Alcohol and Substance Use Among Attorneys
In 2016, the American Bar Association (ABA), the organization that sets educational, ethical, and professional standards for lawyers in the United States, commissioned a nationwide study – in conjunction with the Hazelden Betty Ford Foundation – on the prevalence of lawyer impairment due to alcohol, substance use, and/or mental health disorders.
The purpose of the study was to fill the significant gaps in knowledge and supplement the lack of peer-reviewed data on rates of alcohol, drug use, and mental health disorders among ABA-certified practicing attorneys in the U.S.
Researchers also sought to confirm or refute what they understood as a commonly held belief about attorneys: they drink a lot, and many – if not most – drink enough to be labeled problem drinkers. Although rates of alcohol and drug use among other professions requiring extensive post-secondary education are well-documented, the last large-scale study on the prevalence of alcohol and substance use among attorneys was conducted more than 25 years ago, around 1990.
That study found rates of problem alcohol use for attorneys were close to double that of people in the general population: around 18% of attorneys reported problem drinking, compared to 10% for the general adult population.
That confirms the stereotype, and leads to the two questions that drive this article:
- Is that stereotype still operative? Do people still think lawyers drink a lot?
- What does the new data show about alcohol and drug use among lawyers?
Let’s take a look.
Lawyers and Alcohol: The Stereotype
A brief internet search using the generic phrase “attorneys and drinking” quickly shows the stereotype of the hard-drinking lawyer is alive and well. One of the first results was an article with this title:
“Legally Bombed: Young millennial lawyers, same old alcoholism”
Let’s quickly address both stereotypes in this headline.
First, the use of the word millennial: millennials are grown adults, part of the fabric of our society, and occupy important positions of power and influence in our country and the world. It simply does not work as a diminutive anymore – but that’s beside the point. The point – and the reason we take issue with millennial in this context – is that it serves to trivialize and devalue the lives of an entire generation, which is something that we, as addiction professionals, seek to avoid.
Next, the word alcoholism. Medical professionals rarely use the terms alcoholism or alcoholic anymore. Instead of alcoholism, we say alcohol use disorder, and instead of alcoholic, we say a person with an alcohol use disorder.
So: stereotypes confirmed. And amplified when paired with other stereotypical and stigmatizing labels and language.
Also confirmed is the fact that among the general population, the terms we now use to describe problem drinking, which are, in part, designed to shift understanding toward an acceptance of the disease model of addiction – alcohol use disorder, person with an alcohol use disorder – have not yet become part of our common vocabulary.
We point out the cavalier use of these stereotypical labels in that headline for one reason: they influence the way we, as a society, think about the relevant issues of the day – and as mental health and addiction professionals, it’s our job to counter these labels when they can cause harm or increase misunderstanding. In this case, they do both: a millennial alcoholic attorney may be easy to write off and forget. However, a young adult professional living with an alcohol use disorder sounds different: it sounds like a real person living with a medical condition for which they need help, which is an accurate and compassionate way to both talk and think about them.
Now that we’ve cleared up that semantic tangle, let’s look at the data from the new study, and see if the overall numbers have changed over the past two and a half decades.
Alcohol, Substance Use, and Mental Health Disorders Among Attorneys: The Statistics
Researchers collected data on more than 10,000 certified practicing attorneys through anonymous questionnaires that assessed their alcohol use, drug use, and mental health symptoms. The questionnaires were distributed and collected with the assistance of the ABA, and the data analyzed by a team assembled by the Wisconsin Lawyers Assistance Program and the Hazelden Betty Ford Foundation.
Here are the three metrics they used in the study:
- Alcohol Use: The Alcohol Use Disorders Identification Test (AUDIT). The AUDIT is a 10-question self-reporting tool developed by the World Health Organization (WHO) to screen for problematic alcohol use. It’s widely used and recognized by mental health and addiction professionals for its reliability and validity.
- Drug Use: The short-form Drug Abuse Screening Test-10 (DAST-10). The DAST-10 is a self-reporting tool designed to assess drug use. Like the AUDIT, it’s widely used and accepted by professionals for its reliability and accuracy.
