High-Functioning Addicts: Who They Are, Who Is at Risk and How to Get Help


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. Many professionals who abuse alcohol or other drugs are able to maintain a façade of normalcy, at least for some time.

As an addiction psychiatrist, I see many high functioning professionals in my Santa Monica, California practice who suffer from both mental health and addiction related concerns. An addiction psychiatrist is a mental health and addiction expert who is well trained and experienced to evaluate and treat individuals who are suffering from depression, anxiety, insomnia, PTSD, trauma and/or alcohol and substance use disorders. 

Identifying a High-Functioning Addict

With high functioning professionals who suffer from alcohol and substance use disorders, the consequences of their drinking or using are not always obvious to the casual observer — at least for a while. The high-functioning addict may face hangovers and other physical problems related to their substance abuse, but are able to hide the effects, or may attribute them to other causes (e.g., sickness, stress, lack of sleep) to prevent others from taking notice.

In many cases the addiction is taking a serious toll, but the individual and/or those around them may be in denial. In other cases, the individual is so high-functioning that they have a reserve that someone else might not. We often see doctors, lawyers and executives who are no longer able to perform at their usual extremely high level of function. For them, they may objectively experience a marked decrease in their customary level of performance, yet to the external observer, or to those who do not know them well, they may just be functioning on average with the general population and the decrements may not be noticed. Nonetheless, for those in safety sensitive roles, like physicians and pilots, even a small decrease from previous function levels may be unacceptable.

While the negative impact of drugs and/or alcohol may be subtle in professionals who suffer from addiction, there are a few signs that may identify an alcohol or substance use disorder, including:

While some addicts rapidly spiral out of control, experiencing dramatic turmoil and upheaval in their lives, high funcioning professionals with addiction tend to keep their problems well-hidden, sometimes for years.

Unfortunately, while they are managing to “keep it together,” high functioning professionals are less likely to seek treatment for their addictions and related problems. Asking for help might not even be part of their lexicon, because they may be accustomed to success and controlling all areas of their life. Accepting that they need help with addiction may be a foreign concept. In many cases, the highest functioning professionals do not seek help until they reach a crisis point, such as facing job loss or deteriorating health.

In Which Professions Do We Find Highly Functional Addicts?

According to the Substance Abuse and Mental Health Services Association (SAMHSA), restaurant and food preparation/service is the profession that carries the highest risk for addiction. The construction and media/entertainment industries are #2 and #3 on the list. Other professions, such as law enforcement, have relatively high rates of addiction because of the work culture, as well as the stress and cumulative trauma involved.

However, many of the professionals that I evaluate and treat are Healthcare Professionals and Pilots. Although physicians and other health care practitioners are #16 on SAMHSA’s list of the top 21 professions most at risk for addiction, it is worth noting that when health care professionals develop addiction, they are very likely to be “high-functioners.”

It is estimated that roughly 10% to 15% of health care professionals misuse drugs or alcohol at some point during their careers. Alcohol is the most common substance of abuse, followed by prescription medications. Statistics show that those at highest risk for substance abuse may be emergency room physicians, emergency nurses and staff, anesthesiologists and psychiatrists.

Access to drugs of abuse in their practice of medicine is a large risk factor for many physicians and other health care providers, including dentists and veterinarians.

Another high-risk group is pharmacists. A 1987 study of pharmacists and pharmacy students showed that 46% of pharmacists and 62% of pharmacy students had misused a controlled substance without a prescription. The National Institute on Drug Abuse further found that 11% to 15% of pharmacists experience alcohol or drug dependency problems at some time in their careers. Some studies of drug addiction among professionals cite “unrestricted” access to addictive pharmaceuticals, or “convenience,” as a major factor impacting which professionals get addicted.

Other professionals I see in my addiction psychiatry practice include lawyers and financial industry managers who come in due to stress, burnout or poor work-life balance. Their problems are very similar to those experienced by physicians and other health care professionals. Eventually, job performance and family commitments suffer and they are no longer able to hide their drug or alcohol problem.

