Why 12-Step Meetings are Important

So much can go wrong during your first months of recovery, with everything so fresh and new, and finding yourself often inundated with raw emotions and painful situations you feel ill-equipped to deal with yet. It’s one thing to have a bit of relapse prevention training under your belt from your days during treatment, but it’s another thing altogether to really put those skills to practice in the real world. Suddenly, what you learned seems foreign and too difficult to follow. Most of all, you feel a great sense of uncertainty and anxiety about making the right choices.

Furthermore, you don’t have the structure and schedule that you lived with during your active treatment phase, especially if you went to a residential treatment facility. Now, you’re all on your own, and it’s often a scary and frightening place to be.
First things first: Get yourself to a 12-step meeting. This is the one constant and ongoing support network that you have readily available to you. It doesn’t matter where you are in the United States, there’s likely one or more 12-step groups meeting in your area. There are even 12-step groups meeting regularly in numerous foreign countries and U.S. territories. You also don’t have to physically be in the room to participate, although in-person, in-the-room networking is always the best. Most 12-step fellowships offer online and teleconference meetings for those who can’t make it to a meeting location or need emergency assistance in the form of instant meeting.

Here are some other reasons why 12-step meetings are important:

• They can save your sanity: When things are all haywire in your life and you don’t know where to turn, you always have the support and encouragement of your fellow 12-step members. Just sitting in the room and listening to others talk about their struggles and strategies to overcome difficult challenges can reassure you that you’re not losing your mind. There really is something to this community of individuals all committed to helping one another maintain their sobriety. No, the participants aren’t counselors, and 12-step meetings aren’t a form of treatment, but they are invaluable. They’re a support group of your peers, people just like you who are going through the day-to-day issues of working their recovery.

• No judgments are offered: In the 12-step rooms, everyone is equal. Who you are in real life is insignificant. It’s the fact that you’re committed to your recovery and to helping others maintain theirs. Recovery isn’t a straight-line process, all constantly positive and instantly successful. It takes a lot of hard work and there are often little detours or setbacks as you try out various strategies to deal with certain issues or problems. As you become more comfortable and are willing to talk about your struggles in the room, you can be assured that whatever you say, you won’t get any judgments back from the other meeting participants.

• Find others in recovery who share your particular addiction: Just as you received treatment for your particular addiction at a facility that specialized in such treatment, you also can participate in 12-step meetings whose focus is recovery from that particular addiction. If you’re a recovering alcoholic, your primary 12-step meeting would be Alcoholics Anonymous. If you have a gambling addiction, you will likely attend Gamblers Anonymous. If you have multiple addictions (alcohol, drugs, compulsive sexual behavior, eating disorder, and so on), you can attend meetings for each of them. The point is that you want to be in fellowships where you can relate to the other members – and they to you – because you share similar problems and issues in recovery.

• Group sharing helps the individual: It’s often said that there’s great power in numbers. Nowhere is this truer than in 12-step group meetings. There’s something about listening to one member’s story, everyone nodding in acknowledgement (they’ve all been there), and offering a comforting word or supportive handshake. Just being able to verbalize the knot of emotions and difficulties involved in things like coping with urges, unexpected visits from former friends who are still using or other challenges often helps lift your spirits. Someone in the room may even have some practical advice or solution that worked for them – and may very well work for you. Brainstorming back and forth in working sessions often results in numerous strategies that may prove useful. This is so much better than sitting around at home stewing over a problem and not knowing what to do about it.

• They’re free: Whether you attended a residential addiction treatment program or got treatment on an outpatient basis, no doubt there were significant costs involved. Some addicts who feel they can’t afford treatment, either because they don’t have insurance or insurance doesn’t cover treatment, or because of family hardship, go to 12-step meetings to at least get some idea of how recovery works. While no treatment occurs at meetings, the fellowship is very supportive. Best of all, the meetings don’t cost anything. The only requirements to joining are a genuine commitment to maintaining sobriety and helping others do the same.

Tips on Working the Meeting Rooms

There’s no right way or wrong way to participate in 12-step meetings, but as you rack up attendance in different meetings, you will become aware of ways to best utilize the meetings. Here are a few tips on working the room to maximize your benefits – and those of the other participants.

• Be courteous and respectful: No matter what is said in the room – and sometimes there are heated discussions or things can get very emotional – always be courteous and respectful of others. You may not particularly like a speaker, for whatever reason, but you can always learn something valuable – if you listen to the message.

