Career Killers Substance Abuse: Depression & Stress in the Accounting Profession

Taken from a paper by Don Jones in his work with the Professionalism Enhancement Program of the State Bar of Texas

Contents

I. Introduction

II. Substance abuse, alcoholism & chemical dependency: A short primer on the disease

A. Alcoholism and Chemical Dependency

B. Substance Abuse

C. Signs and Symptoms

D. Denial

E. Treatment

F. Taking Action

1. Avoid Enabling

2. Intervention

3. Know How To Access Help

III. Depression

A. The Impact

B. Signs and Symptoms

C. What To Do

IV. Stress & stress management

V. The Texas CPA Peer Assistance Program

VI. Conclusion

VII. Appendix

I. INTRODUCTION

As an accountant, you occupy a unique position in society. You are called upon to handle the most delicate matters of great importance to your clients. You are entrusted with very private information about your clients' personal and professional livcs. Your pcrformance can contribute to a Client's financial wellbeing or financial ruin. And your performance does not rest solely upon your accounting cxpertisc. Your physical health, mental health, and overall quality of life directly affect your performance, and thus directly affect your clients. Any impairment of your performance ultimately impairs the client, the profcssion, and society. While a license to practice accounting may provide many opportunities and open many doors which otherwise might be closed, it unfortunately does not protect you against the three most common "career killers": substance abuse, depression, and stress.

While most accountants will never suffer from substance abuse or depression, virtually all accountants will at some point in their career interact with someone who does. To get an idea of the size of the problem. the Texas Commission on Alcohol and Drug Abuse estimates the 1997 cost of alcohol and drug abuse in Texas was $19.3 billion, $8 billion of which stems from lost productivity.

This does not include the cost of stress which virtually all accountants find themselves subject to on a daily basis. If not effectively managed, stress can, and does, grow into paralyzing distress or debilitating bum/eweb out.

As a member of the accounting profession, you simply do not have the luxury of treating these problems in your colleagues as none of your business. You owe it to your profession and your clients not only to seek help if you need it, but also to do what you can to extend help to other accountants whose problems impair their ability to adequately represent their clients.

To fulfill your duty to the accounting profession and your clients requires that you do more than just recognize and commit to your professional obligations, You must have at least some base-line knowledge about substance abuse and depression; you must have at least a minimal ability to identifS' the signs and symptoms of these problems; and you must have some idea how to access help. You would also do well to understand the nature of stress and how to manage it in a way that can prevent distress and burn-out.

Toward these ends, this paper presents a basic introduction to the dynamics of substance abuse, depression, and stress, and offers some guidelines for getting help for yourself or for a client or colleague whose life or career is impaired by such difficulties.

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II. SUBSTANCE ABUSE, ALCOHOLISM & CHEMICAL DEPENDENCY: A SHORT PRIMER ON THE DISEASE

A. Alcoholism And Chemical Dependency

In 1956, the American Medical Association officially recognized alcoholism as a primary disease. Until that time, it was viewed as a weakness, a sin, a lack of character, or a symptom of some other emotional or psychological problem. Indeed, some still hold these views, despite research and medical literature to the contrary.

As a disease, alcoholism, like chemical dependency in general, has certain recognizable characteristics and presents certain predictable symptomatology. First, as noted above, it is a primary disease. It does not arise from another illness or an underlying emotional or psychological problem-much as the flu does not result from fever and congestion, but is likely to cause both. Second, the disease follows a predictable and progressive course. Left untreated, alcoholism or other chemical dependency will pass through progressively worse stages, each with its characteristic symptoms, until finally it leads to death. How rapidly each stage progresses may vary widely frem person to person. Third, alcoholism or chemical dependency is a multiphasic disease. That is, it affects all aspects of a person's life: physical, mental and emotional health deteriorates; family relationships and social life suffer; and professional performance declines. Fourth, the disease is permanent and chronic. While it may be arrested through treatment, it cannot be cured. And finally. alcoholsin and chemical dependency is treatable. While the success rates vary and controversy continues over what is the 'best' treatment method, millions of recovering alcoholics and chemically dependent people can attest that the disease can be treated and arrested.

