I. Overview
TLAP is a program of the Tennessee Supreme Court. Pursuant to the Court’s directives, and informed by national medical experts and clinical studies, TLAP’s programming reflects the “gold standard” for assisting licensed professionals and protecting the public.
Confirming the success of TLAP’s program, in FY 2021-2022 TLAP’s monitoring program generated an unprecedented 85% no-relapse success rate in alcoholism and addiction cases.
While astonishing, and perhaps even unbelievable to some (considering relapse is often accepted as the likely outcome of addiction treatment in the general population), an 85% no-relapse recovery rate is in fact an expected outcome in monitoring programs that implement clinical best practices for assisting licensed professionals.
At the core of TLAP’s current programming, individualized services are key. The facilitation of objective and reliable diagnostics and treatment is provided on a case-by-case basis. It is imperative that individualized diagnostics, and treatment if indicated, are facilitated at levels that provide a solid foundation that precedes TLAP monitoring. TLAP monitoring agreements and lengths of monitoring reflect clinical best practices, and include individualized components as needed.
Monitoring is purely clinical. It is not punishment or probation. It is clinically designed to support long-term recovery without relapse, not only during the monitoring period but going forward in life thereafter.
“Think of monitoring as post-surgery antibiotics that should be fully completed even if you are feeling better.”
A number of TLAP’s monitoring participants are totally confidential and voluntary, and are not involved in any bar admissions or disciplinary matter. They are not bound to TLAP and are fully protected by confidentiality. They enter monitoring because their treatment provider and TLAP have explained very valuable health benefits, including lowering relapse risks.
Voluntary monitoring participants are never trapped in TLAP. They can always quit monitoring at any time with no questions asked, but the majority of voluntary monitoring participants complete the program because they have been educated about the clinical benefits of TLAP and its 85% no-relapse recovery rate on average.
Of course, in addition to supporting recovery and mental health, TLAP monitoring also provides the participant with an opportunity to generate an independent and objective record of fitness to practice if need be in licensing or employment matters. TLAP compliance supports the possibility of licensure, reinstatement, and/or continued employment despite a prior history of impairment and/or impairment-related unethical conduct.
II. Scientific Studies and Reports That Support Length of Monitoring Protocols
TLAP’s role in the profession is mandated by Tennessee Supreme Court Rule 33. TLAP provides confidential mental health support and does so at levels that reliably and objectively generate fitness to practice law. In fact, the expectation is that successful TLAP participation and compliance will generate “clear and convincing evidence” that any impairment has been removed and the participant is in stable remission and safe to practice law. This requires a very dependable level of clinical intervention, accountability, and objective verification.
No longer limited to Substance Use Disorder (SUD) cases involving alcoholism and drug addiction, TLAP now also offers an additional type of monitoring tailored to mental health issues that have no SUD component at all. TLAP’s monitoring services are now comprehensive and more complex in order to support the entire spectrum of mental health recovery.
The following history of scientific studies, subsequent reports, and recommendations provide a solid foundation for what is now considered the “gold standard” as to appropriate lengths of monitoring to render support and evidence of full remission and expected long-term recovery.
Of course, these are medical issues, not legal issues. All of the advancements in monitoring SUDs have been accomplished by top addiction doctors, treatment providers, medical experts, and those providing professional monitoring services in the medical profession. These efforts in the field of medicine originated long before Lawyer Assistance Programs were formed.
Some people may become confused and think that the doctors’ programs and studies generated in conjunction therewith are not applicable to any other licensed professionals. On the contrary, all of these medical efforts are singularly focused upon reliably arresting diseases and establishing evidence of full remission. It is ancillary that resultant high recovery rates also support safety to practice a licensed profession be it medicine or law, etc.
In other words, this medical work and monitoring is not at all occupation-specific; it is disease-specific. SUDs, like cancer, diabetes, and other chronic and potentially deadly diseases, do not distinguish between doctors, carpenters, musicians, short-order cooks, stay at home parents, homeless persons on the streets of your downtown, or even the First Lady of the United States (Betty Ford). Cancer is cancer. Addiction is addiction. And these diseases can be extremely powerful adversaries irrespective of one’s perspective and station in life.
