Joseph Grillo, M.D., J.D. (2020)
Law school has been fascinating, frustrating, interesting, intense, and rewarding. I’m an older law student having had a full career in medicine prior to law school. I am surrounded by amazing and accomplished classmates of all ages. The school has many prominent scholars and who have become mentors and friends. I bring to bear a set of experiences – two of importance have been my career as a physician as well as my journey in recovery from addiction. I bear witness to a significant problem – a disproportionally high percentage of my classmates using intoxicants on a daily basis. At least a third are using marijuana daily. In addition, there are a significant number who are dealing drugs. Adderall – regarded as a principle study aid – and cocaine are being dealt by some and used by many. Students are suffering. If history bears out, they will continue on a spiraling destructive path.
A recent course required an oral presentation on a topic of our choosing. Unknowingly, I chose to research and present my findings on addiction in the legal profession. What I found is worth expounding. Also worth noting is that these findings were presented to the university administration. Their response was chilling. In short, they claimed to “have this.” I am certain of a few things – they don’t “have this”, that being stagnant is at the heart of the crisis, and the status quo continues – drugs continue to be sold and consumed, and law students are suffering in silence. Therein lies a microcosm of a crisis within the legal profession.
As a picture of this endemic took shape before my eyes, so did another one: The further I probed, the more apparent it became that substance abuse among America’s lawyers and law students is on the rise and deeply hidden. One of the first things I learned is that there is little research on lawyers and substance abuse. Nor is there much data on drug use among lawyers compared with the general population or white-collar workers specifically.
It is evident from statistics that people in the legal profession are at an elevated risk of experiencing substance use disorders. Even in the setting of increased awareness of the problem, the responses (vis a vis my school’s administration) has been inadequate. Unfortunately, my law school is not providing the necessary proactive resources.
The prevalence of addiction and other mental health disorders amongst lawyers and law students is disproportionally high. Outside of speculation, it is impossible to know the reasons why. Human beings are physically and emotionally complex, so there is no simple answer as to why lawyers abuse substances at a significantly higher rate than others. Lawyers are unique in that they are not only required to work long hours to satisfy existing clients, but also generate new business, and they find themselves working constantly in order to climb the corporate ladder and be named a partner in a law firm. This work schedule often at the expense of home life and promotes isolation. This may be contributory to lawyers seeking to alter their moods.
Before diving into the problem, a brief discussion on how many get to the point of being addicted bears mention.
Depression has been reported to affect approximately 16 million American adults, which equals about 7% of the US population. About half of those diagnosed with depression also struggle with some form of substance abuse. While these numbers are significant, the stats around the issue for lawyers are even more shocking.
More than 45% of attorneys experience depression during their career in the legal field. Of those individuals, nearly 12% of them reported having suicidal thoughts at least once. The major issues of substance abuse in attorneys can be directly attributed to many of the same thoughts and feelings related to depression.
The Krill Study
Krill PR, Johnson R, and Albert L. February 2016. The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys.
One of the most comprehensive studies of lawyers and substance abuse was released in 2016. The study was a joint venture from the Hazelden Betty Ford Foundation and the American Bar Association. The study analyzed the responses of 12,825 licensed, practicing attorneys across 19 states. Participants were asked to fill out an anonymous questionnaire.
Overall, the results showed that about 21 percent of lawyers qualify as problem drinkers, while 28 percent struggle with mild or more serious depression and 19 percent struggle with anxiety. Only 3,419 lawyers answered questions about drug use, and that itself is revealing in that it begs the question as to why so many (75%) of participants ignored the section. It may be due to fear. Alcohol is legal, and therefore is perceived as easier to discuss than drug use.
Of the lawyers that did answer those questions, 5.6 percent used cocaine, crack and stimulants; 5.6 percent used opioids; 10.2 percent used marijuana and hash; and nearly 16 percent used sedatives. Eighty-five percent of all the lawyers surveyed had used alcohol in the previous year compared to a general population of 65%. Nearly 21 percent of the lawyers that said they had used drugs in the previous year reported “intermediate” concern about their drug use. Three percent had “severe” concerns.
Lawyers are almost twice as likely to struggle with alcohol abuse when compared to the general population. The Krill study showed that nearly 21% of lawyers and others in legal professions were considered problem drinkers. As more specific questions were relayed to the surveyed participants, that number jumped even higher to over 36% of attorneys struggling with alcohol abuse. Nearly half of the lawyers in the study stated that the drinking issues began within their first 15 years in the industry, including their time in law school.
Prescription & Illicit Drug Statistics
Many issues surrounding prescription drug abuse have risen for legal professionals due to the easy access and legality of these substances. Unlike illegal alternatives, prescriptions are obtainable with a note from a doctor.
