Beyond the Silence: Removing the Stigma Around Addiction
As the National Task Force on Lawyer Well-Being reviewed the research published in the Journal of Addiction Medicine in 2016 and thought about what we could do to improve our professional well-being in general and our struggles with substance use in particular, we recognized that we needed to change our very culture. No one develops a substance use disorder solely because they work in the legal profession, but we have a professional culture that is very hospitable to the development of addictions and particularly alcohol use disorders. Factors that make it easier to develop an alcohol use disorder include long hours, the adversarial process, the isolation, the level of responsibility, a culture that accepts and even applauds drinking and a culture that values individual freedom and is reluctant to interfere in the affairs of a colleague. If you have ever lost a colleague to an addiction or a suicide you will recognize that this “reluctance to interfere” can be taken to a deadly extreme. On a broad level changing our professional culture means changing the ways we think and behave.
Changing our thinking about addiction will help to dissolve the stigma that currently surrounds both addiction and help-seeking behavior. Lawyers do not seem to have difficulty seeking treatment for dental problems. They will even encourage each other to get a knee or a hip problem checked out or share the name of their physical therapist. But when it comes to problems with alcohol . . . silence. We need to remove the stigma around seeking help for an alcohol problem. Research shows that the most effective way to reduce stigma around addictions is one-on-one contact with a person in long-term recovery. We can do more to create opportunities for lawyers in long-term recovery to speak, author articles and meet with people one-on-one. And, we can learn to talk to each other more openly about problems with the use of alcohol and, thus, break the silence around this difficult subject.
Another significant way to change the way we think is to be mindful of the language we use. We need to talk about addiction with the same respect we give other medical conditions. As lawyers we know the importance of the words we choose to use. Our American society needs to change the language around addiction and we, the legal profession, need to lead the way. We need to talk about a person who has a substance use disorder or an addiction or a problem with substances or a person in long-term recovery and stop using derogatory terms such as addict, alcoholic or drunkard. We need to accurately describe urine screens as “positive or negative” and move away from terms such as “dirty or clean.” When a diabetic’s blood work is disappointing to the doctor and dangerous for the patient, the bloodwork is not described as “dirty.” To reduce the stigma around these illnesses, the medical profession has changed the diagnosis for a problem with substances from “substance abuse or dependence” to “substance use disorder.”
While these changes in thinking and language are important, we in the legal profession also need to look at how our behavior contributes to our culture of drinking. I have attended lawyer functions where many people had a drink or two and everyone had a pleasant time. I have also attended functions where I was asked to evaluate whether to call 911 for a lawyer who had consumed a hazardous amount of alcohol during the function. At least in this situation the lawyer was connected to me and the lawyer assistance program so that immediate and longer-term interventions could be implemented. Too often the response to such a situation is to ignore behavior that is, in fact, a warning sign. We need to be clear about what is appropriate social drinking and be willing to confront our peers about hazardous drinking.
When there is a heavy emphasis on drinking – at the cocktail hour, at dinner and at the beer tasting after dinner – it becomes uncomfortable for lawyers and judges who do not want to drink. People choose not to drink because they are in recovery, because they have another medical condition or take a medication that is not compatible with alcohol use, because of religious reasons, because of family history, because they are training or trying to lose weight or because they simply don’t like it. Many of those people will avoid events with a heavy emphasis on alcohol, where they feel they will not fit in or be welcome. We inadvertently exclude some interesting, talented people in this way. And, if you talk to people who have worked in other professions, they will tell you that the focus on alcohol at lawyer functions is much more pronounced than at other professional functions. This emphasis on alcohol is not inevitable in the legal profession. We can create events where it is acceptable to drink alcohol or not drink alcohol. We can create events where the focus is on socializing, meeting new people, having fun or learning new things, and alcohol plays a minor role or no role at all.
We can offer substance use support groups at our larger functions or within larger organizations. Hosting such groups shows respect and support for those seeking help and managing a challenging health condition. I know of large companies that host cancer support groups. Why not host substance use support groups?
Systemic Support for Change
There are also systematic ways to accelerate this change in our thinking and our behavior. We can alter CLE requirements to include well-being topics including addiction and the importance of seeking help for all mental health challenges, as well as strategies for maintaining optimal health and performance. We can make sure that resources for help are readily available and accessible for everyone in the profession.
I want to congratulate New York on removing questions about mental health diagnoses or treatment from the bar exam application. This removes a barrier for law students wanting to seek help and serves as a great example of systemic change that makes a big difference. We can evaluate whether there are other applications within our profession that still ask about diagnosis or treatment in a stigmatizing manner that discourages help-seeking.
Disciplinary responses to professional misconduct can be tailored to fit whether the judge or lawyer is “sick, dumb, or bad.” A mentor of mine told me this 20 years ago and it still holds true. A “sick” professional needs medical care and a recovery plan. A professional who is “dumb” may need education, coaching or mentoring. Diversion may be particularly appropriate for some in one of these first two categories. With diversion a lawyer with a substance use or other mental health problem or lacking knowledge or skill may be provided the resources and assistance needed to return to a high level of practice. Someone who is intentionally misbehaving or “bad” needs consequences. Of course, some lawyers engaged in professional misconduct may fit more than one of these categories and require a comprehensive response. Our response to professional misconduct should be tailored appropriately if we want the behavior to change and the public to be protected.
I encourage everyone to review the Report of the National Task Force on Lawyer Well-Being or at least the first three pages that lay out the recommendations for the profession. I challenge everyone to find two or three of the recommendations that you can pursue to create the positive change in our culture that the research and our experience so clearly support. If we all pursue the changes in thinking and behavior that are within our power, together we can create a culture that is significantly less hospitable to addictions.
Terry L. Harrell, Executive Director of the Indiana Judges and Lawyers Assistance Program, graduated from Maurer School of Law and is a Licensed Clinical Social Worker (LCSW), a Licensed Clinical Addictions Counselor (LCAC) and has a Master Addictions Counselor certification (MAC). Terry is active with the Indiana State Bar Association and is a Fellow of the Indiana Bar Foundation. She serves on the American Bar Association’s Commission on Lawyer Assistance Program’s Policy and Well-Being Committees and serves on the National Task Force on Lawyer Well Being and as an advisor on the New York State Bar Association Attorney Well-Being Task Force.