From a broad perspective, addiction and compulsivity can be seen as two separate modalities with similar processes and properties:

1. Substances (e.g., alcohol, drugs, food, nicotine)
2. Activities (e.g., sex, work, gambling, spending)

Both of these modalities have similar characteristics that distinguish them as “addictive” or “compulsive.” These characteristics include engaging in repeated behaviors that alter mood or produce pleasurable feelings; the phenomenon of tolerance (engaging in the activity more frequently or more intensely in order to sustain the pleasure); and the impairment, over time, of personal, physical, or social areas of life as a result of these behaviors. The American Society of Addiction Medicine (ASAM; asam.org) published a definition of addiction that encompasses both modalities (tinyurl.com/6u232jc). According to ASAM, the process of active addiction is demonstrated by intensive memory of repeated exposure to rewards (sex, drugs, food). This repeated exposure creates a “craving,” a neurobiological and behavioral response to external cues. For example, seeing an attractive person or watching a movie depicting the use of cocaine might elicit an urge to have sex or get high. The process creates impairment in behavioral control, propelling the person toward the activity despite negative consequences and leading to a progressively dysfunctional pattern of use or activities. Eventually the activity becomes the organizing principal of the person’s daily routine. Even if the activity is suspended or stopped for any length of time, there is a high probability of relapse.

Addiction as a Brain Disease

Over the last decade, advances in technology have allowed scientists and researchers to peer ever closer into the activities and workings of the human brain, yielding advanced understanding of addiction as a brain dysfunction. Seminal work by researchers supported in part by the National Institute on Drug Abuse (NIDA) has determined that the brains of addicts have significant impairment in at least two critical areas. The first is a deficiency in the ability to keep from engaging in behaviors or activities the addict knows may be likely to cause harm or problems. The second involves the overvaluing of drugs or activities that are pleasurable and reinforcing (such as drinking alcohol or gambling at a casino) while at the same time undervaluing alternative and less harmful activities (such as going to a show with friends or exercising at the gym). (For more, see tinyurl.com/m7u9wrn.)

The NIDA researchers label the overvaluing of the pleasurable effects of compulsive activities as “salience attribution.” One male attorney who suffered with compulsive gambling reported that he would spend almost all his non-working free time at the casinos or the race track. Other activities that he had previously enjoyed prior to his compulsive wagering, such as exercising and spending time with his wife and son, no longer provided the subjective pleasure or anxiety-reducing reinforcement that it once delivered. He argued vehemently that his gambling was his way of reducing stress and relaxing.

Addicts also exhibit “impaired response inhibition.” One client of the Lawyers’ Assistance Program of Illinois (LAP) who was arrested for DUI was also cited for spitting in a police officer’s face during the arrest; the attorney was highly remorseful and apologetic during the next day’s court appearance.

The Four Modalities of Addiction and Compulsivity

Although there is substantial agreement and empirical data on the two modalities (substances, activities) of addiction mentioned in this text, some authors and treatment programs identify four modalities:

1. Substances (e.g., alcohol, drugs, food, nicotine)
2. Activities (e.g., sex, work, gambling, spending, gaming)
3. Emotions (e.g., chronic rage)
4. Relationships (e.g., co-dependency, pathological love)

To complicate the process of identifying active addiction and compulsivity further, many clinical authors report that two or more forms of addiction/compulsivity may co-exist in many individuals who suffer some form of chemical addiction. This often-observed clinical phenomenon is termed “addiction interaction disorder,” or AID. AID is defined as two or more addictive processes—chemical and non-chemical compulsions—that interact and reinforce one another. They often just don’t coexist but strengthen or buttress one another. Both addictions can be active at the same time (e.g., an active cocaine addict who is more likely to compulsively gamble when he is high). Often, one addiction is replaced by another; it’s well documented that one of the principals in the development of Alcoholics Anonymous, Bill W., had several extramarital affairs once he put down the bottle and achieved sobriety through AA.

Read the MAP

To help identify and support co-workers who suffer from these complicated and potentially devastating conditions, the authors propose the use of the acronym MAP: Mood or attitudinal disturbances, Appearance or physical changes, and Productivity and quality of work deterioration. MAP is a way to organize the traits, behaviors, or signs to look for in colleagues who may be in peril from an active addiction. These three domains can be used to gauge potential problems among co-workers regardless of whether the disorder turns out to be alcohol, other drugs, gambling, or sexual compulsivity.

In the discussion below, we will show how to read the MAP to identify both chemical addiction and non-chemical compulsivity in the workplace.

Identifying Colleagues Who Are Chemically Addicted

Mood/attitude. As a chemical addiction begins to create noticeable problems for a colleague, changes in mood and attitude become more apparent. That once bright, gregarious, diligent, and flexible co-worker becomes withdrawn, rigid, argumentative, or less cooperative and less enjoyable to work with as the addiction progresses. Any significant change in personal mood or attitude, either about work or home life, can be a sign of an active addiction. Other signs are a general uncooperativeness, frequent argumentativeness or conflict with co-workers or clients, being easily angered, and increased blaming of others for mishaps in the workplace.

