MENDOZA, ARGENTINA -- Physicians with addictions to alcohol, drugs, or gambling--or those charged with sexual misconduct--generally do well in overcoming their problems with good treatment, Dr. Gregory Collins reported at the Sixth World Congress on Depressive Disorders.

But treating colleagues

"The doctor typically blames someone else," said Dr. Collins, who is head of the Alcohol and Drug Recovery Center at The Cleveland Clinic Foundation.

"A big problem is the sense of entitlement or narcissism."

The success of treatment hinges on the impaired physician's serious self-examination and recognition of mistakes. It is imperative that the physician agree to accept help and comply with monitoring, Dr. Collins said.

"Eventually, when they figure out that they really are in trouble, they have a sense of overwhelming guilt and shame," Dr. Collins said.

Suicide can be a major risk under those circumstances.

Of course, an arrest or even an accusation of impairment can be as damaging to the doctor's career as a conviction, Dr. Collins said. In these cases, a report is filed with licensing boards, and the incident becomes part of the public record.

An arrest might be given prominent coverage, but exoneration might not be considered as newsworthy. The negative publicity alone in such cases can cause permanent damage to the doctor's career, even if the physician is later found innocent.

Impaired physicians often are extremely talented, creative, and intelligent individuals who are successful in their careers.

Narcissism can be a major factor underlying disruptive behavior, in which the doctor disregards all hospital rules.

"He is abusive, criticizes fellow employees, throws things in the operating room, curses people out, uses a lot of profanity, tells dirty jokes, makes racist remarks, parks in the handicapped space right next to the hospital, takes the president's parking space," Dr. Collins said.

"Administra-tively, he becomes a problem, and workplace morale suffers."

Risk factors for impairment include a family history of alcoholism or drug addiction.

Another risk factor is early exposure to alcohol or drugs, perhaps before entering graduate school or obtaining a professional degree.

Doctors who practice alone are at greater risk than are those in group practice, Dr. Collins said.

Many doctors have high stress levels and a "workaholic" schedule. Depression, frustration, and exhaustion from overwork may lead to self-medication with alcohol or drugs.

The process of investigating a doctor for substance abuse is usually triggered by a negative event such as a prescription irregularity or a bad surgical outcome that casts suspicion on the doctor.

Some states, such as Ohio, have laws requiring physicians to report doctors who are suspected of impairment.

According to Dr. Collins, rehabilitation attempts to stop what he referred to as the BEAT Pathology: the harmful Behavior, consisting of alcohol or drug abuse; negative Emotions such as resentment, anger, and depression associated with being in treatment; Attitudes of superiority, dishonesty, and paranoia; and "sick" Thinking, based on denial of the situation and focusing on revenge, self-pity, and manipulation.

After the physician has been sober for 2 years, credibility is usually restored. Doctors are usually monitored for 5 years after they return to their practices, Dr. Collins said.

Ninety percent of physicians do recover after treatment.

"They are our best treatment-outcome group," Dr. Collins said.

BY BARBARA J. RUTLEDGE

Contributing Writer