• Keep confidences: It goes without saying that what’s said in the 12-step rooms is confidential. It’s also anonymous, which should give you a great deal of comfort that what you say won’t get out to society at large. Still, these are groups of individuals, and the temptation to gossip isn’t something that 12-step members are immune to. To uphold the principles and philosophy of your 12-step groups, always strive to keep confidences. Just as you want your heartfelt and personal comments kept within the group, so, too should you keep whatever you hear in the room to yourself.

• Don’t be critical: Just because you don’t like something another member has to say or feel that they’re going about their recovery all wrong, keep your criticism to yourself. The whole purpose of being in these rooms is to be supportive of your own and others’ efforts in recovery. This means that you don’t criticize the choices someone else makes. You may, however, offer words of encouragement and support. That’s what most in recovery need, especially newcomers. They don’t have the answers.
That’s why they’re coming to meetings.

• Don’t feel you have to share right away: When you first start going to 12-step meetings, don’t feel you have to spill your guts out right away. It takes time to feel comfortable enough to want to say anything more than your first name. You’re there to listen and absorb, to get a handle on how all this works and whether or not the particular meeting feels right to you. At a certain point, when you do feel like you’re fitting in, you may wish to talk a bit about your story. No one will ever force you to do so. So, don’t worry about when the time will be right. You’ll know when it is.

• Try several different meetings: It may take going to several different meetings to find one that seems to click for you. Whether it’s the people who attend or the location or time or something you can’t quite put your finger on, some meetings just feel more comfortable than others. And, it may very well be that at some point, the meeting you didn’t like to begin with will become just the right meeting later on in your recovery. It’s also important to keep variety in your meetings. Why is this important? When you see the same people over and over again at your meetings, you may tend to tune out what they’re saying. Maybe they say the same things over and over again, and you don’t think you’re getting anything out of it. By going to different meetings, you solve that problem. You’ll have multiple networks of 12-step allies, all helping you in your goal of maintaining sobriety.

• 90 in 90: If you’re new to recovery, you may not be familiar with the 90-in-90 rule. Basically, it means attending 90 meetings in 90 days. Sounds like a lot, doesn’t it? The reason for the rule is that the first months of recovery are often filled with pitfalls. Relapse is common, especially among those who may not have enough coping skills practice. The discipline of attending at least one meeting every day – and you can certainly attend all the meetings you like in a day (meetings are available morning, noon, and night somewhere in your area) – helps you keep needed structure in your life. It also means that you’re always in the presence of others in recovery who can help you keep your priorities straight.

• Find a sponsor: Everyone in 12-step meetings needs a sponsor. A sponsor is someone who’s been in successful recovery for at least one year. Ideally, you’ll look for a sponsor with whom you can relate, someone whom you admire for their ability to overcome the challenges of early recovery, someone with whom you feel comfortable sharing your own issues and thoughts. It may take a while for you to find this individual, and you can always change sponsors if it doesn’t work out. The value of your sponsor is that this is someone that you can call on when you really need help – in the middle of the night, if necessary. In early recovery, your sponsor is the closest thing that you have to a lifeline – in addition to your therapist or counselor if aftercare or continuing care is part of your treatment program. So, while you’re attending various 12-step meetings, pay attention to the various individuals and speakers with whom you may share interests. If you like what one member has to say and he or she has been sober for a year or longer, approach that person and ask if he or she will be your sponsor.

• How to avoid conflicts: Recovery is unique for everyone. Some seem to take to it naturally, while others struggle and slip again and again until they finally seem to get into the process. Understandably, there are bound to be conflicts that arise. When people get emotional, sometimes they say things that others may find objectionable or harsh. It isn’t that they mean to, but all that pent-up emotion and frustration and guilt and shame and rejection that someone feels has to come out somehow. Avoid taking anything personally. If you find that a conflict emerges with another meeting attendee, try to remain calm. You may wish to alternate your attendance at that meeting to days and times when the individual doesn’t attend, or change meetings. There’s nothing that says you’re going to always like everyone in attendance in the rooms. That’s just highly unlikely. But what is true is that potential conflicts can be nipped in the bud. Always take the higher ground. And, if you inadvertently say something you wish you hadn’t, be upfront and apologize to the individual and/or the group as soon as possible.

• Find gender-specific or special group meetings: You don’t have to feel intimidated by going to a mostly-male 12-step meeting or one that has men and women that aren’t in your age group. The good news about 12-step meetings is that there are sections of many chapters that have been created to specifically address the needs of particular groups. There are women-only meetings, meetings for gay and lesbian individuals, meetings for young people, and those for senior citizens. To find such meetings, look at the websites of the 12-step groups and check out what may be available.

• Maintain a home meeting location: While you attend various 12-step meetings, you should have one particular meeting that you commit to attending each week. This is known as your home meeting. Committing to a home meeting will help keep you grounded. It is a place filled with other 12-step members who know you and constantly have your back. In your recovery journey, it’s important to have this familiar and reassuring element to keep you focused on your future in sobriety.

