Graduate Students

Many Notre Dame graduate and professional students express surprise at the many ways in which graduate school is academically and socially distinct from their undergraduate years. Although it is a very exciting time in expanding professional goals, the social life varies greatly from the undergraduate experience. The demands of the work load with new expectations keep graduate students somewhat isolated during the week, and many seem to experience more loneliness and stress than they experienced during undergraduate work. The change in social life may be the result of graduate living, marriage, attending a graduate/professional school away from their alma mater, or perhaps there has been an alteration to the drinking culture. Sometimes the change in stress level can result in drinking alone, drinking during the week, or continued binge drinking on Friday and/or Saturday nights to relieve the stress from the week.

Now may be a good time to use the self-check to evaluate where you are in your drinking habits. As a professional/graduate student, you will soon occupy a unique position in society. Your well-being and that of your clients will depend on the quality of your professional performance. In addition, your performance is dependent upon more than just professional expertise. Physical health, mental health, and overall quality of life directly affect your performance and thus directly affect clients. Any impairment of your performance can ultimately impair clients, the profession, and society. While a license to practice law, medicine, psychology, teaching, etc., may provide opportunities and open doors that might otherwise be closed, it does not protect against common "career killers” like alcoholism, drug addiction, depression, burnout, and stress. While most professionals will never suffer from substance abuse or depression, virtually all professionals will interact with another who does. To get an idea of how rampant these problems are among professionals, consider the following:

• According to the Journal of Public Health (February 1991, vol.81, No.2) about 4% of physicians are substance abusers and another 4% are potential abusers. Research indicates that physicians tend to respond very successfully to treatment.
• The American Bar Association (ABA) estimates that 15- 20% of U.S. lawyers suffer from alcoholism or substance abuse.
• A 1990 Johns Hopkins study of 12,000 people in 103 occupations reported that attorneys lead the nation in depression.
• A recent empirical study in the state of Washington revealed that 18% of the lawyers who practiced 2 to 20 years have become problem drinkers. The number grows to 25% among lawyers who have practiced 20 years or more.
• Alcoholism and other chemical dependencies are estimated to be a factor in at least 27%, and possibly as many as 70%, of professional discipline cases. After two years of sobriety the rate of malpractice decreased to 2-3%.
• Researchers at Campbell University in North Carolina found that 26% of the lawyers in North Carolina were clinically depressed and that 11% of the attorneys in the state think of taking their own lives at least once a month.

The above list does not include the stress experienced by virtually all professionals on a daily basis. If not effectively managed, stress can, and does, grow into paralyzing distress or debilitating burnout.

Click on the Self Assessment link here to do a self evaluation. There are three different self assessments to choose from. Hopefully you will find them helpful.
Self Assessments

Scenario:

Adolescent development includes the thinking “it won’t happen to me.” As an adult we understand that anything can happen at any time. Take the following scenario: You are a 35 year old (a teacher, lawyer, engineer) social drinker that stops on Fridays with co-workers to have a few beers to unwind from the week. A police officer watches you leave the establishment and pulls you over as soon as you leave the parking space. Your BAC is a .08 and you are arrested for DUI.

What are the obvious consequences?

How do you respond to the students, clients, and/or administration that see the arrest in the local paper?

Reflect on whatever the reason, incident or issue that may have brought you to this place. What did you intend for your day? What awareness and/or insight has it helped you to gain?

At some point in your career you will undoubtedly encounter a client or colleague who has been affected by chemical dependency or depression. In a 1992 report, the National Center for Health Statistics estimated that 43% of adults in the United States have experienced some of the effects of exposure to alcoholism, either personally or in their families. In addition, depression impacts an estimated 17.6 million Americans each year. You may represent clients on matters directly or indirectly arising from these problems (i.e. DUI and other criminal offenses, divorces and child custody actions, personal injury cases, bankruptcy, and/or business failures). By ignoring a client’s/co-worker’s alcohol or substance use problem you could be doing him/her a significant disservice.

Take this time to think of your past experiences with friends, acquaintances, and family members. Has alcohol negatively impacted anyone you know? Did you think something should have been done about it?

To fulfill your duty to your profession and clients you should do more than just recognize and commit to your professional obligations. You should have at least some baseline knowledge about alcohol abuse, chemical dependency, compulsive gambling, and depression. You should also have at least a minimal ability to identify the signs and symptoms of these problems and how to access help. You would also do well to understand the nature of stress and how to manage it in a way that can prevent distress and burnout.

