SUBSTANCE ABUSE, CHEMICAL DEPENDENCY AND EMOTIONAL DISTRESS
AND DEPRESSION
Alcoholism, substance
abuse and chemical dependency have become serious problems in the legal
profession. Mirroring their frequency in the general population, attorneys
are not immune from their clutches. In fact, the pressures and stresses of
today’s legal practice may be a contributing factor to the increased
use of these substances by lawyers.
Chemical
dependency, emotional distress and depression occur to some extent in every
socioeconomic group. However it has been estimated that the prevalence of
these conditions within certain professions, including the legal profession,
appears to be significantly higher than in the general
population.
While
chemical dependency and emotional distress and depression are treatable
illnesses, the failure to obtain treatment can progress, bringing personality
changes and deterioration of ethical values, leading to criminal charges,
bar disciplinary action, and worse.
In recent years,
many state bar associations, both voluntary and integrated, have instituted
confidential programs to help lawyers with substance abuse
problems.
These bar programs,
generally referred to as Lawyer’s Assistance Programs or “LAP”
programs, typically operate confidentially, with some states extending the
same privilege to their operations as the attorney-client privilege in those
respective jurisdictions.
Typical
of most LAP programs is the New York State Bar’s program. In addition
to referrals for alcoholism and drug abuse, this program (as do many others)
also takes referrals for stress and depression, as well as for gambling and
other addictions.
In a recent one year period the NYSBA program
took 5,000 calls for assistance.
The
New York State Bar Association Lawyer Assistance Program, in conjunction
with the Committee on Lawyer Alcoholism and Drug Abuse, provides confidential
assistance
to
attorneys, judges, law school students and family members affected by alcohol,
drugs, stress or depression, and educates the legal profession about the
effects of substance
abuse.
The New York State Bar program, typical
of many, received requests for assistance with the following problems from
lawyers:
Alcohol
54%
Other
Presenting Problems
10%
Depression
20%
Drugs
16% (e.g., medical, mental health
and other addictions)
The
State Bar of California’s Lawyers Assistance Program reports a broader
category of participant diagnoses, including:
Substance
Abuse:
40%
Mental
Health:
38%
Dual
Diagnosis:
22%
As may
be anticipated, many attorneys with substance abuse problems also develop
bar discipline problems flowing from their issues. Interestingly, the California
Bar noted an unusual recent trend.
During
the period of 2002-2003, 64% of the lawyers calling for assistance were involved
in bar discipline matters. However during 2004, that figure dropped by 14%
to only 50% of the lawyers calling involved in a disciplinary proceeding.
That’s actually an almost 22% increase in attorneys seeking assistance
without concomitant discipline problems.
The
directors of the California LAP concluded there is a growing acceptance of
the program for all attorneys challenged with substance abuse or emotional
health problems.
In Florida, The
Florida Lawyers Assistance, Inc. (FLA) was created in 1986
by recovering attorneys and addiction professionals to offer help to judges,
attorneys, and law students troubled by alcohol and drug abuse problems,
compulsive gambling, stress, depression, other types of addictive disorders,
and similar conditions which may impair their ability to practice in a competent
and professional manner.
As with most other similar bar operated
programs, the FLA program is confidential
Because of the sensitive nature of addiction and psychological
problems. FLA’s experience indicated that attorneys who may be in need
of help are often very reluctant to seek it.
FLA
recognized this issue and in order to encourage early and confidential contact
for assistance, the Supreme Court of Florida enacted Rule 2-9.11 which authorized
creation of a program to assist Florida Bar members suffering from substance
abuse or psychological problems, and approved Rule 3-7.1(o) which provides
that any treatment provided to an impaired attorney shall be deemed confidential
and may not be admitted as evidence in any disciplinary
proceeding.
In Florida,
50% to 80% of all attorney disciplinary complaints are related to an impairment
issue. This does not differ greatly from the experiences in other jurisdictions,
with the California Bar reporting from 50% to 64%,
Ask Yourself These
Questions:
(Respond with YES or NO and answers
as honestly as you possibly
can)
1. Are your associates, clients, family, or office
staff alleging that your work is being affected by your addictive behavior
(alcohol, drugs, gambling) or your moods?
2. Do you plan your office routine or appointments
around addictive behaviors?
3. Do you ever feel that you just can’t face certain
situations or that you need a drink or drug to do so?
4. Do you drink or use drugs alone, or isolate and
avoid contact with others?
5. Have you ever had a loss of memory while using alcohol
or drugs, although apparently functioning (e.g., a blackout)?
6. Do you ever use alcohol or drugs before a meeting,
deposition, or court appearance to calm your nerves, gain courage, or improve
your performance?
7. Do you find yourself wanting or taking a drink or
drug in the morning, or find it increasingly difficult to function despite
getting adequate rest?
