Doctors and Addiction

Drinking behind closed doors and drawn shades, then trying to cut the shakes with drugs, becomes a way of life for one San Diego County physician. Another local doctor begins a decade of drug abuse when he self-prescribes pain relievers after an operation.

Both have successful practices and are highly regarded in their specialties. Both admit they suffer from alcoholism and drug addiction. But after long struggle, neither has gone back to drugs or alcohol.

It hasn’t been easy.

“The pressures of living affect physicians just as much as anyone else,” said one doctor who has managed to stay clean for two years. “It’s so tempting when you have a whole drug cabinet nicely stocked by the pharmaceutical industry. Just walk in and take the tranquilizer of your choice.”

Suits involving patient neglect or malpractice stemming from alcoholism or drug dependency are extremely rare locally, said David Knetzer, executive director of the San Diego County Medical Society.

“The state Board of Medical Quality Assurance (BMQA) publishes a list every month of those kinds of accusations against physicians, and I can’t remember the last time I’ve seen a San Diegan on it,” he said.

Peer Review Helps

A major factor in this success is the existence of physicians’ peer review committees at local hospitals, local medical society officials say. In the past two years the committees’ political clout has increased to the point where they can force doctors who exhibit bizarre behavior to enter appropriate treatment programs if it is confirmed they are victims of addiction. Such programs, whether locally or statewide, have a 90% success rate for physicians, the officials say.

The committees are most effective, local medical officials say, because they function in the same environment as the doctors do, and can recognize and monitor behavior.

“Hospitals have clout with their physicians because they can withhold a doctor’s privileges to work there. Taking that away is taking away their bread and butter,” said Dr. Ron Mineo, director of clinical services for the McDonald Center for Alcoholism and Drug Addiction Treatment in La Jolla and consultant to the California Medical Society’s Committee on Physicians’ Health and Well-Being. “That threat can coerce a doctor into treatment when he is still in a very early stage of his illness and may not realize he’s sick.”

Mineo is also the chairman of the peer review committee at Scripps Memorial Hospital.

“When it’s brought to our attention that a physician is showing signs of severe mood swings, angry outbursts or mysterious disappearances, we look into it, and if it appears the problem is one of chemical dependency, we’ll call in the doctor before our committee,” Mineo said. “We confront him with the facts we have on hand that may have been gathered by talking to other members of the hospital’s staff who watch the physician’s behavior or possibly from his family and members of his office staff. We let him know we believe he is suffering from the disease of addiction, give him the facts that support that and insist he enter a treatment program.”

Many Have Conquered

Among patients of the McDonald Center, which is at Scripps Memorial Hospital, have been 89 physicians, most of whom have been able to return successfully to practice. Yet even with new insights into the disease, the road to recovery is a huge struggle, fraught with dangers of relapse.

Mineo, a recovered addict himself, knows at first hand how intense the struggle can be.

He began using drugs while a physician at Camp Pendleton in the mid-1960s.

“I was going through a very traumatic divorce. My father had just died. And I was solely responsible for my two very young children.”

To cope with increasing feelings of inadequacy and fear from those events and to be able to fall asleep at night, Mineo began using the drugs Demerol, Talwin, and later alcohol. A 10-year battle with addiction was under way.

Mineo said that one of the new insights into the disease of addiction is that once an individual becomes dependent on one mood-altering substance, there is dependence on all other such substances.

“People who try to recover from drug addiction by drinking or vice versa quickly find out they can control none of those substances,” he said.

About 80% of addicts, including physicians, who come to the McDonald Center enter with a drug they readily admit they have problems with, but they don’t recognize they also have the same problems with other substances, Mineo said.

For example, Mineo said, cocaine addicts often drink to come down off their cocaine high. They don’t think that’s peculiar at all. They come to the facility thinking they have a cocaine problem and an alcohol solution. On the other hand, some alcoholics discover that a hangover isn’t so bad when they take Valium.

“Part of the delusional system that can keep you from seeing you have a problem is that you’re not addicted to anything because you’re addicted to everything,” Mineo said.

His own drink of choice was Scotch. “That’s because I wanted to retain a bit of class. But let me tell you, at 2 a.m. when the liquor stores are closed and you’ve run out of Scotch, the wine available at any 24-hour convenience store will do the job.”

The key to Mineo’s successful recovery turned out to be a fellow physician who, without knowing of Mineo’s problem, told him of his own struggle as a recovering alcoholic.

“I noticed his eyes were clear and that his hands didn’t shake. And he wasn’t ashamed of himself. He told me he had an illness and he was on a recovery program. I didn’t even know what a recovery program was. When I told him I might need some help, he didn’t run away from me or act like I frightened him. As a matter of fact, he didn’t even try to offer any advice or try to fix me.”

A Welcome Change

It was a welcome change from his constant battle with the state licensing board and fellow physicians who looked upon his problem coldly.

“There were and still are some members of the medical profession who are enmeshed in outdated and unwarranted moral judgments concerning chemical dependence who didn’t know what to do with or for me,” he said.

Mineo accompanied his friend to a small Alcoholics Anonymous (AA)-affiliated meeting of physicians and lawyers who were all recovering addicts. “That saved my life,” Mineo said.

Up to that point, he had spent almost a decade of losing jobs and being prosecuted by the oard of Medical Quality Assurance for his drug and alcohol problems.

“Never once was I told there was a disease called chemical dependence and I had it. Never once was I identified as being sick,” he said.

“I can’t tell you how much it meant to have other physicians tell me they understood what my disease was and welcome me there for wanting to do something about it. It was one of the most amazing things that ever happened to me. They didn’t offer me a lecture. They offered me a program of recovery.”

