Imagine you are a local pharmacist. With knowledge and professionalism, you have earned the trust of your community. Now, after years of service, you have developed a substance addiction. What is your next step? Do you risk tearing down the trust and livelihood you have built over the course of your career? Or do you hide it?

For thousands of healthcare professionals with substance abuse problems, these questions are all too real, and for those charged with caring for them, the answers are often less than obvious.

The US National Institute of Drug Abuse reports that 8-12% of health care professionals suffer from substance abuse, with that number increasing for professionals who regularly work hands-on with medications, such as pharmacists. In light of these numbers, professional boards and even governments have policies which govern the process of reporting impaired health professionals. But are these policies effective? It depends, say many who work with substance abuse among healthcare professionals.

Under certain jurisdictions, including professional boards, an individual’s license must be suspended or revoked in the event of impairment, a practice that has raised concerns among some, particularly pharmacists.

“The reason given is that the public trusts pharmacists so much… It’s a case of society saying, ‘We trust you so much so if you do it we punish you hard,’” says Dr. Betty Chaar, Senior Lecturer in Pharmacy Practice and Professional Ethics at the University of Sydney. “[P]harmacists know this and this is one reason you don’t see many drug impaired pharmacists because you will never work again.”

Yet, this doesn’t change the reality that substance abuse and addiction do exist and often arises regardless of a person’s character or professional record. “We need to be more empathetic, we need to be more realistic and we need to invest in help,” says Dr. Chaar.

Dr. Philip Hemphill, Director of the Professional Enhancement Program at Pine Grove Behavioral Health in Mississippi, suggests, “You must have a system of support with full accountability that follows the initial reporting. [T]he monitoring system must have the authority and support of the licensing body.”

That means building trust into the system— trust among patients that professionals can properly care for them, trust among professionals that their licensing body will work as advocates toward rehabilitation rather than base punishment, and trust among those bodies that any issues which arise will be reported promptly.