July-August 2013

A devastating disease rampant among attorneys

David Escamilla

County Attorney in Travis County

This past year I celebrated my 30th anniversary as a licensed attorney. And by the time you read this article, I’ll be completing my 28th year with the Travis County Attorney’s Office. It’s been a remarkable experience. I’ve been so fortunate to witness the highs of working in a prosecutor’s office while suffering very few of the lows. But sadly, there have indeed been lows during that time.
    I think most long-termers would agree that a highlight of our job is the relationships that we form with fellow prosecutors, office workers, judges, law enforcement officers, and even defense lawyers. They become good friends, trusted associates, and sometimes even family. Because we become emotionally tied to these people, their joys and sorrows are often shared among us. And too often, those sorrows relate to alcohol or substance abuse.
    I’ve personally witnessed the devastating impact of this disease among members of our profession. Several have managed to regain control while others are still struggling; some that I cared very much about have lost the battle, tragically, with the loss of their lives. With most, I was involved in the varied efforts to assist them. I’ve counseled with many, and even employed one with the purpose of helping her on the road to recovery. I’ve also had to accept failure and allow an employment relationship to end, all the time fearing that my friend and colleague’s options were few. That person, a witty and very able prosecutor, eventually lost her personal battle with alcoholism and the depression that too often accompanies the disease.
    I’ve often reflected back on our relationship, both as friend and employer, especially rethinking the actions and strategies we had undertaken to turn the situation around during those last few years. I don’t know if I could have done much of anything differently. But I now recognize that the situation was not unique in our profession and, more importantly, that considerable research and assistance is available.
    The American Medical Society determination that alcoholism is a disease dates back to 1957. The National Council on Alcoholism and Drug Dependency and the American Society of Addiction Medicine has since provided this definition: “Alcoholism is a primary disease with genetic, psychosocial, and environmental factors influencing its development and manifestation. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol despite adverse consequences, and distortions in thinking, the most notable being denial of a problem.”
    The American Bar Association estimates that 15 to 20 percent of attorneys suffer from addiction or mental illness, compared to 9 percent of the general population. Consistent with these findings, the National Institute on Alcohol Abuse and Alcoholism estimates that while 10 percent of the U.S. population is alcoholic or chemically dependent, the abuse may be as high as 20 percent among lawyers. And research data from SAMHSA (Substance Abuse and Mental Health Service Administration) support findings that addiction rates among lawyers can approach twice that of the general population. Interestingly, these risks don’t appear to dissipate with age. While 18 percent of attorneys with two to 20 years of experience reported drinking problems, this statistic increased to 25 percent for attorneys who had practiced more than 20 years. Alcoholism is a contributing factor in approximately 30 percent of all suicides. Alarmingly, attorneys as a profession can now lay claim to the highest suicide rate of any profession.
    Substance abuse includes the misuse of prescription drugs and/or dependence on illegal drugs, including heroin and cocaine. Some studies even go so far as to suggest that attorneys abuse cocaine at twice the rate of non-lawyers. Substance abusers are typically functional in the workplace. Almost three out of four are employed.
    Some might assume that these rates are lower among prosecutors and other government lawyers, given that we are spared the additional stress of maintaining a private practice, paying the bills, and generating clients. But studies show that public-service attorneys experience greater stress and burnout when compared to the general population. And still other studies confirm a connection between work-related burnout and substance and alcohol abuse in other professions.
    In fact, prosecutors may have more to worry than many of those in private practice. Two separate studies published in 2003 found that attorneys practicing criminal and family law (prosecutors included) run a higher risk of suffering from compassion fatigue. Compassion fatigue, also called secondary traumatic stress, is defined as “the cumulative physical, emotional, and psychological effects of continual exposure to traumatic stories or events when working in a helping capacity.” Does this sound anywhere similar to our job description? What portion of our workweek is spent reading offense reports and victim/witness statements, listening to victims, and viewing photos, much of which detail violent and traumatic occurrences?
    These statistics highlight not only the debilitating effects sustained among impaired lawyers but also raise questions regarding the level that their clients also suffer. Bar organizations estimate that 50 percent of lawyer discipline cases involve chemical dependency.
    These ominous findings have not gone unnoticed in our profession. Assistance programs began developing throughout the country as early as 35 years ago to help legal professionals impaired by substance abuse. State bar associations, many spurred on by members who had struggled and overcome their own addictions, recognized the threat to the profession and implemented these programs to provide much-needed resources and to support lawyers in crisis.
    According to the U.S. Office of Personnel Management, there are many signs that an employee might exhibit that may indicate a problem. They include: excessive use of sick leave, frequent unexplained or unauthorized absences from work, missed deadlines, careless or sloppy work, and belligerent, argumentative, or short-tempered behavior.
    The CAGE Questionnaire was developed in 1970 by Dr. John A. Ewing and is used for screening patients for alcoholism. CAGE is an acronym made up of its four questions:
1.    Cut Back? Have you ever felt the need to reduce the level of your consumption?
2.    Annoyed? Have people ever annoyed you with their criticism of your drinking or using habits?
3.    Guilty? Have you ever felt guilty while you were drinking or using?
4.    Eye-opener? Have you ever started the day with a drink or drug, either to wake yourself up, relax, or cure a hangover?
    According to Dr. Ewing, two or more “yes” answers indicate a positive history of alcoholism.
    Additionally, the website www .alcoholscreening.org provides individual assessment of alcohol consumption patterns to determine if drinking is likely to be harming someone’s health or increasing his risk for future harm. Through education and referral, the site urges people whose drinking is harmful to take positive action and informs all who consume alcohol about guidelines for lower-risk drinking.
    The Texas Lawyers Assistance Program (TLAP) “provides confidential help for lawyers, law students, and judges who have problems with substance abuse and/or mental health issues.” Its confidential hotline can be reached any time of day or night at 800/343-8527, or at www.texasbar.com/tlap.
    Whether you are the employer, employee, judge, law partner, law firm associate, friend, or colleague of a person struggling with alcoholism or substance abuse, your recognition and understanding of the nature of the problem can be vital in helping that individual. Maybe, just maybe, if I had understood that our profession was particularly at risk to alcoholism and substance abuse, and had I been more aware of the wealth of resources available to us within our profession, I might have persevered and not accepted defeat when I did. Just maybe, we would have another exceptional prosecutor among us today.