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| Bar Bulletin |
February, 2003 |
| The Lap Zone |
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Cunning,
Baffling & Patient: the Disease, the Recover and Relapse Prevention (Part
III of III)
By Carol P. Waldhauser
Milford
James was 47-years-old when his family and friends finally persuaded him
to check into an alcohol rehabilitation clinic. For years, Milford
believed that drinking was an essential part of being a man. Similarly, he
believed that drinking helped one deal with life-events. After all, it
played a crucial role in mourning, whether it was the loss of a friend or
a loss of a case. Likewise, drinking played a crucial role in celebrations
of all kinds (i.e., marriages, births, graduations, golfing events and
winning the big case). Through law school and beyond, Milford even
believed that the bonds of friendship and professional camaraderie were
sealed with a drink!
Unaware of the
slow, steady way that alcohol became an essential part of his life,
Milford had little knowledge that he was experiencing the unwanted side
effect of substance abuse: alcohol dependence.
Today, Milford
is 52. For nearly five years, he has not had a drink. During the past five
years in recovery, he claims that the temptation to pick up a drink has
grown weaker. However, Milford knows that this disease is chronic.
Consequently, he is on always guard – one day at a time. Furthermore,
Milford admits that it took him a long time to get sick and it will take
him a long time to get well from the cunning, baffling and patient disease
called alcoholism.
Some people never
get out of the stage of abusing alcohol, while others never hit bottom.
Still others never get well. Yet they share a common bond: they are all
alcoholics.
The progression of
alcoholism takes place over a long period of time, as must recovery.
Recovery is not just detoxification and abstinence from alcohol; it means
learning to live again, without alcohol. This requires change of negative
habits, as well as personality defects. In Counseling for Relapse
Prevention, Terrance E. Gorski and Merlene Miller clearly describe the
scope of what recovery from alcohol means:
Alcoholism is a
disease that has two cutting edges. The first attacks while the person is
still drinking. This is the obvious and the self-evident side of the
disease. What is becoming increasingly clear is that there is a second
cutting edge to this illness. There is a part of this disease that extends
into sobriety and takes a vicious toll on many individuals attempting to
recover. This sobriety-based edge of the disease is as powerful and
destructive as the alcohol-based edge.
They explain
further that in alcoholism, dependence can develop psychologically,
behaviorally, and socially, as well as physically.
Physical dependence
is marked by pathological use, tolerance and withdrawal symptoms.
Psychological dependence develops as the alcoholic uses alcohol to
experience pleasure to relieve pain. He is dependent on alcohol to feel
good (or better). Behavioral dependence develops as the alcoholic
learns to function with the help of alcohol and feels incompetent or
unable to perform appropriately without it. Because of a state of
dependent learning, the alcoholic finds it difficult without alcohol to
behave appropriately. Social dependence results from an
alcohol-centered lifestyle. As the alcoholic slowly adjusts his life to
assure access to alcohol, friendships and relationships change to allow
and support drinking and to provide protection from the consequences of
drinking behavior. All social activities are alcohol-related and the
alcoholic does not know how to function socially without drinking.
Like the descent
into the disease itself, recovery occurs in stages. To understand the
stages of recovery, it is imperative to understand the compulsion within
the individual that creates a tendency towards alcohol-centered thinking,
alcohol-centered living and the desire to use alcohol as a life-management
tool. It is this “stinking thinking,” as old timers in Alcoholics
Anonymous often used to refer to the personality defects within the
recovering alcoholic, that must be addressed before there is successful
recovery.
These stages
include, but are not limited to, the alcoholic:
- Breaking through
the denial of the disease and admitting that he is an alcoholic;
- Being detoxified
from the alcohol and stabilized both physically and psychologically
through intensive counseling on the disease model, plus abstinence and
withdrawal;
- Reinforcing a
long-term commitment to live a clean and sober life;
- Working on
issues and problems that are alcohol-related and identifying and
resolving other life problems that may be unrelated to alcoholism;
- Identifying the
self-defeating personality styles that are highly associated with
relapse and begin a long term program of personality change.
As our case study, Milford,
indicated, this disease is chronic. He knows that working on his recovery
is a life-long commitment which he does one day at a time.
In reality, alcohol
abuse/dependence affects a significant number of lawyers. In fact, studies
over the past several years confirm that lawyers experience a high rate of
chemical dependency that may be related to the stress of practicing law.
It is estimated that at least 18 percent of lawyers may be dealing with
the issues of chemical dependency and alcoholism. Out of 20,000 lawyers,
3,600 are potentially dealing with or will deal with these issues at some
time in their law career. Similarly, statistics prove that a large
percentage of discipline cases involve alcohol and/or drug addiction.
Although the legal
profession is at high risk for alcohol abuse/dependence, recovery works.
A recent study by the Oregon Attorney Assistance Program (OAAP) provides
convincing evidence that getting lawyers into recovery saves dollars as
well as lives – and protects the public. The OAAP study, completed in
2001, involved 55 recovering lawyers who were in private practice for five
years both before and after their sobriety dates, a ten-year period in
all. The study shows that malpractice and discipline complaint rates for
lawyers before recovery to be nearly four times greater than lawyers in
recovery. Lawyers in recovery also have lower malpractice and discipline
complaint rates than the general population of lawyers, according to this
study. This Oregon study is consistent with other studies looking at
related questions.
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