Butler Center for Research
Substance Use Disorders Among Legal Professionals
Butler Center for Research - March 2017
Addiction Recovery Poses Special Challenges for Legal Professionals
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Occupation-specific treatment programs for substance use disorders have existed for many years among various professional groups, most notably for physicians and airline pilots. Many of these specialized programs pioneered the model of treating addiction as a chronic disease rather than reacting with punitive measures that were historically common, and by addressing profession-specific factors, they have historically boasted very high success rates (in some cases 80%-90% of treated individuals maintained abstinence for 5 or more years).1 More recently, attorneys and other legal professionals have been identified as a high-risk group for substance use disorders, and treatment programs specific to legal occupations are growing in popularity among providers.
Prevalence of Problem Drinking Behavior and Risk Factors Among Legal Professionals
In large-scale national survey studies of professionals, individuals in legal professions have reported higher rates of problematic drinking behaviors when compared to other populations. A recent survey of legal professionals indicated that 36.4% of respondents had scores on the Alcohol Use Disorders Identification Test, version C (AUDIT-C), consistent with problematic drinking;2 in comparison, AUDIT-C scores consistent with problematic drinking have been self-reported by only 15.4% of surgeons.3 When compared to the general population, women in legal professions had much higher rates of problematic drinking based on the AUDIT-C (39.5%1) than women in the general population (19%4), while the proportion of male legal professionals with problematic drinking behaviors (33.7%1) was fairly consistent with men in the general population (32%3). Heavy drinking among legal professionals is not a new concern: A 1990 study assessing problem drinking behaviors among lawyers found that 18% were problem drinkers, as compared to a 10% prevalence rate in the United States at the time.5
Legal professionals have also reported or presented personality characteristics and Axis 2 personality disorders that may be linked to greater propensity for substance use disorders. A 2008 study of personality profiles among attorneys found that antisocial and narcissistic personality configurations (as measured by the Millon Clinical Multiaxial Inventory-III; MCMI-III) were present among 17.6% and 11.7% of attorneys in the sample (respectively),6 as compared to a national epidemiological survey that estimated antisocial and narcissistic personality disorders among 3.2% and 6.2% of the population (respectively).7 Both antisocial personality disorder and narcissistic personality disorder are significantly correlated with addiction and substance use disorders.8, 9
The Stigma of Seeking Help
While some level of stigma surrounds substance use disorders for nearly all populations, 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).10 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.9 This belief grew significantly more frequent among populations with increasingly severe substance use behaviors; 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.9
The economic effects of social capital can also often serve as a barrier to treatment for problem drinking, especially for legal professionals who engage in a great deal of networking among colleagues and clients. Studies have found that alcohol consumption can increase social capital among professionals, resulting in increased status and earnings; on average, self-reported drinkers in professional occupations earn 10%-14% more than reported nondrinkers.11 The culture of alcohol consumption during networking among legal professionals may create status division and unequal social capital for those who do not choose to drink with colleagues,12 further pressuring individuals with self-identified problem drinking behaviors to avoid seeking treatment.
Recovery Among Legal Professionals
The combination of increased prevalence of substance use disorders among legal professionals and occupation-specific barriers to treatment led to the development of specialized lawyer assistance programs (LAPs) throughout the latter half of the twentieth century; as of 2014, state-specific LAPs have formed in 48 states and the District of Columbia.13 Perhaps the most significant role of an LAP is to reduce barriers to seeking treatment by ensuring confidentiality and safety from the unique professional, legal, and political risks that face legal professionals.12 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.9 LAPs are also run by lawyers and judges, who can empathize with the personalities and environments that make up the legal profession.
Summary
The success of occupation-specific treatment has been well documented. Given the unique factors of the legal profession that can involve increased alcohol consumption as part of professional networking and socializing, as well as high levels of stigma associated with the professional and political costs of seeking treatment, there has been an increased focus on the provision of treatment services specific to legal professionals. The success of LAPs in addressing specific professional concerns and providing safe and confidential environments for treatment-seeking further supports the need for programs tailored to the distinct needs of legal professionals.
Since 2011, the Hazelden Betty Ford Foundation has offered a specialized Legal Professionals Program at our Center City location. The program, which was specifically designed to address the needs of lawyers, judges, legal assistants, and other legal positions, is run by providers who have dual experience as clinical practitioners and legal professionals. As a result, patients in the Legal Professionals Program are able to engage with providers who have firsthand experience with the unique factors present among legal occupations, while also receiving specialized assistance with assessing one's practice for compatibility with a healthy lifestyle and communicating treatment details to employers, licensing boards, or other professional contacts, as appropriate. The Legal Professionals Program also offers individual sessions with an attorney-clinician, access and information about attorney-only Twelve Step groups held off campus, and group sessions consisting exclusively of legal professionals, covering topics that include occupational concerns.
Question: Do lawyers really have more issues with alcohol and drug use disorders than other professionals? Why do they need a special program?
Response: Whether it is a result of long work hours, flexibility in scheduling, a professional network that incorporates alcohol into social events more often, or all of the above, lawyers have been identified as a professional group that uses alcohol and other drugs more often than other occupations. A review of the California bar's discipline system estimated that substance abuse is involved in 25%-35% of all situations requiring formal charges against an attorney.14 In addition, legal professionals share a distinct culture with social, personality, and work factors that may lend themselves to higher rates of problematic drinking and that may further be benefited by specialized treatment programs.
Legal Professionals: While it may feel as though seeking help for a substance use disorder could be detrimental to your career, Lawyer Assistance Programs are specifically designed to maintain confidentiality and protect you from negative professional consequences for seeking and receiving addiction treatment. There are certainly some work-related factors that may seem impossible to reconcile with a healthy lifestyle, but practitioners in many lawyer-specific programs have professional experience as both practitioners and attorneys, so they are able to help apply healthy habits learned in treatment settings to a "real world" work environment.
Providers: If you work with legal professionals, it is important to consider the factors that make this patient population unique while developing plans for treatment and continuing care. It may be beneficial to consult with professional attorneys who are familiar with the issue of substance use disorder in the legal profession, or you may wish to speak with a colleague from a lawyer-specific recovery group such as the Hazelden Betty Ford Foundation's Legal Professionals Program or The Other Bar, a nonprofit mutual support group that provides anonymous peer support meetings specifically for lawyers, judges, and law students.
1. Woodworth, A. M., & McLellan, A. T. (2016). Converging advances in science, policy, and public awareness: A time of great opportunity and change in addiction treatment. Brain Research Bulletin, 123, 110-113.
2. Krill, P. R., 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.
3. Oreskovich, M. R., Kaups, K. L., Balch, C. M., Hanks, J. B., Satele, D., Sloan, J., … Shanafelt, T. D. (2012). Prevalence of alcohol use disorders among American surgeons. Archives of Surgery, 147(2), 168-174.
4. Frank, D., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Kivlahan, D. R., & Bradley, K. A. (2008). Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. Journal of General Internal Medicine, 23(6), 781-787.
5. Benjamin, G. A. H., Darling, E. J., & Sales, B. (1990). The prevalence of depression, alcohol abuse, and cocaine abuse among United States lawyers. International Journal of Law and Psychiatry, 13, 233-246.
6. Sweeney, T. J., Myers, D. P., & Molea, J. (2008). Treatment for attorneys with substance related and co-occurring psychiatric disorders. Journal of Addictive Diseases, 23(1), 55-64.
7. Sansone, R. A., & Sansone, L. A. (2011). Personality disorders: A nation-based perspective on prevalence. Innovations in Clinical Neuroscience, 8(4), 13-18.
8. Sher, K. J., & Trull, T. J. (1994). Personality and disinhibitory psychopathology: Alcoholism and antisocial personality disorder. Journal of Abnormal Psychology, 103(1), 92-102.
9. Vaglum, P. (1999). The narcissistic personality and addiction. In J. Derksen, C. Maffei, & H. Groen (Eds.). Treatment of personality disorders (241-253). New York: Springer Science and Business Media.
10. Organ, J. M., Jaffe, D. B., & Bender, K. M. (2016). Suffering in silence: The survey of law student well-being and the reluctance of law students to seek help for substance use and mental health concerns. Journal of Legal Education, 66(1), 116-156.
11. Peters, B. L., & Stringham, E. (2006). No booze? You may lose: Why drinkers earn more than nondrinkers. Journal of Labor Research, 27(3), 411-421.
12. Rahman, N. (2015). Earning the drinker’s bonus: How lawyers can use alcohol and other alternatives to build social capital. Georgetown Journal of Legal Ethics, 28, 875-1135.
13. Cearley, S. (2014). Lawyer assistance programs: Bridging the gap. University of Arkansas at Little Rock Law Review, 36(3), 453-462.
14. McCarthy, N. (November 2000). Statistics tell story of stress, addiction in lives of lawyers. California Bar Journal. Retrieved from http://archive. calbar.ca.gov/calbar/2cbj/00nov/index.htm
Contributors to graphs:
Frank, D., DeBenedetti, A .F., Volk, R. J., Williams, E. C., Kivlahan, D. R., & Bradley, K. A. (2008). Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. Journal of General Internal Medicine, 23(6), 781-787.
Krill, P. R., 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.
Oreskovich, M. R., Kaups, K. L., Balch, C. M., Hanks, J. B., Satele, D., Sloan, J., … Shanafelt, T. D. (2012). Prevalence of alcohol use disorders among American surgeons. Archives of Surgery, 147(2), 168-174.
Woodworth, A. M. & McLellan, A. T. (2016). Converging advances in science, policy, and public awareness: A time of great opportunity and change in addiction treatment. Brain Research Bulletin, 123, 110-113.