The two-way link between alcohol and mental health

 “I’m not drinking today,” says Charlotte* to anyone offering her a glass of wine at a work function or in the pub after a long day. Sometimes she offers an explanation as to why she’s abstaining from alcohol – that she’s driving, or that she simply doesn’t feel like it.

Nine months ago, Charlotte, who has worked as a lawyer in the public service for almost three decades, stopped her almost daily habit of drinking alcohol. “I had been wanting to stop for a long time. I’d just been feeling yuck,” she says.

“I’d never been a morning drinker. I never drank spirits. But I would always think, ‘I’m not going to drink today’, then come five o’clock, as I was driving home from work, I would stop at the bottle shop and get a bottle of wine. That was my killer – I just couldn’t go past that bottle shop without going in.”

Drinking also affected her mental health and wellbeing. “I hated that I couldn’t stop. I just felt rubbish. I would wake up feeling anxious all the time,” Charlotte says.

Being unable to turn down an invitation to go for a drink with a friend after a Mother’s Day lunch was a crucial turning point. After seeking help from her GP, a counsellor and undergoing a stint at a mental health facility, as well as ongoing support from a 12-step program to aid her recovery, Charlotte says she now “feels amazing”. “I have so much energy and I’ve lost 10 kilos,” she says.

Her anxiety dissipated, too. “I was so terrified that I wouldn’t be able to sleep. I was terrified that I wouldn’t be able to function, that I’d be up all night. But I sleep very well, and I no longer feel anxious,” she says.

That alcohol abuse and mental health problems are common across the legal profession is well known. Research suggests that as many as one in three practising Australian lawyers could be problem drinkers. An overwhelming 85 per cent of legal professionals have experienced anxiety or know someone in the workplace who has, according to a 2019 survey by Meritas Australia & New Zealand. For depression, the proportion is 63 per cent.

But what’s less well understood is the complex bidirectional relationship that can fester. In a nasty vicious cycle, alcohol use can make mental health problems worse, and mental health problems can exacerbate alcohol use.

Probing a vicious cycle

People who drink alcohol are more likely to develop mental health conditions, according to research. Alcohol is a depressant that affects the part of the brain that controls inhibition. Drinkers may feel relaxed, less anxious and more confident – but these effects wear off quickly. Over time, alcohol can reduce the chemicals, or neurotransmitters, in the brain that it needs to ward off anxiety and depression. This can lead to drinking more to relieve difficult feelings.

Likewise, mental health problems increase the risk of unsafe drinking, as people often use alcohol to cope. Latest statistics from the Australian Institute of Health and Welfare show people with mental health conditions are more likely to drink at risky levels (37 per cent) than people without these conditions (30 per cent). The Alcohol and Drug Foundation reports that 60 per cent of people with a mental health disorder are also experiencing alcohol and other drug dependence.

“People can be using alcohol as something that’s fun, on the weekend or after work, but because of the impacts on your health it can then start generating mental health issues, which can in turn feed the alcohol use,” explains Robert Taylor, policy and engagement manager at the Alcohol and Drug Foundation. “People can also use alcohol to cope if they’re having a tough week at work or if they’re stressed, and alcohol can exacerbate those difficult feelings.”

Dr Sally Hunt, a clinical psychologist and senior lecturer at The University of Newcastle who is investigating the interconnected nature of mental health and substance abuse, says mental health and alcohol use conditions occur together more frequently than would be expected by chance. Using alcohol to cope with stress or unpleasant feelings is most strongly associated with hazardous drinking. “If drinking is starting to happen as almost like self-medication or a coping strategy, that’s a big warning sign,” Dr Hunt explains.

She says the result is a cycle that’s difficult to escape. “Once that relationship has been established, it forms a vicious cycle where the stress reinforces the drinking, and the drinking reinforces not feeling as well in yourself. It’s absolutely a vicious cycle.”

Alcohol and mental health in law

Charlotte says her drinking habit began in law school and continued throughout her practical legal training and into very senior legal roles later in her career. “It was how we would debrief, talk about what had happened at work, or celebrate what had happened at the end of the week or someone’s birthday – there was always a reason to drink,” she says.

