Why does one profession have higher substance abuse rates than another?
If you look at various articles and tables of addiction rates among different professions, there might not seem to be an obvious pattern at first. Yet, when we look closer, there are some good theories to explain what professions have the highest rates of substance abuse.
Considering that addiction is a form of mental illness, you might think that it would not have an effect on high functioning, hard-working, and intelligent people at a high rate. However, it turns out that people who are very high functioning may be at a higher than normal risk of becoming addicted to alcohol, controlled substance prescriptions, or illicit substances.
What about bartenders and servers in restaurants, bars, and nightclubs?
Of course, it makes sense that bartenders and restaurant servers would have a higher than average risk of becoming addicted to alcohol or drugs. If you have ever worked in a bar or nightclub, you can probably relate to this.
For people who work in alcohol-serving establishments, they have the temptation of being around alcohol for many hours every single workday. Alcohol often serves as a gateway to other drugs.
Hence, in an alcohol-serving establishment, there are likely to be patrons and employees with access to a variety of drugs. Working in a bar or nightclub may expose employees to drug and alcohol use, for some, leading to a dangerous substance addiction.
Why does it seem like being a substance abuse counselor or mental health counselor is a job that has a high addiction rate?
Substance abuse counselor jobs do seem to be held by people who have drug abuse or alcohol abuse histories. Why do people who work in inpatient rehab, doing substance abuse counseling or related social work tend to be in addiction recovery?
It’s not that these jobs lead to heavy alcohol consumption or illicit drug use. An addiction counselor will understand their clients best if they have been through the difficulties of facing addiction and getting help to overcome their addiction.
Hence, the profession of addiction counselor or social worker in the addiction treatment field will tend to attract people who are recovering past drug users. So, while there may be an occasional treatment provider who is using illicit substances such as heroin or methamphetamine, or other illegal drugs, more often, behavioral disorder counselors who work in addiction counseling are more likely to be sober and well established in their recovery.
Among jobs with the highest addiction rates, construction work stands out when it comes to prescription opioid use.
People at the highest risk of drug addiction are those who are predisposed to addiction and who are regularly exposed to drugs or alcohol. What other professions might involve people at risk and frequent exposure? Did you know that construction workers are at high risk of becoming addicted to drugs?
But, why would construction workers have a high incidence of drug addiction? Drug and alcohol use is highly discouraged when working around construction materials and heavy machinery. In the construction industry, workers are at a higher risk of injury compared to other trades.
The risk of injury is connected to the risk of addiction. When a construction worker is injured, they may go to a doctor and get a prescription for opioid pain medication. A small percentage of people who take opioids will become addicted.
So, in construction work, while the risk is not related to drug exposure on the job, the exposure to healthcare for injuries is thought to be the issue. Some workers with injuries involving pain will become addicted to the pain meds prescribed to them.
Fortunately, opioid addiction treatment is a well established field with highly effective treatments, such as Suboxone, ZubSolv, and Sublocade as well as alternatives including naltrexone and Vivitrol. While opioid addiction is one of the most dangerous drug addictions, medication assisted treatment works very well, especially in addressing the current opioid epidemic.
As you might imagine, other professions do not have as high of a risk of addiction because of the lack of exposure to drugs or alcohol. For example, in an office building where workers might be selling insurance, writing software, or providing accounting services, there is a far lower risk of being exposed to drugs or alcohol on a regular basis.
Of course, in many corporate cultures, workers go out to drink together after work. Workers with office desk jobs may also use various substances in their free time. There is still a risk of becoming addicted to drugs, but it is not particularly related to the worker’s profession.
What about doctors? Why do they have a high risk of addiction?
People are generally aware that workers in healthcare have a higher than average risk of becoming addicted to drugs or alcohol. We might think of doctors, nurses, pharmacists, and dentists misusing substances.
Do these healthcare workers, like bartenders and servers, get addicted because of drugs in the workplace? Doctors and dentists prescribe addictive drugs, such as opioid pain pills.
Nurses give out medications to patients. Pharmacists are in charge of large quantities of drugs, including many highly addictive drugs, from opioids to amphetamines.
However, while in some cases being around drugs may increase risk for some healthcare workers, the reason for their increased risk of addiction is somewhat more complex. The medical field tends to attract very hard-working and intelligent people who are then exposed to very stressful training and work.
For example, becoming a doctor is not easy. Students must get top grades in college and complete a list of difficult prerequisites to qualify to apply to medical school. The students who are most likely to get accepted are the ones who put in many hours of study every single day.
