This information guide is intended for psychiatrists who have a
personal substance misuse problem which may be in the form of
problematic binge drinking and risky misuse not amounting to
addiction. The information can be used as a guide only and is not a
substitute for medical or other specialist advice. If you need
further advice and support, please contact the Psychiatrists’
Support Service or one of the organisations listed at the end of
If you are considering whether you
have a problem with drugs or alcohol, then you are not alone.
Because the profession has a raised prevalence of problems, there
are many resources that have been developed to meet its particular
The difficulties and barriers to
seeking help have meant that doctors often present late in the
course of addiction. One aim of this information guide is to
encourage earlier identification and remedial action. The barriers
to treatment are being removed and there are new resources
available for help with drug and alcohol problems.
A useful resource with information
on alcohol use is the Drinkwise
website. You may also find it helpful to keep a diary of your
drink and drug use and jot down the aspects of your use which are
becoming a risk or problem for whatever reason. There are lots of
links and helpful information at the Alcohol Concern
There are many reasons why doctors
are prone to developing problems with alcohol or drugs. These
include cultural norms at medical school and beyond, easy access to
substances and vulnerabilities such as stress and mental illness.
Drug dependence often begins with emotional distress or physical
pain and may be entirely based on prescription or over-the-counter
substances. Other drug or multiple substance use may be illicit or
illegal drug use. Fear of disclosure and a need for confidentiality
is a very real issue.
The Department of Health, the Royal
College of General Practitioners and the Royal College of
Psychiatrists are working to increase the availability of
confidential help to doctors experiencing problems including
substance use. The Practitioner Health
Programme was launched in London in 2008. The service provides
early access and confidential treatment for doctors with health
concerns and addiction problems. Although the face-to-face
consultation service is in the London area, the programme’s website
contains information about a confidential phone line and a wealth
of helpful links to other resources.
What we know about addiction: good news
Treatment and prevention
Once in treatment the outlook for
the addicted doctor is excellent. Doctors are usually motivated to
return to work. This motivation and the fear of sanctions are key
factors to good outcomes, as are supervision and monitoring. The
figures in North America suggest that 80–90% of doctors in
treatment do well over 1–5 years (Galanter et al, 1990;
Bohigan et al, 1996).
Thus, it is important to register
with a general practitioner (GP). This should be someone you can
trust and who can help to address ‘lifestyle’ issues such as heavy
drinking in the aftermath of a divorce or other stressful life
event. Hurried corridor consultations should be avoided and you
should not prescribe for yourself.
You may be one of
There have been no large-scale
studies investigating the prevalence of addiction among doctors in
the UK. In 1998, a British Medical Association Working Group report
estimated that as many as ‘one doctor in fifteen may be affected by
drug or alcohol problems at some point during their careers’ and
the consensus of the report was that these doctors were mainly
male, beyond the mid-point in their careers and more likely to be
in general than in hospital practice (British Medical Association,
1998). More than 10 years on, younger doctors and medical students,
increasingly female, are exposed to a wider range of recreational
psychoactive drugs, which are frequently combined with heavy
alcohol consumption. This occurs against a background of culturally
sanctioned heavy drinking and substance use. There is little
organisational protection against this changing tide of social
Studies from North America suggest
that the prevalence of alcohol problems in doctors may be no higher
than in the population as a whole, and the rate of illicit drug use
may be lower. However, high rates of prescription drug use have
been recognised, mainly opiates and benzodiazepines, in the context
of self-medication for stress. Privileged access to drugs, the
ability to self-prescribe, a stressful working environment,
overwork and a lack of sleep are some of the occupational risk
factors for developing a drug or alcohol problem. Addiction
problems span all specialties and grades of seniority, although
some studies have suggested that anaesthetists and family doctors
may be at greater risk. Psychiatrists and doctors in emergency
medicine have been reported as having the highest rate of multiple
drug use (Myers & Weiss, 1987; Hughes et al, 1992).
There is also real concern that doctors who misuse substances
continue to practise.
