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Distressed Professionals: Today’s professionals are confronted by numerous challenges. The current economic climate creates pressure to remain competitive, relevant, and flexible. This means longer hours, more travel, and involvement in unfamiliar aspects of business compounding the stress that many professionals already face.  Since individuals in high performance fields are prone to overwork, perfectionism, self-denial & deprivation, and have difficulty asking for help they unwittingly place themselves at risk for chronic stress which progresses to burnout. In turn burnout leads to job dissatisfaction and sets the stage for “disruptive behavior”, substance abuse, anxiety, depression, even “diseases of adaptation” which can compromise health. At home relationships with family and friends become strained. The dilemma for many professionals is overcoming obstacles to treatment, both internal and external, in order to obtain relief from mounting distress. Such barriers can include a fear of stigmatization about seeking psychiatric help, a belief that asking for help is a sign of weakness, or even a concern that one’s problems are too shameful to share with anyone. Still other barriers are denial and minimization, extreme self-reliance, professional pride, and reputational concerns.  The logistical problems presented by the need to take time off work to attend treatment vs workload demands can dissuade many professionals from seek help until “later”. The myth is that such problems will resolve without intervention or if one works “harder”!  

Substance Abuse: People use drugs and/or alcohol for a variety of reasons including experimentation, recreation, performance enhancement, or to self-medicate emotional and psychological distress. Fortunately many people do not go on to develop addictive disorders. Problem use or “abuse” does occur however when continued drugs and/or alcohol use interferes with one’s responsibilities, occurs in dangerous situations, or leads to legal or social problems. Excessive use of drugs, alcohol, or even prescription medications can quickly progress to dependence, a core feature of which is the loss of control over use.  This may be evidenced by the need to use increasing amounts in order to achieve the same effect, using more or for longer than intended, unsuccessful efforts to cut back or stop use, giving up important activities in order to use, and using despite adverse consequences.

Dual Diagnosis: For individuals who struggle with psychiatric as well as substance use disorders, i.e. “dual diagnosis”, there are added concerns.  Psychiatric issues may increase the risk for developing addiction.  Conversely substance use may precipitate or worsen co-existing psychiatric illness. When these conditions co-occur, the effects of each are multiplied. Additionally, treatment is less effective unless all issues are addressed.  Thus an initial goal is abstinence from drugs and/or alcohol to allow a more accurate assessment of psychiatric symptoms. For some individuals, "harm reduction" may be what’s feasible. In this case, treatment may focus on increasing one’s motivation to change behaviors. If psychiatric symptoms persist or worsen despite sustained abstinence then treatment including medication management should be pursued.  Ideally this approach is best accomplished in an integrated way under the guidance of qualified professionals.    

Disruptive Workplace Behavior: “Disruptive behavior” is the more recent rubric for other manifestations of stress, burnout, and maladaptation. It encompasses a broad range of actions, verbal or physical, which undermine professionalism and cooperation, interfering with one’s ability to function in the workplace.  Disruptive behavior may present as passive expressions of resistance, such as not responding to phone calls or pages, missing deadlines, excessive tardiness, or absenteeism. Disruptive behavior can be more overt, for example uncooperativeness, rejecting input, blaming others, outbursts or abusive language, intimidation, throwing or breaking objects, sexual harassment, and disorganization. Over time the workplace is impacted. Staff morale erodes as communication breaks down and problems in recruitment and retention occur. Increased staff sick calls, loss of productivity, safety concerns, reputational damage, and even legal risk due to hostile work environment or harassment, may result. It is important to note that not all unsettling behavior is “disruptive”.  Offering critical feedback in good faith or confronting unsafe or unethical practices should not be misconstrued as problematic. Conversely, engaging in disruptive behavior ostensibly for “the sake of the company (or the patient, in the case of healthcare)” is also unjustified. Thus organizations must balance their obligation to maintain safety while ensuring that employees are not unduly targeted.