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BOARD NOTES

published by the

Board of Professional Responsibility
of the
Supreme Court of Tennessee

Special Edition 2016
Mental Health & Substance Abuse Information
for Tennessee Attorneys

Inside:
2

The Prevalence of Substance Use
and Other Mental Health Concerns
Among American Attorneys

Greeting from Jeffrey S. Bivins
Justice, Tennessee Supreme Court

What Can You Do?

Tennessee Lawyers Assistance
Program

Landmark Study: U.S. Lawyers Face
Higher Rates of Problem Drinking and
Mental Health Issues

Does the Board of Professional
Responsibility Consider Substance
Abuse or Mental Health Issues When
Imposing Discipline?

Unwell: Lawyers and the Art of
Practicing Wellness

Law Student Well-being and the
Tennessee Board of Law Examinerâs
Response

Is There a Substance Dependent or
Addicted Lawyer in Your Life? And
What To Do If There Is.

What to do when a Colleague is
Depressed

Greetings from your Supreme Court for this very
important Special Edition of Board Notes. On behalf of the
Court, I want to express our appreciation for this unique joint
effort on behalf of the Board of Professional Responsibility,
the Tennessee Lawyers Assistance Program, the Board of Law
Examiners, and the Continuing Legal Education Commission.
We all felt the need to address this important issue in our
profession in a united front. In some ways, the results of the
ABA/Hazelden study would come as confirmation to some in
our profession of the mental health pressures and concerns
that many of us see anecdotally from time to time today.
However, I think when we see comprehensive scientific
evidence of the breadth, depth, and magnitude of the
substance use and other mental health concerns within our
great profession identified in this study, it demonstrates the
pressing need for us to provide a wake up call and a call to

arms in this critical area. We hope this Special Edition of
Board Notes will do just that.

ORIGINAL RESEARCH

The Prevalence of Substance Use and Other Mental
Health Concerns Among American Attorneys
Patrick R. Krill, JD, LLM, Ryan Johnson, MA, and Linda Albert, MSSW

From the Hazelden Betty Ford Foundation (PRK, RJ); Wisconsin Lawyers
Assistance Program (LA).
Received for publication June 26, 2015; accepted October 25, 2015.
Funding: The study was funded by the Hazelden Betty Ford Foundation and the
American Bar Association Commission on Lawyer Assistance Programs.
Conflicts of interest: Linda Albert is an employee of the State Bar of
Wisconsin. Remaining authors are employees of the Hazelden Betty Ford
Foundation. No conflicts of interest are identified.
Send correspondence and reprint requests to Patrick R. Krill, JD, LLM,
Hazelden Betty Ford Foundation, PO Box 11 (RE 11), Center City, MN
55012-0011. E-mail: pkrill@hazeldenbettyford.org.
Copyright Ã 2016 American Society of Addiction Medicine. This is an openaccess article distributed under the terms of the Creative Commons
Attribution-Non Commercial-No Derivatives License 4.0, where it is
permissible to download and share the work provided it is properly cited.
The work cannot be changed in any way or used commercially.
ISSN: 1932-0620/15/0901-0031
DOI: 10.1097/ADM.0000000000000182

ittle is known about the current behavioral health climate
in the legal profession. Despite a widespread belief that
attorneys experience substance use disorders and other mental
health concerns at a high rate, few studies have been undertaken to validate these beliefs empirically or statistically.
Although previous research had indicated that those in the
legal profession struggle with problematic alcohol use,
depression, and anxiety more so than the general population,
the issues have largely gone unexamined for decades (Benjamin et al., 1990; Eaton et al., 1990; Beck et al., 1995). The
most recent and also the most widely cited research on these
issues comes from a 1990 study involving approximately
1200 attorneys in Washington State (Benjamin et al.,
1990). Researchers found 18% of attorneys were problem
drinkers, which they stated was almost twice the 10% estimated prevalence of alcohol abuse and dependence among
American adults at that time. They further found that 19% of
the Washington lawyers suffered from statistically significant
elevated levels of depression, which they contrasted with the
then-current depression estimates of 3% to 9% of individuals
in Western industrialized countries.
While the authors of the 1990 study called for
additional research about the prevalence of alcoholism
and depression among practicing US attorneys, a quarter
century has passed with no such data emerging. In contrast,
behavioral health issues have been regularly studied among
physicians, providing a firmer understanding of the needs
of that population (Oreskovich et al., 2012). Although
physicians experience substance use disorders at a rate
similar to the general population, the public health and
safety issues associated with physician impairment have
led to intense public and professional interest in the matter
(DuPont et al., 2009).
Although the consequences of attorney impairment may
seem less direct or urgent than the threat posed by impaired
physicians, they are nonetheless profound and far-reaching.
As a licensed profession that influences all aspects of society,
economy, and government, levels of impairment among
attorneys are of great importance and should therefore be
closely evaluated (Rothstein, 2008). A scarcity of data on the
current rates of substance use and mental health concerns
among lawyers, therefore, has substantial implications and
must be addressed. Although many in the profession have
long understood the need for greater resources and support for
attorneys struggling with addiction or other mental health
concerns, the formulation of cohesive and informed strategies
for addressing those issues has been handicapped by the

J Addict Med Volume 10, Number 1, January/February 2016

Objectives: Rates of substance use and other mental health concerns
among attorneys are relatively unknown, despite the potential for
harm that attorney impairment poses to the struggling individuals
themselves, and to our communities, government, economy, and
society. This study measured the prevalence of these concerns among
licensed attorneys, their utilization of treatment services, and what
barriers existed between them and the services they may need.
Methods: A sample of 12,825 licensed, employed attorneys completed surveys, assessing alcohol use, drug use, and symptoms of
depression, anxiety, and stress.
Results: Substantial rates of behavioral health problems were found,
with 20.6% screening positive for hazardous, harmful, and potentially alcohol-dependent drinking. Men had a higher proportion of
positive screens, and also younger participants and those working in
the field for a shorter duration (P < 0.001). Age group predicted
Alcohol Use Disorders Identification Test scores; respondents 30 years
of age or younger were more likely to have a higher score than their
older peers (P < 0.001). Levels of depression, anxiety, and stress
among attorneys were significant, with 28%, 19%, and 23% experiencing symptoms of depression, anxiety, and stress, respectively.
Conclusions: Attorneys experience problematic drinking that is
hazardous, harmful, or otherwise consistent with alcohol use disorders
at a higher rate than other professional populations. Mental health
distress is also significant. These data underscore the need for greater
resources for lawyer assistance programs, and also the expansion of
available attorney-specific prevention and treatment interventions.
Key Words: attorneys, mental health, prevalence, substance use
(J Addict Med 2016;10: 46–52)

J Addict Med Volume 10, Number 1, January/February 2016

Substance Use and Other Mental Health Concerns

outdated and poorly defined scope of the problem (Association of American Law Schools, 1994).
Recognizing this need, we set out to measure the
prevalence of substance use and mental health concerns
among licensed attorneys, their awareness and utilization
of treatment services, and what, if any, barriers exist between
them and the services they may need. We report those
findings here.

TABLE 1.

Participant Characteristics
n (%)

Total sample
Sex
Men
Women
Age category
30 or younger
31–40
41–50
51–60
61–70
71 or older
Race/ethnicity
Caucasian/White
Latino/Hispanic
Black/African American (non-Hispanic)
Multiracial
Asian or Pacific Islander
Other
Native American
Marital status
Married
Single, never married
Divorced
Cohabiting
Life partner
Widowed
Separated
Have children
Yes
No
Substance use in the past 12 mos
Alcohol
Tobacco
Sedatives
Marijuana
Opioids
Stimulants
Cocaine

METHODS
Procedures
Before recruiting participants to the study, approval
was granted by an institutional review board. To obtain a
representative sample of attorneys within the United States,
recruitment was coordinated through 19 states. Among
them, 15 state bar associations and the 2 largest counties
of 1 additional state e-mailed the survey to their members.
Those bar associations were instructed to send 3 recruitment e-mails over a 1-month period to all members who
were currently licensed attorneys. Three additional states
posted the recruitment announcement to their bar association web sites. The recruitment announcements provided a
brief synopsis of the study and past research in this area,
described the goals of the study, and provided a URL
directing people to the consent form and electronic survey.
Participants completed measures assessing alcohol use,
drug use, and mental health symptoms. Participants
were not asked for identifying information, thus allowing
them to complete the survey anonymously. Because of
concerns regarding potential identification of individual
bar members, IP addresses and geo-location data were
not tracked.

Participants

12825 (100)
6824 (53.4)
5941 (46.5)
1513 (11.9)
3205 (25.2)
2674 (21.0)
2953 (23.2)
2050 (16.1)
348 (2.7)
11653 (91.3)
330 (2.6)
317 (2.5)
189 (1.5)
150 (1.2)
84 (0.7)
35 (0.3)
8985 (70.2)
1790 (14.0)
1107 (8.7)
462 (3.6)
184 (1.4)
144 (1.1)
123 (1.0)
8420 (65.8)
4384 (34.2)
10874 (84.1)
2163 (16.9)
2015 (15.7)
1307 (10.2)
722 (5.6)
612 (4.8)
107 (0.8)

Substance use includes both illicit and prescribed usage.

A total of 14,895 individuals completed the survey.
Participants were included in the analyses if they were
currently employed, and employed in the legal profession,
resulting in a final sample of 12,825. Due to the nature of
recruitment (eg, e-mail blasts, web postings), and that recruitment mailing lists were controlled by the participating bar
associations, it is not possible to calculate a participation rate
among the entire population. Demographic characteristics are
presented in Table 1. Fairly equal numbers of men (53.4%)
and women (46.5%) participated in the study. Age was
measured in 6 categories from 30 years or younger, and
increasing in 10-year increments to 71 years or older; the
most commonly reported age group was 31 to 40 years old.
The majority of the participants were identified as Caucasian/
White (91.3%).
As shown in Table 2, the most commonly reported legal
professional career length was 10 years or less (34.8%),
followed by 11 to 20 years (22.7%) and 21 to 30 years
(20.5%). The most common work environment reported
was in private firms (40.9%), among whom the most common
positions were Senior Partner (25.0%), Junior Associate
(20.5%), and Senior Associate (20.3%). Over two-thirds
(67.2%) of the sample reported working 41 hours or more
per week.

Materials
Alcohol Use Disorders Identification Test
The Alcohol Use Disorders Identification Test (AUDIT)
(Babor et al., 2001) is a 10-item self-report instrument
developed by the World Health Organization (WHO) to
screen for hazardous use, harmful use, and the potential for
alcohol dependence. The AUDIT generates scores ranging
from 0 to 40. Scores of 8 or higher indicate hazardous or
harmful alcohol intake, and also possible dependence (Babor
et al., 2001). Scores are categorized into zones to reflect
increasing severity with zone II reflective of hazardous use,
zone III indicative of harmful use, and zone IV warranting full
diagnostic evaluation for alcohol use disorder. For the purposes of this study, we use the phrase ââproblematic useââ to
capture all 3 of the zones related to a positive AUDIT screen.
The AUDIT is a widely used instrument, with well
established validity and reliability across a multitude of
populations (Meneses-Gaya et al., 2009). To compare current
rates of problem drinking with those found in other populations, AUDIT-C scores were also calculated. The AUDIT-C
is a subscale comprised of the first 3 questions of the AUDIT

Ã 2016 American Society of Addiction Medicine

J Addict Med Volume 10, Number 1, January/February 2016

Krill et al.

TABLE 2.

research setting. The DAST scores range from 0 to 10 and are
categorized into low, intermediate, substantial, and severeconcern categories. The DAST-10 correlates highly with both
20-item and full 28-item versions, and has demonstrated
reliability and validity (Yudko et al., 2007).

Professional Characteristics
n (%)

Total sample
Years in field (yrs)
0–10
11–20
21–30
31–40
41 or more
Work environment
Private firm
Sole practitioner, private practice
In-house government, public, or nonprofit
In-house: corporation or for-profit institution
Judicial chambers
Other law practice setting
College or law school
Other setting (not law practice)
Bar Administration or Lawyers Assistance Program
Firm position
Clerk or paralegal
Junior associate
Senior associate
Junior partner
Managing partner
Senior partner
Hours per wk
Under 10 h
11–20 h
21–30 h
31–40 h
41–50 h
51–60 h
61–70 h
71 h or more
Any litigation
Yes
No

12825 (100)
4455 (34.8)
2905 (22.7)
2623 (20.5)
2204 (17.2)
607 (4.7)

RESULTS
Descriptive statistics were used to outline personal and
professional characteristics of the sample. Relationships
between variables were measured through x2 tests for independence, and comparisons between groups were tested using
Mann-Whitney U tests and Kruskal-Wallis tests.

