2 Saxfield Drive, Baguley Hall, Manchester M23 1PY, UK
Received 29 August 2001; in revised form 12 December 2001; accepted 28 January 2002
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ABSTRACT |
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INTRODUCTION |
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The North West Doctors and Dentists Group (NWDDG) is an autonomous self-help group, founded in 1980, to help professionals with a substance misuse problem. The ratio of general practitioners to hospital doctors is 2.6:1, compared with 1:1.2 for all doctors in England (Department of Health and Social Security, 1987). Various sources of referral to the NWDDG are indicated in Table 1
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The aims of the present study were to: (1) evaluate the outcome by March 2001 for the first 100 consecutive doctors who joined the group between 1980 and 1988; (2) determine their duration of recovery, over a period of 21 years; (3) relate this recovery to duration of abstinence and attendance at meetings of the NWDDG and Alcoholics Anonymous (AA); (4) assess the frequency and duration of relapse; (5) report mortality; (6) establish current employment status.
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SUBJECTS AND METHODS |
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RESULTS |
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Questionnaire return and reliability
Of the 66 questionnaires distributed in 2001, 39 were returned by 39 doctors and 18 completed by telephone. The relatives of four doctors reported their recent relapse and deaths which were directly related to alcoholism bringing the total questionnaire response to 61 (92.4%). A test of questionnaire reliability compared the date of first contact claimed on the questionnaire with the known date from the prospective data. Of the 57 completed questionnaires, 51 corresponded to within 6 months, of which 36 corresponded to within a month. One doctor overestimated by 7 months. Three underestimated by 7 months, 8 months and 2 years. Two had entered the correct year, but had omitted the month. Errors and omissions were corrected by telephone. Bearing in mind the long interval of memory recall, it is reasonable to assume that the reported length of recovery and abstinence are reliable to the nearest 6 months.
Outcome
By 1988, there were 76 surviving doctors reported to have had an initial 6 months uninterrupted abstinence and a continued recovery for an average duration of 5 years. By 1997, four more doctors were reported to be alive and in recovery, bringing the total believed to have recovered by 1997 to 80. The outcome in March 2001 for these 80 doctors is shown in Table 3.
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The overall recovery rate for the 100 doctors over a 21-year period is shown in Table 4.
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Mortality and cancer
Mortality is shown in 2Table 7. In addition to those who have died of cancer, there are three who have survived cancer. One has survived pharyngeal cancer for 5 years bringing the total incidence of oral/oesophagopharyngeal cancer to 9%. One doctor has survived colonic cancer for 6 years and one ureteric cancer for 5 years.
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DISCUSSION |
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The 3% of doctors who are drinking normally corresponds with observation in a general population (Chick et al., 1988). The term natural recovery is now used to describe those who recover from alcoholism without help (Burman, 1997
). In an analysis of factors affecting recovery among 93 alcoholics who recovered naturally and 42 who used self-help groups, it was found that there were more commonalities than differences in their respective successful recoveries (Bischof et al., 2000
). Though uncommon, natural recovery appears to be a reality. The three doctors in this survey simply relapsed and discovered that they could drink normally.
In the current survey, abstinence had a high correlation with recovery, as might be expected within a group which has abstinence as its primary goal. Another published report of the relationship between recovery and attending a peer group of doctors states that their devotion to group is reflected by the fact that when no longer mandated, many continue voluntarily, Many report profound relief at discovering that they are not alone and are able to use the group to address their deeply felt sense of shame and come to learn that they can say whatever is on their mind without being criticised, ridiculed, or punished (Fayne and Silvan, 1999). These sentiments accurately reflect the function of the NWDDG, which is to overcome shame, guilt, professional pride and obsessive anonymity to achieve recovery.
Alcoholics Anonymous is a worldwide, respected self-help support for recovering alcoholics (Godlaski et al., 1997). A triennial report by AA indicated that by 3 months after first contact, 50% no longer attend meetings and by 12 months 90% have dropped out (Alcoholics Anonymous, 1990
). In a recent article, it was stated that little is known about the effectiveness of attending AA (Fiorentine, 1999
). The present report shows that attending self-help groups, including AA, is critical to the initial recovery of doctors, but its importance wanes with the passage of time. AA is seen by new doctor members of the NWDDG as a serious threat to their anonymity, which membership of a less threatening professional group is able to avoid. It is the practice of the NWDDG to take new members to meetings of AA some distance from their home town until they have the confidence to attend a group near their home. It is a credit to AA that 15 of 51 doctors with long-term recovery continue to attend.
Relapse happens. A review of 10 short-term (0.756 years) Impaired Physician Programmes in the USA (Nelson et al., 1996) showed an average relapse rate of 36.6%, with a range of 1457%. The encouraging finding in the present report is the high rate of re-recovery from relapse of 45 out of 49 (92%). It is also evident that relapse is better realized in recovery intervals longer than 5 years.
The prospective high level reporting of mortality by relatives was facilitated by having an associated Families Group and monthly reminders of meetings. An alternative method, using death certificates, has been described in a 20-year retrospective analysis of the records of 99 male members of the general population, 88 of whom were traced through the National Health Service Register (Doll et al., 1994). In that study, 11 men lost to follow-up were assumed to be alive, unlike the present study which makes no such assumption. Only seven had death certificates indicating chronic alcoholism or alcohol poisoning, compared with 24 deaths due to alcoholism in the present study. Though the two populations are not entirely comparable, the difference is substantial. There is no evidence to suggest that relatives may over-report mortality due to alcoholism.
Oral and oesophagopharyngeal malignancies have a relationship with alcoholism independently of smoking habits (Chao et al., 2000). Recent research has revealed an association between a genetic cause of cancer of the oesophagus and alcoholism (Yokayama et al., 1999
). Two genes are apparently involved and each additional gene multiplies the risk incidence.
In conclusion, all the evidence in the present survey shows that alcoholic doctors do sustain their established recovery for long periods and are able to continue to contribute to medical care.
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ACKNOWLEDGEMENTS |
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