A recent study published by the the Journal of Addiction Medicine highlights the fact that addiction is an occupational hazard for many in the legal profession. The publication “The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys” was commissioned to ascertain the rate of substance use and other mental health issues among attorneys, as well as their utilization of treatment services and the barriers that they faced in accessing and availing of treatment. The study conducted by the American Bar Association and the Hazelden Betty Ford Foundation is the most recent and up-to-date piece of research on this issue. Prior to its publication there was limited, outdated evidence that was last obtained over twenty years ago. Considering their influence on society and the economy it is extremely important that we accurately evaluate potential impairments and how they can be prevented and addressed.
Some may believe that because of the economic status and social standing of an attorney they are immune from an illness such as addiction. This is not the case and this recent study in addition to other research conducted over the past number of decades
clearly highlights the prevalence of addiction in the law community. In fact the evidence actually indicates that those in the legal profession are at a much higher risk of developing an addiction than that of the general population. Specifically the rate of problem drinking among attorneys is 18% compared to a rate of 10% for the general population.
In order to evaluate and determine the scale of the problem a survey was conducted among 14,895 attorneys, of this a final sample of 12,825 participant’s responses were used. The criteria for inclusion of participants was that they be in employment in the legal profession at the time of the study. The purpose of the survey was to asses the alcohol use, drug use, and mental health difficulties being experienced by the sample. There were a variety of tests used in the study to determine the level of alcohol and drug use/ addiction as well as mental health disorders.
We will focus specifically on the surveys assessing drug and alcohol abuse and addiction. To determine an unhealthy use of alcohol among the legal profession the Alcohol Use Disorders Identification Test (AUDIT) was used. The test is made up of ten self assessment items; developed by the World Health Organization it screens for hazardous or harmful use and the potential for alcohol dependence. The test is scored based on answers from 0-40; scores are then categorized into zones which reflect increasing severity. There are three zones ranging from ‘harmful use’ to a need for ‘diagnostic evaluation for alcohol use disorder’. A score of 8 or more enters respondents into one of the three zones. In presenting the results the study combines all three zones under the heading of ‘problematic use’.
Of the total participants surveyed, 11,278 completed all ten questions and 20.6% of these participants were in the zone of ‘problematic use’. From the total participants, 11,489 participants completed the first three of the ten questions allowing a subscale of use to be calculated. AUDIT -C is the subscale made up of the first three questions which focus on the quantity and frequency of use. The survey showed that 36.4% of the 11,489 participants had a score consistent with ‘hazardous drinking’ or possible ‘alcohol abuse’ or ‘dependence’.
In order to specifically assess drug use, abuse and dependence the Drug Abuse Screening Test was used. It is also a self assessment comprised of ten questions calculating a score to determine the consequences of drug use in both a clinical and research setting. The scores are divided into four categories; ‘low’, ‘intermediate’, ‘substantial’ and ‘severe concern’. Participants were questioned regarding their use of a variety of substances, including both licit and illicit. Of all the participants who used a substance over the past twelve months, the survey showed the type of substance yielded an effect of the frequency of use. Those using stimulants had a higher weekly usage of 74.1%, those using sedatives were 51.3%, tobacco at 46.8%, marijuana at 31% and opioids 21.6%. The majority of participants’ usage and subsequent consequences were in the ‘low’ category at 76%. There were 29% of participants in the ‘intermediate’ category, 3% in ‘substantial’ and 0.1% in the ‘severe concern’ category.
The evidence shows that there is a significant issue with substance use and abuse among those in the legal profession. The alcohol and drug specific tests also addressed the issue of treatment in terms of accessing treatment and the barriers to treatment. Of the total number of participants 6.8% reported seeking or entering treatment for alcohol of drug use. Of this percentage 21.8% reported that they used specific treatment programs, tailored for those in the legal profession. This particular percentage of respondents had a lower mean score in the AUDIT test than those who availed of treatment programs not specifically tailored to the legal profession.
In terms of the barriers and deterrents for entering and seeking treatment, the main issue was a desire for the problem to be kept private. Of all those who sought treatment in the past, 50.6% did not want others to find out they were in need of help, and a further 25.7% of those who have not been in treatment felt the same. The next concern among participants was privacy and confidentiality, with 44.2% of those who have availed of treatment concerned about their anonymity, in addition to 23.4% of participants who have not been in treatment. These statistics are as worrying as the rate of use and abuse; there is a clear reluctance to be open and honest about their dependence which is a huge element of treatment and recovery. Recovery for many is partially reliant on the understanding and support of family and friends and for some this is a crucial aspect of remaining sober. Addiction is an illness shrouded in secrecy, lies, guilt and shame. These emotional and mental aspects of the disease must be addressed in conjunction with abstinence. Effectively overcoming addiction is substantially dependent on our thought processes and beliefs, how we perceive and process the illness and ourselves will ultimately determine an addict’s ability to stay in recovery.
