Posts Tagged ‘Alcoholism’

CHRONIC ALCOHOL DEPENDENT DRINKING DISRUPTS CIRCADIAN RHYTHMS CAUSING INSOMNIA AND DEPRESSION

Thursday, August 26th, 2010

Human beings have a 24 hour biological rhythm cued by changes in daylight called a circadian rhythm. The mammalian clock that regulates our sleep-wake cycle lies in the suprachiasmatic nucleus of the hypothalamus. Temporary disruption of circadian rhythm by international flights causes a combination of insomnia and fatigue known as jet lag.

Every 24 hours we not only show changes in wakefulness, but also in body temperature, hormone production, brain waves and feeding behavior. Many tissues in our body have circadian clock genes. These genes must be expressed properly in the form of transcription and clock proteins for us to survive. Their appropriate expression is a key for people to sleep well, stay healthy and maintain a good mood. In order to operate properly these genes must have sufficient messenger RNA (ribonucleic acid) to manufacture certain proteins.

It has long been known that people who drink heavily on a chronic basis have problems with insomnia and depression. Researchers Ming-Chyi Huang and collaborators at Taipei Medical University and Taipei City Hospital wanted to know if this was related to depletion of messenger RNA in their circadian clock genes.

The researchers recruited 22 male patients diagnosed with alcohol dependency and 12 healthy control subjects. Study of their blood samples showed markedly lower baseline levels of messenger RNA in the circadian clock genes of the AD patients. The study also showed destruction of normal circadian clock gene expression in the AD patients. Reduced circadian clock expression did not normalize following early alcohol withdrawal treatment. Researcher Sy-Jye Leu said this shows that chronic AD has long term damaging effects on the expression of circadian rhythm genes. Their finds were communicated early on 8/24/10, but will be published in full in the November 2010 issue of Alcoholism: Clinical & Experimental Research.

For alcoholic lawyers in denial it’s important to realize that continuing to drink is tampering with your very genes and altering the basic circadian rhythm that sets the time for normal, healthy changes in sleep, waking, brain waves, hormone production, body temperature and hunger. Research from Dr. Joseph Takahashi of the Howard Hughes Medical Institute came out on July 13, 2010, indicating that chronic disruption of circadian rhythm can cause diabetes by impairing the ability of the pancreas to release insulin.

If you’re a lawyer with an alcohol problem who is still in denial, then it’s high time you sought treatment.

OBESITY AND HEAVY ALCOHOL CONSUMPTION ARE A LETHAL COMBINATION FOR YOUR LIVER

Sunday, August 15th, 2010

Public health authorities in the UK have grown increasingly concerned about a rise in the rate of cirrhosis, a potentially fatal liver disease. Cirrhosis is characterized by formation of fibrous tissue, nodules, and scarring, which interfere with liver cell function and blood circulation. Symptoms include weakness, weight loss, fatigue, abdominal swelling due to fluid accumulation, and tenderness and enlargement of the liver. On March 11, 2010, two articles appeared in the British Medical Journal addressing risk factors for cirrhosis, including obesity and alcohol consumption.

In the first study Dr. Liu and researchers at the University of Oxford tracked the health of 1.2 million middle aged women in the UK for an average of 6.2 years. Obesity by itself caused a relative rise in the risk of cirrhosis. For obese women who drank lightly (just .33 to .50 drinks per day) the rate of cirrhosis that would send them to the hospital or kill them within five years went up from 0.8 per thousand to 1.0 per thousand. But for obese women classed as alcoholics (those who drank 2.5 drinks per day) the rate of cirrhosis that would send them to the hospital or kill them within five years was 5 per one thousand versus 2.7 per one thousand for alcoholic women of healthy weight.

In the second study Dr. Hart and colleagues from the Universities of Glasgow and Bristol tracked the effects of body mass and alcohol consumption in more than 9,000 men in Scotland for an average of 29 years. The men, who were part of an older study from 1965-1973, were followed until the end of 2007. The researchers found that increased body mass and alcoholism by itself increased liver disease but when combined with each other the effects were synergistic not additive. Compared with non-drinkers of normal weight, alcoholic drinkers of 15 or more units per week who were underweight had a risk of fatal liver disease that was 3.16 times higher; those who were obese had a risk 7.01 times higher; and those were obese had a risk 18.9 times higher.  

Rates of obesity and rates of obese people who drink heavily have risen significantly in the UK. In an editorial accompanying the research papers it was stated that only 6% of male research participants between 1965 and 1973 were obese, whereas 24% of the participants were obese by the time the second part of the study ended in 2007. The proportion of men who were both obese and reported drinking more than 15 units of alcohol a week was 9.4% in the recent study compared with only 1.7% in the earlier study.

These startling increases in obesity and in heavy alcohol consumption by obese people have occurred in America as well. Yes, America has had a health and fitness craze and a dieting craze for a long time, but many lawyers are overweight and drink way too much. It’s not hard to find excuses since everyday there are huge stacks of work, there are tight deadlines and we are living in a bad economy where lawyers keep getting laid off so there is great pressure on lawyers who are employed not to slack off. We tell ourselves that it’s normal and natural for people to gain x number of pounds for every decade of marriage, or work, or some other marker. We tell ourselves that we deserve a treat for all our hard work, be it a couple of gin and tonics, martinis or scotches; or be it a basket of buttered bread, a bottle of wine and pasta smothered in cream sauce and cheese with a cheesecake dessert.

Studies like the ones in the March 2010 British Medical Journal put the writing on the wall. We have to read that writing and take it in. We have to change now. Instead of cocktails loaded with hard alcohol have a glass of red wine. Instead of white pasta swimming in cream sauce, bacon and cheese, try some whole wheat pasta with extra virgin olive oil, lots of veggies and some lean chicken. Instead of collapsing on the couch and watching crime shows after dinner, what about taking a walk in a pretty spot with your spouse or with your whole family if you’ve got young kids you can’t leave at home. Start going back to the gym and get into a group exercise class for motivation.

          Start slowly and build as your endurance and strength grow and as you shed pounds. Nobody can change all at once, but when you make a conscious effort you can develop healthy new habits bit by bit. The extra years of healthy, productive life in which you can spend time with your loved ones sure beats the agony of cirrhosis and an early grave.

SUCCESSFUL RECOVERY FROM ADDICTION AIDED BY WORKING THROUGH STRESS AND DEFEATED BY IGNORING STRESS

Friday, June 25th, 2010
Researchers have shown that the very behavior pattern which leads to addiction in the first place (using alcohol or drugs to eliminate stress rather than facing and solving a stressful life problem) also blocks recovery by generating cravings when the addict is stressed during recovery.
H. Harrington Cleveland, associate professor of human development at Penn State, and Kitty S. Harris, director of the Center for the Study of Addiction and Recovery at Texas Tech University, gave Palm Pilots to 55 college students who were recovering addicts. They asked the students to use the Palm Pilots to record the intensity of negative social experiences, how they coped with stress and when they had daily cravings. They found that recovering addicts who faced, analyzed and made constructive efforts to solve stress inducing problems had a better chance of staying in recovery. The recovering addicts who ignored stress had double the number of substance use cravings. Their conclusion was that adaptive coping is much more likely to produce successful recovery than avoidance coping. Their study was published in Volume 35, Issue Number One, of the journal of Addictive Behaviors, 2010.
Cravings are extremely unpleasant because they are accompanied by the false thought that “I will die” if I don’t have a drink, a snort of coke, a codeine pill or other substance. The fewer cravings you have during recovery the better your chances of weaning yourself entirely from the substance to which you have been addicted. Some research that came out in June 2010 suggests that the more a person drinks or uses drugs, the less able his brain is able to learn new strategies for problem solving because neurogenesis (the creation of healthy, new brain cells capable of aiding in learning) is impaired. There is little doubt that habitual ignoring of problems and habitual drinking or using of drugs go together. Now we have one new piece of the puzzle. Those who addicts who ignore stress have twice the cravings as those who deal with it.
While lawyers may be great at helping clients solve their legal problems, they may have real difficulty facing and solving their personal problems and this lack of skill could be the source of their addiction. If this is true of you, I suggest the issue isn’t will power, but one of learning and practicing techniques for constructive life-problem solving. There are psychologists and coaches who can help you with this, and it’s worth your effort to locate one and work with him.

