IN THIS ISSUE: Is Your Teenager or Are You Addicted to your Smartphone? Depression & the Young Brain Science and Cannabis Abuse Tips from Dr. Bill W Physician Burnout & Depression 2017 Contributors

IN THIS ISSUE Red Flags for Opioids Did You Know? Dispelling the Myths of Marijuana How to Support a Recovering Addict Tips from Dr. Bill W Never Face a Medical Board Investigation Alone Staff Presentations in 2017

Recognizing the Signs of Substance Use

by Bahar Bastani, MD During the 4 decades of my clinical training and practice of medicine, I always felt a sense of ownership and full responsibility in caring for my patients. What I have noticed over the past decade is a gradual transformation in our health care delivery system and in the attitude of our trainees. Hospitals are being governed as for-profit corporations, run by administrators and lawyers, rather than by physicians, with the aim of becoming more profitable. The...

By Mark Gold, MD Addiction is a chronic multi-dimensional brain disease involving complex biological, behavioral and social systems. The etiology and pathophysiology involves complex epigenetic genetic variables that are not well understood. Most treatment for persons with SUD is crisis-driven acute care – namely detoxification and stabilization, followed by a referral to outpatient care, regardless of the disease severity or level of social support. Moreover, the majority of substance depen...

IN THIS ISSUE PHPs: Outcomes and Variance... Tips from Dr. Bill W. The New Trend in Medicine Comment from the Editor Q & A How do you know when...

IN THIS ISSUE 1. Quitting Time 3. A Second Chance 6. Depression 8. Longer Treatment 8. Missouri Doctor Heads

IN THIS ISSUE: Fast 5 Quiz Breaking the Stigma AMA President Meets Medical Students Register for... Tips from Dr. Bill W Announcing New Medical Director Treating Opioid Use Disorder

IN THIS ISSUE: My Hidden Addiction The MPHP: First Responders for Missouri Physicians Report Reveals Severity of Burnout by Specialty Tips From Dr. Bill W. My Experience in Treatment Addiction is a Brain Disease

To Anyone Considering Treatment for Addiction: Full Discloser, I am writing this testimonial as an endorsement for the Positive Sobriety Institute (PSI) in Chicago, Illinois.

by Troy Parks Physicians from 27 specialties graded the severity of their burnout on a scale of one to seven in a recent Medscape survey – one being that it does not interfere, and seven indicating thoughts of leaving medicine. All but one specialty selected a four or higher. The most affected specialty?

Many in the Missouri medical community associate the Missouri Physicians Health Program primarily with alcohol and drug problems.  This is no longer a correct perception. It is true that when the first physicians health programs were developed in the 1970’s, there were two principal concerns:  1) alcohol and drug use, and 2) suicide.  While some physician health programs may limit their services, the MPHP will attempt to assist Missouri physicians with any problems that could potentially inter...

I had it made.  I was a successful physician.  I had a great practice, good friends, hobbies, and my health was good.  I had a loving wife, grown children and even grandchildren.  I wasn’t wealthy, but I was financially secure.  One cold December night that all changed.  “Who is this woman?” my wife asked while showing me a computer copy of a picture.  Of course, I lied and tried to come up with excuses why the picture was on my computer but it didn’t take long to realize that I was bust...

A good contract by definition is one that is fair and reasonable and is a win-win situation for everyone involved. But how do physicians ensure they are getting a good contract before agreeing to work for a hospital or group practice?

It is a fact that married physicians have a 10-20% higher divorce rate than that of the general population. Of those who stay married, almost half of physicians and more than half of their spouses report that they are unhappy; figures that are approximately 15 percent higher than those for the non-physician population. “ ...The rate of suicide is greater for doctors’ wives than for wives of any other professional group.”

A new study has found that, between 2011 and 2014, the burnout rate among family physicians increased from 45 to 54 percent. Yes, you read that right. Over half of us are experiencing burnout.

IN THIS ISSUE: Tips for Strengthening your Marriage / Relationship Options for Physicians Who Don’t Get Accepted to Residency Programs Practical Tools to Prevent Burnout Tips From Dr. Bill W. 7 Things You Must Know Before Signing an Employment Contract

The Way Forward The US health care delivery system and the field of medicine haveexperienced tremendous change over the last decade. At the system level, narrowing of insurance networks, employed physicians, and financial pressures have resulted in greater expectations regarding produc- tivity, increased workload, and reduced physician au- tonomy.Physiciansalsohave tonavigatea rapidlyexpand- ingmedicalknowledge base,more onerousmaintenance ofcertification requirements,increa...

