Dr. Rachel Docekal, MBA, Ed.D. – CEO of Hanley Foundation
Addiction can affect anyone, regardless of socioeconomic status. However, when it comes to addiction treatment for individuals of high and ultra-high net worth, the challenges are often unique and complex. Affluence creates environments where the usual societal safety nets—such as financial limits, accountability structures, and social consequences—are blurred or altogether absent. The lack of accountability structures can make treatment for the wealthy an intricate balancing act between addressing deep-seated psychological issues, breaking through barriers of denial, and tailoring care to a life of privilege.
In her book, The Golden Ghetto: The Psychology of Affluence, Jessie H. O’Neill explores the emotional and psychological tolls that wealth can take on individuals and families. O’Neill coined the term affluenza to describe the often invisible but profound challenges that come with wealth—such as emotional isolation, a deep-seated fear of failure, and a lack of purpose—which can play a significant role in the development of substance use disorders. Understanding these nuances is critical in developing effective treatment strategies for affluent individuals facing addiction.
The Psychological Weight of Wealth
The Golden Ghetto discusses how growing up in affluence or achieving sudden wealth can shape a person’s psychology in ways that contribute to addiction. People of means often experience:
- Emotional Isolation: Wealth can create social distance, making it challenging to form meaningful connections. This isolation often leads individuals to seek comfort in substances, which promise to fill the emotional void that money cannot.
- Performance Pressure: Those from affluent backgrounds may feel an overwhelming pressure to maintain or exceed their family’s success. This burden can lead to self-medication, particularly when they feel they are falling short of expectations.
- Denial and Enabling: Wealth can shield individuals from the real-world consequences of their actions, allowing them to continue destructive behaviors unchecked. Family members or business associates may enable addiction by covering up or excusing the behavior, believing it will protect the person’s or family’s reputation.
O’Neill’s work highlights how the very privileges afforded by wealth can also become barriers to recovery. Hanley Foundation’s Headwaters program is focused on achieving long-term recovery by focusing on and addressing each client’s unique set of circumstances and diagnoses.
Unique Barriers to Treatment
When treating individuals from affluent backgrounds, barriers to treatment must be considered and overcome:
- Denial and Minimization: Wealth can create a false sense of invulnerability. People of affluence may believe they are immune to the dangers of addiction, given their access to the best healthcare and resources. This denial is often compounded by the fact that their wealth may allow them to maintain outward appearances of success, even while struggling internally with behavioral health issues.
- Privacy Concerns: Affluent individuals often prioritize privacy and discretion above all else, especially when it comes to something as stigmatized as addiction. High-profile individuals may be reluctant to seek help for fear of damaging their reputations or careers, which can delay treatment or push them toward suboptimal, secretive options.
- Enablers Within Their Circle: Family members, employees, significant others, or friends may enable addiction rather than confront it. This is often done out of fear of losing financial support, jeopardizing relationships, or perceived public reputational damage. As a result, the wealthy can become trapped in a cycle of addiction where no one is willing to challenge their behavior.
Matthew Perry, the Friend’s star, dealt with just this set of circumstances. His memoir, Friends, Lovers, and the Big Terrible Thing, discusses his early dependence on alcohol and later addiction to opiates after being prescribed Vicodin (hydrocodone) following a jet ski accident. He described appearing to have it all while secretly dealing with addiction, “From an outsider’s perspective, it would seem like I had it all,” he said. “It was actually a very lonely time for me because I was suffering from alcoholism.”
Tailoring Treatment for Affluent Individuals
Treatment for people of affluence must consider not only their psychological needs, but also the social and cultural factors that influence their behavior. A few key components include:
- Comprehensive Therapy: Even the highest quality traditional addiction treatment programs may not be sufficient for affluent individuals, and the vast majority of “luxury rehabs” are nothing more than a glorified spa. Instead, treatment should focus on quality medical care combined with therapy addressing deeper emotional and psychological issues, such as feelings of inadequacy, loneliness, or unresolved trauma—elements that are often masked by wealth.
