September 7, 2012
Washington Physicians Health Program features effective tools for beating substance abuse
In a room of 100 dentists, on average, nine or more will be struggling with substance abuse, with preferred substances ranging from alcohol to prescription and street drugs. No one knows for certain, but at any one point in time, 1-3 of those 100 dentists will be dependent on their use of alcohol or drugs of abuse.
For members of the general public suffering from substance dependence, the duration and intensity of treatment that people pursue is varied, often with lackluster results. After just 12 months, the rate of relapse for alcohol dependence alone is thought to be 40-60 percent, and the relapse rates for other substances such as cocaine or opioid dependence is noticeably higher. Twenty years ago, the Washington Physicians Health Program (WPHP) was formed to help health care providers beat those odds — and they have. Nationally, physician health programs (PHPs) report a much lower relapse rate (roughly 18-20 percent over five years for all drugs of abuse) than rates for the general public.
Staying substance-free isn’t easy for anyone — while many people in the general public trying to recover from chemical dependency typically don’t go to residential treatment, that path is unusual for WPHP clients. Founded in 1986, WPHP spent the first eight years of its history learning that health care providers with substance dependence who completed residential treatment had better outcomes than those that did not.
After completing residential treatment, the health care provider is asked to enroll in a monitoring agreement with WPHP, which continues for years, allowing them to document their abstinence. While the majority of WPHP’s budget comes from a small surcharge paid by all eligible health care providers when they renew their license, it is not enough to cover all of WPHP’s operational costs. Dentists being actively monitored by the program pay monthly fees to WPHP to help cover the costs of toxicology screening and monitoring visits. The benefits far outweigh the costs, however, with majority of successful participants able to keep both families and careers intact, preserving valuable members of the medical community.
How does it work?
Family members, friends and colleagues with a concern about substance abuse or psychological issues of a health care provider can start the process by calling WPHP — anyone can make a referral. Washington State law provides immunity from civil liability to all reporting sources, whether it is a fellow health care provider, a family member, or another concerned party, and WPHP safeguards the identity of the caller to the best of its ability. It’s important to note, however, that all licensed health care providers are required by law to report, “Any other individual licensed by the Department of Health who has a condition, physical or mental, that may affect their ability to practice with reasonable skill and safety. The report involving a condition that may affect a practitioner’s ability to practice with reasonable skill and safety can be made to WPHP and fulfill the reporting requirement of WAC 246-16-200.”*
Alternatively, a concerned license-holder can also fulfill their reporting obligation by contacting DQAC about their potentially impaired colleague. However, this results in a public investigation that opens the dentist to the possibility of disciplinary action for having an illness. Per WAC 246-16-200, when such a dentist is reported instead to WPHP and complies with the WPHP’s evaluation and treatment recommendations, they can maintain their anonymity from DQAC, avoiding a public investigation.
Buhl explains, “Once a person makes a referral, WPHP does the initial investigative work to determine the details surrounding the substance abuse or a behavioral issue. There are caveats – if there have been instances of patient harm related to some kind of impairment, one is obligated to call the licensing board. If there is any kind of abuse or larger patient harm issue, that would also have to be reported. But if it’s a worry about aberrant behavior or potential substance abuse, individuals can direct their concerns to us first.”
If, after clinically assessing the health care provider in question, WPHP determines a formal outside evaluation is necessary, participants are “referred for a multidisciplinary evaluation at a choice of several nationally-recognized facilities. If treatment is indicated, the practitioner is given a list of acceptable, nationally-recognized programs from which to choose.”* Following treatment, practitioners can return home to practice while being monitored by WPHP and continuing their aftercare. Individuals determined by WPHP not to be substance dependent may be endorsed by WPHP to return to work in the course of a single office visit.
The good news, of course, is that with such high success rates, dentists who enter the program have an excellent chance of continuing their dental career for many years. If you know or suspect that a colleague may have a substance abuse issue, or may be in need of psychological counseling, please call WPHP at 800-552-7236.