by Patrick Krill
How is it possible that so many lawyers are alcoholics? If 30 percent of the lawyers in my firm were really depressed, why wouldn’t they do something about it? Why are so many of us so unhealthy? As lead author of the 2016 ABA/Hazelden Betty Ford study on the prevalence of substance use and mental health disorders in the legal profession,1 it will likely come as no surprise that I am frequently asked all sorts of questions about what the study findings really mean, and what the implications might be for lawyers, law firms, and the public we serve. In this article, I’ll attempt to answer some of those questions, as well as offer some insights into the nature and impact of the unhealthy lifestyles that many lawyers begin to adopt as early as law school.
First, let’s start with the numbers. Drawn from 19 states and all geographic regions in the country, survey responses from approximately 13,000 lawyers were included in our final data sample. Among our most significant findings were that a large percentage of currently practicing attorneys qualify as problem drinkers (between 21 and 36 percent),2 and unacceptably high numbers are also struggling with depression, anxiety, and stress (28, 19, and 23 percent respectively). Younger lawyers are the most troubled and at-risk group, though no age bracket or experience level within the profession could even remotely be held out as an exemplar of good health.
Furthermore, we also uncovered the reasons why lawyers don’t seek help for their mental health or substance use problems. Those reasons relate most often to fears about their reputation and others finding out they have a problem. The bottom line? All around and often hiding in plain sight, many lawyers are struggling, but too afraid to do anything about it. Many more, while perhaps not struggling with a diagnosable substance use or mental-health problem yet, are engaged in unhealthy behaviors that put them at risk for future problems and, at a minimum, greatly diminished well-being.
Now, a couple of important points of clarification, specifically about the findings related to depression and problem drinking. First, while it is clear from the language in our manuscript that 28 percent of lawyers are experiencing “mild or higher levels of depression,” what we didn’t make clear was that of that 28 percent, the majority are experiencing moderate, severe, or extremely severe depression. In other words, the problem of attorney depression is even worse than the numbers first sound. Second, regarding alcohol use, our study did not find that between 21 and 36 percent of attorneys are “alcoholics” as the term is commonly understood. An individual diagnosis of alcoholism or, more accurately, an alcohol-use disorder, would require more information and would typically be arrived at following a structured clinical interview. What our study did find, however, is that between 21 and 36 percent of attorneys are drinking at hazardous, harmful, and potentially alcohol-dependent levels (collectively, “problem drinking”) that may equate with alcoholism upon further investigation or, at a minimum, place them at significant risk for alcoholism and other serious health problems.
Turning now to the tangible impacts of problem drinking on a practicing attorney (and by extension the firms that employ them, and the clients they serve); they are numerous and significant. I’ve distilled them into four main points:
1) The Problem Drinker’s Health and Well-Being Are Greatly Diminished
The connection between excessive alcohol consumption and physical disease is indisputably well-established for everyone (heart and liver disease, cancer, stroke, hypertension, etc.); and the ABA/Hazelden Betty Ford study clearly demonstrate the link between problem drinking and mental-health problems among lawyers specifically. Among the study participants, those who screened positive as problem drinkers also had significantly higher levels of mental-health distress than their peers, while those who fell in the normal range for mental-health symptoms also endorsed far fewer problem-drinking behaviors. While it is unclear if the mental-health conditions of lawyers are driving their problematic drinking or if it is the other way around, the nexus between the two is clear and compelling.
For some people, problem drinking may develop as a maladaptive coping mechanism aimed at alleviating their mental-health symptoms. Unfortunately, drinking your depression and anxiety away doesn’t work, and what you end up with is an attempt at self-medication that comes served with a side of self-defeat. For others, their depression or anxiety could actually be caused or exacerbated by their drinking, meaning the true cost of their alcohol habit is a lot higher than what’s showing up on their bar tab or grocery store receipt.
2) Problem Drinking Is Often Progressive, and Serious Consequences are Inevitable for Some
While it’s true that some people can live an entire adult life with an undiagnosed alcohol problem and generally avoid visible disaster, unaddressed problem drinking tends to be progressive for most others. An eventual loss of control — sometimes gradual, sometimes abrupt — is in the cards for many attorneys who might be “functioning alcoholics.” It doesn’t take clinical expertise to understand that most late-stage or “full-blown” alcoholics didn’t start out that way, and that they were once just heavy drinkers.
