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Gold, incentives and meh

Drug and alcohol addiction among GPs

Dr Stefan Cembrowicz speaks to Dr Alasdair Young of the Sick Doctors Trust about the causes of addiction and its consequences for physicians

How big is the problem?

Is there anything about us that makes doctors vulnerable to addiction?

We estimate a lifetime prevalence of about 10 per cent; this means about one doctor in 10 at some time is going to suffer a problem with drink or drugs. We are seeing a significant increase in the number of doctors who are using street drugs such as cannabis, cocaine and amphetamines.

We tend to be fairly well off so we can afford drink or drugs. Then we have access to drugs, although we have a strong taboo against dabbling in our own prescriptions or drug cabinets, which seems to hold us back until we really hit rock bottom.

So are we selecting the wrong people at medical school?

Maybe some component of what makes us the sort of person who works in a caring profession also renders us vulnerable to addiction.

Perhaps we are the sort of people who need to feel we are doing something worthwhile and useful. Perhaps drugs and alcohol have the same sort of effect and short-circuit into the same mechanism.

There's something for me that makes the professional and the personal parts of our work hard to separate.

Being a doctor is often perceived to involve setting aside your own feelings to attend to somebody else's. The professional doctor is supposed not to let his own feelings intrude into his professional or personal life and so possibly doesn't deal with them terribly well. Maybe again alcohol and drugs play a part here.

Doctors are a fairly healthy bunch who, with the exception of addictions, look after themselves reasonably well. The doctor's professional persona and outward appearance are the last thing to suffer ­ his family life and personal finances may suffer long before it shows in the consulting room.

How long does it take for an addiction to come to light?

With alcohol it tends to take years ­ six or seven years of unhealthy, abnormal drinking ­ before doctors really get

into trouble. But with an increasing number of doctors using street and prescription drugs, these substances can cause problems much more rapidly and so are much more likely to be detected more rapidly.

Is cocaine starting to be a problem?

Yes. There's a lot more cocaine available, although it is almost exclusively a street drug ­ there's very little medical cocaine around for doctors to help themselves to. For a long time cocaine had a mythical aura of upper-class respectability and doctors are no more immune to that than anyone else.

Are attitudes to drug problems changing?

What is driving the problem at present?

Doctors are under a great deal of scrutiny: the Bristol inquiry, Shipman and so on. A lot of people are interested in our competence or lack of it and the GMC and National Clinical Assessment Authority are scrutinising doctors' abilities. Also there has been a change in the profession, which has itself become less tolerant of inappropriate behaviour.

Certainly I've noticed a change during the course of my career: as a young junior hospital doctor it was nothing unusual to have drug-sponsored, fairly alcohol-soaked lunchtime events during the course of the working day, and to a large extent that has all stopped. There is an intolerance of drinking at work.

How has the GMC's attitude evolved in recent years?

The GMC has become dramatically more sensitive to the existence of, and the problems caused by, addiction in the medical community, particularly involving alcohol. Ten or 15 years ago ­ and I can't justify this with any evidence ­ I think the GMC took a fairly lenient view of doctors who were breathalysed.

If there was one offence the doctor got a warning and a suggestion that he might have a look at him or herself, but very little beyond that. Now I think a doctor caught drink-driving would immediately be subject to quite a degree of scrutiny. It's likely they would be asked to be examined by a psychiatrist, particularly if the alcohol level was high.

What are the prospects of treatment?

If a doctor patient of mine becomes unwell in this way, where do I start?

The biggest problem is getting the doctor to admit there is a problem and, second, getting them to put their hand up and say yes, I need some help for this. You're going to have to talk to them.

The Sick Doctors Trust would be happy to help. Many of our members are ourselves in recovery from addiction so we can talk as equals to a doctor who may be frightened.

We can talk from our own personal experience, which is often enormously reassuring to a doctor who thinks that admitting they've got a problem will be professional death.

And as patients we doctors use denial as a way of getting by, just like everybody else. Denial, of course, is the hallmark of all addictions.

