Lawyers and substance abuse.
According to a fact sheet from the American Bar Association's (ABA) Commission on Lawyer Assistance Programs, over 56,000ABA members will have a lifetime alcohol dependency disorder; over 30,000 will have a lifetime drug disorder (other than alcoholism); and over 100,000 will have a lifetime substance abuse disorder.
Ken Hagreen, a former practicing attorney, learned about the problem the hard way. Hagreen, who is executive director of Lawyers Concerned for Lawyers of Pennsylvania (LCL), is in recovery from chemical dependency. He has drawn from his own struggle and from those of others, as well as from knowledge passed along by experts, to raise lawyers' awareness of substance abuse issues. Organizations like LCL help troubled lawyers and their colleagues combat drug abuse and addictions.
In this interview with TRIAL Associate Editor Jennifer L. Reichert, Hagreen discusses the roots of substance abuse, the ways it affects lives, and the steps that can be taken to combat the problem.
How widespread is alcoholism and substance abuse among legal professionals?
Accurate statistics are hard to get. The National Institutes of Health projects that as of 1995 there were more than 11 million alcoholics and more than 7 million alcohol abusers of both sexes who are 18 years of age or older in the United States.
Lawyers are not exempt. It is generally accepted that of those who drink alcohol--lawyers and nonlawyers--10 percent will develop alcoholism.
Is there a difference between substance abuse and substance dependency?
Yes. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), has specific criteria for distinguishing substance abuse from substance dependency. Abuse involves continued voluntary use of alcohol or other drugs despite adverse consequences. Dependency is a state of impaired control--a person feels compelled to drink or use drugs and cannot predict how much or how long he or she will do so.
Distinguishing between abuse and dependency is important because it determines the type of treatment needed. Abuse can be addressed with education and traditional methods of deterrence like the threat of divorce or jail time or the loss of a professional license. Addictions require specialized treatment for a brain-based illness.
So alcoholism is a brain-based illness?
Research points toward the brain as having a key role in addiction. Most people can drink alcohol and not develop alcoholism. This indicates that alcohol is not the causal agent of alcoholism. Rather, alcohol triggers some preexisting condition in certain individuals that leads to impaired control over their use of alcohol.
Scientists are looking for the presence of predisposing factors in the neurobiology and neurochemistry of some people that cause them to become alcoholics, while others can drink safely. Some experts believe that neurotransmitter deficiencies may be involved.
Alcohol mimics the action of the neurotransmitters, triggering an abnormal euphoric reaction that replaces feelings of anxiety or anger. This reaction may be interpreted by the subconscious in away that creates feelings that alcohol or other drugs are a necessary part of the body's overall survival system, similar to the need for water, food, and sex.
Alcoholics are unaware of this subconscious neural activity. They just know that alcohol has helped them feel better than they ever have before.
Unfortunately, long after alcohol has stopped being a "friend" and has become the "enemy," the brain is still sending out subconscious messages telling the person that a drink will make him or her feel better. These messages are so powerful that the person will drink or use other drugs despite adverse consequences and a desire not to use the substances.
This is why specialized treatment is required. Education, threats, and punishment are not enough to overcome alcoholism. Recovery involves a total change in how a person thinks, feels, and acts toward himself or herself and others. This vital transformation does not come about quickly or easily. It takes a lot of time and effort on the part of the alcoholic. Successful recovery is most likely to occur if the alcoholic has help and guidance from those who have already been through the recovery experience.
Are certain personality types more prone to substance abuse?
Probably not. Nonalcoholics--whether they are shy, outgoing, or somewhere in between--may find themselves drinking too much or overusing tranquilizers or other drugs for a variety of reasons, including to celebrate, to relax and reduce stress, to cope with grief, or to sleep. One risky time is following major surgery, when a doctor may prescribe powerful painkillers that can be abused.
There are those, however, who may abuse alcohol or other drugs in an attempt to self-medicate depression. Some may use stimulants to overcome the symptoms of depression, while others, in the manic phase of a bipolar disorder, may drink alcohol or use tranquilizers to bring themselves down in order to sleep.