Risk factors for addiction in
Addiction problems in doctors
usually occur in the context of a number of difficulties including
anxiety, depression, psychological difficulties, stress at work,
family stress, bereavement, an injury or accident at work, pain or
a non-specific drift into drinking (Brooke et al,
The relationship between perceived
stress at work and substance misuse appears to be mediated by
individual psychological vulnerability factors. Difficulties in
childhood can affect perceived stress in adults and this has been
shown to hold true for junior doctors (Brewin et al, 1992;
Psychological risk factors include
goal-directed and perfectionist traits, poor self-esteem, undue
sensitivity, difficulty confiding in others and a low tolerance for
frustration. Anxiety and depression are frequent antecedents to
alcohol and drug problems in all age groups, and suicide is an
ever-present risk. Women doctors with alcohol problems often have a
family history of addiction, have been high achievers at medical
school, have undetected depression and are at a high risk of
suicide (Bissell & Skorina, 1987).
Often the first clue that a doctor
has developed an addiction problem is a subtle change in
personality and/or the development of mood swings or anxiety. Time
is taken off work and outputs become less efficient and reliable.
There is often ‘explaining away’ of out-of-character behaviour.
Close medical colleagues may express concern, but at that stage
there may be no clear evidence of anything untoward. As the
drinking or drug use becomes entrenched, other colleagues will
begin to notice signs, such as the breath smelling of alcohol first
thing in the morning. If concerns about the doctor’s behaviour are
followed up, it may emerge that they have begun to isolate
themselves. There may be physical changes, such as arriving late at
work appearing less well and less smart than usual. Other
associated behaviours include drink-driving charges, frequent
changes of address, multiple locum posts and practice outside the
Might this be you?
If you recognise yourself as having
problems around alcohol or drugs, do take time to consider your
needs and to seek advice from someone you trust, one of the
confidential helplines listed in this information guide,
recommended websites, your GP, or call the Psychiatrists’ Support
You may also be able to start a
process of regulating your use and addressing linked problems. Keep
a diary of what you use. If it is a prescribed drug, discuss this
with your prescribing doctor and devise a careful reduction plan.
If the substance is obtained through other routes, consider setting
Importantly, reflect on whether
past attempts at reduction have proved too difficult to succeed for
whatever reason. This will almost certainly mean a need for
professional help. If all that seems overwhelming, seek help
quickly, describing your pessimistic thoughts; they may be a result
of the depressant effects of the substances and the stress of
coping with the addiction itself, and are likely to respond well to
treatment. The resources listed here provide a range of starting
points to finding the help needed.
Bissell, L. & Skorina, J. K.
(1987) One hundred alcoholic women in medicine. An interview study.
JAMA, 257, 2939–2944.
Bohigian, G. M., Croughan, J. L.,
Sanders, K., et al (1996) Substance abuse and dependence
in physicians: the Missouri Physicians’ Health Program.
Southern Medical Journal, 89, 1078–1080.
Brewin, C. R., Firth-Cozens, J.,
Furnham, A., et al (1992) Self-criticism in adulthood and
recalled childhood experience. Journal of Abnormal
Psychology, 101, 561–566.
British Medical Association (1998)
Report of a Working Group: The Misuse of Alcohol and Other
Drugs by Doctors, pp. 1–15. BMA.
Brooke, D., Edwards, G. &
Andrews, T. (1993) Doctors and substance misuse: types of doctors,
types of problems. Addiction, 88, 655–663.
Firth-Cozens, J. (1992) The role of
early family experiences in the perception of organisational
stress: fusing clinical and organisational perspectives.
Journal of Occupational and Organizational Psychology, 65,
Galanter, M., Talbott, D.,
Gallegos, K., et al (1990) Combined Alcoholics Anonymous and
professional care for addicted physicians. American Journal of
Psychiatry, 147, 1104.
Hughes, P. H., Baldwin, D. C.,
Sheehan, D. V., et al (1992) Resident physician substance
use, by specialty. American Journal of Psychiatry, 149,
Myers, E. & Weiss, E. (1987)
Substance use by internees and residents: an analysis of personal,
social and professional differences. British Journal of
Addiction, 82, 1091–1099.
BMA Counselling Service
Tel: 08459 200 169
BMA Doctors for Doctors
Tel: 08459 200 169
British Doctors and Dentists
British Doctors and
Dentists Families Group
International Doctors in Alcoholics
Medical Council on
Tel: 0207 245 0412
© Royal College of Psychiatrists 2011
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