According to Susan Daicoff (“Lawyer Know Thyself: A Review of Empirical Research on Attorney Attributes Bearing on Professionalism,” 46 American University Law Review, 1337, 1997), up to 41 percent of law students show evidence of clinical depression at some time during law school, and this pathology tends to persist in members of the profession well past law school. Daicoff suggests that the basic personality type of attorneys, coupled with the over-emphasis of the hyper-analytic style and de-emphasis of interpersonal relationships, could begin to explain why law school is apparently the incubator of behavioral health abnormalities in the profession, but this conclusion is still unproven scientifically.

Although there is no research that conclusively demonstrates that the practice of law is more stressful than other professions, those of us who have survived law school, the bar examination, and the vicissitudes of the practice understand from our own personal experience that the stress inherent in our profession has its abrupt beginnings in law school. That has been part of the landscape for lawyers from time immemorial and certainly for much of the last 50 years.

It is increasingly recognized that chronic stress plays an important role in the pathologies of chronic diseases of every kind, including substance use disorder and mental illness. According to Emily Ansell, assistant professor of psychiatry at the Yale School of Medicine, the accumulation of stressful life events affects key regions of the brain, reducing brain volume and function in otherwise healthy individuals. In “Stress Causes Brain Shrinkage” (Yale Daily News, January 17, 2012), it is reported that “[r]esearchers also determined that the changes in brain volume can serve as warning signs for future mental and social disorders, and chronic diseases.”

A Changing Industry

The recent economic troubles have been extremely stressful for practicing attorneys, and this has only added more accumulated stress to the lives of practitioners. Since the financial meltdown of 2008, much of the U.S. economy has been forced to restructure in fundamental ways. The changes have been so profound and so rapid that whatever the future brings to the U.S. economy, it is fairly clear that old business methods, practices, and customs will not be returning. The predictable economic expansions and contractions that have routinely occurred since World War II have had an equally predictable “return to business as usual” as far as the legal profession is concerned. For example, following the recessions of 1973–1974, 1980–1982, and 1989–1992, and even the 2001–2003 contraction, the “business” of law reemerged from these economic difficulties and resumed its consistent and rapid growth.

What has become clearer and clearer since the economic contraction of 2008, however, is that the purchase of legal services has undergone a rapid and profound change. Beginning about 15 years ago, some of the largest and most prestigious law firms in the country have failed, declared bankruptcy, or been merged out of existence because of the challenges the new business climate poses to law firms. The bankruptcy of Dewey & LeBoeuf in 2012 is just a recent addition to the list of dozens of failures among the nation’s most prestigious law firms since the mid-1990s.

A complete list of systemic changes the profession has undergone is impossible to detail here, but broadly speaking, the commoditization of large areas of the practice of law has continued to accelerate since 2008.

Many larger businesses have vastly increased in-house legal staffs, and in-house lawyers are now working as hard, if not harder, than their private-practice counterparts. These lawyers are also subject to the vagaries of corporate downsizing, merger, and bankruptcy.

Legal services are increasingly purchased through the use of requests for proposals constructed by procurement specialists and are driven primarily by cost. In recent times, outsourcing of significant components of litigation to either contract lawyers or high-tech professionals has reduced the per-hour cost of legal services or legal-related services to $25 or $30 per hour. If that were not enough, the proliferation of law-related consultancies, particularly in the business-related practices of taxation, mergers and acquisitions, and debt restructuring, has significantly eroded the practice of lawyers concentrating in those disciplines.

These trends, and their impact on the profession, are not confined to lawyers in large law firms. The advent of tort reform, the increased instability in the small business community that has disrupted stable relationships between clients and their lawyers, the inexorable pace of technological change ever pushing for more productivity and the reduction of costs—all have exposed some fundamental weaknesses in the way in which legal services have been traditionally purchased and delivered. As these methods of purchase and delivery have changed, they are becoming the new “best practices,” resulting in a continuing flattening of gross revenues and net incomes of lawyers who are reliant on commercial activity. In addition, commercial and tort litigation has undergone tremendous change, which has negatively impacted the practices of hundreds, if not thousands, of trial lawyers in the authors’ home state of Ohio, alone.

