Archive for the 'Lawyers' Category

Worse than ever: Pain pills and heroin use

Apr. 28th 2015

More people are dying from opioid overdoses than traffic accidents, yet no one seems to notice or want to address it. As commented on in the April 17th issue of The New York Times, “Serving All Your Heroin Needs”:

 

Meanwhile, the victims – mostly white, well-off and often young – are mourned in silence, because their parents are loath to talk publicly about how a cheerleader daughter hooked for dope, or their once-star athlete son overdosed in a fast-food restaurant bathroom.

 

Look at the numbers: 24,000 deaths from opioids. While the pain pill machine goes about its business of producing more and more addicts, no one says a thing.

 

For parents who do stand up and speak, the response is underwhelming. I attended an event at a large suburban high school billed as a community forum to examine the problems of recreational drug use, prompted by the drug death of a 17-year-old. Her father, Tom, spoke very movingly and passionately about his loss, but the audience was almost devoid of parents.

 

Why? Is it fear of hearing a contemporary bare his soul about a parent’s worse nightmare? Is it hoping that ignoring the problem will make it go away – soon they’ll be off to college anyway? Who knows? But the absence of any passion – any demand for action – was striking.

Stimulant use among 26-to-34-year-olds doubles in four years

The Sunday Times had a second story, this one on abuse of ADHD medications, titled “Workers Seeking Productivity in a Pill are Abusing A.D.H.D. Drugs.” Stimulants like Adderall, Vyvanse, and Concerta are migrating from school settings to the workplace. They’re now in play in demanding professions:

 

These lawyers said they and dozens of young colleagues at their firms had casually traded pills to work into the night and billed hundreds of extra hours a year in the race for partnerships.

 

Overuse leads to rapid heartbeat, acute anxiety, hallucinations, sleep deprivation, and addiction. Just the type of professional you want working on your case or in your firm or client base. Outside of the workplace, these pills are “Mommy Crack,” great for staying thin and multitasking on the home front.

 

Again, this phenomenon starts in high school, where students sell pills or give them to friends to help with academic focus and performance. They’re great for answering the four or five extra SAT questions needed to break 700 and pulling all-nighters for studying and exams. Whether it be weed, alcohol, uppers, or downer, students in every high school know who is selling or providing drugs and drinks, but are unwilling to name names out of fear of being ostracized or to protect their sources.

Silence and indifference

In any case – at the parent or student level – we have created a culture of silence and indifference not seen since the AIDS epidemic. We are beginning to make the connection between binge drinking and date rape among high school and college students, but a similar connection must be made between pharmaceutical companies’ and doctors’ profits and drug dependence and deaths. In both instances, the big businesses supplying the alcohol and pills pay less than 5% of their collateral damage and can never atone for their increasing death toll.

 

Not to minimize the AIDS epidemic, but what we’re dealing with here is on a very large scale. The Band Plays On, with alcohol and opioid deaths exceeding 100,000 per year. When will enough of us join together to stop this growing tragedy?

Becoming addicted to pain pills

Perhaps understanding how opioid dependency develops will be the first step in generating more public support for taking on the drug industry.

 

For those of you unfamiliar with how someone becomes dependent on pain pills, here is how it happens. People have an injury, surgery, or dental work and are given a prescription for 30 pain pills. After just a few days, it takes more pills to obtain the same level of effect in dampening pain. Most patients learn to tolerate their pain and supplement with over-the-counter medications. But then once they near the end of their supply, there is the problem of stopping. Stopping abruptly leads to uncomfortable physical symptoms, so most people taper off. But addicts are not like most people, and they don’t stop.

 

The dependency cycle

 

The dependency cycle begins when a person ups the dose, decides it’s too uncomfortable to quit, or in fact likes the physical and psychological effects from the pills. These narcotics can give a euphoric sensation of withdrawing from the world. Users will continue to seek prescriptions until their doctors decide to cut them off. From there, they turn to doctor-shopping and online ordering, or worse.

 

Switch to heroin

 

Many users – or addicts – switch to heroin because it’s cheaper and more readily available. It also can produce a really powerful and pleasurable body jolt the first few times. This motivates the addict to “chase the high” – trying to reproduce the feelings from that first time by increasing the amount, potency, or by mixing with other drugs. Very dangerous and a big reason for all the deaths. A similar process occurs for other narcotics.

