Drug-addicted boss: How should dental staff react

I have serious concerns that my boss is abusing drugs, possibly prescription narcotics and/or antidepressants. He had knee surgery a couple of years ago, and my coworkers and I believe he may have become addicted then. That's when we started noticing changes in his behavior. He's really a great dentist, and I like him a lot, but I've noticed several signs.

BY DIANNE GLASSCOE WATTERSON, RDH, BS, MBA

Dear Dianne,

I have serious concerns that my boss is abusing drugs, possibly prescription narcotics and/or antidepressants. He had knee surgery a couple of years ago, and my coworkers and I believe he may have become addicted then. That's when we started noticing changes in his behavior. He's really a great dentist, and I like him a lot, but I've noticed several signs.

One of the most obvious signs is that he stays out of work too much. Last year, he missed 65 days of work! I continue to see my patients when he is not here, but it is embarrassing to have to tell the patient that he or she won't be getting an exam because the doctor is not feeling well.

I've also started noticing how his hands tremble sometimes. Some days, he will come in and work until lunch and then tell the business assistant to cancel his afternoon patients because he is not feeling well. He goes in his private office a lot and closes the door. One day last week, I'm sure he had been crying when he came out.

He puts on a happy face around his patients and coworkers, but something is terribly wrong. He has a lovely wife and two children, and I've never known there to be any marital problems over the past five years that I've worked here.

I am at a loss as to what to do. Every week, we are losing more patients. Can you give me any advice?

Midwest RDH

Dear Midwest,

It is obvious that the doctor is going through something very difficult and private, so I doubt there is anything you can do about the situation. It sounds like he needs professional help, and the good news is that counseling for substance abuse problems is available to anyone who needs it. It is likely the doctor is aware of these services, but maybe he has not come to the point where he feels he can reach out for help. I hope he will before it's too late.

As a staff member, you are in a difficult situation. You and I are not trained in dealing with situations like this. It is very hard to stand by and watch someone suffer, especially someone for which we care. However, the doctor needs a properly credentialed professional who has been trained in substance abuse counseling. Dentistry requires a steady hand and the ability to think clearly. Evidently, your boss stays out of work when he does not feel he can provide safe and competent dentistry.

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Unfortunately, the problem of substance abuse among dental professionals is more common than you might think. You can go to any state board website and access the disciplinary actions taken against licensees. What you will find is that most of the actions are taken in response to substance abuse. For example, in North Carolina, many of the disciplinary actions involve practitioners writing prescriptions for medications that were not for dental use. One doctor had his friends come in as patients, and he would write prescriptions for them, usually for Vicodin. I noticed several actions against hygienists, and most of those were for drug or alcohol problems.

A 2010 article in the Academy of General Dentistry journal called Impact states that 10% to 12% of the general population is addicted to drugs or alcohol at some point in their lives. However, the prevalence rate for dentists and physicians is believed to be higher than the general population, at 12% to 19%, and the drugs of choice are alcohol, opiates, and nitrous oxide. "According to the ADA Dentist Health and Wellness Committee, alcohol is the drug of choice for 37% of dentists with substance abuse problems, while 31% use prescription drugs (opiates), 10% use street drugs, and 5% use nitrous oxide." (American Dental Association's Principles of Ethics and Code of Professional Conduct. Chicago: American Dental Association; 2011)

Several states have programs designed to help dental professionals with substance abuse. For example, North Carolina Caring Dental Professionals (NCCDP) was founded in 1994 to offer assistance and consultation for all North Carolina-licensed dentists, hygienists, and dental faculty/students at UNC. The program is funded by license-renewal fees from dentists and hygienists. The organization works to "assist dental professionals, their staff, and their families through all of the burdens of recovery from chemical dependency and behavioral disorders. The NCCDP program provides confidential peer support and professional assessment, treatment, and recovery assistance." They also assist the dental professional with license retention. (nccaringdental.com)

A dentist who develops a substance abuse problem is likely to see a negative impact on his or her practice. If the doctor has to enter a treatment facility for a set period of time, a fill-in doctor would be necessary to ensure that a patient's dental needs are handled in a timely manner. Your post stated that the doctor missed 65 days of work last year. If we consider that most practices work about 16 days per month, that would be four months of productivity missed. Dental practices cannot remain financially viable on hygiene procedures alone, and I don't know how the practice has stayed solvent given this much doctor absenteeism, even if a temporary doctor was retained.

Of course, the most valuable practice asset is the patient base. Your practice is losing patients because of the doctor's absenteeism, and we really cannot blame patients for deciding to go elsewhere when their dental needs are not being met. A heavy loss of patients could spell the end of the business.

I suggest that you start looking for alternative employment, because one thing is sure: If your boss doesn't get professional help soon, there will be no practice. Given the lack of sufficient jobs for hygienists today in many areas of the country, do not delay in putting together a good resume with references, and watch diligently for any openings that may appear on job sites like craigslist or the local newspaper.

The best-case scenario for you would be that your boss turns the practice over to a dentist who is competent to step in and save the ship from sinking. We can always hope that will be the case. But if you are like most of your peers, you need employment stability. The ship you are currently on is going through tumultuous seas and is anything but stable. The signs are clear - take care of yourself and your family. I hope your boss will do the same.

All the best,

Dianne RDH


DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email dglasscoe@northstate.net. Visit her website at www.professionaldentalmgmt.com.

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