Women physicians with substance abuse problems differ in some significant ways from their male counterparts, according to the medical director of Virginia’s Health Practitioners’ Monitoring Program. Yet little research has been done about the best ways to treat these women, she says.

“There have been a few small studies, but for the most part, we don’t have a lot of solid science on this issue,” says Penelope P. Ziegler, MD, who spoke recently about addiction in women physicians at the 2012 Ruth Fox Course for Physicians, part of the American Society of Addiction Medicine annual meeting.

There are fewer women physicians in state programs that monitor doctors with impairing issues, including addiction, Dr. Ziegler notes. “When you look at programs in which almost all participants are dealing with addiction, the underrepresentation of women is even more dramatic.”

In Colorado’s physician monitoring program, women are more prevalent, but they are primarily being treated for other issues, including depression, anxiety and trauma, she points out.

“We don’t really know why women physicians are being treated for addiction in such low numbers. Does it mean there is a lower incidence of addiction among women physicians, or are they seeking help privately so that they don’t end up in state-regulated monitoring programs? Or are they not being identified and referred to these programs because they are more successful at hiding their substance use, thereby ‘getting away’ with whatever they are doing?”

A 1987 study by addiction specialist LeClair Bissell, MD, of 95 alcoholic women physicians and five medical students, all of whom had stopped drinking at least one year before the study began, found most had reached treatment through circumstances other than referral by therapists or intervention by impaired-physician committees. She found 73 reported seriously thinking about suicide before they became sober, and 26 thought about it after the drinking ended. Thirty-eight had made overt suicide attempts, 15 more than once. Marital instability was common.

“While alcohol is still the most common substance to be abused among doctors, among male doctors, opioids are the second-most common drug. Among women, it’s tranquilizers and sedatives,” Dr. Ziegler said.

A study of 1,569 impaired physicians, including 125 women who were enrolled in one of four state physician health programs, found the women were more likely to report past or current suicidal thoughts, and more likely to have made a suicide attempt. This study, published in 2007, also found the women were more likely to abuse sedative hypnotics than men.

In Dr. Ziegler’s program in Virginia, between 2003 and 2011, she found women physicians were 2.5 times as likely to have a psychiatric diagnosis in addition to their substance use diagnosis, most commonly depression and anxiety, compared with men.

“It’s important to realize that women physicians have different needs than male physicians, and they should be referred to substance abuse treatment programs that offer gender-specific interventions,” Dr. Ziegler recommends. “Women should be offered a group in which they can support one another, because they’re going to be in the minority in most treatment settings.”

She adds that as with all women with substance abuse issues, many women physicians struggling with addiction may be dealing with a past that includes sexual trauma, sexual harassment or discrimination, which they wouldn’t feel comfortable talking about in front of men. “So many women with substance use disorders have sexual trauma in their history,” she says. “If you don’t look for it, you’re going to miss a lot of important issues they have to struggle with.”

Because many women physicians with substance use disorders also suffer from anxiety, depression or trauma-related symptoms, it’s important that they be carefully evaluated for these diagnoses, Dr. Ziegler notes. “It appears that women in medicine have specific stress issues that are different from men,” she says. “Their treatment plan must take these issues into account when preparing for going back to work. These women need a specific strategy about how they will deal with stressors that are waiting for them when they get back to practice.”