Tried Suicide First

Another local physician who has had problems with drinking and drugs since youth entered a treatment facility only after a suicide attempt.

“I’m clean and dry today because I’m a member in good standing of Alcoholics Anonymous,” he said.

During his recovery phase he found it especially useful to attend periodic meetings of an AA-affiliated group of 3,000 international physicians, all recovering addicts.

“It was good to share our common experiences,” he said. “It really helps doctors who are trying to come to grips with this problem that is bigger than all of us.”

His advice to other physicians dealing with addiction: “There are about 400 meetings of AA throughout the county. Find the closest one and show up.”

Every addict is blind to his problem, said Dr. John Milner, clinical director of the Alcohol and Drug Treatment Center at Sharp Cabrillo Hospital and a member of the state BMQA’s evaluation committee for its Impaired Physicians Diversion Program.

“I have never met anyone who, at the height of their ambition, decided to become an alcoholic or drug addict. Nobody ever plans to become an abuser. They slip into it,” he said.

Another avenue of help is the San Diego County Medical Society’s Committee on Physicians’ Health and Well-Being, which helps doctors to handle a wide variety of problems, including addiction.

With Special Knowledge

Milner, the chairman, said its primary purpose is to serve as a resource “where we can link those having trouble to professionals who are especially knowledgeable of the problems facing physicians.”

It also serves as a source of aid for a physician’s wife who knows her husband is having an alcohol or drug problem but fears that an indiscreet call for help would destroy his practice and reputation. The committee maintains a special hot line at the society’s offices that is confidential and for the use of any local physician in trouble.

On a statewide level, the BMQA’s Diversion Program for Impaired Physicians also offers treatment for addicted doctors. It was created in 1980 after a change in California law gave impaired physicians the opportunity to be diverted from possible medical board discipline into a statewide treatment program. So far about 400 doctors have gone through the program, and there has been a 90% success rate, said Linda McCready, BMQA coordinator for internal affairs.

“It has been successful far beyond our wildest expectations,” she said.

Jerry Becker, former director and prime architect of the program, said it came into existence because of “the slowness of the judicial process in recognizing and disciplining the impaired physician. In many cases one to two years elapsed from the inception of an investigation until BMQA restrictions were imposed. In the meantime, the impaired physician continued to practice without hindrance, surveillance or treatment,” he said.

Sought Quick Response

When Becker organized the program four years ago, he wanted it to respond as quickly as possible to cases through the formation of a statewide network of regional diversion physician groups. Primary referral is made from the board itself in lieu of disciplinary action. But another main source is local organizations such as the San Diego County Medical Society.

Milner, who assists the BMQA’s diversion program by helping construct individual treatment plans, said the key to a physician’s success in their own program, which typically runs two to five years, is “accepting the fact that they are abusers and will always have that predisposition.”

That first step of acceptance is also the first step of recovery in AA’s general plan and is considered a crucial prelude of most treatment programs.

“When a physician enters the McDonald Center he is treated no different than any other patient. We tell him to leave his degree outside the door,” Mineo said. And that comes as a shock to many doctors.”

The first part of treatment is detoxification.

“Marvelous things happen when you eliminate those chemicals from your body,” Mineo said. “Usually their depression lifts. Judgment returns. And they can begin to make a connection between how they are feeling and the chemicals that have been clouding their brain.” This phase typically lasts 30 to 40 days.

Then counselors help the patient set down examples of where he lost control of drugs and alcohol and how it affected his life.

“This can be the first time a person with this disease sits down with a clear head and adds up the price he’s had to pay for addiction,” Mineo said.

The next step is entering treatment groups to find alternative ways of relating to people without having to use chemicals. It’s in this phase where a patient finds ways to get relief from emotions that may have been repressed for many years.

Not a One-Sided Affair

“At this stage many doctors suffering from addiction realize emotions don’t have to be a one-sided affair,” he added. “After years of working for patients 24 hours a day, they begin to realize that people really do care about them, not for what they do but because they are human beings. They learn that by sharing feelings they can obtain relief from them.”

Dr. C.F. Ward, associate clinical professor of anesthesia at the UCSD School of Medicine and chairman of the California Anesthesiology Society’s Committee for Impaired Physicians, said, “The most encouraging message is the high success rate once a physician is in treatment. It’s a situation where the physician is on top of a pyramid and about to fall off and somebody grabs him by the scruff of the neck and pulls him back up. More than likely the doctor will say, ‘Wow, I’ll never do that again.’ ”

Mineo can attest to how difficult it is to stay sober.

“You do it one day at a time, and it’s really rough,” he said. “It was exceedingly important to me to know this had happened to other doctors and they were able to recover. It’s not a hopeless disease.”

Nor is it in the closet anymore.

During the past 10 years there has been a tremendous upsurge of interest in the problem, resulting in numerous symposiums and discussions within the medical community. The upshot has been the birth of programs such as the BMQA’s and increasing focus on local peer review committees.

Today, every licensed physician in the state receives a booklet called Physician Responsibility, which the BMQA put together two years ago with the California Medical Assn. It explains what the disease of addiction is and emphasizes it as an illness, not a character fault, and gives doctors guidelines to confront the problem. A videotape on the same subject is circulated to all hospitals, and periodically the board sponsors hospital workshops to make staffs more aware of the signs of addiction.

“Back in the 1930s when I first started my practice, this kind of thing was very hush-hush,” said John Pois, 82, medical director of the San Diego Senior Citizens’ Community Medical Clinic. “The big difference back then was that we had no approach to it, no way to tell our colleagues, ‘Hey, you’d better stop doing this.’ Now we have that and the practice of medicine is much the better because of it.”