance abuse. (See for example, Policies 180.969 and 275.949.) Board of Trustees Report 18-(I-93) examined issues of discrimination against physicians with a history of substance abuse by health care plans and developed policy in this area (Policy 285.985), and the AMA Patient Protection Act's call for third party payors to disclose selection criteria is based on this report.


Data on substance abuse among physicians

Beliefs and reports that physicians are more likely than members of other occupational groups to develop problems with alcohol and other drugs are common. This idea appeared early in the medical literature  2 and persists today, often in the absence of good or reliable data. In the 1960s, physicians were reported to be 30 to 100 times more likely than the general population to become dependent on narcotic drugs.3  Despite the lack of evidence supporting this figure, it continues to appear, even in relatively contemporary writing. (See, for example, Domenighetti et al.4) In contrast to these extreme statements, there was growing recognition throughout the 1980s that the prevalence of problems with alcohol or other drugs among physicians was not really known and that more data were needed.5,6,7 Most studies up to that time had been of small samples or clinical populations, which, while informative in many ways, do not give estimates of the prevalence of drug use or drug-related problems in the population. More recent data have been based on surveys, which though not without difficulties (eg, nonresponse bias), provide a more reliable basis for making projections.

Table: Rates of substance abuse among physcians

U.S. prevalence studies: It is routinely reported that one in ten physicians is likely to become dependent on drugs or alcohol in the course of his or her career,8 though the data underlying this assertion are unknown. Since the mid 1980's there have been two major surveys of drug use among U.S. physicians. McAuliffe and colleagues9 surveyed 500 practicing New England physicians (response rate of 70%) and found overall levels of use of drugs were comparable to the general population. While substantial minorities of physicians had used drugs recreationally or had self-treated, most such use was experimental or occasional. In the study, 3.3% of physicians reported having been drug dependent, and 1.5% had obtained professional help for drug dependence. Using multiple criteria, the McAuliffe research determined that 4.2% of physicians were ever "at risk of abusing drugs at some time."9(p807) In a later report on the alcohol use data from the same survey, 2% of physicians were reported to have a current drinking problem, and 3% had ever received treatment for alcohol-related problems.10 There was no discussion of whether there was overlap between those receiving treatment for alcohol problems and those reported earlier to have been treated for drug dependence. The authors concluded that "Physicians were no more likely to abuse substances nonmedically than were other professionals," but, in discussing alcohol, "any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored."10 (p177)

More recently, Hughes and colleagues surveyed a nationwide sample of 9600 U.S. physicians, with a response rate of 59 percent.11 They found that physicians were less likely to use tobacco and illicit substances than were members of the general population, but they were more likely to use alcohol and to self-treat with prescription medications (minor opiates such as codeine and benzodiazepine-like tranquilizers). In the Hughes et al study, 9.3 percent of physicians reported having had 5 or more drinks on at least one day in the past month, and 0.6 percent had had five or more drinks on 20 or more days in the past month. Respondents were asked whether they had "ever abused or been dependent on" alcohol or other drugs. Combining alcohol and other drugs, 7.9 percent answered this question positively. (In surveys of the general population, using data collected from diagnostic surveys rather than self reports, the lifetime risk of any substance use disorder is estimated to range from 13 percent to 26 percent.12,13,14) In total, 4.9 percent of the respondents had ever received treatment for problems with alcohol or other drugs.

Lutsky and colleagues surveyed 824 physicians who had been trained at the Medical College of Wisconsin, obtaining an overall response rate of 57.8 percent.15 These authors defined "impairment" as meeting any one of a number of criteria such as having received treatment, answering yes to two or more CAGE (a four-item alcoholism screen; see  Appendix) questions, or acknowledgement that drug use had affected professional functioning. Respondents were divided into medical specialists, surgeons, and anesthesiologists. Overall, from 14.4 percent to 19.9 percent of these groups met the definition of impairment. These authors do not report the numbers meeting the individual criteria for impairment, and the data showing drug use are reported separately for impaired and non-impaired groups. In addition, the reported drug use data are apparently for any lifetime use only.

Among other US studies, the longitudinal Johns Hopkins Precursors Study reported that, among their 1014 male physicians, the prevalence of alcohol abuse (multiply defined) on any of their follow-up questionnaires was 12.9 percent.16 The staff of a California teaching hospital were surveyed using the SMAST (the 13-item Short Michigan Alcoholism Screening Test; see Appendix) by Siegel and Fitzgerald.17 While 569 questionnaires were sent, a response rate of less than 50 percent was obtained, but they report that 4 percent of respondents were classified as alcoholic, and 10 percent were classified as possibly alcoholic.

