Critique of an Australian Binge Drinking Awareness Campaign in New South Wales

Public health campaigns are an important part of a community’s pursuit to better its citizens’ health. Whether the aim is simply to increase knowledge or to encourage behavior change, public health campaigns use social/behavioral theories to try to construct the most effective message possible. Unfortunately, not all social/behavioral theories are made equal, which means that not all public health campaigns are equally successful in different situations. The Australian “Know When to Say When” binge drinking awareness campaign is a perfect example. According to the campaign’s producers, the New South Wales (NSW) Government, it aims to challenge the community “to consider the amount of alcohol they consume, by placing the spotlight on behaviour that our society erroneously accepts as 'normal' when people drink too much” (13). While certainly an admirable goal, the campaign has some major failings. This paper will examine three major problems behind the “Know When to Say When” campaign and suggest more appropriate methods for each, based on alternative social/behavioral models.

Critique One -The Slogan

The first flaw stems from the campaign’s main slogan of ‘When have you had enough?” That simple phrase is enough to derail any chance of getting the campaign’s message across to its intended audience. While it might seem innocuous on the surface, the slogan has a strong paternalistic, judgmental overtone attached to it. Add in the various follow-ups that NSW has devised: ‘when you get a little silly,’ ‘when you get a little stupid,’ and ‘when you make a mess” with its accompanying “when you just turn in to one,” and the campaign is sure to engender an adverse reaction (13).

This response is explained by Psychological Reactance Theory (PRT). According to this theory, first described by Brehm in 1966, people respond to perceived threats to their freedom by trying to regain control through adverse actions (11). In this sense, freedom is not just a physical reality; it also includes actions, emotions, and attitudes (2). Reactance (opposite reaction) can take many forms, from simply ignoring the message, to belittling or disparaging the source that produced the message, all the way to increasingly engaging in the exact behavior that the message was intended to prevent (12).

One way to elicit psychological reactance is by choice of tone. Using aggressive, dogmatic language gives off a tone of authority that makes the audience feel like children being lectured by their parents (5). This directly threatens freedom of attitude and may be especially detrimental in the case of NSW’s binge drinking awareness campaign because the action that the campaign addresses is already considered socially rebellious. So much research has been done on programs designed to prevent alcohol abuse that authors attempting to review the relevant literature rely on meta-analyses and comprehensive reviews (6; 7). This is pertinent because, despite such a wealth of investment (both mental and financial) into the subject, those in charge of designing new public health campaigns continue to rely on inappropriate social/behavioral theories that continue to elicit this ‘boomerang’ effect of psychological reactance (6).

Alternative Intervention(s)

There is an alternative way to deal with this issue while still using the principles of psychological reactance theory; avoid engendering psychological reactance by toning down the message. Binge drinking may be a dangerous activity and an emotional topic, but presenting it in that way to people already engaging in the activity on a regular basis will not help NSW accomplish its goals. Instead, a better approach would be to generalize the message so that it becomes less accusatory toward the people whose behavior the campaign is targeting. Making sure that the people delivering the message are as similar as possible to the message recipients will greatly reduce the antagonistic tone of the message (8). In addition, telling people something similar to their pre-held beliefs will have positive results and reaffirm their values (8). For example, a more appropriate slogan might be, “You know when you’ve had too much. But do you know what to do about it?” This acknowledges that people are generally smart enough to have a decent idea of their alcohol tolerance, especially if they are frequent (i.e. binge) drinkers. The problem is not that people are unaware of how drunk they can get, it is that they either do not see it as a problem or do not feel they have the power to change their behavior. Altering the tone of the campaign to a subtle, non-accusatory acknowledgement that there might be a control problem, rather than a lack of awareness, not only allows the message to reach a wider audience (for example, those who sit at home alone and get drunk and thus are not featured in the campaign’s social- and family-centered examples), but also presents the opportunity for message recipients to ‘take back control’ of the situation – a central tenet of psychological reactance theory.