5226 (40.9)
2678 (21.0)
2500 (19.6)
937 (7.3)
750 (7.3)
289 (2.3)
191 (1.5)
144 (1.1)
55 (0.4)

Alcohol Use
Of the 12,825 participants included in the analysis,
11,278 completed all 10 questions on the AUDIT, with
20.6% of those participants scoring at a level consistent with
problematic drinking. The relationships between demographic
and professional characteristics and problematic drinking are
summarized in Table 3. Men had a significantly higher proportion of positive screens for problematic use compared with
women (x2 [1, N Â¼ 11,229] Â¼ 154.57, P < 0.001); younger
participants had a significantly higher proportion compared
with the older age groups (x2 [6, N Â¼ 11,213] Â¼ 232.15,
P < 0.001); and those working in the field for a shorter duration
had a significantly higher proportion compared with those who
had worked in the field for longer (x2 [4, N Â¼ 11,252] Â¼ 230.01,
P < 0.001). Relative to work environment and position,
attorneys working in private firms or for the bar association
had higher proportions than those in other environments
(x2 [8, N Â¼ 11,244] Â¼ 43.75, P < 0.001), and higher proportions were also found for those at the junior or
senior associate level compared with other positions (x2 [6,
N Â¼ 4671] Â¼ 61.70, P < 0.001).
Of the 12,825 participants, 11,489 completed the first
3 AUDIT questions, allowing an AUDIT-C score to be calculated. Among these participants, 36.4% had an AUDIT-C score
consistent with hazardous drinking or possible alcohol abuse or
dependence. A significantly higher proportion of women
(39.5%) had AUDIT-C scores consistent with problematic
use compared with men (33.7%) (x2 [1, N Â¼ 11,440] Â¼
41.93, P < 0.001).
A total of 2901 participants (22.6%) reported that they
have felt their use of alcohol or other substances was problematic at some point in their lives; of those that felt their use has
been a problem, 27.6% reported problematic use manifested
before law school, 14.2% during law school, 43.7% within 15
years of completing law school, and 14.6% more than 15 years
after completing law school.
An ordinal regression was used to determine the predictive validity of age, position, and number of years in the
legal field on problematic drinking behaviors, as measured by
the AUDIT. Initial analyses included all 3 factors in a model to
predict whether or not respondents would have a clinically
significant total AUDIT score of 8 or higher. Age group
predicted clinically significant AUDIT scores; respondents
30 years of age or younger were significantly more likely to
have a higher score than their older peers (b Â¼ 0.52, Wald
[df Â¼ 1] Â¼ 4.12, P < 0.001). Number of years in the field

128 (2.5)
1063 (20.5)
1052 (20.3)
608 (11.7)
738 (14.2)
1294 (25.0)
238 (1.9)
401 (3.2)
595 (4.7)
2946 (23.2)
5624 (44.2)
2310 (18.2)
474 (3.7)
136 (1.1)
9611 (75.0)
3197 (25.0)

focused on the quantity and frequency of use, yielding a range
of scores from 0 to 12. The results were analyzed using a cutoff score of 5 for men and 4 for women, which have been
interpreted as a positive screen for alcohol abuse or possible
alcohol dependence (Bradley et al., 1998; Bush et al., 1998).
Two other subscales focus on dependence symptoms (eg,
impaired control, morning drinking) and harmful use (eg,
blackouts, alcohol-related injuries).

Depression Anxiety Stress Scales-21 item version
The Depression Anxiety Stress Scales-21 (DASS-21) is
a self-report instrument consisting of three 7-item subscales
assessing symptoms of depression, anxiety, and stress. Individual items are scored on a 4-point scale (0–3), allowing for
subscale scores ranging from 0 to 21 (Lovibond and Lovibond, 1995). Past studies have shown adequate construct
validity and high internal consistency reliability (Antony
et al., 1998; Clara et al., 2001; Crawford and Henry, 2003;
Henry and Crawford, 2005).

Drug Abuse Screening Test-10 item version
The short-form Drug Abuse Screening Test-10 (DAST)
is a 10-item, self-report instrument designed to screen and
quantify consequences of drug use in both a clinical and

Ã 2016 American Society of Addiction Medicine

J Addict Med Volume 10, Number 1, January/February 2016

TABLE 3.

Substance Use and Other Mental Health Concerns

Summary Statistics for Alcohol Use Disorders Identification Test (AUDIT)
AUDIT Statistics

Total sample
Sex
Men
Women
Age category (yrs)
30 or younger
31–40
41–50
51–60
61–70
71 or older
Years in field (yrs)
0–10
11–20
21–30
31–40
41 or more
Work environment
Private firm
Sole practitioner, private practice
In-house: government, public, or nonprofit
In-house: corporation or for-profit institution
Judicial chambers
College or law school
Bar Administration or Lawyers Assistance Program
Firm position
Clerk or paralegal
Junior associate
Senior associate
Junior partner
Managing partner
Senior partner

Problematic %

11,278

5.18

4.53

20.6%

6012
5217

5.75
4.52

4.88
4.00

25.1%
15.5%

1393
2877
2345
2548
1753
297

6.43
5.84
4.99
4.63
4.33
4.22

4.56
4.86
4.65
4.38
3.80
3.28

31.9%
25.1%
19.1%
16.2%
14.4%
12.1%

3995
2523
2272
1938
524

6.08
5.02
4.65
4.39
4.18

4.78
4.66
4.43
3.87
3.29

28.1%
19.2%
15.6%
15.0%
13.2%

<0.001

4712
2262
2198
828
653
163
50

5.57
4.94
4.94
4.91
4.46
4.90
5.32

4.59
4.72
4.45
4.15
3.83
4.66
4.62

23.4%
19.0%
19.2%
17.8%
16.1%
17.2%
24.0%

<0.001

115
964
938
552
671
1159

5.05
6.42
5.89
5.76
5.22
4.99

4.13
4.57
5.05
4.85
4.53
4.26

16.5%
31.1%
26.1%
23.6%
21.0%
18.5%

<0.001

The AUDIT cut-off for hazardous, harmful, or potential alcohol dependence was set at a score of 8.
Comparisons were analyzed using Mann-Whitney U tests and Kruskal-Wallis tests.

Drug Use

approached significance, with higher AUDIT scores predicted
for those just starting out in the legal profession (0–10 yrs of
experience) (b Â¼ 0.46, Wald [df Â¼ 1] Â¼ 3.808, P Â¼ 0.051).
Model-based calculated probabilities for respondents aged
30 or younger indicated that they had a mean probability of
0.35 (standard deviation [SD] Â¼ 0.01), or a 35% chance for
scoring an 8 or higher on the AUDIT; in comparison, those
respondents who were 61 or older had a mean probability of
0.17 (SD Â¼ 0.01), or a 17% chance of scoring an 8 or higher.
Each of the 3 subscales of the AUDIT was also investigated. For the AUDIT-C, which measures frequency and
quantity of alcohol consumed, age was a strong predictor of
subscore, with younger respondents demonstrating significantly higher AUDIT-C scores. Respondents who were
30 years old or younger, 31 to 40 years old, and 41 to 50
years old all had significantly higher AUDIT-C scores than
their older peers, respectively (b Â¼ 1.16, Wald [df Â¼ 1] Â¼
24.56, P < 0.001; b Â¼ 0.86, Wald [df Â¼ 1] Â¼ 16.08,
P < 0.001; and b Â¼ 0.48, Wald [df Â¼ 1] Â¼ 6.237, P Â¼ 0.013),
indicating that younger age predicted higher frequencies of
drinking and quantity of alcohol consumed. No other factors
were significant predictors of AUDIT-C scores. Neither the
predictive model for the dependence subscale nor the harmful
use subscale indicated significant predictive ability for the
3 included factors.

Participants were questioned regarding their use of
various classes of both licit and illicit substances to provide
a basis for further study. Participant use of substances is
displayed in Table 1. Of participants who endorsed use of
a specific substance class in the past 12 months, those using
stimulants had the highest rate of weekly usage (74.1%),
followed by sedatives (51.3%), tobacco (46.8%), marijuana
(31.0%), and opioids (21.6%). Among the entire sample,
26.7% (n Â¼ 3419) completed the DAST, with a mean score
of 1.97 (SD Â¼ 1.36). Rates of low, intermediate, substantial,
and severe concern were 76.0%, 20.9%, 3.0%, and 0.1%,
respectively. Data collected from the DAST were found to
not meet the assumptions for more advanced statistical
procedures. As a result, no inferences about these data
could be made.

Mental Health
Among the sample, 11,516 participants (89.8%) completed all questions on the DASS-21. Relationships between
demographic and professional characteristics and depression,
anxiety, and stress subscale scores are summarized in Table 4.
While men had significantly higher levels of depression
(P < 0.05) on the DASS-21, women had higher levels of
anxiety (P < 0.001) and stress (P < 0.001). DASS-21 anxiety,

Ã 2016 American Society of Addiction Medicine

J Addict Med Volume 10, Number 1, January/February 2016

Krill et al.

TABLE 4.

Summary Statistics for Depression Anxiety Stress Scale (DASS-21)
DASS Depression

Total sample
Sex
Men
Women
Age category (yrs)
30 or younger
31–40
41–50
51–60
61–70
71 or older
Years in field
0–10 yrs
11–20 yrs
21–30 yrs
31–40 yrs
41 or more yrs
Work environment
Private firm
Sole practitioner, private practice
In-house: government, public, or nonprofit
In-house: corporation or for-profit institution
Judicial chambers
College or law school
Bar Administration or Lawyers
Assistance Program
Firm position
Clerk or paralegal
Junior associate
Senior associate
Junior partner
Managing partner
Senior partner
DASS-21 category frequencies
Normal
Mild
Moderate
Severe
Extremely severe

12300

3.51

4.29

6518
5726

3.67
3.34

4.46
4.08

1476
3112
2572
2808
1927
326

3.71
3.96
3.83
3.41
2.63
2.03

4.15
4.50
4.54
4.27
3.65
3.16

4330
2800
2499
2069
575

3.93
3.81
3.37
2.81
1.95

4.45
4.48
4.21
3.84
3.02

5028
2568
2391
900
717
182
55

3.47
4.27
3.45
2.96
2.39
2.90
2.96

4.17
4.84
4.26
3.66
3.50
3.72
3.65

120
1034
1021
590
713
1219
n
8816
1172
1278
496
538

3.98
3.93
4.20
3.88
2.77
2.70
%
71.7
9.5
10.4
4.0
4.4

4.97
4.25
4.60
4.22
3.58
3.61

DASS Anxiety
P

12277

1.96

2.82

6515
5705

1.84
2.10

2.79
2.86

1472
3113
2565
2801
1933
316

2.62
2.43
2.03
1.64
1.20
0.95

3.18
3.15
2.92
2.50
2.06
1.73

<0.001

4314
2800
2509
2063
564

2.51
2.09
1.67
1.22
1.01

3.13
3.01
2.59
1.98
1.94

<0.001

5029
2563
2378
901
710
188
52

2.01
2.18
1.91
1.84
1.31
1.43
1.40

2.85
3.08
2.69
2.80
2.19
2.09
1.94

121
1031
1020
592
706
1230
n
9908
1059
615
310
385

2.10
2.73
2.37
2.16
1.62
1.37
%
80.7
8.6
5.0
2.5
3.1

2.88
3.31
2.95
2.78
2.50
2.43

<0.05

<0.001

DASS Stress
P

12271

4.97

4.07

6514
5705

4.75
5.22

4.08
4.03

1472
3107
2559
2802
1929
325

5.54
5.99
5.36
4.47
3.46
2.72

4.61
4.31
4.12
3.78
3.27
3.21

<0.001

4322
2777
2498
2084
562

5.82
5.45
4.46
3.74
2.81

4.24
4.20
3.79
3.43
3.01

<0.001

5027
2567
2382
898
712
183
53

5.11
5.22
4.91
4.74
3.80
4.48
4.74

4.06
4.34
3.97
3.97
3.44
3.61
3.55

<0.001

121
1033
1020
586
709
1228
n
9485
1081
1001
546
158

4.68
5.78
5.91
5.68
4.73
4.08
%
77.3
8.8
8.2
4.4
1.3

3.81
4.16
4.33
4.15
3.84
3.57

<0.001

Comparisons were analyzed using Mann-Whitney U tests and Kruskal-Wallis tests.

Treatment Utilization and Barriers to
Treatment

depression, and stress scores decreased as participantsâ age or
years worked in the field increased (P < 0.001). When comparing positions within private firms, more senior positions
were generally associated with lower DASS-21 subscale
scores (P < 0.001). Participants classified as nonproblematic
drinkers on the AUDIT had lower levels of depression, anxiety,
and stress (P < 0.001), as measured by the DASS-21.
Comparisons of DASS-21 scores by AUDIT drinking classification are outlined in Table 5.
Participants were questioned regarding any past mental
health concerns over the course of their legal career, and
provided self-report endorsement of any specific mental
health concerns they had experienced. The most common
mental health conditions reported were anxiety (61.1%),
followed by depression (45.7%), social anxiety (16.1%),
attention deficit hyperactivity disorder (12.5%), panic disorder (8.0%), and bipolar disorder (2.4%). In addition, 11.5%
of the participants reported suicidal thoughts at some point
during their career, 2.9% reported self-injurious behaviors,
and 0.7% reported at least 1 prior suicide attempt.

Of the 6.8% of the participants who reported past treatment for alcohol or drug use (n Â¼ 807), 21.8% (n Â¼ 174)
reported utilizing treatment programs specifically tailored to
legal professionals. Participants who had reported prior treatment tailored to legal professionals had significantly lower
mean AUDIT scores (M Â¼ 5.84, SD Â¼ 6.39) than participants
who attended a treatment program not tailored to legal professionals (M Â¼ 7.80, SD Â¼ 7.09, P < 0.001).
Participants who reported prior treatment for substance
use were questioned regarding barriers that impacted their
ability to obtain treatment services. Those reporting no prior
treatment were questioned regarding hypothetical barriers in
the event they were to need future treatment or services. The
2 most common barriers were the same for both groups: not
wanting others to find out they needed help (50.6% and 25.7%
for the treatment and nontreatment groups, respectively), and
concerns regarding privacy or confidentiality (44.2% and
23.4% for the groups, respectively).

