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June 2005Alarmed by Her Drinking but Afraid to Stopby Ellen A. Begley, Ph.D. Research data gathered over the past 20 years suggest that U.S. attorneys struggle with substance abuse more than the general population of the United States. In this article I will focus on one of the more common problematic drugs — alcohol. Estimates for alcohol abuse among attorneys range from 18 percent1 to 30 percent.2 Prevalent studies of alcohol dependence for attorneys include estimates of from 10 to 15 percent3 and 15 percent.4 In contrast, estimates for alcohol dependence in the general population range from three to 10 percent.5 For attorneys struggling with addictive behaviors, the journey from problematic substance use to abstinence and recovery can be made more difficult by both real and perceived obstacles particular to the legal profession. To the practicing and actively substance-using attorney, concerns about professional reputation, privacy, credibility of work, fear of disciplinary action, and one’s status in the inherently adversarial profession of law can make the process of acknowledging a problem and seeking help seem like a personal and professional minefield. While working as a psychologist and addictions specialist in the WSBA Lawyers’ Assistance Program (LAP), I have realized how these issues can impede individuals getting the help they need. In this article I hope to demystify the recovery process, address some of the misconceptions and fear surrounding the transition out of active addiction, and provide some of the latest information regarding psychological issues that frequently accompany addiction problems. With the above concerns in mind, I interviewed two attorneys about their journey from maladaptive substance use to sobriety while maintaining their careers as attorneys. Both of these individuals volunteer for the LAP, assisting attorneys who struggle with substance abuse and other problems. In this article I will give the story of one attorney who struggled with a number of issues that frequently complicate an individual’s path to recovery, including psychological struggles, professional concerns, and apprehension about aspects of the sober-support community. The second attorney’s story, which will follow in an upcoming issue of Bar News, illustrates the culture of alcohol use among attorneys, the complexity of an attorney dealing with relapse, and the importance of Alcoholics Anonymous (AA). Caroline’s story: “…spending a lot of my time thinking about how to drink.” he first attorney I interviewed was a woman in her mid-50s who started practicing law in the 1980s and has been abstinent from alcohol for 19 years. For this article I have given her the pseudonym Caroline. Caroline first began to wonder if she might be drinking too much in law school. She tried to decrease her alcohol consumption by drinking Diet Pepsi between alcoholic drinks, starting to drink later in the day, eating a lot of food before drinking, and nursing one drink slowly. She noted, “I was spending a lot of my time thinking about how to drink.” She knew she drank a lot and wanted to change this, but she did not consider stopping altogether. During her first job, Caroline was often expected to testify in court, and this “terrified” her. She drank more and more in the afternoon. She was alarmed when she began to consider even more drinking. “I started to think it would be a good idea to drink in the morning before court. Then I wouldn’t be so scared . . . . I thought alcohol would give me courage.” Her coworkers did not notice her increasing alcohol use. Overall, she functioned well at work and her employer gave her positive feedback about her performance. Nevertheless, she had “no confidence” about her work or herself, and was beginning to consider suicide. Depression and anxiety were closing in on her. Alcohol’s impact on Caroline’s work performance became more apparent as she began to make personal and professional decisions while under its influence. “I left my marriage and law firm with about five minutes’ notice, on the same day.” However, the role of alcohol in these impulsive decisions was not clear to her at the time. “I thought I was leaving because of my marriage and because I was in love with another man.” Seeking Help After suddenly leaving her job, and separating from her husband, Caroline’s sister expressed concern that she might lose custody of her four-year-old child. In response to her sister’s alarm, Caroline decided to seek out a therapist. “I knew something was wrong but I didn’t know it was alcohol. I thought I was crazy.” By the second session the therapist told her that alcohol was the problem. Caroline accepted this information readily, as it helped her understand her own inexplicable behavior. To Caroline, it seemed impossible to work as a lawyer without the sedating effect of alcohol. “I didn’t think I could practice because it was too scary to go to court.” Initially, she was not particularly concerned about people in law knowing about her ceasing drinking alcohol. However, her therapist expressed concerns about Caroline’s privacy. Caroline remembers the therapist saying, “if you go to an AA meeting someone might see your car out there.” The therapist recommended she enter inpatient treatment instead. However, already afraid of losing her child, she did not believe she could leave her son for the duration of a program. Instead she found her own path. She did her own readings, found Jean Kirkpatrick’s books on recovery, and grew interested in the sober-support group called Women for Sobriety (WFS). She found a similar group in her area. This local group adapted the principals from WFS but was not officially affiliated with the national group. Of this group, Caroline stated, “I loved it right away.” In these meetings, women’s issues relating to relationships and sexuality could be discussed openly. She attended weekly meetings for five or six years until the group disbanded. After the women’s group ended, Caroline began to consider attending AA meetings. Her preconception was that AA was a highly religious organization. She is a life-long atheist and did not want to enter any organization that was based in religion. Even with this reservation, she tried AA. Its amazing availability made it worth looking into. As her direct experience of the AA fellowship grew, her concerns about its religious roots were addressed. She grew to believe one’s “higher power” can be anything one wants it to be — the group, nature, friends. The overall message for her was: I’m not alone in the world — there are things and people who can help. She became very comfortable with the AA process. No one had a problem with her beliefs, and no one tried to convert