Our Guest: Carl Christensen MD, PhD, Medical Director of Michigan Health Professional Recovery Program
Dr. Christensen and I will be discussing a support group model known as Caduceus. The name Caduceus, sometimes mistaken for the true symbol of the medical profession (Rod of Asclepius), was adopted by recovery groups whose members are recovering medical professionals. Today we will learn about this program and how someone can get connected to one of these groups for recovery support.
Transcript:
Terri
Hello, everybody. Welcome today’s episode. My guest today is dr. Carl Christensen. He’s an addiction medicine specialist and the medical director at Dawn Farm Recovery Center. He is also the medical director of the Michigan’s Health Professional Recovery Program and is involved with a program called Caduceus, which is what our conversation will focus on today. So let me start by first welcoming you, Dr. Christensen, and asking you to tell us a little bit about your background and your path that led you to where you are today.
Carl
So I grew up in Detroit, Michigan, and went to a pre med at University of Michigan and Wayne State University and Wayne State’s Medical School. And after medical school did my residency in obstetrics and gynecology in Detroit, and after that did a fellowship in gynecologic oncology, which is GYN, cancer surgery and chemotherapy down at Duke University and then came back to Wayne State University to work on the faculty. And my career plan was to be a GYN oncologist and teach OBGYN. But my other job, my nighttime job, was that during my residency and fellowship, I had become an alcoholic and a cocaine addict. I actually had several interventions during my residency which were unsuccessful, which is very common because somebody who’s an alcoholic or an addict or both is very invested in making sure that no one interferes with their addiction.
Carl
I was one of those people, and my colleagues and my chairman intervened on me several times. In fact, it was multiple different chairmen over the years, and I did the same thing. I just lied my way through it and I agreed to do what they wanted and then just went back to drinking and using. And when I came back to Wayne State in the 1980s to work at Wayne State, I was doing pretty well at first, but then started having the same problems. My drinking would interfere with work. And I was one of those people that always came on time, always showed up on time. And I turned into one of those people who couldn’t be relied on because of my drinking.
Carl
And eventually I found out from my residents that if they wanted to take care of a patient who, without being supervised, they would ask me to supervise them because they knew I wouldn’t show up. Wow, that’s what things had come to. And I went through all the stuff that people went through as their addiction gets worse. And finally in 1999, I was intervened on again and I was allowed to take some time off and come back and take a drug test, which made no sense, but they were trying to give me one more chance. And I came back and I flunked the drug test and they called me in and said I had tested positive for cocaine and my license was going to be suspended. And that’s when I threw the towel in.
Carl
And they always say that the thing that you’re going to lose next is what stops you, is what makes you ask for help. And I said, I will do anything to keep my medical license because they said it would be suspended. And the doctor who was intervening on me wasn’t really aware of the physician health programs, but he said he’d heard of this program called HPRP and go out and talk to this doctor out in Grand Rapids. And I went out there, and they told me that I needed to be inpatient immediately and that I should not go back to work, which was no problem, because they weren’t going to let me back in the hospital. They told me to leave and don’t come back.
Carl
And I was inpatient treatment for over four months and came back, and my hospital let me come back under a last chance agreement, and eventually, after a couple of months, let me start seeing patients again, and I owe them a debt that I can never repay, because they didn’t have to. They had me dead to rights. They could have kicked me to the curb, and they probably would have felt safer if they had, but they let me come back in. And I was in the HPRP, the Michigan Physician program, for three years. And when I got out, I realized that I enjoyed doing addiction. I didn’t want to go back to doing cancer surgery and cancer treatment. And I’ve been doing this ever since.
Carl
It’s been my full time career, and I’m the past chairman of the HPRP and the current medical director, been medical director for almost ten years.
Terri
Wow, what a long road. So I got a little lost in the date. So this started in residency. So this was very early on in your practice, and it went for how long before you finally got threatened with your license and decided to seek treatment?
Carl
It was 18 years between my first intervention and my last. So that speaks to how hard it is when somebody knows what they’re talking about and can spin a tail, how hard it is to get a healthcare professional, any healthcare professional, to seek help.
