April 02, 2019

Overcoming Stress, Addiction, and Depression

Kenneth J. Hagreen


Most lawyers know that hard work is an essential ingredient to success and that stress is our number-one motivator to work hard. They generally acknowledge that too much stress over too long a period of time may lead to job dissatisfaction and burnout, but many are unaware that chronic stress opens the door to depression, other illnesses, and substance abuse—and substance abuse may trigger a dormant addiction or speed up an existing one. Some lawyers believe they are immune from these stress-related problems and that enduring increasing levels of stress is a measure of their lawyerly prowess. Long workdays and workweeks become the lawyer’s “red badge of courage.” These men and women are often blindsided when chronic stress morphs into job dissatisfaction, burnout, illness, ruined relationships, disciplinary complaints, and malpractice suits. Some lose their families, their jobs, and their law licenses. Some die. These are intelligent, educated, capable men and women. What happened?

Through the past 30-plus years, I have worked with small-town lawyers and international law firms. I have found that most lawyers enter the practice of law with high ideals, a desire to help others, and a healthy ambition to succeed. It appears that some of these lawyers gradually lose their way and one day find themselves in a blind alley of dissatisfaction, dysfunction, substance abuse, depression, addiction, or worse. They are ensnared by the rapidly changing, technologically driven, hyper-paced nature of the law; its increasing complexity and the inability to know everything; unrealistic client expectations coupled with increasing dissatisfaction of clients who may have been accorded procedural due process but perceive a lack of procedural fairness; increasing willingness of clients to sue their lawyer; the decline of collegiality coupled with a growing competitiveness and a combative environment (even within a law firm); less direct, personal contact as communication increasingly takes place through advanced technology; and the drain on emotional health resulting from the daily frustrations of providing legal assistance to many clients whose lives remain entangled in dysfunction, mental illness, and addiction (commonly known as “compassion fatigue”).

It is a wonder that more lawyers are not in worse shape after suffering the physical and emotional beating inflicted upon them by the practice of law. But, the fact remains, many lawyers appear to be doing just fine. Why is it that some lawyers fall into a pit of distress and despair and others do not?

Perhaps the answer lies with the individual. It is well known that a person’s current physical health, lifestyle, and mental health influence his or her reaction to life’s continuous stream of events. Throughout most of my life, I endured anxiety that alternately interfered with or enhanced my ability to function as a lawyer. It could paralyze me or motivate me. This anxiety generally manifested itself as perfectionism, procrastination, and codependency. I believe my anxiety has a neurological basis, which was amplified during my childhood by a perceived need that I should not make mistakes. As a young adult, my experimentation with alcohol and other mood-altering drugs acted as a form of self-medication. During this period of time my anxiety often disappeared. However, relief was temporary. As my addiction progressed, my anxiety returned, and my stress levels rose in proportion to my increasing work responsibilities and declining professional abilities. I worked longer hours, often seven days a week, in order to protect both my job and my need to drink and drug. I know others who had similar experiences as a result of depression, gambling, and other disorders. My point is that some lawyers are more vulnerable to stress as a result of illnesses that they neither asked for nor wanted. These illnesses eventually interfere with their ability to work effectively and efficiently. The stress builds as lawyers fail to keep up and feel their life is spiraling out of control. The alcoholic drinks more; the depressed get more depressed; the pathological gambler keeps gambling.

Although most lawyers do not suffer from addiction or depression, nearly all struggle from time to time with feelings of being under stress. This is usually the result of temporary circumstances in their lives, such as an increased workload or family obligations. Weak time-management skills coupled with a hectic schedule that results in loss of sleep, no time to relax, skipped meals, poor diet, and lack of exercise set the stage for feeling overwhelmed and no longer in control of one’s life. As the stress builds, it degrades the lawyer’s quality of life until his or her normal routine returns. The danger is that, for some, there is always something else to be done that claims priority over a healthy, balanced lifestyle. If not careful, these lawyers become workaholics and enter a world of constant stress.

And, finally, there are lawyers who may or may not be addicted, depressed, or struggling with a hectic lifestyle but are encumbered with personality traits that increase their levels of stress (e.g., perfectionism, low self-esteem, procrastination, worry). The truth is that these personality traits may be the outer signs of deep-seated negative emotions: anger, fear, and guilt. Without help, these lawyers will continue to struggle through life and may later suffer from depression, substance abuse, or other illnesses.

What can be done to help these lawyers?