3) The Problem Drinker’s Functioning Is Suboptimal
In reality, many problem-drinking attorneys can perform at a reasonably high level for many years, at least outwardly. But if you peel back the curtain a bit, you’ll see that they’re not performing at nearly the level they could be in the absence of their alcohol habit. Habitual problem drinking is bad for the one thing lawyers need most — their brain. Working memory, mental flexibility, attention, decisionmaking, problem-solving, processing speed, motivation, and planning abilities are all handicapped by drinking too much, and the brain of a “functional alcoholic” will need to work much harder than it otherwise would to achieve the same result. In tennis, it’s called running around your backhand, and it’s what many hard-drinking lawyers find themselves doing on a regular basis: compensating for a weakness. At a time when competition in many sectors of the legal profession has never been stiffer, having their potential stunted by drinking is as irrational for lawyers themselves as it is for the firms that employ them.
4) Problem Drinkers Have a Heightened Risk Profile
As stated, things don’t always go immediately south for problem-drinking attorneys, especially because they are so adept at compensating for and concealing the impacts of their unhealthy lifestyle. When things do go bad, however, they can go very bad. From the obvious risks like poor performance, loss of clients, and malpractice, to the less-obvious risks, such as the extraordinary amount of time their firm might have to spend dealing with the issue or the emotional and psychological impacts on colleagues, it is hard to overstate just how much volatility might be stuffed into that baggage a problem drinker is carrying around.
When it comes to determining why the legal profession has so much problem drinking and such poor mental health, I always suggest that a good starting point is the stress, followed by the profession’s culture, which promotes terrible learned responses to that stress. Of course, using alcohol to deal with stress is not unique to the legal profession (“I need a drink!” is the clichéd exclamation of pretty much every stock fictional character we see who has had a long or stressful day); but lawyers can take it to another level, and do so at their own peril.
Chronic stress can increase the risk for developing depression, and stress is also a well-known,well-documented risk factor for the onset of addiction, as well for relapsing back into addiction after periods of abstinence and recovery. There is a significant amount of research on this point, but you probably don’t need the data to understand what is on some levels a common-sense equation. Stress is an unavoidable part of life, especially for practicing attorneys, and if your go-to solution for coping with or escaping unavoidable parts of life is drinking or using drugs, you are setting yourself up for a lot of drinking or drug use. The more often this happens, the more reliant you are likely to become on your substance of choice, and soon your stimulus-response pattern (i.e., stress = drink) becomes hardwired into your brain (and sadly, your life).
Unfortunately, and unbeknownst to most heavy drinkers who think that alcohol is helping them manage their stress, it is, in fact, an especially ineffective and self-defeating tool. I’ve already mentioned the connection between problem drinking and mental-health distress that our study demonstrated. Other compelling studies have demonstrated how alcohol use itself exacts a psychological and physiological toll on the body that can compound the damaging effects of stress, and also prolong recovery from a stressful event. In other words, if someone is stressed and drinks to deal with it, they may temporarily feel more relaxed once their blood alcohol content reaches a certain point, but their body is telling and experiencing an altogether different and less pleasant story. To make matters worse, drinking to cope with stress has the paradoxical effect of eventually reducing one’s stress tolerance: long-term heavy drinkers experience higher levels of anxiety when faced with a stressful situation than nondrinkers or moderate drinkers. Finally, and perhaps most important when it comes to stress-drinking and the risk of addiction, stress can also decrease the pleasant effects of alcohol and, therefore, increase the craving for more alcohol to produce the desired effect.
Given the high-stress nature of the legal profession (starting in law school) the connection between stress, poor mental health, and problematic substance use can’t be underscored enough. With technology and our constant state of connectedness only accelerating the pace of an already demanding profession, the stress levels of lawyers don’t show any signs of abating. Moving away from a reliance on alcohol and drugs and toward healthier stress management techniques and resilience-enhancing behaviors has probably never been a worthier or more timely goal for the profession.
1 Patrick R. Krill, Ryan Johnson & Linda Albert, The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. of Addiction Medicine 46 (Feb. 2016), available at http://journals.lww.com/journaladdictionmedicine/Fulltext/2016/02000/The_Prevalence_of_Substance_Use_and_Other_Mental.8.aspx.
2 Id. (citations omitted) (“The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item self-report instrument developed by the World Health Organization (WHO) to screen for hazardous use, harmful use, and the potential for alcohol dependence. The AUDIT generates scores ranging from 0 to 40. Scores of 8 or higher indicate hazardous or harmful alcohol intake, and also possible dependence. Scores are categorized into zones to reflect increasing severity with zone II reflective of hazardous use, zone III indicative of harmful use, and zone IV warranting full diagnostic evaluation for alcohol use disorder. For the purposes of this study, we use the phrase ‘problematic use’ to capture all 3 of the zones related to a positive AUDIT screen.”).
Patrick Krill is recognized as one of the leading authorities on the substance use and mental-health problems of lawyers. He is an attorney, licensed and board certified alcohol and drug counselor, advocate, and founder of Krill Strategies, a behavioral health consulting firm exclusively for the legal profession.