Doctors and Substance Abuse
Drug and alcohol addiction is a common concern among medical professionals. It is estimated that at least 10 percent to 15 percent of physicians will develop a substance use disorder over the course of their lives compared to 8 to 10 percent of the general population. The majority of these physicians continue to practice while impaired for at least several years, sometimes producing dire consequences for the patients they treat.
A five-year longitudinal study conducted by the Treatment Research Institute, the Alabama Physician Assistance Program, and the Institute for Behavior and Health found that alcohol was the primary drug of choice among physicians with substance abuse disorders, with 50.3 percent of the study’s participants treated for alcohol abuse. Prescription or illicit opioid abuse contributed to 35.9 percent of the substance abuse disorders in the study, while 7.9 percent of the study’s participants abused stimulants and 5.9 percent abused other drugs. Additionally, 13.9 percent used intravenous drugs and 50 percent reported using two or more substances.
Why Is Substance Abuse Common Among Doctors?
The link between doctors and drug abuse is an important concern, both to the medical profession as a whole and to the patients being treated. There are many reasons that make doctors and other medical professionals more susceptible to substance abuse.
Easy Access to Drugs
Perhaps one of the biggest reasons for the increased prevalence of substance abuse and addiction to prescription medications among doctors is simply that they have easy access to drugs. Doctors can write prescriptions, and some who use drugs will write bad or phony prescriptions as a way to access prescription medications.
Many physicians, especially those who work in hospital settings, also have a higher level of access to pills or injectable medications. They may prescribe a higher dosage of medication than a patient actually requires, chart that higher dose, and then keep the excess for themselves. They also have access to free samples from pharmaceutical companies, excess pills that patients may bring in for disposal, or prescriptions written by colleagues as professional courtesies.
Lack of Self-Care
There is no doubt that being a physician is hard work. Many work long and irregular hours, making it difficult, or even impossible, to engage in self-care. Often, these long hours on their feet mean that doctors deal with chronic back, leg, foot, or joint pain. Many do not have the time to see their own physicians for treatment. This leads them to ignore pain until it is bad enough that they turn to self-medication to cope.
For doctors who do use legitimately prescribed medications to deal with chronic issues, the stressors and demands of their jobs might lead to an exacerbation of symptoms. This might mean that doctors may take it upon themselves to increase the dosage or frequency that they take prescribed pain medication.
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Trauma and PTSD
Many physicians face traumatic situations on the job that may negatively impact mental health. In fact, a significant number of doctors develop symptoms of post-traumatic stress disorder (PTSD). This is especially true for those who are involved in treating patients with catastrophic injuries, but might also occur in doctors who deal with violent patients or who experience the unexpected deaths of patients.
For many physicians, working conditions can contribute to a higher risk of substance use and abuse. Many doctors face long and irregular working hours, in large part due to increasing doctor shortages. Long hours and the necessity of making frequent and quick life-or-death decisions may lead to increased stress levels, and in some cases, even professional burnout.
Stigma Against Seeking Help
In the medical field, there is often significant stigma regarding substance abuse and seeking treatment. Many medical boards still treat substance abuse as a crime rather than as a disease, issuing sanctions and punishments for doctors found abusing drugs or alcohol. The consequences may include losing one’s professional license to practice, arrests, and imprisonment.
Unfortunately, because of the stigma associated with seeking help or with being discovered with a substance abuse disorder, many physicians with drug or alcohol addiction hide their substance use. This means that they do not seek treatment in the early stages of their addiction, but rather at later stages when the doctors’ personal lives might already be in shambles and they have already made medical mistakes on the job. Often, when others discover the addiction or the doctor finally reaches out for help, the addiction is already at an advanced stage, which can be more difficult and costly to treat.
Habits Formed During Medical School
Studies show that medical students use alcohol, prescription pain medications, and benzodiazepines (benzos) at levels that are higher than their peers of the same ages. This is likely due to the demands of medical school, including the extreme pressure to compete and achieve. If they do not treat their addictions during medical school, doctors may continue to abuse drugs or alcohol after graduation.
Doctors face the same risk factors that increase the likelihood of substance abuse in other populations. They may have experienced trauma from child abuse, sexual assault, accidents, military service, or other life-threatening situations. They may also have a genetic predisposition to addiction or a pre-existing mental health condition, such as anxiety or depression. When these risk factors are combined with the stress, long hours, and potential trauma related to a career in medicine, the risk of substance abuse may soar.
Failure of Peers to Report
While licensing regulations often mean that physicians have a duty to report substance abuse in their colleagues and to report physicians who practice while impaired, physicians actually make few reports about their clients. This conspiracy of silence may be partly an effort to protect colleagues from serious repercussions, such as a loss of a professional license. Doctors may also be reluctant to report a colleague because they fear that doing so might also negatively impact their own career in some way. Some physicians even report fearing retaliatory litigation from the colleague they reported.