The ultimate question is whether these people are substance abusers or whether they are addicted to alcohol or other drugs in addition to suffering from a depressive illness.
What aspects of practicing law might lead an attorney to turn to alcohol or drugs for relief?
Everything. The adversarial nature of the profession (sometimes within a firm); the constant pressure of deadlines and decisions; the increasing complexity of the law and legal procedure; the competition for business; the demanding clients, opposing lawyers, and difficult judges; the isolation of being a sole practitioner; the public's love/hate relationship with lawyers; the difficulties and discrimination women and minority lawyers face; and the long hours that keep lawyers away from their families and friends.
All this may tempt lawyers to relax by drinking or using other drugs. Substances are a quick and easy way to reduce stress and forget about problems for a little while, especially when there is little time for hobbies, exercise, vacations, or other appropriate ways to reduce stress and find a balance between personal and professional lives.
How can lawyers who have a family history of alcoholism dodge the bullet?
They need to know that they are predisposed to developing the disease, and then they have to avoid drinking or using drugs and pulling the trigger.
The safest course is to abstain from drinking or using other mood-altering drugs. The next safest course is to closely monitor alcohol and drug use. If they cause problems at work or at home, the lawyer should seek a professional evaluation and find out if he or she has a problem that requires treatment.
These lawyers should be especially careful when doctors prescribe medication. They should ask for drugs that are not addictive and consult the Physician's Desk Reference to double-check that the drugs are safe to take.
How does dependency adversely affect a lawyer's job performance and family life?
Chemically dependent lawyers may function for a long time in a professionally competent manner, but sooner or later they suffer mental and physical impairment that adversely affects their ability to analyze issues, conduct research and discovery, and meet deadlines. Clients' files may be ignored, negotiations mishandled, settlement checks misplaced or lost, and trust accounts invaded for emergency "loans." Statutes of limitations may expire.
Malpractice suits and disciplinary actions may be brought against these lawyers. They may be arrested for driving under the influence, and health problems may surface. Some may go through separation or divorce when their wives or husbands tire of the string of broken promises to quit drinking and can no longer tolerate the emotional and physical abuse.
All too often, an alcoholic lawyer calls home to tell his spouse that he will be meeting a client or colleague after work for a couple of drinks but will be home in time for dinner. The first drink leads to a second and then a third. The client or colleague leaves, but the lawyer keeps drinking until the bar closes.
On arriving home, the lawyer's wife confronts him about his drinking. An argument ensues, and hurtful things are said. Perhaps the lawyer loses his temper and begins destroying furniture or strikes out at his wife.
The next day, full of remorse, the lawyer apologizes and promises to quit drinking, this time for good. He holds up for a few days or weeks, or maybe even months. But at some point his denial tells him that not drinking is interfering with his relationships with clients and colleagues, that his wife doesn't understand the pressure he is under or that he needs an occasional drink to relax, and that this time he can control his drinking.
Once again, the lawyer stops at a bar for a drink or two. Maybe this time he can count his drinks and go home on time. But if he is an alcoholic, there will come a time when he takes the first drink and cannot control what happens next. Eventually, the marriage will fail.
Left untreated, chemical dependency destroys careers, marriages, and families. It leads to premature death brought on by damage to the body's organs, accidental overdose, or suicide.
What are the tell-tale signs that a colleague may be struggling with substance abuse or addiction?
The most obvious signs are excessive or inappropriate drinking or drug use; repeatedly coming to work hungover or under the influence; drinking or using drugs during the workday; or attending a hearing, deposition, or other legal proceeding under the influence.
Most times, however, lawyers won't know the truth about another's drinking and drug use because they are not together 24 hours a day. They have to look for objective signs of impairment in the colleague's personal and professional life.
For example, is the coworker showing up late for work? Taking long lunches and sometimes not coming back from lunch? Leaving early on Fridays? Does he or she have trouble getting work done properly or oh time? Is he or she not returning clients' phone calls? Missing depositions and hearings? Ignoring correspondence, even from disciplinary counsel? Have the colleague's dress and personal grooming habits, attitude, and personality changed? Does he or she have unusual mood swings?
