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The Physician Health Programs: A New Paradigm of Care Management for Addiction


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Robert L. DuPont, M.D.-
Member, RiverMend Health Scientific Advisory Board for Addiction & Psychiatry. President Institute for Behavior and Health, Inc.

Dr. Robert DuPont addresses the RiverMend Health Scientific Advisory Board on Physician Health Programs (PHPs) and his processes for treating addiction.

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The Physician Health Programs: A New Paradigm of Care Management for Addiction

  1. 1. Robert L. DuPont, M.D., President Institute for Behavior and Health, Inc. The Physician Health Programs: A New Paradigm of Care Management for Addiction
  2. 2. New Thinking about Addiction
  3. 3. Physician Health Programs (PHPs)
  4. 4.  Evaluation and Intervention – Interventions include Medical Director or other senior person from PHP discussing issues raised leading to formal evaluation – Formal evaluations generally include full diagnostic interview with collateral assessment for substance use and other psychiatric medical conditions  Monitoring Contract – Usually for 5 years – Consequences for failure to adhere to recommendations may include further evaluation, treatment and reporting to the state licensing board – “Safe Harbor” provision: postpone/defer impending sanctions the PHP system
  5. 5.  Formal Treatment – All programs require total abstinence from alcohol and from nonmedical drug use – 69% of participants began treatment in residential care; 31% began treatment in intensive outpatient treatment  Long-Term Support & Monitoring – 95% of PHP participants participated in AA, NA, etc. – 70% required worksite monitors – Drug tested average 4 times/month in first year (48 tests/year); by fifth year average was 20 tests/year PHP Addiction Care
  6. 6. Dealing with Relapse
  7. 7. • Large majority of physicians were practicing and were drug- and alcohol-free • Of all physicians at 5 year follow-up (n=802): –78% of sample were licensed or working –4% had retired or left practice voluntarily –11% had their licenses revoked –3% unknown status PHP Results
  8. 8. • Over the course of 5 years: – 78% of all physicians had zero positive drug tests – 14% had only 1 positive – 3% had only 2 positives – 5% had 3 or more positives • 20+ drug test panel • Two-thirds of the PHPs (68%) routinely utilized ethyl glucuronide (EtG) to detect recent alcohol exposure PHP Long-Term Drug Test Results
  9. 9. Estimated Costs
  10. 10. • Compared to standard probation after a one-year period, HOPE probationers were: • 55% less likely to be arrested for a new crime • 72% less likely to use drugs • 61% less likely to skip appointments with their supervisory officer • 53% less likely to have their probation revoked • 48% fewer days of incarceration Hope Probation
  11. 11. • The future of drug treatment is harnessing the principals of the PHP experience in many other settings in which treatment occurs Future Directions