The first time I used crystal, I went to work high. The night before, I had been out celebrating my birthday, and two guys at the bar offered me some “crank.” One bump turned into several lines, and the night stretched into the next morning. I can’t tell you how much we did, but I knew that night that something had changed. “This could be a problem,” I told my friend. “I like this too much.”

My plan had been to party that night then nap the next day before my 5:00 pm shift in the emergency room. Of course, I couldn’t sleep at all, so I was awake the entire day before bouncing into the hospital – miraculously right on time. I was worried at first that the shift would be a struggle, but I still had enough crystal in my body to last through the night. Far from the disorganized disaster that I would later become, that night I was incredibly focused. I saw far more patients than any of the other residents, but the part that was really surprising was how much more fun it was to practice medicine while tweaking. I left the next morning believing the lie that would nearly destroy my career – the lie that I work better on crystal.

Over the next four and a half years, I tried everything in my power to replicate that night, but never could. At first, I could use every now and then, but even from the beginning I knew that something about crystal made be feel different. Not just high or euphoric (though it certainly did both of those things), but also somehow normal, as if I had finally found something critical that had been missing from my life. (I used to tell people I was born with congenital amphetamine deficiency.) Of course, it was only a matter of months before I was using every day. After that, I started smoking it, then started shooting up. Something had gone horribly wrong, but I was completely powerless to change course. Still, I never asked for help. I was going to do things my way or die trying, and I was perfectly willing to die rather than “give in.”

Of course, none of my behavior went unnoticed at work, so four and a half years after my first bump, suicidal and riddled with track marks, I walked into an intervention. Six physicians, supported by a 250-pound security guard, “insisted” that I seek help. I was going to rehab, like it or not.

I went to a treatment center that specializes in addicted physicians (which means that it was very expensive and had a pool), so I met a lot of other doctors who were trying to get sober. Of course, most of them were alcoholics or pill poppers, and the few junkies were mostly anesthesiologists that liked narcotics – in other words, everyone was “different.” Resistant to the end, I wouldn’t listen to any of them, until I met Steve, the first person I ever met who had quit crystal for more than about 30 days. He was three years sober at the time, but the key point was that he didn’t look like he wanted to kill himself. In fact, he seemed pretty happy. At first I didn’t believe that he was really a tweaker, but he told me some of his stories, proving beyond a shadow of a doubt that he was just like me. It was at that point that I knew not only that I could stay sober, but also that I really didn’t have any excuse. I have remained sober ever since.

Once I left rehab, I immediately got a sponsor and started working the Steps, and soon the pain of living began to subside and life started getting fun again. The only thing remaining was getting my medical license back. Fortunately, the medical board allowed me to return to practice, but with several restrictions on my practice.

In addition to these restrictions, I was also placed under several monitoring conditions – part the “standard package” for physicians returning to work after getting out of rehab. I underwent random drug testing (not that anyone needed a lab test to tell when I was high), aftercare group therapy, and monitoring sessions with an addiction specialist, all for five years (and some of it while on rotations that required overnight call). In the beginning it seemed like the monitoring would never end, but as I write this essay, five additional years have passed since the restrictions and conditions were lifted. Time passed quickly – or at least it did as soon as I learned to stop thinking about how much time I had left on my contract and to start concentrating on my recovery and my life.

Despite my initial protestations, I am grateful to this day for all of the initial restrictions on my license. Some people argue whether or not all of these restrictions really help people stay sober, but to me the question is completely beside the point. Facing these challenges forced me to grow up (usually awkwardly and in public), so that I could become an adult in a world of other adults. No one at my job cares if I am “making progress;” they just want me to get my work done. Life is a challenge, and I learned to meet this challenge right off the bat – through the power of the inventory.