Listed is a basic introduction to the dynamics of alcohol abuse and chemical dependency, depression, and stress, as well as guidelines for getting help for yourself, a client, or colleague whose life is impaired by such difficulties.

SUBSTANCE ABUSE, ALCOHOLISM AND CHEMICAL DEPENDENCY:
A SHORT PRIMER ON THE DISEASE

Alcohol Abuse and Alcoholism/ Chemical Dependency

In 1956, the American Medical Association officially recognized alcoholism as a primary disease. Until that time, it was viewed as a weakness, a sin, a lack of character, or a symptom of some other emotional or psychological problem. Some people still hold these views despite research and medical literature to the contrary.

As a disease, alcoholism, like other chemical dependencies in general, has certain recognizable characteristics and presents predictable symptoms. First, it is a primary disease; it does not arise from another illness or an underlying emotional or psychological problem, much as the flu does not result from fever and congestion, but is likely to cause both. Second, the disease follows a predictable and progressive course. Left untreated, alcoholism or other chemical dependency will pass through progressively worse stages, each with its characteristic symptoms, until possibly leading to death. How rapidly each stage progresses may vary widely from person to person. Third, alcoholism or chemical dependency is a multi-phasic disease. That is, it affects all aspects of a person’s life: physical, mental, and emotional health deteriorates; family, relationships, and social life suffer; and professional performance declines. Fourth, the disease is permanent and chronic. While it may be arrested through treatment, it cannot be cured. Finally, alcoholism and chemical dependency are treatable. Success rates vary and controversy continues about the “best” treatment method.

One aspect of alcohol dependence that is still not completely understood is its origin. Some people seem to be born with it, unable to drink moderately from their very first drink. Others seem to develop the disease later in life after drinking or using moderately for years. Evidence strongly suggests that those who have a family history of alcoholism are genetically predisposed to develop the disease themselves. Others suggest that alcoholism or other chemical dependency is the result of a combination of genetic and environmental factors. Ultimately, how or why a person acquired the disease is less important than diagnosis and treatment.

Whatever the origin of the disease may be, it is generally accepted that alcoholics and chemically dependent people physiologically process (from metabolic action to neurochemical response) alcohol and other mood-altering substances differently from non-chemically dependent people. Alcohol abusers and other chemically dependent people experience an overriding compulsion to use alcohol or other drugs, eventually lose control over that use, and continue to use despite negative consequences.

Substance Abuse

The medical community distinguishes between substance abuse and substance dependency. Essentially, there is a continuum from substance abuse to substance dependency. Most people drink alcohol occasionally and don’t experience any resulting problems. However, when the use of alcohol begins to cause or exacerbate problems in a person’s life (i.e. job, marital, or legal problems) and the person continues to use, or if the person repeatedly uses alcohol in physically hazardous situations (i.e. while driving), that person has shifted into the abuse stage. Some people are able to exit out of this abuse stage and never return. Many cannot, however, and their use eventually leads to physical dependence. Below are various types of drinkers.

Occasional Drinkers and Social Drinkers

Occasional drinkers may drink on a few occasions throughout the year or one to two times a month. The occasional drinker knows his/her limit and can take it or leave it when it comes to alcohol. Since over-use is rare with an occasional user, they can bring attention to themselves when they exceed their limit as they have little tolerance to alcohol. Social drinkers may drink with more frequency, extending use two to four times a month, and the social drinker knows their established limit. A social drinker can still take it or leave it and they may have more tolerance than an occasional user. Social drinkers respect boundaries and limits with alcohol but may on rare occasion exceed their limit. Female social drinkers typically limit their use to one to two drinks per occasion and male social drinkers usually have between two and four.

Abusive Drinker

Women who drink more than three drinks and men who drink more than four drinks, on six to eight occasions a month may be drinking too much. Abusive drinkers have an increased tolerance to alcohol so they may not appear as intoxicated as they really are. They may look forward to occasions in which alcohol will be served. Drinking occasions may be taking preference over non-drinking functions. Abusive drinkers are looking for the “buzz” or feeling of intoxication. Abusive drinkers will experience occasional blackouts or fuzzy memories from the evening. Abusive drinkers try to hide how much alcohol they are consuming or minimize how much they drank. Sporadic problems and relationship issues can occur as a result of their drinking.