After getting accepted to medical school and completing a grueling four years of college, the student faces another two years of intense classroom work and then two years of difficult clinical work. After four years of medical school, the student then graduates to being a medical resident.
Many people now describe medical residencies as being abusive workplaces.
Residency typically lasts at least three years. The resident is expected to work very long shifts with heavy workloads throughout the week.
Even at the point of residency, early in a doctor’s career, the seemingly never-ending stress, sleep-deprivation, workload and responsibilities can lead to many residents developing problems with alcoholism or drug addiction. It often starts with the doctor-in-training looking for stress relief at the end of a long and difficult shift.
Another issue is related to the type of person who gets through the system to become a doctor. Intelligence seems to be a risk factor for developing an addiction.
In fact, intelligence and creativity together are frequently associated with addiction. While we might theorize many possible reasons for this, one reason seems to be clear.
Think of addiction as a trap that is highly effective at trapping smart, creative people.
As it is often described, addiction hijacks the reward center of the brain.When we want something, or crave something, at a deep level, we tend to justify why we want it. Our clever and advanced prefrontal cortices are played like a puppet on strings by the ancient and more primitive parts of the brain that are taken over by addiction.
As you can imagine, the more intelligent and creative a person is, the better they will be at both obtaining more drugs and justifying their drug use. Think of addiction as a skilled jockey, clothed in the brain’s reward center, riding the prefrontal cortex like a well-trained horse.
So, doctors are intelligent people, who may have experienced an emotionally abusive upbringing, with parents who insist that their child, to be fully accepted in society, must complete a doctorate degree. There is an old joke that in some cultures, a fetus is considered to be a human being only after it has graduated from medical school.
On top of a difficult childhood with unreasonable high expectations from their parents, the doctor-to-be works excessively hard in college. Addiction sometimes sets in during the college years, with alcohol being used to unwind at the end of a difficult week. Or, the student starts using amphetamines for a competitive edge in studying and test-taking.
Then, medical school and residency each progressively increase the pressure, putting strain on the already psychologically injured doctor-in-training. Add to that the financial terror of going hundreds of thousands of dollars into debt to get through medical school.
The trap leading to addiction has been set. For many people, getting out of the trap early on is easier. They are able to fight the cravings and stay on track, getting to a point where the brain is able to heal over time.
For an intelligent doctor, dentist, nurse, or pharmacist, their own intelligence will be used against them by their addiction.
I imagine the addiction trap to be similar to a crab trap, where a cube-shaped trap made of chicken wire has a small opening that is easy to get into but hard to figure out how to get out of. The occasional crab who encounters the entrance easily slides into the small entrance into the large inner area of the trap, joining other crabs inside. Then, they are unable to find their way out because the opening is small.
While some crabs might find their way out, most will not. The crab trap depends on a crab not being very intelligent, whereas the addiction trap more easily locks in the highly intelligent and creative individuals.
Still, conceptually, I imagine the situations to be similar. The smart addicted person will find every reason to wander all over the trap, looking for answers everywhere but the small opening that is the only way out.
Interestingly, even though addiction and alcoholism does affect healthcare professionals more often than average, it is not as bad as you might imagine. Surprisingly, most healthcare workers do not have easy access to addictive substances. It is not nearly as easy as you might think.
Controlled substances are highly regulated and carefully watched. Most pharmacists, nurses, and doctors will stay away from using drugs that they work with because of the fear of severe consequences which can lead to loss of their career and even imprisonment.
There are exceptions. For example, anesthesiologists have a high risk of opioid use because of frequent access to drugs such as IV fentanyl throughout their workday. Synthetic opioids can be so potent that they only need to take a small amount that might not be missed.
As a result, many of these specialists experiment and a certain percentage will get addicted. Still, operating room nurses are on high alert and all healthcare workers who come in contact with addictive substances keep an eye on each other to prevent a problem that might lead to a tragic outcome for a patient.
What about dentists and the high risk of addiction in the dental field?
Dentists do have a higher than average risk of becoming addicted, yet, the more serious issue faced by dental professionals is suicide. Suicide, unlike drug addiction, is completely irreversible.
In the Narcotics Anonymous program, drug addiction is referred to a slow suicide, or suicide on the installment plan. There does seem to be a connection between addiction and suicide. Some people who have been addicted to drugs state that drugs saved them from commiting suicide.
Why would a dentist want to take drugs or kill themselves? Like any doctor, dentists are under pressure at work and often have serious financial concerns as well.
