Helping addicted doctorsBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7570.s125 (Published 30 September 2006) Cite this as: BMJ 2006;333:s125
Ruth Mayall discusses the work of the Sick Doctors Trust
Sick Doctors Trust: helpline 0870 444 5163, www.sick-doctors-trust.co.uk
British Doctors and Dentists Group: 020 7487 4445 (Medical Council on Alcohol) or via the Sick Doctors Trust helpline
Late in the day, addiction in doctors is being recognised. Unfortunately a rise in awareness does not equate to better management. For many years the profession has been in almost as much denial as its addicted colleagues.
Specific help for doctors
The Sick Doctors Trust is probably the only body in the country that offers help specifically for doctors with addictions. The helpline is manned around the clock by one of six doctors, who take these calls on an entirely voluntary basis. Some of us are in recovery from active addiction ourselves, and have been sober or drug-free for up to 20 years.
We are a registered charity and are grateful to local medical committees and the BMA for funding, which allows us to operate the helpline and be involved in educational activities, helping raise awareness about addicted doctors.
Independent help and advice
It is helpful to callers to realise that they are talking to someone who knows what it is like. Someone who has been through similar frustrations: repeated failed attempts to stop drinking or using drugs. Someone who knows the feelings of guilt and shame and who can identify and reassure them that they are not alone and that they are not the only doctor to have got to this stage of despair. Someone who can show that effective treatment works. Someone who has felt bewildered that they just can't stop and who knows the relentless compulsion to continue taking something that has ceased to be pleasurable but has become necessary on a daily basis, simply to get rid of withdrawal symptoms and enable them to function. Most importantly, this is someone who is independent, who can offer help and advice, but who is not accountable to any regulatory body.
The information given to us is treated with respect and confidentiality. Callers may remain anonymous if they wish, and this does not prevent us giving them the same degree of attention.
We have established good working relationships with the BMA and Medical Council on Alcohol, and we are represented nationally with agencies concerned with performance and patient safety. We receive on average 20 calls a month, with some seasonal variations. We may help to arrange a visit to an appropriate addiction treatment unit, with some leading to prompt admission to a specialist unit for detoxification. Other callers may enter outpatient treatment programmes. Most treatment centres will invite doctors for free assessments and advice on the best action.
We often refer callers to the British Doctors and Dentists Group. This is a group of professionals in recovery from active addiction, with 16 nationwide groups which meet informally each month. It is important that a doctor sent home on “gardening leave” is made aware of this type of support at a time when feelings of isolation and despair run high. He or she can be put in touch with another doctor with personal experience of addiction, perhaps in the same specialty or living nearby.
Calls over the past few years have concerned a wider range of addictions, such as eating disorders, the internet, and mobile texting chat lines. These all cause the same despair to the caller, and have the same effect on finance and family as alcohol or other drugs, but do not carry the same employment consequences and social shame.
What has also become obvious is that callers are getting younger and have shorter histories. This could be the result of increased professional awareness of the problem and how to get help. However, these younger callers are often addicted to opiates, cocaine, or cannabis. As opiates cause physical addiction far more rapidly than alcohol or benzodiazepines, these doctors reach their “rock bottom level” far earlier.
Some callers get in touch only after disciplinary proceedings either from their trust or the General Medical Council (GMC). It is worth mentioning that the GMC is always notified if a doctor receives a conviction in (any) court, whether for prescription fraud, drink-driving, or other reasons. The GMC freely admits that it is aware of only a proportion of addicted doctors and is keen for straightforward cases, where there is no harm to a patient or breach of professional conduct, to be managed locally. However, there seems to be a postcode lottery on how these doctors are managed. Some doctors seek help themselves and never come to the notice of either the trust or GMC.
The difficulty doctors have is accepting that addiction is recognised as an illness by the World Health Organization and, as an addicted doctor, accepting that it's alright to be ill—treatment is available. Several studies have shown neurotransmitter and receptor differences in addicts, particularly 5-hydroxytryptamine, gamma-aminobutyric acid, and dopamine.
We encourage anyone with concerns about their alcohol or drug use to contact us for help or advice. ■