Signs and Symptoms: Knowing How They’re Different Can Make a Difference

Vol. 32 No. 3

By

Patricia Spataro is director of the Lawyer Assistance Program of the New York State Bar Association.

The general signs and symptoms of a person with an impairment are fairly well known and can be captured in one easy statement: observable, significant, and sustained changes in behaviors that negatively impact a person’s ability to function. Whether the impairment is alcoholism, prescription drug abuse, or gambling, the signs and symptoms are similar.


Signs are objective in that they are observable behaviors and are, therefore, similar to facts. Symptoms are subjective in that they are open to interpretation. Alcoholics assign meaning to their symptoms that justifies their drinking. For anyone trying to help an addict and the people impacted by the addict’s behavior, this is a critical distinction. The crux of an effective intervention lies in focusing on the signs (also called the fact pattern). Because symptoms are easily manipulated, using them as a place to get a foothold would be futile.

Symptoms are the experiences reported by the person with the impairment. In her article "Anonymity or Disclosure? The Choice I Made about My Alcoholism," Judge Sarah L. Krauss describes what she was thinking and feeling during her drinking years, as well as what was happening to her during this time. From her perspective, everything in her life was going wrong. What makes this account subjective is that even though the facts were correct—everything truly was going wrong—she at the time interpreted the facts erroneously by assigning blame to others. Like any addict, she viewed the facts of her wayward life as a result of anything and anyone but herself and her drinking.

Signs are what the people closest to the addict sees. These observable behaviors are fact patterns. Although people have intense feelings and opinions about these facts, their feelings and opinions don’t change the facts. For example, an employer may be angry and frustrated by declining work performance, but regardless of how the employer feels, the fact that the person calls in sick most Mondays and Fridays and takes three-hour lunches on the days he does show up doesn’t change. The objectivity of signs gives us the only possible foothold from which to confront the impairment. They are observable behaviors that are hard to debate or argue. Being late, failing to meet deadlines, being moody, treating people disrespectfully, withdrawing, declining work performance, deteriorating personal appearance, defensiveness, lame excuses for mistakes, breath smelling of alcohol, slurred speech, unsteady gait, arrests for drinking and driving—all are examples of signs.

“Enabling” is the process by which we try to change another person by our feelings and opinions about the facts rather than holding the addict accountable to them. All the while the addiction rages on. Maybe those of us who are enablers (hopefully recovering enablers) unknowingly default to a plan of waiting until we are absolutely sure that a person is, in fact, an alcoholic. This will be the indisputable, totally objective fact that the addict can’t deny. It turns out that addicts dispute the most indisputable facts. But don’t be bamboozled . . . take those observable, significant, and sustained behaviors and start using them as leverage. Oftentimes, this is the only thing that works.

Please don’t hesitate to contact your state lawyer assistance program to gain this leverage. The staff of these programs are always willing to give you all the confidential assistance you will need to assist the attorney, judge, or law student who may be showing signs of impairment.

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