doctorrehab

What Happens When Your Doctor Is the Addict?

A perfect stew of factors makes it harder for them to admit they have a problem, which is why there are rehabs designed specifically for them

On a frigid February morning in 2005, Dr. Peter Grinspoon was scurrying back from a lecture on cholesterol management when the sight of a Massachusetts State Police officer and a DEA agent in his office abruptly stopped him in his tracks. “Someone stole my prescription pad,” he reflexively blurted out to them, attempting to create some understandable context for their presence. (Coincidentally, someone had recently copied it and was writing bad prescriptions.) “We know they’re bogus because the person uses perfect grade-school cursive, and I have the worst handwriting.”    

“Cut the crap Doc, we know you’ve been writing bad scripts,” interrupted Bruno, the thin sarcastic DEA agent, karate chopping the air with his hand. Rufus, the portly police officer, explained that Grinspoon was about to be charged with three felony counts of fraudulently obtaining a controlled substance.

It was all true. Grinspoon, now 52, tells me he was helplessly addicted to opiates at the time. The love affair began in medical school when a classmate’s father, a family physician, sent her a bag of sample medications after learning she was sick. The pair of bored medical students were looking up the different pills in their textbooks to see what each did when they came upon one listed as Vicodin. The corresponding page in the textbook read, “Caution, causes euphoria and a false sense of well-being.” Agreeing they had to try this one, they scissored through the thick childproof aluminum packaging and popped a few in their mouths. “It was off the charts euphoria,” Grinspoon recalls wistfully.

The common estimate for drug or alcohol addiction among physicians is between 10 to 15 percent, a distinct increase from the 8 to 10 percent rate in the general population. But Grinspoon says it’s likely much higher since many docs suffer in silence and only ask for help when the wheels fall off and their license is revoked after being wasted in the operating room.

Like many other doctors (and addicts), Grinspoon dedicated an increasing percentage of the next decade to recreating his initial experience with Vicodin (or “chasing the dragon,” as we addicts call it). And so, by the time he was in private practice, he was doing everything he could to obtain opiates — stealing them from relatives, lifting them during patient home visits, even snagging a handful from medicine cabinets while attending open houses with his wife.

When he couldn’t find anymore to steal, fortuitously his kids’ nanny, who was visiting from New Zealand, came down with appendicitis, and he wrote her a prescription for pain medication. When she returned home, Grinspoon kept writing prescriptions for her and picked them up himself, figuring nobody would notice. (While this would immediately raise red flags today, in 2004, opiates weren’t nearly as scrutinized, and it was common for physicians to write prescriptions for family members.) Besides, he got good at rationalizing, figuring, Other doctors go home and drink alcohol, what’s the difference if I snort a couple oxycodone to unwind?

But it didn’t take an astute pharmacist at CVS long to notice something was amiss. When the pharmacist called the number on file and asked for the birthdate of the person with the prescription, Grinspoon couldn’t say. When the pharmacist then asked if Grinspoon was a 19-year-old woman from New Zealand, the jig was decidedly up. Within two weeks, Bruno and Rufus were sitting in his office.

While Dr. Adam Hill’s bottom didn’t include an unannounced visit from law enforcement, it was equally nerve-racking. On an autumn day in 2012, Hill told his wife he was headed to the university lab where he was training. Instead, he drove to a state park 45 minutes from home, walked deep into the woods and settled under a canopy of ash trees with plans to drink himself to death. Feeling overworked, neglected and under-appreciated, for months Hill had relied on a handful of drinks to fall asleep, and the handfuls were increasing. He’d struggled with depression for years, but after moving to North Carolina to begin the next stage of training in pediatric oncology, the depression worsened.

“I was getting bogged down in the pitfalls of modern medicine,” he tells me, explaining how processing never-ending electronic medical records and prior authorizations was exasperating. (Hill, like the three other doctors I spoke to, mentioned the modern U.S. health-care system as a major contributor to their addictions, specifically the autonomy that’s been taken away from them in caring for patients with regard to prior authorizations required for testing, imaging and medication.)

In Hill’s estimation, he’d righteously sacrificed his 20s and 30s to become a healer, and now he was sitting behind a computer screen eight hours a day, mindlessly clicking through insurance forms. “My solution was to silence the internal demons in my head with a cocktail — which became two, three, four, and escalated over several months.” Until, of course, he found himself underneath that canopy of ash trees. It was really only a call to his wife Lauren that saved him. At first, he refused to speak to her, and they sat on the phone in silence until eventually he explained where she could find him. The next day he entered counseling.

For Grinspoon that counseling began with an initial evaluation at the Talbott Recovery Center in Atlanta, founded in the early 1980s by Doug Talbott (the late father of my collegiate squash coach, incidentally), who along with administrator Ben Underwood sought to create the first treatment program in the world specifically designed to meet the unique requirements of doctors suffering from addiction. Talbott and Underwood believed physicians were battling a perfect storm of addiction; basically, they had unfettered access to drugs and unattainable expectations from patients. And since people are used to doctors being right when they explain things — both in the workplace and at home — their alibis tend to stick.

Physicians don’t fit well in the regular milieu of recovering addicts, Underwood tells me, because the latter tends to blindly defer to the former’s professional opinion, thereby eliminating a requisite component of recovery: confrontation. “If you put a doctor in treatment with a population of generic people, they start acting like a doctor,” he explains. “Everyone turns to them and asks questions because they’re a physician. So instead of receiving treatment for their addiction, they wind up in the same destructive headspace that led to it in the first place.”

