Characterization of Problematic Alcohol Use Among Physicians: A Systematic Review

Abstract

ImportanceProblematic alcohol use in physicians poses a serious concern to physicians' health and their ability to provide care. Understanding the extent and characteristics of physicians with problematic alcohol use will help inform interventions.ObjectiveTo estimate the extent of problematic alcohol use in physicians and how it differs by physician sex, age, medical specialty, and career stage (eg, residency vs practicing physician).Evidence ReviewPreferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review, searching Medline, Embase, and PsychInfo from January 2006 to March 2020. Search terms included Medical Subject Headings terms and keywords related to physicians as the population and problematic alcohol use as the primary outcome. The quality of studies was assessed using the Newcastle-Ottawa Scale. We included articles where problematic alcohol use was measured by a validated tool (ie, Alcohol Use Disorders Identification Test [AUDIT], AUDIT Version C [AUDIT-C], or CAGE [Cut down, Annoyed, Guilty, and Eye-opener] questionnaire) in practicing physicians (ie, residents, fellows, or staff physicians).FindingsThirty-one studies involving 51 680 participants in 17 countries published between January 2006 and March 2020 were included. All study designs were cross-sectional, self-reported surveys. Problematic alcohol use varied widely regardless of measurement method (0 to 34% with AUDIT; 9% to 35% with AUDIT-C; 4% to 22% with CAGE). Reported problematic alcohol use increased over time from 16.3% in 2006 to 2010 to 26.8% in 2017 to 2020. The extent of problematic use by sex was examined in 19 studies, by age in 12 studies, by specialty in 7 studies, and by career stage in 5 studies. Seven of 19 studies (37%) identified that problematic alcohol use was more common in males than females. Based on the wide heterogeneity of methods for included studies, limited conclusions can be made on how problematic alcohol use varies based on physician age, sex, specialty, and career stage.Conclusions and RelevanceStudies about problematic alcohol use in physicians demonstrate a high degree of heterogeneity in terms of methods of measurement, definitions for problematic alcohol use, and cohorts assessed. Most studies are primarily self-reported, precluding the ability to determine the true prevalence among the profession. Few studies provide relevant comparisons to aid in identifying key risk groups for targeted interventions.

Attitudes and current practice in alcohol screening, brief intervention, and referral for treatment among staff working in urgent and emergency settings: An open, cross-sectional international survey

“…Alcohol and substance misuse are not uncommon in the healthcare professions. A systematic review of 31 studies involving 51,680 participants in 17 countries, problematic alcohol use was reported by physicians and increased over time (from 16.3% in 2006–2010 to 26.8% in 2017–2020) [ 56 ]. A survey of ED doctors found that (despite being trained in the detection of alcohol misuse) 63% reported that they misuse alcohol at least once a month and 30% once or more a week [ 57 ].…”

Alcohol-Related Deaths of US Health Care Workers

“…Despite an increase in alcohol-related deaths in the US over the last 2 decades, little is known about alcohol-related mortality risks among physicians and other health care workers. Compared with non–health care workers, health care workers have increased drug overdose death risks . An occupational liability to substance use or to risks of painful injuries and access to controlled substances may explain these findings.…”

“…Compared with non–health care workers, health care workers have increased drug overdose death risks. 4 An occupational liability to substance use or to risks of painful injuries and access to controlled substances may explain these findings. Only the first hypothesis would contribute to an increased risk of alcohol-related mortality.…”

Alcohol's impact on fine motor skills: Insights from minimally invasive surgical simulation

“…Evidence suggests a high prevalence of alcohol misuse among physicians, specifically surgeons [ [1] , [2] , [3] , [4] ]. Furthermore, there are grounds to assume that global alcohol consumption among healthcare workers has increased since the onset of the COVID-19 pandemic [ [5] , [6] , [7] , [8] , [9] , [10] ].…”