The Impaired Medical Professionalby Larry Blumenthal, M.D.,Director, Student Health Services While substance abuse is a common reality in our society, health care professionals widely acknowledge feeling ill-equipped to effectively confront the problem when we suspect it exists. The problem is especially difficult when it involves a classmate or professional colleague, where the signs are often subtle. By ignoring the more obvious warning signs or failing to act, we risk losing a productive member of society and endanger both the impaired professional as well as their colleagues, family, and most importantly, patients. While the exact prevalence is unknown, it appears that medical professionals misuse alcohol about the same, street drugs less, and prescription drugs more often than the general population. Job stress and long work hours are frequent rationalizations for substance abuse, despite the fact that these patterns have usually been established by high school and are more strongly associated with genetic factors and coexistent mental illness. Prescription drug misuse usually begins at the time medical professionals receive prescribing privileges and have greater access to controlled substances. This pattern of misuse is commonly initiated by individuals attempting to self-treat legitimate medical problems such as anxiety, depression, chronic headaches, ADHD, etc. Chemical dependence is the uncontrollable urge to use a drug, despite its adverse consequences. For dependence to occur, there needs to be both a drug that is readily accessible, as well as an urge to use that drug. It should come as no surprise that health care professionals are frequently addicted to the drugs with which they are most familiar. Substance abuse is the inappropriate use of a drug, without the uncontrollable compulsion to use it. This is more common than addiction, especially in younger persons, who usually mature out of these behaviors. Unfortunately, devastating consequences including loss of medical licensure, career, and death can result from misuse of alcohol and controlled substances, long before this growth can occur. Chemical dependence follows a common progression, with one of the earliest warning signs being isolation. The individual withdraws from family, friends, and leisure activities, and can frequently exhibit behavioral changes such as mood swings and depression. Domestic problems can follow, such as financial debt, arguments, and divorce. Eventually these problems extend into the workplace, evidenced by sloppy documentation, tardiness, and absenteeism. Classmates, coworkers and colleagues who are compelled to cover these shortcomings often grow resentful of the impaired professional. Academic performance and direct patient care are usually the last things to suffer. In one study, medical students who abused alcohol had higher academic rank and National Board scores than nondrink-ing students. This academic and professional success is commonly used to blunt any suspicions about their possible impairment. The problem often goes undetected because these individuals lead compartmentalized lives, where family, friends, and colleagues see only one facet. Because no one sign is conclusive for impairment, it becomes necessary to investigate on the basis of reasonable suspicion. Formal investigation and intervention is not necessary in every case of suspected alcohol or substance misuse. When the warning signs are early, it may be appropriate for a friend to express their concerns directly to the individual. It is frequently necessary at this time to also give them appropriate treatment resources. It is important that these observations be personalized, nonjudgmental, specific, and voiced out of genuine concern. When advice goes unheeded, further signs of impairment or addiction are evident, or patient care is jeopardized, it is our personal and professional obligation to report our suspicions to the proper individual who has the experience and authority to effectively investigate and intervene. Such individuals may be department chairs, direct supervisors, peer assistance committees, etc. It is essential that any attempts to investigate suspected impairment be done in a discrete, caring, and confidential manner. A punitive, accusatory investigation only serves to further alienate and deter impaired individuals from seeking or accepting effective help. Intervention should only be attempted when substantial and compelling evidence confirms the addiction/impairment. Facts and observations should be as specific and verifiable as possible. The purpose of intervention is to prove to the addict that the problem exists and that they need immediate treatment. One should intervene out of concern and advocacy for the individual with the expectation and hope for recovery. Because the intervention will be met with massive denial and resistance, colleagues or friends should not attempt to intervene individually. It should only be led by one who is experienced in the process, but should ideally involve concerned family, friends, and colleagues. The impaired individual will almost certainly refuse treatment and this is to be anticipated. Coercive measures, such as the threat of dismissal from school, loss of career, reporting abuse to a State Licensure Board may be necessary to get an individual into treatment. The treatment facility should be experienced in the evaluation and therapy of professional impairment. Despite the fact that many of these individuals enter treatment under duress and are still in full denial, their chance for recovery is surprisingly better than for the general population. Up to 85 percent of physicians successfully return to their professional position with effective therapy. While it is important for all to recognize the early warning signs of substance abuse and addiction, it is equally important to be familiar with the procedures and resources necessary to intervene in a timely and effective manner. Available resources for students include: MUSC Counseling and Psychological Services, 792-4930; Recovering Professionals Program, (803) 737-9137). Alcohol Awareness Week
“I think I Have a Problem with Alcohol and/or
Drugs: Where Do I Go From Here?” Deborah Merritt, M.Ed.
“Biological Basis of Addiction” Howard
Becker, Ph.D.
“The Role of Environmental Cues in Alcohol Use
and Abuse” Mike Saladin, Ph.D.
“Substance Abuse: Lessons Learned”
“Alcohol and Depression” Kathleen Brady,
M.D., Ph.D.
Tuesday, Oct. 16
Wednesday, Oct. 17
Thursday. Oct. 18
Friday, Oct. 19
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