Terri
And your drug of choice was alcohol and cocaine, which not readily available cocaine in the or. Of course they have that, but not readily available at work. So it wasn’t something that you were diverting from your workplace. This was all just your own supply that you had. Right. So there was no data or anything to show that you were taking anything?
Carl
No, there was no diversion they could yeah.
Terri
So that adds a little bit more of an element of making it hard to prove potentially from data and talk your way out of, wow, what a long road for you. Do you think I mean, it’s hard to answer, probably, looking back, but do you think if they had maybe threatened your license at the very beginning of your residency or threatened that you would not be allowed to finish residency unless you got help. Do you think maybe that would have made a difference and you could have gotten help, like, way back?
Carl
It would have made a huge difference. And that’s how these programs work for healthcare professionals, for lawyers, for pilots. When you have leverage against someone’s professional license, that’s what works. And that’s really what makes this different from completely voluntary programs, which the difficulty is that if someone walks away from a completely voluntary program, there’s very little that anybody else can do.
Terri
Right? Yeah. So this goes to the whole accountability thing and a reminder to everybody out there that we’re not doing people any favors if we make excuses for them or ignore or don’t confront them or just make assumptions that, no, they’re just going through a hard time without having those hard conversations with them. And then, like you said, you’re not the first physician or first healthcare professional to be able to talk their way out of things, and then we just believe them and it’s like, okay, then even though we know there’s more to it, we just let people talk their way out of it. And it doesn’t do anybody favors. It certainly didn’t do you favors allowing you for 18 years to just continue to go down that road and spiral and then eventually lead to, of course, some patient safety risks. Right.
Terri
Your residents were there by know you weren’t completely engaged, and so it just gets worse as it progresses. Well, thank you for sharing your story. So you got involved with the recovery program and then this group, Caduceus. So tell us a little bit about that group and where does that name come from? Do you know the history of that name at all?
Carl
So, Caduceus, let me read it right off the internet here. It’s the staff carried by Hermes in Greek mythology. So it’s the snake on the staff. And that’s the nickname for healthcare professional mutual help meetings, which is probably what you would call it.
Terri
Okay, so very apropos then. Yeah. Now, is this a particular group or is it a style used by several independent groups that do peer support?
Carl
So there are no set rules. It can be anything from an AA or NA meeting composed of healthcare professionals to a specific type of meeting where it’s not a typical AA type presentation. But healthcare professionals get together and share their experience, and the members of the group that are newer and still having struggles can get advice from people in the group who’ve been around a lot longer.
Terri
Okay, so is the Caduceus part it just refers to being healthcare professionals.
Carl
There’s no set rules for the meetings.
Terri
Okay, all right. Is it just for physicians or all healthcare professions?
Carl
So the Caduceus meetings are for all healthcare professionals. There is a group known as international Doctors and Alcoholics Anonymous or IDA, that is limited, I believe, currently, to anybody who prescribes medications that would include MDS dos, physicians assistants, nurse practitioners, but it’s limited to those groups prescribers.
Terri
Okay. So each group kind of has their own makeup of what it is, but there is one that’s specific. Okay. Now, do they have a particular philosophy that is maybe different than other groups, or is it really just the people that make up the group that makes it different?
Carl
So it’s primarily dependent upon the people in the individual group. Typically, if someone goes to an AA or an NA meeting, it’s more rigid of a setup where people take turns sharing, but there’s not supposed to be what’s called cross talk, which means that you share and then I give you advice or vice versa. In Caduceus, that kind of thing is often encouraged. So share what’s been going on with them, and then other members of the group will chip in and give their opinion and what’s worked for them in the past. And we try and emphasize that you should share your experience and strength rather than simply telling me what to do, tell me what worked for you.
Terri
Right, okay. Well, that makes logical sense to me. Having not been in one, did you attend regular AA meetings where they had more of those rules versus the Caduceus to see for yourself the difference and how one works better than the other?
