Robert L. DuPont, M.D., PresidentInstitute for Behavior and Health, Inc.

www.ibhinc.org

The Physician Health Programs:

A New Paradigm of Care Management for Addiction

New Thinking about Addiction

Physician Health Programs (PHPs)

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

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

Dealing with Relapse

• 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

• 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

Estimated Costs

• 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

• The future of drug treatment is harnessing the principals of the PHP experience in many other settings in which treatment occurs

Future Directions