Cross-Specialty Comparison of Substance Abuse in Physicians

Substance abuse disorders can reduce one’s quality of life, threaten relationships, increase risk of comorbid mental illness, and impair one’s ability to perform work-related tasks. Unfortunately, physicians can be at heightened risk for developing substance abuse disorders. One 20-year longitudinal study found that practicing physicians were more likely to take tranquilizers, sedatives, and stimulants than their counterparts.^[1] Another study found that 73 percent of doctors had taken some form of non-prescribed psychoactive drug.^[2] A shocking report from the Medical College of Wisconsin identified that 15.8 percent of their anesthesiologists had diagnosable substance abuse problems.¹

Research has also shown that susceptibility to substance abuse and substance of choice vary with specialty. Overall, around 10 percent of physicians will suffer from substance abuse at some point during their careers.^[3] Hughes et al. performed a comprehensive self-report study of over 600,000 physicians and broke down rates of drug abuse by specialty.^[4] Here were their findings:

Anesthesiologists: Overall, approximately 7.8 percent of anesthesiologists struggled with substance abuse. However, these physicians were much more likely to abuse opioids specifically, possibly as a result of their increased access to these substances.

Psychiatrists: This specialty had the highest proportion of physicians with substance abuse problems, at almost 15 percent. Psychiatrists also had a threefold preference for benzodiazepines as compared to other doctors. It is not clear why psychiatrists were significantly more susceptible than other specialties, but Hughes et al. postulated that it was the result of their ease of access to prescriptions and normalized relationship with medication.

Pediatrics: Around 6.8 percent of pediatric doctors self-reported substance abuse issues, one of the lowest percentages of all specialties.

Surgeons: Along with pediatrics, surgery had an extremely low rate of substance abuse; only 5.5 percent of surgeons had fallen victim to addiction and/or dependency. 

Emergency medicine: Physicians working in emergency medicine had a relatively high rate of substance abuse, totaling 12.4 percent. They were also significantly more likely to take illicit drugs, such as marijuana or cocaine. Hughes et al. suggested that the reason for this may have been the inherently stressful and demanding nature of their day-to-day work.

These findings point towards the need for interventional support systems and preventative programs for physicians with substance abuse problems, particularly ones tailored to certain specialties. Physician health programs have had notable success in fighting addiction, with over 78 percent of enrolled physicians remaining substance free at a five-year follow-up.^[5] These resources should therefore be considered an integral part of any clinical setting.

References

^[1] Valliant GE, Brighton JR, McArthur C: Physicians use of mood-altering drugs: A 20-year follow-up report. N Engl J Med 282:365-370, 1970. doi:10.1056/NEJM197002122820705

^[2] Lutsky I, Hopwood M, Abram SE, et al: Psychoactive substance abuse among American anesthesiologists: A 30-year retrospective study. Can J Anesth 40:915-921, 1993

^[3] Baldisseri, M.R. Impaired healthcare professional. Critical Care Medicine, 35(2 Suppl), S106-S116, 2013

^[4] Patrick H. Hughes MD, Carla L. Storr ScD, Nancy A. Brandenburg PhD, Dewitt C. Baldwin Jr. MD, James C. Anthony PhD & David V. Sheehan MD. Physician Substance Use by Medical Specialty, Journal of Addictive Diseases, 18:2, 23-37, 1999

^[5] Reading EG: Nine years’ experience with chemically dependent physicians: The New Jersey experience. MD Med J 41:325-329, 1992