Mental Illness Sometimes Overlooked In Substance-Abusing Physicians
Physicians are people too—some respond to stress, anxiety, or pain by drinking alcohol, while others take opiates and sedatives, including those intended for patients.
“Cases have been reported involving anesthesiologists who stole fentanyl for personal use. The drug is a potent analgesic and sedative used to treat pain in patients,” physician health expert Michael Myers, M.D., told Psychiatric News. He is and chair of the Section on Physician Health of the Canadian Psychiatric Association and chair of the Psychiatric News Editorial Advisory Board.
Myers has encountered many doctors who self-medicated with alcohol or drugs to cope with sudden mood swings or extreme anxiety. “Once they were clean and sober, it was easier to detect the mental illness that triggered the substance abuse.”
For example, Myers recalled a surgeon who was addicted to cocaine.“ When he was treated for the addiction and off cocaine, it became clear that he had a mild form of bipolar disorder, which explained his mood swings,” Myers said.
He has learned from colleagues in internal medicine to order a drug screen for doctors when their behavior seems out of character. “The most unlikely people will lie, deny it, and in the end test positive.”
He has encountered physicians who started drinking alcohol in the morning before work to calm feelings of panic or extreme anxiety. “Once they were off the alcohol, it was clear they should have been treated for an anxiety disorder,” Myers said.
Michael Gendel, M.D., a forensic and addictions psychiatrist and president of the Federation of State Physician Health Programs (see box) told Psychiatric News, “We have to be careful in diagnosing cases involving addictions and mental illness. The majority of alcoholics are depressed because large amounts of alcohol in the bloodstream inhibit neurotransmitters including serotonin and dopamine. When the addiction is treated, the depression usually remits.”
A significant minority of people, however, remain depressed after their addiction is treated. “It is important to treat the mood disorder since it can trigger a relapse of alcoholism,” said Gendel, who is also president-elect of the American Academy of Addiction Psychiatry.
Other types of traits or disorders can also lead to behavioral problems. Personality disorders are more common than mood disorders in physicians and are more difficult to treat, he said.
Gendel observed that narcissistic traits are common among physicians and can be addressed effectively through coaching and therapy. “There is a subgroup of people with severe narcissistic traits—who have little insight and take no responsibility for their actions—that may require intensive treatment, possibly in a residential setting,” he said.
Doctors who are perfectionists are often seen in certain specialties such as surgery, anesthesiology, and intensive care that require extreme precision. Because they hold others to their standard of perfection, anything they view as an infraction can incur their wrath, Myers noted.
“If doctors are antisocial, it can lead to serious boundary violations and criminal behavior,” Myers commented.
Gendel wrote the chapter on personality disorders in theHandbook of Physician Health: The Essential Guide to Understanding the Health Care Needs of Physicians, which can be ordered online at<https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod170040>.▪
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Published online: 15 October 2004
Published in print: October 15, 2004
Notes
Psychiatrists who specialize in physician health encounter a lot of comorbid substance abuse and other mental disorders as well as personality traits that can lead to behavior problems.
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