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
44
Embed
Drug and alcohol use by dental healthcare professionals and students
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
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:
American Academy of Oral Medicine 4/12/14
• 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:
American Academy of Oral Medicine 4/12/14
• 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
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%.
American Academy of Oral Medicine 4/12/14
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).
American Academy of Oral Medicine 4/12/14
(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)
American Academy of Oral Medicine 4/12/14
(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
American Academy of Oral Medicine 4/12/14
Kenna, G.A. & Wood, M.D. Journal of the American Dental Association. July 2005; 136: 1023-1032.
American Academy of Oral Medicine 4/12/14
0.8
American Academy of Oral Medicine 4/12/14
American Academy of Oral Medicine 4/12/14
Kenna, G.A. & Wood, M.D. Journal of the American Dental Association. July 2005; 136: 1023-1032.
American Academy of Oral Medicine 4/12/14
Kenna, G.A. & Wood, M.D. Journal of Substance Use, 2005; 10 (4): 225-238.
American Academy of Oral Medicine 4/12/14
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
American Academy of Oral Medicine 4/12/14
Learning Objectives:
American Academy of Oral Medicine 4/12/14
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
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.
American Academy of Oral Medicine 4/12/14
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