Critique Two – Sensationalized Outcomes

The campaign’s second flaw is that it misrepresents and sensationalizes drinking outcomes in both the television advertisement and on the campaign’s informational website. The goal is to convey shameful, socially-inappropriate drunken actions in an attempt to guilt viewers into changing their faulty behavior. The problem is that the negative reactions of others fail to stand out in comparison to the actions of the drinkers. In fact, the television advertisement accomplishes the opposite of its intention; its portrayal of people who have had too much to drink is more fun and amusing than sad and pitiful. It’s easy to overlook any angry, judgmental faces in the background because people watching the advertisement who identify with the scenes are more likely to bemusedly recall a similar episode they had than to feel contrite about that episode.

The television advertisement depicts 10 different scenes intended to showcase common occurrences for people who frequently over-drink, but the majority of these scenes are highly dramatized and hard to take seriously. This is especially true when considering the cohort of society that usually experiences the highest rates of binge drinking: young adult males. These vignettes – particularly the scenes in which a woman falls down while holding a wine bottle, a woman knocks over people’s glasses at a table as she walks by, someone vomits in a cab, and a man runs into a garbage can on the sidewalk and then kicks it loudly – are likely to be misinterpreted. Instead of eliciting feelings of derision or embarrassment, these scenes are likely to be seen as either funny or, worse, something to which to aspire for people of that gender and age group.

The campaign’s website fares no better, also falling prey to over-dramatization. For example, the page titled, “The numbers behind what we drink” is loaded with all sorts of statistics that are portrayed in a duplicitous way, so as to look more extreme than they truly are. NSW achieves this by leaving out the denominators in many of their statistics. One statistic claims that “There are over 3,000 deaths from alcohol in Australia every year” but it does not include the total number of deaths the country experiences for comparison (13). NSW also tries to make some drinking outcomes seem more severe than they are in reality. When the site states that “70% of the population reported experiencing one of 14 'harms' from a stranger within the last 12 months,” they include in this definition such events as avoiding intoxicated people and places, being annoyed by vomit, and urination or littering (13).While none of those actions or outcomes are pleasant, their inclusion in a list of true harms inflicted by binge drinkers as if they are really that critical to people’s safety and overall well-being is highly suspect. It seems more likely that they added these actions in as a way to increase the acknowledgment of ‘harms’ all the way up to 70% to make the effects of binge drinking on others seem more severe.

Alternative Intervention

Rather than try to scare or shame binge drinkers into lessening their alcohol consumption, NSW should focus on subtle education. Dramatizing statistics and potential consequences of persistent drunkenness will only prompt inattention and/or resistance. Instead, NSW should utilize a tactic proven to counter the undesirable outcomes of both Psychological Reactance Theory and the Theory of Optimistic Bias: similarity. PRT has already been described above. The Theory of Optimistic Bias postulates that individuals tend to incorrectly assume that they are more likely than their peers to experience positive events and – importantly for this paper – less likely than their peers to experience negative events (10). In other words, a person’s perception of his/her own risk differs relative to that of others. A central issue of this theory is the perception of control (just as with PRT), in that the amount of control a person considers himself/herself to have over a behavior directly influences the amount of optimistic bias attached to the behavior (10). Similarity is important to both of these theories because its use has been shown to increase perception of control and lessen the effects of the unwanted behaviors, in this case, reactance and bias (4; 8).

For this campaign, NSW should utilize the concept of similarity by either using real people in their campaigns or at least hiring actors that look more like “real” people. The current cast of characters in the television advertisement is too glamorous, amusing, and good-looking for most people to identify with. While some binge drinkers are likely to resemble the actors in the advertisement, the majority of people are unlikely to conform to such standards. In addition, using true stories of unfortunate or undesirable outcomes resulting from binge drinking will be more likely to elicit a positive response to the campaign than using dramatized, stereotypical situations. When a real person relates a story, the audience is able to see and hear the regret in that person’s face and voice. In the current campaign, the actions are depicted as they happen, with few consequences shown. Seeing five seconds worth of a couple of disappointed children’s faces is not sufficient to convince people that their actions are truly detrimental to those around them. NSW needs to focus its efforts on giving binge drinkers stories and people that they can identify with. Not only will this tactic be more likely to get drinkers’ attention, it also provides a potential sign of hope for those who do not think they are able to stop drinking.

