Dave, an esteemed surgeon on the East Coast, self-prescribed some opioids to relieve his shoulder pain. The pills helped the discomfort, and they also wrapped him in a warm sense of calm. With a stressful career and a new baby at home, he liked the feeling and began taking the pills daily. Before long, he replaced oral ingestion with more immediate delivery methods: patches and then injections. When Dave inadvertently injected himself with a paralytic agent and found himself face down on the hospital bathroom floor, unable to move, he became determined to end his drug use. That evening, he threw out every pill in the house. By 4:00 a.m., he was facedown again—this time waving his hand through the soiled water in the diaper pail, desperately trying to find an undissolved opioid pill.
Dave is an example of what those of us in the addiction field call a high-functioning, high-achieving addict—the doctor, lawyer, pilot, CEO, entertainer, or professional athlete who is intelligent, successful, and respected by peers, family, friends, and the public for his or her work, but whose alcohol or drug use has begun to gnaw at the fiber that once held life together so nice and tight.
High-functioning addicts usually use alcohol or drugs to relax or escape their high-pressure world, often feeling a strong sense of entitlement: I deserve to have a few cocktails or a few tokes. At some point, many of them cross the line from use to dependency. High-functioning addicts and their support system—secretaries, nurses, spouses—can all have a lot to lose if the addiction is exposed, so the flirtation with addiction usually stays under the radar for a long while. When things start to turn south outwardly—divorce, mistakes in the operating room, slurred speech when speaking to a client—the support system has crumbled and the addict is exposed.
These addicts are some of the hardest to treat. They are highly intelligent and used to being in charge and taking care of others. In treatment, they have to grasp concepts on an emotional and spiritual level, follow the instructions of their treatment team, and assume the position of being taken care of. All of this makes a good recipe for disaster—until they get it. And when they do "get it," they have by far the best recovery rates among all addicts.
The reasons most high-functioning addicts do so well in recovery are varied. First, some treatment centers have programs designed especially for doctors, lawyers, or pilots. These programs offer the same course of treatment other addicts get with the added benefit of meeting in groups with peers, who recognize and call each other out on their "BS," helping to cut through the denial. Peers confront peers and reach a level of honesty previously unknown to these individuals. The doctor who was stealing medication from an elderly patient can eventually disclose this detail in front of other doctors, but might never release this mental burden before the general public. These specialized programs address the malignant shame that accompanies the professional, especially those in safety-sensitive positions.
Another huge factor in recovery success rates for the high-functioning addict is five-year post-treatment monitoring ordered by a professional board such as the Federal Aviation Administration, the American Bar Association, or a state medical board. For the pilot to go back to his career, the career that he's built his identity on, he must agree to be monitored, a process that includes random drug testing. For the high achiever whose career has been center stage, being allowed to return to his or her chosen profession is a monumental motivator during recovery.
I like to say that addiction is an equal-opportunity destroyer. It doesn't care what gender, race, ethnic background, or age you are or what your current social or career situation is: rich, poor, employed, on welfare. Research has proved that addiction is a brain disease with signs, symptoms, and environmental and genetic links. If we have a family history of addiction and grow up in a respected, well-to-do household, our genetics are a risk factor for addiction. If our family has no history of addiction whatsoever but we grow up in a neighborhood filled with crack houses, our environment places us at risk for addiction.
In addition to the normal indicators for addiction, high-functioning addicts usually display some of the following signs:
• Occupied with a position of responsibility
• Regularly feeling entitled to a drink or drug because they've worked so hard
• Expecting support staff or spouses to make excuses for absences or inappropriate behavior
• Denying the consequences of poor judgment and the lives of those the addict is responsible for (e.g., taking drugs before operating on a patient; drinking before flying a plane full of passengers; presenting a closing statement for a criminal offense with a hangover)
If you think you or a loved one might have a problem with drugs or alcohol, get help. There is no shame in getting help for this disease. Millions of brilliant people have gone through the program and lived to tell about it. Their stories are an inspiration to everyone. Help is available all around you.
To get the ball rolling, sometimes all it takes is one small step such as any one of these:
• Ask a trusted friend or peer if he or she thinks you have a problem.
• Go to an AA or NA meeting.
• Call a local treatment center to schedule an assessment.
• Complete a Betty Ford Center online drinking assessment.
• Talk to someone you know who's in recovery.
• Google "addiction counselor" and your town to find local resources.
• Imagine how friends and family will describe you at your funeral.
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