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Understand the mindset of the recovering health professional

June 14, 2016
by Joseph Garbely, DO, and Greg Gable, PsyD
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Healthcare professionals with substance use problems have unique challenges that must be addressed as part of intervention, treatment and aftercare to achieve successful outcomes. At Caron Treatment Centers, we have recently expanded our healthcare professional treatment continuum to offer a dedicated program and freestanding building with credentialed clinicians who have extensive expertise in treating these individuals and assisting with their re-entry into the workplace.

First and foremost, it is critical for any center working with this population to understand the mentality of a healthcare professional who is struggling with substance abuse. Many healthcare professionals are accustomed to having total control in their lives. They often have an illusion of power over their addictive behavior. Even when consequences in their professional workplace arise, and their colleagues or those personally close to them are pushing for treatment, they have difficulty letting go and accepting help.

In our work with healthcare professionals at Caron, we draw from the work of Harry M. Tiebout, MD, a pioneer in the treatment field and a former chair of the National Council on Alcoholism. Tiebout's landmark paper about the difference between patient compliance and surrender is still highly relevant. We find that this concept is essential to address in the healthcare professional population. These professionals are intensely focused on their career, with a singular goal of checking off boxes to resume their livelihood as soon as possible.

However, a critical part of our treatment work involves helping them to understand that they are more likely to achieve a successful recovery when they can step away from their intellectual selves and tap into their emotional selves—particularly their shame and vulnerability. This represents a significant transition in their recovery process because it changes their way of thinking. Their fear that they will lose everything if they admit to their substance use problem evolves into a new understanding about their lives. They come to see that not only will recovery allow them to regain what they lost in their active addiction, but also that they will surpass their expectations and live a fuller, more productive life.

Impact of peers

We know that a major part of this evolution in healthcare professionals' thinking comes from the positive peer culture they experience in the program. We find that regardless of what type of healthcare professional background they have, these individuals have a similar mentality and are able to bond with and support one another because of a shared experience and perspective. Their identities are typically strongly aligned with their profession, and they have significantly invested in their careers in terms of both money and time. We observe that health professionals commonly use rationalization and intellectualization as defense mechanisms. We find that there are more commonalities than differences among members of different health professions.

Our patients also benefit from being together with those who are in different phases of their treatment. Those with more recovery time help empower and offer hope to those just coming out of detox. We recently had a psychiatrist who was very resistant enter treatment. Without prompting from our clinical team, her peers in the program rallied around her and made it clear that they were invested in supporting her.

Approaches to treatment

Caron employs treatment strategies that are specifically relevant to this population. For example, we place great emphasis on the 4th Step. It is very difficult for healthcare professionals to face their innermost truth, fears and secrets that have been repressed for a long time. It can be extremely painful for them to acknowledge their addiction, given their chosen profession. We help them to develop a habit of writing every day, addressing long-held resentments, and accessing their vulnerability. We convey that they will struggle with their sobriety if they are not honest with themselves and others.

We believe that it is important to help our health professionals recognize barriers to recovery that exist because of unaddressed trauma, anxiety or mood disorders, or personality traits that can impede solid recovery. We use psychometric testing to look carefully at personality issues, and invite our patients to engage in a process of self-discovery and understanding facilitated by the Enneagram model of human personality. This useful system of self-understanding emphasizes acceptance of our core personality traits and mindful awareness of how these operate in our lives, and it offers tools to help make different choices in response to life events.

Often, an understanding of issues related to family-of-origin experiences is important in terms of informing deeper treatment work. Our health professional population is offered a two-day intensive workshop as part of the treatment experience. This workshop is modeled after the Caron Breakthrough program and is facilitated by Breakthrough staff. This intensive workshop greatly facilitates the process of recognizing important issues related to one's family of origin.