by Anna Peck
SDN Staff Writer
It’s a given that there are healthcare professionals out there with substance abuse problems. But, as we prepare to enter practice, many of us find it difficult to imagine that we’ll be working with affected individuals, or that we could become affected ourselves. Few professional programs ask students to consider what they would do if they suspected or knew that someone in their workplace was impaired. And, still fewer programs formally acquaint students with recovery resources.
No one really knows how widespread substance abuse is within the healthcare professions. With their livelihoods at stake, few people are going to admit to having a problem. Additionally, most health professionals are smart people who are relatively good at hiding their problems. A lecture given by Brian Fingerson, the president of the Kentucky Professionals Recovery Network, indicated that the figure is 12-16% for “pharmacists and some other healthcare professionals”1. Given that one out of every nine Americans over the age of twelve was found to have a problem with substance use or dependence in the 2007 National Survey on Drug Use and Health2, the suggested range seems quite reasonable.
As healthcare professionals, we may be more likely to develop substance abuse problems than members of the general population due to high work-related stress, increased access to controlled substances, and our knowledge of drug effects. Those of us who do become addicted may be shielded from discovery by the trust of our patients and coworkers. Plus, we may work very hard to avoid discovery, fearing harsh professional, social, financial, and legal consequences.
By this point, it should be clear that you should expect to encounter impaired healthcare professionals during the course of your career. What is less clear is what role you will play in the situation and how you will feel about it. When you aren’t sure about what is going on, it can be hard to take action. You may only suspect that a coworker is coming to work intoxicated. Maybe there are narcotics missing on a regular basis but you aren’t sure who is taking them. It is reasonable to have fears about accusing an innocent person. You may worry about losing rapport with your coworkers if your suspicions aren’t proven true. There are many other reasons that you may feel compelled not to act. Perhaps you are worried about feeling guilty about turning in a close friend, or taking a provider away from a family. Or, maybe you feel like it’s not your place to take action since others are already aware of the situation.
The bottom line is that an impaired colleague is a danger to both themselves and their patients and needs intervention. If you suspect that a coworker is impaired, you need to connect with someone who can investigate and assess the situation or refer you to resources to do so. This could be your employer, the state board, or a representative from a Professional Recovery Network (PRN) or Caduceus group. If you know that a coworker is impaired, they need to be relieved from duty immediately. But, in order to fully do the right thing, you should also make an effort to connect them the unique support, advocacy, treatment, and recovery resources available through a PRN program. It is may be best to shield yourself by giving the PRN their information and letting the program initiate contact. It is not necessary for the affected individual to know who made the referral.
With the advocacy and monitoring offered by PRN programs, many healthcare professionals are able to regain licensure and return to work while in recovery. These individuals are typically required to sign a contract with the PRN organization and are subject to practice restrictions such as not being allowed to work unsupervised or not being able to work more than a specified number of hours per week.3
While employers or partners must know whether or not a healthcare professional is in a PRN program, coworkers may not.3 They often choose not to identify themselves because they don’t want to deal with the stigma, have their work overly scrutinized, or be judged on a daily basis. If you do discover that a coworker is in a PRN program, I encourage you to be supportive. While there is potential for relapse, PRN programs are used because they work. One pharmacy PRN program coordinator at The Utah Conference on Alcoholism and Other Drug Abuses shared that the drug abuse rates in his state’s PRN program were lower than that of the general pharmacists population. So, with proper monitoring, it may be less risky to hire an individual in a PRN than it would be to hire the average applicant.
For students or professionals interested in learning more about substance abuse in the health professions, I recommend attending the University of Utah’s School on Alcoholism and Other Drug Dependencies, now in it’s 58th year. This annual week-long event is designed to help students and professionals understand and cope with substance abuse and incorporates a mix of speakers, discussions, social events, and open meetings for recovering addicts and families. Exposure to and interaction with recovering health professionals is one of the most valuable aspects of the program. For students and professionals in recovery the school also offers a unique opportunity to connect with a supportive network of people who share similar experiences. The pharmacy section, which I attended this June, is the largest section of the group, with around 300 participants, mostly students. Other healthcare sections included physicians, dentistry, and nursing. Both college and continuing education credit and are available at a reasonable cost. For more information, please visit http://uuhsc.utah.edu/uas/
1) Fingerson, Brian. “Chemical Dependency Among Healthcare Professionals.” Lecture. The University of Utah’s School on Alcoholism and Other Drug Dependencies. Salt Lake City, Utah. 23 June 2009.
2) http://www.drugabusestatistics.samhsa.gov/NSDUH/2k7NSDUH/2k7results.cfm#Ch7
3) Quigley, Michael. “Issues in Relapse Prevention and Monitoring.” Lecture. The University of Utah’s School on Alcoholism and Other Drug Dependencies. Salt Lake City, Utah. 23 June 2009.
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Very good article. Are PRNs almost everywhere, or only in selected areas? It does sound like the best solution, i.e. by addressing the problem but giving them a second chance.
And also, what constitutes abuse? Is any use of an illegal substance abuse? How much use of a legal substance constitutes abuse?
Your interpretations of these surveys is not supported by the data.
You tend to conflate “impaired in the workplace” and “is considered dependent based on the multitude of criteria in the DSM-IV.”
This would probably be okay if you only counted things like ecstasy, meth, cocaine, serious prescription drugs, etc because they tend to eventually consume someone’s life.
