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Alcohol
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Alcohol: Cunning, Baffling and Powerful
Since its formation, LawCare has helped over 500 lawyers. A third of these cases relate to alcohol misuse. It is well established that lawyers drink to excess. Statistics indicate that some 30% of male lawyers and 20% of female lawyers regularly exceed the recommended drinking levels and up to 15% become addicted. Alcohol related deaths in the legal profession are seriously high with lawyers suffering double the national death rate from cirrhosis of the liver.
Ask yourself these simple questions:
If you answered yes to any of these questions then you may have a drink problem. A further test is included in this pack, as is advice about what you can do, and information about the dangers of alcohol addiction.
Connection between alcohol and stress Some 80% of our callers blame their alcohol misuse on work related stress. It is significant that some 76% of our alcohol calls are from or about lawyers at partner level. There is a clear implication that alcohol abuse later in life is a result of unaddressed stress problems earlier in a career. If you are suffering the effects of stress, LawCare can help.
There is life after alcohol LawCare’s statistics show that lawyers drinking to excess have usually cut their alcohol intake by approximately 65% within a period of three months following their call. Of those drinking dangerously high levels or addicted their situation improves by 50% in the same period after calling LawCare.
Worried about Someone Else's Drinking?
Why do people drink?
In the normal way drinking is associated with enjoyment or special occasions. But it is also often used when we are worried or unhappy to try and make us feel better. It also often helps us to feel more confident about mixing with other people. As a result it can play an important role in our lives.
We gradually find that having a drink is helpful in some situations, and as the habit builds up, it becomes more and more difficult to manage on these occasions without a drink. This in turn can lead to someone becoming physically dependent on alcohol to the extent that if they have no alcohol in their blood stream they become ill. If this happens suddenly they may well need medical help.
If the person who is drinking is a member of your family, or a business colleague or partner, their conduct can seriously affect your quality of life and put you under unreasonable stress.
What can you do about it?
Remember that you cannot force someone to stop drinking. However, you can create a climate in which you can encourage and help them to face up to the problems which their drinking is making both for themselves and those around them. Here are a few ideas that people in your situation have found helpful.
Take care of yourself
It is very important to look after your own health. When you are involved with someone who has a drink problem you can soon become drained of energy both for yourself and the other people in your life. And if you get run down and over-anxious you could well become ill too. So do not be afraid to ask for help for yourself. Excessive drinking is a common problem these days and there are plenty of people who will know exactly how you feel.
We are all responsible for our own behaviour, so you should never accept the blame for someone else's drinking. However, you are responsible for your own reactions to it, so it is not a good idea to try drinking with them - it will not help to control their drinking and will just make things worse for you.
As we have said, you are entitled to a reasonable quality of life. If someone's drinking is making life difficult for you talking it over may help you to set boundaries and goals, to make decisions and to make changes.
The Relationship between Alcohol and Depression
Like all drugs, however, alcohol has its side effects. First, it is dangerously addictive. Depression sufferers, with their poor sense of self and perceived inability to control their lives, are unlikely to care about this, or to be able to do anything about it should they sense that they are becoming dependent. A second side effect of particular importance is, ironically, depression. All drugs can be generally categorised as stimulants (speeding up the system) or depressants (slowing it down). Alcohol is a depressant. The feelings of relaxation and well being it promotes are due to this general slowing down and “depressing” of the body’s systems, in particular the brain. Most cognitive processes, from reaction time to emotional responses, will be dulled.
In individuals who were not depressed when they began drinking, alcohol can cause depression. Consumption of alcohol causes an increase in dopamine levels in the brain, leading to feelings of pleasure. With this artificially increased supply of dopamine, however, the brain compensates by producing less. When consistently stimulated into reducing dopamine by excessive alcohol intake, the brain may cease producing dopamine in response to other stimuli altogether. The result is that the addict now requires the drug just to feel “normal” and finds no pleasure in anything except alcohol.
Understandably an alcoholic lifestyle may lead to depression for other reasons. There is a pattern of loss to the alcoholic’s life which will be inevitable unless help is sought. Typically the alcoholic will lose his job, standing in society, driving licence, family, home, health and self-respect. Only the order in which these losses happen varies. If you were not depressed when you started drinking, chances are you will be when the Senior Partner sacks you and your wife walks out.
If you have established that you or someone you know has a drinking problem, then there are a number of steps you can consider taking.
Important Note: When taking any of the above steps, it is vital that you are sober at the time. Most organisations which deal with alcoholics have a policy of not initiating action when the client is drunk. This is to ensure that you understand and will remember what is said and done.
