Alcohol has been a drug for millennia… for a reason. Alcohol works as an anxiolytic and induces euphoria, mostly likely through endorphin release. Unfortunately for some physicians, the combination of a stressful job with a drug that is so effective can lead to problems. A recent study showed that up to 15% of surgeons may have a problem with alcohol abuse or dependence. This is similar to previous reports that somewhere around 8-12% of physicians experience alcohol dependency at some point during their career. Tragically, often as a result of suicide, the mortality rate of alcohol dependency in physicians is as high as 17%.
The following is written by a colleague who is now in practice and has been for several years. It is a heartfelt account of discovery, action and recovery… one that I thought was well worth sharing.
During the third year of my general surgery residency I navigated to a website and read the following:
Answer YES or NO to the following questions.
1 – Have you ever decided to stop drinking for a week or so, but only lasted for a couple of days?
2 – Do you wish people would mind their own business about your drinking– stop telling you what to do?
3 – Have you ever switched from one kind of drink to another in the hope that this would keep you from getting drunk?
4 – Have you had to have an eye-opener upon awakening during the past year?
5 – Do you envy people who can drink without getting into trouble?
6 – Have you had problems connected with drinking during the past year?
7 – Has your drinking caused trouble at home?
8 – Do you ever try to get “extra” drinks at a party because you do not get enough?
9 – Do you tell yourself you can stop drinking any time you want to, even though you keep getting drunk when you don’t mean to?
10 – Have you missed days of work or school because of drinking?
11 – Do you have “blackouts”?
12 – Have you ever felt that your life would be better if you did not drink?
The website was Alcoholics Anonymous, www.aa.org. The website defines a score of four or higher as representative of someone who likely has a problem with alcohol. I answered “yes” to all twelve.
Although upsetting at the time, this information did little to create lasting change in my life. I was still in a profoundly stressful work environment, buried deep in a culture where using alcohol to displace anxiety, anger, frustration, and chronic fatigue, was commonplace.
Why alcohol? I never drank in high school. I never drank in college. I never drank in medical school. I was 28 year of age when I took my first drink, three months into my intern year. I had avoided alcohol for many years because of a family history marred with alcoholism. Why now? The backdrop is a spiritual valley that I had slowly descended into over several years. My former childlike faith seemed like that alone, childlike. There were too many unanswered questions, too many competing world-views. I disengaged from the conversation. I was able to limp through medical school in this state but residency would soon take me to rock bottom. This was a painful world of crushing fatigue, heart-wrenching grief, and endless performance pressure. The anxiety was unbearable. I became infatuated with alcohol because it worked. I felt less anxious. I was able to relax. I was able to commiserate with fellow residents, laugh, complain, and forget…..at least, temporarily. I justified my behavior by telling myself it was a short-term coping mechanism. I only needed to drink to survive residency, it would be a fleeting crutch. Then I started giving a more honest account of my habits: when I was excited and wanted to celebrate – I drank, when I was angry and frustrated – I drank, when I was dejected and depressed – I drank, and when I was bored – I drank. There was no occasion where alcohol wasn’t indicated. It became more than a crutch. Just walking through the basics of life were reason enough to have a drink, not to treat anxiety, but to prevent it.
Admitting you have a problem is always the first step but still miles away from sobriety. I was on vacation abroad when I saw a figurative fork in the road. I knew that if I continued to drink I would either lose my job, permanently damage relationships, or risk my life. I had already managed to avoid paying full price for my behavior to that point and it was clear to me there would be no more opportunities to move on without deep wounds. How could I risk all that I had worked so hard to achieve and all the wonderful GIFTS in my life? The gifts of family, health, and a fortuitous background that enabled success. I went back to the basics. My family, my faith – the very things that had served me so well, for so long. I found peace. I found self-confidence. I realized that showing emotion over the loss of a stranger’s son in the trauma bay was a caring thing to do, not something to fight and hold back. I realized that late-night drinking only made my fatigue worse, adding to my stress level. I realized that a poor speaking performance in front of an attending would soon be forgiven and forgotten, and made up for another time. When anxiety would overwhelm me, I would pray. And that worked too, with the benefit of no hangover.
If you or someone you know is struggling with substance abuse, don’t wait for a tragedy to act.
- Find someone you trust and confide in them. Talk to someone in your house of worship, or sit down with your favorite uncle, your high school chemistry teacher. Go to a meeting of Alcoholics Anonymous, or tap into numerous other resources.
- This is a problem that medical schools and residency programs are familiar with. If you are a medical student, talk to your Dean of Student Affairs. If you are a resident, talk to your Program Director. If you are too worried to do that, at least find someone who is familiar with addiction in your community and talk to them.
- It’s normal that you might be worried about asking for help, but realize that asking for help will not lead to problems with your medical license … but being arrested for a DUI will.
- If you’d like to reach me, you can contact me through Dr. Brandt by clicking on the “Contact” button on the bar at the top of this page. Needless to say, it will be completely confidential.