Substance abuse – the harmful or hazardous use of drugs, alcohol or another substance – has long been associated with the uneducated and unemployed factions of community. But, stereotypes aside, professionals working with substance abusers agree that individuals from all walks of life can be affected – including those employed in executive roles.
Almost ten per cent of the American population has used illicit drugs in the past month, more than six per cent of the population admit to having misused prescription medication over the last year and a staggering 15 million Americans struggle with alcoholism. Perhaps surprisingly, however, many of these individuals do not fit the traditional cookie cutter drug user stereotype.
Take a look at the bigger picture and it becomes apparent that substance abuse is not only a problem within the general population, it’s potentially a greater problem among those with jobs than their unemployed counterparts.
Official figures show that the majority of individuals who abuse substances are in fact employed or seeking work. According to statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), 72 per cent of the 20 million American adults abusing substances are employed. Of the remaining 28 per cent, 11 per cent are seeking work and only 17 per cent are unemployed (SAMHSA 2015).
These initial figures blow the traditional stereotype of a drug user out of the water – and yet there’s more.
In terms of executive professions, rates of substance abuse among management professionals in comparison with other industries are relatively high – 13.5 per cent of men and 7.3 per cent of women in management have a substance use disorder, according to the statistics.
Meanwhile, the rates of substance abuse among those working in finance and insurance are 11.7 and 7.6 respectively, while 9.8 of men and 7.3 per cent of women within the professional services industry have a substance use disorder.
What these figures tell us is that the stereotypical uneducated, unemployed substance abuser is, in fact, a fallacy, and the misuse of substances among executives is a bigger problem than has perhaps been accounted for to date.
Which executive professions abuse substances?
Executives typically hold skilled or management positions in companies – examples being lawyers, pilots, dentists and physicians. There is significant research into substance abuse among the general population but less so with regards to executives in particular.
The available findings highlight, to some degree, the extent of substance abuse in fields like law. A study published by the Journal of Addiction Medicine in 2016 (Krill et al 2016) showed that alcohol abuse in particular is a key concern among attorneys, with more than a fifth screening positive for hazardous, harmful and potentially alcohol-dependent drinking.
Previous studies have shown that lawyers are almost twice as likely as other individuals to have a drinking problem and, taking into account other substances in addition to alcohol, more than 22 per cent of attorneys describe their substance use as problematic.
It could be argued that drinking goes with the territory – lawyers and other professionals have competitive careers, often lavish lifestyles and poor work-life balance. For some, substance misuse is part of the indulgence; for others it’s a release.
Another field in which research into substance abuse is proven yet limited is dentistry. Estimates suggests that between six and ten per cent of dentists display signs of substance abuse, which is approximately on a par with the general population yet potentially more worrying in light of the possible consequences for patients.
Of the substances most commonly abused within the dental industry, alcohol comes out top, followed by cigarettes, marijuana and opiates (Fung 2011).
Research into substance use among pilots is less forthcoming but post-mortem results of aviation professionals involved in accidents between 1990 and 2014 show that between two and three per cent of individuals had traces of illicit drugs or sedating pain relievers in their systems when they died (National Transportation Safety Board 2014).
Among physicians, meanwhile, rates of substance abuse are higher, starting at ten per cent and rising to 15 per cent among some specialties (Baldisseri 2007).
Although the levels of substance abuse among healthcare professionals are consistent with the national average for the general population, the figures are nonetheless disturbing. Many of these executives are tasked with looking after the health and wellbeing of the population, and there are all manner of risks associated with practicing while impaired.
Which substances do executives abuse?
The scope for substance abuse among executives is vast and varied. Educated and employed, executives often have the means to get hold of any substance they choose.
Among attorneys, the most commonly misused substance is alcohol. Back in 1990, a study revealed that 18 per cent of attorneys in the state of Washington were problem drinkers – almost twice the national average of American adults in general.
More recent research suggests that more than 20 per cent of attorneys now abuse alcohol. In terms of other substances in addition to alcohol, stimulants are most commonly misused, followed by sedatives, tobacco, marijuana and opioids (Krill et al 2016).
In the field of dentistry, alcohol is also the most commonly abused substance. A survey by Kenna and Wood revealed that alcohol is a commonly consumed substance among dentists in social settings but other substances are also abused, including tobacco, marijuana, major opiates like morphine and fentanyl, minor opiates such as hydrocodone and codeine and anxiolytics like alprazolam and diazepam (Fung 2011).
