Physicians And Addiction: Living In The Shadows

By Peter Grinspoon, M.D.

shadow of man

I was railroaded into spending ninety days at a residential rehab facility in Virginia, one that specializes in treating addicted healthcare professionals. As a primary care doctor with a nasty habit of gobbling whatever prescription painkillers I could get my hands on, I fit the bill.

I was so opposed to even the idea of rehab that my caregivers and my attorney practically had to drag me, with my fingernails clawing the floor. For me, hell was not other people, but rather, hell was being brainwashed into a twelve-step cult. I resisted going to rehab with every molecule in my body but, unfortunately, I was out of other options. Rehab programs designed for doctors’ place more emphasis on the issues that put physicians at particular risk for addiction in the first place, and on those factors that predispose us toward relapse. Many of us have neglected and sacrificed other aspects of our lives to our all-important careers, leaving a powerful vacuum of guilt and shame when we are no longer allowed to practice medicine. This makes us vulnerable. I, for one, was completely adrift.

While at rehab, I spent dozens of hours in group therapy with other addicted physicians, processing how we ended up at this last stop on the conveyer belt of shame. Some common themes that echoed throughout our discussions were the notion we had been letting everyone around us down for quite some time, and the realization that we weren’t flourishing in the stressful and demanding lifestyle of modern medical practice.

Many of us used drugs and alcohol to close the gap between what we had hoped for in our medical careers, and what we were actually experiencing, in the day to day reality. In a sense, we were drugging away our lost idealism. We were also medicating away all of the other problems in our lives. Angry wife? Take some Percocet. I wish that I could say that rehab was a universally positive experience, but some aspects of my ninety days were downright silly. We were forced to participate in art therapy and family sculpting, activities that would have stupefied your average kindergartener. Many of the counselors who instructed us barely had high school degrees, and lacked any knowledge of addiction beyond the rote memorization of the twelve steps. We had to mandatorily participate in “lectures” which consisted of streams of consciousness repetition of AA platitudes, such as “letting go and letting God.” I still don’t know what that means.

A different aspect of rehab that most people don’t appreciate is that it can be incredibly fun. The general dynamic is of juveniles in detention. I hadn’t laughed so much since high school. I’m not sure that I should reveal this aspect of rehab given that most people who end up in rehab are in serious hot water with their families and their colleagues, and are expected to do penance.

Somehow, amidst all of this therapy and bonding, recovery did start to take hold. For me, the most meaningful and helpful part was the camaraderie among fallen professionals, and the support and insights that we gave each other. There is something about fighting through a problem with others that can give you the strength to get to the other side, no matter how bleak things seem at the time.

While in rehab, I was universally treated as if I had a disease that needed to be addressed with compassion and empathy. This was new to me, and opened my eyes. It filled me with hope for the future, and helped prevent me from being overcome by my guilt, my shame, and by the remorse I had for destroying my life.

After rehab, when I re-entered the “real” world, I had complex situations with both the medical board and the criminal justice system waiting for me. Both of these institutions treated me not with compassion or sympathy, but as if I were a willful miscreant who had deliberately broken laws for the sake of hedonistic pursuits. This does not reflect a modern understanding of addiction, and was quite discouraging to my recovery.

As a predictable consequence of this punitive response to addiction, most doctors who are struggling with chemical dependency are afraid to get help, and remain in the shadows. This is the worst-case scenario, and puts these physicians and their patients alike in jeopardy. As things stand, doctors rarely get help until they get into major trouble and, by that time, damage has been done, some of it beyond repair.

Medical professionals are at exceedingly high risk for addiction to drugs and alcohol. It is estimated that ten to fifteen percent of physicians suffer from addiction, which is higher than the nine percent rate that is often cited for the general public. Healthcare professionals have almost unlimited access to prescription medications and plenty of stress. It is a perfect storm.

With appropriate treatment, physicians have about an estimated eighty percent recovery rate from addiction. The key, of course, is getting them to accept this help. This success rate is astronomically high compared to other populations of addicts. In comparison, A.A. has an estimated success rate of five to ten percent.

Perhaps physicians encounter this degree of success in part because we have so much to lose, such as our hard-earned livelihoods, and in part because we have financial resources to throw at rehabs, therapy, drug tests, aftercare, and the other necessary components of a strong recovery program.

It is imperative that we find ways to export or emulate this model for success to the treatment of addicts in other walks of life, so that we can maximize the numbers of people that can return from the abyss of addiction, to productive, meaningful lives.

Peter Grinspoon, M.D., is a primary care doctor at MGH in Boston, and the author of the upcoming memoir FREE REFILLS: A Doctor Confronts His Addiction, which is to be published by Hachette Books in February, 2016.