ALPS In Brief Podcast - Episode 17: Studying Self-Medication and Seeking a Remedy

ALPS In Brief Podcast - Episode 17: Studying Self-Medication and Seeking a Remedy

Patrick R. Krill, JD, LLM shifted from the practice of law to addiction counseling at the Hazelden Betty Ford Foundation. In partnership with the American Bar Association, Krill collaborated on a study of substance abuse among members of the legal community surveying approximately 15,000 lawyers in 19 states. Mark was able to sit down with Patrick to discuss the study and what can be done to combat addiction and promote lawyer well-being moving forward with a particular focus on solo attorneys and young lawyers. This is the second episode in the Wellness Podcast Episodes.

ALPS In Brief, The ALPS Risk Management Podcast, is hosted by ALPS Risk Manager, Mark Bassingthwaighte.





Hello. Welcome to another episode of ALPS in Brief, the ALPS risk management podcast. We’re coming to you from the ALPS home officer in the historic Florence building in beautiful, downtown, Missoula, Montana. I’m Mark Bassingthwaighte, the ALPS risk manager, and I have the pleasure today of sitting down with Patrick [Krill 00:00:25]. Patrick has been involved with the National Task Force for Lawyer Wellbeing, and we’ve been having some podcasts on lawyer wellbeing, and it’s really a pleasure to have Patrick with us. Patrick, can you take a few moments and just introduce yourself? Tell us a little bit about yourself.


Sure, sure, Mark. Thanks for the invitation to join you today. Quickly, my background is that I’m a former practicing attorney who after about seven and a half years in the profession, realized that I was, as many people at some point in their career do, I was looking for something else and so I made the not easy decision to return to school and I actually pursued a Masters degree, earned a Masters degree in addiction counseling. I knew that counseling, something in the sort of psychology field, was a little bit more aligned with what I was trying to do and what I was seeking in my professional journey to be more in a helping profession. So I got my Masters in addiction counseling and I did my clinical training at a place called Hazelden, which has now become Hazelden Betty Ford, as the two treatment centers merged, and I was then hired as the director of a treatment program for attorneys, judges and law students at Hazelden Betty Ford.

I was with that organization in total for about six or six and a half years, during which time I had the opportunity to counsel hundreds of lawyers and judges and law students from US and some international patients as well, who were struggling with substance use disorder, so what we would typically think of as addiction or substance abuse, but often they were also struggling with a mental health disorder as well, like depression or anxiety. And so I really did, through that work, have the opportunity to understand many of the challenges that lawyers face both in the onset of addiction and depression, but also in what will be probably interesting to your listeners, how do you go back into the practice of law and really maintain whatever wellbeing you may have established while you were away, healing and getting well. Because, as you know, the practice of law is quite demanding and it can be quite stressful and it can put a lot of strains on people.

So I was there and I then I left there in 2016 to launch my own consulting practice and I now work primarily with large law firms and midsized law firms to help them navigate addiction and mental health problems. So whether that’s helping them draft policies, or doing in-house training school, or when crises emerge, helping them deal with those crises. It’s a variety of things that I do in that space, but it’s all related to addiction and mental health. That’s where I’ve been professionally and what my experience looks like.

In relation to that, I’ll just mention quickly two things, I was the lead author of the 2016 ABA Hazelden Betty Ford study on addiction and mental health problems in the legal profession, which gave us the most robust look at these issues in terms of data that we’ve ever had. It was a comprehensive survey of about 15,000 lawyers in 19 states and all geographic regions of the country. What we found there really did lay the groundwork or served as the predicate for the second thing that I wanted to mention, which was the National Task Force on Lawyer Wellbeing in the report published, that group was formed largely in response to what that ABA study found. From there, we then brought together stakeholders from around the profession, formed this task force and worked for about a year on a report that outlines things that all different sectors of the profession can be doing to try and reduce the prevalence of both substance abuse problems and mental health problems and to just sort of improve the overall wellbeing of lawyers and the profession generally because, I’ll just conclude by saying this, the quick and dirty or thumbnail version of where we are in the legal profession, is we have a lot of problems as it relates to the health and wellbeing and psychological distress of practicing lawyers. So we’ve got a lot of work to do.


Yeah, I couldn’t agree more. I have taken a look at the study, the Hazelden study you referenced and authored, incredibly well done. I have been doing some lecturing on it in recent times, and what one of the surprises for me was … I’ve been in the risk management sector here for 20 years now, and we’ve been doing our part, there’s lots of us involved in trying to deal with mental illness and addiction issues, and I always thought that we were making progress, but if there’s anything that I learned from the Hazelden study is over the past 20 years, it seems to me the problem has gotten more severe. I was really surprised by that, looking at older studies and data sets, so you are absolutely spot on, we’ve got a lot of work to do. I think the task force is a great place to start. Can you tell us a little bit about the work being done in the area of lawyer assistance and impairment? Where is the task force taking us?


