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Alcohol and Drug Recovery Center, Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, colling{at}ccf.org
In Response:
We appreciate the comments of Matsumura and Berry regarding our survey on chemical dependency in anesthesiology residents and the outcomes of treatment. We agree that information on the relapse rate of the residents who entered other specialties after treatment for chemical dependency would be both interesting and informative, particularly concerning which specialty was chosen. However, we did not attempt to collect these data, as our survey relied heavily on the recall of the individual program directors and we did not assume that the fate of residents who left for other specialties would necessarily be known to our respondents.
In our opinion, the most significant findings of our survey were that fewer than half of all residents treated for chemical dependency were ultimately successful in completing anesthesiology training and those who persisted on this career path experienced a 9% mortality rate. Both figures are outside of what would be considered acceptable for, say, an elective procedure or operation. In our opinion, these individuals have relatively little time and effort invested in their fledgling careers and the consequences of redirection are far safer than returning to a precarious line of work without the benefit of established sobriety.
We are not suggesting that substance abuse screening and pre-employment drug testing are the answers to this problem. Rather, we are pointing out that little has changed despite genuine efforts at controlling abuse and diversion of controlled substances by anesthesiology trainees. Clearly, additional efforts are indicated given the grim outcome statistics observed in our survey. Improving efforts to identify individuals at risk before acceptance into residency offers a largely unexplored avenue to do so. As we suggest, prospective studies are needed to assess these alternative strategies. Another strategy that may hold promise is the inclusion of mandatory depot naltrexone (1) in the contingency contracts of reentering opiate-abusing residents.
Finally, many of the factors associated with the risk for relapse were of interest to us and are considered in the cases that we treat. Ideally, detailed case reports of each individual identified during the survey period would have made for a more enlightening study. However, as noted in our discussion of the survey’s weaknesses, we strove to keep our survey tool brief and general to obtain a national overview of this issue. We did not feel that the details of each resident’s rehabilitation would necessarily be known to the current program director. A survey of state medical boards or physician advocacy programs may be a better source of this information.
Reference
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