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Often, discussions of physicians' substance use (both licit and illicit) are framed in quantitative terms. The present article provides a complimentary qualitative and posthumanist perspective on substance use challenges illuminated through in-depth interviews with substance use disorder (SUD) recovered physicians' about their experiences with substance use and SUD within their work culture. SUD recovered physicians' experiences include descriptions of fears about being revealed as a substance user, self-medicating to enhance performances during operation or morning conferences and the like. The article draws attention to the role of physician work culture in the development and management of physicians own substance use and SUD. It reports results from my Danish study analysing how professional socialisation and social technologies affect physicians disclosure of their own SUD and their help seeking at work. The work-related aspects that in some cases affect the development of substance use and SUD include hierarchical pressure, emotional strain from critical patient cases and work-related competition. In the analysis a disciplinary paradox concerning the social technologies intended to normalise and standardise physicians' conduct and ensure the quality of treatment. Ironically, the social technologies seemed to have an unintended consequence: to conserve and maintain SUD rather than facilitating treatment and recovery. For instance, I show how the fear of social sanctions in the form of a loss of certification and prescription rights keeps physicians in SUD from seeking external treatment. Rather than producing normalisation as intended, the social technologies in some cases seem to have an adverse effect of strengthening deviance. [ABSTRACT FROM AUTHOR]

Background: Alcohol abuse may be elicited by psychological problems and can influence physicians' health and patient safety. To act on it, we need knowledge on the prevalence of the disorder and its associations with psychological factors and physicians' well-being. The aim of this study was to explore whether burnout and alexithymia are associated with risky alcohol consumption in physicians and whether burnout mediates the association between alexithymia and risky alcohol consumption.Methods: In this cross-sectional study, 4,000 randomly selected physicians received an electronic questionnaire by email containing the Alcohol Use Disorders Identification Test (AUDIT), the Maslach Burnout Inventory Human-Services-Survey (MBI-HSS) and the Toronto Alexithymia Scale (TAS-20). A total of 1,841 physicians completed the questionnaire (46%).Results: 18.8% reached the criteria for risky alcohol consumption. The likelihood of having risky alcohol consumption was associated with high levels of alexithymia (OR=1.93, 95%CI=1.37-2.74, P<0.001). Moreover, risky alcohol consumption was associated with burnout (OR=1.86, 95%CI=1.13-3.05, P<0.014) and each individual burnout dimension: emotional exhaustion (OR=1.89, 95%CI=1.33-2.69, P<0.001), depersonalisation (OR=2.23, 95%CI=1.53-3.25, P<0.001) and low levels of personal accomplishment (OR=1.66, 95%CI=1.14-2.41, P=0.008). Mediation analysis suggested that the association between alexithymia and risky alcohol consumption was partially mediated through depersonalisation.Conclusions: The results emphasize a need for enhancing emotional self-awareness in physicians as psychological traits, work-pressure and alcohol dependence might be self-reinforcing aspects for the individual physician. As alcohol dependence and burnout may have consequences for patient safety separately, the aggregated influence of these factors has to be examined. [ABSTRACT FROM AUTHOR]