My first challenge came about a year after I got sober. Enough time had passed where I could petition the medical board to have a few of the restrictions lifted. I was under the impression that everything was pretty much routine at this point. After all, I had been sober an entire year (practically forever), and I thought it would be patently obvious that I would continue staying sober forever. Somehow, the medical board remained unconvinced. I sent in my request, expecting a quick – and affirmative – reply. Much to my surprise, the board did not quite see things my way. Though they lifted some of the restrictions, they left some of the big ones in place.

About the same time that my petition was going before the medical board, I was in the process of looking for my first post-residency job. I didn’t know what I wanted to do long-term, but I had managed to get a verbal offer on a hospitalist position where I had trained. The salary was considerable, promising relief from my mounting financial stress. It would also offer me plenty of time for meetings and such. In other words, it was perfect, clearly a reward from the Universe for being such a good citizen.

Of course, when the medical board continued the restrictions on my license, the job offer evaporated. At first I was just stunned, then angry. Very, very angry. I shared about this turn of events at every meeting I went to for two weeks, expecting to convince everyone that I had been wronged, hoping to hear some way to convince the medical board of their obvious error. I did not succeed. Instead, I was told in various ways that my job is always to fit myself to the plan of the Universe – not the other way around. Two statements finally got through to me:

1. “I can’t believe how entitled you are;” and

2. “God help us all if we get what we really deserve.”

At this point, I called my sponsor and told him I just couldn’t take it anymore, and he told me to come over right away. Once I arrived at his house, he gave me a piece of paper and a pencil and said, “Make some columns.” I had already completed my Fourth Step inventory, so I knew exactly what to do. I listed the people, principles, and institutions (yes, there were some in each category) with which I was angry, and why. Then came “my part.” I had done this inventory before, of course, but this time, instead of bragging about how “bad” I had been, desperation made me honest. I had lied, committed felonies, abused my privileges, and endangered patients – in short, I was exactly the kind of physician the medical board was designed to protect the public from. They were doing their job, and my good intentions were not enough to overcome years of unacceptable behavior.

Of course, none of this was news to me, but it was so painful to look at that I could only take quick glances at it before. Seeing it in black and white forced me to take a good, long look at my behavior, but more importantly, at my shame and my fear. Although my anger did not disappear immediately, but for the first time in my life I had a sense that all the pain in my life was in some way the result of my own actions and not those of other people. Maybe, then, I could change my behavior and my life would get better. I can be happy regardless of what other people do.

Needless to say, I never got that job. Instead, I took a position seeing patients part-time at the county STD clinic. After my initial thrill of having found a job (any job) wore off, I started wondering whether my career had reached a final, rather boring dead end. Again, the Steps showed me how to work through my fear and realize the contribution I was making every day, both to my patients and my co-workers. Now that I was sober, I was actually responsible, organized, and efficient. I was once again a thoughtful, caring physician, and I earned the respect of my colleagues.

People took notice, and things started to happen. First, I was given a full time position. Next, I was given full responsibility over another clinic. Over the next nine years a series of seemingly random events transformed that job into a faculty position at a major research institution. I never saw that coming (I didn’t even think I liked research). However, practicing the principles outlined in the Steps opened my mind to a wide range of new possibilities, both in my career and in my personal life. I figured out early on that the Steps could keep me from using crystal, but it took years before I really grasped the profound impact they would have on the rest of my life.

Like many individuals in professional fields, some of my mistakes are a matter of record, so they follow me wherever I go. When I applied for my research fellowship, I had to honestly answer the questions related to my drug use and the effects it had on my career. I thought these answers spelled doom for my career plans, but I had years of sobriety demonstrating what the program can do – all of which was also a matter of record. Not only did it not destroy my career, I got my first choice of programs.

I cannot undo the mistakes of my past. I have done my best to make amends for the all the harms I inflicted, but many of them I will never be able to fully correct – especially the ones involving my patients. Every drug test I undergo, no matter how annoying, reminds me that I still have work to do. Practicing medicine is not my right; it is a privilege that comes with great responsibility. The Steps have enabled me to meet this responsibility with grace – and even some humility.