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ALABAMA LAWYER ASSISTANCE PROGRAM

Understanding Addiction, Helping Clients and Colleagues

By Jeanne Marie Leslie rugs change the brain–they according to the American Bar change its structure and how it Association, is 15 to 18 percent.3 D works.1 Many of these changes Lawyers rank high in the incidences of are responsible for the behaviors we see depression compared to other professions in individuals addicted to . and a disproportionate number of has made significant lawyers commit suicide;4 in Alabama advances in our ability to identify and there are about a dozen lawyer suicides understand the mechanisms involved in every year. And these are only the ones the addicted brain. These advancements about which we know. Many lawyers, clearly confirm what many in the addic- including some you know, may be strug- tion medicine field have known for some gling with an addiction or time: the obsession and compulsion to problem when help is readily available use drugs in the addicted brain is instinc- through ALAP. tual and paramount to survival.2 Ignorance and stigma have contributed Addiction Facts to the confusion, moral judgments and Dr. Nora D. Volkow, director of the poor understanding of this destructive National Institute of Abuse and often fatal . Our courts are (NIDA), explains how the neuro-chemi- overwhelmed by the behaviors, criminal cal mechanisms of drug abuse catalyze and civil, associated with addiction. and accelerate the onset addiction: Therefore, understanding addiction is “Recognizing drug addiction as a chron- essential for lawyers. Lawyers are in ic, relapsing disease characterized by com- unique positions to initiate change, to pulsive drug seeking and use is critical to advocate for medical treatment over tra- being able to identify and help those who ditional sanctions and to refer individuals have it. Drugs of abuse the brain by to appropriate help. Clients are more apt mimicking (e.g., to discuss these issues with their lawyers or marijuana) or by altering their regula- and lawyers are in a better position to tion and release (e.g., and amphet- advise and protect their clients’ interests. amine). In this way, they disrupt normal Members of the legal community who brain communication. Repeated disrup- understand addiction can be instrumental tions in the brain’s normal signaling in guiding their clients toward recovery. processes can eventually lead to addic- Moreover, lawyers themselves are at a tion–affecting the very circuits needed to higher risk for the development an addic- exert good judgment and tion problem. Reports now estimate that over actions. With these abilities ‘seized,’ while 10 percent of the general popula- the drug-addicted person will compulsive- tion has problems with an addiction, the ly choose drugs, even in the face of devas- corresponding estimate for lawyers, tating life consequences.” 5