Readily available, licit and free from the connotations and stigma surrounding illegal substances, alcohol would seem on the surface to be a relatively innocuous substance of choice. However, the cost of alcohol misuse is altogether sobering: more than 88,000 Americans die from alcohol-related causes each year, which makes the substance the third most preventable cause of death in the USA (Centers for Disease Control and Prevention 2013).
Among aviation professionals, studies into substance abuse have revealed marijuana to be the most commonly identified illicit drug taken by pilots, with rates increasing between 1990 and 2012. With regards to controlled substances, the most frequently traced drugs in the bloodstream of deceased pilots were hydrocodone (found in Vicodin and Lortab) and diazepam (Valium). Both accounted 20 per cent of the controlled substances identified through post mortems fatal accidents involving pilots (National Transportation Safety Board 2014).
What causes substance abuse among executives?
Substance abuse is a complex phenomenon and, as such, there is no single specific cause. In some cases, substances are used recreationally among friends and in social situations but may develop into abuse over time.
Some substances – particularly alcohol – have a familial element. Individuals may be genetically disposed to abusing substances and the risk of using drugs increases among adults who experienced neglect in childhood (National Institute on Drug Abuse 2019).
Alcohol use disorder tends to run in families – the rate of occurrence is three to four times higher in close relatives of individuals who abuse alcohol. Meanwhile, Individuals with a pre-diagnosed mental illness like schizophrenia or bipolar disorder are also more vulnerable to abusing alcohol, as are those with traits like impulsivity and a low sensitivity to alcohol.
A number of environmental and physiological reasons have given by executives to account for their substance abuse, including using drugs or alcohol as a form of self-medication. Commonly, individuals may turn to substances to help cope with pain, mood or sleep problems.
Executives in particular often face significant levels of stress on a day-to-day basis, cited as a key factor in the development of substance abuse among professionals. Many lawyers, for example, have heavy workloads and may deal with cases that challenge their value systems. Research has shown significant levels of depression, stress and anxiety among attorneys (Krill et al 2016).
Physicians, meanwhile, are under pressure daily and often deal with stressful situations such as emergencies. A 2013 survey highlighted key reasons for abuse of prescription drugs among physicians, with the majority of individuals misusing substances to manage physical pain or emotional/psychiatric distress. Other reasons included to manage stressful situations and to avoid withdrawal symptoms (Merlo et al 2013).
Both doctors and dentists have greater access to prescription drugs than many other professions, too, with physicians being particularly at risk of abuse involving opiates and benzodiazepines (Weir 2000).
Usually, however, when somebody abuses substances, the cause can be attributed to a combination of factors rather than a single source.
What are the risks of executive substance misuse?
Substance abuse comes with a great many risks, some of which pertain especially to executives in ways that aren’t applicable to other members of the general public who misuse substances.
Because so many executive professions are directly linked to the safety of the general public, impairments to functioning caused by substance abuse can be serious. Pilots, dentists and doctors impaired by substances pose a direct risk to the safety of other individuals and the consequences have the potential to be dire.
In addition, the risks to executives themselves are significant – both in terms of their own health and wellbeing, and with regards to their careers.
The risks posed by substance abuse among executives include the following:
Accidents and injury
The risk of accidents, violence and suicide increases with alcohol use disorder and other types of substance abuse. Some substances may cause a person to become violent and aggressive, increasing their likelihood of getting into fights and being injured, or causing injury to others.
Around a fifth admissions to intensive care units are believed to relate to alcohol and the substance accounts for up to 55 per cent of fatal driving events. Meanwhile, between 2007 and 2015, the number of drivers killed in crashes who tested positive for marijuana doubled (National Conference of State Legislatures 2019).
Substance-induced mental disorders
During intoxication, individuals may become vulnerable to substance-induced mental disorders, with sedating drugs like alcohol, hypnotics or anxiolytics having the potential to produce depressive disorders.
Stimulating substances like cocaine or amphetamines, meanwhile, are associated with psychotic and anxiety disorders, and substance withdrawal may cause anxiety and major depressive episodes (American Psychiatric Association 2013).
Sleep and sexual disturbances
In some cases, individuals may turn to substances as a sleep aid, or for stimulation so they can stay alert for longer. However, both sedating and stimulating substances are likely to produce temporary sleep disturbances such as insomnia.
