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Jun 09, 2018

“Physician, heal thyself”

I had the distinct pleasure of attending the American Pharmacy Association’s Institute on Alcohol and Drug Dependencies at the University of Utah last week. The Institute is an opportunity for pharmacy students and other professionals that work with the pharmacy profession to have a life-changing experience learning about substance misuse, the science of addiction, and recovery options. Participants even get to experience AA, NA, and Al-Anon meetings. The attendees consistently relate that this was an once-in-a-lifetime experience.

One of the keynote speakers for the Institute was Dr. Bob Weathers. He is a doctor of psychology whose license has been revoked due to his history in recovery. Unlike other professions where Peer Assistance Programs (PAP) are available, the psychology profession generally speaking does not have access to those supportive programs. Neither does the profession of counseling.

While listening to Dr. Weathers and stewing over how disheartening it is that some of the most liberal, open, and giving of the helping professions can still maintain such a punitive stance on substance misuse and mental illness (potential impairment) I was reminded of a phrase: “Physician, Heal Thyself”. 

There is irony in that statement to me. Every state in the U.S. has a Physicians Health Program (PHP) which is essentially the same thing as a Peer Assistance Program (PAP) but geared towards MDs and DOs. However, upon a search online I was unable to find a Peer Assistance Program that served counselors, especially as part of a contract with the state licensing board. So, essentially, while physicians have access to resources to help them heal; counselors are left to truly “heal thyself”.  Some states do have PAP that serve psychologists, but they are not prevalent[1].

A further irony is that many state boards of counseling appear to take punitive stances towards their licensees who have impairment issues. My own state, Texas, keeps a listing publically on their website of not only which licensees have complaints against their license but specifically list which board rule or ethical clause the person has violated. This is even true for people who are currently under investigation or even just have an allegation that has not been investigated yet. Sadly for those in my state, if can take upwards of two years to resolve an investigation. Meanwhile, your name, license number, and alleged infraction are displayed for the world to see online. Talk about stress! Talk about punitive!

Just like any medical profession, counseling is a safety sensitive profession. As such, counselors run a significantly higher risk of impaired practice than others not in a safety sensitive position.  Studies have shown that 10-15% of all medical professionals will experience an impairment due to substance misuse at some point in their career[2]. If we look at prevalence data from the general population, we can assume that a significant number of these professionals will also have a co-occurring mental illness that may not be treated. Medical professionals, just like any humans, are also susceptible to life stressors like divorce, birth, death, etc. Add into the equation secondary trauma, the stress of being a safe holding container for our clients, and being part of a medical profession in a society that keeps asking for more but offering less and you have a recipe for professional disaster.

Despite that heightened risk for professional impairment and potentially damaging practices to our clients, our licenses, and our careers; we as counselors still tend to significantly lack for resources.

Additionally, there is significant stigma within the mental health professions about self-disclosure. I remember vividly in graduate school being warned against self-disclosure with clients and goodness forbid you choose to self-disclose to peers! This is not a new phenomenon. All medical professionals have a similar stigma within their professions. In a field full of experts, is it truly okay to admit that you aren’t okay?

In my time working in the addictions arena I have been so floored by how open most professionals in recovery are. They own their recovery and they own their struggles. They seem free and they seem happy. My hope is that on the mental health side of the house we can one day be so open with one another; so supportive and kind. But I feel that change may need to come from the top down; reflected within the associations and state Boards and passed down to the counselors within their jurisdictions. We have to learn to say that it’s okay to not be okay sometimes.

Additionally, we have to have resources to offer our peers who are struggling with impairment issues. Their impairment doesn’t make them a bad counselor. It means that they are in need of specialized assistance and support; preferably through a program like a PAP. Studies have shown that professionals who do not have access to a PAP or a PHP and attempt to enter recovery from substance misuse alone are at a 40-60% risk for relapse, and if they do relapse it will be multiple times in their career. However, professionals who have access to PAP or PHP programs have only a 20% rate of relapse and, if they do relapse, tend to only relapse once in their careers[3]. With data like this, it amazes me that more allied medical professions, like counseling, do not have access to these programs in every state.

I am currently working within my own state to see if I can change this. If it’s something you feel strongly about, take up the mantle. We should not be left as a profession to heal our wounds alone.


[1] https://www.apa.org/practice/resources/assistance/acca-toolkit.pdf

[2] Hazelden Betty Ford Foundation (June 2015) Health Care Professionals: Addiction and Treatment

[3] DuPont, Robert L.; et al (2009) Setting the standard for recovery: physicians’ health programs. Journal of Substance Abuse Treatment, 36 (2009), 159-171.

______________________________________________________________________
Brittany Lash is a counselor in Texas and is the director for the Professional Recovery Network (http://www.txprn.com) with the Texas Pharmacy Association. She has experience working in public mental health, mental health public policy, and in training first responders to work with individuals with mental illness.

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  1. 1 Michael Morar 14 Aug
    Hi Brittany 

    Wow!  You are so "right on" with this article/blog posting.  I have often thought about this disparity between mental health professionals and MD/DO's when it comes to the misuse/abuse of substances (past, current and possible).  Especially considering the profession @ greater risk due to access and power.   I find it interesting the perception made by some observers, the legitimacy of what is deemed ok vs. what is problematic mostly based on what is/are "legal" drugs determined by the "Truth" or "Objectivity" of few people and as few as one person (to write a prescription).  Unfortunately, many continue to support the idea that doctors do possess the ability to discern an "objective" reality.  At best it is an attempt at perceiving the reality of another...which is difficult if not impossible.  But better if there is an acknowledged distinction between the two.  Often unnoticed is that this ideology often puts undue pressure on the physician who is then positioned to have all of the answers.  What happens when they do not know the answer, or worse when they are discovered to be wrong or miscalculated?  

    My apologies if it seems I am being hard on the MD/DO's, etc.  In my former life, I enjoyed my job working with medical doctors as a pharmaceutical representative for 15 years and built lots of relationships with many of the amazing caregivers I called on.  The problem is-not-so-much physicians, but with the system that presumes and distributes most of the power to the most related to human, mind, and body to the domain of physicians.  Regardless of who is better trained or has more experience.  Again, lots of pressure to shoulder.  Thanks again for the post. 

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