FOR most of his career, Dr David McCartney has cared for patients who have alcohol and drug problems. What few of them will have realised is how much he can empathise. McCartney, who spent 17 years working as a GP in Glasgow and is now clinical lead for the Lothians and Edinburgh Abstinence Programme (LEAP), is himself a recovering alcoholic.
"I had my issues with alcoholism a few years back," he says. "It was really through that experience of struggling to cope with my drinking, and not finding an easy route out of it, and then finally discovering there was recovery to be had, that led t
o my motivation for getting involved in retraining."
McCartney, who has not spoken publicly about his alcoholism before, knows it is a taboo subject for many in the medical profession. While the British Medical Association (BMA) estimates one in 15 doctors will have a problem with alcohol or drugs during their careers, few talk about it openly.
"Fifteen per cent of the population, including doctors, will suffer with a problem with alcohol or drugs at some point in their career," says McCartney. "Not everyone will have a dependence – for some it will be a temporary thing. But somewhere between 5 and 10 per cent will develop a dependence, and doctors are not protected from that. I don't think being a doctor makes you more vulnerable, but it certainly doesn't give you protection."
McCartney adds there is an almost "corporate denial" within the profession about such problems. He stresses he received "a lot of support" from colleagues, and from the Sick Doctors Trust and the British Doctors and Dentists Group, during his recovery. "For the most part, my colleagues were very helpful," McCartney says. "Sometimes people were embarrassed about it. I think a lot of doctors have this belief that doctors don't really get sick, and there is something slightly embarrassing about not being well if you're a doctor. But that doesn't stand up to scrutiny – we are just the same as everyone else in terms of illness. Some people find it awkward and were not very sure how to manage a colleague who was an alcoholic or a recovering alcoholic."
McCartney believes stress was a factor in his drinking and a family history of alcoholism, he now knows, also put him at increased risk. But he reflects that even those whose genes predispose them to alcohol addiction still have a choice.
He says: "You might not be responsible for the degree of risk you have, or even the development of alcoholism, but you are certainly responsible for what you do about it. It's only hopeless if nothing can be done. There are lots and lots of us who have developed a dependency who have recovered, and it's working out what we have in common and how can we apply that experience to help other people. That's really in a nutshell why LEAP has come about."
The first programme of its kind in Scotland, LEAP offers patients a combination of intensive rehabilitation and supported accommodation for three months to come off drugs or alcohol. Funded by the Scottish Government and run by NHS Lothian in partnership with drug and alcohol action teams, LEAP offers its "graduates" after-care support and access to self-help groups. McCartney had the idea for LEAP after working in a residential treatment centre as part of his retraining in addictions.
"Almost all of these in the UK are in the voluntary or private sector," he explains. "What I wanted was to be able to offer the same standard and quality of treatment from the NHS. That was the challenge."
McCartney secured funding for an initial two years, during which time he and his colleagues will have to show the pilot has benefited patients. "There's two ways to show it works," he adds. "One is the scientific method. We are going to be externally evaluated and that will involve following patients, assessing them carefully and then following them up for a period of a year or so after they've left us. The second way is to listen to individual stories as people pass through treatment."
As no-one has studied a similar model before, he adds it is difficult to predict what success rate LEAP will have.
"What we are doing is not a traditional residential treatment programme – we are trying to do a different kind of model, called 'quasi-residential'. Accommodation is provided at a different site from where the treatment programme is delivered – they are not actually living in the treatment centre."
Studies have shown residential models will result in around a third of patients remaining clean and sober after three to five years. This does not take account of those who might have a relapse, but still go on to a successful recovery. Despite the rigorous assessment procedures, McCartney knows sometimes patients just won't be ready.
"I always say to staff here that not a minute of time that patients have here is wasted, because they are learning something, even if it's just seeing that other people can do it," he says. "And when they are ready, they have got that experience."
Sometimes McCartney, who continues his own recovery through self-help groups, also talks to patients about his experiences with addiction. He says: "You need to be aware of professional boundaries, so it's where it's appropriate to disclose, where I feel it's helpful to the patient. But I think if someone knows I have been through it as well – and it was a struggle – they are getting a bit of hope from my experience."
• LEAP will be officially launched by the Princess Royal next week.
