Objective 9

To describe methods for recognizing and assisting colleagues who may have an alcohol or drug problem.

Currently, the prevalence of alcohol and drug dependence for physicians is similar to the general population. That is, between 5 and 8 of every hundred physicians are dependent on some type of mood altering drug.

There are more than 600,000 licensed physicians in the U.S. Therefore, there are approximately 30,000 to 50,000 physicians now practicing medicine under the influence of a drug dependency!

Recognition is no easy task and it requires an appreciation of the subtleties involved and the skill with which physicians can hide their problems and symptoms. The challenge, however, is not so much to catch a peer hiding their drug habit as it is to see and respond to the obvious behaviors that signal a possible problem.

Mark Twain once said, "It is not the things in the bible that I don't understand that bother me." Perhaps it is not the things we don't know about a colleagues drinking or drug using habits that bother us, it is the clear signals that we tend to ignore for fear of "over-reacting". Later, when the problem is no longer deniable, many regret that they did not do something or say something when they had the chance.

So what are the signs to which we might respond in a helpful way? Here is a list of behaviors that should tell you that there is a good possibility that a colleague is having a personal problem:

• New negative attitudes such as anger, cynicism, antagonism, negativity and social isolation
• Physical deterioration
• Major changes in dress (usually much more casual and sloppy)
• Red eyes
• The smell of alcohol
• Problems with attendance - covering office or call responsibilities

Oddly, with physicians, performance deterioration is one of the last signs of a substance use problem. When performance and safety become issues the problem is usually very severe and the physician's professional future is in great jeopardy (not to mention the safety of the patients he or she is caring for).

It is not necessary to make a diagnosis on a colleague before taking some sort of helpful action designed to help your friend and to protect the profession and the people we serve.
The most helpful thing a physician can do for a colleague is to recognize a potential substance abuse disorder and to take appropriate action.

There are many programs available to help the physician decide on the appropriate action and taking advantage of these programs and their advice is the first step you should take. Programs for physicians who may be suffering with an alcohol or other drug problem are now established in all 50 states. Here in Michigan we have the Health Professionals Recovery Program. Click here to learn more about it.

To find the one in your state, just call your State Medical Society. These programs are almost always independent of State Licensing Boards. An increasing number of hospitals, medical schools and local medical societies are establishing physician health committees consisting of Addiction Medicine Specialists, Psychiatrists, legal experts, and members of credentialing committees.

These committees generally offer help with peer assistance programs and developing intervention protocols. Often these committees will also have written authority to contact training directors and state licensing boards if a physician or student does not follow treatment or relapse prevention recommendations.

The best way to begin the process is to contact a staff person at the state medical society or a member of your local physician health committee. If you feel more comfortable contacting a colleague who is an Addiction Medicine Specialist, you can usually find one by calling the closest alcohol or drug treatment facility.

Legal and ethical issues abound when trying to help a potentially impaired physician. Just as with your own patients, you should be acutely aware of the potential dangers of making public a diagnosis of substance abuse. "Alcoholic" or "Drug Addict" are labels that affect anyone for the rest of their lives. For physicians and other professionals that make their living by providing services to the public, it can be professionally devastating. Therefore, it is wise to leave the investigation of a potentially dependent colleague to the appropriate committee or administrator who have the written authorization to conduct such investigations.

Here are two articles that may help you to understand the dynamics we are talking about in this objective. The first is a Wall Street Journal article that describes in great detail the rise and fall of a cardiac surgeon who developed a dependence on alcohol. It reviews not only the doctors troubles but how his colleagues around him responded. The story does not have a happy ending but is very instructive.

The second article is written by a Doctor who had a frightening experience when arrested for driving under the influence of alcohol. This story has a much happier ending and is instructive in terms of the problems we can get into just drinking "normally". It points out that the advice we give our patients is worthy of our own consideration.

"Cut Down: Two Heart Surgeons See Lucrative Practice Fall Apart",
The Wall Street Journal, Tuesday, September l3, l994, By George Anders, Staff Reporter
 

"What Harm Can Come From A Few Glasses Of Wine?",
Aide Magazine, October l993

Study Questions

Are the following statement true or false?

1. There may be as many as 50,000 doctors now practicing medicine who are dealing with an alcohol or drug addiction.
2. It is not difficult to get early identification of a doctor with a drinking or other drug problem because it is so easy to see their performance deteriorate.
3. Before taking any action that may put a physician under suspicion of having substance abuse problems, you should be certain that the physician meets the DSM-IV criteria for substance abuse or substance dependence.
4. While only a handful of states now have programs for impaired physicians, they are becoming more popular and should be in all states by the end of the century.
5. Impaired physician programs are generally run by State Licensing Boards.
6. Many hospitals and even medical schools now have Physician Health Committees that are designed to help with substance abuse problems of students, residents and physicians.
7. When you want to report a concern about a colleague's drinking or drug taking behavior but are concerned about confidentiality, the best place to start is to talk to a staff member of your state medical society about the process of confidentially reporting a concern about the safety of a licensed physician.
8. When you think a colleague is drinking on the job, you should immediately seek conformation of your observations by talking to nurses and other staff who assist the physician in his or her duties.
9. List at least 5 signs of substance abuse problems among physicians.
   

1. How do you think you would react if you had a partner in practice that behaved like Dr. Philip Rice?
   
   
2. Is there a difference between what you think you should do and what you actually would do if you were Dr. Rice's partner? Why?
   
   
3. What is the moral of the article about the surgeon who gets stopped after having consumed 4 glasses of wine at his son's rehearsal dinner? How does this article relate to your own drinking behaviors?
   
   
4. How could you use the Health and Behavioral Consequences Of Binge Drinking in College article to help with your brief intervention with a college Junior who screened positive for alcohol abuse?