Hidden Habits: Hong Kong Helping Professionals Rationalize Their Own Drug Use

Behind the closed doors of Hong Kong’s counseling rooms, clinics, and classrooms, some of the very people tasked with preventing and treating drug problems are themselves using substances. A new qualitative study published in Frontiers in Psychiatry on 26 October 2026 offers a rare, candid look at this hidden population, interviewing 15 helping professionals aged 21 to 37 who self-reported personal substance use while working in substance-use prevention, rehabilitation, education, healthcare, or related services. The research, led by Gabriel Kwun Wa Lee of City University of Hong Kong and colleagues at Saint Francis University, does not attempt to measure how common this phenomenon is. Instead, it asks a more intimate question: how do people whose jobs depend on professional credibility make sense of behavior that appears to contradict everything they stand for?

The answer, according to the study, lies in a set of rationalization strategies rooted in cognitive dissonance, the mental discomfort that arises when a person holds contradictory beliefs or values. For these participants, the dissonance was acute: they were trained to prevent and treat the very behaviors they engaged in privately. Rather than changing their behavior or seeking help, most resolved the tension by changing how they thought about it, employing three recurrent strategies that the researchers identified through reflexive thematic analysis of narrative, semi-structured interviews conducted in Cantonese and translated into English.

The first strategy was compartmentalization. Participants kept their substance use strictly separated from their professional roles, confining it to small circles of trusted friends and concealing it from colleagues and judgmental contacts. Crucially, they judged their own use not by clinical guidelines but by whether it interfered with daily functioning, a self-assessment approach the authors note mirrors how social workers in prior research evaluate client substance use. As long as participants perceived no impact on their job duties, they justified continuing. Twelve participants imposed self-restrictions, such as avoiding use before work and moderating intake, to maintain what they saw as a clean boundary between their personal and professional lives.

Yet this boundary was more porous than participants’ confident claims suggested. All 15 participants asserted that their substance use caused no physical illness or impairment, but nine privately acknowledged declines in functioning, reporting mental exhaustion, emotional numbness, diminished workability and memory, depressive symptoms, and disrupted life plans. One participant described lingering side effects that persisted for three to six months after frequent use. The researchers interpret this discrepancy not as simple denial but as a complex form of self-assessment in which people can simultaneously see themselves as functioning adequately while recognizing specific adverse effects. Notably, participants with medical backgrounds reported fewer negative effects and even described using their expertise to mitigate harm and, in some cases, to avoid drug tests.

The second strategy involved redefinition and normalization. Twelve participants reframed the illegal status of substances such as cannabis as a political injustice rather than a reflection of inherent danger, arguing that tobacco, alcohol, and even candy could produce worse consequences. Five participants characterized controlled use of substances including cannabis and methamphetamine as merely medicinal. Others linked cannabis to relaxation, creativity, self-care, and compatibility with productive citizenship. One participant even consulted DSM-5 diagnostic criteria to monitor himself, concluding that in the absence of symptoms it was safe to continue, while another cited Netflix documentaries as evidence that cannabis use was normal and trivial. Exposure to such information, the authors note, supplied external justifications that effectively managed dissonance.

The third and perhaps most striking strategy was reframing lived experience as a professional resource. Thirteen participants described the stigmatization of substance use as a barrier to building rapport with service users, and five argued that judgmental attitudes obscure the real motivations behind drug use. One teacher contended that his dual identity as both educator and substance user allowed him to notice early warning signs in students and create spaces for honest sharing that judgmental colleagues could not. Healthcare workers among the participants believed their own controlled use helped them empathize with struggling youth. Participants perceived their insider perspective as fostering an alternative form of trust, one built on shared understanding rather than professional distance.

The substances involved were predominantly recreational and social in function. Cannabis was by far the most common, used by 14 of the 15 participants at some point in their lives, followed by ecstasy or MDMA, crystal methamphetamine, and LSD. Initial encounters typically occurred in social or sexual contexts or amid family conflict. Among men who have sex with men in the sample, participants reported using more potent substances in conjunction with sexual activity, sometimes relying on partners to judge safety. Substance use served coping, social, and sexual functions: seven participants said it helped them adopt an open-minded attitude toward life stressors, while others described it as escape from stigma, emotional distress, or the pressures of work in a high-demand city.

Few participants saw any reason to stop. Thirteen had no intention of quitting entirely, and only two were abstinent at the time of interview, one for three months and one for over three years. Twelve had never received treatment. Those who had encountered rehabilitation services described them harshly, with words like old-fashioned, rigid, and traditional, and some accounts were more severe, including descriptions of feeling locked up, desperate, and suicidal. Abstinence and moderation, when they occurred, were framed as highly personal choices shaped by motivation, relationships, and life stage rather than as outcomes of formal treatment.

The authors are careful to frame these findings within their limits. This was an exploratory study with a small, voluntarily recruited sample, based on retrospective self-reports that reflect subjective interpretations rather than objectively verified functioning. Participants’ accounts of their professional performance were not triangulated through supervisors, colleagues, or work records, so the findings concern perceived rather than confirmed impairment. The study also did not aim to compare occupations or substances. What it does establish is how a small group of practitioners narrated and justified their experiences, not how widespread the phenomenon is or what its objective consequences may be.

Nevertheless, the implications the authors draw reach beyond the individual level to workforce governance. They argue that prevailing professional impairment discourse, embedded in organizational policies and punitive regulatory cultures, inadvertently encourages concealment and delays help-seeking. When practitioners anticipate disciplinary investigation, licence jeopardy, or mandatory reporting, they favor secrecy and informal self-management over timely support, a dynamic the authors describe as a governance paradox in which intensified detection and sanction reduce early disclosure. Rather than zero-tolerance approaches, they propose clear practice-related thresholds distinguishing substance use from demonstrable impairment, confidential disclosure routes, and harm reduction-informed workforce supports, an approach they suggest could better protect both practitioner wellbeing and service quality while maintaining safeguards for the people these professionals serve.

Subject of Research: Substance use and professional identity negotiation among helping professionals in Hong Kong

Article Title: Substance use among helping professionals: rationalization and negotiation of professional identity

Article References: Lee, G. K. W., Chan, G. H., Low, Y. T. A., & Lo, T. W. (2026). Substance use among helping professionals: rationalization and negotiation of professional identity. Frontiers in Psychiatry, 17, Article 1953018. https://doi.org/10.3389/fpsyt.2026.1953018

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1953018

Keywords: substance use, helping professionals, cognitive dissonance, professional identity, Hong Kong, qualitative study, harm reduction, stigma, cannabis, help-seeking, workforce governance, Substance