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Position Papers |

Alcohol and Other Substance Abuse and Impairment among Physicians in Residency Training

Richard D. Aach, MD; Donald E. Girard, MD; Holly Humphrey, MD; Jack D. McCue, MD; David B. Reuben, MD; Jay W. Smith, MD; Lisa Wallenstein, MD; and Jack Ginsburg
[+] Article and Author Information

Requests for Reprints: Dema Daley, Association of Program Directors in Internal Medicine, 700 Thirteenth Street, NW, Suite 250, Washington, DC 20005.

Current Author Addresses: Dr. Aach: Mount Sinai Medical Center, Department of Medicine, One Mount Sinai Drive, Cleveland, OH 44106.

Dr. Girard: Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201.

Dr. McCue: Bayside Medical Center, Springfield, MA 01199.

Dr. Humphrey: Box 410, Rm. A-615, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637.

Dr. Reuben: UCLA School of Medicine, Multicampus Division of Geriatrics and Gerontology, 10833 Le Conte Avenue, Los Angeles, CA 90024.

Dr. Smith: University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724.

Dr. Wallenstein: Albert Einstein Medical Center, Department of Medi cine, 5401 Old York Road, Suite 363, Klein Building, Philadelphia, PA 19141.

Mr. Ginsburg: American College of Physicians, 700 13th Street N.W., Suite 250, Washington, DC 20005.


*This paper represents the current position of the Association of Program Directors in Internal Medicine in its evolving approach to the complex problem of drug and alcohol abuse and addiction among physicians in residency training. Because state statutes vary, it is important to be sure that the program and the policies developed as well as the actions taken are in accord with requirements of state statutes, regulations, and institutional by-laws.This paper was prepared by members of the Resident Services Committee: Richard D. Aach, MD, Chair, Donald E. Girard, MD; Stephen G. Gluckman, MD; David Grob, MD; Holly Humphrey, MD; Stephen Lefrak, MD; Jack D. McCue, MD; David B. Reuben, MD; Jay W. Smith, MD; and Lisa Wallenstein, MD, with the assistance of Jack Ginsburg, Senior Associate for Policy Development, American College of Physicians. This paper was approved by the Council of the Association of Program Directors of Internal Medicine on 20 July 1991.The Resident Services Committee was established in 1986 to offer guidance to program directors in addressing the problems and needs of residents in Internal Medicine training programs. Problems related to stress in residency training were addressed in a previous position paper (1) prepared by the Committee.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;116(3):245-254. doi:10.7326/0003-4819-116-3-245
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▪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 benzodiazepines is greater than that among aged-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.

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