TLAP’s mission is unified with the missions of all other monitoring programs for lawyers, doctors, nurses, and airline pilots, etc.: support truly reliable recovery outcomes so that the professional’s personal health is fully restored, and concurrently render objective and reliable monitoring evidence that proves the professional is in recovery, safe to practice, and does not pose a risk of harm to the public.
The universal challenges in SUD recovery monitoring are:
More simply put, in satisfying these completely aligned missions, how long does someone with SUD diagnoses have to remain clean and sober under monitoring to objectively demonstrate that the risk for relapse has been suitably extinguished in a licensed professional?
What has definitively emerged in the last two decades, both in the general population and for professionals, is the diagnostic significance of successfully remaining clean and sober for five (5) years in moderate to severe SUD cases (what used to be deemed “chemical dependency”).
A five (5) year time period without relapse is of major importance to ALL persons recovering from SUDs, not just licensed professionals.
The following studies and guidelines are a sampling of scientific data that provide support for various lengths of TLAP monitoring:
2003 Study: “A 60-year Follow-up of Alcoholic Men” (1)
This Harvard medical study focuses on recovery rates from alcoholism in the general population over the course of a 60-year period of time. It established that alcoholism is, just like cancer, a chronic disease that cannot really be considered in complete, full remission until there has been no relapse for a period of five (5) years:
“In short, analogous to cancer patients, a follow-up of 5 years rather than of 1 or 2 years would appear necessary to determine stable recovery.”
2005 Study: “Risk Factors for Relapse in Health Care Professionals with Substance Use Disorders” (2)
This is one of the first studies ever completed to confirm the efficacy of monitoring programs for medical professionals. It examined no-relapse rates and successful outcomes in the Washington State Physicians Health Program via the analysis of 11 years of outcome data from its monitoring program.
It revealed that 75% of participants had no relapse while participating in five (5) year monitoring periods.
“Seventy-four (25%) of 292 individuals had at least 1 relapse. Fourteen (5%) had exactly 2 relapses and 10 (3%) had 3 or more relapses”
The study also confirmed that as the length of the monitoring period increased, the risk of relapse significantly decreased.
2005 Monitoring Guidelines: “Physician Health Program Guidelines” (3)
These guidelines were established in 2005 as clinical best practices in monitoring SUD cases per the Federation of State Physicians’ Health Programs (FSPHP):
A) The minimum period of monitoring for substance dependence is 5 years which is consistent with the FSPHP Public Policy Statement on Length of Monitoring.
B) The minimum period of monitoring for substance abuse is 1 year and a maximum of 2 years assuming no additional concerns are raised during the monitoring period.
C) The minimum period of monitoring for diagnostic purposes is 1 year and a maximum of 2 years when there has been a significant incident involving drugs/alcohol, a SUD has not been diagnosed and abstinence is recommended.”
2008 Study: “Five Year Outcomes in a Cohort Study of Physicians Treated for Substance Use Disorders in The United States” (4)
Various leaders in the medical profession began to conduct studies to track the efficacy of appropriate monitoring lengths and refine the parameters of effective monitoring:
“It is important to emphasize that the physician health programs do not treat physicians. They provide evaluation and diagnosis, develop a contract detailing treatment or monitoring, coordinate and facilitate formal treatment and ongoing professional support, and carry out regular monitoring through random visits to places of work and regular screenings for alcohol and drugs— typically for five years”
“From a clinical perspective we interpret these results as evidence that the combination of identification, intervention, formal treatment, professional support, and monitoring by physician health programs is effective in rehabilitating most of these addicted physicians, over at least five years.”
“We examined the laboratory and medical records of the physicians during the five years.”
“Physician health programs seem to provide the best available measures for protecting patients and for recovering physicians’ careers.”
“Conclusion: About three quarters of US physicians with substance use disorders managed in this subset of physician health programs had favorable outcomes at five years. Such programs seem to provide an appropriate combination of treatment, support, and sanctions to manage addiction among physicians effectively.”
