Learning to confront physician substance abuse
We are incredibly selfish people. We make family and colleagues suffer," said a doctor who coped with a longtime drug addiction while in practice. He was speaking to an auditorium filled with rapt DMS students as part of a class on physician substance abuse; it is one session in a fourth-year course for medical students called Health, Society, and the Physician. "It will happen at one time for all of you—that you will have to confront a colleague about this," continued the doctor. That was the reason he and two other doctors were willing to share their stories.
Struggle: Talking to someone about their addictive disorder can be extremely hard, Dr. Seddon Savage told the students. Savage, the director of the Dartmouth Center on Addiction, Recovery, and Education, had put together the two-hour class. People still struggle, she said, with the idea that substance abuse is a disease. Other caregivers can be afraid to confront a colleague because they may think they'll be perceived as pushing some kind of moral message. "I think that doctors are generally pretty strong and independent people, and it's difficult for nonphysicians especially to bring up issues that suggest they're less than full, whole, and strong," explains Savage in a later interview.
Medical researchers, physicians, and the public are starting "to understand and believe that addiction is a chronic medical condition" and to treat it that way, says Savage. Likewise, medical schools are "just beginning to educate young, evolving physicians—medical students—in addiction medicine and in the chronic
medical illness that is addiction. And until that infuses medical education, the perceptions of the general public and the operations of the healthcare system are not going to optimally address addiction in anyone, including physicians." A 1992 study in the Journal of the American Medical Association found that addicted physicians are most likely to practice anesthesiology, followed by emergency medicine, family practice, and general surgery, and that alcohol is the most common substance of choice, with opiates and benzodiazepines close behind.
Stress: For physicians, says Savage, substance use can look like an easy way to relieve the stress of their work—the responsibility for others' health; the privilege and burden of knowing intimate details of others' lives; the long hours; and the competing demands of work, family, and self-care. Some medical professionals hike, listen to music, or exercise to let off steam, while others, Savage says, "kick the dog" or turn to substances.
Addiction is tricky to treat, she explains, since addicted individuals often deny the hold the drug has over them. They crave it because their brain tells them they need it—a phenomenon called the "hijacked brain," since the craving can disorder thinking. The manipulation and denial addicted individuals engage in to protect or regain their use of a drug "are sometimes pretty onerous," says Savage.
One way they can seek help, she told the soon-to-be doctors in the class, is through the committee dealing with physician health that every hospital is required to have. Such committees don't provide direct treatment but make treatment referrals. Physicians can seek help directly; more often, referrals come from friends, colleagues, or hospital administrators. The committees make sure addicted individuals follow the treatment protocol. "The physician health committee is a wonderful concept because it allows us to address health problems as health problems, not as disciplinary problems," says Savage.
Matthew C. Wiencke
If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.
This article may not be reproduced or reposted without permission. To inquire about permission, contact DartMed@Dartmouth.edu.