DETECTING AND TREATING ALCOHOLISM AMONG OLDER LAWYERS

Saturday, June 12th, 2010
More and more lawyers continue to work past age 65, yet for some of them this can be time of loneliness and hidden alcoholism. Approximately 10% of adults aged 18-64 abuse alcohol, while the figure climbs to 17% for adults aged 65 and above. When an older person loses his or her spouse they sometimes gradually let go of the social network they shared with their spouse. This can lead to social isolation, decreased activity, depression and self-medication with alcohol. When you live alone there is no one to monitor your drinking or keep it in check.
It’s crucial to detect and treat alcoholism in older people to prevent a serious decline in health and quality of life before it’s too late. According to the Hazeldon addiction treatment facility in Minneapolis the telltale signs of alcoholism in an older person are: solitary or secretive drinking; a ritual of drinking before, with, or after dinner; a loss of interest in hobbies or pleasurable activities; drinking in spite of warning labels on prescription drugs; immediate and frequent use of tranquilizers; slurred speech; empty liquor and beer bottles; smell of alcohol on breath; change in personal appearance; chronic and unsupported health complaints; hostility or depression; and memory loss with confusion. Once the diagnosis is made an important part of the rehab effort will be to restore the older drinker’s lost social network.
The Queens Hospital Program in Queens, New York, has an alcohol rehab program restricted to people aged 55 and over called It’s Never Too Late. Right now there are few such programs nationally, but the need for programs like this is very great. Hopefully more programs focused on helping older drinkers will be developed. If you are an older lawyer who suspects he may have a drinking problem, or a lawyer who suspects an older colleague may have a drinking problem, today would be a good day to get this checked out by physician. If you have a rehab program in your community that is sensitive and responsive to the situation of older drinkers that would be the ideal place to go.

BINGE DRINKING CAN’T BE DONE WITH IMPUNITY – IT INCREASES ILLNESS AND MORTALITY

Tuesday, June 8th, 2010
In June 2010 the CDC released data showing the excessive alcohol consumption is responsible for 79,000 deaths annually in the U.S. and that binge drinking accounts for more than half of those deaths. A national study of binge drinking among college students in 1999 by the Harvard School of Public Health showed that binge drinking college students die from acute alcohol poisonings, falls, drownings, automobile collisions, fires, and hypothermia resulting from exposure.
Although binge drinking is defined as 5 or more drinks per occasion for a man and 4 or more per occasion for a woman, the typical adult binge drinker will consume an average of 8 drinks per binge episode. Such episodes are associated with car crashes, violence, STDs and unintended pregnancies.
The 1999 Harvard study classified the frequency of binge drinking as frequent if the student binged 3 or more times in a two week period and as occasional if the student binged 1-2 times in a two week period. Students who binged less were defined as non-binge drinkers. Since binge drinkers are not alcohol dependent, they can go for days without drinking any alcohol, and this gives them the illusion they don’t have a problem with alcohol. The truth for them, and for adult bingers, is that they are seriously damaging
their health.
In studies of self-rated health people are asked to rate their own health as excellent, very good, good, fair or poor. People who report lower self-rated health are at greater risk of hospitalization and death than persons who report higher self-rated health. A study of over 200,000 current, adult drinkers by CDC epidemiologist James Tsai and colleagues to be released in the August 2010 issue of Alcoholism: Clinical & Experimental Research shows that binge drinkers are 13 to 23 percent more likely to report sub-optimal self rated health. In this study the researchers. This means binge drinkers are significantly more likely to go to the hospital or die than non-binge drinkers. Tragically the CDC research team reported that 35 million American adults are binge drinkers and 40% of them binge four or more times in any given thirty day period. Heavy bingers have the lowest self-reported health and represent the least healthy, highest risk group.
Because adult binge drinkers go without any drinking for periods of days in order to recover their health and attend to business in between binges, they suffer from the illusion that they don’t have a problem with alcohol and that they aren’t hurting themselves. When asked to honestly self-report their health status adult binge drinkers report it as just fair or even poor, yet somehow their brains don’t make the connection between their sub-optimal health and their binge drinking. People who binge drink endanger others by driving drunk. In the October 2009 issue of the American Journal of Preventive Medicine the CDC reported it had surveyed 14,000 binge drinkers and learned that 12% admitted to driving after their most recent binge. The CDC also found that about half of those who drove drunk did so within two hours of consuming seven or more drinks, and that about a quarter drove after downing 10 drinks or more.
If you’re a lawyer who binge drinks (typically during weekends), please stop pretending that you are not endangering your own health or the lives of others. Please seek help before it’s too late. If you don’t know of an alcohol rehabilitation facility, you can seek advice from your primary care physician or get a referral to a specialist in addiction medicine.