2009 Study: “How Are Addicted Physicians Treated? A National Survey of Physician Health Programs” (5)
This national, watershed study (often referred to as the “Blueprint Study”) was conducted by top medical doctors who are leaders in the field of addiction and treating licensed professionals. The purpose was in part to verify and expand upon the data initially generated by the 2005 Washington State Physicians Health Program study.
With robust monitoring programs emerging pursuant to the FSPHP’s 2005 Clinical Guidelines and otherwise, more data began to appear and independently validate the efficacy of these programs.
Per the Blueprint Study:
“Addicted physicians receive an intensity, duration, and quality of care that is rarely available in most standard addiction treatments: (a) intensive and prolonged residential and outpatient treatment, (b) 5 years of extended support and monitoring with significant consequences, and (c) involvement of family, colleagues, and employers in support and monitoring. Although not available to the general public now, several aspects of this continuing care model could be adapted and used for the general population.”
“A specific and important feature of these PHPs was the development of a formal, signed contract that specified in detail the care, support, and monitoring activities that the participant would have to participate in over the (usually) 5 years of the program.”
The results of this national study confirmed that monitoring for five (5) years (after the completion of appropriate diagnostics and treatment), generates stellar no-relapse recovery rates:
“Physicians then receive randomly scheduled urine monitoring, with status reports issued to employers, insurers, and state licensing boards for (usually) 5 or more years. Outcomes are very positive, with only 22% of physicians testing positive at any time during the 5 years and 71% still licensed and employed at the 5-year point.”
2009 Report: “Setting the Standard for Recovery” (6)
This report (and several other scholarly reports) were soon published in the wake of the exciting findings in the 2009 “Blueprint Study” and cite valuable information on applicable monitoring lengths, such as:
“Most physicians (88%) met diagnostic criteria for substance dependence, and most of these had a minimum monitoring period of 5 years. Remarkably, 78% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring.”
2014 Report: “The New Paradigm for Recovery: Making Recovery – Not Relapse – the Expected Outcome of Treatment” (7)
This report also emanates directly from data generated in the 2009 Blueprint Study and it provides a plethora of data and commentary on the efficacy of professional monitoring programs, and then it takes those findings a giant step forward. It promotes the application of “gold standard” outcomes for everyone, not just doctors, lawyers, and pilots, etc.
If a lay-person seeks to broadly understand professional monitoring programs, why these programs are so amazingly effective, and how protocols for professional monitoring programs like TLAP can actually benefit SUD treatment for the general population, this report is arguably one of the most comprehensive and informative written to date. It is of direct interest to all people who suffer from a SUD diagnosis.
Often referred to simply as the New Paradigm, if only one report is read, it should be this one.
The report is authored by Robert L. DuPont, M.D. and backed by scores of national experts and scholarly studies, (primarily the 2009 Blueprint Study which DuPont also completed and published as part of a team of top doctors). Dr. Dupont is one of the most respected and accomplished addiction doctors in the world.
The New Paradigm report first recognizes the “near-universality of relapse” in the addiction treatment industry, where at best there is only a 50/50 chance (or less) at avoiding relapse.
Then it chronicles and explains the stunning relapse-free success rates of professionals’ monitoring programs for doctors, lawyers, and airline pilots, etc., and promotes this type of effective addiction recovery programming for the general population.
Dupont’s overall position is that it is not equitable for the general public to be insufficiently treated for SUDs such that relapse is the expected outcome, while at the same time doctors, lawyers, and pilots are treated and monitored at higher levels such that recovery without relapse is far and away the expected outcome:
“Professional organizations first adopted monitoring programs for their members that were suffering from substance use problems who were working in safety-sensitive positions. Subsequently and not surprisingly, many of the individuals who developed the professional monitoring programs of the New Paradigm were, themselves, in long-term recovery.”
“Although monitoring for compliance is conducted for other chronic illnesses, such as diabetes and hypertension, the monitoring of substance use disorders by organizations of professionals is unique in that it is mandatory, intensive and prolonged. Unlike other chronic disease monitoring programs, in these substance use disorder monitoring programs, there are serious consequences imposed for non-compliance.”