Canadian studies: Brewster recently undertook a study of drug use patterns among Canadian physicians, pharmacists, and lawyers, surveying 1500 members of each profession, with corrected response rates of at least 75 percent from each.18,19   The study found that physicians and pharmacists used tobacco and alcohol less frequently than did lawyers, but that prescription and non-prescription drugs such as codeine (available without prescription in Canada) and benzodiazepine-type tranquilizers were used more frequently by the members of the two health professions. Heavy drinking (defined as an average of more than four drinks per occasion, or more than 60 drinks per month), was reported by 6 percent of physicians, the lowest level of the three professions. Current regular (more than once per month) use of benzodiazepines was reported by 7.5 percent of physicians, 7.2 percent of pharmacists, and 3.4 percent of lawyers. The reported level of use of illicit drugs was very low. This study is unique among large-scale surveys of drug use patterns of physicians in including other professions which do and do not have access to drugs in their work.

A major conclusion of this study was that, in estimating overall levels of drug use and drug-related problems in a population, alcohol and other drugs should be considered together because the pattern of use, and choice of specific drugs, may differ among groups. When all drugs (excluding tobacco & caffeine) were considered together in this study, the overall level of use of any drug did not differ among the three Canadian professions studied. With respect to treatment, 1.8 percent of physicians reported ever having received professional treatment for problems with alcohol or other drugs, and 2% of responding physicians had attended Alcoholics Anonymous (AA), other than as a guest or speaker. There was undoubtedly some overlap between this group and those receiving professional treatment.18

A recent survey of Quebec physicians (response rate of 51.3 percent from a sample of 2974) found that 2.6 percent of respondents reported having been dependent on alcohol, and 14.4 percent had used benzodiazepines without a prescription more than five times in their lives.20 This latter behavior may not necessarily be associated with drug-related problems. Indeed, compared with a group of university-educated women, female physicians were less likely to use alcohol. In a 1983 survey of Ontario physicians, Brewster7 found that 1.3 percent had received treatment for problems with alcohol or other drugs, a figure comparable to that in the Ontario population at that time.21

Other countries: In Switzerland, Domenighetti and colleagues found that Swiss physicians were more likely to use sleeping pills and tranquilizers than were the general population (sample size of 621 and a response rate of 77 percent ).4 Of physicians, 4.1 percent used these drugs at least once a week, compared to 1.1 percent of the general population. This study did not examine the pattern of use of any drugs other than these sedatives. Juntunen and colleagues surveyed 3496 Finnish physicians (response rate of 76 percent ) with respect to their consumption of alcohol and calculated that 19 percent of male general practitioners and 25 percent of male specialists consumed more than 200 grams of absolute alcohol per week.22 On the Index of Drinking Habits, a measure of alcohol-related problems, 31 percent of male general practitioners and 24 percent of male specialists achieved a score greater than or equal to six, which indicates heavy drinking. These findings represent a higher level of alcohol consumption than in the Finnish population.

Residents and students: Limited data on students and residents are also available. The most recent work in this area is from Hughes and his colleagues23,24 who collected self-report survey data. Among resident physicians, the use of psychoactive substances was generally lower than it was among similar age groups in the general population, although like their older colleagues, the use of benzodiazepines was greater, with self-treatment generally being cited as the reason for such use.23 A study of former anesthesiology residents has reported lower lifetime use of marijuana and cocaine among this group than among other groups of residents, suggesting possible self-selection for drug use and specialty, but in all cases, the use of these drugs was lower among residents than among similarly aged groups in the general population.25

The picture among medical students is less clear. In a survey of 2046 (with a 67 percent response rate) senior students at 23 medical schools, lower rates of substance use were reported for most drugs as compared with comparable age groups in the general population.24 However, for some drugs, namely alcohol, tranquilizers and psychedelics other than LSD, the usage rates were somewhat higher among the students. The data further indicate that, except for the use of tranquilizers, the use of which did increase after entry into medical school, patterns of drug use are generally established prior to beginning medical education. In a study of alcohol use among one class at one midwestern medical school, Clark26 reported that alcohol use by students tended to decline over the students' careers in school but that as many as 18 percent were alcohol abusers (using research diagnostic criteria) during the first two years of medical education.


