Evaluating an Individual’s Treatment Needs
Addiction among Business Executives and Other Managers
The stereotype of an addict or an individual with a substance use disorder (the preferred clinical diagnostic term) remains relatively stable. Individuals with substance use disorders are often portrayed as being uneducated or undereducated, unemployed or underemployed, and underprivileged. In the real world, individuals who struggle with addiction are quite different from the stereotype. According to data compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA), of the nearly 20 million adults between 18 and 64 years old with a substance use disorder, nearly three-quarters are employed (72 percent), 11 percent are seeking work, and 17 percent are not employed.
The latest data from SAMHSA also reveals that:
- Of the individuals employed in the management sector (e.g., business executives and other managers), 11.4 percent had a diagnosis of a substance use disorder within the year prior to the survey. This was the sixth highest rate of all the occupations surveyed. The average percentage of individuals diagnosed with a substance use disorder over all occupations in the survey was 9.5 percent.
- Past-month heavy alcohol use was reported by 9.9 percent of individuals employed in management. This was the seventh highest rate of all the occupations surveyed. The average rate of past-month heavy alcohol use over all occupations surveyed was 8.7 percent.
- Past-month illicit drug use was reported by 12.1 percent of individuals employed as managers. This was the third highest rate of all the occupations surveyed. The average rate of past-month illicit drug use was 8.6 percent over all occupations surveyed.
Abuse of drugs and alcohol is a major financial burden to society. The National Institute on Drug Abuse (NIDA) reports that the cost of substance abuse to businesses in the United States is nearly $600 billion annually. Attempting to understand how certain occupations may be associated with a risk to develop an addiction is an important factor in developing treatment programs and in the implementation of prevention programs.
Be Aware of the Causal Attribution Error
Before going further, it is important to clarify that there are no identified causes associated with the development of substance use disorders. Instead, the development of an addiction in any individual or group of individuals is based on numerous interacting factors. There are several reasons why it would be wrong to assume that being in a particular occupation causes someone to develop a substance use disorder.
- Data from studies looking at the relationship between an individual’s occupation and the rate of substance abuse in that occupation are correlational Surveys like the one from SAMHSA are correlational studies that look at associations between variables (e.g., the association between one’s occupation and the diagnosis of substance abuse/substance use disorders). Because these studies only look at how certain factors are related to one another but cannot rule out or control for multiple outside influences, it is a mistake to assume that the studies are demonstrating some sort of cause-and-effect relationship. As the saying goes, “Correlation does not infer causation.”
- Based on the data from SAMHSA, only 11.4 percent of individuals employed as managers had a past diagnosis of a substance use disorder. If being an executive or a manager actually caused someone to develop a substance use disorder, this percentage would be much higher.
- Numerous risk factors have been associated with an increased probability to develop different types of mental health disorders, including substance use disorders. In some cases, individual experiences, such as stress, peer pressure, etc., that may be more prevalent in certain occupations are also associated with an increased risk to develop a substance use disorder by people employed in that occupation; however, risk factors for substance abuse are not causal factors. Instead, they simply increase the probability that one might develop a substance use disorder.
Risk Factors for a Substance Use Disorder among Executives
According to professional organizations, such as the American Society of Addiction Medicine(ASAM), the American Psychiatric Association (APA), NIDA, and SAMHSA, the major risk factors associated with the development of a substance use disorder include:
- Family member with an addiction: Having a family member who has been diagnosed with a substance use disorder results in a significant increase in the risk that one may develop a substance use disorder. The closer the relationship, such as being a first-degree relative, the greater the associated risk. In addition, having a family member diagnosed with any mental health disorder is also associated with an increased risk to develop a substance use disorder. This risk factor is not specific to individuals who are involved in management or business executives; however, individuals who have other risk factors and also have a family history of a mental health disorder are at even greater risk for the development of a substance use disorder. This risk factor represents both potential inherent factors (e.g., genetics) and environmental factors (e.g., learning that substance use is acceptable from one’s parents).
- Being diagnosed with a mental health disorder: Having a diagnosis of any mental health disorder, such as depression, anxiety, a personality disorder, etc., leads to a significantly increased risk for the individual to develop a substance use disorder. There is research to suggest that managers and executives may have higher rates of obsessive-compulsive traits, depressive symptoms, and stress (another risk factor for the development of a psychiatric disorder) than individuals in the general population. Even though the research indicates that these symptoms often represent subclinical symptoms that may not qualify for a formal diagnosis, APA and ASAM state that having significant issues with depressive symptoms, anxiety symptoms, and/or stress that may not be severe enough to qualify for a formal diagnosis are also potential risk factors that can increase the vulnerability to substance abuse.