HOW ALCOHOLISM CAUSES CANCER AND DECREASES LONGEVITY

Tuesday, June 1st, 2010
Andrea Baccarelli, M.D., Ph.D., and her colleagues presented the results of a study in April 2010 at the Annual Meeting of the American Association for Cancer Research which sheds light on how alcoholism causes cancer and decreases human lifespan, and it has to do with the effect of too much alcohol on telomeres.
Telomeres are a region of repetitive DNA found the ends of chromosomes and are crucial to the genetic stability of cells. Without telomeres to cap their ends, chromosomes would lose their ends (and all the valuable genetic information they contain) whenever they replicated. Telomeres prevent chromosomes from fusing with each other or combining in abnormal ways and thus prevent cancer. Shortened telomeres are associated with increased risk of cancer.
Telomeres affect lifespan because they put a fixed limit on the number of times cells can replicate. In general the longer your telomeres the longer your life and the shorter your telomeres the shorter your life. As we age telomeres gradually and progressively shorten and this is associated with shortening of the human life span.
Heavy alcohol consumption causes oxidative stress and inflammation. Both of these are known to shorten telomeres. Alcoholism is associated in the medical literature with increased risk of many different cancers including cancers of the throat, esophagus, larynx, stomach and liver. Dr. Baccarelli wanted to confirm the link between alcoholism, telomere shortening and cancer. She set up a study in which he measured DNA serum from 59 participants who were heavy drinkers (22% of which consumed four or more alcoholic drinks per day) and from 197 variable drinkers (only 4% of which drank four or more drinks per day).
Results showed that members of the heavy drinking group who chronically abused alcohol had telomeres nearly half as long as the telomeres in the group of non-abusers (0.41 vs. 0.79). Dr. Baccarelli said this difference in telomere length was “very sharp” and shows the strong biological effects of alcoholism at the cellular level. This finding is consistent with the impression that many people have of alcoholics as people who are aging prematurely – something which comes from alcoholics looking so haggard, disheveled and out-of-it.
What does this mean for lawyers who chronically abuse alcohol? It is yet another loud wake up call to STOP DRINKING NOW! It is common knowledge that many alcoholics die young, but alcoholics in denial pretend they will be the exception and live a long life. It is less commonly known that some early deaths of alcoholics are due to alcohol-induced cancer. Now we have proof of the causal mechanism behind the early deaths of alcoholics from cancer. Now we have proof that alcohol is literally destroying bits of DNA at the ends of chromosomes which we need to keep our cells genetically stable over time so we can live longer, cancer-free lives.
Andrea Baccarelli, M.D., Ph.D., teaches  environmental epigenetics at Harvard University. He and his colleagues presented the results of a study in April 2010 at the Annual Meeting of the American Association for Cancer Research which sheds light on how alcoholism causes cancer and decreases human lifespan, and it has to do with the effect of too much alcohol on telomeres.
Telomeres are a region of repetitive DNA found the ends of chromosomes and are crucial to the genetic stability of cells. Without telomeres to cap their ends, chromosomes would lose their ends (and all the valuable genetic information they contain) whenever they replicated. Telomeres prevent chromosomes from fusing with each other or combining in abnormal ways and thus prevent cancer. Shortened telomeres are associated with increased risk of cancer.
Telomeres affect lifespan because they put a fixed limit on the number of times cells can replicate. In general the longer your telomeres the longer your life and the shorter your telomeres the shorter your life. As we age telomeres gradually and progressively shorten and this is associated with shortening of the human life span.  Heavy alcohol consumption causes oxidative stress and inflammation. Both of these are known to shorten telomeres. Alcoholism is associated in the medical literature with increased risk of many different cancers including cancers of the throat, esophagus, larynx, stomach and liver. Dr. Baccarelli wanted to confirm the link between alcoholism, telomere shortening and cancer. He set up a study in which he measured DNA serum from 59 participants who were heavy drinkers (22% of which consumed four or more alcoholic drinks per day) and from 197 variable drinkers (only 4% of which drank four or more drinks per day).
Results showed that members of the heavy drinking group who chronically abused alcohol had telomeres nearly half as long as the telomeres in the group of non-abusers (0.41 vs. 0.79). Dr. Baccarelli said this difference in telomere length was “very sharp” and shows the strong biological effects of alcoholism at the cellular level. This finding is consistent with the impression that many people have of alcoholics as people who are aging prematurely – something which comes from alcoholics looking so haggard, disheveled and out-of-it.
What does this mean for lawyers who chronically abuse alcohol? It is yet another loud wake up call to STOP DRINKING NOW! It is common knowledge that many alcoholics die young, but alcoholics in denial pretend they will be the exception and live a long life. It is less commonly known that some early deaths of alcoholics are due to alcohol-induced cancer. Now we have proof of the causal mechanism behind the early deaths of alcoholics from cancer. Now we have proof that alcohol is literally destroying bits of DNA at the ends of chromosomes which we need to keep our cells genetically stable over time so we can live longer, cancer-free lives.

Click here to purchase The Upward Spiral: Getting Lawyers From Daily Misery To Lifetime Wellbeing by Harvey Hyman

Click here to purchase  audio downloads of  MCLE lectures by Harvey Hyman

NEWLY IDENTIFIED GENES, NEW DRUGS, SPELL HOPE FOR ALCHOLICS

Friday, May 21st, 2010

Why can some people take a few sips from one glass of alcohol at a dinner party and call it a night, while others compulsively gulp down four martinis or two bottles of wine at the same event? Scientists say it’s more than differences in one’s upbringing or culture of origin and that it boils down to genetics. The new scientific consensus is that  alcoholics break down into subgroups with different genetic mechanisms for their susceptibility to alcohol dependence which warrant different therapies.

It has been clearly established for decades that a key factor in many cases of alcoholism is how the dopamine producing reward system of an individual’s brain responds to ingestion of alcohol. Dopamine is the neurotransmitter which lights up the pleasure center of your brain (the nucleus accumbens). In some people ingesting alcohol produces no measurable increase in the brain secretion of dopamine into the nucleus accumbens. In others ingestion of alcohol triggers a large enough increase of dopamine secretion to produce euphoria, and this euphoria overwhelms the capacity of their frontal lobes to put a brake on their drinking. They can’t stop once they take their first drink. What we are now learning is the genetic reason for this phenomenon.

On May 18, 2010, Dr. Vijay A. Ramchandani and his colleagues at the National Institute on Alcohol Abuse and Alcoholism published a study in Molecular Psychiatry online explaining one genetic basis for susceptibility to alcoholism. His work is focused on gene variants for the construction of the opioid peptide receptors in the ventral striatum of the brain where the nucleus accumbens is located. These receptors must be activated to trigger the flow of dopamine into the nucleus accumbens. The genes that code for construction of these receptors have polymorphisms, which are slight differences in DNA sequences which produce slight differences in genetic expression. These appear to be associated with behavioral differences in humans and animals.

The opioid peptide receptor most studied by experts in alcoholism is the mu-subtype. All primates have different variants of the mu-subtype opioid receptor. Dr. Ramchandani knew that monkeys with a gene variant called the mu-subtype opioid receptor 118G found alcohol ingestion very pleasurable and they drank much more alcohol than other monkey when given the chance. In his experiment, Dr. Ramchandani had people with the common gene variant 118A and people with the less common variant 118G drink alcohol or a placebo beverage and then scanned their brains with a PET scanner (a scanner that uses glucose molecules tagged with a radioactive isotope to pinpoint varying levels of metabolic activity in different parts of the brain).

The study showed that people with the less common 1185 gene variant had a significant increase in dopamine secretion into the nucleus accumbens, while people with the more common 118A variant had no increase in their dopamine secretion level. To confirm causality the researchers developed two lines of mice, one with each gene variant. The mice with variant 118G showed a four-fold peak increase level of dopamine secretion consequent to ingestion of alcohol.

In 1995 the FDA approved the use of the drug Naltrexone for treatment of alcoholism. Naltrexone was originally approved to treat drug addicts because naltrexone molecules bind to the opioid receptors in the brain, block other molecules from binding to them and neutralize the euphoric effect of heroin, morphine, methadone, and cocaine. Studies of naltrexone which led the FDA to approve it showed that Naltrexone reduced the pleasurable effects of ingesting alcohol and reduced cravings in alcoholics who were abstaining from drinking.

Charles P. O’Brien, M.D., Ph.D., director of the Treatment Research Center at the University of Pennsylvania, has been studying why some humans and animals have an exaggerated response in their dopamine system when they consume alcohol. Behaviorally alcoholics are people who experience a very positive reaction to drinking alcohol, something that re-enforces their drinking behavior and makes it hard to abstain. What Dr. O’Brien has found is that only some alcoholics respond favorably to Naltrexone, whereas others can take the drug but continue to have intense enjoyment of alcohol with intense cravings for alcohol when they try to abstain.

While Dr. O’Brien refers to the Asp40 allele in his work, this is the exact same polymorphism as mu-subtype opioid receptor 118G under a different nomenclature. Dr. O’Brien is now running a randomized, prospective clinical trial in patients with alcohol dependence to compare the effects of Naltrexone on those with and without the Asp40 allele. If all, or the vast majority of, Naltrexone responders have the Asp40 allele and the non-responders don’t have it, then doctors can order an inexpensive single-gene test to determine if Naltrexone treatment will be useful.

