Needs of Lawyers in Chemical Dependency
and Behavioral Health Treatment
By Jeffrey Friedman

“It’s just coke that you smoke”, the dealer said. “It’s direct.” John drew on the pipe and blasted off into the ecstatic edge of consciousness. This was John’s escape from the worries as well as the responsibilities of his family and his law practice. Unfortunately, within 60 days the drug owned him. So overwhelming was John’s addiction to this insidious drug that it destroyed his friendships, relationships, business interests and ultimately his life.

How did a prominent attorney get to this point? Why are attorneys at higher risk for addiction problems? And why are attorneys generally harder to treat?

A survey which solicited data on lawyers’ attitudes toward chemical dependency and other behavioral health treatment was recently completed. In the following article, Jeffrey Friedman reports on the findings of that research project. This piece is digested from the official report An Assessment of the Needs of Lawyers in Behavioral Health Treatment.

- Carol P. Waldhauser

A 1987 survey by the Washington State Bar Association revealed that in a random sample of constituent attorneys 18 percent suffered from chemical dependency, while 12 percent met diagnostic criteria for clinical depression. These numbers, significantly higher than those in the general population, are similar to the findings of other recent inquiries into the scope and nature of behavioral health issues as they exist within the legal community.

The high rate of substance abuse and other behavioral health issues among attorneys is thought by many mental health professionals to be a consequence of the pressures inherent in the practice of law – and the competitive personality traits of many attracted to the legal profession.  Lawyers tend to work and play hard. Drinking to solidify business and social camaraderie can easily evolve into drinking for the relief of stress.

Lawyers who enter substance abuse or behavioral health treatment often present a characteristic and familiar constellation of clinical issues. That most chemically dependent persons rationalize their substance use is well known to behavioral health therapists. This kind of intellectual justification can, however, become a serious impediment to progress in the treatment of a person who “thinks like a lawyer.”

Cottonwood de Tucson, a behavioral health treatment center in Tucson, Arizona, recently completed a study to investigate the chemical dependency and other behavioral health treatment needs of legal professionals and their attitudes toward such treatment, and to assess the degree to which their needs are being met by currently available treatment resources. 

Two survey instruments were developed specifically for the project. “Key Informant” questionnaires were sent to Lawyer Assistance Program (LAP) personnel in all 50 states and 11 Canadian provinces. “Target Population” questionnaires were distributed through the state and provincial LAPs to anonymous legal professionals who had previously engaged in chemical dependency or other behavioral health treatment. In all, 460 of each instrument were distributed. Data from these surveys was tabulated and subjected to a preliminary analysis before being presented in a round-table discussion comprised of state and national LAP professionals.

The survey instruments sought data in several specific areas, including:

• Lawyers’ attitudes toward treatment that tend to hinder the process of treatment and recovery

• Specific clinical strategies and interventions that lawyers found especially helpful in the treatment process

• Personal and professional qualities of therapists that lawyers in treatment responded to in a positive way

• Ways in which lawyers felt they were misunderstood by clinicians

• Specific ways in which chemical dependency/behavioral health treatment targeted to lawyers could be improved.

Sixty-three “Key Informant” surveys and 112 “Target Population” surveys were completed and returned by respondents. On review, obstacles to accessing treatment reported by survey respondents included the following:

• The primary obstacle that prevented target group informants from accessing care (70 percent) was the belief that they could handle the problem on their own.

• The second significant obstacle faced by target population respondents in making the decision to seek treatment (40 percent) was a concern regarding a potentially negative impact that decision might have on their professional reputation among peers, judges and potential clients.

Those surveyed also reported some perceived pockets of misunderstanding about lawyers among clinical professionals. These included:

• Underestimating or misunderstanding the lawyer’s sophisticated level of denial and highly-developed sense of being right

• Misunderstanding the fact that lawyers often use debate and verbal challenge as a way of discovering and testing the validity of important information rather than argument for its own sake

• Underestimating the enormous professional and social pressures which obtain in many lawyers’ lives.

Conclusions/Clinical Implications

The following conclusions are based upon an extended discussion of survey data with a number of LAP directors and staff members. It was felt that lawyers can best be treated in a milieu of like-cases and integrated with non-lawyers into primary therapy groups as long as lawyer-specific, psycho-educational activities are also available. This is one way in which the special psychological, social and professional realities faced by attorneys can be addressed while reinforcing the commonality of challenges faced by all people in recovery. In order to be optimally responsive, the discussion group felt that behavioral health treatment targeted to lawyers should include:

• Well-trained and experienced clinicians with strong verbal skills and ample ego strength who won’t be overwhelmed or intimidated by highly intelligent and often aggressive personalities

• A strong psychiatric component able to diagnose and treat co-occurring disorders such as depression, bi-polar disorder and PTSD [Post-Traumatic Stress Disorder]

• The availability of respected and successful recovering attorneys who can serve as role models and mentors for lawyers in treatment. This should include patient access to lawyer-specific 12-step meetings (for example, AA)

• An ability and willingness to engage with Lawyer Assistance Programs and involve the LAPs in the continuing-care planning process. Aftercare planners should have detailed information on support resources available through their state or provincial LAP to give discharged patients and strongly advocate that the patient join the LAP if he or she is not already involved

• A strong experiential component (e.g., psychodrama, gestalt therapy) to engage patients on a level other than intellectual

• A sophisticated explanation of medical aspects of chemical dependency and mood disorders, including access to professional level journal articles.

For additional information on this study, or to obtain the full needs assessment report, please contact Jeff Friedman at (800) 877-4520 or by e-mail at jeff.friedman@cottonwood detucson.com.

Moreover, if you or someone you know needs help, treatment and support to overcome their abuse of or dependence on  alcohol, illicit drugs, prescription drugs, food, the Internet, sexual behavior and/or other addiction issues, contact the MSBA Lawyer Assistance Program at (800) 492-1964, ext. 251 or 252, or e-mail cwaldhauser@msba.org. Remember, the MSBA Lawyer Assistance Program is a free, confidential service for both members and non-members of the Maryland State Bar; we do together what we cannot do alone.

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Publications : Bar Bulletin: December, 2003