Doctors get addicted to drugs. There’s not much contention about that. Whether they do so at a higher rate than the general population is a matter of debate. The authors of a new discussion paper suggest that they do, although no evidence is produced in this regard. I’m not so convinced on that point.
There are some things however that we can agree on. What are they?
- There are large numbers of doctors dependent on alcohol and other drugs in the UK. A conservative estimate is 10,000.
- Addicted doctors are reluctant to seek help
- Perceived barriers result in late presentations
- Doctors with good insight and no comorbidity do better
- Engagement with AA and NA is associated with better outcomes
- Doctors do much better in terms of recovery than their addicted patients
Addicted doctors are different
So we have a problem, that’s clear, but why should addicted doctors be given any special consideration as a group? What makes them different? The authors explain:
They are “different” because of the following: high-risk profession, expensive and scarce resource, easier access to drugs and tendency to self-medicate, barriers to help-seeking, issues of patient safety, public confidence and fitness to practice implications, and the good treatment outcomes. Such a view that they are “different” is widely held among opinion leaders in the field.
What can be done to help?
What is suggested is that awareness is raised about addiction in the medical profession, something that is already addressed in the local medical school here in Edinburgh at several points in the curriculum. Secondly, doctors should be offered regular health surveillance, though what form this should take is not detailed (should drug and alcohol testing be done?)
Doctors have to sign a statement saying their health is not impaired once a year, but this is not likely to pick up hidden addictions. I’d like to have heard more about what surveillance might work. A third suggestion is to have better support systems in place, ramp up support at stressful times and ensure a health work/life balance.
It is suggested that disclosure is managed without attaching stigma. The authors are not naive in this regard:
Sadly, as is the case with the lay public, even among the medical profession and maybe even more so, there tends to be a considerable stigma attached to addicted professionals. This can only foster further feelings of shame, self-blame, and guilt in the addicted doctor, all of which delay the doctor’s help-seeking even more. It can also encourage the unhelpful maintenance of unhealthy defense mechanisms such as denial and intellectualization. It is very important that there ought to exist a “no blame” culture at work that can then ensure a nonstigmatized and confidential route into early assessment and treatment.
Finally, help needs to be given to helping doctors back into the workplace. This can be problematic for doctors who have been dismissed because of their addiction, even well into recovery.
Call to action
The paper calls for:
More specialist assessment and treatment services in the United Kingdom. Given the limited evidence base available, further research is desperately warranted in this field but should not delay this call for immediate service provision for addicted doctors. Finally, more guidance and support should be provided for professionals who are involved in the assessment and treatment of addicted doctors.
Some of these moves are afoot in Scotland already. Whenever the subject of addicted doctors comes up I always wish that clients coming to treatment across Scotland had access to the same kind of treatment and support that doctors get, because I firmly believe the outcomes would be so much better if we used physician treatment programmes like PHP in London or similar programmes in the USA as a model of treatment for all patients. It doesn’t seem reasonable that addicted doctors get a different standard of treatment to their patients, something I’ve written about before.
There’s a powerful Guardian feature which touches on some of these themes. You can find it here.
George, S., & Kohli, S. (2014). Addicted Doctors Addictive Disorders & Their Treatment, 13 (1), 25-29 DOI: 10.1097/ADT.0b013e31827b4440