Damage Limitation
You may also want to help yourself in other ways. Consider the following:
based on information kindly supplied by the Medical Council on Alcoholism
If you suspect that you may be drinking too much, keeping a drinking diary for a week or two can help clarify the amount you actually drink, and the reasons behind it. For example, you may think you are a "social" drinker and find that your diary actually reveals that you drink just as much alone as with others.
Beware of making excuses for yourself - "OK, I drank a lot but that wasn't a typical week", blaming circumstances or others - "I wouldn't have bought all that wine if it hadn't been on special offer at the off licence" or questioning the validity of the diary - "These things don't really mean anything anyway." If you do think you have an alcohol problem, then don't look to the diary to demonstrate that actually you are not drinking as much as some other people you could name. If the amount you drink worries you then it is a problem, and the earlier you seek help, the better.
Drinking Diary for the week beginning ______________________
One Unit is roughly either: half a pint (284ml) or beer or cider, a small (125ml) glass of hock wine, a very small (60ml) glass of fortified wine such as port or sherry, a single (25ml) measure of spirits. Drinks poured at home are generally larger than those bought in restaurants and pubs, and strong beers may contain up to twice the usual number of units Use the following guide to assess your drinking from the diary.
Although the above table mentions weekly totals of units, we strongly recommend that you convert these to daily units, i.e. 3 units per day for women and 4 units per day for men. Binge drinking, even within the permitted weekly number of units, can still be dangerous.
A Little About Alcoholics Anonymous
What is AA? Founded in 1935, AA is the world’s largest alcohol recovery programme. It is entirely independent of any outside organisation, and has the considerable advantage of being free. The “anonymous” in the title is taken very seriously. Attendees do not even share their full names, and confidentiality is guaranteed.
What goes on at an AA meeting? There are several different formats for AA meetings. The main ones are speaker meetings and discussion meetings, and there are others which combine these two elements. There are step meetings which focus on one of the programme’s Twelve Steps and traditions meetings which do the same for AA’s Traditions. There are also some promise meetings (though they are rare in the UK) focussing on the benefits of recovery, which are presumably assured to everyone who follows the programme. There are also twelve promises, and it has been suggested that had Moses been an alcoholic we would have had twelve commandments too!
How many meetings should I attend? Much depends on your personal circumstances and also the availability of meetings in your area. AA itself has traditionally recommended that you attend 90 meetings in 90 days. This is not always a practical proposition and our advice would be to attend as many meetings as you possibly can in the first few months. This is partly because it enables you to build up a substantial number of contacts in AA who are available to give you help and support. Also because no two meetings are ever the same it enables you to select the meetings which suit you best personally.
Which meetings should I go to? In the early days it is probably best to concentrate on speaker and/or discussion meetings. You can then progress later in your recovery to the more focussed step meetings. However for most people it is largely a matter of personal choice and geographical availability. We strongly recommend that you attend as many as you can, at least in the early stages of recovery, to help you to establish the meetings which suit you best. Also, if you find that you don’t like a particular meeting, or the people you encounter there, don’t give up. Try attending a meeting elsewhere.
I’m worried I’ll meet a client there. AA has a strict policy of confidentiality, and your client is there for exactly the same reason that you are. He or she will probably be happy that you have made that vital step, and pleased to share this bond of fellowship with you. However, if you are concerned about retaining your aloof professionalism, why not attend a meeting in a different area?
Is there an handbook I can buy? The “bible” of AA is known as the Big Book although the official title is imaginatively “Alcoholics Anonymous”. It is the oldest and most important AA literature having been written by the first members in the 1930’s. The opening chapters explain the basic principles of the recovery programme, and the remainder consists of personal stories, much as they are told nowadays at meetings, telling what members’ lives used to be like, what happened and what they are like now.
Particularly in the early days of recovery we are constantly told to read the Big Book and we equally constantly find things we do not like about it. “The prose style is leaden” or “the tone is too deadly earnest” or “the sophistication level is somewhere near zero”. Some of the chapters might stop a charging elephant in its tracks, but it still works, so we read it anyway.
In addition to the meetings listed above there also some Big Book meetings. At these members usually take turns in reading a couple of paragraphs of the selected chapter. The rest of the meeting is then given over to discussing what was read, with people relating what they heard to their own personal stories and current situations.
I know that AA says I must stop drinking altogether. I don’t want to do that. Is there an alternative? AA has a policy of never saying “must” about anything. All the programme recommends is that you don’t have a drink for one day. Each new day you make the choice not to drink that day. Although there are “controlled drinking” programmes, these tend to be harder to find and may be expensive. Also, our experience at LawCare is that they don’t really work.
