Addictive disease in the form of chemical dependency is present in all classes, cultures, and professions, including healthcare professionals. Its lifetime prevalence in the physician population is estimated to be 10%–12%, essentially the same as that of the general population.¹ Among anesthesiologists, the prevalence appears to be even higher. However, support for this perception is based on diagnosis from treatment programs for chemical dependence where the specialty of anesthesiology is over-represented in relation to most other medical specialties, at least with regard to drugs other than alcohol. This may be because the specialty of anesthesiology is particularly attuned to the issue, monitors its members more closely, and therefore detects chemical dependency more often than specialties that have lower vigilance.

The historic approach to the addicted anesthesiologist has been to assume that those who complete treatment for addiction should be returned to practice. But a 1990 study of chemically dependent anesthesiology residents indicated that prolonged abstinence following treatment is unusual. Startlingly, 7% of those cases presented with death. Two-thirds of the residents who were allowed to reenter their programs after treatment relapsed, and perhaps most frightening, in 16% of those who relapsed, death was the presenting sign.² However, this study was criticized because of its poor design and inadequate inpatient treatment times. Nontheless, its conclusion are likely to be valid, as a 2005 publication found that less than half of anesthesiology residents who attempted reentry successfully completed their residency, while 9% of those attempted reentrants died.³ Such statistics raise the question of whether reentry by residents after treatment for substance abuse should even be attempted, or whether there is an ethical obligation of anesthesia training programs to prohibit residents from returning. This debate remains unresolved, but hopefully will lead to the development of effective standardized guidelines for appropriate evaluation, treatment, monitoring and aftercare (monitoring if returning to work) of the addicted anesthesiologist.

Addiction is approached from the perspective of a disease model in the United States, but it is not treated entirely as a disability. The Americans with Disabilities Act of 1990 prohibits discrimination based on disability, defined as “physical or mental impairment that substantially limits a major life activity.” While physicians who are in current treatment for substance abuse are afforded some legal protections by the act, current substance abuse is excluded as a protected condition.

All physicians have as their primary ethical responsibility the obligation to place their patients’ interests foremost while providing competent medical care with compassion and respect for human dignity. This obligation, in turn, invokes anesthesiologists’ ethical responsibilities to themselves. According to the American Society of Anesthesiologists’ Guidelines for the Ethical Practice of Anesthesiology, they are required to

“maintain their physical and mental health and special sensory capabilities [and] if in doubt about their health … seek medical evaluation and care … [and further] during this period of evaluation or treatment … should modify or cease their practice.”⁴

The unethical and illegal behavior inherent to the impaired anesthesiologist’s addictive disease leads to a gradual inability to provide safe and competent care to the patient. Due to the progressive nature of drug addiction, the anesthesiologist-patient becomes subservient to the incessant demands of the disease. The addicted anesthesiologist may have tangential awareness of this fact, but the same rationalization that accepts or excuses his/her diversion of drugs dims awareness of the declining quality of patient care. Feeding addiction reorders a physician’s priorities, pushing honesty and patient responsibility into the background.