Arecent national ABAstudy on attorneymental health anddrinking has beengetting a lot of buzz.Pun intended. Basedon some small,

historic studies and anecdotally, to be sure, wehave known for years that attorneys are atgreater risk for depression, anxiety, and alcoholproblems than the general public and evenother professionals. This landmark study,however, is the first to ever bring into sharpfocus, with hard data and real numbers, whatwe are facing in our profession across aspectrum of mental health issues. The studywas conducted by the Hazelden Betty FordFoundation and the American Bar AssociationCommission on Lawyer Assistance Programs.The findings were published in the peer-reviewed Journal of Addiction Medicine inFebruary 2016.

Over 15,000 attorneys participated in thenational study, and the dataset was culled toretain only currently licensed and employedattorneys. Responses from attorneys who wereretired, unemployed, working outside of thelegal profession, suspended, or otherwise onany form of inactive status were eliminated,leaving approximately 12,800 responses.Demographics were diverse in both genderand race and captured a robust range of prac-tice settings, practice areas, years in practice,and positions held. This is the most compre-hensive data ever collected regarding attorneymental health, and the single largest dataset.

Drinking: 21% Drinking at Harmful orDependent Levels and 36% Drinkingat Problematic Levels

Study participants completed a ten-question instrument known as the AlcoholUse Disorders Identification Test (AUDIT-10), which screens for different levels of

problematic alcohol use, including hazardoususe, harmful use, and possible alcoholdependence. The test asks about quantity andfrequency of use and includes questions as towhether an individual has experiencedconsequences from drinking. The studyfound that 21% scored at levels consistentwith harmful use including possible alcoholdependence. Males scored higher at 25%,compared to 16% for women. Whenexamining responses purely for quantity andfrequency of use (known as the AUDIT-3),the study found an astonishing 36% ofrespondents drinking at problematic levels.While there is no hard and fast line to define“problematic” levels, problematic drinkingbehaviors can include drinking at lunch orregularly binge drinking. Binge drinking istypically defined as consuming enough tohave a blood alcohol content level of 0.08.That’s about four drinks for women and fivedrinks for men in a two hour timeframe.When the same AUDIT-3 screening measurewas used in a comprehensive survey ofphysicians, 15% of physicians reported use atthis level—less than half of the number ofattorneys reporting such use. It appears thatmore than one in three attorneys are crossingthe line from social drinking to using alcoholas a coping mechanism.

Shocking Reversal of EarlierFindings: Today’s Younger Lawyers atFar Greater Risk

In a significant reversal of a conclusionreached by the last documented, statisticallyvalid study—a 1990 study out of WashingtonState—the study found that younger lawyersstruggle the most with alcohol abuse.Respondents identified as 30 years or youngerhad a 32% rate of problem drinking, almostone in three, higher than any other age group.This finding directly contradicts theWashington study that found the longer an

attorney practiced, the greater the risk ofdeveloping problems with alcohol. That datareversal is very significant, signaling majorchanges in the profession in the last 20 to 30years. And with job prospects at an all-timelow, and student debt at an all-time high,these younger lawyers who are most in need oftreatment are least able to afford it. The LAPFoundation of NC, Inc. is working to bridgethat gap. Please see page 20 for the story.

Depression, Stress, and Anxiety: 28%Report Concerns with Depression

Depression and anxiety often go hand inhand. The study found that 28% of attor-neys, more than one in four, struggle withsome level of depression, representing almosta ten percent increase from the 1990Washington study. Males reported at a higherrate than females for depression. Nineteenpercent reported mild or high levels of anxi-ety, with females reporting at a higher ratethan males. Interestingly, when examiningthe full span of one’s career, approximately61% and 46% reported experiencing con-cerns with anxiety and depression, respective-ly, at some point in their career. Respondentsalso reported experiencing unreasonably highlevels of stress (23%), social anxiety (16%),attention deficit hyperactivity disorder(12.5%), panic disorder (8%), and bipolardisorder (2.4%). More than 11% reportedsuicidal thoughts during their career. Threepercent reported self-injurious behavior, and0.7% reported at least one suicide attemptduring the course of their career.

Like the findings associated with alcoholuse, mental health conditions were higher inyounger, less experienced attorneys and gener-ally decreased as age and years of experienceincreased. The study also revealed significantlyhigher levels of anxiety, depression, and stressamong those with problematic alcohol use,meaning mental health concerns often co-

What’s All the Buzz About?

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occurred with an alcohol use disorder.

Barriers to Seeking Help – No Surprises

As part of the study, participants wereasked to identify the biggest barriers to seekingtreatment or assistance. Categorically, fear ofbeing “found out” or stigmatized was the over-whelming first choice response. Regardingalcohol use, 67.5% said they didn’t want oth-ers to find out, and 64% identified privacyand confidentiality as a major barrier. Theresponses for mental health concerns for thesesame two reasons were 55% and 47%, respec-tively. Additional reasons included concernsabout losing their law license, not knowingwho to ask for help, and not having insuranceor money for treatment.

A surprising 84% indicated awareness andknowledge of lawyer assistance programs(LAPs), but only 40% would be likely to uti-lize the services of a LAP with privacy andconfidentiality concerns again cited as themajor barrier to seeking help through LAPprograms.

Help and Hope

The data is far more extensive than can beoutlined in this short article. There are tellingfindings about drug use, including use of pre-scription stimulants. Rates of depression, anx-iety, and problematic drinking were also cor-related to practice setting, with large firms andbar associations ranking highest. We can slicethe data and analyze it extensively for years tocome. But the key takeaway is that we nowhave hard data showing that one in three-to-four of us are at real risk and are not likely toseek out assistance.

Only 7% of participants reported that theyobtained treatment for alcohol or drug use,and only 22% of those respondents wentthrough programs tailored to legalprofessionals. Participants who sought helpfrom programs tailored specifically for legalprofessionals had significantly better outcomesand lower (healthier) scores than those whosought treatment elsewhere. This suggests thatprograms with a unique understanding oflawyers and their work can better address theproblems.

When I first took this job as director of ourNC LAP, I met a lawyer in a spin class. Shewas sitting on the bike next to me and recog-nized me because my photo had appeared in alocal bar newsletter. She said, “I hope I neverhave to call you or have need for your pro-gram’s services.” I thought about her com-

ment for a moment and said, “Our volunteersare some of the happiest, most balanced, mostresilient lawyers—people—you could everhope to meet. They don’t come to us that way.But if they follow our suggestions, theybecome so. And they even like being lawyersagain.” She said, “Wow. That’s cool. I neverthought about it like that.” Because we areconfidential, most lawyers never see the mira-cles of healing and regeneration that take placeevery day in the transformed lives of those

who are willing to pocket their pride and sim-ply ask for help. There is help and there ishope, and plenty of it. !

Robynn Moraites is the executive director ofthe North Carolina Lawyer Assistance Program.

Infographic reprinted with permission fromthe February 2016 Wisconsin Lawyer article,“Landmark Study: US Lawyers Face High Ratesof Problem Drinking and Mental Health Issues,”published by the State Bar of Wisconsin.

19T HE N ORT H CAROLINA STAT E BAR JOU R N AL