But I mean if you actually look at the data an overwhelming percentage of the drugs are actually alcohol and marijuana. Alcohol and marijuana aren’t the greatest things to put in your body, but certainly someone can use both of those substances in their free time and still come to work of sound mind.
Obviously the abuse of drugs is a bad thing in the medical field when it interferes with work, and it is a personal tragedy when it interferes with someone’s personal happiness, but that doesn’t mean you should misrepresent the scope of the problem.
“A lecture given by Brian Fingerson, the president of the Kentucky Professionals Recovery Network, indicated that the figure is 12-16% for “pharmacists and some other healthcare professionals”1. Given that one out of every nine Americans over the age of twelve was found to have a problem with substance use or dependence in the 2007 National Survey on Drug Use and Health2, the suggested range seems quite reasonable.”
That would be a scary number if indeed 1/8 to 1/6 of medical professionals were abusing hard drugs. But I REALLY doubt that is the reality, if Mr. Fingerson is interpreting data the same way you interpret the 2007 National Survey on Drug Use and Health.
Recognizing when your coworkers are impaired and reacting accordingly is imperative, but portraying medical professionals as a bunch of drug abusers is really misrepresentative of reality is my point I guess.
Also, the University of Utah sounds like a great place to get an unbiased opinion on drug abuse and how to appropriately treat it.
You do realize this is the bastion of mormonism that has therapists/psychiatrists advising gay people to get married to the opposite sex and pray to jesus? The same people who also believe it’s a sin to drink alcohol and coffee because their polygamist, pedofile founder prophesied it?
Greg, did you read the same article I did?
Although your posts seem sincere the content is rather trollish — suggesting it is OK for doctors to come to work after being high or drunk, calling the founder of the Mormons a pedophile (proof please), and besmirching a university simply because it is in Utah (perhaps you intended to pick-on BYU) is quite a good day’s work. Kudos, sir.
This is an important issue that needs more attention.
I think that this estimation is accurate, if not low. Addiction and alcohol abuse is perhaps the most important public health issue of our time. It has been classified as a genetic disease by multiple medical groups, yet people still see it as a moral weakness (see above). The stigma that goes along with drug addiction is horrible. I developed a habit after breaking my femur and having to take pain medication for a prolonged period. Yet I overcame with proper treatment and am now entering the health field. I think that a lot of people think of drug addicts and alcoholics as bums on the street. The fact is that substance abusers come in many forms, including doctors, lawyers, teachers, fireman, nurses, etc. From a medical standpoint we still know very little about addiction, but we do know that it is a disease, and it is time that medical professionals start treating it like one.
Well, the tone of my post was a bit off.
Yeah, I don’t really have a problem with a doctor who gets high or drunk on his/her own time. I drink moderately occassion, and don’t smoke marijuana, but I don’t see a big issue with either of those things.
The university of utah is rank 7th (iirc, didn’t look it up) on US News World Reports listing for most religious universities, and there is plenty of pollution from the mormon community.
As to the comment about pedophelia, it’s accurate. It’s really really well documented both in his own journals and the records of people at the time. He married + had intercourse with a couple of women in their early teens, in addition to his numerous marriages to women of age.
Greg – I love you. Absolutley beautiful. could not have said it better myself.
@Greg
You have some very solid arugment skills; and, I find them an invaluable addition to a fairly 1-sided POV! I always get upset or exuberant by the weekly SDN article, but thanks to fellas like me and you, curious readers will always get their POV of someone who disagrees with the perceived slant of an article, so long as they read the comments sections.
I’ll play devil’s advocate and bite at where you say: “Obviously the abuse of drugs is a bad thing in the medical field when it interferes with work, and it is a personal tragedy when it interferes with someone’s personal happiness, but that doesn’t mean you should misrepresent the scope of the problem.”
Perhaps the abuse of drugs is a bad thing in the medical field when it interferes with work, and it is a personal tragedy when it interferes with someone’s personal happiness, but that IT DOES MEAN that you should misrepresent the scope of the problem!
I’m actually OCPD (so there you have an easy excuse not to argue with someone who will argue endlessly on matters of morality, ethics, or values) so what if I posited that one must weigh the pros/cons of our profession’s benefit by purporting that the problem is worse than it really is?
This article obviously has a purpose, and I think the purpose is akin to something one might read in a Reader’s Digest magazine. A lot of the people who read the SDN weekly article are pre-meds like me, or “post pre-meds” probably like yourself.
I think that if this article has a non-neutral POV or an alterior motive, then I’m glad I have optimistically determined it to be to a scare tactic to dissuade future physicians to becoming lost in a substance-abuse dilemma and to help others who find themselves in a situation involving substance abuse.
If this article is slanted, then I assume good faith in the author’s article. I’m also glad you shared your opinion and didn’t get upset by the comment about appearing “trollish” since I know first hand how difficult it is to deal with having your character and integrity called into question, even if it’s on an anonymous message board or internet forum!
I am glad to see not only your tactful disagreement with the author, but your ability to be respectful to JS and listen to his opinion without becoming hostile. I confident that I’m correct that you could still have given your helpful analysis even if there were some nasty discouragement because you know the value of good journalism.
안녕히 가세요
The responder to Greg with the name of ?? Fighting, your reply made no sense and was terribly written in both grammar and structure. Therefore it was a waste of time. That’s all.
Great read!