- Gender: Males are more likely to struggle with addiction than females; however, the progression from use, to misuse, to formal abuse occurs faster in females than it does in males. Thus, overall, one would expect that male executives would have a higher rate of substance use disorders than female executives, but female executives would make the transition from social use to formal abuse much more quickly than males.
- Peer associations: Pressure or influence from peers to use drugs or alcohol is a significant risk factor that can make one vulnerable to the development of a substance use disorder. Managers and executives who spend time entertaining, attending conventions or parties, etc., may be at a greater risk to develop issues with substance abuse. Peer pressure need not be overt; it is often covert or assumed. Individuals in high-level management positions may assume that they must use certain types of drugs or alcohol in order to conform to the expectations of their role.
- Drug choice: An individual who uses a drug that is associated with a higher potential for abuse and the development of a substance use disorder is at a greater risk to actually develop an addiction than an individual who uses a less potentially addictive type drug. Addictive drugs that are often used socially in management are alcohol and tobacco products. Prescription stimulants and other prescription medications are often illicitly used by individuals in management positions to amplify focus, increase energy, and deal with stress.
- Attitude: If an individual chooses to believe the notion that it is acceptable to use alcohol or other drugs as a means to cope with stress, escape, improve their work performance, or relax, they are more likely to be vulnerable to the development of substance abuse issues than people who do not embrace this philosophy. For instance, executives and managers who consider using stimulant medications in order to improve their focus, work longer hours, require less sleep, etc., an inappropriate course of action are more vulnerable to developing stimulant use disorders than individuals who do not consider this practice to be appropriate.
- Experiencing significant stress: Individuals who experience regular and significant perceived levels of stress are more vulnerable to developing issues with substance abuse than individuals who do not experience stressful conditions. In addition, individuals who have proactive methods for dealing with stress, such as exercise, meditation, relaxation, etc., are at less risk for substance abuse. Perceived stress for managers and executives can take many forms including pressure to perform, threats of termination or demotion, the pressure to move up the ladder, etc. A good deal of this pressure is fostered in the organizational environment, and individuals in management need to recognize sources of stress and learn positive coping skills. Stress can also come from areas outside one’s occupation, such as from a spouse, other family members, trying to juggle personal and professional, financial issues, etc.
Signs of Drug Abuse in Managers and Executives
APA lists formal diagnostic criteria for different types of substance use disorders. Only a licensed mental health professional can formally diagnose a substance use disorder in any person. Individuals who are concerned that they or someone that they know may have a substance use disorder should consider the following signs that are taken from the books The Drug Abuse Handbook and Alcohol and Illicit Drug Use in the Workforce and Workplace:
- Considering use of alcohol or some other drug as equivalent to essential activities in life, such as eating, sleeping, working, etc.
- Having significant feelings of guilt associated with use of drugs or alcohol
- Losing interest in activities that one used to find pleasurable, such as spending time with family, playing sports, engaging in social activities, etc., and spending more time using the substance of choice
- Attempting to cut down on drug or alcohol use without success
- Using the drug of choice in situations where it is dangerous to do so
- Defensiveness regarding substance use
- Using drugs or drinking alcohol first thing in the morning as an “eye-opener”
- Lying about use of drugs or alcohol
- Decreasing performance at work associated with an increase in substance use
Anyone who objectively can confirm that two or more of these signs apply to them should seek a consultation with a licensed mental health professional.
- AA: Alcoholics Anonymous (AA) is a proactive program that provides direction and support for those suffering from alcohol abuse issues.
- NA: Narcotics Anonymous is a 12-Step group similar to AA that focuses on issues with prescription medications.
- NIDA: The National Institute on Drug Abuse has a brochure that can be useful for individuals who are seeking treatment for themselves or someone else. The brochure gives examples of what questions to ask potential treatment providers.
- The American Society of Addiction Medicine (ASAM): ASAM offers numerous resources for individuals who have questions regarding substance abuse/addiction and issues surrounding treatment.
- The Substance Abuse and Mental Health Services Administration: SAMHSA provides a 24-hour treatment locator hotline at 1-800-662-HELP. They also feature an online treatment locator tool.
- Employee Assistance Programs (EAPs): Many organizations have in-house programs for their employees to address issues with substance abuse. These programs are often protective of the individual’s anonymity and rights. Individuals who are employed in organizations that have these resources should be encouraged to use them.