Differential therapeutics and the impaired physician: patient-treatment matching by specificity and intensity

The objective of this study was to determine the nature and degree of patient to treatment matching for a sample of physicians based on differential problem type and severity. Methods included a single assessment of variables using retrospective chart review. Subjects included 108 physicians (98 men and 10 women), who were sampled consecutively from assessments performed over a 2-year period. They represented a variety of specialties, and most were third-party referred, predominantly by state medical societies. Main outcome measures included demographic information, DSM-IV multiaxial diagnoses, the Severity of Substance-Related Disorder scale, and the type and intensity of recommended treatment. It was found that the physicians presented with a variety of conditions that were clustered into three categories: active substance use disorders (52.8%), substance use disorders in remission (17.6%), and psychiatric/behavioral problems (29.6%). An analysis of the appropriateness of matching types of treatment to these problem categories appeared to support a differential assignment process. A range in severity was also found within problem categories and was subsequently tested for correspondence with the range in intensity of recommended treatment. It was found that severity correlated strongly with recommended treatment intensity for all groups. In addition, multiple regression analyses showed that two factors, ability to sustain abstinence and emotional disturbance, were predictive of treatment intensity for the two substance use disorder subgroups (64% of variance accounted for). In the psychiatric/behavioral problem subgroup, such analysis demonstrated that the severity of difficulties with one's significant other was predictive of treatment intensity (89% of variance accounted for).