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Bill J. sits in front of me, 45 years old, athletically built, dressed in an expensive suit, married with two children and making his first visit to a psychiatrist. Bill did not use his real name when making the appointment, would not give any insurance information and had numerous questions regarding our policies on confidentiality. He specifically requested the last appointment of the day and asked if there was a private entrance to my office suite. (His name has been changed for confidentiality reasons.) A successful attorney with a family and an impressive list of clients, Bill leads a life more complicated than it first appears: Bill is addicted to OxyContin, a powerful painkiller. He knew that his $400 a day habit needed to stop � preferably immediately � but he also knew that with demanding clients and a never-ending “to do” list, dropping out of society to check into rehab was not a realistic option. He also knew that simply stopping “cold turkey” on his own is very difficult and could be accompanied by serious medical consequences such as seizures. Bill’s story is becoming more common among attorneys. When we say “drug addict,” most people imagine a marginalized, downwardly mobile criminal, whose life has become a revolving door of jails and institutions, rehabs and detoxes, and periods of abstinence punctuated by mandatory membership in 12-step programs. But there are millions who have never been arrested, have never been to rehab or a detox facility and move with ease and respect within their professional communities. Bill is a classic example. Successful, well-spoken and brilliant, he is simultaneously puzzled and upset with himself. His self-image does not allow him to even say the word “addiction,” instead, choosing to describe his problem as one of “dependence.” Similarly, his shame prevents him from speaking the word “drug,” substituting it with “medication.” Bill doesn’t realize that this attempt to self-deceive with semantics is something I’ve seen hundreds of times, particularly with attorneys who continually interchange otherwise similar words in an attempt to conjure different images. Attempting to downplay one’s problem by using softer language often helps patients justify their behavior and usually contributes to prolonging their problem. Though it is true that dependence and addiction can have different textbook meanings in a pure psychiatric sense, in the actual setting of Bill’s case, “dependence on medication” is often virtually indistinguishable from an “addiction to drugs.” The semantics do not change the condition. Attorneys experience addiction at higher rates than one might think. Attorneys, by definition, are accomplished, motivated achievers. They are adept at the “game face” and can often hide the addiction well from others. Moreover, many drugs can provide the user with an illusion that they are able to work harder, better and faster � even performing better for their employer or clients. Inadvertent addicts I often refer to attorneys as inadvertent addicts because the addiction frequently starts as a consequence of a medication regiment undertaken in connection with a legitimate injury or surgery, not necessarily because of emotional issues that many “street addicts” face. As a result, the treatment options are very different. Appropriate treatment involves consideration of the entire patient and the patient’s needs. Drug rehabs or in-patient hospitals are not always viable options for professionals who simply cannot check out of society and leave their practices and family for the prescribed seven-to-30 days of treatment. Nonetheless, the treatment still needs to be comprehensive and tailored specifically to each patient. For certain patients a modified at-home treatment protocol is prescribed. There are special methods, using cutting-edge medications, to help deter drug cravings and minimize the acute withdrawal symptoms (e.g. nausea, malaise) that may have dogged them during previous attempts at “cold turkey” abstinence. Bill was able to recover safely at home, while continuing with his normal daily activities. The patient starts recovery immediately and doesn’t need to miss one day at the office. As a side benefit, at-home treatments are typically less expensive than hospital stays and drug rehabs, which can cost tens of thousands of dollars in addition to income that might be lost and the confidentiality that may be compromised while taking time off from work. In my practice, I have found that most attorneys respond very well when given the option of a less intrusive course of at-home treatment. When they apply the same character traits that have served them well in the professional sector to their recovery, the outcomes are encouraging. Simply put, they have too much to lose, and they know it. The jury may still be out on the causes of addiction, but in my opinion, the verdict has already been rendered on the treatment. Mark G. Agresti, M.D., P.A., is a board certified psychiatrist based in West Palm Beach, Fla., and medical director of Meditox, a home-based detox program. A frequent speaker on psycho-pharmacological related topics, he maintains a private practice and is a consultant to treatment centers throughout the country.

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