Ã 2016 American Society of Addiction Medicine

J Addict Med Volume 10, Number 1, January/February 2016

Substance Use and Other Mental Health Concerns

TABLE 5. Relationship AUDIT Drinking Classification and
DASS-21 Mean Scores

attorneys aged 31 to 40 (26.1%), with declining rates
reported thereafter.
Levels of depression, anxiety, and stress among attorneys reported here are significant, with 28%, 19%, and 23%
experiencing mild or higher levels of depression, anxiety, and
stress, respectively. In terms of career prevalence, 61%
reported concerns with anxiety at some point in their career
and 46% reported concerns with depression. Mental health
concerns often co-occur with alcohol use disorders (Gianoli
and Petrakis, 2013), and our study reveals significantly higher
levels of depression, anxiety, and stress among those screening positive for problematic alcohol use. Furthermore, these
mental health concerns manifested on a similar trajectory to
alcohol use disorders, in that they generally decreased as both
age and years in the field increased. At the same time, those
with depression, anxiety, and stress scores within the normal
range endorsed significantly fewer behaviors associated with
problematic alcohol use.
While some individuals may drink to cope with their
psychological or emotional problems, others may experience
those same problems as a result of their drinking. It is not clear
which scenario is more prevalent or likely in this population,
though the ubiquity of alcohol in the legal professional culture
certainly demonstrates both its ready availability and social
acceptability, should one choose to cope with their mental
health problems in that manner. Attorneys working in private
firms experience some of the highest levels of problematic
alcohol use compared with other work environments, which
may underscore a relationship between professional culture
and drinking. Irrespective of causation, we know that cooccurring disorders are more likely to remit when addressed
concurrently (Gianoli and Petrakis, 2013). Targeted interventions and strategies to simultaneously address both the alcohol
use and mental health of newer attorneys warrant serious
consideration and development if we hope to increase overall
well being, longevity, and career satisfaction.
Encouragingly, many of the same attorneys who seem to
be at risk for alcohol use disorders are also those who should
theoretically have the greatest access to, and resources for,
therapy, treatment, and other support. Whether through
employer-provided health plans or increased personal financial means, attorneys in private firms could have more options
for care at their disposal. However, in light of the pervasive
fears surrounding their reputation that many identify as a
barrier to treatment, it is not at all clear that these individuals
would avail themselves of the resources at their disposal while
working in the competitive, high-stakes environment found in
many private firms.
Compared with other populations, we find the significantly higher prevalence of problematic alcohol use among
attorneys to be compelling and suggestive of the need for
tailored, profession-informed services. Specialized treatment
services and profession-specific guidelines for recovery management have demonstrated efficacy in the physician population, amounting to a level of care that is quantitatively and
qualitatively different and more effective than that available to
the general public (DuPont et al., 2009).
Our study is subject to limitations. The participants
represent a convenience sample recruited through e-mails and

Nonproblematic Problematic
M (SD)
DASS-21 total score
DASS-21 subscale
Depression
scores
Anxiety
Stress

M (SD)

9.36 (8.98)
3.08 (3.93)

14.77 (11.06) <0.001
5.22 (4.97) <0.001

1.71 (2.59)
4.59 (3.87)

2.98 (3.41)
6.57 (4.38)

<0.001
<0.001

AUDIT, Alcohol Use Disorders Identification Test; DASS-21, Depression Anxiety
Stress Scales-21.

The AUDIT cut-off for hazardous, harmful, or potential alcohol dependence was set
at a score of 8.

Means were analyzed using Mann-Whitney U tests.

DISCUSSION
Our research reveals a concerning amount of behavioral
health problems among attorneys in the United States. Our
most significant findings are the rates of hazardous, harmful,
and potentially alcohol dependent drinking and high rates of
depression and anxiety symptoms. We found positive AUDIT
screens for 20.6% of our sample; in comparison, 11.8% of a
broad, highly educated workforce screened positive on the
same measure (Matano et al., 2003). Among physicians and
surgeons, Oreskovich et al. (2012) found that 15% screened
positive on the AUDIT-C subscale focused on the quantity and
frequency of use, whereas 36.4% of our sample screened
positive on the same subscale. While rates of problematic
drinking in our sample are generally consistent with those
reported by Benjamin et al. (1990) in their study of attorneys
(18%), we found considerably higher rates of mental
health distress.
We also found interesting differences among attorneys
at different stages of their careers. Previous research had
demonstrated a positive association between the increased
prevalence of problematic drinking and an increased amount
of years spent in the profession (Benjamin et al., 1990). Our
findings represent a direct reversal of that association, with
attorneys in the first 10 years of their practice now experiencing the highest rates of problematic use (28.9%), followed
by attorneys practicing for 11 to 20 years (20.6%), and
continuing to decrease slightly from 21 years or more. These
percentages correspond with our findings regarding position
within a law firm, with junior associates having the highest
rates of problematic use, followed by senior associates, junior
partners, and senior partners. This trend is further reinforced
by the fact that of the respondents who stated that they believe
their alcohol use has been a problem (23%), the majority
(44%) indicated that the problem began within the first
15 years of practice, as opposed to those who indicated the
problem started before law school (26.7%) or after more than
15 years in the profession (14.5%). Taken together, it is
reasonable to surmise from these findings that being in the
early stages of oneâs legal career is strongly correlated with a
high risk of developing an alcohol use disorder. Working from
the assumption that a majority of new attorneys will be under
the age of 40, that conclusion is further supported by the fact
that the highest rates of problematic drinking were present
among attorneys under the age of 30 (32.3%), followed by

Ã 2016 American Society of Addiction Medicine

Krill et al.

J Addict Med Volume 10, Number 1, January/February 2016

news postings to state bar mailing lists and web sites. Because
the participants were not randomly selected, there may be a
voluntary response bias, over-representing individuals that
have a strong opinion on the issue. Additionally, some of those
that may be currently struggling with mental health or substance use issues may have not noticed or declined the
invitation to participate. Because the questions in the survey
asked about intimate issues, including issues that could
jeopardize participantsâ legal careers if asked in other contexts
(eg, illicit drug use), the participants may have withheld
information or responded in a way that made them seem
more favorable. Participating bar associations voiced a concern over individual members being identified based on
responses to questions; therefore no IP addresses or geolocation data were gathered. However, this also raises the
possibility that a participant took the survey more than once,
although there was no evidence in the data of duplicate
responses. Finally, and most importantly, it must be emphasized that estimations of problematic use are not meant to
imply that all participants in this study deemed to demonstrate
symptoms of alcohol use or other mental health disorders
would individually meet diagnostic criteria for such disorders
in the context of a structured clinical assessment.

The authors also thank the Hazelden Betty Ford
Foundation and The American Bar Association for their
support of this project.
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the 42-item and 21-item versions of the depression anxiety stress scales in
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Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use
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Beck C, Sales B, Benjamin, GA. Lawyer distress: alcohol-related problems
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Bradley K, Bush K, McDonell M, Malone T, Fihn S. Screening for problem
drinking comparison of CAGE and AUDIT. J Gen Intern Med
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Clara I, Cox B, Enns M. Confirmatory factor analysis of the depressionanxiety-stress scales in depressed and anxious patients. J Psychopathol
Behav Assess 2001;23:61–67.
Crawford J, Henry J. The Depression Anxiety Stress Scale (DASS): normative
data and latent structure in a large non-clinical sample. Br J Clin Psychol
2003;42:111–131 (0144-6657).
DuPont R, McLellan AT, White W, Merlo L, Gold M. Setting the standard for
recovery: Physiciansâ Health Programs. J Subst Abuse Treat 2009;36:
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Gianoli MO, Petrakis I. Pharmacotherapy for and alcohol comorbid depression dependence: Evidence is mixed for antidepressants, alcohol dependence medications, or a combination. January 2013. Available at: http://
www.currentpsychiatry.com/fileadmin/cp_archive/pdf/1201/1201CP_
Petrakis.pdf. Accessed June 1, 2015.
Henry J, Crawford J. The short-form version of the Depression Anxiety Stress
Scales (DASS-21): construct validity and normative data in a large nonclinical sample. Br J Clin Psychol 2005;44:227–239 (0144-6657).
Lovibond, SH, Lovibond, PF. Manual for the Depression Anxiety Stress
Scales. 2nd ed. Sydney: Psychology Foundation; 1995.
Matano RA, Koopman C, Wanat SF, Whhitsell SD, Borggrefe A, Westrup D.
Assessment of binge drinking of alcohol in highly educated employees.
Addict Behav 2003;28:1299–1310.
Meneses-Gaya C, Zuardi AW, Loureiro SR, Crippa A. Alcohol Use Disorders
Identification Test (AUDIT): an updated systematic review of psychometric properties. Psychol Neurosci 2009;2:83–97.
Oreskovich MR, Kaups KL, Balch CM, et al. Prevalence of alcohol use
disorders among American surgeons. Arch Surg 2012;147(2):168–174.
Rothstein L. Law students and lawyers with mental health and substance
abuse problems: protecting the public and the individual. Univ Pittsburgh
Law Rev 2008;69:531–566.
Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric
properties of the drug abuse screening test. J Subst Abuse Treat
2007;32:189–198.

CONCLUSIONS
Attorneys experience problematic drinking that is
hazardous, harmful, or otherwise generally consistent with
alcohol use disorders at a rate much higher than other
populations. These levels of problematic drinking have a
strong association with both personal and professional
characteristics, most notably sex, age, years in practice,
position within firm, and work environment. Depression,
anxiety, and stress are also significant problems for this
population and most notably associated with the same
personal and professional characteristics. The data reported
here contribute to the fund of knowledge related to behavioral health concerns among practicing attorneys and serve
to inform investments in lawyer assistance programs and an
increase in the availability of attorney-specific treatment.
Greater education aimed at prevention is also indicated,
along with public awareness campaigns within the profession designed to overcome the pervasive stigma surrounding substance use disorders and mental health concerns. The
confidential nature of lawyer-assistance programs should be
more widely publicized in an effort to overcome the privacy
concerns that may create barriers between struggling attorneys and the help they need.

ACKNOWLEDGMENTS
The authors thank Bethany Ranes, PhD, and Valerie
Slaymaker, PhD, of the Hazelden Betty Ford Foundation for
their contributions to the analyses (BR) and overall manuscript (VS).

This study has been designated open access as confirmed by Patrick Krill, Hazelden Betty Ford Foundation.
52

Ã 2016 American Society of Addiction Medicine

What Can You Do?
by Laura McClendon
Executive Director, Tennessee Lawyers Assistance Program

The latest research exposing the gravity of the legal professionâs substance abuse and mental health
issues has hit everyone full force. Bar associations, lawyer assistance programs, law schools, and
disciplinary agencies across the country have been scrambling with how to both digest and address
what appears to be an epidemic.
Although the statistics are staggering, there is nothing in them that surprises me. I have been with
TLAP for over 15 years. During that time, we have seen the devastation of addiction, depression,
and suicide engulf and destroy members of the profession in all corners of the state, from small
town solo practitioners to judges. The stats in the research are not just numbers to me; they
represent peopleâ¦smart, young, old, male, female, kind, well-loved peopleâpeople with jobs and
spouses and kids and friends. People who went to college and law school, studied for bar exams,
and entered the profession with hope.
So when does the hope go away? Why does the hope go away? Can anything be done about it?
Unfortunately, the research provides statistics, not solutions.
Itâs an unpopular, sad topic. Itâs been aired on CNN and MSNBC, and written about in USA
Today and the New York Times. Itâs bad press for all lawyers and perpetuates the myth that
lawyers canât be trusted. It doesnât accurately reflect the goodness and altruism that resides in the
profession: the goodness that was the impetus for this special edition of Board Notes.
TLAP works closely with the Board of Professional Responsibility and the Board of Law
Examiners to assist individuals in returningâor remainingâhealthy, productive members of the
legal profession. We want to keep our law students in school so that they can one day be sworn in
with their classmates. We want to keep our bar members in good standing and our judges on the
bench.
But we need help.
What can you do? You can educate yourself about the signs and symptoms of addiction and
depression. You can express your concerns to the colleague at risk. You can schedule
presentations that hit the topic head on. So many of our speaking requests start with âwe donât
want anything depressing,â or âcan you do something fun and uplifting?â I love doing motivating

presentations about happiness and stress management, but I think the âdepressingâ topics have to
be discussed.
Below are some basic tips on how you can assist:
•

•

Visit the TLAP website: www.tlap.org . It contains information on mental health and
substance abuse issues, quizzes, links, and TLAPâs confidentiality policy. You can also
make an anonymous referral, request an appointment, sign up to be a volunteer, or make a
donation.
Call us: 615.877.TLAP (615.741.3238) If you have concerns or questions about yourself,
a colleague or a member of your family, TLAP will listen to your dilemma, ask appropriate
questions, and give sound advice and direction. You can rest assured that you or your
colleague cannot get in any trouble as a result.
Arm yourself with information: Learn about signs and symptoms of depression,
substance abuse, and suicide. TLAP can suggest articles, books, and CLEâs that will
educate you about these issues.
Involve others: Many times your friends and colleagues have noticed similar symptoms
in the lawyer that you are concerned about. Each of you may have a uniqueâbut
essentialâpiece of the puzzle. Donât carry the burden alone. Call TLAP and help us
complete the picture.
Include TLAP: Our staff and volunteers are eager to do presentations, consult with your
firm, and even come to your events. We are not the drink police; we are here to help people
with problems.
Spread the word: Once you learn the value of TLAP, donât keep it a secret! There are
other people out there who need to know that there is a safe place to call when experiencing
difficulties.
Become a volunteer: Visit http://www.tlap.org/what-does-a-volunteer-do

TLAP is a free, confidential assistance program providing consultation, referral, intervention and
crisis counseling for lawyers, judges, bar applicants and law students who are suffering with
substance abuse, stress, or emotional health issues.

Tennessee Lawyers Assistance Program (TLAP)
by Judge John Everett Williams
Chair, TLAP Commission

The Tennessee Lawyer Assistance Program (TLAP) has something for everyone. It offers FREE,
ANONYMOUS, and CONFIDENTIAL assistance to judges, lawyers, and law students in a wide
variety of areas affecting our profession, including addictions, mental health issues, grief
counseling, and suicide prevention training. TLAP is provided by and enjoys the support of the
Tennessee Supreme Court and is set forth in Rule 33.
TLAPâs confident staff is assisted by hundreds of volunteers throughout the state who are willing
to help out fellow lawyers who are struggling with some of the many issues that affect our
profession. These volunteers mentor, take and finish cases, provide counsel, undertake
interventions, and often serve as monitors to those who seek TLAPâs help.
Judge John Everett Williams, chairman of the TLAP Commission, suggests that the best way one
can serve the law profession is by serving as a TLAP volunteer, thereby giving back directly to the
profession which we serve and love. Lawyers enjoy unique and specific pressures that set our
profession apart from others. No one is better suited to help lawyers deal with the many problems
they face than a fellow lawyer. The statistics contained later in this edition of Board Notes make
clear the need is strong for the services that TLAP provides.
The question you should ask yourself is: Are you willing to help your profession in its great hour
of need? If so, call TLAP at 877-424-8527 and sign up today as a volunteer.

Landmark Study: U.S. Lawyers Face
Higher Rates of Problem Drinking
and Mental Health Issues
by Linda Albert
Program Manager, Wisconsin Lawyers Assistance Program (WisLAP)

The first empirical study in 25 years confirms lawyers have significant substance
abuse or mental health problems, more so than other professionals or the general
population. And many lawyers are not seeking the help they need, for the wrong
reasons. Researchers hope this data will promote change within the profession.

