Dual Diagnosis Among Physicians: A Clinical Perspective

Abstract

Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.

Use of Psychotropic Medications and Illegal Drugs, and Related Consequences Among French Pharmacy Students – SCEP Study: A Nationwide Cross-Sectional Study

“…Self-medication with psychotropic medications, use of illegal drugs and alcohol abuse may also be associated with dual diagnosis, which is the co-occurrence of substance use disorders and mental disorders, well known among physicians ( Braquehais et al, 2014 ). We hypothesize that these behaviors of self-medications with psychotropic medications, illegal drugs and alcohol abuse during university years may contribute to dual diagnosis in senior pharmacists.…”

Risk Factors Measured During Medical School for Later Hazardous Drinking: A 10-year, Longitudinal, Nationwide Study (NORDOC)

“…Doctors are at increased risk for suicide, burn-out and depressive symptoms. The first postgraduate years are considered particularly stressful (41)(42)(43)(44) and there is some evidence of a cooccurrence of depression, alcohol/drug abuse and suicide among both doctors (45,46) and within the general population (47)(48)(49). These comorbidities were the subject of a thesis on mental health problems in Norwegian medical students and doctors (50).…”

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study

“…Therefore, mental distress should be considered a more important factor than contextual work stress among hard-working doctors. The most common form of dual diagnosis among doctors in clinical settings is the combination of affective and alcohol disorders [19]. Not seeking help [19,51] and self-prescribing [19,52] are both common among doctors, and interventions and adequate healthcare are needed [40].…”

“…The most common form of dual diagnosis among doctors in clinical settings is the combination of affective and alcohol disorders [19]. Not seeking help [19,51] and self-prescribing [19,52] are both common among doctors, and interventions and adequate healthcare are needed [40]. Given the higher rate of suicide in doctors [53,54], the association between mental distress and drinking should be emphasized.…”

“…In addition, we assume that stress outside of work (life events) may be important [17]. High rates of co-occurring mental distress and alcohol problems have been reported in clinical samples of doctors [18,19] and in the general population [20]. Higher risk of suicide among doctors than in the general population has also been reported [21].…”