Diagnosis and treatment of chemical dependency in professionals.

Accurate diagnosis of chemical dependence is possible with careful evaluation of the patient following the preceding general guidelines. While history is as critical in this field as it is in every other area of medicine or dentistry, we must remain cognizant of resistance in accurate history taking, since the patient has a need to keep the disease hidden. The need for corroborating history through interviews with significant others, spouses or other family members is critical. We all must be aware of the impact of social stigma on our willingness to make the diagnosis, particularly in colleagues, to ensure that we are willing to consider the diagnosis when necessary. Since physicians, dentists, nurses and the other professionals are at least as likely to have chemical dependence as the rest of the population, we must also be willing to identify and discuss with our colleagues issues of chemical dependence. This requires a great deal of courage, since it is often more difficult to confront a friend or colleague with evidence of chemical abuse or dependence. Yet a true friend is willing to confront, particularly when a colleague's family, well-being and professional life are at stake. In the case of chemical dependency, we must be our brothers' and sisters' keeper.