Skip to main content

Advertisement

Log in

Return to Work for Healthcare Professionals with Substance Use Disorders: Clinical, Legal, and Ethical Challenges

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

Occupational health providers (OHPs) and other clinicians who assess readiness to work have a difficult task in assessing return to work for healthcare professionals (HCPs) with substance use disorders (SUDs). About 10 to 15 % of HCPs will misuse drugs or alcohol at some time in their career, yet they are often reluctant to seek help. This paper reviews the clinical challenges of assessing SUDs in HCPs, including risk factors, prognosis, and limited evidence base for work restrictions. Furthermore, ethical and legal challenges throughout the return to work process are reviewed for stakeholders such as HCPs with SUDs, OHPs, other providers, employers, and the public at large. Suggestions are made for stakeholders, particularly for OHPs and other providers, who are navigating this complex environment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Adlersberg, M. (1997). Chemical dependency: helping a nurse return to work. Nursing BC, 29, 9–10.

    PubMed  Google Scholar 

  • American College of Occupational and Environmental Medicine. (2008). The personal physician’s role in helping patients with medical conditions stay at work or return to work. Retrieved from http://www.acoem.org/PhysiciansRole_ReturntoWork.aspx. Accessed 27 Aug 2013.

  • American Psychiatric Association. (2004). Resource document guidelines for psychiatric “fitness for duty” evaluations of physicians. Retrieved from http://www.psychiatry.org/learn/library--archives/resource-documents. Accessed 27 Aug 2013.

  • American Psychiatric Association, Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Americans with Disabilities Act of 1990, as Amended (i.e., including changes made by the ADA Amendments Act of 2008). (2008). Retrieved from http://www.ada.gov/pubs/adastatute08.htm. Accessed 27 Aug 2013.

  • Angres, D. H., Talbott, G. D., & Bettinardi-Angres, K. (1998). Healing the healer: the addicted physician (pp. 34–42). Madison: Psychosocial Press.

    Google Scholar 

  • Baldisseri, M. R. (2007). Impaired healthcare professional. Critical Care Medicine, 35(2 Suppl), S106–S116.

    Article  PubMed  Google Scholar 

  • Berge, K. H., Seppala, M. D., & Lanier, W. L. (2008). The anesthesiology community’s approach to opioid- and anesthetic-abusing personnel: time to change course. Anesthesiology, 109, 762–764.

    Google Scholar 

  • Berge, K. H., Seppala, M. D., & Schipper, A. M. (2009). Chemical dependency and the physician. Mayo Clinic Proceedings, 84, 625–631.

    PubMed  Google Scholar 

  • Boisaubin, E. V., & Levine, R. E. (2001). Identifying and assisting the impaired physician. The American Journal of the Medical Sciences, 322, 31–36.

    Article  PubMed  Google Scholar 

  • Breiner, S. J. (1979). The impaired physician. Medical Education, 54, 673.

    Google Scholar 

  • Bryson, E. O. (2009). Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? The results of a survey of anesthesia residency program directors. Journal of Clinical Anesthesia, 21, 508–513.

    Article  PubMed  Google Scholar 

  • Bryson, E. O., & Levine, A. (2008). One approach to the return to residency for anesthesia residents recovering from opioid addiction. Journal of Clinical Anesthesia, 20, 397–400.

    Article  PubMed  Google Scholar 

  • Buhl, A., Oreskovich, M. R., Meredith, C. W., Campbell, M. D., & Dupont, R. L. (2011). Prognosis for the recovery of surgeons from chemical dependency: a 5-year outcome study. Archives of Surgery, 146, 1286–1291.

    Article  PubMed  Google Scholar 

  • Carinci, A. J., & Christo, P. J. (2009). Physician impairment: is recovery feasible? Pain Physician, 12, 487–491.

    PubMed  Google Scholar 

  • Domino, K. B., Hornbein, T. F., Polissar, N. L., Renner, G., Johnson, J., Alberti, S., & Hankes, L. (2005). Risk factors for relapse in health care professionals with substance use disorders. JAMA: The Journal of the American Medical Association, 293, 1453–1460.

    Article  Google Scholar 

  • Dunn, D. (2005). Substance abuse among nurses—intercession and intervention. AORN Journal, 82(777–782), 785–799.

    Google Scholar 

  • Dupont, R. L., & Skipper, G. E. (2012). Six lessons from state physician health programs to promote long-term recovery. Journal of Psychoactive Drugs, 44, 72–78.

    Article  PubMed  Google Scholar 

  • Federation of State Physician Health Programs. (2005). Physician Health Program Guidelines. Retrieved from http://www.fsphp.org/2005FSPHP_Guidelines.pdf. Accessed 27 Aug 2013.

  • Fox, F. E., Doran, N. J., Rodham, K. J., Taylor, G. J., Harris, M. F., & O’Connor, M. (2011). Junior doctors’ experiences of personal illness: a qualitative study. Medical Education, 45, 1251–1261.

    Article  PubMed  Google Scholar 

  • Garcia-Guasch, R., Roige, J., & Padros, J. (2012). Substance abuse in anaesthetists [review]. Current Opinion in Anesthesiology, 25, 204–209.

    Article  PubMed  Google Scholar 

  • Gross, S. R., Wolff, K., Strang, J., & Marshall, E. J. (2009). Follow-up of provision of inpatient treatment for UK Healthcare Professionals with alcohol dependence: snapshot of a pilot specialist National Health Service. Substance Use & Misuse, 44, 1916–1925.

    Article  Google Scholar 

  • Hughes, P. H., Baldwin, D. C., Jr., Sheehan, D. V., Conard, S., & Storr, C. L. (1992). Resident physician substance use, by specialty. American Journal of Psychiatry, 149, 1348–1354.

