Chemical Dependency and the Physician

Abstract

A pproximately 10% to 12% of physicians will develop a substance use disorder during their careers, a rate similar to or exceeding that of the general population. 1,2 Although physicians' elevated social status brings many tangible and intangible rewards, it also has an isolating effect when they are confronted with a disease such as addiction, which has a social stigma. This isolation can lead to disastrous consequences, both in delaying the recognition of and in intervening in the disease process, as well as in the attendant risk of death by inadvertent overdose or suicide. 3 Further causes for delay in diagnosis include fear on the part of the physician that disclosure of an addictive illness might cause loss not only of prestige but also of his or her license to practice medicine and thus livelihood. Additionally, a physician's family members and coworkers will often participate in a "conspiracy of silence" in an effort to protect the family or practice workers from economic ruin by the loss of the physician's job and income.McLellan et al 2 conducted a 5-year longitudinal cohort study of 904 physicians, 87% of whom were male, who were enrolled in 16 state physician health programs (PHPs). Alcohol was the primary drug of abuse in 50.3%, opioids in 35.9%, stimulants in 7.9%, and other substances in 5.9%; 50% reported abuse of multiple substances, 13.9% a history of intravenous drug use, and 17% previous treatment for addiction. The authors found that certain specialties, such as anesthesiology, emergency medicine, and psychiatry, appeared to be overrepresented in these programs relative to their numerical representation in the national physician pool. Indeed, other investigators have

Narcissistic Personality Disorder: Progress in Recognition and Treatment

“…Stimulants or cocaine may in fact increase performance and enjoyment of work, as well as prolong work hours, which may contribute to a faulty perception of those stimulants' benefits, thus making it challenging to give them up. Similarly, alcohol and other anxiolytics have the potential of alleviating academic and vocational stress, thus making some of the career-focused NPD patients, such as medical residents (41) and physicians (42), especially vulnerable as seen in vignette #4. Dr. B, a medical resident, spent many hours dedicated to his career.…”

Alcohol and Drug Testing of Health Professionals Following Preventable Adverse Events: A Bad Idea

“…These low numbers seem to suggest that such boards do not witness a high number of substance-abusing physicians committing harmful error, especially as aggrieved plaintiffs who would have any reason to believe such would seem highly motivated to report their finding or speculation to the board. On the other hand, licensing board data might themselves be a poor source of information on the degree to which drug or alcohol abuse affects physician behavior, as many states allow physicians to voluntarily enter a physician health program while bypassing their state licensing board (Berge et al 2009;Boyd and Knight 2012). health professionals can illicitly use these substances for years but, arguably, not "abuse" them.…”

“…That kind of temporal delay can easily enable any biological evidence of drugs or alcohol to wash out of a care provider's body and obviate the value of a postincident test. On the other hand, testing for prescription painkillers like oxycodone or hydrocodone is typically excluded in the 8 or 10 panel drug screening tests that follow the Substance Abuse and Mental Health Services Administration's guidelines, despite the fact that they are popular substances of abuse among physicians (Berge et al 2009;Merlo and Gold 2009; U.S. Department of Labor 2014).…”

Physician Wellness and Substance Use-a Brief Review

“…Recognizing signs of depression or substance use in a fellow physician is challenging and confronting or reporting suspicion can make for a difficult conversation. An addicted physician may continue to function at a high level with no behavioural changes [18]. J o u rna l of A lc o h o lis m and D ru g D ep enden c e…”