Addiction + Addictive Behaviors

QUESTION:

Are there any recovery support groups for judges in Western Massachusetts?

ANSWER:

Thanks for this great question! While judges are welcome at our Springfield meeting, we do not currently run a recovery peer support group that is exclusively only for judges.

Our addiction recovery peer support group meeting in Springfield is exclusively for lawyers, judges, law students, and other legal professionals. It meets on the third Tuesday of every month at the Springfield Sheraton — find more here. Judges are welcome and encouraged to attend this, and all attendees are made aware at the start of every meeting about the strict confidentiality of our groups.

While we encourage judges to attend our Springfield meeting, we understand that this can be difficult. Judges may feel that their struggles are different than attorneys’ and be hesitant to share, or they worry about sharing personal concerns or questions with lawyers who may end up appearing in front of them.

If you would like to discuss these types of challenges and explore starting a judges group in Western Massachusetts or just talk with someone, we encourage you to contact our executive director, Anna Levine, who has a lot of experience in the area of recovery and who lives in Western Massachusetts. Although Anna is a licensed attorney, she is not currently practicing and therefore there would be zero risk of her appearing in front of judges that might participate in such a group. Anna will hold in strictest confidence the content of any meetings you or anyone else might have with her.

Anna can be reached at anna@lclma.org or 617-482-9600.

We encourage others in the legal profession to contact Anna (above) to express interest in forming an addiction recovery peer support group meeting in a new location — whether for judges or the legal profession generally.

We also encourage lawyers, judges, and law students in Massachusetts to talk with one of our clinicians to help find the right support. Find more on scheduling a Free & Confidential appointment here.

QUESTION:

I am looking for an alanon meeting in the Cambridge/Arlington/Lexington area. Do you know of any? Does Lawyers Concerned for Lawyers have group support meetings for dealing with an alcoholic spouse?  Thank you.

ANSWER:  

We can’t recommend a specific Al-Anon meeting for you, but you can find a list of various kinds of Al-Anon meetings at  http://www.ma-al-anon-alateen.org/findameeting.php .  On this web page, you can plug in either the day of the week or the town and see what options emerge.

As of this writing (12/15), LCL does not have an Al-Anon type of group (i.e., for family members of alcoholic/addicted lawyers, or for lawyers who have alcoholic/addicted spouses or other family members – it would probably also include adult children of alcoholics/addicts).  But we are more than willing to sponsor such a meeting if we were to get enough potential candidates to express an interest (do you know of any besides yourself?), including at least one person who would serve as a coordinator and chairperson.  Anyone reading this who is interested can contact Dr. Jeff Fortgang of our staff at DrJeff@LCLMA.org.

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My coworkers at the large Boston firm where I work have no idea how out-of-control my life is, even though my work is beginning to show the effect. I am addicted to on-line gambling, which has become more obvious to me since I decided on two occasions to stop and was unable to fight the siren call of web sites that have become my virtual home. I get a rush from gambling that is like nothing else I’ve experienced, and I keep wanting more. I have been ahead of the game financially a number of times, which could have provided a needed cushion against the prospect of layoff in these difficult times, but instead I simply could not help but push the betting further until, ultimately, I have lost so much more than what I ever won. It’s been really hard to admit that I seem to have zero ability to harness my intellect or capacity for lawyerly logic to override the drive to gamble. Since I’m single, there is no dismayed spouse to face. But the combination of the web sites themselves and my worries about unpaid bills and mounting debt is distracting me from the work that my colleagues believe I’m handling. What can I do to turn things around before I am discovered and discarded?

The “rush” that you describe seems to be a common denominator between compulsive gambling and stimulating addictive drugs, especially for those who have been termed “action seeker” gamblers (as opposed to “escape seekers”). As with such drugs, many gamblers experience subjective withdrawal symptoms when the activity is interrupted, and there is a risk of relapse even after years of abstinence (with little or no chance of turning into a “moderate” gambler). Interestingly, new kinds of brain scans used in neuropsychological research show that pathological gamblers exhibit the same kinds of brain activity as do drug addicts when exposed to stimuli associated with the addictive behavior. In other words, for someone addicted to gambling, neuro-chemical events perpetuate behaviors in which we engage without our own consent, so to speak. It therefore becomes highly worthwhile to avoid any gambling behavior or stimuli associated with it.

If you think it’s only a matter of time until your firm discovers that the quality of your work is suffering, and especially if it has an employee assistance program, you might consider speaking to an EAP counselor, or someone the firm may have designated as a contact for alcohol/drug problems. (LCL is, of course, available as your Massachusetts lawyer assistance program, though we will have a less clear picture of the culture of your specific workplace.) Under the kind of policy associated with the employee assistance model, you may get support, and a little time, to return to your former level of functioning by getting appropriate treatment. Treatment may consist of a combination of approaches: self-help (typically Gamblers Anonymous); psychotherapy (often of a cognitive-behavioral bent, focusing on matters such as developing strategies to cope with urges to gamble), and possibly medications. Antidepressants may be helpful, especially if your mood has been affected (and we know that gambling problems can lead to depression that is sometimes quite severe). There has also been some research suggesting (with mixed results) that craving reduction medications developed for use with opiates and alcohol may also help reduce the craving for the next bet.

