Substance Abuse in Doctors According to Physician Specialty

An estimated 10-15% of doctors will develop a problem with substance abuse at some point in their careers.¹ Due to different stressors and access to drugs, the discipline of a physician will often have an impact on the substances that they use. Learn the risk factors for physicians in different specialties.

Anesthesiologists

The vast majority of anesthesiologists with substance abuse issues are addicted to potent intravenous opioids such as fentanyl and sufentanil.² Previous studies have shown that over 40% of anesthesiologists enrolled in Physician Health Programs for there for IV drug use, compared to only 10% for alcohol abuse.³ These drugs are diverted from the workplace, often from their individual patients.

Factors that explain the high incidence of drug abuse among anesthesiologists include their proximity to highly addictive drugs in the operating room, the relative ease of diverting these drugs for personal use, and the highly stressful environment in which they work.⁴ There is also evidence that second-hand exposure to aerosolized intravenous anesthetics in the workplace can sensitize the reward pathways in the brain and promote subsequent opioid abuse in anesthesiologists and surgeons.⁵

Surgeons

Compared to other specialties, surgeons have overall low rates of substance abuse, with the exception of alcohol and tobacco smoking.⁶ A recent study of alcohol use among practicing surgeons in the United States revealed relatively high rates of alcohol abuse and dependence. The highest rates were found in women, with 25.6% of female surgeons having alcohol abuse or dependence problems compared to 13.9% of male surgeons.⁷ These rates are much higher than the 6.2% of the overall U.S. adult population with an alcohol use disorder.⁸

There are several reasons why surgeons may turn to alcohol. Being a surgeon is one of the most stressful occupations possible, as you are responsible for operating on people in life and death situations on a daily basis. Routine surgeries can present unforeseen complications, and even minor mistakes can be devastating. Alcohol may seem like an easy way to relax and cope from all of the stress encountered at the workplace.

Psychiatrists

Psychiatrists have been shown to be more likely to abuse benzodiazepines.6 A systematic review of the literature revealed psychiatrists are especially prone to stress, burnout, and suicide. Stressors for psychiatrists in the United States include:⁹

• Negative characteristics of patients
• Events leading to posttraumatic stress (such as patient suicide)
• Administrative hassles
• Resource deficits
• Staff conflicts
• Long work hours
• Lack of positive feedback
• Low levels of job satisfaction
• Lack of control
• Unpredictability
• Intense responsibility

Emergency medicine physicians

Although emergency medicine physicians account for only 3% of all physicians, they account for 7-18% of physicians enrolled in Physician Health Programs for substance abuse management.¹⁰ A recent study of emergency medicine physicians treated by a Physician Health Program showed that nearly half were treated for alcohol abuse, 38% for opioids, and almost 10% for stimulants.¹¹ Another study found that emergency medicine physicians used more illicit drugs, such as marijuana, compared to other specialties.⁶

Emergency medicine physicians are at the front line of care access, constantly having to deal with demanding and unpredictable situations. Not surprisingly, the jobs of emergency medicine physicians are very stressful. These doctors experience burnout rates of 60%, the highest rate among all physician specialties.¹² Alcohol and opioid abuse may stem from attempts to cope with job stress or self-medicate physical pain. Stimulant misuse likely arises from the combination of long shifts and few days off.

Pediatricians

Like other physician specialties, pediatricians must deal with immense workloads and job-related stress. According to a 2017 survey conducted by the American Academy of Pediatrics, stressful job factors for pediatricians commonly include:¹³

• Finishing up on work at home
• Documenting patient information in the electronic health record (EHR)
• Completing nonclinical activities
• Completing external regulatory requirements
• Keeping current on medical knowledge
• Negotiating salary, contract, promotion
• Linking families with resources

Despite these stressors, pediatricians do not appear as likely to resort to substances. Compared to other specialties, pediatricians have overall low rates of substance abuse.⁶

Treatment Options

Doctors may fear negative repercussions from seeking treatment such as legal action, loss of employment, loss of licensing, among others. However, treatment for doctors is often proven to have high success rates. After completion of rehab treatment, 78% of doctors remained drug-free after 5 years and 71% retained their license and employment after 5 years.¹⁴ In addition to providing very effective treatment for addiction, these programs also assist doctors with reentry into clinical practice once they have undergone successful recovery.

Sources

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2. Kintz, P., Villain, M., Dumestre, V., & Cirimele, V. (2005). Evidence of addiction by anesthesiologists as documented by hair analysis. Forensic Science International,153(1), 81-4.
3. Skipper, G.E., Campbell, M.D., & Dupont, R.L. (2009). Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and Analgesia. 109(3), 891–896.
4. Gold, M.S., Byars, J.A., & Frost-Pineda, K. (2004). Occupational exposure and addictions for physicians: case studies and theoretical implications. Psychiatric Clinics of North America, 27(4), 745-53.
5. Gold, M.S., Graham, N.A., & Goldberger, B.A. (2010). Second-hand and third-hand drug exposures in the operating room: a factor in anesthesiologists’ dependency on fentanyl. Journal of Addictive Diseases, 29(3), 280-281.
6. Hughes, P.H., Storr, C.L., Brandenburg, N.A., Baldwin, D.C., Anthony, J.C., & Sheehan, D.V. (1999). Physician substance use by medical specialty. Journal of Addictive Diseases, 18(2), 23-37.
7. Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J, et al. (2012). Prevalence of alcohol use disorders among American surgeons. Archives of Surgery, 147(2), 168-174.
8. National Institute on Alcohol Abuse and Alcoholism. (2019). Alcohol Facts and Statistics.
9. Fothergill, A., Edwards, D., & Burnard, P. (2004). Stress, burnout, coping and stress management in psychiatrists: findings from a systematic review. International Journal of Social Psychiatry. 50(1), 54-65.
10. McLellan, A.T., Skipper, G.S., Campbell, M., & DuPont, R.L. (2008). Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ, 337, a2038.
11. Rose, J.S., Campbell, M., & Skipper, G. (2014). Prognosis for Emergency Physician with substance abuse recovery: 5-year outcome study. Western Journal of Emergency Medicine, 15(1), 20-25.
12. Shanafelt, T.D., Boone, S., Tan, L., Dyrbye, L.N., Sotile, W., Satele, D., … & , Oreskovich, M.R. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377-1385.
13. American Academy of Pediatrics. (2018). What do early career pediatricians find stressful?
14. DuPont, R.L., McLellan, A.T., Carr, G., Gendel, M., & Skipper, G.E. (2009). How are addicted physicians treated? A national survey of Physician Health Programs. Journal of Substance Abuse Treatment, 37(1), 1-7.