The prevalence of addiction to alcohol and other drugs in the general population is estimated to be approximately 10%, but there have been no large scale studies of the prevalence of addictions in members of the medical profession in the UK.
Various studies show a lifetime prevalence of 10 – 12% in doctors. As many studies rely on postal surveys, (some with quite low response rates), the results may be skewed somewhat in that individuals with current untreated problems are unlikely to respond, and those in recovery may be more likely to respond, as is a Clinical Director who has recently had to deal with a case. Safe to say though, that there is definitely a problem.
A 1998 study of junior doctors in Newcastle-upon-Tyne reported that:
A BMA Working Group, also reporting in 1998, suggested that some 1in15 doctors in the UK may suffer from some form of dependence on alcohol and/or other drugs. This equates to approximately 13,000 doctors and suggests likely 400-500 new cases per year. The fitness to practice of all of these will be impaired.
Since these reports, both observations from the helpline and anecdotal evidence would suggest that cocaine use and dependence has increased considerably over the last decade. Since our working lives are spent helping others, it is easy to push aside our own problems, in addition to which, denial is quite common in medical staff. This is not deliberate, but a part of the whole illness of addiction. That addiction is a chronic illness which therefore requires treatment as for any other condition, is now well-established (see definitions section), but there is still a tendency to feel that it is a sign of weakness, and that maybe things aren't 'that bad'.
That some individuals are more prone to developing addiction is generally agreed. There is no single determining factor, but usually a combination of biological, psychosocial and environmental factors - a mixture of nature and nurture. There is now much evidence implicating dysfunction in the Dopamine transmitter system & it’s involvement in craving. There is also evidence to suggest that the effect alcohol has on an individual’s brain is genetically determined. A family history is present in many alcoholics- those having direct family affected being more at risk.
Alcohol is the commonest substance of abuse in all doctors. Drinking will surprisingly continue despite negative consequences such as job difficulties, relationship breakdowns, financial problems, loss of driving licence; the alcoholic is driven by an irrational compulsion to continue, and frequently results in despair to the point of suicide. Fortunately, the depression associated with active alcoholism often abates when sober.
From the GMC’s figures in 2007 of all their cases with health sanctions, a speciality breakdown showed 39% were GPs, 17.5%, Psychiatrists, 9% General Medicine, 8.5% Surgery, 6.5% Anaesthesia & 6.2% Emergency Medicine. Other specialities represented less than 2% each (reference Dobson B. Head of Case Review GMC 2010, personal communication).
Access & familiarity with a substance play a significant part, since anaesthetists are more likely to abuse drugs than alcohol, to abuse narcotics, and to abuse drugs intravenously [5,10]. Fentanyl can lead to physical addiction in as little as six weeks of use, but more commonly comes to light after at least six months. Consequently the sequelae of opiate addiction are seen in a much younger age group than alcohol abuse.
There is a very real suicide risk after intervention - suspected addicts should not be ‘home alone’ afterwards – a call to either our helpline or the BDDG below can provide a colleague to talk to, who knows how they feel.
Behavioural changes are probably the commonest indicators of substance abuse. Addicts become very adept at hiding problems. These typically begin outside work, such as marital and financial problems. When signs of illness are noticeable at work eg weight loss, the process is very advanced. Even small changes therefore, in someone’s behaviour, if persistent may be the tip of an iceberg and should be taken very seriously.