“The success of the nation’s state physician health programs (PHPs) provides important new evidence on the potential for dramatically reducing relapse and promoting long-term recovery from substance use disorders. This article summarizes the findings of the first national PHP study and outlines six lessons learned from this model of care management: (1) zero tolerance for any use of alcohol and other drugs; (2) thorough evaluation and patient-focused care; (3) prolonged, frequent random testing for both alcohol and other drugs; (4) effective use of leverage; (5) defining and managing relapses; and (6) the goal of lifelong recovery rooted in the 12-Step fellowships. PHPs are a part of a new paradigm of care management that includes the programs developed for commercial pilots (HIMS) and for attorneys (CoLAP). Elements of this model of care have been used with a dramatically different patient population, and with similar success, in the criminal justice system in HOPE Probation and 24/7 Sobriety. The authors review these programs and discuss implications for extending elements of the new paradigm more widely.”
PMID: 22641968 [PubMed – indexed for MEDLINE]
Originally posted via PubMed Commons
“One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.”
―Michael Lawrence Langan. http://www.bmj.com/content/349/bmj.g7603/rr
There is no evidence of good quality (i.e., clinical trials, systematic reviews or large observational studies) to promote the routinary practice of random drug testing to students or employees. Furthermore, the proposal of routinary practices of random drug testing threatens to violate the private life of employees and students.
“The Inquiry concludes that there is no justification for drug testing in the workplace as a means of policing the private behaviour of employees, or of improving performance and productivity. It suggests that although drug testing does have a role to play, particularly where safety is a concern, investment in management training and systems is likely to have a more positive impact and to be less costly, divisive and invasive.”
— Drug testing in the workplace: Summary conclusions of the Independent Inquiry into Drug Testing at Work. June 28, 2004. URL: http://www.jrf.org.uk/publications/drug-testing-workplacesummary-conclusions-independent-inquiry-drug-testing-work
Interventions promoted by Physician Health Programs (PHPs) are mostly supported by anecdotical evidence and “expert opinions”. PHPs operate with little oversight. It is concerning that many physicians referred to PHPs do not have reliable official channels for appealing decisions of PHPs.
“The problem with PHPs, though, is that despite their enormous power, they are generally barely known to most physicians and often operate with little oversight and no real means of appealing their recommendations.”
— Wesley Bond, June 9, 2014. URL:https://www.psychologytoday.com/blog/almost-addicted/201406/help-doctors-substance-use-disorders
Regarding the fourth lesson of this article: I would like to remind the authors of this paper the thin line that could be crossed by the “effective use of leverage”
“When a negotiator has sufficient power to compel a counterparty to accept a set of unfavorable terms, the use of leverage may cross a line into inappropriate or illegal coercion.” –
Kirgis, Paul F., Bargaining with Consequences: Leverage and Coercion in Negotiation (February 9, 2014). Harvard Negotiation Law Review, Forthcoming. Available at SSRN: http://ssrn.com/abstract=2247645
About the sixth lesson: “the goal of lifelong recovery rooted in the 12-Step fellowships.”
I have nothing against addicts voluntarily attending to 12-step recovery program.
But, (it is a big ‘but’)
Do the 12-step programs work for everyone?
Do 12-step programs work when coercion is involved?
There is no evidence to support that routinary referral of patients to 12-step recovery programs is beneficial in the long-term. Furthermore, the potential harms of these interventions could overweight their benefits. The use of coercion in 12-step programs involves the systematic violation of one or more principles of the medical ethics (especially the principle of patient autonomy).
Finally, I would like to make the following statement:
There is a growing body of compelling evidence to support the existence of forensic fraud, widespread corruption, and a total lack of accountability in cases of wrongdoing involving PHPs operating nationwide in the US.
“One of the recurrent themes I keep hearing from those victimized by PHPs is falsified drug and alcohol tests. Attached is an example of what they are capable of. Remember, this group has essentially removed themselves from accountability in drug and alcohol testing via the use of Laboratory Developed Tests (LDTs), a loophole which avoids FDA approval and oversight. Whereas most drug testing is transparent and held accountable, the PHPs use testing that is opaque, unregulated and accountable to no one. Accountability demands both the provision of information and justification for ones actions. PHPs block both. While most drug-testing requires the immediate provision of information if the test is questioned (as it should be), PHPs have put forth the logical fallacy that doctors have some sort of inherent expertise in toxicology and pharmacology and can “figure out” how to circumvent the testing process if they were to get copies of their lab results. They block this provision of information. And even if this information is ultimately provided, as seen below, no outside organizations exist to hold them to account. They do not have to justify their actions to anyone. No safeguards exist to assure integrity and honesty of the sample. No safeguards exist to assure the integrity and honesty of those ordering the sample either.”