Critique Three – Choice versus Compulsion

The third major flaw of NSW’s “Know When to Say When” Campaign is its framing of the issue. Despite the admirable intention to both increase awareness of and educate about the prevalence of binge drinking in Australia, at no point in either the television advertisement or on the website does NSW address the possibility that parts of their target audience could have an abuse problem that is out of the individual’s personal control. The television advertisement frames binge drinking solely as a personal, planned decision and fails to mention any ways to get help if it becomes more than that. The campaign website fares slightly better through its inclusion of a page of “helpful contacts” that lists numbers for agencies such as regional Alcohol and Drug Information Services and various informational websites. Still, there is no mention of possible compulsion or addiction, even in the description of these resources. If as many Australians engage in binge drinking as NSW claims, there are sure to be a good number of citizens with a true substance abuse problem. This campaign focuses on the hurt drinking inflicts on others around the drinker, but it would behoove the NSW Government to consider the hurt binge drinking inflicts on the drinkers, as well. Alcoholism takes victims on both sides of the battlefield.

Although not explicitly stated, NSW seems to have based its campaign on the Theory of Reasoned Action. This is demonstrated by the campaign’s assumption that 1) binge drinking is an action that can be changed simply by personal intent and 2) that social norms have enough influence to incite change to a person’s behavior. In this social/behavioral theory model, emphasis is placed on attitudes, subjective norms, intentions, and behaviors that are directed at something specific; in this case, binge drinking (1). Intention is the best predictor of behavior and is based on perceived control over that behavior (14). In the case of NSW’s campaign, social norms are displayed through the audience’s negative reaction to the inebriated people in each of the video vignettes. If intention is the best predictor of behavior, then this campaign’s failure to appropriately depict negative social reactions, as explained above, makes it unlikely to provoke an intention to change one’s ways.

Alternative Intervention

In order to address this problem, NSW needs acknowledge that addiction is a potential part of the problem it seeks to address and that intention and social norms are not always sufficient to cause a person to change his/her ways. In this respect, the campaign’s approach is not wrong; it is insufficient. Combining the current method with a second social/behavioral theory would enable to campaign to reach a broader range of ‘offenders.’

For those who find limiting themselves to a few drinks or remaining sober more difficult than the current campaign envisions, the Illusion of Control Theory might be appropriate. The problem with this cohort of drinkers is that they actually do not possess control over their drinking habits. Whether these people already know this or have yet to become aware of it because they have not yet tried to stop binge drinking, this theory focuses on returning a sense of control to those without it.

The Illusion of Control theory is based on the concept that humans desire to find a relationship between behaviors and events and, through manipulation of that relationship, believe they can obtain control over their environment. Conversely, humans detest the loss of this relationship and associated control over their environment and experience negative affects when faced with either the perceived or actual loss of that control (3). In other words, if one already worries that s/he lacks control over a situation – for instance, binge drinking – then attempting to control that behavior and failing will have negative repercussions. This is important, not only because it shows that NSW’s campaign could result in depressive or other ‘negative repercussion’ outcomes for the cohort not in control of its drinking habits, but also because it offers a way of addressing the core problem. The campaign needs to devise ways to give those people back the feeling of control over their addiction. According to Thompson, a good way to increase the perception of control over a situation is to use positive feedback, which emphasizes success, rather than failure (9). This could range from simply encouraging people to seek help and praising those that do, to including actual stories of real people who never thought they had a binge drinking problem until they attempted to stop and what they did to overcome their addiction. As with the other two suggested interventions, the concept of similarity when delivering this message is likely to increase positive reaction to the message because it also imparts a sense of control on the individual receiving the message. Proof that enhancing the illusion of control is beneficial was demonstrated in a study conducted on college students by Alloy and Clements. Results showed that student exhibiting greater feelings of control over the test situation were less likely to experience such severe negative repercussions or become discouraged when the outcome did not develop as they had intended, compared to students exhibiting less feelings of control over the situation (9). Effectively combining the current tactic, which relies on the Theory of Reasoned Action, with aspects of the Illusion of Control Theory would be a much more comprehensive way of addressing this important national issue.

