With physicians more likely to become addicted to drugs, compared with the general population, it became a lot more difficult to argue that a drug-dependent person was a “classic psychopath” or inherently “immature and pseudo-aggressive.” The situation was particularly untenable given that, during the fifties and sixties, physicians were the people running most epidemiologic studies and authoring the scientific manuscripts about drug use. They were, unsurprisingly, loath to suggest that the high prevalence of drug addiction among members of their vocation was caused by the fact that doctors are all psychopaths.
And so, instead of blaming that same collective form of psychopathology that they had diagnosed as innate to African-Americans, Latinos and women, epidemiologic papers about addicted doctors quietly gravitated toward different language to talk about drug use and its effects.
In one study from 1966 that compared 100 physicians treated for addiction with 100 matched controls, the authors – physicians themselves, of course – wrote, with a level of subtlety absent in studies of drug use among black Americans, that they found “no correlation between psychiatric diagnosis and drug used” and the study’s participants. As far as the researchers were concerned, doctors couldn’t be crazy, even the ones that overindulged. In a lingering sign of the times, though, the factors the authors deemed most likely to increase the risk of drug use reflected myopic ideas about the root causes of addiction. These included whether participants were married, whether they were Protestant and whether they came from the American South.
Another study, published in The New England Journal of Medicine in 1970, reported that after 20 years of following a group of college students, half of whom had gone into medicine, twice as many of the physicians had used drugs as the group of people who, one assumes, found less respectable careers. Here, the authors again included variables they assumed most relevant to addiction: having had a feeding problem in infancy, having had a private-school education and scoring badly on a math test. Today this kind of paper wouldn’t even make it to a scientific journal editor’s desk, let alone get published.
What these mid-century epidemiologists overlooked about substance use among doctors were the high levels of stress, anxiety and lack of sleep that characterize the medical profession. Coupled with ready access to highly addictive pharmaceutical drugs and a culture of intense competition, doctors were primed to self-medicate.
Having pragmatically turned themselves into their own guinea pigs, doctors had inadvertently revealed their own heightened drug use and, with it, the fatal flaw behind the racist and sexist addiction science they had popularized. This led to only one conclusion: If morally upstanding, intellectually sophisticated white men were succumbing to addiction in droves, then it could not be a disease of the mind. The upshot was that the kinds of variables included in addiction models expanded beyond an individual’s personality or upbringing.
Epidemiological models show how politics, wealth and racism lead to #addiction. Addiction is complex and is not caused by a simple dysfunction of a single neural circuit. https://t.co/V5LZh6kuL7
— Jacek Debiec (@DebiecJacek) December 14, 2019