Among most striking statistics cited in the new national study of lawyer well-being is not the burnout rate that dominated the headlines, although nearly half of respondents did screen positive for high burnout. Of roughly 37,000 lawyers surveyed by the American Bar Association’s Commission on Lawyer Assistance Programs and Krill Strategies, 41.8 percent screened positive for risky drinking, yet only 2.3 percent reported a current alcohol use disorder diagnosis. A statewide study released by the Illinois Lawyers’ Assistance Program on October 13 found the same pattern, with 82 percent of the lawyers who screened at high risk for alcohol use disorder never seeking help, a result that arrived independently of the national data and points in the same direction. Most coverage has treated lawyer risky drinking as a footnote to the burnout story, but the footnote deserves the headline, because the distance between eighteen lawyers who screen positive and one who reports a diagnosis is difficult to explain by ordinary variation in who happens to seek care. This article argues that the gap between screening and diagnosis measures avoidance rather than health, and that the avoidance is sustained both by the habits of mind that make lawyers effective and by a profession that makes asking for help feel dangerous.
A positive screen is not a diagnosis, because a questionnaire flags a pattern worth discussing with a clinician but cannot determine whether any particular lawyer has a disorder. Nor is the picture uniformly worse than it was a decade ago, since hazardous drinking fell by roughly ten percentage points from the 2016 benchmark, although it remains well above typical adult and primary-care levels. What has not changed is the reluctance to seek care: 53.3 percent of respondents cited confidentiality concerns and 49.2 percent cited reputational concerns as barriers, even though 75.2 percent knew that lawyer assistance programs exist. The researchers suggest that fear for the license, a culture that normalizes heavy drinking, and other obstacles may explain why elevated risk so rarely becomes a diagnosis, which means the obstacle is not awareness but the perceived cost of acting on it. Meanwhile, 20.5 percent of lawyers reported that the stress of the profession had increased their own alcohol or other drug use, which points toward drinking as a response to the work itself rather than a separate personal failing.
The mechanism deserves attention because it explains why information alone, including the high awareness of lawyer assistance programs, has not closed the gap. A lawyer who spends the day in adversarial vigilance, scanning for threats and anticipating the other side, keeps the body’s stress response, including the hypothalamic-pituitary-adrenal axis, chronically activated, and alcohol offers fast relief from that arousal. Each drink that works strengthens the habit through negative reinforcement, which is precisely why the behavior can feel like a solution rather than a problem, and why a lawyer can sincerely describe it as under control. The same professional training in self-monitoring and impression management makes seeking help feel like creating a record, so avoidance protects the lawyer’s reputation while the underlying pattern continues. Cognitive-behavioral therapy addresses this directly through functional analysis, mapping the trigger, the drink, and the relief so that alternative responses can replace the pattern, while Buddhist psychology, with its attention to craving and aversion, offers a complementary practice of noticing discomfort and staying with it rather than escaping it.
For the lawyer reading this, the practical question is not whether a label applies but whether the pattern deserves a conversation. Drinking to switch off after work, to fall asleep, or to quiet a replaying argument is a signal worth examining, particularly when the habit has grown over time or is hard to skip on a night when the lawyer would prefer to, and examining it requires neither a diagnosis nor a decision about career consequences. Before disclosing anything to a program or a provider, a lawyer can ask directly how confidentiality is handled, which is the same diligence applied to any other engagement. The gap documented in these studies will narrow only when a question about drinking feels as ordinary within the profession as a question about workload or billable hours, in a culture where the first answer to a hard week has too often been a drink. AttorneyTherapists.com maintains a directory of clinicians who work with attorneys, for those who prefer to begin that conversation with someone who already understands the profession.
