Physician Addiction: How Do We Heal Those Who Heal Us?

  • /Reviewed by: Amy Rontal, MD
  • As we dig more deeply into the world of physician mental health and wellness, the issue of addiction among doctors becomes impossible to ignore. Physician addiction fascinates the public; the doctor who sneaks opiates or drinks heavily is a hallmark of nearly every medical drama on TV. But why does this all too real tragedy capture our imagination?

    According to Gregory Skipper, Director of Professional Health Services at Promises Treatment Centers, our obsession likely stems from the fact that the concept itself feels contradictory. Despite the fact that addiction is now commonly understood to be a disease rather than a choice, there often remains a stigma attached to it — a sense that an addict has somehow failed morally or succumbed to substance abuse due to a personal weakness.¹ For many, this image is directly at odds with that of a doctor — strong, selfless, brilliant, who has worked hard so that people can confidently place their lives in his or her hands.

    Despite this widespread association of doctors with perfection and strength, according to a study by the NIH, “approximately 10%-12% of physicians will develop a substance use disorder during their careers, a rate similar to or exceeding that of the general population.”²

    However, when we look at this statistic in context, the figures aren’t that surprising. Not only do physicians work in a stressful environment with intense hours, but most have easy access to the types of drugs that often ensnare people prone to addiction. In addition, MD status can often make disease and addiction more isolating, and can keep physicians from seeking help due to fear of professional consequences.

    So… what’s being done to help?

    Methods for dealing with the issue of substance abuse vary among states and hospitals, however; most states do not allow hospitals to drug test employees unless they have a written policy in place. As a result, many hospitals have to rely on self and peer reporting to identify doctors who may be abusing substances. The problem is, family members, co-workers, and doctors themselves often remain silent on the subject, either out of fear that they will be held responsible for ruining careers or fear of facing litigation if their accusation is found to be false.³ To combat this fear-induced silence, all but three (California, Wisconsin, and Nebraska) states in the U.S. have programs called Physician Health Programs (PHPs) in place to allow physicians to get the help they need without facing retribution from the medical board.

    These programs were initially conceived in the late 1960s, when the Federation of State Medical Boards called for nationwide programs of probation and rehabilitation for physicians with substance abuse issues. Almost all U.S. State medical societies and jurisdictions brought such programs into existence by the 1970s, when the AMA, over the course of two national health conferences, officially recognized that addiction and alcoholism were health issues, not disciplinary ones.

    What do physician health programs do? 

    Today, the programs — usually mandated by employers but also sometimes solicited by addicted physicians themselves — vary from person to person based on the goals of the state’s PHP, the hospital, the individual physician/patient and their family, and even the Drug Enforcement Agency. Generally speaking, however, these programs abide by the following prescribed process:  First, a report is made by an individual, hospital, board or agency. Once the report is verified through further interviews and investigation, the PHP or a third party specialist will conduct an intervention. During the intervention, which frequently involves friends and family, the physician is informed that he or she will be protected by the PHP and will most likely be allowed to keep their license if they comply with the a specifically-tailored treatment plan.

    Once the affected physician has agreed to seek treatment, the PHP will construct a personalized treatment plan, which includes a detox period followed by a 90-180 day treatment program consisting of detox, group therapy, individual therapy, and family and friend group meetings. Physicians with substance abuse problems in particular need to spend time discussing how they will handle “access to addicting medications, licensure, shame and guilt, return-to-work issues, and dealing with patients.” Â²

    While the existence of a body meant to treat and protect physicians suffering from substance abuse seems comforting in and of itself, it’s also worth noting that these programs appear to be wildly successful. According to a 2009 Mayo Clinic article (citing [Physicians Recovery Network targets attitudes about impairment. Skutar C Mich Med. 1990 Dec; 89(12):30-2.]), Physicians have remarkable abstinence rates after completing an addiction/rehabilitation program compared with the general population. Abstinence rates are between 74% and 90%, similar to another professional group with higher than average success rates, airline pilots.” This is likely, in part, due to the specific, targeted nature of their treatment.

    In recent years, however, some questions have been raised as to the ethics of the programs as they exist today.

    Doctors are beginning to come forward with stories of feeling forced into PHPs without clear proof of support for their diagnoses. Additionally, some object to a lack of structure or protocol for due process surrounding suspension procedures, as there’s no body to oversee them or address complaints. Furthermore, there are those who have voiced concerns regarding the relationships PHPs have with very expensive rehab clinics, which most physicians pay for out of pocket.4

    Now that a conversation has been started about PHP oversight, hopefully we’ll see some positive change in the near future. In the meantime, they offer professional protection while providing physical and psychological treatment to physicians in need. Ultimately, the goal is (and should remain) to help physicians get the treatment they require for issues like substance abuse without fear of losing their licenses. It’s an intense job, with constant stress and easy access to relief for people predisposed to addiction. Physicians are heroes, without a doubt; but they’re still humans who need support.

    1. Skipper, Gregory E. “Confrontational Approach Has No Role in Addressing Physician Addiction.” Mayo Clinic Proceedings 84.11 (2009): 1042. 

    2. Berge, Keith H., Marvin D. Seppala, and Agnes M. Schipper. “Chemical Dependency and the Physician.” Mayo Clinic Proceedings 84.7 (2009): 625–631. Print.

    3. http://www.fsmb.org/directory_smb.html. Federation of State Medical Boards Web site. Accessed May 5, 2009.

    4. Anderson, Pauline. “Medscape Log In.” Medscape Log In. Medscape, 19 Aug. 2015. Web. 20 Sept. 2016.

    5. Physicians Recovery Network targets attitudes about impairment. Skutar C Mich Med. 1990 Dec; 89(12):30-2.