For years Peter Grinspoon, MD wrote false prescriptions, skimmed pills from patients and lied to both friends and family, colleagues and patients, feeding a destructive drug addiction. That was 11 years ago and now, the Harvard educated doctor and primary care physician, is sharing his journey to recovery in the new book Free Re-Fills: A Doctor Confronts His Addiction.
We sat down with Dr. Grinspoon–who is celebrating nine years of recovery–to discuss his book and the unique challenges faced by addicted physicians.
MedTech Boston: Who did you write this book for?
Peter Grinspoon: I wrote Free Re-Fills somewhat for physicians because I felt that a lot of addicted physicians are afraid to get help, but I didn’t write it just for them. I wrote my book for people who are struggling to understand addiction and ideally to help people understand addiction more as a disease than as something that requires punishment. There’s a whole movement to try and understand addiction less as a moral failing and I wanted to help that process along.
Before your recovery, did you at any think of yourself as an addict?
On some level I knew that I was, but the denial is the most dangerous part of the disease. It really is amazing what people are able to be in denial about. I was still seeing patients and still thought of myself as a popular, healthy, mature doctor–there were a lot of things in my life that facilitated my ability to delude myself about this. But on some level, partially conscious and partially unconscious, I knew that I was really in trouble and really screwing things up.
You went through several different programs—you visited Narcotics Anonymous, spent time at a rehab facility, took part in therapy, tried medication—with mixed results. What did you find to be the most key thing in your recovery?
That’s a really great question because I don’t 100 percent know the answer to that. So many things happened at once, it’s like a flawed experiment. A lot of it was that I really wanted to be a doctor again, and that was just not going to happen if I didn’t get through recovery. And a lot of it was my kids. I didn’t want to not see them and not be a stable force in their lives.
I have mixed feelings about rehab. I know there’s been a lot of criticism of the rehab industry and a lot of what we went through rehab frankly was absolutely nuts. But getting me away for three months and getting me into group therapy helped clear my head, so I think that really played a role. I also think part of it was the physician support group meetings that I went to, which are basically AA or NA meetings for doctors and dentists. That sort of comradery was really helpful because you realize you’re not alone and you realize that people can do this, that you can recover.
As a doctor, you know better than anyone the effects of drugs and symptoms of addiction. Because of that knowledge base did you think you knew what you were getting yourself into? As a doctor, how did you intellectually rationalize your behavior?
The answer to that evolved a little bit. In the very beginning, when I was in medical school, we did feel like we knew better and we were untouchable and had this God-like knowledge. Hey we can take Vicodin, we know what it’ll do—it’s fun and cool. It started out like that. But then slowly, imperceptibly, as you become addicted it highjacks the part of your brain that makes you want to do selfish things. You forget the part that says that’s a really bad idea because the part that says feed me this euphoria, satisfy my pleasure centers becomes so much stronger. You’re not in your right mind when you’re fully addicted. I think the part of my brain that should have known and did know was undermined by the fact that I was addicted and that so much of the rest of my brain was focused on getting certain molecules to certain pleasure centers in my brain. The mundane thought of hey you shouldn’t take nine Vicodin didn’t compete with the part of my brain that said wow nine Vicodin, I’m gonna get a great buzz.
Unfortunately, addiction is not uncommon among doctors—an estimated 10 to 15 percent of practicing physicians are addicts. How is the topic discussed among doctors?
It couldn’t be more taboo. Part of the problem is that the treatment for doctors is so punitive that a lot of people are afraid to get help and are afraid to come out of the shadows. That’s why people don’t get help until you read about them in the paper, or they’re drunk in the OR, or they get a DUI. People’s addictions progress because it’s so taboo. Ideally we wouldn’t help people when they’re crashing and burning; ideally we’d be helping people when they recognize they have a problem and ask for help.
As for the repercussions, you talk a lot about the Society to Help Physicians and your process with the medical board calling it “restrictive” an “degrading” throughout the book, but at the end you credit SHP as one of the things that helped you overcome your addiction. What changed your perspective?