Conclusion

Designing appropriate, effective public health campaigns is something that governments and organizations struggle with the world over. Often, the people in charge of designing these campaigns rely on outdated, inappropriate social/behavioral theory models to frame their products. Sometimes, they do not consult any theories at all. Marketing companies and successful businesses, including such unsavory but persistent public health foes as Phillip Morris, are proof that campaigns based on social/behavioral theories can be wildly successful; they just need to be well-researched and well-targeted.

The key to making NSW’s message an effective one is to make it realistic and palatable for its target audience. This includes not passing judgment on popular behavior, appropriately portraying the reality of unhealthy situations by not over-dramatizing them, and understanding that the target audience is not a single entity that will completely respond to a single message.

The third critique is especially important because, as public health professionals, it is not simply our job to educate; it is our job to help those unable to help themselves. While frequent social binge drinking surely does cause harm to those who engage in it on a regular basis, the majority of offenders will likely grow out of the habit, eventually. It is those who cannot move past the drinking that need the help and the hope the most. All three suggested interventions are likely to speak to alcoholics better than the current campaign, if for no other reason than increasing similarity between the campaign and its audience is likely to heighten awareness of the problem. In addition, by positively educating without judgment and depicting more accurate drinking situations, it is possible that people may begin to identify others in their social circles with a binge drinking problem. Even that circuitous route could engender some positive results through interventions and increased emotional support.

The bottom line is that people are not rational beings and the use of any theory, model, or general assumption that employs the assumption that we are is sure to fail. The NSW Government has the proper intentions but clearly views people as rational enough to view its campaign, absorb the message, and act accordingly. This is not a likely scenario and, until NSW is able and willing to integrate interventions that accept people’s inherent irrationality, its campaigns are sure to fail.

REFERENCES

Journal Articles:

1. Blue C. The Predictive Capacity of the Theory of Reasoned Action and the Theory of Planned Behavior in Exercise Research: An Integrated Literature Review. Research in Nursing & Health 1995; 18.2: 105-21.

2. Dillard J and Shen L. On the Nature of Reactance and Its Role in Persuasive Health Communication. Communication Monographs 2005; 72.2: 144-68.

3. Heckhausen J. and Schulz R. A Life-span Theory of Control. Psychological Review 1995; 102.2: 284-304.

4. Helweg-Larsen M. and Shepperd J. Do Moderators of the Optimistic Bias Affect Personal or Target Risk Estimates? A Review of the Literature. Personality and Social Psychology Review 2001; 5.1: 74-95.

5. Quick B. L. and Stephenson M. T. Further Evidence That Psychological Reactance Can Be Modeled as a Combination of Anger and Negative Cognitions. Communication Research 2007; 34.3: 255-76.

6. Ringold D. Boomerang Effects in Response to Public Health Interventions: Some Unintended Consequences in the Alcoholic Beverage Market. Journal of Consumer Policy 2002; 25: 27–63.

7. Sheppard B. H., Hartwick J., and Warshaw P. R. The Theory of Reasoned Action: A Meta-Analysis of Past Research with Recommendations for Modifications and Future Research. Journal of Consumer Research 1998; 15.3: 325.

8. Silvia P. Deflecting Reactance: The Role of Similarity in Increasing Compliance and Reducing Resistance. Basic and Applied Social Psychology 2005; 27.3: 277-84.

9. Thompson S. C. Illusions of Control: How We Overestimate Our Personal Influence. Current Directions in Psychological Science 1999; 8.6: 187-90.

10. Weinstein N. D. Unrealistic Optimism about Future Life Events. Journal of Personality and Social Psychology 1980; 39.5: 806-20.

Books:

11.Brehm J. A Theory of Psychological Reactance. New York: Academic, 1966.

12. Burgoon M, Alvaro E, Grandpre J, and Voulodakis M. Revisiting the Theory of Psychological Reactance. In Dillard J.P. and Pfau M (Eds), The Persuasion Handbook: Developments in Theory and Practice. Thousand Oaks, CA: Sage Publications, 2002.

