Help for the Healers
Temple Psychiatrists Direct Comprehensive Treatment Program for Impaired
Clinicians in Pennsylvania
Substance abuse knows no professional bias. Physicians, nurses, and other medical professionals
are just as likely to become addicts as members of any other occupation. But when you add easy
access to drugs and high levels of occupational stress to the mix, clinicians with substance abuse
issues face a particularly challenging rehabilitation path.
Fortunately, two Temple psychiatrists serve as educators, evaluators, and advocates for addicted
clinicians who want to get help. Based at the TUH-Episcopal Campus, Joseph Garbely, DO, and
Robert Boyd, MD, run a program called Capstone - whose goal is to ensure that Pennsylvania-
licensed clinicians with alcohol and substance abuse issues are treated immediately, effectively,
and in a way that acknowledges the potential recovery pitfalls that come with their profession.
More than 225 patients have participated in the program since its inception in the fall of 2004.
Clinicians who need help enter the Capstone program in one of two ways. Some come of their
own volition, acknowledging their unsuccessful struggle with alcohol or substance abuse. Others
are compelled to participate by the various state agencies that have the power to revoke their
license. While the referral method varies, the first step is always the same: A doctor becomes a
patient, so to speak, and receives a comprehensive psychiatric evaluation and brief medical history.
That process helps Garbely and Boyd determine the scope of the patient's problem. Typically, the
patient is then referred to an inpatient facility that specializes in treating healthcare professionals.
"We have found that primary treatment is essential," said Garbely. "Success hinges on immediate
proper treatment, at a quality facility for a sufficient period of time." The patient needs to "spend
time away from the everyday stresses of work and all of the problems that accrued during addiction,"
Boyd added.
Entering Primary Treatment
Of course, getting patients to go to an appropriate inpatient facility can be challenging.
"We've yet to meet someone who says, 'Thank you. I'm ready to go and my bags are packed.' A
lot of them fight," Garbely said.
"But it's a carrot and the stick kind of thing," he added. "The carrot is you get to practice in your
profession. The stick is you don't." After investing so much time, money, and effort in their
professional development, many clinicians don't want to risk loss of licensure that can result from
refusing to enter treatment.
Continuous Remission
After completing primary treatment, the patients return to Episcopal and participate in ongoing
aftercare. This long-term commitment (five years for doctors; three years for nurses) includes
weekly group therapy, regular toxicology screenings, and mandatory involvement in a 12-step
program like Alcoholics Anonymous or Narcotics Anonymous.
"One of the best prognosticators of success is whether patients have a strong involvement in
some sort of mutual self-help program," said Boyd. "Our patients - in part because of their strong
scientific training background - are sometimes skeptical of 12-step programs. But our experience
has shown that these programs are integral to a patient's sustained sobriety."
Garbely and Boyd believe that addiction is a chronic disease, but continuous remission can be
achieved through sustained therapy and treatment. Demonizing drug use and drug users is
counter-productive, according to Garbely. "We need to get rid of the hopelessness stigma against
addicts," said Boyd. "Intense and prolonged treatment for substance abuse does work."
"A Very Serious Consequence"
Patients entering the Capstone program are under contract with their respective state agency
promising to commit fully to treatment and complete the entire course of therapy as determined
by their doctors. And given the intensity, duration, and frequent monitoring of the Capstone
program, many patients benefit from treatment and are able to sustain their sobriety. But what
happens if they don't?
"When we have a resistant client, we try to work with them ourselves," said Garbely. "But
sometimes we have to pull in the agencies that are monitoring them such as the Professional
Health Monitoring Programs, the Physicians' Health Programs (PHP), or SARPH, a program for
pharmacists." A client's lack of cooperation represents a violation of the contract they signed.
As a result, they can be subject to having their license revoked.
"A Servant's Heart"
According to Garbely and Boyd, almost all the patients they treat can be back in practice if they
want to be. The Capstone program "tries to be fair and let these professionals have a chance to
get the help they need without irreparably marking their career," said Garbely.
"We're here to help them understand that it's not their right to practice, it's a privilege," said Boyd.
"After people get into recovery, they approach their jobs with a different attitude. They love what
they do, and they will do anything to protect that privilege."
Sometimes, the transition back into clinical practice requires re-training or changing professions,
depending on the circumstances. For example, an anesthesiologist with easy access to his or her
drug of choice may need to find a different field in which to practice. In order for recovering clinicians
to work in a particularly sensitive area, they need to learn to handle that kind of access without
relapsing.
Those who successfully return to practice "are better doctors and nurses," according to Garbely.
Boyd agrees. "All of a sudden they have a different attitude," he said. "They practice with a
servant's heart."
--Thomas Mitchell
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