Curing substance abuse is not a spectator sport

Physician substance abuse is still very much a hidden epidemic. Although current stats estimate that prevalence is as high as 10-15%, the numbers are hard to pin down. This isn't surprising as docs who fall victim to addiction often hide their problem exceedingly well — easy enough when you're a health expert. The telltale signs can be near impossible to spot except maybe by another physician, especially one who works closely with the victim. So if you suspect a colleague has a problem, what then?

You have an ethical obligation to step up and do something. Even if confronting a colleague makes you uncomfortable, remember that it's not just a career that's on the line here but someone's life. Before jumping into the fray though, do the groundwork and find out more on treatment options and intervention strategies that work. Also, there are many misconceptions about substance abuse that may mislead you, so be wary. Two common myths that have been busted are that people with these illnesses must "want help" or need to "hit bottom" before they're willing to accept assistance. Victims of substance abuse rarely want or seek help and if you wait till they hit bottom, it may be too late. Another common misconception that was recently shattered deals with the serious business of relapse. A single relapse wasn't thought to be a big deal — after all, old habits die hard, right? Well, thanks to new data, we now know that for some physicians even a single relapse can trigger a complete downward spiral (see our story "Substance abuse relapse — in MDs").

As more studies on substance abuse among physicians emerge, we're getting a clearer picture of this problem — and it isn't pretty. The problem will only get worse if no one is willing to make the first move. You can and must do your part to save an impaired colleague from self-destruction. Typically, at least two people should confront the individual. The minimum goal of an intervention is to get the physician to agree to a clinical assessment. Arrange this session in advance and make sure that the time from intervention to assessment or treatment is short. To be sure your colleague gets help, you could escort the doctor directly to treatment from the intervention. Be prepared to notify regulatory authorities if your colleague refuses help. Usually, laying down the law about the consequences of refusing treatment will help them come round — a little tough love can go a long way. Remember that even if they resent you now, they will thank you later.

— Shereen Joseph, Editor