Dr. Russ Reed, now in his 60s, was the eighth generation of doctors in his family. “My father was the kind of physician who believed that doctors should try each drug before giving any to a patient,” he said. The senior Reed was also the kind of doctor who took three Nembutals–heavy sedatives–to get to sleep at night. “At that time no one thought of that as addiction,” said the son. “The word was hardly used in polite society, and it was certainly never applied to a respected physician.”
His general surgery practice was becoming rather frantic. Drug addiction can take up a lot of time, he discovered, especially if one wishes to keep it a secret. “Mondays and Tuesdays I’d work my ass off,” he said. “Wednesday and Thursday I’d have rounds. I was injecting myself at work, often right through my pants so that I didn’t have to slow down to take my pants off.” Reed would sit in his office chair and stab the needle right into his thigh muscle. “It’s a miracle I didn’t get some kind of infection. Sometimes the needle would go right through the money in my pocket, and money is one of the dirtiest things there is,” he said with a smirk.
In her landmark research, LeClair Bissell studied not only doctors but other professionals, such as lawyers. She wrote in Alcoholism in the Professions, “As treaters of others, professionals may be unusually slow to seek help for alcoholism. Inappropriate treatment and long delays in intervention have been the rule. We cannot know how much harm is actually done to patients or clients by the alcoholic or drug-using professional, but it must be significant.” One doctor described doing surgery in a blackout. That is, he performed an operation from beginning to end and the next day he could not remember a thing about it. “Generally, professional intervention still takes place quite late in a drinking career and usually even then only when some other agency has first become involved.” The head of one treatment center for doctors and other health care professionals said that 70 percent of the doctors he saw came for help only when they were finally in danger of losing their licenses. Yet more than 40 percent of the doctors surveyed by Bissell had never had a colleague or superior mention the problem–even when they were drinking on the job–indicating a high degree of denial among doctors and those working with them. Many of those doctors sought professional help for their problems, but they misperceived their problems as depression, mid-life crisis, or something other than addiction. The people they went to for help were no better at diagnosing the illness. Forty percent of the doctors surveyed were told by psychiatrists that they were not alcoholics–not addicted–even after the doctor-patients described their drinking and drug-use habits. Some of the psychiatrists even offered the addicted doctors other mood-altering drugs as substitutes.
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“In 1973 I knew there was something dreadfully wrong,” Reed said. “I told my wife there was something wrong. I was depressed. I was sick.” And so he did something that addicts have been doing for centuries, something that has been elevated to a thematic genre in literature: he took what’s known as the “geographical cure in which the afflicted person simply moves, hoping that everything will be different in the new location. Reed moved to South America and worked in a mission. And everything, indeed, was different. Well, almost everything. Like the dying hero of Under the Volcano, he lurched through his year in the wilderness, giving one pill to the patient and one to himself–one for you, one for me–until he was on the verge of death. He fed his addiction “mostly with drugs, but occasionally I’d get a fifth of Smirnoff’s and really go at it.”
Today, Reed is grateful that he was not allowed to perform surgery any longer. “I didn’t kill anybody,” he said. “But I know somebody who had an extra operation he could have done without . . .” And he trailed off into a wistful introspection. In fact, his surgical privileges were suspended at the hospital and never regained. But by that time he had already decided that he no longer wanted to practice surgery. He wanted to work treating doctors with PAD.
Doctors today can trace physical addiction to a location in the hypothalamic instinctual center in the brain and even explain that it results from a chemical imbalance within the body’s own pain-mediating system–“a biochemical defect in the hypothalamic instinctual control center in the endorphin and enkephalin systems,” wrote Talbott. Yet few doctors (other than the fairly small number of specialists in addictionology who have recently arrived on the scene) are able to recognize primary addictive disease either in themselves or in their colleagues. (One of the best-known psychiatrists in the country, Mark Gold, director of research at Fair Oaks Hospital in Summit, New Jersey, told me that one of his closest friends was addicted to cocaine and Gold didn’t detect it.) Addiction is a remarkable disease that tells the patient he has no disease. Then it gives him the tools with which to conceal the disease not only from himself but from others. At least for a time.
Primary addictive disease has a psychosocial component as well as a biogenetic one. Most researchers today believe that the genetic disposition to PAD is not in itself sufficient to bring on the symptoms of compulsive drug or alcohol use. Social and psychological factors must be present to trigger the disease. For example, high rates of PAD correlate with “relative affluence, exposure to the sophisticated environment of urban areas, distancing from the more abstinence-oriented fundamentalist religions, social settings in which drinking is accepted, very high (as well as very low) educational level . . .”
