2016 COLLABORATIVE STUDY RESULTS Presented By: Carol P. Waldhauser, Executive Director THE DELAWARE LAWYERS ASSISTANCE PROGRAM (DE-LAP) DELAWARE’S SMALL FIRMS AND SOLOR PRACTITIONERS CONFERENCE APRIL 1, 2016 Carol Waldhauser/DE-LAP 9/17/2018

The current rates of substance use, OUTLINE OF SLIDES: The current rates of substance use, depression and anxiety within the legal profession. Utilization of services Current barriers to seeking help Carol Waldhauser/DE-LAP 9/17/2018

RESEARCH DATA COMPILED BY: Thank you to the ABA, Hazelden Betty Ford Foundation, all bar associations, regulators, committee members, CoLAP staffers and each and every contributor for bringing this project to fruition. Note that in some states discipline agencies helped, impossible to list everyone but want all to know we are grateful for all the assistance we received. Carol Waldhauser/DE-LAP 9/17/2018

History and background of the project: Co-facilitators Linda Albert, LCSW, CSAC, CoLAP Commissioner, Wisconsin Lawyers Assistance Program Manager Patrick R. Krill, J.D. L.L.M., Director, Hazelden Betty Ford Foundation, Legal Professionals Program 2013: Hazelden Betty Ford Foundation approaches the ABA to discuss potential for an innovative collaboration; both organizations recognize the critical need for reliable behavioral health data in the profession. 2014: ABA/HBFF collaboration officially begins; project team is formed, study is designed and administered. Data collection begins. 2015: Data collection concludes, data analysis commences, manuscript reporting key results is prepared and submitted for peer review at a scientific journal. 9/17/2018 Carol Waldhauser/DE-LAP

Historical efforts to understand the impact of behavioral health problems on the legal community Previous data was both limited and outdated. (1996) Attempts to address attorney addiction, depression and impairment were greatly handicapped by lack of current, reliable and persuasive data Frustrations of working with old data in a field resistant to change Rate of “problem drinking” among attorneys estimated to be 18% in 1990 study. This study was based on data from roughly 1200 attorneys in 1 state (WA) Same study found approximately 19% of Washington lawyers experienced statistically significant elevated levels of depression. Limited studies have also demonstrated a strong link between substance abuse and malpractice/discipline. (60% of malpractice claims and disciplinary cases involved substance abuse; 85% of trust fund violations) Carol Waldhauser/DE-LAP 9/17/2018

WHY IS THIS DATA IMPORTANT? Data will help initiate, inform and guide important decision-making and policy development in the following key areas: Resource allocation for Lawyer Assistance Programs Bar examination and admission requirements Law school curriculum requirements; Continuing legal education requirements Discipline guidelines and regulatory association procedures Malpractice reduction strategies Monitoring Referral to treatment Delivery of treatment services Public awareness and stigma reduction Cultivating increased career satisfaction and longevity Carol Waldhauser/DE-LAP 9/17/2018

THE PUBLICATION The Prevalence Of Substance use and Other mental Health concerns Among American Attorneys Authors: Krill, Patrick, Johnson, Ryan, Albert, Linda Journal of Addiction Medicine: January/February issue, 2016 Carol Waldhauser/DE-LAP 9/17/2018

ABA/Hazelden Betty Ford Study-2015 12,825 licensed employed attorneys & judges Males 53.4% Females 46.5% Transgender .1% Diversity of race Asian 1.2% Black/African American 2.5% Caucasian/White 90.9% Latino/Hispanic 2.6% Native American .3% Other .7% Missing .5% Although we gathered 15,000 surveys the selection criteria for participation was being a licensed lawyer and working in a legal position. This narrowed down the available subjects to 12, 825 participants from 19 different States across the country with good regional representation. Carol Waldhauser/DE-LAP 9/17/2018

Professional Characteristics Break down of number and percentage of participants in years in the field, and work environment DE-LAP

Professional Characteristics (cont.) Characteristics continue regarding firm position, hours works and hours of litigation. We thought we’d see a higher percentage of distress symptoms with litigators but we didn’t. DE-LAP

SUBSTANCE USE FINDINGS Carol Waldhauser/DE-LAP 9/17/2018

Alcohol Use- AUDIT 10 20.6 % scored at a level consistent with problematic drinking-Using Audit 10 = problem behaviors and levels of use Problematic drinking = hazardous drinking and possible dependence More males (25.1%) than females (15.5%) among lawyers Using the Audit 3 = levels of use Physicians 15% problematic drinking Lawyers 36.4% More females than males among lawyers Position in the field Higher scores for those working in private firms or Bar Associations For our study we utilized the Audit 10 which has ten questions. The Audit ten focuses on amount, frequency and consequences of use. The physician study used the Audit 3 which has three questions and focuses on amount and frequency of use. We analyzed our data using just the Audit 3 so we could compare to another professional group, doctors. When we did this we found the rate of problematic drinking for lawyers increased to 36.4% compared to 15% for physicians. Possibly this is due to lawyers being self regulating and not under the scrutiny of physicians in their practice. In other words, lawyers “may” be able to drink larger amounts and more frequently and avoid the consequences whereas physicians are unable to do this without being detected. This is a theory only. I do not know why lawyers in Bar Associations had higher levels of problematic drinking. The sample was small but it was a significant finding. Carol Waldhauser/DE-LAP 9/17/2018

MORE RAW DATA: Carol Waldhauser/DE-LAP 9/17/2018

Summary Statistics for Alcohol Use Disorders Identification Test (AUDIT) (cont.) Private firm or bar association and Junior associates had the highest levels.

Self Reporting-Concerns 22.6% felt their use of alcohol or substances was a problem sometime during their lives 27.6% reported problematic use prior to law school 14.2% reported problematic use started during law school 47.7 % reported problematic use started within the first 15 years following law school 14.5% reported problematic use started more than 15 years after law school. We asked the questions whether “you ever thought your use of alcohol or other substances was a problem: if “yes” then before, during law school, within 15 years after law school or more than 15 years out. Results above. Carol Waldhauser/DE-LAP 9/17/2018

Regression Analysis-predictive validity of age, position and years in the field Age 30 and under higher Audit and Audit C scores-more hazardous drinking Less years working in the field = higher Audit scores Working in a private firm or for a bar association yielded higher Audit scores AUD I T SCORES High This was a progression analysis on the instruments, not on the self-report information. We see the reverse relationship to ages, years in the field and positions. Younger, less experienced working in lower positions had the highest AUDIT scores Low Less More AGE AND YEARS IN THE FIELD Carol Waldhauser/DE-LAP 9/17/2018

DRUG USE-DAST Smaller sample 26.7% completed the DAST n= 3419 Low rates of abuse = 76% Intermediate = 20.9% Substantial = 3.0% Severe = .01% The Drug Abuse Screening test was developed in 1982 and is still an excellent screening tool. The DAST has exhibited valid and psychometric properties and has been found to be a sensitive screening instrument for the abuse of drugs other than alcohol. We had a much smaller sample, 3,419 people completed this instrument. We don’t know if concerns about revealing use of illegal substances or abuse of prescription medications lowered the willingness of people to participate or if markedly fewer lawyers engage in this behavior. However, it was still a large group and noted is that of that group 24% were in the intermediate to severe range of drug abuse. Carol Waldhauser/DE-LAP 9/17/2018

Answer to “what substances have you used within the last 12 months?” Carol Waldhauser/DE-LAP 9/17/2018

Taken from the manuscript-stimulants being the drug used most commonly among attorneys after alcohol. Carol Waldhauser/DE-LAP 9/17/2018

40% of the smaller group replied yes to these substances and roughly 15.5 % of that group had or is using without a script. So vast majority of attorneys that used these substances are using them with a script. However think about the risk behavior for those licensed attorneys working in the field engaging in using medication without a script which means getting and using it illegally. Carol Waldhauser/DE-LAP 9/17/2018

MENTAL HEALTH FINDINGS Carol Waldhauser/DE-LAP 9/17/2018

Depression, Anxiety and Stress Scale = DASS-21 Males higher levels of depression than females Same inverse relationship Rates decreases as age increased Junior positions = higher rates The DASS is a 21-item questionnaire which includes three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. Men higher levels of depression than females Carol Waldhauser/DE-LAP 9/17/2018

