Before I share Dr. Grace and Matt’s or Dr. Ajay and Sonia’s struggles with addiction, let me first clarify what addiction is not. Addiction is not a weakness or moral failing. Rather, addictions are coping strategies gone wrong.

Some within the mental health field argue that addiction is primarily a learning disorder characterized by overvaluation of pleasure, inability to accurately assess potential risks, and a failure to alter behavior in response to negative consequences. The word addiction often brings to mind substance abuse, but with the ubiquity of phones, some of the most common addictions today involve behaviors that can be engaged in on a device.

Countless individuals consume substances or engage in potentially addictive behaviors without developing an addiction. However, casual use has likely crossed the line into addiction if it becomes the primary coping mechanism, tolerance increases over time, and the individual feels compelled to continue despite interference with a full, healthy, productive, and connected life. Withdrawal and continued use despite negative consequences are even more compelling indicators.

However you conceptualize an addiction, it can be utterly devastating for both the individual experiencing it and the people who love them.

Case Study #1

Matt became concerned about Dr. Grace’s drinking a couple of years into her first EM attending position. He understood that she was navigating a traditionally male-dominated space and gave her some leeway as she worked to earn her colleagues’ acceptance. He even enjoyed accompanying her on occasional nights out, where binge drinking was part of the work-hard play-hard culture.

The relief Dr. Grace felt within seconds of her first sip reminded her of how unburdened she used to feel. It wasn’t long before a glass or two at home after work became all she could think about as her shifts wore on. Matt absorbed the difference, taking on more of the household and the parenting on the nights she came home too depleted to be present.

It wasn’t until Dr. Grace caught herself seriously considering taking a shot just to face another shift in the understaffed, overcrowded ED that she finally sat Matt down and shared her concerns.

Case Study #2

Sonia can testify to the gut-wrenching pain her husband, Dr. Ajay’s, pornography addiction caused her. Her suspicions were confirmed the day her husband had forgotten to take his phone with him when he went to shower, leaving it unattended in their bedroom.

The initial guilt she felt as she opened his phone quickly disappeared. Countless payments to adult content creators, including “upsells,” along with extensive NSFW photos and videos, made Sonia feel as though the floor had fallen out from under her. 

Despite her husband’s resistance to treatment, Sonia focused her energy on rebuilding what Dr. Ajay’s addiction had taken from her, embracing the clarity that therapy and support group meetings provided. It wasn’t until he was sitting alone in his empty apartment, after no longer being allowed in the family home, that Dr. Ajay’s denial began to fracture.

Dr. Ajay and Sonia, and Dr. Grace and Matt are hypothetical couples, but their stories reflect the very real problem of addiction I often see within the physician and physician family communities.

Why Medicine Places Physicians at Higher Risk of Developing Addiction

It is understandable, given medicine’s prioritization of performance over physician well-being and exposure to chronic stress and various forms of trauma, that physicians may turn to substances or behaviors that provide intense and immediate relief.

Exceptionalism creates a place at the table for addiction to pull up a chair and make itself comfortable. 

Physicians are trained to override limits, and suppress discomfort. In that context, the ability to keep performing can be mistaken for proof that there is no real problem. By the time the consequences are visible to others, the addiction is often far more entrenched than anyone realizes

A career built on being the smartest, most capable person in the room can quietly breed the belief that one is immune to the things that derail others. That they can manage it. That they are different. This mindset can lead physicians to believe that traditional approaches to recovery will not work for them.

Shame is both a driver of addiction and one of the reasons it goes unaddressed for so long. The same culture that discourages physicians from acknowledging that they are not okay makes it nearly impossible to say, out loud, that they have an addiction.

Fear of License Revocation

Fear of the impact seeking treatment will have on one’s medical license is not irrational. This is the most significant barrier preventing physicians from reaching out for help and entering recovery. Many physician directors of substance abuse treatment programs are forthcoming about their own histories of addiction and recovery. They stand as testaments to professional success in open recovery. 

Substance use treatment facilities are bound by some of the most stringent privacy protections in healthcare: not only HIPAA, but also 42 CFR Part 2, a federal regulation specifically designed to protect the confidentiality of substance use disorder treatment records, which imposes significantly stricter disclosure limitations than standard medical records. 

Addiction does not mean the end of a career, but leaving it unaddressed very well might. Physicians have autonomy and agency regarding their path to recovery. 

