May 1997
Volume 61 |
Number 5
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| Is My Spouse a
Drug Addict? |
William P. Arnold III, M.D., Chair
Task Force on Chemical Dependence
Committee on Occupational Health of Operating Room Personnel
"Is it normal for my husband to be leaving syringes
containing blood-stained liquid around the house?"
"Why didn't I spot the problem until it was too late?"
"What should I have been looking for?"
"Is it my fault that he has lost his license to practice
medicine?"
"Why did he die?"
These and other perplexing questions from concerned spouses,
other family members and colleagues of those afflicted with chemical
dependence have been sent my way during my six-year tenure from
1990 to 1996 as Chair of the Committee on Occupational Health
of Operating Room Personnel. The calls continue to come in, now
directed to the committee's Task Force on Chemical Dependence.
They are not intellectual questions requiring a scholarly dissertation,
but rather they are pleas for practical answers that in many cases
have come too late. The aim of this article is to respond, in
a basic way, to some of these questions.
Chemical dependence is a chronic, incurable disease, but it is
treatable. It may be defined as the overwhelming compulsion to
use drugs in spite of adverse consequences. Try as they will to
quit on their own, the physician-addict will continue to steal
controlled drugs and use them until the abuser is either identified
and helped, or dies, whichever comes first. Following successful
treatment, recovering addicts may have lifelong remission; for
some, relapses do occur. Return to the practice of medicine is
the norm, although each case must be handled individually.
Our natural tendency is to deny the likelihood that we would
ever have to face anything as horrible as drug addiction in a
loved one or a trusted associate. Indeed, denial is a major
key in our response to that possibility.
"There is no way that drug use or abuse is keeping my
husband at work for nearly all of his waking hours. He has explained
to me that the era of managed care is upon us and that he is forced
by the current state of affairs to work longer hours. ... Certainly
that accounts for his increasing fatigue and aloofness, lack of
interest in me, our family and his hobbies ... doesn't it?"
These are examples of some of the subtle signs and symptoms of
drug addiction as they creep into the home. Understanding them
is analogous to learning how to operate a fire extinguisher. It
is highly unlikely that you will ever need to call on either the
information that follows or the skills to put out a fire; but
should the need arise, the response must be immediate.
Until recently, the public perception was that the disease is
more common among anesthesiologists than practitioners in any
other medical specialty. Patrick Hughes, a research psychiatrist
at the University of South Florida, has observed that this is
not the case. He feels that the proactive stance taken by ASA
is largely responsible for his findings.
A variety of factors contribute to the development of chemical
dependence in physicians, many more than can be covered in this
article. These include:
- gender - the disease is much more commonly seen in
men;
- intelligence - there is a strong correlation between
outstanding academic performance and the disease;
- age - with the exception of alcohol, addiction to drugs
usually becomes apparent before the age of 40;
- denial - "I can use drugs safely without becoming
addicted";
- a family history of chemical abuse;
- availability - one can become addicted only to those
drugs he or she can obtain; and
- other factors, including stress and fatigue.
Perhaps the most important of these factors, when it comes to
understanding the disease of addiction in anesthesiologists, is
availability. The practice of anesthesiology is unique
among medical specialties in that the practitioner administers
drugs directly to patients rather than ordering others
to perform this task. This in itself makes the drugs immediately
available; they do not have to be stolen from sources not normally
approached by physicians, an action that might raise suspicion.
Perhaps even more important is the potency of the drugs
administered by anesthesiologists. The more potent a drug, the
faster the onset of addiction when a person chooses to self-administer
the drug.
During the course of routine anesthetic management, the anesthesiologist
has available the most powerful of mood-altering drugs known to
mankind. These include intravenous drugs like fentanyl, sufentanil,
remifentanil, alfentanil, not to omit some of the less powerful
such as morphine and meperidine. These names may appear to be
nonsense syllables to those not involved in their administration.
Nonetheless, they become as important to a spouse who comes upon
vials of drugs that appear in the home as does the operation of
a fire extinguisher in the parallel situation.
While addiction to some substances like alcohol, for example,
may not become apparent for decades, addiction to sufentanil will
become obvious within weeks of first use. (It should be noted
that patients receiving anesthesia will not become addicted to
sufentanil or other potent drugs since they are receiving these
drugs in the course of their care.) Although some anesthesiologists
have become addicted to inhaled anesthetics, abuse of these drugs
is rare in comparison to drugs given by vein.
Chemical dependence in physicians is a disease of loneliness,
despair, increasing guilt and fear. It is not a "social"
addiction that is the norm with marijuana, cocaine and other drugs
abused by those in other walks of life. Commonly, the addicted
physician feels trapped, with nowhere to turn and no way to seek
help without losing face, medical license and career. In spite
of progressive difficulty at home, they continue in what may be
viewed as a downward spiral.
Caring guidance is available from experts. Those around the addicted
physician should not attempt to be the sole source of assistance.
Every state medical society in the United States has a program
in place to provide help in these situations. The goals of these
programs are to identify the physicians in need of care, to refer
them to qualified treatment facilities, to monitor them following
completion of formal treatment and to serve as their advocate
during the difficult process of returning to work. Not all recovering
physicians are able to return to their specialty of choice, but
many do so successfully with the assistance of their state's program.
ASA serves as an additional source of confidential assistance.
The telephone number of its Substance
Abuse Hotline appears at the bottom of the inside front cover
of each issue of the NEWSLETTER. In many cases, the callers
are referred to their state's program.
It is the hope that the information provided in this brief outline
may be of help in time of crisis.
For a more in-depth review, you are urged to attend the panel
discussion on chemical dependence and other family issues that
will be presented during the 1997 ASA Annual Meeting in San Diego,
California.
William P. Arnold III, M.D., is Associate
Professor of Anesthesiology at the University of Virginia Health
Sciences Center, Charlottesville, Virginia.
E-mail the author.
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