June 8, 2021
Studies show that between 10% and 15% of physicians in the United States experience substance use disorder at some point in their careers, but many don’t know how to or choose not to seek help, Dr. Sandra Frazier, medical director of the Alabama Professionals Health Program, said during a lecture at The University of Alabama College of Community Health Sciences.
For physicians who do get help, the prognosis is good, said Frazier, who is also professor of medical education at the University of Alabama at Birmingham. She provided the College’s Alice McLean Stewart Endowed Lecture for Addiction Education in May.
Frazier said alcohol leads the list of substances abused by physicians. A 2012 study found that 15.4% of American surgeons had a score on the Alcohol Use Disorders Identification Test, suggesting the presence of an alcohol use disorder. A 2015 study of American physicians of various specialties showed 21.4% had a likely substance use disorder (alcohol or other drugs) based on the Alcohol Use Disorders Identification Test and World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test measures.
How do you know when a physician might have a substance abuse disorder? Frazier said clinical manifestations can include decreased productivity, inconsistent hours, deterioration of performance and appearance, and increased isolation. “Look for changes in behavior,” she said. “If someone is acting differently, it might be worth asking.”
The American Medical Association defines addiction as a biopsychosocial disease that is chronic, progressive and if left untreated, can be fatal. It is characterized by continuous or periodic use of a mood-altering chemical despite adverse consequences. “It’s that you use despite adverse consequences,” Frazier said.
She said this happens because substance use disorder changes the brain. The addicted brain, she said, releases up to 10 times more dopamine – more than eating food and drinking water does. Dopamine plays a role in how the body feels pleasure. “Addiction changes brain circuits and it’s really difficult to control the behavior. Addiction is very, very powerful,” Frazier said.
She said there are several factors that make doctors vulnerable to unhealthy behavior – stress from work or personal lives, and a tendency to be self-critical.
Among the barriers to physicians seeking help: fear of losing their job and medical license, and shame and embarrassment. “And they don’t like to ask for help, they don’t think it’s ok to ask for help, so they suffer in silence when they don’t have to,” Frazier said.
But there are reasons to seek help, and to assist physicians in seeking help, she said. “The obvious is to save a life and career, and to keep patients safe.” And there’s ethical and legal reasons. “It’s our duty, and it’s a liability.”
Frazier said the Alabama Professionals Health Program provides confidential consultation and support to physicians, as well as other health-care professionals. Its process works like this: an addicted individual, or someone else, reaches out to the APHP, which makes a discrete inquiry and possibly a referral for evaluation. From there, there is treatment if warranted, followed by five years of monitoring.
Frazier said the advantages of the APHP process is that it is confidential and there is little threat to a physician’s medical license. “The process is non-punitive and allows for remediation and rehabilitation. If you get help, we will try to protect your license. We will advocate for you.”
The Alice McLean Stewart Endowed Fund for Addiction Education was established in 1994 by Alice McLean Stewart to develop an understanding and increase knowledge of alcoholism and other chemical abuse elements. Stewart taught in the Tuscaloosa City School System and at Partlow State School from 1960-1988. She was involved with various Tuscaloosa organizations and her community and received a Certificate for Outstanding Service to Alcohol Education from UA.