Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

350 IV. SPECIAL POPULATIONSstances, or to the hardware needed for their use (e.g., syringes, alcohol swabs).It may be no surprise that they often use substances to cope. This area hasreceived a fair amount of research attention. For physicians, all 50 states havesystems for physician health.Occupational stresses in the health care setting may contribute to substancemisuse. One study that viewed the 2002 Washington-area sniper shootingsas terrorism found that among employees of a local hospital, with highexposure to trauma, the perception of safety was inversely proportional to therisk of alcohol misuse. Conversely, the use of alcohol was a risk factor for acutestress disorder (odds ratio = 5.1) (Greiger, Fullerton, Ursano, & Reeves, 2003).Abuse is widespread among both nurses and physicians. Using an anonymoussurvey, Trinkoff and Storr found (1998) that 32% of nurses admitted touse of substances. For physicians, alcohol use may be common: One study suggesteda 12% rate of abuse (Moore, Mead, & Pearson, 1990). Physicians may beamong the most resistant to seek help for a real problem (Aach et al., 1992).Physicians also have a high risk factor for addiction. Actually, adults who havegrown up in families with addiction have a tendency to choose health care professions.Physicians have higher access to pharmaceutical drugs but are lessinclined to use street drugs. In the New York State Physicians’ Health Program,88% of the participants used alcohol or prescription drugs, and only 12% usedmarihuana or cocaine. Additional risk factors for SUDs in physicians have beenpostulated to be “pharmacological optimism,” intellectual strength, strong will,love of challenges, instrumental use of medications, and a daily need for denial(Mansky, 1999).As in other professions, there may be a need to tailor treatments for thisgroup. New research has demonstrated that prevention aimed at HCWs can besuccessful (Lapham, Chang, & Gregory, 2000). Confidentiality is a major concernin the care of HCWs, and many centers are especially adept at caring forHCWs (e.g., Talbott Recovery Program). Physicians may gain help throughtwo mutual-help groups, caduceus groups and International Doctors in AlcoholicsAnonymous, which supplement mainstream 12-step programs.High-Responsibility Workers: Air Traffic Controllers,Machine Operators, Drivers, and PilotsOne of the most difficult issues with regard to working with this population is inconsidering when and where to speak up about the dangers posed by theworker, especially when the consultant has a dual agency. While a therapeuticalliance is central to treatment, an important role of the addiction psychiatristis to confront denial and to protect the public (Leeman, Cohen, & Parkas,2001) whether the setting is occupational or private. Notwithstanding the narrownessof the Tarasoff duties, the therapist should remind the patient of thelegal liabilities that result from the risky behavior. One should consider referral