Invisible Problem Drinker

Some drinkers can be identified as an “invisible problem or dependent drinkers.” These adults are practiced drinkers. They always drink when socializing, and as such, find excuses to socialize, celebrate and drink perhaps three to four times per week. They have developed a high tolerance to alcohol and tend to have few ill effects or problems despite consuming large quantities of alcohol. Usually, professionally successful in work and family; they possess high motivation and drive. They may experience blackouts on occasion but do not draw much attention to themselves. Confrontation of use with the invisible problem drinker is difficult as consequences from use are harder to identify; yet others are often concerned about the amount they consume.

Problem Use or Dependency

Since the frequency and intensity of drinking varies widely among people, alcohol dependence can be a challenging distinction to identify. One does not have to drink every day or experience the “shakes” to be considered alcoholic. In fact, only 5% of adults diagnosed with alcohol dependency are non-functional or fit the stereotype of the “alcoholic.” Identifying problems that occur in a person’s life as a result of their drinking and their ability to control their use once they start, better identifies someone who is dependent. A central issue often related to alcohol problems is high tolerance. A female drinking more than four drinks and a male drinking more than five drinks on three-to-four occasions a week may reflect high tolerance. Such a person may have a family history of alcohol abuse or alcohol dependency. That individual may have difficulty stopping their use once they start and might be passing out or experiencing blackouts on a frequent basis. Drinking may become a habit as a way to avoid unpleasant situations or to avoid stress related to such things as family and employment.

Health Consequences

Drinking to the point of intoxication one to two times a week or more frequently over a period of several years can pose serious health consequences including liver disease and cirrhosis, circulatory problems and cardiomyopathy, nervous-system damage and polyneuropathy, alcohol dependence, and psychosis. Alcohol abuse can increase the risk of certain types of cancers, including cancer of the tongue, mouth, pharnyx, esophagus, larynx, and liver. The cancer-producing effects of alcohol abuse increase with the use of tobacco. Current research indicates that men and women do not respond to alcohol in the same way. Women can expect substantially more impairment than can men at equivalent doses. The physical health consequences and dependency issues also happen much quicker for women.

Many tests and diagnostic tools can determine the presence of substance abuse, chemical dependency, or alcoholism. However, you need not be a trained diagnostician to recognize when alcohol or other drug use might be a problem for a colleague or a client. A simple understanding of how the disease progresses and how this progression is manifested in a person’s life, coupled with a willingness to look with a discerning eye, are what is needed to at least determine whether the situation warrants a professional assessment.

While substance abuse, alcoholism, or other chemical dependency manifests themselves differently from person to person, the following are some common and predictable problems. These problems can occur in any order and to any degree. For simplicity, they are described in the second person:

• You drink or use to manage emotions or stress (i.e. to celebrate winning a case, to relax after a stressful day, to deal with anger). Eventually the alcohol or other drug becomes your primary stress reduction tool.
• Your behavior becomes less and less responsible. Your work quality may decrease, you may miss appointments, or you may begin drinking or using on the job or at lunch.
• Your drinking or using begins to intensify negative emotions. You may experience increased anger, resentment, guilt, depression, or anxiety.
• Your behavior begins to conflict with your values and ethics (i.e. lying, mishandling funds, getting a DUI).
• The alcohol or other drug begins to take center stage in your life. You may quit socializing unless it involves drinking or using, you are preoccupied with drinking or using, or you protect the supply to avoid running out. You may also begin drinking or using alone.
• You may engage in efforts to control your use. You may try to control the substance used (i.e. beer rather than hard liquor) or try to control the amount used (i.e. only two drinks per day). You may try to control the time of use (i.e. drinking only on the weekends). These attempts may be effective for periods of time but eventually they fail.
• Your mental functioning is affected. Your thought system becomes increasingly delusional, your behavior may become grandiose, and you may have difficulty concentrating. In addition, your ability to handle stress decreases and you may experience blackouts (memory gaps).
• Your tolerance of alcohol or other drugs increases (that is, more of the substance is needed to obtain the same effect). In late-stage alcoholism, the tolerance becomes wholly unpredictable.
• Your physical health deteriorates. You experience sleep difficulties, weight changes, malnourishment, intestinal problems, ulcers, and liver problems. Ultimately, the disease can be fatal.

