No one wants to think of their doctor as having an addiction, or that they’re being treated by someone who’s abusing alcohol or drugs. But the truth is that doctors are not immune to the problem of substance abuse and addiction any more than any other individual. In fact, in some instances, physician addiction may be even worse.

The Scope of Physician Addiction

Estimates of the number of doctors addicted to substances vary, but recent studies suggest that approximately 10 to 12 percent of physicians will develop a substance use disorder at some point during their careers. This is a rate that is similar to or greater than that in the general population.

But the incidents of substance use disorder as well as the drug of choice appears, according to several studies, to vary by physician specialty. Among physicians, alcohol abuse is the drug of choice for most doctors with addiction. In comparison, only about 10 percent of anesthesiologists enter treatment for alcohol addiction. Instead, studies have found that anesthesiologists are addicted to opioid drugs, particularly potent intravenous opioids, such as fentanyl and sufentanil.

One study by McLellan et al (2008) involved a five-year outcome of 904 doctors, 87 percent of whom were male, and who were enrolled in 16 different state physician health programs (PHPs). In this cohort longitudinal study, alcohol was the primary abused drug in 50.3 percent, opioids in 35.7 percent, stimulants in 7.9 percent and other substances in 5.9 percent.

That wasn’t all. Fifty percent of the doctors reported abusing multiple substances, 13.9 percent had a history of intravenous drug use, and 17 percent reported previous treatment for addiction.

In this study, the authors discovered that certain specialties appeared to be overrepresented in these programs relative to the national pool of physicians. The specialties included anesthesiology, emergency medicine, and psychiatry. The authors suggested that contributing factors may include work stress, ready access to narcotics and psychotropic drugs at work, and even possibly a selection bias in the type of doctors who seek these specialties.

Doctors Delay Seeking Treatment

One point that numerous researchers make is that by the time that doctors with substance use disorder or addiction actually seek treatment, they are usually in the advanced stage of addiction.

Why do doctors delay seeking treatment? For one thing, there is a profound stigma attached to the addicted doctor. One point that numerous researchers make is that by the time that doctors with substance use disorder or addiction actually seek treatment, they are usually in the advanced stage of addiction.

Doctors are also understandably worried that coming forward and seeking help for an addiction will cause them to lose more than prestige in the community. They fear that such a disclosure will also jeopardize their job, including revocation of their license to practice and, with that, economic ruin.

The family and coworkers of the physician abusing substances also play a part in the “conspiracy of silence.” They may be reluctant to confront the doctor or talk with anyone else to arrange an intervention because to do so would have a ripple effect of economic ruin caused by the doctor’s loss of a job and income.

Signs and Symptoms of Possible Abuse or Addiction

Looking at the problem of trying to recognize and identify possible substance abuse or addiction in physicians requires the ability to put two and two together. Not every sign or symptom, in and of itself, necessarily indicates that the doctor has a substance abuse problem, but more than one or a succession of them should certainly be cause for worry.

Gathered from various sources, here are some possible signs that may be suggestive of alcohol dependence:

• Acting in an “out-of-control” manner at social events
• Alcohol smell on the breath
• Ataxia
• Domestic or marital problems
• Erratic performance or decline in performance
• Failure to remember conversations, commitments, or events (otherwise referred to as “blackouts”)
• Frequent hangovers
• Hidden bottles
• Irritability
• Isolation
• Leaving the workplace early on a regular basis
• Moodiness
• Poor performance in the early morning
• Poor personal hygiene
• Problems with law enforcement, such as those arising from episodes of domestic abuse, driving while intoxicated
• Slurred speech
• Sweating
• Tardiness
• Tremulousness
• Unexplained absences
• Unusual traumatic injuries
Possible signs that may suggest dependence on opiates include:
• Adoption of wearing long sleeves (to hide needle tracks)
• Assay of waste drug returned that shows evidence of being diluted
• Dilated pupils (a sign of opiate withdrawal)
• Excessive narcotic use charted for patients
• Excessive sweating
• Frequent breaks to go to the bathroom (to take another dose)
• Frequent unexplained absences from the job during the workday
• Never returning any waste at the end of a case
• Patients arriving in the postsurgical recovery room with pain out of proportion to their charted narcotic dose
• Periods of agitation (sign of withdrawal) alternating with calm (sign the drug was just taken)
• Pinpoint pupils (a side effect of opiate use)
• Rummaging through sharps containers
• Sloppy record-keeping or discrepancies between the charted dose and the dose actually administered
• Spending more hours at work than necessary (to access the source of drug of choice)
• Volunteering for extra call
• Volunteering to clean operating rooms
• Volunteering to provide extra breaks or refusing breaks
• Volunteering to return waste drugs to the pharmacy

