DOCTOR'S EXPERIENCE SHAPES CAREER IN ADDICTION PYSCHIATRY

LEBANON, N.H. --To help substance abusers overcome their addictions, Dr.
Matthew Hopkins keeps an unusually frenetic schedule: four jobs at three
workplaces in New Hampshire and Vermont.

The 38-year-old psychiatrist loves working with patients other doctors
can't stand: alcoholics and drug addicts prone to manipulation and lying.
"I just look at it as a symptom of their disease and try to fix it," he
said. "I see the person behind the addiction."

He also sees himself.

When patients tell him, "Doctor, you have no idea how bad this is," Hopkins
answers: "Actually, yes I do."

A few years ago, Hopkins' schedule included covering up his own alcoholism
and abuse of prescription drugs.

"It becomes a 24/7 job, fueling this addiction and creating an appearance
of normality," he said. "I got very good at it, but eventually it all came
crashing down and I started doing crazy stuff."

That "crazy stuff" included lying to his own psychiatrist to get
prescriptions and writing fake ones when she eventually cut him off. He got
caught when a pharmacist who worked at two drug stores noticed him filling
prescriptions under different names.

The day he was called to the legal office at Dartmouth Hitchcock Medical
Center in May 2003, Hopkins was sure his life was over. He was going to
lose his license, maybe even go to prison. His wife would leave him. His
friends and colleagues would abandon him.

He confessed everything on the spot.

"It wasn't me," he said. "I don't lie to people. In areas other than that,
I don't lie. It made me hate myself."

Though he didn't expect to get a second chance, Hopkins got one through the
New Hampshire Medical Society's Physician Health Program. The program,
which exists in some fashion in every state, guided him through the lengthy
process of treating his addictions, restoring his medical license and
returning to work.

Hopkins signed a five-year contract in 2003 requiring him to spend several
months at a rehabilitation facility, followed by sessions with a therapist
several times a week and monthly meetings with other program participants.
His supervisor files reports on his performance, and Hopkins calls a
toll-free 800-number every day to see if he's been selected for random drug
testing.

"The random drug testing is a really crucial part, because we're picking up
on relapses immediately," said Dr. Sally Garhart, director of the New
Hampshire program.

Several published studies put the substance abuse rate among doctors at 10
to 15 percent, similar to the general public. But the recovery rate among
physicians is nearly 90 percent, or about four times higher, said Garhart,
who also is a regional director of the Federation of State Physician Health
Programs, a non-profit organization administered by the American Medical
Association.

The AMA formally recognized physician impairment as a serious problem in a
1973 policy paper titled "The Sick Physician." Today, its policy on
impaired physicians includes encouraging them to seek help through their
state physician health programs and pushing for further study of the
problem. It also supports programs for medical students to reduce the risk
of future impairment.

In college, Hopkins was "Good-time Matt," known for working hard and
playing hard. In medical school, he started downing a few beers every night
to help him sleep.

"It happened very, very slowly, because I couldn't let it get out of
control," he said. "But that two became three over the course of the year,
which became four, which became five."

By the time he started his residency at Dartmouth Hitchcock, he was
sneaking around and trying to hide how much he drank from his wife, the
only person who knew about his problem.

"I basically would drink as much as I could get away with, never during the
day, only at night," he said. "It was every night, and I was coming to work
with a hangover every day."

He blamed his absent-mindedness on Attention Deficit-Hyperactivity Disorder
and got a psychiatrist to prescribe the stimulant Adderall by not telling
her about his drinking. When he discovered the pills helped cure his
hangovers, Hopkins started drinking more, telling himself he could just
take extra Adderall in the morning.

After taking a month's supply in a week, he told his psychiatrist to stop
prescribing it. A few days later, when she refused his request for just one
more refill, he started writing his own prescriptions and filling them
under the made-up name. He told himself he'd do it only once to wean
himself off the drug, but he couldn't stop.

"I still have no idea how I crossed that line," he said. "It was so easy,
and they didn't even ask for an ID or anything at the pharmacy."

AMA policy says physicians have an obligation to report fellow doctors they
suspect of having a substance abuse problem. But not even Hopkins'
co-workers were suspicious. His supervisor, Dr. Donald West, said Hopkins'
arrest caught the staff completely by surprise.

"The most you could say was he was a little bit erratic about keeping up
with paperwork," he said. "Even that was not anything that made anybody
suspect he had a problem."