All this has translated into a significant reduction in the hiring of new lawyers and lawyers in transition. According to The Wall Street Journal (June 25, 2012), members of the law school class of 2011 had little better than a 50-50 shot of landing a job as a lawyer within nine months of receiving a degree. This has been going on for at least four years, which has created a huge glut of available lawyers. To say that the employment picture going forward for new law school graduates and those lawyers losing their positions is bleak would be an understatement.

Also, the contraction in business has resulted in an increased focus on partner productivity, with partner “de-equitizations” and terminations on the rise. So, not only are the newest lawyers and law school graduates feeling the competitive crunch, lawyers across all age groups, particularly those who are nearing the end of their professional careers, are being subjected to the harsh reality that they have to sink or swim.

The fierce competition, and the diminution of the importance of the lawyer’s role in our communities, has certainly contributed to a lack of civility and professionalism as lawyers chase dwindling and less lucrative business. Popular culture, which can’t seem to decide whether it likes or hates us, has done nothing to improve lawyers’ sense of self and their place in the community.

Although the organized bar continues to do a good job of providing support to lawyers as these lawyers face more and more economic difficulties, many who can’t afford the dues drop out and are essentially cast adrift in a sea of economic trouble and hardship without any professional support.

The Impact on Lawyers’ Lives

If one thing is clear to the Ohio Lawyers Assistance Program (OLAP) and other lawyer assistance programs across the country, it is that these fundamental changes in the practice have greatly increased the chronic stress lawyers face in their daily lives. This stress has accelerated the fracture of the lives of individuals who have a substance use disorder or a mental illness. Previously, the more catastrophic effects of these illnesses may have been masked for longer periods of time because the decline in legal ability and professionalism was more gradual and more tolerated. Frankly, until recently, impaired lawyers have had good “enablers” in firms, among their colleagues, on the bench, and even among clients. In the current economic, social, and professional atmosphere, however, the ability of lawyers to “hang on” has become increasingly difficult. The money simply runs out quicker—along with the patience of colleagues, the bench, and clients. The devastating effects of chronic stress coupled with a substance use disorder or a mental illness are manifesting themselves sooner.

The number of lawyers seeking OLAP’s assistance owing to work-related issues since 2008 has increased by some 10 percent. Janet Piper Voss, executive director of the Illinois Lawyers’ Assistance Program, reports an 8 percent increase from 2010–2011 to 2011–2012. Laurie J. Besden, deputy executive director of Pennsylvania Lawyers Concerned for Lawyers, reports that help-line calls have increased 31 percent in the first six months of 2012. What lawyer assistance programs across the nation are seeing is more work-related stress, depression, anxiety, and more serious substance use and mental illness.

OLAP has seen many solo and small firm practitioners reduced to abject poverty. Their client base is no longer employed, so no one is paying. Court appointments do not pay enough, and the number of lawyers seeking appointments has increased. Jobs that once paid $2,500 are now being done for $500, just to get some money in the door. Lawyers are closing offices and practicing from the kitchen table. New lawyers have debt, no income, and little prospect of employment.

OLAP for the first time in its existence, going back to 1991, has assisted large firm lawyers with one to seven years’ experience who were terminated. These lawyers have no book of business and have no idea how to develop their own practices. They are confronted with no health insurance and sick children, school tuition, car payments, house payments and foreclosures, and no immediate way to meet their financial needs. Some have been able to get help from parents, but that help can last only so long. For example, one of OLAP’s clients has not opened a new matter since early 2009.