One aspect of the disease that is still not completely understood is its origin. Some people seem to be born with it, unable to drink moderately from their very first drink. Others seem to develop the disease later in life, after drinking or using moderately for years. Evidence strongly suggests that those who have the disease of alcoholism or chemical dependency are genetically predisposed to develop the disease. Others suggest that alcoholism or other chemical dependency is the result of a combination of genetic and environmental factors. Ultimately, however, how or why a person acquired the disease is less important than diagnosis and treatment.

Whatever the origin of the disease may be, it is generally accepted that alcoholics and chemically dependent people physiologically process the mood-altering substances (alcohol and other drugs) differently from non-chemically dependent people, from metabolic action to neurochemical response. In this sense, chemical dependency is analogous to diabetes. With diabetes, a person's biochemistry prevents the person from processing sugar normally. With chemical dependency, a person's biochemisiTy prevents the person from processing alcohol or other psychoactive drugs normally. The effects are that alcoholics and other chemically dependent people experience an overriding compulsion to use alcohol or other drugs, eventually lose control over that use, and continue to use despite negative consequences.

B. Substance Abuse

The medical community distinguishes between substance abuse and dependency. Essentially, there is a continuum from substance use, through substance abuse, to substance dependency, Most people who use alcohol, for example, never move from use of the drug to abuse or dependency. They drink alcohol occasionally and never experience any resulting problems. However, when the use of alcohol begins to cause or exacerbate problems in a person's life (e.g., job, marital, or legal problems) and the person continues to use, or if the person repeatedly uses alcohol in physically hazardous situations (e.g., while driving), that person has shifted into the abuse stage, and the warning flags should fly. Some people arc able to back out of this abuse stage and never return. Many, however, cannot; and their use eventually leads to physical dependence.

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C. Signs & Symptoms

Many tests and diagnostic tools can determine the presence of substance abuse, chemical dependency, or alcoholism. However, you need not be a trained diagnostician to recognize when alcohol or other drug use might be a problem for a colleague or a client. A simple understanding of how the disease progresses and how this progression is manifested in a person's life, coupled with a willingness to look with a discerning eye, are all you need to determine at least whether the situation warrants a professional assessment.

While substance abuse, alcoholism, or other chemical dependency may manifest differently in each individual's life, the following are some common and predictable problems. For simplicity, they are described in second person ("you"):

D. Denial

To fully understand substance abuse, alcoholism, and chemical dependency, you must understand the phenomenon of denial. Alcoholism or other chemical dependency is one of the few diseases whose hallmark is denial of the disease itself despite overwhelming evidence to the contrary. This denial is a natural defense mechanism against unacceptable reality. It takes many forms-from mininuzing the amount used or the extend of the resulting problem, to rationalizing the drinking or use, to diverting any confrontation on the problem to another topic, to hostility, avoidance, and isolation. All chemically dependent people engage in denial to some extent, and this denial is the primary block to their obtaining help. Your ability to help someone with an alcohol or other drug problem increases substantially if you are aware of the dynamics of denial.

E. Treatment

To repeat an important point, while chemical dependency or alcoholism is permanent and chronic, it is treatable. Treatment takes on many forms, from intensive long-term in-patient treatment to participation in Alcoholics Anonymous or a similar group. Generally, the extent of treatment is based on such factors as the affected person's physical condition, motivation, ability to remain abstinent, history of previous treatment, and the degree to which the disease has progressed. Withdrawal, or detoxification, from an addictive substance can be at best uncomfortable and at worst fatal, particularly in the case of alcohol withdrawal. Therefore, medical supervision is often Imperative.

Whatever type ot treatment is indicated, it is generally accepted that abstinence from mood-altering chemicals is necessary. Chemically dependent people are not susceptible only to addiction to their substance of choice, be it alcohol or cocaine or prescription drugs. They are susceptible to addiction to any mood-altering or psychoactive chemical. For this reason, it is important that any medical treatment be conducted by a professional well-versed in the disease of chemical dependency.

F. Taking Action

If you begin to suspect that your colleague or your client might have a problem with substance abuse or chemical dependency, you must recognii/ewebe that substance abuse or chemical dependency is not one of those problems that will just solve itself over time. If it is not addressed, it will only get progressively worse. But fortunately, there are steps you can take to get help. Following are some principles you can follow and some actions you can take in attempting to help a chemically dependent colleague or client.

