As physicians, we pride ourselves on diagnostic acuity, precision in judgment, and emotional endurance. But there’s a blind spot many of us share—one that doesn’t respond to intellect, training, or discipline. It’s addiction.
Not infrequently, fellow physicians arrive in my psychiatry practice bewildered. Some of them won’t come right out and say, “I’m an addict.” Instead, they’ll say things like, “I’ve been working a lot . . . and I’ve also been drinking a lot.”
They’re here because they can’t reconcile how they got entangled in it. Addiction was supposed to be for other people.
Addiction Isn’t a Failure of Intelligence or Drive — Which Is Exactly Why It’s So Disorienting for Us
It would be convenient if addiction respected IQ or postgraduate degrees. But data—and clinical experience—tell us otherwise. Physicians are not only not immune to addiction; we are more vulnerable to it. High-achieving professionals report higher-than-average rates of substance use disorders. For example, the point prevalence of alcohol use disorder for female surgeons is 26%, compared to the general prevalence of 8% of women in the US.
The truth is that knowledge and training do not protect against addiction. In fact, they may camouflage it longer and make it harder to confront.
Stress Is a Factor — But Not the Mechanism
Yes, practicing medicine is inherently stressful. Long hours, emotional burdens, regulatory demands, existential responsibility . . . all of those add weight. But if stress alone caused addiction, then every internist, surgeon, and nurse would have an addiction.
Moreover, low-income, low-education populations carry enormous chronic stress. But data shows increased substance use with higher education levels. We must look beyond the simple narrative that stress is the primary driver.
What actually seems to be at play are personality traits and psychological patterns that predate our careers. Or to put it differently, those predating factors often lead us into our careers.
More information here:
Seeking Mental Health Support as a Doctor
Carrying the Scars of My Upbringing While Turning Hardships into Success
Physicians and the Psychology of Overdrive
Most physicians didn’t fall into medicine. We pursued it with intensity and purpose. That’s not random. The qualities that make one thrive in this field (hyper-responsibility, delayed gratification, internalized validation systems, a love for rewards of our intelligence and diligence) also create risk factors for compulsive overwork and addictive tendencies.
This isn’t just about working long hours. It’s when emotional regulation, identity, and safety become fused with achievement. It’s when rest evokes guilt, and productivity becomes compulsive.
Developmental Contributors: The Hidden Factors
Now, let’s go through some frameworks to understand common pathways to this problem. One or both of these are often present in high achievers with addiction, but, of course, these aren’t all encompassing.
#1 Early Life Stress and the Drive to Control
Difficult childhood experiences—like being teased or left out, abuse, neglect, emotional absence, and highly critical environments—often prime people to overachieve in adulthood as a defense mechanism. For some, medicine doesn’t just represent a profession. It’s also a fortress for control, safety, or proving our worth. Nobody wants to feel lesser than or forgotten.
The problem is: what protects us early becomes maladaptive when it never gets updated. Worse, when our adaptations are rewarded into young adulthood, we only further reinforce a life around overfunctioning. This positive feedback loop continues later in life until, eventually, it breaks us.
#2 Childhood Environments That Prioritized Outcomes
Some physicians with addiction didn’t experience overt trauma, but they were raised in environments where performance was paramount. From grades to accolades, success was equated with worth. Emotional needs, downtime, acceptance, and self-attunement took a back seat.
The problem is that these people often feel deep internal pressure to achieve, but at the insidious cost of no internal permission to simply exist. They’re productive but disconnected. This is fertile ground for behavioral addictions, because doing feels safer than stillness.
The Professional Identity Crisis of Addiction
When the very cognitive and behavioral traits that made someone successful become the sources of dysfunction, it’s no wonder high achievers are confused about why they have an addiction and don’t see a way out.
And that’s where treatment often fails us. Advice to “slow down” or “set better boundaries” may sound logical, but it completely misses the complexity of this psychological architecture. If someone’s physician or therapist offers that as a primary solution, you may want to seek out a deeper model.
You can’t brute-force your way through addiction. Of course, that method appeals to someone who thrives with that style, but to no avail. Setting rules for yourself or using logic to reason your way out of addiction simply doesn’t work. The persistence and cognitive strengths of a physician that bring results in the hospital unfortunately don’t translate into reasoning your way out of the more abstract and emotional struggle of addiction.
More information here:
Burnout Is Expensive: The Financial Case for Prioritizing Mental Health
Flourishing at Work: What Physicians Get Wrong About Career Happiness
A New Path Forward: Expand the Operating System
Here’s the good news: healing does not mean dismantling your professional life or abandoning ambition. Big internal changes lead to different ways we relate to our current lives, not necessarily dramatic outward moves. We want to master our strengths, not throw them away.
I often teach in recovery the metaphor of “widening the bowl” (an Eastern philosophical concept). You still get to keep the characteristics that led to addiction—your drive for perfection and high achievement—but with an expanded capacity for emotional presence, rest, connection, and other aspects of being human.
The first thing most people do with that idea is to strive for a balance of work and play. The problem, though, is that if one’s character is unchanged, play can still be done with the old work ethic: playing with too much expectation, pressure, efficiency, goal-setting, disappointment, etc. That can look like working out or playing a sport with too much focus on efficiency, or perhaps not enjoying it after certain goals or obstacles get stressful. It’s work disguised as play.
While a superficial balance is better than no balance, the ultimate development is to meet almost all activities (work or play) with a balance of both pressure and calm. Imagine the peak athlete who can laugh just after losing. Or an executive who enjoys fun banter or leaves an opportunity on the table to make it to a kid’s event.
It’s not “out with the old, in with the new,” but “some of the old, some of the new.” In practical terms for doctors, that might mean knowing that our work is high stakes and important but releasing our grip on full control of any one outcome. You might take patient care seriously enough to be good and diligent, but not try significantly more to improve a patient’s life than the patient is trying themselves. Or still be a leader and make an impact but only to the extent that feels healthy and natural to you.
To address the sublayer of this concept, it’s about no longer needing to use achievement as a means of feeling more valid or secure. Instead, we must develop a more stable and internal sense of who we are, which allows us to more freely decide what to achieve according to our natural interests. We want to be driven by a healthy sense of who we are, not by an invisible force trying to heal old wounds. That’s what helps us leave a drink alone, enjoy a calm evening, and maybe laugh a little more.
What do you think? Have you or anybody close to you dealt with addiction as a doctor? What methods did you or they use to get through it?