The sixth day of January 2007 is a significant date for attorney Anne Renc. Thatâs the day she
stopped drinking alcohol. Renc was halfway through her second year at the University of
Wisconsin Law School when it hit her. âI realized that if I didnât get a handle on this, I wasnât
going to be a lawyer.â
Alcoholism was in the family genes. âDrinking became a crutch for me to deal with the stress of
law school,â said Renc, now an assistant state public defender in Stevens Point. âI wouldnât say
law school encouraged drinking, but there was a perception that drinking was part of how you
dealt with pressure, at least in a colloquial word-of-mouth way.â
For the first half of her law school career, Renc drank heavily, even during final exam periods. She
didnât drink every day. But when she did consume alcohol, she drank to excess. âThe first year, I
was doing what I was supposed to do, maybe not as well as I could. But I was getting by,â she
said. âThings really started to fall apart the fall semester of my second year, though. I was having
a hard time getting to class and doing the work.
âLooking back now, I donât think I would have been able to finish school if I kept drinking. Once
I was ready to admit I had a problem, I knew what I had to do.â She entered an alcohol and drug
treatment program.
Acknowledging a Problem
Renc graduated three semesters later, in 2008. When she applied for her law license, she disclosed
her treatment to the Wisconsin Board of Bar Examiners (BBE), which assesses an applicantâs
character and fitness to practice law. âI got a letter from a psychiatrist and put the BBE in touch
with the people helping me in recovery, so they could ensure I was getting better and was fit to
practice.â In June 2008, Renc was admitted to practice law and became a member of the State Bar
of Wisconsin.

She has maintained her sobriety since January 2007, and gets professional help for depression and
anxiety, mental health issues that first surfaced when she was in high school but were never treated.
âThose mental health episodes were present through law school and remain present today, but I
never sought professional help before.â
Itâs humbling to admit you have a problem you canât fix on your own,â Renc said. âItâs even harder
for lawyers because we are in the business of fixing things. But we have to change the perception
that substance abuse or mental health issues only apply to other people, or people on the street. If
we donât realize that those things apply to us, as lawyers, things wonât change and people wonât
get better.â
While Renc is among a small minority of lawyers who openly acknowledge prior or existing
substance or mental health conditions, problem drinking and mental health concerns are significant
among lawyers, especially younger ones, according to a recent and comprehensive landmark study
of U.S. lawyers. The study, called âThe Prevalence of Substance Use and Other Mental Health
Concerns among American Attorneys,â1 also indicates that many lawyers are not seeking the help
they need, for the wrong reasons.
âLawyers fear that help wonât be confidential and someone will find out, and if someone finds out,
their practice and livelihood will be ruined,â said Linda Albert, program manager of the Wisconsin
Lawyers Assistance Program (WisLAP), a State Bar of Wisconsin program, who helped lead the
study. âThose are critical errors in their thinking.
âFirst, programs like WisLAP are confidential. Second, seeking help voluntarily does not, by itself,
impact someoneâs law license. It just allows them to be healthier, minimizing the risk of breaking
ethical rules. We want to dispel the misconceptions, eliminate stigmas attached to mental health
and substance abuse issues, and encourage lawyers to get the help they need before bigger
problems arise.â
Landmark Study: First Empirical Study in 25 Years
Anecdotally, thereâs a widespread belief that lawyers have significant substance abuse problems
or mental health disorders, more so than other professionals or the general population. But the last
time anyone conducted an empirical study was 1990, when researchers surveyed approximately
1,200 attorneys in Washington State to determine that lawyers there had significantly higher rates
of problem drinking and depression than others outside the profession.
âThe available data was so limited, and so outdated. In my opinion, it was no longer credible,â
said Patrick Krill, director of the Hazelden Betty Ford Foundationâs Legal Professionals Program
in Center City, Minn., a rehabilitation center for attorneys, judges, and other legal professionals
with addiction and co-occurring mental health issues. Krill is also an attorney and a licensed drug
and alcohol counselor.
âThat was a real frustration,â says Krill. âIt was difficult to raise awareness and promote change
in the profession with outdated information. We needed reliable data to illustrate the significance
of this problem.â

To that end, Krill spearheaded a landmark study on substance abuse, depression, and anxiety
concerns among U.S. lawyers. WisLAPâs Albert, also a member of the American Bar
Associationâs Commission on Lawyer Assistance Programs, spent months helping Krill and others
form a collaboration. Recognizing the need for reliable data, the ABA approved a resolution to
partner on the project. The Hazelden-ABA collaboration resulted in findings that were officially
released in the Journal of Addiction Medicine, and were announced Feb. 6 at an ABA-sponsored
press conference.
With the help of 15 state bar associations, including the State Bar of Wisconsin, almost 15,000
lawyers from 19 states in every region of the country completed an anonymous 2015 survey
assessing alcohol use, drug use, and symptoms of depression, anxiety, stress, and other mental
health concerns. Of those, nearly 13,000 respondents met the criteria for inclusion in the study:
lawyers had to be licensed in the United States and currently employed in the legal profession as
an attorney or judge. Close to equal numbers of men and women participated, identifying their
respective age groups, job position types, and whether they worked in private firms, state bar
associations, government or nonprofit organizations, or other working environments.
âThis is a huge data set,â said Krill. âWe wanted to get a clear picture of whatâs going on with
licensed and employed attorneys and judges in America, and this is a representative sample from
all corners and regions of the country, from the biggest metropolitan areas to the smallest towns.
What we found is that the problems are far reaching and consistent. Thereâs no one group within
the profession that seems to be immune to behavioral health problems, and the problems are
significant.â
Alcohol Abuse: 21 Percent Report Problematic Drinking
Approximately 11,300 participants completed a 10-question instrument, known as the Alcohol Use
Disorders Identification Test (AUDIT-10), which screens for different levels of problematic
alcohol use, including hazardous use, harmful use, and possible alcohol dependence. The test
identifies quantity and frequency of use, and asks whether an individual has experienced
consequences from drinking. Of the approximately 11,300 respondents, 21 percent scored at a
level consistent with problematic drinking. Alcohol abuse was identified in 25 percent of men
respondents, compared to 16 percent of women.
Of those identified as working in private firms, approximately 23 percent were considered problem
drinkers, the highest of any working environment other than lawyers working in bar associations,
at 24 percent. (In some states, not including Wisconsin, the state bar handles lawyer disciplinary
matters and has staff attorneys who work on those cases or on other legal matters.)
Of the private-law-firm lawyers identified as junior associates, 31 percent identified as problem
drinkers, the highest compared to senior associates (26%), junior partners (24%), managing
partners (21%), and senior partners (18.5%). Thus, the data suggests that a higher rate of lowerlevel lawyers engage in problem drinking behavior, and problem drinking slightly decreases as
they move up the law firm chain.

For lawyers in other working environments, the rate of alcohol use disorders is also relatively high
under the AUDIT-10. Of those identified as in-house, governmental, public, or nonprofit lawyers,
19 percent were considered problem drinkers. Approximately 19 percent of those identified as sole
practitioners had an alcohol use disorder. Approximately 18 percent of the in-house corporate or
for-profit organization lawyers were considered problem drinkers, and approximately 16 percent
of judges identified as having an alcohol problem.
When sifting data by age and years of practice, it becomes clearer that younger lawyers are
struggling the most with alcohol abuse. Respondents identified as 30 years or younger had a 32
percent rate of problem drinking, almost 1 in 3, higher than any other age group. Those attorneys
ages 31-40 reported a 25 percent rate of problem drinking. Starting at age 51, the percentages fall
below 20 percent.
Problem drinking also correlates with years of practice, based on the data. Of the lawyers who
reported working for 0-10 years, approximately 28 percent of them reported problem drinking
behavior, compared to those with experience of 11-20 years (19 percent), 21-30 years (16 percent),
and 31-40 years (15 percent).
According to Krill, that data is very significant.
âThe old data suggested that the longer somebody stayed in the profession, the more likely they
were to become a problematic drinker,â said Krill. âThat aligned with a perception that the legal
culture sort of promotes drinking and itâs a stressful profession, so the more exposure a person has
in terms of years, the more likely a problem would develop. We found that thatâs not true at all.
Itâs the reverse now.â
Krill said the data shows the risk of developing a drinking problem is highest for attorneys in their
first 10 years of practice. âBeing in the early stages of a legal career is strongly correlated with a
heightened risk of developing an alcohol use disorder,â Krill said.
Approximately 11,500 participants answered the first three questions of the AUDIT-10, allowing
a subset test known as AUDIT-C to be performed. The AUDIT-C, recently used to gauge problem
drinking among U.S. physicians, measures frequency and quantity of alcohol consumed. It does
not ask about consequences. It simply asks how often an alcohol drink is consumed, how many
drinks are consumed in a typical day, and how often six or more drinks are consumed on one
occasion.
Of the 11,500 AUDIT-C respondents, 36 percent scored consistently with problematic drinking.
Thatâs well more than double the 15 percent of surgeons and physicians screening positive on an
AUDIT-C in 2012, and triple the percentage of highly educated workers sampled in 2003 under
the same test. Although not an apples to apples comparison, a recent study of substance abuse and
mental health issues among the general U.S. population found that about 12 percent of young
adults (ages 18-24) had an alcohol use disorder, and about 6 percent of adults ages 26 or older had
an alcohol use disorder.2

Most notably, 44 percent of lawyers reported that their use of alcohol was problematic during the
15 year-period that followed graduation from law school. Another 28 percent reported problematic
use that started before law school, and 14.2 percent said their problem drinking started in law
school.
Drug Abuse: Picture Less Clear
Researchers used the 10-question Drug Abuse Screening Test (DAST) to gauge low, intermediate,
substantial, and severe drug abuse among participant lawyers and judges. Drug abuse includes the
nonmedical use of illegal substances or prescription drugs, or the use of prescribed or over-thecounter medications in excess of prescribed or directed amounts. Only 27 percent of all
respondents completed the DAST, a much smaller sample than the AUDIT, which had almost full
participation.
âWe can speculate that a lower sample means drug use is not as prevalent as alcohol use among
lawyers, and thatâs logical,â Albert said. âBut you may also have lawyers who donât want to
voluntarily disclose information about illegal drug use, even though the survey was confidential
and anonymous.
âThey would likely be more open to answering questions about alcohol, since alcohol is legal. So
the picture is less clear. Obviously, any indication of drug abuse among lawyers is concerning,â
she said.
Of the 3,419 participants that completed the DAST, 0.1 percent reported severe drug use. Three
percent reported substantial drug use, 21 percent reported intermediate use, and 76 percent reported
low use. Albert says low use means low quantity and frequency with little or no consequences.
The highest rate, 16 percent, reported using sedatives, which include depression, anxiety, or
sleeping medications. About 10 percent used marijuana or hash, and 6 percent reported opioid use.
Krill said the significant number of participants reporting low and intermediate drug abuse is
troubling when one considers the proliferation and addictive nature of todayâs prescription drugs,
such as opioid-based painkillers. âIf a lawyer is abusing prescription medications, it can quickly
turn to âsubstantialâ or âsevereâ use,â Krill said. âAnd given the even higher stigma associated with
drug use, lawyers may be even more hesitant to seek help.â
Depression, Stress, and Anxiety: 28 Percent Report Concerns with Depression
Approximately 11,500 participants completed a 21-question Depression Anxiety Stress Scales
(DASS-21). Approximately 61 percent and 46 percent reported experiencing concerns with
anxiety and depression, respectively, at some point in their career. Respondents also reported
experiencing social anxiety (16 percent), attention deficit hyperactivity disorder (12.5 percent),
panic disorder (8 percent), and bipolar disorder (2.4 percent). More than 11 percent reported
suicidal thoughts during their career. Three percent reported self-injurious behavior, and 0.7
percent reported at least one suicide attempt during the course of their career.

Approximately 28 percent reported concerns with mild or high levels of depression, males at a
higher rate than females, and 19 percent reported mild or high levels of anxiety, females at a higher
rate than males. Of all respondents, 23 percent reported mild or high levels of stress, which
involves mental or emotional strain attached to a certain event. Anxiety involves a constant or
consistent feeling of worry.
Like the rates associated with alcohol use, mental health conditions were higher in younger or less
experienced attorneys, and generally decreased as age and years of experience increased. The study
also revealed significantly higher levels of anxiety, depression, and stress among those with
problematic alcohol use, meaning mental health concerns co-occurred with an alcohol use
disorder.
âWe see that many lawyers are drinking as a way to cope with stress, anxiety, or depression. Others
may experience those mental health conditions as a direct result of their drinking,â Albert said. âIn
both equations, alcohol is a common denominator that, if removed, will improve a lawyerâs health
and wellness.â
The annual study of substance abuse and mental health issues among the general U.S. population
found that more than 9 percent of those ages 18-24 experienced a major depressive episode in 2014
– symptoms lasting two weeks or longer – compared to 7 percent of those ages 26-49, and about
5 percent of those ages 50 and older.3
Barriers to Treatment
Only 7 percent of participants report that they sought treatment for alcohol or drug use, and only
22 percent of those respondents went through programs tailored to legal professionals. But the
participants who went through treatment programs tailored specifically for legal professionals had
significantly lower (healthier) AUDIT scores than those who sought treatment elsewhere. This
suggests that programs with a unique understanding of lawyers and their work can better address
the problems.
Respondents were asked to identify the biggest barriers to seeking drug or alcohol treatment. About
67.5 percent said they didnât want others to find out, and 64 percent identified privacy and
confidentiality as a major barrier. Approximately 31 percent noted concerns about losing their law
license, and 18 percent said they didnât know who to ask or didnât have the money for treatment.
Respondents raised the same concerns when asked about the barriers to seeking help for mental
health issues. Approximately 55 percent said they didnât want others to find out, and 47 percent
raised confidentiality and privacy concerns. Another 22 percent said they didnât know who to ask
for help.
Close to 70 percent of respondents said alcohol and drug addiction or mental health topics were
not offered in law school. Approximately 84 percent said they were aware of lawyer assistance
programs (LAPs), but only approximately 40 percent said they would be likely to use those
services if the need arose. Again, privacy and confidentiality concerns were cited as the major
barrier to seeking help through LAP programs.

