• Early detection can prevent significant consequences of substance abuse

    by Lewis Fry, an Avant member and medical student at Monash University

    The university pub is a location familiar to many students, and while it is well known that the student lifestyle is often associated with alcohol use and perhaps illicit drug experimentation or use, the risk of substance use disorder (SUD) is not so commonly discussed.

    Substance use disorder is a pattern of alcohol or drug use characterised by a pattern of behaviours that may negatively affect a person socially, impair their school or work performance, or lead to increased risk taking behaviours.1 It may be characterised by dependence – an inability to control substance use despite the problems it causes. It may also be associated with tolerance or withdrawal.

    The lifetime prevalence of substance abuse in Australian doctors is approximately 8%.2 While there is little data on substance abuse in medical students, an analysis of cases managed by the Victorian Doctors Health Program indicated substance use disorder began in medical school for 16% of the respondents.2

    Drug use patterns amongst medical students are similar to the general population, most commonly alcohol and cannabis3-5. As students progress to become doctors, increasing rates of prescription drug abuse may also emerge.6,7

    Alarmingly, death or near fatal overdose is the presenting symptom in 7-18% of doctors,8 and anaesthetists abusing propofol have a 45% mortality rate.9 It is worth noting that substance abuse is often coupled with psychiatric morbidity and stress-related disorders.

    Mandatory notification obligations

    The professional consequences of substance abuse are also important to consider. Under the National Law, a mandatory notification to the Australian Health Practitioner Regulation Agency (AHPRA) is required if a health practitioner or education provider forms a ‘reasonable belief’ that a student’s impairment may place the public at substantial risk of harm in the course of their clinical training.10,11 Refer to AHPRA’s Guidelines for mandatory notifications.

    Depending on each case, a mandatory notification to AHPRA for substance abuse may result in the suspension of a student’s registration, conditions being imposed on their practice, further health assessment, and possible long-term impacts on their ability to continue their studies and future registration.10,11

    Signs of substance abuse

    Signs of substance abuse are subtle and varied. Denial of the problem is common amongst not only those with SUD, but also amongst their family, friends and colleagues, who often unconsciously dismiss their suspicions.12,13 However, early detection can prevent the development of significant harm. If you think you may have a substance abuse problem or are concerned about another student’s alcohol or drug use, the table 6,12,14,15 below lists possible emotional, social and physical signs of substance abuse:


    Emotional Social Physical
    - Personality change
    - Mood swings/anxiety
    - Irritability
    - Behavioural change
    - Erratic or decreased performance
    - Drunk/intoxicated often at social events
    - Social withdrawal
    - Lateness
    - Relationship problems
    - Problems with law enforcement
    - Sexual promiscuity
    - Patient complaints
    - Dishevelled appearance
    - Weight loss
    - Change in diet
    - Smell of alcohol
    - Unexplained minor injuries
    - Signs of intoxication or withdrawal e.g. slurred speech, tremors, excessive sweating, dilated or pin point pupils
    - Needle marks
    - Addition of long sleeves


    What can you do?

    If you are a student and you feel that you might have a substance abuse problem, there are a few steps that you can take:

    • Seek help – your first port of call should be your own GP. Your GP can refer you to local support services if necessary
    • Seek peer support from respected colleagues or mentors
    • Doctors’ health programs and services are confidential sources of assistance where you can get help. See below.

    There are a number of treatment options available for substance abuse depending on the case; typically the treating team may involve an addiction specialist or psychiatrist, psychologist and general practitioner. For support in accessing these services, Doctors’ Health Advisory Services provide personal advice to doctors facing difficulties, personal crisis and stress.

    If you are concerned about a fellow student’s alcohol or drug use, arranging an informal, collegiate, supportive and empathic chat with the student over a cup of coffee can often work. During the chat you should (gently) express your concerns about their alcohol and drug abuse, be understanding and provide a listening ear. If the student is receptive, you can suggest they seek further support. If you are concerned about a fellow student’s immediate safety, appropriate professional help should be sought.

