Medical professionals recommend assistance if two or more of the following CAGE questions are answered affirmatively:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or get over a hangover?

Health professionals are advised to diagnose GAD if the three following symptoms presents:

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
• The anxiety and worry are associated with three (or more) of the following six symptoms
• Restlessness or feeling keyed up or on edge;
• Being easily fatigued;
• Difficulty concentrating or mind going blank;
• Irritability;
• Muscle tension;
• Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
• The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not attributable to the physiological effects of a substance, another medical condition, and is not better explained by another mental disorder.

According to the DSM-5, medical professionals are advised to diagnose MDD if:

• Five or more of the following symptoms present and are experienced at least once a day for a period of two weeks:
• You feel sad or irritable most of the day, nearly every day;
• You are less interested in most activities you once enjoyed;
• You suddenly lose or gain weight or have a change in appetite;
• You have trouble falling asleep or want to sleep more than usual;
• You experience feelings of restlessness;
• You feel unusually tired and have a lack of energy;
• You feel worthless or guilty, often about things that wouldn’t normally make you feel that way;
• You have difficulty concentrating, thinking, or making decisions; and/or
• You think about harming yourself or committing suicide.
• Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.
• Mood represents a change from the person's baseline.
• Impaired function in one’s social life, work, or education.
• The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication), another medical condition, and the symptoms are not explained by any psychotic disorder.

It is widely believed among experts and an open secret in the legal community that many attorneys struggle with mental health issues, alcohol, and substance abuse. However, until a few years ago, virtually no studies have actually been conducted to assess the empirical and statistical evidence underlying this belief and so these issues had been mostly unexamined for decades.ⁱ New studies in the field tend to support higher than average rates of mental health and drug use among the legal community at large, and that young attorneys in particular are an significantly at risk of developing and suffering from alcohol abuse and mental health issues at rates substantially higher than their more senior counterparts.

The ABA, as part of its mission to promote professional competence as well as support its attorney members and the sustainable practice of law, funded a comprehensive study to determine the levels of mental health, alcohol and substance abuse within the profession, in addition to the factors relating to these issues.

Among other things, the study found an overall 20.6 percent of the respondents scored at a level signifying problematic drinking, and that the rate of problem drinking among younger attorneys (defined as 30 or younger) was 31.9 percent, a rate nearly double the rate disclosed by their colleagues aged 51 to 60, and again, nearly double the 14% problem drinking rate of general American public.ⁱⁱ Interestingly, if not surprisingly, risk factors for problematic drinking include working in private firms or for bar associations, with 27% of respondents reporting problematic use before law school and 43.7% developing within 15 years after matriculation.

ⁱⁱⁱ

Of all (including older) study participants who endorsed use of a specific substance class in the past year, stimulants had the highest rate of weekly usage at 74.1%, followed by sedatives (51.3%), tobacco (46.8%), marijuana (31%) and opioids (21.6%).^iv Most self-reported substance abusers’ drug usage was determined to be of low and intermediate concern, around 76% and 20.9% respectively, with the substantially and severely concerning usage rates determined to be 3% and 1%.^v

The most common mental health conditions reported were anxiety (61.1%), followed by depression (45.7%), social anxiety (16.1%), attention deficit hyperactivity disorder (12.5%), panic disorder (8.0%), and bipolar disorder (2.4%).^vi Women, the study found, were more likely than men to suffer from anxiety, while men were more likely to suffer from depression, and problematic drinking was found to positively correlate with both mental health conditions.^vii These mental health issues were found to track similarly to alcohol abuse in that they generally decrease as both age and years in the field increased.^viii

The issues faced by young attorneys represent a continuation of the trends, and expansion of the stress, that very often begins in law school. Nearly 80% of law students disclosed they were somewhat or very likely to seek help from a health professional for alcohol, drug, or mental health issues, but few actually did.^ix Likewise, while a self-reported 42% of law students thought they needed help for mental health concerns, only about half that group actually received counseling from a health professional.^x Discouraging factors reported by these students include threatened bar admission, job, academic status; social stigma; privacy concerns; and financial reasons.^xi This is of course alarming for law students, but is also particularly salient for young attorneys who have previously faced these issues during law school because research has shown that past behavior is the best predictor of present and future mental fitness.^xii

ⁱ Justin Anker, Ph.D, Attorneys and Substance Abuse, BUTLER CENTER FOR RESEARCH 1.
ⁱⁱ American Bar Association. Addressing Impaired Attorneys, https://www.americanbar.org/groups/law_practice/publications/law_practice_magazine/2019/MJ2019/MJ19Schimmerling/ (last visited Jan. 3, 2020).
ⁱⁱⁱ Patrick R. Krill, et. al., The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. OF ADDICTION MED. 46, 48 (2016). ^iv Patrick R. Krill, et. al., The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. OF ADDICTION MED. 46, 49 (2016).
^v Patrick R. Krill, et. al., The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. OF ADDICTION MED. 46, 49 (2016).
^vi Patrick R. Krill, et. al., The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. OF ADDICTION MED. 46, 49 (2016).
^vii Patrick R. Krill, et. al., The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. OF ADDICTION MED. 46, 49 (2016).
^viii Patrick R. Krill, et. al., The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, 10 J. OF ADDICTION MED. 46, 50 (2016).
^ix American Bar Association, National Task Force on Lawyer Well-Being, The Path to Well-Being: Practical Recommendations for Positive Change (2020), available at https://www.americanbar.org/content/dam/aba/images/abanews/ThePathToLawyerWellBeingReportRevFINAL.pdf
^x American Bar Association, National Task Force on Lawyer Well-Being, The Path to Well-Being: Practical Recommendations for Positive Change (2020), available at https://www.americanbar.org/content/dam/aba/images/abanews/ThePathToLawyerWellBeingReportRevFINAL.pdf
^xi American Bar Association, National Task Force on Lawyer Well-Being, The Path to Well-Being: Practical Recommendations for Positive Change (2020), available at https://www.americanbar.org/content/dam/aba/images/abanews/ThePathToLawyerWellBeingReportRevFINAL.pdf
^xii New York Bar Association, Working Group on Attorney Mental Health, The Impact, Legality, Use and Utility of Mental Disability Questions on the New York State Bar Application (2019), available at https://www.nysba.org/mentalhealthreport/