593

Medical Education

A Survey on the Prevalence of Alcoholism Among the

Faculty and House Staff of an Academic Teaching Hospital
BARY J. SIEGEL, MD, and FAITH T. FITZGERALD, MD, Sacramento, California

We studied the extent of alcoholism among faculty and house staff of an urban, university-based teaching
hospitaL Of 569 questionnaires sent, 282 (50%) were returned and 271 of these were complete enough to
be interpretable. Of those responding, 12 (4%) were classified as alcoholic and 26 (10%) as possibly
alcoholic. There was no statistically significant difference in the prevalence of alcoholism in physicians
from the different medical specialties or in regard to gender. Nevertheless, with 14% of the respondents to
our questionnaire being classified as either alcoholics or possible alcoholics, it appears that this is a
pervasive problem in our profession thatdeserves further study.
(Siegel BJ, Fitzgerald FT: A survey on the prevalence of alcoholism among the faculty and house staff of an academic teaching
hospital. West J Med 1988 May; 148:593-595)

In the last decade a great deal has been written about the
problem of alcoholism among physicians. Very little is
known about the actual prevalence of this problem, however.
A 1986 review of the literature on alcoholism and drug abuse
among physicians suggests that the true prevalence of alco-
holism in this group is unknown.1 To date there have been
only two published reports of surveys of physicians where
standard measures of alcoholism were used. Both of these
surveys, however, were administered only to subgroups of
physicians that were not necessarily representative of physi-
cians as a whole, and the prevalence of alcoholism reported
in these studies differed markedly.23 Accurately assessing
the magnitude of alcoholism in medical professionals, espe-
cially physicians, is clearly a matter of considerable impor-
tance. The definition, identification, and treatment of
impaired physicians is of immediate concern to patients, reg-
ulatory boards, and society as a whole. To obtain more infor-
mation on the prevalence of alcoholism among physicians,
we surveyed a broad group of physicians.
Materials and Methods
A slightly modified version of the Short Michigan Alco-
holism Screening Test was sent to all faculty and house staff
of an urban, university-based teaching hospital (Figure 1).
The only notable modification of the questionnaire was the
addition of a second component to question six, where re-
spondents were asked whether their attendance at a meeting
of Alcoholics Anonymous was part of a class assignment or a
clinical rotation. Limited demographic information was also
requested. Each alcoholism-indicating response was as-
signed a one-point value. Respondents scoring zero to one
point were classified as nonalcoholic. Those with two points
were considered to be possibly alcoholic. Those scoring
three or more points were classified as alcoholic. This system
is similar to that used by Selzer and colleagues.4 The data
were analyzed using the Catmod procedure in the statistical
analysis system and a mainframe computer.5
From the Division of General Medicine, University of California Davis Medical Center, Sacramento.
Reprint requests to Bary J. Siegel, MD, Department of Internal Medicine, Division of General Medicine, Primary Care Center, Rm 3120, 2221 Stockton Blvd, Sacramento,
CA 95817.
Results
House staff and faculty were sent 569 questionnaires. Of
these, 282 (50%) were returned, with 271 complete enough
to be interpretable and scored in the manner described in the
methods section. These constituted the final sample upon
which we based our results. A total of 12 (4 %) of the respon-
dents scored 3 or more points and were classified as alco-
holic. An additional 26 (10%) respondents scored 2 points
and were classified as possibly alcoholic. The remaining 233
respondents scored 1 or fewer points and were classified as
nonalcoholic.
Of the 271 respondents, 147 (54 %) identified themselves
as men. Of these, 6 (4%) were alcoholic and 16 (11 %) were
possibly alcoholic. A total of 43 (16%) of the respondents
identified themselves as women; one (2 %) was classified as
alcoholic and three (7%) were classified as possibly alco-
holic. Of the 81 subjects who declined to state their sex, there
were 5 (6%) alcoholics and 7 (9%) possible alcoholics (Table
1). There was no statistically significant difference in the
prevalence of alcoholism among these three groups (X2 with
4 degrees of freedom (df = 1.8, P=.77).
We also examined the influence of the respondents' med-