All these indicate that something is wrong. It may or may not be substance abuse or addiction. It could be depression, bipolar disorder, or compulsive gambling. Or perhaps the attorney's spouse is suffering from one of these illnesses, turning the colleague's life into one of personal and professional dysfunction.
A physical exam, including a thorough family and personal history, will reveal the facts needed to determine if the colleague is suffering from substance abuse, addiction, depression, or something else.
Whether a colleague is a substance abuser or an addict can only be determined by an addictions specialist. Some heavy drinkers and drug users are abusers, not addicts. It is not how often or how much a person drinks or uses drugs that defines addiction. Rather, it is the impaired control over when a person uses the substances and how much is used on any occasion. As Dr. Carlton Erickson, a research scientist who has been studying the effects of alcohol on the brain for 20 years, said, "Addiction is not a `too much, too often' disease; rather, it is an `I can't stop' disease."
What steps, if any, should a concerned colleague take to help?
Approaching a lawyer who may have a problem requires special care. The goal should be to stop protecting the attorney from the consequences of drinking or drug use. Colleagues should help the person recognize that he or she has a problem and have him or her agree to seek help. Colleagues should encourage their coworker to get a professional evaluation by an addictions specialist, who can make a proper diagnosis and develop an appropriate treatment plan.
Local or state lawyer assistance programs can help assess the situation.
What are lawyer assistance programs?
They are independent charitable corporations or special bar committees run by lawyers. Their primary concern is to provide confidential help to lawyers, judges, and law students in distress. All deal with alcohol and other drug-related problems. Many also help with compulsive gambling, depression, stress, and other serious mental and emotional illnesses.
Some programs are staffed by health care professionals who provide direct assistance, while others are staffed by recovering lawyers who will refer a person to local health care professionals. All have a network of recovering lawyer volunteers who are willing to share their personal experience and give their time to help other lawyers in distress.
Some of our readers may represent clients who have drug and alcohol problems. Any advice?
Try to steer them toward a local addictions counselor or treatment facility. Until they face and deal with their alcohol or drug issue, these clients will continue to have problems, be they criminal, domestic, financial, or work-related.
In some situations, there may be a direct causal link between a client's legal problems and his or her drinking or drug use. Getting the client evaluated by an addictions professional and into a treatment program may not resolve the client's legal problems, but it may help to mitigate the consequences of his or her improper or illegal conduct.
What about lawyers facing disciplinary actions for misconduct resulting from substance abuse or addiction? What should they do?
They may wish to inquire about their state's sobriety monitoring program. These programs require a lawyer to participate in a recovery program specifically tailored to his or her needs under the watchful eye of another attorney or treatment professional who will report the recovering lawyer for noncompliance.
During the investigation phase of a disciplinary action, voluntary monitoring can document the lawyer's recovery and provide evidence to the disciplinary tribunal that the lawyer no longer poses a serious risk to clients. This should be followed up with court-ordered post-hearing monitoring, which can effectively dispel disciplinary counsel's concerns that the attorney may relapse and harm clients.
Monitoring programs have allowed many attorneys to keep practicing law during early recovery rather than have their law licenses suspended.
How does the legal profession view lawyers who seek help for addictions?
The profession is increasingly supportive but is still unsure of its role. It is embarrassing to the profession to admit publicly that some of its members are addicts. There is confusion about whether addiction is self-inflicted and whether punishment or treatment is more appropriate. There is reluctance to invade another lawyer's private life through intervention, even when the failure to do so may result in a premature alcohol-related death. And there is the misguided sense of loyalty that says, "If I just help Bob get through his current crisis, he will quit drinking."
Lawyer assistance programs are helping the organized bench and bar come to terms with these issues so impaired lawyers can be helped earlier in their illness and prevented from further damaging their health, families, and careers. Of course, the by-product of all this is the prevention of further harm to clients, reduced disciplinary actions and malpractice suits, and an enhanced reputation for the profession.
According to the National Institute of Alcohol Abuse and Alcoholism, employees who are encouraged to seek treatment by their employers are slightly more likely to recover from their addiction and improve their job performance than those who are not. How can law firms help employees overcome substance abuse or addiction?