Denial

To fully understand substance abuse or substance dependency, it’s beneficial to understand the phenomenon of denial. Alcoholism and other substance dependency are among one of the few diseases whose hallmark is denial of the disease itself despite overwhelming evidence to the contrary. Denial takes many forms: from minimizing the amount used or the extent of the resulting problems to rationalizing the drinking or use. People affected by alcoholism may try to divert any confrontation on the problem to another topic and may exhibit hostility, avoidance, and isolation. Most people who abuse substances including alcohol engage in denial to some extent and this denial is their primary obstacle to obtaining help. One’s ability to help someone with a substance problem increases substantially if awareness exists regarding the dynamics of denial.

Treatment

To repeat an important point, while chemical dependency or alcoholism is permanent and chronic, it is treatable. Treatment takes many forms, thus offering a more personalized fit for individuals. Generally, the extent of treatment is based on factors such as the affected person’s physical condition, motivation, ability to remain abstinent, history of previous treatment, and the degree to which the disease has progressed. Treatment can be in the form of groups, Alcoholics Anonymous, modified Intensive Outpatient Programs, regular I.O.P., or inpatient hospital stay. In more serious stages, withdrawal or detoxification from an addictive substance can be at best uncomfortable and at worst fatal, particularly in the case of alcohol withdrawal. Therefore, medical supervision is often imperative.

Whatever type of treatment is indicated, it is generally accepted that abstinence from mood-altering chemicals is necessary. Chemically dependent people are susceptible not only to addiction to their substance of choice, be it alcohol, cocaine, or prescription drugs, but they are susceptible to addiction to any mood-altering or psychoactive chemical. For this reason, it is important that any medical treatment be conducted by a professional familiar with chemical dependency.

Taking Action

If you begin to suspect that your colleague or client might have a problem with alcohol or chemical dependency, you must recognize that alcoholism or chemical dependency is not one of those problems that will just solve itself over time. If it is not addressed, it will get progressively worse. Fortunately, there are steps you can take to get help. As a professional and client advocate, assistance should be extended to other professionals and to clients when needed. Following are some principles you can follow and some actions you can take to help someone who is abusing alcohol or other drugs.

Avoid Enabling

First, avoid enabling. An enabler is someone whose actions shield a chemically dependent person from experiencing the full impact of the consequences of their addiction. An enabler, by words or actions, helps the affected person continue to deny the problems that are occurring due to use and inadvertently contribute to the user spiraling downward. Enabling can take many forms, but the most common are:

• Denying that the affected person has a problem (“Old Joe doesn’t have a drinking problem.”).
• Rationalizing the person’s drinking, using, or resulting behavior (“Susan works hard¬ so she deserves to party hard.”).
• Making excuses and lying for the person (“Jack’s been sick a lot lately.”).
• Doing for the affected person what he or she should be handling personally (Carrying most of Ellen’s workload, making sure her cases get handled properly, paying her bills, etc.).
• Rescuing that person from the consequences of his or her behavior (Lending Mark money, “cleaning up” his problems for him, etc.).
• Avoiding confronting the problem at all (avoiding the person or the topic).

Ultimately, the issue becomes the effect of your good intentions. If your actions allow the chemically dependent person to continue in that dependence, you are hurting them, not helping.

Intervention

As discussed above, for treatment of chemical dependency and substance abuse to be effective, the denial of the problem must be penetrated. In some cases, the behaviors and consequences of the use itself will break down the chemically dependent individual’s denial. Problems in their families, job, legal matters, and/or health become too much to deny and the person admits he or she has a problem and seeks help. For some people, however, this realization may come too late or may never come at all. Fortunately, the chemically dependent person need not always hit bottom before getting help. Often, an intervention is appropriate and effective.

Vernon Johnson, M.D., in his book INTERVENTION: HOW TO HELP SOMEONE WHO DOESN’T WANT HELP defines intervention as “a process by which the harmful, progressive, and destructive effects of chemical dependency are interrupted and the chemically dependent person is helped to stop using mood-altering chemicals and to develop new, healthier ways of coping with his or her needs and problems. It implies that the person need not be an emotional or physical wreck … before such help can be given.” Anything that interrupts the process of the disease and guides the chemically dependent person to help is an effective intervention.