Substance Abuse and Mental Health Issues: Why So High?
Albert and Krill say that question cannot be answered definitively. But the data will help substance
and mental health professionals formulate possible answers. They suspect lawyers may have
higher rates than other professionals or educated populations based on the inherent stress of the
job. As advocates and counselors, lawyers are trusted to handle important matters with high stakes
for clients.
They can also be susceptible to compassion fatigue, characterized as the âcumulative physical,
emotional and psychological effects of being continually exposed to traumatic stories or events
when working in a helping capacity.â4 No doubt lawyers seek outlets to deal with pressures and
stress, and two avenues exist: positive outlets, like exercise, and negative ones, like substance
abuse.
Albert and Krill say lawyers also can be somewhat isolated, or enabled by the professionâs drinking
culture. Physicians, for instance, work in community environments where people will notice
problematic behaviors. Thatâs not always true for lawyers, especially solo practitioners. There may
be no one asking them if theyâre okay, Albert said. Or staff members may cover for lawyers,
fearing any consequences that impact the lawyer will also impact their own employment.
In addition, younger lawyers are entering the profession with higher rates of student loan debt and
fewer job opportunities, aside from the normal stress of learning to be a practicing lawyer. Those
additional factors may contribute to the higher rates of substance abuse and mental health concerns
among younger lawyers with fewer years of practice, Albert says.
âNewer and younger lawyers may be forced to take or work in jobs they donât like, because they
just need the work,â Albert said. âSome have to put off marriage or having families because of
financial concerns. There is real stress that compounds from that, stress that can lead to depression,
anxiety, and substance abuse issues. Itâs logical to conclude that those issues could arise.â
Drinking has become (or always has been) socially acceptable in the legal profession, Krill and
Albert note. Many law students drink to blow off steam, as Renc explained. Those habits may
carry over into law practice, where alcohol can be viewed as an acceptable pressure valve. Itâs also
a vehicle to celebrate success, face defeat, or network with clients, potential clients, or other
lawyers. The lawyer drinking culture is even popularized through various TV law dramas,
perpetuating the perception that drinking is just what lawyers do. How many shows end with two
lawyers sipping scotch, discussing the case? How many times do you hear TV lawyers utter the
phrase: âI need a drink.â Moderate and responsible alcohol consumption aside, what happens when
lawyers actually feel the âneedâ to drink?
When drinking becomes problematic, or lawyers develop mental health conditions, the pervasive
stigma associated with those issues creates a barrier for lawyers to seek help, Krill says. âThereâs
a lot of stigma attached to substance use disorders and mental illness. Because a lawyerâs
reputation is so important, thereâs a fear in admitting vulnerability or weakness, or admitting that
we are struggling,â he said. âAnd those fears can be justified, because this can be a harshly
judgmental and highly competitive environment. But when this data comes out and people realize

how many lawyers are struggling, it will be difficult to view these issues through such a judgmental
lens. Thatâs my hope anyway.â
Barriers to Early Intervention: Searching for a System-wide Solution
Albert says fighting the stigmas of mental health and substance abuse needs to happen on many
levels. âIt needs to be a systems approach,â she said. âFrom law schools to bar associations, from
licensing and disciplinary agencies to employers and lawyer assistance programs, all legal
stakeholders must work together to address the problem,â she said. âWe still have this kind of
blame-shame bias. We can break those stigmas by educating people, and helping them understand
that itâs smarter to get help.â
Renc understands. She tells her story openly because she wants fellow lawyers to know that
seeking help is the right decision. Her decision to get treatment in law school undoubtedly saved
her legal career, she says, and her disclosure to the BBE did not prevent her from obtaining a law
license. That is, law students with substance abuse or mental health issues should not wait to get
help.
Jacquelynn Rothstein, director of the BBE, says that when applicants disclose drug, alcohol, and
mental health issues, one of the first questions the BBE considers is how that problem has affected
an applicantâs life and how the applicant has addressed it. âWe also look at whether those
conditions affected an applicant in an employment or academic setting, whether there were arrests,
convictions, or other problematic behaviors. An applicantâs conduct and behavior are an integral
part of determining whether an applicant is fit to practice,â she said.
âIf an applicant is being treated and thereâs evidence of treatment after having a history of
problematic behavior, then that in and of itself may not prevent the applicant from getting admitted.
That is true,â she said. âBut if you have an ongoing active history of drug, alcohol, or mental health
issues, and you have not treated it, that may well be a problem for the applicant. Obviously, we
want to encourage those in need of treatment to obtain it.â
Although Rothstein acknowledges that disclosing a drug, alcohol, or mental health-related concern
alone may not bar applicants from the practice of law, she is quick to point out that each case is
different. âWe look at it on a case-by-case basis. There is no blanket approach to addressing these
issues. There are numerous factors in determining an applicantâs character and fitness to practice
law.â
As of 2011, the BBE is also authorized to grant conditional admission for applicants whose record
may otherwise warrant denial but who agree to certain conditions and demonstrate ongoing
recovery and the ability to meet the competence and character and fitness requirements.
In 2014, seven applicants were conditionally admitted based on substance use-related issues, one
was conditionally admitted based on mental health issues, and one had both substance abuse and
mental health issues.
âConditional admission may be another option for applicants who are willing to do what they need
to do,â Rothstein said. âWe certainly are not trying to discourage people from getting treatment.

But we also donât want to send the message that abusing drugs and alcohol is okay. Because it
isnât.â
Importantly, an individual is conditionally admitted and the terms of the conditional admission are
confidential, with some exceptions. In addition, conditions may require monitoring or other
involvement with WisLAP, a confidential program for lawyers and judges whether they seek help
voluntarily or are mandated to participate. But what people may not know is that WisLAP is also
open to law students, and the data shows that law students may need a place to turn.
Another recent study of law students from 15 law schools found very high rates of binge drinking,
marijuana, and prescription drug abuse, in addition to high rates of depression and anxiety.
Approximately 79 percent of those using prescription drugs without a prescription used Adderall,
a stimulant, to help them concentrate and study longer.
When asked what factors would discourage students from seeking help for drug or alcohol
problems, more than 60 percent identified a potential threat to bar admission, job, or academic
status. The studyâs authors concluded that attitudes and cultures must change; students must be
encouraged to get help rather than keeping mental health and substance abuse issues secret.
Office of Lawyer Regulation: Substance Abuse, Mental Health Issues Underlie Grievances
Some lawyers fear losing their law license if someone finds out they are seeking treatment for
drugs, alcohol, or mental health-related issues. The Office of Lawyer Regulation (OLR)
investigates grievances against lawyers to determine if they have violated their ethical duties under
the Wisconsin Rules of Professional Conduct for Attorneys. OLR Director Keith Sellen says many
grievances are sent to the OLR, not because a lawyer has decided to seek treatment for their
problem, but precisely because a lawyer has not sought help and the condition starts affecting the
lawyerâs ability to practice law.
âWe see a lot of grievances where the lawyerâs practice is struggling because of substance abuse,
depression, or some other medical incapacity,â Sellen said. âA lot of these cases involve an
expansive pattern of failure to act with diligence on behalf of a client, or failure to communicate.
In other words, a chemical dependency may be preventing them from doing the work required of
the representation.â
Sellen noted that the OLR often sees cases after itâs too late. âIf lawyers are able to identify the
concern and cause earlier, before it becomes a real problem, and they are willing to seek help
through WisLAPâs confidential program, then a lot of these cases where conduct gets out of control
could be avoided.â
On the flip side, once a lawyer has fallen through the cracks and the OLR gets involved, there can
be ways to get back on track. âWhen lawyers are referred for mandatory treatment and monitoring,
those cases are assigned to WisLAP. Weâve had success with lawyers being able to recover and
restore themselves and get their practices back up and running. So WisLAP works in two ways.
Itâs preventative and restorative.â
Sellen acknowledges that lawyers may have reasons for not seeking help, âbut those fears should
be overcome by the potential ramifications of not seeking help. The bottom line is that you can do

this in a way thatâs confidential,â he said. âWisLAP does not report that to the OLR. This is an
appropriate policy because we want to encourage lawyers to take advantage of the confidential
program,â he said.
Moving Forward: Defining a Response
âI canât say that there was any good news that came from this study,â Krill said. âThe good news
comes from what we can do with it. Now we know the scope of the problem. Now we can define
a response, and develop more informed strategies for dealing with it.â
Krill said law schools could use the data, especially data on the struggles of young lawyers in the
early stages of their careers, to incorporate health and wellness into their law school curriculums.
Bar associations and continuing legal education (CLE) accreditation agencies such as the BBE
could evaluate CLE requirements to determine programming that addresses substance abuse and
mental health issues.
For Wisconsin attorney Paula Davis-Laack, who now runs the Davis Laack Resilience Institute,
the data informs her work helping lawyers on stress management, burnout prevention, and
resilience. A former practicing lawyer, she earned a masterâs degree in applied positive psychology
and is trained in the study of resilience. She teaches specific skills to help lawyers deal with
adversity and stress.
âIâve been looking for this type of data,â said Davis-Laack, who practiced law for seven years
before experiencing burnout. âIt will help as I approach law schools and law firms interested in
my training and workshops on resilience. They want to see data and research that says lawyers
need these skills.â
âI do some work with law schools and the students are really craving this type of information,â
she said. âThey want to learn how they can have a sustainable career in this profession, especially
when they hear stories about the high rates of substance abuse, depression, and anxiety among
lawyers.â
Davis-Laack says that law firms are also interested in her work on resilience as they lose secondor third-year associates. âThey donât have the coping mechanisms to get through uncertainty in
the first few years of practice. Suddenly they hit a road bump, and they think a new firm will fix
the problem.â
Existing research also shows that lawyers are not the most resilient bunch, Davis-Laack says.
âLawyers tend to be somewhat thin-skinned. They donât like to be called out and corrected. When
challenges and adversity happen, they donât have the right coping skills. They tend to resort to
negative behaviors like excess drinking. Thatâs typically what Iâm finding, and now we are seeing
that in this new data.â
Richard Brown, former chief judge of the Wisconsin Court of Appeals and a former member of
the ABA Commission on Lawyer Assistance Programs, says this data underscores the importance
of educating judges and lawyers about the warning signs and the resources available to help them.

âPart of the problem is that people with depression, anxiety, or substance abuse issues donât often
know they need help. They may be unhappy, they may be drinking too much, but they donât
consider themselves to need help. To me, part of the problem is getting the horse to water. That
means alerting people that they should seek help if they start seeing the symptoms. A lot of it is
education.â
Judge Brown noted that when he was on the ABA commission several years ago, Wisconsin was
selected as part of a pilot project to conduct judicial roundtables, where judges would get together
and discuss the stresses of the day-to-day job. At first, it didnât work.
âBut we kept doing it and finally, we got to a point where judges were finding this to be very
helpful. We arenât talking about case law. We are talking about what to do when something is
bothering you. How do you cope with the stress of the job? You hear people talking and realize
we are all dealing with the same kind of issues. And we are educating each other on what might
be considered a problem.â
Brown said a judicial roundtable was held at the Wisconsin Judicial College last year. âEverybody
came away saying we should do this again next year. Maybe the lawyers could do something like
that.â Albert says WisLAP has started doing just that – roundtable discussions with both lawyers
and law students.
Krill, who spearheaded the study, likes where these kinds of ideas are headed. âWhile nobody can
be excited about the specific findings, I am really excited about the impact this can have on the
profession. Hopefully it can help us help a lot of people.â
Says WisLAPâs Albert: âThis study triggers a call to action for all parts of the legal system to join
together to make a positive impact. We need a cultural shift that puts health and wellness into the
equation of lawyering. Ensuring lawyers are healthy is a central part of professional responsibility.
But itâs going to require a collective effort among those who interface with lawyers throughout
their careers.â
Endnotes
_________________
1

P. Krill, R. Johnson, L. Albert âThe Prevalence of Substance Use and Other Mental Health Concerns among
American Attorneys.â J. Addiction Medicine, Jan./Feb. 2016.
2

Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health,
U.S. Depât of Health & Human Serv., Substance Abuse and Mental Health Services Admin. (Sept. 2015).
3

Dianne Molvig, The Toll of Trauma, 84 Wis. Law. 12 (Dec. 2011).

See Helping Law Students Get the Help They Need, 84 The Bar Examiner 4 (December 2015); see also Lawyer
Assistance Programs: Advocating for a Systems Approach to Health and Wellness for Law Students and Legal
Professionals, 84 The Bar Examiner 4 (December 2015).

Reprinted with permission of the February 2016 Wisconsin Lawyer magazine, the official
publication of the State Bar of Wisconsin.
22

Does the Board of Professional Responsibility Consider
Substance Abuse or Mental Health Issues
When Imposing Discipline?
by Michael U. King
Chair, Board of Professional Responsibility

As an attorney in private practice, I understand that no one wants to call the Board of Professional
Responsibility to self report a violation of the Rules of Professional conduct. The fear of that day often
times compounds attorneysâ problems and delays substance abuse or mental health treatment. The purpose
of this article is to alleviate some of those fears by providing information about the disciplinary process and
how substance abuse and mental health issues can affect discipline.
The mission statement of the Tennessee Board of Professional Responsibility has three distinct
parts. The first part is the one that keeps us up at night, which is âto assist the Court in protecting the public
from harm from unethical lawyers by administering the disciplinary process.â What is often times missed
is that the Board is also tasked with assisting âthe public by providing information about the judicial system
and the disciplinary system for lawyers; and, to assist lawyers by interpreting and applying the Court's
disciplinary rules.â Itâs this last section dealing with assistance to lawyers that I want to emphasize.
The BPR does not discipline lawyers simply because they have substance abuse problems or mental
health issues. If you are struggling with substance abuse, rest assured that disciplinary counsel will be
happy to answer your questions, explain the rules of professional conduct and refer you to the Tennessee
Lawyers Assistance Program (TLAP) for evaluation and treatment.
So what should you do if your substance abuse or mental health problem has caused a violation of
the Rules of Professional Conduct? The simple answer is: be honest; tell us about your problem; and ask
for help. I know itâs easier said than done, but let me explain. First and foremost, your mental and physical
health is more important than your profession. If youâre healthy, you are more productive and less likely
to violate the rules of professional conduct.
Second, hiding substance abuse and mental health issues generally compound disciplinary
problems. For example, letâs say an attorney has violated RPC 1.8 Lack of Diligence by failing to timely
file a complaint. Assuming this is an isolated occurrence, the ABA Standards For Imposing Lawyer
Sanctions, Rule 4.4 would indicate that a public censure is appropriate. Should the same lawyer fail to
disclose an underlying substance abuse or mental health problem that results in additional violations of RPC
1.8, the ABA Standards For Imposing Lawyer Sanctions, Rule 4.41 and Rule 4.42, provide that suspension
or disbarment is appropriate when a pattern of neglect results in harm or potential harm to the client.