Enter Ami

I first met Amiram Elwork in 1997 when Pennsylvania’s lawyer assistance program (Lawyers Concerned for Lawyers of Pennsylvania, Inc., or LCL-PA) added stress and depression to its help-line outreach services. Ami, as most friends call him, is the director of the Law-Psychology Graduate Training Program (JD/PsyD) at Widener University and the author of Stress Management for Lawyers (now in its third edition, Vorkell Group, 2007). By profession he is a psychologist, teacher, and public speaker. I’m a lawyer who in early 1983, at age 32,was shoved into recovery for alcoholism and drug addiction (it didn’t stick until mid-1984). I practiced law from 1977 until I went to work for LCL-PA in 1990. Ami and I have different family and personal histories, educational backgrounds, career paths, and experiences helping lawyers in distress. Ami sees the world through the eyes of a clinician trained in recognizing and changing maladaptive learned thoughts, emotions, and behaviors. I view life through a 12 Step pair of glasses supplemented by an informed layman’s understanding of the influence of neurochemistry on how we think, feel, and act. Despite our differences, we share the same passion for serving lawyers in distress.

Over the years we have collaborated on several continuing legal education programs. Our conversations were collegial and informative, although for a long time I struggled with reconciling Ami’s talks on learned behavior with my knowledge of the role of neurology in causing alcoholism. Most 12 Steppers have an innate skepticism of psychologists when it comes to treating alcoholism. I’d always sneak into the conversation that therapy does not cure addiction and that the safest course for alcoholics is abstinence. However, in all other areas of our discussions regarding helping the distressed lawyer we were in full agreement.


My Experience

When Ami and I discuss what can be done to help lawyers in distress, we generally validate what we each know. For example, I function better when I keep a regular sleep routine (i.e., go to bed at the same time and get up at the same time with an average of eight hours per night). I feel better when I exercise, moderate my intake of caffeine and sugar, and don’t overeat. I do my best when I avoid HALT—that is, getting too Hungry, Angry, Lonely, or Tired. HALT throws off my body’s chemistry, lowers my resistance to stress, and interferes with my ability to cope. Also, I use worrying as an early warning signal to work smart. I immediately list all of my projects, deadlines, and priorities. I prepare a short to-do list for each project; identify problems, scheduling conflicts, and where I need additional support; prepare a more detailed action plan; and then get to work. At that point I am usually too busy to worry; however, should I continue to worry, I ask myself what is the worst thing that can happen to me and can I survive it? With age has come the wisdom of knowing that I can probably survive anything. It may not be pleasant and I may not like it, but I can learn to accept it. Should I continue to worry, I know it is time to seek professional help, as my worrying may be the symptom of an anxiety disorder or depression.

Speaking of anxiety, mine was often accompanied by lack of self-confidence and fear of failure. I thought I wasn’t as good as the other lawyer. This was a major source of my stress. I also thought I had to win every case, solve every problem, and help everyone who came through my office door. I worked hard and I had many successes, but they were never enough. To add insult to injury, my low self-esteem undermined my ability to charge and collect legal fees.

Just this side of bankruptcy I landed a job as in-house counsel with a real estate development company, and my career took off in a new and profitable direction. Nevertheless, my anxiety and lack of confidence followed me. This time it popped up disguised as codependent behavior. In other words, I thought it was my responsibility to solve any and all corporate legal problems that were brought to my attention. I had no work boundaries, and as a result, I worked more hours than anyone else in order to complete my assigned work and the extra work I felt obligated to do. My personal time was sacrificed for the good of the company (or so I thought).

One day the other vice presidents conducted an intervention of sorts—they pointed out that although I work hard, I did not work smart. Having a knack for expressing myself concisely, I gave them a two-word reply and left the room. After I cooled off, I apologized and asked one of the guys for help. He showed me how to identify and organize my priorities and create a realistic work schedule. I finally had a proper set of priorities and work boundaries. I quit trying to solve everyone’s problems.

Although I now possessed the basic skills to work smart and set healthy boundaries, I still hadn’t mastered my low self-esteem. It fueled my perfectionism and tendency to procrastinate. It was many years later before I discovered that by working smart, I could identify a reasonable amount of time, energy, and other resources to be devoted to a project based on its importance and due date and then give myself permission to do the best I could within those parameters. It did not have to be perfect. This reduced my stress dramatically and had the added benefit of nearly eliminating my procrastination. As my friend Ami recently said, he strives for continuous improvement and excellence—not perfection. This dovetails perfectly with my 12 Step recovery program, which speaks of claiming progress rather than perfection.


Ami’s Insight

Much of what Ami and I talked about was nothing new to either of us, but we enjoyed one another’s company as we exchanged ideas for new educational programs. Then, at a recent lunch meeting, he shared with me a personal revelation—something that changed his outlook on life. He talked of experiencing a deeper insight into the role that being true to oneself plays in a person’s life. Now, this is not to say that Ami did not previously understand and promote personal values as a therapist. He has always acknowledged that having good values is commendable and has lived his life accordingly. What had changed for Ami was his understanding of the emphasis to be placed on honoring one’s personal belief system. He clearly saw that a very important source of good health and happiness is found in how we live our lives. Ami went on to explain how both 12 Step programs and therapeutic techniques such as cognitive therapy ultimately bring us to the same point: to an understanding of what we really believe in and who we want to be, and to an inspiration to do our best to be that person in all of our affairs. Right thinking and right action lead to healthy feelings, which reinforce our right thinking and right action. In other words, we think and live our way into a continued state of good physical and emotional health (this relationship, by the way, is backed up by scientific studies on neural plasticity and epigenetics).

