A landmark study by the American Bar Association and the Hazelden Betty Ford Foundation depicts a profession troubled by problem drinking, depression, anxiety—and abiding fears about seeking help. In a pair of interviews, Joan Bibelhausen of LCL and study co-author Linda Albert discuss the findings and what the profession can do to address them.
Minnesota Lawyers Concerned for Lawyers Executive Director Joan Bibelhausen
Bench & Bar: You’ve worked in Minnesota’s lawyer assistance program for some time. Did any of the findings of the ABA/Hazelden study come as a surprise to you?
Joan Bibelhausen: In looking at the study, the numbers that are confirmed are surprising to many people. But looking at the levels of distress we see at LCL and the types of issues that people call with when they’re looking for help, none of it was terribly surprising. LCL has been in existence for 40 years as of August; LCL has been engaged with substance issues from the beginning. In 2001 we started helping with mental health issues as well.
B&B: In the wake of the study, a lot of observers have been struck by the findings about problem drinking among younger lawyers, which directly contradict a longstanding assumption that the main problems were with middle-aged or older attorneys. Does your experience at LCL bear out a surge in problem drinking among younger lawyers in particular?
Bibelhausen: The numbers regarding younger lawyers were unexpected. I think there’s been an increase in drinking culture at the law schools over the last dozen years-plus. There has also been an increase in more recent years in efforts to raise alcohol awareness. I think the economy has contributed to the distress that is out there. There are fewer jobs, and those jobs may not feel secure. [Alcohol] is one of the ways that many reduce stress, and it’s a social lubricant for lawyers. If you look at new or young lawyer sections, the events that get attended are the ones that include alcohol. It’s the same with the ABA. The events that get attended are going to include alcohol.
B&B: The study also suggested that problem drinking happens at higher rates in private practice settings than in government/public or corporate/in-house roles. Does that comport with your program’s experience?
Bibelhausen: If you look at the actual study numbers, the percentages are somewhat higher in private practice. But if you look at the numbers overall, there is a considerable degree of stress in all settings. While it’s somewhat higher [in private practice], that doesn’t mean that we now think all the attention must be paid to private practice. At LCL we see distress across the board, and we need to remember that any area has the potential to give rise to the levels of distress that might result in the sorts of statistics we’re seeing in the study.
B&B: What advice would you have for an attorney who might be concerned about his or her own drinking?
Bibelhausen: Ask for help. There are organizations like LCL that can help you assess your own use and look at what triggers the use. Has anybody talked to you about it? Has anybody ever said, “Don’t you think you’ve had enough?” or “I’m worried about you”?
And how has that felt to you? Are you annoyed by that? If you’re finding yourself reacting defensively to someone else’s concern, then it may be time to take a look. Lawyers or their family members can call LCL, and we can offer an evaluation. Sometimes there are underlying situations that can trigger unhealthy drinking. It may be that they’re dealing with a high degree of stress and that’s one of the ways they handle it. It may be that attending to those causes will decrease their use. Some people, on the other hand, are at a point where they really should stop drinking. A thorough evaluator will assess your use and other factors and make recommendations.
When we look at these statistics—20.6 percent met the criteria for problem drinking based on subjective questions, and an even higher percentage met the criteria based on questions about frequency and amount of use—not all of these people are addicts, or attending to client matters under the influence. Rather it’s use that often occurs after work. There are certainly people who do work under the influence, but in many cases this is what we’re doing [after hours] to relieve our stress. And that can definitely impact our effectiveness the next day.
I am actually more concerned about the figures regarding depression. The rate of problem drinking receives the most coverage. Drinking may or may not be outside of work but depression is 24/7. And 28 percent of respondents reported symptoms of depression. That concerns me much more.
B&B: Obviously there is sometimes a synergy between drinking and depression, but it sounds like you encounter a lot of lawyers who grapple with depression irrespective of chemical issues.
Bibelhausen: That’s right. Depression and anxiety. More men reported symptoms of depression and more women symptoms of anxiety. They’re both mental health issues that can affect one’s ability to work, to function effectively, to feel any joy in what they’re doing in their work or personal lives. These are brain diseases and they need treatment. And yet, so often in the legal or general press and in other settings, there’s ridicule. In our profession, we’ll hear statements like somebody “just can’t cut it.” Or “they can’t handle their liquor.” Things like that. If we pay attention to these issues in each other, maybe we can start to make a difference.
This isn’t a lawyer assistance program issue. It’s a profession issue. It’s up to all of us to be mindful that something we say can make the difference in someone getting or not getting the help that they need.
B&B: What advice do you have for someone who’s concerned about a colleague’s drinking or personal affect or energy level? What should they do?