How Long Should You Attend?

Many newcomers to recovery and 12-step group attendance wonder how long they’ll have to attend. There’s no right answer to this question. The fact is that after you attend meetings for about a year, you should continue to attend them for as long as you feel that you are getting something out of them. Many individuals continue to go to meetings for years or even decades after they’ve been successfully in recovery. They have built a community for themselves that keeps them on track.

At some point, however, when you feel that you are fully grounded in your recovery principles and have completed all your 12 steps, you may wish to give back. At this point in your recovery, you may wish to or are asked to become a sponsor. You may find yourself leading meetings, organizing workshops, helping out in job fairs or providing other services unique to your background and capabilities. You may even wind up starting your own meeting in an area that desperately needs one.
Some individuals with years of recovery go on to study and become alcohol and drug abuse counselors. Others write books on their personal recovery in order to help others.

Bottom line: How long you attend 12-step meetings is really up to you. Remember that recovery is a lifelong process. You can come and go in meetings, be away for extended periods, and come back again to find that the rooms still work for you. The 12-step meeting works because of the generosity of spirit of attendees and the overall commitment to sobriety. It has been that way since the founding of the first Alcoholics Anonymous meeting and all subsequent 12-step fellowships. It will always be that way. This, in itself, is a tremendous example of the solid support that 12-step fellowships offer for all those in recovery.

At the conference titled “Blending Addiction Science and Practice: Evidence-Based Treatment and Prevention in Diverse Populations and Settings,” NIDA Director Dr. Nora Volkow discussed the many factors that make substance abuse addiction a multifaceted disease. Substance abusers are affected by their environments, genetics, psychology, biology, and emotions. As an addiction progresses, the abuser experiences negative changes to their body on a neurobiological level, causing multiple repercussions in their personal health, behavior, and development.

Traditional treatment for addiction includes cognitive-behavioral therapy and rehabilitation that may include pharmaceutical intervention. With the integration of these novel drug addiction vaccines, recovery patients may become more adhesive to treatment programs and more capable of completing recovery and remaining abstinent. The new vaccines are designed to help suppress cravings and prevent the addictive molecules in illicit substances from reaching the brain, which causes dependency. As many recovering addicts often experience relapse after treatment, these new vaccines will effectively lower the risk of setback and help change recovery treatment strategies. Recovery treatment periods are extended to incorporate this vaccination stage that helps meet the need of relapse prevention. The goal of the conference was to incorporate new clinical research into standard addiction medicine practice.

If the immune system can be strengthened to withstand the presence of such addictive substances as nicotine or cocaine, can addiction be defeated? Clinical trials with the new vaccine called NicVax from Nabi Biopharmaceuticals have shown signs of this possibility. NicVax stimulates the immune system to produce antibodies in response to nicotine, which bond to the nicotine molecules in the system and prevent them from entering the brain where they generate psychoactive effects. Without this ‘high’ that changes the brain’s neurotransmitters and makes normal brain function dependent on the presence of nicotine, tobacco use may become less addictive, and quitters may actually stay abstinent.

In NIDA’s human trials, more than 30% of NicVax participants were able to successfully overcome their addictions and remain abstinent after having developed antibodies. According to NIDA, approximately 71 million Americans over the age of 12 are current tobacco users. About 440,000 tobacco-related deaths occur each year, or approximately one in five American deaths. NIDA has also found that 35 million smokers are aware of the dangers of smoking and wish to quit, but 85% of those who attempt cessation will relapse. Of the latest vaccines, NicVax will most likely be the first one available for prescription. NicVax may also become an ideal component of recovery therapy since it does not produce any adverse effects. It may take a few more years before NicVax gains FDA approval if it increasingly demonstrates positive results.

NIDA also revealed its new treatment program for adolescents suffering from opioid addiction: Buprenorphine Treatment for Young Adults. Buprenorphine, an anti-addiction medication, is already used in addiction treatment for adults addicted to heroin and other opioids, but NIDA research conducted in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA) has shown that buprenorphine can be just as effective for adolescents. The program involves an extended treatment period for young adult patients which includes long-term use of buprenorphine medication, as opposed to the typical shorter detoxification period followed by post-treatment medication. Buprenorphine not only helps control opioid addiction by suppressing cravings, but it may also help younger patients adhere to treatment, complete recovery, and achieve long-term goals. NIDA is offering a three-hour training program for clinicians and addiction medicine specialists that explains how buprenorphine works in adolescent patients, how to select appropriate patients from this vulnerable group for buprenorphine treatment, and the legalities surrounding the use of the new medication.

