ABSTRACT
Alcohol and other drug abuse is the leading cause of physician impairment. Prompt identification and early intervention by colleagues are the most effective ways of dealing with this problem in hospital residents. The author offers guidelines for recognizing the progressive signs of trouble inadvertently sent out by abusers, as well as effective ways in which colleagues can intervene. Also offered are steps in evaluation and treatment that can effectively address these illnesses and prevent compromising patient care.
Subject(s)
Internship and Residency , Physician Impairment , Substance-Related Disorders/prevention & control , Aftercare/organization & administration , Humans , Osteopathic Medicine , Preventive Health Services/organization & administration , Professional Staff Committees/organization & administration , Substance-Related Disorders/diagnosisABSTRACT
While the alcohol withdrawal syndrome (AWS) is frequently encountered in a number of medical settings, its clinical management is inconsistent. Appropriate management of the AWS can be enhanced by objectively quantifying principal symptoms. The modified or Milwaukee Selective Severity Assessment (MSSA) measures 10 symptoms of the AWS, providing clinicians with a quantitative indication of the syndrome's severity. The MSSA was administered to 487 successively admitted alcoholics entering an inpatient chemical dependency treatment center. The MSSA was used to evaluate the severity, monitor progression, and determine efficacy of treatment of the AWS. The MSSA aided clinicians in deciding which patients required pharmacologic intervention for their AWS. Two groups of patients are described: 435 whose AWS was not judged to be severe enough to require medication, and 52 whose AWS was sufficiently severe to warrant pharmacologic intervention. The MSSA allowed clinicians to accurately identify patients requiring pharmacologic intervention of the AWS: only 10.6% of 487 hospitalized alcoholics required pharmacotherapy. The MSSA is a convenient, effective, and efficient tool for monitoring the AWS.
Subject(s)
Alcohol Withdrawal Delirium/diagnosis , Psychoses, Alcoholic/diagnosis , Severity of Illness Index , Adult , Alcohol Withdrawal Delirium/drug therapy , Alcohol Withdrawal Delirium/physiopathology , Female , Humans , Male , Prognosis , Reproducibility of ResultsABSTRACT
Of 40 participants of a two-year program for rehabilitating alcohol- and other-drug-dependent physicians, 15 have completed 24 months of treatment and monitoring, eight have completed 12 to 23 months, ten have completed one to 11 months, and seven discontinued treatment before completion. Of the 33 treated physicians, 31 have returned to full practice and 22 have experienced no relapse. The prognosis is quite favorable for most impaired physicians in appropriate treatment, monitoring, and follow-up are provided.