I have read the Twelve Steps, and I’m put off by all the God stuff. I’m an atheist, so surely AA is not suitable for me. The steps talk about God as you understand him. Whether you have the traditional view of God, or choose to make Mother Earth or your pet cat your higher power doesn’t matter. The point of the Steps is to release you from the impossible task of trying to control your own drinking by placing the burden on someone else. AA has helped millions of people to rebuild their lives without alcohol – Christians, Buddhists, agnostics and atheists alike.
How do I “Join” Initial contact numbers are contained in your local telephone directory. Details of the location of meetings, with contact numbers, are contained in the AA publication “Where to Find” which can be purchased at most AA meetings. Or you can phone LawCare and we will tell you where your nearest meeting is held.
If you have more questions about AA which you would like answered before you go to a meeting, then why not look at the website: www.alcoholics-anonymous.org.uk or phone LawCare on 0800 279 6888.
Introduction The mental and physical health, the family relationships, the social life and the relationships at work of addicts gradually break down. They are unable to face up to their addictive behaviour or the consequences of it. It is not that they refuse or pretend not to see the problem. They cannot see it.
This "denial" often affects their family, friends and colleagues who focus on the symptoms rather than the causes of their condition. Denial is most likely to be broken down after the addict has faced a "rock bottom" and when they get appropriate help and support, either professionally, through, e.g. LawCare, psychiatric help, a treatment centre or counselling or from a self-help group such as Alcoholics Anonymous, Narcotics Anonymous or The Lawyers' Support Group. There is a pattern in the lives of addicts, for which an experienced person can gain a "feel" or instinct.
Indicators The following factors may indicate addiction.
Family
Appearance and health
Possible Solutions
I had a pretty happy and settled childhood. Dad was mostly away on business, but Mum was a very strong and determined woman. The only trauma I remember was when my Aunt died unexpectedly. She had been a heavy drinker, and years later I learned that Mum had been addicted to painkillers, but I still never saw addiction as anything I should be wary of.
I started drinking heavily at University, partly because it improved my social life. I was ambitious and perfectionist and I worked hard, ended up with a 2.1 in Law and started a traineeship at a medium sized firm in the south of England. I joined some local sports clubs which is where I met Amanda, a trainee accountant and a very bright and attractive woman.
When I qualified I moved to a larger firm, and that’s where the problems started. I was dumped in a small and smelly office with no one to ask for help and fee targets which bore no relation to my ability to do work which was still new to me. The partner in charge of my department took great pleasure in undermining my confidence and generally treating me as though I was a waste of space. I became very stressed and would work pretty late in the office to try to keep up. As the saying goes, work hard, play hard. As well as the sports clubs, Amanda and I joined a local Wine Tasting Society. One of my rare holidays was a long weekend in France with Amanda and some of the other members trying some fantastic wines. When I was really stressed out I would stop at a wine bar on the way home to do some tasting of my own.
I held my own against the bullying partner and was made a partner myself the same year that Amanda and I married. She was pregnant when we married, and we had another child very soon after the first, so by the time I was thirty I was a partner with a nice house, a beautiful wife and two children. I really thought I had made it, especially when I was invited to join Rotary, Round Table and the local residents association. Being such a pillar of the community really suited my ego. The meetings were also great opportunities for drinking, especially as I took on responsibility for opening the meeting rooms and could get a couple of drinks in before everyone arrived. I remember at one meeting wondering why everyone else drank so slowly. I could drink two pints in the time it took them to drink one.
I was still stopping by the wine bar or pub each night too, and although I usually left the office by 6, most nights I didn’t get home until 8.30. Usually I would find the kids were in bed, and Amanda was looking pretty fed up having eaten her dinner alone and left mine in the microwave.
When I was 32 I had a minor accident while driving back from a Round Table meeting. No one was hurt but the other driver insisted on calling the police, I got breathalysed and ended up losing my licence. It was reported in the paper and I was extremely embarrassed and annoyed by this. Amanda had to give me a lift into work every morning, and I’d get a taxi home after I’d been to the pub. It was about this time that Amanda started to complain about my drinking and how it was harming our family. She even used the word “alcoholic”. I was incredibly irritated at this, I pointed out that I was only a social drinker and that the reason I went to the pub after work was because the alternative was to come home to her miserable face and constant nagging.