Healthcare professions with the highest rates of substance abuse include doctors, nurses, and pharmacists. Yet, dentists are very high on the impaired healthcare worker list.
Possibly, the specifics of being a dentist, having to spend the day looking and working in people’s mouths, increase work dissatisfaction for some people over the other healthcare professions. I remember spending time as a student with an ear, nose, and throat specialist who was getting ready to retire.
I remember that one day he pulled back from looking into a patient’s ear and took a momentary break. He shook his head, looked at me and said, “I am sick of spending my life looking into tiny holes in people’s heads.” Maybe his frustration is similar to what many dentists experience.
Why do so many musicians and actors have addiction problems?
You might think that musicians, actors, and artists have followed their dreams and are doing the work they always wanted to do. So how are these career paths that lead to higher rates of addiction?
In the world of music, from rock and roll to pop to jazz, the problem with drug and alcohol addiction seems to be more serious than any other field. What is it about being a rock star that leads so easily to addiction?
Your first guess might be the lifestyle. It is not so different from the lifestyle of a bartender or server in a hip nightclub. Drugs and alcohol are always around and available in the fast life of rock and roll.
Yet, many people who inhabit that world do not become addicted. There are many people who try drugs or have occasional alcoholic beverages and do not go down the path of addiction. And, of the people who are in the entertainment business, it does seem to be the performers who are disproportionately affected.
This brings us back to the issue of intelligence and creativity. There is an interesting concept that has been studied and discussed in the world of psychology about the correlation between intelligence and creativity.
It is believed that IQ and creativity are closely related up to a certain point. A person with below average intelligence will likely not be very creative. Someone with average intelligence will be proportionally more creative, but less so than someone whose IQ is a bit higher.
Does the creative genius of top musicians, performers, and artists put them at greater risk of becoming addicted?
This direct, linear relationship works up to an IQ of about 120. While not genius level and not quite gifted level, 120 is well above average and is intelligent enough for a person to do just about anything in life. So, what happens to creativity at this level?
The theory is that the linear relationship between intelligence and creativity no longer apply. That is to say that a person who has an IQ of 120 could possibly have off-the-charts levels of creativity. Or, a super-genius with an IQ of 150 might, relatively, not be very creative at all.
While there have been experts who have expressed doubt about this effect, it does seem to make sense. Top-level artists in the entertainment business do tend to have incredible levels of creativity, and they tend to be at least fairly intelligent.
I once read that the average IQ of a Harvard student is about 120. If that fact is true, that means that just about any successful artist could possibly have gotten into Harvard if they had applied themselves to their schoolwork in high school.
It also means that rock stars have the potential to learn difficult subjects, such as calculus or electrical engineering. Of course, most are too busy composing and performing to go back to school to complete difficult degrees that probably will not help their careers.
So, what does this have to do with addiction, artists and performers? Remember, people who are highly intelligent and creative are more likely to be predisposed to addiction, and they have more difficulty overcoming addiction.
Creative genius may even be more of a risk factor than just raw intelligence. A smart person may be a good problem solver, but a highly creative person will come up with novel solutions that most people would never have thought of.
Imagine that creative power under the control of a destructive addiction. A person caught up in active addiction is at the mercy of the addiction process and their best mental abilities are used against them.
So, while cocaine or heroin might be passed around the backstage area of a rock concert, the musicians are possibly more susceptible to becoming addicted compared to many of their roadies or managers. Of course, there are other factors at play as well.
The typical employee of a rock band who sets up amps and microphones is easily replaced if they become impaired by drugs or alcohol. To a certain extent, the members of the band may feel that they are untouchable and even expected to party publicly. Of course, at some point, even the band members must be replaced when addiction gets too far out of hand.
What about lawyers? Are lawyers at higher than average risk for addiction?
What profession has the highest rate of alcoholism? Did you think it was the bartenders and servers? It turns out that attorneys have among the highest rates of alcoholism and substance use of all professions.
I remember seeing a movie where a lawyer openly smoked marijuana and bragged about how he represented drug dealers and charged them, so he could represent marijuana-related cases for free. Normally, I would look up the name of the movie to list it here, and maybe I will in a future update, but it’s not important.
Suffice to say that many fictional and real-life lawyers are known to be heavy drinkers and sometimes substance users, often seeming to have no fear of consequences. Maybe they have less fear because they work with the law, so they feel more comfortable pushing the limits and sometimes crossing the line.
