Professionals and Addiction

All Treatment had the pleasure of interviewing Stephanie Loebs, Executive Director and Gina de Peralta Thorne, Director of Business Development of the Farley Center in Williamsburg, Virginia about professionals who struggle with addiction.

AT: What are the most common reasons professionals fall into addiction, assuming they are a well educated demographic?

Stephanie Loebs: I think on the surface, it is stress, family dysfunction, and chronic pain. And by stress, I mean workplace stressors or financials stressors and things like that. However, the next layer into the addiction, you will most likely find that there is a genetic predisposition; meaning that there is alcoholism or addiction in the family. And not only do they have the genetic predisposition, but they have the learned behavior that to deal with life's normal stressors that drinking and drugging is the solution.

At the next layer down, at the core, as the science of addiction medicine has been advancing, what we are finding more and more apparent, particularly in the professional population, is trauma. Whether it's childhood trauma, sexual trauma, emotional trauma, physical trauma, neglect, abuse, harm, or the trauma that has occurred as a result of their substance abuse, there is usually trauma. Meaning while they were drinking or drugging, they found themselves being dis-inhibited by the substance. Finding themselves doing things they normally would not have done such as promiscuity, gambling, stealing, lying, cheating, all of those things. So we are finding really at the core, that there is a lot of trauma, particularly with the professional population.

they have the learned behavior that to deal with life's normal stressors that drinking and drugging is the solution.

AT: Do you believe professionals hide their addictions more so than other demographics?

SL: Yes. Addiction is the disease of isolation. There are only two things addiction demands from their victims: that it wants them alone and it wants them dead. And that's just the facts. The reason why it wants them alone is so that person has no comparison or reality check. The addict will say "if you had my problems, you'd drink to", "my life is terrible", "this is the only solution", "I deserve to feel better", "my pain is so bad", "my memories are torturing me", or whatever the case may be. Professionals, because it is not accepted for a professional to be dependent on substances — they're not in crack houses, they're not in shooting galleries, though they may be in bars — but for them to be so intoxicated they're in a black out is unacceptable. They need to be able to handle their alcohol. So you find that these people are more likely to be alone and using.

Gina Thorne: And we often hear about the concept of terminal uniqueness. Professionals think that they are so unique in their situation; no one else understands where they are. And what we do here is help them understand they are not the only ones that are going through this, and by helping them be in an environment with like peers that are looking across the room from them, who look like them, who have the same types of issues, maybe different details, but the same type of issues, it helps them see that it's not just them. They're not alone.

AT: What is the most important thing professionals should look for when seeking treatment?

SL: Peer-based support groups and licensed professionals who have worked with professionals. I think the credentialing and licensing of their treatment providers is a very important thing to look for. Now I'm a little biased here, but they should look for an abstinence-based program, I think that is the most effective. When you're looking at career disruption, they're going to need to go back to their employers and workplace and say to them "I am abstinent. I am not using methadone or Suboxone or anything like that. I am here and I will serve my clients, my patients, my customers, out from under the influence." I think abstinence-based treatment for professionals is probably the only answer if they intend to regain what they've earned in their life, in their career.

abstinence-based treatment for professionals is probably the only answer if they intend to regain what they've earned in their life, in their career.

I think that they need to know the treatment program understands that addiction is a chronic illness. That it is not some moral deficiency, or a psychiatric disorder – this is a chronic illness, and a primary chronic illness. And that yes, they may have anxiety or a mood disorder – 80% of bipolar patients have a substance abuse problem or are substance dependent. Our most common occurring disorder is depression – and that has to be treated aggressively and concurrently. To get treatment for their substance dependence, they have to go to a program that understands it is a primary chronic illness.

GT: And if I may add, one of the other pieces that is necessary, is that a facility needs to know how to help with re-entry back into their chosen profession, or not. But you have to have that expert who can say to that anesthesiologist who wants to go back to practice, that it may not be the best option for them, and how can we help reintegrate them back into their community and their career. And to have relationships with physician health programs around the country who understand the importance of long-term monitoring. If that facility doesn't have those relationships, then they are not the best place to send someone for professional help.

SL: Or that inner-city school teacher, who is overwhelmed with outrageous classroom sizes and violent pupils. Well maybe she needs a transfer to a nicer school district or move out of teaching. This is a really important point that they have experience getting these people back to their lives and back to their work.

AT: Can professionals recover and successfully return to their career?

SL: Absolutely.

GT: There are three key pieces that need to be in place for that to happen. The first is that they have to be entrenched in a 12-step community. The second is they have to be part of an advocacy-driven system. The third piece is a monitoring system. Those three pieces are critical in success for long-term sobriety.

We integrate that and build that into the foundation into their treatment experience when they walk through the door. It's critical when a professional is seeking treatment that they're asking those hard questions to facilities to make sure that they have those in place. We can't speak to the long-term effects without it, but we can speak to the long-term effects with it, and we know there's success with that.

AT: Do professionals struggle with the stigma associated with addiction?

