I knew Peter so intimately and, at one point in my life, loved him so deeply, it is unbearable to think of him alone at the end. Not so much that he might have been in pain, but far more, that he might have been frightened. I think that if I had been there—even if I couldn’t have saved him—I could have provided some comfort. I could have held his hand.
In January 2017, I move into an apartment in New York City and begin a part-time graduate program for a master’s degree in social work, with an eye toward eventually doing some work in end-of-life care. I don’t intend to stop writing; I just want to write about something different, about what it means to be human today, to pursue answers to questions about life, death, addiction, recovery, hate, love, justice, and joy. Before I can do any of that, though, I need to understand Peter’s death beyond the personal, in a bigger context. I need to see where his story—the drug-related death of a white-collar, affluent, and outwardly successful professional—fits into the larger story of drug use and abuse in America. It is the only story I can think about and the one I need to write first, before any others.
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WHEN I START MY research, I feel sure that Peter’s death isn’t an outlier at all but the edge of an unidentified trend—white-collar addiction. Then I find an article titled “White-Collar Pill Party” by Bruce Jackson, published in The Atlantic magazine in August 1966, almost fifty years before Peter died.
The story shows its age—the way people speak, the copious use of the word junkie, the portrayal of women. And while it seems very 1960s, it’s also very twenty-first century.
With unknowing prescience, Jackson wrote in 1966: “A lot of people take a lot more pills than they have any reason to. They think in terms of pills. And so do their physicians: You fix a fat man by giving him a diet pill, you fix a chronic insomniac by giving him a sleeping pill. The publicity goes to the junkies…but these account for only a small portion of the American drug problem. Far more worrisome are the millions of people who have become dependent on commercial drugs. The junkie knows he’s hooked; the housewife on amphetamine and the businessman on meprobamate [precursors to benzodiazepines like Xanax and Klonopin] hardly ever realize what has gone wrong.”
Two months after Peter died, Theodore J. Cicero, a professor of psychiatry at Washington University School of Medicine and an expert on addiction, published a paper in the journal Cerebrum titled “No End in Sight: The Abuse of Prescription Narcotics.” He wrote: “Other than the obvious high, what purpose do these drugs serve that accounts for their popularity? It turns out that the initial potent high is not really what most users seek. Rather, narcotics relieve anxiety or depression by providing a short-lived escape from difficult circumstances.” Since the 1970s, Cicero has published more than 200 articles on substance abuse; in the last fifteen years he has focused on the epidemiology of opiate abuse. The initial high for an addict is pure bliss, writes Cicero. “But pure bliss becomes an elusive goal and does not repair emotional dysfunction and unpleasant circumstances.”
According to the CDC, more than 70,000 Americans died from drug overdoses in 2018. The vast majority of those deaths resulted from synthetic opioids like fentanyl being mixed into black market heroin, cocaine, methamphetamines, and benzodiazepines. By their own admission, more than two million people in the United States have opioid-use disorders, according to a recent government phone survey, and that number is likely an undercount because (among other reasons) not everyone with a drug problem has a telephone. After Peter’s death I wanted to learn more about drug use by professionals like him—not only lawyers but investment bankers, doctors, nurses, hedge fund managers, technology company executives, software engineers, and the like—because I find their drug use the most perplexing.
If people in white-collar professional jobs, who are among our society’s most well-educated, driven, and high-achieving citizens, are becoming addicts, what does that say about us as a society? I ask myself, what is the point of being here at all, of striving to achieve success in careers and personal lives if so many want to escape once they get there?
I begin interviewing as many professionals as I can to find out which drugs they use and why. I am looking for some common denominator to help explain why they would take the risk and to help me understand why Peter did. Some of the professionals I interview know they have a drug problem but aren’t seeking help. Many are in recovery, and others use but feel they don’t have a problem. For the latter group, drugs are simply a hack—a shortcut—a way to be more productive, more focused, less depressed, less anxious, more chill, more social, less bored, more creative, just better, without having to go through the uncomfortable process of self-examination and self-reflection. Without having to, for example, get more sleep, eat healthier, meditate, spend time with family and friends, get a psychiatric evaluation and treatment. Those things take time, and time is one thing many of those in this group feel is in short supply.
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PROFESSIONALS ABUSE DRUGS AND alcohol for many different reasons, but one I heard often was a longing for something more, something different. Something else. Right after Peter died, Ben, a highly successful criminal defense attorney in his early fifties, was arrested for possession of methamphetamine. Two years earlier, Ben was living in an East Coast suburb and had a comfortable life with his wife of three decades, Penny, a doctor. That year, though, Ben became withdrawn. He was losing weight, dying his hair, dressing oddly, making humming noises, and had developed a twitch. He started taking unexplained business trips and often stayed out late into the night, saying he was working. Penny thought Ben might be having an affair. Then his colleagues began calling her, saying Ben wasn’t showing up for court, and when he did, he looked like he had slept in a ditch the night before. Sometime in the middle of 2015, Ben just stopped coming home. By that point, Penny had cycled through a host of explanations: a midlife crisis, Huntington’s disease, adult-onset Tourette’s syndrome, frontotemporal dementia, and finally, she believed, her husband had a brain tumor, because the symptoms seemed to indicate that. She enlisted the help of her brother to try to coax Ben into seeing a doctor, but Ben refused to go. On the way home from that unsuccessful attempt, Penny’s brother called and asked, “Are you sure Ben’s not taking meth?” Her brother worked in law enforcement; he felt his brother-in-law’s appearance resembled that of the meth addicts he arrested.
