Chemical Dependency

Indicators of Impairment


  • Negative world view characterized by anxiety, depression, guilt, anger
  • Multiple medical problems:
    • Hypertension
    • tachycardia
    • gout
    • gastritis
    • sleep disturbances
    • sexual problems
  • Self-medication including mood altering chemicals
  • Delusional ideation i.e. “It can’t happen to me.”
  • Frequent or unusual accidents
  • DWI charges or other legal difficulties
  • Behavior that is in conflict with personal values

Family and Interpersonal

  • Family conflict
  • Isolation and withdrawal from family and family activities
  • Unexplained absences
  • Acting out behavior by children
  • Dissolution of marriage
  • Increasing dysfunctional family system
    • Spouse and other family members assume duties and obligations of impaired person
    • Family attempt to “cover up” for the impaired person’s behavior
    • Family members accept blame for the person’s impairment
    • Unsuccessful attempts to “Normalize” the family
    • Family or spouse develop a negative world view characterized by fear, anxiety, depression, guilt and anger
    • Withdrawal from normal community activities and relationships

Work History or Resume Clues

  • Unexplained gaps in resume
  • History of previous limitations on licensure
  • Frequent job changes and “geographical cures”
  • Problem of verifying references or resume itself
  • Unusual medical problems or disabilities
  • Application for specific job does not seem compatible to level of professional training
  • Reluctance to have laboratory tests done or physical exam performed
  • Isolation from professional community
  • Insurability problems


  • Inappropriate behavior at medical meetings
  • Concern by Associates of change in attitude and/or behavior
  • Adverse changes in professional demeanor
  • Long absences from the office with disruption of patient appointments
  • Associates become “professional enablers”
    • Assume impaired person’s duties
    • Makes excuses for impaired person
    • Try to “wait it out”
    • Become embarrassed by the impaired person’s behavior
  • Complaints by office personnel and/or patients
  • Malpractice suites
  • Complaints to grievance committees
  • Changes in ordering and prescribing practices regarding mood altering drugs

Professional Relationships (Hospital)

  • Avoidance of peers
  • Making rounds at unusual times
  • Missing rounds
  • Patient complaints
  • Inappropriate dress and/or hygiene
  • Change in handwriting
  • Change in quality of progress notes
  • Unusual or inappropriate orders
  • Excessive laboratory tests
  • Excessive consultation
  • Poor response time to hospital pages, i.e. “The broken beeper syndrome”
  • Hospital personnel question competence and/or behavior
  • Frequent citations by review panels i.e., quality assurance panels
  • Involvement in litigation against hospital
  • Practice in areas of medicine for which the person is not qualified

Resources for Chemical Dependency

On Impulsivity: The Neuroscience of Behavior Associated with Addiction
ASAMAGAZINE | June 12, 2014
Impulsivity – or the inability to inhibit responses despite their negative consequences – may partly explain why some individuals are more prone to develop addiction when exposed to drugs of abuse and offer clues for providing treatment. Read the complete article.