Is Medicine Driving Doctors to Drink?

Between 10% and 15% of US physicians suffer from a substance use disorder, a rate slightly higher than that of the US population as a whole, a recent Medscape article revealed.

But physicians struggling with abuse or addiction differ from other members of the public in one critical respect: They have taken an oath to care for others. However, the article cited two surveys in which physicians who met the criteria for substance abuse and dependence were more likely to say they had committed a major medical error in the previous 3 months than their peers who didn’t meet the criteria.

“When doctors are impaired, everyone suffers,” the article pointed out, including the physicians themselves.

Why do some doctors become hooked? “Medicine attracts many high-achieving, compulsive, perfectionistic individuals who derive a strong sense of self-worth from their jobs,” the article noted. “If a doctor’s commitment morphs into overwork, exhaustion, and a work/life imbalance, alcohol and other drugs may become a dangerous balm.”

Add to that physician access to potent prescription medications, and it’s not hard to understand how some doctors might step over the line. “Whereas alcohol abuse is the most common form of drug abuse for both physicians and the population as a whole, research shows physicians are more likely than the general population to abuse benzodiazepines and opiates,” the article stated.

The article quoted addiction experts who urged doctors with an alcohol or drug abuse problem to get help, offering some suggestions. Doctors who suspect that a colleague is impaired were urged to broach the subject with that individual or at least bring the matter to a hospital wellness committee’s attention as an act of compassion and a patient safety concern.

For a number of doctors who offered comments, the problem of physician addiction and dependence reflected a larger problem with society as a whole.

The reason a lot of people get hooked is because of the sanctimonious ‘all-or-nothing’ attitude of our society,” wrote an orthopedic surgeon. “Why are the numbers so much better in Europe, where 6-year-olds have a thimbleful of wine with Sunday dinner and hit adulthood ‘knowing’ about alcohol?”

“For as much physical, emotional, and economic damage that alcohol causes, it gets hardly any attention; instead, it is advertised and promoted to our youth,” an ophthalmologist remarked. “A shameful, festering wound on the face of our society.”

But other commenters saw the problem as one endemic to medical culture.

“Why do medical professionals often become alcoholics/addicts and then hide it as the disease progresses? I think one reason has to do with the culture of medicine,” an internist opined. “Medicine is all about identifying symptoms and reflexively prescribing substances to alleviate those symptoms. I don’t think we realize what a huge impact that has on us subconsciously over time as healthcare providers. We are expected to be super-human while teaching our patients to take good care of their bodies. We are discouraged from taking time off when we are sick or burnt out, and as the for-profit medical system evolves, we are pushed harder and harder. There is a disconnect between teaching and preaching wellness and the way healthcare providers live themselves. The system is broken.”

“Medicine is uncomfortable discussing and admitting its substance abuse problem,” another doctor wrote. “Case in point: When I was starting to have daily problems that were harder and harder to hide in medical school, no one ever spoke to me in the clear terms I needed to hear. They knew I was drug-seeking for the pills I was addicted to. They knew I was drinking alcohol daily (“they” being MD department heads and advisers, as well as student counselors at the Top 10 medical school I trained at). No one said to me, ‘You have a disease, and it’s called addiction/alcoholism. You need to go to rehab and 12-step meetings to get better.’ Meanwhile, I went to student/faculty events and saw students getting wasted to the point where they could not speak in front of faculty, who thought it was cute and part of normal medical student life.”

Other physicians took the opposite view: that focusing on the minority of physicians who abuse substances misses the larger picture.

“Ten percent of physicians suffer from a substance use disorder,” a surgeon commented. “Ninety percent do not. Thank you for that indirect credit to the majority of us.”

“Is it less interesting to write about how the vast majority of physicians lead productive lives without chemical dependencies?” an orthopedic surgeon wondered.

Several physicians, recovered alcoholics, took personal responsibility for their problem.

Say what you want about ‘stress, perfectionism, compulsion,’ etc., the fact is, I drank alcohol because I am an alcoholic,” wrote an emergency physician, who said he has been sober for 13 years. “I don’t understand what underlies the difference between me and a ‘normal’ person,” he confessed. “Many of my colleagues are just as perfectionistic and compulsive as I am and are doing the same job. They don’t abuse alcohol or drugs. I was very good at trying to hide my drinking, and I got away with it for years. Thank goodness I don’t remember any poor clinical outcomes that resulted from this. In fact, I took some pathetic pride in the fact that I was never drunk on the job. I lived in constant fear of being discovered, and much of the fear was based on my assumption that if I admitted to my addiction, I would have to stop being a doctor. By the time I was finally confronted by hospital administration and tested positive for alcohol during clinical duty, I was so tired of running and hiding that I was actually relieved. I did have to take a few months off for rehab, and I followed guidelines for monitoring by my state medical board. For the past dozen years I have been back to work, and my clinical practice has flourished. I feel better than I ever did prior to my intervention. I am very grateful for all of those people who helped me through the transition away from alcohol.”

A few commenters weren’t buying the reasons that some doctors develop substance use problems.

“There are reasons and there are excuses,” a vascular surgeon remarked. “You list factors contributing to drug and alcohol abuse, but the reason is that some people make bad choices.”

“So now we make excuses for a profession in which persons have lost their way, using words like ‘high-achieving,’ ‘compulsive,’ ‘perfectionist,’ ‘overwork,’ ‘exhaustion,’ and ‘work/life imbalance’ to make the absurd excuse that alcohol and other drugs then become a dangerous balm,” a medical oncologist remarked. “My goodness, no other profession, now or in history, has had these same characteristics? They have only recently been discovered in ONLY the medical profession? How about a dose of ethics, morality, balance, strength of character, and positive outlook in the ‘good’ that doctors can do?”

“Nobody is making excuses!” a radiation oncologist fired back. “And medicine was not singled out. Physicians have the SAME rate of alcoholism as the general population, not significantly higher than dentists or other educated, intense professionals. Look at firefighters and policemen: Their rates of substance abuse are higher. The point is that there is help. Most university-affiliated hospitals have physician health teams that will treat anonymously. I myself have benefitted from this interaction (not for addiction but for burnout), and it was done quietly and effectively. Now that I am much healthier, I no longer feel the need to hide my problems, and have pointed several colleagues in the same direction. The point is not to make excuses. The point is to get appropriate treatment and get better.”