Often, those with substance abuse addictions also experience comorbid disorders. Further research from NIDA has been focusing on how to best integrate effective treatment techniques into such vulnerable groups as American Indian and other native populations who experience high levels of substance abuse and HIV infection. NIDA hopes that an interwoven treatment model that includes indigenous and Western strategies for trauma and substance abuse recovery will generate positive results in recovery and prevention efforts. Also, NIDA discussed strategies for creating more effectual counseling and medical treatment for military personnel suffering from substance abuse disorders, post-traumatic stress disorder (PTSD), and other psychological and social disorders.

Iceni, which led a campaign to help sex workers off the streets following the serial killing of five young women in Ipswich in 2006, played a major role in the BBC show “Five Daughters.”

The program was a three-part drama starring Sarah Lancaster and Ian Hart that chronicled the lives of the murdered women and their families, and the drug addictions that drove them to prostitution.

Brian Tobin, director and co-founder of Iceni, said he had been "very moved" by the calls, emails, and pledges of money, totaling £10,000, that he has received from members of the public since the last episode aired on Wednesday.

"I came into the office and I had half a dozen donations via the website. They have kept coming," said Tobin, whose part in the program was played by Sean Harris, known for his role as Ian Curtis in “24 Hour Party People.”

"We have had a lot of people give £20, or £50, some have pledged more. We’re at £7,500 now, and with the pledges, that will go up to £10,000,” Tobin added.

A month ago, the charity, which relies on nine full-time staff, three part-time workers and 22 volunteers, lost a quarter of its £360,000 annual funding due to cutbacks and had to make two full-time staff and a part-time post redundant.

Tobin, who set up the organization in 1999 in a restroom (removing the sink to make way for a desk) said the donations will help them to treat the 300 people they see annually.
He said many donors had seen relatives or friends die through drug addiction.

"There is a consistent number of people who have been affected directly because their loved ones have been affected by drug addiction. A lot had lost people though drug abuse,” he said, adding, “It’s been very moving. One unemployed chap said he was going to donate a tenner out of his next giro. The money is fantastic and it will all help, but it also gives us a sense that we are valued. The drama picked up on how difficult and isolating drug work can be."

The murders of Gemma Adams, 25, Anneli Alderton, 24, Paula Clennell, 24, Tania Nicol, 19, and Annette Nicholls, 29, by truck driver Steve Wright over six weeks in 2006, re-ignited the national debate over street prostitution and drug abuse.

It prompted agencies in Suffolk to tackle the problem: police arrested curb crawlers, female officers worked with women on the streets, and council drug schemes allowed addicts faster and easier access to the heroin substitute methadone.
Many of around 30 street prostitutes underwent drug treatment and the scheme was widely recognized as a success. Ipswich no longer has a red-light district and many former sex workers are now drug free, although "a handful" remain in treatment, according to Tobin.

"I am in touch with all of them," he said. "I can understand some people’s attitude towards addiction—drug abuse causes untold misery. But I’ve said to people, ‘Come and see what those trying to get off drugs are doing here.’"

Honesty is the Best Policy – But…

Deception, keeping things from those we care about, glossing over the truth and hoping it won’t come back to bite us is a dangerous path to take. The more lies you tell, the more difficult it becomes to keep track of them. If you tell one version of your background to one person, or a group of people, say your boss and co-workers, another to your family, and another yet to new acquaintances, how are you going to remember what you said to whom? What happens when these people interact and the contradictions in your past come to light? What do you think happens then – to your credibility, reputation, trustworthiness, and reliability?

You might jeopardize or ruin your chances for a promotion, or lose a lucrative potential contract. Your spouse or significant other could feel, and rightly so, betrayed and unsure of the foundation and nature of your relationship. If there are children involved, or the desire to have children, not knowing about your addiction could pose serious questions about family heredity and genetics.
How should you handle the truth about your past? How much detail should you go into, and when is the appropriate time to even have a discussion about your addiction?

It would be wonderful to state that you should always be truthful. But the fact is that not everyone has a right to know about things that happened in your past – certainly not the stranger on the street or very casual acquaintances. Some things are best kept closer to the vest. That’s the “but” in the strategy.

Let’s take an example. You should be prepared to state honestly, if the situation warrants it, that you had a problem with alcohol, received treatment and have been sober for the past 10 years. Be straightforward and don’t go into details. Briefness is best. After all, no one is perfect. We all have challenges, obstacles, and missteps in our past that we’ve had to deal with. Thanks to a greater awareness that addiction is a treatable disease, today there is much less stigma attached to it than in years past. Nonetheless, there still is a stigma about addiction. So, if the other person seems to take it as a matter of fact and doesn’t pursue the subject, consider that you’ve said enough.