Whatever the results of Dr. O’Brien’s study may be, some alcoholics don’t respond to Naltrexone. How can they be helped with regard to medication? Right now there are three new research avenues for drugs. The first is trying to find a pill that would overcome the effects of too much CRH (corticotrophin releasing hormone) going from the hypothalamus to the pituitary. Over-secretion of CRH is what drives the adrenal glands to pump out too much stress hormones (adrenalin and cortisol) in highly stressed, anxious people. Individuals with this problem have way more CRH receptors than normals, and the ideal pill would be one that binds with those receptors, blocks the effects of the oversupply of CRH and produces no harmful side effects. So far pharmacologists have not been able to develop such a pill.

The second candidate is a drug that would target substance P. Substance P is a neurotransmitter that is involved in the transmission of pain impulses from the peripheral to the central nervous system and which modulates the body’s immune and inflammatory responses. In some situations Substance P can imitate the effects of CRH in the human brain when a person is stressed. Markus Heilig, Ph.D., and his research group believe that Substance P may be involved in some cases of alcoholism and that blocking the neurokinin 1 receptors for Substance P might reduce their dependence on alcohol.

In 2009 Heilig teamed up scientists at Eli Lilly to test this hypothesis. They created a line of mice that lacked the NK1 receptor for Substance P, and demonstrated that these mice do not develop alcohol dependence or drink as much as normal mice when given increasing amounts of alcohol. Early human clinical trials have begun. In a placebo controlled study on 50 persons Eli Lilly scientists used a PET scanner to show their oral formulation caused 90% blockage of Substance P receptors. When put under stress and given access to alcohol the treated individuals had reduced craving and showed reduced release of CRH using functional MRI. Thus this avenue is research is showing some early promise, but is still a long way off before the FDA approval process can begin.

The third candidate is the drug Varenicline, a smoking cessation drug approved by the FDA marketed by Pfizer under the name Chantix. This drug binds to and partially activates the receptors for nicotine. It lessens the enjoyment of smoking and the craving for a cigarette in people who are abstaining. Approximately 80% of heavy alcohol drinkers with alcohol use disorders also smoke. Selena Bartlett, Ph.D., director of pre-clinical development group at Ernest Gallo Clinic and Research Center at UCSF Medical Center, tested Varenicline on rats and found it helpful in reducing their experimentally-induced alcohol dependence. In July 2009 S.A. McKee (a psychiatrist at Yale University Medical School) published a preliminary study in Biological Psychiatry indicating that using Varenicline for seven days reduced alcohol consumption level and alcohol craving in a group of 50 persons who were heavy-drinking smokers.

The potential promise of Varenicline must be greeted with some caution. First, its application would not be universal, but would apply to those alcoholics who are still smokers. Second, in 2008 the FDA received reports of increased depression, Suicidality and completed suicides in some people using this drug and Pfizer changed its packaging label to reflect this concern. In 2009 the FDA issued an Alert to let health care providers and the public know that Chantix use is associated with these problems but the existence, if any, of a causal mechanism is not yet known. Although it’s a far less serious side effect, Varenicline produces nausea in some people.

Although we have not yet reached the point where psycho-pharmacology can cure alcohol dependence, medical researchers and major drug manufacturers are beginning to make some headway in understanding genetic susceptibility to alcoholism and how to develop medications targeted to reduce that susceptibility.

Click here to purchase The Upward Spiral: Getting Lawyers From Daily Misery To Lifetime Wellbeing by Harvey Hyman

Click here to purchase  audio downloads of  MCLE lectures by Harvey Hyman

HOW TO AGE WELL FOR LAWYERS

Wednesday, February 10th, 2010

      In 1974 Henri Amiel said, “To know how to grow old is the master-work of wisdom, and one of the most difficult chapters in the great art of living.”

      The average age of lawyers working in the U.S. today is 45. This can be a stressful and difficult time for many reasons. You’ve been working for 20 years or so, but work may not have matched your hopes with regard to earnings level, financial stability, intellectual interest or enjoyment. Although you’re straining to put away money for the future college education of your children, are you having trouble communicating and getting along with them? Have you lost a parent to illness or are you under the strain of helping care for an aging parent afflicted with stroke, Alzheimer’s or another disabling illness?  

       Are you sagging or showing a bulge about the middle and wondering forlornly where the body you had in high school went? If you’re a man is your hair gone or thinning on top? Has your long term marriage left you feeling taken for granted, unappreciated or even invisible at times? Are you and your spouse irritable toward each other? Do you argue a lot? Is your level of sexual intimacy unsatisfactory? Are you feeling pressured and harried by all the bills that never stop coming at the office and at home? When was the last time you had a truly fun and relaxing vacation?  Does life seem more and more like a tiring treadmill that you’d like to unplug and take some time away from?

      If you’re not springing out of bed each morning filled with vitality and enthusiasm for the day at middle age, you’re not alone. Middle age is often the time of life when lawyers suffer from struggles with work satisfaction, finances, family relationships, personal health, depression and substance abuse. It can be a time of disillusionment with religion and wavering faith or loss of faith. It is often the time in life when lawyers resort to medications for anxiety, depression and/or sleep, and when they start carving time from their weekly schedule to see a psychologist or therapist.   

       While anti-depressants help a substantial number of people with severe depression, which is a biological event, the medical evidence is that anti-depressants don’t do much for people with mild depression arising from dissatisfaction with the lives they’ve built. Therapy isn’t always an effective solution either because most insurance policies severely restrict the number of visits you can make to a psychotherapist. The idea is to help you just enough so you can adjust to an acutely distressing situation, rather than fund an ongoing exploration and reconstruction of your adult self. Even if you have the resources to pay for long term psychotherapy, the process of re-visiting, making sense of and accepting or forgiving painful situations in childhood is not always successful.

       This article explores self-help strategies to enable lawyers in their middle years to age well and increase their health and happiness as they grow older. In our era improved nutritional and healthcare practices can keep us alive into our 80s. The big question is do you want the next three or four decades to be a blessing or a burden? Are you willing to take control, do some planning and invest some energy in your own future welfare or just keep sliding into a deeper pit? Modern studies of adult development indicate that an old dog can learn new tricks, and that we can transform our attitudes and relationships sufficiently in middle age to overcome an unhappy past.

       The model of adult development which was dominant in the last century was the one articulated by such American psychologists as Charlotte Buhler and Else Frenkel-Brunswick. They said human beings ascend developmental steps until middle age, when the period of “regressive growth” begins marked by symptoms of decline and gradual retirement from life. In 1965 Canadian psychoanalyst Elliot Jacques coined the term “mid-life crisis.” Jacques theorized that most adults underwent an episode of falling apart during middle age when they sensed the passing of their best years and recognized the onset of decline. The conventional image of a midlife crisis for a man was to have an affair and buy a Corvette.

       Between 1978 and 1987 developmental psychologist Erik Erikson published three major books on adult development which set forth a very different view. Erikson advocated a more optimistic model in which psychologically healthy adults continued to change, develop and grow throughout their lifespan as they successfully met life’s challenges. During the 1980s empirical research on adult development showed that the number of adults who had the sort of mid-life crisis described by Elliot was just 10%. This research concluded that for many people mid-life was a time for reflection and re-assessment rather than for freaking out.

