The Protective Wall of Human Community - The New Evidence on the Clinical and Public Health Utility of Twelve-Step Mutual-Help Organizations and Related Treatments

Research conducted by John Kelly, PhD, ABPP
Substance use disorders are often chronic conditions conferring a prodigious burden of disease, disability, and premature mortality in most middle- and high-income countries. Ubiquitous mutual-help organizations (MHOs), such as AA, despite being community-based and peer-led, are a de facto part of most societies’ response to addressing the endemic problems caused by substance use disorders and are the most commonly sought source of help for alcohol and other drug (AOD) problems. Until recently little was known from a rigorous scientific standpoint about the clinical and public health utility of these organizations or about the efficacy of the clinical interventions (twelve-step facilitation [TSF]) designed to facilitate their use during and following treatment. Following a call for more research from the Institute of Medicine of the National Academy of Sciences in 1990, a flurry of rigorous randomized controlled trials (RCT), cost effectiveness analyses, and studies of the mechanisms through which the largest recovery MHOs, AA, confers benefit, has revealed that AA and TSF interventions are valuable, empirically-supported, highly cost-effective interventions that confer benefit through dynamically mobilizing a variety of therapeutic mechanisms. AA and similar freely available community-based 12-step and non-12-step (e.g., SMART Recovery) MHOs may be the closest thing public health has to a “free lunch.”

The Perfectionist Paradox - Report on 2024 Lawyer Perfectionism Study

2024 – Research conducted by Patrick Krill, Jordana Confino, and Jens Näsström

In 2024 NALP collaborated in a joint research project on perfectionism in the legal profession, lawyer mental health, and well-being. This study aimed to understand the mental health challenges faced by lawyers, taking into consideration both working conditions and often-overlooked individual psychological profiles, in order to support future interventions designed to promote mental health and well-being in the legal profession. The findings suggest that lawyers are negatively impacted by the effects of perfectionism when it comes to both well-being and professional performance. Unlike innate traits, perfectionism is learned and is therefore malleable. Cognitive-behavioral therapy (CBT) and coaching are two approaches that can dial back perfectionism’s worst effects. Read the full report to learn more about:

  • The relationship between perfectionism and mental health challenges, including stress, depression, and workaholism.
  • The link between perfectionism and professional hindrances, including resistance to feedback and reduced engagement, motivation, and longevity.
  • Recommendations for mitigating the negative effects of perfectionism on both the individual and institutional levels – without compromising work quality.

Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attrition among licensed attorneys

May 2021 – Research conducted by Justin Anker and Patrick Krill

Abstract: Rates of mental illness and heavy alcohol use are exceedingly high in the legal profession, while attrition among women has also been a longstanding problem. Work overcommitment, work-family conflict, permissiveness toward alcohol in the workplace, and the likelihood of promotion are all implicated but have yet to be systematically investigated. Data were collected from 2,863 lawyers randomly sampled from the California Lawyers Association and D.C. Bar to address this knowledge gap. Findings indicated that the prevalence and severity of depression, anxiety, stress, and risky/hazardous drinking were significantly higher among women. Further, one-quarter of all women contemplated leaving the profession due to mental health concerns, compared to 17% of men. Logistic models were conducted to identify workplace factors predictive of stress, risky drinking, and contemplating leaving the profession. Overcommitment and permissiveness toward alcohol at work were associated with the highestlikelihood of stress and risky drinking (relative to all other predictors) for both men and women. However, women and men differed with respect to predictors of leaving the profession due to stress or mental health. For women, work-family conflict was associated with the highest likelihood of leaving, while overcommitment was the number one predictor of leaving for men. Mental health and gender disparities are significant problems in the legal profession, clearly requiring considerable and sustained attention.

The Path to Lawyer Well-Being: Practical Recommendations for Positive Change from the National Task Force on Lawyer Well-Being

The Task Force* was created in 2017 in response to the findings of the 2016 ABA Hazelden Study. This report’s recommendations focus on five central themes: (1) identifying stakeholders and the role each of us can play in reducing the level of toxicity in our profession, (2) eliminating the stigma associated with help-seeking behaviors, (3) emphasizing that well-being is an indispensable part of a lawyer’s duty of competence, (4) educating lawyers, judges, and law students on lawyer well-being issues, and (5) taking small, incremental steps to change how law is practiced and how lawyers are regulated to instill greater well-being in the profession.

* The Task Force included the ABA Standing Committee on Professionalism; ABA Center for Professional Responsibility; ABA Young Lawyers Division; ABA Law Practice Division Attorney Wellbeing Committee; The National Organization of Bar Counsel; Association of Professional Responsibility Lawyers; National Conference of Chief Justices; National Conference of Bar Examiners and the ABA Commission on Lawyer Assistance Programs.

Suffering in Silence: The Survey of Law Student Well-Being and the Reluctance of Law Students to Seek Help for Substance Use and Mental Health Concerns

Autumn 2016 – Research conducted by Jerome M. Organ, David B. Jaffe, and Katherine M. Bender, Ph.D.

This article reports the results of the Survey of Law Student Well-Being (SLSWB) implemented in spring 2014 at fifteen law schools around the country. The SLSWB is the first multi-school study in over twenty years to address law student use of alcohol and street drugs, and the first-ever multi-school study to explore prescription drug use and the mental health concerns and help-seeking attitudes of law students. The results of the study indicate that roughly one-quarter to one-third of respondents reported frequent binge drinking or misuse of drugs, and/or reported mental health challenges. Moreover, the results indicated that significant majorities of those law students most in need of help are reluctant to seek it. The article concludes by discussing how law school administrators and other relevant leaders within the legal academy and legal profession can promote and improve wellness so that law students are better-positioned to find success as law students and to serve their future clients well as lawyers.

Problem signs in law school: Fostering attorney well-being early in professional training

May 2016 – Research conducted by Krystia Reed, Brian H Bornstein, Andrew B Jeon, and Lindsey E Wylie

Abstract: Attorneys suffer from high rates of stress, alcoholism, and mental health problems that are costly for the legal system and impair their abilities to serve their clients. There is some indication that these problems begin in law school. The present study assessed a cohort of law students at an American law school for their reported levels of stress, depression, anxiety, substance use, and overall adjustment/coping. Findings indicate that law students suffer from high levels of stress, anxiety, depression, and alcohol use, and that these problem behaviors fluctuate throughout the course of law school. We discuss the implications for law student/lawyer well-being and legal education.

The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys

February 2016 – Research conducted by Patrick R. Krill, JD, LLM, Ryan Johnson, MA, and Linda Albert, MSSW

The first nationwide empirical study in 25 years confirms lawyers have significant drug or alcohol problems or mental health problems, more so than other professionals or the general population. And lawyers are not seeking the help they need, for the wrong reasons. Researchers hope this data will promote change within the profession.