"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 carea
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
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." '
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."