It is essential to appreciate that just putting the drink or drugs down doesn’t instantly result in a cure. Being left with many of the feelings and problems that caused drinking in the first place will cause a relapse if not dealt with.
Approaches that produce good results are usually based on comprehensive models of recovery that are being attended over extended periods of time, such as the Alcoholic Anonymous (AA) related Twelve Step or Relapse Prevention models, like SMART recovery.
Treatment for substance dependence that can cause dangerous physical withdrawals, such as alcohol, often starts with an in-patient detox arrangement followed by a residential rehabilitation setting that involves attending Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) or SMART recovery meetings, 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 might suggest, exclusively for opiate users but for any drug problem.
In a letter to the Lancet half a century ago, Dr Max Glatt observed that doctors who attend both the British Doctors & Dentists Group (BDDG) and AA do well (Glatt, 1975).
Evidence for twelve-step facilitation (TSF) programmes in the addiction field has been growing over the past 80+ years since the foundation of AA. A Cochrane systematic review, more recently published, showed that TSF/AA interventions lead to improved rates of continuous abstinence at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence) in comparison to other manualised approaches. This effect remained consistent at both 24 and 36 months (Kelly, 2020).
The enthusiasm of the above publication led to the forming of the All-Party Parliamentary Group on 12 Step Recovery – their website has links to all UK active 12-step groups that address alcohol (AA), general substance dependence (Narcotics Anonymous – (NA), Drug Addicts Anonymous (DAA), or specific substances such as Cocaine Anonymous (CA), Heroin Anonymous (HA), Marijuana Anonymous (MA) and Crystal Meth Anonymous (CMA). The site also links to 12-step groups that support people with behaviour or process addictions such as gambling, sex, over-eating and general emotional problems as well as lists UK groups that support family and friends of people with addiction.
As afore mentioned, SMART recovery has a good meeting base in the UK (in-person and online). Some of the 12-step groups and some alternatives to 12-steps are operating in other countries and their online meetings are potentially accessible in the UK, examples are US based Women for Sobriety (WfS), German Blaues Kreuz.
The value of being supervised by a complete ‘programme’ as in the UK Practitioners’ Health Programme (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 and even financial advice.
Relapse
(Domino, 2005) found that there were three main factors leading to relapse in Health Care Professionals with substance use disorders:
- a family history of addiction
- use of a major opioid in presence of a co-morbid psychiatric diagnosis, e.g. bipolar disorder or depression
Relapse rates were noted for a quarter of the 292 individual health care professionals monitored by the Washington Physicians Health Program between 1991and 2001.
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 the 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 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. (Donaldson, 2006)”
References
Domino, K. B. (2005). Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders. JAMA, 293(12), 1453. https://doi.org/10.1001/jama.293.12.1453
Donaldson, L. (2006). Good doctors: Safer patients—The Chief Medical Officer’s prescription for regulating doctors. Department of Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC1557883/#:~:text=For%20established%20doctors%20continuing%20competence,retraining%20and%20rehabilitation
Glatt, M. M. (1975). DOCTORS WITH A DRINKING PROBLEM. The Lancet, 305(7900), 219. https://doi.org/10.1016/S0140-6736(75)91387-2