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."