Today I am “in recovery,” but not “recovered” from my addiction.  Yes, for years my chemical abstinence has been and will be monitored and verified by hundreds of negative urine tests as well as hair, blood, and fingernail tests administered by the Medical Board.  But real recovery involves a constant battle to overcome old compulsions, selfishness, and toxic ways of thinking.  “Relapse warning signs” or “behavioral relapses” can be harder to identify than a “hot urine” but no less threatening to my recovery.  I continue to work with counselors, psychiatrists, and therapy groups to help me see when my behaviors are drifting toward the narcissism and self-centeredness of my past.  I, like every real addict, will remain a work in progress.

It is also useful for me to tell my story.  I’ve told it multiple times at 12-step meetings.  On the surface, everyone’s tale is different.  Yet the themes of powerlessness, selfishness, and delusion resonate with every addict and alcoholic who hit a bottom low enough to earn a chair in the room.  People can see our disease as a great equalizer that respects not wealth, education, nor status.  But recounting my struggle benefits me the most.  It combats the addict’s tendency to minimize or deny the consequences of our disease.  I need to regularly walk through my history.  Yes, I stole medications from my mother.  I wrote hundreds of bogus scrips.  I endangered my colleagues’ medical licenses.  I drove a car and saw patients while impaired.  I embarrassed my family.  I went to jail.  I relapsed.  I lived under house arrest for two years.  My natural inclination is to squeamishly turn away from those unpleasant facts.

It’s Changed My Perspective 

These things also help prevent me from judging other addicts.  I certainly don’t see “criminals” in the same light anymore.  My time in jail was mercifully brief, but my 30-day cross-country tour of five lock-ups in four states exposed me to lots of inmates.  A distressing number of them were just sitting there bewildered by their circumstances.  They had never had a chance to see themselves as sick.  They had been cast aside and punished by society for the transgression of simply having a chronic, relapsing disease.  When I had told a cellmate about my charges, he responded with a hearty, disarming laugh, “Yo doc, you ate all dem pills!  I feel ya!”

But what if that man had had access to the treatment and support that I had?  How different might his life be today?  With my wealth and privilege, I have an obligation to embrace the opportunities those provide.  I have an obligation to say that the so-called “war on drugs” is a misplaced priority.  There is no question that resources applied in the enforcement of drug laws could be redirected to treatment and prevention with a much more cost-effective and humane result. 

I’m sure there are some folks who would look at the final disposition of my case (five years of supervised probation) as yet another example of a rich, white guy avoiding the jail time every other defendant would have gotten.  I don’t disagree.  But I believe this is a time where the standard approach to these cases in our criminal justice system, especially mandatory sentences, is misguided.  In other words, I don’t think I was treated too leniently—I think others are treated too harshly.  

There are many who are simply aghast at the “size” of my addiction.  The number of total pills and prescriptions were plastered over the news as if they indicated a greater level of irredeemability and culpability.  “Massive, shocking,” etc.  However, neither I nor most addiction specialists would see it that way.  No one carefully records in a central database the exact number of drinks an alcoholic has taken over several years.  Same thing with street drugs.  I had developed an effective system of accessing retail pills years before the Prescription Drug Monitoring Program came on the scene.  It is not surprising, nor meaningful, that this method became effective in tracking me for three years after my drug use had reached its peak (or, if you prefer, its’ bottom).  Addiction is simply a persistent, relapsing, and ultimately fatal disease.  It is sometimes caught early, it is more often caught later like mine was.

I Share My Story To Help Other Healthcare Professionals

I have also begun to share these events with an even broader audience.  Each year, I speak to second-year medical students.  I know that, statistically, there are those among them who suffer from this disease.  Maybe some acknowledge it, but many probably don’t.  I might say something that they will hear and remember.  Maybe a connection will be made and a seed planted.  Perhaps they will get a glimpse of what I never saw when I was using.  I wish that they can see a future without their drug of choice that can be happier and more rewarding than anything they are experiencing now. 

When I reflect on the single, most tragic feature of my addiction, it was this: a lack of any hopeful vision.  It is common for addicts to sum up their bottoms by saying, “I couldn’t live with the drugs and I couldn’t live without them.”  That is why suicide is so prevalent at that stage.  If that is where you really are, that is what you really feel, then ending your life is horribly rational.  As I sank deeper into addiction and depression, I clutched the pills as if they were a life raft that could buoy me up.  They were the only solution I knew.  If they weren’t working, it just meant that I should take more.