- Depression: The Depression Anxiety Stress Scales-21 (DASS-21). The DASS-21 is a self-reporting tool that screens for symptoms of depression, anxiety, and stress. Like the AUDIT and DAST, research confirms the validity and reliability of this test.
And here’s the data:
Attorney responses to the AUDIT showed:
- 20.6% reported problem drinking – that’s more than triple the national rate of 6.2%.
- Men showed higher rates of problem drinking than women – that’s consistent with national prevalence data.
- Attorneys under the age of 35 showed higher rates of problem drinking than those over 35 – that’s also consistent with national prevalence data on problem drinking.
- Attorneys employed by private firms showed higher rates of problem drinking than those employed in other milieu.
This part of the study was problematic.
Only 26% of the attorneys completed the drug use assessment – we’ll leave you to connect the dots on why, but we’ll offer this opinion: anonymous or not, an attorney who understands the law is unlikely to admit to illicit drug use on a written survey.
With that said, among the attorneys who did report using a specific substance during the 12-month period before answering the survey, here’s what the data showed:
- 74% reported using stimulants
- 51.3% reported using sedatives
- 31% reported using marijuana
- 21.6% reported using opioids
Attorney responses to the DASS-21 showed:
- 61.1% experienced symptoms of an anxiety disorder
- Nationwide prevalence: 19.1%
- 45.7% experienced symptoms of a depressive disorder
- Nationwide prevalence: 7.1%
- 12.5% experienced ADHD symptoms
- Nationwide prevalence 4.4%
- 8% experienced symptoms of panic disorder
- Nationwide prevalence: 5%
- 2.4% experienced symptoms of bipolar disorder
- Nationwide prevalence: 3%
- 11.5% reported suicidal ideation
- Nationwide prevalence: 3.7%
- 2.99% reported self-harm/self-injury
- Nationwide prevalence: 2.5%
- 0.7% reported at least one suicide attempt
- Nationwide prevalence: 0.6%
These numbers reveal that attorneys experience higher rates of problem alcohol use and mental health distress than the national averages. However, the study also shows that only 6.8% reported receiving specialized treatment. When all study participants, including those who did and did not report receiving treatment, were asked to identify any barriers – hypothetical or actual – to obtaining treatment, the responses were surprising. Both the treatment and non-treatment groups indicated that fear of others finding out they needed help and concerns regarding privacy kept them from seeking treatment.
What Treatment Providers Can Do
We’ll circle back to the semantic digression at the beginning of this article:
“Legally Bombed: Young millennial lawyers, same old alcoholism”
It wasn’t really a digression at all.
Here’s why: lawyers show a rate of problem alcohol use that’s triple the national rate, yet few of those with problems seek treatment. When asked why, they indicated fear of being found out and privacy concerns kept them from seeking treatment.
Why would they fear being found out? Why would privacy be an issue?
Because the stigma still surrounding alcohol use disorders and treatment for alcohol use disorders is powerful. The study authors write:
“As a licensed profession that influences all aspects of society, economy, and government, levels of impairment among attorneys are of great importance and should therefore be closely evaluated.”
The levels of impairment have been evaluated, and the results are clear: due to a combination of their elevated rates of both problem alcohol use and experience of mental health symptoms – particularly symptoms of depression and anxiety – lawyers are at an increased risk of developing an alcohol use disorder – and the risk is higher for lawyers early in their career than for those later in their career. The study authors write:
“[B]eing in the early stages of one’s legal career is strongly correlated with a high risk of developing an alcohol use disorder…the highest rates of problematic drinking were present in attorneys under the age of 30 (32.3%), followed by attorneys aged 31 to 40 (26.1%), with declining rates reported thereafter.”
What treatment providers can do – from addiction professionals to primary care physicians – is understand that while all lawyers are at risk of problem drinking, young lawyers are (1) at high risk of developing a full-blown alcohol use disorder, and (2) less likely than others to seek help when they have problems with alcohol or drugs.
This means that any physician treating a young lawyer, in any context, should pay special attention to the warning signs of addiction: disrupted relationships, problems at work, problems at home, sleep disruption, anger, irritability, sudden loss or gain of weight – all while creating an environment where their patients feel safe and secure in disclosing information they feel might put their career, reputation, and professional status in jeopardy.