Professionals and Addiction
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.
