Archive for the 'Lawyers’ Link to Recovery' Category

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 »