Substance use among medical students: time to reignite the debate?

BACKGROUND: Substance use among medical students could impact on the conduct, safety and efficiency of future doctors. Despite serious medicolegal, ethical and political ramifications, there is little research on the subject, especially from the Indian subcontinent. We aimed to explore the patterns of substance use among a sample of medical students from the Indian subcontinent. METHODS: An opportunistic, cross-sectional survey of medical students from 76 medical schools attending an inter-medical school festival. A brief self-reported questionnaire was used to identify current and lifetime use of tobacco, alcohol, cannabis, heroin and non-prescription drugs. Multivariable logistic regression analysis was used to identify factors associated with illicit substance use. RESULTS: Responses from 2135 medical students were analysed. Current alcohol and tobacco (chewable or smoked) use was reported by 7.1% and 6.1% of the respondents, respectively. Lifetime use of illicit substances was reported by 143 (6.7%) respondents. Use of illicit substances was strongly associated with use of tobacco, alcohol and non-prescription drugs. CONCLUSION: This study provides a snapshot of the problem of substance use among medical students from the Indian subcontinent. The reported prevalence of alcohol and illicit substance use in our sample was lower, while tobacco use was similar, when compared with data from western studies. Further research is needed from the Indian subcontinent to study nationwide patterns of substance use among medical students, and to identify important determinants and reinforce protective factors. Strategies need to be developed for supporting students with a substance use problem.

Alcohols and other substance use/abuse among junior doctors and medical students in a teaching institute.

Substance related disorders have become matters of global concern because of its negative impact on individual health, familial, social and professional life. This study aims to assess prevalence of alcohol and other substance use among students and junior doctors at teaching institute. This descriptive study conducted on medical students, following convenient sampling method. Results revealed the prevalence rates of 'ever used', 'last year used' and 'last month used' were 63.5%, 56.5% and 42.5% respectively. The most preferred substance was alcohol (90.9%) and only 32.2% females 'ever used' substance. Cannabis use was seen exclusively among male (15.0%) students and opioid use was not found. Alcohol is most prevalent substance of use/abuse and was common among house officers and medical students.

A pioneering experience in Brazil: the creation of a support network for alcohol and drug dependent physicians. A preliminary report

OBJECTIVE: The objectives of this study are to present the creation and operation of a support network to help physicians in Brazil, describe the socio-demographic profile, and investigate the prevalence of mental disorders and chemical dependence among physicians seeking treatment. METHOD: Semi-structured interviews using ICD-10 criteria were conducted to obtain data regarding alcohol/drug dependence, and psychiatric comorbidity. Socio-demographic and occupational characteristics were obtained. RESULTS: 247 patients made contact and 192 attended the first evaluation visit. Of those, 158 were male, and most (55 percent) were married. The mean age was 42.4 ± 11.1 years. The reasons for seeking treatment were: comorbidity between mental disorders and chemical dependence (67.7 percent); chemical dependence (20.8 percent); mental disorders (7.8 percent); and burnout (4.2 percent). The mean interval between the detection of the problem and seeking treatment was 7.5 years. Factors associated with the severity of the problem included unemployment (21.6 percent), difficulties of practicing professional activities (63.5 percent), problems with the Regional Council of Medicine (13 percent), psychiatric hospital admission (31.2 percent), and self-medication (71.8 percent). In our sample, 9.3 percent of the physicians had changed their area of specialization. CONCLUSIONS: A high prevalence of psychiatric disorders was found in this sample as well as psychosocial and professional problems. Treatment networks focusing on the physicians' mental health could catalyze cultural changes in treatment-seeking behavior, thereby improving early detection and treatment.