8. Have you missed a court appearance, other appointments
or responsibilities because of drinking, drug use, or gambling, or just because
you felt too overwhelmed or unable to function?
9. Have you ever felt any of the following because
of your drinking, drug use, or gambling: fear, remorse, guilt, loneliness,
depression, anxiety, anger, or a sense of impending doom?
10. Is your addictive behavior or your mental state
making you careless of your professional responsibilities, your family’s
welfare, or other personal obligations?
11. Does your drinking, drug use, or gambling lead
you to places or people you would not normally associate with, or have you
or others recognized that your behavior is sometimes unusual or erratic?
12. Are you becoming increasingly reluctant to face
your clients or colleagues in order to hide the effects of your drinking
or drug use or your emotional state?
13. Do you lie to cover up the amount of alcohol or
drugs you are actually using, about the size of bets you are placing, or
about the way you really feel?
14. Have you ever taken funds from your trust account
to support your addictive behavior?
15. Have you ever been hospitalized or treated directly
or indirectly as a result of your drinking or drug use, gambling, or
psychological problems?
16. In general, do you find it increasingly difficult
to function in a legal setting, or do you find that your attention to work
is declining?
If you answered YES to one or more of the above questions,
you owe it to yourself, your family, your profession, and your clients to
contact your local Lawyers Assistance
Program.
Signs & Symptoms
of Chemical Dependency
Alcohol/Drug
Self-Test
This
series of questions about the use of alcohol and/or drugs is an informal
inventory of "tell-tale signs" with many items tailored to lawyers. It is
not a list of official diagnostic criteria and does not substitute for a
professional evaluation (which FLA or your Bar Association Lawyer’s
Assistance Program personnel can confidentially provide in person or refer
you to a certified evaluator).
1. Do I plan my
office routine around my drinking or drug use?
2. Have I tried
unsuccessfully to control or abstain from alcohol or
drugs?
A "yes"
answer to any of these questions suggests that it would be wise for you to
seek professional evaluation (a comprehensive list of Bar Association
Lawyer’s Assistance Programs is included at the end of this activity),
but may or may not indicate that you have a diagnosable addictive disorder.
Evaluations of alcohol/drug problems should be done by a clinician with addiction
credentials and/or experience working in an addiction-oriented
setting.
Depression
Self-Test
Emotional distress and depression can
be serious problems for lawyers. Take the following self-test and see how
you
score.
Here
are two self-screening tests developed by Dr. Douglas G. Jacobs, a key figure
in National Depression Screening Day (each October). They are not intended
to substitute for a professional evaluation (to which a Lawyer’s Assistance
Program can refer you), needed to actually make a diagnosis of
depression or manic-depression (also known
as bipolar disorder).
Depression:
1. I am unable to
do the things I used to do.
Mania:
1. I have a decreased
need for sleep.
The Disease of Addiction and Other
Mental
Illnesses
`Understanding the complex
nature of the disease of addiction is critical to an attorney, member of
the judiciary, or members of government who protect our
citizens.'
by
Roger A. Goetz, M.D
Addiction
appears
voluntary, spiteful, pathetic, frightening. The behavior that it causes surrounds
its victims with violence, degradation, guilt, anger, hopelessness and death.
Until the advent of technology that permitted the study of the internal
mechanisms of brain cells and neurological tracks, the disease of addiction
had been called sinful, possession by the devil, a character weakness, a
symptom of serious psychiatric disorders, or the result of stupidity.
The devastating
effects of intoxication were recorded by Moses in ancient times, yet the
difference between episodic intoxication and the chronic debilitating nature
of addiction was not recognized until the 17th century. Unfortunately, as
we prepare to enter into the 21st century, the attitudes of the 18th and
19th centuries persist. The myths of history have hindered the proper management
of the disorders of addiction and remain an emotional issue to this day.
As with most mental
disorders, even intelligent and educated people are taken aback by the associated
violence. They are often confused by the paradox of rigid control of the
affected person to protect society while simultaneously providing care and
protection to the victims who have the disease. To protect society and control
the disease, the physician and the lawyer must be a team to provide leadership
and guidance to society. Understanding the complex nature of the diseases
of addiction is critical to an attorney, member of the judiciary, or members
of government who protect our citizens.
The intense governmental
and research efforts exerted during the epidemic of substance abuse and addiction
during the last half of the 20th century have led to clarification of the
differences between intermittent intoxication and the disease of addiction.
According to studies by the National Institutes of Health, addiction is a
multi-factorial biogenetic disorder that affects approximately 14 percent
of the United States population. It is as involuntary as other medical
conditions.