Suspected Physician Addiction

Let’s say that someone who works alongside the physician notices one or more signs or symptoms of alcohol or opiate addiction. He or she feels like something should be done but is nevertheless extremely reluctant to “blow the whistle” or get involved. The coworker may feel like it’s not his or her place to say anything, although by remaining silent, the situation could deteriorate to the point where the addicted physician causes the death of a patient.

The coworker could also be afraid of getting sued by the physician that they accuse of being addicted. A counter to this is the addition by medical licensing boards in many states that include the possibility of sanctions if a doctor knows of or becomes aware that a colleague is addicted or suspected of being addicted and fails to either intervene or notify the state PHP.

As seen in the previous section, the signs and symptoms of alcohol or opiate addiction vary considerably. They range from subtle and mile to blatantly apparent, even to the casual observer.

There’s also the fact that many physicians may be able to operate at a high level of functioning, so-called functioning alcoholics, although the same is also true with doctors addicted to certain opioids. There may only be the faintest hint that there’s a problem, and that, only over time.

Still, with the health and safety of their patients at stake, doctors who are addicted really need to have someone intervene to force the issue.

Intervention for the Addicted Doctor

There are many different ways of looking at an intervention. In the context of an intervention for the addicted doctor, it is, in essence, a confrontation with the suspected addict with the goal of forcing the individual to accept or submit to a formal chemical dependency evaluation by experts.

It is important to note that if a doctor is suspected of acute intoxication or addiction and is in charge of patient care, or who may be on-call or in charge of patient care in the near future, he or she should be immediately removed from such patient responsibility. In other words, the doctor should not be allowed to continue to care for patients.

The difficulty in arranging an appropriate intervention or even providing the intervention is something to take into consideration. No one should ever just go up to a doctor suspected of addiction and in a one-on-one exchange, either ask if the doctor is addicted or suggest that the doctor stop using alcohol or drugs. The doctor will be quick to deny it, in the first place, and such a confrontation could even be dangerous to the accuser. After all, the threat of disclosure jeopardizes the suspected doctor addict’s livelihood and career.

So, how should coworkers or superiors proceed if they suspect a colleague or employee doctor is addicted to alcohol or drugs? In an article on physician dependence The Mayo Clinic Proceedings lays out a generalized approach that may be useful to consider.

First, if doctor addiction to substances is suspected, a review of policies should take place, followed by notification of the appropriate contact, and then performing a discreet investigation. If the problem is identified, the next step is to notify the PHP and/or intervene. If the problem is not identified or is inconclusive, the recommendation is to observe. But if the problem has been identified and the PHP notified or there has been an intervention, the suspected addicted doctor should be referred to chemical dependency evaluation. If he or she refuses, termination should be considered.

If the chemical dependency evaluation identifies the problem, the suspected addicted physician should go immediately into treatment, either inpatient or outpatient chemical dependency treatment. If the doctor refuses to cooperate, termination should be considered. Should the chemical dependency evaluation prove inconclusive, the doctor should be allowed to return to work and overt or discreet observation should continue.

Following treatment, if a return to work is recommended, the doctor must sign a mandatory contract with PHP to monitor his or her recovery. If a work return is not recommended after treatment, the doctor should either be retrained or terminated.

Treatment for Substance Abuse or Addiction for Doctors

What exactly does treatment for substance abuse or addiction for doctors consist of? Do they just go into the same type of treatment setting that the general population suffering from substance abuse or addiction goes to? Is the treatment the same or is it markedly different?
In one sense, the evaluation of doctors with substance abuse is similar to that of any person being evaluated for dependence or addiction to substances. They both require a thorough evaluation, a detailed substance use history, and additional collateral information gathered from family, friends, coworkers and pharmacies. But with addicted doctors, skilled at rationalization, denial and resistance, a multidisciplinary team with experience working with such doctors is an absolute necessity.

