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PAUL: A Physician's Illness


Each day Paul sits in the trenches of the drug war, helping drug addicts and alcoholics recover from their disease. As a physician and counselor, Paul has studied and heard about the devastating effects of addiction. But he also has first-hand knowledge. He himself started using drugs and alcohol at age 16, and it was a 10-year battle with addiction that led him to treatment at the same Atlanta, Georgia, program where he is now the medical director.


"A Vacation From Life"

Paul started using alcohol in his teens to deal with his feelings of failure, he says. He came from a high-achieving family and was constantly anxious about failure. "In high school and until college, I never had to work very hard at anything," he says. "That thought made me feel worse. . . . I almost needed to produce failure." Paul was a casual-to-moderate alcohol drinker in college; then, in graduate school, he was introduced to other drugs, including heroin and cocaine. Paul says he was drawn to the drugs because they gave him "a small vacation from life." He had taken opiates before, after dental surgery, and he remembered how good they made him feel. When he injected heroin, he says, "I felt an inner peace like I had arrived at home and found what I was looking for all my life." Heroin, he adds, didn't make him sleepy but instead made him "calm and clearer thinking." The euphoria made him want more. "I never thought I would become addicted, despite the fact that I was injecting it," he says. "I was able to maintain a fairly normal life."

But the pressures of life fueled his drug use. When Paul was preparing to apply to medical school, he found out his mother was dying of breast cancer. She wanted Paul to come home to Ohio so she could spend more time with him before she died. Paul applied to medical school near home and got in. He thought going home would put an end to his drug-using since he was leaving behind the friends he did drugs with in Oregon. But he was mistaken.

Getting Hooked

Paul considered his foray into heroin and cocaine "a fling." Unfortunately the relationship grew to be more like an abusive marriage. In attempting to cope with medical school and the pain of watching his mother die, Paul started drinking more and turning to drugs. His mother had a lot of pain killers around, and he would steal her morphine occasionally. "Clearly my using wasn't like it used to be," he says. "It was no longer experimental. In retrospect that was when I started getting more addicted." In medical school Paul's focus on his drug habit became more intense. "When I finished a test, I would think about drinking or snorting cocaine." Thoughts about how to procure the drug became a constant, he says. "I didn't know how to get out. I was so hopelessly trapped."

After Paul's mother died, he started working in a laboratory at the medical school where he had access to pharmaceutical cocaine. Occasionally, he would inject the drug for a more intense effect. In the later instances, he sometimes became paranoid and near-psychotic. Because he binged periodically but didn't use the drug all the time, however, he was still able to attend classes and appear to be coping with the pressures of medical school. After finishing medical school, Paul returned to Oregon to begin his residency. Paul looked forward to going back to the community of friends he had left behind with whom he had first started using heavy drugs. "Part of my distortion was that I thought these people were my family," he says. "They looked after each other."

But it was during his residency that Paul's encounter with drugs became more dangerous. He was injecting cocaine more regularly, and he would often call in sick because he was in what he describes as a psychotic state. Sometimes, he would not appear during ward rounds. One night, Paul knew his drug using had gotten out of hand when after injecting cocaine he feverishly dismantled his bathroom, which he thought was infested with bugs. The next day, lying on his bathroom floor, Paul decided to give up cocaine. Instead, he turned back to opiates. He was able to write his own prescriptions for the drugs, which was illegal but easy.

Although Paul was still considered an academic star, his behavior didn't go unnoticed. By now a grossly inadequate medical resident, he was pulled out of his residency for failing in his clinical skills, and was able to do only research. His addiction led him to do a lot of dumb things, he says; for instance, he'd be working on charts in the hospital and sitting in the medical records room while drinking beer. "Probably the most nutty part about it was that I thought people wouldn't notice," he says. "There was a sense that somehow you could fool people."


I never thought I would become addicted, despite the fact that I was injecting.


After a while, however, his behavior could no longer be ignored. The Oregon Board of Medical Examiners got wind of his illegal drug diversions and confronted him about his problem by handing him a pile of prescriptions he had written. The Board wanted Paul to get treatment and suggested a place. But he still did not comply. Looking back today, Paul said he needed to be dragged to rehabilitation, not just told where to go. He continued writing his own prescriptions for and using opiates until he was arrested and taken to jail.

In jail, Paul suffered through opiate withdrawal; he vomited, couldn't eat, and lost weight. He was taken to a treatment center on a stretcher. After three weeks of detoxification, Paul returned to face the medical board, which ordered him to turn in his medical license and go to Atlanta to Ridgeview, the rehabilitation center where he is now medical director. This time, Paul's father, also a doctor, physically took Paul to the treatment center, where he stayed for six months.

Paul says the treatment he underwent did more than just get him to quit drugs. "By the time I came to treatment I was emotionally immature, I didn't know how to deal with frustration or anger or interpersonal conflict." Paul says a lot of treatment "was figuring out how to care for myself and be good to myself and resolve conflict without being frustrated."

Still without a medical license, Paul returned to Oregon to tell the Board of his progress. Paul had decided that he wanted to work in an eating disorders clinic in Atlanta, but he needed his medical license back. The Board agreed, but on a probationary basis. He started working in hospitals and learning about eating disorders. (The psychologist who helped him gain an understanding of that condition later became his wife.)

Figuring out how to care for myself

Paul, a neurologist, eventually did a fellowship in addiction medicine while in Atlanta. After several years of working in addiction therapy at hospitals in the area, Paul was asked to direct the recovering professionals and addiction program at Ridgeview. Paul demurred for two years, feeling he wasn't ready, but after being asked a second time he decided to take the job, where he's been for the past seven years.

Paul has now been in recovery for 13 years. Although now and then he thinks about drugs and alcohol, he says, the urge to drink and use drugs left him many years ago. Paul acknowledges that his experience helps him in dealing with his patients.

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He doesn't broadcast that he's a recovering addict, but he doesn't hide it, either. Among his patients, "I think there is a certain amount of trust, because I've been there," he says.

Paul says people who are addicted need compassion and a firm hand: "The most important lesson I learned in recovery was when the jail cell door closed. I realized I couldn't talk my way out of this one. I knew I had hit bottom." His own sense of enlightenment [as a therapist]," he adds, comes from that experience. "It was my own personal struggle with addiction that got me here. . . . I'm one of those people that suffered and no longer suffers, and I'm one of those people that's filled with gratitude." Working with addicted patients, he adds, also has helped him heal. "To some degree, my own ability to see what I had done reflected through other people's words has engendered compassion for myself."

-- Janet Firshein

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