I was ecstatic. Before me was a therapist with the courage to challenge years of formal psychological education, training, and experience in a quest to find out if there was another “truth” that could more effectively help those in distress. In the process, he bridged the gap that often exists between the therapeutic community and 12 Step fellowships—an all-too-often formidable schism between those with valuable and effective psychological techniques and those who have gone through the crucible of the 12 Step recovery experience but who are skeptical of anyone who has not walked in our shoes. Ami had, if you will, found his own Rosetta Stone enabling him to effectively engage both therapy and recovery. For example, Ami talked about how lawyers can reduce stress by becoming “emotionally intelligent,” that is, by developing a greater awareness and understanding of their (and others’) negative emotions and learning how to effectively respond to them. He discussed the three types of negative emotions (guilt, anger, and fear) that plague many of us and seem to pop up automatically from nowhere to undermine our peace of mind. Ami emphasized how both cognitive therapy and working a 12 Step program can address these issues. I then shared how my freedom from these negative emotions occurred gradually through 20-plus years of “working the Steps,” but how I experienced a quantum leap in my recovery when I began applying the principles of cognitive therapy and motivational interviewing to my daily life. Once I became fully aware of how subconscious fear, guilt, and anger entered into my day-to-day existence, understood what erroneous thoughts preceded these feelings, and began to challenge these thoughts, I was freed from hanging onto these feelings. And with that freedom, my low self-esteem all but disappeared.

By the end of our conversation, it was clear that Ami and I understood each other in a way that transcended our different life experiences.


A Shared Commitment

At our most recent lunch meeting, we revisited our discussion on values and how we can assist individuals in aligning their lives with their core beliefs. Ami reminded me that we may use a different jargon, but the tools of the therapist and the 12 Stepper are the same. Both approaches are based on certain timeless, universal principles that always effect change: awareness, understanding, intelligent analysis, and action. We both acknowledged that these are the keys to changing your life from one of distress, dysfunction, depression, or addiction to one of improved health and increased happiness. We took turns sharing how each of us used these principles to free ourselves from the bondage of perfectionism and, also, for me, from anxiety and addiction. We acknowledged our gratitude and our desire to share these “open” secrets to happiness with others. Our conversation was personal as well as professional.

We then discussed how any man or woman whose life does not conform to his or her core values will ultimately suffer feelings of guilt, anger, and fear. These feelings generate high levels of distress and discomfort that will cause the perfectionist to obsess even more over work, the worrier to lose even more sleep, and the substance abuser or addict to pick up a drink or drug—all of them acting in the only way they know how in an elusive quest for relief. But we agreed that lawyers are intelligent and capable of change. Upon recognizing the symptoms of distress, depression, or substance abuse, the lawyer can seek out a qualified professional to assess the true nature of the problem as well as the current level of risk for harm and make suggestions on how to improve the quality of his or her health. The keys are to become familiar with the general warning signs of distress, to be vigilant in keeping an eye out for them, and to use these warning signs as a signal to seek help and make the appropriate changes:

Warning Signs of Distress

  • Sleeping too much or sleeping too little
  • Insomnia
  • Sudden weight gain or weight loss
  • Increasing levels of irritability and impatience
  • Regularly using alcohol or other drugs to relax or to fall asleep
  • Using more alcohol or drugs to either obtain the desired effect or to feel normal
  • Regularly feeling angry or fearful
  • Having increasing feelings of hopelessness and self-pity
  • Engaging in unsafe or inappropriate activities
  • Feeling alone and misunderstood
  • Increasing isolation and dropping out of social activities that you used to enjoy
  • Difficulty concentrating, remembering, or making decisions
  • Loss of energy and motivation
  • Thoughts of ending your life

Sometimes all you may need is a self-help book. Other times may require professional help to treat anxiety, depression, addiction, or another disorder.

And for those who believe that taking your life will not matter to anyone, please know that we do care about you, we want to help you, and some of us once felt as you do now. But we have found a new life where hope and happiness are a reality. Getting help only takes a phone call to your local lawyer assistance program or crisis hotline. Making that call can be difficult. But it will pay off. Had I not accepted help, I would never have met Ami Elwork, I would not have enjoyed his friendship, and my life would not be as enriched. I also wouldn’t understand the role conditioned learning played in my life and how by becoming aware, understanding those subconscious triggers, and taking action I have freed myself from the past. Thank you, Ami. 

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