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Treating the High-Functioning Addict
Who Are They?
“High-functioning addict” (HFA) is a term used to describe individuals who are able to perform well at work and maintain a successful appearance despite their addiction to alcohol and/or other drugs. Many are living a dual life: high-performing executive or professional by day, addict or alcoholic by night.
Regardless of vocation, what they all have in common is an extraordinary ability to prevent their substance use from adversely affecting their job or career, at least for a while.-Arnold M. WashtonHFAs are typically high-achievers who maintain a high standard of living. Some are heads of corporations, senior managers, entrepreneurs, technology wizards, or celebrities. Others are physicians, dentists, attorneys, or engineers. Regardless of vocation, what they all have in common is an extraordinary ability to prevent their substance use from adversely affecting their job or career, at least for a while.
Some HFAs are also able to keep the problem hidden from family members and friends. This is a difficult balancing act that can go on for a very long time, sometimes for many years. Typically, the problem becomes exposed to the light of day by an unexpected crisis such as a DWI arrest, medical emergency, inappropriate behavior at a work-related event, divorce, loss of child custody, or report of impairment to a professional licensing board.
Fortunately, however, some HFAs are able to acknowledge the problem and seek professional help before a severe crisis occurs. Their motivation and readiness for change may emanate from severe anxiety or depression caused by chronic substance use or feelings of frustration and helplessness from multiple failed attempts to control or stop the use.
Barriers to Facing the Problem and Getting Help
A combination of factors can make it difficult for HFAs to acknowledge that their substance use is a serious problem and seek professional help. High-achievers are accustomed to being in control and feeling capable of resolving problems on their own. Even if they reach a point of acknowledging that their substance use has spun out of control, they are likely to see treatment as a sign of weakness and reject the idea of seeking professional help, should anyone dare to suggest it. They usually see themselves as indispensable at work and are generally unwilling to make personal health issues a priority.
They live under constant pressure to perform and feel entitled to indulge with alcohol and drugs as reward for their accomplishments.-Arnold M. Washton
HFAs are usually not accountable to anyone at work for their time and whereabouts. They live under constant pressure to perform and feel entitled to indulge with alcohol and drugs as reward for their accomplishments. Because HFAs do not fit the societal stereotype of addict or alcoholic, others may unwittingly enable the HFA’s risky behaviors by failing to recognize and confront the problem. Sometimes family members and close friends are the last to know about and/or acknowledge the full extent of the HFA’s problem.
Given the status and power that HFAs usually command in the workplace, it is unlikely that others will confront them, even when they see obvious signs of problem behavior. It has been said that high-level executives are often addicts “hiding in plain sight.” Clients and co-workers who do the same at business dinners and other work-related functions often camouflage their heavy drinking. What’s more, HFAs often have the financial means to avoid consequences of their substance abuse. The money they may spend on alcohol, drugs, expensive dinners, and related activities is not likely to put a dent in their standard of living.
In addition to all of the above, high-achieving substance abusers often have personal qualities that can either help or hinder their ability to come to grips with an addiction. Many are highly competitive, resourceful, and demanding of themselves and others. They have a history of making important decisions and solving complex problems. While it’s easy to see how these traits could prevent HFAs from seeking help, these characteristics can also help them make the changes necessary for succeeding in recovery.
If their business or professional career is jeopardized by substance abuse, they stand to lose not only large incomes, but also vital aspects of their identity and self-esteem.-Arnold M. WashtonHighly advantaged individuals can be highly motivated to avoid incurring heavy losses related to alcohol and drug use. If their business or professional career is jeopardized by substance abuse, they stand to lose not only large incomes, but also vital aspects of their identity and self-esteem. The potential consequences can be disastrous. Substance-abusing physicians, attorneys, and other licensed professionals can face the ominous threat of losing their license to practice, their livelihood, and possibly their entire career.
