Lawyer Stress Work Addiction

8/22/2019 Lawyer Stress Work Addiction

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Lawyers, Stress,Depression and

Burnout:

Work Addiction?

Lawyers, Stress,Lawyers, Stress,Depression andDepression and

Burnout:Burnout:

Work AddictionWork Addiction??Ray Baker MD

www.healthquest.ca

[email protected]


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Objectives

Stress, depression, compulsive

work, addiction

Some neurobiology

Common symptomsGetting help


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Acute Stress as aMood Elevating

Experience

Norepinephrine surge, locus ceruleus

Dopamine release from reward centre

Cortisol release from adrenal cortex

Adrenaline release from adrenal medulla


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Neurobiology of Chronic Stress

Endorphin depletion (pain tolerance)

Serotonin depletion (Sleep, mood)

Dopamine depletion (hedonic tone)

Locus ceruleus overactivity (fight-flight)


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Stress

ACUTE CHRONICElevated

endorphins,dopamine,

adrenaline

Cardiovascular

Emotional

Fight-flight

Decreased

endorphinsdopamine

serotonin

Sleep disturbance

Cardiovascular

Gastronitestinal Immunological

Psychiatric


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Stress: great imposter

Interpersonal problems at work

(supervisor) at home

Substance use disorders

Depression

Unresolved emotional issuesMedicalization of non-medical

issue


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Top 10 Sources of Workplace

Stress

Feeling of not-contributing, having no influence

Lack of 2-way communication Being unappreciated

Inconsistent/illogical management

Career and job ambiguity: whats going on? Unclear company direction and policies

Mistrust: office politics, gossip

Doubt: not sure of rules, who handles what

Random interruptions

Treadmill: too much to do, too little time

Wilson/Wilkerson Unheralded Business Crisis in Canada


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Addictions: What Are they

A pathological relationship witha mood altering activity with life-

damaging consequencesDisease of brain with

psychosocial factors in etiologyand expression


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Addiction: a disease of the brain

An inborn or acquired relativeunderfunction of the circuitry of the

mesolimbic system responsible for

reward, pleasure and hedonic toneResulting in the inability to comfort or

soothe oneself, increased dysphoria, a

deficit in hedonic tone


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How Do Drugs Work?

Mesolimbic Dopamine system(craving, reward, pleasure)

Locus Ceruleus

(withdrawal: frustration, anxiety)


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Dopamine ReleaseDopamine Release

Nucleus Accumbens goesNucleus Accumbens goesSquirtSquirt


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The Invisible Disabilities:

a common etiologyAddictions, depression, chronic pain

syndromes, chronic unrelieved stressshare:

lack of serotonin, endorphins, dopaminedisturbance in brain centres responsible

for sleep regulation, stress modulation,emotions, fight-flight, reward-

reinforcement


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Compulsive Work

Behavioural syndromemanifesting as self-imposed

demands, inability to regulateones work habits, over-

indulgence in work to the

exclusion of most other lifes

activities

RobinsonRobinson


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Addiction Hierarchy

A

lcoho

lism

SEXUALAddiction

Heroin/Cr

ack

Addictio

n

Gluttony

Binge-P

urge

Eating

CompulsiveExercise

Workaholism

Workaholism

Comp

ulsive

Spend

ing

Solv

entA

b

use

Prescription Drugs


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Symptoms of Work Addiction

Time pressure - hurry sicknessNeed for control - others wont get it right

Perfectionism - no room for mistakes

self/others

Relationships strained - fail because of

work

Binge work pattern - self-inflicted deadlines

Robinson 98


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Symptoms of Work Addiction

Restless, irritable, discontented - if not

working

Blackouts - D.W.W., even when hes

home, hes not

Impatience - might cause mistakes bc

going off half-cocked

Human Doing - only as good as my lastachievement

Neglect self-care - never enough timeRobinson 98


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Burnout

IrritabilityFatigue

Sleep disturbancePoor concentration

Memory loss

Loss of motivation


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Diagnosis of

Depression

Depressed mood/ irritability Apathy, loss of interest

Weight loss/wt. gain

Insomnia/hypersomnia Psychomotor agitation/retardation

Fatigue

Worthlessness/guilt

Loss of ability to think/concentrate/decide

Suicidal ideation

Presenting Clinical Picture ofSubstance Dependence


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Addicted (dysfunctional)