At the same time, those afflicted may become less available to others in the workplace. They may have frequent unexplained and extended disappearances from the office—including calling in ill on Fridays or Mondays—and may miss important meetings or court dates. Extended lunches or early departures, especially at the expense of productivity, may become the norm. The co-worker begins to demonstrate an attitude of “I care less” about her responsibilities, others in the workplace, and the quality of her work.

Appearance/physical manifestation. The most notable warning signs of substance abuse at work include disheveled or unkempt appearance, slow or slurred speech, glazed-over look in the eyes or bloodshot eyes, and, in the case of alcohol abuse, the odor of alcohol on the breath or on the person of the individual. One of the authors recalls a co-worker who started to show up at work in wrinkled clothes and sometimes wearing two different-colored socks. Shortly thereafter others complained that this person had fallen asleep on the job. It should be noted in this case that there was no odor of alcohol, but the staff member did exhibit glazed eyes. This prompted a referral to the employee assistance program for an assessment, which determined the staff member was addicted to sedative medication requiring treatment.

Other signs of an active chemical addiction include the appearance of being chronically tired or ill, sweating, and a constant runny nose or sinus problems. Depending on the substance used, intoxication at the workplace may be easy or more challenging to spot. Someone intoxicated with alcohol most often will demonstrate an unsteady gait or difficulty walking or moving about. Someone showing signs of hyperactivity, flight of ideas or tangential speech, increased anxiety or restlessness, and even paranoid or delusional thinking may be under the influence of a stimulant (e.g., cocaine, Adderall, Ritalin). Someone intoxicated with opiate-based pain medication (e.g., Vicodin, OxyContin) or heroin will demonstrate drowsiness, slurred speech, impairment in alertness and focus, and noticeable constricted or “pinpoint” pupils.

The addicted co-worker, in an effort to hide his deteriorating appearance or more frequent intoxication, may try to avoid others as often as possible and begin to isolate himself. Isolation is evident by spending almost the entire workday in the office alone and having excuses why he can’t join others for lunch or attend meetings. He may arrive to and depart from work without acknowledging others. It becomes increasing difficult or impossible to reach him outside of work.

Productivity/work quality. Work performance of an active addict/alcoholic is often characterized by inconsistency. You won’t often get the same quality of work twice; it becomes more difficult to predict which “worker” (the good or the bad) will show up today. As a direct result of tardiness, absenteeism, and frequent intoxication, the addicted colleague’s concentration, diligence, and productivity are significant lowered. The resultant depression and anxiety that often accompany active addiction will strongly impact the worker’s pride, interest, and enjoyment in her work. When you remove these three components of a successful worker, the motivation to sustain quality work and productively is diminished or entirely eliminated.

So let’s now turn our attention to identifying non-chemical compulsivity in the workplace by highlighting a co-worker with a compulsive gambling problem.

Identifying Colleagues who are Compulsive Gamblers

Mood/attitude. A colleague who has a gambling addiction will often obsess about gambling, casinos, the race track, and even speculating in the stock market. Similar to a person with a chemical addiction, the gambler will constantly be thinking and planning his next trip to the casino. If you ask such a person what he did over the weekend, his activities will likely all be focused on gambling in some form. Another indication that someone has an issue with gambling is financial problems, which can be presented as elevated stress and anxiety. A colleague who is talking about bouncing checks and maxing out credit or is asking to borrow money may have a gambling problem.

Appearance/physical manifestation. Depression is often associated with an active gambling compulsivity. Many gamblers express feelings of chronic loneliness and depression. But depression is also noted when a gambler tries to cut back or quit. People suffering from depression may not care about their appearance or appear tired and ill.

Productivity/work quality. You may see changes in a person’s work productivity and quality as gambling is prioritized over other responsibilities. She will be less motivated as she focuses more and more on achieving that “next big win.” Additionally, she may be distracted and less focused as a result of the depression and the mental preoccupation with gambling.

How You Can Help a Colleague

If you are beginning to suspect that a colleague is demonstrating signs of addiction or compulsivity, the following are beneficial steps in getting help for this co-worker:

• Talk to your colleague directly and say what you have observed.
• Encourage your colleague to contact your state’s lawyer assistance program.
• Seek out assistance from an appropriate professional on how you can get help for your colleague.

Most states have a lawyer assistance program that can help start the process. For a directory of lawyer assistance programs, visit the ABA Commission on Lawyer Assistance Programs’ website (americanbar.org/colap). You can also contact the National Helpline for Lawyers (866/LAW-LAPS; 866/529-5277) or the National Helpline for Judges Helping Judges (800/219-6474).

One of the most rewarding and reccurring experiences we have at LAP is receiving the many messages from attorneys who have been helped by colleagues. They tell us how proud they are of “their profession” because colleagues have taken the time and risk to reach out to them and assist them in getting help. As Mary Ann McMorrow, the first female chief justice of the Illinois Supreme Court, stated about the LAP approach: “It’s a case of helping each other. When you are impaired, you are sick. When [we] see someone in need, we should step up and give our best.”

Robin Belleau, JD, LCPC, is executive director of the Lawyers’ Assistance Program of Illinois.

Tony Pacione, LCSW, CSADC, is clinical director of the Lawyers’ Assistance Program of Illinois.

Previously posted on GPSolo.