What Discourages Addicted Executives From Seeking Help?

Myths about who becomes addicted

Contrary to common stereotypes, high-functioning executives and professionals – including physicians, attorneys, corporate executives, and others – are just as prone to developing serious alcohol and drug problems as people in many other socioeconomic groups and life circumstances. However, one important difference is that executives and professionals are frequently better able to keep their addiction hidden from view because they have the resources needed to maintain a high level of functioning or at least the outward appearance of doing so that camouflages the chaos in their personal lives.

The perfect storm: High stress and high reluctance to seek help

The drive to keep up appearances, that everything is okay, can be a serious barrier to recovery from substance abuse

Source: Photo by Christian Bowen on Unsplash

An intense drive to keep up appearances can make it difficult for high-functioning substance users to acknowledge the problem and seek appropriate help. Fear of being found out is fueled by the real and imagined fallout this would cause, personally and professionally. That’s why office-based treatment provided in the private practice of an addiction psychologist rather than a public clinic can be such a valuable option. It often allows them to access the professional help they need without fear of exposure.

Engaging ambivalent executives

Robert, a married 38-year-old financial services executive in New York City, came to see me several days after waking up one morning in a Boston hotel room with a strange woman in his bed. He had no memory of how he or she got there. He did remember going to a bar after a long day of marathon work meetings and calling his wife to let her know that he was going out for a late dinner with co-workers and would call when he returned to his hotel room. Not only did he fail to call her later that evening, but he then slept through an important work meeting the next morning.

While recounting these events to me, Robert became visibly anxious while struck by the realization that his risky behavior had gone completely off the rails and that he needed to put on the brakes before things got even worse. He gave his boss a clever excuse for missing the meeting, but his wife remained suspicious. Fortunately, he went to see his family doctor for an STD test, and while there the doctor encouraged Robert to see a private addiction specialist, which is how he first came to see me.

Robert flatly rejected suggestions from family and friends that he go to an inpatient rehab program. He feared that colleagues and co-workers would question why he was suddenly absent from work. During the initial consultation, Robert stated that he’d been a heavy drinker since college, but felt that his alcohol use was generally under control. His drinking spiraled on the heels of two recent and very positive life events:

1. A promotion on his job that involved a huge salary increase
2. The birth of his first child.

As he spent more time away from home at business dinners often accompanied by other heavy drinkers, Robert's drinking escalated substantially. At the end of many drunken nights in hotels on the road, he found himself seeking the company of escorts for sex.

Abstinence or moderation?

Because of his financial successes and exemplary functioning at work, he had trouble viewing his episodic and somewhat situation-specific binge drinking as a "problem". He stated to me that while was willing to cut back, he was not interested in giving it up completely. It became clear that pressuring Robert to accept total abstinence as his treatment goal would not be productive.

Negotiating a solution

Negotiate the solution that works for you. One size fits all just does not work.

Source: Brooke Lark on Unsplash

I agreed to help Robert develop a plan to learn how to drink moderately. But, first, I suggested that if he were to take a temporary break from drinking, it would help his body “reset” and increase his chance of succeeding with moderation. Calling it an “experiment, with abstinence,” I suggested that if he were to temporarily abstain from alcohol for say 30 days, he could at least temporarily eliminate all risks associated with drinking. Robert agreed to try the experiment. These “negotiations” felt comfortable to him from a professional standpoint rather than being instructed what to do and were a much more palatable approach for him than an all-or-nothing ultimatum, something that high-end executives usually react to badly.

Additional tools and support

Robert was anxious about an upcoming business trip that would provide many opportunities for heavy drinking. I suggested that he take daily disulfiram, starting several days prior to his trip, and continue on it until he returned home—if alcohol is consumed, disulfiram's effects include headache, nausea, vomiting, chest pain, among others. Although not a long-term solution, it would work well to prevent him from drinking in high-risk situations. He agreed.

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Robert also agreed to start twice-weekly individual sessions. During our sessions, he revealed personal insights that were key to his troubles. Robert felt a sense of emotional and sexual disconnect from his wife following the birth of his child, yet felt helpless to do anything about it. His father was a successful attorney and alcoholic who died of liver disease at age 57. Worse, as much as he wanted to avoid history repeating itself, he saw his father in himself and it frightened him.

After a few weeks of these sessions, when Robert felt safe, I suggested he consider the possibility of participating in a small support group I run for executives and professionals. Initially, he was resistant and then ambivalent, but I suggested that he meet informally with a member of the group, himself a successful executive, to get a better sense of the group and how it could be helpful. Following that meeting, Robert not only entered the group but was surprised by how comfortable he felt in the very first session. The group members shared similar lifestyles, issues, and goals. He mentioned to the group that he had been abstinent for 30 days and hoped to remain so for at least 60 days before deciding whether to try moderation. The group was non-judgmental and warmly accepting of him.

Robert did complete the 30-day experiment and in the end, opted to extend for an additional 90 days while he continued in both group and individual therapy. Robert learned firsthand the value of participating in an ongoing support group with like-minded professionals in conjunction with weekly individual psychotherapy.

Takeaway lessons

• Individually-tailored treatment that meets people "where they are" is attractive to high-functioning substance users as compared to traditional "one size fits all" treatment
• Psychological issues intertwined with alcohol and drug use must be identified and addressed to prevent relapse over the long-term

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