In the 1960s, Dr. Johnson formalized a process that is often referred to as the Johnson Institute Model of intervention. This model involves a structured and rehearsed conversation with the chemically dependent person by a group of family members and concerned others (i.e. law partners, other colleagues). Led by an intervention specialist, each member of the intervention group addresses the chemically dependent individual with specific instances of the individual’s drinking or using and describes how the individual’s behavior affected that member of the group. The intervention is intended to bring the reality of the disease into focus and to motivate at least some measure of desire for help. This type of intervention is highly specialized and can be very delicate. It should be undertaken only under the direction of an experienced intervention professional. It may be possible to contact your local mental health facility for assistance in providing an intervention for someone.

How to Access Help

Outpatient and inpatient treatment facilities are scattered throughout every state and country. They vary widely in services provided, the experience and expertise of the professional staff, treatment philosophy, and cost. It is important to investigate alternatives and be familiar with local providers in your surrounding area, if you will ever need to refer someone. Know at least three providers in your area that you have spoken with and feel comfortable with the services they provide.

DEPRESSION

Depression can affect any graduate student, regardless of age, sex, or profession. With studies showing law students and lawyers leading the nation in the incidence of depression, it should go without saying that this is a problem demanding our attention. All of us, at one time or another, feel “blue” or “down in the dumps.” We all get sad or feel grief after a loss. Depression, though, is more than this. It is a medical disorder that affects a person’s thoughts, feelings, health, and behavior day in and day out. It affects an estimated 17.6 million Americans each year and yet only about 20 percent of those afflicted ever seek help. Women are twice as likely to suffer from depression as their male counterparts.

Lawyers, more than other professionals, seem particularly reluctant to seek help for depression. Some are unwilling to admit their depression for fear they will be seen as weak or unreliable. Others believe they should be able to handle their personal problems just as they handle their clients’ legal problems. Further, many simply do not recognize that there is even a problem.

Signs and Symptoms

Obviously, the first step in addressing a depression problem is acknowledging its existence. Someone with major depressive disorder will present a number of symptoms nearly every day, all day, for at least two weeks. These include at least one of the following:

• Losing interest in things you used to enjoy or feeling sad, blue, or down in the dumps

At least three of the following:

• Feeling slowed down or restless and unable to sit still
• Feeling worthless or guilty
• Having troubles sleeping or sleeping too much
• Experiencing loss of energy or feeling tired all the time
• Gaining or losing appetite or weight
• Thinking of death or suicide
• Having problems concentrating, thinking, remembering, or making decisions

What To Do

If you meet these criteria or believe a friend does, it is important that you not ignore the problem and hope it goes away. The longer serious depression goes untreated, the more likely it is to become chronic and damaging. Left alone, depression can cut short a promising professional career, destroy a loving family, and ultimately can lead to suicide. True depression typically is not something you can “shake yourself out of.” Even between depressive episodes, most people who go untreated continue to experience negative effects such as inability to concentrate, disorganization, and apathy. Often, it is only a matter of time before the next depressive episode begins.
Getting treatment is often easier and less painful than you might imagine. It is important, though, that you see a professional trained in the treatment of depression. Usually, treatment will consist of medication, psychotherapy, or some combination of the two. Often, people with depression begin to see positive results within a month of beginning treatment. If you are not sure where to start, your employer may have an employee assistance program that can help. The program can get you in touch with other professionals who have recovered from depression and refer you to a number of health providers in your area who can assess your condition and help you get treatment.

GAMBLING

You Bet Your Life

A generation ago, legalized gambling was rare, limited to the casinos in Las Vegas or Atlantic City, some racetracks and a few state lotteries. Today, gambling opportunities are as close as the local convenience store or your laptop computer. Many experts equate Intemet “day trading” as a form of legalized gambling, rather than investing.

Over 80% of Americans participate in some form of gambling according to the Florida Council on Compulsive Gambling. This number is likely to increase with the proliferation of new forms of legalized gambling, including scratch games, video keno, sports wagering, local casinos, bingo and video poker. For many people, gambling is an occasional recreational activity that doesn’t present a problem, but for some people it is a debilitating disease which can cost them their careers, their families, and their lives.

Problem Gambling is defined as gambling behavior that causes disruptions in any major area of life: psychological, physical, social, or vocational. The term “Problem Gambling” includes, but is not limited to, the condition known as “Pathological,” or “Compulsive” Gambling. The American Psychiatric Association describes these terms as a progressive addiction characterized by increasing preoccupation with gambling, a need to bet more money more frequently, restlessness or irritability when attempting to stop, “chasing” losses, and loss of control manifested by continuation of the gambling behavior in spite of mounting, serious, negative consequences.