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1. Avoid Enabling

First, avoid enabling. An enabler is someone whose actions shield a chemically dependent person from experiencing the full impact of the consequences of alcoholism. An enabler, by words or actions, helps the affected person continue to deny the disease and continue spiraling downward in his or her disease. Enabling can take many forms, but the most common are:

• Denying that the affected person has a problem ("Old Joe doesn't have a drinking problem"):
• Rationalizing the person's drinking, using, or resulting behavior ("Susan works hard-she deserves to party hard");
• Making excuses and lying for the person ("Jack's been sick a lot lately");
• Doing for the affected person what he or she should be handling personally (carrying much of Ellen's workload, making sure her clients get handled properly, paying her bills, etc.);
• Rescuing that person from the consequences of his or her behavior (loaning Mark money, "cleaning up", his problems for him, etc.);
• Avoiding confronting the problem at all (avoiding the person or the topic).

Ultimately, the question comes down to the e/J/ewebc: of your well-meant behavior. If your actions allow the chemically dependent person to continue in that dependence, you are hurting that person, not helping.

2. Intervention

As discussed above, for treatment of chemical dependency and substance abuse to be effective, the delusional nature of the disease (the denial) must be penetrated. In some cases, the consequences of the disease itself will break down the chemically dependent individual's denial. The family problems, job problems, legal problems, and/or health problems all finally become just too much to deny, and the chemically dependent person admits he or she has a problem and seeks help. For some people, however, this realization may come too late-or may never happen at all. But fortunately, the chemically dependent person need not always "hit bottom" before getting help. Often, an intervention is appropriate and effective.

Vernon Jolson, M.D., in his book Intervention. How To Help Someone Who Doesn't Want Help, defines intervention as "a process by which the harmful, progressive, and destructive effects of chemical dependency are interrupted and the chemically dependent person is helped to stop using mood-altering chemicals and to develop new, healthier ways of coping with his or her needs and problems. It implies that the person need not be an emotional or physical wreck... before such help can be given." Anything that interrupts the process of the disease and guides the chemically dependent person to help is an effective intervention.

In the 1960's, Dr. Johnson formalized a process that is often referred to as the "Johnson Institute Model" of intervention. This model involves a structured and rehearsed confrontation of the chemically dependent person by a group of family members and concerned others (e.g., employees, other colleagues), led by an intervention specialist. Each member of the intervention group confronts the chemically dependent individual with specific instances of the individual's drinking or using, and describes how the individual's behavior affected that member of the group. The confrontation is intended to bring the reality of the disease into focus and to motivate at least some measure of desire for help. This type of intervention is highly specialized and can be vety delicate. It should be undertaken only under the direction of an experienced intervention professional.

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3. Know How To Access Help

Innumerable resources around the country offer help to chemically dependent people. Many communities have a local council On alcoholism and drug abuse, and that can be a good place to start. Virtually every community has a local Alcoholics Anonymous group listed in the phone book.

Outpatient and inpatient treatment facilities are scattered throughout the country. They va/eweby widely in cost and services provided, and should be checked carefully for licensure or accreditation status, the experience and expertise of their professional staff their treatment philosophy, their current patient census and counselor-to-patient ratio, and their cost. Most insurance policies will cover chemical dependency treatment to some extent. In Texas, group insurance policies are required by statute to cover chemical dependency to the same extent that they cover other health problems. Tex. Ins. Code Art. 3.51-9 (Vernon Supp. 1992).

IlI. DEPRESSION

A. The Impact

All of us. at one time or another, feel "blue" or '/ewebdown in the dumps." We all get sad or feel grief after a loss. Depression, though, is more than this. It is a medical disorder that affects one's thoughts, feelings, health, and behavior, day in and day out. It affects an estimated 17.6 million Americans each year, affecting twice as many women as men, and yet only about 20% of those afflicted ever seek help.

Accountants seem particularly reluctant to seek help ('or their depression. Some are unwilling to admit their depression for fear they will be seen as weak or unreliable. Others believe they should be able to handle their own personal problems just as they handle their clients' problems. And many simply do not recognize that there is even a problem.

