| The College of Physicians and Surgeons of Alberta (CPSA) is mandated to ensure that a physician is fit to practice and does not pose a risk to patients. This will become a pertinent issue if a physician, who is in recovery from substance abuse, is in active medical practice when he/she relapses. Physicians with substance abuse issues meet with the Assistant Registrar when they return from treatment and, at that time, sign a five year contract with CPSA. One of the conditions of returning to active practice is that they remain clean and sober. A relapse may be seen as a breach of this contract. To assist the CPSA in arriving at a decision as to the best course of action to restore the individual’s commitment to behavioral change and return to recovery, information is gathered from a team that might include, but is not excusive to the following: - Medical Review Officer
- Program Coordinator of the Physician Health Monitoring Committee (PHMC) Monitoring Group
- Treating Physicians
- PFSP Clinical/Program Director and Case Coordinator
- Head of Department at physician’s worksite or colleagues if in a group family practice.
- Spouse, significant others or support people
Definition Recurrence of psychoactive substance dependent behavior in an individual who had previously achieved and maintained abstinence for a significant period of time beyond withdrawal. (ASAM) Relapse to old behaviour is not a failure; it is a normal part of recovery for many individuals, and it can help the individual to find out things about themselves that will help them to prevent it from happening again. An individual in relapse may show behaviours that include: - Failing to keep appointments.
- Refusal or evasion of drug screens.
- Experiencing feelings of disappointment and shame that may present as anger, sarcasm or suicidal ideation.
- Being seen by others as moody, irritable or unreliable.
- Occasioning complaints from patients, colleagues or staff.
Early identification of the risk of relapse and active outreach to the individual at risk is very important in restoring the individual’s commitment to behavioral change. Manifestations of relapse - Pre-relapse thinking and/or behavior that may trigger an actual return to using (e.g. an alcoholic who goes back to the pub to meet his old drinking friends and intends to drink only coffee, or the gambler who returns to the casino just to observe). An individual who does not continue to maintain their recovery program (i.e. narcotics abuser who stops going to NA meetings, and loses contact with his sponsor, is in danger of using).
- Brief relapse (sometimes known as a slip), the individual returns briefly to his old substance abuse behaviour (usually a single incident of using).
- Prolonged relapse is when the individual continues beyond a single instance of using.
Identification of Relapse - Positive drug screen or breathalyzer.
- Self-report by individual.
- Third party report of individual’s relapse behaviour.
Management of Relapse might include prevention: - Maintenance of individualized recovery program.
- Regular monitoring group attendance (PHMC).
- Random bodily fluid monitoring or regular daily breathalyzer testing.
- Participation in PFSP Case Coordination.
- Attendance at Caduceus meetings.
- Regular attendance at 12-Step meetings and involvement with sponsor.
Management of Brief Relapse
Management may be influenced by whether the incident was self disclosed or found on a random screening, but may include any or all of the following: - Increased frequency of screening or daily breathalyzer on the way to work if alcohol is the abused substance (if the physician has a positive test, they would be prohibited from going to work that day and their car keys confiscated).
- Physician should meet with their addictionologist as soon as possible to identify triggers which had precipitated relapse behaviour.
- Individual counselling possibly arranged through PFSP.
- Advice to increase attendance at 12-Step meetings and contact with sponsor.
- Licensure and contractual issues would be reviewed by the Assistant Registrar.
Management of prolonged or repeated brief relapse
Management might include all or any of the above and return to a treatment centre for further inpatient treatment would be considered. |