“I said no,” Penny told me. “I had married my own diagnosis. I was convinced it was a brain tumor. Meth was completely outside of my experience and he wasn’t a drug user.” It wasn’t until her husband was arrested, in the fall of 2015, that Penny learned the truth. Ben is now in recovery and drug-free; I ask him why he started using in the first place.
“I was at a point where I had done everything I wanted to do, my life was so good,” he says. “But there was this middle-age, crazy feeling I had, thinking, is this all there is? I think of the opening lines of Dante’s The Divine Comedy: ‘At the mid-point of the path through life, I found myself lost in a wood so dark, the way ahead was blotted out [sic].’ It was like that; I went down a dark rabbit hole.” Meth gave Ben “a sense of euphoria and power and clarity” at a moment in his life, he says, when he took everything good in it for granted. “I had worked all these years to establish myself and was at this sort of a pinnacle, and I was like, ‘Now what?’ ”
Ben’s reasons for using meth—that “now what?” brand of emptiness or boredom—aren’t all that different from the reasons Tony, a slim man in his mid-thirties with a master’s degree in quantitative analytics, originally sought out something to make him feel better.
Tony is a vice president at a hedge fund in New York City; he has been taking Adderall, the amphetamine used to treat attention deficit disorders, since 2012, when he was in his late twenties. In the finance industry, cocaine has historically been the stimulant of choice, but as finance jobs beco
me more demanding, the industry’s drugs of choice now include “performance enhancers,” like Adderall and Vyvanse.
Tony was prescribed Adderall by a psychiatrist with whom he had met to discuss depression. “I had a great life, but I still felt sad,” Tony recalls. He chose investment banking as a profession after reading a magazine article that ranked it near the top of the country’s highest-paying careers. “I made a decision to turn toward Wall Street,” Tony says. “By twenty-five, I was a hedge fund vice president. I’d hit my goal. And I was like, now what? I felt like there was nowhere else to go.”
His doctor suggested some cognitive behavioral therapy for the depression. Tony asked him, “Can I just take a pill?” The psychiatrist said yes, and then asked questions about Tony’s ability to focus, something he hadn’t really thought about. Tony answered honestly, that it wasn’t a problem. But he also mentioned that he had tried Adderall a few times in college and found it fantastic. “The doctor asked me basically, ‘Was the Adderall useful?’ And of course it was, it did wonders for my grades. So he said, ‘If you want I can start you on a low-dose prescription for that too,’ and I thought, sure, why not?”
Tony started taking 10 mg of Adderall a day. (The customary dose starts at 5mg and goes up, only if necessary, at 5mg increments weekly, rarely exceeding 40 mg a day.) Six years later, Tony has a prescribed dose of 90 mg a day. The reason he needs so much now is that he’s built up a tolerance to the drug from such long-term use. In fact, he has developed a system of drug use he tells me is “super stable” and reminds me of Peter’s system of recording the dosages and timing of injections in order to avoid overdosing. Tony explains: “I compress the dosage for three weeks—so I use 120 mg a day—and then I ease up a little coming to the end of three weeks and don’t use for the last week of the month. I can time myself so that I come down on Sunday—I developed an algorithm that lets me optimize the dosage,” he explains. “I overdose, so to speak, in the beginning, and then I have a week to chill.”
We are sitting at a counter in the window of a midtown coffee shop and Tony is, without a doubt, wired. He’s dressed fairly causally—jeans, a button-down shirt, and brightly colored athletic shoes—and is speaking quickly, tapping his foot, whipping out his phone to show me a new app he created and then photos of his dog. Tony is so productive now he is able to complete complex side projects for the firm and for himself in his off-hours. In addition to his VP responsibilities he recently began overseeing information technology at the firm, including managing security, which is extremely important in finance. “I taught myself to penetration-test firewalls,” Tony tells me. “I wrote a new app that’s proprietary, just for our firm, to manage investments. And I’ve been tinkering a little with hacking too.” Employees in most countries work less as they become wealthier, but highly paid workers in the United States, like Tony, actually work more—later at night, earlier in the morning, and on weekends.
Alexandra Michel, a former Goldman Sachs associate and now a business professor at the University of Pennsylvania, has spent more than a decade researching how working this way transforms employees. She did a nine-year study of investment bankers and found they would allow their physical health to decline in order to be better, higher-achieving investment bankers, some of whom worked up to 120 hours per week, even when there was nothing urgent to do.
