Substance Abuse

Special Edition of Board Notes, 2016

Signs and Symptoms of Substance Abuse in Executives and Professionals


  • Appears intoxicated or hung over
  • Deterioration of physical appearance and grooming
  • Shakiness, tremulousness
  • Unpredictability, strange behavior, inappropriate behavior
  • Withdrawal from responsibility
  • General changes in overall attitude
  • Overwhelmed easily, unable to manage emotions, emotional outbursts, overreacts
  • Aggressiveness or becomes withdrawn
  • Forgetfulness, poor concentration, short attention span, “blank spots” in memory
  • Loses sense of humor, misinterprets situations, loses sense of perspective
  • Becomes suspicious and distrustful
  • Loses touch with reality at times
  • Loss of intellectual sharpness, creativity, business acumen
  • Becomes indecisive, confused
  • Change in weight
  • Frequent medical visits
  • Frequent absence and inability to account for whereabouts during work day, misses deadlines, appointments
  • Legal, family, social, medical problems


  • Needs a drink to relieve stress
  • Quickly drinks or gulps down several drinks to “loosen up”
  • Availability and consumption of alcohol becomes the focus of social or professional activities.
  • Individual becomes erratic, temperamental, irritable, difficult to get along with
  • Misses deadlines
  • Chronic lateness
  • Quality of work deteriorates
  • Quality of presentations deteriorates
  • Poor business judgment
  • Trouble making decisions
  • Misses work on Mondays and Fridays
  • Frequent medical leaves of several days duration
  • Missing during the middle of the workday
  • Odor of alcohol when around individual, especially on breath
  • Shakiness, trembling hands in the morning
  • Frequent trips to hospitals, medical providers
  • Increase or decrease in weight
  • Changes in skin appearance, including flushed skin on nose and cheeks
  • Repeated injuries, bruises, cuts & scrapes, limping
  • Repeated complaints of fatigue, lack of energy, inability to concentrate, headache
  • General “run down” appearance
  • Legal difficulties

Stimulants (cocaine, methamphetamine and others):

  • Dry mouth and nose, bad breath, frequent lip licking, teeth grinding, body tremors.
  • Excessive activity, difficulty sitting still, lack of interest in food or sleep.
  • Irritable, argumentative, nervous, extreme moodiness.
  • Talkative, excited speech and incessant talking but conversation often lack continuity; changes subjects rapidly. “Grabs spotlight” during presentations, meetings
  • Runny nose, cold or chronic sinus infections, nose bleeds.
  • Use or possession of paraphernalia including small spoons, razor blades, mirror, little bottles of white powder and plastic, glass or metal straws.
  • Euphoria, expansive mood
  • Chronic financial difficulties in spite of more than adequate compensation
  • Progressively aggressive or violent behavior, unusual temper tantrums
  • Increased physical or sexual activity
  • False sense of confidence and power
  • Purposeless, repetitious behavior
  • Compulsive cleaning, grooming, sorting, disassembling

Depressants (barbiturates, tranquilizers):

  • Symptoms of alcohol intoxication with no alcohol odor on breath (slurred speech, stumbling gait, droopy eyes, etc).
  • Lack of facial expression or animation
  • Flat affect
  • Flaccid appearance
  • Slurred speech

Opiates (painkillers, heroin, morphine):

  • Euphoria, tranquility, apathy, and impaired judgment. (Although the initial effects are generally calming or dulling, psychomotor agitation and aggressiveness can occur).
  • Excessively active, frantic or lethargic, drowsy, nods off during meetings
  • Slow breathing
  • Very pale and sweaty or extremely thirsty
  • Small, “pin prick” pupils
  • Nausea
  • Frequent itching and scratching
  • Red and raw nostrils (sign of sniffing)
  • Wears long sleeves even when inappropriate (sign of injecting)

Alcohol Self-Test

This series of questions about one’s use of alcohol and/or drugs is an informal inventory of “tell-tale signs” with many items tailored to lawyers. It is not a list of official diagnostic criteria and does not substitute for a professional evaluation.

  • Do I plan my office routine around my drinking or drug use?
  • Have I tried unsuccessfully to control or abstain from alcohol or drugs?
  • Do my clients, associates, or support personnel contend that my alcohol/drug use interferes with my work?
  • Have I avoided important professional, social, or recreational activities as a result of my alcohol/drug use?
  • Do I ever use alcohol or drugs before meetings or court appearances, to calm my nerves, or to feel more confident of my performance?
  • Do I frequently drink or use drugs alone?
  • Have I ever neglected the running of my office or misused funds because of my alcohol or drug use?
  • Have I ever had a loss of memory when I seemed to be alert and functioning but had been using alcohol or drugs?
  • Have I missed or adjourned closings, court appearances, or other appointments because of my alcohol/drug use?
  • Is drinking or drug use leading me to become careless of my family’s welfare or other personal responsibilities?
  • Has my ambition or efficiency decreased along with an increase in my use of drugs or alcohol?
  • Have I continued to drink or use drugs despite adverse consequences to my practice, health, legal status, or family relationships?
  • Are strong emotions, related to my drinking or drug use (e.g., fear, guilt, depression, severe anxiety) interfering with my ability to function professionally?
  • Are otherwise close friends avoiding being around me because of my alcohol or drug use?
  • Have I been neglecting my hygiene, health care, or nutrition?
  • Am I becoming increasingly reluctant to face my clients or colleagues in order to hide my alcohol/drug use?

A “yes” answer to any of these questions suggests that it would be wise to seek professional evaluation, but may or may not indicate that you have a diagnosable addictive disorder. 

Attorneys and Substance Abuse- Stats & Research

Substance Abuse and Mental Health Problems, Growing Problem for the Legal Profession  ABA Journal 

Bumps in the Road ABA/GPSolo Publication