Substance Use Disorder

Is your use of alcohol and/or drugs impacting your day-to-day life or your ability to practice law?  Do you think you may be drinking too much, or are you using legal or illegal drugs to an extent that is causing disruptions in your practice or your personal life?

You are not alone and there is confidential help available.  MAP can connect you with a peer support volunteer.  Check our list of support groups for 12-step meetings.

The National Institute on Alcohol Abuse and Alcoholism poses the following questions to help you assess whether you or a loved one may be using alcohol in a problematic way.  In the past year have you:

• Had times when you ended up drinking more, or longer than you intended?

• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?

• Spent a lot of time drinking? Or being sick or getting over the aftereffects?

• Experienced craving — a strong need, or urge, to drink?

• Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

• Continued to drink even though it was causing trouble with your family or friends?

• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Generally, signs that a you, or a colleague, may be suffering from substance use disorder may include:

General:

1. Appears intoxicated or hung over
2. Deterioration of physical appearance and grooming
3. Shakiness, tremulousness
4. Unpredictability, strange behavior, inappropriate behavior
5. Withdrawal from responsibility
6. General changes in overall attitude
7. Overwhelmed easily, unable to manage emotions, emotional outbursts, overreacts
8. Aggressiveness or becomes withdrawn
9. Forgetfulness, poor concentration, short attention span, "blank spots" in memory
10. Loses sense of humor, misinterprets situations, loses sense of perspective
11. Becomes suspicious and distrustful
12. Loses touch with reality at times
13. Loss of intellectual sharpness, creativity, business acumen
14. Becomes indecisive, confused
15. Change in weight
16. Frequent medical visits
17. Frequent absence and inability to account for whereabouts during work day, misses deadlines, appointments
18. Legal, family, social, medical problems

Alcohol:

1. Needs a drink to relieve stress
2. Quickly drinks or gulps down several drinks to "loosen up"
3. Availability and consumption of alcohol becomes the focus of social or professional activities.
4. Individual becomes erratic, temperamental, irritable, difficult to get along with
5. Misses deadlines
6. Chronic lateness
7. Quality of work deteriorates
8. Quality of presentations deteriorates
9. Poor business judgment
10. Trouble making decisions
11. Misses work on Mondays and Fridays
12. Frequent medical leaves of several days duration
13. Missing during the middle of the workday
14. Odor of alcohol when around individual, especially on breath
15. Shakiness, trembling hands in the morning
16. Frequent trips to hospitals, medical providers
17. Increase or decrease in weight
18. Changes in skin appearance, including flushed skin on nose and cheeks
19. Repeated injuries, bruises, cuts & scrapes, limping
20. Repeated complaints of fatigue, lack of energy, inability to concentrate, headache
21. General "run down" appearance
22. Legal difficulties

Stimulants (cocaine, methamphetamine and others):

1. Dry mouth and nose, bad breath, frequent lip licking, teeth grinding, body tremors.
2. Excessive activity, difficulty sitting still, lack of interest in food or sleep.
3. Irritable, argumentative, nervous, extreme moodiness.
4. Talkative, excited speech and incessant talking but conversation often lacks continuity; changes subjects rapidly. "Grabs spotlight" during presentations, meetings
5. Runny nose, cold or chronic sinus infections, nose bleeds.
6. Use or possession of paraphernalia including small spoons, razor blades, mirror, little bottles of white powder and plastic, glass or metal straws.
7. Euphoria, expansive mood
8. Chronic financial difficulties in spite of more than adequate compensation
9. Progressively aggressive or violent behavior, unusual temper tantrums
10. Increased physical or sexual activity
11. False sense of confidence and power
12. Purposeless, repetitious behavior
13. Compulsive cleaning, grooming, sorting, disassembling

Depressants (barbiturates and tranquilizers):

1. Symptoms of alcohol intoxication with no alcohol odor on breath (slurred speech, stumbling gait, droopy eyes, etc.)
2. Lack of facial expression or animation
3. Flat affect
4. Flaccid appearance
5. Slurred speech

Opiates (painkillers, heroin, and morphine):

1. Euphoria, tranquility, apathy, and impaired judgment. (Although the initial effects are generally calming or dulling, psychomotor agitation and aggressiveness can occur).
2. Excessively active, frantic or lethargic, drowsy, nods off during meetings
3. Slow breathing
4. Very pale and sweaty or extremely thirsty
5. Small, "pin prick" pupils
6. Nausea
7. Frequent itching and scratching
8. Red and raw nostrils (sign of sniffing)
9. Wears long sleeves even when inappropriate (sign of injecting)

Do you know an attorney or are you an attorney who may need help?

In 2016 the ABA Commission on Lawyer Assistance Programs (CoLAP) in collaboration with the Hazelden Betty Ford Foundation, conducted nation-wide research on lawyer impairment.  the study concluded that lawyers experience problematic drinking at a higher rate than other professionals; lawyers also experience mental health distress at significant rates. 

The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, Journal of Addiction Medicine, January/February 2016