Sure, yeah. So what the task force report did, really, it broke out recommendations for various stakeholders in the profession. So for example, there is a set of recommendations for the judiciary, things that they can be doing within their own sphere of influence to improve lawyer wellbeing, there are recommendations from law schools, there are recommendations for professional liability carriers, legal employers, lawyer assistance programs, and it’s meant to provide tangible, concrete recommendations that each of these different groups can look to and begin to incorporate in their own world. There are also general recommendations for the whole profession to try and reduce the level of incivility and toxicity in the profession, which as you might imagine, feeds into depression. It can also feed into substance abuse in the form of self medication.

Just as a quick aside, I can tell you that a lot of the patients that I treated in my program would report that they never really even liked drinking that much, or certainly it was never their intention to find themselves addicted to alcohol or drugs, but it was really self-medication. It was the only way that they knew how to blow off steam. It’s just a form of dealing with psychological distress and then it turned into its own problem. We know that that’s a real phenomenon in the legal profession specifically.

But beyond there, beyond that, there are other recommendations for the profession, for individual stakeholders. I would encourage anybody listening to this podcast to simply Google or perhaps you can publish it as a companion to this podcast or otherwise circulate through  your listeners, the task force report, it was published … Open access, there are no restrictions on its use, you can copy it, distribute it, do whatever you want with it, there’s no restriction at all on that. I would encourage people to take a look at it and see what they might be able to take from it and bring into, for example, their own local bar association or their own other professional group that they might belong to in the profession. So it’s just out there in the public domain for lawyers to begin incorporating.

But beyond that, there are also formal efforts underway at the state level, to bring the recommendations down from the national, to the state, to the local. So for example this past week I was at the National Conference of Bar Examiners Annual Meeting and I was on panel with a couple of my task force co-authors, and we were surveying the audience, there were about 40 or so chief Justices from jurisdictions around the US in attendance at our session, and we were surveying the audience, and it’s clear that in more than a dozen states around the country, the chief Justices are taking the lead on this initiative and they’re saying we should form a statewide task force to look at implementing these recommendations at the state level. They really are trying to filter it down in their jurisdictions. And those states that aren’t already forming their own internal, if you will, task forces, are being encouraged to do so, and I’m sure that a lot more are going to be coming online over the course of the next 12 to 18 months.

That’s how you can visualize this, if you will, changing the culture of the profession, which is what we set out to do. It was this national report intended for the whole US legal profession, all of the different sectors and stakeholders. But now in terms of implementation, since there isn’t one national body that, for example, controls the profession, it really does come down to statewide and then even local implementation of the report recommendations.


I will see that we get a link to that for our listeners. We definitely will post that with the blog.

As I listened to what you’re talking about, you made a comment about transitions, and I’d like to explore that briefly in this way, what do you think, if you will, the roadblocks long are as a profession, has there been much discussion or look at that? How do we remove the roadblocks to the degree that you see them?


Yeah. Well, I mean that was also one of the goals of this task force report to suggest some things that we can do. I can tell you my view, which is also consistent with the task force view, is that one of the biggest roadblocks that we have to lawyers to taking care of themselves and getting help when they need … Let’s just frame the issue more specifically, let’s focus, just for now, on the more narrow issues of addiction and mental health problems. When it comes to those specific issues, when lawyers are struggling or they think they may be struggling, what keeps them from raising a hand or reaching out, picking up the phone, trying to get some sort of help, telling a colleague they’re struggling, is a fear of what that’s going to do them professionally, a fear that it could jeopardize their reputation, jeopardize their clients, possibly it could somehow impact their license, and so there’s just a lot of fear around these issues. That’s why lawyers tend to try to deal with the problems by themselves, on their own, or to just ignore the problems and pretend like they’re not there.

So to the extent that we can change that culture, that we can begin to destigmatize seeing a therapist, destigmatize going to treatment, destigmatize being in recovery from addiction or having overcome depression or chronic anxiety, that’s going to go a long way towards improving the landscape around these issues. That’s one area that we need to work.

The other is really chronic, the chronic stress and the demands of the profession. Now, some of that is probably not likely to change, I mean if you think about client demands, if you think about the expectation of being available all the time that technology has now brought into our lives, some of that is just … I don’t have easy answers for how you solve that, but what we can do is to try to reduce the level of toxicity and incivility amongst and between ourselves. If we, as a profession, begin to just be a little bit more civil and maybe take a little bit of the adversarial nature out of our adversarial system, that, again, could reduce some of the stress and anxiety that lawyers experience which leads to other problems.