       During the past couple of years Carlos Strenger, a Professor of Psychology at Tel Aviv University, has written articles saying it’s time to cast off the stereotype of the mid-life crisis as a myth and to see our middle years as a time of transition. Strenger says if you’re willing to make the most of what you learned during the first half of your life, the second half will be happier and more fulfilling. Making the second half of your life a blessing rather than a burden is more important now than ever, since life expectancies have kept rising.

       How are we to do this? Strenger says you should do four things: recognize you have a great deal of time in front of you with the ability to re-make your life for the better and start planning; identify your strongest abilities and the things that please you the most without regard to what your parents, teachers, coaches or mentors said; make choices based on knowledge and experience instead of “youthful blind ambition” and be willing to invest the energy it will take to make changes no matter how daunting the obstacles; and make full use of colleagues, friends and family to support you in the new directions you want to take. 

       The strongest and most scientific case that people can make major changes in their lives from 50-75 and wind up Happy-Well instead of Sad-Sick at the finish line (the period from 75-85) comes from George Vaillant, M.D. Dr. Vaillant says that no matter how difficult or sad our childhoods were, we each have a chance to mature emotionally and socially and reach a happy old age if we commit ourselves to grow in healthy directions. Do you remember the E.F. Hutton commercial in which everyone stopped to listen to what he had to say about stock investment? Dr. Vaillant is like the E.F. Hutton of adult development. What he says counts.

       The suicide of Dr. Vaillant’s father caused him to have a lifelong interest in adult human development. He became a psychiatrist, a professor at Harvard Medical School and an expert on the process of recovery in schizophrenia, heroin addiction, alcoholism and personality disorder. In 1967 he became the Director of the Harvard Study of Adult Development and he has served in that capacity for the past 33 years.

       The Harvard Study began over 80 years ago and is the longest running, the best financed and by far the most respected prospective study of adult development in the world. Most studies of human development are retrospective, which means the experts review records of past human health and behavior, select variables to study, crunch the numbers and try to account for why certain individuals flourished and others floundered. A prospective study is one in which the participants are screened and selected in advance, and then carefully followed (with questionnaires, medical exams and interviews) as they age to determine how they respond to life’s challenges and opportunities as they age.

       These kinds of studies are expensive and difficult to pull off. They require a high degree of organization, coordination and effort from the investigators and a high degree of loyalty and cooperation from the participants over the decades. The Harvard Study cost millions of dollars, but was worth it, because it was run very professionally and the participants remained extremely loyal and cooperative. It has yielded very valuable data to understand the human aging process.

       The primary objective of the Harvard Study was to ascertain the causes of positive aging and figure out why some people lived longer, stayed healthier and felt happier than others over the course of a lifetime. The researchers wanted to know what factors mattered and which didn’t for the aging process to be successful. During the course of the Harvard Study the participants endured all the ups, downs, joys, and sorrows that all of us do – marriage, divorce, the births of children and grandchildren, deaths in the family, periods of good health/ability and periods of illness/disability, gaining and losing employment, building up a business and losing a business and so forth.

       Watching the participants handle these real life events, the investigators discerned patterns that made for successful aging. On the psycho-social side, they found that investing in your marriage (to deepen the love, intimacy and friendship between spouses); learning to make lemonade out of the lemons life throws at you; working to keep widening your social radius (making new friends as old ones die off); making the time to keep learning, playing and creating; and finding ways to be of service to others were keys to a happy old age. On the physical side, they found that not smoking, moderate use of alcohol, regular exercise and maintaining a normal weight were key to healthy aging.

       The people in the study with bad marriages, the ones who complained bitterly about life’s disappointments and held grudges, the self-absorbed ones who put no effort into making new friends or assisting others; and the ones who watched lots of TV instead of reading, engaging in sports or engaging in creative or artistic pursuits were sad. The ones who didn’t take good care of themselves – the ones who smoked, abused alcohol, didn’t get regular exercise or maintain a normal weight – ended up sick.  

       If you really want to end up Happy-Well rather than Sad-Sick, now is the time to implementing changes in your routines. The Harvard Study demonstrated that people could grow progressively happier into old age if they stayed hopeful about the future, kept active and kept learning, making new friends and playing throughout life. The least happy were those who stopped learning, growing and making friends – the ones who became stuck, passive and complaining – the ones who weren’t living life but felt life was happening to them and didn’t like what life was dishing out.

       The passive complainers were pessimists who felt that happiness depended on having the right set of external circumstances and that they had been dealt a bad deck. The happy ones recognized that even if life had not given them circumstantial advantages (like loving parents, money, high social class, a high IQ or a fine education) they still had an inner potential to make their lives good and be of service to others. The happy ones used their energy to make the most of their inner potential.   

       The Harvard Study (which is still going on) contains three separate groups or cohorts:

 (1) The Grant Cohort consisting of 268 sophomores at Harvard University selected between 1939-1942 by physicians Arlie Bock and Clark Heath as academically solid students without evidence of physical or psychological difficulty. All of them were white, but not all of them were from wealthy or privileged backgrounds. Half of the men were on scholarships or worked during college to help pay tuition. They had a mean IQ of 130-135. At age 50 they had a mean income of $105,000.

(2) 500 inner city teenage boys from Boston (99% Caucasian) selected in 1939 by Harvard Law School professor Sheldon Glueck. They had all the risk factors for juvenile delinquency (such as living in poor families in blighted, slum neighborhoods) but did not engage in delinquent behavior. Their mean IQ was 95 and at age 50 their mean income was $35,000.

(3) 672 female students (99% Caucasian) attending Stanford University selected by Stanford professor Education Lewis Terman in between 1920-1922 on the basis of their having an IQ of 140 or higher. Their mean IQ was 151 and by age 50 their mean income was $35,000 (which reflected lack of opportunity and low pay scales for women).

       Study investigators interviewed the parents and teachers of the participants. Of the 268 Harvard University sophomores who started, 248 remained in the study after graduation. Until their deaths they answered detailed questionnaires every two years, had a physical examination every five years and were interviewed every fifteen years. Some of them are still alive and have been interviewed four times. Glueck reduced the number of inner city youth from 500 to 456 for reasons of expense. The 456 who remained in the study also answered biennial questionnaires, had a physical exam every five years and gave periodic interviews. The Terman Cohort answered questionnaires every 4-5 years and was not given physical exams. They have been studied by successive investigators over the past 80 years. Dr. Vaillant interviewed 40 of the survivors of the Terman Cohort in 1987 at a time when their average age was 78.

       By age 80 both the Harvard Cohort men and the Terman Cohort women enjoyed a mortality only half of what would be expected for their white peers. The Inner City men had a comparatively more rapid rate of physical decline and tended to die about 10 years earlier than the other groups, something associated with lack of education and higher levels of smoking, alcohol consumption and obesity. However, at age 70 the health of the 29 Inner City men who graduated college was the same as that of the Harvard Cohort men. 

       Dr. Vaillant has published and discussed the results of the Harvard Study in many different periodicals. For the benefit of the lay public he summarized the results with plenty of illustrations from his interviews of the study participants in a fascinating book titled Aging Well that came out in 2002.

