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Health care workers are healers.
They put a cast on your broken arm. Nurse you back to health from an infection. Perform life-saving surgeries.
But even those who heal us can need help, including with addiction. It’s estimated that 10 to 15 percent of health care workers will misuse substances at some point in their lives, according to various studies.
“Unfortunately, [addiction] does affect everyone, including health care professionals. We hear all the time, ‘Shouldn’t they know better?’ … and that’s just not true,” said Dr. Michael McCormick, medical director of the health care professionals program at the Pennsylvania-based Caron Treatment Center.
The likelihood of a health care provider developing a substance-use disorder is no higher than for the general population, according to treatment providers interviewed by The Sentinel.
But for health care workers, drug or alcohol misuse comes with a unique set of challenges, including more access to prescription drugs, and the risk a medical professional can pose to patients if intoxicated on the job.
Along with the personal impact, addiction can also lead to drug diversion in the workplace.
Locally, a federal investigation is ongoing after gallons of fentanyl solution were stolen or unaccounted for at Cheshire Medical Center in Keene.
An ICU nurse admitted to stealing hundreds of bags of the solution since last fall. Prior to her death in March, she wrote a letter to the state licensing office describing the stress of the COVID-19 pandemic in prompting her to start taking the drugs for personal use.
To help health care workers battling addiction, specialized recovery programs have launched locally and beyond, with a slightly different focus, and they appear to have higher success rates than other rehabs.
“The evidence is there that these programs work,” said Dr. Molly Rossignol, medical director of the N.H. Professionals Health Program, a monitoring and treatment referral nonprofit for health care professionals with a substance-use disorder. “It’s accountability, it takes a lot of work, it’s a huge commitment, but it certainly works.”
Sparse data
There are limited data on how common addiction is among health care workers.
The federal Substance Abuse and Mental Health Services Administration’s most recent, substantive study of substance-use disorders by occupation was done in 2015. The agency no longer tracks this information, according to spokesman Christopher Garrett.
The data were part of the federal agency’s National Survey on Drug Use and Health, questions for which the administration changes over time, Garrett said.
“The industry and occupation questions were removed … for a variety of reasons including feedback that the standard categories created in the past did not accurately represent new industries or occupations,” he said in an email.
The report — which looks at survey data for full-time workers in various professions from 2008 to 2012 — showed that 4.4 percent of health care or social assistance workers said they’d used alcohol heavily in the past month.
Additionally, 5.5 percent said they’d used illicit drugs in the previous 30 days, while 5.7 percent said they’d had a substance-use disorder in the past year.
Alcohol, as in other occupations, is the most commonly misused substance for medical professionals, treatment providers interviewed by The Sentinel said, though exact figures are difficult to determine.
Opioids and prescription drugs, which are readily accessible for many health care workers, are a close second.
Specialized treatment
Recovery programs tailored to health care workers are beneficial, treatment providers said. Medical professionals’ distinct risk factors — like higher work stress levels than most professions, sleep deprivation and access to prescription drugs — make them more susceptible to relapse.
State licensing boards also require more intensive treatment for health care workers who struggle with addiction because of the potential risk their substance misuse presents to patients. Specialized treatment offers more rigorous interventions than traditional rehabs to help ensure medical providers can safely return to work.
A five-year evaluation of physician treatment programs in the nation from 1995 to 2001 by the Treatment Research Institute, published in the British Medical Journal, found that nearly 80 percent of those who completed one of these programs were still licensed and practicing after five years.
A separate study by the same researchers in 2009 found that 22 percent of health care professionals tested positive for substance use at any time during the five years after finishing treatment.
Comparatively, about 40 to 60 percent of people in general rehabilitation programs will relapse, according to the National Institute on Drug Abuse.
“That number is kind of mind blowing,” McCormick, the Pennsylvania-based doctor, said of the comparison.
Caron‘s inpatient program in Pennsylvania started about six years ago, with a capacity for 21 patients. People have come from across the country to enroll, McCormick noted, including from New Hampshire.
The core of the treatment is the same as in traditional rehab, with about six weeks of detox and therapies, followed by a 12-step program.
But McCormick said that by being with peers, health care workers in the program can be more vulnerable in group settings, which can help them recover.
He added that the COVID-19 pandemic has only exacerbated that need for peer support.
Most dentists and oral surgeons, for example, had to temporarily shut down their practices, which McCormick said led to more misusing substances to cope.
He recalled leading a group session a few months ago, when COVID-19 quickly became the topic of discussion.
“I’ve got 20 people in the room, and 18 of them are crying and bawling about how COVID affected them …,” he said. “It’s affected everyone, but it was very eye opening to sit in that group and see that.”