Last but not least, the Board considers aggravating and mitigating factors when imposing attorney
discipline. Rule 9.22 of the ABA Standards for Imposing Lawyer Sanctions lists the following aggravating
factors: prior discipline; dishonesty or selfish motive; pattern of misconduct; multiple offenses; bad faith
obstruction of the disciplinary proceeding; false statements, false evidence or other deceptive practices
during the disciplinary process; refusal to acknowledge wrongful nature of conduct; vulnerability of the
client; substantial experience in the practice of law; indifference to making restitution; and illegal conduct,
including that involving the use of controlled substances. By failing to face substance abuse and mental
health problems, attorneys often times exacerbate their situation resulting in more severe discipline.
In contrast, Rule 9.32 sets out mitigating factors which include, in part: the absence of a dishonest
or selfish motive; full and free disclosure to disciplinary board or a cooperative attitude toward the
proceedings; physical disability; mental disability or chemical dependency including alcoholism or drug
abuse; and remorse. The Board considers mental disability or chemical dependency to be a mitigating
factor only in those instances when the Attorney acknowledges the problem and seeks treatment. Rule
9.32(i) defines as a mitigating factor:
(i)

Mental disability or chemical dependency including alcoholism or drug abuse when:
(1) There is medical evidence that the respondent is affected by a chemical dependency or
mental disability;
(2) The chemical dependency or mental disability caused the misconduct;
(3) The respondentâs recovery from the chemical dependency or mental disability is
demonstrated by a meaningful and sustained period of successful rehabilitation; and
(4) The recovery arrested the misconduct and recurrence of that misconduct is unlikely.
(5)
Tennessee Supreme Court Rule 9, §36.1 allows the Board, its hearing panels or Disciplinary Counsel to
make written referrals to TLAP and monitor the attorneyâs progress and compliance with a drug, alcohol or
mental health treatment plan.
In summary, the Boardâs goals are to protect the public and assist lawyers through information.
Both of these goals are accomplished by keeping our lawyers healthy and providing the assistance they
need to treat substance abuse and mental health issues. The ABA/Hazelden Study included in this Special
Edition of Board Notes provides alarming statistics about the mental health of our profession. If you or
someone you know has a substance abuse or mental health issue, please take advantage of the free services
offered by the Tennessee Lawyers Assistance Program, 877-424-8527.

Unwell – Lawyers and the Art of Practicing Wellness
by Tracy Kane, Partner, Dodson, Parker, Behm & Capparella, P.C.

You are a âSuper Lawyer,â named âBest of the Bar,â president of this or that organization, recently
promoted, won that big case, or received an above-average bonus last year. You are hitting all
your marks, but are you well?
Statistics show us that while many of us are âsuccessfulâ by the measuring sticks of our profession,
we are not well. In fact, we are precariously unwell and it is not good for our firms, our clients,
our community, our respective families, and most importantly, it is not good for us individually.
Many of us who are even âhealthyâ are not alwaysâor at least not consistentlyââwell.â
For over two decades now, bar associations around the country have been citing statistics that
showed 18% of lawyers were problem drinkers (nearly twice the national average at the time)1 and
19% suffered from statistically significant elevated levels of depression (compared to just 3% to
9% of individuals in Western industrialized countries). In response, lawyer assistance programs
have been implemented around the country, most of which have been operating for over a decade
now. Things should be getting better, right? Wrong.
With the most relied upon statistics for lawyer health and wellness now a quarter of century old,
the American Bar Association (ABA) Commission on Lawyer Assistance Programs and the
Hazelden Betty Ford Foundation undertook a new study in 2014, the results of which were just
released this past February.2 The report reveals that the wellness landscape is not only not better
for lawyers, it is worse and itâs particularly worse for young lawyers practicing ten years or less.
The recent study, which set out to conduct the most comprehensive national research to date on
the topic, reported that 21% of licensed, employed lawyers qualify as problem drinkers, 28%
struggle with some level of depression, and 19% demonstrate symptoms of anxiety.3 The study,
published in the Journal of Addiction Medicine, found that younger attorneys in the first 10 years
of practice exhibit the highest incidence of these problems.4 The study also compared attorneys
with other professionalsâincluding doctorsâand determined that lawyers experience alcohol-use
disorders at a far higher rate than other professions.5 The results also showed that the most
common barriers for attorneys seeking help were fear of others finding out and general concerns
about confidentiality.6
With all the âprogramsâ and âinterventionsâ that have been instituted over the last two decades,
why are we not even incrementally better? You can blame the fragile economy, disruptive
technological changes facing the profession (dare I sayâ¦ âlegal industryâ), the billable hour, or
our constantly-wired lives, but these things can be said of just about any profession or industry
sector. Lawyers still outpace all other professions in the percentage that suffer from anxiety,
depression, and substance abuse.

Maybe you are asking yourself right now, âwhy is attorney health and wellness important to the
bar? Who cares if Iâm happy all the time or not?â
I would venture to say that itâs not about trying to make lawyers âhappy,â itâs about the quality of
our professional and personal lives and the sustainability of our profession in a new technological
century.
Practicing law is stressful and sometimes your decisions have life or death consequencesâor at
the very least life-alteringâfor your clients. Practicing law often means shouldering the stress
and pain and suffering of our clients, but high stakes work is the not exclusive purview of lawyers.
Many lawyers seem to wear their misery as a badge of honor; that somehow, if they are the most
over-worked and miserable person, it must mean they are the best lawyer to their clients.
Unmanaged stress, however, can have a very direct, negative impact on your body, thoughts,
feelings and behavior.7 Stressed out, sleep-deprived, unhappy, and unhealthy lawyers do not serve
their clients well and often there are tangible signs of this: poor quality work, missed deadlines,
poor client communication and responsiveness, and even more egregious acts like alcohol or drug
abuse, misuse of client funds, and self-harm like overdose or suicide.
I believe it is possible to be both a great lawyer and a healthy lawyer, but it requires prioritizing
health and practicing wellness daily.
For me, I did not grow up prioritizing daily health and wellness. I grew up a very southern girl
who loved honeybuns and bacon and hated to sweat. I was active, but did not practice wellness.
When I was 20, however, my health seemed to evaporate overnight. I lost my energy and focus
and suffered from fast-moving, extreme mood swings. In short, I was going âcrazy,â or at least
thatâs what it felt like.
As it turned out, I was diagnosed with hypothyroidism. As I learned about the condition, I got
great advice from my doctor at the time that fundamentally changed how I thought about health.
In essence, if I wasnât starting from my best baseline health, there were limits to what any
medication was going to do.
From that point forward, I educated myself about nutritionâvitamins, minerals, chemicals, toxins,
fats and carbohydrates, etc. I knew the basics, but I didnât really understand the chemistry of it. I
became proactive and intentional about what I ate and drank. I started to exercise regularly and
found a way to stay motivated by training for races. (I am a type-A lawyer after all.) I was
fortunate that a temporary health set-back forced me at an early age to change the way I thought
about health and wellness from âsomething to do laterâ to âsomething I do every day.â
What does it mean to be âwellâ?
Wellness is not static. It is not something you achieve or a final destination. It is a practice,
something lawyers should find quite easy to understand.

A practice is something that you do every day, not with an expectation of perfection, but in an
effort to get a little betterâa little more efficient, a little more effectiveâevery day. This is true
whether you are practicing an art form, practicing law, or practicing wellness.
In a practice, you focus on daily mastery (not ultimate perfection). In a practice, you expect that
some days you achieve the best version of yourself and some days you fall short, but you get up
the next day and continue to practice. Even those that practice wellness can get hit with challenges
or a loss that throws you off course and leaves you spinning. Sometimes you need help to get back
into your practice.
What are the fundamentals of a wellness practice?
In response to the ABA/Hazelden Betty Ford Foundation study, the American Bar Association in
collaboration with the ABA Young Lawyersâ Division developed online tools for lawyers focused
on four essential elements of health: (1) sleep/rest, (2) emotional/social connections, (3) physical
activity, and (4) nutrition.8
Sleep/rest – Sleep is often one of the first and easiest things people trade for a few additional hours
to get things done, but scientific studies have started to show that there are not only short-term
consequences, but also long-term health impacts.9 Beyond sleep, there is a growing movement that
mindful meditation can be particularly helpful to lawyers to reduce stress and restore civility.10
The Mindfulness in the Law Joint Task Force was established in 2012 to provide information,
training, and the opportunity for lawyers to gather to share mindful meditation sittings as a vehicle
for restoring civility, decreasing stress, and enhancing the fundamental fabric of the legal
community.11
Emotional/social connections – 21st century lawyers often practice in isolation, even when they
are in large firms with tons of people in the building. Lawyers donât often interact with other people
outside of email. We write and revise agreements or briefs on our computer alone in our office
and circulate drafts by email. We even interface with most courts and administrative agencies
today through electronic filing and communication. Research is starting to find a negative health
impact related to social isolation, including less resilience to everyday stress as well as things like
vascular resistance, a risk factor for hypertension, slower wound healing, and poorer sleep
efficiency.12 There is a growing body of research that having meaningful relationships with peers
and family (âattachmentsâ) influences health and disease outcomes through different cortisol
patterns.13 So spend a few extra minutes over the proverbial watercooler, head to dinner with
family or friends, or make the effort to stop by the next NBA Happy Hour.
Physical activity – It probably goes without saying all the positive health impacts of incorporating
even moderate physical activity into your life, but did you also know that increased physical
activity positively impacts your mental health as well. Something as simple as a brisk, 20-minute
walk can enhance your mood and clear your mind.14
Nutrition – If you can only muster the will to change one health-related aspect of your life, the
top of the list should be the substances you ingest. Other than sleep, it is the most impactful change
you can make. Not only does the food you eat affect your physical health in ways such as heart

disease and diabetes, but it is the fuel that powers your emotional and mental health. In short, crap
in = crap out.
Given that we have known about our professionâs inordinate propensity to be unwell for 25 years
and have implemented various programs to improve our state of health in spite of that, and yet
wellness among lawyers continues to get worse, I believe a more fundamental shift in both thought
and deed must happen to affect change.
What are we going to do about it?
We should start by adopting wellness as part of our core professional values, just like pro bono
service and continuing education. We should hold ourselves accountable to our values by
recognizing the best examples of good lawyers practicing wellness. We should change the words
we use to describe our profession and start mentoring each other in wellness.
You can incorporate small, essential elements of wellness into each dayâan apple instead of a
candy bar (or maybe just a smaller candy barâ¦), a 10-minute nap or mindful meditation in the
afternoon, a mid-day walk in the sunshine, or a brief but meaningful question for your colleague
like, âWhat was your favorite part of today?â
With all of this in mind, the Nashville Bar Association Attorney Health and Wellness Committee
has committed to change the conversation about health by finding big and small ways to support
the practice of wellness in our legal community each day, month, and year.
Throughout the year, we aim to provide information about health and wellness topics in the weekly
newsletter and monthly in the Journal. We are working on free weekly yoga classes for NBA
members as well as regular walking, running, and cycling groups around town. There will be
CLEs on implementing a wellness plan at your firm, practicing mindful meditation, and identifying
and supportingâwithout judgementâthose among us who are struggling in their practice. We
will encourage you to run or walk the Race Judicata, play a round of gold in the annual NBA golf
tournament, or challenge yourself to walk 10,000 steps per day during the month of November.
As we integrate health and wellness information and programming into the daily life of the
members, we also want to be sure that we recognize those firms and individuals who embody our
values and demonstrate a commitment to the practice of wellness throughout the year.
The Nashville Bar Association Attorney Health and Wellness Committee is ready to change the
conversation about health and wellness among Nashville lawyers and we hope that by doing so,
little by little we will move into the day where each lawyer in our Bar has a thriving practice in
one of the nationâs healthiest profession.
Endnotes
1
The most recent and also the most widely cited research on lawyer substance abuse and mental health issues comes
from a 1990 study involving approximately 1200 attorneys in Washington State. See G.A. Benjamin, E. Darling &
B. Sales, The prevalence of depression, alcohol abuse, and cocaine abuse among United States lawyers, 13 INT.J.
LAW PSYCH. 233-46 (1990).

News Release, ABA Commission on Lawyer Assistance Programs, ABA, Hazelden Betty Ford Foundation release
first national study on attorney substance use, mental health concerns (Feb. 3, 2016), available at
AmericanBar.org/News/abanews/aba-news-archives/2016/02/ aba_hazelden_betty.html; see also Patrick R., Krill,
JD, LLM, Ryan Johnson, MA & Linda Albert, MSSW, The Prevalence of Substance Use and Other mental Health
Concerns Among American Attorneys, 10 J. Addiction Med. 46 (Feb. 2016), available at
Journals.lww.com/JournalAddictionMedicine/Fulltext/2016/02000/The_Prevalence_of_Substance_Use_and_Other_Mental.8.aspx.
3

Krill, et al, supra note 2, at 48-50.

Id. at 51.

Id. at 52.

6 Id. at 50.
7

See, e.g., Mayo Clinic, Stress symptoms: Effects on your body and behavior (July 19, 2013),
MayoClinic.org/Healthy-lifestyole/Stress-Management/In-Depth/Stress-Symptoms/art-20050987; American
Psychological Association, Stress Effects on the Body, Apa.org/HelpCenter/Stress-Body.aspx.

