SOCIOLOGY AND PUBLIC HEALTH
There are higher than average rates of addiction with professional careers. Most of this article is going to focused on those professionals who have licensure requirements, as it is common for them to have mandated recovery treatment programs. It also is important to acknowledge that professionals in recovery can get some of the highest success results, and this may be highly connected to the monitoring and accountability qualities of their program.
Because of the emotional strain and stress connected to the life of a doctor, it is very common for them to develop mental health conditions such as depression or substance use disorders. The highest substance use disorders are based on physician class. For instance, anesthesiologists score the highest of physicians for developing an opioid addiction. Emergency room physicians have very high rates of stimulant abuse. Psychiatrists have greater than normal rates of alcoholism.
Often, professional healers struggle with healing themselves. They are emotionally invested in being available to others but tend to neglect basic self-care needs. In our experience at CeDAR working with addicted physicians, it is very common for their work status and competency to be the last thing to go. They will likely lose their marriage, physical health, and pastimes first before having career dysfunction. In fact, that career often can be the only remaining safe place for them. Once that career is placed on the line, say by a professional monitoring program, the physician often breaks down.
Of all the people who receive addiction treatment, the highest success rates belong to the physicians. National statistics show that physicians in recovery have about a 78% success rate for 5 years of recovery! This number is exceedingly high and is markedly higher than the baseline population. We can learn from these physicians, not so much by how they approach recovery, but by the structured algorithm in place for them.
These physicians maintain the 5-year recovery rates because they absolutely have to! They often times enter treatment quite angry, resentful, argumentative, and pompous. Ultimately, they hit a wall which is the medical board and the professional health organization. This organization basically says to them:
“Doctor, we do understand that you don’t think you have an addiction….well we think you do and we have a duty to keep the public safe. If you would like to continue practicing medicine, we’re going to ask that you do every single thing we say. In exchange for that compliance, we will offer you a protective shield from the medical board. If you refuse, we cannot offer you anything and you will be at the mercy of the board.”
The physicians play ball. They are required to attend weekly recovery groups, submit weekly urine screen tests, and have quarterly meetings with the physician’s health program. That program will refer them to other physicians and therapists to receive ongoing support and care. The length of this commitment tends to be about 5 years. If that physician is unable to maintain recovery, they are sent to rehab and have to restart the process or have their license suspended.
How can we learn from the paths of these doctors in recovery? Accountability and longitudinal care are strong ingredients to being successful. If you can work with your clinician to build some of these ingredients for yourself, you can reach success rates comparable to those impaired doctors.
Practicing lawyers have an overall less structured recovery program than the physicians, and this can cause some general problems. Lawyers are one of the highest professional careers for alcoholism. A common way an attorney enters treatment is through a required substance evaluation following a DUI offense. This will lead to recommendations for counseling, certain levels of treatment, or other guidelines for the attorney to remain clean and sober. If that attorney fails to follow the specified requirements, they will face disbarment just as with the addicted physicians.
Some state attorney counsels are more actively using third-party monitoring companies, such as the Soberlink device. This product functions as a mobile breathalyzer and provides a paper trail for verified sobriety every month. If an attorney gets flagged for having a substance use disorder or consequence from substances, they may be mandated to monitoring through such a program to prove a significant period of sobriety.
Many cities have professional support groups for addicted attorneys. The concept of “lawyers helping lawyers” can be found in many 12-step circles. As there are many more practicing attorneys per city than physicians, there often is a larger critical mass of self-help programs and group guidance if someone is needing help.
Nurses show significantly high rates of substance abuse and there often are multiple variables in play. Of the nurses who become addicted to a substance, they often also score higher for dual diagnosis issues such as past trauma or depression. The nurses are on the front lines of healthcare and exposed to constant medication delivery, hence opioid painkillers are a significant issue for these nurses. Diversion of the painkillers can lead to the nurse getting terminated or referred to a nursing professional monitoring program.
Similar to that of the addicted physicians, nurses will have to enter a contract with the monitoring agency to prevent consequences from the nursing board. Through compliance and monitoring with the program, that nurse is able to retain a nursing license and continue to practice.
There are comparable programs and scenarios for such careers as pilots, pharmacists, veterinarians, and psychologists. The common thread amongst these careers is that there is a license at stake and a duty to the public trust. This means that there can be a monitoring agency that serves a dual role of working to help the professional while also holding them accountable for recovery to serve the public. If you are receiving a surgery, you have a right to know that your surgeon is not intoxicated in the operating room. The professional programs help to verify that safety.
We can learn things from these programs and apply them to you. Overall the ingredients of:
Longitudinal approaches seem to be massively helpful in someone remaining in recovery. Through that time, the ultimate hope is that the person feels better, shows a more balanced life, and wishes to continue their recovery into the future. We hear many families and people ask “What happens to the physicians after those 5 years?” Overall, we don’t have a good answer to that question. One would suspect that relapse rates somewhat go up once the monitoring expires, but the premise that the person is in better health seems indicative that recovery will extend. That seems to be the best we can hope for as a health system working to support these professionals.
Read more CeDAR Education Articles about Sociology and Public Health including Learning from the HIV / AIDS Epidemic.