ical specialty on the prevalence of alcoholism. The only spe-
cialties in which no one was identified as being either alco-
holic or possibly alcoholic were physical medicine and
rehabilitation and therapeutic radiology. The highest preva-
lence of alcoholism was found in the specialties of family
practice and obstetrics and gynecology, where 14% of the
respondents were identified as being alcoholic. No one iden-
tifying themselves as a member of the specialties of anesthe-
siology, physical medicine and rehabilitation, therapeutic ra-
diology, or psychiatry was classified as an alcoholic. The
highest prevalence of those classified as possibly alcoholic
was found in the group containing pathology, radiology, and
nuclear medicine, in which 36% of the respondents fell.
Among those respondents who declined to state their spe-
594
594ALCOHOLISM
TABLE 1.-Effects of Gender on Prevalence of Alcoholism
Non- Possibly
alcoholic, Alcoholic, Alcoholic, Total,
Gender No. (96) No (96) No. (96) No. (96)
Men ............ 125 (85) 16 (11) 6 (4) 147 (54)
Women ......... 39 (91) 3 (7) 1 (2) 43 (16)
Decline to state .... 69 (85) 7 ( 9% 5 (6) 81 (30)
Total ......... 233 (86) 26 (10) 12 (4) 271
cialty, only 5 % were classified as alcoholic and the rest were
classified as nonalcoholic (Figure 2). Despite the extreme
variation in the prevalence of alcoholism among various de-
partments, the null hypothesis that the mean of all of the
departments is equal cannot be rejected (X2 with 18 df=
27.3, P= .07).
Discussion
Previous estimates of the prevalence of alcoholism
among physicians have varied widely. Murray suggested that
it is much higher than that in the general population,6 while
other investigators have suggested with equal conviction that
it is probably no greater than that of the general popula-
tion.7'8 Our knowledge of the true extent of the problem is
hampered by the application of an often imprecise definition
of alcoholism, the surveillance of only highly selected sub-
populations, such as hospitalized patients or those physicians
in trouble with medical disciplinary or licensing boards, and,
perhaps, the failure of physicians to make this diagnosis in
their peers.19
Thus far, there have been only two reports in the litera-
ture wherein alcoholism-indicating surveys have been used
to determine the prevalence of alcoholism in physicians. The
first study was conducted on a group of physicians, most of
whom were family practitioners, attending a continuing
medical education conference. The Self-Administered Alco-
holism Screening Test was completed by 399 physicians. By
this instrument, the authors concluded that this group had
2 % alcoholics and 5 % possible alcoholics.2 These results are
quite different from those published in the only other study in
1. Do you feel you are a normal drinker? (By normal, we mean you drink
less than or as much as most people.)
2. Does your spouse, a parent, or other near relative ever worry or com-
plain about your drinking?
3. Do you ever feel guilty about your drinking?
4. Do friends or relatives think you are a normal drinker?
5. Are you able to stop drinking when you want to?
6. Have you ever attended a meeting of Alcoholics Anonymous?
If you answered yes, was this part of a class assignment or clinical
rotation?
7. Has drinking ever created problems between you and your spouse, a
parent, or other near relative?
8. Have you ever gotten into trouble at work because of drinking?
9. Have you ever neglected your obligations, your family, or your work for
two or more days in a row because you were drinking?
10. Have you ever gone to anyone for help about your drinking?
11. Have you ever been in a hospital because of drinking?
12. Have you ever been arrested for drunken driving, driving while intoxi-
cated, or driving underthe influence of alcoholic beverages?
13. Have you ever been arrested, even for a few hours, because of other
drunken behavior?
Figure 1.-Modified Short Michigan Alcoholism Screening Test,
with modifications placed in bold-faced type.
ALCOHOLISM IN PHYSICIANS
which an alcoholism-indicating survey was used. In this
study, the Michigan Alcoholism Screening Test was sent to
all of the house staff of the Presbyterian Hospital in New
York. Of the 417 house staff surveyed, 188 responded. Of
these, 13% had scores that indicated either suggested or
presumed alcoholism.3
Based on these studies, the prevalence of dysfunctional
drinking in physicians would appear to be anywhere from 7 %
to 13%. There are many possible explanations for this dis-
parity. In the Lewy survey, questionnaires were mailed, and
