From the perspective of an addiction counsellor in Singapore, addiction or substance use disorder, as it is now termed, usually looks like the guy or gal sitting next to you at work, on the MRT, in court or in the boardroom. Substance Use Disorder is a spectrum, so includes both the colleague who can’t get through the day without a quick drink, and the guy on the park bench drinking methyl alcohol. People struggling with this disorder might be introverts or extroverts, people pleasers or “don’t give a damn” managers. In other words, they may act and look just like you and me.
But what goes on behind our many masks might be very different indeed. Let’s look at the example of Lawyer A.
Let’s say you meet Lawyer A in the lift on the way to your office. She is immaculately dressed, looks a bit tired and stressed, and is polite but reserved. You know she lives in a big house and has an expensive handbag and everyone says she is a brilliant lawyer. You want to be exactly like her one day.
What you don’t know is that Lawyer A had a difficult childhood and has struggled with addiction all her life. She has attended multiple rehabs, but whenever her trauma and associated core beliefs are triggered, she has a tendency to immediately swing into her maladaptive behaviours. At the moment she is drinking 5 bottles of wine a day, throwing up after each bottle, not because she wants to, but because she has to. She is also throwing up all her food, and her bulimia is now out of control. She can’t sleep at night, but must perform at work in the morning, so has started abusing her prescription medication just so she can get five hours sleep. When she can’t sleep, she shops online, and the boxes and bills are piling up and her finances are out of control. Her immune system is non-existent, she is constantly sick, but she feels she can’t take time off from work due to her position. Her partner has left her, she rarely sees her friends because she would rather be at home drinking, and her depression is now so debilitating that she is in the care of a psychiatrist.
What about Lawyer B?
You meet Lawyer B in the washroom. Everyone knows Lawyer B is about to make partner. He is super smart, handsome, aggressive, and a bit arrogant. It’s whispered that he has a drinking problem, but because he is handling some of the firms biggest clients, well, it’s part of the job! He barely acknowledges you and you admire his suit as he walks past.
However, Lawyer B is the child of an alcoholic, and grew up in an abusive household. Consequently, he likes to control his environment as much as possible to secure his psychological safety. He is increasingly finding the stress of the job and making partner to be challenging. On his way home, he somehow always finds himself in a bar and then making excuses to his family. Sometimes he wakes up and has no idea where he is, and last night he didn’t make it home. You met him in the washroom this morning because he had been trying to make himself presentable after a long night that he can’t quite remember. His wife is about to leave him, and his two sons are very distant as they don’t like the way he treats their mother. He has moved into a separate bedroom at home, and he knows divorce is on the horizon. He has made promises not to drink at home but has a couple of bottles stashed in secret locations so that he doesn’t have to sneak out at night to buy more. His friend told him about another drug that would make him feel as good as alcohol but without the hangover the next day, so he bought some illegal pills, but now he is both drinking and taking the drugs, and he can’t stop. He is worried that work will find out. To minimize his stress during the day he has taken to vaping, and hides a vape at work. He is also abusing benzodiazepines because his anxiety is becoming intolerable.
In each of these examples, you may notice that there is a change in personal functioning, a change in occupational functioning, a change in relational functioning and a change in social functioning. Whilst there are 11 criteria for substance use disorder in the Diagnostic and Statistics Manual V (2013), and it is best diagnosed by a professional, these four key markers are readily observable, and change over time. You may also recognize an element
of pain and suffering, and that behaviour that once managed stress has become maladaptive and imprisoning.
Substance Use Disorder is complex, and to some extent, we are still trying to understand why some of us suffer and some of us do not. What we do know, is that the single biggest risk factor for addiction is childhood trauma, thanks to the The Adverse Childhood Experiences study published in 1998 by VJ Felitti, RF Anda, D Nordenberg et al., and now duplicated in Sweden, Australia, Canada, and many other countries. Trauma can include the big T type (an assault, a natural disaster) or little t type, often known as Complex Trauma, such as childhood abuse, domestic violence, repeatedly witnessing violence or abuse, or an upbringing with a narcissistic or alcoholic parent. Trauma symptoms are multiple and may include mood swings, erratic behaviours, inappropriate emotions, fear, agitation, anxiety, and irritability, eating disorders, people pleasing and timidity, the constant reliving of the event, problems with relationships with others, and issues with intimacy. It is often these issues that lead us to self-soothe with alcohol, drugs, sex, porn, gambling, shopping, or food. Trauma has a strong correlation with addiction.
