Enhanced Recovery Outcomes & Monitoring Programs

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In the U.S., we commemorate and celebrate our inalienable right to life, liberty and the pursuit of happiness on July 4th.  To place a safety net around such individual rights, however, regulations have been established to ensure that certain activities are only conducted by those who possess a minimal level of education, training and/or competence so that public safety is maintained.  For this reason, no one has a “right” to drive an automobile or fly an airplane, or set up practice as a doctor, lawyer or other professional, without obtaining a valid license.  In this way, the rights of all are safeguarded by placing minimal requirements on those given the “privilege” to drive a car, fly an aircraft, or practice a profession.

The privilege of being issued any license is a valuable asset that can only be kept in force by adhering to standards set by the regulatory agency which is empowered to restrict or revoke such licenses if warranted.  Thus, any license can be used as potent leverage to ensure that the licensee conforms to established standards in the field, be that the highway, skyway, hospital or court room.

Monitoring the recovery from addiction of licensed professionals has a long track record of documented success.  For decades, tightly structured programs which monitor physicians, nurses, attorneys, and airline pilots have provided a highly effective, non-public method of enhancing public safety, while increasing the likelihood that such professionals will achieve and maintain a lasting recovery.

Accountability to remain within the parameters of such monitoring programs clearly rest on the shoulders of each individual participant.  Adherence to the requirements set by such programs is deemed highly desirable by participants as each has a professional license which hangs in the balance.  As a professional’s license corresponds directly to their ability to make a living, most professionals in monitoring programs are extremely invested and highly motivated to achieve a successful, if not stellar, outcome.

Thus, the stage of professional monitoring programs is set by a potent form of leverage which casts a hook into the monitored professional.  Fundamentally, the force exerted on the monitored professional is the ability to revoke or restrict their privilege to practice their profession, binding them to adhere strictly to their monitoring agreements.  Such leverage serves as a formidable contender which can effectively compete against any strong cravings to re-engage in alcohol and other drug use.  

Monitoring programs go far beyond what their name signifies, which is the provision for toxicology screenings of participants at random intervals for alcohol and drug use.  While such toxicology testing is usually performed for a long period of time, often five or more years, additional requirements customarily include formal evaluation, diagnosis and treatment by certified experts in the field of substance use disorders.  Inpatient treatment is often mandated and follow-up care is frequently required for an extensive period of six or more months after discharge from inpatient care. 

A compulsory sabbatical or leave of absence from professional practice is a typical initial stipulation of monitoring programs because such a reprieve enhances the professional’s ability to cultivate recovery skills.  Customarily, documented 12 Step program attendance is required, as well as attendance at peer support group meetings which are populated solely by other recovering members of a particular profession. 

Recent studies of physician health programs, which is the common term utilized for programs monitoring physicians, have demonstrated a remarkable success rate that any addiction treatment program would envy.  In one such study, 78% of the 904 physicians monitored for five years or longer showed no return to alcohol or other drug use (DuPont).  Long-term success rates of pilot monitoring programs reported by the aviation industry boast abstinence rates exceeding 85% (Aviation Medicine Advisory Service).  Similar rates of recovery from addiction have been noted in data pertaining to other professions with established monitoring programs, such as nurses (Trossman).

By replicating some of the strategies already in use by professional monitoring programs, sufficient leverage may be exerted on non-professionals afflicted with addiction.  Although it would be an extremely difficult undertaking to generate the quality or quantity of leverage currently used by programs monitoring licensed professionals, such accountability may hold the key to optimally enhancing the long-term recovery outcomes for the general population which typically range between 40%-60% (Angres).   Given that morbidity and mortality related to addictive disorders robs a countless number of individuals of their inalienable right to life, liberty and the pursuit of happiness, adopting some of the aspects of professional monitoring programs seems to warrant exploration.

References
Angres, D.H., Bettinardi-Angres, K., & Cross, W.  (April 2010).  Nurses with chemical dependency: Promoting successful treatment and reentry.  Journal of Nursing Regulation. 1(1), 16-20.

DuPont, R., McLellan, A.T., Carr, G., Gendel, M., & Skipper, G.E.  (2009) How are addicted physicians treated?  A national survey of physician health programs.  Journal of Substance Abuse Treatment.  37(1), 1-7.

Trossman, S.  (2003).  Nurses and addiction: Finding alternatives to discipline.  American Journal of Nursing.  103(9), 27-28.
Aviation Medicine Advisory Service, FAA-Sanctioned pilot alcohol abuse programs in business aviation.  Accessed online on 7/4/2011.at http://aviationmedicine.com/articles/index.cfm?fuseaction=printVersion&articleID=18

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