Of course, when an addiction gets out of control, even a lawyer may eventually cross the line and be at risk for being disciplined. But why is it that lawyers seem to be more at risk for developing addictions?
It is likely that lawyers are in a similar situation to doctors, being under significant pressure through school and after school. They are under pressure to survive academically and professionally as well as financial pressure from student loans.
Lawyers are especially at risk for developing alcoholism. Alcohol can be a part of an attorney’s professional life, having a drink with partners or even clients at professional dinners.
In addition to exposure to alcohol, and being under a great deal of stress, lawyers also tend to be intelligent and creative people who may be at higher risk of becoming addicted. Lawyers might be thought of as being like bartenders, doctors, and rock stars all rolled into one when it comes to addiction risk.
Add to that a sense of confidence and independence that many successful lawyers experience and a dislike of asking for help. For some high performing people, becoming a lawyer may be a perfect storm of addiction risk.
What do doctors and lawyers have in common that can lead to their addiction getting more out of hand than other professions?
Addiction, like other health-related conditions, has different stages of severity. A person may be in the early stages of developing an addiction, or they may have a serious full-blown addiction that is out of control and difficult to treat.
Why is it that doctors and lawyers might be more at risk for letting their addiction progress further than people in other professions? One issue is that the organizations that provide oversight for both professions can be intimidating.
These professionals who become addicted may fear serious consequences and loss of their careers. Hence, they struggle in silence as their addiction rages on and grows in severity.
While it is true that consequences for doctors and lawyers from the medical boards or state bars can be severe, it is a difficult problem. These impaired professionals are licensed with their states and the state governments have an obligation to protect the public.
Yet, there is much room for improvement in handling these cases to make the path to a professional being able to recover and continue in their career less onerous. Doctors and lawyers should have less fear in coming forward to ask for help.
What about police officers?
There have been incidents of law enforcement officers having issues with prescription drugs or illicit drugs. Police officers are first responders who often deal with drug overdose deaths on the streets.
Along with other dangerous situations out in the field, law enforcement is a stressful and dangerous job. It is not hard to believe that substance abuse disorder can be a risk for police officers.
Just like any stressful career, some law enforcement officers may find themselves engaging in heavy drinking after work. When a person binge drinks on occasion, they may be a gray area drinker.
Gray area drinkers are at higher risk of developing alcohol use disorder. Pharmacological extinction techniques, such as The Sinclair Method, using naltrexone, can help to get gray area drinking under control.
Because police officers may be subject to regular drug testing, they may be more likely to engage in drinking alcohol over using illicit substances. Alcohol abuse can be very damaging to the body, but fortunately, medication-assisted treatment can be highly effective in reducing or eliminating alcohol use.
What other professions have a high risk for addiction?
Have you heard about any other professions that might have a higher than average risk of developing alcoholism or drug addiction? Please share your thoughts and opinions through the contact page of this site.
It is very interesting to consider that in certain professions, we expect the highest performing human beings to work in these areas, and we expect that they submit themselves to training that can seem to be abusive. Why would we not expect there to be some psychological fallout from such a process?
In some cases, people in these professions are at higher risk for suicide. They may also express symptoms of other mental illnesses.
If we expect the best of the best candidates to enter professions such as healthcare, law, and the arts, we should be more protective of these highly talented people who are willing to go through with the long and difficult process of mastering their field. The educational and training processes should be addressed to be less abusive and take into account that many of the best performers are also very sensitive and at a higher risk of developing mental health issues and addictions.
And, people who are valuable members of a profession who develop an addiction problem should be encouraged to ask for help without being treated as if they have a moral deficiency. It is time to drop the stigma associated with addiction. People who suffer from drug or alcohol addiction are far from being expendable. I remember years ago, when I was a medical student, I overheard a conversation amongst two hospital administrators. They were half-joking about a surgeon on staff in the hospital.
One of the men said, “he’s our best surgeon if you can just get him to sober up.” Of course, no one wants to go in for surgery not knowing if the surgeon is going to show up drunk. Yet, the process of rehabilitation should be respectful and have a clear goal of providing treatment in order to get impaired professionals back on track and back to work.
To this day, I have no idea who that surgeon was or what became of him. Yet, I wonder if he was ever able to achieve lasting sobriety. And if he did, how many lives was he able to save, making a positive difference in the lives of everyone connected to his patients?
Helping people to recover has a powerful rippling effect that can lead to helping many other people, who in turn may help even more people. By changing our views of addiction, we can do our part in making a difference in the lives of many people, far beyond just those who are addicted.