There is a dark side to stress and it shows itself in the
offices, homes and lives of dentists so overwhelmed they turn
to extreme measures to avoid and dull the pain. These maladaptive
coping methods range from excessive gym visits,
lengthy hours of screen time, sleepless nights, self-injurious
behaviors and drug abuse. The shame and embarrassment of
these actions make dentists feel alone. But they're not alone.
In fact, the statistics on substance abuse among dentists are
staggering. Fortunately, there is a way out.
As a new graduate, I purchased a well-established but
antiquated dental practice. I was stuck with old equipment
and a hygiene program I didn't want a part of, so after
only six months I realized the way this practice was going
wasn't for me. I implemented changes including new equipment
and better practice management. The next seven years,
my gross increased 400 percent (with an average of 52 percent
I was practicing dentistry, had time for my family and
for golf. I was doing what I loved to do. I had money and
time and toys. Life seemed great. Unfortunately, I didn't
know how to make a budget and I was afraid to admit it so
I never asked for help.
After a few years my practice took off but I was stressed
about treatment acceptance. I attended CE courses to offer the
very best treatment but became frustrated when I was relegated
to basic procedures. It became very taxing and stressful to me
when patients refused what I considered ideal treatment. The
stress and pressure of gaining case acceptance was mounting
and patients could tell by how I presented treatment.
I was the first in my area to use modern technology, and
word of mouth spread fast, so quickly I became overwhelmed.
I began to feel apprehension each morning on my
way to work. It wasn't clear what was wrong at first. I finally
realized I was afraid of losing patients. I had them and I
needed to keep them.
The practice had exploded. My hygiene schedule was
booked eight months out and my operative scheduled six
months out. I went from 36 hours of office time to 54+
hours a week. We overfilled our schedule from the cancellation
lists. Weekends were spent doing lab work. I wouldn't
allow myself to delegate anything. I was working like a
machine and ignoring what my body was trying to tell me; I was burnt out. It was so bad my wife quit setting a place
for me at the dinner table. Of course, I justified it like everything
else, as part of the job.
During this time, I developed chronic sinus headaches. I
was so busy I didn't dare miss a day of work to take care of
myself. I was taking up to 20 Tylenol per day to get through.
The pounding of my head and the constant stress became so
much I finally had to do something.
The Slippery Slope
One evening before leaving the office, I decided to take
one of the many hundred Vicoprofen samples I kept for
patients but rarely remembered to dispense. It wasn't 40
minutes later I felt like a new person. I had energy! And a
(false) sense that my stress had just been chopped in half. My
headache was totally gone - why go see a doctor now?
Eight months later I was addicted to hydrocodone.
Instead of waking up looking forward to the day, I woke up
to count how many pills I had available to make it through
the day. It seemed the only thing that mattered.
At the same time, the rest of my life became unmanageable.
My family became a superficial presence in my life, my
friends and social acquaintances didn't matter any more,
hobbies no longer interested me, my spending became out
of control and I neglected several quarterly estimated payments.
I isolated myself from everyone and everything, not
realizing the extent or impact until later. The worst part: I
was afraid to confide in the very people who loved and cared
for me. The shame and guilt was stifling. The little pill that
cured my headache and relived my stress was now controlling
every facet of my being.
When I couldn't get pills, I would substitute with alcohol
or shopping. Living in excess was a habit my body and
mind had become accustom to. At this point, I'd been fighting
this for four years. I knew I had become addicted but
still never considered myself an addict.
As a result of the sinus infection and the surgery required
to resolve it, I came clean to my wife and we decided it
would be best to sell the practice and move. The stress of
running the practice coupled with the stress of returning to
a comfortable environment was too much. With all my
spending, practice upgrades and extra toys we'd racked up
such significant debt that we had to declare bankruptcy. It
all happened so fast, I had no time to divert funds and we
I moved to a new location and was set up to start as an
associate in a large practice. I should have done my homework
better. The practice that had promised a nice paycheck
did nothing but frustrating dentistry for PPO pricing. I
tried to work more hours to make up the financial difference
but ended up with terrible tendonitis in my elbow. I ended
up at a pain clinic only to be prescribed oxycodone. I knew
better, but the addict was stronger. Within a short period of
time, I was back to a full-blown addiction. Three months
went by and a friend who understood what I was dealing
with referred me to a psychiatrist who prescribed me a medication
which had only been available for about four years -
Suboxone. It immediately changed my life for the better. It
took away the compulsiveness to use opiates and blocked the
receptors if I did decide to use.