When she was at home at night when her children were small, and her marriage was breaking down, “my drinking out socially stopped and the drinking at home started”. “It was just easy to go home, crack open the bottle and think, ‘I’m only having one or two glasses.’ And the next thing you know, you’re doing it every night,” Charlotte says.

For Isabella Ferguson, alcohol fuelled anxiety, burnout and the eventual end of her 20-year legal career. “It was something that encroached on my life quite slowly, but it was always there for stress relief, for overcoming anxiety and particularly in the marketing sense. If I had to go to conferences or give presentations, I would always have alcohol – a few glasses to get me through,” she says.

“And then there was the long hours. I would go home and need to do advices into the night, and a glass or two of wine would help me get it done. I can remember really letting loose at legal conferences and our firm end-of-year Christmas parties. It was the ultimate stress relief, and there are so many moments that I regret.”

Ferguson retrained as a counsellor specialising in alcohol dependence and she works with many lawyers. “The legal profession is certainly one that is drinking to excess and in risky quantities more so than other professions,” she says, explaining that the stressful, high-pressure demands of the work and the personality types attracted to the profession are important contributors.

“If you are a person that has a susceptibility to drinking already, by the time you’ve entered the legal profession you’re going to have a greater likelihood of that developing into a problem,” Ferguson says. “The anxiety, the stress, the long hours, the competitive nature and the culture of law firms are the main ingredients that can set you up for leaning on alcohol to be successful and to get through.”

Culture of excessive drinking

Another critical factor is obvious to most: that alcohol is baked into the fabric of the legal profession. At almost every firm function, conference, networking event or informal get-together, alcohol is available – and its consumption encouraged.

“Many of the big firms, middle tier firms and so on have functions to celebrate or bring people together, which are very good things to do, but there’s a culture at these events that can lead to excessive drinking – there’s no doubt about that,” says Greg de Moore, an associate professor of psychiatry at Sydney’s Westmead Hospital and board member of the Minds Count Foundation, which promotes workplace psychological health and safety in the legal community.

Dr Hunt says the perception that many of these events are an extension of the workplace creates stronger expectations around drinking alcohol. “Drinking as a form of networking can be tricky because people feel that it’s something they have to do and they won’t get opportunities work wise if they aren’t out having a long lunch or playing golf and going to the pub afterwards, or whatever it may be,” she says.

Indeed, Ferguson says she’s had clients share stories of choosing alcohol-free options at private legal functions and have their partners criticise them because “they’re not mingling enough”. “It’s these sorts of microaggressions that are really unhelpful,” she says.

When combined with the high-pressure environment commonly found in law firms, social expectations around drinking can further amplify the troubling interplay between alcohol and mental health problems. “We know that these two things are going to become intertwined and reinforce each other. That’s a big challenge for the profession as a whole,” Dr Hunt says.

Normalising non-drinkers

Along with the usual supports firms put in place for mental wellbeing, and to encourage help-seeking for alcohol-related issues, Assoc Prof Moore recommends that every lawyer have a regular GP.

“It’s a policy that firms can put in place, too,” he says. “I really like this concept because it broadens it beyond just alcohol and mental health, so you get rid of some of the stigma. It might sound simple but at many of the big law firms, a lot of lawyers, particularly men, will not have a GP.”

He says it’s especially critical that the profession decouples networking and marketing events from expectations to drink alcohol. “Most law firms are providing alcohol-free drinks at events now,” he says. “It’s also helpful to shift events typically held in pubs, bars or restaurants where there’s a lot of drinking to different venues.”

Taylor says taking the focus away from alcohol is an important step. “There are ways that workplaces can create opportunities to connect that may have alcohol present but are not predominantly focused just on alcohol,” he says.

Ferguson agrees, explain that a workplace culture that “promoted and congratulated a non-drinker in the firm” would have helped her to better manage her drinking. “A non-drinker was seen as somebody that was bit lackluster,” she says. “I would have loved to have seen mentioned before Christmas parties or marketing events or presentations, ‘Hey guys, we really applaud those who don’t drink. This is an option for you – there are alcohol free drinks here.’”

Shifting expectations around drinking and providing stronger support systems can help break the cycle, promoting mentally healthier workplaces where alcohol is an option rather than an expectation. “We need to make it easier for people to have a choice – where drinking is not the default,” Dr Hunt says.

*Name changed at interviewee’s request