Aach R D, Girard D E, Humphrey H, McCue J D, Reuben D B, Smith J W, Wallenstein L, Ginsburg J
Mount Sinai Medical Center, Department of Medicine, Cleveland, OH 44106.
Ann Intern Med. 1992 Feb 1;116(3):245-54. doi: 10.7326/0003-4819-116-3-245.
Substance abuse and impairment are serious societal problems. Physicians have historically had high rates of substance abuse, which has been viewed as an occupational hazard. Most authorities agree that the rate of alcoholism among practicing physicians is similar to that among control populations and that the rates of other substance abuse are greater, although some studies have shown no difference. Data about substance abuse among residents in training are limited but suggest that the use of benzodiazopines is greater than that among age-matched peers, whereas the use of alcohol is similar between the two groups. Medical institutions, including those with teaching programs, have legal and ethical responsibilities concerning substance abuse among current and future physicians. Many training programs, however, do not provide educational programs on this subject, do not have faculty trained in substance abuse medicine, and do not have a formal system to address the problem of residents who are suspected or known to be substance abusers. This position paper examines the extent of substance abuse, including alcohol abuse, among physicians in residency training. It outlines approaches to the problem and delineates responsibilities of institutions and residency program directors. Recommendations are made to establish an informational program and a clearly defined, organized process to address the problems of substance abuse among residents. Careful and humane approaches can be used to identify and treat residents with substance abuse problems and thus allowing them to complete their training as competent and drug-free professionals.
药物滥用和功能障碍是严重的社会问题。从历史上看，医生群体中药物滥用率一直很高，这被视为一种职业风险。大多数权威人士认为，执业医生中的酗酒率与对照人群相似，而其他药物滥用率更高，尽管一些研究表明并无差异。关于培训住院医师药物滥用情况的数据有限，但显示苯二氮䓬类药物的使用高于年龄匹配的同龄人，而两组之间酒精的使用情况相似。包括设有教学项目的机构在内的医疗机构，对当前及未来医生的药物滥用问题负有法律和道德责任。然而，许多培训项目并未提供关于该主题的教育课程，没有受过药物滥用医学培训的教员，也没有正式系统来处理疑似或已知存在药物滥用问题的住院医师。本立场文件探讨了住院医师培训阶段医生药物滥用（包括酒精滥用）的程度。它概述了解决该问题的方法，并明确了机构和住院医师培训项目主任的职责。建议建立一个信息项目和一个明确界定、有条理的流程，以解决住院医师的药物滥用问题。可以采用谨慎且人道的方法来识别和治疗有药物滥用问题的住院医师，从而使他们能够作为称职且无药物问题的专业人员完成培训。
