For professionals such as physicians, lawyers, and accountants, addiction to alcohol or other drugs can mean the loss of a license to practice, a shattered career, financial distress, and family upheaval.

But there's another option for many professionals to use well before they hit bottom--a way to face their addiction, get treatment and return to productive work while remaining free of disciplinary action. That option is peer assistance.

Peer assistance reconciles two rights that could otherwise war with each other. One is our right to competent help when we walk into the office of a doctor, lawyer, accountant or other professional--the kind of help that a person impaired by alcohol or other drugs may not be able to provide. Second is the right of professionals to receive confidential treatment--the same kind of treatment that any person with the disease of addiction deserves.

The philosophy underlying peer assistance is based on compassion rather than punishment, allowing professionals to remain in their career while turning their lives around. Yet this is an uncompromising compassion, demanding that professionals get treatment for addiction and stay clean and sober.

One example of how this happens is a peer-assistance group named Physicians Serving Physicians, based in Minneapolis.

Ironically, physicians can find themselves at high risk for substance abuse and dependence. Their professional autonomy and access to prescription drugs--when paired with long work hours and high stress--create the potential for chemical abuse. What's more, their public prestige lends them an air of invincibility, and other physicians or health care associates may not be willing to take the risk of confronting a colleague.

"In all the years that I've been involved with peer assistance, I've seen that physicians are one group that is very challenging to reach," said Diane Naas, executive director of Physicians Serving Physicians and Accountants Concerned for Accountants in Minnesota. "I think that's because physicians are accustomed to giving advice and not used to taking it. But once they do enter treatment, physicians do extremely well. Their recovery is enhanced once they see that they're dealing with a disease. They know that diseases are treatable."

Sometimes impaired physicians contact Naas directly. But usually Naas hears first from a physicians colleague, friend or family member. When Naas own research confirms that the physician shows signs of addiction, she typically organizes an intervention designed to get the physician into treatment. Often this meeting includes the physician, concerned friends and family members, and another physician who is already in recovery.

"I think of intervention work as caring enough to say the very worst," Naas said. "Intervention is holding up a mirror to someone, helping them to see themselves as others have seen them in relationship to addiction."

Peer-assistance groups typically cooperate with diversion programs, which add the element of accountability. In Minnesota, for instance, physicians who enter treatment are required to report their illness either to their licensing board or to the Health Professionals Services Program (HPSP), the diversion program. HPSP was created by the state to protect the public from professionals who cannot practice health care with reasonable skill and safety.

HPSP carefully monitors its participants to make sure they comply with treatment and stay free of chemicals. Monitoring usually lasts three years and includes aftercare programs and regular reports from the participants therapist and work supervisor. It also includes random drug screens. As long as physicians meet the requirements, their treatment stays confidential and never goes to the licensing board. About 90 percent of physicians followed by HPSP stay sober through the three years of their monitoring.

Of course, this is just one example of peer assistance. For information on peer assistance for other professionals, contact any of the following groups. While the following may focus on a certain geographic region of the United States, they can direct you to sister organizations across the country.

--Published January 6, 2003