Drugged-Out Doctors Find Help Among Their Peers

SMYRNA, Ga. —  The doctor from Indiana was grasping for the right word to describe his days as a drug addict when he would lie, cheat and steal to get his daily dose of courage.

“Powerless,” he said.

“I was stealing drugs and writing phony prescriptions,” said Robert (Butch) Bottorff, 33, an anesthesiologist from Jeffersonville, Ind. “I knew I might get caught and lose my job and my family. But I did it anyway.”

Bottorff’s habit was fentanyl, a powerful synthetic analgesic that provides a quick high and is reported to be far more addictive than street narcotics.

For four years, the physician diverted drugs from patients and crept away into corners of the hospital to shoot up.

“I was sort of a self-anesthesiologist,” said Bottorff, managing a faint smile.

The life of an anesthesiologist is one of “boredom followed by panic,” said Bottorff. “There is either nothing going on or you’re in a crisis situation.”

He had the time, the access to the drugs and the inclination. “It gave me a lift, a sense of well-being,” he said during a break from treatment at Ridgeview Institute, a nationally respected private psychiatric hospital in Smyrna, an Atlanta suburb.

Bottorff insists that his addiction never jeopardized the well-being of his patients, although he admits that drugs became the focal point of his life. He tried to get help once but a few weeks in a treatment program did little good and within a few days he was back to his old habit.

Finally, he was confronted by hospital officials, stripped of his license and left out of work. His family life was in shambles, his future in serious doubt.

“I was full of guilt, full of shame and I had no self-esteem,” Bottorff said. “I felt like I was an inch tall.”

As astonishing as Bottorff’s story might be, it is not unique.

Medical professionals--including doctors, dentists, nurses and pharmacists--have a rate of addiction to alcohol and drugs at least as high as the general population figure of 7% and, according to some experts, higher.

Despite more than a decade of study, accurate numbers are hard to come by. Some researchers say the addiction rate among medical personnel is four to six times higher than in the general public. Officials at Ridgeview Institute, a nonprofit facility that pioneered the treatment of doctors on drugs, say the rate is twice as high.

The American Medical Assn. is a bit more conservative, estimating that substance abuse among physicians is probably no greater than in any other profession. But the AMA takes the problem seriously, sponsoring seminars and conferences nationwide in an attempt to alert doctors and their families to signs of addiction.

“Our feeling is that something ought to be done no matter how widespread or not widespread the problem is,” said an AMA spokeswoman. “It’s something that needs to be addressed.”

Whatever the numbers, their message is alarming. The thought that people entrusted with the health of others are destroying their own health has grave implications.

But experts like Dr. G. Douglas Talbott say it’s not an easy matter to blame addicted physicians for being irresponsible.

“It is a big problem,” said Talbott, founder of the Impaired Health Professionals Program at Ridgeview, where he has treated more than 1,200 health professionals in a little more than a decade.

Talbott knows. In the 1960s, he had a successful practice as a cardiologist. He also had a drug and alcohol problem.

“I was a disgrace to my family and a blight on the medical community,” Talbott, 61, said candidly.

At one point, he checked into a psychiatric hospital, but it was not until he began attending Alcoholics Anonymous meetings that he made any progress.

Back on his feet, Talbott became project director of a Baltimore study of Skid Row alcoholics. For firsthand research, he would live for days at a time panhandling as a derelict on the street.

Those days of survival training led Talbott to establish Ridgeview, a program for health professionals sponsored by the Georgia Medical Assn. as the first of its kind in the nation.

“I’m a recovering, chemically dependent person,” said Talbott, who is credited by the AMA with bringing the problem of impaired physicians into the national spotlight. “I got to where I got not from reading books but experimentally.”

There are now about a dozen institutions where health professionals are treated as a separate group. Although some in the field see no reason to separate physicians from other professionals, Talbott and those who have been through his program say doctors are a different breed and swear by the Ridgeview setup.

Simply put, they point out, doctors do not make good patients.

“You’ve got to treat them with their peer group,” Talbott said. “If you don’t, they’ll play God with the other people in the group who are not health professionals. It’s just natural.”

Bottorff wound up in Ridgeview’s intense four-month program after an unsuccessful stay at another facility where impaired physicians were not separated from other patients.

“Doctors (as patients) just can’t relate well to other patients,” he said.