       In Aging Well Dr.Vaillant groups the study participants into one of four categories once they’ve reached age 50. These are the Happy-Well, the Sad-Sick, the Prematurely Dead and the Intermediate. The Happy-Well were subjectively happy, happy according objective assessment and healthy both mentally and physically according to the study psychiatrists and physicians. The Sad-Sick were subjectively and objectively unhappy, unwell mentally and/or physically and sometimes partially disabled. The Prematurely Dead were seriously depressed with one or more severe illnesses and severe disabilities. The Intermediate were people who overlapped and blurred the boundaries of different categories.

       Only one in six of the Happy Well was dead by age 75. Half of the Sad-Sick were dead by 75. All the Prematurely Dead were dead by age 75. Ninety percent of the Happy Well who reached 80 years of age had “all their marbles” which is considerably higher than the national average. These people had successfully replaced their former workmates with good friends, found creative outlets (e.g. mastering a symphony on the piano or translating a literary classic from a foreign language) and learned not to take themselves too seriously. With age they grew less egotistical, less competitive, more fun loving and more affectionate. They made wonderful grandparents. It pays in many ways to be Happy and Well as an older person.   

       If psychologists knew as much about aging as they thought they did, then it should have been possible for the Harvard Study investigators to predict with certainty, or at least a very high degree of accuracy, who would turn out Happy-Well or Sad-Sick based on their initial, comprehensive assessment of study participants which included interviews with the participants, their parents and their teachers and review of all pediatric health records, college health records, college grades and college activities.

       Not surprisingly the investigators were right in predicting a happy future for students who had happy childhoods in which they were loved, accepted and helped to trust their emotions and the Universe. The big surprise came with regard to predicting the future for students who had desolate and relatively loveless childhoods. The good news is that in a substantial number of these cases, the prediction for unhappy, unsuccessful aging turned out wrong.

       The value of the study as far as Dr. Vaillant was concerned was: (1) in debunking myths that certain factors destined a person to have a certain quality of life; (2) in demonstrating that adults can change, mature and improve with age (like a fine wine); and (3) in showing what factors do promote successful aging – even in people who did not appear to be good candidates for a happy old age based on a bleak childhood. 

       Here are some of the key findings from Aging Well:

       By age 50 the following things had no significant effect one’s psychological status: Birth order, childhood physical health, the distance in age between you and the next child or the death of one or both parents.

        Bad events in childhood do not doom us. They do not deprive us of the potential for happiness. Children who were treated poorly by being ignored, neglected, screamed at, or hit, and who were not loved in a healthy, consistent way while growing up, can still mature into happy, well adjusted adults. Given the number of study participants who overcame loveless childhoods to become happy adults, Dr. Vaillant concluded that an unhappy childhood becomes less important over time.

      While we cannot change our temperament (things like tested IQ, personality style of introversion/extroversion or heredity aspects of our social intelligence) these things do not determine our level of happiness as adults. Happiness as an adult is more a function of character which is within our control. We can make an effort to overcome our fear of others, to increase our comfort with others, to increase our self-assurance, to express our opinions more openly, to criticize our children less and so forth.

      Certainly there were women from the Terman Study with very high IQs who were Happy-Well and flourishing, but some of the women with very high IQs from that study became sad, lonely people with an ever-shrinking social circle. On the other hand there people with low IQs from the Inner City group who grew to enjoy their work, make many friends, find pleasure in family and enjoy life.

      Growing up in a wealthy, privileged home does not guarantee one will be happy and well in old age. There were a number of people in the study who came from a high social class with all the material advantages while growing up, but went through adulthood as negative, friendless people, some of whom drank themselves to a premature death. One of these people was a successful, wealthy trial lawyer. This man had a succession of relationships with women but never married. He put in just the amount of time needed at work to win his cases, but reserved his weekends for heavy drinking. He did not serve a mentor to any associates or serve on any law firm or bar association committees. He had no close friends. He died of alcoholism before age 75.

     On the other hand the study showed that growing up in a family where one was truly and well loved by one’s mother significantly raised the odds of being in the Happy-Well group. Children well loved by their mothers who grew up without depression and who did not seek psychiatric help or anti-depressant medication before age 50 appeared not to need spirituality or religion to be happy. On the other hand, children who grew up without a loving mother and who exhibited serious depression before age 50 were able to use spirituality and religion to become happier after 50.

       How one manages anger is a good predictor of aging well or poorly in adulthood. Study participants who habitually exploded in anger or buried it deep inside did poorly. Study participants who could express anger in a healthy way reported having gratifying careers and relationships. Dr. Vaillant says it’s more challenging for an adult to express anger in a healthy way if he had parents who didn’t tolerate his  emotions, who labeled them as misbehavior and who weren’t able to “hold” his sadness, love or anger. Yet, it’s possible as an adult to recognize you have difficulty expressing anger, to work on it in therapy and get better at it.

       Based on his readings of his predecessors in the study of adult development (such as Erik Erikson) and his own observations of the study participants as they aged, Dr. Vaillant came up with three “essential tasks of adulthood.” According to Dr. Vaillant the more satisfactorily an adult accomplishes these tasks the greater the probability he will be in the Happy-Well group as he ages. The three tasks he named were Generativity, Keeper of Meaning and Integrity.

       According to Dr. Vaillant, “Generativity involves the demonstration of a clear capacity to unselfishly guide the next generation…. and to be in relationships where one cares for those younger than oneself” but where one respects the autonomy of younger people and holds the reins of control loosely. A generative person is one who shares his self and gives it away after he has developed an identity and consolidated his career skills. A generative person helps to build community “by serving as a consultant, guide, mentor or coach to young adults in the larger society.” Dr. Vaillant says that in all three Study cohorts mastery of Generativity tripled the chances that members would experience joy not despair  during their 70s.

       Being a Keeper of Meaning refers to preserving one’s culture (“the collective products of mankind”) by transmitting it to the young. While a generative person takes a succession of individual young people under his wing to mentor, the Keeper of Meaning guides groups, organizations and bodies of people toward the conservation of past traditions. Dr. Vaillant says that a wise old judge, the chairman of a town historical society, the ongoing correspondent for a college class long past graduation, a village matriarch, a genealogy maven and an antique refinisher are all examples of people who discharge this function. Keepers of meaning are not partisans who take sides and do not feel loyalty to any one person. Their virtues are those of wisdom and justice, and their loyalty is to the past and the whole of society.

      Integrity is the hard won sense of order in the world including the “acceptance of one’s one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions.” Integrity is the ability to affirm that life was worth living in the face of declining mental and physical function and the imminence of death – something that models hope and courage for the young.

       In general the members of the three Study cohorts who were Happy-Well in their old age had mastered these three tasks in sequential order. However, not all Study participants handled each task equally well or in the order that Dr. Vaillant laid out. Some participants were much better at one task than another. Some worked on the last task first or worked on all three at once.

       Dr. Vaillant says, “One life stage is not better or more virtuous than another.” and “Adult development is neither a footrace nor a moral imperative. It is a roadmap to help us make sense of where we are and where our neighbors might be located. It also contributes to our ‘wholeness’ from which our word ‘health’ is derived. In old age there are many losses and these may overwhelm us if we have not continued to grow beyond ourselves.” 

      Being generative, a keeper or meaning or having integrity all have to do with one’s attitude and orientation. Are you a philanthropist (a lover of humankind) and an altruist (one who helps others because it’s the right thing to do not because you expect a reward) or are you a ruthlessly competitive person who will sacrifice anyone to win a case, make the big bucks and buy the most toys to flatter his own ego? Being a smart person with a high IQ or having a lot of money in the bank from being a big business success can’t substitute for the three virtues of the second half of life or ease your way into the Happy-Well group.

