Alcohol and stimulants in demanding professions: quiet self-help

“It’s not that I drink because I feel bad. I drink so I can stop thinking about tomorrow’s hearing.”

The sentence is said calmly, almost matter-of-factly, as if it were a technical detail of the working day. At eight in the evening the last file is closed and a glass of wine is poured. At ten, a second. In the morning, coffee — two, then another before the meeting. And in particularly long weeks perhaps a tablet that a colleague once mentioned as “completely harmless, just for focus”. None of it looks like a problem. Taken together, it looks like a system that works.

That system is what I want to write about here. Not addiction as we picture it from films, but the quiet, orderly, well-hidden self-help of people who do very demanding work — doctors, lawyers, investment bankers. People who are used to solving problems on their own, and who are often very good at it. Until they no longer are.

Quiet self-help: the glass as a tool

In the 1980s the psychiatrist Edward Khantzian described what became known as the self-medication hypothesis. His idea was simple and, for its time, bold: people do not reach for substances at random or purely for pleasure. They often choose them because the substance helps them bear something they cannot otherwise manage — anxiety, inner restlessness, emptiness, exhaustion. Seen this way, the substance is an attempted solution, not only a source of trouble.

The hypothesis has its critics and does not explain everything, but it captures one thing very well: for people in demanding professions, alcohol and stimulants often have a function. Alcohol switches off. A stimulant switches on. The first helps the mind stop in the evening, the second gets it running again in the morning. When a substance is doing a job, it is very hard to see that it has also become part of the problem — after all, it “helps”.

That is why I call it quiet self-help. It is not dramatic, not conspicuous, and often socially acceptable. A glass after a long day is almost a ritual in Slovenia. Coffee in large quantities is a sign of dedication. I have written more about why addiction is not a matter of willpower but of changes in the reward system in Addiction is not weak will.

What research shows about lawyers and doctors

The best-known study on this is American. In 2016 Patrick Krill and colleagues published the results of a questionnaire completed by roughly thirteen thousand lawyers. On the AUDIT screening questionnaire, about one in five (20.6%) scored in a range indicating hazardous or harmful drinking or possible dependence. That is considerably higher than in the other highly educated professional groups they were compared with. Where the problems were most common was also surprising: not among senior lawyers at the peak of their careers, but among younger ones, in their first years of practice.

The study needs to be read with care. It involved American lawyers, participation was voluntary, and a questionnaire is not a diagnosis. But it showed something the profession had previously preferred to overlook: in a profession that rewards endurance, drinking can hide inside the very rhythm of the work.

Similar studies among doctors have painted a related picture. Michael Oreskovich and colleagues found that a significant proportion of American surgeons met the screening criteria for alcohol problems, more often among female surgeons than male. An older study by Patrick Hughes and colleagues from 1992 showed that doctors do not necessarily drink more than the general population, but they were more likely to use sedatives and painkillers they had prescribed for themselves. Access is an important part of the story here.

For investment bankers there is far less reliable research. There are personal accounts, journalism and ethnographic studies about the culture of long nights, but I do not know of serious figures I could rely on. So I will not quote any.

Stimulants: when you want to manage more than your body can

With alcohol, at least we know what we are talking about. With stimulants the picture is blurrier. The group includes very different things: large amounts of caffeine and energy drinks, nicotine, prescription medicines used for attention deficit hyperactivity disorder, and illegal drugs such as cocaine.

It is important to separate two things. ADHD medication prescribed by a doctor after a proper assessment, and taken as prescribed, is legitimate treatment and helps many people a great deal. It is something else when a person without a diagnosis takes a colleague’s tablet to get through the night before a deadline, or when a doctor with access “gets hold of” such a tablet for themselves. Then the stimulant is not a medicine but a tool for stretching performance beyond the limits the body sets.

Caffeine often does not even get counted. I have written about why small everyday addictions matter more than they seem in Caffeine, nicotine and energy drinks.

A cycle that keeps itself going

The most insidious thing about quiet self-help is not any single substance but the combination. A stimulant during the day and alcohol in the evening complement each other in a cycle that can keep turning for months or years.

Alcohol does help you fall asleep, but the sleep that follows is shallower and more fragmented, especially in the second half of the night. You can read more in the knowledge base under alcohol and sleep. So in the morning you are more tired than you would otherwise be, and you need more coffee or something stronger. More stimulant during the day means a more wound-up nervous system in the evening — and more reasons for a glass.

From outside, this cycle looks like performance. The person is at work, delivers on time, operates, negotiates, wins. The cost shows up elsewhere: in irritability at home, in mornings that get harder each week, in no longer being able to fall asleep without a glass, and in the sense of being good only at work.

Why these professions in particular

It is no accident that quiet self-help often appears in people whose work carries heavy consequences. A few common threads stand out, both in conversations and in the professional literature.

• Mistakes are not allowed. In surgery, in court or on a major deal, the price of an error is high. The tension that comes with it does not end when you get home.
• The working day has no end. On-call shifts, deadlines, transactions across time zones. The body has no natural moment to switch off, so you create one artificially.
• The culture rewards endurance. Whoever lasts longer is better. Whoever admits they cannot cope risks looking weak.
• Drinking is part of the job. Business dinners, celebrations when a deal closes, conferences. The glass is sociable, expected and often paid for.
• Access. Doctors have access to medication; people with high incomes have access to everything else.

There is one more thread, the one talked about least: these people have often been used, since childhood, to being the ones who cope. Free time, rest and needs were always something to be earned. When someone runs on reserves for that long, a substance brings not pleasure but relief. Work itself can become the substance — that is the subject of Work addiction: the one addiction people reward.

