Episode 11 – Breaking Down Alcohol
Dr. Ashish Bhatt ❘
It’s something the majority of Americans consume, but also an addictive substance. Dr. Bhatt explains how alcohol works in the brain.
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by Dr. Ashish Bhatt | ❘
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Hayley: Hi, everyone. This is Hayley, and you’re listening to “Straight Talk with the Doc,” a podcast on addiction, mental health, and treatment. We have our content director Jeff with us, and of course our medical director Dr. Bhatt. How are you guys today?
Dr. Bhatt: We’re good, we’re good. How are you?
Jeff: I’m doing good, too. It’s a nice day. It’s a good day.
Hayley: So today I wanted to bring up a topic that isn’t talked about all that much, because I think a lot of people may just be unaware that it’s happening and that’s addiction in the medical profession. I think a lot of us see doctors, nurses and healthcare workers as this entity that is impervious to drug or alcohol abuse, but obviously healthcare workers are still people and anyone is capable of developing an addiction.
This can also be dangerous because people in healthcare have access to drugs that people in other professions don’t have access to. As well as the fact they might not seek treatment because they’re afraid of losing their livelihood. I wanted to break this down a little bit today.I saw a statistic from the National Institutes of Health saying that 10 to 12% of physicians will develop a substance use disorder during their careers. Dr. Bhatt, can you talk about reasons that this might occur?
Dr. Bhatt: Sure.I think you’ve said it earlier is that we’re no different than anybody else–doctors, nurses, any health care prof–we’re all human beings. So let’s just make it clear–the same risk factors that could apply to anybody could apply to physicians, or other healthcare practitioners, regardless of the work that they do. Let’s look at that. If somebody does have any co-occurring disorder or mental health condition, obviously those are risk factors that could increase substance abuse. If you have any medical conditions that create pain or discomfort or psychological sadness as a result those medical illnesses can be a risk factor.
Our genetics, on those conditions that do show heritability can increase the incidences of people using and becoming addicted and those commonalities–common theme risk factors like trauma and abuse that someone may have suffered, so that could crossover into anybody that is a healthcare practitioner. They can suffer from those same risk factors as anyone else. Then there’s the other component that why somebody might be an addict is they also may have had earlier accessibility or easier accessibility to narcotics and controlled substances and that could be a specific risk factor that might exist in this population.
Additionally, there’s a high-risk, high-stress job, I’m sorry, that healthcare professional does entail dealing with death often, dealing with human beings. So it is stressful, the amount of that has to be done, the amount of bureaucracy that has to be worked out, and the stress of saving lives. That’s a big one. That’s one that tends to affect people. If you think about it, all the normal risk factors that exist, plus the fact that you’re dealing with high-stress job, plus the access to these substances probably puts them at playing level or slightly higher than the general population.
Jeff: Dr. Bhatt, would you also say that it’s fair to say that because of the sensitivity of drug and alcohol abuse in the medical profession they have to hide it more, or be more careful about it, which creates more secrecy almost about use?
Dr. Bhatt: Yeah for sure. I think that doesn’t speak as much of the risk of them developing, but the risk of it being under recognized. I think that you’re talking about a population that is very educated and often held to a certain regard, coming forward with a disease that is very stigmatized is very hard for these individuals. It shows a loss of control, it shows also a loss of control, it shows that they’re not practicing what they preach, it’s very embarrassing, and it can be difficult for them to seek treatment.
And with physicians and healthcare professionals, also because of all of that structure and that support that exists and whatever capabilities they were able to put in their lives and become workers in a profession that is often difficult, you’ll see that their work life is more preferred but if you dive more into their personal lives, you’ll see that that is often a wreck. Yeah the secrecy, the lack of being able to talk about it, it being taboo not only in society for some people, but definitely in that profession, yeah it’s tough. It’s tough to come forward.
Hayley: Earlier, you mentioned the stress that healthcare workers can be under. For people that don’t really know, can you kind of talk about the stresses that they have that they might that cause them to start abusing drugs and alcohol?
Dr. Bhatt: I mean life and death. How many people can say they hold someone’s life in their hands? That means the way that they act, react, think, the outcome could be if someone continues to live or if they die. I think that’s a tremendous burden and responsibility that they place upon themselves and that comes with tremendous stress. And if somethings go wrong, the guilt and the internal frustration that they have to live with. And I do believe certain specialties that may be more prone to having substance use disorder vulnerability due to the innate nature of them and the amount of stress that goes with it; emergency medicine and psychiatry that deals with people that suffer with people with mental health and maybe those professions that have access to more higher lethal agents like anesthesiology.
