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Walk the line

29 Nov 2019 / Wellbeing Print

Walk the line

Professional stress can lead to problematic and dangerous addictive behaviour.  The only sure path to authentic workplace wellbeing is disruption to workplace culture at all levels.

Within our addiction services, I frequently observe the pressure legal professionals are under. As with all competitive professions, the pressure can be relentless, coming from every angle – financial worries, increased administration, complaints, staff conflicts, and ever-increasing expectations from the public.

She works hard for the money

In addition, ambitious professionals tend to have a habit of heaping pressure upon themselves. Successful legal professionals will also be aware that success can bring with it even more increased demands, pressures and deadlines. Some young legal professionals struggle to meet the combination of high work demands and raising children.

Much of the difficulty here can be attributed to the increased urbanisation and breakdown of traditional support structures, such as neighbours and local community groups.

To compound matters, family are often located hundreds of miles away, unable to provide support, while childcare costs continue to soar. These problems are not exclusive to Ireland: an increase in population stress is reported in multiple studies from many locations worldwide.

Insomnia

According to research carried out by the Law Society in 2018, stress negatively affects solicitors’ ability to do their jobs. For stressed professionals, sleep disturbance might be the first sign of difficulty. This disturbance can be time limited, but occasionally progresses to a sleep disorder where daytime fatigue and poor work performance sets in.

An anxiety disorder may emerge in the form of persistent nervousness throughout the day and night, known as ‘generalised anxiety disorder’. Anxiety may also emerge in the form of short, intense panic attacks.

An unexpected period of insomnia, anxiety or low mood can be very distressing. Alcohol, addictive substances, and gambling can seem to provide a short-term reprieve from these distressing symptoms.

Too much alcohol

In Ireland, we have some of the highest rates of binge drinking in Europe. Professionals are consuming dangerous levels of alcohol on a regular basis.

A bottle of wine can be consumed in three large 250ml glasses. For a 13.5% bottle of wine, this equates to ten units of alcohol. If this happens three times a week, it is represents an intake off nearly three times the weekly recommended units for women (currently 11 units a week). If a man drinks in this same fashion, they will also be drinking well in excess of recommended levels (currently 17 units a week).

When alcohol is consumed above recommended levels, it affects practically every system in the body. The liver is particularly vulnerable, and women appear to be more susceptible, perhaps due to their lower body mass index.

From a mental perspective, we know that alcohol does not aid in reducing stress and insomnia – it actually adds to stress, as it induces anxiety and depression. Addiction is another unwanted effect of using alcohol to alleviate stress.

The progression from marginally excessive alcohol use, to problematic use, on to full-blown alcohol dependence can be swift. The person can also have very little insight into the fact that their intake has become compulsive.

I wanna be sedated

Sedative medications (known as benzodiazepines and z-drugs) are commonly prescribed by doctors in the treatment of anxiety and sleep difficulties. Common examples are Xanax, Valium and zopiclone. These drugs are valuable medications in the management of anxiety, stress, and sleep problems.

However, these medications are addictive and are recommended for short-term use only. When used for too long or at a higher-than-recommended dose, addiction can occur. Estimates from Britain suggest that up to one million people are addicted to benzodiazepines. There is no question that the availability of these drugs over the internet has increased rates of addiction to these substances.

The internet has allowed individuals to purchase unlimited amounts of benzodiazepines from the comfort of their own home, without any interaction with street drug dealers. The addictive nature of these drugs can lead to a need to take more to obtain the same effect.

Craving for more of these drugs can also emerge, leading to addiction. Protracted use can lead to memory difficulties, road-traffic accidents, falls, balance problems and confusion.

Sister morphine

Other medications offering temporary relief from the demands of modern professional life are opioids. Some opioids in Ireland (such as codeine) are available over the counter. Stronger forms of codeine and other opioids such as morphine are only available with a prescription. In the United States, there are an estimated 130 deaths a day as a result of opioid overdoses.

Pharmaceutical companies initially reported that these medications were not addictive, but it quickly became apparent that this was not the case. The problem escalated to the extent that a state of emergency was declared in the US in 2017. Legal professionals will be aware of the current class actions in the US concerning opioids and the negative effects they are alleged to have on the individual.