What About Loved Ones?

The closer your relationships, the more honest you need to be. This just stands to reason. They’re bound to find out at some point anyway, so why try to hide your addiction? You don’t need to be blatant about it, parading your sobriety like a badge of honor. This makes others nervous, as if you have something you’re trying to prove to yourself. Save your declarations about your sobriety for your 12-step group meetings. That’s where it really belongs. Your fellow 12-step members have all been in your shoes and understand the stresses, cravings, urges, and tough times every addict faces in recovery. They’re also uniquely qualified to help you through their support and encouragement. They don’t ask anything in return, and aren’t going to jeopardize your relationships, job or social standing. Again, choose where you want to be the most open and direct.

Your spouse, partner or significant other deserves to know the most about your addiction. This is your life mate, the person with whom you share more than just your physical bonding. He or she should already know about your past, but if you’ve kept it secret up to this point, now’s the time to get it out in the open.

While it’s understandable that you would feel like this would be a bombshell that could end the relationship, it’s worth taking the risk in order to strengthen your union. The question no longer becomes one of if you should tell your spouse/partner/significant other, but when and how. Here you have a lot of discretion and latitude. You still need to pick the time, place and manner of delivery.

Tips for Telling Your Spouse the Truth

Think about what pleases your spouse the most. Is it a romantic dinner for two or a getaway to a favorite vacation spot? Does your spouse really love a thoughtful gift, flowers, or a pre-paid spa appointment? What about season passes to a nearby ski resort or a membership in a golf club? Is the best time over coffee at sunset or during a picnic lunch at a lakeside park?
Make a list of all the ideas you can come up with. Next, look over the list and see which ones are the most doable. By this, we don’t mean the easiest, but the ones that you believe will result in the receptiveness or willingness to listen to what you have to say. The timing and time of the revelation should be when you are alone together. Do not have any distractions or pressing appointments that will interfere with a solid discussion. This is true even if your spouse asks for time to think about it before discussing it further. Put yourself in the other person’s shoes. Wouldn’t you want time to think about such an admission before blurting out your reactions?

Prioritize the list and choose the one that seems to provide the most likely positive result. By this we mean that you’ve selected a time, place and manner that will set up the situation so that you can have a private and personal discussion about your addiction. The best advice about talking with your spouse about your addiction is to be loving and honest. Demonstrate your affection before you begin talking about the situation, and ask that your partner hear you out. You may also wish to say that you want him or her to take as much time as necessary to think about it before venturing any comment or opinion, and that you will answer any questions when they are ready.

Be Prepared for Tough Questions

Of course, having made the statement that you’d answer any questions, you need to be ready and willing to do so. Be prepared for some tough ones. The discussion may be hard for your spouse to initiate, and he or she may not do it at the most appropriate time. If possible, change your schedule to be able to accommodate the more in-depth conversation that you need to have with your spouse. If it’s not possible to go into it at the moment your spouse brings it up, specify a time that’s mutually agreeable and then stick to it.

Here are some of the questions that may pop up:

• When was the last time you used (drugs, alcohol), or engaged in addictive behavior (gambling, compulsive sex)?
• How long were you addicted? How long before I met you were you addicted?
• What age were you when you first began using drugs and/or alcohol?
• Were you ever arrested?
• Have you ever had any sexually transmitted disease? How long ago were you tested?
• Did you undergo formal treatment for your addiction?
• Did you ever suffer a relapse?
• Have you ever had serious financial difficulties, legal problems, lose a job or promotion as a result of your addiction?
• Is your condition inherited? Is your father, mother or some other close relative an addict as well?

Where to Go Next – After You’ve Had the Discussion

If you have a generally good relationship with your spouse, you should feel a great sense of relief that this secret about your addiction is finally out in the open – between the two of you. This takes a tremendous burden off you and, while it’s understandably not something your spouse would be pleased about, the fact that you have revealed it says a lot about your strength of character and integrity – as well as your love.

You trust in your spouse’s willingness to accept you for who you are, just as you would be willing to accept anything in his or her past. Another point to be made is that you should ask for your partner’s help in going forward. This gives your spouse the opportunity to acknowledge what it took for you to get this off your chest and to share it with the person you most care about. Your spouse may even say something like this: We can work through this together. Reiterate that recovery is a day to day process, and you appreciate the understanding, consideration and willingness to be a part of it.

What happens if your spouse, after you’ve revealed your addiction, says this is something they really can’t deal with? You need to be ready to accept this on the face of it. Very often spouses need some period of time for the knowledge of your addiction to sink in, to come to terms with how they feel about it and whether it compromises your overall relationship to the point of dissolution or separation.