Characteristics related to the use of alcohol and other drugs

Like the issue of substance use and abuse among physicians, much has been made of supposed patterns of use within the profession. But again, the pronouncements and subjects overstate the available data. For this review, only specialty and gender are considered.

Specialty: Among physicians in treatment for problems with alcohol and other drugs, anesthesiologists, psychiatrists, and family practitioners have been reported to be over-represented.27,28,29,30 However, the pattern of specialty representation differs widely among reports of treatment programs, and there are many that do not report over-representation of particular specialties. Also, because of the differences among treatment programs in their attractiveness to, or recruitment of, particular specialties, these data cannot be taken to indicate differences among specialties in the prevalence of problems with alcohol and other drugs. In their recent survey of Medical College of Wisconsin graduates, Lutsky and colleagues found no difference among anesthesiologists, medical specialists, and surgeons in the numbers who met their criteria for impairment.15 The study of Swiss physicians found that psychiatrists were more likely to use sleeping pills and tranquilizers than were other specialists; 10.6% of their respondent psychiatrists reported daily use of sleeping pills or tranquilizers.4 Psychiatrists were also most likely to report all types of drug use, and current self-treatment in McAuliffe's survey of drug use among New England physicians.9 Surveys of drug use patterns among resident physicians have reported higher levels of use of some drugs in some specialties psychiatry, anesthesia, surgery, and emergency medicine.31,32,33 However, in these studies the numbers of respondents in some individual specialties were small, so patterns across specialties cannot be reliably measured.

In the Survey of Drug Use Patterns by Canadian Professionals, the drug use patterns of anesthesiologists and psychiatrists were examined separately from those of other specialists and primary care physicians.18 Psychiatrists were most likely to be daily smokers, frequent (more than 20 days per month) users of alcohol, and regular (more than once per month) users of benzodiazepines. Primary care physicians were least likely to be daily smokers, frequent users of alcohol and to have ever used sedative-hypnotics.

Gender: Among physicians in treatment for problems with alcohol and other drugs, women are usually under-represented relative to their numbers among practicing physicians.34,35 This is consistent with general population data, where women are also under-represented in treatment programs.36 In describing a group of physicians in treatment in the United Kingdom, Brooke and colleagues report that, although women are under-represented in their sample, the numbers are consistent with the numbers of women in the population experiencing problems with alcohol and other drugs.27 These studies are subject to the same caveats as the specialty data from treatment programs discussed above and cannot be taken to indicate the prevalence of drug-related problems among women physicians.

None of the U.S. surveys of prevalence of drug use among physicians have reported gender comparisons. Preliminary analyses of the Canadian Survey of Drug Use among Professionals suggest that female physicians are less likely than their male colleagues to be current tobacco smokers and frequent users of alcohol (use on 20 days per month or more).18 On the other hand, women physicians were more likely than men to be occasional (less than once per month) users of analgesics and to have used codeine in the past year. The Quebec survey reported that women were less likely to report alcohol dependence (1.2 percent) than were men (4.6 percent). 20 Women physicians were also less likely (12.1 percent) than were men (17.6 percent) to have used benzodiazepine-type tranquilizers more than five times in their lives without a prescription. Female physicians were more likely to be abstinent from alcohol, or to be regular drinkers, than were other university educated women in Quebec, who were more likely to be occasional drinkers. Juntunen and colleagues found that women physicians consumed much less alcohol than did their male colleagues.22 With the growing numbers of women in medicine, one research priority should be study of the use of alcohol and other drugs, and other health issues, among women physicians.


Other impairments

Data on other conditions that lead to impairment among physicians are even less common than are data on substance use and abuse. While it is commonly agreed that substance abuse problems are the most common impairing condition handled by physician assistance committees, other problems do present to these programs. For example, the Medical Society of New Jersey's program widely regarded as one of the premier programs in the nation reports that about one-fifth of its cases deal with a psychiatric impairment (other than alcohol or dementia).37 Data collected in 1986 as part of the American Medical Association's Socioeconomic Monitoring System revealed that 2.6 percent of responding physicians reported having some physical condition that limited their ability to practice. About 3 percent of the nation's population have disabilities performing daily activities.38

Treatment issues

On the whole, data suggest that physicians who are treated for abusing alcohol or other drugs do quite well, with success rates of 70 percent or more,28,37 and some data indicate better recovery for physicians than the general population.39 As a rule, state programs develop treatment programs with their clients, which lay out the terms of treatment and monitoring as well as indicate the consequences for failure to comply. Although inpatient treatment seems to be the preferred mode for treating chemical dependency among physicians, there is in fact no empirical evidence to suggest that impatient treatment is better than alternatives.

