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Drug and Alcohol Use by Dental Healthcare

Professionals and Students

George A. Kenna, Ph.D., B.S.Pharm., R.Ph.

Assistant Professor of Psychiatry Center for Alcohol and Addiction Studies

Brown University, Providence RI

Clinical and Investigational Pharmacist

Miriam Hospital, Providence, RI American Academy of Oral Medicine 4/12/14

Learning Objectives:

Discuss the prevalence of alcohol and other drug use by dentists

compared to other healthcare professionals and to the general population

Consider if suicide rates are higher in the dental profession

Know the basics for identifying substance use disorders (SUDs) in

yourselves and colleagues

Recognize the basics for treatment and support

Understand the importance for dentists and dental students to be involved

in ongoing education of SUDs

American Academy of Oral Medicine 4/12/14

• While not citing any prevalence studies of substance use by dentists, Hedge (1985) estimated that as many as 15% to 18% of dentists could be addicted to drugs and alcohol.

• “Chemical dependency has received much attention as a

national problem, and current evidence suggests that it

may be more widespread among dentists than among the

overall population of the United States.” (Clarke, Chiodo,

& Cowan, 1988. )

• “The health professions may attract those vulnerable to drug abuse because of their emotional impairment due to alcoholic and emotionally abusive parents.” (Coombs, Drug Impaired Professionals, 1996)

Speculative Comments:


• Several studies of dental students (Bowermaster, 1989; Sammon et al; 1991; Sandoval et al., 1988; 1990) suggested that many dentists come from dysfunctional families or families with a history of alcoholism or chemical dependency. e.g. Sammon et al. (1991) reported that 35-39% of students at two dental schools had an alcoholic parent or grandparent.

• Chiodo and Tolle (1997) drawing on non-representative disciplinary action data, deduced that dentists were at higher risk for substance use and abuse than the general population, and questionably concluded the literature had consistently reported disproportionately higher rates of chemical dependency in HCPs.

Speculative Comments:


• Used qualitative or treatment samples

• Poor use of measures

• Assessed only one healthcare profession

• Used professional organizations to recruit

• No consideration of Type II error

Problems with many previous studies included:

―Prevalence of Alcohol and Other Drug Use and Abuse

in Healthcare Professionals

• The major aim of this study was to investigate the prevalence

of substance use in the major groups of HCPs using

methodologically sound criteria.


Method

• Used validated measures

• Stratified by zip-codes

• Randomly chose Dentists, Nurses, Pharmacists, Physicians

licensed in Rhode Island, but living in RI, MA or CT only.

• 6 contacts over 8 weeks: Social-exchange theory (Dillman,

2001)

• 7 page self-report survey

• N = 479/697

• Response rate 68.7%

– MDs = 63.4% to RNs = 73.3%.


Dentists

Registered

Nurses

Pharmacists

Physicians

Number of

Licensees*

755 18,927 1,917 4,174

Gender Men

80.3

Women

19.7

Men

10.7

Women

89.3

Men

51.6

Women

48.4

Men

74.3

Women

25.7

Demographics Supplied by the Rhode Island Department of Health

Note. The Department of Health figures differ from those used for the study as they include all

licensees regardless of state of residency.

(Kenna Dissertation, 2003) American Academy of Oral Medicine 4/12/14

American Academy of Oral Medicine 4/12/14 (Kenna & Wood, Journal of the American Pharmaceutical Association, 2004).


(Kenna & Wood, Journal of the American Pharmaceutical Association, 2004)

American Academy of Oral Medicine 4/12/14 (Kenna & Wood, Journal of the American Pharmaceutical Association, 2004)


(Kenna & Wood, Journal of the American Pharmaceutical Association, 2004). American Academy of Oral Medicine 4/12/14

American Academy of Oral Medicine 4/12/14 Kenna & Wood, Drug and Alcohol Dependence, 2004

Alcohol Use and Misuse During the Past Month

Dentists

(n = 81)

Nurses

(n = 70)

Pharmacists

(n = 87)

Physicians

(n = 69)

NHSDA

2002

Quantity by Frequency Index

Mean drinks/ month (SD)

26.7 *

(21.9)

20.5

(18.8)

18.4

(15.9)

17.9

(20.3)

Mean drinking days/month 12.6*

(8.4)

10.7

(7.9)

9.3

(6.7)

10.0

(7.8)

Mean drinks/drinking day 2.1

(1.1)

1.9

(.86)

2.0

(1.0)

1.7

(.88)

Heavy episodic alcohol use (%) 15.9 * 8.5 12.0 7.7 18.1

Heavy alcohol use (%) 0.9 0.8 0 1.9 5.7

Consider self a heavy drinker (%) 0.9 0 0 1.9

Consider self a problem drinker (%) 0.9 0 0 0

Kenna & Wood, Drug and Alcohol Dependence, 2004

*P<.05; **P<.01; ***P<.001


Kenna, G.A. & Wood, M.D. Journal of the American Dental Association. July 2005; 136: 1023-1032.