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B. Signs & Symptoms

Obviously, the first step in addressing a depression problem is acknowledging its existence. Someone with major depressive disorder will present a number of symptoms nearly every day, all day, for at least two weeks. These include at least one of the following:

• losing interest in things you used to enjoy; or,
• feeling sad, blue, or down in the dumps;

plus at least three of these:

• feeling slowed down or restless and unable to sit still; feeling worthless or guilty;
• gaining or losing appetite or weight;
• thinking of death or suicide:
• having problems concentrating, thinking, remembering, or making decisions;
• having trouble sleeping, or sleeping too much;
• experiencing loss of energy or feeling tired all of thc time,

C. What To Do

If you meet these criteria, it is important that you not ignore the problem and hope it goes away. The longer serious depression goes untreated, the more likely it is to become chronic and damaging. Left alone, depression can cut short a promising career, destroy a loving family, and ultimately, lead to suicide. True depression typically is not something you can "self-treat," "shake yourself out of" or simply 'wait out". Even between depressive episodes, most of those who go untreated continue to cxpenence negative effects, such as inability to concentrate, disorganization, and apathy. And often, it is only a matter of time before the next depressive episode begins.

Getting treatment is often easier and less painful than you might imagine. It is important, though, that you see a professional trained in the treatment of depression. Usually, treatment will consist of medication, psychotherapy, or some combination of the two. Often, people with depression begin to see positive results within a month of beginning treatment-some earlier, some later. If you are not sure where to start, the Texas CPA Peer Assistance Program can help. They can get you in touch with other accountants who themselves have recovered from depression, and can refer you to a number of professionals in your area who can assess your condition and help you get treatment.

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IV. STRESS & STRESS MANAGEMENT

We've all heard about the dangers of too much stress in our lives. I won't fill this paper with statistics about how it causes heart disease, ulcers, and emotional disorders. And I won't bother you with all the talk about how stressful the practice of accounting can be. You know when you are "stressed out," and you know if too much stress is a problem in your life. Therefore, this section will examine the nature of stress, rather than its triggers, and will offer you some ideas about what you can do to manage it.

The truth is, stress is important in our lives. Without stress, we would have a very difficult time walking, eating, working, playing, you name it. The activity of living takes a certain amount of stress to carry out And all of us at one time or another find ourselves in high pressure situations in which our stress level rises above our comfort level. A real problem arises only when our natural stress levels are allowed to grow into almost chronic distress. And distress, much of the time, is something we do to ourselves. Which means, of course, that much of the time we can do something about it.

Three ingredients create distress: (1) the situation (external stressors); (2) our perception of the situation (internal stressors); and (3) our response to the situation. And despite all of our finger pointing and blaming, most of the time the situation itself has the least impact of all. Change the situation without changing the way you perceive and respond, and while you may experience some immediate relief, you do little to change your distress level in the long run. But change your perception and alter your response, and whether the situation has changed or not, your distress will decrease.

Any external situation which presents us with change or demands Our performance obviously increases the stress in our lives. Changing jobs, deadlines, family needs, financial demands-all of these are stressful situations. Even with many external situations, we are the ones who set them up to be stressful. We agree to meet deadlines we know we can't meet. We accept tasks for which we have no time. We make promises we know can't be kept.

What makes stressful situations distressful are our perceptions and responses. The more we perceive the situation as a threat (particularly to our self-esteem, our security, or our relationships) and the less we perceive that we have any ability to constructively respond, the more distress we will feel.

When we are distressed we feel defensive, depressed, defiant, and dependent. We are disorganized and indecisive. Important aspects of our lives (sleep, diet, relationships, spirituality, etc.) get out of balance. Basically life just seems unmanageable, and all sense of fun and enjoyment is out the window.

So what to do? This is where stress management comes in. Actually, we all attempt stress management every minute of every day. Everything we do in life is an effort to reduce our stress level or prevent an increase in our stress level in the future-from brushing our teeth to going to work to paying a traffic fine. We make the judgment, consciously or unconsciously, that the action we have chosen is or will be somehow less stress-producing than the alternatives. Sometimes we're right-sometimes we're not.