The Brattleboro Retreat started a similar program at the beginning of the year. It’s broken up between a partial hospitalization and intensive outpatient program, according to Director James Benton, a licensed psychologist.
Before launching the specialized program, the Retreat was already seeing a steady number of health care workers for substance-misuse issues, he said.
The Retreat already offered specialized treatment for first responders and other public safety professionals, with a partial-hospitalization and intensive outpatient program it launched in 2009.
The psychiatric and substance-use treatment provider saw more people in that field comfortable seeking out help through this avenue than with traditional programming.
“I think the same is true for health care professionals,” Benton said. “They may not want to share their experiences in a general setting.”
Health care workers in the partial hospitalization program — one step below residential treatment — participate in five group therapy sessions per day from Monday through Friday. The intensive outpatient option is slightly less of a commitment, with three groups per weekday.
Both treatment programs, which serve up to 10 people at a time, also require one additional meeting per week with an individual therapist and psychiatrist.
Like Caron’s programming, Benton said the Retreat’s is geared toward the specific challenges health care workers face, like dealing with compassion fatigue.
“You go into this profession wanting to take care of people, and especially with COVID, a lot of people are getting burnt out of caring for people …,” Benton explained.
In Minnesota, the Hazelden Betty Ford Foundation‘s health care professionals program focuses on inpatient care, according to Chief Medical Officer Dr. Alta DeRoo.
The program has about five to 10 people enrolled at once, staying for 15 to 60 days. After that, DeRoo said it is recommended that health care workers complete an outpatient program.
She explained that the inpatient program is encouraged at first because it’s best to take health care workers out of their environment and nix any temptations to return to work too soon.
“The very strengths that professionals have like problem-solving, caretaking, professionalism, are also the stumbling blocks to recovery …,” DeRoo said. “They’ll use a lot of intellectualization along the way, where they try to explain their addiction away.”
And while the rate of addiction is not higher for health care workers, DeRoo said they often push off treatment for longer.
“Health care professionals come when their disease has progressed to a later state, … whereas people who may not have such demanding careers may [not] have ignored … their disease,” she said.
State-level assistance
To help health care professionals find the right treatment program, most states have hubs set up to assist with referrals and monitor their recovery, as part of the Federation of State Physician Health Programs.
The national organization started in 1991, its website says, evolving from initiatives taken on previously by various medical associations and boards.
The state-level programs — which often are independent of state leadership, including licensing boards — provide confidential assessment, treatment referrals, resources and monitoring. In addition to substance-use disorders, the programs can help with mental-health issues and other health conditions.
New Hampshire’s Professionals Health Program became a nonprofit in 2008, but has been operating since the early 2000s, according to Rossignol, its medical director.
She said 35 percent of referrals between April and June were because of concerns of substance misuse.
Sometimes the health care workers themselves call, Rossignol noted, while other times it’s an employer asking for advice. Either way, the call remains private.
She added that the stigma surrounding substance-use disorders is even greater for these professionals, which makes it harder to seek help. The hope is that the anonymity removes at least one barrier.
“One of the reassurances we give folks who call us is we are a confidential program,” Rossignol said. “I don’t wear a badge. I don’t have any specific reporting mandates.”
McCormick, of Caron Treatment Center, echoed Rossignol’s point on stigmatization, saying health care workers are often held to a higher standard.
However, he stressed that those going through this are not alone, and that getting treatment is not a sign of weakness.
“We’re all taught throughout our training to not complain, that there’s a job to do, get it done … ,” he said. “But by showing vulnerability and asking for help, it’s actually the strongest thing you can do.”
If you or a loved one is struggling with a substance-use disorder, The Doorway — a recovery services referral hub at 24 Railroad St. in Keene — is open Monday through Friday, 8 a.m. to 5 p.m. Support through the state’s 24/7 hotline is also available at 211.
To reach the New Hampshire Professionals Health Program, call Rossignol at 491-5036 or visit its website at nhphp.org.
The Retreat can be reached at 1-800-Retreat or at brattlebororetreat.org.
The Substance Abuse and Mental Health Services Administration can also help people in need. Visit findtreatment.samhsa.gov or call its national helpline at 1-800-662-43567.
Funding for the Monadnock Region Health Reporting Lab comes from several sources, including The Sentinel and several local businesses and private donors. We continue to seek additional support. The newsroom maintains full editorial control over all content produced by the lab. Olivia Belanger can be reached at 352-1234, extension 1439, or obelanger@keenesentinel.com. Follow her on Twitter @OBelangerKS.
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