May 01, 2015

Substance Abuse and Mental Health: Going Solo Isn’t an Option

Patrick R. Krill

If there’s one common denominator among lawyers, especially in a solo or small firm setting, it’s the tendency to work long hours. Either out of necessity or passion, you’re probably more than familiar with early mornings, late nights, and shrunken weekends. Keeping such hours may be necessary and good for business, but chances are it’s not good for your relationship with addictive substances or your mental health. In fact, according to a new study that made headlines earlier this year (, people who work in the neighborhood of 50 hours per week are significantly more likely to engage in risky drinking than people who work 35 to 40 hours per week. And unfortunately for many lawyers, even 50 hours per week doesn’t cut it. Binge drinking, probably the single riskiest form of drinking, is on the rise in America and killing six people a day according to another recent study ( Notably, it’s a behavior that is most common among the same group that represents the largest demographic in the legal profession—middle-aged men. Furthermore, the link between working long hours and depression is also well established, with one study in particular linking long hours to more than double the risk of becoming depressed (

If none of this sounds especially foreign or surprising to you, it may be because you can personally relate, or maybe it’s just because you’ve been in or around the legal profession long enough—starting with the experience of law school—to have seen your fair share of behavioral health problems such as substance abuse and depression. While the exact dimensions of these problems in the legal profession have been difficult to pinpoint, owing mostly to a limited amount of reliable data, the consensus among many in the field has always been that the problems are substantial.

A new, nationwide survey of licensed attorneys is currently being administered by the Hazelden Betty Ford Foundation and the American Bar Association to determine present rates of substance use, depression, and anxiety in the legal profession ( Until this data is analyzed and the study released later in 2015, however, the old numbers are what we have to work with, and the old numbers aren’t good: Available estimates peg the problem drinking rate among attorneys to be roughly twice that of the general population. That’s right, nearly double. Perhaps even more alarmingly, attorneys are more than three times as likely to struggle with depression as the average adult.

What’s behind these extreme rates of depression and problem drinking? The answer is less straightforward, but the rampant, multi-dimensional stress of the profession is certainly a factor. And, not surprisingly, there are also some personality traits common among lawyers—self-reliance, ambition, perfectionism, and competitiveness—that aren’t always consistent with healthy coping skills and the type of emotional elasticity necessary to endure the unrelenting pressures and unexpected disappointments that a career in the law can bring.

Clinicians, researchers, and members of the legal profession themselves have written, theorized, and debated about whether it’s the culture and structure of the profession that is more to blame, or whether it’s the personality types of people who are drawn to law school in the first place that make them more susceptible to developing these problems. In reality, it’s a combination of both, and more. Not only does the culture of the legal profession encourage and foster some very unhealthy behaviors—beginning in law school when these behaviors are deeply ingrained in the psyches of would-be attorneys—but the personalities and values of those attracted to the law as a career often provide fertile ground in which these behaviors can take root.

A New and Growing Concern

It’s important to be aware that when it comes to substance abuse, it isn’t just alcohol that is threatening the health and productivity of many in the legal community these days. While drinking certainly remains the primary substance of choice for most attorneys and legal professionals, sobriety has another enemy growing in the ranks. And more times than not, that enemy is born on a prescription pad.

In fact, when Hazelden Betty Ford Foundation and the ABA announced last year that we would be conducting an authoritative new study of the substance use rates in the legal profession, it came as no surprise that one important difference between our project and the existing research on attorney addiction would be an in-depth look at how prescription drugs are impacting the field. Although we don’t yet have an accurate sense of exactly how widespread the problem of prescription drug abuse is in the profession, we do know that treatment programs and lawyer assistance programs throughout the country are seeing increases in the number of clients who struggle with painkillers, stimulants, and anti-anxiety medications. And, given how serious and far-reaching the prescription drug abuse epidemic is in the American population generally, it would be naive to think that the legal profession is somehow insulated from this trend.

There are three classes of prescription drugs that someone in the legal profession is most likely to abuse:

  • Opioids. Commonly prescribed because of their effective analgesic, or pain-relieving properties, medications that fall within this class include morphine, codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), and other related drugs. OxyContin and Percocet are among the most commonly abused drugs in this class and are frequently prescribed by physicians in greater quantities and for longer periods of time than they should be. Long-term use of opioids can lead to physical dependence and addiction, and taking a large single dose of an opioid could cause severe respiratory depression that can lead to death. Although these drugs may at first be legitimately prescribed as the result of an acute injury or physical ailment, they are highly seductive for their euphoria-inducing and stress-relieving properties. In short, prescription painkillers generally make people feel good, a feeling that is easy to overindulge in and become hooked on without even trying. Of the lawyers whom we regularly treat for opioid addiction, very few if any knew just how dangerous the drugs could be when they started taking them.
  • Central nervous system (CNS) depressants. CNS depressants, sometimes referred to as sedatives and tranquilizers, are substances that can slow normal brain function, which makes them useful in the treatment of anxiety and sleep disorders. Given the high-stress nature of the legal profession and the high rates of anxiety reported among many in the field, it is not surprising that these drugs would be especially attractive to this population. Among the medications that are commonly prescribed for these purposes are barbiturates and benzodiazepines (e.g., Valium, Xanax, Klonopin). These medications are rarely appropriate for long-term use, can often lead to physical and psychological dependence, and can be very dangerous when combined with other substances such as alcohol.
  • Stimulants. As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure and increase heart rate and respiration. They are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD). More and more these days, stimulant use in the legal profession starts in law school, with students commonly turning to these medications to enhance their focus and attempt to increase their competitive edge. Withdrawal symptoms associated with discontinuing stimulant use include fatigue, depression, and disturbance of sleep patterns. Repeated use of some stimulants over a short period can lead to feelings of hostility or paranoia. Further, taking high doses of a stimulant may result in a dangerously high body temperature and an irregular heartbeat. There is also the potential for cardiovascular failure or lethal seizures.

Moving Toward the Solution

So what can you do if you or an attorney you know is possibly struggling with substance abuse or a mental health issue such as depression or anxiety? The most important thing you can do is also, for many attorneys, the most difficult: reach out for help. If this sounds easy to you, or you think that a struggling colleague would find it easy, you’re certainly in the minority.

The general climate in the legal profession tends to be emotionally isolating, rigorously demanding, anxiety provoking, and lacking in adequate consideration for balance or personal wellness. Most attorneys wear their hard-earned ability to swim in such rough professional waters as a badge of honor, and they aren’t inclined to let others know they suddenly “can’t cut it.” And it’s this fear—that others will find out they’re weak, vulnerable, or troubled—that is one of the most common reasons that attorneys cite when asked why they believe seeking help isn’t a good option for them.

Whether it’s their peers, colleagues, clients, friends, or even family members, lawyers are overwhelmingly reluctant to let anyone in their universe know about a personal problem that could make them appear incompetent, unreliable, untrustworthy, or otherwise not up to the job. Sometimes their fears are exaggerated and out of touch with the reality of their situation, but sometimes they are not: The legal profession, as an industry, is currently behind the curve in terms of dealing with substance abuse and mental health issues in a proactive way, and the stigma associated with them is both powerful and persistent. Until the profession as a whole experiences a systemic and effectual shift in attitudes and approaches to attorney well-being, it’s up to us to take better care of ourselves despite the sometimes enormous pressure not to do so that a legal practice can bring with it. And taking care of ourselves regarding our substance use and mental health means not going solo in our efforts.

Regardless of our preference for, or predispositions toward, self-reliance, problem solving, independence, and hard work, there are some issues that simply cannot be successfully tackled alone. Substance abuse and mental health concerns top that list. Ironically, of all the terrible things that can come along with these problems—mental anguish, physical decline, spiritual vacuums, and untimely death—perhaps none are as avoidable, and interruptible, as the isolating shame and guilt that often ride shotgun as addiction or depression settles into the driver’s seat. As your addiction or depression grows, you can begin to lose control of your life, subsequently resulting in feelings of frustration, failure, or worthlessness—feelings that are easy to internalize if you aren’t willing to discuss your struggles with someone. In turn, isolation or self-medication may follow—a maladaptive coping strategy that leads to the problems growing further still. It’s a predictable cycle, universal in its rhythms and consistent in its manifestation. But here’s the thing: It’s also entirely breakable—if you are willing to acknowledge that there might be a problem and reach out for help. It’s not an easy step for any attorney to take, but it’s an imperative one if the lawyer hopes to avoid the litany of unfortunate consequences and unnecessary pain that can come from attempting to ignore or keep secret problems that tend to be progressive in nature.


For a variety of reasons, lawyers struggle with mental health and substance abuse problems at a heightened rate. Although they may face a variety of challenges in their efforts to overcome these problems—including many of their own personal attributes, the chronic pressure of their work environments, and the disincentives toward help-seeking that these environments contain —lawyers can and do recover when they acknowledge their struggles and become willing to involve others in their efforts to get well. By reaching out and availing themselves of assistance, lawyers take what is usually the most difficult but the most important step toward reclaiming their well-being: not going solo.


Patrick R. Krill

Patrick R. Krill, a licensed attorney and board-certified alcohol and drug counselor, is director of the Hazelden Betty Ford Foundation Legal Professionals Program. In this role, he helps addicted attorneys, judges, and law students on the road to recovery.