Physicians and other health care providers have multiple opportunities in the course of a typical... more Physicians and other health care providers have multiple opportunities in the course of a typical practice year to identify and treat individuals who abuse alcohol and other drugs. Although substance abuse is very common in clinical practice, providers routinely fail to intervene in a timely fashion due to negative attitudes, incomplete knowledge, and poorly developed practice skills. Over the past ten years, addictions training of licensed health care providers nationally and in Maryland has improved significantly. This article describes recent national training trends and current educational programs statewide for medical students, physicians in residency and fellowship programs, and licensed providers in dentistry, nursing, pharmacy, psychology, and social work. Several strategies for improving professional training in addictions in the future are discussed and the importance of shifting to an interprofessional training model is emphasized.
A structured in-depth interview employing standardized criteria was used to determine the prevale... more A structured in-depth interview employing standardized criteria was used to determine the prevalence of lifetime and current alcohol dependence (alcoholism) in unselected consecutive patients admitted to a regional Level I trauma center. Of 629 patients, 157 (25.0%) were current alcoholics at the time of injury. An additional 87 (13.8%) were diagnosed as lifetime non-current alcoholics. There was no significant difference in the rates of current alcohol dependence among patients injured in vehicular crashes (23.5%), other unintentional trauma victims (29.3%), and those injured as a result of violence (24.6%). Of BAC+ (blood alcohol concentration positive) patients, 54.5% were current alcoholics. However, 14.4% of alcohol-negative patients were also diagnosed as alcohol dependent.
Physician impairment contributes to patient morbidity, malpractice claims, physician license loss... more Physician impairment contributes to patient morbidity, malpractice claims, physician license loss and suicide. This paper describes four years of experience of the University of Maryland's Professional Assistance Committee. The committee is composed of medical staff members. Its mission is to help impaired physicians obtain assessment, treatment and monitoring, and to protect patients from harm. The committee has evaluated 23 cases over the past four years. Ten were credential checks, and 13 investigations of active problems. Eight of the 23 cases were for alcohol, eight for drug, and seven for behavioral problems. Only one person lost medical staff privileges. The committee has been well accepted by the medical staff and hospital administration and can be easily reproduced in other hospitals.
The pressure to gain mass, power, explosiveness, and endurance and to obtain a performance edge c... more The pressure to gain mass, power, explosiveness, and endurance and to obtain a performance edge continues to a part of sports. Anabolic agents, including selective androgen receptor modulators along with peptides, hormones, and metabolic modulators, continues to evolve. Methods to promote transcription to modify gene expression are a part of the evolution. In order to monitor and improve doping detection, the Athlete Biological Passport has been created. This article provides an up-to-date review of alcohol, anabolic androgens and related agents, stimulants, opioids, and cannabis and related compounds and their effects on athlete health and performance.
BackgroundSubstances from various classes may be used for recreational purposes, self-treatment o... more BackgroundSubstances from various classes may be used for recreational purposes, self-treatment or to boost performance. When substance use shifts from occasional to regular, heavy or hazardous use, positive and negative effects can develop that vary by substance class and athlete. Regular use of recreational or performance enhancing substances can lead to misuse, sanctions or use disorders.ObjectiveTo review the prevalence, patterns of use, risk factors, performance effects and types of intervention for all classes of recreational and performance enhancing substances in elite athletes by sport, ethnicity, country and gender.MethodsA comprehensive search was conducted to identify studies that compared the prevalence and patterns of substance use, misuse and use disorders in elite athletes with those of non-athletes and provided detailed demographic and sport variations in reasons for use, risk factors and performance effects for each main substance class.ResultsAlcohol, cannabis, to...
Physicians and other health care providers have multiple opportunities in the course of a typical... more Physicians and other health care providers have multiple opportunities in the course of a typical practice year to identify and treat individuals who abuse alcohol and other drugs. Although substance abuse is very common in clinical practice, providers routinely fail to intervene in a timely fashion due to negative attitudes, incomplete knowledge, and poorly developed practice skills. Over the past ten years, addictions training of licensed health care providers nationally and in Maryland has improved significantly. This article describes recent national training trends and current educational programs statewide for medical students, physicians in residency and fellowship programs, and licensed providers in dentistry, nursing, pharmacy, psychology, and social work. Several strategies for improving professional training in addictions in the future are discussed and the importance of shifting to an interprofessional training model is emphasized.
A structured in-depth interview employing standardized criteria was used to determine the prevale... more A structured in-depth interview employing standardized criteria was used to determine the prevalence of lifetime and current alcohol dependence (alcoholism) in unselected consecutive patients admitted to a regional Level I trauma center. Of 629 patients, 157 (25.0%) were current alcoholics at the time of injury. An additional 87 (13.8%) were diagnosed as lifetime non-current alcoholics. There was no significant difference in the rates of current alcohol dependence among patients injured in vehicular crashes (23.5%), other unintentional trauma victims (29.3%), and those injured as a result of violence (24.6%). Of BAC+ (blood alcohol concentration positive) patients, 54.5% were current alcoholics. However, 14.4% of alcohol-negative patients were also diagnosed as alcohol dependent.
Physician impairment contributes to patient morbidity, malpractice claims, physician license loss... more Physician impairment contributes to patient morbidity, malpractice claims, physician license loss and suicide. This paper describes four years of experience of the University of Maryland's Professional Assistance Committee. The committee is composed of medical staff members. Its mission is to help impaired physicians obtain assessment, treatment and monitoring, and to protect patients from harm. The committee has evaluated 23 cases over the past four years. Ten were credential checks, and 13 investigations of active problems. Eight of the 23 cases were for alcohol, eight for drug, and seven for behavioral problems. Only one person lost medical staff privileges. The committee has been well accepted by the medical staff and hospital administration and can be easily reproduced in other hospitals.
The pressure to gain mass, power, explosiveness, and endurance and to obtain a performance edge c... more The pressure to gain mass, power, explosiveness, and endurance and to obtain a performance edge continues to a part of sports. Anabolic agents, including selective androgen receptor modulators along with peptides, hormones, and metabolic modulators, continues to evolve. Methods to promote transcription to modify gene expression are a part of the evolution. In order to monitor and improve doping detection, the Athlete Biological Passport has been created. This article provides an up-to-date review of alcohol, anabolic androgens and related agents, stimulants, opioids, and cannabis and related compounds and their effects on athlete health and performance.
BackgroundSubstances from various classes may be used for recreational purposes, self-treatment o... more BackgroundSubstances from various classes may be used for recreational purposes, self-treatment or to boost performance. When substance use shifts from occasional to regular, heavy or hazardous use, positive and negative effects can develop that vary by substance class and athlete. Regular use of recreational or performance enhancing substances can lead to misuse, sanctions or use disorders.ObjectiveTo review the prevalence, patterns of use, risk factors, performance effects and types of intervention for all classes of recreational and performance enhancing substances in elite athletes by sport, ethnicity, country and gender.MethodsA comprehensive search was conducted to identify studies that compared the prevalence and patterns of substance use, misuse and use disorders in elite athletes with those of non-athletes and provided detailed demographic and sport variations in reasons for use, risk factors and performance effects for each main substance class.ResultsAlcohol, cannabis, to...
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Papers by David McDuff