Websites:

13. New South Wales Government. Know When to Say When. New South Wales, Australia. http://www.whentosaywhen.com.au/index.php

14. University of Twente. Theory of Planned Behavior/Reasoned Action. Enschede, The Netherlands. University of Twente. file:///F:/721%20Paper%20B/Theory%20of%20 Reasoned%20Action_ %20U_Twente.htm.

A Critique of Lawyers Concerned for Lawyers – Karen Marcus

Introduction

While alcohol and drug addiction is a widespread public health problem, lawyers and law students are particularly prone to fall prey to this epidemic. Lawyers are twice as likely to become addicted to alcohol or drugs as is the average American (1). About one-fifth of lawyers abuse alcohol; one-quarter of lawyers have used cocaine (2). For law students facing overwhelming workloads and strict curves, the drug of choice is the concentration-enhancing Adderall (3).

Because lawyers have a legally-binding fiduciary duty to serve their clients loyally and competently, the legal profession has been reluctant to admit that such a large percentage of lawyers use substances that affect their ability to effectively advocate (4). However, some legal organizations, such as Lawyers Concerned for Lawyers, have begun to bravely confront the issue.

Lawyers Concerned for Lawyers of Massachusetts (hereinafter LCLMA) is “the sole lawyer assistance program in Massachusetts exclusively dedicated to helping with the many personal and professional issues of life in the law” (5). Sponsored by the Supreme Judicial Court of Massachusetts and paid for by the yearly registration fee to practice before the Massachusetts bar, LCLMA reflects an important attempt by the legal community of Massachusetts to recognize and support the struggles of its members (6). One of LCLMA’s most important services is a public health intervention program for lawyers struggling with drug or alcohol abuse. LCLMA provides assessment services, peer support networks, and support groups for attorneys facing these addictions (6). While LCLMA’s addiction program has taken the unprecedented step in Massachusetts of facing this problem head-on and has provided invaluable services to the legal community, the intervention could be more effective. This paper will suggest that a sister organization to LCLMA that more carefully takes account of public health theories could better address the alcohol and drug addiction problem among lawyer. This paper will address three major flaws with LCLMA’s addiction intervention, suggest ways that a sister organization that avoids these flaws could improve on LCLMA, and explain how behavioral models and theories support these new methods.

Critique of Current LCLMA Approach to Attorney Addiction

LCLMA has three major flaws in its intervention to stop attorney alcohol and drug addiction. First, the program fails to address the root causes of attorney and law student addictions, assuming instead that these addictions stem from stress alone. Second, despite its best efforts to provide anonymity, LCLMA’s partnership with the legal entities responsible for punishing incompetent attorneys prevents lawyers from truly trusting their services. Third, the program makes only the most modest attempts at public education; its approach is almost entirely at the individual level.

Root Causes of Addiction Veiled by Illusion of Control

LCLMA attributes the disproportionate rate of attorney alcohol abuse solely to “personal and professional patterns of over-achievement, heavy workloads, intense competition, and daily stress” (7). Because LCLMA attributes alcohol addiction solely to individual lawyer stress, the main form of alcohol abuse prevention intervention it provides is individual counseling, either provided to overworked attorneys to forestall an alcohol addiction or provided to already addicted attorneys to help them stop drinking (6). Although stress is certainly a factor, this approach fails to acknowledge that several complex factors, rather than stress alone, make lawyers and law students uniquely susceptible to alcohol and drug addiction.

The need to concentrate for long periods of time on complex and detailed legal problems encourages the use of drugs that improve concentration or prevent exhaustion, such as Adderall and cocaine (3). New lawyers, suddenly catapulted to one of the highest pay grades in the country, can afford these expensive drugs much more easily than can the average American (8). The wealthy firms and companies that hire lawyers also often cater events that supply large amounts of alcohol (9). These networking events are touted to law students and young lawyers as the lifeblood of their burgeoning careers (10); alcohol consumption is the social lubricant always provided at these networking events.