For stress management to be effective over the long haul, the key is not merely to learn certain little tricks that address only the symptoms, although these strategies can be important tools in dealing with your immediate response. The key is in learning to live your life and see your world, in a way that makes distress less likely. In other words, like so many other things in life, stress management is not an event, it is a process. Here ire some principles that, when practiced on a daily basis, can help you manage your stress and keep your distress at a minimum.

• First:, take responsibility for yourself, your life, your behavior, and your stress. If you don't take responsibility, you effectively delegate it to someone or something else (consciously or not), which means you effectively delegate control over your life-and your stress level-to someone or something else.
• Identify your principles, values and goals-what's important to you and what you want out of life-and behave consistently. If a strong family life is most important to you and yet you repeatedly take on tasks that make it impossible for you to be with your family, you will feel distress. The more your behavior matches your values and principles, the less distress you will experience. Also, make sure your principles, values, and goals apply to you and your behavior. If your values are centered on everyone else in your life acting fairly and appropriately, you set yourself up to be distressed. People don't always act in accordance with your goals. And finally, make sure your principles, values, and goals are flexible enough to allow/or your being human. If it is important to you to be perfect and never make mistakes, you will live your life in a constant state of distress.
• Learn to practice a measure of acceptance in your life. Things just won't always go the way you want them to. Focus more of your attention where you have influence and less of your attention where you don't.
• Don't take yourself too seriously all the time. At least once a day, do something just because you enjoy it, however small it may be. Find some humor in your day. Get some perspective.
• Conduct an inventory of yourself and identify your own personal internal stressors. Are you a "peoplepleaser"-do you have a hard time saying "no?" Are you a perfectionist-does every mistake take another notch out of your self-worth? Identification is half the battle to resolution. If you need help dealing with these issues, get it. Also, identify your own personal cues that signal when you are distressed. Do you tense up? Do you get headaches? Do you become irritable, angry, or defensive? Do you feel confused-do you have a more difficult time than usual making decisions?
• Build yourself a support system and use it. Find someone you can trust and with whom you can talk honestly and openly about your fears and your failures as well as your hopes and successes. Find someone who can give you perspective, someone else who can remind you what is really important to you and what is not, another someone who can help you laugh. But remember, a support system is only supportive if you use it. Set up regular appointments with these friends. Call them even when you don't want to (since that is usually when you are distressed).
• Finally, learn some of the tricks that work for you in addressing the symptoms of distress-exercise, meditation, relaxation exercises, recreation, music, worship at church or other spiritual practice-and use them regularly. Be careful, though, of the sinkholes many of us have fallen into in the search for "instant stress management"-when you use alcohol or other drugs as your stress management tools, you may set yourself up for the distress of substance abuse and addiction.

In short, take responsibility, act with integrity where you have influence, accept the rest, know yourself, use your support, give away, and practice relaxation. And remember: you won't always do this right. Just focus on the daily process of stress management, and over time you will begin to notice that the times of distress become fewer and further between.

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V. THE TEXAS CPA PEER ASSISTANCE PROGRAM

Few states in the U.S. have a peer assistance program to extend help to CPAs whose lives and careers are impaired because of physical, mental, or emotional problems. Texas is one of those few. Most members of the Program are volunteers conimitted to helping their fellow CPAs in need. These members are recovering from substance abuse and/or depression, They have, 'been there, done that' and lived to tell about it. The program's stated purpose is:

To offer CONFIDENTIAL assistance to Ceritfied Public Accountants and accounting students who may have a drug or alcohol dependency or mental health problem.

The program's hotline number is 800.289.7053. The program has a variety of resources available to provide assistance. If appropriate, a volunteer member will contact the referred CPA and arrange an informal meeting at which the alleged impairment can be discussed. If indeed the CPA is suffering from an impairment, the member will help him or her to obtain the appropriate assistance. Frequently, this assistance can come from local CPA support group meetings in which CPAs can speak freely and confidentially and receive support from their peers. The program also maintains a listing of professional services offered by outside providers to which the CPA may be refereed.

The program was established under the Tex. Health & Safety code Ann. §467 (Vernon 1989). Under this statute, all communications by any person with the Program (including staff, committee members, and volunteers) and all records received or maintained by the Program are confidential. This becomes of particular importance when refereed CPAs find themselves respondents in disciplinary proceedings.