While this issue isn’t as common as alcohol addiction, approximately 10% of lawyers struggle with prescription drug abuse. They’re commonly used by lawyers who are trying to stay up later to complete their work or others to sleep at night as a means of stress relief. Problems arise as individuals mix alcohol with prescriptions, leading to additional risks of dependence and potentially overdose.
Data on illicit drug use is less reliable due to the simple fact that these substances are illegal. Most people who are taking them, including lawyers, aren’t willing to admit it. But a large number of legal professionals still resort to things like heroin and cocaine, as well as others for relief from their depression and the weight of their job.
For many, the excitement of law school ended when school began. Excessive workloads and intense competition with like-minded intelligent perfectionists leads to long hours of study and creates an enormous amount of stress.
Some research shows that before they start law school, law students are actually healthier than the general population, both physically and mentally. Lawyers start facing very heavy workloads and conflicts with their value systems right when they enter law school, and they likely use alcohol or drugs to cope. The formal structure of law school starts to erode that. Students are expected to compete for grades, work long hours and have the added concern of student debt combined with only a marginal earning potential in the initial years in practice.
Barriers to Seeking Help
While some level of stigma surrounds substance use disorders, legal professionals face some unique factors that may discourage them from seeking help for problematic drinking and substance misuse.
In a national multisite study of law students, the most frequently endorsed barriers to seeking treatment for substance use disorders were “potential threat to bar admission” (endorsed by 63% of the sample) and “potential threat to job or academic status” (endorsed by 62% of the sample).
Approximately half of law students in the study (49%) reported a belief that if they had a drug or alcohol problem, their chances of getting admitted to the bar would be better if the problem were hidden. 72% of individuals who reported three or more serious substance use behaviors in the previous two weeks (including behaviors such as two or more binge drinking episodes, use of street drugs, and use of prescription drugs without a prescription) believed they had a better chance of being admitted to the bar if they hid their problems rather than actively seek help.
Substance abuse addiction is a chronic progressive incurable disease characterized by the loss of control over the substance. It is incurable and, without treatment, uniformly fatal. It is a disease that knows no social or economic barrier. Lawyers and judges are no exception. On the other hand, addiction is very treatable.
If this is you, the only option is to seek treatment. If you don’t, you will lose. At best, your life will be marginalized. You are up against a foe that is much more powerful than you. You stand to lose everything – including your life. Seeking out a solution is very difficult. Our minds are overrun with thoughts that prevent us from doing so. We deny our plight – even when the rationale mind would clearly conclude otherwise. If you suspect that you have a substance problem, you are ideally situated. Your mind has provided a glimpse of reality and you are now in a position to move forward. Read on.
Like it or not, lawyers who drink or use drugs are significantly more at risk of losing control than the general population. Studies indicate that the law, along with other helping professions such as medicine, dentistry and social work tend to attract a statistically greater number of those of us who are prone to the development of chemical dependencies, predominantly alcoholism. Alcoholism and drug addiction, as illnesses, follow a predictable course with common symptoms presenting at every stage regardless of type and frequency of psychoactive substances used. Left untreated, this course will inevitably progress to extreme social, organic and emotional dysfunction and to death
Many people continue to think of the addict as being a homeless person living on skid row. Less than 5% of alcoholics and drug addicts live on skid row. Most have families and homes, jobs and careers. Many lawyers may still feel that they cannot be addicts since they still have these homes, families, offices, together with their law practice. Undoubtedly, recognition of addiction is difficult and an enormous obstacle to getting help.
Remember that addiction is a progressive disease and a lawyer may practice law as a social drinker without difficulty or repercussions for many, many years. Drug addiction usually progresses more rapidly. The onset of these diseases can be very, very gradual. Addiction is a progressive, degenerative disease which always gets worse and never gets better. A lawyer with a drinking or drug problem can never recover by cutting back or slowing down. The only treatment for alcoholism and for drug addiction is complete, unconditional abstinence, forever, one day at a time.
The trick to achieving a lasting solution is intervention at the earliest possible moment. The question is what to do if you’re aware of a problem or find yourself a legal predicament. The fear for most is the damage done to one’s career if found out. The following are a few practical suggestions.
Formal bar-sponsored “lawyer assistance” programs (LAPs) have sprouted throughout the United States. Many of these programs have been accompanied by rules that permit lawyers to seek help on a confidential basis. Let me suggest, however, that caution is in order. There is a very real conflict between the functions of the bar in assisting lawyers in reforming their behavior, or seeking help for their addiction, and in protecting clients against lawyer misconduct.
Typically, LAPs are sponsored by the state’s bar association. While there remains a great deal of resistance to treatment by legal professionals, LAPs have generally established a reputation for confidentiality among emerging lawyers: 80% of law students believed a conversation with an LAP regarding problematic substance use would remain confidential, while only 58% believed the same conversation would remain confidential if brought to their dean of students.
