BACKGROUND. This study sought to resolve conflicting views about whether physicians are especially prone to alcohol abuse. METHODS. Using an anonymous, mailed questionnaire on substance use, we surveyed 500 physicians, 510 pharmacists, and 974 of their students. The physicians and pharmacists were selected randomly from the state society's membership lists, and students selected were from local school lists. Follow-up surveys were sent to nonresponders at two-week intervals. RESULTS. The physicians and medical students did not drink especially heavily and were no more vulnerable to alcoholism than were their counterparts in pharmacy and other professions. Physicians differed from pharmacists in their style of drinking (greater frequency, smaller quantity), but not in total amount of alcohol consumed. Drinking habits among physicians were not associated with medical specialty or type of practice, but were positively related to gender (males drank more than females) and to age (older doctors were more apt to qualify as heavy drinkers than were younger doctors). CONCLUSIONS. Physicians were no more likely to abuse substances nonmedically than were other professionals. Any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored.
BACKGROUND. Rhode Island's Division of Substance Abuse asked us to assess the State's drug treatment needs and make recommendations regarding its treatment system for the next three years. METHODS. We used a statewide telephone drug use survey of 5,176 households supplemented by drug-related hospital discharges, Division of Drug Control statistics, and interviews with providers, state officials, and out-of-state experts. Drug abuse was measured with items from the Diagnostic Interview Schedule. Abusers were asked if they were receiving or wanted to receive treatment. RESULTS. Survey responses, used to estimate the unmet need for drug treatment, indicated a need to triple drug treatment services. Regression models using survey data indicated that the treatment network was overly centralized in the Providence area. Interviews with state officials, clinicians, and out-of-state experts provided material for recommendations on reimbursement policy, treatment mix, quality assurance, and cost containment. CONCLUSIONS. The RI Department of Health's certificate-of-need program adopted our overall recommendation for tripling the drug treatment system as its guideline in evaluating proposals for new treatment facilities. With State funding of a new adolescent center and expansion of outpatient slots in the private sector, this recommendation has now been fully implemented.
The State of Rhode Island contracted with the authors to prepare a statewide, comprehensive substance abuse prevention plan. The literature review revealed a lack of research on statewide planning for prevention services. To obtain data for Rhode Island's plan, the authors conducted a family of studies including synthetic estimation, key informant interviews, a telephone survey of agency directors, program budget analysis, construction of a statistical index for estimating the optimal geographic allocation of prevention dollars, and a review of General Laws regarding tobacco, alcohol, and other drugs. Their recommendations include the increased funding and coordination of prevention services, allocating services according to need rather than population size, greater use of social policy as a prevention tool, and a shift in primary prevention programming from senior high to lower grades and in program emphasis from information-education to psychosocial programs.
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