Adult and Adolescent Mental Health Blog

The team at Fifth Avenue Psychiatry aims to help both adults and adolescents with substance abuse and mental health issues.

Opiate Detox for Lawyers, Even Attorneys Get Hooked on Heroin

The Path to Opioid Abuse for Attorneys

Popular culture portrayals of the legal profession may draw young people to law school: giving impassioned arguments in front of a jury, laying out a compelling case in front of a judge. A promising young law student may enter school with hopes of helping the disfranchised or aiding in the reform of the criminal justice system. However, once they exit the hallowed halls of their law school, reality paints a grimmer picture.

Dozens of gifted students fight over the privilege of proofreading a partner brief. Relegated to stockrooms and cubicles, young attorneys work in excess of 70 hour weeks to rise above the competition and earn a spot in a firm. Idealism and optimism take a backseat to concerns of wealth and status.

Over time, the stress of the job begins to take a toll, and young attorneys look for coping mechanisms to deal with both the fast pace of the lifestyle and the demands of senior partners.

A Permissive Culture of Drug Abuse

Once they leave law school, many young attorneys learn that the unspoken mantra of the profession is “work hard, play hard.” Long days at the office turn into long nights, back into long days. To keep up with the crowd, lawyers may feel pressure to use illicit drugs or drink excessively.

What’s worse, to combat the effects that one drug has, an individual may turn to another to avoid withdrawal and achieve a chemical homeostasis. Lisa Smith, a recovering addict, attorney, and author of the memoir “Girl Walks Out of a Bar,” recalls waking up in the morning drunk, going to work, and doing lines of coke in the bathroom to maintain a sense of focus for a long day’s work.

In a field where performance is king, drug problems may go unnoticed. High achieving individuals like attorneys become functional drug addicts. Throughout the course of her addiction, Ms. Smith notes that she rarely missed a day of work and never received a negative performance review. As long as positive work performance continues, law firms turn a blind eye to party culture and allow it to continue. Unfortunately, the permissive culture surrounding substance abuse in the legal profession claims many lives.

Lawyers and the Opioid Epidemic

Lawyers and the Opioid EpidemicThe opioid epidemic does not discriminate – it does not care about a person’s socioeconomic status, level of education, or class rank. In fact, some research shows that opioid use among attorneys is higher than that of the general population.

Eilene Zimmerman wrote an in-depth profile about drug abuse in the legal profession, after the overdose death of her ex-husband Peter. The manuscript revealed that opioid use is nearly twice that of the general population. A study from the Journal of the American Medical Association Psychiatry supports this claim, as it found that white people from affluent backgrounds are using opioid painkillers at greater rates.

Opioid painkillers, in light of crackdowns and new prescribing guidelines, are not as easy to obtain as they were previously. For this reason, those with an addiction to opioids continue to turn to heroin when prescription pill supplies run dry.

A 2014 study found that 75 percent of those who were on heroin got there via a dependence on prescription opioids. The study showed that as prescription opioid use decreased, the amount of heroin use increased. Like any other person struggling with an addiction, attorneys turn to heroin when they cannot get prescription opioids, since it is both cheap and readily available.

The foundation for opioid and prescription drug abuse starts early. A survey from the American Bar Association found that as soon as six months into law school, many students show signs of mental illnesses such as depression, anxiety, hostility, or panic disorders. This can lead them to self-medicate with alcohol or seek prescriptions with a high potential of abuse, such as benzodiazepines, to cope with the stresses of school and subsequent employment.

Substance Abuse Treatment and Opiate Detox

The legal profession has some of the highest levels of illicit drug use, but attorneys struggling with a substance use disorder are less likely to seek addiction treatment. Several barriers to access may affect their ability or willingness to get clean.

  • The nature of the profession makes many young attorneys hesitant to take time off work to focus on their own health. According to one attorney, who spoke to Zimmerman on the condition of anonymity, “If you admit you have a problem, there is a line of 10 people behind you waiting to take your place.”
  • The permissive culture of the profession makes it difficult to get clean and stay that way. As long as work performance is satisfactory, senior partners turn a blind eye.
  • Since illicit drug use is rampant in the profession, it may be difficult for newly recovering attorneys to return to the workplace, surrounded by potential triggers.

