“In my mind, I had this self-image, this self-perception that I’m something. I cannot let anyone know about this problem I have because it could dismantle me.” ~ Jason Snyder, executive director of the Consumer Health Coalition in Pittsburgh, Pennsylvania, speaking to Jeffrey Benzing of PublicSource Professionals with an addiction problem are faced with a difficult dichotomy. On the one hand, they have the outward appearance and all the trappings of a successful life – the elite high-paying career, a position of trust and responsibility, respectable professional affiliations, an elegant home, a fancy car, and even the requisite two-point-five rosy-cheeked children. But in secret, they suffer from the terrible disease of addiction, and because of that, they face the same powerlessness as any other person lost to excessive alcohol or drug abuse. No matter how tight their grip on their life is, addiction is always stronger, and their life is slowly becoming unmanageable.
“I’m Above All This Stuff”
Denial is a strong characteristic common virtually all addicts, and that personality trait is especially strong amongst many substance-abusing professionals, partly because in their own mind, they do not fit the stereotypical profile of the “typical” addict – i.e. dirty, homeless, stealing to support their habit, etc. Being as a rule well-educated, professionals often have an exaggerated sense of how they are “managing” their addiction. They will justify their actions and behaviors by telling themselves – and anyone who perceptively shows concern – that everything is under control. “I never considered that I was an addict. I was a doctor… I saw it as my right to relax and release pressure because I was under such an incredible amount of pressure,” said one physician, as quoted in a book review of Drug-Impaired Professionals published by the Journal of the Royal Society of Medicine.
Although the medical community now recognizes addiction as a disease, specifically a brain disorder, the actions committed by a person in active addiction are still criminal. This is especially true for professionals to use their position to obtain and use drugs. “Drug diversion”, as the practice of stealing drugs is officially known, is a real and present risk among professional healthcare workers. Currently, an average of 103,000 technicians, nurses, doctors, and other professionals in the field have substance abuse or addiction problem, and the primary drugs of choice are narcotics such as fentanyl or oxycodone. Some studies indicate that the true number could be even higher – estimating that as many as one in 10 practitioners could fall into alcohol or drug abuse at some point in their lives. Doing the math based on those estimates shows how woefully inadequate the support system is because only a fraction of practitioners are enrolled in rehabilitation programs designed for healthcare workers. Such programs are voluntary, with the benefit being that those who complete treatment are typically not in danger of disciplinary action. The overall goal is to have 1 %-3% of a state’s practitioners enrolled in such programs, based upon the generally-accepted estimated prevalence of substance abuse among healthcare workers. If the goals were met, even at 1%, that would mean that approximately 50,000 healthcare professionals across the nation would be enrolled in drug rehabilitation. That is nowhere near the case. Using California for an example, the shortfall is evident. In 2007, the state had over 125,000 licensed doctors, but only around 250 were enrolled in substance abuse treatment. That number represents less than .2%. It is obvious that there is still a stigma attached when where practitioners who need treatment are free to seek it. The program was so ineffective that in 2008, the physician assistant program was closed by the Medical Board of California. Doctors must now voluntarily enroll in confidential, private treatment. Most private programs do not have the resources to monitor physicians after they return to practice. Professionals in other high-risk jobs, such as pilots or bus drivers, have safeguards already in place to identify those with substance abuse problems, but the healthcare industry primarily relies on its workers self-refer. In addition to simply being unrealistic, that paradigm also puts lives at risk. Some states have adopted a “crime and punishment” model that is in force when patients are injured due to a practitioner’s substance abuse. US Attorney John Kacavas says that drug abuse in the medical field “can’t be treated just as an addiction and treatment problem. To protect the patient, there has to be a law enforcement component.”
Experts at Hiding the Addiction
Because their public image, professional standing, and personal relationships are at risk if discovered, many professionals with addictions become quite adept at maintaining a façade of normalcy. Often, those closest to them, including their spouse, children, and coworkers are largely or even completely unaware that a problem exists. Hiding drug use and using when alone are to primary symptoms of the disease of addiction. Here are some of the more common tactics that a professional with a drug addiction quickly learns to employ –
- Working Late – This is the #1 tactic used by addicted professionals to hide their drug abuse. It is understood that success requires effort, and the professional’s family is usually accustomed to frequent absences. In that situation, it is very easy to spend hidden time seeking, acquiring, and using drugs all while ostensibly “working late”.
Also, the absences make it more difficult for those closest to the addict to pick up on the telltale signs of addiction – mood swings, blackouts, diminished appetite, changes in sleeping pattern, etc.
- Associating with other addicted colleagues – In an attempt to justify their own usage, some substance-abusing professionals will seek out others whose drug problem is just as bad, or perhaps even worse, than their own.
There are several reasons why they do this. First, they will have a friend who won’t judge them or ask questions. It’s much easier to give themselves permission to use when drugs are already part of the social relationship. Secondly, in their own mind, they can tell themselves that their problem “isn’t that bad”, because their friend is so much worse. By comparison, their own drug problem seems moderate.
- Making the extra effort – All addicts and alcoholics hide the true extent of their usage, but because they have so much to lose, many professionals will often go to a much greater lengths – (health care professionals) stealing medication samples, writing reciprocal prescriptions with other addicted colleagues, under-medicating patients, (legal professionals) offering reduced billing in exchange for drugs, and even going as far as driving to different towns where they might not be recognized, in order to use.
- Hiding income/scheming to get more money – No matter the income level, money is always a problem for a person lost to addiction. In order to successfully disguise their addiction, many professionals will tap into retirement or college funds, or attempt to conceal extra money from overtime, bonuses, or raises.
Once again, they will self-delude themselves into justification by saying it is “their money” that they have earned by their success while telling themselves that since addicts can’t be successful, they obviously aren’t addicted. Like many people with substance abuse problems, professionals are very practiced in this type of faulty circular logic.
- Placing blame on others – This is an old standby for addicts – a person’s drug use is always someone else’s fault. If their spouse was more supportive or didn’t nag so much… If their boss wouldn’t put them under so much pressure… If their doctor would only write them a sufficient prescription. By bringing up other people’s mistakes, the addict diverts attention away from their drug usage.
The Best Solutions
A large number of addiction specialists are of the belief that the best and fastest way to address the drug problem among high-level professionals such as medical practitioners is to provide better education on how to prevent addiction and specifically, how to spot possible impairment among colleagues. This would mean more attention to the issue of drug abuse during training and a requirement for periodic continuing education. William Pendergast, president of the National Federation of State Physician Health Programs, says that because addiction is a disease, not a moral failing, the best solution is to remove the stigma associated with substance abuse treatment so high-level professionals won’t be afraid to seek help. John Shapiro, the medical director of the Physician’s Health Program in Pennsylvania says, “The message we need out there is…we can treat these people and get them healthy.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281466/ https://www.post-gazette.com/local/region/2015/07/26/Addicted-and-affluent-One-professional-s-fight-with-stigma-denial-and-opioid-painkillers/stories/201507260087 https://www.usatoday.com/story/news/nation/2014/04/15/doctors-addicted-drugs-health-care-diversion/7588401/