Recovery

Some of the most inspiring growth I have witnessed in my career as a therapist has been watching clients move from the depths of addiction to active recovery. It is one of the clearest examples of human resilience. Clients arrive for  treatment often feeling broken, exhausted, ashamed of what they have done, who they have become, and are convinced they are beyond help. The willingness to face what is hardest about oneself, and to keep showing up anyway, is a kind of perseverance and integrity that does not get nearly enough credit. What grows out of recovery is not just sobriety, but a life that feels more sustainable, present, connected, and authentic.

If you are reading this and suspect that you or your partner has an addiction, I hope the same for you.

An Important Note About Caring For Your Marriage in Recovery

As a therapist with extensive experience working with couples and treating addiction, I want to share a statistic with you that very few in the mental health field are aware of. Married couples with a partner in recovery are four times more likely to divorce. Don’t let this leave you feeling defeated; let it inform how you proceed. Addiction may begin with one partner, but recovery alone does not repair the disconnection that addiction leaves behind in a marriage. If the relationship is going to heal alongside the individuals, it requires new relational skills, shared language, support, structure, and its own place in the recovery process.

Recovery is a time of rapid individual growth and reorganization of the relationship. All the recovery support groups mentioned below are wonderful at helping individuals achieve individual recovery. Seeking the support of an experienced marriage therapist who can help you integrate that individual growth as you create a new, healthier relationship is critical for the long-term success of your marriage. Just as recovery can transform an individual, it can also transform a marriage.

What To Do If You Believe You Have an Addiction

• Attend a 12-Step or SMART Recovery meeting today. Meetings are held virtually and in-person 24/7. Both approaches are evidence-based.
• Make an appointment with a psychiatrist, licensed therapist, or licensed chemical dependency counselor who can assess for the appropriate level of care, or contact an inpatient treatment center. In the case of sex or pornography addiction, seek a licensed therapist who is a Certified Sex Addiction Therapist (CSAT) or contact an inpatient treatment center.

What You Can Do If You Believe Your Partner Has an Addiction

• Trust your gut. Addiction is skilled at minimizing its impact and diverting attention. If something feels off, it likely is.
• Name it. Do not let the addiction control the narrative. When you are ready to speak with your partner, approaching the conversation with honesty, care, and concern will help you maintain your own health and well-being, which is separate from theirs.
• Do not wait for your spouse to seek support. You deserve health and support independent of your partner’s choices. Support group meetings and therapy will help you lay the groundwork for a healthier future, not one dictated by your partner’s addiction.

The three “Cs” of Al-Anon are a friendly reminder: “I didn’t Cause it, I can’t Control it, and I can’t Cure it.”

Resources for Physicians and Their Spouses Struggling with Addiction

Physician-Specific Support

Federation of State Physician Health Programs (FSPHP) – A starting point for identifying Physician Health Programs (PHPs) in your state

National Support & Referral

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline 800-662-HELP (4357). Free, confidential treatment referral and information service (24/7).

Workplace Support

Employment Law Attorneys
Provide confidential guidance and advocacy related to workplace rights and protections

Human Resources (HR) Department
Can help you understand available leave options, benefits, and workplace protections

Specialized Treatment Resources

Certified Sex Addiction Therapist (CSAT) Directory

Inpatient Treatment Centers with Programs for Professionals

• Hazelden Betty Ford – Program for Professionals
• Pine Grove – Recovery Track for Professionals
• Capo by the Sea – Recovery for Physicians
• Positive Sobriety Institute – Impaired Physicians Program

12-Step Recovery Groups 

• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)
• Pills Anonymous (PA)
• Cocaine Anonymous (CA)
• Crystal Meth Anonymous (CMA)
• Marijuana Anonymous (MA)
• Heroin Anonymous (HA)
• Nicotine Anonymous (NicA)
• Gamblers Anonymous (GA)
• Overeaters Anonymous (OA)
• Sex Addicts Anonymous (SAA)
• Sex and Love Addicts Anonymous (SLAA)
• Sexual Recovery Anonymous
• Sexual Compulsives Anonymous
• Workaholics Anonymous
• Shopaholics Anonymous
• Spenders Anonymous
• Debtors Anonymous (DA)
• Clutterers Anonymous (CLA)
• Online Gamers Anonymous (OLGA)
• Internet and Technology Addicts Anonymous (ITAA)
• Food Addicts Anonymous (FAA)
• Food Addicts in Recovery Anonymous
• Emotions Anonymous

Non-12-Step Option 

SMART Recovery (secular)

Resources for Affected Partners

12-Step Support Groups

• Al-Anon
• Nar-Anon
• Families Anonymous
• Codependents Anonymous (CoDA)
• Codependents of Sex Addicts (COSA)

Non-12-Step Option

SMART Recovery (secular)