As with almost all addicts, the addicted physician will be adamant in his or her denial that there is a problem. Thus, obtaining an accurate and detailed history of substance use may be extremely difficult. Reliance on reports from family, friends, coworkers, etc., may also require the use of signed releases or waivers by the addicted doctor to obtain.
In order to properly diagnose addiction, to determine whether it does exist and the extent of the problem, the substance use evaluation has to be as complete as possible.

During this evaluation phase, a complete medical history is obtained and a physical examination is performed. Addicted doctors very often neglect their own health. An evaluation with the family seeks to gather information on how the individual doctor functions and how the family has been affected by the doctor’s suspected addiction.
Psychiatric and psychological evaluations are also conducted, due to the fact the co-occurring psychiatric illness, also called a dual-diagnosis disorder, is common among addicted physicians. A substance use disorder in conjunction with a simultaneous major depressive disorder, anxiety or panic disorder, or bipolar disorder, can sabotage the physician’s recovery from addiction – if both disorders are not treated concurrently.
Cognitive screening is also conducted. This is because there is often substantial memory and cognitive impairments in doctors with alcohol or methamphetamine dependence.

Getting to the treatment phase, the addicted doctor needs to be in a program that specializes in the treatment of physicians with dependence or addiction. Detoxification is a necessary first step prior to initiation of any treatment. The alcohol and/or drugs have to be out of the doctor’s system before formal treatment begins.

Most treatment programs aimed at addicted doctors have curricula that are similar to treatment for addicts in the general population, although there are specific therapeutic modalities that are targeted at physicians. With the addicted doctor treatment program, then, the doctor can expect to participate in individual and group psychotherapy, addiction education (learning about the disease of addiction), and peer fellowship.

Most physician-oriented substance abuse treatment programs are abstinence-based and adhere to the 12-Step program philosophy. Addicted doctors will attend 12-step groups, such as Alcoholics Anonymous or Narcotics Anonymous, as part of their overall treatment program.

Doctor-specific modalities include group meetings with multiple addicted-physician peers. In fact, this is a primary feature of treatment programs for doctors with substance addiction. During these meetings, the addicted doctors learn how to recognize their own addictive behaviors. Their peer discussions cover such issues as problems with licensing, guilt and shame, dealing with patients, access to addicting medications, and the often-thorny issues around returning to work.

The treatment plans are tailored to the specific addicted doctor and are crafted to align with the goals of the patient – i.e., to get clean and sober – as well as their employers, the state PHP, and other interested parties (which may include the Drug Enforcement Administration, for example). Recommendations include attendance at self-help meetings post-treatment, as well as continuing therapy, monitoring and any workplace limitations.

Returning to Work

Should the doctor return to work following treatment for substance use or addiction? The research shows that doctors who successfully complete treatment for addiction and participate in rehabilitation programs have a very high abstinence rate. These abstinence rates range between 74 percent and 90 percent, which is similar to the higher-than-average abstinence rate of airline pilots.

Returning to work generally requires the doctor to sign a mandatory contract with the state PHP, involving monitoring, random and for-cause drug screening, workplace education and monitoring, and so on. Failure to comply with the program may result in reporting to the state medical licensing board, disciplinary action, possible public disclosure, sanctions, and suspension or revocation of license to practice.

Some doctors, before they can return to work, will have limitations placed on their ability to prescribe medications, particularly opioids or other addicting medications.

In the case of anesthesiologists who are addicted, who have access to and use of highly addictive drugs, following treatment their professional activities may be limited to nonclinical roles. They may be directed to a new practice specialty or to roles such as teaching, research or administration. This is because the relapse rate for anesthesiologists is very high and is associated with a consequent high risk of death.

In Conclusion

There is no doubt that addicted doctors can cause great harm to their patients if they continue to abuse substances and no one intervenes. It is not in the best interests of anyone concerned to allow an addicted physician, or one that is suspected of having an addiction, to continue to practice as usual.

While the hurdles to getting an addicted doctor to acknowledge the problem and accept treatment may be high, the success rate for doctors who do successfully complete specialized treatment for their addiction and also participate in self-help meetings, monitoring and continuing peer and other therapy is encouraging. These doctors are highly motivated to be able to return to the practice of medicine.

As it is true of addiction in any individual, the addicted doctor has no guarantee of continued abstinence. It takes continued dedication, vigilance and hard work to ensure sobriety is maintained. But it can be done. Thousands of addicted doctors have gone through substance abuse treatment programs successfully, completed their PHP contracts, and have returned to work.