Baldisseri Marie R
Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Crit Care Med. 2007 Feb;35(2 Suppl):S106-16. doi: 10.1097/01.CCM.0000252918.87746.96.
The objective of the article is to present the available data from the literature on substance use disorders in healthcare professionals. Prevalence, risk factors, treatment options, and reentry into clinical practice are discussed.
Impairment of a healthcare professional is the inability or impending inability to practice according to accepted standards as a result of substance use, abuse, or dependency (addiction). The term substance use disorder can be divided into substance abuse and dependence (addiction). Substance abuse results in adverse social and professional consequences. Addiction manifests as physiologic and behavioral symptoms related to a maladaptive pattern of substance use.
It is estimated that approximately 10% to 15% of all healthcare professionals will misuse drugs or alcohol at some time during their career. Although the rates of substance abuse and dependence are similar to those of the general population, the prevalence is disturbing because healthcare professionals are the caregivers responsible for the general health and well-being of the general population. Healthcare professionals have higher rates of abuse with benzodiazepines and opiates. Specialties such as anesthesia, emergency medicine, and psychiatry have higher rates of drug abuse, probably related to the high-risk environment associated with these specialties, the baseline personalities of these healthcare providers, and easy access to drugs in these areas. Drugs and alcohol are mostly used for "recreational" purposes by medical students. Residents and attending physicians use drugs of abuse for performance enhancement and as self-treatment for various reasons, such as, pain, anxiety, or depression.
Institutional, local, and statewide impaired-physician programs are now available for the active treatment and rehabilitation of impaired healthcare professionals. Many of these programs are also designed to assist the clinician with reentry into clinical practice. Rarely is punitive action taken when the healthcare provider undergoes successful treatment and ongoing follow-up management. Overall recovery rates for impaired healthcare professionals seem to be higher compared with other groups, particularly with intensive inpatient management and subsequent follow-up care.
本文旨在呈现文献中有关医疗保健专业人员物质使用障碍的现有数据。讨论了患病率、风险因素、治疗选择以及重新回归临床实践的情况。
医疗保健专业人员的功能受损是指由于物质使用、滥用或依赖（成瘾）而无法或即将无法按照公认标准开展工作。物质使用障碍一词可分为物质滥用和依赖（成瘾）。物质滥用会导致不良的社会和职业后果。成瘾表现为与物质使用的适应不良模式相关的生理和行为症状。
据估计，所有医疗保健专业人员中约有10%至15%在其职业生涯的某个时候会滥用药物或酒精。尽管物质滥用和依赖的发生率与普通人群相似，但患病率令人不安，因为医疗保健专业人员是负责普通人群总体健康和福祉的护理人员。医疗保健专业人员滥用苯二氮䓬类药物和阿片类药物的比例更高。麻醉、急诊医学和精神病学等专业的药物滥用率更高，这可能与这些专业相关的高风险环境、这些医疗保健提供者的基线性格以及这些领域容易获得药物有关。医学生大多将药物和酒精用于“娱乐”目的。住院医师和主治医师出于提高工作表现以及自我治疗等各种原因（如疼痛、焦虑或抑郁）而滥用药物。
现在有机构、地方和全州范围的医生功能受损项目，用于积极治疗和康复功能受损的医疗保健专业人员。这些项目中的许多还旨在帮助临床医生重新回归临床实践。当医疗保健提供者成功接受治疗并进行持续的后续管理时，很少会采取惩罚性行动。与其他群体相比，功能受损的医疗保健专业人员的总体康复率似乎更高，尤其是通过强化住院管理和随后的后续护理。
