Saving Lawyers 1 Less Drink at a Time

The Not-So-Obvious Link Between Alcohol and Anxiety
Law360
February 13, 2017

By Jennifer L. Gibbs
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Approximately 20 percent of the general population experiences an anxiety disorder at least once in their lifetime. Law students and lawyers, however, report to struggle with anxiety at twice that rate.[1] “The official number is that something like a gazillion lawyers are stressed out, and that amounts to a bajillion percent of the profession.”[2]

But what if pouring over a lengthy legal opinion while pouring a nightly glass of wine is actually contributing to, and not alleviating, the high levels of stress widely reported in the legal profession?

The link between alcohol and anxiety has been the source of both intrigue and debate among investigators and clinicians for decades.[3] To that end, some believe there is no link, believing alcohol disorders and anxiety disorders are standalone issues. Others believe that those experiencing anxiety tend to drink alcohol to cope with anxiety disorder — e.g., self-medication. But a third theory is that anxiety is a consequence of alcohol consumption. This theory is called the substance-abuse anxiety model.[4]

At first blush, the nightly drinker may brush off this theory, claiming, instead, that the nightly glass of wine is a far cry from “substance abuse.” However, “at-risk” or “heavy drinking” is defined as more than 14 drinks per week for a man and more than seven drinks per week for a woman.[5] For the non-daily drinker, one can also be considered a heavy drinker if the person consumes more than four drinks (for a woman) and five drinks (for a man) within a two-hour period.[6] Considering these guidelines, it is not surprising that more lawyers may find themselves in the problem drinker category than would like to admit. Lawyers are likely turning to alcohol to lessen stress and anxiety, to socialize, and even to sleep better. And yet, research shows that alcohol can lead to anxiety due to the brain-chemical changes, alcohol withdrawal symptoms, feelings regarding the negative consequences of drunken behavior, the effects of alcohol on the ability to learn vital coping skills, and the detrimental effects of alcohol on sleep. Unfortunately, many are unaware that their nightly pour could be causing or exacerbating the anxiety that is plaguing the legal profession, beginning in law school.[7]

Although alcohol is a depressant, it is also an indirect stimulant.[8] Alcohol directly affects brain chemistry by altering levels of neurotransmitters — the chemical messengers that transmit the signals throughout the body that control thought processes, behavior and emotion. Alcohol affects both “excitatory” neurotransmitters and “inhibitory” neurotransmitters. An example of an excitatory neurotransmitter is glutamate, which would normally increase brain activity and energy levels. Alcohol suppresses the release of glutamate, resulting in a slowdown along your brain's highways. An example of an inhibitory neurotransmitter is GABA, which reduces energy levels and calms everything down. Drugs like Xanax and Valium increase GABA production in the brain, resulting in sedation. Alcohol does the same thing by increasing the effects of GABA.

The science behind the anxiety-alcohol link is based on the fact that although acute alcohol intake increases the brain chemical GABA, chronic alcohol dependence results in an overall GABA deficiency, and may induce anxiety.[9] Jolene Park, founder of Healthy Discoveries, a corporate wellness consulting and training company, coaches professionals, business leaders and entrepreneurs who are rethinking drinking. Park also believes alcohol use can result in anxiety. According to Park, “Since alcohol targets GABA receptors, the brain responds by reducing its natural production and responsiveness of GABA. Therefore, alcohol increases anxiety and suppresses optimal brain function and performance.”

Moreover, withdrawal from alcohol can induce increased activity of both the limbic system and norepinephrine system, both of which are involved in the production of panic attacks.[10] Repeated withdrawal episodes can result in a process known as kindling, which is a progressive neural adaptation making the drinker more susceptible to anxiety and exacerbates stress-induced negative affect when alcohol intake stops.[11]

Additionally, those regularly drinking to excess may engage in risky behavior with severe consequences,[12] including family disruption, problems at the workplace, criminal convictions and financial problems.[13] The added stress of these negative social consequences could result in increased feelings of anxiety and stress.

It has also been shown that alcohol use in the presence of stress stimuli could interfere with the learning of coping skills — skills critical to a long and prosperous legal career.[14] To that end, one study found significant alcohol consumption rewires the brain so it is less able to cope with and rebound from stressors it encounters.[15] The study is important because it not only identifies how alcohol has a detrimental effect on an important emotional process, but also offers insight into how alcohol might do so by disrupting the functioning of some very specific brain circuits.[16]