Prescription Drug Monitoring Program targets April 2017 rollout By Sam Page, MD, St. Louis County Councilman

Physician Job Security: Time to Check Your Contract? Tips From Dr. Bill W. A New Tool to Combat Opioid Addiction in the St. Louis Region Demystifying Alcoholics Anonymous, a Chapter at a Time

For the past 6 years or so, I’ve been employed as a locum tenens neurologist. I’ve practiced as a neurohospitalist in a 300-bed community hospital and two large teaching hospitals.

It wasn’t until the state police and the DEA were sitting in my primary care office that I finally stopped denying that I was hopelessly addicted to prescription opiates. The DEA agent said, “Doc, cut the crap, we know you’ve been writing bad scrips.” The windows in my office didn’t open, otherwise I might have jumped out and fled. As it was, I was charged with three felony counts of fraudulent prescribing.

Treatment Outcomes Matter Today substance use disorder treatment is a vital part of the solution to the national drug problem, with heroin and opioid addiction its greatest challenge. Some patients now complete treatment, achieve sobriety and enter long-term recovery with the assistance of medications. Others do so without the assistance of medication. This is a worthy public health achievement to be celebrated. But most patients do not succeed with current care. The lessons and methods o...

The Doctor’s New Dilemma by Suzanne Koven, M.D. The woman sits perched on the end of my exam table, leaning forward, blond curls tumbling over her eyes, her precarious posture mirroring her emotional state. Though the symptom she describes is relatively minor — some diarrhea on and off — she appears distraught. She grips the table as if doing so will hold back her tears.

Recently published by Medscape, in March 24, 2016, this article is highly recommended for all those professors, program directors and other administrators involved with medical students. Several key quotations are provided below: “Approximately one third of medical school students meet criteria for alcohol abuse or dependence -- double the rate of their age-matched non-med student peers -- with burnout and high educational debt primarily to blame, new research shows.”

Celebrate! You are sober and, for the moment, free of your addiction! How does it feel? Are you happy? Are you sad? Which is it?

One day in January, I was facilitating a fourth-year elective course with eight medical students. It was a medical humanities class, and the topic that afternoon was the virtue of forgiveness. A student named David led the discussion, and I listened as they exchanged ideas. When their energy waned, I asked, “Do any of you have someone to forgive from your clinical experiences? Did anything ever happen that you need to forgive or perhaps still can’t forgive?”

The surgeon was moody. He seemed drowsy at work. He was secretly an alcoholic.

Counseling Impaired Docs: Help Programs May Need Retooling as Hospitals Expand Physician Employment By Lisa Schencker The surgeon was moody. He seemed drowsy at work. He was secretly an alcoholic. The situation could have led to patient harm, the loss of his license and malpractice lawsuits. But none of that happened. Instead, a member of the hospital’s wellness committee, after speaking with the doctor, connected him with the Positive Sobriety Institute in Chicago. Such programs often work...

Often it takes a tragedy for a discussion to open up about medical student and resident suicide. People will wonder why a bright young student or physician decided to end his or her life, but it rarely translates into positive changes within the training environment.

Implementing Change to Reduce Depression and Burn Out Among Physicians in Training by Robert Bondurant, RN, LCSW, and Nancy Morton, BS Often it takes a tragedy for a discussion to open up about medical student and resident suicide. People will wonder why a bright young student or physician decided to end his or her life, but it rarely translates into positive changes within the training environment.

When Daniel H. Angres, 66, reads the headlines about the growing numbers of baby boomers addicted to -- and overdosing on -- prescription pain pills, he’s grateful that he found help for his own pill addiction 33 years ago. “I was sort of a product of the ‘60’s and ‘70’s; I kind of did all of the stuff many folks did during those days in terms of pot and alcohol,” Angres recalls. It wasn’t a problem, he says, until his late 20’s or early 30’s, when chronic pain led him to take pa...

AAMC Reporter, June 2015 Making errors is an inherent part of learning, even in medicine. Shame and guilt about errors, though, can have a major impact on the progress of resident physicians and how they interact with peers, colleagues, students, and patients.

