Substance Abuse: Relapse Risk
Basic, Special Problems or Issues in Anesthesiology
Substance abuse has consistently proven itself to be a major public health problem in the United States for many years. Drug abuse is generally greater among men, young and unmarried individuals, Native Americans, and those of low socioeconomic status. It frequently coexists with personality, anxiety, or other substance use disorders. Unfortunately, the lifetime treatment rate is only about 8%. Substance use disorders have been heavily stigmatized despite frequent demonstration that regular drug use changes brain chemistry and neuronal structure. This encourages a cycle of tolerance, withdrawal, craving, and relapse.
Anesthesiologists appear to be at a higher risk for substance abuse than other physicians and many delay seeking treatment out of fear of losing medical licensure. Treatment is patient specific and often focuses on both behavioral and pharmacological interventions. Of anesthesiologists who do make it to a formal rehabilitation program, the relapse rate has been reported to be as high as 25%. In the general population, relapse rates for substance use disorders is about 40-60% and very similar to that of other chronic medical conditions such as hypertension and asthma. The most common triggers for relapse among anesthesiologists appear to be stress cues associated with drug use and physical contact with drugs of choice. Though not uncommon, relapse can be very dangerous and often deadly.