1. Promoting Resident Wellness by Addressing Physician Substance Use and Abuse Margaret M. Rea, Ph.D. GME Counselor

2. Objective: Increase Awareness of and Promote Treatment of Physician Substance Use and Abuse

3. Substance abuse in physicians does exist and needs to be addressed so the system can provide the needed assistance Assistance that allows the MD to continue to perform, while safe guarding patients

4. Questions to Answer: 1. How widespread is alcohol and substance use in your colleagues? 2. What behaviors might indicate to you that one of your colleagues had a problem? 3. Have you had experiences with abusing or addicted colleagues? 4. How have you typically responded to a colleague you feel has a substance use problem? Why?

5. Physicians-Specific Factors 10-15% of physicians develop a substance abuse problem Family history substance abuse 90% of physicians referred for substance abuse treatment are males ER, Psychiatry, Anesthesiology, academic medicine slightly greater risk Other psychological and psychiatric illness High stress

6. Cont’d Access control substances (diverting samples meds, self-prescribing, falsifying prescriptions; obtaining prescriptions from colleagues) Cigarette use >1 pack per day

7. What are Physicians Using? Alcohol is number one Marihuana Prescription opiates Cocaine

8. Signs of Substance Abuse in Physicians

9. Changes in Personal Behavior Isolation and withdrawal from family Erratic behavior Legal problems Domestic tension Separation partner Sexual promiscuity

10. Changes in Social Behavior Inappropriate behavior at social functions DUI Citation reckless driving down from DUI Detioration personal hygiene Accidents, falls etc

11. Changes in Professional Behavior Tardiness Rounds at odd times to escape scrutiny Diminished performance Over prescribes meds, diverts meds, request samples Long-sleeved shirts to cover track marks Subject hospital gossip Alcohol on breath Slurs speech Does not respond to pages

12. Work Behavior Differs Depending On Substance If work is source substance; increased isolation, longer hours If source away from work like ETOH:poor work performance, late Mood swings, depression, irritability

13. Why is it Hard to Recognize? Addicted physicians continue to function at high levels for a long time only when performance is markedly impaired Alcohol hard to detect as it is accepted socially and even encouraged Hard to tell misuse from abuse ETOH Usually detected through complaints of others

14. Why is Substance Use by Physicians Often Not Identified or Addressed ?

15. Physician's Own Denial Unable to recognize they have a problem If they see the problem they make the mistake of assuming they can handle it themselves Physicians do not see themselves as in need of help, they are the ones who help others Physicians see substance use and abuse as a personal and moral failure not as a disease

16. Denial by Family Do not know how to help so they do not voice their concerns Do not know where to turn for help Fear that the physician will destroy his or her career if the problem is addressed and in turn their family will suffer

17. Denial by Peers and Institution Locked into a conspiracy of silence Fear retribution by physician Risk a friendship or working relationship Seen as trouble maker by other colleagues, “do not rock the boat” Collude with physician that they can handle the problem on their own

18. Physician, Family Members, Peers and the Institution Often do not Understand the Potential Resources That Exist to Assist Physicians Which Will Allow them to Continue to Practice

19. Prognosis Good Recovery rate for physicians who enter treatment and are followed for 5 years is 90% with monitoring Physicians respond better than general population to intervention

20. Treatment can save a career without the risk of loss of license

21. Where Should Physicians Go for Help?

22. GME Counselor For Support and Referral

23. Medical Staff Well-Being Committee Committee administers a monitoring program for Medical Staff members who are suffering from substance abuse or dependence, or physical or mental health issues that impair their ability to work and function at their best. The Committee provides advice, recommendations, and assistance to individual physicians and to groups or committees who request assistance or recommendations. The committee can also be of assistance in helping residents/fellows navigate issues with the medical board in instances such as a DUI and the possible repercussions from the medical board. The committee can be reached through its chair, Dr. Peter Yellowlees, or through Dr. Margaret Rea, the GME counselor.

24. Other Resources AA: (916) 454-1100; (916) 454-1771; www.alcoholics-anonymous.org www.alcoholics-anonymous.org NA: (916) 732-2299; (916) 732-2298; www.na.org www.na.org CA: (916) 386-3545; (800) 347-8998; www.ca.org www.ca.org

25. What if a Colleague is Impaired Make an anonymous complaint to Program Director Contact the GME Counselor for input Contact the Well-Being Committee for advice Anonymous complaint to Medical Board Contact physician directly

26. How to Approach a Colleague? Start from a clinical perspective and state concern regarding resident and patient safety Avoid diagnosis and describe the behavior Offer Phone Numbers for Well-Being Committee and /or other resources