Similarly, drugs can affect sexual function and performance, and both types of substance may result in sexual disturbances.
Ill-effects on organ systems
Misusing substances can affect the body’s organs. Alcohol, for example, when consumed repeatedly in high amounts, can affect almost every organ system, including the central and peripheral nervous systems, the gastrointestinal tract and the cardiovascular system.
Around 15 per cent of individuals who use alcohol heavily experience liver cirrhosis and/or pancreatitis, meanwhile sustained substance abuse causes irreversible brain damage and increase an individual’s risk of cancer and lung diseases (Bradford Health Services 2018).
Infectious diseases
Substance abuse can effect a person’s functioning, personality and mood, with some substances decreasing levels of inhibition and increasing risk-taking behavior. An individual’s judgment may be compromised, potentially leading to risky sexual or other encounters.
Trading sex for drugs, having unprotected sex and sharing needles are all examples of risky encounters that could increase an individual’s chances of catching infectious diseases like HIV or hepatitis C (National Institute on Drug Abuse 2016).
Career and reputational repercussions
Admitting to a problem like substance abuse isn’t easy for an executive – especially because doing so could have a negative impact on their reputation, employment and in other key areas of their life.
However, the isolation and denial that go hand in hand with executive substance abuse comprise a potential recipe for disaster – the solution to which can only be found in seeking help.
The national cost
Abuse of substances comes at a personal cost but also accounts for more than $750 billion each year in costs relating to healthcare, crime and lost work productivity.
The overall national cost of tobacco misuse is around $300 billion, while alcohol abuse costs the country $249 every year. Illicit drug abuse accounts for $193 billion annually and misuse of prescription opioids costs the nation $78.5 billion each year (National Institute on Drug Abuse 2017).
What are the treatment options for executives with a substance abuse problem?
Drugs taken in excess activate the brain’s reward system, making substance abuse difficult to overcome. However, there are various forms of treatment available to help executives bring their problem under control.
The first step to overcoming substance misuse is recognising the problem. Patterns of using drugs, alcohol or another substance that causes detriment in some area of functioning is a clear indication that something’s wrong.
Here in the USA, there is a significant treatment gap. According to official figures, approximately 20.7 million people needed treatment for a substance use disorder in 2017, but only four million individuals – or 19 per cent – received treatment.
Interestingly, of those who needed but did not receive treatment, only one million – or 5.7 per cent – actually felt they needed treating (SAMHSA 2017).
Although the estimated rate of relapse for substance use disorders is somewhere between 40 and 60 per cent, recovery is attainable. At any given time, around ten per cent of the American population of over-18s are in recovery from substance abuse (Office of Alcoholism and Substance Abuse Services 2012).
Treatment for substance abuse among executives may include the following:
- Behavioral therapy
- Medication
- Treatment for co-existing conditions
- Preventative skills training
- Dedicated impairment programs
- Ongoing follow-ups
When it comes to treating executives with a substance misuse disorder, there is no single successful approach. Treatment plans are typically most effective when tailored to the individual, incorporating both medical and mental health care as appropriate.
There may be elements of community or family-based recovery and support, or an impairment program may be recommended. Such programs have typically been to treat and rehabilitate impaired healthcare professionals – often with a view to helping a physician or dentist re-enter clinical practice after recovery (Baldisseri 2007). Some programs are peer-assisted; diversion programs on the other hand lay out recommendations for treatment and mandatory testing (Fung 2011).
There are many options available for overcoming substance misuse, beginning with admittance and a commitment to changing unhelpful patterns of behavior. Breaking the cycle of denial is a pivotal point in understanding the problem and being open to positive change.
The benefits of overcoming substance abuse are manifold. There are clear health benefits and potential improvements in relationships, areas of functioning and finances. On a national scale, treatment for drug abuse can help reduce the health and social costs associated with addiction by far more than the cost of the treatment itself (National Institute on Drug Abuse 2018).
A qualified psychotherapist with awareness of how the brain works and a knowledge of executive addiction can help change the underlying thoughts and behavior that contribute to the substance abuse.
