The telltale signs of possible substance abuse
From the February 2000 ACP–ASIM Observer, copyright © 2000 by the American College of Physicians–American Society of Internal Medicine.
Residents need to be able to recognize the symptoms of drug abuse in their colleagues, said Dema Daley, executive director for the Association of Program Directors in Internal Medicine in Washington. Residency is a team effort, and residents who intervene on behalf of their colleagues are helping their colleagues, the institution and most importantly, patients.
Experts say residents should look for the following warning signs in their colleagues:
•Significant behavioral changes. "This is the differential diagnosis," said Michael Weisz, FACP, who also is an associate professor of medicine at University of Oklahoma. A formerly sociable colleague may begin to avoid after-work get-togethers and casual conversation. Residents with substance-abuse problems may also show mood swings, anxiety, depression and eventually suicidal tendencies. Physical appearance may deteriorate, and residents may disappear into private areas such as an office or restroom. You also may find these residents at the hospital when they are not on duty, or seeing patients late at night to avoid colleagues. Other telltale signs are long sleeves on a hot summer day (to cover needle marks), uneven gait or the smell of alcohol on the breath.
•Trouble at home. A colleague's frequent disappearances, schedule discrepancies and arguments may be leading to conflict on the home front. Marriages begin to fail.
•Legal problems. You may learn that the resident has been arrested for drunk driving, has been disciplined by the medical board for prescription-writing violations or has serious financial problems.
•Work suffers. Residents are often the last to notice changes in a colleague. Nursing and administrative staff have probably already complained of behavioral and work problems. Patient complaints may have followed. You may have been putting in extra hours to cover tardiness and absenteeism. Your colleague also may be less reliable and less likely to be decisive. Handwriting may become indecipherable, and charting may be incomplete or filled with errors. The resident also may insist on being the one to administer parenteral narcotics to patients or may be prescribing inappropriately large narcotic doses (and pocketing the therapeutic excess.) Your colleague may ask you for prescriptions or may write personal or family scripts
See also, "For Residents Facing up to an occupational hazard: substance abuse."
Physician recovery
programs
- Rush Behavioral Health, Downers Grove, Ill. 630-969-7300
- Springbrook Northwest, Newburg, Ore. 800-333-3712
- Talbott Recovery Campus, Atlanta, Georgia. 800-445-4232
- Williamsburg Place and the William J. Farley Center, Williamsburg, Va. 800-582-6066
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