“Following evaluation, the PHP oversees and manages the treatment, long-term monitoring and advocacy of the participants, for a period of five years or longer. A monitoring contract is signed, holding the participants to the standards of the PHP including abstinence from alcohol and drugs, with immediate and serious consequences for non-compliance.”
“Among physicians monitored for five years following treatment, 78% never had a positive test for alcohol or drugs.”
“When considering the New Paradigm for Recovery, it is important to consider fairness and equitable access of care. If an effective diabetes management program was only available to certain groups of people (in the way that the New Paradigm programs of HIMS, PHPs, and LAPs are available to pilots, physicians and lawyers, respectively to treat substance use disorders), the nation would not stand for it.”
“The same standard should apply to those suffering from substance use disorders; the effective system of care management of the New Paradigm should be accessible to all in need. It is encouraging that many programs, such as those featured in this report, have created care management programs of the New Paradigm but there remains a large gap in availability of this care management to the masses.”
Independent studies and information, wholly unrelated to the New Paradigm, confirm and underscore the comparatively dismal relapse rates experienced in the general population. Only 35% to 50% of individuals treated in the general population remain abstinent for 1 year or more. (8,9)
The bottom line: everyday SUD treatment in the general population on average renders unsuccessful outcomes to the extent that it is more likely than not that the person will soon resume alcohol and/or drug use.
Such outcomes can be disastrous. Relapse is not benign. Every incident of relapse is a treacherous “roll of the dice” that invites risks such as accidental overdose, car accidents, DUI, other criminal prosecutions, incarceration, death, and even suicide. One single relapse can generate permanent damages that cannot be mitigated.
As for licensed professionals and protecting the public, personal health is not the only consideration. Regulatory authorities cannot be expected to ignore risks to the public and license an individual with an insufficient treatment and monitoring history that is expected, on its face, to most-likely generate a return to active addiction and potential impairment.
2016 Study: “Risk of Relapse Declines Significantly After 5 Years of Abstinence from Alcohol” (10)
In concert with the first study cited on this FAQ response (the 2003 Harvard medical study on the relevance of 5 years of continuous recovery in establishing full remission from alcoholism), this new 2016 study is also focused on managing SUDs in the general population, and it is not focused upon or limited to licensed professionals.
It states that at five (5) years of continuous sobriety, not only is a person’s recovery deemed to finally be stable, the five (5) year length of continuous sobriety actually reduces a risk of relapse to the same level of developing a SUD as any other member of the general population.
This five (5) year milestone in the stability of recovery in the general public is also strikingly important in the context of seeking to be licensed, or be reinstated, as a lawyer, doctor, or pilot. With five (5) years of reliable and objective TLAP monitoring, regulators can be comfortable and very confident in licensing a person with a SUD history:
“Various additional studies have provided further evidence that after 5 years of abstinence, only about 15% of individuals with a historical diagnosis of alcohol use disorder (AUD) will relapse.”
With five (5) years of successful TLAP monitoring, the lawyer literally poses no greater risk of alcoholism and addiction, or harm to the public, than any other member of the profession.
“Now that we have established the validity of 5 years as a milestone in recovery, let’s turn to the second part of our proclamation. We claimed that the percentage of individuals formerly diagnosed with AUD [Alcohol Use Disorder] who would be expected to relapse after 5 years of abstinence was similar to the prevalence of AUD in the general US population.”
“After 5 years of abstinence, a recovering alcoholic has approximately the same chances of lifetime relapse as a randomly selected member of the general US population has of experiencing alcoholism in the coming year.”
2019 Monitoring Guidelines: “Physician Health Program Guidelines” (11)
After almost twenty years of analyzing and studying the results of clinical best practices across the nation in supporting and monitoring recovery from SUDs, the FSPHP updated its Clinical Guidelines to reflect all that has been learned.
As to monitoring lengths, here are the updated recommendations for SUD cases:
The period or time frame for monitoring substance use disorders is generally determined by the severity of the disorder:
2. Substance Use Disorder, mild: generally, 2 to 5 years.
3. Substance Use Disorder, moderate/severe: generally minimum of 5 years.
Compared to the 2005 FSPHP Guidelines, and based upon the analysis of monitoring outcomes since that time, these new guidelines actually expand the application of five (5) year monitoring lengths.