I felt a bit guilty about this later so I started drinking faster and buying cans and bottles at the supermarket so that I could get home earlier. When I got my driving licence back I started to buy them on the way into work. Red wine and bitter gave me a terrible hangover which a drink cured instantly. I would sit in the car park behind the office drinking a can before I went in, so I was usually late for work, but compensated by being the best lawyer I could be. The clients loved me because I promised them compensation levels and completion dates the others just could not guarantee. I came unstuck a couple of times, most notably miscalculating a completion statement, which ended up costing the firm a lot of money. A week later I overdid the wine a bit and when the Senior Partner came to see me in my office at 10.00 a.m. I was very drunk. As a result the firm suggested that I leave, and said that they would give me a good reference if I agreed to do so.
I had started to realise by now that my drinking was not normal, but blamed my club memberships which centred around drinking. This seemed an ideal opportunity for a fresh start so I got a job with a firm two hundred miles north. Family life never seemed the same after our move. Amanda tended to eat dinner with the kids and stopped consulting me on decisions about the house. She was also making excuses for me to the neighbours. After six months at the new firm the Senior Partner told me that the firm had a strict alcohol policy, which I was breaking. He said that if I wanted to tackle my problem then the firm would support me, but if I was not prepared to do so then I would not be made a partner as had been promised at interview. They gave me a leaflet about Lawcare and suggested I get in touch.
I felt this was unjustified. My drinking didn’t affect my work and I was not prepared to stop just because of their policy, so I set up practice by myself. A few months later there was a nasty incident at home which ended with me hitting Amanda, and she and the kids moved out. The divorce, mortgage, maintenance and alcohol began to cause financial problems. When I discovered a shortfall on office account I borrowed from client account to fill it, paying it back some day later. As matters got worse, I tried this trick again, and again. After two years, however, the OSS contacted me. At the same time I lost the house and moved into a bedsit.
The people from the OSS suggested I see my GP. The doctor prescribed anti-depressants - I didn’t tell him how much I was drinking. The SDT suspended me indefinitely and once again suggested I contact LawCare, which I finally did. I didn’t mention the drinking at first, but the man on the phone asked how much I was drinking and suddenly we were talking about alcohol. He sent me some literature and suggested Alcoholics Anonymous. He also said he would put me in touch with another lawyer who used to be an alcoholic. David rang me the next day. He suggested I go to AA with him, but I said I just wanted to try cutting down first so he gave me the number of an Alcohol Advisory Service.
The programme did make me feel better about myself, but it didn’t stop my drinking. I called LawCare again, and between them and my GP they got me a place in a treatment centre. I was very scared at the thought of giving up drinking forever, but the “one day at a time” approach helped and I was soon feeling very much better both physically and mentally. When I came out of treatment I went with David to AA. I was scared of meeting a client there, and as fate would have it the first person I ran into was a former client, Tom. He grinned and said, “I wondered whether you would ever get here!” I was surprised to realise that he had known about my drinking and to learn that Tom had been alcoholic, but Tom told me he binge drank at weekends, and was sober weekdays. This was just as dangerous.
Tom became my sponsor and was always there if I needed support. I went to a meeting most days, in various towns. Some I didn’t enjoy as much as the one I went to with Tom and David, but AA was still a better place to be than the pub. After a year I got complacent because I attended my niece’s wedding and woke up at home the next morning with a horrendous hangover. Tom and David helped me through the feelings of guilt and self disgust.
I resumed contact with my children, and after a while I went back to work, in a Law Centre at first and then, when my suspension was lifted after five years, as a locum. Through that I was offered a good position with a local firm. Tom became my most lucrative client, and I had a good deal of other work through AA contacts. I also became a LawCare volunteer and began helping other lawyers rediscover life, just as David had helped me. My alcohol problems had taken up the best part of twenty-five years of my life, but in recovery I was able to regain my self-respect and part of what I had lost. When my daughter got married I was able to give her away, and toasted her happiness with orange juice.
“Jim” is not a real person. This is a composite story built up from a number of LawCare’s case files. A fuller version of Jim’s Story, including footnotes explaining how his experience is typical of alcoholics, is available from LawCare.
The term "drug dependency" describes a situation where a person is using drugs in such a way that their social relationships and physical or emotional welfare are affected. A person who is drug dependent will have a strong desire for a particular drug and will increasingly need larger amounts of the drug to achieve the same effect as before. If they stop using the drug for a while and then start taking it again the craving for the drug quickly reappears. Stopping the drug can lead to physical "withdrawal" symptoms such as nausea and shaking; if this happens the person is physically dependent on the drug. Drug use becomes the centre of the person's life, and other activities (including employment) and pleasures are progressively neglected. As a result, relationships with family, friends and others may suffer.