If so many additional factors beyond mere stress exacerbate the problem of addiction among lawyers, why does LCLMA concentrate on stress alone? The theories of Optimistic Bias and of the Illusion of Control may explain why the lawyers who created LCLMA may have been reluctant to face these additional causal factors. The Optimistic Bias theory posits that individuals will always overestimate their chances of a positive outcome in any given situation (11). The related Illusion of Control theory suggests that individuals see themselves as being more capable of assuring their own success than is mathematically possible (12). LCLMA’s emphasis on stress suggests that the lawyers who created LCLMA may have fallen prey to these two types of thinking. While they laudably wanted to help their addicted colleagues, they may not have wanted to admit that they themselves could fall prey to addiction. The idea that the stress of competition and overwork alone causes alcoholism and drug addiction includes the veiled assumption that only those weak attorneys who cannot compete or keep up with the workload will succumb to these addictive behaviors. Looking through the lenses of these two theories, this assumption may have reassured the lawyers who started LCLMA with the notions that they were more in control than these weak attorneys. In contrast, the other causes of alcoholism among lawyers insist on the uncomfortable notion that any lawyer – even very good lawyers – can become alcoholics or drug addicts. After all, the most competitive lawyers may seek the edge that Adderall or cocaine might give them, the highest paid elite are the most capable of buying these expensive drugs, and every good lawyer knows the importance of networking. Perhaps because of optimistic bias and the illusion of control, LCLMA refuses to confront a number of major factors that cause attorneys to become addicted to alcohol and drugs. This flaw prevents LCLMA from being fully effective because LCLMA shapes its interventions around only one of several causal factors.

Lack of Trust Due to Stigma

The second flaw of LCLMA is its close association with the Supreme Judicial Court (“SJC”) and the Board of Bar Overseers (“BBO”) (6). LCLMA’s decision to connect with these organizations is understandable. The SJC and the BBO legitimize LCLMA, shows support by the most formal legal institutions in Massachusetts for provision of services to attorneys, and (perhaps most importantly) fund LCLMA (6). However, the close connection with these groups may prevent lawyers from trusting LCLMA enough to seek help.

The SJC and the BBO’s championship of LCLMA is admirable; however, these institutions face a major conflict of interest in funding and support LCLMA. As the highest court in Massachusetts, the SJC is responsible for maintaining the ethical standards within lawyers practicing at the Massachusetts bar. The SJC delegated part of this responsible to the BBO: the BBO’s sole purpose is to “investigate and evaluate complaints against lawyers” (13).

As previously mentioned, one of the most important ethical obligations lawyers, as fiduciaries, owe their clients is competence (4). Because drug and alcohol addiction can dramatically affect behavior and ability, an addicted lawyer may not be able to competently serve his client. The fact that this inability stems from disease or mental disorder does not negate this obligation. Failure to competently protect and advocate on behalf of clients can result in official sanction, loss of license, or even a malpractice suit for money damages; addiction cannot shield an incompetent lawyer from these consequences (14-15).

The threat of these punishments formalizes the stigma within the legal community that is associated with addiction. While the SJC and BBO have a legitimate interest in protecting attorneys’ clients, the side effect is to confirm the marginalization of all addicted attorneys. Labeling theory holds that stigmatization of mental illness and addiction can lead those facing these issues toward behaviors that add to the problem, including hiding the problem and withdrawing from friends and colleagues who might suspect a problem (16). In the case of addicted attorneys, fears of public exposure and loss of license could easily prevent them from seeking LCLMA’s help.

Because attorneys undergoing treatment for addiction may reveal incompetent behavior that amounts to ethical misconduct or malpractice, it is very problematic that LCLMA relies on the patronage of the two institutions responsible for punishing this misconduct. LCLMA attempts to resolve this conflict through anonymity policies that attempt shield attorneys from the SJC and BBO (17). However, these policies simply cannot solve the problem completely. First of all, true anonymity cannot exist in a group-service model, and LCLMA exhibits the typical chinks in the armor: attorneys seeking help will bump into their colleagues in the hallways and the group support listservs are not anonymous. Nor can LCLMA claim that BBO is entirely hands-off; in fact, the BBO often supervises the LCLMA services provided to an already-sanctioned addicted attorney fulfilling the rehabilitation requirements to be reinstated after loss of license (18).