The second risk factor is that substance use disorder is linked to IQ. Individuals with high IQs are over-represented percentage wise in the severe substance use disorder spectrum. We have yet to understand why.
The third risk factor is genetics. If you have a family member who has struggled with addiction, you are much more likely to do so yourself.
The legal profession has a higher rate of addiction and particularly alcoholism than the general adult population, with alcohol accounting for 95% of addiction in lawyers and judges in the USA. Studies conducted across many other jurisdictions indicate that alcoholism in the profession is somewhere between 15 and 24% and there is of course a corresponding correlation between substance and alcohol use and malpractice.
Lawyers are at risk of the same genetic and environmental factors as any other demographics; however, some might say that the unique requirement to maintain a cool, calm exterior whilst listening to or dealing with difficult cases, the competition, complexity and demands of the job, and the competition between colleagues may be one of the reasons that substance use disorder is so prevalent. We also know that chronic job stress in work cultures that may thrive on pressure, crisis, competition, and success, can cause neurological changes.
Is there any good news? What can I do if I am experiencing chronic stress, excessive substance or alcohol use or process disorders such as bulimia or anorexia, sex addiction or gambling?
The good news is that substance use, and addiction can be treated and managed successfully. Thanks to neuroplasticity and our ever-increasing knowledge of the brain, we can help people learn to counteract addiction’s effects on the brain, and on their behaviour, and regain control of their lives. Trauma and Addictions treatment focusses on the underlying disorder as well as the symptoms.
Get as much help as you can. Reach out to a friend, a counsellor or a 12-step program. Getting vulnerable and admitting your challenges are the first step toward recovery. As a second step, you may wish to cut down on your substance of choice. And as a third step, be willing to get to the root of the issue – what is it that is causing you to engage in maladaptive behaviours?
Recovery starts when we are willing to travel a path towards emotional sobriety. This means addressing the negative emotions or states that may have led to the development of our substance use. This is possible via behavioral therapy which helps us to identify the behavioral and cognitive adaptations that were once useful but are now maladaptive. Treatment also teaches us how to experience negative or difficult emotions without acting on them – so we are able to sit with our discomfort, rather than medicate it. We are also taught to live in the present, to experience and do new things so as to form new neural networks and pathways and behaviours, to engage in acts of self-care and to reach out to others for support. The journey can be long, but the outcomes are worth it – and many of the strengths that you have as lawyers and professionals are the very same strengths that you can leverage in recovery. We build and develop resilience, fortitude, problem solving, compassion, all your skills, to find you the life that you deserve to be living.
The first step is the hardest, but it’s never too late. The inevitable progression of substance use disorder means that you will eventually lose everything that you haven’t lost already. Getting an appointment with a counsellor, looking into confidential recovery programs, making a promise to yourself today to get some help means that you will never look back and can start your recovery journey today.
Most counsellors and therapists have walked the very same path as you and have lived experience of substance use, addiction, trauma, and recovery. Many come from other professions, the law, medicine, entertainment, finance. Their ability to journey alongside you as you progress through recovery is as a guide, who has trodden the path with many others many times before. They know the challenges you are likely to meet along the way, the areas where you might need hand holding, the potholes that are on the road and how to navigate them. More importantly, perhaps, is that they have made it to the other side, and are now living the lives that we were all meant to live, with values, purpose and meaning. Their own journeys provide hope to those looking to escape the ties that bind.
Visions at Promises works with all kinds of addictions – providing recuperative care programs such as 1-1 counselling, group therapy, an intensive outpatient program, specialist groups, family therapy and medical detox. Contact us on visions@promises.com.sg or if you would like to reach out to this author directly, alexis_fosler@promises.com.sg for a free assessment and consultation.
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Alexis is a qualified psychotherapist with a special interest in substance use disorder. She has a Masters in Counselling and a Masters in International Addiction Studies. Alexis has substantial experience in addictions, trauma and eating disorders and is passionate about supporting clients in the early stages of recovery to lead healthy, positive and substance-free lives. Alexis has worked as a COO and CEO in the financial and Lifestyle space in Asia and as such frequently counsels and mentors those who work in these and other high-pressure environments.