To foster this professional peer-based recovery model, Talbott holds what they call “Caduceus Club” meetings, where new male doctors (and females on a separate campus) introduce themselves to the existing population of physicians and alumni who return to regulate the meetings as role models. Small-town dentists — who are often addicted to whippets because they’re short-acting, easily accessible and undetectable on drug tests — respond particularly well to the camaraderie found in the Caduceus Club, Underwood says. “It’s a very depressing profession. To begin with, nobody wants to be at the dentist, so we often see issues related to self-image.” Other topics commonly covered at Caduceus Club meetings include the problematic access to narcotics, the grind of being on call seven days a week, and as Hill noted above, the disdain of wrestling with insurance companies instead of caring for patients.

The role models effectively serve to break down what Talbott considered to be the greatest limiting factor for physicians in recovery — their “God complex.” “I remember a chairman of a Department of Orthopedic Surgery at a major university in the Midwest,” Underwood says. Everyone knew he was addicted, but they figured the famous surgeon could do no wrong and looked the other way, which Talbott referred to as “the Conspiracy of Silence.” After a few weeks surrounded by other addicted doctors, though, the esteemed orthopedic surgeon began getting called out by his peers. In particular, one of them, the chairman of neurology at an Ivy League medical school, looked him in the eye and explained that he was “full of crap.” “Physicians are told yes all day long,” Underwood notes. “But when another physician who’s regained his or her medical license after accruing three years of clean time says, ‘You’re lying about your behavior,’ they listen. They may not like it, but they listen.”

Grinspoon calls physician support meetings like the Caduceus Club the most meaningful component of his recovery — not only for the experience, strength and hope he benefited from, but also for the professional education he received. For example, should he confess everything to a state medical board in the hopes of regaining his license? What should he keep quiet? Are there strategies to combating patient stigma? “That stigma is so deep,” he says with a sigh. “Doctors are thought of as people without problems, be they physical or emotional. Few consider that we may need care, too. Doctors are expected to be robots that perform perfectly, which makes it difficult to get any kind of sympathy.”

While Talbott is the oldest recovery program in the U.S. specializing in addicted physicians, it’s not the only one. The Farley Center in Williamsburg, Virginia; Bradford Health Services in Birmingham, Alabama; and Caron Treatment Centers in Pennsylvania all detox doctors, too. Dr. Joseph Garbely, the 55-year-old medical director at Caron, tells me their Healthcare Professionals Treatment Program receives physicians from across the country who live and recover together in a dedicated building on the Caron campus. Echoing Underwood, Garbely says such an environment is critical to helping those in denial move to a place of surrender where they can accept their powerlessness.

“Amongst their peers, they’re right-sized,” he says, referencing the trust that comes from being around other doctors who are also working on patching back together their practice and personal life. “Physicians are expected to have agency over patients and their lives, so admitting powerlessness over a substance is difficult. We’re not saying they have to relinquish power over their patients. We’re just saying they’re not going to be able to fix this by themselves.”

Anesthesiologists have the highest rate of addiction among physicians and are overrepresented in recovery centers catering to safety-sensitive professionals (i.e., pilots, pharmacists, nuclear power plant operators, etc.), Garbely says, explaining that it’s a matter of their access to highly addictive drugs like fentanyl. What’s more, they’re expected to deliver these drugs to patients at a moment’s notice, meaning they have loaded syringes on them at almost all times. So when life’s stressors build up, it’s not uncommon for them to reach into their pocket and shoot themselves up.

Matt Reilly (a pseudonym), a 43 year-old anesthesiologist at Yale New Haven Hospital, tells me he had a classmate who was using fentanyl during their first year of residency. Since every drop of the drug is closely monitored, it didn’t take long for hospital officials to step in. “They had a car waiting in the driveway to take him to Talbott the same day,” Reilly recalls. “They said, ‘You can go now and this goes very well, or you can refuse and this gets really ugly, really fast.’ And off he went.” As did any hopes of ever becoming an anesthesiologist, since anyone found to have substance-abuse issues while in anesthesiologist training is typically banned from returning. Likewise, Talbott strongly recommends their population of anesthesiologists return to teaching or research positions rather than the O.R. After all, Underwood notes, “That’s like leaving the kid in charge of the candy store!”

Fortunately, both Grinspoon and Hill regained their medical licenses and have 11 and 7 years of recovery, respectively. In 2016, after years of keeping his substance abuse struggles to himself, Hill presented a lecture in front of his colleagues at Riley Hospital for Children in Indiana about the obstacles physicians face when seeking recovery. The following year he shared his path to recovery even more publicly, writing a first-person account in the New England Journal of Medicine. “I finally realized somebody needed to speak up about this,” he says.

Grinspoon returned to practicing medicine in Boston where he serves as a primary care physician at Massachusetts General Hospital and an instructor at Harvard Medical School. In addition, he spent two years as an associate director of the Massachusetts Physician Health Service, ironically the same body that sent him to Talbott in the first place. In 2016, he published a memoir, Free Refills: A Doctor Confronts His Addiction, documenting his journey. In it, he explains that physicians who suffer from addiction tend to do quite well with recovery, with success rates as high as 80 percent — thanks to having both the resources to expend on treatment and a heightened motivation to stay clean.

“You put half your life into being a doctor,” he says. “The only question is whether you’re gonna get help on your own terms, or whether, like me, help is gonna come crashing in on you.”