Addiction Treatment for Doctors: Overcoming Obstacles to Change

For doctors, psychiatrists, and other prescribing clinicians in the field of addictions, health, and mental health, admitting we have a problem with drugs or alcohol is not only difficult, it’s dangerous. While the stakes are high for anyone who develops an addiction, we face the additional possibility of losing our professional licenses and practices. We‘re not just at risk of losing a job; we risk losing careers that required up to a decade in training and education to attain. These fears and potential losses fuel our denial and inhibit us from seeking and receiving the help we need.

We face additional obstacles in accessing and utilizing systems for support. We understand that self help functions on anonymity and we know that HIPPA ensures our confidentiality in treatment. We also know that in the real world, secrets get shared and sometimes lives get ruined. We know that access to electronic health care records is relatively easy to misuse and we cannot afford gossip or undue scrutiny.

We can never be certain how our employers will respond if we are honest and forthcoming. We know that the organizations we work within are generally far more concerned with liability than with those who do the work (hence the term, “Human Resources”). We see a stark contrast between how patients and professionals are viewed when they have the same disease.

Systemic Solutions

Systems that remain ineffective and indifferent must be manipulated. No one is more manipulative than we addicts and alcoholics. We readily use our skill set for getting everything else we want, now we can use it to attain treatment and support in ways that ensure our privacy.

I favor radical use of loop holes. If addiction can flourish underground then treatment and recovery can too. We can best ensure confidentiality by making use of “life coaching” and “recovery coaching” - under the right circumstances, it’s off book treatment done by trained professionals who aren’t subject to licensing and reporting.

I advocate seeking out clinicians who are willing to acknowledge that we may live with multiple conditions and only describe one of them to our health insurance providers. Hypothetically, I could access a dual diagnosis clinician and say something like, “I need help with managing feelings of sadness and anxiety. I would also like to discuss substance abuse with you, but I will not do so if there exists a possibility that I might be diagnosed with a substance abuse disorder.” Describing concerns about how a diagnosis would impact job security is something any clinician should be willing to consider and those of us who “get it” will provide the assurances needed.

I encourage professionals to take leave time for “health conditions.” Our employers (generally) have no right to know what specific health condition is limiting us, only that we have a medical need that demands attention. When pressed, I suggest stating, “I have a disease. I prefer not to discuss the specifics of it and I thank you for respecting that.”

We Have Met the Enemy & He is Us

Many of us found that our egos are our greatest obstacles to seeking support. We find ourselves crushed by the weight of expectations – ours and others. We stand on pedestals we didn’t seek to be on and fear falling. We’re supposed to know better. We’re supposed to be immune. We’re supposed to be able to heal not only others but ourselves as well. We have the insight and ability to serve others and often lack the conviction and willingness to help ourselves.

Too many of us are hypocrites. We would never advise others to struggle alone. We know that living with a disease makes one deserving of support and treatment, not shame. We hate the powerlessness of watching those we serve decline and we rail against it. We hate the disease and fight it. We know to demand accountability from our patients, even as we fail to uphold it in our own lives.

Accountability, The Fox & The Hen House

Abstinence cannot be our only goal. To consider this alone is arrogance. We may well experience periods of being clean and sober, but as long as we maintain a prescription pad, we hold the key to our own demise and there is no fail-safe.

Personally and professionally there are factors that placed us at risk. Many of us burned out on the job and kept going. Many of us found the demands of work and family to be an impossible balancing act. Regardless of what brought us to the point of relying on a drink or drug to cope, we must be willing to not only get into the solution, but to do so with someone who has the ability and willingness to call us out on our self deception, complacency, and unmet needs.

Regardless of how our patients, colleagues, and communities see us, we are no more than human. Examining our expectations and the personas we maintain allows us to become more genuine, to get our needs met, and to develop a manageable life. Happiness, joy, and freedom are unattainable when we seek to be everything to others and strangers to ourselves.

“You treat the disease, you win…you lose. You treat the person, you win, no matter what the outcome.” – Patch Adams