We can advise you with some assuredness that you should not expect, at any point, to turn into a “normal” gambler, and that getting help from others (peers and/or professionals) is more likely to bring success than attempting to solve the problem on your own

Unfortunately, all the very potent painkillers present the potential for abuse and/or addiction. We checked with a chronic pain specialist about Ultram, which some internet sites tout as non-narcotic and therefore safer, but he tells us that some patients have abused or become dependent on it, and that there are published reports of addiction relapse (e.g., to heroin) triggered by using this medication.

Some patients on methadone maintenance (and methadone, of course, is an opiate) get some pain relief, but we know that many people end up abusing methadone, as well, by obtaining it “on the street.”

The safest options, not surprisingly, are the ones with a slower and less dramatic effect. Naturally, this includes the so-called NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen. Our consultant tells us that many patients have also found that certain antidepressants, muscle relaxants, or anti-seizure medicines make a significant dent in their pain.

Safer still, and sometimes quite effective, are the non-medicine approaches such as meditation, appropriate exercise, and acupuncture. All pain treatment options are best discussed with a physician who is well acquainted with the areas of both pain management and addictions.

I am a 50 year old solo practice lawyer, and I think I continue to turn out very good work. I am also a fairly conventional person. But the fact is that I am addicted to opiates. I was introduced to them when, a decade ago, I had the first of a series of surgeries for back and joint problems and needed painkilling medication to recover. I’m not certain where the pain ended and the addiction began, but I have developed a very high tolerance and a true dependence. Whenever I try to walk away from these pills, I get very, very sick and simply cannot cope with my responsibilities. I am finally realizing that I need help to get unhooked – but I have run into some roadblocks, because I have no health insurance. What options do I have?

Here we run into the problem of living in a land where health insurance is not universal, and where many cutbacks have been made in both private and government-supported services. For detox, you have essentially three possibilities: (1) one of the public detoxes, supported by the Department of Public Health, which may not be particularly inviting places, but can safely withdraw you from opiates; generally you must call every morning to ascertain whether a bed is available; (2) “free care” at a general hospital that has a detox unit – which requires a potentially time-consuming application process including proof of income and assets, but offers a wide range of medical services at that hospital to those who qualify; (3) office-based detox (or maintenance) now offered by a small number of specially certified physicians and clinics using either of two medications, Subutex or Suboxone – generally involving a fee for both physician and medicine, unless you find a free-care option through a hospital clinic.

Detox, however, is only the beginning, and relapse potential is significant enough to warrant further assistance. For some people, a combination of self-help meetings (e.g., Narcotics Anonymous) and professional outpatient treatment (either self-pay or via hospital free care) may be sufficient. Others will find that they need a longer period of time away from home and their usual haunts. Massachusetts has a number of halfway houses with no financial barriers, but gaining admission may take months and many will require that you come directly from a hospital. So-called “sober houses” are rented residences of various kinds that require abstinence as a condition of tenancy. Some have a staff and may provide house meetings or transportation to self-help meetings; others are essentially boarding houses. A number other facilities (generally in other states) offer a combination of residence and counseling at a price well below an insurance-oriented Massachusetts program.

That is a rough overview of the kinds of resources available to the uninsured person with an addiction. In some cases, LCL may be able to loan you funds to help cover treatment costs. As usual, we suggest that you arrange a face-to-face meeting with one of our staff, who can review the particulars and assist you in the search for appropriate resources.

I have a question about the utility of medicines for alcoholism, particularly with regard to my husband, who has never latched onto AA or counseling. One of my friends has recommended Antabuse, while another friend with experience in this area says it’s useless. Are there other alcoholism medications as well?

Antabuse (generic name disulfiram) has been around since 1948. It blocks the normal metabolism of alcohol, causing a buildup of a chemical called acetaldehyde which then triggers an immediate and extremely uncomfortable physical reaction described as “a combination panic attack and stomach flu.” It can be severe enough (depending in part on how much alcohol is ingested) to call for emergency room treatment. One hears that this reaction could in theory be lethal, but we have never come across such a case.

The idea, of course, is that fear of the severe Antabuse reaction to drinking will act as a deterrent to the impulse to drink and buy time for the recovering individual to develop sobriety skills, i.e., new ways of thinking and coping. Some have been disappointed in the effectiveness of Antabuse, because many alcoholics find a way to rationalize discontinuing the medication. When a sufficient number of days have elapsed, they have regained the option to drink without a reaction. Thus, the motivation to avoid that first drink, despite any temptations, cravings, or urges, must thus be quite strong. In order to avoid subverting the benefit of Antabuse in this way, some people will establish an “Antabuse Contract” contract with an observer, such as a spouse. Antabuse, which is only applicable to alcoholism, is generally not prescribed to individuals with compromised livers or heart disease.