0.8



Kenna, G.A. & Wood, M.D. Journal of the American Dental Association. July 2005; 136: 1023-1032.


Kenna, G.A. & Wood, M.D. Journal of Substance Use, 2005; 10 (4): 225-238.


0

10

20

30

40

50

60

70

Den t ist s Nur ses Phar macist s Physician s

One or more f amily members

*P<.05; **P<.01; ***P<.001

***

Family History of Alcohol Problems

American Academy of Oral Medicine 4/12/14 Kenna, G.A. & Wood, M.D. Journal of Substance Use, 2005; 10 (4): 225-238.

0

5

10

15

2 0

2 5

3 0

Den t ist s Nur ses Phar macist s Physician s

One or more f amily members

Percen

tage

*P<.05; **P<.01; ***P<.001

**

Family History of Drug Problems

American Academy of Oral Medicine 4/12/14 Kenna, G.A. & Wood, M.D. Journal of Substance Use, 2005; 10 (4): 225-238.

Summary of Results • General Results

• The prevalence of illicit drug use by HCPs only slightly exceeds that of the general population

• Based on self-report those HCPS who report illicit drug use appear more poly-drug experienced (data not shown)

• Dentists consumed significantly more alcohol than all but nurses

– More reported past month use of marijuana however the

prevalence of drug use by Dentists does not exceed that of other

HCPs

– Received significantly more offers to drink alcohol in social

situations than other HCPs (data not shown)

– Lowest proportion of family history of alcohol and drug use of

HCPs surveyed





compared to other healthcare professionals and to the general

population





Understand the importance for dentists and dental students to be

involved in ongoing education of SUDs

CAUSES OF STRESS IN DENTISTRY

•Confinement and Physical problems often sitting in one position

•Isolation

•Economic pressures

•Time pressures

•Compromise treatment frustration

•Patient anxiety

•Lack of exercise

•Alcohol use increases stress, anxiety and sleep problems

•Dentist's personality • compulsive attention to details;

• extreme conscientiousness;

• careful control of emotions;

• unrealistic expectations of himself or herself and others (i.e. employees and

patients);

• a marked dependence on individual performance and prestige. Lang R DDS (2007) http://www.oralhealthgroup.com/news/stress-in-dentistry--it-could-kill-you/1000214585/?&er=NA

American Academy of Oral Medicine 4/12/14 Roberts et al., High-risk occupations for suicide. Psych Medicine 2013 Jun;43(6):1231-40.

American Academy of Oral Medicine 4/12/14 Roberts et al., High-risk occupations for suicide. Psych Medicine 2013 Jun;43(6):1231-40.


Are suicide rates higher in the dental

profession?

• No strong evidence to support this notion – Alexander (2001) and Sancho & Ruiz (2010) found little

valid evidence that dentists are at greater risk for suicide

than the general population.

– Looking at Roberts et al (2013) data, perhaps just

coincidental

• More data is needed

Sancho FM, Ruiz CN. Risk of suicide amongst dentists: myth or reality? Int Dent J. 2010 Dec;60(6):411-8.

Alexander, Stress-related suicide by dentists and other health care workers Fact or folklore? JADA

2001 132, 786-794 .

http://boston.redsox.mlb.com/NASApp/mlb/index.jsp?c_id=bos






population








What is a Substance Use Disorder?




Statement on Substance Abuse Among Dentists

(Trans.2005:32)

Resolved, that the following ADA Statement on Substance Abuse among Dentists be adopted.

Statement on Substance Abuse among Dentists

1.Dentists who use alcohol are urged to do so responsibly. Dentists are also urged to use

prescription medications only as prescribed by an appropriate, licensed healthcare professional

and to avoid the use of illegal substances.

2.Colleagues, dental team members, and the dentists’ family members, are urged to seek assistance

and intervention when they believe a dentist is impaired.

3.Early intervention is strongly encouraged.

4.Dentists with addictive illness are urged to seek adequate treatment and participate in long term

monitoring protocol s to maximize their likelihood of sustained recovery.

5. Impaired dentists who continue to practice, despite reasonable offers of assistance, may be

reported to appropriate bodies as required by law and/or ethical obligations.

6. Dentists in full remission from addictive illness should not be discriminated against in the areas

of professional licensure, clinical privileges, or inclusion in dental benefit network and provider

panels solely due to the diagnosis and recovery from that illness.

7.The ADA encourages additional research in the area of dentist impairment and the factors of

successful recovery.

American Dental Association Current Policies Adopted 1954-2012 Copyright

2013, American Dental Association, 211 East Chicago Avenue, Chicago, Illinois 6061

Teaching Dentists and Dental Students about

Substance Use/Dependence


Statement on Substance Use among Dental Students (Trans.2005 :329)

1. The ADA supports educational programs for dental students that address professional

impairment associated with substance abuse.

