JANUARY 30, 2004

"Addiction is an illness, not
a moral weakness"

Homewood Health Centre treats MDs. The director,
Dr Graeme Cunningham, was once a patient

a holistic approach

Homewood Health Centre Inc. is an anomaly in Canadian health care—a privately owned and publicly funded mental and behavioural health facility that functions like a hospital. Founded in 1883 as a sanatorium to provide "quality care in a calm and pastoral setting," it upholds that tradition in a 21st-century fashion, presenting a holistic approach that offers meditation and 12-step programs along with exotica such as horticultural and art therapy. Homewood has 312 beds and, with its library and greenhouse, dining rooms and coffee shop, gym, boutique and bowling alley, feels to the casual visitor rather like an international conference centre or spa.

In addition to its specialized services for doctors, Homewood provides psychiatric services for all Canadians. Treatments include drug, alcohol and gambling addictions; programs for depression, anxiety and stress; programs for men and women with anorexia nervosa and bulimia nervosa; programs for older adults, crisis, community and outpatients and the largest in-patient post-traumatic stress facility in Canada. Homewood has 27,870 square metres of space on 16 hectares along Guelph's Speed River, includes the non-profit Regional Centre for Excellence in Ethics, and was the recipient of the Canada Awards for Excellence Quality Award in 2002.

Contact Homewood at (519) 824-1010 or www.homewoodhealth.com.

At 8:30 in the morning of January 8, 1986, a taxi drove away from a treatment centre with an empty 40-ouncer in the back seat. "That was my last drink," Dr Graeme Cunningham says 18 years later, "and as I sat in the lobby waiting to be taken to detox, smelly and unshaven, ashamed and guilty, a young lady put her arm around my shoulder and said 'I'm your buddy in this — the first few days are hard.' I told her how badly I felt, and that I should know better because I was a doctor. 'So am I,' she said, and by so doing effectively gave me permission to not be a bad doctor, but a sick doctor getting better."

Dr Cunningham has walked the walk ever since. When he went back to his private cardiology practice in northern Ontario, he soon decided not to stay with it. "I could not stay healthy and in balance and work the way I was expected to work," he says, "so I went back to school at the age of 45, with a wife, five kids and a mortgage."

He did a residency in addiction medicine at the Addiction Research Foundation in Toronto, then signed on as a member of the staff. One day he gave a talk to doctors at Homewood Health Centre in Guelph, Ontario and they asked him to join their team. "The medical director asked if I would be interested in running a dedicated program for drugs and alcohol. I agreed on the condition that I could have a specific stream for doctors. When he asked why, I told him that not only was I alcoholic, but my father, also a doctor, was alcoholic as well. So in my mind I'm committed to trying to help physicians as well as other folks." Homewood agreed, Dr Cunningham took the job and almost 4,000 doctors have been through for treatment since 1989. '

Although the incidence of alcohol abuse and drug addiction within the medical profession has been distorted by misunderstanding and speculation, statistics indicate these problems occur in physicians at just about the same rate as the general population. The key difference is that it's a lot more difficult for physicians to reach out for help. Apart from the obvious medico-legal implications, they have to overcome additional societal pressures and taboos.

"Addiction is an illness, not a moral weakness," Dr Cunningham says, "but we're a pedestal profession. When you're on a pedestal and society says you should know better, those of us who are sick believe that message. In fact, the things that make us good doctors can also make us more susceptible to not taking care of ourselves: the classic example of a physician is 'I will care for you, but I will defer my own needs to try to meet yours.' I understand that, and society to a great extent demands that. In addition, 30% of us who go to medical school come from homes where a parent is alcoholic, so the dynamic you get into as a kid may leave you with coping skills that are less than healthy. For example, many of us are prepared to put off looking after ourselves, to take on other people's responsibilities in an overly responsible way, to be misused and criticized but not fight back. We're more likely to stuff our anger and then it comes out in other ways."

Dr Cunningham, now Associate Clinical Professor of Psychiatry and Director of the Addiction Division at Homewood, models ideally as an empathic therapist. Clearly comfortable in his own skin, he's both vibrant and relaxed, a self-realized man who wears his well-being as casually as his crewneck and chinos. He speaks with compassion and humour in a soft Glaswegian burr that brings to mind Theodore Roosevelt's well-known Monroe Doctrine adage: speak softly and carry a big stick. Because, of course, this quiet-voiced man wields a whole lot of clout. He is, along with his good friend Dr Ray Baker, one of the two leading addictionologists in Canada. He had a strong hand in the 1995 start-up of the Ontario Medical Association Physician Health Program (PHP) and is extremely proud of what has been achieved so far: "I believe our program here in Ontario is now the gold standard of PHPs in North America."

He served as President of the Ontario College of Physicians and Surgeons for the past year, ending his term on December 1, 2003 with the satisfaction of having met his objectives. "When I was elected to council five years ago, my goal was to bring some education and some sense about physician health issues to the licensing body, and I've been able to do that, especially with the legal department. They had no idea what it meant to be a sick doctor getting better; what they were seeing were just bad doctors who needed to be punished. I was able to bring a perspective and they were willing to listen. In the PHP we've developed excellent monitoring programs and treatment for docs who are addicted or mentally ill." '

Disruptive doctors
Now he's forging ahead in new directions with a focus on disruptive doctors, a group with problems that don't fit existing models. "They're mostly men," he says, "although there are a few women in the bunch. They're not respectful, they criticize nurses, they don't keep their charts up to date. They may be pretty good docs but they're a pain in the ass to work with. They may be depressed, they may be ashamed, they may be in the wrong profession, but they don't fit into the models for addiction or mental illness. I've managed to persuade the College to begin an initiative to try to set up a way to assess them. I'm now leading a disruptive physician working group and we hope to develop assessment and treatment options by next year. There's worldwide interest in dealing with these doctors; I've been invited to talk about it at a Saskatoon meeting of colleges and an international meeting of colleges in Dublin in April."

His top priority, however, continues to be the treatment of doctors with addictive behaviours. What defines an addictive disease? "Any behaviour that one uses to cope with feelings that does not involve an interpersonal reaction runs the risk of becoming addictive." Dr Cunningham's advice? "Take nothing from a bottle to make yourself feel better, work better, or sleep better. And if you're in doubt, ask your granny."



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