COMMENTARY

Gripping Interview: How One Addicted Doctor Recovered

Arthur L. Caplan, PhD; Cheryl Karcher, MD, MS

Disclosures

January 06, 2017

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Hi. I am Art Caplan, head of the Medical Ethics Division at the New York University Langone Medical Center in New York City. Typically, I use these blogs to talk about an issue, give my opinions, or draw attention to something of importance. But I have a rare opportunity today. Dr Cheryl Karcher is with me. She is a dermatologist, an expert in aesthetic medicine, and a recovering addict.

Dr Karcher, I thought it would be of interest to our physician audience to hear from you, given the challenges physicians face with drug abuse, depression, and mental health problems. We have talked about all of that in my series, but you have lived it. You have come out through the other end of that tunnel, and I thought my audience would be interested in hearing from you. How did you become addicted? What happened?

Dr Karcher: This did not begin until late in my life. I had undergone several surgeries: three anterior cruciate ligament replacements, a total shoulder replacement, a hysterectomy, and three bone grafts in my neck. All of this fed into the addiction. I remember the very first time I took a Percocet after one of the surgeries. I took it and felt like, oh my God, I am peaceful. Nothing is bothering me. I am not worried. I am not anxious. I can do what I need to do without a lot of turmoil in my brain. I remember that first time so well.

Dr Caplan: What made you decide that you could not keep going in this direction?

Dr Karcher: I tried many times to stop myself. I used to send my family away for the weekend and try to withdraw while they were gone. I would make it to Monday, but after work, when I would come home, I had to take care of this and that, and this and that, and I just could not make it through Monday night. I finally realized that either I was going to do this for the rest of my life or I had to stop, and that there was never going to be a good time to stop. It was never going to be convenient for me. It was going to be miserable. I sought help from an addiction psychiatrist. I said, "I cannot stop myself."

Dr Caplan: Did your family have any inkling about what was going on?

Dr Karcher: No clue. I was highly functioning, as many physicians are.

Dr Caplan: You sometimes hear these physicians say, "I am great. I am a rocket scientist."

Dr Karcher: Yes, my recovering physician buddies have said that—"When I was using, I was a rock star. I was great in the ER." Of course, their judgment is impaired.

Dr Caplan: When you finally went to that addiction specialist, who else did you believe needed to know? I am sure many of the people watching this are thinking, are you crazy? I am not telling anyone. I cannot. I am going to lose my career. I am going to maybe lose my family. I am going to lose my patients. There is no way.

Dr Karcher: That is why so many physicians do not get help. The stigma alone will boot them out of the door. Their colleagues will no longer respect them. What if someone tells on them to the board? What if they lose their license? That is their livelihood. How will they support their families?

Dr Caplan: But why? Is this not a disease?

Dr Karcher: Yes. It is a disease; insurance pays for it; it is in the Diagnostic and Statistical Manual of Mental Disorders. However, the medical community is tough. The medical community, even though they say they know it is a disease, even though they say it is not a moral issue, treats addicts as if they lack morals and ethics.

Dr Caplan: Addiction is viewed as a failure of character, despite all the talk about disease models and addiction as a disease. I believe it would be inspiring for our viewers to hear how you came through it, how you got support. What was most effective? What helped you? What really got you to turn the corner?

Dr Karcher: My case is a little unusual in that I was outed publicly.

Dr Caplan: By whom?

Dr Karcher: I was outed by a SWAT team. The press had been given a heads-up the night before. I walked into my office and the SWAT team came and arrested me, and before I was out of my office, I was on MSNBC. I was on all the news stations. Mine is a different story.

But as with many addicted physicians, I did not go to the state board because I was afraid. I was afraid I would lose my license. I was afraid I would get into massive trouble. I was afraid I would not be able to work again. I did not want the stigma. I did not want anyone to know. I had been sober for a year and a half before that day when the SWAT team came. During that year and a half, I had gotten a lot of help to stay sober. I went to 12-step programs, which are immensely helpful. For me, the program for addicted physicians is particularly helpful.