The addition of
certain chemicals (i.e., alcohol, narcotics) to the genetic substructure
permits the activation of the illness of addiction. As in many illnesses
with a genetic substrate, such as diabetes, some forms of heart disease and
arteriosclerosis, the genetic potential to develop the disease is enhanced
by adding chemicals. Examples of this phenomena include giving fatty substances
to the susceptible heart patient and altering dietary intake of carbohydrates
in Type II diabetics. Since little can be done to alter the potential for
addiction in people who have the genetic structure, it is important to identify
high-risk populations. Individuals who drink excessively to the point of
intoxication and still function are different from many who drink less and
are seen daily on the street corners. Their addiction totally interferes
with their ability to survive successfully in society. By the time society
identifies the individuals with the genetic potential, though, it is often
too late to alter the course of their lives.
For many years medical
and legal efforts focused on types of drugs and the differences between various
drugs, such as alcohol, cocaine, tranquilizers, or other sedatives. It is
now known that addiction is not drug-specific. Alcoholism is drug addiction.
The cocaine addict has the same disease, requires the same treatment, and
requires the same abstinence as the alcoholic. A basic tenet of recovery
is total abstinence from all mood-altering substances.
An understanding
of the nature of addiction requires an understanding of neurotransmitters
and related interactions in the human brain stem. Although an article of
this nature is not intended to be scientifically detailed, it is necessary
to understand the primitive nature of the disorder and to have an understanding
of the phenomena of denial.
Mood-altering substances
affect the cerebral cortex (intellect), cerebellum (balance), frontal lobe
(emotion), and mid-brain (instincts) in all humans. In those with potential
for addiction, however, far more happens within the brain. Those deviations
result in addiction.
In laymen's terms,
the brain is a structure which reacts to internally produced chemicals. These
chemicals, called neurotransmitters, are the mediators of the instincts for
survival, reproduction, and interpreting the external environment through
impulses from sensory organs. These chemicals produce the familiar "fight
or flight" response, panic, sexual arousal, or hunger, and interact to produce
mood, including depression, and elation. The addition of "addicting" chemicals
into the human brain mimics or alters these normal chemical processes in
specific areas of the brain.
In the case of substance
abuse and addiction, the removal of external chemicals through abstinence,
after detoxification, is essential in treatment and recovery. In the disease
of addiction, after exposure to external chemicals, the complex processes
are permanently distorted and thus the return to normal drinking, drug use,
or other chemical use is impossible. All drugs and chemicals used in addicted
individuals must be thoroughly supervised by some healthcare worker who knows
the biochemical interactions involved.
Denial is the hallmark
symptom of addiction. As one can see, the normal chemical responses in the
brain are synchronous with external circumstances. The sight or sensing of
an approaching train at high speed produces fright and ultimately flight,
hopefully. If the internal chemical environment and the external environment
no longer correlate, that is, for example, the brain is bathed in a sedative
drug such as alcohol, it fails to identify the danger of the approaching
train and the entire organism reacts in denial of the impending danger and
disruption. Since denial is an internally mediated chemical reaction, it
is different from lying, and it is not a voluntary response. "Breaking" the
denial by proper treatment is the keystone to the therapeutic process. It
is as important as total abstinence from all mind-altering drugs in recovery.
A person in denial is honestly unaware of the etiology of the life's problems.
The belief that the problem (substances) is really the solution is astonishingly
persistent.
The treatment of
the chemically dependent professional is very successful. All properly managed
treatment systems, such as FLA, have recovery rates which are phenomenally
higher than those seen in the general population. The reported statistical
recovery rate is approximately 80 percent, plus or minus one standard deviation
of 10.4 percent.
The treatment of
the professional must proceed with an understanding of the highly emotionally
charged, chemically induced primitive mid-brain responses that will be
encountered in the process. This results in the helping professional often
being the focus of anger, revenge, deviant behavior, and violence. This
corresponds to the altered internal brain chemistry of the victim of addiction.
Addiction and substance
abuse problems are the most frequently referred to any organized statewide
health program, usually accounting for between 60 percent and 70 percent
of all referrals. The second most common referred condition is depression
as either chronic, recurring depression, or bi-polar disorder. Although the
circumstances resulting from addiction and abuse often produce depression
which disappears after detoxification, abstinence, and treatment, there are
a significant number of cases in which depression exists independently of
substance abuse or as a concurrent medical condition.
As with substance
abuse, depression in its various forms including bi-polar disorder (formerly
called manic-depressive syndrome), is a chemical phenomena. When modern
anti-depressive drugs are used in conjunction with proper medical and
psychological management, depression is highly responsive to treatment. It
is not a matter to be dealt with independently. Depression requires observation,
medication, guidance, activities involved toward recovery and environmental
adaptions.