Bottorff recently came to the end of his treatment at Ridgeview and looked forward to going home to Indiana where his wife, two children and--he hopes--a new life in the medical profession await him.

“There’s a lot of apprehension,” he said. “I’ll have to face people who will say, ‘We don’t want you.’ I might have to change specialties, but I’m going to be practicing medicine in some way, shape or form.”

Talbott believes three factors make health professionals easy prey for addiction: chronic stress, easy access to drugs and alcohol and the burden of society’s reverence for doctors.

“I call it the ‘M. Deity Syndrome,’ because we must be everlastingly in control,” Talbott said. “You’re told in the beginning that you’re special, and you obviously are special in terms of making life-and-death decisions. But combine that with the ‘Titanic Syndrome,’ where physicians are taught they’re unsinkable, and you’ve got problems.

“Doctors are never supposed to be wrong, and doctors are never supposed to get tired. They swallow up their feelings and that takes its toll.”

Denial is a characteristic common to any addict. For health professionals, the denial is even more steadfast. It usually takes some serious consequence--the loss of a license, criminal charges or a failed marriage--before a physician will seek treatment.

But once they are cajoled or threatened into Ridgeview or some other special program for health professionals, Talbott said, the results are overwhelmingly successful. Ridgeview reports a success rate in excess of 85%. Most return to the medical profession.

A majority of Ridgeview’s patients have multi-drug problems--alcohol, cocaine and crack are among the most prevalent, although so-called “designer drugs” such as fentanyl are becoming quite common.

During the first month at Ridgeview, the impaired physician goes through a vigorous detoxification program that generally leads to a good deal of soul-searching.

Move to Halfway-House

In the second month, the doctors move to a halfway-house and undergo outpatient treatment. For the final two months, they resume their roles as physicians and work with addicts at Ridgeview and other treatment centers as part of a “mirror-image phase.”

Once they leave the program, Ridgeview patients participate in ongoing family therapy, undergo extensive post-treatment monitoring and pay regular visits to groups such as Alcoholics Anonymous or Narcotics Anonymous.

Most of the doctors come from outside Georgia, and four months is a long time away from home. Add a hefty price tag of $14,000 and Ridgeview becomes a lengthy and expensive cure.

But those who know say it takes that long and costs that much to break old habits.

“When I came to Ridgeview, I hardly knew who I was for a few weeks,” said Dr. Charles Browne, a surgeon from South Carolina. “I had no hope and no way of looking up. I was willing to die.”

Browne, 59, scrambled back to his feet and became a doctor again. He’s now on the staff at Ridgeview.

Browne was a fine thoracic surgeon, maybe the best in Anderson, S.C. But he lost it all with drugs and booze. There were blackouts, failed marriages and a stack of drunken driving arrests.

“The police would take care of me by not charging me when they found me drunk,” Browne recalled. “They allowed me to keep drinking and drugging. They’d say: ‘Charlie Browne is the best surgeon in town sober and the second-best drunk.’ They believed it, and I believed it.

“But you know, the public doesn’t need doctors nearly as much as they think they do.”

Browne, hooked on morphine and Demerol in addition to alcohol, tried drying out in several treatment programs. Each stay would start out promising enough, but he always managed to convince himself he did not have a problem. In a room full of non-doctors, Browne also discovered he did not want to be just another patient.

“Doctors are so arrogant,” Browne said. “I’d tell the group leader to go get me some coffee and I’d run his group. I didn’t get a damn thing done for myself.”

Hits Rock Bottom

Finally, Browne hit rock bottom. He was downing two liters of vodka a day. His family was gone and so was his license. He faced criminal charges for stealing drugs and writing illegal prescriptions. He couldn’t pay his bills, and went without heat and running water. His health was shot. He spent his days in a state of incoherence.

A doctor on the skids sounds like a contradiction in terms, and Browne is the first to concur.

“Sure it’s illogical,” he said. “But we’re arrogant. Look at how many lungs I’ve operated on for cancer, yet I continue to smoke.”

When the bottom fell out, Browne was sent to Ridgeview by his family. Days went by before he noticed the lovely wooded campus or remembered his name.

But he made it and regained his license. He thinks about the choices he faced and figures he made the right ones.

“It’s simple,” Browne said. “You either get sober and live one day at a time or you go to prison or you die.”