Physician Health Matters

Physicians May Be Included in the Ranks of High-Functioning Alcoholics

Luke is a physician who limited his drinking to weekends during his internship year because of the rigorous schedule. Luke was chosen as the “best teaching resident” and was his medical school class president. He was slated to be the youngest chief of staff at the local hospital and received several professional accolades from physician-colleagues testifying to his high performance.

Luke is an accomplished physician, but he is also a high-functioning alcoholic (HFA) — now in recovery. His story is not unlike those of other HFAs, people who can maintain their academic standing, career, and personal life while still drinking alcoholically.

Certain personality traits and tendencies allow HFAs, including physicians, to have both professional and personal successes. These traits include a meticulous work ethic, perfectionism, and a drive to overachieve and please other people. Many HFAs also have a competitive nature, “workaholic” tendencies, a strong physical constitution, and high standards of personal achievement.

Characteristics of High-Functioning Alcoholics

A 2007 study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) concluded that about 20 percent of alcoholics are “highly functional” and that only 9 percent are of the “chronic severe subtype” — the stereotype of the low-bottom alcoholic. Other addiction experts estimate that as many as 75 to 90 percent of alcoholics are high functioning. The characteristics of HFAs as they relate to physicians include, but are not limited to, the following:

Denial. Physicians often have difficulty viewing themselves as alcoholics because they don’t fit the stereotypical image and because they are successful. Denial, present in most alcoholics, can be especially pronounced in physicians. Because physicians themselves are knowledgeable about illness and disease, they often believe they can “fix” themselves — increasing both their personal denial and the denial among their colleagues. The usual red flags of many more stereotypical alcoholics that are often recognized by an employer, loved one, therapist, or other health care provider may go unnoticed with HFA physicians because of their ability to hold their outside lives together.

Drinking Habits. Many HFAs use alcohol as a reward and/or justify drinking to relieve stress. But one alcoholic drink sets off a craving, and HFAs often obsess about the next drinking opportunity. They also often display personality changes and/or compromise their usual morals when intoxicated. And they repeat unwanted drinking patterns and behaviors even if they have an inkling that their habits are problematic.

HFAs are often well-respected for job/academic performance, and many are able to maintain somewhat normal social lives. But although they appear to the outside world to be managing life well, they are skilled at living a compartmentalized life and are often adept at hiding their drinking from others.

Often by sheer luck, few HFAs experience significant tangible losses and consequences from their drinking. This reinforces the belief that because they have not lost everything, they have not hit bottom.

Physicians are accomplished professionals, and the very characteristics that so often contribute to their success — intelligence, hard work, and determination — often make them reluctant to ask for help. If physicians are unable to recognize or to seek and accept help for their own alcohol problems, they may not be able to properly treat patients with similar issues.

Therefore, it is crucial that physicians be honest with themselves. If they suspect they have an alcohol problem, they should reach out for help from a safe harbor such as Physician Health Services — for their own sake and that of their patients.

– Sarah Allen Benton, L.M.H.C.
Author of Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights

For confidential alcohol screening, assessment, or referral to treatment, contact Physician Health Services at (781) 434-7404, (800) 322-2303, ext. 7404, or www.physicianhealth.org.