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The following discussion thread excerpt is from an ongoing law.com online seminar, Stress, Substance Abuse & the Legal Community, moderated by Michael Cohen, Director of Florida’s Lawyer Assistance Inc. For more information on this program, other law.com seminar offerings, and our upcoming seminars, please visit http://www.law.com/seminars. MICHAEL COHEN, DIRECTOR OF FLORIDA’S LAWYER ASSISTANCE INC, FORT LAUDERDALE, FLA. First off, welcome to all new participants and welcome back to all our panelists and returning participants. I’d like to at least start by sticking to the script (last year, the tangents we went off on were probably more productive than the planned topics, so you’re welcome to take this where you want) with a fairly simple topic: detection. What should you look for when you believe a colleague, employee, or judge may have a substance abuse problem? I am hoping that our participants are not all lawyer assistance program (LAP) personnel and recovering lawyers, so we’re not “preaching to the choir,” so we should start with the basics: the Monday morning absences, excuses for late work, unreturned phone calls, etc. I’ll leave it there for now – perhaps some of our LAP directors like Bonnie Waters and Carol Waldhauser can start this off. BONNIE WATERS, LAWYERS CONCERNED FOR LAWYERS, BOSTON, MASS. Detection is the first step toward getting someone the help they need. The problem in the legal profession, however, is that you are dealing with a population that is reticent to act for fear of consequences to job and income. A lawyer will work diligently to hide any problems and will try to solve the problem on his/her own, which results in the problem being detected in the late stages when the situation is bad enough that it can no longer be ignored. As a LAP Director, I am constantly being told by managing partners in law firms that they think what we are doing is wonderful but they are fortunate in not having the problem in their law firm so they have no need for our services. The more education that can be directed toward symptoms of problems, as well as the benefits and success with treatment, the better. Lawyers are taught from day one to resolve problems, which they seem to do well for others but never for themselves. They also are trained not to show weakness. The profession needs to recognize its humanity and make it acceptable for its members to seek help when necessary. Another problem with detection in this profession is no one really feels comfortable dealing with the personal problems of others and do not want to be seen as squealers. I am sure that Barbara Bowe, a new panelist and senior clinician in our office, will have additional comments. BARBARA BOWE, LAWYERS CONCERNED FOR LAWYERS, BOSTON, MASS. As a follow-up to Bonnie Waters comments … regarding detection it is important to remember that a “cigar is not always a cigar”. The obvious signs have to do with physical/behavioral/emotional/relational changes that an individual goes through in the process of developing an addiction. However, sometimes what appears to be a substance abuse problem is not, and this speaks to the importance of having a clinician skilled in substance abuse disorders doing the evaluation. The legal profession can be a very stressful and difficult way to make a living. Often the lawyer is so well trained on how to help others he/she falls short on knowing how to help himself/herself. Lawyers are masterful in putting their lives into “compartments” and therefore avoiding dealing with their own difficulties until the pain becomes so overwhelming they are forced to seek help (hospitalized, marital separation, physical problems, unable to work) or are told they must seek help (by the Board of Bar Overseers, managing partners, bar advocate association, Judge, etc). The more educated people in the profession become about the down side of constantly wearing the “full metal jacket,” the better their chances are of seeking help sooner than later. MICHAEL COHEN It’s almost 4 p.m. on the East Coast and I have to wonder, “Where is everybody?” Effects of the holidays? Perhaps we’re just too busy, as Barbara pointed out. It might be interesting to discuss this very topic, i.e. why taking the time to take care of ourselves is always at the bottom of our list of priorities, and how do we get the message to lawyers that if they don’t move it up on the list, everything else will eventually fall apart. ANONYMOUS I find my alcohol consumption rises in proportion to the amount of “noticing” I do. The more I notice things in my immediate world and the larger world, the more depressed I get and, thus, the more I have a tendency to drink. When I notice that the biosphere is being destroyed at incredible rates, that cultural extinctions proceed apace, that there is little meaningful “community” sensibility and that I generally opt for the “truth” rather than the corrupt “winko” conspiracy I see all around me, that I am now in solid middle age and not very well off financially — I just get depressed. I don’t see how anyone can notice these things (and, of course, many other things) and not be depressed. If I seek the help of a therapist, and have my health insurance pay for it, this counts against me for future health and life insurance. Apparently, diagnoses involving depression send you on a fast track to higher premiums or abandonment of health insurance at the earliest opportunity. I don’t really like the option of local AA-type treatment because I live in a town where people know each other and would use such information against me if it was to their legal advantage. If I were in a large city, I could be more anonymous. However, I have no plans to move to a large city. Now, we could all not notice the things I notice. That is certainly a survival strategy for many. However, I just cannot not notice these things. I see our country heading (if not already there) towards a state of mass character disorder and dysfunctionality becoming more and more normal. I see it as the elephant in our living room nobody admits noticing. I am certainly not suicidal, but neither am I genuinely optimistic and enthusiastic about the things I notice. When I say, “notice,” I am talking about gut-level noticing with its attendant gut level