Doctors doing drugs and drinking: some physicians with substance abuse problems are protected by family and friends

Physician Executive, Sept-Oct, 2004 by Monique Fields

Editor's note: Names of the doctors interviewed for this article who freely talked about their past substance abuse problems are being kept confidential in order to protect their privacy.

As a director of pharmacy at a California hospital, Dr. Kevin stole Vicodin, Percocet, Demerol and morphine. He used them to get high, and there was no way for his colleagues to detect his abuse of his authority.

Dr. Kevin's deceit was an inside job. He knew that when drugs reached their expiration date they would be good for another six months to a year. When 10 pills came back from the hospital floor, he logged in that five came back. If anyone ever checked, they would find the inventory of the five pills and never miss the five he put in his pocket.

He exploited a sad reality.

A hospital's accountability doesn't work when the abuser is one of its very own. Pharmaceutical paperwork where Dr. Kevin worked required two signatures. As the supervisor, Dr. Kevin was always the last to sign off on such transactions. Even when confronted about his erratic behavior, he had a solid alibi. No drugs were missing and hospital records proved it.

"They actually would have never caught me until I died," Dr. Kevin says.

The reason: Physicians tend to be better at hiding their addictions, drug treatment experts say.

That may correspond with the findings of ACPE's Physician Behavior survey where the vast majority of respondents indicated that substance abuse was behind bad behavior in only 10 percent or less of the cases. Several survey participants noted, however, that it's often difficult to determine if a doctor has a problem with drugs or drinking.

What's more is that family and colleagues help doctors keep alcohol and drug abuse out of sight. Family and colleagues look the other way when seeing troublesome behavior, failing to report it. As a result, the disease gets a head start, sometimes making treatment more complex and difficult.

The delay getting treatment is just putting off the inevitable, says Warren Pendergast, MD, associate medical director for the North Carolina Physician Health Program, one of more than 40 treatment programs nationwide specially designed for medical professionals.

"The problem is going to come out eventually," he says.

That's what happened to Dr. Kevin.

One of his supervisors knew he was doing something, but he couldn't prove it. The supervisor watched as Dr. Kevin couldn't keep his mind focused on his job and noticed when he fell asleep at the counter. The supervisor didn't smell alcohol and cast that possibility aside. He also says he knew Dr. Kevin wasn't taking anything from the pharmacy because he had checked all of the records. Dr. Kevin laughed at those words, knowing he had duped his supervisor. In the end, it would be the first of six such confrontations.

Longtime habit

By the time Dr. Kevin started stealing drugs from hospitals, he had been abusing alcohol and drugs for years. He started drinking alcohol to fit in when he was 16. He quickly graduated to marijuana and then to opiates and tranquilizers. He used the drugs to kill the fear, the fear of the unknown. He didn't feel comfortable in his own skin until he had some alcohol or drugs in his system. On top of that, he chose a field where he would have unfettered access.

That's the primary difference when it comes to doctors and other abusers. Colleagues don't believe doctors would put their careers in jeopardy. For their part, doctors also have garnered a significant amount of respect by the time they walk through hospital doors and begin practicing medicine.

Or as Pendergast puts it: "People just don't think of doctors getting sick."

Dr. Kevin, though, was sick. He flunked out of his first treatment program, going on a five-day binge of valium, amphetamines and cocaine just days before he was set to graduate. The second time around he lasted 88 days. When he finally confronted his addiction, he freed himself of alcohol and drugs for more than two years.

But it only took one sleeping pill for him to relapse. One tiny, 0.25 milligram Halcion. That one pill set off a chain reaction that left Dr. Kevin so high he couldn't pick himself off the floor when he needed to urinate. Like most abusers, Dr. Kevin was in denial.

A recovering addict has at least one sponsor, a mentor of sorts who has experienced some of the same challenges. When Dr. Kevin's sponsor moved to another city, he convinced himself that he could be his own sponsor.

At the same time, Dr. Kevin's job was keeping him awake at night. He had been charged with completing a pharmaceutical report for the Joint Commission on the Accreditation of Hospitals, covering three years. But Dr. Kevin only had been at the hospital for two years. He spent his time fabricating information for the third year of the report. When a doctor suggested he take a sleeping pill to alleviate his bouts of guilt, Dr. Kevin's support system wasn't there. He took the sleeping pill. Then he went to get 100 more.

"To whom it may concern," he prayed, as he lay on the floor that day. "Help me or let me die."