Family

Addict Chief Enabler

Hero Scapegoat Lost Mascot

Dont

TrustTalkFeel

Somatizationof feelings


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Children from Addicted Family

Systems: Core Issues

Control

Trust Feelings: alexithymia

Dependence

Ungrieved losses

Fear of abandonment

All or nothing thinking

High tolerance for inappropriate behaviour

Over-responsibility for others Neglecting own needs

Difficulty resolving conflict

Problems maintaining intimacy

T. Cermak 93


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Cognitive Distortions of the

Workaholic Lawyer

Perfectionistic thinking: anything less

than perfect is unacceptable

All-or-nothing thinking,

overgeneralization, black and whitethinking

Magnification of the negative

Blurred boundaries around work: roles

spill over

Robinson 98


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Cognitive Distortions of the

Workaholic Lawyer

People-pleasing thinking

Pessimistic thinking: world is hostile

Helplessness thinking, victim thinking

Serious thinking: no place or time forhumor

Externalized thinking: if I get the outsidestuff right, Ill feel OK

Robinson 98


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The emotions of the

Workaholic

Emptiness

Low self-esteem

Shame

AngerConfusion

Numbness

The problem is. Because of

alexithymia they neither recognizenor express these feelings


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IAMNOWHERE


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Baseline AssessmentBaseline Assessment

Medical Hx & Px

Lab and IxsPharmanet

Pain HxAddiction Hx

Self-Administered

Questionnaires

Psychiatric Hx

Mental Status

Psychosocial Hx

Collateral Interviews

BiomedicalBiomedical

Psyc

hiatric

Psychiatric Psych

osocial

Psychos

ocial


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C A R E S SC A R E S SRecovery ChecklistRecovery Checklist

CCoping skillsoping skills

AAccountabilityccountability to othersto others

RResponsibilityesponsibility for selffor self

EEducationducation about illness and recoveryabout illness and recovery

SSocial support networkocial support network

SSpiritual healthpiritual health

Adapted from Baker, 2002


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Take responsibility

for change:

Be proactive

Stop rationalizing, blaming,intellectualizing, denying, being a victim

You are responsible for your ownrecovery


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Recovery Suggestions

Learn to identify emotions, ways todeal with them

Work on cognitive distortionsStress management: quit a

committee, phantom clients,throwaway journals

Practice saying NO nicely


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Changing

Share plans with friend, familymember

Join a group (Al-Anon, ACOA,CODA, church/temple/synagogue)

Join a lawyers-in-recovery groupGet a sponsor/mentor


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Changing

Learn prayer and meditationSet a weekly date with your honey

Do something fun, funny, silly

Take up that hobby/skill/craft you

always secretly wanted to do (but

never had time)


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Bibliotherapy for Stressed

Out Lawyers (and theirfamilies)

Chained to your desk - Robinson 1998, New

York Univ. Press

Feeling Good - Burns, 1992, Avon

Your money or Your Life - Dominquez &

Robin, 1992, Penguin

7 Habits of Highly Effective People - Covey,

1989, Simon & Schuster

Margins - Swenson, 1992, Navpress


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Questions?

STUMP THE DOCSTUMP THE DOC


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SummaryCompulsive work as an addictive disorder endemic

amongst lawyers

Stress is a symptom, not a disease

Similar neurobiology in chronic stress, depression,addiction

Family system perpetuation

Effective therapy includes cognitive changes,

balance, practice


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Ray Baker MD FCPF FASAMMedical Director HealthQuest

604-808-4619

[email protected]

Documents

Lawyer Stress Work Addiction