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| "High" Achievers |
| Feature Articles - Cultural | |
| Written by Eileen Moon | |
| Wednesday, 31 March 1999 | |
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Dr. B, an obstetrician-gynecologist with a thriving group practice, arrived at work after a night of drinking to discover that he’d been on call the previous evening.
Four babies had been delivered — two by cesarean section and two by normal childbirth. He had, in fact, delivered all four babies the previous evening. Mothers and children were doing fine. The only problem was, he couldn’t remember any of it. While society is moving away from the perception of substance abusers as Skid Row losers, it’s still a long way from recognizing that the pervasive problem of addiction is as common at the highest levels of society as it is at the lowest. In some cases, it’s more common. Terminal uniqueness High achievers who get high often suffer from what author and physician Abraham Twerski, MD, calls “terminal uniqueness.” Doctors, lawyers, priests, nuns, rabbis, airline pilots and executives may operate under the delusion that they are too accomplished, too intelligent, too capable to fall victim to a disease they can’t control. After all, they manage to control so much else in their lives. And though other alcoholics and substance abusers may share that feeling of “terminal uniqueness,” Dr. Twerski points out, high achievers often have an impressive track record to point to when they want to prove that they are indeed unique. The truth is that although they may be unique, their disease is as common as yesterday’s news. In his 1998 book, Substance-Abusing High Achievers, Twerski relates the story of a highly respected surgeon and president of a university hospital, who was admitted to the hospital for a liver biopsy, where Twerski found him lying on an icebag. The surgeon had recently come out of a rehabilitation facility for “highfalutin’” people. I said to him, “Doctor, at that rehab, they treated you like a special person. Your disease is not in your brain. Did you notice they biopsied your guts? Your guts and the guts of a sixth-grade dropout are the same.” As Twerski points out, “It’s the disease and not the degrees” that makes substance abuse an equal opportunity destroyer. “The popular concept that an alcoholic is a Skid Row bum or at the very best someone who is struggling to keep his head above water, and that an addict is a heroin junkie who alternates between nodding off and stealing VCRs, reinforces the denial of someone who is alcohol or drug addicted and is still functioning well,” Twerski says. “Not only is the addict himself deceived by his successful functioning, but those around him — wife, family, friend, employer, doctor — may also fail to realize the presence of an addiction problem in someone who is operating in high gear.” “Physicians are human beings first and physicians second,” says Dr. David Canavan, director of the Physicians Health Program for the Medical Society of New Jersey, which oversees the treatment and rehabilitation of impaired physicians with the cooperation of the state Board of Medical Examiners. By the time a physician is referred to him, Canavan notes, his problems are usually severe. Family members and colleagues may have tried to protect the substance-abusing physician for fear that his career would be ruined or the family’s economic stability shattered. While colleagues may fear recriminations for reporting a fellow physician, once a physician achieves sobriety, in most cases he feels only appreciation for those who stepped in to save him from himself. “Most of those who have gotten treatment are very grateful to those who blew the whistle,” he says. One case related by Twerski involved a physician who was chief of surgery at a Pennsylvania hospital. Every evening the physician would come home and settle in front of the television with a case of beer. That’s where he would be the next morning, too. His wife feared that one day he would arrive at the hospital drunk. But she feared public exposure more, worrying that if she went for help, people might recognize her and spread the word, destroying her husband’s credibility and medical practice. Spouses of professionals in trouble, like other spouses of an addicted person, often believe they must keep the secret of their husband’s or wife’s addiction. They may excuse the escalating substance abuse because of the increasing pressures they know their spouses are experiencing in the workplace.
Nonchemical coping But that method of coping often ends in catastrophe. Less toxic solutions to stress may include meditation, a return to hobbies abandoned in the past, exercise, careful attention to diet and rest, and a means of connecting to fellow human beings in a positive way outside the work environment. In most cases, a physician’s problems with substance abuse begin to wreak havoc on his home life before his professional life is affected. Once problems become apparent in the workplace, he is likely to be referred by his department head for treatment — and because his license to practice hangs in the balance, he tends to be highly motivated to cooperate. Unless there has been a public incident, such as a driving while intoxicated charge, most physicians are able to seek treatment without affecting their professional reputations. “We have a certain amount of confidentiality that we can offer our physicians with the cooperation of the state Board,” says Canavan. The Physicians Health Program imposes requirements on the recovering physician that may include regular urine testing, mandatory attendance at AA or NA meetings and ongoing follow-up that may last for the life of the physician’s career. One physician in Canavan’s program has been followed up in recovery for 17 years. Easy access to drugs About 10 to 13 percent of the general population is actively alcoholic, Canavan estimates, and the same percentages hold true for physicians But in the area of drug abuse, physicians are slightly more at risk because they have ready access to prescription drugs and because they may be susceptible to the notion that their professional knowledge makes them invulnerable to the hazards of drug abuse. The same risks may apply to nurses, pharmacists and others with easy access to pharmaceuticals. Among the first-person accounts in Twerski’s book is that of a pharmacist who began taking the prescription drug, Percocet, to help him sleep, even though he knew that was not what the drug was intended to treat. By the time authorities confronted him and forced him to enter treatment, his life was descending into chaos and he was consuming 20 Percocet tablets a day. Easy access to medications and a culture that condones drinking frequently sets the stage for substance abuse because it offers respite from the feelings of low self-esteem and inadequacy that many of us — including high achieving professionals — carry into adulthood as a result of childhood experiences. The mask of success The difference is that the high achiever appears so capable and successful that it