People with addiction are often portrayed as hopeless social derelicts or hedonistic rock stars. Rarely are media articles about substance use disorders accompanied by images of well-dressed, intoxicated lawyers or pictures of doctors misusing drugs from the pharmacy. In reality, however, many highly respectable occupations feature elevated rates of addiction.
Professional occupations demand superior levels of responsibility, accountability, and performance that separate them from other occupations. Professionals typically hold a license or official accreditation to practice in their field. They may own a business or be a member of their company’s executive team. This frequently involves having the lives, livelihood, and future of clients and customers in their hands.
Consequently, it is not uncommon for professionals to turn to drugs or alcohol to handle the pressures of high expectations and work-related stress, or simply to help their brains wind down and get some sleep at the end of a long day filled with tough, consequential decisions.
One group of professionals with a significantly elevated risk of addiction and enormous impact on the well-being of their patients is physicians. A researcher at the University of Florida’s Center for Addiction Research and Education interviewed 55 physicians being monitored by their state physician health programs for problems relating to alcohol and drug abuse in 2013. Of those, it was found to be that drug abuse among healthcare professionals was astonishingly high, with 69 percent (38 doctors) abusing prescription drugs. In describing their motivation, most said they turned to prescription drugs to relieve stress and physical or emotional pain.
One doctor who fell into that trap is Peter Grinspoon. As he recounts in his book Free Refills, he was addicted to opioids and almost ruined his career over his addiction. “Doctors are prone to drug and alcohol abuse,” Dr. Grinspoon writes in the Los Angeles Times. “It’s estimated that rates of addiction among the general population run from 8 percent to 10 percent; among physicians, the rates start at 10 percent and rise to 15 percent. What appears to account for the difference is physician distress, and in the case of drug abuse, plentiful access.”
For Grinspoon, easy access to drugs in med school meant misusing samples and stealing drugs from nurses’ stations. “Slowly, imperceptibly, as medical school went by, my seeking out, obtaining, and use of these medications escalated,” Grinspoon wrote in Free Refills. When Grinspoon started working in a Boston hospital, he had his own prescription pad, a situation he compared to “giving a book of matches to a pyromaniac.”
Physicians may have a high rate of substance use disorders, but they also have a high rate of recovery from addiction. They are usually strongly motivated to work on their recovery because they are at risk of losing their license to practice medicine. Many times, they can also rely on a strong professional support network.
In Dr. Grinspoon’s case, the Society to Help Physicians (SHP) and the medical board demanded he go into a rehab program. The SHP has been criticized for its tricky mission of being both an advocate for physicians while also policing them. However, this safety net for physicians, which felt coercive at first, turned out to be the support Grinspoon needed.
When he relapsed, he immediately called his best friend from rehab. He informed the SHP, his psychiatrist, and his parole officer. Being honest about the relapse turned the threat of sanctions into support for Grinspoon’s continued recovery.
Another group of professionals with stressful and possibly life-saving missions on behalf of clients is lawyers. A 2016 study funded by the American Bar Association and the Hazelden Betty Ford Foundation found that American attorneys “experience problematic drinking that is hazardous, harmful, or otherwise consistent with alcohol use disorders at a higher rate than other professional populations. Mental health distress is also significant.”
In his book, The Addicted Lawyer, Brian Cuban speaks of “eye-popping rates of problem drinking and depression” revealed by this “first-ever nationwide study of substance and alcohol use in the legal profession.”
Like physicians, lawyers often work long hours, and both professions exhibit a strong correlation between work-related stress and substance abuse. “Younger, less experienced lawyers working in firm settings have higher levels of distress symptoms than their older, more experienced peers, and being in the early stages of one’s legal career is strongly correlated with a high risk of developing an alcohol use disorder,” writes Cuban.
Eilene Zimmerman’s article, “The Lawyer, the Addict,” in the New York Times recounts the addiction and death of her husband, Peter, a high-powered Silicon Valley attorney who worked more than 60 hours a week for 20 years.
“Peter, one of the most successful people I have ever known, died a drug addict, felled by a systemic bacterial infection common to intravenous users,” writes Zimmerman. “Of all the heartbreaking details of his story, the one that continues to haunt me is this: The history on his cellphone shows the last call he ever made was for work. Peter, vomiting, unable to sit up, slipping in and out of consciousness, had managed, somehow, to dial into a conference call.”
A 2007 study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is part of the National Institutes of Health, described about one-fifth of American alcoholics as “high functioning.” According to the NIAAA study, members of this cohort are “typically middle-aged, well-educated, with stable jobs and families.”
Many of the supposedly high-functioning substance users are professionals such as doctors and lawyers who are highly dedicated to their craft. They tend to believe that they can keep their substance misuse under control and that their addictive behavior will not bring any harm to their patients and clients. It’s a dangerous assessment, as the addicted brain has a very biased way of judging the risks for the substance user and other people involved. If the addiction is not discovered and treated in time, the consequences can be tragic.
Commercial airline pilots face a similar situation. They are away from home a lot, work long hours, and are responsible for the safety of their passengers. And they increasingly try to control stress levels with substance use.
A 2014 study by the National Transportation Safety Board (NTSB) showed that an increasing number of pilots are using both legal and illegal drugs, raising safety concerns about how the risk of impairment could affect performance. The NTSB study examined the toxicology reports of 6,677 pilots killed in crashes from 1990 to 2012. It revealed that pilots testing positive for at least one drug during that period increased from 9.6 to 39 percent, while pilots testing positive for two drugs increased from 2 to 20 percent.
The character played by Denzel Washington in the movie Flight is a useful illustration of that problem. Despite drinking and using cocaine, the pilot, Whip Whitaker, is able to land a plane in an emergency situation, saving all the passengers.
Captain Whitaker is convinced he can control his alcohol and drug use enough to avoid it having a negative impact on his work. He certainly doesn’t believe he needs treatment. But substance use, while “high-functioning,” is only the initial phase of the disease of addiction. The addict is living on borrowed time with potentially disastrous consequences.
The Inpatient Drug & Alcohol Treatment Program for Professionals at Lakeview Health is an addiction recovery program designed specifically for professionals—such as doctors, commercial airline pilots, lawyers, and executives of all industries—who need comprehensive assessment and treatment for addiction. This specialized program at Lakeview Health provides the level of care necessary to detox and treat professionals with substance use disorders, co-occurring mental health disorders, and a history of trauma or post-traumatic stress.
Patients are assigned to staff with specialized training who help navigate the complex systems unique to them which increases engagement and disarms their defenses. They participate in the Professional Treatment Series, a sequence of group therapy sessions designed specifically for the modern professional. This series provides the opportunity to interact with others who can relate to the issues common to professionals regardless of their area of expertise. Going through rehab with professional peers allows patients to share openly in a non-judgmental environment, accept personal responsibility without defensiveness, and develop the tools for personal growth and self-awareness needed for successful recovery, sobriety, and—ultimately—a safe return to work.
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