If you or someone you know is in crisis right now: call or text 988 (Suicide & Crisis Lifeline). For a possible overdose or any medical emergency, call 911. For help finding treatment, the SAMHSA National Helpline is free and open 24/7 at 1-800-662-4357.
The short answer
Doctors, nurses, pilots, lawyers and other licensed professionals often fear that seeking help will end their careers. In many fields, professional health programs or peer assistance programs exist to help people get treatment, return to work safely and sometimes avoid discipline. Confidentiality has limits, so understand the rules before you start, and consider talking to a lawyer who knows your profession.
Why professionals hesitate
- Fear of losing a license or job
- Shame and stigma
- Worry about patient or client safety
- Concern about privacy
- Difficulty taking time off
These worries are real, but untreated substance use is also a risk to your health and to the people who depend on your work.
Types of programs
| Profession | Common programs |
|---|---|
| Physicians | State physician health programs, which coordinate evaluation, treatment and monitoring |
| Nurses | State peer assistance or alternative-to-discipline programs |
| Pharmacists, dentists and other health professionals | State professional health programs |
| Pilots | Employer and union programs, such as the HIMS program, connected with FAA medical certification |
| Lawyers and judges | Lawyer assistance programs in each state |
| Teachers, first responders, military, executives | Employee assistance programs and peer support |
Names and rules vary by state and profession. Ask your professional association or licensing board where to start.
How these programs usually work
- Confidential contact: you can often reach out for information without a formal report.
- Evaluation: an assessment, sometimes at an approved facility.
- Treatment: at a program the professional health program recommends or approves.
- Monitoring agreement: a multi-year contract that may include random testing, regular check-ins, peer support and reports to the licensing board or employer.
- Return to work: a plan for returning, sometimes with limits at first.
Benefits and trade-offs
Benefits:
- A structured path to treatment and returning to work
- Support from people who understand your profession
- In some states, reduced discipline for people who engage voluntarily
Trade-offs:
- Monitoring is intensive and can last for years.
- Confidentiality has limits. Programs may report to the board if you do not comply or if patient safety is at risk. The rules differ by state and program.
- Testing and costs can add up.
- A lapse can have professional consequences.
Know your rights before you start
- Consider a lawyer who works with professionals in your field before you sign a monitoring contract.
- Read the agreement carefully, including what is reported, to whom, and what happens if you slip.
- Ask about confidentiality. Treatment programs follow strict federal privacy rules for substance use treatment records, but a monitoring agreement usually involves signing releases. Know what you are authorizing.
- Ask about leave and job protection. (See [Can You Take FMLA Leave to Go to Rehab? Your Job Protections].)
(This is general information, not legal advice.)
Choosing a treatment program
Look for programs with experience treating professionals, which may offer:
- Comprehensive assessment, including mental health
- Evidence-based treatment and medication when needed. (See [Evidence-Based Therapies in Addiction Treatment: CBT, DBT and Contingency Management].)
- Peer groups of other professionals
- Help with the return-to-work process
- Strong aftercare. (See [What Is Aftercare? How to Build a Relapse-Prevention Plan].)
Verify licensing and accreditation, and ask about costs. (See [How to Find a Legitimate Rehab Center: Accreditation and Red Flags] and [Luxury vs Standard Rehab: What You Actually Pay For].) Executive programs can offer privacy and work flexibility, but they are not automatically better.
Impairment and patient safety
If your work puts others at risk, working while impaired is dangerous. Many professions have duties to step back from practice and to report impaired colleagues. Seek help before an incident, because early, voluntary action often leads to better outcomes.
If you are worried about a colleague
Talk to them privately and with care, or contact your professional health program, employee assistance program or supervisor, depending on your profession and policies. (See [How to Talk to a Loved One About Addiction Without Pushing Them Away].)
First steps
- Contact your state professional health program, peer assistance program or employee assistance program, and ask about confidentiality.
- Talk to a doctor or counselor about an assessment.
- Consult a lawyer who works with professionals.
- Call the SAMHSA helpline (1-800-662-4357) for referrals.
Frequently asked questions
Will I lose my license if I get treatment?
Not necessarily. Many professionals return to work through monitored programs. Outcomes depend on your profession, state and circumstances.
Are professional health programs confidential?
Often they offer confidential contact, but there are limits and reporting rules. Ask before you sign anything.
How long does monitoring last?
Often several years, depending on the program and profession.
Do I need a lawyer?
It is wise to talk to one who knows your profession before signing a monitoring contract.
What if I’m worried about a colleague?
Contact your professional health program or employee assistance program, or speak to them with care.
Sources
- Federation of State Physician Health Programs. fsphp.org
- National Council of State Boards of Nursing. Alternative-to-discipline programs. ncsbn.org
- SAMHSA. National Helpline and FindTreatment.gov. samhsa.gov
This article is for general information only and is not medical or legal advice. Rules differ by profession and state, so consult a qualified professional.