Trends, both positive and negative, can tell us a great deal about the world around us. Robert Waldman, MD, head of the detox program at the Cliffside Malibu treatment center in Los Angeles, says that where physicians and addictions are concerned, the trend is a negative one.
According to Waldman, in the past many states had active diversion programs whereby a physician might voluntarily seek private and properly monitored treatment administered by a state agency with the right to do so. More recently, many states have eliminated those programs, and physicians are no longer feeling that encouragement, Waldman says.
“And so, I suspect, though I don’t have facts to share, that unfortunately this action is going to send professionals back under cover,” he says. “In the past I’ve treated podiatrists, surgeons and medical doctors who had voluntarily presented for treatment, but I haven’t seen any in quite some time.”
Causes of addiction
Waldman believes there are two main factors that contribute to physician addiction. The first is simply that working in the medical profession is a high stress position. The second is that physicians have far easier access to addiction-causing agents. The combination of stress and accessibility are what lead to the prevalence of addictive disease in physicians, regardless of where they are in their careers.
“I’ve had experience with physicians at Cliffside Malibu who were unhappy in their profession and couldn’t figure a way out,” Waldman says. “They were behaving irresponsibly with respect to themselves, and maybe a better term might be risky behaviors … sort of a cry for help. I’ve also had medical students, steered into the profession by parents, who had little interest or commitment to the profession, and were self-sabotaged substance abusers. Those are the types of behaviors that I’ve seen more recently.”
Waldman also points out that the signs and symptoms of addictive disease are no different in a physician than they are in any other individual. Changes in behavior and appearance are among the key signs that something might be wrong. If that’s the case, especially in a shared practice where a strong relationship among colleagues already exists, then Waldman believes that a direct approach is the only appropriate method for dealing with the situation.
“You’ve got to confront somebody in a caring way and offer them help, but also put them a bit on the spot so that they realize you have a good grip on their situation and what’s driving it,” Waldman says. “I would hope that [in a shared practice] you would have a relationship that would enable you to speak openly about your concerns.”
Addressing the problem
Self-diagnosis and self-treating of addictions is not only rare, it’s ill advised, says Waldman.
“The doctor who has himself for a patient has a fool for a doctor,” he adds.
Addicts in general, he explains, are in denial, which is part and parcel of the problem. Rarely do individuals recognize it in themselves and decide they need treatment. Intervention and help usually comes from family members, employees, employers, co-workers and, possibly, the legal system; there’s usually a motivating event that leads to the understanding that they do have a problem.
“I had a practitioner who came to me at Cliffside Malibu who was alerted to their addictive disease and its impact only when the supplier of office meds indicated that this physician’s orders and requisitions far exceeded the norm, and that they should anticipate a call from higher, more important government agencies,” Waldman says. “That was a bit of a wake up call, because that was somebody who was using their own pills. That led to a call to a lawyer who called an interventionist, and the patient ended up admitted to Cliffside Malibu to get recovery and show good faith.
“So, most of the time, doctors are no different than the general population,” Waldman continues. “They need some event, some negative event, to wake them up to the fact that they’re in hot water, and they’d better wake up to it.”
Waldman stresses the point that physicians are no different than anyone else when it comes to addictions. Their situation, and easy access, is what puts them at increased risk. And that’s when they need help.
“If you allow yourself to fall victim to that risk, it’s unlikely you’re going to recognize that you have fallen victim,” Waldman says. “Someone else is going to need to tell you.”
Ed Rabinowitz recently wrote One More Dance, a book about one family's courageous battle against time and glioblastoma brain cancer. Read more about the book here.