 

Over-prescribing

 

Painkillers are meant for acute pain, not chronic pain, as are most other drugs, such as anxiety or sleeping medications. But remember, this starts with the doctor handing out the initial 30-pill prescriptions or samples provided by Big Pharma, enough to hook some patients, as the drug companies know all too well. And it’s no secret that doctors are liberal with the scripts – even doling out Norco (acetaminophen and hydrocodone) by the handful to newly-postpartum nursing mothers. It’s hard to keep saying no when it’s always offered.

Transforming public opinion and policy

Attacking the supply side seems like a good first step, but that means overcoming deeply entrenched social stigma, leaving the shadows, and finding the courage to tell our truths – namely that these problems don’t exist in a vacuum. With opioid-related overdose deaths occurring every four minutes, we can no longer pretend that these “dirty” deaths are only happening to strung-out junkies living on the streets in the inner city. They are happening to us, our families, and our friends. Fortunately, new generations are stepping forward to start conversations aimed at transforming public opinion and policy.

To Tom, the father who spoke out at the community forum, you are not alone, and we will not forget your daughter.

NYT recognizes John A’s vision for estate planning

Nov. 10th 2014

This past weekend, I was thrilled to see John A. Warnick featured in The New York Times for his accomplishments in creating the Purposeful Planning Institute. In the article, “Focusing on the Human Element of Estate Planning,” John A receives well-deserved recognition for taking the initiative (and risk) to focus estate planning on transmitting family values rather than merely asset preservation.

 

“What we stand for is making sure the planning has a deeper purpose and meaning to it than just being driven by taxes,” Mr. Warnick said. “The challenge is to get those core planning disciplines — lawyers, C.P.A.s, wealth managers — to start with ‘why’ instead of immediately marching into ‘how.’ ”

 

John A began thinking about how traditional estate planning was missing a key element – the impact on beneficiaries – after receiving an irate call from a 21-year-old complaining about a delayed distribution.

 

But this particular call got Mr. Warnick, then a lawyer at a large law firm in Denver, thinking about how estate planning was missing the human component. The emphasis was on transferring the most money to heirs free of estate tax and then insulating that money from creditors. “I said, ‘There has to be a better way to do planning so all this tax-efficient, elegant trust planning doesn’t hurt people,’ ” he said. “I saw well-intentioned, technically precise plans reap negative unintended consequences.”

 

In my experience working with families and trustees dealing with addicted and/or dysfunctional beneficiaries, far too many trust documents lack effective provisions to prevent the “negative unintended consequences” he is talking about. So, again, congratulations to John A helping parents write estate plans that help rather than hurt their heirs.

Good enough for doctors – Part I

Aug. 13th 2014

Applying the PHP model for our impaired attorneys
Managing the recovery process

Like lawyers, impaired physicians were historically silenced by the overwhelming stigma of addiction. Today’s physicians’ programs have succeeded in lessening this barrier by providing a defined path to recovery and career restoration.

During my tenure as director of the Hazelden Legal Professionals Program, I first learned of the remarkable success rates for doctors (often enrolled in a specialized track at Hazelden) who continued to follow the medical profession’s structured recovery model. The governing bodies for pilots have also created a similar program. The facts:

  • Doctors have first time continuous abstinence rates of 78 percent at five years.
  • 92 percent of airline pilots are continuously abstinent at two years.

No other groups approach these recovery rates, and in fact, studies show one-year continuous abstinence rates at less than 25 percent for the general population. Because most of the literature discussing these programs comes from the Physicians’ Health Programs (PHP), we will use PHPs as our model.

In your current position, it is invaluable to be familiar with the reasons why programs for doctors are so successful and how to apply the same protocols to lawyers. As I mentioned, I will identify the key elements over the next month, but it begins today with one major reason:

Firms – not the impaired attorney – manage the recovery process.

Medical boards manage the recovery process for impaired physicians. In reality, it’s the boards that are achieving high outcomes because without their active oversight of the treatment and post-treatment process, success rates would be much lower. The boards:

  • Tell the doctors where to go to treatment,
  • Review progress reports,
  • Identify and oversee therapists and groups to attend after treatment; and
  • Receive reports from drug testing services.

This is in contrast to the current system for attorneys who either find resources on their own or talk to their health providers, often with goal of minimizing the length and intensity of treatment. The firm usually has limited knowledge regarding progress, whether treatment appears to be successful, and what changes are needed to support abstention upon return to work. This lack of accountability is a major cause of relapse and resulting risk to the firm. Firms need a much better handle on the risk of relapse, just as medical boards already do.

Case management system

Medical boards use a case management system to oversee doctors participating in their treatment and recovery programs to improve their chances for sustained recovery. “Case management” refers to the coordination and implementation of services on behalf of the patient by a case manager (CM).

