Evaluating an Individual’s Treatment Needs
Addiction among Doctors, Nurses, Pharmacists
The medical profession is one of the most esteemed, and the reality is that every member works extremely hard to maintain the high standards of the field. The stress can lead some to drug abuse.
Stress in the Medical Profession
An article in TIME specifically addresses the stress involved in being a hospital doctor. According to research, up to 40 percent of US physicians will experience job burnout, with surgeons and OBGYN doctors particularly at risk. Professor Anthony Montgomery of the University of Macedonia (Greece) believes that the way doctors are trained makes burnout inevitable for some. Throughout school and then their hospital residencies, there is great emphasis on an individual doctor’s technical abilities. Then, doctors are cast into the highly social and emotional environment of a hospital and patients. The tension between having to be technical and needing to be social and sensitive is one potential source of stress. The following are additional possible sources of stress for doctors:
- Poor-work life balance, which results in doctors having less time for family and a social life
- Pressure to reduce the costs of healthcare, which adds stress to the diagnostic process, treatment, and other facets of patient care
- A general perception among the public that doctors are heroes, which can be psychologically crippling for doctors who are bound to make mistakes on the job
- A loss of enthusiasm among doctors, which can be emotionally, psychologically, and physically devastating given the unrelenting demands of the job
Nurses face their own unique forms of stress in addition to being subjected to many of the same stressors that doctors experience. Stress in the nursing profession is well documented. Per the American Holistic Nurses’ Association, nurses experience a high rate of stress compared to other professions due to:
- Patient care
- The high level of responsibility
- Having to be adaptable to change
- The pressure of making big decisions
- Lack of resources
- Difficulty in balancing work-home obligations
- Management issues
- The physical demands of the job
Pharmacists are key players in the medical professional and also subjected to unique forms of daily stress. According to Pharmacy Times, one study of pharmacists reported that 68 percent experienced stress on the job and were overworked. Approximately 50 percent of the pharmacists studied said they had work-home balance issues. The study also noted a common grievance: Pharmacists felt that much of their time was taken up with mundane tasks (calling doctors’ offices, being placed on hold, etc.), and there was not enough time for patient counseling and care. In addition to these stressors, the following are common in the pharmaceutical profession:
- Job instability (i.e., uncertainty that the position will continue)
- Short staffing
- A lack of continuing education in the profession
- Inflexible supervisors or managers
Although not discussed in detail here, it is critical to keep in mind the many other individuals who are involved in the medical profession and their vulnerability to stress (e.g. physician assistants, paramedics, medical assistants, front desk personnel, pharmacy assistants, etc.). Even in the face of stress, many people working in the medical profession want to remain in their specific job or at least in the field.
When a person employed in the medical profession starts to abuse alcohol or other drugs, help is needed. The person is likely trying to cope with a problem, work-related or otherwise, and has turned to a vice that will only worsen existing problems and create new ones. It is important to know that effective drug recovery treatment, including extensive counseling, is always available.
Substance Abuse in the Medical Profession
According to a USA Today article, across the US, more than 100,000 physicians, nurses, healthcare aides, medical technicians, and others have abused prescription medications such as fentanyl and oxycodone. It is estimated that one in 10 medical practitioners will experience alcohol or other drug abuse at some point during their lifetime. This percentage is similar to that of the general public.
In response, professional assistance programs have sprung up across the nation. According to one estimate, these programs are attempting to enroll 1-3 percent (or 50,000-150,000) of doctors, nurses, and additional medical personnel but have not been able to hit this target. According to the Medical Board of California, in 2007, less than 0.2 percent (about 250) of physicians in the state were in a treatment program though it was estimated that approximately 1,260 required treatment.
An insightful article published on Medscape discusses substance abuse among doctors in specific. It is critical to look at this group in isolation from others to figure out how best to prevent doctors from initiating into drug abuse and to most appropriately help those who already have. According to Lisa Merlo, PhD, of the University of Florida’s Center for Addiction Research and Education, doctors have the same rate of drug abuse as the general population but mainly abuse prescription drugs, simply because they have access to these drugs.
Merlo conducted a study of 55 doctors who were in a state physician assistance program for drug recovery. Merlo found that 69 percent of the doctors in recovery (38 in total) had abused prescription drugs. When asked why, the doctors reported that they wanted to relieve stress or psychological pain. The doctors were not seeking a recreational high but rather used the drugs as a way of coping with work or work-related issues. In addition to stress, some doctors may be self-medicating an undiagnosed condition, such as depression. The results of this study and others can be used to create or improve methods to eliminate the barriers to entry to treatment programs.
Per an article in the ModernMedicine Network, addiction among nurses is a quiet epidemic. According to the American Nurses Association (ANA), approximately 10 percent of nurses experience substance dependence. This rate is similar to the national average. In real numbers, that’s about 300,000 registered nurses. When the types of drugs are considered, the similarity between nurses and the general public shifts. Nurses tend to abuse prescription medications at a higher rate, and cocaine and marijuana at a lower rate. Among nurses, the most commonly abused drugs are (from least to most): inhalants, tranquilizers, sedatives, opioids (e.g. fentanyl), amphetamines, and alcohol. Though all nurses are potentially at risk of substance abuse, nurses in psychiatry, oncology, critical care, and anesthesia likely face an increased risk of abuse because of the high demands in these areas. Also, nurses have relatively easy access to psychoactive drugs within these practice areas (and others).
