MetroHealthAnesthesia Learning Anesthesiology
CHEMICAL DEPENDENCY
COULD MY COLLEAGUE BE A DRUG ADDICT?...

July 6, 2005
Greg Gordon, MD
Objectives: Participants will
  1. Experience heightened sensitivity toward the disorder of chemical dependency
  2. Be able to define and describe symptoms of the disease of chemical dependency
  3. Be able to help in decisions about intervention, referral for treatment and return to work.

Definition:
Chemical dependency =
  • CONTINUED (COMPULSIVE) use of a
  • CHEMICAL SUBSTANCE,
  • despite adverse CONSEQUENCES, indicating a CONTROL problem.
  • Major concomitant associated sign or symptom is usually DENIAL of loss of control.

Disease model
  • Primary, chronic progressive disease.
  • May be fatal.
  • Three essential elements:
    • HOST (each of us is vulnerable)
    • AGENT (duration and progression largely function of agent)
    • ENVIRONMENT

Sometimes all it takes: environment helps host become willing to experiment once with agent.
  • Spontaneous recovery is possible but relatively rare.
  • Outside help is almost always needed.
  • Denial: colleagues, friends, family, too. ("conspiracy of silence")

Narcotic and/or ethanol abuse: 10-13% of anesthesiologists

Areas to look for problems as disease progresses:
Drug use takes priority over increasingly more alternatives leading to progressive loss of control in the following areas (usually in this order):
  1. Community, social, church, avocations
  2. Friends, colleagues
  3. Family, loved ones
  4. Job, work, making a living (personal identity)
  5. Life itself

Historical notes
  • William Halstead, the "father of modern surgery" suffered from cocaine and morphine addiction.
  • Horace Wells, dentist who first noted analgesic effects of N2O, tried it on himself, died by suicide four years later in jail.

Anesthesiologists:
  • 4% of docs,
  • but 12% of docs in treatment for substance abuse

Treatment
Recovery model of Alcoholics Anonymous
Detox/Education/Behavior modification
  • Inpatient start often necessary
  • Group therapy
  • Naltrexone (po: 72 hours duration)
  • Antabuse

Prognosis - Eg.: MAG-IPP (Medical Assoc of Georgia Impaired Physician Program):
  • 334 docs; 4 mos inpatient + 20 mos outpatient:
    • 93% in recovery, practicing medicine 2-10 yrs out
    • mortality from addiction: 1%
  • Anesthesiologist subgroup: (resident, academic, private)
    • 56 completed treatment:
      • 55 in recovery, practicing medicine (36 in anesthesia)
      • 25% relapsed:
        • 90% first year
        • 98% first two years
    • 9 did NOT complete treatment: 4 DIED of addictive disease (>40% mortality)
References



Greg Gordon MD,
Updated: