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Substance use and other mental health concerns among US  attorneys

Monday, February 22, 2016
posted by Douglas Keene

lawyer and mental healthOver the past few years, following a number of high-profile attorney suicides, much more attention has focused on mental health needs of attorneys. The study we are featuring today was funded by the Hazelden Betty Ford Foundation and the ABA Commission on Lawyer Assistance Programs.

In short, the authors conclude we need to pay more attention to the mental health needs of attorneys in this country and we need to address the stigma and loneliness often experienced with these struggles. What we want to do with this blog post is display some of the numbers referenced in the article itself. If you are an attorney struggling with depression, anxiety, and/or excessive substance use (or know one who is)—you are very much not alone.

The authors of this study wanted to count the incidence of substance abuse and other mental health concerns and so they assessed alcohol use, drug use, and symptoms of depression, anxiety and stress in a group of 12,825 licensed and employed attorneys. To pull together a group of this size, “recruitment was coordinated through 19 states. Among them, 15 state bar associations and the 2 largest counties of 1 additional state emailed the survey to their members”. Participants were not asked for any identifying information (and IP addresses and geographic location data were not tracked).

In the group were roughly equal numbers of men (53.4%) and women (46.5%) and the most commonly reported age group was between 31 to 40 years of age while the sample included attorneys up to 71+ (as long as they were licensed and employed). Most of the participants (91.3%) identified as White. Private firms were the most common work environment (40.9%) with the most common positions listed as Senior Partner (25%), Junior Associate (20.5%), and Senior Associate (20.3%). Over 2/3 of the sample (67.2%) reported working 41 hours or more per week. In other words, this is a pretty representative sample of practicing attorneys.

Here are some of the numbers the authors reported on mental health and substance abuse issues in this large group of attorneys.

Alcohol use. Of the 11,278 participants who completed all ten questions on the measure of alcohol use, 20.6% scored at the level “consistent with problematic drinking”.

Men had higher levels of “problematic drinking” than women, younger participants had higher “problematic drinking” scores than older attorneys, and those who had been working as attorneys for shorter times were drinking more than those who’d worked in the field longer. Attorneys working in private firms or at bar associations had higher rates of drinking than those in other employment situations. Junior and senior associates drank more than those in other positions.

22.6% reported feeling alcohol use (or other substance use) had been a problem at some point in their lives. (27.6% said the problematic use was before law school, 14.2% during law school, 43.7% within 15 years of completing law school and 14.6% said their substance use had been a problem more than 15 years after completing law school. Age was the only significant predictor of alcohol use (with younger attorneys drinking more than older attorneys).

Drug Use. Participants also completed questions regarding substance use other than alcohol. Perhaps because many of these substances are illegal, there were not enough participants completing the questions to compare to national norms. However, the most common drugs in at least weekly usage were stimulants, sedatives, tobacco, marijuana and opioids.

Mental health issues. 11,516 participants completed the questions on mental health issues so we have good comparison numbers here. Men had higher levels of depression but women had higher levels of anxiety and stress. Older participants had higher levels of both stress and depression. Those who were classified as “non-problematic drinkers” on the earlier measure also reported lower levels of depression, anxiety and stress.

The most commonly reported mental health conditions were anxiety (61.1%), depression (45.7%), social anxiety (16.1%), attention deficit hyperactivity disorder (12.5%), panic disorder (8.0%), and bipolar disorder (2.4%) 11.5% reported having had suicidal thoughts during their career, 2.9% had “self-injured” in some way in the past and 0.7% reported at least one prior suicide attempt.

The authors express concerns that the high rate of problematic use of alcohol and the relatively high rate of anxiety, stress and depression among attorneys be addressed. They say that the level of problematic drinking is at a rate among lawyers that is much higher than other populations. Depression, stress, and anxiety are also significant issues and both substance use and mood disturbances are often effectively treated (and can be treated at the same time). The authors express hope that specialized treatment services and guidelines for attorney recovery will be developed similar to what has been done for impaired physicians.

For all of the talking about the universality of mental health issues (substance abuse, stress, anxiety, depression), it is difficult to admit it, or to seek support or assistance in coping with it. One of the issues not described in most of the article is whether the person reporting the history felt themselves to be a “problematic drinker”, or whether the mood and anxiety problems were brief or chronic. Those factors have a lot to do with whether people choose to seek help. Unfortunately, the social and professional stigma that causes people to deny problems and resist seeking help isn’t going to go away soon.

Krill PR, Johnson R, & Albert L (2016). The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys. Journal of Addiction Medicine, 10 (1), 46-52 PMID: 26825268

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