The 1999 National Gambling Impact Study estimates that of the 125 million Americans who gamble at least once a year, approximately 7.5 million have some form of gambling problems, with another 15 million “at risk” of developing a gambling problem. The study indicated that problem gamblers cost society approximately $5 billion per year and an additional $40 billion in lifetime costs for productivity reductions, social services, and creditor losses. Other addictive behaviors such as alcohol or drug abuse generally coexist with problem gambling and may be a contributing factor to the compulsive gambling or relapse. For example, after going out and getting drunk, an individual may, contrary to their earlier intention, decide that it would be a good idea to place a few bets. Unlike drug or alcohol abuse, however, there is no telltale physical symptoms (like slurred speech or stumbling) characteristic of gambling addiction.

Problem gamblers typically fall into two general types: action gamblers are typically men who prefer “skill” games like poker, craps, horse racing, and sports. They may believe they are smart enough to beat the odds and win consistently. Escape gamblers tend to be women or elderly people who gamble to escape problems, preferring “hypnotic” games like slots, bingo, scratch tickets, and video poker. According to a study done in December 2000 by the online research firm PC Data, women make up the majority of Internet gamblers.

Experts believe that problem gamblers follow a cycle of progressive stages as they fall into the grip of compulsive gambling. Not all of the stages progress in an exact order nor are they limited to a specific time period. However, they do manifest specific financial ramifications. In the winning stage, the gambler still has money and feels in control. Gambling enhances their self-esteem and ego, and winning seems exciting and social. The gambler may shower family and friends with gifts, or take expensive vacations.

Eventually, the winning stage turns into the losing stage. As losses pile up, the gambler becomes preoccupied with gambling and makes larger and more frequent bets and might “chase” losses in the hopes of breaking even. At this point, the gambler will max out credit cards, cash in insurance policies, pawn or sell personal property, and dip into retirement or investment accounts. Lies, loan fraud, absenteeism, family disputes, and job changes are frequent danger signs.

Some problem gamblers will seek professional help at this stage but others proceed to the next stage before getting help. At the desperation stage, the gambler experiences health problems, like panic or insomnia, as debts pile up and relationships deteriorate. Having exhausted their financial resources, some gamblers turn to crime and action gamblers begin gambling like escape gamblers to avoid their misery and feelings of hopelessness. Others simply run away from their family and debts, while some may attempt suicide.

Help, including treatment, counseling, and financial assistance is available. A first step is to have your coworker or client call his/her employee assistance program if you are concerned about a possible problem. Assistance is private and, like all aspects of employee assistance programs, confidentiality is assured by statute.

National Council on Problem Gambling: 10 Questions To Ask Yourself About Gambling Behavior

1. Have you often gambled longer than you had planned?
2. Have you often gambled until your last dollar was gone?
3. Have thoughts of gambling caused you to lose sleep?
4. Have you used your income or savings to gamble while letting bills go unpaid?
5. Have you made repeated, unsuccessful attempts to stop gambling?
6. Have you broken the law or considered breaking the law to finance your gambling?
7. Have you borrowed money to finance your gambling?
8. Have you felt depressed or suicidal because of your gambling losses?
9. Have you been remorseful after gambling?
10. Have you gambled to get money to meet your financial obligations?

If you or someone you know answers “Yes” to any of these questions, consider seeking assistance from a professional.

STRESS AND STRESS MANAGEMENT

Consider creating the perfect stress-producing situation. It would demand a high level of performance with strict time limitations. Perhaps it would include conflict and confrontation with a win/lose outcome. It should also require constant critical judgment of your performance while giving you only a limited amount of control over that judgment. Throw in long hours with little or no break and potentially high stakes and you should have a perfect recipe for high stress. Sound familiar? Graduate school and professional positions, whether or not you love the school, practice, or work, is stressful. Some of us thrive on that stress and seem to perform better under it. Others respond to it less favorably by getting sick, depressed, and finally burning out. Whether you are the former or latter or somewhere in between, learning how to mange your stress is important not only for yourself, but for your clients as well.
A stressor is anything that raises the stress or pressure level in our lives. Stressors can be external, such as deadlines, speaking in public, conflict with others, or other job performance demands. The more threatening we perceive them, the more stress they create.