Anecdotally, it seems that options for physicians with impairments due to other illness or conditions are much more constrained. Calls to the AMA's Physician Health Program on these issues are not uncommon. In addition, support for recovering physicians is lacking; one state program director has noted the discrimination and lack of empathy for physicians who have been diagnosed with a mental illness (other than substance abuse), particularly for those who have suffered from bipolar disorder.

Conclusion

The surveys of patterns of drug use among physicians that have been conducted in the last decade generally indicate that, overall, physicians are not more likely than other members of the population to use alcohol and other drugs or to require treatment for problems associated with such use. While there may be some indication that physicians are more likely to use some of the prescription drugs, particularly for the purposes of self-treatment, this may be balanced by reduced overall levels of use of alcohol or some other drugs. When all drugs are considered together, physicians' overall prevalence of use is not outstanding. Also, the suggestive findings of increased levels of use of prescription drugs, and reduced levels of alcohol use, are relative to other groups. It is clear that, among physicians as well as among other members of society, alcohol is by far the most popular drug and is the drug that is most frequently associated with problems.

The finding that physicians may not be more likely than other members of the population to experience problems with alcohol and other drugs does not mean that the profession should not address this issue. All US states and Canadian provinces now have programs to help physicians who develop problems, and the profession is developing an increasing interest in the prevention of drug use and associated problems. Future research should be aimed at collecting information that would support the development of prevention programs. While some research has been conducted on personal risk factors, attention might be more profitably turned to research on structural risk factors: the ways that medicine and medical education are organized. Issues that might be explored are undergraduate medical education and postgraduate training, the role of the increasing numbers of women physicians, the effect of changes in the health care delivery system to more community-based and preventive models, and the resulting changes in physician practice situations. Similarly, additional information should be sought on the range of impairing conditions that affect physicians.

Recommendations

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1995 Annual AMA meeting. 

  1. The AMA defines physician impairment as any physical, mental, or behavioral disorder that interferes with ability to engage safely in professional activities and will address all such conditions in its Physician Health Program. 
  2. The AMA encourages state medical society-sponsored physician health and assistance programs to take appropriate steps to address the entire range of impairment problems that affect physicians, to develop case finding mechanisms for all types of physician impairments, and to collect data on the prevalence of conditions affecting physician health. 
  3. The AMA encourages additional research in the area of physician impairment, particularly in the type and impact of external factors adversely affecting physicians, including workplace stress, litigation issues, and restructuring of the health care delivery systems.

