A survey was conducted of all Boards of Medical Examiners in the US, pertaining to actions taken physician drug abuse. During 1976, verification of only 37 actions taken against American physicians for drug abuse was obtained; in contrast, 142 actions were taken in Canada the previous year. Response rate to the questionnaire was 72%, however, only 18% of the responses gave actual figures regarding action taken. Legal reporting requirements for physician drug abusers in the US were also surveyed. Factors affecting therapeutic management of physician abusers were discussed in light of difficulties encountered by therapists and peers. Collective data from treatment of 8 physician abusers were reported. Physician abuse is a significant but under-reported problem. Physician drug abuse is characteristically of long duration and known to spouses and colleagues. Few physician abusers voluntarily seek treatment. The need for continued support and the development of impaired physician programs was emphasized. Predisposing causes, effect of the abuse on the practice of medicine, family stress and outcome was discussed. A management approach for the physician abuser was outlined.