Pattern & profile of substance use disorder (SUD) in physicians

Sir,

Physicians are at a higher risk of substance use disorders (SUD) in view of the stressful nature of their job and easy access to medicines12. The pattern, prevalence and characteristics of substance abuse in physicians are different from the general population2. Alcohol use among medical students and practicing physicians is a growing concern in India3.There is limited information available on physicians with SUD from India.

This study was conducted at the Centre for Addiction Medicine (CAM), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India, after approval from the Institute Ethics committee. The study was a retrospective database based analysis. The database contained information of all the in-patients’ socio-demographic details, clinical history, examination findings and treatment details. These details were entered in the database after evaluation of each case independently by at least two qualified psychiatrists. We extracted the data from July 2007 to June 2012. During this period, there were 58 physicians admitted to the CAM. Descriptive statistics was used to analyse the data. The demographic and clinical details are as mentioned in the Table.

Table Demographic and clinical details of physicians admitted (2007-2012) (n=58)

The sex ratio was in keeping with general trend of treatment seekers in India4. The physicians in our study had a later onset of initiation of substance use (26 ± 8 yr) and dependence criteria (32 ± 8 yr) than the rest of the treatment seeking population567. But this was in concordance with the other available literature of SUD in physicians2. Also these physicians had taken 10 years to come for treatment after the dependence pattern was established. Among these physicians about 58 per cent were using prescription drugs as one of their primary substances of abuse. All those who abused opioid, were using prescription opioids. Cannabis was used in 13 per cent as secondary substance of abuse. The profile was different from rest of the substance users’ population because cannabis usage was found to be low and benzodiazepine users were more4. This could be explained by the fact that this study looked at the primary drugs of abuse for which these physicians got admitted to the hospital and also there was easy accessibility to benzodiazepines for physicians.

Of the 58 physicians studied, 34 (58%) had comorbid psychiatric disorders. The disorders were mood disorders in 23 (39%), anxiety disorders in seven (12%), and psychotic spectrum disorders in four (7%). Marital discord was found in 23 (40%) of them.

On the routine assessment of premorbid temperament it was found that 21 (37%) had externalising traits (ADHD, conduct disorder and oppositional defiant disorder related symptoms), 10 (18%) had internalising traits (depression and anxiety related symptoms) and six (11%) had both externalising and internalising traits. At the time of entry into the treatment 12 (20%) were in pre-contemplation phase, 23 (40%) in contemplation and 23 (40%) in preparatory phase of motivation. As there was no uniform treatment policy and there were lapses and relapses, follow up duration was taken as an outcome factor in the study. Nineteen (33%) of them were never followed up after discharge, 19 (33%) dropped out of treatment within one year after the admission, 20 (34%) were on follow up regular treatment even after one year. Mean duration of follow up in the later was 13 months. Although the follow up rates were relatively better than that in the general patients with SUD8, it was poorer when compared to the western literature910. This can be explained by the non-availability of good documentation and reporting systems in case of treatment dropouts especially in physicians11.

The limitations of this study were small sample size, retrospective reviewing of the database and inclusion of only in-patients in the study. This limits the generalizability of the findings. In conclusion, physicians are in the risk group for SUD with respect to availability and accessibility to prescription medications. There is a need to study the community prevalence and treatment barriers in this group leading to delay in treatment seeking and poor follow up rate.