What models of addiction do you find most helpful when dealing with sick doctors?

Those of us who are in recovery all embrace the concept that total abstention from alcohol and other mind-altering drugs is essential if we're to get better.

The GMC and other regulatory bodies expect that doctors who want to go back to work abstain totally from drugs and alcohol, in much the same way as train drivers and airline pilots are also expected to abstain if they happen to suffer from an addiction and wish to return to work.

Is there any place for methadone maintenance?

I have never heard of a doctor on methadone maintenance being allowed to return to work by the GMC.

When a doctor presents to you, is admission likely to be necessary?

Very often by the time somebody comes to us asking for help the problem has got so severe that inpatient treatment is indicated. Increasingly, the GMC and employers are much more comfortable with a doctor who has been through a period of inpatient treatment.

That's not to say there aren't doctors who get well without going through inpatient treatment; there always has been a steady trickle of doctors who get well through AA and NA, who have managed to do something about their problem before it has impacted significantly on their professional life.

How is hospital admission arranged?

It has been recognised for some time that doctors have special needs. You cannot realistically put a doctor into a hospital next door to his own patients ­ the risk of blackmail, extortion and so on is too great. Doctors have been recognised as being entitled to out-of-area treatment.

What recovery rates can we expect?

The best studies, from Canada and North America, show doctors can, once in treatment, achieve success rates of more than 90 per cent, meaning they are clean, sober, happy and return to professional life.

The good news is that with revalidation and new organisations like the National Clinical Assessment Authority there are going to have to be structures in place to retrain and help doctors who have been off sick for all sorts of reasons, or who have got behind with their professional development or have become clinically incompetent.

What support is available

for GPs?

What avenues of help are there for doctors?

Like anybody else the doctor should have a GP he or she can go to. We can also go to Alcoholics Anonymous and Narcotics Anonymous or we can contact the BMA Counselling Service.

There are various local schemes supported by PCOs, such as the Avon COPE Scheme.

The British Doctors and Dentists Group is a peer support group of

doctors and dentists in recovery from addiction, run along parallel lines to AA. There are 16 groups functioning in the UK and Ireland.

Where does the Sick Doctors Trust fit in?

The trust is an organisation run by doctors for doctors, whose primary concern is assisting doctors who are suffering from an addiction ­ to alcohol or drugs.

As an independent organisation, not part of 'the system', we are able to promise anyone contacting us absolute confidentiality.

Anyone in a more formally constituted body has a moral and legal obligation to report a sick doctor to the GMC or their employer.

Our philosophy is first of all that recovery is possible, that recovery is very worthwhile both professionally and socially, and that if recovery is to be of any value then it has to be enjoyable and rewarding.

The principal thing we do is run a helpline, open to doctors, their relatives, practice partners or any other interested person who wishes to ring up and ask about what help a doctor can get for problems with an addiction.

Once a doctor has made contact we will inform them of practical help and treatment, help them find funding, and put their family members in contact with people who can help, support and encourage them. Then we help them deal with the GMC and other regulatory authorities.

We are largely self-supporting. We get modest contributions from the BMA and one or two LMCs and other charitable organisations. Some members make deeds of covenant. We are a charity and we don't make a profit.

Useful resources

Sick Doctors Trust:

Tel: 0870 444 5163

or e-mail

BMA 24-hour Counselling Service:

Tel: 08459 200 169

Medical Council on Alcohol:

Tel: 020 7487 4445

or e-mail

The British Doctors and Dentists Group

can be contacted via the MCA (above)

National Counselling Service for Sick Doctors

Tel: 0870 241 0535

or e-mail

Doctors Support Network

Tel: 07071 223 372

or e-mail

British International Doctors Association

Tel: 0161 456 7828

or e-mail

Stefan Cembrowicz is a GP in Bristol

Alasdair Young is a consultant psychiatrist and vice-chair and founding member of the Sick Doctors Trust

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