Those specialties also on top of the stress also have certain access to drugs. Medicine has changed over the last ten years, and many decades, and the amount of work that doctors have to do, healthcare workers in general has increased. The amount of volume they have to see probably in the same amount of time has increased. The way that we’ve changed from our record keeping so that fitting often a more busy schedule in a different amount of time is created a discrepancy, and the healthcare workers are facing a lot of issues. On top of it, it’s a very sensitive, emotional profession, especially if you lose somebody. I don’t want to get into too many technicalities, but it’s a hard job. It’s a hard job with a huge responsibility and that stresses it itself. It can be often very isolating, too. I think people have thoughts that these doctors, nurses and healthcare practitioners, they have a lot of money, they must be going on vacations. It’s actually contrary. They may be, but that’s not the most part of it. Most often doctors are working hard, long hours, and they took a lot of energy and time and sacrifice to get to those roles in the first place.
Hayley: Is it fair to say that somebody in that position they might not be comfortable, say talking to their spouse of close friends about it because they might not understand what they might go through at work everyday.
D: Telling somebody outside about the work life, yeah, I think doctors don’t always want to talk about what’s going on in the hospital or the clinic when they go home. Similarly with nurses or other healthcare practitioners. They are just repeating physicians here, when we talk about addiction, It isn’t’ just physicians at all; it’s the full gamut of healthcare workers. Similarly, a lot of people at work don’t talk about their home lives. I want to repeat something as it repeats to many people and many professions, not just healthcare workers. Often when they develop addiction it’s not gonna be the work life that’s getting compromised first. Often if you ask or do the investigation, that the private life has been already affected. Their personal life has been affected. If you asked their loved one or their spouse, they’ll probably tell you some of the symptoms or the consequences of their substance abuse that has not spilled out into their work life which eventually will. It’s very hard for somebody who suffers with true addiction to keep it separate from home or work.
Jeff: That’s common among many professions, not just medical professions. Lawyers, marketers, basically anything. A lot of people do believe that as long as they get up in the morning, and go to work and come home safe, then they’re doing fine, regardless of how bad their personal life is spiraling.
Dr. Bhatt: You hit it on the head. We tend to, I think we talked about this in another segment. Most people suffer with addiction; their family life is often the first to go. Their work life is preserved. There’s a high level of accountability there’s a certain process; plus it’s your life line right? I mean that’s the thing that gets you paid.
You’re probably gonna be a little more cautious around your work to get intoxicated or behave in a certain way. It’s unacceptable.With the healthcare workers, though it has to be unacceptable. There’s no options. You can’t have an impaired person coming to work in such a sense of the situation where you have the lives of other people in your hands. Being addicted is one thing, but being addicted when it’s not just affecting you, but the lives of others who come to you to get care, this is a big issue and it needs to be addressed obviously.
Hayley: I wanted to break that down a little bit, kind of like what’s going on in their brains because like you said, it’s their lifeline. They’re educated people; they know that abusing drugs or alcohol can jeopardize their career, everything that they’ve worked for. How are substances affecting the brain to make them feel as though it’s worth the risk?
Dr. Bhatt: So that part of addiction, that cognitive error in thinking, the distortions, the change in that motivational hierarchy of what’s important and what’s not, the denial, the rationalization, all of those things-that’s not different; that’s shared amongst addiction regardless of what profession you work in. So that’s what’s happening–they’re constantly speaking and convincing themselves that their inner voice is saying “How do I get through?” there is shame and there’s guilt and there’s probably fear and anxiety that this is hidden, but if that means they need to keep doing it in order to stop feeling withdrawal, or you know to continue to maintain that job, or not looking vulnerable or weak, it, by seeking out for help. There’s this sad conflict of voices of one, probably saying it’s not a problem. I can take care of it; if I just do it this one time, or I need to do it for this job, I need to pay my rent, or whatever. And there’s that other one that’s totally distorted. I don’t have a problem; there’s nothing wrong. I don’t know what they’re talking about. If they were in my shoes, they would have to do the same thing.”
There’s this polar opposites, of maybe this rational side of understanding and convincing that is just gonna be time limited or circumscribed, to certain situations, versus that complete denial that anybody else would recognize as something that is totally wrong, and they’re not. I think again that’s par with the disease itself, not necessarily the profession, so it applies to physicians, healthcare workers to pilots, anybody suffering from addiction. That’s the hallmark of the disease; you have this altered way of thinking, and unfortunately it allows you to be susceptible to greater consequences. It’s ironic because it’s often those big consequences that have to happen before somebody thinks about changing.