As noted in the ModernMedicine Network, one study of pharmacists found that 46 percent of participants had used a prescription medication without having a prescription. Of the pharmacy students interviewed, 62 percent had used a prescription medication without a prescription. Of the pharmacists interviewed, 20 percent reported having used a prescription drug with no prescription at least five times over their lifetimes. A National Institute on Drug Abuse survey found that 11-15 percent of pharmacists experienced alcohol abuse at some point over their careers. This figure may be lower than the true number.
Pharmacy Times published a personal account of drug abuse by a pharmacist. Though his drug abuse did not start during his pharmacy studies, he shares that he and his classmates regularly used drugs and were encouraged, in part, by their understanding of pharmacology. They understood the difference between lethal and non-lethal doses and the psychoactive effects associated with different drugs. Ultimately, the pharmacist stopped using drugs in the interest of maintaining his pharmacy license. He did, however, risk losing his license on numerous occasions, which is itself a sign of a substance use disorder.
Doctors, nurses, and pharmacists experiencing substance abuse tend to be spotlighted when it comes to discussions about addiction among medical professionals. However, it is critical to be mindful of how stress, work-life balance, workload, physical/psychological/emotional drain, and other issues affect personnel across the medical field. Understandably, professionals and support people in the medical industry may be hesitant to seek help. They may feel that their livelihood, reputation, and financial stability will be jeopardized. For this reason, it is important that these individuals feel supported at every step of the recovery process, beginning with the first time they ask for help. The best practice is for medical personnel in need of help to reach out to an addiction specialist at an accredited rehab center or ask a trusted person for assistance. Recovery is always achievable, and there are numerous treatment options available.
Treatment for Those in the Medical Profession
Drug rehab centers across the US offer specialized treatment programs to help doctors, nurses, pharmacists, and other medical professionals. It is helpful to note that professional treatment programs do not necessarily use specialized addiction treatment methodologies. Rather, these programs tailor existing evidence-backed treatment methodologies to professionals and work with them as a discrete group.
A program may treat mixed-professionals (e.g., lawyers, doctors, CEOs, etc.) or cater specifically to one profession, such as state assistance programs for doctors. In some instances, the rehab center will exclusively treat professionals, while other programs will offer a professional recovery program within a mixed-client center.
Accredited, professional rehab centers guarantee confidentiality, though getting help should never be seen as shameful. There are many reasons clients may want confidentiality, and the hope is that shame is not one of them. Getting help is the most courageous step a person can take when experiencing substance abuse.
A Note on Physician Health Programs
An article published in the Journal of Substance Abuse Treatment takes an in-depth look at Physician Health Programs. These programs are not designed to provide treatment, but they do make referrals and provide a host of supportive services. According to the article, physicians tend to receive an exceptionally high and varied level of care compared to the general population. For example, most (if not all) states require that doctors be monitored for a period of years after completion of a program. This type of structured aftercare can help to prevent relapses.
Doctors, as licensed professionals, have an additional incentive (compared to non-licensed working people) to maintain sobriety in order to maintain their right to practice medicine. Further, doctors typically have adequate health insurance and resources to support their recovery process and aftercare. Doctors have many factors militating in favor of lasting recovery, and this fact will hopefully encourage those in need to seek help.
- State-to-state Physician Health Programs: These state-run assistance programs can be found through a simple online search. For example, in New York, doctors, physician assistants, and certain other medical professionals can contact the Committee for Physician Health, a division of the Medical Society of the State of New York.
- Fellowship groups or mutual-aid meetings: These groups can be instrumental to the recovery process in the short-term and long-term. The following are specialized meeting possibilities for members of the medical profession:
- International Doctors in Alcoholics Anonymous
- Alcoholics Anonymous (online information for professionals)
- Narcotics Anonymous for professionals
- SMART Recovery for professionals
- National boards: These organizations may be able to provide information on various specialized or state-run assistance programs:
- National Board of Physicians and Surgeons (NBPAS)
- Board of Nursing (NCSBN)
- National Association of Boards of Pharmacy (NABP)
- ACGME: Medical doctors working in a hospital residency program toward their board certification may contact the Accreditation Council for Graduate Medical Education (ACGME) for assistance.
- Insurance: Affected individuals with healthcare coverage can contact their insurance company for information about drug rehab centers that participate in the insurance program.
- NIDA: Family and friends can find a wealth of useful information through the National Institute on Drug Abuse.
- Publications: Books are a helpful source of self-education but should never replace speaking with an addiction specialist. The following are some books about the process of recovery from the viewpoint of medical professionals who experienced addiction:
- From Harvard to Hell…and Back: A Doctor’s Journey through Addiction to Recovery (2013) by Sylvester Sviokla III, MD
- Impaired: A Nurse’s Story of Addiction and Recovery(2009) by Patricia Holloran, RN.
- Incomprehensible Demoralization: An Addict Pharmacist’s Journey to Recovery (2008) by Jared Combs, PharmD