The most significant stressors, however, are often internal. A number of things can increase the stress in our lives, ranging from an intolerance of our own mistakes to expectations that other people hold us to. The way institutions and situations act or unfold and worry about the future may also be a stressor for some. The bad news is that through these internal stressors we create much more stress on ourselves than we get from the outside without even realizing it. The good news is that we have it within ourselves to change.

There may not be a lot you can do about some of the external stressors during a trial, presentation, or major project. Many of them are simply built into the structure of the process and for the integrity of the process need to stay there. The time constraints, the constant judgment, the conflicting positions-these are all intentional parts of the process. We can, however, do a lot to change our reactions to these external stressors and to reduce the other stressors that we bring to the process.

Stress management is really about lifestyle. This is not something you can decide to do the morning of a stressful day and expect it to work. It involves living choices that must be made early and practiced daily. Consider the following seven “S’s” as stress management training for professionals.

1. Sleep. Get enough of it on a daily basis. A tired mind and body are poor allies in stressful situations.
2. Sustenance. Treat your body like a friend. Eat well, exercise daily, and learn some stretching techniques to help you relax. Avoid relying on the false stress reducers like alcohol, caffeine, or nicotine. When you experience illness or distress, get help.
3. Solitude. All of us need some time alone; some people need a lot, some only a little. It’s not the amount of time you spend alone that matters but what you do with that time. This is time to refill your emotional reserves and to give your mind a chance to quiet down and rest. The better you can learn (through meditation, relaxation, restful activity, and recreation) to quiet your mind of all the chatter, the more effective your solitude will be.
4. Sharing. Just as solitude is important, so is sharing your thoughts, your emotions, your hopes, your fears, your life, and your stress with someone else. Learn how to interact with others, particularly your family and close friends, as a genuine, present human being. Practice listening to someone else and really try to understand what they are saying. Find people you trust enough to share your failures with as well as your victories. Your life is stressful enough without trying to do it all alone.
5. Silliness. Don’t take yourself so seriously. It doesn’t matter how big and important your career is; if you can’t laugh at yourself, you’re a heart attack waiting to happen. At least once a week, do something fun that involves no competition. Nothing relieves stress and tension better than a good laugh. Try to laugh a dozen times a day.
6. Spirituality. Spirituality doesn’t necessarily mean religion. Find what works for you and than pay attention-to it. If a particular religion or spiritual practice works for you, put it into action in your life. If getting out in nature is a spiritual experience for you, go regularly. Whatever you choose let it give you some perspective on your life. A strong sense of spirituality can also provide you with guidance and direction which will help to reduce anxiety, worry, and guilt.
7. Schedule. Make stress management a part of your life. Schedule time for all of the other “S’s.” The less time and energy you have to devote to simply trying to find the time, the more likely you can do things like exercise, play, or enjoy some solitude.

Stress management is important to your clients, your colleagues, your family, but most of all to you. Professional practice is inefficient, ineffective, and just plain not fun if you are stressed out. Managing stress takes commitment, but the time and energy you devote to it is an investment in yourself.
No one can do this for you. No one but you can make life any more or less stressful for you. You alone have the power to make positive change in your life. You can contact campus resources or employment resources to develop your own stress management program using deep relaxation, meditation, time management, and other stress reducing techniques.

CONCLUSION

The percentage of people who suffer from substance abuse and/or addiction or depression is substantial. Fortunately, most campuses and employers recognize the problem and are taking action to address the issues through assistance programs. Programs are effective only when individuals are able to identify the signs and symptoms of substance abuse/chemical dependency and depression and are open to receiving help. These programs not only save the lives of many impaired professionals and clients, but they also serve to protect the public and professional organizations as a whole from the often devastating effects of these “career killers.”

LICENSE TO PRACTICE: THE IMPACT OF SUBSTANCE ABUSE, MENTAL OR EMOTIONAL ILLNESS, OR PRIOR PROBLEMS

An applicant for a license to practice in many professions may require the applicant to respond to questions bearing on his/her “character and fitness” to practice. Often times applicants are not aware of or prepared for these types of questions or they may have worries about past indiscretions including legal convictions, bankruptcy, or alcohol violations. This section addresses the questions that could be asked on an application, explains the process for review, and provides guidelines for answering questions.

