Are you reading this while coming down after a drug enhanced night out? If you are, you are probably not the only one. Ian Harwood, a registered mental health nurse and medical student, investigates drug use in medics

Most prospectuses for medical schools throughout the world do not refer to one of the most important personal skills and qualities needed to be a traditional medical student. Alongside academic ability and good problem solving skills must lurk the necessary endurance levels to face a grilling from a consultant through the fog of crippling hangovers, near fainting from starvation, and the exhaustive effects of coming down from last night's ecstasy tablets or lines of cocaine. Is this overdramatic? Not according to the experts.

When the fun stops

Qualified doctors display much higher levels of persistent alcohol and drug misuse than other members of society. In 1998, the BMA estimated that one in 15 doctors in the United Kingdom were alcohol or drug dependent.¹ This is significantly higher than in the general population. A survey of house officers in the same year found that more than half of those surveyed regularly drank more than recommended safe alcohol consumption limits, 11% used cocaine on a regular basis, and 10% pointed to use of cocaine, ecstasy, or amphetamines. A study published last summer found that doctors are the professionals most likely to have alcohol related deaths.²

It is generally recognised that doctors experience higher levels of psychological disturbance compared with equivalent professional occupations.³ Alcohol and other drugs, often self prescribed, are the coping strategies adopted by medical practioners often beginning during their early years at university. According to one study, substance misuse is not confined to any sector of the profession and that it affects male and female doctors of every age and grade of seniority.⁴ It crosses international frontiers and cultural boundaries with impunity.

It'll never happen to me

The appalling fact is that we know the downside of addiction and substance misuse but choose to ignore with an "it will never happen to me" attitude. No, of course it won't--we all know that doctors are gifted super humans who fix others. We all have the deep down comforting knowledge that addiction really does happen only to others. Addiction and chemical dependency are not the most glamorous of the glittering prizes awaiting us when we jump through the final hoop and switch from being Student Nobody to Doctor Somebody. It can happen, it does happen with frightening regularity, and the chances are that it could happen to you. A self described alcoholic doctor, speaking anonymously, tells of their stigmatising addiction in harrowing terms: "Three horrific weeks, drinking vodka on my sofa, tormented with the conflict of compulsion to drink against the knowledge that the habit would lead me to jail, psychiatric ward, or, the more attractive option, death."⁵

This doctor had not asked for help before, despite knowing that they had a problem, fearing that disclosure could result in suspension. This doctor has since rebuilt a professional life and practises under medical supervision. Chillingly they add, "As a doctor, with my 'insight' and knowledge, I assumed immunity to addiction."

Begin at the beginning

Heavy consumption of alcohol has long been the acceptable face of medical education. Doctors are introduced to the socially acceptable coping mechanism of heavy drinking while at medical school. The drinking culture is perpetuated in and out of the classroom--how many consultants have you heard make jokes about jolly medical students getting drunk and being incapable of attending lectures the next day? This obviously refers to the boys among us--the real men, as only the most politically correct of our medical mentors would dream that this could encompass the women in our midst. But they must have forgotten their medical education--anyone who has ever been to any undergraduate social event knows that the Great British Medical School is an effective social leveller as far as consumption of alcohol is concerned. Men and women are equally vulnerable.

Getting caught

Students are encouraged to let their hair down and have fun--the old cliché "work hard; play hard" seems to work until you cannot work effectively because of an excess of playing. "Have fun but don't let it interfere with your academic progression," is the unspoken message. Once qualified, this converts into, "Do what you like but don't get caught." Doctors facing complaints are referred to the General Medical Council's health committee. According to a presentation given by Dr Eilish Gilvarry, a consultant psychiatrist at the Newcastle-upon-Tyne Drug and Alcohol Unit, in 2001 latest figures show that of those doctors involved in complaints procedures against them who were invited to be medically examined after initial screening, 72% were on grounds of problems related to drugs or alcohol.

Of those doctors allowed to continue practising under GMC supervision at the end of 1998, after assessment by the health committee, 58% were purely drug and alcohol related with a further 13% related to a dual diagnosis of problems related to psychiatric and substance misuse. More than three quarters of sick doctors undergoing supervised practice are doing so because of alcohol and other drugs.

MARIO TAMA/GETTY IMAGES

White lines--don't do it

Crossing the line

One of the definitions of addiction is continuing to do something that you do not want to do, even when it messes up your life. It is much easier to deal with problematic substance abuse as it is developing. Recognising the warning signs is paramount to changing what can become a spiral of self destructive behaviour.⁶ Students can learn the constituent questions for the recommended CAGE questions to ask patients about their drinking habits but what about us? What should we, today's medical students, be asking ourselves?

• Do you ever feel that you have done something you didn't want to do because you were off your face?
• Do you look forward to weekends when you can drink and use drugs as much as you like, without restriction?
• Have you ever failed to do your best in an assignment or exam because you were feeling the after affects of booze or drugs?
• Do you regularly drink or use drugs to relax, to chill, and escape from the daily grind?
• Do you drink or use drugs to change how you behave, to loosen up, and to cast out the demons of those stuffy parental inhibitions?

Check how often you do this and look at your behaviour objectively. Not sure? Ask your mates. Act as if you were a patient you were assessing. Calculate your weekly consumption of alcohol--remember more than 28 units for men and 21 for women is deemed unhealthy. Be honest because it is only yourself that you are kidding.

If you are concerned and do not want to talk to the universities' student support services, you can contact the BMA's counselling service (only if you are a BMA member) for further advice and guidance. In the United Kingdom there is a self help group of working health professionals, mainly doctors and dentists who have undergone problems with substance misuse, which meets on a regular basis and which would welcome any calls from medical students. All contacts are treated in the strictest confidence--these people know how highly regarded total discretion is for members of our profession.

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