A conversation that starts with a glass

Such a conversation rarely begins with the word alcohol. Most often it begins with sleep, with irritability, or with a partner’s remark. Something like this (a composite, not a real person):

“My wife says I drink too much. I don’t think so. I’m never drunk.”
“What would happen if one evening you didn’t pour a glass?”
“I probably wouldn’t sleep. I’d lie there replaying what I said in the meeting.”
“So the glass isn’t really about pleasure.”
“No. It’s so that I’m not there any more.”

That last sentence is the key. When a substance serves to make a person “not there any more”, we are no longer talking about a habit but about the way this person retreats from their own feelings. That does not mean it is addiction — only a doctor can judge that. It does mean there is something beneath the glass that deserves attention.

Why it is so hard to ask for help

People who are used to helping others or solving complex problems seek help for themselves late. There are several reasons.

The first is fear for one’s reputation. A doctor, lawyer or banker lives on trust. The fear that someone might find out what is going on, and that it might affect their career, is often greater than the fear of the problem itself. What the professional consequences are in any given profession is a legal question I cannot judge here — but I do know that fear of them often keeps people silent for too long.

The second reason is self-image. Someone who has built an identity on coping finds it hard to admit they can no longer cope. I write more about how a profession becomes an identity, and why the shame that comes with it is so strong, in When your profession becomes your identity.

The third reason is expertise itself. A doctor knows how addiction is treated, so they think they can manage alone. A lawyer knows how to argue, so they can also argue why their drinking is not a problem. A clever mind is an excellent defence counsel. How doctors often make poor patients is the subject of When you help everyone except yourself.

Exercise: a week of honest observation

Before you decide whether this is a problem for you, I suggest spending a week simply observing. No judgements and no promises to change anything.

1. Write down what you take and when. Every glass, every coffee beyond the second, every tablet not prescribed for you by a doctor. Just the facts, without comment.
2. With each entry, write one word about what you felt just before. Tiredness, tension, anger, emptiness, boredom, relief.
3. Write down what you expected the substance to do. Calm you down? Help you sleep? Get you through two more hours? Mean you don’t have to think?
4. At the end of the week, read the notes as if someone else had written them. What would you say to a friend who showed you these pages?
5. Try one evening differently. Not as a test of willpower, but out of curiosity: what happens when the glass isn’t there? If you notice physical signs such as shaking, sweating or strong restlessness, talk to a doctor.

This exercise will not tell you whether you are addicted. It will tell you what job the substance is doing in your life. And the job is what can be explored in therapy. If you would like a more structured view, the questions in Am I an addict? Questions that say more than quantity may help.

Where this explanation does not apply

The self-medication hypothesis is appealing because it takes some weight off: you don’t drink because you are bad, but because things are hard. But I want to be honest about its limits.

Not every after-work glass is self-medication. Many people drink moderately, for pleasure and company, and have no problems with it. Looking for deep meaning in every glass would be just as mistaken as overlooking a real problem.

Addiction also has a biological side. Heredity, the body’s response to alcohol and the changes in the brain that come with repetition are real. Once dependence is established, it is no longer driven only by the original reason. Understanding “why” matters, but on its own it does not stop the drinking.

Sometimes the problem is the job, not the person. When a system demands sixteen-hour days, shifts without rest and constant availability, we should not pretend the responsibility is only the individual’s. Therapy can help a person; it cannot fix a working environment that systematically wears people out.

Therapy is not a substitute for treatment. When it comes to physical dependence, misuse of prescription medicines or illegal drugs, the first port of call is a doctor. Psychotherapy can be an important part of the journey, but it cannot replace medical care.

Where to find help

If you recognise yourself or someone close to you, the first step is a conversation with your GP or a psychiatrist. A doctor can assess whether this is addiction and refer you on if needed. That applies if you are a doctor yourself — perhaps especially then.

Very important: if you drink heavily every day or regularly take sedatives, do not stop on your own all at once. Withdrawal can be dangerous and should be supervised by a doctor. Why this is so is explained in Withdrawal: why it deserves to be taken seriously. You will also find a basic explanation of addiction in the knowledge base under addiction.

Alongside medical treatment, psychotherapy can also be very helpful. In it we look not only at how to stop, but above all at what the substance has been carrying for you all this time — tension that could not be spoken, tiredness you were not allowed to admit, shame at not coping. In relational family therapy, in which I am training as a therapist in training under supervision, we also look at where this pattern comes from: who taught you that you must manage everything alone, and who in your family carried a similar burden before you. Sessions take place in person in Ljubljana, and I also work in English.

Self-help groups such as Alcoholics Anonymous can also help, and anonymity is one of their founding principles. For people worried about their reputation, that is often an important detail.

If thoughts of not wanting to live come up alongside all this, do not wait. In Slovenia, call the mental health crisis line on 01 520 99 00 (every day from 7 pm to 7 am), the Samaritan helpline on 116 123 (24 hours a day), or in an emergency 112. Alcohol and stimulants can sharpen thoughts and moods considerably, so at such times it is especially important not to be alone.

What to remember

• For people in demanding professions, alcohol and stimulants often have a function: the first switches off, the second switches on. That is exactly why they are hard to see as a problem.
• Among American lawyers, about one in five screened positive for hazardous or harmful drinking, most often in the early years of their careers.
• A stimulant by day and alcohol at night create a cycle that sustains itself through poorer sleep.
• The question is not only how much you drink, but what the substance makes possible — and what you could not bear without it.
• If you drink heavily every day, do not stop alone. The first port of call is a doctor; psychotherapy can be an important part of the journey alongside it.