The Clinicians Are Not Alright: Substance Use, Mental Health and Burnout Among Health Care Workers
Substance abuse is somewhat of a taboo topic. While many know that it exists, it is hard to talk to someone we think may be struggling with substance abuse, or to recognize the issue within oneself. Despite its sensitive nature, substance use disorders are quite common. According to the National Survey on Drug Use and Health, 19.7 million Americans had a substance use disorder in 2017, with 8.5 million of those adults also dealing with a co-occurring mental health disorder.
Health care workers are not immune to the struggles of substance abuse. Studies estimate that 10-15% of all U.S. medical professionals will misuse drugs or alcohol at some point during their career, with data from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) suggesting that prior to COVID-19, at least 100,000 health professionals struggled with a substance use disorder. While many health care professionals know the detrimental effects of substance abuse, they may be unable or unwilling to recognize the signs when it comes to themselves.
Prior to the pandemic, the American Addiction Centers estimated that 4.4% of healthcare workers had a problem with heavy alcohol consumption and 5.5% of medical professionals struggled with illicit drug use. It’s estimated that physicians are five times more likely than the general population to abuse opioid and benzodiazepine medications because of their increased access. The body becomes dependent on these highly addictive drugs after just two to three weeks, and can negatively impact the person’s physical health, mental health, work life, and personal relationships.
Substance Use, Mental Health, and Burnout
Substance use is not only a problem within itself, but its relationship with burnout and mental health can have catastrophic consequences for those struggling. Physician burnout has been found to have a direct impact on anxiety, depression, substance abuse, and other mental health disorders. Research suggests a reciprocal relationship between burnout and mental health, but the research is ambivalent if one consistently causes the other.
Substance abuse is a risk factor for suicide. More specifically, studies have found that substance abuse leads to an increased risk of depression and suicide in physicians. Physicians have higher rates of depression and anxiety disorders and are at higher risk of death by suicide than the general public. This amalgamation of problems creates a noxious environment that should have been addressed long ago.
Another problem adding to this is that despite their higher rates of mental health disorders, physicians seek mental health care much less frequently. This is likely due to fear of being stigmatized or fear of repercussions from employers and state medical boards. The belief that physicians should take care of all their own problems themselves is outdated and dangerous. Physicians need help just like everyone else. Unfortunately, many health care organizations say they support providers’ mental health while not actually supporting those dealing with problems, and the fear of being stigmatized or facing negative repercussions for mental health problems is the reality for many.
Substance Use and Mental Health Since COVID-19
Substance use and abuse has increased throughout the COVID-19 pandemic. During a June 2020 survey, the CDC found that 13% of U.S. adults started or increased their substance use since the pandemic began. Other reports indicate that up to 30% of participants drank at risky levels to cope with the additional stress.
While the full impact of COVID-19 on health care workers' mental health is still unknown, predictions based on previous traumatic events are dismal. Research from the 2003 SARS (Severe Acute Respiratory Syndrome) outbreak suggests that public health crises contribute to increased anxiety, mood disorders, and PTSD (Post Traumatic Stress Disorder). In general, large-scale disasters are associated with increased rates of PTSD, depression, and substance use disorders.
Studies have found that different stressors from COVID-19 contribute to increased substance abuse risk among the general population and suggest that healthcare workers are at an extremely elevated risk because of the magnitude and compounding nature of their stressors. And the negative impact of increased substance abuse without adequate support is devastating. A recent study from the Well Being Trust warns that the stress, isolation, and unemployment from COVID-19 could cause up to 75,000 deaths related to drugs, alcohol, and suicide.
There is an intersection of chronic workplace burnout with acute trauma and stress from the pandemic. Burnout has been a problem in health care for a long time, and has a lasting, negative impact on both the health care workers suffering and the health care system as a whole. The acute stress of COVID-19 is predicted to have lasting negative impacts on the mental and physical health of clinicians for years to come. These combined traumas could have irreversible impacts on these physicians and the healthcare system, which is why this crisis needs to be addressed now. It is not the responsibility of the clinicians to fix this, but it is the responsibility of health leaders everywhere to fix the system that is, once again, letting down the very people who make it possible.
Help is Available
If you or someone you know is struggling with substance abuse or mental health problems, these resources can help:
SAMHSA Helpline: 1-800-662-4357
National Suicide Prevention Lifeline: 1-800-273-8255
Physician Support Line: 1 (888) 409-0141
Crisis Text Line: Text HOME to 741741 (US and Canada)
UK: 85258
Ireland: 50808
American Addiction Centers 24/7 hotline: (888) 818-5947
Federation of State Physician Health Programs: a nonprofit that provides confidential assessment, referral to treatment, resources and monitoring for physicians/healthcare professionals, and those in training who may be at risk of impairment from mental illness, substance use disorders and other health conditions
By Tristan Dooley