Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

Executives and Other VIPs15. Addictions in the Workplace 349Some special considerations exist for dealing with substance-abusing executivesand leaders, because their impact on other people magnifies the effects of theirproblems. Moreover, they are often insulated from help by virtue of their positionand may feel pressure to appear professional and authoritative. Some executiveshave always dealt with emotional distress by covering it over, perhapsthrough self-medication with drugs or alcohol. Similarly, others have relied onthe socially lubricating effects of alcohol, or on the short-term performanceenhancement of cocaine for their success. Leaders with addictions feel furtherimpelled to avoid advice and help, and can end up feeling quite “lonely at thetop.” Being at the top of the heap can enable substance use. Executives canmake their own schedule in a way that allows for substance use. Some feel thatordinary rules do not apply to them—a feeling that is further compounded bythe physical and psychological effects of substance abuse. Among VIPs such asmedia celebrities, the acquired narcissism that accompanies a successful careercan lead to greater difficulty in reaching out for or accepting help.Employees often feel helpless and demoralized when faced with a distressedand possibly substance-abusing boss. Under these circumstances, employees(and other executives) commonly protect the impaired executive. This caninclude doing his or her work, ignoring inappropriate instructions, covering upmistakes, and helping to keep the secret. This is sometimes rationalized as “TheDevil you know is better than the Devil you don’t know.”As a result, management, human resources, and occupational medicinepersonnel need to be alert to signs of possible substance abuse. This includesvisible distress or intoxication, impaired judgment or performance, decreasedinterpersonal skills, unexplained absences, and more. An ombudsman programoffers a discrete and protected channel for employee concerns, as can a confidentialoccupational medicine department. If a problem is noticed at work, theexecutive needs to be approached by senior management, human resources,occupational medicine personnel, or an ombudsman. The approach should bediscrete and focus on genuine business performance concerns. Occasionally, itis appropriate to involve family members in the process.It is important that any clinical treatment not treat the executive as a VIP.To do so often results in attempts by the patient to control the treatment, minimizeproblems, avoid comprehensive psychiatric and medical evaluation andtreatment, or avoid Alcoholics Anonymous (AA) or similar programs.Health Care WorkersHealth care workers (HCWs), a diverse group that includes, for example, academicphysicians, floor nurses, and laboratory technicians, share a niche in aworkplace that combines high stress and sometimes access to addictive sub-