Two other medications have been developed to help with recovery from alcoholism. Campral (generic: Acamprosate), widely used in Europe to reduce alcohol craving, is now FDA-approved for use in the US to decrease relapse to heavy drinking in abstinent alcoholics. It appears to help re-stabilize neurotransmitter systems that suffer changes due to long-term drinking. Though reversible within weeks or months of sobriety, these changes appear to be responsible for relapse-inducing discomforts, e.g., anxiety, irritability, sleep interference.

Another drug, ReVia (Naltrexone), originally used to treat narcotic addiction, was discovered to also reduce relapse to alcohol. It is believed to act on certain opiate receptors in the brain by blocking the release of dopamine in the brain’s “reward system” producing alcohol-related euphoria. Drinking no longer produces a buzz and therefore reduces craving. A reportedly more potent and long-lasting version of ReVia is Revex (Nalmefene), which blocks all opiate receptors. A 3rd drug, Topomax (Topiramate), is an anti-seizure medication also commonly used to stabilize moods. A recent study suggested it may reduce drinking and craving in alcohol-dependent patients who are not yet abstinent., though it is not yet FDA-approved for alcoholism treatment. The effectiveness of these drugs, which are not without mild to moderate (but usually short-term) side effects, depend on the desire to stop drinking, and are adjuncts rather than substitutes for psychosocial interventions such as counseling and self-help groups. Our experience suggests that those who would use medications as stand-alone treatment for alcoholism would be at especially high risk for relapse.

Only with anonymity would I disclose my concern. I am a 39 year old female paralegal in a large law firm, and involved in a clandestine affair with one of the firm’s partners. I am also married with a 10 year old child. This is actually my second such relationship at the firm. I don’t think my coworkers know, though I’m not certain about his secretary. For me, it’s not just the sex, though the secrecy of that, at the office, makes it exciting. It’s romantic. I think about him all the time, and how he seems to care more about me than my husband does. The problem is that I realize I’m jeopardizing my family life and probably my job. I can usually justify my behavior to myself by blaming my self-centered husband, but on some level I’m ashamed, and lost as to how to sort this out.

Your affair can be looked at in a number of ways. In one way, it can perhaps be understood as a symptom of marital problems, as “acting out” your feelings of neglect rather than addressing them more directly with your husband or going into couple therapy. Although the partner with whom you are involved may be a very appealing man, it may be that the intensity of your attraction to him, and to the object of your previous work relationship, really does not have a lot to do with him as an individual.

Some people may become more obsessed with sex or crushes in connection with mood swings, but will behave in less risky ways when an underlying mood disorder is treated. Furtive affairs sometimes can be seen as a type of “sexual addiction.” While men viewed as sexual addicts tend to engage in activities such as compulsive voyeurism, masturbation, use of pornography, or picking up strangers, women seem to be more likely to become obsessed with what feels like romance and what might be called pseudo-intimacy. In either case, there can be a “high,” perhaps representing a neurochemical process, that overrides good judgment.

Regardless of the lens through which you attempt to understand your affair, it certainly deserves your conscious attention. Rationalizations aside, you seem to recognize that you may soon find yourself suffering a myriad of negative professional and personal consequences. Why not follow up your anonymous question by coming to meet with us for a full, confidential evaluation and a referral to someone with whom you can face the issue head on.

My law partners and colleagues know that I’m alcoholic and have not had a drink in almost a year. However, they don’t know about my struggles with painkillers, which I began using on a prescription basis years ago to deal with a very painful, recurrent medical condition. Sometimes these pills offer me the only means of relief I can find (short of returning to drinking). But I have also quickly developed a tolerance, needing higher and higher dosages. Subsequently, things have gotten out of control – first, I’ve had to go to multiple doctors when no one doctor will prescribe enough, and later I’ve endured debilitating withdrawal symptoms in order to get off these drugs. When I begin to discuss these matters at meetings or group therapy, it’s clear that people see me as no-longer-sober. But they have no concept of the kind of physical pain that recurrently hits me. Do you have any ideas?

Painkillers, as you know, are opiates (may also be referred to as opioids or narcotics), and can be addictive. The pain relief literature indicates that the vast majority of those who use prescribed painkillers (such as Percocet, Vicodin, or Oxycontin) do not abuse them and, if at appropriate dosages, get no “high.” This may also be true for some individuals with a history of addiction, but the risk for abuse is much greater. Some of us are simply “wired” in such a way as to readily develop tolerance, leading to the pattern you describe. Others feel so drawn to the psychological effects of opiates (described as a kind of cushion from life’s sadness and worry accompanied by an artificial sense of wellbeing) that they are compelled to use more than necessary. Those who do not abuse the painkilling medication still run the significant risk of triggering their primary addiction (in your case, alcohol).

No one would suggest that you bear with constant, severe pain, nor would anyone advise you to discontinue opiates abruptly. In fact, a detox may be needed. But a recovering person in pain might do well to consider the following:

§ There are many non-addictive pain reduction measures (medical, behavioral, physical). Although none of these will provide the powerful, immediate relief of an opiate, they do provide means of reducing pain without risk of reviving an addiction or creating a new one.

