Problematic alcohol use in physicians is rising, but its true prevalence is unknown
Problematic alcohol use among physicians appears to be on the rise, but self-reported studies preclude the true prevalence in the profession, according to researchers.
“Problematic alcohol use in physicians poses a serious concern to physicians' health and their ability to provide care. Understanding the extent and characteristics of physicians with problematic alcohol use will help inform interventions,” Janet Wilson, a medical student at the University of Ottawa, and colleagues wrote in JAMA Network Open.
The researchers conducted a systematic review to better understand how pervasive problematic alcohol use is for physicians, and how it might vary by characteristics like age, specialty and sex.
For their evidence review, Wilson and colleagues included studies that assessed problematic alcohol use through validated tools, such as the Cut down, Annoyed, Guilty and Eye-opener (CAGE) questionnaire, Alcohol Use Disorders Identification Test (AUDIT) and AUDIT Version C (AUDIT-C).
The researchers included 31 studies in 17 countries that were published between January 2006 and March 2020. A total of 51,680 participants were involved in the studies — all of which had designs that were cross-sectional, self-reported surveys.
Wilson and colleagues found that, regardless of measurement method, “problematic alcohol use varied widely (0% to 34% with AUDIT; 9% to 35% with AUDIT-C; 4% to 22% with CAGE).”
In 2006 to 2010, reported problematic alcohol use was 16.3%. In 2017 to 2020, the prevalence jumped to 26.8%. However, “it remains unknown whether this increase is indeed accurate or whether it is due to increased transparency by physicians in self-reporting problematic alcohol use because of a changing culture of medicine.”
Nineteen studies examined the extent of problematic alcohol use by sex, and seven of those — 37% — “identified that problematic alcohol use was more common in males than females.”
“Based on the wide heterogeneity of methods for included studies, limited conclusions can be made on how problematic alcohol use varies based on physician age, sex, specialty, and career stage,” the researchers cautioned.
One difficulty the researchers noted was that “the definition of what constituted a positive screen for problematic alcohol use varied widely between studies.” Additionally, they noted that “most studies reported low response rates,” which suggests that physicians could “be hesitant to participate in studies assessing problematic alcohol use.”
“Physicians who use alcohol-related screening questionnaires as part of their practice may be familiar with the scoring systems and may answer in such a way as to screen negative for problematic alcohol use. Physicians may be likely to underreport use for fear of reprisal by colleagues and licensing boards,” they wrote. “Therefore, the low levels of problematic alcohol use identified in this review likely underestimate the scale and consequent harms from alcohol use by physicians.”
The researchers concluded that “studies about problematic alcohol use in physicians demonstrate a high degree of heterogeneity in terms of methods of measurement, definitions for problematic alcohol use, and cohorts assessed.” Additionally, they noted that since most studies are primarily self-reported, the ability to determine the true prevalence among the profession is precluded.
“Cultural changes minimizing stigma and reducing obstacles to seeking help may encourage physicians who suffer in silence to seek help. Future research could also aim to better understand factors that limit physician disclosure of problematic alcohol use and ultimately deconstruct these factors to promote care-seeking behavior in physicians,” Wilson and colleagues wrote. “Furthermore, a clearer understanding of what sex, age, physician specialties and career stages are most at risk for problematic alcohol use would help inform the development of physician health programs that identify problematic alcohol use and establish timely interventions for those in need.”
The American Addiction Centers offer resources specifically for physicians in need, and there are various confidential ways to contact them and learn about treatment: visit this page or call (866) 685-9481.