    Substance abuse is an important issue to be aware of, both for students now and throughout their careers. Early recognition and help can prevent significant personal, health and professional consequences.

    Personal support services

    If this article raises concerns for you or someone you know, Avant’s Health and Wellbeing website
    provides information on doctors and substance abuse.

    Avant’s Personal Support Program also provides confidential counselling to Avant members who are suffering health issues. Ph: 1300 360 3641300 360 364.

    Our Medico-legal Advisory Service provides specialist medico-legal advice and support to Avant members – available 24/7 in emergencies. Ph: 1800 128 2681800 128 268 FREE.


    1. American Psychiatric Association. Substance-Related and Addictive Disorders. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2014.
    2. Wile C, Jenkins K. The value of a support group for medical professionals with substance use disorders. Australas Psychiatry [Internet]. 2013 Oct;21(5):481–5. Available from: http://apy.sagepub.com/lookup/doi/10.1177/1039856213498289
    3. Baldwin DC, Hughes PH, Conard SE, Storr CL, Sheehan DV. Substance Use Among Senior Medical Students: A Survey of 23 Medical Schools. JAMA. American Medical Association; 1991 Apr 24;265(16):2074–8.
    4. Pickard M, Bates L, Dorian M, Greig H, Saint D. Alcohol and drug use in second-year medical students at the University of Leeds. Med Educ. 2000 Feb;34(2):148–50.
    5. Boland M, Fitzpatrick P, Scallan E, Daly L, Herity B, Horgan J, et al. Trends in medical student use of tobacco, alcohol and drugs in an Irish university, 1973–2002. Drug and Alcohol Dependence. 2006 Nov;85(2):123–8.
    6. Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance Use Among Physicians and Medical Students. Medical Student Research Journal [Internet]. 2014 Apr 23;3:26–35. Available from: http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Winter-2014-Substance-Use-Among-Physicians-and-Medical-Students.pdf
    7. Akvardar YLZ, Demiral Y, Ergor G, Ergor A. Substance use among medical students and physicians in a medical school in Turkey. Soc Psychiatry Psychiatr Epidemiol. 2004 Jun;39(6).
    8. Garcia-Guasch R, Roigé J, Padrós J. Substance abuse in anaesthetists. Current Opinion in Anaesthesiology. 2012 Apr;25(2):204–9.
    9. Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013. Anaesth Intensive Care. 2015 Jan;43(1):111–7.
    10. AHPRA. Legal Practice Note - Students with an Impairment - LPN 5 [Internet]. AHPRA. 2013 [cited 2015 Jan 16]. pp. 1–4. Available from: http://www.ahpra.gov.au/Publications/legal-practice-notes.aspx
    11. AHPRA. Legal Practice Note - Practitioners and Students with an Impairment - LPN 12 [Internet]. AHPRA. 2012 [cited 2015 Apr 14]. Available from: http://www.ahpra.gov.au/documents/default.aspx?record=WD13%2f9983&dbid=AP&chksum=cNb7VU68ZOvtXoQiaFacKA%3d%3d
    12. Bryson EO, Silverstein JH. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 Nov;109(5):905–17.
    13. Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. Am J Med Sci. 2001 Jul;322(1):31–6.
    14. The Association of Anaesthetists of Great Britain and Ireland. Drug and Alcohol Abuse amongst Anaesthetists: Guidance on Identification and Management [Internet]. The Association of Anaesthetists of Great Britain and Ireland. 2011 [cited 2015 Jan 5]. pp. 1–40. Available from: http://www.aagbi.org/sites/default/files/drug_and_alcohol_abuse_2011_0.pdf
    15. Berge KH, Seppala MD, Schipper AM. Chemical dependency and the physician. Mayo Clin Proc. 2009;84(7):625–31.