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The National Council on and Helping Clients of ALAP referrals come from a third party Drug Dependence reports that addiction is Addiction-driven behaviors often result (employer, judge, family member or col- America’s number one health problem and in problems involving the legal system. league) and there is no disciplinary involve- the leading cause of both death and disabil- They may show up in any number of ment. Lawyers call ALAP for any number ity.6 The and Mental courts. The best resolution to your of reasons, as mentioned above, but also for Health Services Administration’s National client’s case may depend on assisting stress, burnout or other difficult life situa- Household Survey on Drug Abuse reported your client in obtaining an appropriate tions. ALAP provides education, interven- an estimated 20.4 million Americans age evaluation and, if necessary, treatment. tion, monitoring and referrals to appropriate 12 or older were current users of illicit The ability to demonstrate to the court treatment when indicated. drugs in 2006, meaning that they used an that your client is taking the necessary Impairment may present itself with an illicit drug at least once during the 30 days steps to address his/her addiction can addiction to drugs, , gambling or prior to the study interview.7 have a significant impact on your client’s other behavioral symptoms. Mental In an article, Alan Leshner, Ph.D., and case. As a lawyer, assisting your client in health issues include stress, burn-out, then director of the National Institute on obtaining an evidence-based practice depression, bipolar disorders, and obses- Drug Abuse, describes the process of assessment is important. This type of sive-compulsive disorders. Other impair- addiction as the “oops phenomenon.” 8 He assessment is proven to be successful, is ment issues may be related to aging, such explains that individuals who use drugs backed up with research methodology as dementia or Alzheimer’s. Most do not intend to become addicted, just as and is the standard criteria used by most lawyers do not want to talk about these someone who eats fatty foods does not courts. The American Society of problems but when they find themselves expect or intend to develop coronary Patient Placement in the position of having to acknowledge artery disease. The individual who Criteria is a widely used instrument for a colleague’s impairment, or that a mem- smokes does not plan on developing lung placing clients in the appropriate level of ber of their firm is using drugs, all sorts or any of the other illnesses asso- care.11 An evaluation, coupled with your of questions are raised. ciated with smoking. When most people client’s being in treatment or scheduled As a lawyer, your initial reaction may be first use drugs, including alcohol, they do to enter a particular treatment program, liability concerns, for your firm, yourself it to feel better and to alleviate feelings of goes a long way in demonstrating com- and your colleague. These are legitimate stress. What starts out as a means to feel pliance to the court. It also can prompt concerns which will need to be addressed. good a couple of evenings a week can your client in initiating the changes nec- For most of us, our colleagues are also our become, for some individuals, the only essary for recovery. However, this type friends, and you will naturally have person- way they can feel “normal.” 9 of approach is not for every client. The al concerns for your friend and your The controls the non-volun- sanctions for non-compliance in drug friend’s family. Remember that lawyers in tary functions basic to survival such as court diversion programs can be harsh. A these situations are sick and full of shame. heartbeat, respiration, appetite and thirst. clear understanding of what your client’s They need support and help–not judgment. The mechanisms for pleasure or reward individual needs are will help determine That being said, client safety must be are also a function of the midbrain. The how best to proceed. ensured. Impairment issues are serious and “rush” or the intense feeling of exhilara- if your firm has no policies in place for tion associated with drugs of abuse is handling these types of situations ALAP’s caused by a rapid release of in Helping Partners and assistance can be invaluable. the midbrain. Repeated use of drugs can Other Attorneys Perhaps most problematic is the situa- cause long-lasting changes, which, in turn, The Alabama Lawyer Assistance Program tion where a judge is showing signs of affect the pathways used to process infor- (“ALAP”) is a confidential program obvious impairment. At the present time mation. These changes can impair motor designed to assist members of the legal pro- procedures for reporting possible judicial skills, moods and memory processing, fession with impairment issues. A lawyer impairment issues require a signed affi- many of the same behaviors and symp- does not risk sanctions for contacting ALAP davit. Individuals are not given anonymi- toms associated with addiction. However, about any problem he/she may be experi- ty. Therefore, early behaviors which may not all individuals who abuse drugs will encing. Referrals can be made anonymously. indicate a problem not only are not report- experience these types of changes nor will In Alabama, about 50 percent of all ALAP ed, but are essentially enabled to progress. they all become addicted.10 referrals occur by virtue of a disciplinary The Judicial Inquiry Commission will be But for individuals who do become order. Obviously, the compliance or non- having hearings on reviewing the Canons entrenched in addiction, they endure pain compliance with the program for these types of Judicial Ethics and will be addressing and suffering, both physically and psy- of referrals is reported back to the appropri- these issues in the near future. It is hoped chologically, to a point where the cost of ate disciplinary authority. Since the majority that by instigating changes in how these getting high outweighs any benefit using of grievances filed against lawyers are found issues can be reported and, therefore, may have once provided. At this point, to involve a problem with an addiction investigated, there will be reduction the an individual can no longer the and/or mental health illness compliance to a tragic and often public situations we have judgment necessary to make a “logical” recovery program benefits both the lawyer seen in the past. Unfortunately, when decision to stop. and the public interest. The other 50 percent these issues are made public the lawyer or

