Alcoholics Anonymous in residency

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ELM2015

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Hi all, I'll be starting my intern year this June. For the past few years (basically since med school started) I have been struggling increasingly with alcohol abuse and I am fed up. (For the record, I have never been in trouble with the law, my school or hospital for any alcohol related issues and have never done anything to endanger patients). However I am ready to quit and I am interested in attending AA meetings in my new city. It's a medium sized city, and I know AA is of course anonymous, but I am afraid of either running into someone from the hospital or someone finding out and possibly jeopardizing my job. Is this a valid worry?

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Hi all, I'll be starting my intern year this June. For the past few years (basically since med school started) I have been struggling increasingly with alcohol abuse and I am fed up. (For the record, I have never been in trouble with the law, my school or hospital for any alcohol related issues and have never done anything to endanger patients). However I am ready to quit and I am interested in attending AA meetings in my new city. It's a medium sized city, and I know AA is of course anonymous, but I am afraid of either running into someone from the hospital or someone finding out and possibly jeopardizing my job. Is this a valid worry?
Make sure that you never ever even taste alcohol again if you decide to attend AA meetings! If someone would see you take a sip of alcohol knowing you have attended those meetings it would be interpreted as falling of the wagon… Hard to explain that you just attended those meetings prophylacticly.
 
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Check out Caduceus meetings, AA for physicians.
 
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There will be many different AA options to pick from. If you've never attended, you'll find that different meetings have different styles -- some read from the Big Book, some have people speak, some are more religious than others, some do other things, some a combination. You'll also find that different meetings have different "vibes" and you'll want to find several that work for you.

If you're serious about giving up alcohol, you should start attending now. Waiting to move is a mistake. Going to AA is hard. I'm not an alcoholic, so I have no personal experience. But I have spent some of my time in training working and talking with alcoholics in AA. If it was easy, everyone would do it. As an MS-4, you'll have much more time now. You may need to attend several meetings a day.

When in residency, you'll find it harder to attend meetings due to your schedule. You'll need to find very early AM meetings, or late evening meetings. Some experience now will help you more quickly assess which meetings will be more valuable.

Wanting anonymity in AA is understandable. But ultimately you'll discover that being an alcoholic is just part of you, not something you need to hide from others. Anyone who sees you at AA would be very unlikely to report you -- AA is supposed to be private and personal. And even if they did report you, attending AA is perfectly legal. If you're attending AA and not drinking, you're not doing anything wrong.

In fact, you may wish to disclose that you're an alcoholic to your program. Being an alcoholic is considered a disability under the ADA. You could insist on time during the day to attend AA meetings. I wouldn't do this unless you absolutely needed mid-day meetings to help keep sober. Again, a good reason to start going to AA now rather than waiting. Also, when you apply for a training license, they may ask you if you have a drinking problem -- you'll have to decide whether to be honest or not. If honest, they will place you in a monitoring program (which might help with your sobriety) and will alert your program. If not, if you do end up in trouble, you'll be much worse off.

Ultimately, your drinking will catch up with you and cause problems if you don't get it under control. In fact, I expect it is already causing problems and you just can't see them. Get help, and get it now. Quitting alcohol is hard. Maybe you can just stop and that's it -- and if so, that's great. But if not, you'll need help. Reach out and get it now.
 
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Hey, you just did the 1st step! It will take many of your patients and colleagues an entire lifetime before they can even admit they have a problem. Get your act together now and never look back. Good luck!
 
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Good luck!!!
 
AProgDirector sounds like the kind of Program Director I wish ran the world, but I suspect they do not. I agree with some of their advice, but mostly not.

I don't agree about sharing this with your program 110%. I do agree about doing everything you can to address this NOW. You will never be younger than you are today, and your day will never be better/more free/more full of anything good in life as it is before residency.

I've seen a lot of really really ugly things happen to docs with mental health issues, and that's not nearly seen as much of a "failing" as EtOH/drug use (I DO NOT SEE MENTAL HEALTH OR SUBSTANCE PROBLEMS AS FAILINGS) but my experience with the profession is that it often is viewed as such, and you can't afford to have the potential hellfire that may rain down upon you.

Stay away from the PHP. Seriously. Google about them to see why that is not a body you want the attention of.

"Make sure that you never ever even taste alcohol again if you decide to attend AA meetings! If someone would see you take a sip of alcohol knowing you have attended those meetings it would be interpreted as falling of the wagon… Hard to explain that you just attended those meetings prophylacticly."
Agree wholeheartedly.

"Could use your insurance or pay out of pocket for a good therapist near you for a good 3-4x/month."
Agree wholeheartedly. Try to keep this a secret from your program, try to go somewhere that doesn't have the same EHR as where you work.

"Caduceus"
Agree wholeheartedly, but keep in mind what Trauma Surgeon said, and that you are more likely to run into docs you know than in regular AA.

You can consider rehab, and should do so if necessary, but keep in mind that attendence of outpt or inpt rehab for substances or inpatient tx of mental health issues can be things that will follow you around the rest of your career because those questions frequently appear on med license and credentialing apps.

Check out my post at http://forums.studentdoctor.net/threads/resident-friend-joked-about-suicide.1116935/#post-16240368
It's a little off topic but it talks about how to address sensitive medical issues when it comes to residency.

I also cut and paste with some edit from another post:
Be very proactive about seeking care and taking care of yourself before starting. Before accumulating more documented history of these ----- conditions, or how they may affect you at work, look into maximizing some good disability insurance (good insurance is own occupation insurance, you can read more in other threads). I would cough up the cash if you can and consult an ADA attorney just to plan for any and all contingencies. Go to docs not affiliated with your institution if possible on your days off. Do not tell your program director unless it starts to affect performance, and if it is affecting your performance then it is CRUCIAL that they are then aware of this as a disability. Immediately contact an ADA attorney in that case. Never tell anyone about any dealings with any attorneys at any time.

I don't mean to discourage you from seeking help, I APPLAUD YOU.

I just want to be sure that your proactivity and self-care regarding this and any other medical issue are kept confidential as they should be and that it does not in any way open you up to any unintended negative consequences. It's tempting to think that other doctors will understand, and they do in theory, but not if they are questioning if it has any effect on your performance, patients, your colleagues, and the program. In that equation you are the least important consideration they have and paranoia abounds and no one looks good under a microscope.

While a lot of the healing that takes place at AA is sharing your story, there is also a lot of healing to be had just taking part silently, and seeking a sponsor you can trust. This goes against AA's traditions in some ways, but in that case there would be nothing to implicate you, if you were ever asked you could say you were there for personal reasons to learn more (a vague, yet true statement).

Adult Children of Alcoholics/Dysfunction is another 12 Step group I would refer you to. Google them. A lot of people in other 12 Step programs find this one to be helpful, sometimes more helpful than the program they are in, and there's 0 stigma because to qualify for the group you just have to identify with the Problem or Laundry List, meaning that plenty of people attend those programs with no substance issues, although many with substance issues get a lot out of the group. You can't tell just by membership or looking at someone at ACA if they have substance issues or not.

For doctors with any medical issues, the system is always more concerned about running the system, and protecting patients. They will tend to you as a very valuable and useful tool, but only as much as you are a valuable and useful tool. Dehumanizing, I know. You're going from med school a place you pay to be nurtured to a future doctor (and how kind was that process?) to a place that wants you to get 'em in get 'em out.
 
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