reactions. I don’t keep my noticing limited to the strictly “head” realm, where I can do all those wonderful mental gymnastics we are taught to do in law school. Do you think I should keep noticing as I do (it takes guts to do that, I think) or try to develop better techniques to just stuff it and move on? The latter method always eventually leads to the former, however. Is there a way to practice law as a more healing art and still make a modestly successful living? PHILIP LYON, JACK, LYON & JONES, NASHVILLE, TENN. This is my entry (finally) and a reply to Anonymous. My office has been moved from one side of our Nashville office to the other, and my computer network only worked in my old office until a little while ago. So I have had my own stress overload today. I was saddened to read the comment of Anonymous and hope that his concerns are as false as were mine. When I went into treatment nearly 20 years ago, I wanted to make sure I did so far away from home so no one would know. I was amazed that most everybody in town (200,000 plus) knew that I had a major league drinking problem long before I recognized it. Be this as it may, if his groups of AA do not keep confidences of new and old members then I would be surprised, but I know it is easier for me to accept this now rather than then. I would suggest an AA group in a nearby city until a greater comfort level is achieved, if ever. MICHAEL COHEN Thanks for the input, Phil, and it’s nice to have you back. I, too, was troubled by the post from Anonymous. I know that I could use any situation (bad or good) to drink over, and certainly there are times when the problems in this country and the world can get overwhelming. However, I have found that drinking doesn’t make the problems go away; it only makes my own situation worse, and then I’m no good to anyone. While I would not push Anonymous to go to AA, I certainly have learned some lessons from the Fellowship, the most important being that when I think my life is bad, go out and help someone whose life truly is worse than mine (and you know that isn’t hard to find at all). That way, I’m part of the solution rather than the problem. I would also agree with you about going to AA. The only reaction I’ve ever had to people finding out I go to meetings is respect, admiration, and support. Of course, I didn’t learn that lesson until I got desperate enough to go to meetings no matter what. I hope Anonymous doesn’t have to get to that point before he/she sticks his/her head into a meeting room. LAWRENCE KRIEGER, DIRECTOR OF CLINICAL EXTERNSHIP PROGRAMS, FLORIDA STATE UNIVERSITY COLLEGE OF LAW, TALLAHASSEE, FLA. The first thing I want to say is “good for you,” Anonymous. I’ll come back to that in a minute. But first, OK, I’m home finally after delayed travel, and happy to connect with everyone. Hello! I was also troubled by the post, but more so, I was encouraged by it, truthfully. Frankly, before that post I was going to reply to the detection points by throwing in that denial is the problem I think most of us have (including the firm mentioned). Essentially, people don’t have the courage to see that they have, or even may have a problem, and so they don’t have to get to the point of deciding to ask for help or not. I do agree that asking is tougher for lawyers or law students (or at least we have more good excuses not to ask than other people do), but the bigger hurdle is admitting to one’s self at the threshold that a problem may be there and need attention. So I say to Anonymous: yes, there’s a lot of sad and depressing stuff out there. but there’s also an attitudinal, and possibly biochemical as well, basis for responding by becoming depressed. The biochemistry of alcohol is that it temporarily allays the sense of depression (depending on the type of depression), but then leaves the brain chemistry depleted so that the depression is likely to return more easily and be more severe. Also, there are more than the two options you’re seeing — either stuff the reality or see it and be depressed. There is a big difference between feeling sad, or regretful, and feeling depressed. My final comment for now — this is the benefit of essentially asking for help; one generally receives it! There are many, many ways to deal with problems besides alcohol, drugs, overwork, spending, or whatever. Perhaps more discussion during the week will raise some of the other alternatives; if not, please feel free to call me after the conference to discuss this. I know the others would say the same thing. There are ways to look fully at reality and enjoy life in a useful way. a couple of books that might be of interest: “Learned Optimism,” Seligman; “Seven Weeks to Sobriety,” (author’s name forgotten) has a detailed section on depression, alcohol, and biochemistry, which might explain some things. BARBARA BOWE Dear Anonymous: I read your post this morning when I got to my office here in Boston. I have a few thoughts for you to consider in your deliberations about what to do for yourself. The lens in which you are viewing the world is very cloudy at the moment (and maybe it has been for awhile); consequently, everything has a negative spin. You are sounding like the glass is half empty. The question is not so much about how to be “less sensitive” or not tuned in to your surroundings; it relates to what you do with the information you take in. You sound depressed (biochemical, situational, clinical) and in a bit of an emotional hole, which will probably not change by itself. If you are drinking in response to feeling down, then you will continue to feel down, as that is the function of alcohol (CNS depressant). The question is: are you feeling badly enough to want to do something about it? I hear that you see some road blocks (AA in your community, therapist diagnosis, life ins[urance], etc.), and I am wondering if you will use these as a reason to not be eligible for help and change or whether you will take the risk and help yourself. Right now you are talking about drinking as a “solution” to your pain, which in time will only broaden the hole you find yourself in. If you continue to ask all the questions and supply your own answers you will slide further down that emotional slide. My advice is to take a chance and ask for help.

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