Whatever the reaction, you have to be ready for it. If your spouse rejects you – temporarily or permanently – after you talk about your addiction, it doesn’t reflect on you as a person. It doesn’t make you bad or worthless or undeserving of his or her love. It doesn’t mean that your life is over, or that you will suffer an immediate relapse, lose your standing in the community or be rejected by your friends. You should, however, seek the encouragement and support from your aftercare counselor and/or your 12-step group sponsor and members.

A Few Words About Being Open With Friends

Depending on the length and closeness of your friendship, decide when and how to say anything about your addiction. Naturally, if you are an alcoholic in recovery, you will need to avoid circumstances where everyone is drinking. If you’ve been avoiding going to the bar with co-workers who are friends after work on Friday nights, for example, at some point you may wish to say that you’re an alcoholic and you now live a life of sobriety.

If you had a problem with marijuana or cocaine and friends light up a joint or snort coke in your presence, the first thing you should do is leave. At another time, you may wish to inform them that you once did drugs but are now sober – and intend to stay that way. Ask them not to do drugs in your presence. Tell them that it may affect your relationship if they continue to do so.

Former problem or addicted gamblers can’t take the chance of dropping a few casual bets or buying some Lotto tickets. If friends ask you to get in on the football pool or go to the casino, tell them you don’t bet. You may or may not want to say you were a compulsive gambler. As long as you have received treatment for your addiction and are in recovery, there’s no need to go into detail about your gambling addiction. What’s the point? It will just give them something to talk about – and gossip is not in your best interest.

Of course, if you have a very close friend with whom you share many interests, similar outlook and have discussed many confidences, perhaps this is one person that you may wish to tell of your addiction. Weigh and balance what feels right to you and act accordingly.

What About a New Love Interest?

Again, timing is everything. Gauge how receptive the person may be to the revelation and whether you should bring it up at this time. If you do think the time is right, say something simple and direct. I had a problem with heroin (or marijuana or ecstasy or LSD, etc.) in the past, but I’m so glad that’s in my past. I’ve been clean and sober ever since. But, don’t say this unless it is true. If you still have a problem and either haven’t sought treatment, or began it and quit, or have relapsed, maybe this isn’t the time to get involved with someone new. It’s not fair to either of you. And, if you fall into this category, you really need to get some professional help – and pronto.

Attitude is Everything

Finally, having the discussion with others – any others – about your addiction depends a great deal on your attitude. If you are positive, upbeat, and have an openness and straightforward attitude, it will serve you better than if you are down in the dumps, depressed, anxious, and nervous. How you portray yourself to others helps them calculate whether the knowledge of your addiction is something that is truly in your past or something that will potentially bring problems.

Look forward to meeting new people and to continued lasting relationships with your current friends. Remember that you are not defined by your addiction. Your life in recovery is what you make it. You are the person you have chosen to be – one who is clean and sober. Your life choices and everyday actions, even your friends, are impacted by this decision to live your life free of addiction. Celebrate that fact and move forward. You will find that you are no longer troubled by how open you can be about your addiction.

So far, the Lawyer Assistance Program sounds like a pretty good deal. Instead of suffering the full and undiluted consequences of the Bar’s powerful disciplinary process, attorneys may be able to avoid punishment, perhaps entirely, by entering a treatment center or program. The same concept underlies California’s general drug diversion program which, presumably, reduces jail populations by sending addicts for treatment rather than to jail.

Based on the assumption that 20% of all active attorneys are addicted to drugs or alcohol, which is widely accepted in the scientific community, California has approximately 35,000 attorney addicts. And that’s not all. Based on a study that showed a 26% mental illness rate among attorneys, there should be almost 50,000 attorneys seeking treatment for mental illness (although these populations largely suffer from both substance abuse and mental illness). However in 2008, only .4% of California’s attorneys participated in the program. Of that number, only 25% entered voluntarily (i.e. not already under a disciplinary proceeding or investigation). Sadly, what looks good on paper for substance abuse treatment often does not work in reality.

Perhaps participation is low due to the fact that those behaviors and personality traits that are common among some attorneys, such as aggression and perfectionism, also foster denial and inhibit the ability to admit there their is a substance abuse problem. Also, the stigma associated with drug or alcohol abuse could ruin or impair an attorney’s career. However, perhaps the main reason attorneys do not seek treatment for alcoholism or drug addiction is that they cannot afford to.