The Alabama Lawyer 349 ALABAMA LAWYER ASSISTANCE PROGRAM

judge and their families suffer, as does the duct… The requirement to report percent in non-specific programs. 16 public perception of the administration of includes reporting of a lawyer whose Obliviously, completing treatment is an justice. Knowing what to look for and conduct indicates that he or she is suffer- important part of establishing recovery, what to do if you or a colleague or judge ing from addiction (or “chemical depend- but authors also concluded that lawyer is in need of help is important. Early inter- ency,” as termed by the General assistance programs were a significant vention can save a life, a family and a Counsel’s office).” 13 part of their 85 percent long-term (a year career. The chance of ethical violations or But more importantly, the General to five years) recovery rate. 17 harm to clients is greatly reduced the Counsel also concludes “a confidential A variety of approaches are used in sooner the cycle of the addiction is inter- report to ALAP fulfills the lawyer’s treatment programs to help clients cope, rupted. Firms should have established reporting obligation.” The General handle cravings and manage their dis- policies in place for handling issues relat- Counsel further stresses that reporting is ease. However, not all treatment pro- ing to impairment. No other issue is as the best way to help a colleague and to grams are alike and finding an appropri- important nor is a firm more vulnerable do your duty at the same time. ate program for lawyers or clients can be than when these issues surface. ALAP will “In most instances, the reporting of challenging. Again, contacting ALAP is come to your firm and put on a free CLE misconduct brings to a head a bad situa- probably the best solution. When your seminar to assist you in devising policies tion which needs to be addressed, both client enters treatment, make sure the and procedures appropriate to handle for the benefit of the lawyer and the pub- necessary releases are signed in case you these types of situations. ALAP also lic. The system itself is improved signifi- need to contact your client while he/she assists firms in handling back-to-work cantly by ensuring that those who prac- is in treatment. Treatment programs issues. tice law do so in an ethical and compe- adhere to strict confidentially laws and if The Lawyers Helping Lawyers tent fashion. When either of these char- the proper releases are not signed, having Committee is an active committee of the acteristics of representation is lacking, access to your client can be difficult. Alabama State Bar comprised of lawyers the lawyer’s reputation, and that of the There may be a waiting list before and judges who are knowledgeable about legal profession, suffers greatly.” 14 your client or colleague can enter a treat- addiction and mental health issues. The There is no reason not to call ALAP if ment program. Therefore, it is important committee members assist ALAP in see- you see someone displaying symptoms to get recommendations by the evaluator ing that bar members in need of assis- of impairment whether it is you, a family on the things your client can do to tance are given confidential help. member or another lawyer. Lawyers do remain abstinent while waiting for an not have to face these issues alone. We opening. The recommendations may Your Obligation to Report have helped hundreds of members of include participating in an - Impaired Attorneys Alabama’s legal community and we can based group, individual therapy or sub- help you too. Visit our Web site, mitting to drug screens while waiting to The ASB General Counsel’s office www.alabar.org/alap/. enter the treatment program. Any one of published an article in the July 2001 edi- these behaviors reflects a for tion of The Alabama Lawyer about change and communicates to the court reporting misconduct, including miscon- Treatment that these matters are being taken seri- duct relating to lawyer impairment as The U.S. Department of Health & ously. Make sure your client is also keep- stipulated by Rule 8.3, Alabama Rules of Human Services, Substance Abuse and ing a record of groups and meetings that Professional Conduct: Mental Health Services Administration (“SAMHSA”) funded a five-year study they are attending. “(a) A lawyer possessing unprivi- on the impact of treatment of 5,388 leged knowledge of a violation of clients in publicly-funded substance Find Resources for Rule 8.4 shall report such knowl- abuse programs across the United States Treatment edge to a tribunal or other author- and found “that drug and alcohol treat- Below is a list of Web sources to help ity empowered to investigate or ment works. That is, the receipt of treat- identify treatment facilities in your area. act upon such violation.” 12 ment is associated with significant reduc- • Findtreatment.samhsa.gov tions in drug use, criminal behavior, ill “[S]elf-regulation requires that lawyers • Addiction.com report misconduct, unless the reporting health and associated characteristics, and • Alabama Department of Mental of misconduct violates Rule 1.6, the best evidence assigns most of these Health at ADMH/MR Confidentiality… But less than ten such reductions to the therapeutic effects of 15 reports are filed by Alabama lawyers treatment.” • www.mh.alabama.gov each year… This is [a] sad commentary, A study published in 2004 in the • ALAP at www.alabar.org/alap/ Journal of Addicted Disease followed when national statistics show that in at • [email protected] least 75-80 percent of matters involving lawyers who completed treatment and • The American Bar Association lawyer misconduct, a judge or another found that 79 percent of lawyers com- Commission on Lawyer Assistance lawyer observed, was subjected to, or pleted treatment when a lawyer-specific Programs at www.abanet.org/ was personally aware of the miscon- program was initiated compared to 47 legalservices/colap/home.html.

