Significant research has shown startlingly high rates of alcohol and substance use disorders (ASUD) among medical professionals. While few studies have been conducted on veterinarians specifically, it stands to reason they share similar trends.
To shine light on ASUD, Phil Richmond, DVM, CAPP, CPHSA, CPPC, CCFP, the founder and CEO of Flourishing Phoenix Veterinary Consultants LLC, reviewed prevalence data and attempted to slay the stigma surrounding this mental health issue during a presentation at the 2024 Midwest Veterinary Conference. Richmond is celebrating 16 years of sobriety after alcohol and substance use nearly cost him his veterinary career. He advocates and consults for positive culture and individual, team, and organizational psychological health, safety, and well-being in veterinary workplaces.
Looking at the Numbers
To really drive home the magnitude of alcohol and substance use among medical and veterinary professionals, Richmond shared results from several studies:
- According to addiction specialists, 12-15% of medical professionals meet the criteria for an alcohol or substance use disorder at some point in their careers.
- 12.9% of male physicians meet the criteria for alcohol use disorder, and 21.4% of female physicians meet the criteria for alcohol use disorder (2015 Mayo Clinic self-reported survey).
- 24% of physicians say they turn to alcohol to cope with burnout (2022 Medscape National Physician Burnout & Suicide Report).
- 69% of doctors in Physicians’ Health Programs reported they misuse prescription medications to relieve stress and physical or emotional pain (Dupont et al. 2009, Journal of Substance Abuse Treatment).
- Opioid and benzodiazepine use disorders are five times higher in medical professions than the general population. “As veterinarians, we have the keys to the candy store,” said Richmond. “Access is an issue and something that increases our risk.”
In 2019, Whitte et al. published a study in JAVMA looking at suicides among veterinary professionals from 2003 to 2014. On the toxicology screens, 51% of veterinarians had alcohol in their systems, 42% had benzodiazepines such as Xanax and Valium, and 13% had opioids. Forty-eight percent of vet techs had opioids in their systems. The presence of these substances doesn’t necessarily mean the individuals had use disorders, but it underscores the association between alcohol and/or substance use and suicide, said Richmond.
“If we want to address suicide in our profession, we must be able to talk about alcohol and substance use disorders from a place of understanding and reserve judgment,” he said.
Richmond also cited a link between these disorders and adverse childhood experiences (ACEs). According to the Adverse Childhood Experiences Study and other reports, an individual who experiences four or more of these traumatic events is 6.9 times more likely to have an alcohol use disorder, 37.5 times more likely to attempt suicide, and 7-10 times more likely to have an alcohol or substance use disorder than someone with no ACEs.
“As veterinarians, if we saw something that created this increased risk of disease in our patients, we’d be all over it,” said Richmond. “For me, this feels like a way to talk to people who don’t necessarily understand alcohol and substance use disorders and, when we know someone has a disorder, being able to look at them through a different, compassionate lens.”
The Pathology of Alcohol and Substance Use Disorders
In individuals with ASUD, the prefrontal cortex—the rational part of the brain—gets bypassed during decision-making. As a result, they can’t “outthink” the addiction, “which is a damned thing for us as veterinary professionals,” said Richmond. “We think our thinker is so smart that we’ll be able to get over it.”
He quoted a statement from an editorial in JAMA: “The intellect that physicians (or veterinarians) rely on to learn their craft allows them to develop exceptional rationalization, denial, and resistance techniques. Thus, recognition of their disease is difficult.”
“This is why we often don’t get treatment until we’re a mess,” Richmond added.
According to a study of ASUD in doctorate-level medical professionals (Dupont et al. 2009), of those who needed treatment, 95% wouldn’t admit it. Of the 5% who believed they needed treatment, 2/3 made no effort to obtain it.
“It’s important to remember that not all health professionals with a use disorder display impairment, especially at first,” said Richmond. “Again, this is why we can show up to work and seem like we’re OK, but we’re not.”
Other reasons, according to the Florida Professionals Resource Network (the state’s Physician Health Program), that peers, colleagues, and employers don’t often identify health care professionals with use disorders include:
- Not knowing that chemical dependency is a primary disease with signs and symptoms and a specific course that can be identified, documented, and treated.
- A lack of knowledge about signs of the problems in the workplace.
- A fear of being wrong.
- A fear of the same thing happening to them.
- Not understanding employers’ obligations under state boards and statutes.
- Hoping things will get better.
“What we need to know is as veterinary professionals, our job is the last thing to go,” Richmond explained. “Relationships have probably gone to hell, things in our lives are probably going down. But we hang on to our jobs, we show up almost to the very end. When we start seeing issues show themselves at work, that person is probably really in trouble.”
Seeing Past the Stigma
There’s a huge amount of stigma around alcohol and substance use disorders. According to WHO, substance use disorder (labeled as illicit drug use disorder) is the most stigmatized disease, and alcohol use disorder (labeled as alcoholism) is fourth on the list. For comparison, HIV/AIDs is No. 2.
This is, in part, because throughout history we have tried to explain addiction using a moral model, and many people still do. They believe individuals with addiction are choosing to use drugs, but “remember that dopamine saliency makes it impossible for them to make rational decisions,” said Richmond. People might also view individuals with addiction as self-centered, morally bankrupt, crazy, or stupid.
“Alcohol and substance use disorders are diseases of the brain; they are not a lack of willpower, intelligence, or moral failure,” he explained.
As such, he said the language you use when discussing these issues matters. Words like substance “abuse” and “abuser” evoke automatic negative thoughts about individuals with related problems, according to the Recovery Research Institute.
Stigma is a powerful barrier to treatment and understanding. “How many of you know a veterinary professional in recovery?” Richmond asked the audience. “There are way more than you know about because they’re not walking around holding up a sign. What’s the benefit of being open about addiction if they’re going to be stigmatized for it?”
Education and Intervention
Alcohol and substance use disorders are plagued by misconceptions. “It is vital to our profession that we educate our teams” about the disease, its signs, and how to intervene, said Richmond. Common physical and behavioral signs of use disorders, according to the Florida Professionals Resource Network, include:
- An observable decline in physical or emotional health.
- Atypical weight changes.
- Inability to mentally focus and keep track of a conversation.
- Shakiness, tremors of hands, agitation.
- Unsteady gait.
- Unsatisfactory documentation performances and or illegible written communication.
- Defensive if questioned or confronted.
- Alcohol on breath with attempts to cover with mints or mouthwash.
- Missed deadlines.
- Questionable practice judgment.
- Increased interest in patient pain control.
- Frequent absences or illnesses.
If you note these signs in a colleague, “the goal of intervening is to make sure a problem is recognized and dealt with for the well-being of the professional and to assure safe practice in the workplace,” said Richmond, listing the basic principles of workplace intervention:
- Document specific observations, including date, time, place, and practice or conduct concerns.
- Become familiar with the employee’s practice baseline.
- Follow workplace policy on reporting practice or conduct concerns.
- Do not discuss suspicions with colleagues.
- Contact your state VMA or PHP with questions.
“It is important to remember that this is a disease, and treatment is not punitive,” he said. “Most states protect veterinarians’ licenses and allow for an opportunity to heal and recover through treatment and monitoring.
“Luckily, recovery rates are extremely high in medical professionals,” he added. “And treatment often results in greatly improved well-being.”
Related Reading:
- Vet Wellness Briefs: Learning Acceptance
- Compassion Fatigue for Equine Veterinarians
- Vet Wellness Briefs: Simple Ways to Feel Better
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