Chemically dependent health professionals

Early on, I was able to control and/or curb the use of alcohol periodically.... [Later] I started each day remorseful and promising myself I wouldn't drink, but almost invariably concluded the day drinking.... The last days of drinking were horrible. Nothing was functional in my life except the anger and resentment I directed at those who were trying to help. Until the final stages of my drinking, to my knowledge, no one ever suggested to me that there may have been a problem, and I certainly couldn't recognize the problem in myself.​myself. Anonymous1 Table 1 Risk factors for addiction in health professionals Family history of chemical dependence Access to pharmaceuticals Emotional problems High levels of stress Thrill seeking Self-treatment of pain Chronic fatigue View it in a separate window An unused 5-cc syringe lay among the rubble of my failed efforts. As I picked up the syringe, a thought flickered across my mind: What would it feel like?... Months later, I was profoundly aware of the deception that had taken over my life—it was almost like having another personality.... One time I overdosed and put my head on the operating table next to the bypass patient. I had nodded off and was fast asleep. The surgeons and others made light of it, and I excused my aberrant behavior by saying I was overworked and exhausted. Igor Rosien2 Fortunately, these physicians ultimately received treatment, established recovery, and lived to tell their story. Not all are as fortunate. Untreated addiction to alcohol or drugs is a devastating, chronic, and often fatal disease. The hallmark of addiction is the compulsion to continue to use a substance even after having adverse reactions to it. Addicts are neither morally weak nor lacking in ethical character or willpower. They develop guilt and shame as their behavior violates their own value system. In physicians, the disease of addiction is almost always in an advanced state before signs and symptoms becoming obvious in the workplace. Although the actual prevalence remains unknown,3 8% to 12% of health professionals are estimated to develop a substance-related disorder at some point in their life. Risk factors that may increase the likelihood of addiction in health professionals are shown in the box below.4 Early symptoms of chemical dependency are frequently nonspecific. Chemical dependency has been called the “great imposter and masquerader” and likened to syphilis in its ability to mimic multiple conditions.5 The table lists symptoms frequently seen as addiction develops.