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March 02, 2015 Asked and Answered

How can attorneys get help without harming their careers? (podcast with transcript)

By Stephanie Francis Ward

With such a stressful profession, many attorneys face addiction and other mental health issues. If you find yourself struggling–or know another lawyer who is–what resources are out there? Does admitting a problem have to harm your career? What are your ethical duties if you do know that a colleague is battling an addiction, or suffering from mental health problems?

In this month’s Asked and Answered, the ABA Journal’s Stephanie Francis Ward speaks with Patrick Krill of the Hazelden Betty Ford Foundation’s legal professionals program to find out more. Krill is currently finishing a study in conjunction with the ABA to research substance abuse, depression and anxiety in legal profession.

Related article:

ABA Journal: “Lawyers who self-medicate to deal with stress sometimes steal from those they vowed to protect”

Podcast Transcript

Stephanie Francis Ward: Alcohol addiction among lawyers has always been higher than it is in many other professions, and the stress of practicing law, particularly as more attorneys find it increasingly hard to earn money, doesn’t help.

I’m Stephanie Francis Ward. And on today’s Asked and Answered podcast, we’re discussing addiction in the legal profession with Patrick Krill, an attorney. He’s the Director for the Hazelden Betty Ford Foundation’s Legal Professionals Program. The group, working with the American Bar Association, is in the process of compiling a survey about lawyers, addiction, and mental health issues.

Patrick, I’ve heard that about 18 to 22 percent of people in the legal profession have addiction issues, and comparatively, about 10 percent of the general population has addiction issues. I know that, with many lawyers who are struggling with addiction, there is resistance to get help. Do you think that, for those lawyers, do they realize they’re not the only lawyers who are having these problems?

Patrick Krill: Hi, Stephanie. It’s nice to be with you. And, ironically, yes, most lawyers that I’ve treated and many more that I’ve spoken to in recovery about this issue almost universally say that they are aware of the heightened substance use disorders, addiction, alcoholism, whatever you want to term it, in the legal profession. They have seen it, starting in law school, and they have seen it certainly in their practice and in their work environments, maybe among their colleagues.

But that awareness that they’re not the only ones—the reason I say ironically—is because that hasn’t really done a whole lot to encourage people to come forward, even knowing that it’s a pretty pervasive and widespread problem. There’s still a reluctance to acknowledge that someone’s dealing with it.

Stephanie Francis Ward: So perhaps it’s that shame of not being perfect.

Patrick Krill: That’s a big piece of it, so there is the shame of not being perfect. Lawyers do tend to exhibit a lot of perfectionistic traits. There’s a really pronounced fear of harming one’s reputation and of maybe in some way not seeming up to the task. Maybe, in some way, there’s a fear that their license could be jeopardized, that their business could be jeopardized. They could lose the trust of colleagues, of clients.

There’s a whole host of reasons while attorneys will cite they not likely are willing to acknowledge these types of problems or get help for them.

Stephanie Francis Ward: One thing that I find interesting about that is it seems to me that, if you were going to hire a lawyer, one of them had a substance abuse problem and was in recovery and was working his or her recovery, the other one was trying to keep his or her act together as tight as they could, just kind of hanging on by their fingernails to not go off the wagon, the choice of who you’d hire, to me, seems to be, well, of course, you’d want the first choice.

I mean, that’s someone who has made some hard decisions and done some complicated things with their lives and come out the better for it.

Patrick Krill: Well, you know, that’s a really great insight. Unfortunately, it’s not shared by everybody in the profession. And I think that’s possibly just due to the pervasive stigma that exists around substance use issues and around depression, around any sort of behavioral health issue. There’s a really significant stigma.

But, to your point about between those two different individuals, which one would actually make the better addition to your team, to your firm, to whatever the case may be, categorically, the first person. I mean, you’re absolutely right.

And somebody who has acknowledged their difficulties and dealt with them in a proactive way and is working a program of recovery, they’re going to be more reliable. They’re going to be more clear-headed. They’re going to be more focused on their work and less distracted by their addiction or by their mental health problems.

And they’re just generally, all around, going to be performing at a higher level than somebody who, as you put it, is hanging on by their fingernails and really trying to manage appearances and just hold it all together, which is—that’s very, very common.

That person, their first priority is not their book of business. It’s not their duties to their client or their firm. Their first priority is managing and hiding and concealing the problems that they’re buckling under.

So, again, you’re really right about which one of those two individuals would be the better candidate.

Stephanie Francis Ward: What can you tell us briefly about your ongoing survey that you’re working on with the ABA? When do you expect that it will come out?

Patrick Krill: Well, what I can tell you generally about the survey is that we’re really excited about it, and we’re really pleased with how it unfolded and how we were able to roll it out across the country.