Bar applicants may be required to fully disclose information about the following topics:

• Financial problems. These may include any bankruptcies, unpaid child support, checks written with insufficient funds within three years of the date of application, unpaid local or state fines, and overdue student loans.
• Substance abuse. The current or past dependence upon and treatment for use of alcohol or drugs.
• Mental health issues. The current existence of a mental, emotional, or nervous disorder or condition that could affect the applicant’s ability to practice.
• Academic discipline. Incidents in which the applicant has been disciplined by an academic body.
• Civil proceedings. These may include malpractice suits when applicants have been licensed to practice law in other states or landlord-tenant disputes.
• Suspensions or disbarment by another State Bar. If the applicant has been practicing in another state and is applying for admission to another state Bar she/he must disclose these proceedings.
  
  Failure to disclose will weigh heavily against the applicant and could be grounds for denying admission to the Bar or other professional licensure.
  There are three primary reasons for the character and fitness review: 1) protection of the public, 2) protection of the administration of justice, and 3) protection of the public impression of a profession. Although the words “character and fitness” are often used together, the words have separate definitions when applied to applicants. “Character” is generally used to describe the honesty and integrity with which a person deals with others. “Fitness” is a person’s competence and ability to practice, both physically and psychologically.

An applicant’s mistakes, poor choices, diseases, or disorders are not necessarily an insurmountable hurdle or barrier to obtaining licensure. Most mandates are to identify individuals who are dishonest or who are unable to discharge their fiduciary duty to the clients. Fiduciary in this sense is broader than holding a valuable physical property in trust and includes responsible upholding of the confidences and the general best interests of the client.
Many applicants who suffer from the alcoholism or chemical dependency or who suffer from a mental, emotional, or nervous disorder fear that disclosure will hinder or prevent their licensure. This is not necessarily true. Issues of importance include: (1) when was the disease or disorder most recently active or symptomatic? (2) has the applicant acknowledged, accepted, and sought assistance for the disease or disorder? (3) has the applicant followed through with the recommended treatment for recovery? (4) has the applicant recently relapsed? and (5) if the applicant relapsed, what did the applicant do in response to the relapse?

An applicant who has acknowledged and taken responsibility for his/her disease or disorder and has engaged in a treatment or recovery program, and whose professional level of functioning is not significantly impaired by the disease or disorder, should expect a positive result from a review. An applicant who denies a disease or disorder, does not seek help, does not follow through with a treatment program, fails to disclose information, is devious or dishonest in answering questions, or fails to cooperate can expect a negative result from the review.

When a review committee becomes aware of a current chemical dependency or mental illness, it may require an applicant to submit to a professional evaluation. If current chemical dependency or mental illness is confirmed by a professional evaluation, the review committee may defer the admission decision pending receipt of evidence that the applicant has undergone treatment and is maintaining in recovery.

The review committees and more stringent background checks for licensure is a reflection of community standards and changes with the times. In the past, the national trend was to deny admission to all convicted felons. There is now a national trend toward a more flexible standard. In 1984, 10 states prohibited licensing of felons, the other 40 states accepted applications. In 1994, an American Bar Association surrey reported that 44 states and the District of Columbia would not bar an application from a convicted felon.’ The term "convicted of a crime” will not automatically lead to the denial of admission. For example, juvenile offenses and convictions for actions in another state which are not actionable crimes in some states do not automatically lead to admission denial. If you have been convicted of a crime you may want to inquire further of the licensure committee in order to determine if you fall within the exceptions allowing consideration for admission.

Factors or circumstances that may result in denial of admission include:

• Multiple arrests or convictions
• Multiple offenses or problems. For example, combinations of speeding tickets, DUII’s, assaults, or dishonored checks
• Lying or engaging in dishonesty on an application
• Deviousness or unwillingness to provide explanatory information.

If you are concerned that your character and fitness may be in question, be sure to keep these important guidelines in mind:

• Be completely honest
• Cooperate fully

You will not be penalized for seeking help or assistance for problems, but you may be penalized for not getting assistance when there is strong or clear evidence that a problem exists.

Bibliography

I Jennifer C. Clark, “Conditional Admission of Applicants to the Bar: Protecting Public and Private Interests,”The Bar Examiner, May 1995, p. 54.
2 [bid, p. 56.
3 Maureen M. Carr, `The Effect of Prior Criminal Conduct on the Admission to Practice law: The Move to more Flexible Admission Standards,"The Bar Examiner, February, 1997, pp. 17-18.

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