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Addiction in Dentistry William T. Kane, DDS, MBA

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Every dentist from the first day of dental school has heard of the high rates of suicide, alcoholism and divorce in the dental profession. Dentistry has held this reputation for many decades. When one thinks of addiction, alcohol and drugs are at the top of the list. There are also, behavioral addictions such as compulsive gambling, sexual compulsivity, eating disorders, compulsive shopping and problematic Internet use. Dentists and their family members can be affected by one or more of these addictions.

Addiction is a complex primary, biogenetic, psychosocial, chronic progressive disease that if left untreated could lead to death. The good news is addiction responds well to adequate treatment. A recent definition of addiction is as follows, "Addiction coops the brain's neuronal circuits necessary for insight, motivation and social behaviors. This functional overlap results in addicted individuals making poor choices despite awareness of the negative consequences; it explains why previously rewarding life situations and the threat of judicial punishment cannot stop curtailing addictions."¹

Dentists are especially susceptible to addictions and emotional impairments due to their stressful working environment and striving for perfection. Dentists are trained to be both technicians and artists, performing exacting procedures in isolated environments, determined to achieve the mythical "ideal restoration." Dentists who are prone to addiction struggle with exaggerated fears, deficient interpersonal skills, internalizing their patients' anxieties, a competitive nature and easy access to drugs. These burdensome circumstances can result in the feelings of inadequacy or failure, and create a fertile ground for addiction and or psychological disorders. This begins on the first day of dental school and carries over following graduation. Some individuals deal with these stressors better than others. Stated another way, some of us deal with life on life's terms better than others.



The percentage of the dental profession affected by addiction is basically the same as the general population; estimates range from 11 to 20 percent. However, there are subtle differences specific for dentists with addictive diseases. For instance, the drug of choice may be different in most cases, but the disease of addiction is the same. Addiction tends to progress over time. At first, addicted dentists can be a master at hiding their drug use from their family, office staff, and of course patients. Family and office staff might begin to make excuses for deteriorating behavior and performance. When excuses begin, this enables the addictive disease to begin to spiral downward. The isolation of a solo dental practice further contributes to this process. The dentist with an addiction feels very isolated and alone. He or she feels that they are the only one in the dental profession that are in the throws of addiction.

As addiction progresses, personal and professional lives deteriorate. Most individuals with the addiction tend to blame others, events, circumstances – you name it – for their problems. The dentist with an addiction will be in denial that he or she indeed has an addiction. For the most part, they are incapable of asking for or receiving help. It has been reported that suicide was actually the result of the end stage disease of addiction.

Often the denial is broken as a result of some sort of intervention. This can come in the form of an investigation from a state dental board, a DUI, some type of personal or professional crisis, or even a well-planned professional intervention. The goal of an intervention is for the dentist involved to have a multidisciplinary evaluation by professionals in addiction treatment and hopefully follow through with the recommended treatment. This is when the healing begins as the dentist begins his or her journey in recovery. Discovering there are other dentists in recovery is very comforting and provides tremendous support for those just beginning their journeys.

Most state dental associations have programs to assist dentists, dental team members as well as family members dealing with addiction or wellbeing issues. These programs have been in existence for many years and have helped thousands of dentists restore their personal and professional lives. There exists in dentistry, as well as other professions, something called, "The Conspiracy of Silence." This involves knowing or strongly suspecting a fellow dentist or even a patient of an addiction issue and taking no steps to help this person. By saying nothing or doing nothing the individual with the addiction continues to suffer in desperation. Generally, we, (the dental profession) keep silent by rationalizing, "It is none of my business," or, "I am not my brother's or sister's keeper."

Most dentists and dental team members know a professional colleague or patient who is indeed suffering from an addictive disease. The suffering colleague might be in one's own geographic area or even a classmate in a different part of the state or country. Indications that a professional colleague may be having an addictive disease issue is not difficult to notice. Dentists need to be diligent as well with their patient populations for those in active disease as well as recovery.

It is fairly easy to familiarize yourself with knowledge of addictions. An excellent source of information is a dentist who is in recovery. Most are very helpful in sharing their stories of addiction and the journey in recovery. Our patients who are in recovery are also great resources. Look on the Web site of your State Dental Association to see if they have information concerning well being or addiction issues. I have also provided you with a list of resources you can contact.