    PubMed  Google Scholar 

  • Katz, J. D. (2012). Occupational health considerations for anesthesiologists: from ergonomics to economics. ASA Refresher Courses in Anesthesiology, 39, 65–71.

    Article  Google Scholar 

  • Long, M. W., Cassidy, B. A., Sucher, M., & Stoehr, J. D. (2006). Prevention of relapse in the recovery of Arizona health care providers. Journal of Addictive Diseases, 25, 65–72.

    Article  PubMed  Google Scholar 

  • Mansky, P. A. (1996). Physician health programs and the potentially impaired physician with a substance use disorder. Psychiatric Services, 47, 465–467.

    PubMed  Google Scholar 

  • McLellan, A. T., Skipper, G. S., Campbell, M., & DuPont, R. L. (2008). Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. British Medical Journal (Clinical Research Edition), 337, a2038.

    Article  Google Scholar 

  • Menendez, J. B. (2010). Americans with Disabilities Act-related considerations when an alcoholic nurse is your employee: when is a nurse legally considered a “direct threat” to patient safety? JONA’s Healthcare Law, Ethics, and Regulation, 12, 21–24.

    Article  Google Scholar 

  • Menk, E. J., Baumgarten, R. K., Kingsley, C. P., Culling, R. D., & Middaugh, B. (1990). Success of reentry into anesthesiology training programs in residents with a history of substance abuse. JAMA: The Journal of the American Medical Association, 263, 3960–3962.

    Article  Google Scholar 

  • Merlo, L. J., & Gold, M. S. (2008). Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harvard Review of Psychiatry, 16, 181–194.

    Article  PubMed  Google Scholar 

  • Merlo, L. J., & Greene, W. M. (2010). Physician views regarding substance use-related participation in a state physician health program. American Journal on Addictions, 19, 529–533.

    Article  PubMed  Google Scholar 

  • Miller, L. (2009). Doctors, their mental health and capacity for work. Occupational Medicine (Oxford), 59, 53–55.

    Article  Google Scholar 

  • Minnesota State Legislature. (2012). 2012 Minnesota Statutes. 147.111 Reporting Obligations. Retrieved from https://www.revisor.mn.gov/statutes/?id=147.111. Accessed 27 Aug 2013.

  • Minnesota State Legislature. (2012). 2012 Minnesota Statutes. 214.33 Reporting. Retrieved from https://www.revisor.mn.gov/statutes/?id=214.33. Accessed 27 Aug 2013.

  • Monroe, T., & Kenaga, H. (2010). Don’t ask don’t tell: substance abuse and addiction among nurses. Journal of Clinical Nursing, 20, 504–509.

    Article  PubMed  Google Scholar 

  • Monroe, T., Vandoren, M., Smith, L., Cole, J., & Kenaga, H. (2011). Nurses recovering from substance use disorders: a review of policies and position statements. Journal of Nursing Administration, 41, 415–421.

    Article  PubMed  Google Scholar 

  • Moutier, C., Cornette, M., Lehrmann, J., Geppert, C., Tsao, C., DeBoard, R., & Roberts, L. W. (2009). When residents need health care: stigma of the patient role. Academic Psychiatry, 33, 431–441.

    Article  PubMed  Google Scholar 

  • Rosen, A., Wilson, A., Randal, P., Pethebridge, A., Codyre, D., Barton, D., & Rose, L. (2009). Psychiatrically impaired medical practitioners: better care to reduce harm and life impact, with special reference to impaired psychiatrists. Australasian Psychiatry, 17, 11–18.

    Article  PubMed  Google Scholar 

  • Saunders, D. (2006). Substance abuse and dependence in anaesthetists. Best Practice & Research. Clinical Anaesthesiology, 20, 637–643.

    Article  Google Scholar 

  • Serra, C., Rodriguez, M. C., Delclos, G. L., Plana, M., Gomez Lopez, L. I., & Benavides, F. G. (2007). Criteria and methods used for the assessment of fitness for work: a systematic review. Occupational and Environmental Medicine, 64, 304–312.

    Article  PubMed  Google Scholar 

  • Shaw, M. F., McGovern, M. P., Angres, D. H., & Rawal, P. (2004). Physicians and nurses with substance use disorders. Journal of Advanced Nursing, 47, 561–571.

    Article  PubMed  Google Scholar 

  • Shore, J. (1987). The Oregon experience with impaired physicians on probation: an eight year follow-up. JAMA: The Journal of the American Medical Association, 257, 2931–2934.

    Article  Google Scholar 

  • The Genetic Information Nondiscrimination Act of 2008. Retrieved from http://www.eeoc.gov/laws/statutes/gina.cfm. Accessed 27 Aug 2013.

  • Wilson, J. E., Kiselanova, N., Lutz, R., Mandler, T., Tran, Z. V., & Wischmeyer, P. E. (2008). A survey of inhalational anaesthetic abuse in anaesthesia training programmes. Anaesthesia, 63, 616–620.

    Article  PubMed  Google Scholar 

  • Wunsch, M. J., Knisely, J. S., Cropsey, K. L., Campbell, E. D., & Schnoll, S. H. (2007). Women physicians and addiction. Journal of Addictive Diseases, 26, 35–43.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gregory P. Couser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Couser, G.P. Return to Work for Healthcare Professionals with Substance Use Disorders: Clinical, Legal, and Ethical Challenges. Psychol. Inj. and Law 6, 238–249 (2013). https://doi.org/10.1007/s12207-013-9166-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-013-9166-7

Keywords

Navigation