A degree of ambivalence can be expected before an individual decides to take action or make changes in his or her life. It is common for those struggling with substance use and/or mental health disorders to deny that they have a problem. Science has shed light on why such denial is common. The chemical and structural brain changes that result from many of these illnesses can impair the function of the part of the brain responsible for logic and reasoning. This presents a challenge to those encouraging a colleague or loved one to seek treatment. The nature of these illnesses, the stigma attached to them and the tendency of lawyers to retain control and responsibility to solve any problem (especially their own) can work against the impaired attorney, judge or law student.

Individuals with mental health or substance use disorders often operate with a cognitive distortion that continuously tells them they are unworthy of being helped, they are beyond help, no one can possibly understand how they feel, and no one can be trusted. They may abstain from engaging in compulsive behaviors for a few days, a few weeks or a few months in an effort to prove to themselves and others that they can control their alcohol or drug use or the symptoms of their mental illness. They may also justify their substance use or other compulsive behavior as a well-earned reward for working hard, or as a reasonable release from the pressures of a busy work or home life.

Many of these illnesses are chronic and progressive; as the illness worsens over time, the personal and professional functioning of an individual dramatically declines. It may take several carefully crafted approaches before a struggling lawyer, judge or law student becomes willing to accept the help they may desperately need.