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Addiction – Professionals

Recognizing & Helping a High-Functioning Addict at Work

Posted on October 20th, 2017

High-functioning addicts — a term attributed to people who have substance use disorders yet manage to maintain a job, support a family and sustain busy social lives — often perform well in the workplace while things start progressively spinning out of control in their personal lives.

According to the National Survey on Drug Use and Health, 9.5% of full-time workers aged 18 to 64 have abused alcohol or illicit drugs in the past year. This makes it likely that, at some point, you will work with someone who has a drug or drinking problem.

Certain Professions Make Addiction More Likely

Rates of addiction among the general population are estimated at 8% to 10%, while rates of addiction among physicians and other health care workers are somewhat higher. Medical professionals in clinical environments are at greater risk for addiction than others. For example, a 2014 study revealed that 10% to 14% of emergency department physicians will develop a problem with substance use at some point in their careers.

What accounts for the higher addiction rates among medical personnel? Typically a combination of high stress, high expectations, an attitude of self-reliance and invulnerability (i.e., “I know what I’m doing, so I can use this medication without becoming addicted to it”), and ready access to substances of abuse. Yet, these same characteristics are seen among professionals in other industries as well, particularly those with high levels of stress or trauma, such as law enforcement, first responders and the military.

Thrill-Seeking or Stress Management?

Many people who abuse substances, particularly professionals who hold positions of high authority or responsibility, aren’t typically thrill-seekers looking to get high. While some may be hoping to enhance their performance in high-pressure situations like the boardroom, surgery theatre or combat zone, many are simply overworked, overwhelmed and exhausted, and looking for some relief. A 2013 study conducted by researchers at the University of Florida’s Center for Addiction Research and Education found that nearly 70% of physicians who participated in their study cited stress and physical or emotional pain as their motivation for turning to prescription drugs.

Detecting Substance Abuse Early

Early detection of substance abuse is imperative in ensuring safety of work environments, of course, but early detection is also vital in ensuring that an addicted person receives treatment as soon as possible. If substance abuse continues unchecked, the rate or volume of abuse can escalate, making it more likely that the user will become functionally impaired, thus increasing safety risks at work.

Health care workers and those in other professions may continue abusing substances for long periods without detection because many work settings do not require random drug testing as a method of early detection. A lack of early detection measures can lead to escalation of drug use.

Signs of Substance Use Disorders

How can we recognize signs of addiction or substance abuse in work environments where there are no formal processes for early detection and intervention? It can be challenging to detect substance abuse in a high-functioning addict, particularly in a physician or other professional who knows how to hide the signs. It requires a bit more vigilance, but it is possible.

Eight ways to spot a high-functioning addict in a professional setting:

  1. Long sleeves. A tendency to wear long sleeves at work, even during warm seasons or where this formality is not required, may indicate a co-worker is trying to hide needle marks.
  2. Eye drops and breath fresheners. Use of eye drops before/during work hours (perhaps a special type that makes pupils appear normal), or use of breath mints and breath sprays at work may indicate that someone is trying to cover up on-the-job drinking or smoking of illicit drugs.
  3. Unexplained absences. It’s not unusual for people struggling with addiction to miss work, be late for appointments or meetings, or have more sick days. They may report multiple family “emergencies,” or a spouse or family member may call in sick for them. They may disappear unexpectedly during work hours or leave early for “meetings.”
  4. Alcohol overuse at social gatherings. Someone who is using prescription medications to relieve stress may also misuse alcohol for the same reason. At work-related parties or social functions with colleagues, a substance abuser may consume a high volume of drinks or may continue drinking long after everyone else has had enough.
  5. Changes in mood, behavior and/or appearance. Addiction to substances, whether to alcohol or a drug, can lead to changes in mood, attitude and behavior, as well as to physical changes and withdrawal symptoms. Has a colleague recently lost a lot of weight? Has their personality changed? A high-functioning addict may develop a bad attitude at work when they are hungover or have gone a few hours without using. If they have become psychologically or physically dependent on a substance, withdrawal symptoms may make them grouchy, short-tempered or more difficult to work with at certain times of day. Alternately, they may display hyperactive or manic behavior at certain times, and sluggish behavior at others.
  6. Medication shortages in a clinical setting. Like regular civilians who become addicted to medications, doctors, nurses, dentists, veterinarians and other health care professionals may obtain legitimate prescriptions for certain drugs, such as opioid painkillers. However, if/when they are unable to refill those prescriptions, they may begin accessing the medicine supply at the clinic or hospital. Be vigilant of medication supply shortages that occur despite recent order fulfillments.
  7. Distancing and isolation. If you notice that a colleague has disengaged or distanced themselves from the rest of the team at work, or that interactions have become strained, these can be signs that the addicted person’s problem has grown worse and they are having a hard time keeping things together.
  8. Inconsistent job performance. Take note if a worker who was previously a top performer or consistent producer starts making mistakes or displaying a more erratic job performance, with some good and bad days. These can be signs of escalating addiction.

