There is a reason the ABA requires a portion of your CLE hours be on the topic of substance abuse. Addiction is currently the #1 health concern in the U.S. and has extremely high rates in the legal profession, nearly twice that of the general population, 20% versus 10%. The objectives of requiring substance abuse education is to describe stressors contributing to depression, addiction and suicide in the legal profession by providing symptom profiles of depression, post-traumatic stress and substance abuse. Suicide is among the leading causes of premature death among lawyers; lawyers are 60% more likely to commit suicide than the general public. Substance abuse increases the suicide risk TEN-fold and as such, suicide is the third leading cause of death in lawyers behind cancer and heart disease. Attorneys need to learn to recognize the signs of addiction and know where and how to get help.
Stress is a major link between depression and substance abuse. Understanding stressors that lead to depression helps us recognize where the feelings are coming from and ultimately break the cycle from depression to substance abuse.
As attorneys, the pressure for billable hours is always at a high. And amongst recent graduates, general job dissatisfaction stems from the job being far from what law students expect. Practices and income are declining as a result of a stagnant economy, one of the bleakest job markets in history and paying off massive student loan debts causes major financial stress across the field. Attorney complain of no control over their personal lives, disrupting family life and sometimes causing divorce. Additionally, working with disturbed, distressed or highly traumatized clients, hearing traumatic narratives day in and day out would put stress on anyone.
The “culture” of the legal profession breeds adversarial, competitive and cut-throat personalities; there is an overall loss of intrinsic values. And the pressure to make partner could be the highest stressor of all. Associate attorney is ranked as the “unhappiest job in America” mainly because students come out of law school with hopes to get a good job and with that good job, the pressure to move up brings constant worry and stress to the daily grind. Perfectionism is rewarded in law school and in practice yet produce chronic feelings of “If I don’t do it perfectly, it’s not good enough” which leads to “I am not good enough.” Additionally, the overdeveloped sense of personal responsibility for lost cases drives intense feelings of the need to avoid failure.
As a result of the stressful culture, lawyers are three times more likely to suffer from depression than those in other professions and therefore the rate of substance abuse among lawyers is twice that of the general population. Substance abuse increases the suicide risk TEN-fold and as such, suicide is the third leading cause of death in lawyers behind cancer and heart disease.
Similar to learning to recognize the stressors leading to depression and substance abuse, knowing and recognizing the symptoms of depression and addiction let us know when we need to seek help or when another is in need. You want to try to recognize when something in your life is out of the ordinary or when you feel “off.”
Depression is identifiable by a combination of the following symptoms. Disturbances in your sleep, whether it be you are sleeping too much or not sleeping enough. A loss of interest or pleasure in usually stimulating activities. Eating, appetite and weight variances, more than the usual. Fatigue, lethargy, restlessness, and / or irritability. Feelings of worthlessness, excessive or inappropriate guilt, suicidal thoughts or actions. Difficulty concentrating or making decisions where you had no difficulty before.
“Secondary Traumatic Stress” is what happens when you listen to traumatic stories day in and day out. The symptoms are similar of those with Post-Traumatic Stress Disorder (PTSD), usually symptoms that give you a heads up that you have been affected in an extremely negative way that you can’t get past. This is distinguished by intrusive thoughts or images of distressing events, both while you are awake and while you are sleep. Hyper-arousal marked by extreme agitation, jumpiness and avoidance of reminders or triggers of the disturbing event.
Substance abuse usually begins as a temporary “solution” to the depressed or severely stressed attorney. Alcohol initially lifts the mood but ultimately makes depression, stress or anxiety worse when the drinking stops. Cocaine really lifts the mood but will drop you as high as it seems to lift. Marijuana takes the edge off of the overly stressed but impairs short-term memory and new learning which can become it’s own problem for your career. Anti-anxiety drugs (Benzodiazepines) like Xanax, Ativan and Valium are highly addictive and when mixed with alcohol, can turn lethal. Once addicted, lawyers loses their good judgment and they are a slave to their drug of choice. A good way to recognize substance abuse is by asking yourself if you have ever felt that you should cut down on your drinking or drug use, have you ever felt badly or guilty about it? Have you ever had a drink or used drugs first thing in the morning as a cure to a bad hangover or come-down? Answering yes to these questions is a good sign you should probably stop drinking or using and if you can’t stop on your own, you need to seek help.
Addiction is marked by the need to drink or use drugs to function, there is an overall obsession or loss of control over the next drink or use and the need for increasing amounts to gain the same effect. Continued use despite negative consequences to your family, job, mental or physical health, a DUI or disciplinary actions. Cravings increase and relapses occur despite repeated efforts to quit. Severe symptoms of withdrawal in attempts to cut back including insomnia, agitation, depression, lying and a lack of concentration.
Solutions and Treatments
The ABA reported that 27% of disciplinary cases involved alcohol misuse. The longer attorneys with substance abuse-related problems remained untreated, the more likely they are to be defendants in malpractice suits. Approximately 60% of current malpractice suits have their basis in chemical dependancy.
The stigma that “Real lawyers don’t ask for help” comes from our competitive, tough, aggressive and dominant personalities, and asking for help implies weakness. A solution to this is to do addiction training in your office regarding the nature of mental health and addiction stressors and symptoms. Put policies in place that will support employees seeking help and following through with it. Seek early identification and solutions to stress-related problems that lead to addiction. It is important not to enable a fellow attorney with a problem, it won’t help for you to pretend it doesn’t exist and it may end up negatively affect your firm down the line.
Some State Bar Associations provide recovery and continued sobriety programs. The California Bar Association provides the Lawyer Assistance Program (LAP) for attorney’s grappling with stress, anxiety, depression, substance use or concerns about their career.
The Other Bar is another California program supporting recovery in the legal community that hosts meetings for continued sobriety and has a 24 hour hotline for emergency support (1-800-222-0767).
There is a program in Utah, Lawyers Helping Lawyers that aids attorneys struggling with addiction, mental health concerns, stress, burnout, and issues impacting their ability to practice responsibly and participation is always confidential.
And there is aways traditional therapy as well as Alcoholics Anonymous (AA) and similar programs you can reach out to for help.
The legal profession breeds high stress, high responsibility and high traumatic-exposure jobs which leads to a higher risk for depression, anxiety and addiction. Be mindful of yourself and recognize when things are out of the ordinary, especially when your daily functioning is impaired. Depression and addiction can happen to anyone and their are multiple ways to seek help or to help a colleague.