In my experience, again, in terms of reading various articles and studies, lots of this initially is directed to Bar Association, directed at large firms, these kinds of things, but the reality is a tremendous percentage of lawyers practicing, at least in the United States here, are in the solo law firm setting. Do you have thoughts or does the report in terms of the recommendations … Do they address this segment? If so … I just, again, I’m curious of your thoughts, how do we deal with the problem on the front lines of the solo, small firm setting?


Yeah. Well, I think you’re absolutely right, the majority of lawyers don’t practice in large or really firm of any size settings, and they are in fact solo or small firm lawyers. The report doesn’t include solo practitioners as a stakeholder, if you will, for the reason that it was really geared towards institutions rather than individuals because the thought was about making change at the system level, the systems of the profession.

That said, I know that lawyers who are in solo practices or small practices, they often face really, really … The burdens they face are greater than lawyers practicing in larger farms and the challenges they face in terms of being able to take care of themselves are also sometimes greater. For example, if you’re a solo practitioner and you’re addicted to alcohol and you know it’s causing a problem and you know you should probably get some help, you just can’t go away or you don’t have the resources, you can’t take time away from your practice, you don’t have anyone to help you, that’s a real challenge. Similarly, if you’re in solo practice and you’re struggling with depression, you don’t have somebody that you can offload some of your work to for a period of time so there are real logistical challenges that solo attorneys face that aren’t present in the bigger firm setting. Unfortunately, in that arena, we don’t have resources that are as robust as they should be systems. We have lawyer assistance programs in most states around the country, have a lawyer assistance program that is in some … Some of them are very well developed and very well staffed and they have great programming, others in less populous states, they might be just a less effective resource because they don’t have as large a staff or they don’t really have the ability to serve as many lawyers.

But that’s one place that solo practitioners have historically been able to find some assistance when they don’t have the resources to come along with being a larger firm. So to the extent that anyone out there is not familiar with your state’s lawyer assistance program, I would encourage you to explore it because they may in fact be a really good resource for you and have some, if not, live counseling sessions that they would offer or groups that they may facilitate that you would be able to attend. Chances are they’re going to at least have the ability to direct you to other resources and to provide content and just put you on the right path.


Yeah. I want underscore for listeners that these programs are confidential.




I think at times people are afraid to reach out. Again, as you mentioned earlier, I don’t want to be labeled mentally ill or something like this, but the resource that you’re talking about here, in many, many states, is really a very good resource. It is not about weeding out the week among us, it is about helping, those of us that have these challenges and struggles to get back on track and to get back into the profession in a stronger, more competent, healthy way. So I think, again, to those of you listening, if you’re personally struggling with a problem or know someone who is, please don’t minimize the value of this particular resource.


Yeah, I agree with that and I just want to pick up quickly on something you just said about it getting back on track. I’ve worked with a lot of lawyers who have gone through the rehabilitative process, and if I haven’t worked with them professionally, I’ve known them, and you really can come out, not only as good as you were before, but better. So you can have increased confidence, and increased performance, and focus, and reliability, and stamina, and clarity, I mean there’s just so much value in getting ahead of the problem and doing something about it and getting some assistance. It is, by no means, is it an indication of a weakness or a flaw. In fact, I think that getting help and saying I need some help, I need to take care of myself for a period of time, that is in fact demonstrative of good judgment, and that in my view, makes you more professional.


The last brief topic or issue I’d like to talk about is when I think about, again, the solo, small firm setting in terms of the majority of lawyers practicing here, and also just thinking about some of the data in the study, which surprised me, and that’s that younger lawyers are really struggling, even in the law school setting. It seems to me  that that in terms of the institution or an institution that can really assist in changing this long-term, I mean this isn’t going to happen overnight, but is working with law schools to change some things, is there anything going on in that arena, in that space?


It is, and you’re right, because that is essentially the beginning of our professional journey and that is also where a lot of the problems start, it’s where a lot of the mindset really takes hold that if you have a problem you better keep that to yourself. So there is a lot happening at the law school level there within the American Bar Association’s commission on lawyers assistance programs, which I’m a part of, we have a lot of energy devoted to facilitating change in law schools, but I know a lot of individual schools are beginning to take a long, hard look at this. Some schools are being forced to, Harvard Law School, for example, which is arguably where some of the best and brightest lawyers in the country, they recently published a study on the health and wellbeing of their own law students because the students forced the administration to conduct the study because they knew that there was a lot of distress happening all around them. The results of that were pretty, in their words, grizzly, and so the students themselves are beginning to wake up to these issues and they’re really tuning in to the increased focus on lawyer wellbeing and they’re saying, this isn’t what I want for my professional life, this isn’t what I want waiting for me after the end of three years and all of this hard work.

