Chronic Stress Leading to Addiction in Medical Students
Medical school is a rewarding and exciting time for many students and their families. There are high hopes of academic achievement, future career aspirations and success. Getting to work closely with other professionals, all pursuing the same dream, can be exhilarating and motivating.
Nevertheless, there is another side of medical school that can have devastating effects on students, their families, patients and long-term career. Medical school students face demanding workloads and high academic expectations. These pressures combined with family and social stressors can leave many students feeling overwhelmed and struggling to cope. Eventually, this stress may lead to anxiety and depression, which wraps students up in a vicious circle of despair.
When students face these stressors, many of them become discouraged and desperate. They may begin to turn to drugs and alcohol as a means of coping with their troubles or to help stimulate their performance so they can achieve more. For these reasons, addiction among medical students is a serious problem that affects a distinct segment of our future doctors.
As students struggle with addiction during medical school, many of them may carry over their substance abuse into their professional careers when they face different and sometimes greater pressures. The burden of debt from expensive medical school tuitions becomes a reality when they must begin to pay back their loans. This burden further affects the physician as well as their patients and the medical community.
Thankfully, the growing awareness regarding addiction in medical students and professionals is leading to better opportunities for specialized treatment and recovery options.
Lifestyle of Medical School Students
Medical students maintain an exceptionally busy lifestyle, which revolves around studying and practicing to become physicians. With days packed full of classes, clinics and more, medical students can burn out quickly and succumb to the pressures of pursuing this challenging career.
The volume of workload that medical students face after leaving their undergraduate degree is staggering. Often medical students report that their workload has doubled or even tripled in the amount covered and assigned. Often times, students will sacrifice their personal health such as sleep, exercise and diet in order to find enough time to accomplish their workload.
To become a doctor, students may devote eleven or more years to education and specialization. After a four-year undergraduate degree, medical students go on to take another four years of medical school. Already by this time, students have essentially devoted their adult lives to schooling. This alone creates enormous pressure to succeed out of fear of having wasted their time. After medical school, graduates go on to conduct a three-year residency or up to seven years to further obtain a specialization.
Becoming a doctor is a long-term commitment that can be daunting for students who are not fully prepared for the demands of their education and profession. For many students, there are plenty of lifestyle sacrifices to make including social gatherings, family commitments or other life events that don’t fit into their busy schedules. All of this leads to a lifestyle without a healthy balance or prioritizing their wellbeing.
Rate of Addiction in Medical Students
The use of substances (including both drugs and alcohol) among the medical community is well documented. Specifically regarding medical students, the rate of substance abuse has been a concern for many decades. This has led to several studies focusing on the ongoing issue of addiction in medical students, in order to identify how severe the problem really is.
Since 1973, researchers have conducted dozens of studies on the rates of substance abuse among medical students. Studies have looked at a number of factors including substance type, ethnicity, age, marital status and financial debt. Many of these studies have surveyed students across several medical schools and from around the world.
One study in particular conducted a survey at a single school in the United States. The third-year medical students were asked about their personal use of drugs, particularly stimulants, during their time in school.
Here are some of the findings regarding the rates of substance abuse among medical students:
- 20% of students were lifetime users of drugs
- 15% of medical students reported using stimulants while in school
- 83% percent of students who reported using stimulants during medical school, used them to boost focus and cognitive performance
- Over half of the students who were using stimulants had obtained some of the drugs without a prescription
- 25% of medical school students reported being offered stimulants without a prescription
Other findings included the disproportionate use of stimulants among white medical students versus Asian medical students. Additionally, while only a few students were clinically diagnosed with ADHD, almost three times as many students were taking un-prescribed stimulants for ADHD.
The study also found that the rate of stimulant use among medical students didn’t vary by age, marital status or academic performance levels. Stimulant use and dependence on drugs can affect any medical student from any background.
Another study found that of the students surveyed whom reported using stimulants during medical school, 20% of them were using daily. This level of dependency is alarming and causes concern among other related healthcare professions. Stimulant use in particular doesn’t just affect medical school students. The use of stimulants is also widespread among pharmacy and dentistry students, who face large workloads and similar stressors.
Beyond the use of stimulants, medical school students are also at risk for trying and abusing other types of drugs, such as opioids, tranquilizers and alcohol. Another study showed that one-third of medical students abused alcohol as a way of calming themselves down at night and escaping from their high workloads. Students who show signs of emotional exhaustion, burnout and feelings of losing their identity are those who are more likely to abuse alcohol or develop a dependence.
Rates of Addiction in Medical Professionals
Beyond medical students, substance abuse is a concern among licensed physicians as well. One study looked at the rate of substance abuse among practicing physicians. The results showed that an estimated 10% to 12% of physicians will become addicted to substances at some point during their careers. Depending on their specialization, the type of substance abused may differ.
