When Addiction Becomes the Boss

Published on October 29, 2014 by David Sack, M.D. in Where Science Meets the StepsA surgeon passes out drunk in the operating room yet blames dehydration and fatigue. A commercial pilot downs more than 15 rum and Cokes at a bar just hours before flying a 727. A doctor memorizes his patients’ birthdays and addresses so he can pick up prescriptions in their names. It’s always disturbing when drugs or alcohol take over a life but especially so when it happens to those we count on to be in control – the doctor, the pilot, the business executive, the judge, the attorney, among others. But as these anecdotes show, elite professionals are just as vulnerable to addiction as the rest of us. In fact, they may be more so, simply because of the way they are wired. “The very nature of these execs, these Type A personalities that seek to control their environment and who use work as their affirmation, is conducive to addiction in the first place. It almost fosters the very personality that we see most commonly in addicts,” explains Matt Eggleston. He speaks from experience. Eggleston was one of those Type As – a high-achieving, prominent attorney and special judge in Tennessee until alcohol and drug use brought his life crashing down and took him close to death more than once. Now, several years sober, he works helping those with similar addiction issues and often speaks before groups about the professional’s ability to get in the way of his or her own recovery. “We are the ones who fix things; we don’t get fixed,” he says. “So there is this natural resistance to doing the fundamental thing that every addict needs to do, and that’s ask for help.” Instead, denial becomes the norm. Consider the rum-and-Coke-drinking pilot. At his trial, he insisted his many years of hard drinking meant he had been able to handle all the alcohol in his system, measured at 0.13 percent, more than three times the legal limit for pilots. The judge didn’t buy the rationalization, giving him 16 months in jail, taking away his pilot’s license and reminding him that alcoholism isn’t “a license to kill.”

Adding Up the Signs

Acknowledging a substance abuse problem can bring with it a loss of authority, reputation and income. Small wonder then that struggling professionals generally ignore their issues for as long as possible, often reinvesting themselves in the one thing they know how to control – their work. “That’s why you see so many workaholics that also have some kind of substance abuse hidden,” says Eggleston. “They’re thinking, ‘If I can take control of this environment that I know and do a really good job then it’s proof that I don’t have a problem.’” Even when they do acknowledge problems percolating under the surface, “We try to problem-solve, we try to manage, manipulate, control, which we’re very good at, and typically it’s an utter failure.” Eventually, even work will fail them, and the signs will be impossible for others to overlook: meetings will be missed, safety will be compromised, others in the organization will suffer and negative effects will cascade. It’s at this point that colleagues or family members commonly push the person toward help. Employee assistance programs or professional boards may also step in. It’s what happened in Eggleston’s case. He didn’t seek help; it came to him through the Tennessee lawyers’ assistance program, which assessed his issues and directed him to treatment. He now volunteers for its board. Most professions have assistance organizations such as these, and they can be enormously helpful in minimizing fallout to careers, assisting with licensing boards, monitoring recovery and addressing return-to-work issues. They can also help arrange for workloads to be covered – a vital consideration. Professionals often delay getting help fearing that all will crash if they leave. Most important, the organizations can help get the person to safety and to the proper

Saying Yes to Help

Despite the challenges, treatment can work, especially when professionals are grouped together in programs that understand their mindset. “Most of us enter any kind of therapeutic program with the preconceived rejection of asking for help,” Eggleston says. “It’s not necessarily conscious, but it presents unique challenges for the clinical team.” Working with other professionals can help overcome that resistance. “I’m going to feel more comfortable, more at ease, more willing to talk about what’s going on with me because I’m going to feel a little bit safer. I’m going to see other lawyers or judges who’ve been through it and I’m going to say, ‘These guys did it. These guys were where I was, and now they are over here and I want to be over there.’” Tailored treatment also helps professionals get past the sense of uniqueness that can come with exceptional career achievements and that can hinder recovery. They may be pilots or doctors or CEOs, but “we learn that we’re no different from the 19-year-old addict in the next room.” The good news is that while professionals generally may be slow to seek help, once they do, their abstinence rates after treatment tend to be well above the general public. A Mayo Clinic study, for example, noted rates of around 74-90 percent for medical professionals and airline pilots. For the general population, the typical one-year abstinence rate after treatment is closer to 20-60 percent. Recovery doesn’t always happen on the first try, however. For Eggleston, it took multiple attempts, a not uncommon scenario that speaks to the power of addiction and of the professional’s tendency to try to think their way through to a solution rather than admit they are no longer calling the shots. “It’s that moment you realize you can’t fix it and you allow others or other things or a spiritual higher power to help you, that’s when you actually get to the other side and into recovery, which is so foreign to Type A successful businessmen and women and doctors and executive and lawyers,” he says. After treatment, support groups geared toward professionals can help them stay on track. The key is never to let down your guard, Eggleston says. “The disease is progressive, it’s terminal and it never sleeps,” he says. “And the moment that we think, ‘OK, I’ve got this’ is the moment we are in trouble.”