Photo: Natsumi Chikayasu/The Guardian
The pandemic is making the US drug epidemic even worse – and many of its victims include white-collar professionals.
Being a civil litigation lawyer is stressful in the best of times but during the pandemic, that stress became overwhelming for Russell, a young attorney in Minnesota. When the lockdown began, Russell was already facing a crushing workload and multiple deadlines. By mid-March, he was also isolated, working from home without the support of colleagues or the structure of an office.
Russell, who did not use his real name and spoke on condition of anonymity, had been sober for nearly four years after battling a heroin addiction, but when the lockdown began he felt the need for something “to take the edge off”. He started using kratom, an herbal extract made from the leaves of an evergreen tree that grows in south-east Asia. Kratom, which is legal, has an opioid-like effect on the brain, producing pleasure and sedation; in small amounts, it acts as a stimulant. Kratom was helpful for a few days, and then it wasn’t. “I just thought, why am I wasting my time with this?” he recalls. So Russell bought some heroin and overdosed in his home office. His girlfriend found him. “The bottom line is, I have a disease that justifies whatever it needs and COVID gave me that justification,” he says.
Witness the collision of two epidemics. The new one, COVID-19, with its own deadly consequences, is making the epidemic that already existed – the drug epidemic – even worse. And many of its victims include those we often think of as society’s least vulnerable: white-collar professionals.
Employment in a wide range of white-collar professions – including finance, law, insurance, media, tech, sales, and advertising – has plunged. According to the Bureau of Labor Statistics, business and professional services alone lost 1.5m jobs since February; leisure and hospitality have lost 4.1m; education and health, 1.2m.
Lawyers are especially vulnerable to substance abuse; they already have high rates of depression, anxiety, and alcoholism, and many are struggling. The New York City Lawyer Assistance Program recently held a webinar discussing substance use and mental health. Normally, a webinar like that would attract about 100 attorneys, says Eileen Travis, the program’s executive director. About 700 attended. “There is tremendous fear, tremendous uncertainty,” says Travis.
At the end of May, the Kentucky Lawyer Assistance Program held a webinar titled "Managing Your Anxiety and Well-Being While Transitioning into the New Normal," and gave attorneys the ability to ask questions anonymously. Pre-COVID, about 50 lawyers would have shown up; more than 500 attended. “That is insane for us,” Yvette Hourigan, who directs the program, told me. The state’s legal community is populated mostly by smaller firms and solo practitioners who are losing business and fighting to stay alive.
Nina Vasan, a clinical assistant professor of psychiatry at Stanford University School of Medicine and a concierge psychiatrist at Silicon Valley Executive Psychiatry, says her professional clients – “top 1% sort of folks” that include tech execs, entrepreneurs, venture capitalists, lawyers, and investment bankers – are struggling in ways she hasn’t seen before. The isolation, uncertainty, and lack of control are a perfect setup for depression, anxiety, drug use, and excessive drinking.
Part of the problem seems to be a lack of repercussions. Few professionals are driving to and from the office now or traveling for business. They only have to look good from the neck up for 8 am Zoom meetings, so it’s easier to hide intoxication or a hangover. Vasan said for the first time in her career, two of her executive clients showed up for their therapy session high. Other clinicians I spoke with say the same thing has happened to them. “I’ve had two different clients disclose to me mid-session they had a buzz, and it was like, 11 in the morning,” says Ashley Annestedt, a psychotherapist who sees clients remotely. “Pre-pandemic I would unpack that, but now I’m like, yeah, you have four kids at home under 10. I empathize, but I also don’t want this for you long-term.”
New, real-time data from ODMAP – the Overdose Detection Mapping Application Program – at the University of Baltimore shows that drug overdoses are surging during the pandemic, having risen about 18% since stay-at-home orders were implemented in mid-March. That’s partly due to illicit (and illegally purchased) drugs being more dangerous than they have ever been. Although the number of opioid prescriptions has been steadily declining, overdoses are rising. That’s because illegally obtained opioids and other drugs (including cocaine, methamphetamine, and benzodiazepines) are being cut with the synthetic opioid fentanyl, of which just a tiny amount – 2mg – can be fatal.
For professionals trying to stay sober and in recovery, the pandemic has been especially tough. Isolation and a lack of connection are triggers for using, and often precipitate an overdose. When my ex-husband Peter – a partner in a prominent law firm with a hidden IV drug addiction – died five years ago, it was when he had been isolated. Peter had been using for at least a year, but when he finally alienated his children, friends, and colleagues, when he stopped showing up at the office, stopped returning calls, emails and texts – that was the end. Peter walled himself off in his beautiful home, ostensibly working from there but really on a drug-fueled bender, injecting himself with opioids and amphetamines continuously for days, until he died.
Connection and community are usually found in meetings like AA and NA, which have largely moved online. For many people that works, but for many others, it doesn’t. Michael Waxlax, a licensed addiction counselor supporting male patients in Hazelden Betty Ford’s Professionals Program, says face-to-face meetings give many attendees feelings they can’t summon virtually. “They know the feeling when they walk into the room at an AA meeting, the musty smell of the church basement, that energy, the fellowship, that immediate sense of belonging. Those kinds of connections may be unconscious, but we associate them with recovery.”
For professionals who went to school for years to earn MBAs, MDs, PhDs, and JDs, who have had very determined career paths, identity is often inextricably linked to career. Losing the office and support staff, not being as needed by clients who are pulling back because of their own financial problems, declining revenue – all of that can cause an existential crisis for professionals, as they question their place in the world and their purpose. And that can also be a trigger for self-medication.
Nathan, who also wished to remain anonymous, for example, deeply identified with his work as a dentist serving low-income patients in Ohio. He was used to seeing about 20-25 patients each day at the clinic where he works, and he loved it. But once the COVID shutdown began, he was only allowed to do emergency or palliative dental treatment. Usually, it was just him and one assistant. All the positives about his work were gone – no more teaching kids about flossing and avoiding sugar, it was just patients who had neglected their teeth and now had pain and infections. “I started drinking every day. For a few weeks, I also took Xanax to help me sleep. My wife was pregnant and I kept wondering, am I bringing something home with me? I was suffering from anxiety and boredom,” he told me. Nathan’s drinking kept escalating, but he made a promise to himself that when the baby arrived, it would end. On the way home from the hospital, his wife and new baby in the backseat, he stopped at the liquor store. “That was it,” Nathan told me. “I went right into treatment.”
Addiction psychiatrists and counselors that treat professionals repeatedly told me that as the pandemic persists and we head into winter, they are bracing for “an onslaught” of mental health and addiction problems. And not just among lawyers and salespeople and investment bankers, but also healthcare professionals – doctors and physicians assistants and nurses.
Jessica Sellar, outreach director at The Ridge Ohio, a residential treatment facility in Milford, Ohio, says in the last three months, The Ridge has admitted twice as many healthcare professionals as they usually do. “I think we’ve only scratched the surface, or that we haven’t even scratched the surface,” says Sellars. “There is going to be a huge amount of collateral damage from this.”