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December 13, 2000

Alcohol and Substance Abuse Among Medical Residents—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(22):2874. doi:10.1001/jama.284.22.2869

In Reply: Program directors in our study believed that alcohol and substance abuse were underlying causes contributing to the poor performance of their problem residents "half of the time or more frequently" in 2% of the cases. Similarly, the program directors responded that substance abuse rehabilitation programs were helpful "half of the time or more frequently" for 7% of problem residents in situations in which this intervention was felt to be applicable.

In a national survey of resident physicians, Hughes et al1 found that, compared with nonphysician age-matched peers, residents reported a higher rate of alcohol and benzodiazepine use in the proceeding month. Aach et al2 outlined the responsibilities of residency training programs in dealing with alcohol and substance abuse and impairment among physicians in training. Recommendations focused largely on the identification of these residents (by approaches such as referral and self-referral), as well as effective intervention strategies (eg, confrontation), and treatment options.2 Despite the effort of educational systems, substance abuse problems among resident physicians likely remain underdiagnosed. In a study of residents in emergency medicine,3 only 1% of current residents were estimated by program directors surveyed to be impaired by alcohol, but 12.5% could be diagnosed as having alcoholism by clinical criteria.

Alcohol and substance abuse may be underlying causes contributing to some of the more frequently seen apparent deficiencies among problem residents including poor judgment, inappropriate interactions with colleagues, and tardiness. It is also conceivable that problem residents with apparent deficiencies (such as a poor knowledge base) or other underlying causes of their deficiencies (such as stressors or depression) look to alcohol and drugs as an escape from their problems.

Our study described the diverse and complex array of deficiencies seen among problem residents and the range of underlying causes that should be considered when faced with a trainee who is struggling. We believe that an individualized approach with careful attention and consideration of personal factors, including but not limited to alcohol and substance abuse, may result in more successful management of problem residents.

Hughes  PHConard  SEBaldwin  DC  et al.  Resident physician substance abuse in the United States.  JAMA. 1991;265:2069-2073.Google Scholar
Aach  RDGirard  DEHumphrey  H  et al.  Alcohol and other substance abuse and impairment among physicians in residency training.  Ann Intern Med. 1992;116:245-254.Google Scholar
McNamara  RMMargulies  JL Chemical dependency in emergency medicine residency programs: perspective of the program directors.  Ann Emerg Med. 1994;23:1072-1076.Google Scholar