'Exquisite denial'—physicians in the throes of addiction

Working as a physician in the ER at the start of the COVID-19 pandemic was one of the darkest points in my career. It was also one of the heaviest drinking periods in my entire life.

My experience with alcohol

I live in a small mountain town in California, and back then, I was working at a large hospital 5 hours away in Southern California where I grew up. I would make the 5-hour drive, work four to five ER shifts in a row, park in my parent's driveway after each shift, finish off a bottle of wine and fall asleep in the back of my Toyota 4Runner.

So many factors drove me to drink after I finished my shift in the wee hours of the morning: intubating patients in the ER, explaining to family members at their car window why they couldn't accompany their very sick loved ones into the hospital, working 12-hour overnight shifts without COVID protocols in place, and trying to swallow the fear of this unknown virus.

Within 2 weeks, I knew I needed an alternative coping mechanism to deal with the trauma I was enduring, so I started going to weekly therapy sessions and traded my morning bottles of wine for long runs on the beach.

For similar reasons, I drank heavily in residency, and nothing good came out of these habits. So I knew if I didn't seek therapy sooner than later, I could end up down a dangerous and dark path.

I consider myself lucky, as I never went to work under the influence, a not-so-uncommon habit for many physicians who have a substance use disorder.

Acknowledging the reality

Research suggests that addiction is cause for concern among healthcare professionals. Just take a look at the stats:

• A Critical Care Medicine study estimates that "10 percent to 15 percent of healthcare professionals will misuse drugs or alcohol at some time during their career."

• Medical professionals are more likely to abuse prescription medications, with higher rates of abuse, specifically with benzodiazepines and opioids.

• Given the increasingly stressful environment in our healthcare system, substance-induced impairment among healthcare professionals is anticipated to grow, per an article published in Substance Abuse Treatment, Prevention, and Policy.

• According to data from the US Substance Abuse and Mental Health Services Administration, at least 100,000 medical professionals struggle with a substance abuse disorder.

• According to a study conducted by the CDC, nearly 30,000 people may have been exposed to hepatitis C over 14 years by infected hospital employees using narcotics intended for patients.

In a New England Journal of Medicine article, Abraham Verghese, MD, spoke to the issue of physicians and addiction, writing:

"I heard incredible stories of drug use … the doctor who loaded her windshield-wiper reservoir with bourbon and routed it into the cab so she could take hits between hospitals; the doctor who would catheterize himself to fill his bladder with artificial urine solution to void when he had to give a urine sample for testing; the doctor who used the pretext of a home visit to steal back the narcotics he had prescribed. As varied as the tales were, the doctors had one common feature—namely, exquisite denial that allowed them to believe they could still care for patients perfectly well."

What are the consequences?

Medical professionals have some "unique advantages" when it comes to feeding their own addiction: easy access to drugs through self-prescribing, prescription fraud, and stealing medications from the hospital, in combination with knowing how to treat and prevent withdrawal symptoms, and knowing which substances to mix just enough to take the edge off.

A medical background doesn't mean you're in control. These "unique advantages" can cost you your life, your patient's life, your medical license, and your freedom. 

When your alcohol or drug use spirals out of control, you become afraid, and even if you know you need help, oftentimes you don't seek it for fear of facing disciplinary action, losing your job, losing your license, and/or dealing with shame and humiliation if anyone were to find out. Often your addiction may be so deeply buried that you don't think about how you are jeopardizing your patients' lives.

Finding solutions

Getting professional help for substance misuse or addiction is best done sooner than later. If you or someone you know is concerned about the potential for abuse, asking for help at the very beginning can potentially reduce your risk of severe consequences. With that said, it is never too late to seek help.

The consequences of not getting help are much worse. If you harm a patient or make a mistake while you are impaired, the consequences can be disastrous, and at the very least, you could face extremely high malpractice judgments or manslaughter charges.

Self-reporting is the best option

Reporting yourself to the state monitoring agency is an essential early step to your recovery. State monitoring agencies are there to protect patients, but they are also there to protect healthcare providers. Being proactive by self-reporting shows the state monitoring agency and your employer that you want to get better and keep doing the work you love.

The state monitoring agency can help you enter into an addiction recovery program and work with your employer to keep your job by demonstrating that you are taking the appropriate steps to seek treatment. Please don't wait until someone reports you to your employer or the medical board. 

Specific programs designed for healthcare professionals 

There are reasonable and fair systems in place designed specifically to help impaired medical professionals seek the treatment they need while also helping to protect jobs and medical licenses. These programs address the underlying triggers physicians face in the workplace and their personal lives and provide group therapy sessions where physicians can share their experiences and stressors in a confidential and safe setting.

The recovery rate and the ability to maintain sobriety after treatment are much higher for physicians than for the general population. After completing treatment, most physicians can resume their employment. 

Source:

1. Verghese A. Physicians and Addiction. New England Journal of Medicine. 2002; 346:1510-1511.

2. Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007 Feb;35(2 Suppl):S106-16.

3. Kenna GA, Lewis DC. Risk factors for alcohol and other drug use by healthcare professionals. Subst Abuse Treat Prev Policy. 2008;3:3.

4. Merlo L, & Gold M. Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harvard Review of Psychiatry. 2008.16(3)181-94.

5. Merlo LJ, Trejo-Lopez J, Conwell, T, & Rivenbark J. Patterns of substance abuse initiation among healthcare professionals in recovery. The American Journal on Addictions. 2013. 22;605–612.

6. Schaefer, MK, & Perz,JF. Outbreaks of infections associated with drug diversion by US health care personnel. Mayo Clinic Proceedings. 2014;89(7)878-87.