Although it has long been recognized that stress alone does not cause alcoholism, drug addiction, or other forms of mental illness, stress certainly is not unrelated to these conditions. Substance use disorders and mental illnesses manifest themselves independent of life’s stressors, but chronic stress certainly aggravates the symptoms of the underlying psychiatric condition and may increase the desire to “self-medicate” those symptoms. And although not every alcoholic or addict is mentally ill, most alcoholics and addicts exhibit the symptoms of a mental illness—depression, anxiety, panic disorder, and the like. Similarly, not every mentally ill individual is an alcoholic or drug addicted, but many become dependent on alcohol or drugs in an attempt to self-medicate the symptoms of their mental illnesses.

Because chronic stress alters brain chemistry and size, which alterations cause symptoms that mimic those of mental illnesses, whether the individuals also have an underlying psychiatric disorder is hardly relevant. For those who do, chronic stress will trigger the symptomatology of psychiatric disorder, substance use disorder, or mental illness. For those who do not, chronic stress and chronic overuse of substances may eventually manifest themselves in drug or alcohol abuse, if not dependence.

Assistance for Lawyers in Need

Because there will never be a return to the practice of law as most of us have known it, the new economic realities will continue to play out over the next ten to 20 years with an ever-increasing number of individuals simply unable to handle the accumulated stress generated by these economic uncertainties. OLAP projects that those who have underlying substance use disorders or mental illnesses will continue to need more immediate and more pronounced care after intervention. Accordingly, our traditional focus on intervention and education will be of ever-increasing importance as time goes on.

It is also very apparent that new strategies will have to be developed by lawyer assistance programs in order to accommodate the ever-increasing number of attorneys who will be unable to adapt to changed economic circumstances because of their underlying substance use disorder or mental illness. For example, OLAP is increasingly finding that many individuals of all ages and types of practice are simply ill-suited to the practice of law and, for reasons of both mental and physical health, need significantly more structured, dependable, and less stressful occupations in either law-related fields or other endeavors in order to manage their substance use and mental health conditions.

Although younger practitioners who are ill-suited for the practice of law are self-identifying earlier and leaving the field, many of our older colleagues, because they need to continue to work beyond normal retirement for economic reasons, must strongly consider leaving the profession for overall health reasons. Accordingly, career counseling and diversions from the practice will be of more and more importance in the future, as will other programs specifically designed for the elderly practitioner.

While certainly not new, the educational mission of lawyer assistance programs is even more important now than it has been in the past. Always a part of their core mission, education is critical to stigma reduction, and stigma reduction facilitates early identification and early intervention on those with substance use and mental health issues.

Unfortunately, when it comes to chronic stress, alcoholism or drug addiction, and mental illness, many still believe that these conditions are either self-generated or the result of mental or moral weaknesses. Alcoholics and drug addicts are condemned because the illness is “their fault”; mental illness is greeted with skepticism and the feeling that the afflicted individuals must “pull themselves up by their bootstraps”; and those impacted by chronic stress are simply “weak.” These stereotypes live on despite a mountain of medical evidence indicating that these diseases and conditions affect organic changes in the brain over which the sufferer has no control.

Lawyer assistance programs find themselves having to emphasize, even in this enlightened age, that every chronic disease known to mankind is a product of genetic, environmental, social, and psychological factors. Many cancers, chronic heart disease, and type II diabetes are just as much a product of “self will” as alcoholism or drug addiction. Each one has a behavioral component, whether it consists of poor nutrition, lack of exercise, or other factors within the control of the individual, but none of these other medical conditions are singled out for the same kind of opprobrium as substance use disorders and mental illnesses.

Where to Get Help

All states have a lawyer assistance program (LAP) of some kind, where direction for assistance is available at no charge and with no judgment. Nearly all have confidentiality—what a LAP learns is not disclosed to discipline. There is no reason not to seek help, for yourself or for a colleague. Links to and telephone numbers for these state LAPs can be found on the website of the ABA Commission on Lawyer Assistance Programs (COLAP): www.americanbar.org/groups/lawyer_assistance.html. Just go to the section labeled “Resources for Help” and click “State and Local Lawyer Assistance Programs.”

