Alternate Approaches to 12 step

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Slide1: 

Victorian Doctors Health Program Dr Naham (Jack) Warhaft M.B.,B.S., F.A.N.Z.C.A., F.A.Ch.A.M. Medical Director VICTORIAN DOCTORS ICPH Ottawa, Nov 2006 An Alternative Approach to 12-step Participation in the Management of Addicted Physicians

Slide2: 

Victoria is the second largest state by population in Australia. It has about 5 million people; 17 000 doctors and 2000 medical students It covers an area about the size of North Carolina. Approximately 3 million live in Melbourne and a further 1 ½ million within 90 minutes drive VICTORIA

Slide3: 

VDHP - Principal Aims To assist doctors and medical students whose condition will, or is likely to, impact adversely on their ability to continue to practice medicine. An independent legal entity Confidential professional service

MODEL: 

MODEL US and Canadian PHPs The original intention was to use the North American model. It became apparent that it would have to be Modified to suit Australian conditions Commenced May 2001

VDHP Services: 

VDHP Services Intervention Assessment and referral Case management Aftercare and monitoring Assistance with re-entry to work Caduceus (support and monitoring) groups Family support Advocacy – Work, MPBV, Courts

Administrative Structure: 

Administrative Structure Independent Board of Management: 3 doctors appointed by the AMA 3 doctors appointed by the Medical Board (but not on the Medical Board) Chairperson jointly appointed by AMA and MPBV Fully funded by the Medical Board

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Main differences between Australia and North America CULTURAL LEGAL

Some Cultural Differences: 

Some Cultural Differences Concept of ‘cross addiction’ is poorly recognised More Secular Society Religion is considered a more ‘private’ matter Low level of religious observance (monthly attendance is approximately 10% in Australia compared with over 40% in the US). This has implications for 12-step programs, but AA / NA are well established all over the country Anti-authoritarian attitude ‘Drink til you drop’ attitude. Moderate inebriation is tolerated. ‘Wowsers’ are thin on the ground. In Australia:

Legal Differences: 

Legal Differences Much lower level of litigation in Australia (but we’re learning, and catching up fast!) As a consequence, some of the North American programs appear to us to be more rigid (less capacity to tailor to individual needs) We have never had a lawyer represent a doctor at the VDHP or at a back-to-work conference Our MPBV is more interested in impairment than drug use

Recovery Pathways: 

Recovery Pathways

Selection criteria include: 

Selection criteria include Narrow repertoire of drug use Past history of treatment and relapse Family history Consideration of comorbid disorders Enthusiasm for or resistance to 12-Step program Total or limited abstinence requirement

Program Requisites: 

Program Requisites High quality Intense Enduring

Program components - Therapy: 

Program components - Therapy

Reservations about these Results: 

Reservations about these Results No differentiation between dependency or abuse Outcome measures are imperfect Difficulty in labelling participants as 12-Step or Non-12-Step

Results Comparison of 12-Step and Other Pathways (71 participants in Case Management, Aftercare and Monitoring Program – ‘CAMP’): 

Results Comparison of 12-Step and Other Pathways (71 participants in Case Management, Aftercare and Monitoring Program – ‘CAMP’)

Relapses: 

Relapses

Some examples of Non-12-Step Alcoholics: 

Some examples of Non-12-Step Alcoholics ‘Saltbush Bill’ – 40’s radiologist – now sober 3 years ‘Waltzing Matilda’ – 36 yr ENT surgeon – now sober 1 year ‘Ben Bowyang’ - 40’s pathologist, DD, 3 years sober ‘Crocodile Dundee’ – 50’s physician/academic, DD, 1 year sober

Some examples of ‘Other’ Other drugs: 

Some examples of ‘Other’ Other drugs ‘Ginger Mick’ – 65 yrs anaesthetist, narcotics relapsed after 8 years. Now 5 years clean ‘Ned Kelly’ – 60 yrs anaesthetist, narcotics, now 10 years clean, but passed on to us due to personality disorder ‘Snowy River’ – 35 yrs GP, narcotics. Now 2 years clean ‘Midnight Grease’ – 26 yrs, cocaine, speed, alcohol etc. came as student. 3 years clean (1 lapse)

Conclusions: 

Conclusions The VDHP data over 5 years shows no significant difference between the outcomes of the 2 groups The wider use of alternatives to AA/NA may assist in the retention in ongoing treatment of some participants Further studies are required to help clarify the situation

Conclusions: 

Conclusions Our results suggest that there are effective alternatives to 12-Step participation in the management of SUDs in physicians The experience of the VDHP is that high quality, intense and enduring alternative programs have a significant place in their management.

Further Studies: 

Further Studies It is hoped that in 2007, every VDHP participant with SUDs will be independently reassessed. Outcomes will be analysed in relation to: Diagnosis (dependency or abuse) 12-Step or Alternate Program “Drinking” or “Total Abstinence” Outcome measures will also be reviewed.

Slide22: 

Victorian Doctors Health Program Tel. 9495 6011 Level 8, Aikenhead Building 27 Victoria Parade Fitzroy 3065 vdhp