Dr Caplan: There are physician 12-step programs?

Dr Karcher: Until just recently, there was only one physicians' meeting, once a week, for all of New York City. We have now grown to three meetings each week. That is what I found most helpful.

Dr Caplan: Some areas of the country may not have physician-specific programs, but regardless, the 12-step was a big help to you.

Dr Karcher: Yes, but specifically the meetings for physicians because their problems were the same as my problems. I would listen to another physician addict, but anyone else, I believed, would not understand. This small group of physicians really helped me a lot.

Dr Caplan: Did people come forward to say, "You should move; you should leave town"?

Dr Karcher: The first thing my addiction psychiatrist asked me was whether I wanted to kill myself.

Dr Caplan: I see. That is moving in a different direction, but yes.

Dr Karcher: Many people do relocate once they are found out, but no, I did not have people asking me that. Eventually, a reporter from the New York Times called me and said, "You have not moved, you did not bury your head in the sand. What is going on? Can we do an article about you?" I said, "No, thank you." Being in the public eye has its downsides. They called again and said, "Everyone is dying of opiate addiction." There were nine deaths within a couple of days in Staten Island. The opiate epidemic is big enough that it was discussed during the presidential debates. And the New York Times is calling me and saying, "You did not die, you did not move away. What is going on?" The best help I got was from other physicians.

Dr Caplan: Physicians who had been through it.

Dr Karcher: Physicians who are recovering addicts, recovering alcoholics.

Dr Caplan: I cannot recall ever meeting a physician who was willing to come up to me and say that I am a recovering anything.

Dr Karcher: I do not know of anyone else who was outed as I was. I believe it is my job to show that a recovering addict can be successful and happy.

Dr Caplan: You are still working.

Dr Karcher: I am working. I have two beautiful offices. I can think of nothing else I would ever want to do than what I do. I am a dermatologist and I love it with all my heart. I am very good at it.

Dr Caplan: Is your family supportive?

Dr Karcher: My family has been unbelievably supportive. I am lucky to have had a very, very supportive husband. I have two small children, so that was an issue. We were able to hide a lot of it from them. The problem is, only a few physicians show up to Caduceus, the doctors' 12-step meeting. There are many other physicians who need help but do not show up.

Dr Caplan: Some of them are watching.

Dr Karcher: I pray to God that some of them are watching. When the article was published in the New York Times,[1] physicians were calling me from all over the nation, saying, "I thought my life was over; I need help but I do not want to go and get it." It is a nationwide issue and it is an issue that has to be discussed.

Dr Caplan: I know you are willing to speak with and help others. You are willing to be a resource for them. What would you say to a physician who says, "I think I might have a problem"?

Dr Karcher: If someone came to me, I would say, "Let me take you to this meeting. Other physicians will be there. Do not worry, they all have issues. Do not be embarrassed. It is actually quite fun." It really is a lot of fun. If they go to someone else for help, I would urge that person to tell them about these doctors' meetings. If that kind of meeting is not available, then urge the person to try not to drink or use drugs for 90 days and see what happens. It has to be handled with art and with kindness. It has to be handled nonjudgmentally, otherwise the addict is going to run. The stigma with physicians is a bad scene and it is unnecessary.

Dr Caplan: I am so grateful that you would put yourself on the line and come forward. Few do. Maybe more will when they see this.

Dr Karcher: I hope so.

Dr Caplan: If they want, we will put them in touch with you. Perhaps we can spread the 12-step model for physicians to other parts of the country. Or perhaps they can do it on the Web, or we can find other ways to bring people together. You have been a wonderful role model. You have shown that you can come through this, survive, have a career, go on. I believe that is quite an inspirational message. Thank you.

I am Art Caplan from NYU Langone Medical Center. Thank you very much for watching.

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