the participants may have felt that their anonymity was more
secure than that of physicians at a continuing education con-
ference. Thus, they may have answered their questionnaires
with greater candor, resulting in a higher number of identi-
fied alcoholics. Alternatively, the participants in the survey
of house staff may have been much younger than those who
attended the continuing education conference. If young phy-
sicians drink more heavily than older ones, this could also
account for the difference in the prevalence of dysfunctional
drinking in these two studies. Also, those who attend con-
tinuing educational conferences are a self-selected group.
Perhaps the conference where the survey took place in the
study by Niven and associates was such that it selected for
nonalcoholic physicians, and the prevalence of alcoholism,
therefore, was found to be lower than that in a random group
ofhouse staff.
To obtain more precise information on the prevalence of
alcoholism in physicians, we decided to apply a structured,
validated, alcoholism-indicating questionnaire to a broad-
based group of working physicians in multiple disciplines
over a wide age range.
In our study of the house staff and faculty of a university-
based teaching hospital, 4% of the respondents were identi-
fied as being alcoholic and 10% as being possible alcoholics.
These findings stand in marked contrast to the prevalence of
alcoholism reported in the study of physicians attending a
continuing education conference. The prevalence of dys-
functional drinking in our group is also higher than that
reported in the house staff at Presbyterian Hospital.
80 -
Nonolcoholic
70- Possibly Alcoholic
* Alcoholic
60
w 50-
: 40-
30 -
20 -
10
An
Lt FP
LLL LLkt
Dl Ob Pe PM Ps Su 0
IM
Figure 2.-The graphs show the number of respondents by medical
specialty. An anesthesiology; FP = family practice; IM = internal
=
medicine and related specialties; Dl = pathology, radiology, and nu-
clear medicine; Ob obstetrics and gynecology; Pe = pediatrics;
=
PM = physical medicine and rehabilitation and therapeutic radiology;
Ps psychiatry; Su surgery and its subspecialties; 0 = declines to
= =
state
THE WESTERN JOURNAL OF MEDICINE
THl
o MAY 1988 0 148
There was no statistically significant difference in our
cohort in the incidence of alcoholism by sex of the respon-
dent, but almost 30% of our respondents declined to identify
their gender, perhaps out of fear of being identified. Thus,
we can say little from our data about the true relationship
between gender and alcoholism in physicians.
Medical specialty also bore no statistically significant re-
lationship to alcoholism in our study. However, a pro-
nounced variation was noted in the prevalence of alcoholism
in different specialties and may have achieved statistical sig-
nificance had the cohort been larger. It was striking to note
the high number of alcoholics in the specialties of family
practice and obstetrics and gynecology compared to none in
anesthesiology, physical medicine and rehabilitation, thera-
peutic radiology, or psychiatry.
Since slightly more than half of those surveyed did not
return their questionnaires, it would be hazardous to draw
any firm conclusions from this study-we have no knowledge
of the prevalence of alcoholism among those who did not
return the questionnaire. Yet, with 14% of those who did
respond being classified as either alcoholics or possible alco-
holics, it appears that this may be a pervasive problem that
clearly demands further study.
If further studies do substantiate this high rate of alco-
holism, what can be done about it? How can physicians,
hospitals, and state licensing boards concurrently assure the
best therapy for those physicians affected, as well as protec-
tion for them and for their patients? Rehabilitation can be
more successful in alcoholic physicians than in nonphysician
alcoholics. In one report, 76% of alcoholic physicians were
abstaining one year after discharge from treatment, as op-
o 5 595
9
posed to 61 % of patients in the general population."0 Na-
tional, state, and hospital boards have constructed detection
and therapy programs for impaired physicians that have been
effective.I1-13 Reluctance to identify and "stigmatize" pro-
fessional colleagues with a diagnosis of alcoholism is a major
impediment to care.9 We must continue to design programs
aimed at educating physicians and medical students in the
realities of alcoholism and its treatment, the prevalence of
this disease, and the availability of Alcoholics Anonymous
and other rehabilitation programs.
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