OBJETIVO: Pretendemos apresentar a criação e o funcionamento de serviço específico para médicos no Brasil, descrever o perfil sociodemográfico, prevalência de transtornos mentais e dependência química entre médicos que buscaram o serviço. MÉTODO: Foram realizadas entrevistas clínicas semi-estruturadas baseadas no CID-10 para diagnóstico de dependência de álcool/drogas e comorbidade psiquiátrica. Um perfil sociodemográfico e ocupacional foi obtido. RESULTADOS: 247 contatos foram feitos e 192 pacientes compareceram ao primeiro atendimento. Destes, 158 eram homens, a maioria casados (55 por cento), idade média de 42,4 ± 11,1 anos. As causas de procura por atendimento foram: comorbidade entre transtorno mental e dependência química (67,7 por cento), dependência química (20,8 por cento), transtornos mentais (7,8 por cento), burnout (4,2 por cento). O intervalo médio entre a identificação do problema e a busca de tratamento foi de 7,5 anos. Desemprego (21,6 por cento), problemas no exercício profissional (63,5 por cento), problemas no Conselho Regional de Medicina (13 por cento), internação psiquiátrica pregressa (31,2 por cento) e auto-medicação (71,8 por cento) associaram-se à gravidade dos problemas. Mudança de especialidade ocorreu em 9,3 por cento da amostra. CONCLUSÕES: Observamos uma prevalência alta de transtornos psiquiátricos bem como problemas psicossociais e profissionais nesta amostra. Serviços específicos de atenção à saúde mental dos médicos podem ter efeito catalisador nas mudanças culturais quanto à procura de ajuda, favorecendo a detecção precoce e tratamento.

Perfil clínico e demográfico de médicos com dependência química / Clinical and demographical aspects of alcohol and drug dependent physicians

OBJETIVO: Traçar o perfil clínico e demográfico de uma amostra de médicos em tratamento por dependência química, avaliar comorbidades psiquiátricas e conseqüências associadas ao consumo. MÉTODOS: Foram coletados dados de 198 médicos em tratamento ambulatorial por uso nocivo e dependência química, através de questionário elaborado pelos autores. RESULTADOS: A maioria de indivíduos foi do sexo masculino (87,8 por cento), casados (60,1 por cento), com idade média de 39,4 anos (desvio padrão=10,7 anos). Sessenta e seis por cento já tinham sido internados por causa do uso de álcool e/ou drogas. Setenta e nove por cento possuía residência médica e as especialidades mais envolvidas foram: clínica médica, anestesiologia e cirurgia. Comorbidade psiquiátrica foi diagnosticada em 27,7 por cento (Eixo I do DSM-IV)¹ e em 6 por cento (Eixo II do DSM-IV)¹. Quanto às substâncias consumidas, o mais freqüente foi uso associado de álcool e drogas (36,8 por cento), seguido por uso isolado de álcool (34,3 por cento) e uso isolado de drogas (28,3 por cento). Observou-se o intervalo de 3,7 anos em média entre a identificação do uso problemático de substâncias e a procura de tratamento. Quanto à busca por tratamento, 30,3 por cento o fizeram voluntariamente. Quanto aos problemas sociais e legais observou-se: desemprego no ano anterior em quase 1/3 da amostra; problemas no casamento ou separação (52 por cento), envolvimento em acidentes automobilísticos (42 por cento), problemas jurídicos (19 por cento), problemas profissionais (84,8 por cento) e 8,5 por cento tiveram problemas junto aos Conselhos Regionais de Medicina. CONCLUSÃO: Os autores recomendam medidas assistenciais e preventivas para o problema.

Substance abuse by medical students and doctors.

The doctors are vulnerable to substance abuse/addiction due to their ready accessibility to the substances of abuse. There is higher percentage use of alcohol, tranquillisers and psychedelics among medical students, and dependence rates are 5% for medical students and 3% for doctors. Majority of the substance-abusing doctors are graduates, belong to medicine speciality (21%) and majority of them prescribe drugs to themselves (37%). The consultants experience more substance related complications, despite having late age of onset of alcohol and substance dependence, less number of concomitant substance abuse and less career handicap. Stress (situational, personal and professional), medical student abuse and family history of alcoholism are the major risk factors. Despite paucity of studies in Indian population, substance use is reported between 32.5% to as high as 81.2% among medical students, intems and house physicians. In spite of the treatment dilemmas, the physicians do respond favourably to treatment. These findings have implications in planning preventive and interventional strategies for this professional group.