Talking to a Colleague About Their Addiction

No one wants to get a friend or colleague into trouble or permanently damage their career. However, if you suspect a colleague of having a substance use disorder that is impacting their work (or patient safety), confronting them about it can be a good first step. An honest conversation lets them know their problem has become noticeable to others, and you are giving them a chance to seek professional help before a crisis occurs or they get reported to a higher authority.

Here are four things to consider when talking to a colleague about their addiction:

  1. A one-on-one, discreet approach may work best to avoid negative consequences. This is especially important if your colleague is a doctor and you work in a state that doesn’t have a state-run physician’s health program — currently, there are no active state PHPs in California, Nebraska and Wisconsin. Conduct some research before your one-on-one discussion so that you can inform your colleague of private treatment programs in the area that specialize in working with doctors and other high-level professionals. Some of these programs coordinate with licensing and regulatory boards to help mitigate disciplinary actions and ease re-entry to the workplace after treatment.
  2. Confrontation by a colleague may be the only way a professional in a high-ranking position is going to face their addiction and get help for it. High-functioning addicts rarely ask for help. Taking action to confront a colleague about their problem one-on-one — however daunting it may be — is like throwing them a lifeline. Your private intervention may be the one thing that leads them to treatment and recovery.
  3. Choose your timing. It is important to approach a colleague about their addiction at the appropriate time. In addition to speaking with them alone and in private, be sure to also approach them when they are not high, hungover or agitated. You want them to be able to focus on what you are saying and to synthesize the information when they are clear-headed. They may get defensive (denial and defensiveness go hand-in-hand with addiction) but, hopefully, they will respond with remorse over their behavior and see that they need professional help.
  4. Be calm and compassionate, yet firm. Make it clear that although it is up to them to recognize and admit that they have a problem, you can see that their addiction is impacting their work. Convey that you respect them and assure them you will keep things confidential, but they must get professional treatment. Don’t cave in to denials of a problem, negotiations for more time or alternative “self-help” treatment methods — all of these can result in delayed treatment, continued substance abuse and a crisis.

Approaching a colleague about their addiction can be daunting, but focus on the fact that your action may help them. If you can encourage them to enter addiction treatment, they will receive therapy and psychoeducational resources that help them manage the underlying issues that initially drove their addiction, such as stress, lack of support or healthy coping mechanisms, co-occurring mental health issues, and more.

Taking Steps to Help an Addicted Colleague

If an honest conversation with your colleague doesn’t go well or isn’t feasible, you may need to take the next step. In corporate work environments, employees who suspect a co-worker is using alcohol or other substances on the job can notify a manager or human resources director. The suspected employee will typically be summoned to a private meeting with their supervisor, who will discuss the problem and give them a warning about potential consequences. They may even encourage them to take a short leave of absence to undergo addiction treatment.

Employees in many work settings feel stymied by the thought of “snitching” on a colleague, because reporting the problem may cause them professional embarrassment or humiliation, and possibly, the loss of their job and livelihood. For professionals working in medical environments, things can be even more complex and the consequences more far-reaching.

Reporting a physician suspected of substance abuse could lead to the loss of their medical license. Thankfully, many state medical boards in the U.S. run addiction rehab programs just for physicians. Doctors in those states who are reported for substance abuse are diverted into these state-run rehab programs, or physician health programs (PCP). As long as they complete the state program and abide by the rules of the aftercare plan, they can usually avoid losing their medical license and suffering other punitive damages — though this is not always guaranteed. The good news is that many alumni of these programs return to work and achieve long-term remission of their addiction, with promising recovery rates of at least 78% for those who complete 60- to 90-day treatment and submit to post-treatment drug testing and monitoring.

Whatever intervention approach you choose, the best-case scenario is that you can avert a potential crisis and prompt your colleague to get proper treatment, enter recovery, retain their job, and return to work a healthier, happier person with new skills and support in place to help prevent relapse.


High-functioning addicts: Intervening before trouble hits. W Glauser. NCBI, NIH, March 2016.

When the addict is a doctor. The trend against punitive measures runs into resistance when the addict could cause medical errors. Steven Ross Johnson. Modern Healthcare, May 2016.

Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon. Shelly Reese. MedScape, January 2014.

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Firefighters & Addiction: When the Heroes Need Help

Posted on August 24th, 2017

Firefighters are true heroes. They save others and risk their lives on a daily basis. They devote their lives to rescuing others.