Signs of Alcohol Abuse
Symptoms of alcohol abuse in the medical workplace include:
- Breath that smells like alcohol
- Decreased performance
- Mood swings
- Absences or other unusual time away from work
- Slurred speech
- Erratic behavior
- Hidden bottles of alcohol in locker or office
- Unexplained absences or tardiness
- Hangovers at work
Signs of Opioid Abuse
Symptoms that may suggest that doctors are abusing prescription or illicit opioids:
- Experiencing cycles of agitation followed by periods of calmness
- Refusing breaks
- Spending more time at work than necessary
- Wearing long sleeves (to hide needle tracks)
- Taking frequent bathroom breaks or unexplained absences during the day
- Dilating or pinpoint pupils
- Volunteering to return excess medications to pharmacies
- Offering to clean operating rooms
- Reporting “lost” prescriptions frequently
- Rummaging through sharps containers
- Treating excessive numbers of patients with charted opioid prescriptions
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Risks of Substance Use in Doctors?
For doctors with substance abuse disorders, their addiction does not just affect them and their family members. Unfortunately, patients often feel the impact as well. Alcohol and drug use may impair physicians’ judgment and produce an increased likelihood of reckless behavior. These conditions may lead to diagnostic and treatment mistakes, even sometimes costing patients their lives.
Doctors who inject drugs also run the risk of infecting patients. For example, in New Hampshire, forty-six patients were infected with hepatitis C after an intinerant hospital technician injected himself with patients’ pain medications, refilling the syringes with saline. There have also been hepatitis outbreaks in Denver and Jacksonville stemming from health care workers stealing and injecting patient medications.
With Treatment, There is Hope
Increasingly, state medical boards are taking a therapeutic, rather than a punitive, approach to doctors and substance abuse. Rather than revoking doctors’ licenses, many state boards are allowing physicians with substance use disorders to complete specialized inpatient rehab to treat their addictions and coexisting mental health disorders.
As part of agreements with state medical boards, physicians treated for substance abuse often undergo five years of monitoring. During those five years, doctors must submit to random drug tests and assessments and participate in follow-up treatment and support groups.
What to Expect in Rehab and Recovery
Many doctors who seek treatment for substance abuse disorders attend an impatient treatment facility, often in a rehab center that specializes in treating professionals and executives. There are often unique situations that arise when treating doctors and rehab centers with this expertise are equipped to handle them, including counseling for trauma and working with state medical boards when transitioning the physician out of treatment.
Once admitted to a treatment facility, you will first undergo detoxification. Addiction specialists will help you manage your withdrawal symptoms and cravings and support you in taking these early steps toward living a clean and sober life.
You may then participate in both individual and group therapy to help you progress through recovery and teach you the skills necessary to cope with professional and personal stress. If necessary, you will also receive counseling for underlying trauma or mental health disorders.
After you are released from inpatient treatment, you will most likely continue your recovery with outpatient therapy and sobriety groups, such as Alcoholics Anonymous and Narcotics Anonymous. This support may be instrumental in helping you to maintain your sobriety as you transition back to your career and family life.
If your state has a Physician Health Program (PHP), you may also receive additional confidential support and an individualized treatment plan that includes drug testing and frequent monitoring. While this might seem invasive, this monitoring process may help you transition back to work while maintaining sobriety, even if you continue to have access to addictive substances. It is also often a requirement for maintaining your licensure following substance abuse treatment.
The research on doctors and addiction treatment success is promising. With appropriate rehab treatment, doctors often experience a 70 percent to 80 percent rehab success rate, which is extremely high among any population. In addition, after five years of recovery, three quarters of physicians studied continue to practice medicine. This illustrates both the effectiveness of finding proper treatment and the promise of a full recovery and continued successful career following rehab.
If you suspect that you or a colleague have a substance abuse disorder, it is important to seek help immediately. Addiction is a disease and the best way to overcome it and prevent devastating consequences to both yourself and your patients is to begin the process of becoming clean and sober. While being forthcoming about your addiction might seem overwhelming and scary, with treatment, there is a good chance that you may continue to practice medicine and enjoy a long and healthy recovery.
Our insurance verification team works quickly to verify your insurance benefits to place you into one of our centers as soon as possible. Because of our industry expertise we will be able to verify this information in a timely manner and can advocate for more coverage or more time in treatment. We strive to do this as quick as possible while also maximizing your coverage. Our insurance verification process is of no cost to you and there are absolutely no obligations.
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