The program is under no obligation to report, and indeed is prohibited from reporting or releasing, any information to any entity in the State Board's disciplinary system without the CPA's permission. Additionally, §467.005(b) states that "[a] person who is required by law to report an impaired professional to a licensing or disciplinary authority satisfies that requirement if the person reports the professional to an approved peer assistance program." Further, §467.008 provides that any person who "in good faith reports information or takes action in connection with a peer assistance program is immune from civil liability for reporting the information or taking the action", with the presumption being that the person acted in good faith.

The majority of referrals to the program are received from impaired CPAs themselves. Other referrals come from partners, associates, office staff, judges, court personnel, clients, family members, friends, and grievance committees.

VI. CONCLUSION

Even given the darkest of estimates, the majority of CPAs have no problem, and never will have a problem, with substance abuse or depression. On the other hand, given the best of estimates, if even only ten percent of the CPAs in the country suffer from such identifiable and treatable diseases, not to extend help would be a travesty. Individual CPAs must be willing and able to identify the signs and symptoms of substance abuse and depression and accept the responsibility to take some action to extend help, Further, is CPAs become more adept at identifying these problems in their colleagues and clients, and more skillful at addressing the issue -and assisting in rehabilitation, they become better able to serve as zealous and effective advocates. This not only saves the lives of many impaired CPAs and clients, but also serves to protect the public and the accounting profession as a whoJe from the often devastating effects of the disease.

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APPENDIX VII

Substance Abuse & Chemical Dependency

Al-Anon Family Groups (Al-Anon Family Group Headquarters, Inc. 1985)

Alcoholics Anonymous, 3d ed (AA World Services 1976)

Covington, A Woman's Way Through the Twelve Steps (Hazelden 1994)

Johnson, Intervention How To Help Someone Who Doesn't Want Help (Johnson Institute Books 1986)

Johnson, I'll Quit Tomorrow: A Practical Guide to Alcoholism Treatment (Harper & Row 1980)

Kinney & Leaton, Loosening the Grip: A Handbook of Alcohol Information. 4th ed. (Mosby Year Book, 1991)

Mann, New Primer on Alcoholism (Holt, Rinehart & Winston 1981)

Manual on Alcoholism (American Medical Association 1968)

Milam & Ketcham, Under the Influcncc: A Guide to the Myths and Realities of Alcoholism (Madrona Publishers 1981)

Robertson, Getting Better-Inside Alcohlics Anonymous (Win. Morrow & Co. Inc. 1988)

Scientists Search for an Alcoholism Gene. Dallas Morning News, May 24, 1993

Depression

Beck, Cognitive Therapy of Depression (Guilford 1979)

Benjamin, et al, The Role of Legal Education in Producing Psychological Distress Among Law Students and Lawyers. 1986 Am. 2. Found. Res. J. 225 (1986)

Burns, Feeling Good: The New Mood Therapy (Signet 1980)

Cohen, Out of the Blue: Depression and Human Nature (W.W. Norton & Co. 1994)

Copeland, Living Without Depression & Manic Depression '-(New Harbinger Publications 1994)

Cronkite, On th/eweb Edge of Darkness (Delta 1994)

Eaton, Occupations and the Prevalence of Major Depressive Disorder, 32 Journal of Occupational Medicine 1083(1990)

Herrrnnann, Depressing News For Lawyers, Chicago Sun-Times, Friday, September 13, 1991, p.1

Stress

Benson, The Relaxation Response (William Morrow & Co. 1975)

Carson, Taming Your Gremlins (Harper Perernnial 1983)

Covey, The 7 Habits of Highly Effective People (Simon & Schuster 1989)

Covey, Merrill & Merrill, First Things First (Simon & Schuster 1994)

Kirsta, The Book 0f Stress Survival (Simon & Schuster 1986)

LeVan. Lawyers' Lives Out of Control: A Quality of L!fe Handbook (WorldCom Press 1992)

Moyers. Healing and the Mind (Doubleday I 993)

Nuernberger, Increasing Executive Productivity (Prentice Hall 1992)

Sells, The Soul of the Law (Element 1994)

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