At 2016 Annual Meeting, NCBP, NABE both address alcohol, substance use, mental health problems

There’s still a great deal of “defensiveness” in the legal profession regarding the high prevalence of drug and alcohol abuse, mental health problems, and similar impairment issues, said Patrick R. Krill, former director of the Legal Professionals Program at Hazelden Betty Ford Foundation and principal and founder of Krill Strategies.

Whether because of confidentiality fears, uncertainty about the exact nature of the problem, or some other issue, putting off a call to the lawyer assistance program for too long can end a career—or a life, said Terry L. Harrell, executive director of the Indiana Judges and Lawyers Assistance Program and chair of the ABA Commission on Lawyer Assistance Programs.

Krill, along with Linda Albert, a licensed clinical social worker and certified alcohol and drug counselor at the State Bar of Wisconsin, spoke at the 2016 Annual Meeting of the National Association of Bar Executives. Later that week, Harrell addressed members of the National Conference of Bar Presidents, on a panel that also included Raul Ayala, a member of the ABA CoLAP Advisory Committee, and Bree Buchanan, director of the Texas Lawyers' Assistance Program at the State Bar of Texas.

Albert and Krill, along with another researcher, were co-authors of a landmark study that was conducted by Hazelden Betty Ford and ABA CoLAP and published earlier this year in the Journal of Addiction Medicine. Together, the two programs gave bar leaders and staff members a detailed synopsis of the study, and an inside view of a crisis in the profession.

What did the study find?

Speakers at both programs noted that the study, based on data collected in 2014 and 2015, was the first one published since 1990. Here are a few key findings from the study, which involved about 13,000 attorneys in a variety of practice settings across the country:

• Based on the Alcohol Use Disorders Identification Test from the World Health Organization, 20.6 percent of respondents could be classified as problem drinkers. The percentage was higher among males (25 percent) and among those who had been in practice for 0-10 years (approximately 30 percent).
  
  
• When simply asked whether their use of alcohol or other substances had been a problem at any point in their lives, 22.6 percent said yes. Among those, 27.6 percent said that this problem existed before they started law school; 14.2 percent said the problem developed while they were in law school; 47.7 percent said it developed within their first 15 years of practice; and 14.6 percent said this occurred 15 or more years after completing law school. “Being in the early stages of one’s legal career is strongly correlated with a higher risk of developing an alcohol use disorder,” Krill noted.
  
  
• The data regarding substance use was far less abundant and reliable, Krill said, because two-thirds of respondents chose to skip those questions even if they answered the ones regarding alcohol and mental health problems. Krill said this could indicate that this topic makes lawyers very uncomfortable—even as part of an anonymous survey.
  
  
• As for mental health problems, 28 percent of respondents indicated that they suffered from depression, 19 percent said they suffered from anxiety, 11.5 percent had experienced suicidal thoughts, and 0.7 percent had made an attempt. Albert noted that this represents the highest suicide rate in any profession, and Krill pointed out that in general, the data showed that mental health problems were especially prevalent among younger respondents.
  
  
• Among those who said they had a mental health issue, 63 percent said they had never sought help for it. Among those who indicated that they had a problem with alcohol or another substance, 93 percent said they had never pursued treatment.

Alarm bells for young lawyers?

Speakers in both programs advised attendees to pay attention to the fact that younger lawyers appear to have especially high rates of both alcohol problems and mental health issues.

Albert mentioned the study recently released by Educating Tomorrow’s Lawyers, in which practicing attorneys were asked which skills and attributes new lawyers needed right away, as opposed to which ones they could learn on the job. The characteristics that were most often indicated as immediate needs were generally tied to professional character and behavior, such as diligence and trustworthiness, Albert noted—and how well can a new lawyer carry out those responsibilities if he or she has an untreated mental illness or drug or alcohol problem?

The picture that emerged from the Hazelden/CoLAP study, particularly as it pertains to young lawyers, is one in which these problems will have a significant impact on clients and the public and are, Albert said, “incompatible with a sustainable professional culture.”

One big barrier to treatment for law students, Albert noted, is the character and fitness evaluation associated with the bar exam; those who are suffering with such problems are often “terrified” of this test and think that they’ll fail it if they seek help.

It can be helpful, she said, to “increase transparency” by bringing character and fitness examiners to law schools to answer questions—and to clarify that a prospective new lawyer can get in trouble for attempting to conceal a problem that has gone untreated, but not for successfully seeking treatment and being open about it.

Albert, as well as other speakers—and attendees—in both programs also pointed to the typical law school culture that is rooted in competitiveness, stress … and heavy drinking.

What gets in the way of treatment?

One serious barrier, Buchanan said—and one that may be especially true for LAPs that are under a bar association’s auspices—is the persistent belief that LAPs aren’t completely confidential. But, she said, “what it really boils down to is stigma” and the pervasive view that such problems are a sign of “moral, personal weakness” rather than a disease.

To help fight this stigma and put others at ease, Buchanan said she often begins educational programs on substance abuse by disclosing that she is a recovering addict. (During the question-and-answer period at the NCBP session, a few attendees prefaced their remarks with a similar statement.)

Ayala, himself a recovering alcoholic, said it can be especially difficult for a lawyer of color to seek help. Minority lawyers are “marginalized and late to the party,” said Ayala, who is Latino. Many are in solo practice, he continued, and thus don’t have others watching their actions and expressing concern. For those at a larger firm, he added, lawyers of color are often “the last hired and the first fired,” and feel that they must work extra hard—and certainly not disclose that they have a problem.

Bar associations themselves should talk more often about such problems and how to get help, Ayala said—and mainstream bars should make a particular effort to get this information to lawyers of color, who are often “disconnected.”

Ayala was involved with his local and state bar, which is how he happened to read—just when he was at “rock bottom”—a letter on this topic from the president of the Riverside County (Calif.) Bar Association for a State Bar of California publication. The letter included an email address and a phone number for the LAP, which prompted Ayala to reach out.

Lots of work to do—and not just for LAPs

Buchanan, who called the Hazelden/CoLAP study “the most significant piece of information we have ever had regarding attorney wellness and wellbeing,” said it offers “possibilities for real, systemic changes” at every career and life stage.

Over the years, LAPs have broadened in scope from drug and alcohol treatment to assistance for mental health issues, and lately, for stress. Harrell would like to “broaden the net further” to offer support for other, sometimes temporary conditions, such as grief, a sick child, or mild depression. There’s a continuum of difficulty in life, she believes, and “most of us will need some help” at some point.

Albert believes that, too, but said the work ahead will be difficult—and must be a priority for the entire organized bar, not just the LAP. “’Help’ is a four-letter word among the legal profession,” she noted, and changing that will require more than a quick fix and a one-off program or two—or trying to motivate lawyers through fear of losing their license.

Instead, she said, the courts, LAPs, bar associations, and other stakeholders must join together in “a movement to change the culture of the practice of law.”

That important work begins with more openness, Ayala said; whether the problem at hand involves alcohol, another substance, a mental health condition, or a similar impairment, “It’s a human problem,” he said. “It’s a human condition—so, why can’t we talk about it?”

Free ABA webinar offers more information

To learn more about this landmark study and related issues, make sure to attend a free ABA webinar, featuring Albert and Krill and moderated by Harrell, on Thursday, September 15, 1:00-2:30 p.m. Eastern time. ABA CoLAP has also compiled many articles about the study, including those from bar association publications; scroll down to "announcements" on the CoLAP page to access the links.