We just finished data collection a few days ago, in fact. And so now we’re in the process of starting to analyze the data, and we have a huge data set. We ended up with approximately 15,000 surveys from licensed attorneys throughout the country. We have a pretty nice geographic representation from all areas of the country. And we have 15,000 lawyers who have responded to the study.

And we’re hoping to have the results ready for publication and for sharing this summer. That’s the goal, and I have no reason to think that we won’t get there.

So it was an important study; it was an overdue study. And one of the main motivations that I had for us doing this in the first place was the lack of current and reliable data around these behavioral health issues in the profession because, if we don’t understand what’s going on today, it’s hard to tackle the problems and have informed strategies for dealing with them.

Stephanie Francis Ward: My understanding is the last significant survey on this was probably when, in the early 1990s?

Patrick Krill: Yeah, yeah.

Stephanie Francis Ward: Why is that? I mean, why do you think they haven’t—does this tie into what we’ve been talking about and that the profession doesn’t really want to acknowledge it’s a problem?

Patrick Krill: I think that’s a big piece of it, so I don’t know if there have been proposals or if people have tried to look at this in previous decades and just not been able to get the momentum or get it going, or maybe nobody has wanted to study it. I don’t know. But what I can tell you is that it’s certainly consistent with my view that the profession is very reluctant to deal with these issues and to take a look at them.

Now, the American Bar Association Commission on Lawyers Assistance Programs, who is our partner in this endeavor, they are the exception. Obviously, that’s an organization that is really dedicated to improving the behavioral health of the legal profession.

So the fact that we were able to partner with them, I think it’s a landmark—it’s really a landmark study, and I’m hoping that it’s going to help a lot of people in all different corners of the profession, once we’re able to really take a look at and see what’s going on.

Stephanie Francis Ward: I think one of the things, too, that should be really interesting about this study is that it’s going to look at the misuse of prescription medicines, which may not have been as much of an issue 20 years ago. Would you agree that that’s become a bigger issue than it was a while back?

Patrick Krill: Hands down. So, in the study that was done in the early ’90s, that really looked and focused on problem drinking. And alcohol remains, far and away, the substance of choice for attorneys, judges, and law students. There’s no doubt about that. Alcohol is the primary substance of choice.

However, consistent with what we’re seeing in the general population in the United States, there has been a huge spike in the amount of prescription drug abuse and dependence. It is easily and by most experts’ analysis or evaluation of the situation, prescription drug abuse is an epidemic in the United States.

And so, to think that the legal profession, which is a profession which is already very susceptible to substance abuse issues in the first place, would somehow be insulated from what’s going on in the rest of the country in that regard would be naïve.

So we are certainly expecting our study to demonstrate that prescription drug abuse problem is happening in the legal profession, just like it is in the general population.

And I’ll just add to that really quickly that we here, in our treatment program, are certainly seeing more lawyers dealing with that issue, and so are Lawyers Assistance Programs around the country.

Stephanie Francis Ward: I’m curious, because I would imagine, as someone who counsels people who come to you, this might come up a fair amount. A lot of times, it seems like people have a lot of pain in their bodies, oftentimes in the back. Pain oftentimes manifests there. At the same time, I think real severe back pain and maybe other joint pain oftentimes seems to tie into depression.

So, if you have someone who seems to be having these problems with substance abuse, but they say, “Well, what do you want? Do you want me to be in pain? My back is killing me,” do you hear that sort of response sometimes? And, if so, how do you help them?

Patrick Krill: Well, you do hear that response, and you do run into that issue. There’s no doubt about it that depression certainly has physical manifestations. And a lot of times, people won’t even really understand—clients, patients, they won’t really understand that what they’re dealing with might be a depression issue, and it’s manifesting through physical symptoms.

And, I mean, you can’t blame—anybody is going to want to sort of relieve their symptoms, and self-medication is obviously—I mean, it’s oftentimes a pretty common thing that people turn to.

In terms of saying, “Would you prefer that I was in pain?”, there are a lot of alternative strategies to pain management that are available to people today, whether it be through acupuncture or a variety of non-addictive medications or a combination of the two, physical therapy. There are a lot of different ways to manage pain.

Mindfulness—there’s been a lot of demonstration in recent years that mindfulness can actually be a super effective pain management tool.

So, for clients who are saying, “Would you rather I be in pain?”, our response is, “No, of course not.” Nobody wants to be in pain, and being in pain is going to make somebody a lot more likely to return to substance use. There’s just—there’s no two ways about that.

But the point is there are other ways to get at the problem and to facilitate recovery from substance abuse and addiction, while also helping somebody and relieving their pain.

