Studies show the incidence of doctors, nurses, and other healthcare professionals who are addicted to alcohol and other drugs is concerning. One in 10 physicians is estimated to be addicted, with numbers for nurses and other healthcare professionals considered to be approximately the same. (1,2) While the primary problem amongst physicians is alcohol abuse (50.3%), the number of physicians using prescribed medications is higher than rates among the general public. (2) For anesthesiologists, highly potent injected opioids are the most commonly abused drugs. (3) Despite common barriers, though, there are ways to successfully treat addicted healthcare professionals and recovery rates are amongst the highest measured.
In treating addiction, state health professional programs are indispensible. Such programs emerged in the 1970’s after recognition of the extent of the problem by the AMA. (4) To prevent potential harm to patients and the addicted physician, rapid confirmation that a substance use problem may exist and immediate intervention are vital. All hospitals and medical clinics should have policies that guide responses to impairment of healthcare personnel.
Addiction is a disease of the brain’s reward circuitry; primarily in the limbic system and the pre-frontal cortex. Advances in the neurobiology of addiction have revealed supraphysiologic release of dopamine, establishing an excessive signal of reward by addictive substances. (6) Pre-frontal inhibition of drug use secondary to conscious recognition of mounting consequences would be a normal response, but is undermined as limbic drives prevail. Survival itself is reprioritized and becomes secondary to the ongoing use of the drug. (7) This reprioritization explains how the addicted continue to use drugs while adverse consequences mount. The prominence of the new limbic drive for the drug recruits the neocortex to preserve continued drug access and use; it should not be surprising that the addicted will deny use, bargain for situations allowing continued use and even give up careers, family and sometimes life itself in the pursuit of the addictive substance. Treatment for addiction is rarely sought spontaneously.
Unfortunately, for addicted healthcare professional who are often unable to recognize the problem, there are many reasons why peers and family do not identify or intervene. Medical schools provide few days of training in addiction, and the vast majority of primary care physicians are unable to recognize and treat alcoholism. (8,9) Colleagues are hesitant to intrude in another’s private affairs and will resist acting on a disease about which they have little knowledge. (10) Addiction can be misunderstood as a choice, not an illness, inhibiting action by others. There may be a “conspiracy of silence” in the workplace and the home, limiting involvement on the part of friends, family and colleagues. Employees may fear for their jobs and careers if they attempt to intervene. Family members may know of the addiction earlier than those in the workplace, but could hesitate to act for fear of financial consequences or loss of job and prestige. Fear of litigation can limit attention to this disease. Stigma and bias also interfere. Often, people cannot believe a physician could have an addiction or only believe addiction occurs in the lower socioeconomic classes. (11)
Treatment in specialty programs designed for healthcare professionals is necessary to address the issues unique to healthcare personnel. These programs require complete abstinence from drugs and the vast majority uses a 12 Step model based on the principles of Alcoholics Anonymous. McLellan et al revealed that 95% of physicians were treated using a 12 Step model and 78% entered residential treatment for a mean of 72 days (range 30-90 days). (3) The good news is that physicians have remarkable recovery rates when involved in appropriate treatment and monitoring programs. Recovery rates for physicians rank alongside those of commercial airline pilots, which are the highest measured: 74-90% stay completely drug and alcohol free. (3,12,13,14,15,16) As a result, most physicians can return to practice with a solid recovery program and monitoring in place.