References

  1. AMA Council on Mental Health. The sick physician: Impairment by psychiatric disorders, including alcoholism and drug dependence.  JAMA 1973;223:684-687. 
  2.  Mattison JB. Morphinism in medical men.  JAMA 1894;23:186-188. 
  3. Modlin HC, Montes A. Narcotic addiction in physicians.  Am J Psychiatry 1964;121:358-363. 
  4. Domenighetti G, Tomamichel M, Gutzwiller F, Berthoud S, Casabianca A. Psychoactive drug use among medical doctors is higher than in the general population.  Soc Sci Med 1991;33:269-274. 
  5. Talbott GD. Impaired physicians: The dilemma of identification.  Postgraduate Med 1980;68(6):56-64. 
  6. Bissell L, Haberman PW.  Alcoholism in the Professions. New York: Oxford University Press; 1984. 
  7. Brewster JM. Prevalence of alcohol and other drug problems among physicians.  JAMA 1986;255:1913-1920. 
  8. Webster TG. Problems of drug addiction and alcoholism among physicians. Pp 27-38 in Scheiber SC, Doyle BB (Eds)  The Impaired Physician. New York: Plenum; 1983. 
  9. McAuliffe WE, Rohman M, Santangelo S, Feldman B, Magnuson E, Sobol A, Weissman J. Psychoactive drug use among practicing physicians and medical students.  New England Journal of Medicine 1986;315:805-810. 
  10. McAuliffe WE, Rohman M, Breer P, Wyshak G, Santangelo S, Magnuson E. Alcohol use and abuse in random samples of physicians and medical students.  Am J Public Health 1991;81:177-182. 
  11. Hughes PH, Brandenburg N, Baldwin D, Storr CL, Williams KM, Anthony JC, Sheehan DV. Prevalence of substance use among US physicians.  JAMA 1992;267:2333-2339. 
  12. Helzer JE, Burnam A, McEvoy LT. Alcohol abuse and dependence. In: Robins Ln, Regier DA, eds.  Psychiatric Disorders in America. New York: The Free Press; 1991: chap 5. 
  13. Bourdon KH, Rae DS, Locke BZ, Narrow WE, Regier DA. Estimating the prevalence of mental disorders in US Adults from the Epidemiologic Catchment Area Survey.  Public Health Rep 1992;107:663-668. 
  14. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States.  Arch Gen Psychiatry 1994;51:8-19. 
  15. Lutsky I, Hopwood M, Abram SE, Cerletty JM, Hoffman RG, Kampine JP. Use of psychoactive substances in three medical specialties: Anesthesia, Medicine and Surgery.  Can J Anaesth 1994;41:561-567. 
  16. Moore RD, Mead L, Pearson TA. Youthful precursors of alcohol abuse in physicians.  American J Medicine, 1990;88:332-336. 
  17. Siegel BJ, Fitzgerald FT. A survey on the prevalence of alcoholism among the faculty and house staff of an academic teaching hospital.  West J Medicine 1988;148:593-595. 
  18. Brewster JM.  Drug Use Among Canadian Professionals: Executive Summary of the Final Report. Health Canada. Ottawa, Minister of Supply and Services Canada, 1994. (Cat. H42-2/64-1994-1). 
  19. Brewster JM, Ruel JM. Professional practice and drug use by Canadian physicians. Paper presented at the International Conference on Physician Health, Ottawa, September 18, 1994. 
  20. de Koninck M, Guay H, Bourbonnais R, Bergeron P, Tremblay MA.  Femmes et médicine: Enquête auprès des médecins du Québec sur leur formation, leur pratique et leur santé. Montréal: Corporation professionnelle des médecins du Québec, 1993. 
  21. Smart RG, Gillies M, Brown G, Blair NL. A survey of alcohol-related problems and their treatment.  Canadian J Psychiatry 1980;25:220-227. 
  22. Juntunen J, Asp S, Olkinuora A, Aarimaa M, Strid L, Kauttu K. Doctors' drinking habits and consumption of alcohol.  BMJ 1988;297(6654):951-954. 
  23. Hughes PH, Conard SE, Baldwin DC, Storr CL, Sheehan DV. Resident physician substance use in the United States.  JAMA 1991;265:2069-2073. 
  24. Baldwin DC, Hughes PH, Conard SE, Storr CL, Sheehan DV. Substance use among senior medical students: A survey of 23 medical schools.  JAMA 1991;265:2074-2078. 
  25. Lutsky I, Abram SE, Jacobson GR, Hopwood M, Kampine JP. Substance abuse by anesthesiology residents.  Acad Med 1991;66:164-166. 
  26. Clark DC, Eckenfels EJ, Daugherty SR, Fawcett J. Alcohol use patterns through medical school.  JAMA 1987;257:2921-2926. 
  27. Brooke D, Edwards G, Taylor C. Addiction as an occupational hazard: 144 doctors with drug and alcohol problems.  Br J Addiction 1991;86:1011-1016. 
  28. Gallegos KV, Lubin BH, Bowers C, Blevins JW, Talbott GD, Wilson PO. Relapse and recovery: Five to ten year follow-up study of chemically dependent physicians: The Georgia experience.  MMJ 1992;41:315-319. 
  29. Pelton C, Ikeda RM. The California physicians diversion program's experience with recovering anesthesiologists.  J Psychoactive Drugs 1991;23:427-431. 
  30. Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia's Impaired Physicians Program: Review of the first 1000 physicians: Analysis of specialty.  JAMA 1987;257:2927-2930. 
  31. Bunch WH, Dvonch VM, Storr CL, Baldwin DC, Hughes PH. The stresses of the surgical residency.  J Surgical Research 1992;53:268-271. 
  32. Hughes PH, Baldwin DC, Sheehan DV, Conard S, Storr CL. Resident physician substance use, by specialty.  Am J Psychiatry 1992;149:1348-1354. 
  33. Myers T, Weiss E. Substance use by internes and residents: Analysis of personal, social and professional differences.  Br J Addiction 1987;82:1091-1099. 
  34. Glaser FB, Brewster JM, Sisson BV. Alcohol and drug problems in Ontario physicians: Characteristics of the physician sample.  Canadian Family Physician 1986;32:993-999. 
  35. Martin CA, Talbott GD. Women physicians in the Georgia impaired physicians program.  J Am Med Women's Association 1987;42:115-121. 
  36. Ellis K, Rush B.  Alcohol and other Drug Services in Ontario: Results of a provincial survey, 1992. Toronto: Addiction Research Foundation, 1993. 
  37. Reading EG. Nine years experience with chemically dependent physicians: The New Jersey experience.  MMJ 1992;41:325-329. 
  38. American Medical Association.  Guides to the Evaluation of Permanent Impairment. (4th ed.) Chicago: American Medical Association; 1993. 
  39. Morse RM, Martin MA, Swenson WM, Niven RG. Prognosis of physicians treated for alcoholism and drug dependence.  JAMA 1984;251:743-746.

