High Rates of Problem Drinking Reported by Surgeons

Norra MacReady

February 25, 2012

February 25, 2012 — Alcohol abuse and dependence are significant problems among surgeons in the United States, a new survey shows.

Of 7197 respondents, 1112 (15.4%) met the diagnostic criteria for alcohol abuse or dependence on a widely validated screening instrument, lead author Michael R. Oreskovich, MD, from the American College of Surgeons (ACS), Chicago, Illinois, and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, and colleagues report in an article published in the February issue of the Archives of Surgery.

Nearly twice as many female surgeons had scores suggestive of alcohol abuse or dependence as did male surgeons (25.6% vs 13.9%; P < .001). In contrast, recent surveys estimated that 10.5% of men and 5.1% of women in the general population met the criteria for alcohol dependence, according to the authors.

Of surgeons reporting a major medical error within the 3 months before the survey, 561 (77.7%) had symptoms of alcohol abuse or dependence compared with 161 (22.3%) without such symptoms (P < .001).

"To our knowledge, this study is the first of its kind to specifically look at the point prevalence of substance use disorders among physicians," the authors write. Point prevalence is the proportion of a population that has a particular illness or condition at a specific point in time.

Dr. Oreskovich and colleagues decided to conduct the study after observing a paucity of data on alcohol abuse among American physicians. They sent the Alcohol Use Disorders Identification Test, version C (AUDIT-C), to all ACS members for whom they had valid email addresses. The AUDIT-C is a 3-item, 12-point test that has been validated in several American populations. A score of at least 4 for men or 3 for women suggests problematic alcohol consumption, and scores of at least 5 for men or 4 for women point to alcohol abuse or dependence.

The researchers sent questionnaires to 25,073 surgeons, of whom 7197 (28.7%) responded. Respondants who were childless or "partnered," rather than single, married, or widowed, were at higher risk for alcohol abuse or dependence (P < .001 for all comparisons), and dissatisfaction with one's partner or spouse was another risk factor (P = .003). In addition, respondents with AUDIT-C scores of at least 4 for women or 5 for men were significantly more likely to have symptoms of emotional exhaustion and depersonalization (P < .001 for both). Overall burnout, symptoms of depression, and suicidal ideation also were significantly associated with symptoms of alcohol abuse or dependence (P < .001 for all).

Factors associated with a lower risk for alcohol abuse or dependence included longer time in practice (P < .001), working longer hours (P = .02), and spending more than the median number of nights on call each week (P < .001).

The observation that alcohol abuse was more prevalent among women than men is of particular concern, writes John A. Fromson, MD, from the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, in an invited critique. "This critical finding must serve as a catalyst for future investigation as to the cause, effective treatment, and prevention of alcohol use disorders among female and male surgeons."

Other experts warn that the data should be interpreted cautiously, given the low response rate. In an editorial accompanying the study, Edward H. Livingston, MD, from the University of Texas Southwestern Medical Center, Dallas, and Joseph S. Wislar, MS, from JAMA in Chicago, write that the response rate of 29% in this study was "far lower than the 60% minimum required by some biomedical journals." Such a low response rate leaves the data open to several possible biases, especially nonresponse bias. For example, if surgeons who drink more heavily are less likely to respond, the researchers would underestimate the prevalence of problem drinking in this population.

In their article, Dr. Oreskovich and colleagues acknowledge this possibility, but suggest that the large sample size might compensate for some of the potential bias. They encourage other medical societies to conduct similar investigations among their members, with the hope that greater knowledge may lessen the shame and stigma that may be preventing many physicians from seeking help.

Two of the study authors were paid as coinvestigators by the Washington Physicians Health Program. The other authors of the study, the critique, and the editorial have disclosed no relevant financial relationships.

Arch Surg. 2012;147:110, 168-174. Article abstract, Critique extract, Editorial extract

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