Carl
So I was required to go to both, and this was a lucky accident. Typically in programs like HPRP, you’re only required to go to one meeting a month, and somebody checked the wrong box and said, I had to go to one meeting a week, and I didn’t find out about that until ten years later. I’m glad they made the mistake because I went to a meeting, Caduceus meeting every week, and that really was a big source of strength to me.
Terri
I would think that one a month would not be enough.
Carl
I agree.
Terri
Yeah. Okay, well, good. Well, I’m glad it helped your success of recovery and peer support. Okay, so you answered the question. Well, sort of, maybe. Does the Michigan Recovery Program require someone to attend Caduceus or just a type of meeting? Any type of peer support type?
Carl
We require Mutual help meetings, which can be either AA or NA. It can also include Smart Recovery, which is really the primary other type of meeting available in Michigan. We don’t require that it be AA, and we also require one Caduceus a month.
Terri
Okay. All right. So the Caduceus groups run. You go to the meeting, you’re sharing with each other what works for you, encouraging each other. Do they do things outside of the meeting? Is it the typical, like, what you think of that you have a sponsor and then somebody that you’re sponsoring and you stay in touch? Is it the same type of process?
Carl
A lot of people in healthcare will get a sponsor from Caduceus, because one thing is that there’s a lot of stigma, being an addictive physician or nurse or pharmacist. And that often doesn’t go over very well at an AA or an NA meeting. So a lot of people will seek out a sponsor who is in that same profession, and there’s not as much stigma in sharing with them or taking direction for them. And it’s the same thing with pilots. Pilots, if they were to go to a regular AA meeting and talk about flying impaired, there would probably be panic in the so they have their own called I believe it’s called birds of the feather that’s built around the same principles as Caduceus.
Terri
Yeah. No, I think that makes sense. And I think also, too, from the perspective of for a healthcare professional, the different stressors and things that you see throughout your day, other people can’t necessarily relate to. So I would think that there’s that common ground that you all start with that gives you something to kind of relate to. Do you find that’s beneficial too? Yeah. And then you’re also all concerned about your license as well, which is quite a bit.
Carl
Yeah.
Terri
Another thing that bonds you. Okay.
Carl
That’s what brings people in. That’s what believe that’s what makes us successful, but it’s not necessarily what keeps us there once we’ve gotten some recovery under our belt.
Terri
Absolutely. Yeah. Do you find, just from your experience, people going through probably most of your people are in the Michigan’s Recovery program, I would guess. Right. Are you in a group that’s local to Michigan, or is it virtual that anybody can attend?
Carl
So we have the first Caduceus meeting I ever went to was out in Grand Rapids, Michigan. That’s still going as a combined zoom and face to face. And for the zoom part, we do have people from out of state. The other meeting is based in Ann Arbor, and again is Zoom and Face to Face. And we do have a few people from out of state who have moved away from Michigan.
Terri
Okay. Do you have anecdotal feel for how successful these healthcare professionals are in their recovery programs? I mean, do you see a fairly high relapse rate with them?
Carl
Here’s where I get to break. Typical addiction treatment is listed as being about 40% to 50% effective. But when you look at those studies, it really only applies to, like, a single drug. So when they talk about the success rate of medications like Suboxone and methadone, they’re only talking about opioids. And the relapse rates, when you stop those medications are typically over 90%.
Terri
Wow.
Carl
It’s terrible. The healthcare groups, the physician groups have a success rate of somewhere, I think it’s safe to call it 80% or higher, five years out. And that’s been reinforced as being the same about ten years out. And pilots have the same claim. They have about the same success rate. So our success rates are just sky high compared to other addiction treatments. And I really put it on. Two things. We recognize that it’s a chronic incurable condition by the time that people like me get into this treatment program. And the other thing is the leverage. And that’s really always there.
Terri
Okay, so you approach it as this is a lifetime thing you’re going to be working on and we’ll support you, and then if you don’t, you got a lot to lose.
Carl
Yes.
Terri
Okay. All right, that makes sense. So how would one go about getting connected to a group if they wanted to?