They are the ones running toward the fire when everyone else is screaming and running away and they comfort those who have been traumatized.

That’s why it’s so hard for them to ask for help when they are struggling, especially when it comes to firefighters and alcohol abuse, substances and other addictions.

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Professional Self-Regulation: 12 Signs That It Is Time to Address your Addiction

Posted on July 17th, 2017

By Gregory Skipper, MD, Director of Professional Health Services at Promises

As medical professionals, an important aspect of holding ourselves to ethical guidelines and standards of conduct is recognizing when we may be working while we are impaired by drugs or alcohol.

Although our line of work gives us a keen understanding of how impairment can put patients and others at risk, it is interesting how often physicians and others in the medical field overlook the signs indicating they themselves have a problem with addiction. There may be myriad reasons for this oversight, and many of them are understandable. Yet, a key responsibility of practicing medicine is professional self-evaluation and self-regulation.

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A Recipe for Addiction? The Unique Challenges Health Care Professionals Face

Posted on May 19th, 2017

Certain characteristics make some people more vulnerable than others to addiction. There is a hereditary component, of course, as we know addiction can run in families. But DNA does not necessarily make addiction a foregone conclusion and likely only contributes to about 50% of the risk of developing addiction. Environment and personality characteristics also play roles in addiction, sometimes contributing to a “recipe” of combined factors that make one person more likely than the next to fall victim to substance abuse.

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Length of Addiction Treatment for Physicians: How Much Is Enough?

Posted on May 16th, 2017

By Gregory Skipper, MD, Medical Director, Promises Professionals Treatment Program

Why do we physicians become addicted? And, once addicted, why are we likely to deny a problem exists and unlikely to seek help … until colleagues or the medical board step in? The answers to these questions are important because they are directly related to determining the most effective length of treatment for addicted physicians.

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High-Functioning Addicts: Who They Are and Who Is at Risk

Posted on March 20th, 2017

By Matthew Goldenberg, D.O., Board Certified Psychiatry and Addiction Psychiatry

Associate Medical Director, Promises Professionals Treatment Program

It is estimated that 10% to 14% of the U.S. population is addicted to drugs or alcohol. Many of those affected, including nearly 20% of all alcoholics, do not fit the stereotypical image of an addict — they are able to maintain their job, they may have spouses and children, and often enjoy busy social lives. These “high-functioning” addicts (HFAs) abuse alcohol or other drugs while maintaining a façade of normalcy.

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Can Physician Health Programs Really Help Doctors in Crisis?

Posted on March 13th, 2017

By Gregory Skipper, MD, Medical Director, Promises Professionals Treatment Program

It has long been recognized that physicians face heavier workloads and more intense stressors than the average working professional. We expect a lot from doctors, who must juggle their personal lives with extremely demanding schedules and often daunting medical challenges.

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Can Addicted Doctors Return to Practice?

Posted on January 11th, 2017

An addicted doctor is a scary idea. If you know firsthand what addiction is like, you know that an addict puts his substance of choice first, ahead of everything else. The need to get high, to eliminate withdrawal and to just feel better again is overwhelming. When a doctor puts those needs first, naturally his patients suffer. The good news is that there are specialized programs designed to help physicians overcome addictions. But many people might wonder if a doctor in recovery should be trusted to practice again.

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How to Cope With Physician Burnout

Posted on December 18th, 2016

Physicians face a lot more stress at work than most people do. Many of these doctors work long hours, skip out on sleep and face decisions that mean the difference between life and death for their patients. It’s easy to get run down on the job, especially with few breaks or vacations. There are healthy and meaningful solutions to physician burnout, but unfortunately many doctors cope in non-productive ways and are more susceptible to substance abuse than the general population.

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Preventing and Treating Addiction in Physicians

Posted on December 17th, 2016

Drug abuse in healthcare professionals is a real problem and one that most people never consider until it affects them. Rates of substance abuse and addiction are higher among physicians and nurses than in the general population. Reasons for this phenomenon include factors such as work stress, long hours, making choices that impact lives and that could kill someone, getting burned out at work and having access to substances of abuse. There are ways that this problem can be prevented and addressed.

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Bottle to Throttle: What Happens to Drunk Airline Pilots?

Posted on September 26th, 2016

By Greg Skipper, MD

A friend of mine went to play golf in Scotland, and while there he went to a pub to get a sandwich. The pub owner asked why he was in Scotland and my friend responded, “To play golf.” The owner retorted, “Laddie, you are in the right place.” The bartender then offered my friend a beer and he responded, “I don’t drink,” and the bartender then replied, “Laddie, you are in the wrong place.”

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