Hayley: Absolutely. That’s actually something else I read is that addiction in physicians is usually advanced before they receive intervention. At this point, their personal life may have fallen apart now something is happening and in their professional life as well. What are the differences in treatment and treating someone with an advanced addiction and something that’s still a little bit earlier on before certain damages have been caused?
Dr. Bhatt: Hopefully with any illness, the earlier you catch something, the less repercussions may happen or may not happen. Hopefully, if you could catch something earlier, you could intervene and prevent other negative aspects or consequences from happening to the person physically or to people around them.so it’s best if some, but often due to the nature of addiction, nobody wants to get help, until it’s a big deal. Getting help for a person for addiction often is not easy, because they don’t see it as a problem, and it’s often still because they’re functioning in other aspects of their lives, so they can’t see that broader picture.
On other side, it often takes something big to happen before people end up asking for help; or maybe not even asking, getting the help that they deserve. I think with professions like these, healthcare, things that have a license and the fact that there’re intelligent people; they go to become a pilot or become a physician or a nurse because you weren’t able to put that course of study together despite whatever context you lived in, so these are smart individuals. There’s that protective side that happens because these people can navigate and compensate due to that hopeful intelligence and knowledge.
The minute you threaten to take that away from them well that might be the motivation or the coercion that needs to happen and unfortunately make them go to treatment. That’s another point I know some statistics there, they tend to do well there though; healthcare workers especially physicians- they tend to do well, once it’s identified once it’s come out once they’ve gone into treatment, they have one of the higher recovery rates amongst anybody. I think doctors and pilots tend to be some of the top in terms of maintaining sobriety.
Hayley: What should a healthcare worker do? They know they have a problem, they know that they need treatment, but there’s that fear if I come out and say this, and I have a problem with substance abuse I could lose my license, I can lose my job, they might be afraid they might not be able to go back to work. What kind of advice would you give to somebody in that situation?
Dr. Bhatt: Hopefully, there’s somebody that’s close to them who is recognizing this, is able to have a sit down conversation. The degree of intervention, or the degree of response that a person could give you varies so greatly, right? We all know this, we’ve all worked with people with addiction or know somebody with addiction, it’s not–you don’t get the same response. We tend to think if you address somebody they’re gonna deny it for whatever reason. Let’s not talk about the underlying, they might deny it. So it becomes hard to talk about the person, one who is in denial, a person in denial it’s hard to get them to seek help.
Often it might require an intervention. Having an intervention with a group of their colleagues or their friends or their family and or bosses and really show, “Listen we all are here.” Sometimes that person just needs to see all of those people around them and it’s like “Oh my God” because they’re able to hide it when not confronted, when facing only one person, but when you’ve got everybody in your immediate close personal life around you, that often can be that catalyst to go and get treatment. And those people are prepared. They’re prepared to cover the doctor’s case load and say yeah your home life will be taken care of, yes your job will be here when you come back, sober. Those are ways without being punitive.
Maybe this person could be more receptive to get help, without threatening. Then these professional health programs that are run kind of along with the states that license these healthcare practitioners, they tend to give a case management type response. They act like a buffer between a healthcare practitioner and their licensing agency. They tend to evaluate those professionals, develop a treatment plan, a monitoring plan and establish a degree of safety that has to be proven and demonstrated and if that person can complete their contract or complete their mentoring, they’re often allowed to practice again without any supervision. These professional health programs that are run in combination with the state, they’re there, so that’s another way of seeking help. So, if somebody knows that they have a problem, they should try and volunteer to reach out to these health programs.
The sad part of this is that it can be a very scary experience. These professional healthcare programs are often very bureaucratic; they can seem authoritarian, and it can be very scary when you are asked to maybe stop the practice while the assessment process is taking place.At the same time, these are things that you either can do or there could be some significant consequences that can occur if somebody’s ends up having some sort of malpractice or wrongful or something like that. We can imagine what bad things can happen.
And if we haven’t got to that degree if there’s a sound person still able to make proper judgement and is recognizing that they’ve either relapsed, then they could go themselves and seek treatment. Ask for a leave of absence and either research online or go to AddictionCenter.com, for example, and look up different treatment centers that might cater to the special population of healthcare professionals. It really depends on where the person is at but definitely going about it in a supportive way and almost preparing the road for the healthcare practitioner that it’s ok to go and seek treatment and this is what we’ll do to go and re-establish yourself that’s often a better way than becoming too unsupportive.
Hayley: Say I was somebody working at a hospital and I suspected that a higher up employee, somebody at the hospital, was abusing drugs. What would my options be, if I’m afraid of confronting them? Are they gonna deny it? Am I gonna get fired? What would somebody do in that situation?
