Issues in the recovery of physicians from addictive illnesses.

The issues discussed in this article introduce and examine topics related to physicians' health which are salient in their clinical usefulness or their heuristic value in planning future research. Physicians in general possess physical, emotional and intellectual strengths that are needed to face high stress and low social support. Physicians are also less likely to seek routine medical care. With many illnesses physicians are inherently resistant but have higher risk factors. It is postulated that the opposing tendencies cancel each other. Physicians have better intrinsic physical and mental health but live under higher stress and get less routine preventive care. Physicians also may have a tendency to live healthy lives without addiction but have high risk factors for addiction. Adults who have grown up in families with addiction have a tendency to choose health care professions. Genetic composition may predispose to alcoholism and other chemical addictions. Taking into consideration inherent health and risk it is thought that physicians have a similar prevalence of alcoholism and drug dependence as compared to the general population. Physicians have higher access to pharmaceutical drugs but are less inclined to use street drugs. In the New York State Physicians' Health Program, 88% of the participants used alcohol or prescription drugs and only 12 percent used marihuana or Cocaine. Additional risk factors for Substance Use Disorders in Physicians have been postulated to be pharmaco-logical optimism, intellectual strength, strong will, love of challenges, instrumental use of medications and a daily need for denial. These factors require rigorous investigation to establish their role. Clinical approaches and techniques discussed include the incubation period for a Substance Use Disorder, initial high tolerance, state dependent learning, and the signal properties of drugs. As recovery progresses it is postulated that it becomes increasingly important to deal with substitute addictions and family of origin issues.