Substance Use and Abuse

To the Editor. —I agree with Dr Westermeyer 1 that Hughes et al 2 and Baldwin et al 3 "have provided a valuable service" through their research on substance use among medical students and residents, but I am very disturbed by the focus of his editorial. It appears that Westermeyer has joined other Americans in ascribing the cause of impaired physicians (and pilots, ship captains, etc) to their use of illicit or improperly obtained drugs. The results of the studies he reviewed suggest otherwise. In both studies, alcohol is the most frequently used substance, with over 80% of all respondents reporting alcohol use. The survey of residents included questions on daily use and found that, except for marijuana and amphetamine use, where only 0.3% and 0.1% of respondents reported daily use, none of the other categories of illicit or prescribed drugs included daily users. In contrast, 5.0% of alcohol users