Doctors struggle with drug and alcohol addictions at similar or higher rates as the general population. They are exposed to many of the same risk factors for addiction and mental health disorders as people outside the medical profession, such as genetic predisposition, childhood trauma, and the presence of anxiety, depression or other mental health issues.
These risk factors are compounded by certain pressures inherent in the medical profession, including:
- Educational Demands
Some studies have shown that American medical students use alcohol, benzodiazepines and prescription opiates at a higher rate than their peers. This may be caused, in part, by the educational demands of preparing for a medical career, which include four years of undergraduate school, four years of medical school and a three-year residency program. In addition to long hours and pressure to compete, some programs have a culture that endorses substance abuse as a way to cope with stress.
- Extended Workdays
Being a physician often requires long workdays and rush trips to the hospital at all hours to deal with emergencies. In addition to being mentally and physically exhausting, working 60-plus hours per week can interfere with family, recreation and self-care (e.g., a healthy diet, exercise and sleep) and increase the risk of heart disease, depression and other illnesses.
- Patient Care
Patient care can be one of the most rewarding, and most difficult, parts of medical practice. Unexpected outcomes, failure to relieve pain, and treating patients that are exceptionally demanding, violent or noncompliant can be a source of anxiety and depression for physicians. Very few physicians receive adequate training to manage these stressful patient care issues.
Chronic stress, brought on by long hours, heavy patient loads and a lack of emotional support, can increase a physician’s risk of addiction. In surveys, most doctors deny using drugs or alcohol to self-medicate, though it would be understandable for doctors with a predisposition for addiction to use substances to relieve stress or manage emotions.
- Availability of Addictive Substances
Addictive drugs are easily accessible to physicians as part of day-to-day practice. Compounded by the ability to prescribe medications, some doctors may illegally self-prescribe for months or even years before drawing attention. This may explain why the rates of prescription drug abuse are higher among physicians than the general population and substance abuse rates are especially high among anesthesiologists who regularly work with a variety of potent medications.
- Failure to Report
Although physicians have a professional duty to report colleagues who may be practicing while impaired, studies suggest that few actually make a report when faced with this situation. This type of professional “courtesy” supports addictive behaviors, increases the risk of self-harm, loss of license and harm to patients, and prevents addicted doctors from receiving the help they need.
The “conspiracy of silence” may be perpetuated by family and coworkers of the addicted physician, who fear that confronting the doctor or arranging an intervention may negatively impact their own career and/or financial stability.