Many studies suggest physicians are not at greater risk than the general population for substance use disorders—approximately 10% to 12% will develop chemical addictions during their careers. They tend to use prescription drugs more often than the general public and are more likely to have access to drugs in the workplace or through personal prescription. A survey conducted by DuPont et al. found that the most common drugs of abuse were alcohol (50%) and opioids (35%). The other 15% included stimulants, sedatives, marijuana, and other substances. Across PHPs, 31% of physicians had problems with both drugs and alcohol, with nearly half (48%) also qualified for psychiatric disorders and/or pain problems.
Identification of Addiction in the Workplace
The addicted professional has unique features and tendencies as compared to the general population. Proper identification is essential for the treatment of addiction in the professional. The workplace is often the last place addiction is exposed, so if there are signs at work, the disease is usually progressed. There is increasing emphasis on educating professionals about the course of addiction in themselves and their colleagues. This has been driven in part by addiction being given a disease status—chemical dependency falls under the category of a disability with legal ramifications for employers—and due to the high prevalence of substance use disorders and addiction in our society. Proper identification results from adequately educating those around the addicted professional about the disease of addiction and its manifestations. Education in the work place is critical in determining whether a colleague is addicted, and should include discussions about the potential liability and legal ramifications of drug diversion and drug abuse.
Signs That Typify Addiction in the Workplace
There are a number of signs that typify addiction in the workplace, and gaining some knowledge signs of the disease can facilitate proper identification. These include:
- Chaotic personal and professional life;
- Frequent tardiness and absenteeism;
- Poorly explained accidents and injuries;
- Relationship discord: martial, family, professional;
- Deterioration in personal appearance;
- Significant weight loss or gain;
- Long sleeves and tinted glasses inappropriate for the setting;
- Overuse of cologne and breath fresheners;
- Legal problems, e.g., DUIs or arrests for possession, disorderly conduct or in the case of healthcare professionals, inappropriate prescribing of controlled substances;
- Severe mood swings unrelated to situations or exaggerated mood responses, dramatic change in personality;
- Increased isolation (often due to shame and fear);
- Withdrawal from family, friends and coworkers (e.g., always refuses social invitations);
- Frequent disappearances during work hours;
- Overt evidence of addiction at work such as the smell of alcohol on the individual’s breath during working hours;
- Cognitive impairment;
- Excessive time spent with narcotics, missing/unaccounted-for narcotics, excessive “wasting” of narcotics, medical records discrepancies involving narcotics (e.g., record shows patient received half the amount that was drawn, or twice the amount actually given based upon observation), avoidance of medication reconciliation procedures (specific for healthcare);
- Dilated or pinpoint pupils;
- Drug-seeking, e.g., asking other physicians for prescriptions for mood altering substances at a healthcare workplace;
- Increase in physical complaints;
- Financial strain;
- A negative or apathetic attitude; and
- Working extra shifts (in order to obtain substances).
These changes can be gradual or sudden, and an individual usually exhibits several signs from the above list.
The professional usually takes care to conceal the addiction from the workplace because he or she prioritizes his or her professional identity and thus, as noted above, the workplace is often the last place that addiction is noticed—by which point the condition is progressed. Moreover, the workplace is oftentimes the source for the health professional’s substances. Protecting his or her drug source becomes paramount to the addicted professional.
Simply stated, addiction can be detected by observing the professional’s work performance. Often, regularly scheduled performance evaluations will illustrate a decline in productivity and quality of work. Performance evaluations and other policies and procedures for handling discovery of addiction problems are badly needed, as addiction has become increasingly common. A lack of pre-existing policies may result in medical or legal liabilities, and also perpetuates the ongoing addiction, which can have catastrophic consequences for the addicted physician and the innocent people with whom that professional comes into contact within the workplace.
Whatever the means of identification, it is imperative to verbalize suspicions in an appropriate manner. When overt evidence of addiction in the workplace is apparent, this often represents a progressed condition. Employers or colleagues often feel the need to avoid confrontation or question their observations. This can create a “conspiracy of silence” that only allows the addiction to progress with possible adverse effects on both the addict and the workplace. If employers and colleagues could think of an intervention as a compassionate and necessary step for the addict, it would benefit everyone. An intervention is often implemented by intervention professionals under an employee assistance program (EAP) or an outside consultant trained in professional interventions. A planned intervention has the greatest success.
Points to Remember
- Identification of an addicted peer requires knowledge of signs and symptoms of addiction and the ability to compassionately and effectively implement an intervention or other assistance measures. Healthcare workplaces can arrange for continuing medical education programs to inform physicians on this subject.
- A “conspiracy of silence” is common in professions, but ineffective and reckless for the safety of the addict and others.
- There are compassionate and effective ways to intervene, such as referral for treatment and supervision under the auspices of a physician “Well-Being Committee” in a hospital, or the use of an EAP within the organization. Hospitals accredited by The Joint Commission are required to have such committees.