Carl
So if somebody has been referred to a physician health program or a nurse’s health program, they will give you some type of contact information because you’re going to be assigned a therapist and a group therapist, and that will be typically where you get the information from. If you’re not involved in a healthcare professional monitoring group, you can go online. And some states have meetings listed online. Michigan does not. So you would need to seek out somebody in your community that you knew was in recovery, that was in your healthcare profession.
Terri
Okay, so that’s interesting. Is there a reason behind why Michigan doesn’t list?
Carl
Well, it’s our organization tries to keep ourselves at arm’s distance from Caduceus, so we’re not seen as influencing it. We don’t want it to know like a group therapy session. The meetings are available on the website for IDA International Doctors in AA. But again, you have to be some type of prescriber to get to that group. And unfortunately, that leaves out the single biggest group of healthcare professionals, which is RNS and BSNs who wind up being monitored. They have online groups themselves, but we try not to get involved, so we’re not seen as being controlling it.
Terri
Okay. All right. So, yeah, a few things involved there, and maybe not as easy to get connected for somebody that just raises their hand and like, okay, I need some help. Let me find some help somewhere, which is maybe a little, I don’t know, counterintuitive for somebody that’s looking to get some help. And they’re having trouble finding a healthcare based group that they can get in.
Carl
With without being in a monitoring program, that could happen.
Terri
Yeah. Okay, all right. Have you seen yeah, so that’s an interesting question. If somebody is trying to do it themselves and wants to bypass the monitoring program and just go into one of these groups, as I would assume, alcoholics and people in the general community, they just go straight to AA. Do you see as much of a success rate, or do you see much of that happen at all? Just since you’re mostly involved with the professional recovery program?
Carl
I know healthcare professionals who have hidden themselves from monitoring, and I’ve seen people be successful and not successful. I don’t have any way of estimating how successful they are on their own.
Terri
Okay. But typically going through the recovery program, the monitoring program, and a support group is going to be your best bet because of the accountability. I’m guessing you don’t really have that same accountability if you just go straight to a peer support group without the monitoring piece of it.
Carl
Correct?
Terri
Yeah. Okay. That all makes sense. Okay. All right. Well, I had interviewed Carolyn Bachelor before with your program, the Michigan program, and she did a great job kind of running that down for us. I don’t know if there’s anything that you would like to say specifically about the Michigan’s Health Professional recovery program. It’s open for all disciplines, is that correct?
Carl
If I remember, Michigan, out of all the states, michigan covers more professionals than any other state. So, yeah, I think it’s, like 29 different licenses or something huge like that. Again, nurses are the biggest single group because they’re the biggest single number of healthcare professionals. They are rolled into our program. Some states have a separate nursing program, like Ohio does.
Terri
Okay. All right. Yeah, I know. I always feel bad picking on the nurses when I talk about diversions or give talks or whatever. It’s always a nurse. It’s like, sorry, there’s just more of you out there. So there’s more examples. Great. Okay. Well, this is interesting. This is great. I had never heard of Caduceus until Carolyn mentioned it, so I’m glad we had this opportunity to talk, especially in light of the fact that it may not be as easy to find one of these groups as one might think. So I think it’s important for the healthcare professionals out there to know that something like this does exist, because I do agree that to group healthcare professionals together to have these types of conversations and support and recovery is definitely beneficial. It’s a different kind of people. We think differently.
Terri
We have different stressors and stuff that we go through every day, not necessarily different trauma that we come with. Right. We’re all humans, and we’ve all grown up in the same world, but we face different things in our profession. So I think it’s nice to group them together. And it’s fantastic to hear about the success rate that you are seeing with physicians. That’s very encouraging. And I think you should encourage the listeners, too. Not only do not ignore the problem, confront somebody and get them help and use that licensing leverage over them if need be. And number two, the rate of success is very high, so that’s encouraging. All right, well, thank you so much for sharing your story and the information you did about Caduceus. I appreciate it.
Carl
Thanks for inviting me.
