Prognosis
As indicated by reports from treatment programs, most recovering
physicians are able to return to a productive professional life.[171]
[192]
Successful outcomes are dependent on lifelong
participation in aftercare programs, total abstinence from drugs and alcohol, and
continual acknowledgment of one's disease. Unfortunately, these data include all
physicians treated rather than indexing rates of recovery by medical specialty.
Although no data are yet in print, some now believe that the prognosis for long-term
sobriety in anesthesiologists depends on the age and the status of the physician
at the time of identification. Residents who have been dependent on fentanyl appear
to have a significant rate of relapse.[162]
Although
each case must be handled separately, strong consideration should be given to a change
in specialty for junior residents who become addicted to potent opioids.
The American Board of Anesthesiology permits a physician recovering
from alcoholism or other drug dependence, who is otherwise qualified, to take both
the written and oral examinations. After a candidate with this history has satisfied
the requirements for certification, "the [board] will determine whether it should
defer awarding its certification to the candidate for a period of time in order to
avoid certification of a candidate who poses a direct threat to the health and safety
of others."[193]
If the American Board of Anesthesiologists
deems that such deferral is appropriate, "the [board] will determine the length of
time the candidate's certification is deferred following an individual assessment
of the specific circumstances of the candidate's history of alcoholism or illegal
use of drugs." This practice is in keeping with the intent of the ADA.[193]
Addiction is a lifelong disease. It acute effects can be overcome,
but its sequelae leave an indelible mark on each victim. Recovering physicians have
a disease that makes them guilty in the eyes of others, and they are forced to prove
their innocence whenever they are challenged. Because there is no way to ensure
that substance
abuse will not lead to addiction, the only absolute protection is to avoid the illicit
use of drugs entirely.