Five (5) years is still the minimum length of monitoring in moderate to severe SUD cases, but now five (5) years is also recommended as an option in mild SUD cases.
On a final note about SUD monitoring lengths: on a case-by-case basis, current trends also include the option of increasing monitoring lengths to periods longer than five (5) years. Relapse under monitoring as a licensed professional is a very serious event. Some programs are recommending a new ten (10) year monitoring agreement in the wake of a relapse under monitoring. If yet a second relapse occurs during the new ten (10) year monitoring period, then it is an option to recommend lifetime monitoring during the time the person is licensed, all so as to support the person and protect the public. Finally, if multiple relapses continue, then permanent revocation of licensure may occur as regulatory authorities see fit.
2021 Study: “Essential Components of Physician Health Program Monitoring for Substance Use Disorder: A Survey of Participants 5 Years Post
Successful Program Completion” (12)
Of course, the overall expectation of completing monitoring for five (5) years is that the participant has objectively achieved full remission, is entrenched in practices of good recovery hygiene, and has fully become comfortably enmeshed in the fabric of their local recovery community, both generally and among peer professionals’ groups. But what happens next? Do these program graduates remain in recovery?
This recent study reveals data on success rates long after the five (5) year monitoring program is completed. The outcomes remain excellent even five (5) years after the monitoring program has been finished:
“Using their own definition, (97%) of respondents reported that they currently considered themselves to be ‘in recovery.’ Additionally, 79% of respondents reported no use of alcohol since the completion of their PHP monitoring agreement.”
“Notably, 88% of respondents endorsed continued participation in12‐step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was ‘money well spent.’”
“When asked whether they would have been able to maintain sobriety under a ‘monitoring only’ agreement, 76% of physicians reported they would have been unsuccessful without formal SUD treatment.”
“Most participants reported continued participation in mutual support groups 5 or more years after completing their monitoring agreements. In addition, self-reported recurrence of substance use and recovery rates were extremely encouraging: 89% self‐reported that they completed their agreement without any recurrence of use during the monitoring period, with nearly 10% reporting only one recurrence. This is comparable to outcomes reported in a previous national PHP study and slightly better than reported outcomes in a large single-state study. Notably, 97% of respondents reported that they currently considered themselves to be ‘in recovery.’ This recovery rate and those in other PHP studies (consistently near 80%) far exceed the SUD remission rates in studies of other clinical populations (typically 35%–50%), most of which relied on far shorter follow-up periods and/or a less-rigorous definition of recovery.”
Against the backdrop of all the foregoing, it is now very clear: in moderate to severe SUD cases, numerous studies and resulting reports confirm that appropriate levels of diagnostics and treatment, followed by five (5) years of high-quality monitoring, generates exceptional rates of reliable long-lasting recovery that remain long after completion of the monitoring program.
This category of monitoring is new to TLAP and is now available to address “grey zone” cases. These cases involve a history of conduct (DUI, etc.) related to substance use, but after the person has completed a TLAP-approved evaluation and/or assessment, it is still not clear whether the person has a diagnosis and current clinical situation.
As part of the continuation of an ongoing multi-disciplinary diagnostic process, there may be a need to “diagnostically” monitor the participant in one of these two categories:
1) The assessment detected a substance use disorder diagnosis that appears to be in stable remission and there is no current recommendation for any treatment; however, the person’s history shows inadequate treatment (or even no treatment at all, etc.) such that the person’s sustained remission and abstinence needs objective verification; or,
2) The assessment indicates it is strongly suspected that the patient currently has a substance use issue and a diagnosis, but the inpatient testing has not detected it, so there is a need to objectively “rule out” and verify there is no diagnosis.
In such cases, monitoring lengths of one (1) to two (2) years of frequent random drug screening are indicated to objectively verify that the participant can remain clean and sober as necessary to demonstrate solid long-term recovery, or else rule out a diagnosis.