SL: Absolutely. If you look at recovery, not so much at treatment, but at recovery – we're probably in the fourth generation of recovery of people who have fully recovered from the inappropriate use of drugs and alcohol. Right now, it's about time, as recovery professionals, to stand up where we fell down. It's important for this country to understand that treatment works, number one. And recovery is possible. And a life recovered is beyond imagination. But the stigma still exists. It's still out there and it's still overwhelming. It's like a continuum. On the very positive end of the continuum, you have treatment that works and treatment that is possible. On the other end you have a group of people that have been damaged by alcohol and drugs as children, and they are displacing their anger, resentment, and frustration out on people that are trying to stay sober. The idea that someone can't recover and they are somehow putting people at risk, which are all very true facts if they are under the influence, but getting beyond this disease – there are a lot of us out there who have recovered. What do you do when the boys want to go out after work and have a drink? Do you not go? Do you tell them you're an alcoholic? What do you do? And that's what Gina was talking about. We have to teach them not only how to go back to work, but how to re-enter life as a sober person, dealing with that daily stigma and ignorance, that this is a disease.

It's important for this country to understand that treatment works, number one. And recovery is possible. And a life recovered is beyond imagination.

GT: One of the things that we work really hard to do is when we get a professional that comes in who is dead set against informing their employer that they have an addiction. We respect that and we understand where they are at in that moment of their addiction, but through the course of treatment and through the course of their work here with our therapists, with our medical team, and with the peers in their program, we help them understand the value of recovery when they can self-disclose.

SL: Appropriately.

GT: Yes, appropriately in a way that won't harm their career, and that this is a necessary part of their life in recovery. The idea that self-disclosure may be important to recovery is an idea that's suggested gently and with a lot of love. But when you're working with high-functioning professionals who tend to intellectualize a disease that is normally a feeling disease – you have to have the right type of people in place to do that. And often times, obviously, people are very protective of their career and they don't want to self-disclose, and we respect that, but we allow them the time to see the value in eventually doing that and understanding that it's a healthy part of recovery.

SL: Earlier, we were talking about how this is a disease of isolation – and if professionals isolate more than someone that is not a professional. Not properly self-disclosing is another form of isolation, another way to keep it a secret and feed the stigma. It is a very very dangerous place for recovering addicts and alcoholics to be – keeping secrets.

AT: What signs of addiction should employers look for?

SL: First of all, addiction is addiction. Yale or jail. Male or female. The most apparent thing they all seem to walk in here with is an overwhelming sense of shame. How that looks when they're out there trying to negotiate life under the influence, is that they have lost a sense of self, a sense of passion, and they have lost joy. They have lost their joy. Life becomes this overwhelming burden. The glass is always half empty. They take no pleasure in life.

That was all pretty big. What do you see? I'm going to tell you, they're a professional. The last place you're going to see any symptomology is at work – that's the last place. If things are showing up at work like job shrinkage, misappropriation of funds, excessive absenteeism, unexplained behavior, if that's happening at work, then you should probably know that's mid- to late- stage addiction. What you're going to see before it shows up at work is, the kids are acting out, their home life is chaotic, they may be going through a divorce or separation, their lights are getting shut off, they always seem to be in some sort of chaos despite the fact that they're doing OK at work. If you're looking at healthcare professionals, they tend to be workaholics, they're never away from work, they're always working, and they're always pushing and pushing and pushing. And what that pushing does, is it entitles them to use, entitles them to drink. "If you worked as hard as I did, you'd drink too. You would deserve to drink; you would deserve to use drugs." There's this thing called "un-manageability" in their life. If you scratch the surface it's pretty apparent. Other things that you'll see is illnesses, they're heavy smokers, usually nicotine dependent, they're moody, difficult, and disruptive at work. They want to keep just about everyone at arm's distance. Predominately, as far as attitude goes, it is never, never their fault, nothing is their fault. They cannot accept responsibility.

Do I make that phone call and risk damaging that person's career, or leave it alone and worry about whether or not that person's going to die because I didn't do anything?

GT: The other thing to add to that is, from time to time we get phone calls from referral sources that will say "I've got this doctor working with us and his attitude is different and his behavior is off, we don't see him using and we don't know if he's using. What can we do about that?" We do offer in-resident and outpatient evaluations. We do almost 40 of those a year. People will come in, who just aren't sure, will do an intensive battery of assessments with a team of experts who will look at the family, collecting collateral information so we can ascertain whether this is truly an issue of addiction or something else. If you're an employer and scratching their head, I just don't know if that's what it is, I just don't get it, what's wrong with "Bob"? They can contact us, and utilize us a resource for that. People are always on the fence with "Do I make that phone call and risk damaging that person's career, or leave it alone and worry about whether or not that person's going to die because I didn't do anything?"

SL: One more thing, tailgating something what Gina just said. The very best thing that could happen is that, if you are worried about someone at work, is that you are wrong. That he doesn't have an alcohol or drug problem – that would be the best thing that could happen. That your observations and concerns, worries are completely unfounded – that would be the best thing. The worst thing that could happen is if you did nothing about it.

GT: The fundamental piece we like to give people when walking away, trying to decide if this is a decision they want to make, because they themselves are a healthcare professional or a professional with a career-preservation issue, is that they are not alone, treatment works and we are just a phone call away, and we can help. That is the most important message we can get across for people.

All Treatment does not provide medical advice, diagnosis or treatment. See additional information.