Stephanie Francis Ward: And do you see many instances where someone will come to you who maybe is just misusing their pain medicine, and they’re also not in touch with their feelings and pushing them down, and they get in touch with those feelings and own them and talk about them, and they find that the pain gets much better once they get in more touch with their feelings and emotions?

Patrick Krill: Yeah, absolutely. That’s certainly common, as well. Something that is prevalent in the legal profession is what’s known as a co-occurring disorder. So a co-occurring disorder is when somebody has a substance use disorder in combination or in tandem with a mental health disorder, such as anxiety or depression.

And we see, I’d say, 60 to 70 percent of the clients that we treat here have a co-occurring disorder. So they meet criteria for a substance use disorder, whether it be with alcohol or other drugs, and they also have, we’ll say, depression. And it’s a matter of sort of untangling the two, as you might imagine, and trying to figure out which preceded the other. And it’s a big of a chicken-and-the-egg kind of quandary, and you really need to take a look at that stuff closely.

But what you find is that, when you treat both concurrently, and if you are doing your best in providing the most effective treatment to treat both concurrently, symptoms tend to remit with both conditions.

So, to your point, somebody might start to make some progress and have some breakthroughs and really start to heal around some of the issues that come along with their substance use disorder, and their mental health condition improves, and vice-versa. So, absolutely, there’s a big connection between the two.

Stephanie Francis Ward: What can employers do to help? It seems that, oftentimes, when legal employers have an employee who they think might have a substance abuse problem, and there’s a lot of suspicion that something is just not quite right with that person, I think with the law, people oftentimes don’t want to say anything because they feel like I need to have direct knowledge that something’s going on, and that’s hard to get with mental health and addiction. What are your thoughts? What can employers do to help?

Patrick Krill: Well, I guess what I’ll say as sort of a threshold comment is they have to do something, right? And going back to what we were discussing earlier, there is a tendency in the legal profession within the culture of the legal profession, for a variety of reasons that it would take more time to discuss, but there’s a tendency to sort of want to look the other way or have a head-in-the-sand approach to behavioral health issues among our colleagues or among our employees in the legal profession.

And that’s really not acceptable because that has led to and fed the heightened rates of substance use disorder and anxiety, I mean, and depression. When we don’t actually deal with these issues, they continue to grow and get worse, both in individuals and systemically within the profession. So the only thing that employers must do is to do something and not look the other way.

So, in terms of specifics, I would say that the first step is to gain some education around the issue. There are plenty of resources available, whether it be through a program such as my own, whether it be through a Lawyers Assistance Program, whether it be through an Employee Assistance Program. There are a lot of resources available. There are a lot of tools out there. There’s a lot of material.

And it’s important for the firm management, if it’s the HR department, whoever it is, to educate themselves around the issue and to feel comfortable in approaching somebody and in having what is oftentimes an uncomfortable discussion.

Stephanie Francis Ward: Okay. Can you explain a little bit about overall Lawyers Assistance Programs’ duties to report? It’s my understanding that, for a lot of the assistance programs, their staff doesn’t have a duty to report when someone comes to them.

And I think a lot of lawyers, they don’t realize that because there’s always this thing, “Well, I don’t want to get someone in trouble. I don’t want to get this guy disbarred. He seems to be having a lot of problems.” But the truth is, if you go to LAP, you’re most likely not going to get the person disbarred.

Patrick Krill: Most Lawyers Assistance Programs have a rule that exempts them from reporting misconduct to discipline. So the rules of every state bar and every Lawyers Assistance Program, as it relates to the state bar, they’re different obviously in each state.

But I can say, as a general matter, most Lawyers Assistance Programs are exempt from reporting misconduct to discipline. And I think lawyers need to know that, that there is a true firewall there and that there is not going to be reporting of these issues or of misconduct.

It’s a slightly different scenario, in terms of confidentiality, right? There can be a duty to report if somebody poses an imminent harm to themselves or others, consistent with general sort of reporting duties in any sort of licensed profession more broadly.

But, in terms of attorney misconduct that they may have committed in relationship with their substance use disorder or their anxiety or their depression, Lawyers Assistance Programs are exempt from having to report that.

And my experience has been that there is a misunderstanding about that in the profession and that most lawyers really just have these notions that word will get out, that their license will somehow be jeopardized. And most of the time, that’s just not true.

Stephanie Francis Ward: Do you have a sense of how often addiction issues figure in, in attorney discipline matters?

Patrick Krill: Well, we know that there are studies that demonstrate a correlation. I don’t have a reliable or accurate number. I have seen—there was one study that I saw. I believe it was out of Oregon a while back that pegged a number somewhere around 60 percent of all lawyer malpractice and discipline issues, at least in that state, were related to substance use disorders. That’s not surprising to me at all.

