Med Students: Exceptionally High Rates of Alcohol Abuse

Nancy A. Melville

March 24, 2016

Approximately one third of medical school students meet criteria for alcohol abuse or dependence ― double the rate of their age-matched non–med student peers ― with burnout and high educational debt primarily to blame, new research shows.

"This is the first study to explore the relationship between alcohol abuse/dependence and burnout among medical students," senior author Lotte N. Dyrbye, MD, professor of medicine and medical education at the Mayo Clinic College of Medicine, in Rochester, Minnesota, told Medscape Medical News.

"In this national cohort of medical students, a third [of students] met criteria for alcohol abuse/dependence. That is a much higher prevalence than what has been previously reported in similarly aged US college graduates," Dr Dyrbye said.

The findings are from a national survey that the investigators sent to 12,500 medical students in 2012. The study was published online March 1 in Academic Medicine.

200% Increase in Education Cost

Among 4402 (35.2%) persons who responded, 1411 (32.4%) met diagnostic criteria for alcohol abuse or dependence, measured using the Alcohol Use Disorders Identification Test (AUDIT-C).

Among risk factors showing the strongest association with alcohol abuse were burnout (P = .01), depression (P = .01), low mental quality of life (P =.03), and low emotional quality of life (P = .01).

The data also showed that alcohol abuse/dependence was more likely among those who were younger (P = .04), single (P < .001), or had a student loan debt of more than $100,000 (P < .01).

Compared with the 32.4% of medical students meeting the alcohol abuse/dependence diagnostic criteria, a recent sample of college-educated persons aged 22 to 34 years in the United States showed that only 15.6% had alcohol abuse/dependence, the authors note. The rate among medical students was nearly twice the rate previously reported among surgeons and physicians, as well as the rate in the US adult population.

Although burnout, younger age, and being single have previously been identified as risk factors for alcohol abuse in medical students, the study is the first to show a relationship with student debt, Dr Dyrbye said.

"No previous study has explored the relationship between medical student alcohol abuse/dependence and educational debt. Financial debt, however, has been previously associated with alcohol abuse/dependence in the general population. So although the finding was not totally unexpected, it is very important, as the cost of attending medical school has risen by over 200% in the past decade," she added.

The study notes that as of 2014, the average medical student graduated with a debt of $180,000.

"If educational debt continues to rise in the face of lower earnings, the psychological toll of educational debt may become even more severe," the authors add.

The study found that the rate of suicidal ideation (9.4%) was similar to that reported in previous research among medical students. It was higher than the rate reported in the general US population (5.7% among 18- to 29-year-olds). Approximately 35% of medical students who reported having suicidal ideation in the survey had coexistent alcohol abuse/dependence.

Although the Association of American Medical Colleges and other organizations provide information on debt management, Dr Dyrbye said the findings underscore the need for improved interventions to prevent the effects of stress among physicians in training.

"Approaches are needed to address alcohol use, burnout, and the cost of medical education," she said.

The issue of burnout in medical training, from medical school through residency and beyond, has been well documented. Research published last year showed that as many as 70% of medical residents in the United States met criteria for burnout, as reported by Medscape Medical News.

Striking Finding

Commenting on the findings for Medscape Medical News, Allison B. Ludwig, MD, assistant dean for student affairs at Albert Einstein College of Medicine, in New York City, said that she was not surprised to see that the rate of alcohol abuse/dependence was higher among medical students than in the general population, but she was struck by the magnitude of the difference.

"For many students, specifically those who do not take time off between undergraduate and medical school, medical school can feel like a continuation of college — students study hard, but they also 'blow off steam' by going out and, often, binge drinking," she told Medscape Medical News.

She noted that the tool used for determining the presence of alcohol abuse can cast a wide net.

"The Audit-C, which is the alcohol screen used in the study, would be positive for any student who drinks only on weekends and has three to four drinks on those occasions," Dr Ludwig said.

"Therefore, I think many college students would fall into this category, and hence, it is not surprising that medical students do, too. I would be curious to see the rates of alcohol abuse amongst a cohort of students in another professional school (eg, law or MBA [Masters of Business Administration] students)."

Programs such as one offered through the Committee for Physician Health (CPH), in New York State, can be help students, residents, and physicians who are struggling with addiction or mental health issues, she added.

"I have found this program to be incredibly helpful in working nonpunitively with students struggling with addiction," Dr Ludwig said.

"However, the key here is prevention. I do not believe that the CPH can handle the numbers seen in this study, and if we continue to allow our students to become burned out, then we are failing the next generation of physicians."

Dr Ludwig noted that at Albert Einstein College, where there is a focus on decreasing the stigma of asking for help, medical students take part in a wellness panel at orientation.

"[In the panel], senior students talk about their own struggles adjusting to medical school and their experience in seeking mental health," she explained.

"Since we started doing this, we have seen an uptick in mental health referrals, which we think is a good thing. The need has always been there, but students are now finally seeking help."

Mindfulness Helpful for Burnout

Jullia A. Rosdahl, MD, PhD, an assistant professor of ophthalmology at the Duke Eye Center, Duke University Medical Center, in Durham, North Carolina, who has published research on a mindfulness-based resilience approach to addressing burnout in medical residents, said that boosting awareness of the problem among students and their mentors is essential.

"It seems like awareness is key, that burnout and substance abuse, as described in this article, are real problems," she told Medscape Medical News.

She added that a mindful approach on the part of mentors may help reflect back to trainees.

"I think mindfulness can help the mentors, too ― mindful, other-focused listening to the trainees, for example ― and for the mentors themselves in managing stressors so that they don't burn out. Self-care is important for physicians at every stage of training."

The study received funding from the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-being.

Acad Med. Published online March 1, 2016. Abstract

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