LAPs certainly have a role in helping lawyers and law students to achieve a continuous recovery. Many of us are benefitted by a structured program where we are monitored and held accountable. The LAP has a great motivator – it can (and will) report a lawyer for non-compliance. This “forces” the lawyer to remain sober, and this sort of coercion is not only powerful, but is often effective. But for LAP programs, many of us would not have achieved long-term and continuous sobriety. This coercive force is a double-edged sword.
There are lingering concerns about issues such as confidentiality. Once a person comes to the attention of the LAP, certain requirements will be attached (infra). Participation with the LAP is becomes mandatory. Whether or not these requirements are in the best interest of the person, if he refuses or fails to be compliant, the LAP will likely report the person to the state bar. If a person relapses (even a very brief relapse – which happens to many who are in early recovery), he may be reported. At what point does a confidential conversation progress to a reporting to the state bar association? I cannot answer definitively except to point out that “confidentiality” is relative.
Concerns such as these are valid. LAPs usually require that the participant enter into a treatment contract, which lasts for a duration of two to five years. The process is clearly coercive. You will not be given a choice – because if you refuse, the likely outcome is that you will be reported to the bar. You will likely be required to submit to regularly occurring, random drug screening, evaluations by mental health workers, attendance at a residential treatment program, and the like. All of this amounts to significant expense. Once again, failure to comply fully will result in the LAP reporting you. This often includes compliance with expensive evaluations and treatment. Often you may lose choice in treatment evaluators and providers. Odds are that you will be directed to one of the “approved” residential treatment programs. All this speaks to significant expense and may be unnecessary, depending upon the individual.
LAPs have been the subject of great debate over the recent years – and for good cause. Because LAPs are typically sponsored by the state bar association, it turns out that the oversight/treatment arm (the LAP) and disciplinary arm are both run by the same organization – the state bar. This scheme results in an inherent conflict of interest.
It may turn out that you have no choice but to submit to the LAP – perhaps because of being reported for misconduct or you’re facing legal problems. If this is the case, my suggestion is that you have experienced legal counsel represent you and accompany you to the initial meetings. It is at this point that your best interests be protected.
Overall, whenever possible, my view is that you are best served to avoid the LAP and earnestly and diligently seek help elsewhere. At best, the relationship between lawyer assistance and confidentiality is tenuous.
There are alternative solutions for treatment, particularly if you’ve not come to the attention of the bar. First, try to enter recovery on your own. This method has withstood the test of time. Millions of suffering addicts have found a lasting sobriety within the walls of Alcoholics Anonymous and Narcotics Anonymous. This means to locate a list of Alcoholics Anonymous or Narcotics Anonymous meetings in your area. Meeting lists are available on-line. You will find people with the same issues as yours, only they have found a solution and are more than willing to assist you. This is a path that should not be discounted because it can be effective. If you are not satisfied with the meeting that you attend, try going to another. It may take a while to find a meeting to your liking. Don’t give up. There are many types and styles of meetings. You can find one that suits your needs. Stay with it – even if you relapse (which is not uncommon). The secret to success is persistence.
If you require acute treatment, you should certainly not delay. There can be serious medical complications associated with withdrawal – particularly from alcohol. You should present first to your primary care physician. Discuss your condition openly. He is trained and capable of providing safe treatment in most instances. He may be able to safely treat you on an out-patient basis. There are medications that will ease your withdrawal symptoms – and they are very effective. If you require admission to a hospital, don’t hesitate. You may refuse to provide release for your medical records. Unlike the medical profession, there is no affirmative duty for healthcare providers to report lawyers.
While conducting my research, I learned of many law firms that actually specialize in assisting lawyers and other professionals who are in the midst of addiction and require substance abuse treatment. This is done for a fee. I am particularly intrigued by this approach, because confidentiality is assured via the attorney-client relationship. There is a level of security. If necessary, law firms will know of treatment facilities where your anonymity will be guarded. If there are legal issues at hand, they may assist you in dealing with them. If the involvement with an LAP is necessary, they will provide you with experienced and competent representation.
Finally, you may call or contact me. I’ve experienced the same struggles that you have. I clearly know how to be a drunk, but now have a rich experience in sobriety and know how to achieve a continuous and lasting sobriety. I will do all at my command to assist you. I have considerable experience working with others. It is rewarding, joyous and an honor for me to do so. Your confidentiality will be guarded and there is no cost.
In the end, my suggestion is to not go it alone. Active addiction is lonely and isolating. You needed experience this loneliness anymore.
National Household Survey on Drug Abuse
The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys; Krill, Patrick R. JD, LLM; Johnson, Ryan MA; Albert, Linda MSSW
Journal of Addiction Medicine: February 2016