Good enough for doctors – Part I

13/08/14 8:43 PM

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.

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