Historically, traditional treatment programs have been reluctant to accommodate the special needs of high-functioning clients, claiming that customizing treatment to meet the special needs of HFAs fuels their “narcissism,” “grandiosity,” and “sense of entitlement.” Unfortunately, this stereotype has made treatment options even less appealing to HFAs.
A growing population of high-functioning substance abusers has increased the demand for alternatives to traditional treatment programs.
In recent years, the proliferation of private treatment programs – especially luxury inpatient rehabs catering to the needs of upscale clients – has been nothing short of extraordinary. This is a testament to the high rates of addiction among high-functioning and other socio-economically advantaged people.
Many of these facilities offer luxury hotel-like accommodations, Internet access, personal amenities, and an extensive menu of traditional and holistic treatments. The luxury environment and personalized treatment are designed to attract and serve the high-functioning client. While these types of facilities are important options, the overwhelming majority of people who seek professional help for addiction are more likely to contact outpatient rather than inpatient treatment providers. Rarely is inpatient treatment the option of first choice unless the severity of the problem, external pressures, and other considerations propel them in that direction.
In addition to privacy and confidentiality concerns, they eschew dogmatic one-size-fits-all programs. They want flexible, individualized care that can be adjusted to fit into their busy work schedules.-Arnold M. Washton
Not only do HFAs gravitate to outpatient rather than inpatient treatment, but they are also more likely to initially seek out office-based private practitioners rather than agency-based addiction treatment programs. In addition to privacy and confidentiality concerns, they eschew dogmatic one-size-fits-all programs. They want flexible, individualized care that can be adjusted to fit into their busy work and travel schedules. Many HFAs are critical consumers who research their purchase options before making a choice. They are aware that there are a variety of different treatment approaches to choose from. They are often skeptical of addiction treatment providers claiming that AA and other 12-step programs offer the one and only effective way to achieve lasting recovery.
Several weeks of individual sessions may be needed to establish a more solid therapeutic relationship before the client is willing to consider entering an outpatient therapy group or attending self-help meetings. Nonetheless, doing so should be presented as a choice, not a mandate. Some clients refuse to enter a counseling or self-help group no matter what. Their freedom of choice needs to be respected. The principles of motivational interviewing – including “start where the client is” and “roll with resistance” – are important guidelines for engaging and retaining HFAs in treatment.
Many HFAs are aware that emotional and psychiatric issues may be linked to their use of alcohol or drugs as “self-medication.” In fact, many have seen a mental health therapist or are doing so now and may be taking antidepressants prescribed by an outside psychiatrist. It is not surprising, therefore, that when choosing a provider these clients often prefer to see a substance abuse specialist who is also a licensed mental health practitioner (e.g., psychologist, psychiatrist, etc.) with the expertise to address both types of problems.
Here are some additional suggestions that can help enhance the appeal and effectiveness of treatment services for high-functioning addicts.
Treat clients as valued customers. This means routinely providing a high level of customer service including flexible appointment times and evening/weekend hours to accommodate clients’ work and travel schedules; responding to after-hours requests for advice and support; and, timely coordination of care with other treatment providers when indicated.
Respect and work collaboratively with the client’s choice of treatment goals. Many high-functioning addicts have been maintaining the appearance of a successful, problem-free life. Not surprisingly, their goal is usually to moderate alcohol or other substance use rather than stop completely. It is important to work with clients in a harm-reduction mode (as opposed to an abstinence-only confrontational mode) while helping them to clarify the multi-dimensional nature of their attachment to alcohol and other substances in the hopes of gently moving them toward healthier choices.
Offer a menu of treatment options. It is essential to have a range of treatment services and levels of care to accommodate different needs. This would include individual and group services, psychiatric evaluation and medication management, and psychotherapy services. It is also helpful to have intensive services for clients needing more structure and support (e.g., upon discharge from inpatient rehab) and non-intensive services for clients with busy schedules who are more stable in their recovery.