Substance Abuse: The Executive Epidemic

Substance abuse – the harmful or hazardous use of drugs, alcohol, or another substance – has long been associated with the uneducated and unemployed factions of community. But, stereotypes aside, professionals working with substance abusers agree that individuals from all walks of life can be affected – including those employed in executive roles.

Almost ten percent of the American population has used illicit drugs in the past month, more than six percent of the population admit to having misused prescription medication over the last year and a staggering 15 million Americans struggle with alcoholism. Perhaps surprisingly, however, many of these individuals do not fit the traditional cookie-cutter drug user stereotype.

Take a look at the bigger picture and it becomes apparent that substance abuse is not only a problem within the general population, it’s potentially a greater problem among those with jobs than their unemployed counterparts.

Official figures show that the majority of individuals who abuse substances are in fact employed or seeking work. According to statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), 72 percent of the 20 million American adults abusing substances are employed. Of the remaining 28 percent, 11 percent are seeking work and only 17 percent are unemployed (SAMHSA 2015). These initial figures blow the traditional stereotype of a drug user out of the water – and yet there’s more.

In terms of executive professions, rates of substance abuse among management professionals in comparison with other industries are relatively high – 13.5 percent of men and 7.3 percent of women in management have a substance use disorder, according to the statistics. Meanwhile, the rates of substance abuse among those working in finance and insurance are 11.7 and 7.6 respectively, while 9.8 of men and 7.3 percent of women within the professional services industry have a substance use disorder.

What these figures tell us is that the stereotypical uneducated, unemployed substance abuser is, in fact, a fallacy, and the misuse of substances among executives is a bigger problem than has perhaps been accounted for to date.

Which executive professions abuse substances?

Executives typically hold skilled or management positions in companies – examples being lawyers, pilots, dentists, and physicians. There is significant research into substance abuse among the general population but less so with regards to executives in particular.

The available findings highlight, to some degree, the extent of substance abuse in fields like law. A study published by the Journal of Addiction Medicine in 2016 (Krill et al 2016) showed that alcohol abuse, in particular, is a key concern among attorneys, with more than a fifth screening positive for hazardous, harmful, and potentially alcohol-dependent drinking.

Previous studies have shown that lawyers are almost twice as likely as other individuals to have a drinking problem and, taking into account other substances in addition to alcohol, more than 22 percent of attorneys describe their substance use as problematic. It could be argued that drinking goes with the territory – lawyers and other professionals have competitive careers, often lavish lifestyles, and poor work-life balance. For some, substance misuse is part of the indulgence; for others, it’s a release.

Another field in which research into substance abuse is proven yet limited is dentistry. Estimates suggest that between six and ten percent of dentists display signs of substance abuse, which is approximately on a par with the general population yet potentially more worrying in light of the possible consequences for patients.

Of the substances most commonly abused within the dental industry, alcohol comes out top, followed by cigarettes, marijuana, and opiates (Fung 2011).

Research into substance use among pilots is less forthcoming but post-mortem results of aviation professionals involved in accidents between 1990 and 2014 show that between two and three percent of individuals had traces of illicit drugs or sedating pain relievers in their systems when they died (National Transportation Safety Board 2014).

Among physicians, meanwhile, rates of substance abuse are higher, starting at ten percent and rising to 15 percent among some specialties (Baldisseri 2007). Although the levels of substance abuse among healthcare professionals are consistent with the national average for the general population, the figures are nonetheless disturbing. Many of these executives are tasked with looking after the health and wellbeing of the population, and there are all manner of risks associated with practicing while impaired.

Which substances do executives abuse?

The scope for substance abuse among executives is vast and varied. Educated and employed, executives often have the means to get hold of any substance they choose.

Among attorneys, the most commonly misused substance is alcohol. Back in 1990, a study revealed that 18 percent of attorneys in the state of Washington were problem drinkers – almost twice the national average of American adults in general. More recent research suggests that more than 20 percent of attorneys now abuse alcohol. In terms of other substances in addition to alcohol, stimulants are most commonly misused, followed by sedatives, tobacco, marijuana, and opioids (Krill et al 2016).

In the field of dentistry, alcohol is also the most commonly abused substance. A survey by Kenna and Wood revealed that alcohol is a commonly consumed substance among dentists in social settings but other substances are also abused, including tobacco, marijuana, major opiates like morphine and fentanyl, minor opiates such as hydrocodone and codeine, and anxiolytics like alprazolam and diazepam (Fung 2011).