§ If there really is no reasonable alternative to opiate medication, there are a number of strategies you can employ in order to minimize the likelihood of escalating, addictive use. These might include: openness with a physician who will collaborate respectfully on this issue; openness with and active connection to others who are supportive of your recovery; appointing someone to hold and administer the medications; monitoring yourself for inclinations to take more pills than necessary, or to continue longer than necessary. Even if you use an opiate, it is possible that, with adjunctive use of the non-addictive alternatives alluded to above, you may have fewer episodes of intensified pain.

Feel free to come in and discuss these matters with us at LCL, where, on a confidential basis, we can help you put together a well-considered plan.

My son has been detoxing from Heroin at a Habit Management Center. They are using Methadone. The doctor at this center suggested that my son have his primary care doctor prescribe Buprenorphine for him after he is done with the center. He has no insurance and is private pay. At this time he can only afford a 30 days at this current program. The habit management center said that there aren’t many doctors that are able to prescribe this. In research that I have been doing I understand that the drug is called Suboxone and is used as a continuation after the Methadone. Can you let me know which doctors can prescribe this in our area. We live in north central Massachusetts. Thank you.

Only recently has buprenorphine been approved use for treatment of opiate addiction. Itself an opiate, buprenorphine is seen as offering certain advantages over methadone, including: · It is designed to be administered at a doctor’s office rather than through a clinic, making it more flexibly accessible; · Less severe withdrawal symptoms is someone stops taking it abruptly; o reportedly less susceptible to adverse effects or a “high” if someone takes too much (whether intentionally or unintentionally). Subutex is the brand name for straight buprenorphine. For longterm use, Suboxone includes both buprenorphine and naloxone, which further reduces craving. Both medications come in the form of tablets which are held under the tongue to dissolve. Like methadone, burprenorphine may be used either for ongoing maintenance or for gradual withdrawal from opiates.

Thus far, very few doctors have obtained training and certification to prescribe buprenorphine. What’s more, we have found that some who are certified are not actually accepting patients. We do notice, however, that the list has been growing even within the past few months. To view a list of physicians who can prescribe buprenorphine, go to the following web site http://www.buprenorphine.samhsa.gov/. Then click on Physician Locator, and then on Massachusetts.

Buprenorphine is not necessarily the optimal treatment for every opiate addict. In any case, we recommend that it be accompanied by other supports including counseling.

I consider myself an intelligent and capable person. I graduated near the top of my class in a fine law school, and have achieved a level of success as a lawyer. In fact, I pride myself on being an organized and logic-driven person. That is why I have been adamant that I can find a way to stop or control my alcohol and drug use on my own. But somehow I keep losing sight of these goals and ending up with ever-worsening problems as a result of drinking and drug use. How can this be?

The role of choice and will in human life tend to be grossly exaggerated. In fact, we all respond to a variety of genetic and biological forces (along with the impact of environment, conditioning, etc.) that in large part direct our behavior.

Brain research is rapidly expanding our understanding of addictions. Especially for those with susceptible genes, repeated exposure to alcohol/drugs actually brings about changes in brain cells. The brain adapts to the incoming chemicals and comes to “expect” them, and in some cases becomes unable to function normally without them. The biochemical processes involved in this adaptation create symptoms associated with addiction, such as craving, tolerance, withdrawal, etc. These neurological modifications occur largely in more primitive parts of the brain (such as the ventral tegmental area, nucleus acumbens, amygdala and hippocampus) that we share with other animals. Laboratory rats, for example, can readily develop addictions. When you experience cravings or urges to use a substance, the more sophisticated, rational parts of your brain may be no match for these impulses. People who habitually engage in addictive behaviors often bow to such urges, enlisting defense mechanisms such as rationalization that are powerfully compelling at the time, though they will seem naïve in retrospect.

The picture varies greatly from person to person (or, should we say, brain to brain), but the limited power of our rational faculties may be another way of understanding the AA concept of being “powerless over alcohol.” It also helps explain why in general it is so helpful to avoid “triggering” stimuli, pay close attention to feelings and thought patterns linked to alcohol/drug use, and stay closely connected to people who are not abusing substances. You could begin by talking to us; together we can put together a plan that may work for you.

Though I have never laid a hand on client funds, I have bankrupted myself through gambling. I’m in recovery from alcoholism, but I haven’t been able to stop myself from falling into the trap of an occasional impulsive trip to the casino in Connecticut, to the point of maxing out several credit cards via cash withdrawals. I know that gambling can be considered another addiction, but until now I never thought of adding GA to my AA. Can you enlighten me?

