“Why am I not asking for help?”
This is the question Mary Taylor, MD, a pediatric cardiologist and pediatric critical care physician, asked herself after realizing she had alcohol use disorder (AUD). “If I had a medical condition, I would ask for help. If I had cancer, I’d go get treatment.”
On a national scale, Taylor is hardly alone. According to the Association of American Medical Colleges (AAMC), 21.2 million Americans have substance use disorder (SUD), and only 11% of that population seeks treatment. Although there are few current data to indicate how many physicians are included in that number, research suggests that the rate of physician impairment mirrors that of the general population, meaning that an estimated 10% of physicians have SUD. Most cases go untreated.
More than three fourths of license actions taken against physicians were related to substance use, according to a recent study published in JAMA.
Compound all this with the fact that the stress of COVID-19 has placed healthcare workers in particular at high risk for substance use and abuse and it appears we’re facing an epidemic of a different kind: the increasing number of physicians living with untreated SUDs, putting their lives, careers, and sometimes even the lives of their patients in danger.
As Taylor and thousands of other physicians have discovered, help is available for getting into recovery and back to practicing medicine. Sharing their stories can be a big step forward in dismantling the stigma of addiction and encouraging other physicians to seek what can be lifesaving treatment.
Back to Health and Back to Work
The Federation of State Physicians Health Programs (FSPHP) has evolved over the past 30 years from initiatives taken by the American Medical Association, the Federation of State Medical Boards, and medical societies. State physician health programs (PHPs), of which there are currently 48, focus on outreach, education, and health monitoring for physicians at risk for impairment, including those recovering from an SUD. PHPs do the latter by finding an appropriate treatment facility for physicians and, upon completion of treatment, engaging them in a long-term monitoring contract (usually 2–5 years). Such contracts often include attendance of Alcoholics Anonymous (AA) meetings and random drug testing. As long as a physician remains in compliance with their contract, they are able to continue to work.
“State physician health program services save lives. Period,” says Scott Hambleton, MD, DFASAM, and incoming president of the FSPHP. Hambleton points to a study that reviewed the long-term model of PHPs and confirmed that physician recovery rates are markedly higher than those of the general population. Another study shows that after 5 years or more, 81% of the participants had zero positive drug screens, and 95% had their license and were working as a physician.
Today, the organization continues to support and improve individual state members and to educate physicians about PHP services, which sometimes include correcting misconceptions. Hambleton, who participated in his own state’s PHP and is in recovery, is aware that PHPs have faced some criticism regarding the stringency of their monitoring requirements, which he says is necessary to provide advocacy for a healthcare provider to safely practice. Or they face criticism about not being strict enough.
“One camp highly stigmatizes physicians with addiction and believes they should never practice medicine, and the other side thinks physicians should be able to practice under any circumstances, even when their fitness to practice safely is in question,” says Hambleton.
He acknowledges that sometimes the criticism is warranted but explains that not all PHPs are able to provide the same level of services because of a variety of factors, such as support from their respective regulatory agencies, medical societies, and legislatures. Differences in financial support and adequate staffing can sometimes be quite significant. In an effort to increase consistency in delivery of services of individual PHPs, the FSPHP has developed a review program entitled Performance Enhancement and Effectiveness Review (PEER). “However, the truth is frequently distorted,” says Hambleton. “And because of confidentiality, the physician health programs cannot tell their side of the story.”
An overwhelming number of physicians are willing to share their stories, albeit anonymously, on the FSPHP website, making a not only solid testimony for PHPs but also illustrating that however different one’s journey into addiction may feel, the similarities are far greater.
Such is the case of Mary Taylor and another doctor, Peter Grinspoon, MD, a primary care physician at Massachusetts General Hospital. Both came to their respective state’s PHP with different backgrounds and under different circumstances. Taylor sought help for AUD, whereas the US Drug Enforcement Administration (DEA) busted Grinspoon for writing bad scripts to support his opiate addiction.
Their journeys were incredibly difficult, life-altering, and in the end, life-affirming.
Taylor’s Story: Acknowledging the Need for Help
Taylor grew up in a state where social drinking ran rampant. “People drank alcohol for every occasion. It was a way of life,” she recalls. Taylor, a married mother of three children and already well into her practice at a large academic medical center, fell into the social drinking category until she underwent gastric bypass surgery and lost 100 pounds.
“Sometimes there’s a cross addiction between food and alcohol,” Taylor explains. “And when you have gastric bypass, you get rid of part of your stomach that metabolizes the alcohol.” Suddenly, her response to alcohol felt different. “When I drank, I felt more comfortable in my own skin, and I thought more like everyone else feels normally.”
Luckily, Taylor’s drinking never resulted in her being charged with driving under the influence of alcohol or with an arrest, but it did have a negative effect on her family. She started missing her children’s events, and her husband eventually suggested that her drinking might be a problem.
Taylor wouldn’t get the care she needed for about 5 more years, but that’s not to say she didn’t make attempts. She approached her own physician, who directed her to the employee assistance program at the hospital where she worked. There, she underwent an evaluation and was told that she did in fact have AUD and recommended she go to a treatment center. However, that advice was offset by that employee’s supervisor, who said Taylor had untreated depression and anxiety and should try antianxiety medicine and drinking a little less.