So there’s change happening at the grassroots level there, which I think is very encouraging because that is where the change needs to start, because if you come into the profession, law school is a transformative process, it changes the way people think, it changes their attitudes around things like substance use and mental health, and it really kind of makes them view their reputation as being more important than anything else. If we can start chipping away at some of that problem thinking, that’s going to do a lot of good for the younger generation.


Well, Patrick, I really, really appreciate you taking the time to talk with us today and I really wish tremendous success for you and your fellow members of the task force. We’re off to a great start. I should say you’re off to a great start, and it seems like we’re getting some real traction more and more at a grassroots level, and I really hope that that continues.

To our listeners, I would like to say thanks for listing in yet again. If in future you have a topic of interest that you’d like to see discussed on the blog, please don’t hesitate to reach out to me at That’s a wrap. Thanks for listening. Bye-bye.


Patrick R. Krill, Principal and Founder, Krill Strategies

 Recognized globally as a leading authority on addiction, mental health, and well-being issues in the legal profession, Patrick R. Krill is an attorney, licensed and board certified alcohol and drug counselor, author, advocate, and thought leader.  His groundbreaking work in the area of attorney behavioral health includes initiating and serving as lead author of the first and only  national study on the prevalence of attorney addiction and mental health concerns, a joint undertaking of the American Bar Association  Commission on Lawyer Assistance Programs and the  Hazelden Betty Ford Foundation. Patrick’s highly specialized background and unique breadth of knowledge relating to the substance use and mental health of lawyers make him a widely sought after expert and trusted resource for solving one of the legal profession’s most difficult problems.

Patrick is the former director of the Hazelden Betty Ford Foundation’s Legal Professionals Program, a preeminent clinical treatment program for addicted attorneys, judges and law students. While leading that program, he counseled many hundreds of legal professionals from around the country who sought to better understand and overcome the unique challenges faced on a lawyer’s road to recovery.  From young solo practitioners to equity partners in the largest global firms, law students to sitting judges, Patrick has successfully counseled patients from around the world and across all practice settings, offering distinctive guidance and uniquely qualified insights about achieving and maintaining recovery, health and well-being in the practice of law.

Patrick has authored more than sixty articles related to addiction and mental health, including his biweekly advice column for, and frequent contributions to and other national outlets.  Also a regular source for print and broadcast media, he has been quoted in dozens of national and regional news outlets, including the New York Times, Wall Street Journal, Washington Post, Chicago Tribune, and countless legal industry trade publications and blogs. Patrick has been a guest on numerous national broadcasts, including multiple appearances on NPR and the Dr. Drew Podcast.

As a frequent speaker about addiction and its intersection with the law, Patrick has taught multiple graduate-level courses in addiction counseling, and has spoken, lectured, or conducted seminars for over one hundred and fifty organizations around the world, including law firms, professional and bar associations, law schools, and corporations.

Patrick serves on the Advisory Committee to the American Bar Association Commission on Lawyer Assistance Programs, and in October 2017, was honored with the Commission’s Meritorious Service Award for Outstanding Contribution to Lawyer Well-being.  In 2017 he was also appointed to ABA President Hilarie Bass’s Working Group to Improve Lawyer Well-being, and is a member of the National Task Force on Lawyer Well-being, and co-author of its 2017 Report, The Path to Lawyer Well-being: Practical Recommendations for Positive Change. In November 2016, he was presented with the “LCL Founders Award for Service to the Profession” by Minnesota Lawyers Concerned for Lawyers.

BA, Political Science and Government, American University

JD, Loyola Law School

LL.M., International Law, American University Washington College of Law

MA, Addiction Counseling, Hazelden Betty Ford Graduate School of Addiction Studies

Bar Admission: California



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Since 1998, Mark Bassingthwaighte, Esq. has been a Risk Manager with ALPS, an attorney’s professional liability insurance carrier. In his tenure with the company, Mr. Bassingthwaighte has conducted over 1200 law firm risk management assessment visits, presented over 550 continuing legal education seminars throughout the United States, and written extensively on risk management, ethics, and technology. Mr. Bassingthwaighte is a member of the State Bar of Montana as well as the American Bar Association where he currently sits on the ABA Center for Professional Responsibility’s Conference Planning Committee. He received his J.D. from Drake University Law School.