Physician substance abuse and addiction: recognition, intervention, and recovery
The OMA Physician Health Program (PHP) was founded in 1995, with
an initial mandate to provide assistance to physicians who experience
problems with drug and alcohol abuse and addiction.
lished in the Journal of the AmericanMedical Association, Brewster said,
Risk factors Commonly abused substances
hol problems fall into both categories. Recognition Signs of Addiction in Physicians
that will clearly identify an addictedcolleague.
• Increased sick time and other time away from work
• Patient and staff complaints about physician’s changing
• Increasing personal and professional isolation
• Unpredictable work habits and patterns
• Moodiness, anxiety, depression, suicidal thoughts or gestures
• Uncharacteristic deterioration of handwriting and charting
• Unexpected presence in hospital when off-duty
• Inappropriate prescription of large narcotic doses
• Insistence on personal administration of parenteral narcotics to
more irritable than expected. Previ-ously decisive, reliable and predic-
breath at work, are worrisome signs.
of a “medical personality,” PHP staff
tion, especially if there is a “threat” to
close contact with the doctor until it is
feel guilt and shame about what theyhave done and how they see them-selves as a result of their illness.
are at play, the doctor confronted inan informal manner, no matter howwell-intentioned and thorough, maynot respond favourably.
when considering addicted doctors. The first is that they must “want help”before intervention is successful. Thesecond is that they must “hit bottom”before they will be receptive to assis-tance.
misconceptions. Confronting animpaired colleague, while difficult,must be done swiftly and compe-tently. It can be a life-saving action.
tion is called intervention. It hasbeen well described by VernonJohnson and others,6 and an outlineof the intervention process has beenpublished in the Ontario MedicalReview.7
Components of a Recovery Program
as to encourage full compliance withall prescribed recovery activities. Pro-
• Outpatient aftercare: group and individual therapy
• Mutual help group: Alcoholics Anonymous (AA), Narcotics
Anonymous International Doctors in AA (IDAA), Women for Sobriety
• Pharmacotherapy (e.g., disulfiram, naltrexone)
• Healthy balance between work, rest and leisure activities
• Assessment, treatment of concurrent problems (e.g., psychiatric,
• Rigorous monitoring, including random body fluid analyses
substance use disorders in physiciansis much like that in the general popu-lation. But outcomes, especially
Treatment: substance abuse and addiction
dence, never experiencing a relapse.
risk use of mood-altering substances.
of the addicted physician’s family. Monitoring
fessionals can facilitate this transition.
really are our brothers’ and sisters’
Rev 1999;66(3):54-56. This article is
sicians. JAMA 1986; 255(14):1913-20. Suggested reading
fessionals. In: Principles of AddictionMedicine. American Society of Addic-
vulnerabilities of physicians. NEJM
signs and symptoms of distress. OntMed Rev 1999;66(5):46-47. This arti-
Dr. Kaufmann, CCFP, FCFP, a former family
cians. Canadian Journal of Diagnosispractitioner, is medical director of the OMA Physician Health Program. Dr. Kaufmann is
6. Johnson VE. I’ll Quit Tomorrow. certified in addiction medicine by the American Society of Addiction Medicine.
19 and 16, and a daughter aged 11. Separated from her husband for EXAMINATION four years, she looks after the children by herself, apart from every On examination, Joni was very guarded when moving in any direction second weekend when her ex-husband has the younger two children. and held herself very rigidly throughout the consultation. She winced Joni has had low back pain for the past
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