her. Integrating Recovery into Work Identity After regaining her footing, Caroline returned to work as an attorney. At times she feared bosses would think less of her if they knew she was a recovering alcoholic. In her first new job following her cessation of alcohol use, she did not reveal that she was in recovery. While at a work party the inebriated relative of a coworker kept insisting Caroline have a drink and went so far as to press a drink into her hand. Caroline’s response to this awkward situation was: “You know I’m driving home and I’m not drinking,” effectively ending the interaction. Over time, she revealed why she did not drink to some colleagues. She discovered that the people she feared would think less of her did not. In fact, after making her recovery status known to her employer and coworkers, she was asked to help a coworker approach a relative about her drinking problem. Ironically, this was the same person who had previously pressured Caroline to drink at a party. Contrary to her therapist’s fear of her being “found out,” she never experienced negative consequences related to other attorneys knowing she was in recovery. Of her current practice, she states, “I’m doing well and I think I’m a better lawyer due to recovery.” She feels she knows better how to help others because of her own recovery process. “I don’t feel superior to my clients.” Caroline attends one weekly AA meeting for attorneys only. She sponsors others in AA and volunteers to help attorneys struggling with addiction. She has attended her own individual therapy and reads literature related to recovery. She has structured her life in a way that helps her “work on problems I see in myself as soon as I can.” Caroline recalls romanticizing her drinking during her 20s. She identified herself with public figures, artists, and great writers who have also struggled with substance abuse. This may have delayed her realization that she had an alcohol problem. She believes it is important for people who wonder about their substance abuse to seek someone’s help to assess it. Of attorneys drinking to cope with the stress of the profession, she says; “They don’t realize that all those things they already worried about won’t be a problem . . . . They won’t worry about the missed calls, other mistakes, and of smelling like alcohol. . . . They won’t have to worry about not making it to the bar if they work late. They won’t have to worry about hiding the alcohol they keep at the office.” A person won’t have to worry about not being in top form because of being under the influence or recovering from his or her last binge. Caroline’s work, which includes public speaking, has been much less stressful since she stopped drinking. “The practice of law gets nothing but easier when you stop . . . . There is no aspect that isn’t better.” Caroline’s story brings up several issues that are often intimately related to alcohol dependence. Caroline discussed her increasing anxiety about public speaking as one of the emerging crises that led her to make dramatic changes in her life and eventually reach out for help. Research indicates that there is a strong relationship between anxiety and alcohol use. There is some controversy about causation, but I will avoid the chicken-and-egg question here (see G. Vaillant’s The Natural History of Alcoholism Revisited (1995), pp. 77-79, for a succinct discussion). The overall literature points to the fact that (whether or not alcohol is the cause of anxiety, vice versa, or not) once someone has an anxiety disorder, alcohol is a terrible form of “treatment.” Instead, alcohol acts as an avoidance strategy, and avoidance breeds more anxiety. Avoidance in the form of alcohol sedation prevents direct exposure to the feared event and the distressing feelings it generates. Alcohol may seem like a short-term solution, because it temporarily dampens anxiety around the event. However, this prevents the individual from learning that he or she can tolerate being fully present for the event, as well as all the negative feelings and physiological reactions he or she has about that event. Repeated exposure leads to a gradual lessening of the anxiety response over time. In contrast, the person using a substance avoids this exposure, and experiences some short-term relief reinforcing the avoidance behavior and increasing his or her apprehension. All too often, an individual makes the disastrous assumption (as did Caroline) that more and more alcohol is needed to deal with the increasing anxiety. This spiral accelerates the development of both the addiction as well as the anxiety problem, with each feeding the other. Often it is only after abstinence has been established for an extended period of time that the question of which condition (anxiety or addiction) is primary can be answered. During the height of her alcohol use, Caroline experienced profound loss of confidence and thoughts of suicide — strong indicators of depression. Chronic alcohol use more often creates depression rather than depression leading to more alcohol use (Vaillant, pp. 80-85). Furthermore, there is alarming evidence of a connection between alcohol dependence and suicide. Consider that 25 percent of suicides are committed by people with alcohol dependence, and an estimated seven to 15 percent of alcoholics commit suicide. In summary, alcohol use simply makes anxiety and depression worse, sometimes with fatal results. Caroline’s story illustrates many of the issues that I often hear from individuals struggling with substance abuse. Her effort to find help exemplifies the highly individual nature of a person entering recovery. Caroline sought support particular to her needs related to her gender, psychological issues, and profession. She made good use of a range of tools — individual therapy, a women’s sober-support group, and a 12-step meeting exclusively for attorneys. Ellen A. Begley, Ph.D. is a clinical psychologist currently working as the addictions specialist for the WSBA Lawyers’ Assistance Program. Support Resources for Attorneys in Washington State The WSBA Lawyers’ Assistance Program (LAP) offers individual therapy and referral services for addiction problems and other mental health issues. LAP office: 206-727-8268. Addiction specialist Ellen A. Begley, Ph.D.: 206-733-5988. NOTES 2 Frances, Alexopoulos, & Yondow, Lawyers’ Alcoholism: Alcohol and Drug Abuse in the Affluent, Barry Stimmel, M.D. ed. 59-66 (1984). 3 Ibid. 4 Drogin, E., “Alcoholism in the Legal Profession: Psychological and Legal Perspectives and Interventions,” 15 Law & Psychology Review 117, 127 (1991). 5 Schuckit, M., An Introduction to Diagnosis and Treatment of Alcoholism, Alcohol Medical Scholars Program (2000).
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