Whether or not you are a member of the ABA, you can find news, information, and tips in each of these areas at
AmericanBar.org/Groups/Young_Laywers/Initiatives/fit_to_practice.html.
9

Multiple studies link sleep deprivation to type 2 diabetes, obesity, cardiovascular disease, among other chronic
issues, See, e.g., Division of Sleep Medicine at Harvard Medical School, Sleep and Health,
HealthySleep.med.harvard.edu/Nee-Sleep/whats-in-it-for-you/health.
10

Mindfulness is an awareness of life in the present momentâsomething many experts and practitioners note is
easy to say, but difficult to achieve. We lead busy lives, we constantly hold the past and project the future and in that
state of clutter, we experience greater stress and anxiety. Mindfulness creates the opportunity, no matter how brief,
to pause, breathe, and become aware of how we are reacting in a given situation. This instance provides an
opportunity to moderate our reaction and respond thoughtfully. See, e.g., Jan. L. Jacobowitz, The Benefits of
Mindfulness for Lawyers, 20 TYL (Winter 2016), available to ABA members only at
AmericanBar.org/Content/dam/aba/publications/young_lawyers/TYL_v20n02_WI16_Layout_WEB.pdf-273k-201603-15.
11

Id.; see also Mindfulness in Law Joint Task Force, MindfulnessInLawCommittee.com.

John T. Cacioppo & Louise C. Hawldey, Social Isolation and Health, with an Emphasis on Underlying
Mechanisms, 46 PERSPECTIVES IN BIO & MED. S39-S52 (Summer 2003 supp.), available at
Psychology.uchicago.edu/People/Faculty/Cacioppo/jtcreprints/ch03.pdf.
13

See, e.g., M.C. Pistole, Amber Roberts & Marion L. Chapman, Attachment, Relationship Maintenance, and Stress
In Long Distance and Geographically Close Romantic Relationships, 27 J. SOC. & PERSONAL RELATIONSHIPS 535552 (2003), Abstract available at ScholarWorks.gvsu.edu/Counseling_Articles/2/; Paula R. Pietromonaco, Casey J.
DeBuse & Sally I. Powers, Does Attachment Get Under the Skin? Adult Romantic Attachment and Cortisol
Responses to Stress, 22 Curr. Dir. Psych. Sci. 63-68 (Feb. 1, 2013), Abstract available at
Ncbi.n.m.nih.gov/pmc/Articles/PMC4192659.
14

See, e.g., Kristin Wier, The exercise effect, 42 APA MONITOR ON PSYCHOLOGY 48 (Dec. 2011), available at
Apa.org/Monitor/201/12/Exercise.aspx; Gretchen Reynolds, How Walking in Nature Changes the Brain, N.Y.
TIMES Well Blog, July 22, 2015, Well.blogs.nytimes.com/2015/07/22/How-Nature-Chages-The-Brain/?_r=0.

Reprinted with permission; first published in the April, 2016 issue of the Nashville Bar Journal.

Law Student Well-being
and the Tennessee Board of Law Examinersâ Response
by Jeffrey M. Ward, President, Tennessee Board of Law Examiners, and
Lisa Perlen, Executive Director, Tennessee Board of Law Examiners
on behalf of the full Board:
Barbara M. Zoccola, Vice President, U.S. Attorneyâs Office (Memphis)
William L. Harbison, Secretary Treasurer, Sherard, Roe, Voight & Harbison, PLC (Nashville)
Julian L. Bibb, Stites & Harbison, PLLC (Nashville/Franklin)
Hon. William M. Barker (Ret.), Chambliss, Bahner & Stophel, PC (Chattanooga)

In 2014, preliminary results from a study conducted on Law Student Well-Being, were
presented at the October 2014 CoLAP Conference in Nashville, Tennessee. Subsequently, Laura
McClendon, Executive Director of the Tennessee Lawyers Assistance Program (TLAP), shared
those results with the members of the Tennessee Board of Law Examiners (TBLE) and the
Tennessee law school deans. The results were disheartening: 89.8% of respondents reported
consuming alcohol, 13.7% used marijuana, 2.5% used cocaine and less than 1% used LSD during
the 30 days prior to the survey.
Of the 89.9% consuming alcohol, 43% of respondents admitted to binge drinkingi at least
once in the prior two weeks and 22% reported binge drinking two or more times in the same time
period. Men were more likely to binge drink than womenii. Based upon the study results, the rate
of binge drinking among law students is significantly higher comparable rate of 36% of graduate
students (43% vs. 36%) who reported binge drinking at least once in the last two weeksiii.
Additionally, nearly 25% of respondents who answered the questions in the 2014 study that
comprised the CAGE assessment, a widely-used alcoholism screening tool, would be considered
to need further substance abuse screening.
As to drug use, other findingsiv included increased use of marijuana and cocaine but
decreased use of LSD, heroin and other psychedelics. Use of prescription drugs, both with and
without a prescription, was studied for the first time. Overall, 14.4% of respondents used
prescription drugs without a prescription. More men than women used prescription drugs without
a prescription but more women used anxiety, sleep, or stimulant medication with a prescription.
Many (12.6%) shared their prescription drugs. Close to half of respondents who reported using
prescription drugs without a prescription were using them with greater frequency than they did
prior to law school.
The 2014 study also asked questions about depression, anxiety, eating disorders, attention
or learning disorder, and suicidal thoughts. The frequency of depression among law students
screened was 17.6%. This compares with 14% among graduate students screened by the Healthy
Minds dataset from 2007-2014v. Similarly, 17% of law student respondents who were screened
tested positive for anxiety, compared to 9% of graduate students. Of those who reported having

depression or anxiety, a significant percentage reported being diagnosed with the problem only
after entering law school.
An important part of the study was the information gathered regarding respondentsâ
attitudes toward seeking help for substance abuse and mental health issues. Most (81%) would
seek help from a health professional but only a few (15% or fewer) would consult a Dean.
Additionally, while 81% claimed they would seek help from a health professional, only 4%
admitted to having actually sought such helpvi. Most were concerned that seeking help was a
potential threat to bar admissions, job opportunities, academic status, or a social stigma. Many
expressed concerns about privacy, financial resources, or the time required for treatment. More
than one-third (39%) believed they could handle the problem themselvesvii.
Needless to say, the results of the study caused significant concern for the TBLE.
Conventional wisdom anecdotally suggested that alcohol and substance abuse was more of an
issue for seasoned lawyers who had a drink or three each night after a long day at the office. What
we are seeing, however, is that new lawyers are entering the profession with higher rates of alcohol
and drug dependency, depression, and anxiety.
In order to raise awareness, representatives from the TBLE and TLAP visit every law
school in the state at least once a year to address issues of lawyer and law student well-being. We
talk to 1Ls and 3Ls about the need to disclose to the law school, the confidentiality of disclosures
to TLAP, and the need to be candid in the bar admissions process. Law students are encouraged to
contact TLAP while in law school so that, if monitoring is needed, the process can begin before
the bar admissions process. Successful TLAP monitoring while in law school is a positive indicator
to the TBLE that the bar applicant is serious about remediating past actions. Since the Supreme
Court added Section 10.05 to Tennessee Supreme Court Rule 7 in 2010, 30 bar admission
applicants have been conditionally admitted while under a TLAP Monitoring Agreement.
Following those conditional admissions, only 2 licensees were reported for non-compliance, and
both had their license suspended almost immediately.
In recent years, the TBLE has seen a steep increase in the number of alcohol- and drugrelated disciplines and arrests reported by bar applicants. In July 2015, 10% of examination
applicants had at least one alcohol or drug offense that resulted in school discipline or a criminal
charge of public intoxication, open container violation, possession of a controlled substance or
paraphernalia, or DUI. Although many of the criminal charges were dismissed and/or expunged,
the prior event itself raised a potential character issue that had to be disclosed to the Board. Patterns
of such behavior are of significant concern to the TBLE and often result in a referral by the TBLE
to TLAP.
The TBLE hopes that educating our law students about the prevalence of substance abuse,
depression and mental health issues in the legal profession will result in increased awareness of
these problems and reduction of the stigma that has previously been associated with them in order
to assist and encourage our future lawyers to seek the help they need to succeed. We continue to
work with the Tennessee law school deans to promote law student wellness so that we license
lawyers who have an understanding of the challenges they face and who know that there are
avenues for confidential assistance should the need arise.

Binge drinking is defined in the study as five or more drinks in a row for men or four or more drinks in a row for
women. âHelping Law Students Get the Help They Need: An Analysis of Data Regarding Law Studentsâ Reluctance
to Seek Help and Policy Recommendations for a Variety of Stakeholdersâ. The Bar Examiner, December 2015: 8-15
at page 8.
ii
Id. at page 8.
iii
âThe Healthy Minds Studyâ, http://healthymindsnetwork.org/
iv
All findings are from J. M. Organ, D. Jaffee, and K.B. Bender, Materials prepared for and presented at CoLAP
Conference in Nashville, TN, October 2014. The findings are discussed in detail by the same authors in âHelping
Law Students Get the Help They Need: An Analysis of Data Regarding Law Studentsâ Reluctance to Seek Help and
Policy Recommendations for a Variety of Stakeholdersâ. The Bar Examiner, December 2015: 8-15.
v
âThe Healthy Minds Studyâ, http://healthymindsnetwork.org/
vi
âHelping Law Students Get the Help They Need: An Analysis of Data Regarding Law Studentsâ Reluctance to Seek
Help and Policy Recommendations for a Variety of Stakeholdersâ. The Bar Examiner, December 2015: 8-15, at page
10.
vii
Id. at pages 10-11.

Is There a Substance Dependent or Addicted Lawyer in Your
Life?
And What To Do If There Is.

1. Do You Know a Lawyer who

ï¸ She experiences blackouts, car
accidents and feels guilty about her
actions while under the influence.

Drinks or uses drugs a lot?

ï¸ She has a âpersonality changeâ when
drinking or using.

ï¸ He binges occasionally, reports a few
hangovers now and then and talks about
the euphoria of getting high or drinking.

ï¸ She attempts to control: drinking only
wine or beer, limiting her drug use to
prescription rather than street drugs,
drinking only on weekends or during
certain hours of the day or evening,
working out a formula for spacing
drinks, never using or drinking alone, or
never drinking or using with others.

ï¸ Over consumes only on occasion but
he seems to use alcohol or drugs as an
escape from stress or for pure pleasure.
ï¸ When he drinks or uses drugs, his
behavior is sometimes embarrassing yet
he may continue to assert that he can
handle it and that using is just part of
life.

ï¸ She begins to worry about her
tolerance to and increasing consumption
of alcohol or drugs. She may even try to
quit but is unable to stay stopped.

ï¸ He would be insulted if someone
called him an alcoholic or addict.

ï¸ She begins to experience signs of
withdrawal after a period of not
drinking or using: anxiety, shakes,
elevated heart rate, nausea, decreased
appetite, insomnia, sweating, confusion
and in some cases, paranoia. When these
symptoms occur, she may need a drink
or drug in the morning to quiet those
nerves.

ï¸ He may be able to moderate use or
stop altogether.
Lacks control over drinking or
drugging?
ï¸ She experiences a lack control over her
drinking that manifests in drinking or
using more than planned or in an
increase in the time spent using or
drinking.

ï¸ After serious drinking or using bouts,
she is remorseful and wants to stop. As
soon as she feels better though, she will
begin to think that she can really drink
or use moderately next time.

ï¸ She feels the need to drink or drug
routinely, regardless of the
circumstances and may be experiencing
the phenomenon of craving or symptoms
of physical dependence.

ï¸ She still meets responsibilities fairly
well on the job or at home. The idea that
drinking will probably become
progressively worse and may cause the
loss of family, job, or the affection of
others seems ridiculous to her.

Usually, they have tried some form of
counseling, a special diet or vitamin
therapy and for a little while the
situation may have improved, but then
they return to old patterns and the
progression downward continues.

ï¸ She admits that she would like to stop
drinking. Tomorrow.

ï¸ They lose all interest in constructive
social relationships, in the world around
them, and perhaps even in life itself.

Has suffered negative consequences
because of drinking?

Seems beyond help?

ï¸ These drinkers have begun to
experience adverse consequences as a
result of their drinking or drugging.
They have lost friends, experienced
marital and family difficulties,
separation or divorce.

ï¸ By now, this individual has been in one
hospital or treatment center after
another.

ï¸ They tend to isolate and devalue
personal relationships. If they socialize
at all, they seek out people who drink
and drug similarly.

ï¸ There is evidence of physical
deterioration and illness including
hepatitis, pancreatitis, and cirrhosis and
withdrawal symptoms of hallucinations,
seizures and delirium tremors (DTs).

ï¸ He has been arrested, incarcerated,
grieved against or disbarred.

ï¸ They are often underemployed, have
moved from job to job, have been fired,
or have walked off the job.

ï¸ He is volatile, impulsive, angry,
violent, appears dangerous or insane and
oblivious to reality when drunk or high.

ï¸ They have tried âgeographical curesâ
by moving from job to job, city to city or
state to state hoping that each situation
will be different.

ï¸ Friends, family, colleagues want
nothing to do with this drunk/addict.
ï¸ The courthouse gossip is rampant.

ï¸ They have sought help from therapists
or doctors and may even have been to
treatment, hospitals, and may even have
tried AA or NA or CA.

ï¸ People may say that he is beyond help
and have stopped trying to help.

2. The Truth.

ï¸ They know that they cannot drink or
use drugs like others but are unable to
understand why. They honestly want to
stop but cannot.

There are many lawyers representative
of these four categories. In fact, itâs
estimated that , at a minimum, 10-12
percent of all lawyers are challenged by
substance abuse or dependency. There
are also many lawyers who have

ï¸ In searching for a path to sobriety,
they become increasingly desperate.

man and woman can achieve remission,
or recovery.

recovered from substance dependency
and addiction. TLAP staff, its volunteers
and the family, friends and colleagues of
lawyers with alcohol or drug problems
know what it is like to live with and
work around someone challenged by
addiction and dependency. We also
know that recovery is possible. We
hope. We act. We donât give up.

4. What can you do?
So youâve been read about alcoholism
and drug addiction in the Texas Bar
Journal, youâve done your own internet
research at reputable sites, youâve
witnessed some behaviors that youâve
identified as possible symptoms of
alcoholism or drug addiction in your
colleague and now you want to do
something. You may want to explain to
your friend that you know that
alcoholism is an illness. You now know
that treatment works so you want to
urge your colleague to get an
assessment, go to treatment or even
head straight for the nearest A.A.
meeting. But will this work?

