Very Personal Issues and Effective Practice

by Anne Chambers, LCSW, Director, Missouri Lawyers’ Assistance Program

Attorneys and law students are at an increased risk for alcohol abuse, depression and marital/family concerns. The rates of alcohol abuse, depression and divorce for attorneys have all been identified as above average compared to other professions.  

Lawyers are hard-working professionals. In 2010-2011, the Bureau of Labor Statistics estimated that a third of attorneys work 50 or more hours a week. Attorneys also face some unique pressures, including critical deadlines, the competitive nature of law, the responsibility of helping clients resolve difficult, complicated or contested matters, and the pressure that accompanies the awareness that one party may emerge from court a perceived victor and another a perceived loser.    

In 2010, The Substance Abuse and Mental Health Services Administration (SAMHSA) reported a 7% rate of alcohol abuse or alcohol dependence in the United States for people age 12 or older. That figure represented 17.9 million people. Of attorneys with substance abuse problems, alcoholism accounts for 95% of substance abuse problems in lawyers and judges. Although it can and does happen, addiction to prescription and illegal drugs is much less common for attorneys.  

Lack of communication and lack of diligence are the top two ethical complaints clients make about attorneys overall, not only in Missouri but in general. In 2012, these two categories areas alone accounted for about half of total complaints resulting in OCDC investigations. Serious, unaddressed problems appear to increase risk. Studies in the US and Canada estimate that up to 50-60% of discipline prosecutions and malpractice claims against attorneys involve alcoholism and other unaddressed personal concerns.  

Alcohol abuse is generally seen as a maladaptive pattern of alcohol use leading to significant impairment or distress. Examples include failure to fulfill major role obligations at work, school or home, recurrent use in hazardous situations and repeat problems. Work performance may suffer, as may the attorney’s personal life. Abuse may continue despite the problems but there may be times the person “swears off” drinking for periods of time, then resumes it. With alcohol dependence, tolerance develops, with the person requiring more alcohol for the person to get the desired effect. The person continues drinking in spite of adverse consequences, which can grow more severe and include things like DWIs, illnesses, liver disease, financial hardship and other problems. The person may make unsuccessful attempts to control or cut down use, devote substantial time to consuming alcohol and start to give up or reduce other activities that were important. Morning drinking or drinking throughout the day may enter the picture to hold off withdrawal. Withdrawal serves to fuel further drinking because of symptoms such as sweating, racing pulse, hand tremors, insomnia, nausea, vomiting, physical agitation or anxiety that may start hours after cessation or reduction of alcohol intake. The person may find themselves in a spiral.   

Signs of a possible problem with alcohol can include blackouts, unexplained accidents and injuries, repeated or multiple auto accidents, delayed treatment for injuries, tardiness, defensiveness, financial problems, drinking becoming more of a focus and other activities taking second fiddle. Denial is often present, and words of concern may meet with insistence that things are fine. Physical concerns may include sudden weight loss or gain, slurred speech, persistent cough, pupil changes, bloodshot eyes, increased temperature, heart rate or blood pressure, changes in sleeping patterns, an unusual smell on the breath or body, tremors, reduced coordination, deteriorating appearance, and a declining quality of life.   

Alcoholism is a disease that can be treated. The earlier the person receives treatment, the better the chance of recovery. Alcoholism is a progressive disease that kills over 250,000 annually. Active alcoholics are at greater risk for serious accidents and substance abuse increases risk for other health problems. The good news about substance abuse is that attorneys with successful treatment often return better than ever.  Professional care and self help and support groups can play important roles in recovery. The attorney who was a rainmaker can get that edge back. 

Depression has different forms and symptoms can range from mild to severe. Adjustment concerns occur when a person has a difficult time coping with a challenging situation, or the challenge has endured for a long time and the person feels overloaded. Examples might include feeling depressed while caring for a loved one with a long term illness, while facing financial hardship or some other stressor. For some people with depression, there is a family history.  Dysthymia is chronic, lower grade depression. Major depression includes symptoms that can pose major challenges including feeling depressed most of the day, feeling depressed more days than not, feeling sad, empty and tearful, losing pleasure in activities, withdrawal, changes in appetite, fatigue, weight loss or gain and difficulty with sleeping too much or too little. A person facing depression may feel helpless, hopeless, and worthless or that that things cannot improve. Because depression can come with feelings of inappropriate guilt people sometimes think that they are to blame for their feelings versus viewing depression as an illness that is no one’s fault. Concentration can become more difficult, and a previously confident and decisive person may find themselves feeling indecisive. Performance may start to suffer; productivity may slow down. 

Bipolar disorder is a mood disorder characterized by significantly elevated mood, sometimes interspersed with depression. Mood swings, agitation, impulsive ideas, poor judgment and loss of sleep can cause problems during acute phases of the illness. Bipolar disorder can move more quickly than some other forms of mental illness so it is important to stay on top of the condition.   Medication and treatment noncompliance can be challenges. People sometimes feel so well in between episodes they may feel the condition is gone for good. If the disorder remains unchecked, impulsivity, mood swings, spending sprees, and social indiscretion can cause problems at work and at home.  

For depression, most people who get help report significant symptomatic relief in a number of weeks. With improvement, people feel more like their usual selves, more confident and light of spirit. Usually the improvement starts subtly and increases. 

You are at the heart of all the work you do. When you sit down with a new client, you bring all your knowledge about the law, your training, your skills of persuasion and advocacy. Even strong professionals can have off days, where fatigue, stress, an argument from last night, or a personal concern can intrude.  Caring for yourself can help you stay on top of your career, help you bring your A game with you and keep your competitive edge sharp.   

If a personal problem is interfering, please contact the Missouri Lawyers' Assistance Program at 1-800-688-7859 for free, confidential assistance.     

Bibliography

  1. Keeping the Edge:  Professionalism without Burnout, Jim Brady, LCSW, MOLAP, PowerPoint, 2012.
  2. Commission on Lawyer Assistance Programs, American Bar Association Website, americanbar.org/groups/lawyer_assistance, 2012.
  3. “Drug and Alcohol Abuse and Addiction in the Legal Profession,” The Legal Profession Assistance Conference.
  4. DSM-IV-TR:   Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, Text Revision. American Psychiatric Association, Washington, DC, 2000. DSM-IV: 
  5. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994. 
  6. DSM-III-R:   Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. American Psychiatric Association, Washington, DC, 1987.
  7. Howard, Jim.  “How Can I Help a Loved One Who Has an Alcohol Problem?” MOLAP, 2004.
  8. “Lawyers,” Occupational Outlook Handbook, 2010-2011 Edition, US Department of Labor, Bureau of Labor Statistics, pp. 1-2.
  9. OCDC, “Report of the Office of the Chief Disciplinary Counsel,” 2005. 
  10. Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
  11. “Warning Signs of Addiction”, Kansas City First Call Website, 2012.