I wholeheartedly subscribe to the disease model of addiction.  It’s clearly not like schizophrenia or other psychoses.  We addicts are often acutely aware of our reality, the harm and damage we are doing to ourselves and others.  It is paradoxically cruel that way.  I would compare the affliction to serious obsessive-compulsive disorder.  Sufferers may know intellectually that their behavior is irrational and self-destructive, but they are tortured by anxiety, fear, and discomfort if they fail to perform their ritual, keep washing their hands, locking their doors, counting red cars, or hoarding old newspapers.  If the disease progresses untreated their lives are truly unmanageable.  I don’t think addiction is so far removed from that.  I drank and used drugs despite outrageous risks and consequences.  Stopping seemed so much worse.

I Hope To Educate The Public About Safety With Professionals In A Recovery Program

In my recovery, I have become aware of legions of health care workers who also suffer from addiction.  The core symptoms of the disorder are no different in us than in anyone else: the cravings, the obsessions, the selfishness, the lying.  I have learned that, though my consequences were dramatic, my case was typical of other doctors in most respects.  By the time a physician’s drug or alcohol use is manifest and noticeable to coworkers and patients, it has reached a very advanced stage.  We will inflict enormous destruction on our spouses, children, and ourselves before we let it affect the care we deliver.  Doing a good job at work is more than just a professional responsibility, it defines us.  And that is an obstacle to declaring ourselves and asking for help as our disease progresses.  We are healers.  It is uncomfortable and awkward to become a patient.  There is also a very harsh, independent, work-oriented culture in medicine.  No one wants to appear weak.  Taking care of other people has been our life’s work, a calling for many of us.  It is extremely hard to admit that our care of patients has been compromised. 

And, of course, there is the fear of regulatory and legal consequences.  We are like commercial pilots, air traffic controllers, or railway engineers.  The public has a legitimate interest in being physically protected from impaired health workers in a way that does not apply to bankers, lawyers, teachers, or other types of professionals.  Even enlightened, sympathetic agencies may be required to take harsh actions.  But are we like the pilot who is losing his eyesight?  Should people say, “It is a shame that this doc has this disease and I feel bad for her, but she just can’t be allowed to operate on my grandmother.”  I think the analogy is wrong.  It turns out that a physician (or a pilot, for that matter) who is known to, and enrolled in, a professional monitoring program may actually present less risk to the public.  Think about it: Would you prefer to be treated by a doctor who is required to provide frequent, random urine specimens for all drugs and alcohol? Or, someone under no supervision at all?

Addiction Carries A Misleading Stigma

Unfortunately, I’m not sure public opinion is there yet.  I saw a recent issue of Consumer Reports magazine.  On the cover was a doctor dressed in a disheveled and stained white coat, tipsily holding a martini—“What you don’t know about your doctor could hurt you.”  The gist of the story was that the disciplinary action and “probation” measures taken by state Medical Boards were life and death bits of information that every patient should have.  The assumption was that if a doctor needed to be monitored, he must be dangerous.  All sorts of misconduct were lumped together from a simple DUI to fondling patients.  The notion that physicians in substance abuse monitoring programs could practice just as safely, or even more safely, than their colleagues was never considered.

One reason addiction is stigmatized is that the drinking or drug use presents the illusion of a choice.  Even those of us with the disease are often confused about that.  It seems like it should just be a matter of will.  So we feel weak, worthless, and morally contemptible.  In treatment, they explained to us that it is actually a disease that impairs the ability to make choices.  The neural pathways of the brain have been hijacked and distorted.  Need for the substance or behavior is conflated with other basic, functional biologic needs such as food or sex.  Engaging in the addiction activates pleasure centers that, through hundreds of thousands of years of evolution, exist to help guide humans toward the necessities of life.  It is no more reasonable to expect an untreated alcoholic to leave a bottle alone in a room than it would to expect a freezing man to discard a blanket or a starving man to leave a plate of food alone.  Yes, if the immediate negative consequences are great enough, that moment might be delayed, but eventually his will yields to this physiologic reality.

There Is Effective Help

It is ironic that, though addiction is plainly a disease and a medical malady, the best-known treatment is a spiritual and psychic one.  There are no convincing studies proving that the 12 steps work.  But that is primarily because of the myriad technical and procedural confounders of any proper investigation.  People who stick with AA and do the steps were probably more motivated than those who drop out, so perhaps their prognosis was better to start with.  There is no way to properly randomize individuals to a spiritual experience.  Plus, how would you even define success?  No relapse in a year?  Five years?  Are all relapses of equal concern?  As a result, it seems unlikely that evidence for the efficacy of AA will ever be more than anecdotal, occupying the lowest station on the biostatistical food chain.  But some of these anecdotes are amazing stories of hopelessness and despair transformed by psychic change.  Millions of people credit AA with saving their lives.  That must mean something.