Administration for the LAP is costly, especially since staff therapists and counselors work directly for the Bar. The cost of administering the program comes from State Bar dues – $10 from each of California’s roughly 170,000 active members. But those fees do not cover the cost of enrolling in a treatment center, attending professional counseling sessions, drug testing, or professional evaluations.

Each attorney must pay for the costs associated with participating in the program, including the cost of enrolling at an addiction treatment center. Although financial aid is available to those who cannot afford the cost of treatment via low-interest loans, the maximum amount one can borrow is fairly low relative to the cost of treatment. Last year, twenty percent of participants took advantage of LAP’s financial assistance plan, which is offered based on income for an initial 12-month period. After a year, the availability for financial assistance for continued treatment is evaluated on a case-by-case basis. After completion of the program, participants are required to repay the loan over five years at 7% interest. If they fail to complete the program, the balance becomes due and payable immediately. By the end of 2008, the financial assistance plan had loaned out approximately $1.75 million to cover the cost of treatment center attendance and other recovery-associated items.

However, I suspect that low voluntary participation in the LAP is largely a result of the enormous financial hit an attorney would take if he or she were to suspend practicing law to enroll in a formal program at an addiction treatment center. In order to fully realize the benefit of the program, more financial assistance needs be offered not just for treatment, but also for income replacement while attending a treatment center. If that becomes a reality, we might see the number of attorneys participating in the program increase dramatically.

Millie Anne Cavanaugh, Esq. is a Los Angeles immigration lawyer and former insurance defense attorney licensed to practice law in California and Massachusetts. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.
 

The California Lawyer Assistance Program (LAP) is a comprehensive program of professional support and structure including expert assessment, arrangements for enrollment at addiction treatment centers, monitored continuing outpatient treatment, random drug and alcohol testing, and professionally facilitated or peer support groups. The program also offers limited, free short-term counseling to all attorneys for stress, burnout, or career challenges.

A twelve-member committee oversees the program and can adopt the rules and regulations needed to run it, including guidelines for acceptance or denial into the program, criteria for identifying successful completion or termination for failure, and recommendations for rehabilitation criteria. The State Bar is tasked with outreach to make attorneys, the legal community, judges, and the general public aware of the program. Outreach programs include continuing legal education (CLE) courses related to prevention, detection, and treatment of substance abuse, as well as speaking engagements at law firms, bar associations, and other law-related venues.

In order to enter the program, an attorney can either self-refer, be referred by a concerned family, friend or colleague, or be referred via a disciplinary body such as the Office of Chief Trial Counsel or State Bar Court. A main qualification of participation is that the issues must not involve actual harm to the public or clients and stem from self-administration of drugs, nonviolent procurement of drugs for self-administration, or mental illness only.

California’s Lawyer Assistance Program cooperates with the attorney discipline and Bar admissions programs and reports participation treatment status and treatment violations. The State Bar Court Alternative Discipline Program refers attorneys with pending disciplinary proceedings and investigations related to the consequences of substance abuse or mental health issues. The State Bar Committee of Bar Examiners uses the LAP where substance abuse or other mental health issues exist in State Bar applicants whom examiners feel could become contributing members of the Bar after treatment.

Participation in the California LAP does not absolve an attorney of the requirements of the disciplinary system. Upon entering the program the attorney may be required to change his or her bar status to “inactive” and refrain from practicing law for a period of time, or submit to practice restrictions or limitations. However, if an attorney is not already under the jurisdiction of the disciplinary system, self-referred and colleague-referred participation is strictly confidential and should not trigger any sort of investigation.

Each attorney participant is assigned a local case manager who is a licensed clinician experienced in substance abuse and mental health. Initially, the case manager’s role is to immediately address life threatening issues, handle medical needs, and provide emotional support. A new participant attends closed professionally facilitated support groups and local self-help programs. Within a week, the participant undergoes comprehensive assessment by the case manager. The assessment can lead to a referral to medical professionals, psychiatric professionals, or addiction treatment center for further evaluation.

Each attorney meets with an evaluation committee composed of health professionals and a local attorney who has experience in recovering from drug or alcohol abuse. After the committee reviews reports generated by initial evaluations, individualized components of the long-term recovery program are finalized. Progress in the program is monitored by the case manager, group facilitator, and the evaluation committee.

For those suffering from more mild mental health issues, such as stress, burnout, relationship struggles, or career concerns, California lawyers can receive two free counseling sessions with a local therapist who specializes in working with legal professionals in order to prevent manageable problems from escalating into full blown meltdown.

A team of professionals facilitate support groups around the state, with locations in Santa Rosa, Agoura, Los Angels, Chico, Fresno, Torrance, Oakland, San Francisco, Tustin, Laguna Niguel, San Jose, Palo Alto, Fresno, Palm Springs, Santa Barbara, North Hollywood, Pasadena, Tarzana, Claremont, Riverside, Woodland Hills, Seal Beach, San Diego, Santa Monica, Sacramento, and Davis. The program also employs peer counselors, who have intimate knowledge of substance abuse in the legal profession.

