In an article published in the American Journal of Psychiatry, author A.B. Srivastava, M.D. states that while research indicates physician impairment is as prevalent as it is in the general public, the stigma associated with addiction requires impaired healthcare professionals to overcome more obstacles (than their public counterparts) in order to get proper intervention, evaluation and treatment. He concludes while state-level physician health programs bring together impaired doctors with cutting-edge treatment, follow-up monitoring and support for ongoing recovery maintenance, nonetheless resistance to self-reporting needs to be addressed by way of destigmatizing those afflicted by the disease of addiction.
The cited research points to the rate of physician impairment being at 15% and the general public being at 13%.[1] However, Srivastava notes doctors struggling with substance use disorders aren’t easy to recognize for numerous reasons. Besides having easy access to prescription drugs (including opioids and other addictive, mood-changing medicines), physicians tend to have a substantial knowledge of “what addiction looks like,” hence their greater ability to hide their chemical dependency and drug use from their employers, co-workers, family and friends.[2]
And studies have shown medical doctors self-report less often than other professionals, “due to the professional implications, stigma, and lack of awareness about mechanisms for reporting and avenues for referral to treatment.”[3]
The unfortunate result of this is the majority of physicians who struggle with a substance use disorder don’t get sufficient treatment. To add credence to the cited lack of self-disclosure among impaired doctors, of those who do receive treatment, only one in four admit themselves and nearly three-quarters are referred by colleagues, loved ones, a state board of medicine, etc.[4]
Srivastava relays that state physician health programs, such as Professionals Resource Networks (PRNs), have since the 1970s been in place as a mechanism to help healthcare professionals recover from substance use disorders. Working in alliance with state boards of medicine, they orchestrate addiction treatment and follow-up monitoring.
Upon intake, the impaired physician meets with a medical doctor who has a background in addiction medicine or addiction psychiatry, and conducts a comprehensive evaluation. A recommended protocol for treatment is arrived at, as well as a course of future monitoring to be put in motion upon successful completion of treatment. These elements are made clear to the PRN (or associated state physician health program), and a formal contract articulating such is agreed to and signed by the physician. To be able to continue practicing medicine, the physician must agree to and comply with all aspects of the contract.
Fortunately, according to Srivastava, the typical PRN program works with only a specified number of addiction treatment centers, all of which provide cutting-edge treatment and cater to the unique needs of impaired healthcare professionals. Besides medically-assisted detox, these programs most often include residential treatment or intensive outpatient treatment, when determined applicable by the PRN; individual, group, and family-oriented therapy; participation in 12 Steps programs (e.g., Alcoholics Anonymous, Narcotics Anonymous or Caduceus — a 12-step-based fellowship for physicians; and medical care and therapeutic counseling, especially when psychiatric comorbidities are present or identified during treatment. In addition, PRN programs can offer resources to handle addiction-related legal issues.[5]
Upon successfully completing one’s agreed-upon treatment protocol, the impaired physician starts the monitoring phase of their contract, which typically lasts 5 years and includes random drug testing. During the monitoring period, verification of one’s attendance at ongoing recovery support meetings (A.A., N.A., etc.), and whatever healthcare visits were established in the contract (e.g., meetings with a therapist, psychiatrist or primary care physician, etc.). Again, any failure to abide by the contractual agreements made at the time of intake may result in a variety of consequences or punishments, including loss of one’s license to practice medicine.
All-in-all, it’s hugely beneficial to both the impaired physician and his/her patients, employers, co-workers and families to have these PRN programs available to help those doctors struggling with chemical dependency find recovery and freedom. However, Srivastava emphasizes the added importance of educating society and healthcare professionals themselves about the true nature of addiction, to diminish and hopefully eradicate the stigma associated with it.
[1] Oreskovich MR, Shanafelt T, Dyrbye LN, et al. “The prevalence of substance use disorders in American physicians.” American Journal of Addiction. 2015. 24:30–38
[2] DuPont RL, McLellan AT, White WL, et al. “Setting the standard for recovery: physicians’ health programs.” Journal of Substance Abuse Treatment. 2009. 36:159–171
[3] Ibid.
[4] DuPont RL, McLellan AT, Carr G, et al. “How are addicted physicians treated? A national survey of physician health programs.” Journal of Substance Abuse Treatment. 2009. 37:1–7
[5] Ibid.