Dr. Bhatt: It’s definitely best not to confront somebody at work like that. It might not go well. You might end up allowing that person to prepare; it’s often best to go to your own supervisor. Hospitals do have steps in place that colleagues coworkers who are suspected of maybe using and being under the influence and that way it protects that person reporting also. Hospital systems usually have ways that you could go to their human resources department and their medical staff that help them guide them and often especially go there first and maybe discuss it. Everybody is a little bit different but bring up the scenario to the person there, without disclosing the person’s name, just so that person’s comfortable just so they know what the consequences to others would be and those people should be trained to help guide you in how to report somebody you’re concerned of being impaired.
Hayley: Could you tell me about the process that somebody goes through after they’ve completed treatment and returning to their job, where they may have access, again, to the drugs they were abusing. How is that handled?
Dr. Bhatt: With healthcare providers, I can’t speak about every specific case, but in the evaluations that I have done and provided, there’s often an contract that’s out in place, a contract for a certain amount of monitoring and a certain round of stipulations in that contract of what they’re accessibility is. It doesn’t just go from “Hey we’ve identified a physician or a healthcare practitioner, a nurse, or a mental health tech of some whatever wrong doing in the hospital and when I mean wrongdoing, not being an addict being wrongdoing, but the behaviors of stealing medications or whatever.
So they will have a graded level of re-entry; they will have a certain level of maybe appear, monitor, or mentor somebody who they can go to, they often will have individual counseling, they often will have restrictions on what medications they can handle or prescribe what areas they can work in and these often are handled by the professional health program that the doctor or the practitioner will hopefully be apart of. This way if they complete this successfully, they’re usually capable of not having any public complaint listed under the Department of Health website, support of that professional health program offered by the state and somebody is watching them along the way.
I think that’s a smart way to do this; you never want somebody who’s been identified as a substance user even though they probably hate it, and they are full of pride and “Oh my God how am I gonna navigate my life going back to the hospital and doing so,” but believe it or not it’s the prudent thing to do, it’s the smart thing to do and getting treatment doesn’t automatically make you capable of going into a sensitive area. But the steps are there, and it’s often written by a contract or the course of treatment that is established at the evaluating physician or the treating physician at any program you’ve gone to, combined with the case management with whatever health program they’ve engaged with. But it’s a gradual graded re-entry into responsibility, practice, and supervision until supervision has been seen as allowable.
Hayley: Dr. Bhatt, is there anything that we didn’t talk about on this topic that you think people should know?
Dr. Bhatt: I’m glad that is a topic we’re discussing today. I think it is something that is not spoken about enough. I think right now with the pandemic, especially, there’s gotta be people working under more duress and more distress, I say gotta be like sounded so cavalier and loose, no there is, there are, there are people already just because of that pa…so right now it’s really important to look out for those who are on the front line, those who are dealing with that additional strength, stress, excuse me, and provide them that support.
It doesn’t have to be punitive, but just keep gauging, looking at that barometer, looking at how they’re behaving to see if there’s any signs or symptoms of impairment, changes in behaviors, irritability, and not necessarily any of those things could be substance related, but it could be 100% coming from stress, but at the same time, not just putting it on the back burner and not being afraid to ask somebody “Hey how are you doing? And how are things going? How are coping?” Usually, if you ask at the right place and the right time, if they’re not intoxicated or inebriated, you’ll get an honest response. Obviously, if they’re under duress, under pressure if it’s done in a way that is.
Makes them feel like their back’s against the wall, then say ok, (inaudible) irritable or denial, or almost “How could you type of thing” so there’s no exact recipe for this, but the fact that we’re talking about it and we’re recognizing health care people, they’re humans, they’re like they rest of us, they’re susceptible to the stresses and risks of living and working during the time of the pandemic especially, and with the roles that they inherently carry everyday, so yeah substance abuse issues exist there, and just being aware of them and knowing help and it often exist in the professional health programs of a state, but also private treatment centers, many of them, many of them offer professional health tracks that you could reach out to before the problem becomes huge, and that could be found on AddictionCenter.com.
Hayley: Well, thank you for talking with me Dr. Bhatt about this topic, cause like you said, it’s important especially right now, and thank you to everyone who’s listened. You can listen to more podcast episodes, and you could check out more information on this topic, and more topics and resources on AddictionCenter.com. We hope to have you next time on “Straight Talk with the Doc.”
Dr. Ashish Bhatt
Addiction Center’s Medical Content Director, Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.
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