Lawyers and alcohol

As a psychotherapist, one of the questions I often debate, particularly with my clinical supervisor, is whether you ask patients about their current pharmacological intake. However, when I pose this question, it is not limited to beta-blockers or aspirin. Those things are traditionally considered related to formal medication, which is the notion that usually guides people’s responses. When I ask the question, though, it references all the uppers and downers, such as coffee and alcohol.

Medical and physiological realities

Alcohol is, in fact, an essential part of any conversation about the role of substances in people’s lives. Unfortunately, it is rarely appreciated or understood for what it is. Clients often tell me they are non-drinkers or low drinkers. Then I explain how medicine defines a non-drinker as someone who has less than one beer or less than one glass of wine (12.5g of alcohol) in a month. After hearing the hard facts, the patients shift uncomfortably in their chairs. I have always found the myths we tell ourselves and rely upon are the ones that are commonly the most painful or destructive.

However, unravelling the myths regarding substance use is the only way to approach this issue properly. The Australian National Health and Medical Research Council (NHMRC) recommends drinking no more than two standard drinks daily to reduce the risk of alcohol-related harm over a lifetime. However, a traditional drink at the bar is frequently two drinks; if you drink a bottle of wine, it’s about eight standard drinks. The NHMRC estimates about 10 per cent of Australians are problem drinkers, yet the American Bar Association estimates about 36 per cent of legal professionals would be classified as problem drinkers.

The conversation

Any conversation about substance use often starts and ends with behaviour. There are, however, several important medical and physiological realities that need to be considered. Most of the male barristers I see do not regularly visit their GP. Western medical or allied health services are generally governed by objective analyses and therefore present a constant challenge to world views based on things other than medical and physiological reality. The factual information is often missed, forgotten, or not accessed when one approaches any consideration of their relationship with substances. Figures from the Australian Bureau of Statistics suggest one in 10 Australians are problem drinkers, 32 per cent of lawyers suffer from depression associated with disability, and 40 per cent of law students report moderate to extremely severe depression. In addition, 50 per cent of depressed professionals selfmedicate with alcohol. These statistics reflect the difference between subjective views of what is appropriate and those views based on more objective criteria.

The effects

There are numerous things to note regarding the harmful health effects of substance use. Speaking in general terms, elevated use of substances falls within the classical delineations applicable to a documented increase in cancer, heart disease and heart failure, high blood pressure, deterioration of ejection fraction (EF), HBA-1C diabetes, fatty liver, irritable bowel syndrome (IBS), erectile dysfunction (ED), headaches and even debilitating migraines. Research shows 16 to 24 per cent of lawyers suffer from alcoholism during their careers. The demanding nature of the work, the long hours, competing demands and onerous obligations make lawyers particularly susceptible to drinking alcohol in an unsafe manner. It is a stressful job with scrupulous adherence to consistently high standards. Many times, alcohol is seen as the reward for the not-so-pleasant places the work requires you to navigate.

Many lawyers are reluctant to admit they have issues with stress because alcohol dependency uniquely takes away, or at least masks, their subjective adverse experience of stress. Alcohol has a detrimental impact on the brain. Iron accumulation in the brain due to alcohol consumption may explain why even moderate drinking is linked to compromised cognitive function. Iron accumulation is a plausible pathway through which alcohol negatively affects cognition. Research also suggests higher brain iron could be involved in Alzheimer’s and Parkinson’s disease pathophysiology. Drinking more than seven units, or 56g, weekly is associated with a high assist susceptibility for all brain regions. At the very least, any objective analysis highlights a connection between unhealthy consumption of alcohol and the adverse performance in your practice or business, your marriage or interpersonal relationships and your health.

Professional legal practitioners do want to be able to think, to be able to articulate an opening statement, as well as interact meaningfully with their significant others and associates and then enjoy those non-lawyer things that make life so rewarding. A misconception is alcohol makes us happy and relaxed. Still, scientifically, it is considered a depressant and addictive, so the more alcohol you drink, the sadder your body becomes – and the more you want to drink to get rid of that feeling. Excessive drinking can cause irreparable harm to the brain and body. As a depressing factor, alcohol can compromise metabolism, making way for unhealthy weights to be maintained. Obesity can accelerate ageing and the deterioration of numerous body parts essential to critical function. Depression and alcohol tend to go hand in hand. Alcohol masks depression just like it can help with many other mood disorders. The alcohol molecule is anxiolytic, a drug that can be used to reduce anxiety and many who suffer from depression by self-medicating with alcohol.

Conclusion

In discussions with my colleagues, it seems many other healthcare professionals do not ask patients about alcohol consumption. The healthcare system in Australia, like most others around the world, is under enormous pressure. Many elective surgeries have been postponed for months or years and there is a discrete bottleneck in providing or contact with primary care. Consequently, primary care physicians have learned to book and address patient ailments as singular and often discrete events dictated by the perceived basis upon which the client has arranged the visit.

Alcohol screening is something I do regularly, though not in the first few sessions. Building trust to get honest and reliable answers about such matters is essential. Primary care physicians traditionally don’t ask about alcohol consumption because it is often seen as a lifestyle choice, not a health or therapeutic issue. This approach does not, however, sit comfortably with the realities of the physiology of the substances regularly used in the management of our lives. Some very cold hard truths are connected with substance use that cannot be ignored and they need to be factored into any such conversation. Besides the complex reality of substance use physiology, one needs to consider behaviour. This, however, needs to be done in a context to gain a proper understanding of it. There are several elements to the appropriate behaviour and the context.

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Rebecca Ward MBA is the CEO of Barristers’ Health, focusing on sustainable careers for the legal profession: linkedin.com/in/berekaward (Rebecca); and: linkedin.com/company/74750883 (Barristers’ Health) Rick Green is a practising barrister at the Queensland Bar of 26 years’ standing, working predominantly in areas including or related to personal injury: linkedin.com/in/rick-green-9234b013

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