Readily available, licit, and free from the connotations and stigma surrounding illegal substances, alcohol would seem on the surface to be a relatively innocuous substance of choice. However, the cost of alcohol misuse is altogether sobering: more than 88,000 Americans die from alcohol-related causes each year, which makes the substance the third most preventable cause of death in the USA (Centers for Disease Control and Prevention 2013).

Among aviation professionals, studies into substance abuse have revealed marijuana to be the most commonly identified illicit drug taken by pilots, with rates increasing between 1990 and 2012. With regards to controlled substances, the most frequently traced drugs in the bloodstream of deceased pilots were hydrocodone (found in Vicodin and Lortab) and diazepam (Valium). Both accounted for 20 percent of the controlled substances identified through post mortems fatal accidents involving pilots (National Transportation Safety Board 2014).

What causes substance abuse among executives?

Substance abuse is a complex phenomenon and, as such, there is no single specific cause. In some cases, substances are used recreationally among friends and in social situations but may develop into abuse over time. Some substances – particularly alcohol – have a familial element. Individuals may be genetically disposed to abusing substances and the risk of using drugs increases among adults who experienced neglect in childhood (National Institute on Drug Abuse 2019).

Alcohol use disorder tends to run in families – the rate of occurrence is three to four times higher in close relatives of individuals who abuse alcohol. Meanwhile, Individuals with a pre-diagnosed mental illness like schizophrenia or bipolar disorder are also more vulnerable to abusing alcohol, as are those with traits like impulsivity and low sensitivity to alcohol.

A number of environmental and physiological reasons have given by executives to account for their substance abuse, including using drugs or alcohol as a form of self-medication. Commonly, individuals may turn to substances to help cope with pain, mood, or sleep problems.

Executives in particular often face significant levels of stress on a day-to-day basis, cited as a key factor in the development of substance abuse among professionals. Many lawyers, for example, have heavy workloads and may deal with cases that challenge their value systems. Research has shown significant levels of depression, stress, and anxiety among attorneys (Krill et al 2016).

Physicians, meanwhile, are under pressure daily and often deal with stressful situations such as emergencies. A 2013 survey highlighted key reasons for abuse of prescription drugs among physicians, with the majority of individuals misusing substances to manage physical pain or emotional/psychiatric distress. Other reasons included managing stressful situations and to avoid withdrawal symptoms (Merlo et al 2013).

Both doctors and dentists have greater access to prescription drugs than many other professions, too, with physicians being particularly at risk of abuse involving opiates and benzodiazepines (Weir 2000).

Usually, however, when somebody abuses substances, the cause can be attributed to a combination of factors rather than a single source.


Dr. Kevin Fleming
Dr. Kevin Fleming
Dr. Kevin Fleming is a three-time University of Notre Dame grad and Founder of a global neurotechnology-based firm, Grey Matters International, Inc., that concentrates on providing true sustainable behavior change solutions for distinctive clientele seeking to go beyond mere self-help, coaching, and therapy. His work has been featured in top media outlets including The New York Times, CNN, Forbes, Fortune, Christian Science Monitor and has been endorsed by faculty members in both Harvard Medical and Business Schools, given the crossover illusions of success and happiness that confuse high performing brains of our modern day. This innovative neuroleadership research and practice of his prompted an invite to speak for top Middle Eastern leaders in 2008, which had cabinet members for the King of Jordan in attendance. He received a feature chapter on his behavior change work in a book that hit the tops of both Wall Street and NY Times bestseller charts, ALL IN by Adrian Gostick. With the growth of Grey Matters International his offering of cutting edge neurotechnology options for creating breakthroughs in mental health, he was asked to be an expert aftercare resource for the CBS hit show "Face the Truth", created by the producers of The Doctors and Dr. Phil. In addition to being considered as one of the top personal & executive coaches globally (published in interviews and anthologies with the great Marshall Goldsmith, the late Stephen Covey, and Deepak Chopra), he is the U.S. Ambassador for the International Regulatory Body of Coaching and Mentoring. He is also on the Advisory Board for the DeNicola Center for Ethics & Culture at the University of Notre Dame. He resides in Jackson Hole, Wyoming, and Tulsa, OK and enjoys singing/songwriting and recording as a semi-professional recording artist and studio drummer, having recorded projects with the producer/bandmate affiliated with Carole King and Dan Fogelberg.

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