Physician Drug Abuse Can Be Treated Successfully - A Review of Dr. Skipper's Article
As a lawyer for doctors we see a major gap in California and many other states. Doctors can be very successfully treated for drug and alcohol issues but the programs and rules surrounding physician addiction tend to be punitive and often counter productive. As a human being our lawyers want doctors to receive treatment but as "lawyers" sometimes time off from work for a 30 or 60 day treatment program will end a career. No one gains from that approach.
Robert L Dupont and Gregory E Skipper wrote an exellent article titled "Six lessons from state physician health programs to promote long-term recovery". Read the article.
Meanwhile, here is a summary of the article and some comments.
Summary of the Article (but read it in full as well!)
"Six lessons from state physician health programs to promote long-term recovery" by Robert L. DuPont and Gregory E. Skipper, is published in the Journal of Psychoactive Drugs (2012), draws from the first national study of U.S. state Physician Health Programs (PHPs). These programs manage substance use disorders (SUD) among physicians through structured, long-term care rather than short-term treatment alone.
The authors highlight the exceptional success of PHPs, where sustained recovery rates are significantly higher than in general addiction treatment populations (often citing related studies showing 70-80% abstinence over 5+ years). The paper distills six key lessons from this model that contribute to low relapse rates and promote lifelong recovery: Note: If you have a problem and a PHP is offered by your state there are still some landmines and our lawyers can help you navigate them. For example, we had a treatment center in Florida that was to me (Daniel Horowitz) like a center from a horror movie. Once you were in they wouldn't let you out and if you left they reported to the state that you were so badly addicted that you refused treatment! That being said, treatment is the only viable option and let's see what the authors say works.
- Zero tolerance for any use of alcohol or other drugs.
- Thorough evaluation and patient-focused care planning.
- Prolonged, frequent random testing for alcohol and drugs.
- Effective use of leverage (e.g., linking continued licensure to compliance).
- Clear definition and management of relapses (treating them as opportunities for re-intervention rather than failure).
- The goal of lifelong recovery, strongly rooted in participation in 12-Step fellowships like Alcoholics Anonymous.
The article argues that these elements shift the paradigm from expecting relapse to expecting sustained recovery, offering a replicable framework not just for physicians but potentially for broader SUD treatment. When you select a program see if these if these six factors are genuinely addressed by the program. It is likely that the program staff are aware of Dr. Skipper's work and you can bring the article with you and discuss the points before you sign up.
Review of Six lessons from state physician health programs to promote long-term recovery
This 2012 article remains a foundational and influential piece in the field of addiction medicine, particularly for professional health programs. Its strengths lie in grounding recommendations in empirical data from a landmark national PHP study (the "Blueprint Study"), which demonstrated remarkably high long-term recovery rates—far superior to typical outcomes in general addiction treatment (where relapse rates often exceed 40-60% within a year). However, we believe that at the best centers relapse rates are much, much (did I say MUCH) lower. And also how do you define relapse. A good program is set up to help someone with a one day or one week relapse. Centers also train their patients to avoid harming others when they are relapsing. It is important to recognize that there are degrees of addiction and degrees of relapse so the statistic while accurate does not tell the whole story.
The six lessons are practical, evidence-based, and logically interconnected: combining strict accountability (zero tolerance, testing, leverage) with supportive elements (tailored care, relapse management, 12-Step integration) creates a "contingency management" system that motivates sustained change. The emphasis on lifelong recovery as the explicit goal challenges the prevailing "acute care" model of addiction treatment, making a compelling case for extended monitoring and peer support.
One potential limitation is the unique context of PHPs: physicians are a highly motivated population with high stakes (license loss) and access to resources, which may not fully translate to broader populations. The heavy reliance on 12-Step programs could also be seen as less inclusive of secular or medication-assisted approaches (though the article focuses on abstinence-based recovery).
Overall, this is a highly valuable paper—clear, concise, and optimistic. It provides actionable insights for improving SUD outcomes and has influenced policy, including debates over confidential recovery programs in states like California. Even over a decade later, it stands as strong evidence that structured, long-term care management can make sustained recovery the norm rather than the exception. Recommended for anyone interested in addiction treatment reform or physician wellness.
Again our review is quick and there is much more out there.. Other articles by Dr. Skipper
See Dr. DuPont's program
See Dr. Skipper's Program
Warning
If you are treating a patient while impaired you are at risk of criminal charges. For example, if a patient dies due to a surgical error and it is proven that you were intoxicated at the time of the surgery, you could face murder or manslaughter charges. This is rare but it is not out of the question. If drug or alcohol use arises in the context of a medical malpractice case there is a danger that you might lose insurance coverage.
About Daniel Horowitz
Daniel Horowitz is a lawyer who represents physicians in licensing, peer review, drug and alcohol issues and criminal matters. You can call Daniel for an initial evaluation at (925) 283-1863