  Table. Rates of substance abuse among physicians

Study

Rate*

Comments

Baldwin et al24

3.4%

Self-identified as alcohol dependent, for cocaine, .7%; anonymous survey of senior medical students

Brewster18

6%

Heavy drinkers; survey of Canadian physicians

Clark et al26

18%

Alcohol abusers by RDC criteria; longitudinal study of students at one midwestern medical school

de Koninck et al20

2.6%

Self reports of alcohol dependence; Quebec physicians

Hughes et al11

8%

Self identified drug dependency; US physician mail survey

Hughes et al23

0.2%

Self identified alcohol dependence in last year, 0.2% for marijuana, 0.1% for amphetamines; anonymous mail survey of US resident physicians

Juntunen et al22

24-31%

Heavy drinking; survey of Finnish physicians on alcohol use

Lutsky et al15

14.4-19.9%

Impairment defined broadly; survey of physicians trained at Medical College of Wisconsin

Lutsky et al25

15.8%

Self-admitted substance abusers; survey of use during residency training by former Medical College of Wisconsin residents

McAuliffe et al9

3.3%

Self-reported drug dependency, with 4.2% "at risk;" survey of 500 physicians in New England

McAuliffe et al10

2%

Current drinking problem; further analysis of data from reference 9

Moore et al16

12.9%

Prevalence of alcohol abuse multiply defined; longitudinal data from Johns Hopkins Precursors Study

Siegel and Fitzgerald17

4%

Alcoholic as defined by SMAST, 10% possibly alcoholic; survey of staff in California teaching hospital

*Note: See comments for explanation of the rate. The figures reflect impairment, abuse, study-specific definitions and clinical diagnoses dealing with substance use or abuse. Studies using diagnostic surveys have estimated the lifetime risk of any substance use disorder in the general population to range from 13 to 26 percent.12-14
Back to text

Appendix

CAGE screening tool for alcoholism:

Have you ever felt you ought to  Cut down on your drinking?

Have people Annoyed you by criticizing your drinking?

Have you ever felt bad or  Guilty about your drinking?

Have you ever had a drink first thing in the morning (Eye opener)

to steady your nerves or get rid of a hangover?

Two or more positive answers indicate probable alcoholism. One positive answer merits further evaluation

SMAST: Short Michigan alcoholism screening test

  1. Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.) [No=1 point]  
  2. Does your wife, husband, a parent or other near relative ever worry or complain about your drinking? [Yes=1 point]  
  3. Do you ever feel guilty about your drinking? [Yes=1]  
  4. Do friends or relatives think you are a normal drinker? [No=1]  
  5. Are you able to stop drinking when you want to? [No=1]  
  6. Have you ever attended a meeting of Alcoholics Anonymous? [Yes=1]  
  7. Has drinking ever created problems between you and your wife, husband, parent, or other near relative? [Yes=1]  
  8. Have you ever gotten into trouble at work because of your drinking? [Yes=1]  
  9. Have you ever neglected your obligations, your family, or your work for 2 or more days in a row because you were drinking? [Yes=1]  
  10. Have you ever gone to anyone for help about your drinking? [Yes=1]  
  11. Have you ever been in a hospital because of drinking? [Yes=1]  
  12. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages? [Yes=1]  
  13. Have you ever been arrested, even for a few hours, because of drunken behavior? [Yes=1]
    Back to top

Reports by topic

Last updated: Sep 25, 2007
Content provided by: CSAPH