No matter what assurances LCLMA provides, LCLMA will never convince attorneys of their safety from punishment. Because LCLMA is so closely connected to the two institutions that regulate behavior within the legal community, addicted lawyers fearing sanction may never feel entirely comfortable seeking help from LCLMA.

Lack of Public Education Focus Due to Lack of Group Models of Behavior

LCLMA’s third flaw is its failure to use group models to understand and combat lawyer addiction. As discussed above, LCLMA emphasizes only the stress and overwork causation factor of lawyer and law student addiction. One of the problems that stem from this focus is an individual-model level theory of intervention. The theory that only the lawyers who cannot quite cut it and succumb to stress and overwork become alcoholics implies the further idea that alcoholism is a private, individual problem. Because LCLMA sees alcoholism and drug addiction as problems that affect individuals at only the most private level, the focus of LCLMA’s work is in providing one-on-one counseling, referrals, and small support groups to addicted attorneys seeking help (18). While counseling addicted attorneys is incredibly important, LCLMA does little work to prevent addiction before it starts. The extent of their preventative work is narrow: they “from time to time” provide presentations and they publish materials on addiction usually written by other groups (19-20). LCLMA could be much more effective in preventing drug and alcohol addiction among attorneys through a public health campaign that reaches all law students and practicing attorneys as a group. Currently, LCLMA artificially limits its impact by dealing with attorneys one by one only after they have already developed a problem.

Proposal: A sister organization

After analyzing the three main flaws that prevent LCLMA from more effectively combating addiction within the legal community, it is possible to consider how a new and improved sister organization to LCLMA could avoid these pitfalls and better fulfill this admirable goal. This new organization devoted to addiction problems alone would be separated from LCLMA – and from the LCLMA’s affiliation with the SJC and the BBO. While the new organization would continue to provide the same individual counseling that LCLMA provides, it would also provide a number of other programs.

A great deal of its work would be focused on public health campaigns aimed at preventing the average lawyer or law student from becoming addicted to alcohol or drugs. These campaigns should include regular presentations to law schools and firms on safe behaviors and prevention. There would also be presentations that combat some of the root causes of addiction rather than addiction itself. For example, the organization could provide presentations on how to safely improve concentration, on the importance of avoiding drinking too much at networking events, and on money management. Such campaigns would be supplemented by a new, brighter, more complex website that would provide information to average lawyers and not simply to those seeking intervention services. This information would be presented in the form of personal stories of successful attorneys who overcame an addiction.

Perhaps the most important services it could provide would be services to solve some of the problems – including stress – that lead to addiction without introducing alcohol. The organization could do so by presenting itself to the majority of the legal community as an organization that encourages a better quality of life for all attorneys in order to prevent addiction. For example, the organization would have a section of its website devoted to links to stress-reducing “splurges” that attorneys could take advantage of over their brief breaks, including popular spa visits or weekend getaways. Most importantly, the group could provide regular networking functions that provide non-alcoholic drinks and food. By inviting all members of the legal community to these functions under the auspices of an organization dedicated to improving quality of life for attorneys, the group could promote awareness of addiction prevention while also directly combating the causes of this disease.

Defending the New Organization

Although the current LCLMA provides valuable services to Massachusetts attorney, the proposed new sister organization would solve the three major problems that prevent it from being more effective. Firstly, the expansion of public education programs and services that attempt to solve some of the problems that lead to alcoholism and drug addiction would address the root causes of attorney addiction. Secondly, the separation of this group from the SJC and BBO would assuage any fears addicted attorneys might have of being punished for seeking help. Finally, the new public education programs and services would help to change the legal community as a group rather than focusing on one individual at a time.

