Abstract
The purpose of this study was to assess the cumulative incidence of substance use among anesthesiologists during training and practice, the effect of stress on drug use, and deterrent efficacy of institutional prevention programmes. The 260 anesthesiologists who had trained at the Medical College of Wisconsin between 1958–1988 were surveyed by mail regarding psychoactive substance use. Analysis of 183 responses focused on demographic and psychosocial factors. Substances used most frequently included: alcohol (91.6%), marijuana (30.8%) and cocaine (9.4%). Twenty-nine (15.8%) anesthesiologists were identified as being substance-dependent: 19 were alcohol-impaired; six were drug-impaired, and four were dependent on both alcohol and drugs. Impairment was more prevalent in anesthesiologists who had completed their training after 1975. Fifty-eight (32%) anesthesiologists had used illicit drugs to “get high”; 11 acknowledged daily use for two weeks or more, with eight admitting dependency. Substance abuse was more common in parents of impaired anesthesiologists (35.7%) than in unimpaired colleagues (8.1%; P < 0.001). The divorce rate for impaired anesthesiologists (24.1%) was greater than for unimpaired anesthesiologists (5.2%; P < 0.001). Increased stress during training was not reflected by increased substance use. Few recalled any drug counseling whatsoever. Seventy percent assessed hospital drug control policies as fair or poor. Younger respondents (bom after 1951) were more critical of drug control programmes than their older cohort. Incidents of substance abuse were reported for both residents and faculty. Psychoactive substance abuse remains a serious problem among anesthesiologists.
Résumé
Cette étude avait pour objectif la recherche de la vérité sur la toxicomanie des anesthésistes pendant leur formation et l’exercice de leur profession lors de périodes de stress et l’efficacité des programmes de prévention. Les 260 anesthésistes formés au collège de médecine du Wisconsin entre 1958 et 1988 ont reçu par la poste un questionnaire sur l’utilisation des drogues psychoactives. Les 183 réponses reçues ont été analysées en tenant compte de facteurs démographiques et psychosociaux. Les produits les plus utilisés ont été dans l’ordre: l’alcool (91,6%), la marijuana (30.8%) et la cocaïne (9,4%). Vingt-neuf anesthésistes s’identifiaient comme toxicomanes: 19 par l’alcool, six par les drogues, et quatre par les deux substances associées. Les plus grands usagers sont ceux qui ont terminé après 1975. Cinquante-huit (32%) ont recherché l’effet euphorisant; onze ont reconnu leur utilisation pendant deux semaines ou plus. Huit se disent dépendants. L’abus des toxiques était plus fréquent chez les parents des anesthésistes toxicomanes (35%) que chez les non-utilisateurs (8,1%, P < 0.001). Le taux de divorces chez les anesthésistes utilisateurs (24,1%) était plus élevé que chez les non-utilisateurs (5,2%, P < 0.001). L’augmentation du stress pendant la formation ne coïncidait pas avec l’utilisation de narcotiques. Peu se sont rappelé d’avoir eu des conseils sur le sujet. Soixante-dix pourcent ont jugé la politique de contrôle hospitalier des narcotiques de moyenne à pauvre. Les plus jeunes parmi les répondants (nés après 1951) étaient plus critiques des programmes de contrôles des narcotiques que leurs confrères plus âgées. Des épisodes d’usage abusif ont été signalées tant chez les résidents que chez les professeurs. L’abus des substance psychoactives demeure un problème d’importance chez les anesthésistes.
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Lutsky, I., Hopwood, M., Abram, S.E. et al. Psychoactive substance use among American anesthesiologists: a 30-year retrospective study. Can J Anaesth 40, 915–921 (1993). https://doi.org/10.1007/BF03010092
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DOI: https://doi.org/10.1007/BF03010092