       We only have so many minutes to spend in our lives and only so much energy to utilize during those minutes. Buddhist monk Matthieu Ricard said “Don’t spend your life killing time since time will eventually kill you.” Clearly we want to stay busy, rather than waste our time, but what we do and the spirit in which we do it is crucial to whether we will age successfully. If we spend it mainly on making money and buying stuff will this make us happy? Matthieu Ricard says a life of self-absorption and chronic selfishness is destined to be unhappy, whereas a life spent being of service to others will be a happy one, because our greatest source of joy is being useful and leaving the world better for our having been here.

      You may be resisting this line of thinking, because lawyers are so very status competitive and because law firms and their systems of compensation and promotion are so money-oriented. But don’t be fooled. The Harvard Study concluded that having abundant money was not related to happiness in old age. Some of the most well off participants were lonely, drank heavily and took poor care of themselves. To avoid loneliness, it’s essential to remain socially useful and help out other people. Acts of kindness and altruism enlarge the heart and increase joy. Even when age has put physical limitations upon you, a person can offer emotional support, comfort and advice to others. Some of the happiest people in the study had become mentors or wisdom figures.

      Dr. Vaillant illustrates this from the lives of participants in the Harvard Study as well as the following quote from psychologist Edmund Stanford: “The real secret of a happy old age is once more in service for others carried on to the end of life – a service which, on the one hand, gives perennial interest to life by making the old man [or woman] a participant in the life of all those about him, and on the other, surrounds him with love in return.”  

      The happy people were the ones who did not complain about every ache and pain, but who showed cheerful tolerance of the indignities of old age and a graceful acceptance of their dependency needs. By seeking medical help when you need it and being openly grateful for the services of a kind physician, you’re making lemonade out of lemons.

      Happy people were able to see life as a journey. Instead of becoming dour and pessimistic as some abilities declined, they maintained hope in life. They not only continued to do for themselves whatever they could still do, but tried new things and celebrated their new skills or activities.

        A good marriage at age 50 predicted positive aging at 80, but surprisingly having low cholesterol levels at age 50 did not. A good marriage sometimes provided the love, care and support a participant did not receive as a child, and made up for that lack.

       Learning to play and create after retirement adds more to life’s enjoyment than retirement income. By play Dr. Vaillant is referring to sports like tennis, skiing, golf, hunting or fishing. He’s also referring to having a good sense of humor and exercising your humor muscle often by laughing. By creating Dr. Vaillant is referring to activities that draw upon feeling, emotion and intuition like painting, sculpting, pottery, writing poetry or singing in a choir.   

       Objective good physical health was less important to successful aging than subjective good health. It’s all right to be ill as long as you don’t feel sick.

         Learning to balance the gratification of one’s appetites (for food, drink, sex, etc.) with one’s capacity for self-control and learning to balance one’s instinct for adventure with one’s tendency  to avoid risk for self-preservation is a key to successful aging. The participants who learned to live with neither too much desire and adventure, nor too much caution and self care were happiest. The health nut who gives up Cuban cigars, scotch whiskey, French cuisine and Italian romance to live to 100 can no longer tell if he’s still alive at age 30. On the other hand, the person who obsessively trains for and participates in super-endurance sports events, can end up anorexic, depleted and an outcast in the family he’s always avoiding.

       One of the essential paths to reaching a happy old age is to befriend “the loving and health giving individuals within one’s social matrix wherever they may be.” By this Dr. Vaillant means making close friends with the good people we encounter (a boss, a colleague, a neighbor, a relative) and remaining intimate with those people through life. Further, it’s crucial to replace those wonderful friends with new ones when the old ones die. The loss of close friends and loved ones is inevitable and can be overwhelming, unless we “widen our social radius” as we age.

       Study participants who made no effort to replace the best friends who died became lonely, sad and depressed. Those who befriended new people as they aged were happiest in their old age. To maximize the benefits of old or new friendship we must “take people in.” By taking someone in, Dr. Valliant means something more than inviting people over for dinner.

       He’s referring to the process of opening your mind to the other person’s perspectives on life (so you can learn something from them) and opening your heart so you allow the other person to care for you and love you in the way they want. To be capable of such friendships requires the capacities for forgiveness and gratitude. It also means taking a break from always being the one to help and take care of others. Dr. Valliant found that the Study participants in the Sad-Sick group were the ones who failed to widen their social radius and to take people in.

Conclusion Aging successfully means staying healthy and growing progressively happier past age 50. The people who do it stand a very high chance of living into their 80s “with all their marbles,” plenty of friends and much to look forward to in the way of social activities, new learning, play and creative activities. While no one is guaranteed successful aging, no one is doomed to be unhappy even those who had desolate, loveless childhoods. You can age successfully by mastering and implementing the techniques and virtues described in Dr. George Vaillant’s book.

Good luck. I hope every one of you ends up Happy-Well. 

 

           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THE LEAST KNOWN AND MOST EFFECTIVE INTERVENTION FOR ALCOHOLISM

Tuesday, November 10th, 2009

             If you’re a lawyer or the family of a lawyer looking to hire someone to conduct an alcoholism intervention, it’s crucial for you to know that there are different models of intervention with markedly different objectives and methods.  

             In the United States alcoholism intervention is dominated by the Johnson model which is driven by good intentions but is limited in ways that can severely restrict its long term effectiveness. The Invitational Systemic Approach (also known as the systems model) is much more effective, but is practically unknown and little used for that reason.  

             If you ask anyone how an alcoholism intervention is done 99% of the people who have a response will describe the Johnson model. While a Johnson model intervention frequently succeeds in manipulating and shocking an alcoholic into treatment, it frequently engenders lasting resentment (rather than gratitude). With relapse as high as 80% and resentments being the number one trigger for relapse, starting the treatment and recovery process in this way is not preferable. 

             A traditional Johnson model intervention takes about one hour and is focused primarily on the alcoholic and his drinking. There is no focus on the family, no protocol for producing psycho-social transformation and healing of the wounded family and no follow up with the family or even the alcoholic.

             The Johnson model was developed by Rev. Vernon Johnson, an Episcopal priest in Minnesota and a recovered alcoholic who worked in the field of alcohol intervention from 1962 until his death in 1998. Contrary to AA he believed an alcoholic did not have to hit “rock bottom” before he could sincerely commit to sobriety. He also believed that intervention by the family should be done as early as possible, before the disease of alcoholism had progressed too far. He co-founded the Johnson Institute in Minnesota in 1966, which has trained over 8,000 people to use his methods.

             In February 2009 the Johnson Institute was absorbed by the Hazeldon Foundation Center for Public Advocacy of Minnesota. Hazeldon is the largest non-profit rehab center for chemical dependency and offers graduate studies in addiction counseling. Be aware that none of the 50 states have licensing or training requirements to conduct an alcoholism intervention, so you do not need an M.A. in addiction counseling to conduct interventions based on the Johnson model. Some interventionists just take a weekend class before they take their first client. 

             The typical charge for a Johnson model intervention is a flat fee of $5,000 for 4 hours or less of preparation work with the family and the 1- 2 hour intervention. The preparation work is related to how the family will behave at the intervention. It does not include teaching the family long term strategies and skills for dealing with the alcoholic after the intervention is over. The odds that a Johnson model intervention will produce long term sobriety are highest when the interventionist has been trained at the Johnson Institute, has done hundreds of interventions and has solid references from other families. 