Defense #1: Address the Root Causes of Addiction

The first major correction the new sister organization makes to LCLMA is to address directly the multiple factors that cause and exacerbate addiction among attorneys and law students. Because many students and attorneys drink in the context of networking events, the new group will sponsor networking events that do not involve or encourage alcohol. To address both the stress of lawyering and the impetus of highly motivated lawyers and law students to do above average work over long periods of time, the group will provide alternatives to Adderall and cocaine by advertising relaxing and rejuvenating products, services, and trips. To counter the temptation to buy expensive drugs that many young lawyers face when they suddenly can afford them, the organization will provide money management seminars. The sister organization will also aggressively market the need for preventative techniques to average attorneys and lawyers by making many presentations at law schools and firms and by providing extensive materials on a user-friendly website.

By addressing the aspects particular to the legal field that cause individual addictions, the new organization will be much more effective than LCLMA. The social structure of lawyers as a group shapes the disease of addiction that haunts the legal community (21). Only by addressing all the different factors that cause attorney addiction will a service group be able to effectively intervene to stem the epidemic; by refusing to do so, LCLMA doomed itself to individual-based interventions rather than group-based preventative measures (22). By addressing the causes of addiction within the legal world, the new sister organization will structure its resources in a way that promotes a new culture of addiction prevention within the legal community (23).

Defense #2: Acknowledge & Protect Against Stigma

By severing ties with the SJC and BBO, the new sister organization will earn the trust of addicted attorneys. These attorneys will be more likely to seek help from the organization once they are assured that no groups associated with the organization have an incentive to punish their behavior. Although the LCLMA’s connection with these organizations showed that the official arbiters of attorney conduct approved of the organization, these arbiters could express their approval in less intrusive ways, as through simple statements of approval. Their affiliation with LCLMA attempted to ignore the stigma associated with attorney addiction; this merely encouraged those stigmatized to hide their addictions and engage in self-destructive behavior (21). While the public education aspects of the new group may help to address the stigma, the most immediate and important step to take is to acknowledge that the stigma exists and avoid subjecting addicted attorneys to the stigmatizing of their peers (24). The new sister organization will be more effective because it addresses the feature of stigma specific to the legal community: the fact that exposure could lead to official condemnation and loss of license (25). By refusing the involvement of official attorney conduct oversight boards like the SJC and BBO, the new group will reassure addicted attorneys that they can seek help without risking their careers.

Defense #3 – Approach Incorporates Group Models

In addition to combating the causes of addiction, the new prevention approach also takes advantage of several group behavior models. For example, by reframing the sister organization from an organization that helps addicted attorneys to one that seeks to improve the lifestyle and help the careers of all attorneys (while also promoting awareness of addiction), the group takes advantage of one of the core tenets of marketing theory (26). Instead of selling attorneys what the group thinks they should want (to avoid alcohol and drugs), the group sells attorneys on what they do want (better careers and easier quality of life) (27).

The new group’s emphasis on creating networking events will be particularly important to reaching its goals. By helping reframe the group under marketing theory to one that “sells” better careers under marketing theory, the sober networking opportunities actually help to provide these better careers (13). This action takes advantage of Maslow’s Hierarchy of Needs (28). Scholars since Maslow have argued that order of needs for a particular group of people is context-specific; because the legal community is defined by people engaged in a particular career, the stability of the career is a very low order need within that community (29). Because maintaining the security of a stable career is a lower order need than is health for attorneys, the new group focuses on satisfying the higher order need only as part of providing for the more immediate need. The networking focus also takes advantage of the theory that health-related behaviors spread through social networks (30). These sober networking events will promote a healthy behavior – networking without alcohol – and diffuse it through the new networks of colleagues created at these events (31). The new sister organization will therefore be more successful than LCLMA because it structures its more robust addiction prevention campaign around several of the most innovative group-level theories of behavior.

Conclusion

In conclusion, LCLMA is a valuable resource to attorneys in Massachusetts that nonetheless could be more successful if it addressed several of its structural problems. In particular, LCLMA does not address the many root causes of attorney addiction, does not provide the true anonymity to addicted attorneys that their stigmatization within the community requires, and does not utilize group-level theories of behavior. The sister organization proposed above would solve these problems by reframing itself to address these root causes of addiction, by acknowledging the stigma of addiction and separating itself from organizations that may seek to punish addicted attorneys, and by structuring its addiction prevention campaign around several group-level behavior theories.

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