Self-destructive
activities and changes in mood, just as changes in physical function, require
evaluation by experienced professionals. There is little controversy over
the successful treatment of mental illness. The success rates in illnesses
which commonly occur in attorneys and other professionals exceed recovery
rates associated with most chronic medical conditions. However, inadequate
treatment, non-traditional methods, and self-treatment are as fatal in mental
illness as they are in diabetes, cancer, and heart disease.
At a time when mental
health care is being denied for financial reasons to many ill people and
mental health treatment resources sacrificed, it is extremely important that
lawyers and other professional workers receive immediate, extensive care
to preserve society's investment in their profession. Over the years, this
task has been efficiently, economically and compassionately accomplished
by Florida Lawyers Assistance, Inc. The judiciary, the Bar and individual
attorneys who have struggled with this dilemma, are to be congratulated on
their
success.
(Dr. Roger A.
Goetz
was a certified addictionologist who until the time of his death in March
1998 acted as the director of the Florida Impaired Practitioners Program.
In addition to his work with the PRN, Dr. Goetz sat on the Florida Lawyers
Assistance board of directors from its inception in 1986 until the time of
his death.)
BAR ASSOCIATION LAWYER’S ASSISTANCE
PROGRAMS
CONFIDENTIAL HELP FOR LAWYERS WITH
SUBSTANCE ABUSE, EMOTIONAL DISTRESS AND/OR RELATED
PROBLEMS
ABOUT EXTERNAL
INTERNET LINKS IN THIS
PROGRAM:
All links shown below were working as of the publication date of this program.
The publisher cannot and does not accept any responsibility for validity
of third party’s links. To access the links shown below, with your computer
connected to the internet, click on the indicated
links.
The following
alphabetical resources are offered for lawyers to obtain confidential assistance
with substance abuse and/or emotional distress problems and
issues.
Some of the following
programs have a Website and/or e-mail address; those are indicated by
A Blue Link on their
Name or
E-mail
link.
Others may be contacted by phone only. Phone numbers have been provided where
available.
ALABAMA
Lawyer
Assistance Program
334-834-7576
E-mail
ALASKA
Lawyers
Assistance Committee
907-264-0401
E-mail
ARIZONA
Member Assistance
Program
602-340-7313
ARKANSAS
Arkansas Lawyers Assistance Program
(ArLAP)
CALIFORNIA
State
Bar of California
The Other
Bar
415-334-0796
E-mail
COLORADO
Colorado Lawyer's Health
Program 800-432-0977
or
CONNECTICUT
Lawyers Concerned for
Lawyers
DELAWARE
Lawyers
Assistance
Committee
302-995-7001 24 hours
DISTRICT OF
COLUMBIA
Lawyer Counseling Program
FLORIDA
Florida Lawyers Assistance,
Inc. 800-282-8981 (National) 24
hours
E-mail
GEORGIA
Drug
& Alcohol Resource Center
800-289-0201
E-mail
HAWAII
Attorney
& Judges Assistance Program
IDAHO
Idaho
Lawyer Assistance
Program
208-334-4500
E-mail
ILLINOIS
Lawyers'
Assistance Program, Inc.
INDIANA
Judges
and Lawyers Assistance Program
IOWA
Lawyers
Helping Lawyers
800-243-1533
E-mail
KANSAS
Impaired
Lawyers Assistance
Committee
866-342-9308
KENTUCKY
Kentucky
Lawyers Assistance Program (KYLAP)
LOUISIANA
Alcohol
& Drug Abuse Committee
MAINE
Maine
Assistance Program for Lawyers
1-800-530-4627
E-mail
MARYLAND
Lawyer Counseling Program
MASSACHUSETTS
MICHIGAN
Lawyers & Judges Assistance
Program
MINNESOTA
Lawyers Concerned for
Lawyers
651-646-5590
E-mail
MISSISSIPPI
Lawyers
and Judges Assistance Program
MISSOURI
Lawyers'
Assistance
Program
800-688-7859 24 hours & answering
service
E-mail
MONTANA
NEBRASKA
Alcohol & Drug Abuse
Committee
402-475-6527
E-mail
NEVADA
Lawyers
Concerned for Lawyers
702-455-4827
E-mail
NEW
HAMPSHIRE
Lawyers
Assistance Committee
603-224-6942
E-mail
NEW
JERSEY
Lawyers Assistance Program
800-246-5527 24 hours
NEW
MEXICO
Lawyers
Concerned for Lawyers
NEW
YORK
Lawyers Helping
Lawyers
800-255-0569 24 hours (Nationwide)
LAP
related resource in New York
NEW YORK
CITY
NORTH
CAROLINA
North Carolina Lawyer Assistance Program
NORTH
DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE
ISLAND
SOUTH
CAROLINA
SOUTH
DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST
VIRGINIA
WISCONSIN
WYOMING
PUERTO
RICO
VIRGIN ISLANDS
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