There is no cohort for whom the risk of addiction is absent, but for some the pathways to treatment and support are harder to access.
One of these, ironically enough, comprises doctors – and the reason is a notably sharp form of stigma, and a unique fear that accompanies it.
“I always remember a participant in my research talking about how it’s okay for a doctor to be depressed or anxious,” said Dr Owen Bradfield, a Senior Research Fellow at the University of Melbourne School of Population and Global Health.
“The profession and the public can relate to that. But it’s much harder if the doctor has a psychotic illness or a drug or alcohol use challenge.
“I think it’s much more difficult for the public and even for the practitioner’s peers to wrap their head around the fact that they’re a doctor and yet they have these problems.
“I think stigma is a big part of the additional challenge that doctors in those circumstances face.”
One GP with firsthand knowledge of this is another Owen – Dr Owen Harris – whose professional life, affected by drug and alcohol use allied with mental ill-health, came to halt when his peers decided to act.
“Eventually my business partners – because I’d bought into a general practice – they knew something was wrong and they didn’t know what,” he said.
“Things just kind of snowballed and I came clean to them. They arranged for me to go and see the Victorian Doctors Health Program (VDHP).
“I slept through that appointment – even though I intended to go. On the basis of that, they made the mandatory report to the Australian Health Practitioner Regulation Agency (AHPRA) and then I immediately had to stop work.
“I felt pretty betrayed and let down, but that I now understand that my former business partners acted in good faith, and I don’t hold any resentment.”
AHPRA took action, suspending him from practice.
Dr Bradfield – who is also chief medical officer for an indemnity insurance provider – has looked in detail at the psychological impact of regulatory notices on doctors and other health care workers.
In a 2023 paper published in the Australian Journal of General Practice, he and his co-authors found that these “regulatory processes caused distress, symptom relapse, suicidality, financial pressures and work difficulties”.
Beneath those objective impacts, there are also often psychological ones as well.
Being a doctor is the core of self-identity for many GPs, explained Cheryl Wile, a clinical psychologist with the VDHP. The loss of that identity can be devastating.
“I’ve been with the program since it formed 25 years ago,” she said. “During that time, we’ve lost 19 doctors to suicide, misadventure or health conditions linked to addiction.”
A common contributing factor to GP distress in this field, she noted, was the fear of being found out.
“Doctors will say, ‘I’ve got this, you know, I can do this on my own, I’m going to be fine.’ But with that type of health issue, you just can’t do it on your own – although some will test that hypothesis a fair bit at times. But they think: if I tell anyone I’ve got this health problem, I’m never going to work as a doctor again.”
The VDHP runs a self-help group for doctors with AOD challenges. It is called Caduceus – a reference to the winged staff entwined by snakes that often symbolises medical practice.
Caduceus comprises Victorian doctors and medical students with substance use challenges. Guided by a facilitator, members meet online once a week for an hour and a half to share experiences and support each other.
Admission to the group is strictly controlled by the VDHP.
“Occasionally we get calls from doctors saying, I want to join the group, but I want to do it independently, which we don’t allow,” explained Cheryl Wise.
“We don’t allow that for numerous reasons, including just being protective of the group, recognising the vulnerability and confidentiality of its members.”
Dr Harris continues to participate in Caduceus, which he described as “a critical part of my recovery”.
In particular, the realisation that he was not the only physician with substance use challenges persuaded him to face one of his greatest fears.
“Connection is key and that’s a huge part of why groups like Alcoholics Anonymous and Narcotics Anonymous work,” he said.
“Because of shame and self-stigma, I’d resisted going to rehab for a very long time.
“I think a big part of that was the public nature of the process. It’s not public in itself, but the thought of identifying myself as a doctor and everything else was terrifying.
“Finally, I got there and it was life changing.”
Just how many doctors develop substance use disorders is unclear – in part because of secrecy and unwillingness to disclose in the face of stigma and possible career-ending consequences.
Until a few years ago a report to the Medical Board of Victoria – as it was then called – concerning substance use resulted in a compulsory referral to the VDHP and Caduceus. These days the process is voluntary.
It’s a development about which Cheryl Wise is unsure. For one thing, it makes accurate numbers impossible to know. Asked to estimate how many medical professionals have been part of Caduceus over the quarter century of its existence, she is blunt.
“Thousands and thousands,” she said.
Dr Bradfield is more conservative in his estimation of the scale of AOD concerns in the profession.
In a paper published in the Medical Journal of Australia in 2026, he and his co-authors wrote: “The prevalence of impairment among doctors in Australia is unknown. Limited epidemiological evidence from overseas suggests that as many as 14 per cent of doctors are impaired at some point in their careers.”
Perhaps the true picture will never be fully visible, but there are at least some developments that may make disclosure and help-seeking less stigmatising.
“The regulator, AHPRA, has put a lot of time and effort into thinking about how they manage health and impairment notifications,” said Dr Bradfield.
“We’ve certainly noticed an improvement in the manner in which those investigations are managed. You know, the language used in correspondence is different. They’re much more responsive, much more mindful of the impact that these processes have on doctors’ health.”
Cheryl Wiles still sees room for further change.
“AHPRA can be in their language to people like doctors who are suspended for health issues not gentle, let’s say,” she said.
“That can be very, very anxiety producing for doctors.”
In a written statement, a spokesperson for AHPRA said the organisation was intent on minimising the mental health impact of complaints.
“In recent years, AHPRA has focused on minimising distress for practitioners who have a complaint made about their health, including mental health and alcohol and substance misuse,” the spokesperson said.
“AHPRA is committed to making its processes more timely, empathetic and transparent for everyone involved.”
The full statement is available here.
Dr Harris, meanwhile, has returned to practice – providing proof that seeking help to overcome substance use challenges is not a career-ending strategy.
He credits his return to the effects of rehab and the continued support of Caduceus, his own GP, his psychologist, psychiatrist and family members. A group effort, but a successful one.
“I entered rehab in 2019,” he said.
“Generally the trajectory since then has been very good. And now I’m in a very good position, recovery-wise.”
