Contingency contracting treatment of drug-abusing physicians, nurses, and dentists

Seventeen drug-abusing physicians, dentists, and nurses entered contingency-contracting treatment. They deposited with their therapist letters to their respective licensing boards, confessing renewed drug abuse and surrendering their licenses. Each contract directed the therapist to collect frequent urine samples and to mail the letter if a scheduled sample was not provided, or contained drugs. The followup occurred a mean of 20 months after signing the contracts, which were of varied duration. Drug use dramatically declined for most patients after a contract was signed. Most patients' personal and professional lives also improved over the followup time. Twelve patients had suspended licenses or professional privileges before signing the contracts. All then worked; two subsequently lost their licenses through the contract mechanism, and three lost their licenses for other reasons. About half of the patients completed a full year with no apparent relapse. Relapses were more common when contracts were not in effect than when they were.