This category of monitoring has no SUD component at all. In these cases, such as bipolar, depression, or anxiety, etc., the person has completed the TLAP-approved evaluation and assessment process and it has been established that they do not have any issues with alcohol or drugs. Instead, their needs are centered upon establishing an objective record of their responsible medication management with a TLAP-approved psychiatrist, and possibly participating in TLAP-approved therapy as well if indicated.
These monitoring agreements typically range in lengths of one (1) to (2) years. Because these cases do not involve an addiction factor, the monitoring agreement does not require abstinence, random drug screening, or recovery meetings, etc. Instead, mental health monitoring primarily requires reports from a TLAP-approved treating psychiatrist to verify that the person is showing up for all scheduled appointments, continuing to take their medication as prescribed, and to alert TLAP if there is a change in medication, diagnosis, or stability. Moreover, it requires updated reports from therapists, etc., if applicable.
In these cases, the TLAP Case Manager (professional clinician) serves as the TLAP Monitor because these pure mental health cases are outside the scope of support experience traditionally supplied by TLAP peer volunteers as lay persons in recovery from alcoholism and addiction.
Against the backdrop of all the above and foregoing, TLAP’s current monitoring lengths are based upon definitive, irrefutable, and validated clinical evidence that has been reinforced by almost two decades of medical experience in supporting and monitoring fitness to practice for licensed professionals.
These lengths of monitoring have long been implemented in other LAPs as well. For example, in Louisiana’s LAP, five (5) year SUD monitoring agreements have been utilized for three decades and since its inception in 1992, all based upon best practices and recommendations by top doctors and treatment centers for licensed professionals. For many years now, the Louisiana program has generated an average 95% no-relapse rate in alcoholism and addiction cases.
Over and above the information generated by monitoring programs and medical experts, the American Society of Addiction Medicine (ASAM) Criteria (13) also specifically validates the work of LAPs and PHPs, etc. The ASAM Criteria manual includes a detailed chapter on the specialized clinical needs of attorneys and other licensed professionals who hold the public’s trust.
ASAM has long recognized that certain subgroups of licensed professionals, specifically including attorneys, require higher levels of diagnostics, treatment, and objective monitoring to support reliable recovery from SUDs. By greatly reducing the odds of relapse via specialized services through LAPs and other such programs, licensing authorities can consider allowing attorneys with these chronic illnesses to objectively achieve reliable remission and safely practice a profession again.
This ASAM level of care not only provides appropriate support for the rehabilitation of lawyers and doctors, etc., but it is also considered by ASAM to be “the ‘gold standard’ of addiction care in the United States” and is directly applicable to benefit the general population and all persons with SUDs. ASAM specifically references PHPs, LAPs, and other such monitoring programs for professions as leading the way in pioneering very effective levels of SUD support and recovery.
III. Witnessing the Miracle of TLAP Monitoring
The disease of addiction always seeks to negotiate “an easier, softer, way” and bristles when it is denied. This tension comes to bear in cases where the Board of Law Examiners (BLE), the Board of Professional Responsibility (BPR), or the Tennessee Supreme Court has ordered the person to establish compliance with TLAP.
Some of these official referrals to TLAP do not think they have a problem, do not want any help, or else want no part of TLAP. Others may admit having an issue but then want to design their own attenuated monitoring program and have TLAP endorse it, rather than adhering to objective best practices. Still others try to bully and attack TLAP, instead of cooperating. A fair amount of fragmented, negative, and inaccurate misinformation gets spread around about TLAP in these cases. Behind the scenes, however, you can rest assured that there is always a complete record that supports TLAP’s recommendations.
It is heartwarming to witness the progress of TLAP’s successful monitoring participants. In the fullness of time, even formal BLE and BPR referrals who were initially angry about TLAP monitoring can and do come to understand and appreciate TLAP’s invaluable support. The following is a sampling of feedback from a person formally referred to TLAP (presented anonymously and with permission). This person has completed a journey that began in resistance, transitioned to cooperation, and arrived at appreciation and gratitude:
TLAP provides all of its top-tier services, including appropriate lengths of monitoring, as the direct result of strong leadership and specific directives from the Tennessee Supreme Court on the efficacy level it expects the profession to receive from TLAP programming. TLAP remains dedicated to best practices and the integrity of its programming, educating the profession on mental health challenges that lawyers face, and providing accurate information about TLAP’s mission to provide the best and most effective life and career-saving services possible to the lawyers, judges, and law students in Tennessee.