Understanding the problem
There are two main characteristics to addiction in the legal profession; firstly it begins early with the onset of addiction occurring for people while they are law students. Secondly it is progressive and gradual, for many they take part in the culture of drinking for many years without any noticeable effect until eventually it catches up with them and they recognize that it is no longer social, they are no longer in control and they are now dependant. The influence of the drinking culture among the legal profession is evident in the fact that 95% of attorneys and judges suffer from alcoholism as opposed to addiction to other drugs.
In trying to understand this addiction and particularly in trying to tackle it we must look at the origins. It is reported that 8% of prelaw students have concerns around their alcohol consumption. The figure increases year on year with 15% of first year students reporting concerns, 24% of third year students and a three fold increase of 26% among law school alumni.
So why law students and law practitioners; many believe it is due to the strenuous demands of the job a and the high stress levels that working in the law profession entails. The American Bar Association estimates that nearly 20% of all lawyers in the United States suffer from some form of alcohol or substance abuse issues, citing the main contributing factor as stress. The proof of gradual progression of addiction is indicated in studies by the American Bar Association which show an increase of nearly 10% in addiction between those practising law from two to twenty years and those practicing law for twenty five years or more.
Often mental health disorders or illnesses are associated with addiction. For those in the law profession this is very apparent as most of those who suffer from an addiction also have issues with depression, anxiety and stress. Mental health issues in the legal profession are much more common than the general population, and if substance use and abuse is practiced to curb this, it is no surprise that addiction rates are so high.
The destruction caused by addiction engulfs all aspects of an individual’s life. For those in the legal profession it is a vicious circle; the career seemingly causes the addiction and the addiction can jeopardize or cost the individual their career. Studies show that approximately 60% of disciplinary prosecutions and malpractice claims in Canada and the United States involve alcoholism. Addiction therefore does not alone have a very personal cost but can prove financially costly to the legal industry. Disciplinary proceedings resulting in malpractice lawsuits prove hugely damaging to a lawyer’s career and can result in an end to their practice of law.
Why are law practitioners more vulnerable?
Stress and heavy work loads can be attributed to many professions, so why is this resulting in an increase in substance abuse and mental health disorders among law practitioners. Some believe that from the outset those who enter the legal industry are at risk, not alone because of the work load, but because of their personality, behaviour patterns and characteristics. The industry itself is highly demanding, intense and stressful, requiring a level of commitment and dedication at the uppermost level to achieve success. Combine this with often unmanageable workloads and a work environment with a culture of drinking and you have an addiction vacuum. The drinking culture alone puts lawyers at risk; it is proven that environments that accept alcohol consumption have a greater likelihood of having employees prone to alcohol problems. Studies show that drinking is common practice among law practitioners while working, with 66% reporting social drinking that is connected to work.
Various pieces of research on this issue indicate that the issue of addiction arises quite early in the profession. Many law students report using alcohol as a way to relax or relieve stress or tension and as an escape from their problems. Many experts believe that it is not alone the work load that causes stress and anxiety but the intense level of competition and the need to succeed and achieve perfection. Those who enter the legal profession are often overachievers and perfectionists that set themselves extremely high goals and failure is not an option. Their success, status, recognition and career can often be the entire basis for their self worth, if this is jeopardized or perceived as lagging in anyway it could prove too much to cope with.
Other risks factors for students and newly qualified law practitioners is the reality of the legal profession; some may become disillusioned once actually practising law. The reason for entering the profession and the original intentions they had may not be possible or achievable in practice and this can lead to loss of self worth and a loss of identity. For others they may need to compromise their values or beliefs to be successful and fulfill their duties, resulting in a loss of integrity and personal satisfaction. Such harsh realities can prove extremely challenging and leave people void of emotional and personal substance that in turn can pave the way to mental health difficulties which as studies show are clearly linked to substance abuse and addiction.
The demands and requirements of law students and those in the legal profession heighten their risk of developing an addiction but could this risk be as much to do with their specific personality types as their career choice. Most law professionals are said to have two significant personality traits, perfectionism and pessimism. Perfectionism raises the level of stress hormones in an individual, possibly explaining the prevalence of mental health issues among this group. The need to avoid failure at all costs and a limited ability to recognize achievements or success leaves for a very negative self image and attitude to life. Perfectionists often find it difficult to gain any satisfaction from what could actually be considered a success or even superior in terms of performance or results. There is a serious inability to recognize their achievements and in actual fact this makes perfectionists very unsure, awkward and low in confidence. They are constantly second guessing themselves and over analyzing to a point of obsession.