The signs that doctors are impaired usually are subtle, Garhart said. They
may avoid their peers, appear fatigued or act grouchy, but work usually is
the last thing to suffer, she said.

"It's personal and family situations that suffer first," she said. "Or
there may be some issues with the staff. Patients have no clue. That is
preserved."

Today, Hopkins spends three mornings a week at the veterans' hospital in
Vermont running group sessions for substance abusers and working in a
clinic for heroin addicts. Tuesdays and Thursdays, he's at Dartmouth
Hitchcock, seeing individual patients, helping operate a new intensive
outpatient program and holding group sessions at the medical center's
heroin clinic. Friday afternoons, he assesses Dartmouth College students
who've gotten in trouble with alcohol or drugs.

West describes Hopkins as gentle and understanding, but also tough with his
patients.

"He's much more grounded. He's one of those people who's sort of thankful
for having been addicted because it really turned his life around," he said.

Hopkins embraces the demanding schedule not only because he's grateful for
his second chance but because he wants to dedicate his career to addiction
psychiatry, a field he hadn't seriously considered before. He hopes being
candid about his experiences will prompt others to get help.

"I want people to know that this is something that can happen to anyone,"
he said. "I like to look at myself as an example of someone who's in
recovery, who's done it and put my life back together."

The AMA formally recognized physician impairment as a serious problem in a
1973 policy paper titled "The Sick Physician." Today, its policy on
impaired physicians includes encouraging them to seek help through their
state physician health programs and pushing for further study of the
problem. It also supports programs for medical students to reduce the risk
of future impairment.

In college, Hopkins was "Good-time Matt," known for working hard and
playing hard. In medical school, he started downing a few beers every night
to help him sleep.

"It happened very, very slowly, because I couldn't let it get out of
control," he said. "But that two became three over the course of the year,
which became four, which became five."

By the time he started his residency at Dartmouth Hitchcock, he was
sneaking around and trying to hide how much he drank from his wife, the
only person who knew about his problem.

"I basically would drink as much as I could get away with, never during the
day, only at night," he said. "It was every night, and I was coming to work
with a hangover every day."

He blamed his absent-mindedness on Attention Deficit-Hyperactivity Disorder
and got a psychiatrist to prescribe the stimulant Adderall by not telling
her about his drinking. When he discovered the pills helped cure his
hangovers, Hopkins started drinking more, telling himself he could just
take extra Adderall in the morning.

After taking a month's supply in a week, he told his psychiatrist to stop
prescribing it. A few days later, when she refused his request for just one
more refill, he started writing his own prescriptions and filling them
under the made-up name. He told himself he'd do it only once to wean
himself off the drug, but he couldn't stop.

"I still have no idea how I crossed that line," he said. "It was so easy,
and they didn't even ask for an ID or anything at the pharmacy."

AMA policy says physicians have an obligation to report fellow doctors they
suspect of having a substance abuse problem. But not even Hopkins'
co-workers were suspicious. His supervisor, Dr. Donald West, said Hopkins'
arrest caught the staff completely by surprise.

"The most you could say was he was a little bit erratic about keeping up
with paperwork," he said. "Even that was not anything that made anybody
suspect he had a problem."

The signs that doctors are impaired usually are subtle, Garhart said. They
may avoid their peers, appear fatigued or act grouchy, but work usually is
the last thing to suffer, she said.

"It's personal and family situations that suffer first," she said. "Or
there may be some issues with the staff. Patients have no clue. That is
preserved."

Today, Hopkins spends three mornings a week at the veterans' hospital in
Vermont running group sessions for substance abusers and working in a
clinic for heroin addicts. Tuesdays and Thursdays, he's at Dartmouth
Hitchcock, seeing individual patients, helping operate a new intensive
outpatient program and holding group sessions at the medical center's
heroin clinic. Friday afternoons, he assesses Dartmouth College students
who've gotten in trouble with alcohol or drugs.

West describes Hopkins as gentle and understanding, but also tough with his
patients.

"He's much more grounded. He's one of those people who's sort of thankful
for having been addicted because it really turned his life around," he said.

Hopkins embraces the demanding schedule not only because he's grateful for
his second chance but because he wants to dedicate his career to addiction
psychiatry, a field he hadn't seriously considered before. He hopes being
candid about his experiences will prompt others to get help.

"I want people to know that this is something that can happen to anyone,"
he said. "I like to look at myself as an example of someone who's in
recovery, who's done it and put my life back together."