Works Cited
1) Vaillant, G. E. (2003). A 60-year follow-up of alcoholic men. Addiction, 98(8), 1043–1051. https://doi.org/10.1046/j.1360-0443.2003.00422.x
2) Domino KB, Hornbein TF, Polissar NL, Renner G, Johnson J, Alberti S, Hankes L. Risk factors for relapse in health care professionals with substance use disorders. JAMA. 2005 Mar 23;293(12):1453-60. doi: 10.1001/jama.293.12.1453. PMID: 15784868.
3) McCall, S., Carr, G. D., Gundersen, D., Pendergast, W., Ramirez, M., Bedient, T., Gehrke, C., Hankes, L., & Gendel, M. (2005). Physician Health Program Guidelines. Federation of State Physician Health Programs, Inc.
4) McLellan, A. T., Skipper, G. S., Campbell, M., DuPont, R. L. (2008). Five Year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ, 337(nov04 1). https://doi.org/10.1136/bmj.a2038 Neuraptitude – NCPHP. (n.d.).
5) DuPont, R. L., McLellan, A. T., Carr, G., Gendel, M., Skipper, G. E. (2009). How are addicted physicians treated? A national survey of Physician Health Programs. Journal of Substance Abuse Treatment, 37(1), 1–7. https://doi.org/10.1016/j.jsat.2009.03.010 Neuraptitude – NCPHP. (n.d.).
6) DuPont, R. L., McLellan, A. T., White, W. L., Merlo, L. J., Gold, M. S. (2009). Setting the Standard for Recovery: Physicians’ Health Programs. Journal of Substance Abuse Treatment, 36(2), 159–171. https://doi.org/10.1016/j.jsat.2008.01.004 Neuraptitude – NCPHP. (n.d.).
7) Baxter, L., Demitor, M., DuPont, C., DuPont, H., Fortner, N., Gitlow, S., Gold, M., et al. (2014). The New Paradigm for Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment (pp. 1-34) . A report of the John P. McGovern Symposium hosted by the Institute for Behavior and Health, Inc.
8) Fleury, M.-J., Djouini, A., Huỳnh, C., Tremblay, J., Ferland, F., Ménard, J.-M., & Belleville, G. (2016). Remission from Substance Use Disorders: A systematic Review and Meta-analysis. Drug and Alcohol Dependence, 168, 293–306. https://doi.org/10.1016/j.drugalcdep.2016.08.625
9) White, W. L. (2012, March). Recovery/Remission from Substance Use Disorders an Analysis of Reported Outcomes in 415 Scientific Reports, 1868-2011. Retrieved February 2, 202 Neuraptitude – NCPHP. (n.d.).
10) Neuraptitude – NCPHP. (n.d.). Retrieved February 2, 2023, from https://www.ncphp.org/wp-content/uploads/2017/06/Relpase-declines-after-5-years.pdf
11) Federation of State Physician Health Programs (FSPHP), Inc. (2019, April 16). Physician Health Program Guidelines. www.fsphp.org. Retrieved February 2, 2023.
12) Merlo LJ, Campbell MD, Shea C, White W, Skipper GE, Sutton JA, DuPont RL. Essential Components of Physician Health Program Monitoring for Substance Use Disorder: A Survey of Participants 5 Years Post Successful Program Completion. Am J Addict. 2022 Mar;31(2):115-122. doi: 10.1111/ajad.13257. Epub 2022 Jan 17. PMID: 35037334; PMCID: PMC9303734
13) Mee-Lee, D., Shulman, G.D., Fishman, M., Gastfriend, D. R., Miller, M.M., & Provence, S. M. (2013). In The Asam Criteria Treatment For Addictive, Substance-Related, And Co-Occurring Conditions (pp. 340–349). Essay, American Society of Addiction Medicine.