Finding a New York Opiate Drug Detox Treatment Center – Psychiatrist NYC

Attorneys looking to break the cycle of addiction may not know where to turn or the options available to them. Quality, individualized psychotherapy specifically tailored to a person’s needs can help them develop healthy coping strategies for everyday job stresses. One-on-one outpatient therapy is also beneficial for those who want to protect their privacy and experience minimal disruption to their everyday lives.

A clinic dedicated to an individualized approach can help a person taper off opioids slowly, minimizing discomfort. When deemed beneficial, an addiction therapist can also supervise medication -assisted treatment (MAT). MAT combines FDA-approved medications to treat opioid abuse with evidence-based mental health interventions that support long-term recovery. The FDA has only approved three medications for the treatment of opioid addiction, and one of the most effective is called Vivitrol.

What Is Vivitrol?

Vivitrol doctors may prescribe the medication for the treatment of post-acute withdrawal syndrome (PAWS) and cravings that are related to opioid or alcohol addiction. It comes in an intramuscular formulation or as a pill. The intramuscular injection only requires monthly dosing, while the pill is once daily. It works by blocking the opioid receptors in the brain, which eliminates the euphoric “high” that a person experiences after using. It also helps the body return to homeostasis, so the brain and body can function normally without the need for opioids (which drives withdrawal symptoms).

Vivitrol has several advantages. First, unlike methadone, a person taking Vivitrol can do so in the privacy of their own home (because of the high potential for abuse, people taking methadone must do so in supervised clinics). It is also longer acting than some other forms of medication-assisted treatment – while methadone’s effects last around a day and a half, Vivitrol’s effectiveness can last up to one month.

Lastly, Vivitrol has a very low risk of abuse and diversion. Because of its mechanism of action, it will make a person who is using opioids experience withdrawal symptoms. Vivitrol is only suitable for those who have been through opiate detox – a period lasting 7-10 days, on average. Vivitrol providers may recommend MAT if they think the benefits of the treatment outweigh the risks.

Who Should Take Vivitrol?

Vivitrol is an effective treatment that is safe for most of whom would benefit from MAT.

The main risk of taking Vivitrol is mild discomfort after the initial injection. Some people report nausea, dizziness, or headache. Taking Vivitrol can carry a small risk of complications such as liver toxicity or eosinophilic pneumonia. As such, it might not be a good choice for those who have liver disease or allergies to certain medications.

Research, from the National Institute on Drug Abuse, shows that medication-assisted treatment modalities are more effective than behavioral interventions alone. Treatments like Vivitrol can help attorneys taper off opioids privately while receiving psychosocial treatment for opioid use disorders and other co-occurring mental health conditions.

Finding the Way Back from Addiction

Substance abuse in the legal profession is a systemic issue that stems from lack of support from superiors, a culture that allows drug use to occur, and a highly competitive workplace environment. The profession, as a whole, needs to prioritize mental health in the workplace, starting in law school. If law students took courses about learning the warning signs of addiction or mental health issues, they would be better poised to help themselves or colleagues in the future. Additional instruction on developing healthy coping strategies to deal with stress would also be beneficial.

Institutional changes, however, do not occur overnight. In the meantime, it is up to individual attorneys to look out for their own health and those of their colleagues. Seeking high-quality, individualized treatment on an outpatient basis can preserve anonymity, create minimal disruptions to daily routine, and support long-term recovery.

Fifth Avenue Psychiatry specializes in discreet, one-on-one treatment modalities for high-achieving professionals struggling with substance use disorders and other co-occurring mental health conditions. Interventions are evidence-based and focus on a holistic treatment of the individual, addressing all factors contributing to addiction. Outpatient services are convenient and allow patients to continue their daily lives while learning coping strategies for dealing with the stressors of their world. Our addiction therapists are highly trained and give patients the tools they need to achieve long-term recovery.

Find Details on Opioid Dependency and Treatment

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