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Conclusion 12. J. Anthony McClain, “Opinions of the General 16. Timothy J. Sweeny and Joseph Molea, “Treatment of Counsel,” The Alabama Lawyer, July 2001. Attorneys with Substance-Related and Co-Occurring Addiction has become America’s num- 13. Ibid. Psychiatric Disorder Demographics and Outcomes,” ber one public health problem. Lawyers Journal of Addicted 23, no. 1 (2004): 54-5. 14. Ibid. representing clients with addiction prob- 17. Ibid. lems need to understand the disease and 15. U.S. Department of Health and Human Services: know about the appropriate resources, Substance Abuse and Mental Health Services Administration, National Treatment Improvement because they are in the best position to Evaluation Study—Final Report, March 1997, 219. advocate for their clients’ interests. Available online at www.icpsr.umich.edu/ Jeanne Marie Leslie, RN, M.Ed, is director of Lawyers are not immune from these SAMHDA/NTIES/NTIES-PDF/ntiesfnl.pdf. the Alabama Lawyer Assistance Program. problems, and the stressful nature of prac- ticing law–taking on other people’s prob- lems–may contribute to the increased incidence of addiction and depression among members of the legal community. Lawyers provide services to improve lives and families. It only makes sense that when these types of illnesses affect lawyers the same commitment and con- cern should be extended. ALAP wants to make sure that you know that the ASB Lawyer Assistance Program is concerned for the well-being of the profession and the well-being of the individual lawyer: you and your friends, partners and col- leagues. The Alabama Lawyer Assistance Program and the state bar’s Lawyers Helping Lawyers Committee are commit- ted to helping members in need. ▲▼▲

Endnotes 1. Alan I. Leshner, Ph.D., director, National Institute of Drug Abuse, National Institutes of Health NIDA Home Medical and Health Professionals, June 14, 2005, “Oops: How Casual Drug Use Leads to Addiction” May 2, 2008, Available at www.nida.nih.gov/. 2. Ibid. 3. American Bar Association: Commission on Lawyer Assistance Programs (CoLAP) homepage. 4. Ibid. 5. Nora D. Volko, M.D., director, National Institute of Drug Abuse, National Institutes of Health NIDA Home Medical and Health Professionals, 25 May, 2007. “Message from the NIDA Director for Medical The most difficult problems require the and Health Professionals” July 2, 2008, Available at www.nida.nih.gov/. most innovative responses. 6. National Council on Alcoholism and Drug When the shadows of title problems Dependence, Inc., NCADD Fact Sheet, 2007.

7. Substance Abuse and Mental Health Services loom, a unique approach makes all the difference. Mississippi Valley Title responds. With in-depth knowledge Administration, National Household Survey on Drug Abuse, 2006. to serve your local needs instantly. Strength to offer national resources and reserves immediately. 8. Alan Leshner, “Oops: How Casual Drug Use Leads to Addictions,” National Institute on Drug Abuse, dru- gabuse.gov/Published_Articles/oops.html. Flexibility to change with your business readily. Call us today. 9. Ibid. 10. Ibid. 11. U.S. Department of Health & Human Services, Substance Abuse and Mental Health Services 1-800-843-1688 www.mvt.com Administration (SAMHSA), 1990.

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