The “case” being managed is actually the alcoholic/addict, so a more accurate term might be “patient or addict management.” Prior to leaving treatment, patients and their counselors prepare a list of activities to support continued abstinence and stable recovery. These activities comprise a post-treatment plan, discharge, or case plan.

If attorneys in early recovery would follow a suggested discharge plan and work to find productive activities in the community, the sustained abstinence rate for patients leaving treatment would likely be higher.

The problem – and it is a significant one – is that attorneys leaving treatment do not follow these plans and directions. Left to their own devices, lawyers race from treatment to practice law longer and harder than ever to prove they have been “cured.” This is called the “compliance problem” and, more often than not, results in relapse.

In order to improve recovery rates, we advise firms to employ a CM to encourage the addict to attend the activities specified in the post-treatment plan and otherwise support recovery. The idea is to improve compliance by the attorney with post-treatment plans through case management.

Case manager accountability

The CM works on behalf of the firm and keeps the firm informed regarding progress in recovery and drug and alcohol testing results. The CM also helps with communication between the firm and the recovering attorney in ironing out any issues – on either side – that may be jeopardizing abstention.

One consideration to keep in mind is that the CM needs to be given the authority by the firm to oversee attorney treatment and progress so there is a single point of communication. In too many firms, authority for attorneys with behavioral concerns is given to a committee, which often has trouble being decisive when confronted by an upset colleague.

The first and most important step

Understanding the importance of managing the recovery process and providing accountability/oversight – and knowing how and why to do those things – is the first and most significant step in restoring the work and the lives of impaired attorneys. Stay tuned for Part II, where I will discuss therapeutic leverage.

One lawyer joke too many

Jul. 29th 2014

No more room for the actively impaired attorney

Lawyer addiction rates are twice the national average

Estimates suggest that attorneys, judges, and law students struggle with addiction at roughly twice the national average; as many as one in five lawyers has an active addiction problem; and it gets worse the longer they practice. Rates are also much higher for both depression and suicide.

These are powerful and eye-opening numbers to be sure, clearly demonstrating the need for proactive efforts and resources to reduce the prevalence of active behavioral health issues in the profession. Profound consequences — both subtle and explicit — impact firms every day.

As an attorney/addiction clinician in recovery, I have worked to help solve this crisis. Addiction is a chronic disease, and law firms must confront it accordingly.

The tangible risk to the firm is documented

Despite the fact that they may be under-serving clients, losing energy and focus, becoming more erratic and less reliable, lawyers typically plow forward until the consequences become too severe to be tolerated. Often the line is crossed into malpractice and disciplinary problems:

60 percent of all disciplinary actions and 85 percent of trust fund violations are connected to addictive behavior.

Even with these risks staring them in the face, firm administrators and managing partners fail to confront problematic behavior indicative of an underlying behavioral health disease or condition. It is easy for the rest of the firm to follow suit, believing that it is not their business and quietly looking the other way. This approach has a long and entrenched history in a culture already imbued with a play-hard, work-hard ethos.

The damage to the firm of ignoring these problems is incalculable

I will write about this subject in more detail in the future, but suffice it to say that these problems predictably become worse without treatment, until the attorney and the firm suffer untold damage. Reputations are destroyed, productivity is decreased (every single day), lawyers — particularly lateral hires who often have their own existing issues — leave, retire early, or implode; clients leave; and the firm’s chemistry and investment in talent evaporates.

If it’s good enough for doctors, it’s good enough for attorneys

Most lawyers are unaware that doctors and pilots have very high success rates for recovery from addiction. Their programs are different than those for the general public, including attorneys.

 

  • Physicians: 74 percent continuous sobriety at five years
  • Pilots: 92 percent continuous sobriety at two years

 

Addiction is the only field of medicine where doctors receive different treatment than the general population. If the same success rates applied to cancer treatment with differential outcomes, there would be massive lawsuits — but not for addiction treatment.

These groundbreaking rates of success can inspire firms to commit to learning about these programs and how to apply the same protocols to their lawyers, staff, clients, and families.

Achieving high recovery rates for addicted attorneys

As the founder of the Hazelden Legal Professionals Program (and director until this past January), I am committed to educating firms and lawyers in order to destroy the stigma standing in the way of seeking treatment. And more importantly, implementing the physician/pilot model as the template for establishing stable recovery and return to the firm.

We can and must do a much better job of protecting our profession and those of us who serve it.

Posted by Link Christin | in Addiction, Lawyers, Lawyers' Link to Recovery | No Comments »