The keys to addictive behavior remain enigmatic, but clearly it is influenced by factors beyond those that determine most of our actions. In most cases, we learn from experience and make relatively sane choices, while in the case of an addiction we feel drawn to keep repeating a behavior even though it has already led, recurrently, to negative consequences. Compulsive (or, as it’s called in the diagnostic manual, “pathological”) gambling may be even more complicated than chemical dependency, inasmuch as family and psychological factors seem to play a larger role. For example, some studies point to higher rates of childhood abuse and of mood disorders. Nevertheless, there is a growing body of data to suggest that all addictive behaviors may share a common neural pathway involving the brain’s mechanism for producing rewarding experiences. That may be one reason why something like 35 percent of those with substance abuse or dependence also meet the diagnostic criteria for pathological gambling at some point in their lives, while in general it affects 1 to 3 percent of adults. It has been reported that as many as half of compulsive gamblers exhibit observable “withdrawal symptoms” (such as sweating and insomnia). Recent studies using functional MRI and PET scans have actually shown that pathological gamblers produce the same patterns of brain activity in reaction to gambling situations as those shown by alcoholics/drug addicts exposed to their substance of choice. Like those with other active addictions, compulsive gamblers tend to avoid getting help (and to deny the need for it) unless forced into it by significant others or dire circumstances. And the gambler can even convince himself that continuing the behavior will actually solve the problem (i.e., win enough money to cover debts), though ultimately it only gets him in deeper. Most people caught in the grip of such an addiction need active and frequent support in order to combat the impulse and avoid slipping back into denial. This is where both professional treatment (outpatient – there is virtually no coverage for inpatient rehab unless the person is suicidal) and Gamblers Anonymous can be crucial. One needs all the help available to combat the seductive influence of lotteries, casinos, sporting events, and internet gambling sites. You might do well to treat your gambling as a “cross-addiction”, just as if you had stopped drinking and become dependent on opiates. LCL can assist you in putting together a plan for support and treatment.

My wife, who is also my law partner, has been an active alcoholic for the better part of our 25-year marriage. We’ve tried counseling a couple of times, with little benefit. I finally started Al-Anon meetings, which are enormously helpful but also lead me to realize that I may have difficult decisions to make. I also feel like I need to do something about my practice – clients who don’t pay, disappointing financial rewards, abusive judges, and the charade of having a law partner who can’t function as one. With kids in college, I can’t just call it quits. I need to make a change, but what and how?

Although you don’t spell it out, it is fair to assume that you have been investing increasing amounts of time and energy (mental, emotional, and physical) in well-intentioned efforts to “help” your wife/partner overcome her problem, manage her behavior, and compensate for the consequences of her drinking. (That’s a lot of work when the drinker is both your professional and domestic partner and children are involved!)

The chaos and confusion created in a relationship, family, or even a business by alcohol or drug abuse can be profound, leaving you feeling frustrated and angry, tired, guilty, anxious, resentful, and doubting your own judgment. With all that, work performance and satisfaction are naturally likely to suffer. Although you may have legitimate complaints about work, it is probably not possible to sort out the sources of your dissatisfaction. This is not an ideal time to make a career decision.

While it may appear that your wife has the problem with alcohol, the most important and helpful thing you can do for yourself (as well as her) is to get help for yourself. As the drinker increasingly loses control over her drinking, the partner struggles to compensate, often with overly controlling behaviors. This pattern can become a self-perpetuating cycle that is damaging to both people. With appropriate help and support (e.g., Al-Anon; an appropriately specialized therapist – which LCL can help you find), you can gradually learn to disengage from the cycle. The drinker and spouse must each come to recognize and deal with their own problems. At that point, you may see the forest and the trees clearly enough to make a wise decision about your career.

I work in a state agency, while my husband has a solo real estate and criminal practice. As his alcoholism progressed, his practice deteriorated and our home life became chaotic. Now that he’s been sober for nine months, I’m not sure whether our lives are better or worse. He is running his practice more reliably but generating less income than he did a few years ago. At home, there is much less fighting or day-to-day uncertainty, but there is little closeness or communication with me or with our two kids. He’s at AA meetings almost every night, and I find myself resenting his friends there, with whom he seems more involved than with me. Is this recovery?

Yes and no. As alcoholism progresses over a period of years, the family generally adapts, accommodates it (e.g., through denial and shifts of responsibility), and this dysfunctional system becomes the new norm. After the drinking stops, there is a pull (within the whole family, not only the alcoholic) to slip back to that unhealthy status quo. All family members generally need a period of healing and rebuilding (healthier ways of functioning) before they are equipped to fully engage in closeness, communication, negotiation of needs, etc. Dealing with these processes in the old ways may lead to a return of drinking, denial, chaos, and so forth.

Early sobriety, then, can be a very trying time, even when it is also a time of relief and hope. For many or perhaps most families at this stage, a period of focusing on individual recovery is needed (while not ignoring children’s needs), to build a new foundation. This does mean that personal growth becomes a higher priority than work or even some family activities. If you yourself are not in Al-Anon and/or therapy, now may be a good time to start. (In some cases, a structured form of couple/family therapy may also be warranted.) But take heart: Assuming that the marriage survives the challenges of this early phase of recovery, your marital relationship can later renew itself on more solid ground, and surpass the kinds of couple and family closeness that you’ve known in the past. We at LCL would be glad to consult with you more specifically about this process, and discuss helpful resources for both yourself and your children.