It might seem reasonable to assume that physicians, of all white-collar professionals, know enough about addiction to steer clear of substance abuse. That could be why the percentage of doctors that will develop a substance-use disorder is about the same as it is for the general population, 10 to 12 percent. But doctors are five times as likely to misuse prescription drugs (as opposed to street drugs), probably because they have easy access to them, and their addiction (when compared with the general public) is usually much more advanced by the time it is identified and treated. The authors of a five-year study of doctors with mental health or substance-use problems found that those in anesthesiology, emergency medicine, and psychiatry were particularly susceptible to addiction. The top three reasons for drug abuse were the same as those cited by other kinds of professionals: to manage physical pain, to manage emotional and psychiatric distress, and to manage stress.
In addition to law, finance, and medicine, the tech industry has a drug problem too. Anne Delaware, an addiction nurse and counselor who has worked in the field for thirty-five years (including intake and counseling positions at musician Eric Clapton’s Crossroads Centre in Antigua, which provides high-end addiction treatment), said one of her clients in Silicon Valley recently told her about being in the boardroom of a large technology company and seeing cocaine all over the table. “He said everyone was ‘doing lines’ and he felt like he had to do it too,” she told me. “It’s like the 1980s in the Valley now, with all the amphetamine and cocaine use.” Delaware also facilitates the multifamily group program at Summit Estate Recovery Center’s outpatient facility in Saratoga, California, a small, affluent city in Silicon Valley.
Although I interviewed clinicians at Summit and spoke to patients, I wanted to reach more people in the tech industry to get some sense of how widespread drug use is and what, exactly, people are using. I posted a query to the online discussion forum Hacker News in the summer of 2018, asking users to tell me—using only their HN handles as identification—about their experience of drug use, either directly or what they were seeing around them.
Hacker News is owned by the start-up accelerator Y Combinator in Silicon Valley (it provides seed funding for new businesses and helps guide them through the early stages of development). The Hacker News site gets about four million views a day, and it is used largely by those working in technology and related fields like finance and the hard sciences (where the introduction of new technologies has been transformative). Ten hours after I posted my initial query, I had six hundred responses. I would have had more but many potential commenters posted they were worried about being publicly candid, even if only identified by their user name. I soon got a secure and encrypted email address, which made those who wanted to email me privately more comfortable about doing so.
A large number of commenters wrote that they were using stimulants and marijuana. “I love stims, especially modafinil [modafinil is used to promote wakefulness in people who suffer from extreme sleepiness, a condition known as narcolepsy],” wrote one commenter in response to my post. “I’ve witnessed time and time again the scenario where person A is completely awestruck by person B and their accomplishments and doesn’t realize it’s because they have a literal advantage due to performance enhancing drugs. Then someone says, ‘Oh yeah, so and so takes a ton of Adderall, didn’t you know?’ and everything begins to make more sense.”
Another HN commenter wrote that he used Adderall and cocaine. “I remember a CEO of one of my early start-ups would give me 5 mg addies to help me get more done. I appreciated it because it was great to get the added boost to focus. I eventually worked my way up to taking 30 mg of XR [extended release] (legally, doctor prescribed) and it was the most productive I have ever been in my life. I worked 24 x 7. I was working a normal consulting job while also working on a start-up/app in my spare time. I did ui/ux/frontend/backend/api development and sent cash overseas for an iOS developer that I managed. None of this would have been possible without stimulants.” Yet this engineer also found the lifestyle unsustainable, he wrote, and quit cold turkey, something he didn’t recommend. Quitting Adderall all at once can cause serious depression and anxiety, as well as a host of other symptoms, among them nausea, panic attacks, headaches, and vacillation between insomnia and sleeping too much.
Grant, who used to be a senior manager at gamemaker Zynga in San Francisco, told me his opioid addiction began one afternoon at a point in his life when he felt miserable in his job. He Googled “how to find pain pills on the streets of SF.” Half an hour later he was walking back to his office with a pocketful of Vicodi
n, a commonly prescribed opioid painkiller. The pill made him feel better about everything, says Grant, who has a history of depression. But what started out as one 10 mg pill every four or six hours has evolved, five years later, into a 300–400-mg-a-day habit. Grant has spent more than $100,000 over the past five years on drugs.
Others on the forum talked about microdosing LSD, which is just what it sounds like—taking very small amounts of acid. Some commenters said it made them more creative and productive. One user wrote that he has both microdosed LSD and taken small amounts (less than 5 mg) of d-methamphetamine (a drug prescribed under the brand name Desoxyn, used to treat ADHD and obesity). “LSD can certainly increase productivity,” he wrote, adding that it also provided a boost of energy similar to what he could get from an amphetamine. In journalist Michael Pollan’s 2018 book How to Change Your Mind about the history, science, and effects of psychedelics, he writes that “the practice of microdosing—taking a tiny ‘subperceptual’ regular dose of LSD as a kind of mental tonic—is all the rage in the tech community.”
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