Dr Kevin Fleming, a change agent for executives and Founder of Grey Matters International, who has more than a decade’s experience treating professionals in the grip of substance misuse and addiction, comments:
“One can completely understand the need for self-medication these days with the pace and demands of the modern day executive: non-stop information overloads, boundaryless schedules, and endless conflict management routines all predispose the brain to be autonomically hyperaroused, failing to reset itself when it needs to. This failure will eventually erode self-regulation and attempts at balance and happiness. Grey Matters International is the only company that works on the executive brain—-from the inside out—-with cutting edge neurotechnology, and then from the outside-in, working on their family, relationships, in the hopes of achieving the ultimate life of success and contentment.”
Substance Abuse and Mental Health Services Administration (SAMHSA) (2015) The CHBSQ Report, Short Report https://www.samhsa.gov/data/sites/default/files/report_1959/ShortReport-1959.html Date Accessed: 26/06/2019.
Krill, Patrick R. JD, LLM; Johnson, Ryan MA; Albert, Linda MSSW. (2016) The Prevalence of Substance Abuse and Other Mental Health Concerns Among American Attorneys Journal of Addiction Medicine: January/February 2016 – Volume 10 – Issue 1 – p 46–52 doi: 10.1097/ADM.0000000000000182.
Fung, E. Lange, B. (2011) Impact of drug abuse/dependence on dentists http://www.dentistwellbeing.com/pdf/SO11_Fung.pdf Date Accessed: 26/06/2019.
Centers for Disease Control and Prevention (2013) Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Average for United States 2006–2010 Alcohol-Attributable Deaths Due to Excessive Alcohol Use. https://nccd.cdc.gov/DPH_ARDI/Default/Report.aspx?T=AAM&P=f6d7eda7-036e-4553-9968-9b17ffad620e&R=d7a9b303-48e9-4440-bf47-070a4827e1fd&M=8E1C5233-5640-4EE8-9247-1ECA7DA325B9&F=&D= Date Accessed: 26/06/19.
National Transportation Safety Board (2014) Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment https://www.ntsb.gov/safety/safety-studies/Documents/SS1401.pdf, Date Accessed: 26/06/2019.
Baldisseri, M.R. (2007) Impaired healthcare professional Crit Care Med. 2007 Feb;35(2 Suppl):S106-16. DOI: 10.1097/01.CCM.0000252918.87746.96.
National Institute on Drug Abuse (2019) Does addiction run in families? https://easyread.drugabuse.gov/content/does-addiction-run-families-0 Date Accessed: 26/06/2019.
Merlo, Lisa J.; Singhakant, Supachoke; Cummings, Simone M.; Cottler, Linda B. (2013)
Reasons for Misuse of Prescription Medication Among Physicians Undergoing Monitoring by a Physician Health Program Journal of Addiction Medicine: September/October 2013 – Volume 7 – Issue 5 – p 349–353 doi: 10.1097/ADM.0b013e31829da074.
Weir, E. (2000) Substance abuse among physicians JAMC, 13 JUIN 2000; 162 (12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232529/pdf/cmaj_162_12_1730.pdf Date Accessed: 26/06/2019.
National Conference of State Legislatures (2019) Drugged Driving | Marijuana-Impaired Driving http://www.ncsl.org/research/transportation/drugged-driving-overview.aspx Date Accessed: 26/06/2019.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bradford Health Services (2018) Damaged Organs in Drug and Alcohol Abuse https://bradfordhealth.com/damaged-organs-i-drug-alcohol/ Date Accessed: 26/06/2019.
National Institute on Drug Abuse (2016) Why are cocaine users at risk for contracting HIV/AIDS and hepatitis? https://www.drugabuse.gov/publications/research-reports/cocaine/are-cocaine-abusers-risk-contracting-hivaids-hepatitis-b-c Date Accessed: 26/06/2019.
National Institute on Drug Abuse (2017) Trends & Statistics https://www.drugabuse.gov/related-topics/trends-statistics Date Accessed: 26/06/2019.
Substance Abuse and Mental Health Services Administration (SAMHSA) (2017) NSDUH Annual National Report https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report Date Accessed: 26/06/2019.
Office of Alcoholism and Substance Abuse Services (2012) Survey: Ten Percent of American Adults Report Being in Recovery from Substance Abuse or Addiction https://www.oasas.ny.gov/pio/press/20120306Recovery.cfm Date Accessed: 26/06/2019.
National Institute on Drug Abuse (2018) Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Is drug addiction treatment worth its cost? https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost Date Accessed: 26/06/2019.