2.Dental students who use alcohol should strive to do so responsibly. Dental students are

also urged to use prescription medications only when prescribed by an appropriate,

licensed healthcare professional and to avoid the use of illegal substances.

3. Dental school administration and faculty are encouraged to promptly intervene once

aware of inappropriate substance use by a student.

4. Dental schools are strongly encouraged to support a student’s referral to an addiction

treatment program, if appropriate, and indicated by a thorough evaluation, prior to

making disciplinary decisions.

5.Dental schools are encouraged to support only the responsible use of alcohol on their

premises or at their functions or by faculty when with students in social settings.

American Dental Association Current Policies Adopted 1954-2012 Copyright 2013,

American Dental Association, 211 East Chicago Avenue, Chicago, Illinois 6061


The Story of Lance Smith

Graduated Posthumously Class of 2001


The odor of alcohol on the breath or strong odor of mouthwash or mints to mask the

alcohol.

Hand tremor that occurs (when in alcohol withdrawal)

Excessive perspiration

Absent from work without notice, frequent absenteeism or late for work (? Alcohol

abuse)

Unexplained disappearance during work for long periods of time

Sleeping or dozing off while on duty

Frequent bathroom breaks

Deterioration in personal appearance

Reports of illness, minor accidents, and emergencies

Confusion, memory loss and difficulty concentrating

Increase in sloppy recordkeeping.

Work performance that alternates between periods of high and low productivity.

Unreliability in keeping appointments and meeting deadlines

Personality changes and mood swings

Behavioral signs and symptoms of AOD use


• Probably the most difficult professional decision a

dentist can make is to confront a co-worker with an

AOD problem.

• Dentists should consider that many colleagues in

retrospect feel that an intervention probably saved their

lives.

• As with physicians, nurses and pharmacist, if dentists

cooperate with treatment it is generally expected that

most will be allowed to resume their profession.

Taking Care of Your Own:






population

Consider if suicide rates higher in the dental profession







Recovery Assistance Programs

•If a dentist requests help from a counseling agency, they will not

be reported

-the information they provide is by law confidential.

•However first step is usually inpatient treatment

•Inpatient e.g. Hazelden (part of Betty Ford Foundation),

The Farley Center, Talbott Recovery Center etc;

•Followed by Outpatient counseling programs.

•Referral to 12 step programs e.g. AA, NA etc.

•Caduceus is a 12-step program just for healthcare

professionals



Treatment Success

•The goal of returning a recovering dentist to practice with

the proper aftercare and monitoring program is realistic and

almost always successful.

•No data for dentists but a 1988 survey examined pharmacist

assistance programs in all 50 states and the District of

Columbia.

•Just over 88% of pharmacists successfully completed

treatment and returned to practice.

McNees, G.E., & Godwin, H.N.. American Pharmacy, 1990; NS30 (5):33-37.






population








Dental School Curricula

Huggett et al

40


For Practicing Dentists

CMEs e.g.: http://mediasite.video.ufl.edu/Mediasite/Play/20a

372f19a0e4855a2f8c7f0041e3b711d

American Dental Association Health and Wellness Resources etc http://www.ada.org/4503.aspx

http://mediasite.video.ufl.edu/Mediasite/Play/20a372f19a0e4855a2f8c7f0041e3b711d

http://mediasite.video.ufl.edu/Mediasite/Play/20a372f19a0e4855a2f8c7f0041e3b711d

http://www.ada.org/4503.aspx


../LIU Presentation/main.htm

For over 20 years, the ADA has actively supported the Dentists

Section of the Utah School on Alcoholism and Other Drug

Dependencies in Salt Lake City.

-Annual weeklong program to bring together dentists and

dental students (as well as many other groups of healthcare

professionals and others) with various state coordinators, state

administrators, industry representatives and interested persons

from around the country to listen to updates on various aspects of

AOD intervention and treatment.

Dental Section

http://medicine.utah.edu/uas/Dental%20Introduction.htm


../LIU Presentation/main.htm

http://medicine.utah.edu/uas/Dental Introduction.htm

Conclusions •Rates of AOD abuse or dependence among dentists may be no greater than in the

other healthcare professionals and is similar to the general population but the

consequences of any impairment can have adverse effects on the dentist, practice and

patients.

•Alcohol use seems to be greater among dentists than other healthcare professionals

and is the greatest (drug) threat to a dentists health.

•Family history of alcoholism/drug appears lowest of major healthcare professions

•Stress is a ubiquitous problem for dentists but probably not more so than many

other jobs in the healthcare professions.

•Suicide does not appear to be a greater problem in dentistry than in any other

healthcare professions, but more data is needed.

•The profession has an ethical obligation to ensure that its practitioners can

discharge their duties with skill and safety.

•Policies should promote early discovery of professionals who overuse AOD in order

to minimize the period of time that patients are at risk of being harmed.

•Treatment is almost always successful.


Contact:


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