My husband was in an accident about 7 years ago, and really hurt his back. He has been taking painkillers ever since. This includes Tylenol #3,and Percocet. I know this does help his pain, but I can not find out anywhere what this does to him physically. Now I know there is a risk of addiction, but I want to know if this could hurt him internally-what damage can it do to his insides?

We are mental health clinicians and not physicians or pharmacists. Our main experience with painkillers, as your question indicates, is that we’ve seen many individuals whose medically appropriate use progressed to become addictive – a significant concern with long-term use, and a very difficult dependence to shake.

These medications are narcotics, like morphine or heroin. Narcotics tend to take a much lesser toll on the body than some other drugs, notably alcohol. According to the Physicians’ Desk Reference, they may mask pain and prevent diagnosing illnesses (such as abdominal conditions). They may also increase intracranial pressure in head-injured individuals. They depress (that is, slow down) the nervous system, so that driving and other activities may be impaired. They also depress respiration, and in cases of significant overdosethis can lead to consequences including stupor and even death. The doctor and pharmacist would also want to prevent problematic drug interactions, e.g., with the older types of antidepressants on top10pharma.net. These medications also contain acetaminophen, which has its own dangers, including liver damage (especially in high amounts or in combination with alcohol).

Aside from addiction concerns, the dangers are limited, and must be weighed against the helpful effects. However, since addiction concerns are real, we generally recommend that people with chronic pain conditions seek second opinions before staying on narcotics indefinitely (or at all, if there is any history of addiction), and try alternative treatments (such as acupuncture and mind-body approaches) that present virtually no dangers. For more medically oriented information, you might try on-line resources such as the nurse’s PDR site (www.nursespdr.com/) or Web MD (www.WebMD.com), as well staying in close touch with the physician.

My brother and I are in a general legal practice together. Since he was in college, the family has been aware of his gambling problem; even he will acknowledge it, while at the same time denying its seriousness. At one point he went to some meetings of Gamblers Anonymous, but felt it had nothing to offer him. His gambling has drained very large sums from the accounts of family members and led to losing his wife and house. I am concerned about his getting his hands on the firm’s funds despite my efforts to prevent that. We’re all upset (except my brother) – what can we do about him?

You and your family are ahead of the game in having recognized that compulsive gambling (the official psychiatric diagnosis is “pathological gambling”) is the reason for recurrent and otherwise mysterious disappearance of funds, but it sounds as if you could use help in how to address the problem. As for the fact that you upset while your brother is not, this is likely because he (like others with addictive behavior patterns) is relying on the defense mechanism of “denial.” This is perhaps understandable, since when compulsive gamblers really see the mess caused by their behavior they can become severely and even dangerously depressed.

Compulsive gamblers have usually gone through an initial phase where their gambling paid off in a big way, and provided pleasure and excitement. Later, the winnings are followed by losses, often heavy losses, not only in money but in self-esteem. At this point, the gambler typically gambles more, in an attempt to win back what was lost, and starts to borrow money and hide the extent of gambling. As the condition progresses, gambling takes up ever-increasing space in the compulsive gambler’s mind and life. If lying, stealing, pawning, etc. are the only ways to get more money, he (2/3 are men) will often take those options, even if that behavior is inconsistent with his value system.

Although your family is aware of the problem, it sounds as if you have in some ways “enabled” the situation, e.g., by providing funds to cover losses or by accepting your brother’s taking them. You have also kept him as a partner in your practice and perhaps in effect joined his avoidance of confronting the problem. As you know, any misuse of client funds (which may yet happen if it has not already) is an extremely serious matter. Since he remains in some type of denial, the greatest hope for change at this point lies within the family. We would strongly suggest professional help for you and the other family members, as well as attendance at Gam-Anon, the support group for family members of compulsive gamblers. If your behavior changes, it is much more likely that his will follow. We know of a number of resources that may be of help to you – give us a call on our helpline, 1-800-LCL-0210 (which can be anonymous if you prefer), or arrange to come in and talk it over.

Years after my own recovery from alcoholism, I am worried about my wife, also an attorney. Several years ago, she developed a very painful spinal condition for which she was prescribed painkilling medication. The medication helped. For a long time, she used it as prescribed, but within the past year I know her use has escalated. She has been making sloppy errors in her practice, which I have fortunately been able to correct before any damage was done. But worse, she just isn’t tuned into life, or her family, the way she used to be. The other day, I found extra bottles of her pills under the bed. They were prescribed, but by a different doctor. What am I to make of this?