Bibelhausen: They can get coaching from a lawyer assistance program on how to talk to somebody with dignity, compassion, and respect. We can hear what the concerns are and talk about how to reach out. Lawyer assistance programs are confidential—particularly in Minnesota, where I think we have the highest confidentiality rules in the country. If someone calls LCL we’ll ask questions and offer guidance and suggestions. If it seems it might be helpful to involve some of our volunteers—many of whom are in recovery themselves—we can put that in place.
Sometimes a lawyer will say “I’m not hurting anybody else. I haven’t missed a court date. I haven’t gotten a complaint from the Lawyers Board.” Yet they’re really not bringing their A game. That’s the question to ask: Are you impacted by what might be a mental health issue or by the use of alcohol or other substances? And is it enough to make a difference in how you’re performing personally and professionally? In some cases we can facilitate an intervention, for either substance use or mental health issues. Reaching out to someone in a group setting can be very powerful and motivating.
It’s important to recognize that lawyer assistance programs in each state approach things differently. In some states, such as Wisconsin, when a lawyer is involved with the discipline system and has an alcohol problem, discipline and the lawyer assistance system may work together. In Minnesota, if people wonder when LCL is going to talk to the Office of Lawyers Professional Responsibility, the answer is never. We want people to feel they can call us, regardless of what’s going on, and get help. LCL will not report to the Office of Lawyers Professional Responsibility (and under MRPC Rule 8.3(c) we’re exempt from doing so), will not report to a law school, will not report to an employer. Someone can call us and ask for help and it will be nonjudgmental and absolutely confidential. We’ll refer them to the help they need, which includes up to four free counseling sessions throughout Minnesota.
We want to hear from people who have ideas about how to get the profession talking about these kinds of issues. What can we do to improve those statistics? What can we do to get the resources out to the people who need them? We’re interested in working together, because we’re better together. This is not just an LCL issue; it’s an issue for everyone in the profession. It’s an issue for every legal employer who now knows that their lawyers in the first 10 years are most distressed. LCL can help. There are many who need us who have not been comfortable calling. The entire profession can be an ally in helping lawyers, judges and law students know that it’s okay to ask for help and there’s a safe place to call.
The profession could support lawyers’ assistance at a much higher level. Most lawyers’ assistance programs are woefully underfunded. Minnesota is supported in part by a portion of the lawyer license fee, but we also must fundraise. We don’t have enough to do a lot of the work that we would like to do. This is a critical issue in our profession. It doesn’t have to be this way. We don’t have to have these rates of substance use, we don’t have to have these rates of depression and anxiety, and we don’t have to have 11 percent of the people who answered this survey saying they’ve had thoughts of suicide. That’s horrifying. We can change that and we need to.
JOAN BIBELHAUSEN, J.D. University of Minnesota, is executive director of Minnesota Lawyers Concerned for Lawyers. She has spent more than two decades working with lawyers who are at a crossroads because of mental illness and addiction concerns as well as work/life balance, stress, and related issues. She has served on the ABA Commission on Lawyers Assistance Programs (CoLAP) and is currently on its Advisory Commission.
ABA/Hazelden study co-author Linda Albert
Bench & Bar: It had been a long time since there had been any systematic study of lawyers and alcohol and mental health. Two-part question: Why do you think it had been so long, and what did you learn?
Linda Albert: I don’t know that it’s ever been done before on a national level—in fact, I don’t believe it has—that we have taken a look at the legal community and the current prevalence of both substance use issues and mental health concerns. I think that’s what makes it a landmark study. I believe the amount of years that can go by is due to the difficulty of getting the data and having the resources to put together a scientific study. So that’s where the collaboration was so critical between the American Bar Association Commission on Lawyer Assistance Programs and the Hazelden Betty Ford Foundation. We needed both of these large leaders from the fields of the legal profession and the treatment of addiction and co-occurring disorders to join together to have enough resources to do a national study.
So with the collaboration, we had the ability to do this. For the first time now, we have the current rates. I think there are several things that we have learned. I think we’ve learned that attorneys in the United States have significantly higher rates of problematic drinking, along with depression and anxiety, than the general population. I think another piece of information that was new is that… we found, contrary to previous research, that it’s our younger lawyers who have higher levels of problematic drinking and mental health concerns. We also were able to [measure] how the level of problematic drinking compares to levels of depression, anxiety and stress. What we saw is that they do parallel each other—the higher the level of problematic drinking, the higher the levels of depression, anxiety, and stress our lawyers were experiencing.
Another key finding is that there is very limited help-seeking behavior among this population. For me, it almost seems like a fear-based population when it comes to trying to seek help. I look at it as errors in the thinking about the confidentiality [of assistance programs]. I believe that services are confidential and that people can get help without others finding out or having it impact their licenses. Yet overwhelmingly, the data demonstrated that there was a fear of telling anybody—even going to a self-help group. I think that plays out significantly in addressing the problem and decreasing the levels of problematic use as well as depression or anxiety.