“It was off to the races from that point,” Taylor recalls, “because a doctor just said I was fine. And that person almost killed me.” Over the next 6 months, her drinking escalated to the point where she was experiencing multiple blackouts and her family was struggling.
She then sought help from a psychiatrist, who laid out her options in an impactful way: “One of three things is going to happen. Either you’re going to get sober and be just fine, you’re going to kill somebody or experience some irrevocable consequence and lose your family, or you’re going to die.” The choice seems to be an obvious one, but in the midst of addiction, getting sober can seem like the most unlikely of all possibilities.
In 2009, Taylor was traveling out of town for work when she hit the “rock bottom” of her addiction. Her drinking had reached its pinnacle, and she nearly died from alcohol poisoning. Her husband found her, and on their way back home, she knew she needed help. “I just hung my head down and said, ‘God help me.’ ” She hasn’t had a drink since.
Taylor told her husband to take her directly to a treatment facility. She was admitted and stayed for a week before learning about the state’s PHP, the Tennessee Medical Foundation. She transferred to a physicians-in-recovery program outside of Birmingham, Alabama, where she spent 3 months. In treatment, Taylor says she had no idea whether she’d have a husband, family, or career when she got out. “But I knew that if I didn’t acknowledge and embrace recovery, then I wouldn’t have those things anyway.”
Taylor’s 5-year contract with the Tennessee Medical Foundation stipulated that she complete an inpatient treatment program, followed by a 1-month intensive outpatient program, attendance at 90 AA meetings in 90 days (she attended 120), and random drug testing.
Taylor sought to move to another state to accept a new career opportunity and have a fresh start. Two years into recovery, she met the medical director of the Mississippi Physicians Health Program (MPHC) and transferred her 5-year contract from Tennessee. After she completed her contract, Taylor volunteered to serve on the committee for the MPHC, which she still does today, and she shares her story to the incoming medical school class at the institution where she works.
“When you’re initially in recovery, it may feel like the PHP is policing you and they’re the bad guys, but they’re really your advocate to assure the state medical boards that you are doing everything in compliance and staying sober,” Taylor says. “The accountability and support of the PHP system helped to establish the foundation of my recovery.”
She celebrated 13 years of sobriety this past April.
Grinspoon’s Story: Cornered by Addiction
Growing up in a Boston suburb, Peter Grinspoon experimented with drugs. Like many kids, he was curious and a bit of a risk taker, but he was always a straight-A student who stayed out of trouble. But during his third year of medical school, he tried some samples of Vicodin with a friend. Grinspoon had never before tried an opiate, and it was nothing like he’d experienced before. “I can’t even describe how euphoric I was,” he recalls.
He would spend the next 10 years seeking opiates, but he says his addiction really cemented itself about 5 years into practice as a primary care physician. As such, Grinspoon had easy access to opiates. He could self-prescribe, take pills discarded by patients, or write bad scripts.
“Physicians have immediate access, and they’re under so much stress. It’s like a perfect storm for addiction,” he says. “The addiction takes on a life of its own. You do all this crazy drug-seeking behavior, stepping over all kinds of moral boundaries that you think you would never cross in a million years.” (Grinspoon provided a detailed account of his journey in his 2006 memoir, Free Refills: A Doctor Confronts His Addiction.)
Grinspoon’s ability to hide and rationalize his SUD strengthened his addiction. “If you protect your job, you protect your addiction, because you have money and access,” he says. Grinspoon never took opiates during work; he was a successful physician, helping people and keeping the family together, all of which he used to justify his addiction.
“I was in a lot of denial,” he admits. “In the back of my mind, ‘get over my addiction’ was something that I was planning on doing but never quite got around to it.” He also felt cornered: if he asked for help, the medical board would likely take punitive action against him because of patient involvement.
“For me, the option was to get crucified by the medical board and destroy my career, or keep hiding my addiction,” he says. “Neither is a very palatable option, but if you’re in the position of the stressed-out, addicted doctor and functioning at work, why would you talk to the medical board? Who would voluntarily get in trouble?”
Eventually, trouble found him. A bad script caught the attention of the DEA. They came to Grinspoon’s office and charged him with three felony counts of inappropriately prescribing a controlled substance. He lost his license for 3 years, was put on probation, and couldn’t leave the state without permission. The state PHP placed Grinspoon in a Christian-based rehabilitation center (“I’m an atheist Jew from the Northeast,” he says) for 90 days. Upon completion, the PHP entered him into a 5-year compliance contract.
He had several relapses but has been sober since 2008.
He doesn’t credit his success to the rehabilitation facility he attended nor the 12-step programs he was required to attend. “Physician peer support helped most,” he says, “and the leverage that the physician health program had. It provided accountability.”
That same year Grinspoon accepted a position at Massachusetts General Hospital, where at least four other physicians he knew of went through a PHP. In 2013, he served as the associate director at the PHP in Massachusetts, Physician Health Services, sitting at the opposite side of the table, helping other doctors. “It kind of came full circle,” he says.
Nearly 15 years into recovery, Grinspoon considers himself a better physician having gone through this experience. “I think that people are better doctors once they get over the hump and into recovery than they were before the process,” he says, “because recovery is about listening to people, and being humble and connecting with other people. All those tools carry over to other parts of your life.”
Andrea Goto is a frequent contributor to Medscape. See her previous work here and here.
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