- Family Therapy and Boundaries: In many affluent families, boundaries are blurred, and roles become intertwined with financial dependency. For example, an individual’s closest relationship could be with the person managing their trust. Addressing these issues through family therapy is crucial in setting healthy boundaries and breaking the cycle of enabling behavior.
- Purpose-Driven Recovery: Many individuals of affluence struggle with a lack of direction, often turning to substances to fill the void. Treatment programs that focus on helping individuals rediscover meaning in their lives— what we at Headwaters refer to as a person’s purpose – whether through philanthropy, creative pursuits, or personal growth—can be vital in fostering and sustaining long-term recovery.
Dr. Paul Hokemeyer, the renowned author and expert, discusses how families often wield wealth and power to keep their family members from seeking help for a behavioral health issue. Hokemeyer explores how damaging and misguided these reactions can be in his book Fragile Power, writing, “Instead of empowering the patient, they shame them; and, instead of motivating them towards health, they punish them into deeper realms of their pathology by diminishing their internal motivation to change.”
Understanding Addiction in Individuals of Affluence
Jessie H. O’Neill’s The Golden Ghetto serves as a critical resource for understanding the psychology of affluence and its connection to addiction. I often refer to her book or Paul Hokemeyer’s Fragile Power when discussing the emotional struggles that wealth can bring, exposing the darker side of privilege that is frequently hidden behind the façade of success. O’Neill beautifully illustrates how financial means can lead to emotional impoverishment—a reality many wealthy individuals face. The feelings of emptiness and isolation she describes are often precursors to addictive behavior, and without addressing these core issues, recovery efforts may fail.
It is also critical to have empathy and understanding when treating affluent individuals. Just because someone appears to “have it all” does not mean they are immune to the same emotional struggles as anyone else. In fact, their wealth can exacerbate these issues, leading them to feel even more trapped by their circumstances.
Breaking Free from the Golden Ghetto
Addiction treatment for individuals of affluence requires a unique approach—one that addresses the underlying psychological issues of wealth, while also considering the barriers that wealth creates in seeking help. It is important to remember that affluence may offer material comfort, but it can also create emotional and psychological struggles that are just as real, if not more hidden, than those faced by others. Addiction is not a respecter of wealth, and long-term recovery must involve addressing the emotional isolation, pressures, and enabling environments that so often accompany lives of privilege.
Treatment at Headwaters: Tailored Care for Affluent Individuals
For individuals of affluence seeking recovery, Headwaters offers a highly personalized approach that addresses the unique complexities of addiction within individuals of means and in positions of high responsibility and visibility. Headwaters’ expert medical and clinical staff specialize in treating individuals from high-net-worth backgrounds, understanding the distinct challenges that wealth creates in both addiction and recovery. Treatment at Headwaters focuses not only on physical sobriety but also on the deeper psychological aspects of addiction from substances and process addictions (gambling, overeating, internet, and sexual dysfunction).
At Headwaters, patients benefit from a completely private, confidential, and individualized treatment experience tailored to their specific needs. The program integrates executive-level care, which recognizes the professional and personal responsibilities carried by individuals of great responsibility. Combining evidence-based therapies with holistic approaches, Headwaters helps patients rebuild their emotional lives, establish healthy boundaries, and develop a renewed sense of purpose—all in a format that respects the high-stakes demands they often face.
Clients begin treatment in one of eight bespoke suites in a private section of Hanley’s campus set on 14 acres of botanical gardens within Palm Beach County, Florida. When appropriate, clients move to a fully staffed private residence. By providing this comprehensive, thoughtful care, Headwaters offers an environment where individuals can address both their addiction and the psychological factors tied to their affluence, facilitating lasting recovery and emotional healing.
Hanley Foundation’s Headwaters is a non-profit addiction treatment program for executives, public figures, other affluent individuals, and their loved ones. Headwaters offers leading-edge, personalized clinical care for mental health and substance use disorders, and our professional and compassionate staff can help you achieve holistic wellness. To start your healing journey, call 561-270-1753 today.