            Unfortunately the big profit for a relatively easy five hours of work has attracted unscrupulous people to the field. These people are untrained and do not work full time. They moonlight as interventionists on weekends, motivated by the cash.  Some of these people hold down day jobs in fields like real estate that are completely unrelated to addiction intervention or counseling.

            Since interventionists are unregulated by state governments there is a wide disparity of integrity and training amongst them. It is common for moonlighters doing Johnson interventions to ignore calls from distraught family members post-intervention when the alcoholic recants his decision to get treated, drops out of treatment or relapses after treatment. They view their job as completed once they have conducted a one hour intervention. This leaves the family at a loss for what to do next after paying the interventionist $5,000. Not surprisingly such families are frustrated, angry and frightened.  

 The Limitations of the Johnson Model

             The assumption of the Johnson model is that the alcoholic will recover if he can just be made to enter treatment, and its sole objective is to get the alcoholic into treatment. It is an ambush method that is sometimes called “the surprise attack at dawn” because of when it often performed. It is deceptive and confrontational in nature. The alcoholic is given no warning at all of the intervention or he might be told to attend a family gathering such as a lunch, but is not given advance notice of the real purpose of the gathering. When he shows up he is confronted with the evidence that he is an alcoholic, told that his family will no longer tolerate his drinking and warned that he must enter treatment or face the direst consequences which could include separation or divorce with loss of custody of his children.

             A Johnson model intervention is timed to occur when the alcoholic will be most receptive to the get-treatment-or-else message because he is at a low ebb. Typically it occurs after the alcoholic has screwed up in some way (broken a promise, lost a job or damaged the car), feels guilty and is vulnerable to admitting he really does have a drinking problem after all. Not surprisingly many targets of this form of intervention do go into treatment for alcoholism.

             The problem is that some never complete treatment and most relapse. The conventional estimate is that 80% resume drinking. With this quick-fix method, the numbers of targets who undergo lasting cognitive, emotional and psycho-social changes that bring them true health and true integration back into their family must be exceedingly small. Some alcoholics drink and use drugs. Some have a dual diagnosis, meaning they drink because they have untreated unipolar or bipolar depression, and their drinking exacerbates their depression which stimulates more drinking. Manipulating an alcoholic into joining AA will not address or resolve all of the alcoholic’s problems when he has co-occurring problems that go beyond drinking. And, with all of the focus being on the alcoholic, the family gets little or no help of their own.

 The Systems Model of Alcoholism Intervention   

             In order to learn about the systems model I met with Alice Tanner, J.D., I.S., an intervention specialist based in Tiburon, CA. The systems model was developed by Wayne Raiter, LCSW, and Ed Speare, MBA, CSAC. Ms. Tanner received her original training with Ed Speare, and had two follow up trainings with Wayne Raiter. She has clients in California and across the country. The systems model assumes success is more likely if you do not trigger the alcoholic’s shame, and if you do not mislead, deceive or lie to him.  In her work, the alcoholic is invited to attend the intervention and told in advance who will be present and what will be discussed. The alcoholic is treated respectfully, as a person with a deadly illness rather than as a misbehaving screw-up.

           He is told that his attendance is optional not mandatory, and that although the family very much wants him there, the family meeting will occur with or without him.  The systems model focuses on the whole family rather than the alcoholic and his drinking. It scrutinizes the disease of alcoholism and how it harms every member of the family. A basic assumption of the systems model is that if the family system changes the way it perceives and responds, then every person in the family will change. It also assumes that every person in the family has been harmed and needs healing. The objective is to educate each family member about their role within an addicted system and commit to a plan of recovery best suited to restore sanity and health.

             Ms. Tanner uses the standard systems model approach which is to conduct a two day workshop with the entire family. Well over 90% of the time the alcoholic shows up and participates in the workshop, most probably because his family is reaching out to him and it would be a foolhardy and self-destructive act of defiance to absent himself. This is the alcoholic’s one real chance to be part of the solution instead of being the problem. This is his one real chance of healing himself and his family after years of being ill and hurting the ones he loves.

             The two day workshop is conducted in a non-judgmental way. It includes information on the medical aspects of addiction (e.g. how people become addicted and what goes on in the addict’s brain). There is much discussion about the role of family members in enabling the alcoholic to drink. Enabling is common for the non-drinking spouse to avoid the stress of confrontation and to reap the benefits provided by a functional alcoholic who continues to be a good provider. Ms. Tanner cautions the family and the alcoholic that consequences are inevitable but no one can choose what they will be or when and how they will occur. One real life situation she mentions involved a successful businessman who drank alcoholically for many years under his wife’s nose with nothing seriously amiss ever happening, until one day he crashed his car and killed 3 people, putting himself in prison, leaving his wife without his income and leaving his young teenage son fatherless. 

             Ms. Tanner tells the family that the costs of intervention are massively exceeded by the costs of not treating or under-treating alcoholism. She passes out a sheet of paper entitled The High Costs of Untreated Addiction. It mentions not just the financial costs of defending DUI charges or responding to a lawsuit for marital dissolution, but lost job promotions and career opportunities, lost relationships, lost lives, lost freedom, demoralization, guilt, remorse and shame. She also talks about the inter-generational harm of alcoholism. So often the alcoholic had a father and grandfather who drank, and is now faced with children at home who are showing signs of drinking, using drugs or both. When will this inter-generational suffering end? The systems model provides a variety of tools for ending it. 

             Along with the standard two day educational workshop, Ms. Tanner offers an extended service option that can go for 6-12 months which she regards as the optimal way to proceed. She says the odds of sustaining crucial life style changes for each member of the family improve with this option. During the extra 6-12 months she teaches the family members how to implement the tools she taught them in the midst of real life challenges. For example, the family may need help with relapse triggers and prevention, when the alcoholic shows signs of struggling with his demons. Ms. Tanner is always available to answer their questions by e-mail or phone and will visit them if needed. Many of her clients tried the Johnson method, and ended up against a wall, because their loved one relapsed but the interventionist wouldn’t return their calls. Ms. Tanner can be reached at www.bayarea-intervention.com

             There are plenty of lawyers suffering from alcoholism or alcohol abuse who can’t quite bring themselves to try AA or in-patient alcohol rehab, or who tried them and didn’t obtain lasting recovery. If you are one of them, and you really want to recover, then I would suggest trying to find a well trained intervention specialist who uses the systems model. Ms. Tanner will fly anywhere in the United States to work with you and your family so long as the client pays her travel costs. Since alcoholism is a potentially lethal disease that frequently causes severe harm to a lawyer’s career and family life, this is an investment that seems well worth it.

              In fairness it should be noted that if a Johnson model intervention is handled the right way by the right people it can precipitate long term sobriety and personal transformation. In his book Getting A Winning Verdict In My Personal Life, trial lawyer Gary Gwilliam describes a Johnson model intervention that he credits with saving his life and his career.

              This intervention was conducted by the lawyer who founded The Other Bar as a recovery group for alcoholic lawyers. The co-participants were other lawyers who knew Mr. Gwilliam and who cared very deeply about his health and welfare. They were firm with him but conveyed great sincerity and concern instead of acting in a punitive way. Instead of feeling shamed, Mr. Gwilliam felt moved to make a permanent change.