Bitter pill

Over-the-counter codeine is often taken to ease the symptoms of stress. Headache, lowered immunity leading to viral infections, migraine, and muscle tension are all potential routes to taking codeine. Many are unaware that codeine is in the same medication group as morphine and heroin, and they believe it to be harmless. The medication is often initially taken sporadically before escalation to everyday ingestion occurs.

Daily doses can then increase in some cases up to 72 tablets in one day (three packets of 24 tablets). The problem of codeine addiction was acknowledged in Ireland, with restrictions on the sale of codeine within pharmacies in 2012.

The internet has undoubtedly aggravated the problem, where the drug is sold openly through online pharmacies. The internet has also opened up the possibility of progression from codeine to taking prescription-only drugs like morphine, oxycodone and fentanyl.

Cocaine

Levels of cocaine availability in Ireland are now thought to be in excess of boom-time highs, with reports that it is easier to order cocaine than a pizza. Users report being energised, with an intense focus after cocaine use that enabled them to keep going with a hectic lifestyle prior to losing control over the drug.

Some will pose the question as to how a legal professional could engage in illegal drug taking when it is so obviously detrimental to the individual and their career? Starting use is much easier nowadays due to the ready availability of the drug.

Attitudes have also softened, with some considering the drug to be relatively benign. The reality is that, although cocaine may have very short-term benefits to a stressed professional, the effects on the physical and mental health for many is devastating.

Magic carpet ride

The legal profession should be concerned about the rise of ‘designer drugs’ in relation to future entrants to the profession. A study at Cambridge University indicated that 10% of students used drugs to enhance study performance. The data did not focus specifically on law students, but we can reasonably assume that they are represented in this data.

Up to 25% of US students have purchased concentration-enhancing drugs like modafinil (used in the treatment of depression) and/or methylphenidate (a stimulant used in the treatment of attention deficit hyperactivity disorder) to aid their study performance. Irish student bodies have raised their concerns about the prevalence of these drugs on Irish campuses.

All drugs have potential side effects, and these drugs are no different. In some cases, taking these concentration-enhancing drugs in healthy subjects has the opposite effect, leading to tiredness, lack of motivation, feelings of nausea, confusion, and even psychosis.

The ace of spades

Online gambling is increasingly used as a form of distraction and stress relief. The sophisticated suites of modern gambling products provide a highly accessible means of escape. Rapid developments in online gambling have made gambling products accessible on a 24-hour basis.

Some professionals use online gambling as a means of regulating emotions and to avoid dealing with negative emotional states.

‘Gambling disorder’ is an addictive state where the person continues to gamble in the face of very obvious adverse effects. One of the most notable adverse outcomes in gambling disorder is the accruement of debt. Intense pressure to alleviate the situation can lead to theft.

Under pressure

Sometimes, being vigilant about our own stress levels and eliminating the destructive nature of stress within our working lives is all that is needed. For others, where multiple pressures and demands are present, making positive changes before the physical and mental effects of stress arise is critical.

These changes include reducing excessively long hours, introducing healthy eating and exercise programmes, exploring the benefits of meditation and compassion, reigniting past passions (including hobbies), as well as developing new and novel interests.

Understanding your own limits, and knowing and believing that wellbeing is an indispensable part of a lawyer’s duty of competence, can help us give impetus to this. Self-awareness can be a real catalyst for tangible change.

Stress management and high-quality wellbeing education programmes are also great additions to any workplace. They are even better if they lead to legal practices identifying patterns of ‘workaholism’ within individuals and toxicity within teams. In many small businesses and big organisations, overworking is seen as a necessary rite of passage before graduating onto higher ranks.

A hard day’s night

Supporting a culture of overworking, however, may be facilitating the development of mental ill-health and addictive behaviours. It can also reinforce stigma associated with help-seeking behaviour.

Taking small, incremental steps to changing workaholic cultures can instil greater wellbeing in the profession. For example, those with an interest in promoting positive mental health might champion stress-management initiatives within the workplace; sharing this article might be the first step you take today.

Certainly, it would be a great way of sending a clear message to fellow professionals that protecting one’s mental health is valued. If you are a leader within an organisation, that message would be made even clearer to fellow professionals.

If this article has brought up any personal issues or concerns for you, please visit the Law Society’s Professional Wellbeing Hub to find a list of independent services you can connect with at www.lawsociety.ie/wellbeinghub.

Prof Colin O'Gara
Prof Colin O’Gara is a consultant psychiatrist and head of addiction services at St John of God Hospital, Stillorgan, Dublin