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In our survey of Am Law 200 leaders about substance abuse and mental health problems in large law firms, we asked them to opine about the causes. After all, who better to understand the situation on the ground than those who regularly encounter these problems among their lawyers?

Still, I was concerned that since these leaders generally lack expertise in addiction and mental health, their opinions would amount to nothing more than well-intentioned speculation.

Fortunately, in reviewing our survey's results on this question, I am left to believe that this group does in fact understand what is causing the problems, which should theoretically make solving them somewhat easier. Theoretically.

When asked to rank five possible causes for substance abuse and mental health problems in firms, the overwhelming majority of respondents (79 percent) cited stress and workload as the primary culprit and, in doing so, validated the countless anecdotes of former patients of mine, as well as my own observations and theories. The stress in the legal industry really can drive a lawyer to drink, use drugs, struggle with depression and anxiety, or all the above. I'll elaborate.

First, on stress and addiction: Stress is a well-known and well-documented risk factor for the onset of problematic substance use and addiction, as well for relapsing back into addiction after periods of abstinence and recovery. There is a significant amount of research on this, but you don't need the data to understand what is on some levels a common-sense equation.

Stress is a common experience for lawyers, and if your go-to solution for coping with it is drinking or using drugs, you are setting yourself up for frequent and excessive drinking or drug use. The more often this happens, the more reliant you are likely to become on your substance of choice, and soon your stimuli-response pattern (i.e. stress = drink or drug) becomes hardwired into your brain and your life. Even for the majority lawyers who abuse but do not become fully addicted to alcohol or drugs, the toll on their physical and mental health can be both significant and underappreciated.

Unfortunately, and unbeknownst to most drinkers who think that alcohol is helping them manage their stress, it is in fact an especially defective and self-defeating tool in that regard. Compelling studies have demonstrated how alcohol use itself exacts a psychological and physiological toll on the body that can compound the damaging effects of stress, while also prolonging recovery from a stressful event.

In other words, if you're stressed and have some drinks to deal with it, you may temporarily feel more relaxed once your blood alcohol content reaches a certain point, but your body is telling and experiencing a different and less pleasant story. (The same can be said for other drugs as well, though the metabolic processes and physical manifestations involved may vary.)

To make matters worse, drinking to cope with stress has the paradoxical effect of eventually reducing one's stress tolerance. Long-term heavy drinkers experience higher levels of anxiety when faced with a stressful situation than non-drinkers or moderate drinkers.

Finally, and perhaps most important when it comes to stress-drinking and the risk of addiction, stress can also decrease the pleasant effects of alcohol and therefore increase the craving for more alcohol to produce the desired effect.

Turning to stress and mental health, the relationship is just as straightforward. Excessive and chronic stress can lead to or exacerbate depression, anxiety, or both. Just as with addiction, some individuals will be more predisposed to depression and anxiety than others because of genetics, prior life experience, and innate characteristics, but even those with no heightened predisposition can find their mental health adversely affected by the chronic stress of the legal profession.

According to the 2016 American Bar Association/Hazelden Betty Ford study that I led on substance use and mental health disorders in the legal profession, the self-reported lifetime prevalence of depression among attorneys (47 percent) is roughly 2.5 times higher than in the general population (17 percent to 20 percent).

Clearly there is something unique and specific to the legal profession that is responsible for this disparity, and it isn't that the profession is somehow populated with a wildly excessive number of people predisposed to mental health problems. Rather it is, in large part, the chronic stress, as well as the lack of healthy coping skills that many lawyers have to deploy against that stress.

Given the high-stress nature of the legal profession (beginning in law school), the connection between stress, problematic substance use, and mental health can't be underscored enough. The stress levels of lawyers don't show any signs of abating, with technology and our constant state of connectedness only accelerating the pace of an already demanding profession. In fact, something I hear from large firms on a near-constant basis could be paraphrased as “there isn't much we can do about the incoming stress.”

Regardless of whether that is actually true in all contexts, moving away from a reliance on alcohol and drugs and toward healthier stress management techniques and resilience-enhancing behaviors has probably never been a worthier or more timely goal for the profession.

It is critical to note, however, that many highly stressful professions don't seem to suffer from the same high levels of behavioral health problems, so the stress alone can't take all the blame.

The factor in our survey viewed as the next most likely cause of substance abuse and mental health problems is a reluctance to acknowledge or discuss them, followed by a lack of support for personal well-being, social and cultural influences, and toxicity within the profession.

Going into this research project, I expected social and cultural influences to be ranked more highly, but our results suggest that, following stress, the conspiracy of silence around addiction and mental health continues to be a problem in Big Law. This would seem to explain, at least in part, why another highly educated, highly stressed profession—medicine—seems to be faring better when it comes to addiction specifically, reporting statistics that essentially align with the general population: They've been more willing to talk about the problem.

The legal profession is clearly making strides in that regard, with lawyer well-being, mental health and substance abuse now more frequent topics of discussion than ever before. Both the current and immediate past president of the ABA have made well-being a primary strategic focus of their terms, signaling a growing recognition of the importance of these issues for the future health of the profession.

At the same time, this survey also made clear that the stigma surrounding addiction and mental health in large law firms is alive and well, as discussed in the previous article in this series. As the legal profession continues to normalize the conversation about mental health and well-being, it is imperative that law firm leaders commit to preventing stigma, prejudice and fear from derailing those efforts, and that they begin to demonstrate greater support for well-being generally.

Next week's column will take a closer look at the policies, resources and education that firms in the Am Law 200 are making available to address addiction and mental health problems. I hope to see you back here then!

Read more:

Big Law Leaders Say Stigma Comes With Addiction and Mental Health Problems

ALM Survey on Mental Health and Substance Abuse: Big Law's Pervasive Problem

 

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.