Self Reporting of Mental Health Concerns Anxiety 61% Depression 45.7% Social Anxiety 16.1% ADHD 16.1% Panic Disorder 8.0% Bipolar Disorder 2.4% Self report Question relates to mental health concerns over the course of their legal career. Interesting that most reported anxiety even thought the instruments picked up depression at a higher percentage. Possible that some people may interpret their symptoms of depression as anxiety versus depression, with ruminating thoughts, sleep problems or general unrest. Carol Waldhauser/DE-LAP 9/17/2018

Help Seeking Behaviors- Two Common Barriers Not wanting others to find out they needed help-Stigma Concerns regarding privacy or confidentiality No one can know The question was asked separately for AODA and MH. “have you ever received services, treatment or help for your alcohol or drug useage? This included self help groups, religious services etc. The rates were very, very low considering the high rates of problematic drinking and depression and anxiety. Carol Waldhauser/DE-LAP 9/17/2018

This represents mental health services or support groups of any kind. Carol Waldhauser/DE-LAP 9/17/2018

Barriers to AODA Treatment Barriers to getting help for alcohol or drug problems Carol Waldhauser/DE-LAP 9/17/2018

Majority of services for MH cited as individual therapy (89 Majority of services for MH cited as individual therapy (89.5%)- in other words of the 37% who got help for MH they sought it through individual therapy. AODA = Self Help (58.8%) closely followed by Individual Therapy (54.4%)-majority of the 7% who got help for AODA they sought it through self-help groups followed by individual therapy. Carol Waldhauser/DE-LAP 9/17/2018

AODA BARRIERS Concerns not drastically different for the different areas. Significantly more people with AODA problems (67%) didn’t want others to find out versus (55%) with MH problems felt that way. Privacy and confidentiality also higher % concerned with AODA (64%) versus MH (47%). I think this reflects that for lawyers it is possibly more acceptable to get help for MH concerns or to have a MH concern that it is an AODA problem. Carol Waldhauser/DE-LAP 9/17/2018

Denial? Justification? STIGMA Who wants to be associated with this? Carol Waldhauser/DE-LAP 9/17/2018

Don’t really like the 61% that are neutral to very unlikely to use a LAP.  Carol Waldhauser/DE-LAP 9/17/2018

Concerns about using a LAP paralleled concerns about getting treatment or help of any kind. Carol Waldhauser/DE-LAP 9/17/2018

What Have We Learned? Attorneys in the United States have significantly higher rates of problematic drinking and mental health problems than the general population. According to the Substance Abuse and Mental Health Services Administration 6.6% of adult Americans experienced a major depressive episode in 2014 and 6.4 had an alcohol use disorder.* Younger, less experienced lawyers working in small firms or bar associations have higher levels of distress symptoms than their older, more experienced peers. Lawyers don’t seek help for their behavioral health problems because they fear someone will find out and it will discredit them and possibly affect their license. *See http://www.samhsa.gov/atod/alcohol  Carol Waldhauser/DE-LAP 9/17/2018

TREATMENT/MH/AODA AGENCIES/ SOLIDIFY THE MESSAGE AND THE WORK LAW STUDENTS LAWYERS JUDGES LAW SCHOOLS ADMISSIONS BAR/ DISCIPLINE TREATMENT/MH/AODA AGENCIES/ Health Forums LAPS CLE Carol Waldhauser/DE-LAP 9/17/2018

AGAIN, SPECIAL THANK YOU TO: TO: The ABA CO-LAP COMMISSION, Linda Albert, Wis. LAP Hazelden Betty Ford Foundation FROM: The Delaware Lawyers Assistance Program/DE-LAP Carol Waldhauser/DE-LAP 9/17/2018

DE-LAP THANK YOU 405 N. KING STREET, SUITE 100 B WILMINGTON, DELAWARE 19801 CALL: private/confidential line: (302) 777-0124 Or e-mail cwaldhauser@de-lap.org Carol Waldhauser/DE-LAP 9/17/2018