In last week's column on the ALM Survey on Mental Health and Substance Abuse, I covered the key takeaways from the responses to the survey, which came from ALM 200 law firm leaders.

In this column, I  focus on the specific issue of the stigma surrounding addiction and mental health problems in a law firm setting.

As someone who has researched the issue and written and spoken extensively for years about why it is that lawyers struggle with problematic substance use and mental health distress more than nonlawyers, I believe the culture of the legal profession—often starting in law school—deserves more attention as one of the keys to improving the situation. At the root of that culture are our personal beliefs about substance abuse, addiction and mental health problems—beliefs that are both directly shaped by, and clearly reflected in, prevailing institutional norms about what types of behaviors and conditions are acceptable for someone who calls themselves a lawyer.

Make no mistake, those beliefs are largely problematic.

The overwhelming majority of respondents to our survey reported a stigma in the legal profession related to addiction to alcohol or drugs (94 percent), depression (81 percent) and anxiety (75 percent). These findings help explain, in part, one of the main takeaways from the 2016 ABA/Hazelden Betty Ford study that I co-authored about the prevalence of substance use and mental health disorders in the legal profession: Lawyers don't seek help for their problems because they fear that someone will find out. Assuming you were an attorney at a large firm, where stigma around behavioral health issues clearly exists, it is perfectly understandable why you would fear others finding out that you had a problem and needed help.

The challenge for firm management—and for all of us—thus becomes how to reduce the stigma surrounding substance abuse and mental health problems and increase comfort with seeking help. It means being less judgmental, especially around problems that the profession itself often causes.

It's important to note that, while it may be worse among lawyers, stigma around addiction and mental health is not confined to the legal profession, and some aspects of the attitudes we uncovered in Big Law align with research on addiction and mental health stigma in the general population.

For example, our survey suggests that mental health problems are less stigmatized than addiction at these firms, something that is consistent with what we know about attitudes in the broader public. At the same time, however, there seems to be less of a divergence in Big Law than the general population when it comes to the differing levels of stigma between the two conditions.

First on alcohol abuse and addiction: While it is true that most people who occasionally abuse alcohol do not develop an addiction to alcohol, alcohol abuse is almost universally a predicate of alcohol addiction, a condition that has been recognized for half a century by the medical community as a chronic disease. To stigmatize alcohol addiction significantly more than alcohol abuse is analogous to strongly stigmatizing diabetes but not the unhealthy diet which precipitated it.

If firms are going to tolerate (or worse, encourage) unhealthy behaviors around alcohol, it is disingenuous to stigmatize the conditions that may arise as a result. Such attitudes are either hypocritical or demonstrative of a lack of appreciation for the consequences of the work environments firms sometimes create. Perhaps they are both.

Specifically, 78 percent of firms report there is no stigma attached to occasional alcohol abuse, meaning the behavior is clearly well tolerated and highly normalized. Yet, if that abuse turns to addiction, attitudes change quickly. This type of logic isn't the profession's best look. Research has shown that, when it comes to workplace culture, perceived permissive drinking norms are the strongest direct predictor of employee problem drinking, even more so than stress. If lawyers (and leaders) in large firms are going to stigmatize alcohol or other drug addiction, perhaps they should work harder to tackle the permissive drinking norms which can cause it.

Finally, on the causes of depression and anxiety, the survey results again demonstrate hypocrisy, a lack of appreciation for the consequences of the work environments we create or both. None would dispute that a career in Big Law is synonymous with long hours, high stakes and high stress. These are the costs that many lawyers view as outweighed by the numerous benefits of such a career, but they are also all factors which can cause depression and anxiety.

A meaningful exploration of the overlap between lawyering and known risk factors for depression (external stress; internal stress, such as perfectionism; conflict; frustration; feelings of inadequacy; and substance abuse) is beyond the scope of this article, but the point is that the overlap is significant. Same goes for anxiety, itself a frequent co-conspirator of depression. To land on intellectually honest ground, Big Law—and the entire legal profession—should work harder to combat the stigma associated with the mental health problems its demands frequently engender.

Next week's column will take a closer look at the causes of substance abuse and mental health problems in Big Law, and the fourth column in this series will discuss the policies, resources and education that firms are making available to address those issues. I hope to see you back here then!

The ALM Intelligence Compass full survey on the mental health and substance abuse is available here for Compass subscribers. Not a subscriber? Click here.

Patrick 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.

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