So I don’t have an exact number that I feel comfortable sort of endorsing an exact percentage. But I think that there is a pretty clear and strong correlation for a variety of reasons.

Stephanie Francis Ward: If a lawyer has some concerns for a colleague about substance abuse, what advice would you have for that lawyer about what to do?

Patrick Krill: Well, if somebody is concerned about their colleague and they think that there might be some level of impairment that’s the result of a substance use disorder, I would encourage them—going back to what I was saying, an employer’s duty—I would encourage them first to get a little bit of education around it, just so they feel comfortable having a knowledge base around what these issues are.

So, say it’s somebody who doesn’t have any firsthand or even familial experience in dealing with a substance use disorder, and they’re really just sort of coming at it as a pure layman, but they see a colleague who’s struggling, spend a little bit of time just sort of familiarizing yourself with the resources that are out there. Maybe read a few articles about what the disease of addiction looks like and how it manifests. Talk to some professionals and just sort of establish a base level of knowledge around it because I think that will make you more comfortable in approaching that colleague.

Now, lawyers, we’re really good at getting up to speed on new subject matter, new topics, and whatever the case may be, in order to confidently handle a matter or something like that. So learning how to approach a subject cold and get a grasp on it is something that we all can do pretty well. So that’s the first step, understanding the issue.

And then the second step really is being willing to have a conversation with the individual. And you want to make sure that you’re fostering an atmosphere of dignity and respect and confidentiality, and to the best of your ability, presenting in an empathetic way. Those are critical pieces.

You don’t want to accuse; you don’t want to threaten; you don’t want to coerce; you don’t want to come at somebody because the reality is that there’s a lot of denial. Denial’s sort of the hallmark characteristic of the substance use disorder.

So, chances are, if you accuse, threaten, coerce, whatever the case may be, you’re going to be met with a much more defensive posture around this than if you approach your colleague from a place of concern and empathy, and you’ve demonstrated to them that you do have a little bit of knowledge around this, and you understand some of what they might be going through, and maybe you even have some resources that you can point them towards.

So that’s my advice for a general strategy. And I would never hesitate to involve as many professionals as you can and get their input and guidance, as well.

Stephanie Francis Ward: What if you are a lawyer, and you’re concerned for yourself, you feel maybe shameful, or you’re worried some about your use of a certain substance? What advice do you have for that lawyer who feels like he or she might be struggling, but hasn’t done anything to help themselves yet?

Patrick Krill: Yeah. So, as you might imagine, that’s a really common situation for lawyers to find themselves in, where there’s some sort of internal warning light going off or a warning bell saying, “This seems like it might be getting out of hand. This seems like it might be becoming problematic.”

And I think the first thing is to listen to that voice and to acknowledge it. And if you’re having that conversation with yourself, if you’re thinking, “I might need a little bit of help around this,” or, “I might need to explore this a little bit further,” that probably means you do.

So avail yourself of some of the resources that are out there. There are online assessments. There are assessments that you can take. You can have a face-to-face assessment done with a chemical dependency counselor, with a Lawyers Assistance Program, whatever the case may be.

You could have a telephonic assessment, or you could just really sort of read up about it a little bit and explore the issue because the tendency, the sort of default mindset is to push it away and to say, “No, maybe I just drank too much last month. This isn’t an issue.” And that’s where we want to go, and that’s where the mind wants to go with this, and that’s the exact opposite approach of what you want to be doing.

So, if you think there’s an issue, explore it. Be willing to dig into it a little bit. And the DSM-5, which is the most current diagnostic and statistical manual, which is used in terms of making diagnoses and evaluating somebody’s substance use, just potential substance use disorder, has 11 criteria that if you look at it, it looks like a pretty straightforward list of things that you can evaluate your own sort of drinking by.

And I think that’s something that most lawyers would be able to look at and just answer, at least to themselves, whether or not they might be in some level of trouble there.

Stephanie Francis Ward: Patrick, that’s everything that I have for today. I want to thank you so much for your time. I really appreciate it.

Patrick Krill: Thank you, Stephanie. It’s been my pleasure.

Stephanie Francis Ward: I’m Stephanie Francis Ward, and thanks for listening to the ABA Journal’s Asked and Answered. We’ll be back next month, so please tune in.

[End of Transcript]

Updated on March 5 to add the transcript.

In This Podcast:

Stephanie Francis Ward
Patrick R. Krill directs the Hazelden Betty Ford Foundation’s legal professionals program. An attorney and addiction counselor, he helps judges, lawyers and law students with recovery. Krill also writes about addiction and recovery for the Huffington Post, and is working on a national study with the American Bar Association that focuses on lawyers, substance abuse, depression and anxiety.