Avoiding unhealthy coping mechanisms in your medical career

Doctors and substance abuse is a topic the profession rarely talks about openly, despite doctors being trained to spot problem drinking and drug use in their patients. 

That same skill doesn't always turn inward, even as the pressures of medicine push some clinicians towards unhealthy coping mechanisms that quietly become a problem. 

Many stay silent out of fear that seeking help will trigger a mandatory notification to Ahpra, our national regulator.

Here, experts explain how to know if you have a problem, the real risks of coming forward, and where to find confidential support.

Why do doctors turn to substances, and is culture part of it?

Evidence on whether substance abuse and addiction is more common among doctors than the general population is limited, though the link with distress is clear.

Beyond Blue's 2013 landmark survey on the mental health of doctors and medical students found hazardous or high-risk drinking was far more common among doctors with high (6.9%) or very high (8.9%) psychological distress than those with low distress (1.3%). It was also significantly higher among male doctors (18.1%) than female (10.9%).

A 2023 systematic review of 31 studies across 17 countries found problematic alcohol use among physicians rose from 16.3% to 26.8% between 2006 and 2020.

Professor Dan Lubman, Director at Turning Point and Professor of Addiction Studies at Monash University, says doctors use substances for the same reasons as everyone else — to relax, sleep or get through a tough day. What's different is the load they're often carrying. 

"Working in the medical field can involve long hours, shift work and high-stakes decisions. People often may turn to alcohol and drugs as either a way to switch off or keep going."

Addiction Medicine Specialist Dr Chris Holmwood says misuse of substances such as benzodiazepines and opioids among doctors is also common, largely due to easy access.

Doctors' own high standards compound the problem because they're "difficult to achieve in modern healthcare settings", he adds.

Prof Lubman traces the pattern of pushing through and prioritising work over health to the early days of medical training. 

"This is changing, but needing help still looks like a weakness," he says. "Alcohol fits into that culture well because it's legal, social and easy to hide."

Early warnings signs

Doctors protect their clinical work fiercely, so problems usually show at home long before they show at work, says Prof Lubman. 

Early signs are private: needing a drink to unwind or sleep, needing more for the same effect, drinking alone, or planning your roster around when you can drink or use.

Dr Holmwood flags daily drinking as an early concern and says looking forward to that first drink is worth noticing.

"The 'I could do with a drink' thought should give cause for reflection," he says.

Sharper red flags include self-prescribing "just this once", prescribing for family, or still having alcohol in your system at work — which is notifiable conduct under Ahpra.

What stops doctors admitting there's a problem?

Recognising, admitting and acting on a problem are three separate hurdles, says Dr Holmwood. 

"If the culture accepts higher levels of alcohol use as normal, that dissonance doesn't develop. Without adverse outcomes — health, legal, interpersonal — or family and colleagues commenting, people are less likely to see there's an issue."

Stigma remains the biggest barrier, Prof Lubman says, even as we've become more empathetic about addiction.

Perceptions of colleagues can be harsh too: Beyond Blue's 2013 survey found 40% of doctors thought a colleague with depression or anxiety would be seen as less competent.

Doctors are also trained to be the helper, not the patient, Prof Lubman adds. 

"There's a belief that they should be able to sort it out by themselves." Ultimately, fear of burnout being exposed or losing registration keeps many silent, he says.

Beyond Blue found over a third of doctors (34.3%) named impact on their registration as a barrier to seeking help, and over half (52.5%) were worried about confidentiality.

How mandatory reporting works

A notification to Ahpra can be triggered by impairment, intoxication while practising, a significant departure from professional standards, or sexual misconduct. 

But a treating practitioner isn't required to report automatically just because a doctor-patient has a health condition. They must weigh the nature and severity of the impairment, what treatment the patient is engaging in, and the actual risk to the public. 

Dr Patrick Clancy, GP and Avant Medical Advisor, says the threshold — a 'substantial risk of harm' — is deliberately high, so a well-managed illness would rarely trigger a report on its own. The fear driving doctors to delay treatment for this reason is largely unfounded, he says.

"If the condition is being managed so the risk to the public is reduced by effective controls, there is no requirement to notify." 

Controls can include treatment, leave, supervision or a modified scope of practice. 

Western Australia fully exempts treating doctors from mandatory reporting altogether to enable doctors to seek mental health treatment without fear. The AMA, RACGP and Avant would like to see this model adopted nationally. 

Why seeking help early matters, and can you keep practising? 

If the issue is reported or self-reported, regulators look closely at whether a doctor has recognised the problem and taken proactive steps, says Dr Clancy. 

"Doctors who come forward early generally place themselves in a better position than those who ignore the warning signs." 

The real risk, he says, is continuing to practise while impaired. 

"The key question isn't whether a doctor has a diagnosis, it's whether they're able to practise safely."

Many doctors who engage in treatment continue to do so, he says.

Dr Holmwood says overcoming dependence takes time, and recovery may mean reducing or pausing clinical work while a treatment plan takes hold. 

Confidential support available

There's a range of peer-to-peer and confidential support services available for doctors independent of Ahpra, including national helpline Drs4Drs, state-based Doctors' Health Services and Australian Doctors In Recovery (ADR), a peer fellowship for those recovering from addiction. 

Dr Holmwood recommends having a GP outside your own practice, and contacting your medical indemnity organisation early if Ahpra becomes involved, as they can connect you to experienced professionals. 

"Remember that there are plenty of people who can help and who want to help — and plenty who have had the same issues and overcome them," he says.

Prof Lubman adds that treatment can be very successful, and doesn't have to mean rehab.

"There's a really good broad range of treatment, including outpatient care and effective medications. Getting support really helps."

Key takeaways:

• Doctors face the same substance use risks as anyone, heightened by overwork and a culture where asking for help looks weak.
• Early signs are private: drinking alone, needing more to cope, or planning around use.
• Stigma, not actual legal risk, is the biggest barrier to seeking help.
• Ahpra's reporting threshold is deliberately high; well-managed conditions rarely trigger a notification.
• Coming forward early protects your career; most doctors can keep practising safely with support.
• Confidential help is available independent of Ahpra.