Treating High-Functioning Addicts

Addiction treatment, for individials with a severe substance use disorder, is most effective when it includes the following:

As with any addiction treatment programs, a program geared for professionals and other high-functioning professionals with substance use disorder(s) should avoid shaming and further stigmatizing people because of their addiction. One of the major fears professionals often have about seeking treatment is the loss of their career. The treatment program should be a safe space where those in recovery can learn to be honest with themselves and others. Addiction is often an isolating disease, and treatment should not further isolate the addicted professional.

Because they seek to hide their addiction for as long as possible before bottoming out, many high-functioning addicts are grappling with relatively advanced behavioral, emotional and physical issues by the time they come to treatment. In short, their disease is often more advanced than it is for others who may seek treatment earlier. For these reasons, treatment for professionalss should encompass all of the biological, psychological and social risk factors and triggers for relapse. A program that addresses the family as a unit is also important. Addiction is a family disease and professionalss need their families’ support and assistance so that old patterns do not persist after primary treatment is completed.

The good news is that by following these recommendations, professionals with addiction can achieve better outcomes than the general population. The drive of the professional and their desire to return to work can help motivate them to achieve successful recovery. The recommended accountability tools, such as monitoring and recovery groups, provide additional support and catch relapses early when they do occur.

The first step is to get evaluated and an addiction psychiatrist is trained and experienced to make an accurate diagnosis and to provide individualized treatment recommendations. It is always better to start treatment early, before the disease of addition causes major consequences in a professionals personal and professional life. In some cases, an evaluation may be mandated by a hospital, licensing board or other stakeholder. My hope is that this provides an opportunity to get things back on track and to obtain a clinical diagnosis and evidence-based recommendations, in what otherwise may be a legal/administrative process. 


Stay Tuned! 


Dr. Goldenberg
email: docgoldenberg@gmail.com
On the Web: docgoldenberg.com
Twitter: @docgoldenberg
Instagram: docgoldenberg

The Huffington Post Articles: https://www.huffingtonpost.com/author/mattgoldenberg-950


*Matthew Goldenberg D.O. is an addiction psychiatrist, board certified in General and Addiction Psychiatry and is a mental health and addiction expert. He maintains a private psychiatry practice in Santa Monica, California. 

The conditions Dr. Goldenberg treats include depression, (major depressive disorder, MDD), bipolar disorder (mania and hypomania, aka bipolar depression), anxiety disorders (such as panic disorder and panic attacks; obsessive compulsive disorder, OCD; Posttraumatic Stress Disorder, PTSD); Attention Deficit Hyperactivity Disorder, ADHD; insomnia and sleep problems; addiction (alcoholism, drug addiction aka substance abuse and substance dependence); behavioral addictions aka process addiction (food addiction, gambling addiction sex addiction etc). 




5 Tips for Recognizing the High-Functioning Alcoholic or Addict. David Sack, MD. Psych Central, 2012.

The Problem of Surgeons and Drinking. Physician Health Program. Addiction Treatment for Doctors, 2015.

Drug addiction among nurses: Confronting a quiet epidemic. Many RNs fall prey to this hidden, potentially deadly disease. Mary Ann B. Copp. Modern Medicine Network, 2009.

Pharmacists get addicted, too. Jared Combs, PharmD. Drug Topics, Voice of the Pharmacist. Modern Medicine Network, 2009.

Use and abuse of controlled substances by pharmacists and pharmacy students. WE McAuliffe et al, 1987.

Recovering substance-impaired pharmacists’ views regarding occupational risks for addiction. LJ Merlo et al, 2012.

Trinkoff AM, Zhou Q, Storr CL, and Soeken KL. Workplace access, negative proscriptions, job strain, and substance use in registered nurses. Nurs Res. 2000 Mar-Apr; 49(2):83–90. [PubMed]

Hughes PH, Storr CL, Brandenburg N, Baldwin DC, Anthony JC, Sheehan DV. Physician substance use by medical specialty. Journal of addictive diseases. 1999; 18(2):23–37. [PubMed]

Bennet J, O’Donovan D. Substance misuse by doctors, nurses and other healthcare workers. Current Opin Psychiat. 2001; 14(3):195–199.

The relationship to alcoholism of occupation, class and employment. Ojesjo L. Journal of Occupational Medicine. 1980; 22(10):657-66.

Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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