How is drug dependency treated? Treatment of drug dependency involves treating both the physical and psychological problems that result from drug use. Medical treatment may be necessary for health problems related to drug use, such as liver disease. If a person is physically dependent on a drug he or she will need to undergo detoxification. This involves replacing the drug with a prescription medicine and gradually reducing the dose to minimise the occurrence of withdrawal symptoms.
The mainstay of most treatment for drug dependency is an intensive programme of group work and individual counselling aimed at helping the person to develop strategies to cope without the use of drugs and to adopt a healthy lifestyle. Various activities may be used to encourage the person to recognise the problems that led them to become drug dependent and to overcome these problems by developing self esteem and positive attitudes. Often therapists may themselves have been treated for drug dependency and so can empathise with their patients, helping them to accept that abstinence is not an impossible dream but an attractive and realistic option.
In-patient treatment for drug dependency in a specialised hospital normally lasts about 5-6 weeks but, depending on the degree of addiction and desire of the addict to break free, out-patient treatment or even voluntary attendance at self-help groups such as Narcotics Anonymous may be effective.
Treatment for drug dependency can be a stressful time for patients because they have to confront and resolve their underlying problems and learn to cope without a drug that was once central to their life. Support from family, friends and colleagues is therefore vital for successful treatment.
If you or a family member, friend or colleague are dependent on a drug then help can be obtained from a number of sources. LawCare (call free on 0800 279 6888) has details of counsellors, hospitals and treatment centres throughout the country and can make referrals and offer advice not only on treatment but on how the matter might be handled within the profession. Your GP is also a good starting point, or contact Narcotics Anonymous on 020 7251 4007 (weekdays) and 020 7730 0009 (weekends).
Prescription Drugs
In the early sixties big drug companies such as Roche and Wyeth developed a new "miracle drug". Known as benzodiazepines this group of drugs dampens down activity in the brain and are highly effective for acute anxiety.
Doctors started expressing concerns about these drugs when they found that patients experienced withdrawal effects when they tried to stop taking them. These were similar to the withdrawal symptoms of alcoholics and drug addicts and included delirium tremens (a state of confusion with trembling and hallucinations), sleeplessness and intense anxiety. Since the drugs had originally been prescribed for anxiety many doctors assumed that these effects were a return of the original symptoms caused by stopping the medication and simply represcribed the tranquiliser. Hence there were - and still are - many patients regularly taking benzos just to prevent withdrawal. Today it is estimated that 1.2 million patients are dependent on these drugs, some of whom have been taking them for up to 30 years.
Benzos are more addictive than heroin, and yet they are prescribed to one in four adults. In pregnancy Benzos cause addiction in the unborn child and the baby may need intensive care after birth. There are still occasions however where benzodiazepines are still the most effective treatment. These include a life threatening condition called status epilepticus (repeated seizures), severe disabling anxiety and acute insomnia. In such situations they should be prescribed in the lowest possible dose for no more than four weeks. Benzos have side effects, particularly in long-term use. Perhaps the most harmful of these is the feeling of being in a daze or emotionally anaesthetised - tranquilised. Many who do successfully come off them say it is like waking up and finding a chunk of their lives gone. Which are the Addictive Drugs? Almost all drugs are potentially physically or psychologically addictive. Whenever you are prescribed a medicine ask your doctor whether it is addictive, whether it has side effects or contraindications, whether it can be taken with any condition or medication you already have and how long you will need to take it for. Most GPs are well aware of the dangers of benzos but there are still some, particularly older GPs, who may prescribe them without warning you of the dangers. Some brand names of benzodiazepines to look out for are; o Valium (Diazepam) o Librium (Chlordiazepoxide) o Mogadon (Nitrazepam) o Ativan (Lorazepam) o Oxazepam o Loprazolam o Temazepam
For more Information Contact;
Council for Involuntary Tranquilliser Addiction (CITA) 0151 949 0102
Addictions Anonymous 020 7584 7383
Benzact 01670 504155
LawCare 0800 279 6888
LawCare in Scotland 0800 279 6869
LawCare for Barristers 0800 018 4299
Inpatient treatment for alcoholism can be expensive, but, combined with attendance at AA, it is also the most effective way of achieving sobriety. Until recently many centres required a period of detoxification prior to admission - anything between 24 hours and two weeks without alcohol. Fortunately these days most centres offer detox, usually medically supervised, at the start of the treatment process. Most centres operate the 12 step Minnesota model programme of AA. When choosing a treatment facility, it is not necessary to select somewhere nearby; treatment can often be more successful when the patient is far away from his or her "comfort zone" and less able to check out and go home easily prior to completion of the programme. More information on each centre is available from LawCare.
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