As he dressed for work he saw the face of his wife, holding up two prescription bottles in front of his eyes. She told him she was calling the Medical Licensure Commission in Montgomery to tell them he was addicted to drugs.
"She knew I had problems, over a few years," James Tarrence, MD [all names in this article are pseudonyms, to protect privacy] says. "But I managed to convince her I was OK until she realized I was getting worse. That's when she made the call."
Despite the events that her phone call set in motion—losing his license, entering an intensive rehabilitation program—Tarrence says he feels fortunate that things happened the way they did: "I definitely would have ended up either dead, or in deep trouble. But I was sick enough, and so afraid of the consequences—losing my job, having to move my family, being a sort of pariah--that I couldn't see any way out."
Though no exact numbers are available, a 1992 study published in the Journal of the American Medical Association estimates that about eight percent of health care professionals abuse drugs or alcohol—a figure that Medscape.com describes as conservative. Alcohol is more widely abused than prescription drugs, the study showed, and doctors and nurses are far less likely than the average population to use illicit drugs such as heroin and cocaine.
There's a good reason, says counselor Lorena Wright, that treatment facilities such as Bradford Health Services have separate rehabilitation programs for medical professionals and the general public:
"In a word, ego," she says. "I see them when they come in, and their faces are just blank. They're physically here, but they're not really 'here' yet."
It's no accident that patients such as Dr. Tarrence could never have imagined themselves being in a rehabilitation program. "As a rule, the medical professionals that we see haven't hit the kind of 'bottom' that's talked about in the Big Book," Wright says. "It can take a long time to break down that ego, that sense of denial."
The "Big Book," of course, being the handbook of Alcoholics Anonymous (AA), founded in 1935 in Akron, Ohio, and today claiming more than two million members in some 100,000 groups worldwide. The organization was co-founded by Bill Wilson, a businessman, and Dr. Bob Robinson, a physician and surgeon.
It has also spawned numerous subsequent fellowships such as Narcotics Anonymous, Overeaters Anonymous, and others, as well as auxiliary groups such as Al-Anon and Nar-Anon for friends and family members of people with addictions--groups organized on the belief that "addiction is a disease that is enabled by family systems."
The AA program is often criticized for making "God, as we understand him," or "a Power greater than ourselves" the basis of its 12 steps, or principles. Some critics go so far as to call AA a religious cult. And its origins were less than all-inclusive. It would be a year before the initial group admitted its first female member, and another three years before admitting its first Catholic. In 2011, Alcoholics Anonymous is billed as "having a membership spread across diverse cultures holding different beliefs and values."
Most services such as Bradford require its patients to attend a 12-step program during recovery, as opposed to alternatives such as the Rational Recovery movement. But counselor Wright says that's only because of AA's proven success rate.
She uses a metaphor to describe the preference: "Let's say you're on the fifth floor of a building and you want to get to the ground. There's a chance you can jump out the window and still walk away, but the odds say you're better off taking the stairs. Which are the 12 steps of AA."
Another medical professional who found herself on the figurative "fifth floor" is Linda Davin, RN, a nurse who overcame an alcohol addiction, but replaced it with IV opioids, also known as strong prescription painkillers in liquid form. She, and all the nurses who worked on her floor of the hospital, were called in for a surprise drug test after an empty syringe was found in a restroom.
"I didn't have the guts to admit the syringe was mine," she says now. Like Tarrence, she couldn't picture herself in treatment: "I knew I'd be fired, that my family and co-workers would know. I'd rather have died than look bad, so I attempted suicide. Twice. Those ER and ICU bills are still coming due."
What Tarrence, Davin, and other professionals in treatment faced was at least 90 days of an inpatient rehabilitation program, which included both counseling and medical interventions to help with their sometimes severe withdrawal symptoms from drugs.
For Tarrence, that withdrawal involved "Aches, cramps, diarrhea, nausea, and a feeling of extreme anxiety that's hard to explain." As Davin describes it, "You're yanked out of your comfy society, and are left to feel all the feelings your addiction has kept you from."
"The best case scenario would be six months in a halfway program afterward," says Wright, "but that's not always possible." Tarrence's and Davin's mutual fears about being stigmatized were not imaginary. "For better or worse, people in medicine are held to a higher standard," Tarrence says. "Fortunately, Alabama has effective programs to help us recover. Not all states do."
There's also a double standard for doctors and nurses, according to Tarrence: "I don't know of any institution that randomly tests physicians, but nurses are held more accountable. Technically it's because nurses are employees and doctors are independent contractors, but it's still a double standard. If physicians were randomly tested, people would really get their backs up, but I have no doubt that a lot more doctors would be in treatment."
In that regard, the Alabama Board of Nursing has created the Voluntary Disciplinary Alternative Program, or VDAP, for members who realize on their own that they need help. There are significant differences in such sanctions as ongoing drug-monitoring requirements, and counselor Wright says that, from a rehabilitation perspective, voluntary participation could mean "more of a willingness for change."
Physicians in recovery are typically monitored for two years. Some, such as Tarrence, have malpractice insurers whose own requirements are more stringent. To maintain his insurance, he'll have to be tested on some basis throughout his career.
Wright, the counselor, learned the 12-step program the hard way: from the inside out. This past December, she attended a ceremony in which she received her 24-year "chip" from AA, representing 24 continuous years of sobriety. "I still attend three meetings a week," she says.
Davin and Tarrence are success stories: both have completed treatment and returned to their professions. And both describe their emotional "turning point" during rehab in similar terms:
"I was amazed to be surrounded by such supportive people," Tarrence says. "Some people don't understand and they shun you, but that's life. The downside is nowhere close to what I imagined." For Davin, it was the realization that "being honest was the hardest part. I didn't spontaneously combust, and people still liked me. The energy I'd wasted on all my defenses was freed to be channeled into recovery."
Seeing such transformations is one reward of an often-challenging job, says Wright:
"The most satisfying part of what I do is watching the growth of our clients. To see them studying the program, getting sponsors, getting well. When they first come, they look blank, angry, scared. Then one day you see a light come on in their faces, and they look completely different.
"I strongly believe that medical professionals in recovery are better at what they do. They're more empathetic toward their patients. More human, more real."