The primary prevention of addiction in the physician.

A review of the literature suggests that the causes of addiction in the physician include: 1) a genetic component; 2) a dysfunctional family; 3) a college atmosphere where alcohol is part of the ritual of passage; 4) self-selection of a medical school career by introverts and over-achievers; 5) unrealistic expectations of medical school and a medical career; 6) the suppression of feelings and avoidance of intimacy in medicine; 7) the insensitivity of some faculty, amounting in some cases to abuse; and 8) the various other stresses of medical training, practice, and life. Primary prevention programs described in the literature include education about alcoholism and drug abuse, stress management skills education, encounter and discussion groups, workshops, and counseling. An important element in preventing addiction in the physician is the psychological ability to cope with the serious stresses which will inevitably be encountered. Suggestions are offered for a course that will improve the ability of students to cope with these stresses.