If you are concerned about a professional colleague, pick up the phone and call the Program Director of the Well-being Program in your particular state. The information you provide is strictly confidential. Your phone call may save your colleague's personal and professional life.

Briefly discussing addiction in the dental profession is comparable to a writing exercise in Philosophy 101. The assignment: "Discuss the meaning of life as it relates to the forces of good and evil, compare and contrast, give two examples of each, and do this in 150 words or less." This is the first of several articles specifically on the various aspects of addiction in dentistry I aim to write for Dentaltown Magazine over the next year.

Reference
1. Volkow, N. D., Baler, R.D., Goldstein, R.Z., Neuron 69, Feb 24, 2011 p 599
Author’s Bio
William T, Kane, DDS, MBA, graduated from the University of Missouri – Kansas City School of Dentistry in 1980. He maintains a general practice in rural Dexter, Missouri. In addition to practicing dentistry, Dr. Kane's interest and passion have been in the area of recovery and wellness. Since 1987, Dr. Kane has been the Chairman of the Dentist Well – Being Committee for the Missouri Dental Association. Additionally, Dr. Kane served as a member of the Dental Wellness Advisory Committee (DWAC) with the American Dental Association. Dr. Kane is very familiar with issues facing patients with addictive diseases and has published and presented on these topics. He also completed an MBA in 1992 from Southeast Missouri State University. In the fall of 2010, Dr. Kane received his Fellowship in the American College of Dentists.
National and State Health & Wellness Programs

ADA Dental Health and Wellness Department
Web site: www.ada.org/4497.aspx
Contacts:
Alison M. Siwek, Manager
siweka@ada.org
312-440-2622
Mary Gilliam, senior project assistant
gilliamm@ada.org
312-440-7473

State Dental Associations
Colorado Dental Association Concerned Colorado Dentists
Web site:
http://www.cdaonline.org
Contact: Michael Ford
303-810-4475

Louisiana Dental Association Dental Well Being Advisory Committee
Web site: www.ladental.org/cms/content/view/181/41/
Contact: Jamie Manders, NODA
jamiemanders@yahoo.com
504-366-8193

Maryland State Dental Association Dentist Well Being Committee
Web site: www.dentistwellbeing.com/
Contact: Robert White, Clinical Coordinator
410-328-8549

Massachusetts Dental Association Dentist Well Being (C-DAD)
Web site: www.cdad.org
Contact: Thomas Derosier, Chair
tderosier@aol.com
508-540-0303

Minnesota Dental Association Dentist Wellness Program
Web site: www.mndental.org/dentist_home/member_services/wellness_program/
Contact: Sand Creek Group
800-632-7643

Mississippi Dental Association Council of Supportive Services
Web site: www.msdental.org/aboutmda/councils
Contacts: Bruce Scarborough, Chair
601-446-8389

Montana Dental Association Dentist Health and Wellness
Web site: www.mtdental.com
Contacts: Ingrid McLellan, Council Member
dr-ingrid@qwestoffice.net
406-443-5526

Nevada Dental Association Northern Nevada Dentist Health and Wellness Committee
Web site: www.nndental.org/default.php?p=Co
Contacts: Michael Day, Chairman
mday212735@aol.com
775-358-5265

New York State Dental Association Chemical Dependency Committee
Contacts: Health Affairs
jdonnelly@nysdental.org
800-255-2100

North Dakota Dental Association
North Dakota Dept. of Health Oral Health Program
Web site: www.ndhealth.gov/oralhealth
Contacts: Kimberlie Yineman, Director
kyineman@nd.gov
701-328-4930

Rhode Island Dental Association Dentists Health
Web site: www.ridental.com/councils.cfm
Contacts: Robert Champagne
401-351-1110
Raymond George, Jr.
401-434-1127

Colegio de Cirujanos Dentistas de Puerto Rico Commission of Oral Health
Web site: www.ccdpr.org/portada/comisiones/26
Contacts: Arminda Rivera Mora, President
drariveramora@gmail.com
787-242-1187
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