One of the most unfortunate clinical scenarios in the world of addictions is that of people like your wife. They take legitimately prescribed narcotics, such as Percocet or Vicodin (or Fiorinal/Fioricet, a barbiturate), for severe pain, and end up with two illnesses — the original source of pain plus bona fide substance dependence. Most people who use painkillers (and who have no previous addictive history) are able to maintain a steady dosage for physical pain. A significant minority, however, find that they develop a tolerance. They need increasing amounts of the medication to achieve the same results and consequently keep increasing their dosage. They also gradually come to use the medication to cope with an ever-expanding range of situations and feelings. When the physician ultimately refuses to prescribe any more, the affected individual (who by now feels unable to cope without the pills) typically finds new sources, e.g., a friend, or one or more other doctors from whom to obtain more prescriptions, or may even begin to forge prescriptions. The individual’s life becomes more and more organized around pill-seeking and pill-using. The addictive behavior patterns and the side effects of these medicines can create that emotional distance and interference with personal and professional functioning that you have observed in your wife. Mood swings may become more noticeable, often alternating between irritability and withdrawal.

Treatment begins with a safe, medically supervised detoxification and, as in your own case, is followed by the more challenging work of learning how to live on a daily basis without the addictive substance. Both professional treatment and self-help groups are typically recommended, and the process takes time, effort, and commitment. What makes it especially tough is that the physical pain returns and must be dealt with. Amazingly, many people find that over time, even without addictive medications, their nervous systems seem to adapt to the pain so that it fades to the background. Others recognize that they may never have tried non-addictive pain-reduction approaches such as acupuncture or biofeedback.

We would be happy to meet with you and your wife to develop a treatment plan and help implement it. The so-called “snitch rule,” by the way, does not apply to LCL. If your wife denies her need for help, we can talk with you (and any other concerned people in her life) about how you might approach the situation. The situation is very serious and, if ignored, is likely to worsen, but it is far from hopeless.

My wife and I are family law attorneys. Lately, she has been expressing concern about my drinking. I don’t think I have a problem, but I don’t want to be “in denial” either. I only dirnk two to three days a week, mostly on weekends. I admit that sometimes I drink enough to get silly or maybe become a bit sarcastic, but I hold my liquor well, never drive after drinking, and have never missed work. I just enjoy drinking. It doesn’t seem to bother anyone but my wife. I do think I should probably cut down, but am I missing something?

It may not be possible to tell at this point, but the crucial issue is whether you fall into the category of “social drinker,” “alcoholic abuser,” or “early stage” alcoholic (alcohol dependence is the diagnostic term). The terms social or moderate drinking apply to most drinkers and imply a capacity to limit drinking to usually one or two drinks almost automatically with minimal effort. There are no recurrent negative consequences of drinking

Alcohol abuse generally involves heavier drinking with some potential danger (such as driving under the influence), recurrent negative consequences, or interference with one’s ability to handle responsibilities, for example as a worker or parent. Some clinicians believe that alcohol abusers can learn to prevent further probelms by moderating their drinking.

Many who abuse alcohol will turn out to have been “early stage” alcoholics and will develop more severe problems. Some of the key features of alcoholism are:

· Inability to consistently limit or regular how much you drink once your start;
· Finding that drinking becomes central in your thoughts, plans, and behavior;
· “Needing” a drink, rather than merely wanting one;
· Returning to drinking despite repeated clear and predictable negative consequences.

Alcoholism is a “progressive” disorder, meaning that it usually becomes more severe over time. Ironically, the high tolerance you describe (“holding your liquor”) is not a boon as much as it is a risk factor, paving the way for potential alcoholism. If you have alcoholic biological relatives, repeatedly drinking more than you intended, or behave in ways you later regret, you may well be alcoholic. If others are bothered or concerned, that sign should also be taken seriously.

Unfortunately, there is no way to drink safely if one is alcoholic. Most people faced with such concerns will try to limit their drinking to non-problem proportions. Those who are essentially alcoholic will be unable to do so consistently. It is not actually necessary to “hit bottom” (lose career, family, health, etc.) in order to halt the disorder in its tracks by learning how to live alcohol-free.

Occasionally, LCL and various clinics offer a “self-assessment” or “contemplation” group for those trying to clarify the type of alcohol or drug problem they have and whether abstinence is necessary. If you are interested in such a group, call LCL.

My husband is the attorney in our family. He is well regarded at his firm (environmental law), both professionally and personally, but when he comes home he no longer involves himself with the family. He withdraws to his computer and seems to be more connected to the internet than to me or our children. At first I supported this interest, seeing it as a nice way for him to relax. Now, however, it has become a major source of conflict and alienation. When his modem broke last month, he ran frantically to get it replaced, like an alcoholic desperately seeking alcohol. I can’t get him to see this problem. Any ideas?

When we first heard talk of computer and internet activity as addictive it seemed trivial, but in fact reports of this phenomenon have accumulated. Although there is controversy as to whether to use the term “addiction” when no drugs are involved (e.g., gambling, sex and now computer use), it is clear that in some individuals, such behaviors can produce the same kind of syndrome. These people feel compelled to return again and again to actions that have demonstrably and repeatedly led to negative consequences in areas such as health, family relationships and financial status. They may experience little or no capacity to limit the behavior once they start. There may be many contributing factors, including a yearning to avoid difficult emotions or facts, interpersonal problems and even biochemistry. For example, your husband’s computer activity may affect his brain chemistry, creating a kind of “high.”