Another study found that among the physicians suffering from addiction, over 50% of them abused alcohol, while 35.9% abused opioids. Another 7.9% abused stimulants and the remainder abused other types of substances. Half of the physicians in the study reported they used a mixture of multiple substances.
Like medical students, many physicians feel isolated or ashamed of their addiction, which only further compounds their dependency problems.
Causes and Risk Factors of Addiction in Medical Students
There are several reasons why medical students become addicted to drugs and alcohol during their medical school years. Students face a variety of risk factors during their time spent in medical school. Workload, family pressures, debt and inadequacy all combine to create a negative environment that students wish to cope with or escape from.
For some medical students, it becomes a way of life to abuse substances. It can easily draw them in and be explained away as normal behavior. Additionally, medical students can easily obtain drugs and alcohol and therefore, the accessibility can be a determining factor in their addiction.
Burnout: Medical students often report feelings of burnout and emotional exhaustion. Studies have shown that greater than 50% of medical students report feeling this way. Stress affects the body physiologically and psychologically, which creates risk factors for substance abuse. Over time, if the body is under too much sustained stress for too long, it will experience burnout or exhaustion, inhibiting a student’s ability to function and perform.
Financial Stress: Medical students face a number of financial worries that can lead to anxiety and panic. The average medical school student’s debt load is $180,000 after scholarship and grant amounts. This type of financial burden is placing a lot of anxiety on medical students before they’ve even graduated. Additionally, financial debt can cause added family and social pressures, further driving up feelings of anxiety.
Depression: Facing chronic anxiety, worry and stress, some medical students eventually enter a state of depression. Studies have shown that 25% of medical students meet the criteria for depression, with 14% of them reaching moderate to severe depression levels.
Pressure to Succeed: Medical school is a large investment in a student’s future. With so much money, expectation and competition on the line, students feel an enormous amount of pressure to succeed. Thoughts of failure and not meeting their family’s or their own expectations only compounds further as they continue their way through medical school.
Peer Pressure: Outside of academic, family and financial pressures, medical students also face social pressure from their fellow students and friends. They realize they have a lot on the line and feel obligated to maintain their image of success. Peer pressure also comes in the form of social drug and alcohol use among a close-knit community of students. As word spreads that one group of students is taking performance-boosting drugs, the prevalence of drug use can continue to grow amongst other groups.
Easy Access to Drugs and Alcohol: Because so many medical students meet the criteria for depression, they are able to obtain specific prescription drugs and thus be vulnerable to abusing them. Additionally, prolific alcohol use on campuses makes it easy for medical students to be exposed to and develop an alcohol dependency.
With the ongoing crisis of prescription drugs being sold on the street, it is relatively easy for students without a prescription to obtain prescription drugs of different varieties.
Types of Substances Medical Students Abuse
There is a wide variety of substances that medical students can potentially abuse. Some students may choose particular types of substances over others for many different reasons, including what is available to them or what their friends are using. Past experiences using drugs and alcohol can also play a factor.
Some of the most common substances involved in addiction among medical students include:
- Stimulants (excluding caffeine)
- Illegal drugs
Stimulants: Stimulants, known as “uppers,” are drugs taken to temporarily boost energy and alertness. The most well-known brand name of prescription stimulant is Ritalin. Stimulants are known to be highly addictive over time if abused or not taken under medical supervision.
For many medical students, it becomes easy to justify the use of stimulants as a way of boosting academic performance. Because students sacrifice their sleep and personal health, it drives them to look to substances to compensate. Students see stimulants as a way to improve their focus, keeping them awake and improving academic performance, specifically on exams.
The stimulant drugs that are most prevalent among medical students are those intended to treat ADHD and similar mood or sleep disorders. These stimulants include methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine, benzphetamine and lisdexamfetamine.
Opioids: Opioids are a narcotic pain medication that is available through a prescription. Opioids block pain receptors in the brain while providing sensations of euphoria. With addictive properties, opioids are one of the most commonly abused prescription drugs.
With the high levels of stress and pressures of medical school, students turn to synthetic opioids to sedate or numb themselves and escape from responsibilities. Today opioids are also becoming a popular street drug, available for people even without a prescription. Opioid drugs include fentanyl, codeine, oxycodone, morphine, methadone and meperidine. Some of the more famous brand names are OxyContin, Demerol, Fentora and Vicodin.
Tranquilizers: Tranquilizers are drugs that are prescribed to depress the nervous system. Doctors commonly prescribe them as anti-anxiety drugs, muscle relaxants, sedatives or anesthetics. Specifically, drugs under the benzodiazepine family can become addictive and cause concern over developing a possible dependency.