may take much longer before anyone guesses how much trouble they’re in. In families where there is active alcoholism or other dysfunction, kids may seek to excel as a means of control. Living in chaos, they seek order and often become addicted to work itself. “A child who grows up in an environment where it’s not safe to be himself may achieve athletically or academically,” says author and speaker Kay Gilley, founder of the Intentional Leadership Program for Work-Addicted Executives in Durham, North Carolina. Those achievements may bring the child a kind of approval that is a substitute for love. But as they earn respect, prominence and economic well-being, they often lack any sense of satisfaction. Their string of successes leaves them feeling confused, dissatisfied and unhappy. “Not all high achievers are work addicts,” Gilley cautions. “It’s more about why they’re doing it than what they’re doing,” she says. “It’s quite typical in my first few minutes with an executive that he’ll say something like, ‘I’ve achieved every goal I ever set and I still feel empty.’ They just don’t feel alive. The balance is missing.” From the outside, “Jennifer” appeared to have everything, a successful lawyer with a husband and children, she thought she’d come a long way from her childhood as the daughter of an alcoholic. “Life with Daddy was chaotic so my siblings and I became ‘model’ children,” she relates in Twerski’s book. “I can never remember being disciplined for anything. We simply did not step out of line. I was an overachiever in school and I buried myself in schoolwork.” Although she vowed not to become an alcoholic like her father, the first time she had a drink, she blacked out. As time passed, she learned that she could never count on stopping after one or two drinks. Drinking became the medicine she used to anesthetize the feelings of fear and inadequacy that plagued her despite her achievements. “I was a fraud,” she says now. “A model citizen on the outside and a complete mess on the inside.” In her first visit to AA, she first disdained the woman who spoke that night, thinking she was a loser compared to her own achievements as “Miss Law Review”, “Miss Successful Lawyer.” But she soon realized that she had it all backwards. It was Jennifer herself who was the real “loser”, struggling with blackouts, people pleasing, low self-esteem and irrational fears that brought a continuing sense of impending doom. With sobriety came healing. “I’m not a phony anymore,” says Jennifer. “I can tell people my feelings. I can stand up for myself. I can talk about things without inspiring resentment. I can believe in myself.” Another pitfall for high achievers who suffer, like Jennifer, from feelings of low self-esteem is the adrenaline rush they get from working harder, longer and faster than anyone else. “It’s almost as if they’re on a treadmill of life and the faster it goes the more ‘juice’ they shoot back into themselves,” says Gilley, a recovering work addict herself. Society contributes to the problems of high achievers in trouble with an outpouring of adulation that makes it hard for an addict to recognize that they’re just as human as the rest of us. “The single greatest barrier to recovery from alcohol or drugs is the person’s inability to recognize the problem,” says Gilley. “The denial is particularly intense in people who have achieved considerable influence and cannot admit a loss of control.” An underlying component of any addiction is a feeling of being different or special. “If a person has low self-esteem, which I define as unwarranted feelings of unworthiness,” says Twerski, “they try to become executives or professionals to overcome that feeling. The problem is never resolved in their high achievement.’’ “In fact”, Twerski continues, “the same factors that contributed to their drive to excel — a feeling of inadequacy, a sense of being different or unique — may lead them into substance abuse. “The problem of low self-esteem makes a fertile ground for any of the addictions. A person who starts with low self-esteem becomes a doctor with low self-esteem; becomes an executive with low self-esteem.’’ The same holds true for those who toil in less notable occupations. “A rather constant finding among chemically dependent people is a negative self-image that predated the use of chemicals, often by many years,” Twerski says.
Spiritual awareness “There is a strong emphasis in recovery on spirituality,” he says. “The person must become aware of the inherent basic goodness of every person. If a person can come to a true self-awareness and get rid of all the distortions that have crept in, then a person will have good self-esteem.” And good self-esteem is a potent weapon in the war against substance abuse. “Awareness of one’s true value would militate against doing things that are self-ruinous,” Twerski notes. When a person enters treatment, however, they may be feeling as bad as they can feel about their own self-worth. “If I can think of him basically as a good person,” says Dr. Twerski, “Then he can have a good feeling about himself.”
That good feeling can be the first step toward a sober and satisfying life. But Twerski believes that recovering professionals should also participate in regular meetings of 12-step groups, where they will be able to grow in their understanding of addiction as a far from unique disease — and where they will be able to gain a greater sense of their own connection to the rest of humanity. “The whole focus of 12-step groups is to get people in a position to have an experience with the Divine,” says Gilley, making a clear distinction between spirituality and religion. But encouraging those who have worked hard to avoid their feelings to experience their own vulnerability may be a slow process. "The whole training process for physicians has been designed to keep them from feeling,” Gilley says, noting that that approach is often taken to help a physician deal with the death and sickness he or she witnesses on a daily basis. “But we can’t turn it off one place without turning it off everywhere.”
Recovery “Once people begin to feel their aliveness, they don’t want to shut it down with alcohol, drugs, food or work,” Gilley says. “They want to be alive.” Dr. B., the drunken deliverer of babies, ultimately achieved sobriety after four detoxifications. In order to achieve their sobriety, physicians must cope with feelings of guilt about their behavior while under the influence — and the guilt can be difficult to deal with. “They feel that they betrayed their profession,” says Canavan. “They feel that, as doctors, they’re not supposed to have a problem.” The good news, he says, is that once they’re in recovery, “They aren’t the worst doctors, they’re the best doctors.” “We’re all human,” concludes Twerski. “We’re all subject to the same conditions whether we are possessors of university degrees or whether we are low down on the totem pole, whatever that is. Your high achievement does not protect you.” Eileen Moon is a freelance writer in Atlantic Highlands, NJ.              |
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