“It is a great advantage not to drink among hard drinking people.”
~ F. Scott Fitzgerald
“Drink the first. Sip the second slowly. Skip the third.”
~ Knute Rockne
A recent study published by the Journal of Addiction Medicine found that the rates of substance abuse — especially alcoholism — are even higher among lawyers than previously thought. Many lawyers from the millennial generation have already learned in law school professional responsibility classes that the legal profession produces problem drinkers at rates higher than other professions. However, this recent study, authored by Patrick Krill, Linda Albert and Ryan Johnson, revealed a problem that runs perhaps deeper than anyone previously realized.
The study, titled “The Prevalence of Substance Use and Other Mental Health Concerns among American Attorneys,” sampled 12,825 licensed and employed attorneys across 19 states, including Colorado. The study, which sought voluntary participation through an anonymous online questionnaire, found that one out of five, or 20.6 percent, of practicing American lawyers and judges exhibited signs of “hazardous, harmful and potentially alcohol-dependent drinking.” Comparatively, only about 6.8 percent of the general U.S. population abuses alcohol by this same measure. Legal professionals are therefore over three times more likely to abuse alcohol than the average American. The same study also examined the mental health of respondents, finding that 28 percent of lawyers experienced depression, 19 percent experienced anxiety and 23 percent experienced stress. This is the only data to have been collected on the topic in more than 25 years. A 1990 study of lawyers in Washington state determined that 18 percent of lawyers were problem drinkers and 19 percent suffered from depression.
The authors of the Journal of Addiction Medicine study know something about this topic. Lead author Patrick Krill is a licensed attorney, a board certified alcohol and drug counselor, and a graduate-level instructor in addiction counseling. Krill is also director of the Hazelden Betty Ford Foundation Legal Professionals Program, where he assists lawyers, judges and law students struggling with addiction. Co-author Linda Albert is the program manager for the Wisconsin State Bar Lawyer Assistance Program, which provides mental health and addiction resources for Wisconsin lawyers and judges.
In their study, the authors sought to assess alcohol consumption patterns by asking participants to answer the ten-question Alcohol Use Disorders Identification Test (AUDIT), which the World Health Organization (WHO) developed to ascertain signs of alcohol abuse. The AUDIT assessment is scored on a scale of zero to 40, with a score of eight or more indicating “hazardous or harmful alcohol use.” To assess drug use patterns, participants completed the ten-question Drug Abuse Screening Test (DAST). Finally, the seven-item Depression Anxiety Stress Scales (DASS) test was incorporated to screen for mental health problems among participants. The results indicate a much higher rate of substance abuse and mental health problems among lawyers compared to other professions. For instance, the authors of the study compared the AUDIT-C subset score between lawyers and physicians. AUDIT-C is a subset of questions within the full AUDIT screen, which asks about frequency and quantity of alcohol use. Using AUDIT-C, 36.4 percent of lawyers and judges in this study screened positive for indications of alcohol use disorders, while only 15 percent of physicians and surgeons scored positive on the same screening in a 2012 study. The average of all highly educated American professionals is estimated to be 11.8% positive for alcohol abuse, according to a 2003 study.
The AUDIT test seeks to assess a person’s “alcohol consumption, drinking behaviors and alcohol-related problems.” Two of the ten questions ask about the number of drinks that a person consumes, but this can be misleading. A standard drink is defined as a 12-ounce beer (containing 5 percent alcohol), 5 ounces of wine, or 1.5 ounces of hard liquor. However, a pint (16 ounces) of craft beer (or hard cider) with higher alcohol volume could be as much as two standard drinks. Many people underestimate the number of alcoholic drinks they consume and the frequency of their drinking.
This begs the question of how much does the average American drink? According to a Washington Post analysis by Christopher Ingraham in 2014, 30 percent of Americans do not drink at all. Another 30 percent of Americans drink, on average, less than one drink per month. However, the top 10 percent of American drinkers (24 million people) drink on average more than ten drinks per day. The Centers for Disease Control also reports similar numbers.
Krill and Albert readily admit that there are some flaws in their methodology. By seeking voluntary responses from participants by email, the sample is not necessarily random. On one hand, legal professionals with particularly strong opinions on substance abuse and mental health may be more likely to respond, leading to a selection bias. On the other hand, lawyers in the throws of substance abuse at the time may have avoided responding to the questionnaire. Although confidentiality was ensured and the study did not track IP addresses or email addresses of respondents, some may have declined to respond out of confidentiality concerns. Finally, it has been shown that many people underestimate their own drinking quantity and frequency, and many questions in the survey rely upon participants’ subjective self-reporting of their own drinking patterns. Taken together, these shortcomings may have skewed the results, and the study’s authors admit the methodology is imperfect. However, as the first study in 25 years on the topic, the results show a continued problem of substance abuse and mental health in our profession at rates significantly higher than in other highly educated professions and the general population.
Krill’s and Albert’s analysis concluded that “[t]hese data underscore the need for greater resources for lawyer assistance programs, and also the expansion of available attorney-specific prevention and treatment interventions.” Krill recommends expansion of funding and services for lawyer assistance programs and raising awareness within the practice of law.
Fortunately, the Colorado Lawyer Assistance Program (COLAP), which is located on Diamond Hill in Denver, provides some resources to Colorado attorneys, judges and law students. COLAP was established by Rule 254 of the Colorado Supreme Court and opened its doors on January 1, 2012. Barbara Ezyk, executive director of COLAP says, “We work really hard here in Colorado to promote wellness. We have to continue to remind attorneys that asking for help is a sign of strength, not weakness,” she explains. Ezyk suggests that the adversarial system can breed uncertainty, and lawyers who are facing trouble become stuck and do not know who they can trust to help. COLAP can help. The program is completely confidential. “We have to do a better job to remind people that this is confidential,” acknowledged Ezyk. The staff of four fields roughly 35 first-time contacts each month, and sometimes as many as 50 first-time contacts in a single month. When a person calls in, “one of the biggest things we do is listen,” says Ezyk. After listening to the problem, COLAP sets up the attorney or judge with an appropriate network of resources that they can utilize to overcome the problem they are facing. This referral may be to a local addiction counselor, psychologist, psychiatrist or even respondent’s counsel for an ethical grievance, if applicable. COLAP is well-networked with support groups and resources throughout Colorado and the program’s central aim is to help. COLAP currently has 137 volunteers who provide confidential peer-to-peer assistance. COLAP also works with Colorado Lawyers Helping Lawyers (CLHL), a volunteer board that provides support groups and assistance.
COLAP hosts presentations and exhibit tables at many continuing education events and at Colorado’s two law schools. “Law schools are key,” says Ezyk. COLAP has a presence at 1L orientation, has office hours every semester, and often accepts invitations to speak to professional responsibility classes at DU and CU law schools. Ezyk and her team work with matriculating law students facing stress about the bar exam and the required disclosures for the Board of Bar Examiners. Ezyk notes that this year’s theme of the ABA Commission on Lawyer Assistance Programs’ Annual Conference is “We’re Better Together.” That is COLAP’s aim in a nutshell. COLAP advocates a focus on wellness in the legal community and wants to help lawyers, judges and law students so that we can better serve our clients and the public.
Although the results of the recent publication by Krill and Albert are cause for concern, the rise in availability of support through lawyer assistance programs nationwide is making a positive difference. “I believe the tide is turning; we are making a difference,” says Ezyk.
If you need help, please make a difference in your own life and career by reaching out. COLAP can be reached at 303-986-3345, or via email at email@example.com. For more information, visit coloradolap.org. D