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 Substance Misuse

"Stressidency" is a time during which your stress management will be put to the test. While you have healthy coping behaviors for stress (or you would not have made it this far), all of us also have some unhealthy stress responses. These may include excessive spending, emotional eating, smoking, excessive caffeine intake, social isolation, avoidance, and excessive alcohol or substance use. The additional stresses of residency may challenge your management of these unhealthy coping behaviors.


Estimates are that 9-12 percent of medical professionals experience substance use problems, similar to the general population.  Substances most frequently misused by residents are alcohol and prescription medications. For example, 18 percent of primary care residents in a 2017 survey reported binge drinking in the prior month (Green et al. 2017). An additional element of risk for residents is self-prescribing. While resident self-prescribing has decreased dramatically in the last 20 years, a survey by Guille and Sen (2012) found that 7.6 percent of residents self-prescribed medication. The impact of substance misuse can be career and life altering. As a health care organization, MCHS takes substance misuse very seriously as it directly relates to our Mission, Vision and Core Values. MCHS policies related to substances are linked in the References Section of this topic page below.


Warning Signs/Self-Assessment

McBeth and Ankel (2006) noted that "one of the most fundamental problems with timely treatment of impaired residents is delayed recognition and diagnosis." While Collins (2016) reported that "physicians are notoriously good at obscuring their illness and delaying treatment until the last moment, usually when they are finally faced with legal and/or professional consequences." You do not need to become one more example of this.

If you are starting to wonder about your alcohol or substance use, then talk with someone- a trusted friend or peer or consult with us and do an honest self-assessment with one of these tools:


What's Next

If your use of alcohol or substances is starting to be of concern to you or those who care about you, then please consult with RWBC. We will listen and help you develop a plan to successfully manage this and not let substance use disrupt your residency and your life.

Alcohol or substance misuse fits within the bigger context of self-care and stress management. After you read this topic page, please also consider the topic pages on Self-Care Plans, Emotion Shifts, Burnout and Depression Those topic pages provide ideas on managing stress in healthy ways to help reduce the use on alcohol or substances to cope. And as always, please consider contacting us on RWBC for a confidential consultation. Here's what to expect in a consult with us.



  • NIH resource website 
  • Recovery resource website for self and others 
  • Behavioral Health and Wellness Comprehensive Toolkit for Physicians
  • Physician Health Committee Substance Abuse Page (has information on risk factors, warning signs)
  • MCHS Substance Abuse policy
  • MCHS Policy Drug Free Workpla​ce
  • Green, M., Johson, JA., Seale, JP., Tindol, A., LeKB., Clemow, DD., Barham,AH, and Miller,DP. The Prevalence of Binge Drinking Among Primary Care Residents. Substance Abuse. 2017 July-September; 38(3): 292-296.
  • Guille, C., Sen,S. Prescription Drug Use and Self-prescription Among Training Physicians. Archives of Internal Medicine, vol. 172(No.4) Feb 27,2012 pg. 371-372.
  • McBeth, B.D., Ankel, F.K. Don't Ask, Don't Tell: Substance Use by Resident Physicians. Academic Emergency Medicine, vol. 13 (No. 8) August 2006 pg 894-895.
  • Collins, L. Escaping Addiction with Dignity as a Medical Student. ALiEM, Medical Education, July 12, 2016 accessed at