Some clinicians are beginning to specifically address so-called computer addiction. But that may be a moot point if your husband does not see it as a problem. A family oriented therapeutic approach may be fitting at this stage, and that process may need to begin with you. If you call us to arrange an assessment, we’d be glad to help clarify the problem and refer you and your husband to appropriate resources.

My husband is the attorney in our family. He is well regarded at his firm (environmental law), both professionally and personally, but when he comes home he no longer involves himself with the family. He withdraws to his computer and seems to be more connected to the internet than to me or our children. At first I supported this interest, seeing it as a nice way for him to relax. Now, however, it has become a major source of conflict and alienation. When his modem broke last month, he ran frantically to get it replaced, like an alcoholic desperately seeking alcohol. I can’t get him to see this problem. Any ideas?

When we first heard talk of computer and internet activity as addictive it seemed trivial, but in fact reports of this phenomenon have accumulated. Although there is controversy as to whether to use the term “addiction” when no drugs are involved (e.g., gambling, sex and now computer use), it is clear that in some individuals, such behaviors can produce the same kind of syndrome. These people feel compelled to return again and again to actions that have demonstrably and repeatedly led to negative consequences in areas such as health, family relationships and financial status. They may experience little or no capacity to limit the behavior once they start. There may be many contributing factors, including a yearning to avoid difficult emotions or facts, interpersonal problems and even biochemistry. For example, your husband’s computer activity may affect his brain chemistry, creating a kind of “high.”

Some clinicians are beginning to specifically address so-called computer addiction. But that may be a moot point if your husband does not see it as a problem. A family oriented therapeutic approach may be fitting at this stage, and that process may need to begin with you. If you call us to arrange an assessment, we’d be glad to help clarify the problem and refer you and your husband to appropriate resources.

OK, my law partners and spouse have finally convinced me that it’s insane for me to continue to drink. Now they want me to start going to AA meetings, but I am put off by the emphasis on being powerless, and by what I think is a religious tone. Someone told me that there are alternatives. Can you fill me in?

To be honest, our staff has had by far the best results with AA, which also has the longest track record and by far the most available meetings. Probably more than half of newcomers are initially uncomfortable with aspects of AA such as the ones you mention, but perhaps that would be true for any new group experience, and the obstacles are usually overcome.
However, you asked about alternatives to AA and two come to mind, Women for Sobriety (WFS) and SMART. SMART is known as Rational Recovery in some parts of the country.
Historically, WFS grew out of a sense that women’s sensibilities were not well addressed at AA. Nonetheless, WFS encourages concurrent AA attendance. In general, WFS places greater emphasis on concepts such as love and relationships. Meetings have a bit more in common with group therapy than AA meetings do, and seek to empower women. Unfortunately, WFS has only a few meeting in Massachusetts.
SMART on the other hand is a self-help application of Rational Emotive Therapy (RET) to alcoholism/addiction. (RET is also known as Rational Behavior Therapy.) The program emphasizes values such as self-control, self-reliance and the power of rational thinking as a means of combating drinking behavior (unlike AA’s emphasis on powerlessness). For example, an individual facing the urge to drink would be encouraged to use the “sobriety spreadsheet” as a tool to identify and challenge irrational thoughts. Feelings such as guilt and wishes to be loved are seen as useless and irrational. The AA concepts of “higher power” and using a “sponsor” also are non-existent in SMART. Participants are encouraged to discontinue meeting after a year of abstinence, whereas AA sees ongoing meeting attendance as core to the ongoing recovery process.
There are of course many more differences between these programs than can be summarized here. What they have in common is availability at no cost. Also, contrary to rumor, all the programs support the notion that abstinence from alcohol and other drugs is the only workable goal for an alcoholic or addict.

I am a 36-year-old law student in my first year of graduate school. I have always been overweight, even as a kid, but when I started law school, I was at my all time best. I was eating sensibly, getting exercise regularly and was 40 pounds down. However, by the end of September, I was totally stressed out and started compulsively eating again. I can’t stand myself right now. I have gained back 10 pounds already and am terrified that I will gain back all the weight. Please help.

First of all, you haven’t lost it all. The information and perspective you had been acquiring is still within you, it’s just buried under stress and old behaviors. What’s happened to you is what happens to all people under periods of great stress: they will resort to using old coping styles — even regressive ones that have an emotional price tag attached if they need to — to keep themselves from getting overwhelmed. From a psychological viewpoint, this is extremely important as it keeps people from falling apart.
Instead of beating yourself up, use the presence of old behaviors as a signal that the stress you are under is great, and that you need to get some extra support for yourself. Overeaters Anonymous can be a great support; meetings are plentiful and free. Call them at 781/641-2303 for a meeting list. Counseling is another resource for more support. Your school may have student counseling services but if not, call LCL to schedule an appointment.