Pessimism could be said to be synonymous with attorneys; a study carried out in the nineties showed that in all graduate school programs, across all professional fields optimists out performed pessimists, with one exception- law school. Pessimism in terms of career success is actually a positive trait and it serves to enhance and progress careers in the legal profession. Attorneys need an element of pessimism as they must be skeptical of clients, witnesses, defence, judges and juries. It allows them to focus on worse case scenarios and thus be prepared for all possibilities or issues that may arise. For a successful career it works, for a successful life it does not. Having such a negative and skeptical outlook adds to an individual’s stress and anxiety, leads to isolation and depression and prevents people from seeing any good in the world.
Constant critical and analytical thinking can be draining and continuous skepticism limits people in a personal and social capacity, possibly leading to a very lonely existence, isolation, depression or suicide. Many law practitioners because of their perfectionism and pessimism are often unconfident, awkward, anxious and unsure. It is rare that anyone would list these adjectives to describe an attorney. Many legal professionals create and maintain a persona of confidence, leadership and self assuredness that is a façade. The longer this persona exists the harder it becomes to share genuine feelings of emotion, tenderness or discomfort. A professional mask as part of their careers can also make it extremely difficult to recognize and admit they have a substance problem and even more difficult to ask for help.
While the onset of addiction has been documented as early as law school the highest rate and largest problem with alcoholism is found among senior law practitioners. Addiction in the profession is a gradual and progressive issue but supports are required at all levels of the profession. Research shows that the vulnerability for addiction begins early on and if those in the industry wish to address the problem they must begin to look at the origins and the culture within the law community. Education and support as preventative measures can work to ensure a reduction in addiction among law professionals in later years.
Specialized Help & Support
There are many justifications for having specifically tailored addiction treatment for those in the legal profession. This can be somewhat rooted in the characteristics of attorneys, as we’ve already discussed this section of the population have specific personality traits and perspectives increasing the potential for addiction and sabotaging their potential for recovery. These personality traits and characteristics in addition to their careers require a specific approach to treatment if it’s to be effective. The trait of perfectionism among those in the legal profession means the apparent weakness, or character flaw of having an addiction is heightened, and guilt and shame as a result is magnified.
Many in the legal profession who suffer from substance abuse or dependence have an ability to function normally in their professional lives. Because of this it can be easy to minimize and dismiss the reality of just how severe their problem may be. Skills and attributes necessary and positive to a person’s career or professional abilities can actually hinder their recovery. They also argue and convince people of certain facts and scenarios for a living, making them expert at putting forward a convincing and compelling case. Their skills also make them more likely and more able to rationalize and justify their substance abuse or dependence. It is for these reasons that specialized, specifically designed treatments are crucial for law professionals.
The barriers outlined in the Hazelden Study also mean that they need high quality facilities that absolutely respect confidentiality and privacy, without such facilities their likelihood of entering treatment is further reduced. The rate of addiction among this particular group also highlights the need for specialized treatment in order to effectively address this issue. Considering the early onset of addiction among law students and attorneys it is also crucial that preventative measures are taken. Addicts in general are excellent liars and skilled in manipulation, add this to an individual who is in many ways trained and a professional in this area, makes them a much more difficult group to treat. As perfectionists they are also less likely to admit defeat and or to accept help from others.
For years the severity of this problem went under researched and unreported, it is now highlighted as an epidemic among this profession and measures are gradually been taken to address it. Bar Associations across the country are stepping in and working to support members. The South Carolina Bar Association established the HELP Task Force in 2008 to raise awareness of this issue and promote the prevention of substance abuse, mental illness and suicide. The Bar also has a confidential service- Lawyers Helping Lawyers for lawyers who are suffering from addiction or mental illness. There are also several Lawyer Assistance Programs (LAP) across the country supporting all those in the legal profession from students to judges. Bar Associations and LAPs around the country are working develop and deliver education, prevention, identification and rehabilitation.
There are many established facilities that have specific programs to cater to the needs of those in the legal profession. One of the most notable and prestigious is the Hazelden Betty Ford Foundation who has a comprehensive Legal Professionals Program. The Program takes into account all factors of a legal professional’s life from family, mental health, career, education/ understanding and continuing care. As with anyone embarking on the journey of recovery, research and clarity are crucial in choosing a treatment program. You need to be clear on what the facility has to offer, the approaches, methods and therapies used and if it fits your unique needs.
While research and knowledge on this matter is now more current and the issue of addiction in the legal profession has been highlighted over the past number of years, there is still a lot of work to be done. The magnitude of the problem requires intervention and preventative measures to be taken at the initial stage of addiction- in law school. Lawyer Assistance Programs are working to educate and inform law students on the damaging effects of substance abuse, addiction and the prevalence of these issues among the legal community. The American Bar Association and various treatment facilities continue to highlight the issue and to ensure that adequate, specified supports are available. In light of the scale of the problem, work must be ongoing and additional resources must be allocated to awareness and treatment programs for the legal profession. The recent Hazelden Study offers greater clarity and understanding of the issue and provides the relevant bodies with the necessary information to work towards effectively addressing this issue.
See The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys Study here.