If the above information is not enough evidence that a daily glass of wine or two could be negatively affecting the mental health of lawyers, studies show that drinking is detrimental to sleep in that it affects sleep stages, lightens sleep and causes abrupt awakenings.[17] After an evening of drinking, the brain chemical GABA allows a person to fall into a deep sleep.[18] However, once GABA is metabolized, much of it changes into the excitatory glutamate. The glutamate-releasing brain regions (such as the reticular activating system which partially modulates sleep/wake and arousal) then kick in, resulting in middle-of-the-night disruptions.[19] Studies also show that sleep deprivation can cause an anxiety disorder.[20] All good reasons for lawyers to forego a nightcap before retiring for the evening. Although simply limiting or abstaining from alcohol is unlikely to completely alleviate the stress associated with the practice of law, lessened alcohol consumption combined with other proven stress-reducing activities, such as meditation, a healthy diet and regular exercise, could result in a generation of happier lawyers. “Nothing about the practice of law exempts it from the rule that people perform better when they are thriving, not stressed and miserable.”[21] To that end, Victoria Smith, a lawyer practicing in the U.K., noted a significant decrease in her anxiety levels after taking part in "dry January." Per Smith: “I've still got a lively 7-year-old, full-on commute, and people to manage etc., but anxiety is less of an issue, and I feel more certain of decisions made around life's issues. I also have more faith in myself and feel more in control with more measured responses to issues. There's also a hell of a lot more time in the day!” Thus, a lawyer currently experiencing anxiety may wish to ask the question: Am I drinking because I’m stressed, or am I stressed because I’m drinking? The answer may be surprising.

—By Jennifer Gibbs, Zelle LLP

Jennifer L. Gibbs is a partner in Dallas office of Zelle LLP. She has over 20 years of experience in the insurance industry and, as a litigator, focuses on first-party property insurance coverage disputes resulting from catastrophic losses such as hail, wind, ice, water damage, collapse, fire and explosion. After taking on an alcohol-free challenge through www.oneyearnobeer.com, she noticed a significant decrease in stress and anxiety. She now wishes to share her positive experience with the legal community.

The opinions expressed are those of the author(s) and do not necessarily reflect the views of the firm, its clients, or Portfolio Media Inc., or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.

[1] http://www.lawyerswithdepression.com/articles/how-stress-and-anxiety-become-depression-2/

[2] http://www.abajournal.com/magazine/article/how_lawyers_can_avoid_burnout_and_debilitating_anxiety

[3] See Joshua P. Smith, Ph.D. and Carrie L. Randall, Ph.D., Anxiety and Alcohol Use Disorders, Comorbidity and Treatment Considerations, Alcohol Research 2012; 34(4); 414-431.

[4] Id.

[5] https://health.gov/dietaryguidelines/2015/guidelines/appendix-9/

[6] Id. One drink = 12 oz. beer, 5 oz. wine and 1.5 oz (typically a shot glass) of liquor. For context, a 5 oz. pour of wine will yield 5 glasses per bottle of wine.

[7] Jeena Cho, Can We Finally Talk About the Elephant in the Room? Mental Health of Lawyers, http://abovethelaw.com/2016/02/can-we-finally-talk-about-the-elephant-in-the-room-mental-health-of-lawyers/

[8] http://www.forbes.com/sites/daviddisalvo/2012/10/16/what-alcohol-really-does-to-your-brain/#47190bf1413b

[9] Id.

[10] Id. (citing Kushner, M.G.; Abrams, K.; and Borchardt, C., The Relationship between anxiety disorders and alcohol use disorders; A review of major perspectives and findings, Clinical Psychology Review 20: 149-171, 2000. PMID: 10721495; Marshall, J.R., Alcohol and Substance Abuse in Panic Disorder, Journal of Clinical Psychiatry 58(Suppl2): 46-49 1997, PMID: 9078994.

[11] Id. (citing Breese, G.R.; Overstreet, D.H. and Knapp, D.J. Conceptual framework for the etiology of alcoholism: A “kindling”/stress hypothesis. Psychopharmacology 178:367-380, 2005.

[12] Id. See also DSM-IV criteria for AUDs (APA 2000).

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/mid/NIHMS361546/

[14] Id.

[15] Nature Neuroscience (http://www.nature.com/neuro/journal/v15/n10/full/nn.3204.html)

[16] https://www.sciencedaily.com/releases/2012/09/120902143143.htm

[17] http://www.huffingtonpost.com/russell-rosenberg-phd/alcohol-sleep_b_902578.html

[18] https://www.washingtonpost.com/national/health-science/a-night-cap-may-get-you-to-sleep-but-studies-show-it-will-also-make-you-sleep-less-well/2013/12/02/a126dc6c-56f9-11e3-8304-caf30787c0a9_story.html?utm_term=.d591c595866c

[19] Id.

[20] https://www.adaa.org/understanding-anxiety/related-illnesses/sleep-disorders

[21] http://www.lawpracticetoday.org/article/teaching-lawyers-happiness/