It is important to appreciate that just putting the drink or drugs down doesn’t instantly result in a cure. Being left with many of the feelings & problems that caused drinking in the first place will cause a relapse if not dealt with.
Centres which produce good results are usually based on the Twelve Step model of recovery which starts during the time as an in-patient and involves attending Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) where many issues can be addressed. Attendance at these meetings is invariably a condition of registration if the GMC is involved. NA meetings are not as the name suggests, exclusively for opiate users, but for any drug problem.
There is now increasing evidence to confirm the value of being part of a group in recovery, lending support to the concept in 12 step groups of “I can’t, but WE can”.
In a letter to the Lancet many years ago (January 1975), Dr Max Glatt observed that doctors who attend both the British Doctors & Dentists Group and AA do well.
In 1980, Kaye [1] observed "it has been our experience that alcoholics recover and remain sober as a result of the 'Group Experience' and those who try to recover on their own sooner or later relapse or become dependent on mood-changing drugs".
There are also groups for help with gambling, sex addiction and food issues. In addition, there are other groups for those who don’t ‘take to’ AA or NA such as SMART recovery.
The value of being supervised by a complete ‘programme’ as in our PHP and not just a spell in a treatment centre is in the continuous monitoring. This is so important. Many addicts strangely quite welcome hair testing as an extra safeguard (perhaps the one positive of being under GMC review!); random urine testing was associated with much better outcomes in one study compared to a non-monitored group. Also important as part of a continuing programme of recovery are regular ‘aftercare’ groups, psychiatric , psychological & even financial advice.
In an excellent article, Domino [2] found that there were three main factors leading to relapse:
1. Intravenous drug use
2. A family history of addiction
3. A co-morbud psychiatric diagnosis eg bipolar disorder or depression
The presence of any of these factors was associated with a significant risk of relapse and signals the need for very close monitoring.
Narcotics Anonymous warns against the thought that it is safe to drink alcohol if the primary drug problem was for instance opiates. True, there are some who can drink safely, but our experience shows that vast majority cannot. More often, an addict will eventually find that they drink alcoholically and demonstrate the same lack of control etc as with the primary drug.
It often takes quite a while for this to be manifest, but alcohol is after all a drug, and addicts would be wise to heed to this advice.
In an Annex to the Report 'Good Doctors, Safer Patients' (July 2006) by Sir Liam Donaldson, CMO at the Dept of Health, he says:
"It is accepted that doctors are at higher risk of alcohol or drug addiction than many other professional groups. The precise extent of the problem is not clear but could amount to 10% of all doctors. Addicted doctors are a source of potential harm to themselves and their patients. Only by identifying and engaging such doctors can that harm be reduced."