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Dear Patrick:

What advice do you have for a busy lawyer to get help for an addiction and mental health problem without suffering a career setback? I have a colleague who should really take some time off and get well, but she is unwilling to step away from her practice out of fear of losing any part of what she has built.

M in Chicago

Dear M:

I'm going to largely sidestep what would be, in a perfect world, the inherent ethical irony of your question: that a busy, practicing lawyer would be unwilling to stop handling clients' important matters for any period of time necessary to address a substance use or mental health problem because they don't want to harm their career.

The fact that it is even a choice—and that I'm about to tell you how widespread a conundrum it is—says something unfortunate about how casually our profession views the relationship between substance abuse, mental health and fitness to practice.

Your colleague's fear is exceptionally common, and one I have heard expressed on countless occasions. During my time directing a clinical treatment program for attorneys, judges and law students, I would frequently speak by phone with people who were considering treatment but had questions for me as they were weighing their options for how to best address their situation.

The most common concern? That their career or practice would suffer if they took time off. My response? Focus on the big picture and stop making excuses.

Assuming your friend does have a substance use or mental health problem, there is never going to be a “good time” to address it, but there will be “less bad” times, such as before any major consequences occur.

Now, it's been a few columns since I've quoted song lyrics, so let me bring The Clash into the equation. When pondering the time old question, “Should I stay or should I go?” those legends of British punk opined, quite correctly, that “if I go there will be trouble, and if I stay it will be double.” When it comes to the decision about whether to seek help for an addiction or mental health problem, truer words have rarely been spoken. Or sung.

Yes, it's true that taking time off to get well presents a legitimate challenge, and any number of practical obstacles. It is equally true that over time, unaddressed substance use and mental health problems have the potential to end a career outright, or at least inflict heavy damage. So, yeah, if she goes there will be trouble, but if she stays, it will—or at least could be—double.

By way of analogy, a dispassionate analysis of your colleague's situation yields a pretty straightforward conclusion: Delaying treatment while remaining immersed in a stressful environment makes about as much sense as knowing you have a heart condition and continuing to gorge yourself on cheeseburgers, while you avoid the cardiologist out of fear of what it could do to your practice. Play that game long enough, and at some point your practice becomes irrelevant.

(Sidebar: Without diminishing or disputing the real and credible challenges that lawyers may face while trying to step away from their practices to seek treatment or otherwise get well, those challenges are also sometimes greatly exaggerated and overemphasized as part of an organic manifestation of the disease process for which treatment is needed in the first place. In other words, denial, rationalization, excuse-making and distorted thinking are part and parcel of the psychology of addiction, and people aren't always quite as busy and utterly indispensable as they say or think.)

As to your question, there are many good ways to get help without suffering a career setback, or at least not a significant one. Without knowing more about your colleague's history, or any formal diagnoses she may have, it is hard to say what level of care would be appropriate for her, and therefore how much time she would need to be away from the office.

If her condition is such that outpatient care would meet her needs, she may not need to be away much at all. If her struggles are more serious, she could be away for 30 days or more. But by viewing this situation for what it is—a medical issue that, if left unresolved, could have serious consequences—her priorities will hopefully come into focus and allow her to take whatever logistical steps are necessary to facilitate getting well.

Finally, I'll say that any amount of time she takes off will be an investment that pays substantial long-term dividends. I can say unequivocally that lawyers who are able to successfully address their substance use and/or mental health problems end up as better lawyers. Not only better than the lawyer they were prior to getting well, but often better than many of the other lawyers around them. In addition to being free from an active or untreated addiction or mental health problem, they will be more clear-headed, reliable, stable, energetic, focused and even-tempered.

If those aren't rewards worth prioritizing, I don't know what would be.

Have a question? Send it to [email protected], and I'll see you back here in two weeks.

Patrick R. Krill is the founder of Krill Strategies, a behavioral health consulting firm focused exclusively on the legal industry. Go to www.prkrill.com for more information.