3. An incurable illness.
There are many paths to dependency
and addiction. Some drink in an out-ofcontrol way from their first drink. Some
are vulnerable to the illness because of a
genetic predisposition. Others become
dependent or addicted through decades
of use. Some are daily drinkers. Some
only indulge on the weekend. Others
may be able to abstain for long periods.
The hallmark behaviors of dependency
and addiction include continued and
compulsive behavior despite medical or
adverse consequences and loss of
control. The behaviors are supported by
an elaborate defense system designed to
sustain use, escape the consequences of
alcohol or drug use and maintain selfesteem. Manifestations of this defense
system include denial, minimization and
projection of blame.

Sometimes, it does. There are those who
call for help on their own, go to AA, go
to out-patient or in-patient treatment
and stop drinking or drugging. But the
truth is that most active alcoholics and
drug addicts are not ready and willing to
quit simply because someone suggests it.
TLAPâs experience is that lawyers may
be particularly resistant to admitting a
drinking or drug problem.
Hereâs why: Research suggests that the
illness is firmly rooted in brain
chemistry and that the compulsion to
drink or drug, located in the primal
midbrain, trumps the cerebral cortexâs
21st century messages to stop. In short,
in his mind, the need to drink or use may
literally seem like a matter of life or
death.

The people challenged by dependency or
addiction are sick and suffering from a
disease for which there is no known
cure. Theywill never be able to drink or
drug moderately or non-addictively for
any sustained period. It is also a
progressive, multi-systemic, chronic and
terminal illness that affects physical,
mental, emotional and spiritual health
and development. Because of these
characteristics, they must learn to
abstain from alcohol and drugs
completely to lead a normal life. Every

5. When is the âright timeâ to
intervene?

Conventional theory indicates that a
person must either be ready or âhit
bottomâ before they will take action to
stop drinking. But how do you know if
that person has hit bottom and may be
receptive to your concerns? No one
really knows. You may think your
colleague should be ready. But what
constitutes a bottom for one person will
not necessarily constitute a signal to
stop in another. In short, one personâs
moment of clarity where the decision is
made to seek help is individual as oneâs
fingerprints. Story after story indicates
that the events that precipitated people
to seek help are many: family
intervention, drunken public behavior,
police intervention, headlines in the
newspaper or a look from your child on
the morning after.

to 12-step calls, peer interventions,
âJohnson Modelâ interventions,
invitational model interventions and so
on and so on.
â Leverage a bad day. Timing is
sometimes important. Approaching
someone who is struggling with the
negative consequences of his addiction
or dependency may be more receptive to
your suggestions than during the âgoodâ
times.
â Donât try to talk to someone when he is
impaired. It doesnât work.
â Donât label the individual with a
diagnosis. Expressions of concern, offers
of hope and specific ideas for a solution
are helpful. Speaking honestly about
how the individualâs drinking or drug
use has affected you, giving specific
examples, is recommended. Labeling
someone an addict or an alcoholic will
backfire.

So you may try to get the individualâs
attention in myriad ways and times. Of
course, there are some general
guidelines:
â Get some education about the illness
that youâre up against – Al-Anon (a 12step groups for friends and family of
alcoholics/addicts), therapists, doctors,
TLAP and AA members all have some
practical experience with the disease
and may be helpful.

â Be armed with solutions. Offer ideas
about ideas about how to get help. Have
phone numbers available and offer to get
the individual to help immediately. If
your friend seems even remotely
receptive, act quickly; the small opening
in the hard shell of addiction wonât stay
open long. You may not get another
chance.

â Get assistance and coaching from the
experts. Again, members of AA, NA, CA
in recovery, TLAP staff and peer
volunteers, local treatment centers,
knowledgeable therapists, doctors and
professional interventionists are some
great resources. Someone who has
recovered from the same illness may be
an ally when you have these
conversations. They have instant
credibility; you may not. Other
interventions come in a variety of flavors
from intimate one-on-one conversations

â Donât enable. This means: Never do for
John what John can do for himself. Stop
protecting him from consequences. Be
honest: Donât cover up, lie, stand in or do
his work. Donât ignore the problem.
Donât be a scapegoat. Donât try to
control her drinking or his drug use.
Respect his dignity. Be realistic about
events. Allow success or failure. Share
your hope for recovery. Participate in his
good behavior. Offer concrete solutions.

Take a look at your own behaviors and if
necessary, get help for yourself. Check
out Al-Anon.

â Draw appropriate boundaries.
Sometimes, because of the disruption
caused or because the situation has
become intolerable, you may decide to
detach from the situation and leave the
individual to face his or her problems
alone. Remember that detachment is
different from abandonment. A therapist
or the principles of Al-Anon can be
helpful allies in making these decisions
and sticking to them. There are times
when youâve done enough.

6. The Heartbreak of Dependency
and Addiction.
It may take some time to get your
friendâs attention. He may protest that
his problems are different and that
treatment or AA. is not necessary or
right for him. She may argue that her
drinking isnât that bad. She will often
point out that she is a long way from the
bottom of the ladder. She may simply
continue to insist that she can stay clean
and sober on her own.

7. Hope and Help.
Whether you are the husband, wife,
employee, judge, law student, law
partner, law firm associate, friend or
colleague of a person challenged by
drugs or alcohol, your understanding of
the nature of the problem can play a
vital part in helping that individual to
achieve and maintain recovery. Please
remember that there is hope and there is
help. You are not alone.

Anyone who knows or cares about
someone with a drug or alcohol problem
may find these reactions and evasions
bitter pills to swallow. The simple truth
is that you canât always force recovery
on someone. But you can be available for
the moments when your friend or family
member may be more receptive to the
idea of getting help. If the person you
care about refuses to accept help, there
are things you can do:
â Be prepared for the next opportunity.
Get educated about available resources:
TLAP, therapists, doctors, treatment
centers, AA, CA, NA. Call TLAP to talk
to us confidentially about the issues.
Visit a local treatment center or get
online and search the internet to become
acquainted with local and national
treatment options for professionals.
Attend an open meeting of AA, CA or
NA to get some personal knowledge
about the program. Be in the best
position to help when the time comes.
â Cultivate confidence and patience to
encourage him to begin the process of
recovery.

Reprinted with permission by the Texas Lawyers' Assistance Program at www.texasbar.com.
37

What to do when a Colleague is depressed
1. Find Out More About
Depression.

Is it serious? Depression can be very serious.
Suicide is often linked to depression.
Male lawyers in the United States are
two times more likely to commit suicide
that men in the general population.

What is depression?
Depression is more than the blues or the blahs; it
is more than the normal, everyday ups and
downs. When that âdownâ mood, along
with other symptoms, last for more than
a couple of weeks, the condition may be
clinical depression. Clinical depression
is a serious health problem that affects
the total person. In addition to feelings,
it can change behavior, physical health,
appearance, professional performance,
social activity and the ability to handle
everyday decisions and pressures.

Are all depressive disorders alike?
There are various forms or types of depression.
Some people experience only one
episode of depression in their whole life,
but many have several recurrences. Some
depressive episodes begin suddenly for
no apparent reason, while others can be
associated with a life situation or stress.
Sometimes people who are depressed
cannot perform even the simplest daily
activities like getting without of bed or
getting dressed. Others go through the
motions but it is clear that they are not
acting or thinking as usual. Some people
suffer from bipolar disorder in which
their moods cycle between two
extremes – from the depth of
desperation to frenzied talking or
activity or grandiose ideas about their
own competence.

What causes clinical depression? We do
not know all the causes of depression but there
seem to be biological and emotional factors that
may increase the likelihood that an individual
will develop a depressive disorder. Research
over the past decade strongly suggests a
genetic link to depressive disorders;
depression can run in families. Difficult
life experiences and certain personal
patterns such as difficulty handling
stress, low self-esteem, or extreme
pessimism about the future can increase
the chances of becoming depressed.

Can it be treated? Yes, depression is
treatable. Between 80 and 90 percent of
people with depression can be helped.
There are a variety of antidepressant
medications and psychotherapies that
can be used to treat depressive
disorders. Some people with milder
forms may do well with psychotherapy
alone. People with moderate to severe
depression most often benefit from
antidepressants. Most do best with
combined treatment: medication to gain
relatively quick symptom relief and
psychotherapy to learn more effective
ways to deal with lifeâs problems,
including depression.

How common is it? Clinical depression is a
lot more common than most people think. It
will affect more than 19 million
Americans this year. Early 1990âs
research indicated that lawyers might be
more vulnerable to depression than
other professionals. Almost half of all
callers to the Texas Lawyersâ Assistance
Program hotline talk about symptoms
that sound like depression.

The most important step toward
overcoming depression – and sometimes
the most difficult – is asking for help.

psychotherapy and medication is
beneficial.
Myth: Talking about depression only
makes it worse. Fact: Talking about
things may help a friend or colleague
recognize the need for professional
help. By showing friendship and caring
concern and by giving uncritical
support, you can encourage your friend
or colleague to talk to another trusted
adult, TLAP or mental health
professional about getting treatment.

Why donât people get the help they
need? Often people donât know they are
depressed so they donât ask for or get the right
help. Most people fail to recognize the
symptoms of depression in themselves
or in other people. Also, depression can
sap energy and self-esteem and thereby
interfere with a personâs ability or wish
to get help.

3. Know the Symptoms.

2. Be Able To Tell Fact From
Fiction.

The first step toward defeating
depression is to define it. People who
are depressed often have a hard time
thinking clearly or recognizing their
own symptoms. They may need your
help. Check the following boxes if you
notice a friend or colleague with any of
these symptoms persisting longer than
two (2) weeks:

Myths about depression often separate
people from the effective treatments
now available. Friends and colleagues
need to know the facts. Some of the
most common myths are these:
Myth: Heâs such a great lawyer, he just
canât be depressed! Fact: Lawyers get
depression too. Intelligence, success
or position in the community are not
barriers to depression. Depression can
affect people of any age, race, ethnic or
economic group.

Do they express feelings of:
ï¸ sadness or emptiness?
ï¸ hopelessness, pessimism or guilt?
ï¸ helplessness or worthlessness?
Do they seem:
ï¸ unable to make decisions?
ï¸ unable to concentrate and remember?
ï¸ to have lost interest or pleasure in
ordinary activities – like sports, hobbies,
social activites?
ï¸ to have more problems at work and at
home?

Myth: Lawyers who claim to be
depressed are whiners and weak and
just need to pull themselves together.
Thereâs nothing that we can do to help.
Fact: Depression is not a weakness but
a serious health disorder. People who
are depressed need professional
treatment. A trained therapist or
counselor can help them learn more
positive ways to think about themselves,
change behaviors, cope with stress and
problems, or handle relationships. A
physician can prescribe medications to
help relieve the symptoms of depression.
For most a combination of

Do they complain of â¦
ï¸ loss of energy and drive – so they seem
âslowed down?â
ï¸ trouble falling asleep, staying asleep,
or getting up?

ï¸ appetite problems: are they losing or
gaining weight?
ï¸ headaches, stomach aches, or back
aches?
ï¸ chronic aches and pains in joints and
muscles?

Â·Encourage or help the individual to

Has their behavior changed suddenly so
thatâ¦
ï¸ they are restless and more irritable?
ï¸ they want to be alone most of the
time?
ï¸ theyâve started missing work,
deadlines, appointments or dropped
hobbies or activites?
ï¸ you think they may be drinking
heavily or taking drugs?

treatment until symptoms begin to
abate.

Have they talked about
ï¸ death
ï¸ suicide – or have they attempted
suicide?

Â·Engage in conversation and fellowship.
Listen.

4. How To Help.

out realities and offer hope.

make an appointment with a
professional and accompany the
individual to the doctor.

Â·Encourage the individual to stay with
Â·Encourage continued communication
with doctor about different treatment
options if no improvement occurs.

Â·Offer emotional support,
understanding, patience, friendship and
encouragement.

Â·Refrain from disparaging feelings; point
Â·Take remarks about suicide seriously,

If you checked several of the boxes
above, your friend or colleague may need
help. The most important thing you can
do for someone who is depressed is to
get him or her to a professional for an
appropriate diagnosis and treatment.
Donât assume that someone else is
taking care of the problem. Negative
thinking, inappropriate behavior or
physical changes need to be addressed as
quickly as possible.

do not ignore them and donât agree to
keep them confidential. Report them to
the individualâs therapist or doctor if
your friend or colleague is reluctant to
discuss the issue with you or her/his
doctor.

Â·Invite the individual for walks, outings,
to the movies and other activities. Be
gently insistent if your invitation is
refused.

Your help may include the following:

Â·Encourage participation in some

Â·Give suggestions of names and phone

activity that once gave pleasure –
hobbies, sports, religious or cultural
activites

numbers of reputable therapists or
psychiatrists.

Â·Donât push the depressed person to

6. Act now.

undertake too much too soon; too many
demands may increase feelings of failure.

Early and professional treatments for
depression can lessen the severity of the
illness, reduce the duration of
symptoms, and may also prevent
additional bouts of depression.

Â·Eventually with treatment, most people
get better. Keep that in mind and keep
reassuring the depressed person that
with time and with help, he or she will
feel better.

5. Where To Get Help.
The Texas Lawyersâ Assistance
Program* can help you in a variety of
ways by providing crisis counseling;
education and training resources;
assistance with identifying reputable
mental health professionals and
treatment options in your community;
strategies and coaching for
conversations with your friend or
colleague and information about suicide
prevention resources. In certain
circumstances, TLAP may be able to
directly assist in your conversations
with your colleague or friends.

*The Texas Lawyersâ Assistance Program
(TLAP) is a confidential crisis counseling
and referral program that helps Texas
lawyers, judges and law students who are
challenged by substance use and other
mental health disorders, including clinical
depression, anxiety and stress related
concerns.

If you donât access TLAP, please
consider contacting other resources who
can help prepare you with names, phone
numbers and other information about
where to send your friend or colleague
for assessment and treatment. These
resources may include family doctors,
psychiatrists, psychologists, social
workers, licensed professional
counselors, community mental health
organizations, hospital psychiatric
departments and outpatient clinics,
university or medical school affiliated
programs, state hospital outpatient
clinics, family service and social
agencies, clergy, private clinics,
employee assistance programs and local
medical and/or psychiatric societies.

Please call TLAP at 800-343-8527 for more
information.
This article was adapted from the
National Institutes of Mental Health
publications, âWhat to do when a friend is
depressedâ (2001) and âDepressionâ
(2002).

Reprinted with permission by the Texas Lawyers' Assistance Program at www.texasbar.com.

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