Hope Despite the Times

The new economic realities have undoubtedly taken a toll on lawyers and their families, but there is still cause for optimism. OLAP’s clients who comply with our and treatment providers’ recommendations change their lives for the better. Ninety percent of the people with whom we work successfully deal with any disciplinary issues, get their practices back on track, resolve problems with creditors and tax authorities, face criminal and civil matters, and get their personal lives back in order. Not all stay in the practice, but if they leave, it’s with a clear head and a plan for what to do next. Not all stay married or in relationships, but they move on without creating any more turmoil. The feared catastrophes rarely occur. The legal profession is very supportive—we all know that “there but for the grace of God go I.”

Below are the stories of two lawyers who have made just such a turn for the better. Their names have been changed, but their stories are real—and they show that positive outcomes are possible for those who accept help.

Bob. Bob was a solo general practitioner with 15 years’ experience. As the economy contracted, so did his number of paying clients. Jobs that used to pay $1,000 he was now doing for $250, just to keep some cash coming in the door. Monthly receipts dropped from an average of $12,000–$15,000 to $3,000–$5,000. He let his secretary go and was creating his own pleadings and correspondence.

Bob’s wife of 12 years was scared and angry about the mounting bills at home; they were behind four months on their mortgage. He found himself feeling more lost, alone, and depressed (“I went to law school to live on $2,000 a month?”). With less to do at the office, the local bar became a place to commiserate and find some temporary relief. His wife’s anger only increased as he came home late, drunk, and distant. Their arguments escalated, and she was contemplating divorce. Their two children began having behavioral problems at school and home.

After nine months of drinking four or five days a week, Bob started failing to return client calls, three clients filed grievances, and he missed some hearings. One of the judges called Bob in after a missed appearance and was alarmed to smell alcohol at 1:30 pm. The judge called OLAP while Bob was sitting in chambers. We did an assessment later that week, determined that Bob needed treatment for alcoholism, sent him for intensive outpatient treatment, and signed him to a three-year recovery contract.

Eighteen months later, Bob is sober, his marriage is back on solid ground, and he is rebuilding his practice. He sent OLAP the following note in gratitude: “Thanks to you and your support, I have my life back. I know that I would be divorced and in disciplinary problems, if not disbarred, had you not showed me how to change my life. I am forever grateful.”

Susan. Susan first was referred to OLAP when she was going through the admissions process six years ago, as she had a couple alcohol-related incidents in college. At the time of the admissions assessment, she was on the borderline for substance abuse. We sent her to an alcohol/drug education program for a day, and she responded positively. She passed the bar exam and got into an office-sharing arrangement with four other solos, doing whatever came in and getting court-appointed misdemeanors and felonies.

Susan was a good lawyer, well thought of by her colleagues, the prosecutors’ offices, and the judges and their staffs. She also was the life of the party, hanging out after hours with other lawyers at the local bars, active in the trial lawyers association, and volunteering for judges’ fundraisers, etc. A first stop for drunk driving was reduced, but the second arrest six months later, at age 32, landed her in jail at 3:30 am on a Saturday morning. She was in our office Monday afternoon, where we diagnosed alcoholism, anxiety, depression, and post-traumatic stress disorder (she had many incidents as a teen that she never told anyone about until our assessment).

We sent Susan for intensive outpatient treatment for alcoholism and to a therapist to work on her mental illness issues. She also worked with a psychiatrist to get the correct medications in place. She is continuing to comply with her four-year recovery contract.

Susan made it through the drunk-driving conviction, made it through the 90-days’ driver’s license suspension, and is making it through the two years of probation. She continues to go to three to five AA meetings a week, takes the prescribed medications, and is active in her domestic violence support groups. Her practice continues to grow. A couple months ago she told me, “I didn’t know what happiness is until I got help.”

A Look to the Future

Over the next ten to 20 years, as the practice of law continues to evolve and the economic stress of the profession continues to mount, more and more lawyers will be in critical need of assistance through lawyer assistance programs. Just as the mission of these programs have evolved through the years, it must continue to evolve in order to provide the necessary support for those who find themselves in these very difficult circumstances.