Medical students will often be prescribed benzodiazepine drugs to help subdue their anxiety during medical school. Common brand names of tranquilizers include Ativan, Valium, Serax and Librium.
Alcohol: Alcohol is another substance that can become easy to abuse under a great deal of pressure. To cope with their heavy workloads, medical students turn to alcohol and binge drinking in order to let go of tension and release anxiety. The easy access to alcohol combined with the peer pressure setting of school can influence medical students looking to escape.
The extreme amounts of pressure and workload can lead to feelings of depression, which they seek to forget about temporarily by indulging in alcohol or binge drinking to the point of blacking out.
Illegal Drugs: Medical students and even medical professionals may take illegal drugs such as cannabis or cocaine as a way of coping with stressors. Medical students may abuse cannabis as a form of tranquilizer drug to alleviate tension and anxiety. Due to the widespread availability of cannabis, many students have easy access to this drug.
Cocaine is a chemical stimulant that students may take advantage of in order to obtain temporary bursts of energy and alertness. Like taking prescription stimulants, students may use cocaine for the same effects of helping to boost academic performance, particularly on test days.
Once a dependence on drugs and alcohol forms, it can be incredibly difficult for medical students to stop taking them. The result is a possible long-term substance abuse problem that sadly affects their personal and professional lives.
How Drug Abuse Impacts Lives of Medical Students
While medical students may begin to abuse drugs and alcohol as a means of coping with their stress or improving their academic performance, oftentimes the opposite effect ensues. Due to their ongoing pressures, medical students face chronic health problems that damage their overall wellbeing and life balance.
As medical students continue to rely more heavily on drugs and alcohol to cope with their stress, their general health continues to decline. Some medical schools have started to fight back against this issue.
Medical schools face the ongoing challenge of ensuring students are given an adequate workload while protecting their overall health. In the long run, reliance on drugs and alcohol can have damaging consequences for the student and for the professional medical community.
How Drug Addiction in Medical Professionals Impacts Patients
As medical students go on to graduate and become practicing physicians, their drug dependency often continues. This is because the pressures of being a new physician are just as great, if not greater, than they are in medical school. With the realities of patients, ongoing education and debt coming to fruition, some first and second year physicians rely on their substance abuse to cope with new types of burdens.
Ultimately, a physician’s substance abuse can go on to affect the level of care that they are able to provide for patients. Doctors face all types of stressors in dealing with patients alone. From guilt to unexpected outcomes and failure to relieve pain, many issues cause doctors to stress over patient care.
But when doctors abuse substances, another set of issues arise. Hangovers, withdrawal, depression, irritability and lack of focus can all occur when addicted to drugs or alcohol. When the physician isn’t in the right mindset to practice medicine, then the patient may not receive the appropriate treatment.
Additionally, if a doctor is personally addicted to prescription medications, he or she may be more likely to overprescribe medications to patients.
How Drug Addiction in Medical Professionals Impacts Future Careers
The abuse of alcohol or drugs, either illicit or controlled, can have a damaging impact on a physician’s career. As drug dependency grows, the addict begins to look for ways to obtain drugs and perpetuate their habit. Often, physicians who have direct access to controlled substances will abuse their power in order to feed their addiction.
This not only affects the physician, but it also impacts medical resources and colleagues. Colleagues who know of fellow physicians struggling with addiction may feel a duty to report. Moreover, substance abuse can lead a physician to lose credibility and ultimately damage their professional career.
On the other hand, when substance abuse becomes acceptable among the medical community, it can prevent the addict from getting the recovery treatment they need to live a healthy and productive life. Many physicians withhold information about a colleague’s substance abuse out of a professional loyalty or courtesy to the addicted physician. Without ongoing treatment, both medical students and practicing physicians will likely face consequences in their future career.
Treatment for Drug Addiction Among Medical Students and Professionals
When substance use develops into an addiction or a dependency, the user must obtain treatment. Unfortunately, there is a stigma around drug addiction that prevents many from getting help – especially among the medical community.
Today, there are resources in place at many medical schools to help medical students who face substance abuse problems. Referrals to Student Heath Services, student-faculty committees and other protocols can help and encourage students to seek early intervention treatment. These programs provide students with a thorough evaluation and tailored treatment while respecting their confidentiality.
In terms of medical professionals struggling with substance abuse after medical school, there are further resources available. In response to this issue, many states have established Physician Health Programs (PHP) in order to address the ongoing issue of burnout, stress, depression and health factors that doctors face. PHPs offer confidential support for physicians struggling with substance addiction.
Holistic and specialized treatment for substance abuse can ensure that medical students or physicians receive the help and support they need to be successful in their medical career. If you or a loved one are facing the problems of addiction in medical students, contact 12 Keys Rehab for a consultation.