Making errors is an inherent part of learning, even in medicine. Shame and guilt about errors, though, can have a major impact on the progress of resident physicians and how they interact with peers, colleagues, students, and patients...

My focus this edition is exercise and its benefit during recovery from drugs and/or alcohol abuse. If you aren’t already participating in a regular, vigorous exercise program, you should consider beginning one soon.

It is a fact that married physicians have a 10-20% higher divorce rate than that of the general population. Of those who stay married, almost half of physicians and more than half of their spouses report that they are unhappy; figures that are approximately 15 percent higher than those for the nonphysician population. “ ...The rate of suicide is greater for doctors’ wives than for wives of any other professional group.”

You were referred to the Missouri Physicians Health Program (MPHP), emerged from your initial evaluation, and were instructed to follow a particular pathway to sobriety. The reason you are in this position is that you have been identified as a physician who needs help. Your life and career have taken a sudden and unplanned diversion. That may mean a loss of your current position as a medical professional. Also, it may mean a loss of an important personal relationship. What do you do?

Malpractice stress is one of only two well described work stress syndromes, the other being burnout; they are not mutually exclusive. It can be one of the most painful and overwhelming experiences a physician faces in their career. This article will review the characteristics of malpractice stress, and ways to conceptualize it and approaches to managing it.

Meta-tag Description: Myths about alcoholism are pervasive in the world of alcoholism and treatment, myths are dangerous because they can be determining factors in life and death situations...

Myths about alcoholism are pervasive in the treatment community. Click to read some of the most damaging myths keeping people from a healthy recovery.

“A boo is a lot louder than a cheer.” --Lance Armstrong When I was still a medical student, most of my friends already called me Doc, and I was the go-to-person, or “anchor man,” during times of sickness or trouble. One particular day, I got a frantic phone call from a couple of friends who said, “Harry, you gotta get over to Jake’s house. He just got back from Mexico, and something’s very wrong.”

Objectives - Articulate the mismatch of brief episodes of treatment and the life-long nature of substance use disorders - Describe the physician health programs as a model of care management for achieving long-term recovery - which includes no use of alcohol or other drugs - Define the proposed standard of five-year recovery and show how it fits into the evolving system of health care.

Addiction is a disease that none of us asked for or deserve. It is NOT self-inflicted, as some would suggest. However, addiction is a unique disease in that the person afflicted is generally responsible for his/her own long-term treatment. Who is better suited to that task than a physician? We physicians are trained to utilize whatever resources are necessary to properly treat our patients, and I challenge you to use that same dedication to treat yourself.

It is safe to say that the concept of addiction as a disease is certainly controversial. Does this mean it is wrong or not of value? Another controversial concept was the germ theory of disease. This theory attempted to explain some diseases by the action of microorganisms. These small organisms, too small to see without magnification, invade humans, animals and other hosts.

It is safe to say that the concept of addiction as a disease is certainly controversial. Does this mean it is wrong or not of value? Another controversial concept was...

Hello, Friend: My name is [Fill in your name, here], and I am an addict. My name can definitely go in this blank. I became addicted to the prescription sleeping medication AmbienTM in the late 1990s.

An overworked married pediatrician was attracted to a single mom in his practice. They became friendly and one day he offered to help if she ever needed anything fixed around the house. Eventually she called and asked him to come over to fix a leaky faucet. This started an affair that lasted several months. When his wife discovered the affair, he broke it off.

The internal and external stresses associated with a physician’s life often affect the family. When the physician is abusing drugs or alcohol, the pressures are magnified. There may be long hours, emotional isolation, excessive devotion to medicine, pressures from regulatory agencies, threats or reality of liability suits, complacency about physical health, spending sprees, infidelity, eating disorders and sleep disturbances.(See Table 1, page 6, for other possible stressors for the family.)

Impairments in physicians present risks to the public, the physician, the family, the hospital, and to professional colleagues of the physician. Impairment may result from psychiatric illnesses such as depression, from advancing age, from physical disabilities and from dependence upon drugs.

This year MPHP encountered our first physician with a process addiction involving video gaming. What is process addiction? It can be defined as a compulsion to engage in a pattern of behaviors (sex/pornography, eating, internet, video games, gambling, compulsive shopping/spending, etc.) and to continue in the pattern despite adverse consequences.