Part of it was being a little bit more mature. I was so mad at the pharmacist that busted me when she busted me. I was so angry and resentful, and now, in retrospect, I’m very grateful to her. I could have overdosed. I might not even be here if she didn’t do what she did. It’s a change over time in my attitude and it’s the same with SHP.
My addiction was fighting for its life. I thought I was this successful doctor that had it under control. That couldn’t be further from the truth, and so I thought it was very coercive and degrading to have to take drug tests and have to go to support group meetings and listen to people. But over a long painful process, over time I’ve come to understand that it’s such a luxury to have that. Physicians tend to do really well because we have things like SHP, and we have resources and have a lot to lose–our livelihood and our medical license. Being in recovery I came to appreciate a lot of the very things I hated when I first had to deal with it.
The SHP has been questioned regarding its duality as an advocate for physicians and as a policing body. As someone who has gone through its process, do you think maintaining this duality is the most effective way for SHP to operate?
It’s a very tricky and delicate balance. All kinds of problems arise because the board wants the SHP (where I worked for two years as an associate director) to be more like policemen because they want to make sure people are really being monitored and really coming clean.
But at the same time, you see doctors that are recovering and doing great and it can be really frustrating to see how unaccepting and unsupportive the board can be, not always, but really can be. Sometimes you feel like the same prejudices that society at large has against addicts are magnified in the medical board. Granted they do have the component of protecting patients and that’s a whole other discussion and a really important part of what they do, and I’m sure that’s part of what makes them so conservative, but at some point you feel like if a medical board made out of doctors can’t understand addiction as a disease that requires compassion and treatment not punishments and criticism, who can understand that?
So you sort of get both sides when you’re at SHP and it’s a very delicate balance. Whether it’s the most effective way to address this…I don’t know that it’s the most effective that it could possibly be, but physicians generally have an 80 percent recovery rate when they comply and go through the physician help programs. That’s astronomical for addiction. Part of that is that doctors have a lot of resources and a lot to lose but part of it is because of the physician help programs. I can tell you as a primary care doctor who works in an inner-city clinic, I don’t have nearly an 80 percent success rate with my addict patients. I know there’s been a lot of criticism but they do have to get credit for a lot of people that they’ve helped, including me.
You say in the book that “taking pills was a way of saying fuck you to the unreasonable demands” of your job and your life at that point. Everyone knows doctors enter into a very demanding job and atmosphere. What would your suggestions be for changing that atmosphere for the better?
There have been steps in the right direction. When I was a resident there were 36 hour shifts. I was hallucinating after about 30 hours. That’s so destructive. Now you’re only allowed to have 24 hour shifts, so people are trying to change it. That’s still pretty crazy and inhumane and I think they could do more in terms of not having residents work these astronomical hours, but I think part of it is the culture, the culture of the rugged individual who’s self sufficient and isn’t supposed to get sick.
The hardest part is going to be re-conceptualizing what a doctor is. Part of what I try to get at in Free Re-Fills is that doctors are patients, doctors are people. They’re not a separate class that doesn’t have problems. The more that they get treated as people and the less they’re put on a pedestal and then criticized when they fall off it, the healthier it will be for everybody.
What’s the most important thing to keep in mind about addiction?
It’s so important that people understand that addicts don’t mean to hurt anybody and that they’re sick, they’re ill, and the only way to treat them is with compassion, not with shaming and punishment. I just hope that Free Re-Fills helps nudge things along in that direction. They’re already heading in that direction, but that’s a really important theme I want to emphasize because there are a lot of really miserable people out there and to just put them in jail or to criticize them doesn’t get them better.
Paula is a freelance science writer and strategic communications associate at Health Leads. Formerly a managing editor at MedTech Boston, she has a B.S. in Journalism from Boston University and has worked with the New England Center for Investigative Reporting, Boston Globe, Social Documentary Network, BU Today and several nonprofit organizations. She can be reached at email@example.com.
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