B&B: What, if anything, surprised you in the results?
Albert: It was disheartening to see the high level of depression. Previous studies had been in the 15-18 percent range, and our study had 28 percent of subjects indicating some form of depression. Along with depression can come other problems—problems handling cases, being able to concentrate, being able to get good sleep. It can affect physical health and wellness. That was certainly a surprise—to see that there was such a jump in the percentage of lawyers experiencing depression.
B&B: With respect to both drinking and depression, there were gender gaps in the results. What did you make of those?
Albert: The gender gap has been demonstrated pretty consistently in the research on alcohol use disorders, where men are experiencing this at a higher rate than females are. Certainly there isn’t anything from our study that can let us say, this is why. I think from being in the field myself as a licensed alcohol and drug therapist and mental health therapist, I can say that the culture influences that—that women will say there’s more permission for men to go out and drink together. Even though women have become much more engaged in careers and out in the community, there still isn’t the same type of acceptance for women to go out and drink hard in our culture as there is for men.
The other thing we don’t know is whether, because of women feeling more of a stigma about their drinking and being more likely to hide their use of alcohol, they just aren’t reporting it at that level. So I can’t tell you definitively. Some of the things women have told us about the culture and the stigma could certainly impact that.
B&B: What sort of gender gap did you see in the mental health categories?
Albert: We saw men experience depression at a higher rate than women did. But women had a higher rate of anxiety. That was interesting. I would have anticipated seeing a higher rate of depression among women. Anecdotally, we think about women being more likely to go in to their doctors and talk about depression and seek help for it. But within the legal field, we found that men scored higher for depression on our instrument.
B&B: Why the spike in problem drinking among younger lawyers, do you think?
Albert: We think it’s really a confluence of factors that could be pushing that. Certainly the changes in our economy since 2008 have changed the options for young lawyers, with fewer job options. There are generational differences with our younger lawyers where many of them are wanting to be in the larger cities and they aren’t willing to relocate out into the rural areas, so maybe they aren’t finding the work.
Their large level of student loan debt [is a factor]. It’s very expensive to go to law school, and most law students enter law school believing they will get a lucrative position, and then they find upon graduating that it’s difficult to get a job and the starting salaries aren’t sufficient for them to both support other expenses and pay off their student debt. So they end up putting off traditional developmental milestones such as marriage, having children, buying homes. And the pressures they feel financially can impact their health and well-being. For some, [there is] a sense of disillusionment about what they thought practicing law was going to bring them versus what it does. So they experience a lot of stress, which results in depression and anxiety. And some use alcohol to cope. It’s just a very difficult time for young lawyers.
B&B: One factor that always comes up in discussions about lawyers and issues of alcohol abuse or depression is the abiding fear in the profession about having one’s reputation damaged if one comes forward with chemical or mental health issues. Are we making progress on that stigma? Has it lessened through the years?
Albert: Well, from the data in our study, what we found is that that is a huge barrier to lawyers getting the help that they need. So I certainly can’t say there’s evidence that it is decreasing. There is a messaging system that law students and lawyers seem to adhere to that says, don’t get help—because if you do, it’s not going to be good for you professionally. The permission to seek help is not there. That’s going to take a system-wide response for all entities within the legal profession that interface with law students and lawyers and judges. They need to be giving a different message, and that will take some time.
Lawyer assistance programs have been working on this for the past 30 years, but my belief is that it has to expand well beyond lawyer assistance programs. This has to be taken on in strategic plans of lawyer regulation and bar administration and law schools and large firms. Any entity that interfaces with legal professionals needs to take a look at what we can do differently to encourage legal professionals to believe it’s okay to have a problem, that it’s okay to be a human being, that you’ll have the support you need as long as you’re addressing this and going in a healthy direction.
But also [there’s a need] to address the parts of the culture where law students talk about the competitive nature in law schools and the stress they feel from that, and lawyers talk about the adversarial, competitive nature of practice, but they leave themselves out of the equation. The teaching and the messaging from all systems has to be, “Keep yourself in the equation. Be very intentional about your health and wellness.” You know, health and wellness is not fluff. There’s so much rhetoric about it, but lawyers and law students have to be very intentional to stay well in this profession.
LINDA ALBERT, a Licensed Clinical Social Worker (LCSW) and a certified alcohol and drug counselor, is employed by the State Bar of Wisconsin as the manager of the Wisconsin Lawyers Assistance Program. She is co-author of the ABA/Hazelden Betty Ford collaborative research study on the current rates of substance use, depression and anxiety within the legal community.