Firms can look to their state bar's model law firm drug and alcohol policy or to the model policy of the ABA Commission on Lawyer Assistance Programs. These policies encourage lawyers to ask for help for alcohol and drug problems by recognizing that dependency is a treatable illness. Law firms should review their existing policies for conflicts and revise them accordingly.
For example, one firm's original policy stated that employees using illicit drugs or using prescription drugs illegally would be dismissed. An addendum, however, encouraged employees with any kind of drug problem to seek help through the firm's employee assistance program. The conflict and confusion the original policy engendered most likely kept employees from seeking help for fear of being fired.
A firm that has no policy should consider adopting one of the models. And a firm should review state and federal disability discrimination laws to ensure that its policy meets legal requirements regarding those who seek help. The firm should also examine the availability of treatment under its health insurance policy and make sure that all treatment remains strictly confidential. In addition, education programs,sponsored by the firm can heighten awareness, increase understanding, and encourage lawyers to seek help for substance abuse and addiction.
How can someone overcome the concern that seeking help--getting into therapy--carries a "mental illness" stigma?
Confidentiality and education. Lawyers are afraid of asking for help and having their partners, staff, clients, friends, and others find out. They believe--and sometimes rightly so--that disclosure will cause irreparable harm to their reputations and practices. Strict confidentiality provides the only assurance that if a lawyer seeks help, it will be kept private. In time, as recovery takes hold, the lawyer may become less protective of his or her anonymity and may choose to disclose recovery to others.
The stigma attached to addiction goes away when people begin to understand the causal factors underlying the illness, that is, that alcoholism and drug addiction are not the result of personal weaknesses or failings, lack of will power, or low morals. Addiction is rooted in complex neurobiological and neurotransmitter dysfunctions over which people have no control.
Treatment, psychotherapy, and 12-step programs can help a person learn to live without taking drugs.
How can lawyers who have dependency problems succeed in the legal profession and not rely on alcohol or other drugs to escape the pressures of the job?
Addiction can be arrested, but there is no cure. A recovering alcoholic or addict must remain abstinent. The best way to do so is to participate in a 12-step program. Some towns and cities have lawyers-only meetings that can help newly recovering lawyers become comfortable with "public" meetings. The 12-step program helps people develop a way of life that allows them to cope with the stress without resorting to alcohol or other drugs.
Maintaining a proper diet, sleeping well, and exercising help. Finding a balance between work and personal life goes a long way. Living within financial means is important. The bottom line is that recovering lawyers must make whatever changes are necessary to live without picking up a drink or other mood-altering drug. If necessary, they may have to change jobs or careers to reduce work-related stress and keep their sobriety.
How can lawyers turn stress that might lead them to picking up a drink or other drug into something positive?
Stress can be positive when it is seen as a warning signal to take action to avert harm. Feelings of stress should be examined. Why am I anxious? Do I need to put in more time at work? Do I need to improve my time-management skills? Am I not attending to my recovery program? Is my family being ignored? Am I not taking care of my health? Do I need professional help to understand why I feel stressed and to find out what I can do about it?
Once lawyers understand what is causing their stress and what they can do to relieve it, they can prepare a plan of action and properly address those issues.
Abstinence, combined with a recovery program, will lead to a new life of happiness, productivity, and usefulness that goes beyond anything the addicted attorney ever imagined. I know this from my own experience and from other addicted attorneys who have found serenity and a sense of purpose in a life based on recovery.
Patient and persistent efforts in this area will yield a better balance and more happiness in life and will help recovering attorneys be better lawyers, better spouses, better parents, and better human beings. Recovery can transform an attorney's life into a state of existence that far surpasses the temporary euphoria brought on by a drink or other mood-altering drug.
Help is just a call away
ATLA's Quality of Life and Substance Abuse Committee assists members who are concerned about stress, drug and alcohol abuse, and other quality-of-life issues. Contact the cochairs with your concerns: David Bossart, P.O. Box 2187, Fargo, ND 58108-2187, (701) 271-8030; Laura McKinnon, P.O. Box 1127, Fayetteville, AR 72702-1127, (501) 5211555.