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Successful Treatment of Physicians With Addictions

Successful Treatment of Physicians With Addictions

Addiction treatment for medical personnelPhysicians generally display better health and have lower rates of all-cause mortality than the general population.1 However, their education, nutrition, and lifestyle do not offer similar protection from substance abuse and dependence. Prevalence rates of alcohol abuse and dependence among physicians are about equal to those seen in the population as a whole, while prescription drug misuse and dependence rates are far higher.2,3 Addiction impairs more physicians than any other disease.4

Defined as “a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. . . . [Addiction] is characterized by impaired control over drinking and/or drug use, preoccupation with the drug or alcohol, use of drugs or alcohol despite adverse consequences, and distortions in thinking, most notably denial.”5 The recognition that addiction is a disease, rather than a character flaw or failure of willpower, has led to the development of effective treatments and has helped reduce the stigma associated with rehabilitation and recovery. This model promotes the acceptance of treatment in persons with addiction disorder and results in increased satisfaction with care and improved prognosis.

This article briefly reviews the factors that contribute to physician addiction, why the need for treatment is so important, and what the barriers to treatment are. It concludes with the presentation of a model for successful treatment.

Contributing factors

The causes of physician addiction are not fully understood, although it appears that many factors can contribute to the development of this disorder. For example, the ready access that physicians have to drugs and their ability to self-prescribe have been suggested as potential pathways to addiction. Indeed, despite the fact that physicians are less likely than the general population6 to smoke cigarettes7 or use alcohol or illicit drugs,3,8 rates of prescription drug abuse are higher among physicians.9 Currently, more attention is being paid to this important issue, particularly within the field of anesthesiology.10,11 Yet, not all physicians who have an addiction disorder abuse prescription drugs. Work-related stress has been pinpointed as an another contributor to physician addiction, but physicians with addictions typically deny using substances to self-medicate and describe using them for euphoric effects.12

Building on research involving the role of reward neurocircuitry in addiction,13,14 recent studies have provided support for the hypothesis that some physicians may be neurobiologically sensitized to develop addiction as a result of chronic exposure to small amounts of addictive substances that are aerosolized and can be inhaled or absorbed through the skin.15 This hypothesis can help explain why opioid abuse and dependence occurs most commonly among anesthesiologists and surgeons.

While numerous pathways to abuse and dependence exist, this hypothesis has been useful because it can be tested and may explain why some physicians become addicted.15-17 Physician addiction reminds us of the limitations of education as a protective factor against drug abuse. Finally, factors contributing to addiction in the general public, such as family history of addiction, comorbid psychiatric diagnosis, or early drug experimentation, may also influence the development of addiction among physicians.

Need for treatment

Regardless of the contributing factors, the importance of obtaining treatment for addicted physicians cannot be overstated. The potential consequences of neglecting substance use disorders extend beyond the physician to his or her patients, coworkers, and family members. Indeed, clinical experience suggests that disruption or discord in the physician’s primary relationship (eg, spouse) is virtually always present in cases of addiction. The lives of family members are negatively affected, and children are at increased risk for psychological problems and substance use.18


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