What he didn't tell me or realize is that only nine states
currently allow physicians and dentists to practice while taking
Suboxone, my state not being one of them. After I
switched practices, my previous boss called the state's wellness
committee concerned about my use of Suboxone while
practicing. On the phone, the wellness committee requested
I be evaluated for five days for addiction. Five days turned
into 90, which my insurance did not cover.
Once I finished the program, I took two months off
work. I didn't realize the toll my environment would play
when I returned. I went back to the same dilapidated office
and back to the same routine I'd burnt out on just months
before. I was still accountable to the state wellness board. I
had to call every morning to see if I needed to take a drug
test. When I learned they would only ask for one drug test a
month, my addict brain kicked in again.
Despite my diligent attendance at 12-step meetings,
I was already emotionally relapsing. I felt like hell every
day. I ended up relapsing about 11 months into my contract.
I didn't care. All I wanted was to feel "normal"
again. Another relapse and more treatment that I felt to
be a total waste of time - group therapy and one-size-fitsall
After returning home I received a call from the wellness
committee stating they were turning me into the board. In
the end, I felt it was in my best interest to surrender my
license. I knew I had to focus on my depression and anger
issues, which had been diagnosed both times on admission
to treatment. The time was now for me.
Now I'm without a license in the state I live in. I am full
of resentment and anger toward the wellness chairman, the
treatment center and myself. After 135 days of inpatient
treatment, I had to find a way to stay emotionally healthy.
Resentments and anger left unchecked will lead to relapse.
Since I wasn't going to be practicing, I knew it was in my
best interest to get back on maintenance Suboxone. I spoke
with my physician and psychiatrist who both agreed.
Don't be surprised if you might relate to parts of this article
as the prevalence of stress-related addiction (including
alcoholism) is high in our professional community. We are
not born with innate coping mechanisms to stress. Everyone
handles it differently. My addiction started from self-medicating
to relieve chronic pain, but stress fueled the fire.
|Advice for Managing Stress
- Find a healthy work-life integration.
- Only practice and live the way you feel comfortable.
- Seek others who have different expertise. Refer procedures
you don't like or are uncomfortable performing.
- Hire a CPA for your practice finances.
- Hire a broker to help you find an associate.
- See your doctor if you're in chronic pain.
- Find outlets outside of work.
- Talk about it (contact your insurance company for a
referral for a therapist).
My brain never seems satisfied and is on constant guard,
even with four years sobriety. My mind frequently ruminates
with recurring episodes of what I've managed to throw away.
To put my circumstance in perspective, I calculated very
loosely that my lack of stress management and addiction has
cost me and my family more than $3 million. This disease
will decimate you and those around you in the worst ways.
It strikes insidiously, stealthy and often unintentionally
The disease always wins. It lurks around in your brain's
pleasure centers "holding cell" just waiting for a bondsman to
let it out. Once it's out, it tells you that you can control everything
now and the cycle starts again, only worse. And while
my experiences is with opiates, all chemical and process addictions
will lead you down this path if not intervened upon.
Having lived through this experience, reflecting on the best
of the best and worst of the worst, the key for all professionals
is to find a healthy work-life integration and only practice and
live the way you feel comfortable. Take CE courses on topics
you want to learn more about - maybe self-management or
finance. Also utilize professionals - hire a CPA for your practice finances. Hire a lawyer whose forte is health care. Have an
expert explain the loan process to you. Teach yourself to delegate,
and don't be afraid of what you don't know.
The Doctor's Advice
We don't have to be everything to everyone. We are, by the
nature of our profession, subject to "secondary traumatic
stress" or "compassion fatigue." But you do not have to absorb
Think about where to set your personal and professional
boundaries. Since we can't see ourselves, and our loved ones usually
enable us, our employees are scarred of us and our friends
rarely see us, this overburdening stress can easily go unchecked.
Because dentists are overachievers who carry an enormous
workload and stress, the tendency to escape from daily problems
is often through the use of alcohol and drugs. For those
who think they are off the hook, there are process addictions
including gambling, Internet porn, and eating disorders; anything
that overloads our dopamine receptors can become
"addicting." Find a healthy outlet to relieve daily stress, lower
the workload, enjoy practicing again and enjoy yourself and