Successful completion for some participants will result in eligibility for full reinstatement, elimination of restrictions, and either dismissal of the discipline case or a recommendation for a reduction in proposed discipline. The entire foundation of the program rests on the fact that information obtained during the course of participation is strictly confidential and not discoverable or admissible in a civil or disciplinary proceeding for those who successfully complete the program.

The incidence of mental illness in California’s legal community, either on its own or in combination with substance abuse, has stunned program administrators. Depression is, by far, the most common mental health issue facing attorneys today in a profession whose depression rate exceeds that of any other career. Administrators of the LAP have found that almost three quarters of new participants have a mental health diagnosis; this required the LAP to increase the number of qualified clinical staff and intensify delivery of treatment services in recent years. Only 30% of new participants suffer from substance abuse without an underlying mental illness.

Millie Anne Cavanaugh, Esq. is a Los Angeles immigration lawyer and former insurance defense attorney. She is licensed to practice law in California and Massachusetts. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.

Attorneys are also less likely to voluntarily seek admission to a treatment center, fearing job-related complications, harm to professional reputations, and financial problems. Denial is also a huge problem for attorneys; because they are often looked to for assistance and strength in their professional lives, attorneys are also less likely to admit that they have a problem and to seek treatment for it.

States have acknowledged the increased incidence of substance abuse or mental illness in the legal community and have taken steps to reach out to attorneys who need help, offering incentives to enter a treatment center instead of the disciplinary system. Many states have enacted Lawyer Assistance Programs (LAP) either through the State’s attorney regulating body (called the "State Bar" in many places) or through independent organizations that are authorized to act on the Bar’s behalf.

A Lawyer Assistance Program seeks to identify troubled attorneys and help them find a treatment center for their particular problem, with an emphasis on confidentiality. How they go about accomplishing this goal, and the particular ramifications for an attorney’s career, vary from state to state. Most LAPs offer intervention, peer counseling, professional counseling, and referral to addiction treatment centers or addiction treatment professionals. In some states, participation in the LAP will help the attorney eliminate or reduce discipline for harm suffered by clients due to their addiction. In other states, treatment will not help an attorney avoid the disciplinary process but may help them retain their right to eventually practice law again.

The American Bar Association is a big proponent of the state LAP system, offering an independent LAP program evaluation process, guidance, and resources. States look to the ABA model system and other state programs when developing strategies for dealing with alcohol and drug addicted attorneys in their own states. State bars and lawyer oversight organizations have very large incentives for keeping their attorneys off drugs and alcohol. Alcoholism and drug addiction in the legal community not only cost the general public millions of dollars each year due to incompetent or inefficient lawyering, but it also reduces the public’s trust in the legal system overall.

A review of state lawyer assistance programs, such as Arkansas’, reveal that some LAPs partner with addiction treatment centers to offer customized treatment to this unique class of alcoholics and drug addicts. Some treatment centers offer specialized professional health programs (PHP), where doctors, lawyers, businesspeople and other professional individuals can receive treatment that is tailored to the issues that typically affect those in high-stress professions. These treatment centers are often more flexible with treatment protocols, schedules, and in-patient requirements than other mainstream addiction treatment programs, recognizing the need to allow the patient to participate in business matters, when necessary, to preserve his or her career and to encourage them to finish the treatment. The treatment centers also focus therapeutic techniques on those particular behavioral or personality characteristics that make professionals, such as doctors and lawyers, so much more vulnerable to substance abuse than the general population.

While the avenues now exist for attorneys to get help with their substance abuse issues, encouraging participation in the programs is still a huge hurdle. Unless the attorney has formally entered the disciplinary system, and sees the LAP as a way to reduce or eliminate discipline, attorneys have been reluctant to voluntarily enter state-sponsored LAPs either because they do not think they have a problem, do not know or trust that the program is confidential, or cannot afford the time or money it will take to get clean.

To address this problem, many states allow a colleague or judge to refer someone to the LAP, whereas before this the options were either entering through the discipline system or through self-referral. When the LAP receives a third-party referral, a counselor usually contacts the attorney to gently offer assistance or to help determine if there is, in fact, a substance abuse problem. While enrollment at a treatment center is often recommended for those with substance abuse issues, less structured treatment such as weekly professional or peer counseling sessions can go a long way in helping someone cope with the stress or depression that can result from a high-pressure career.

State bars and attorney regulatory authorities should be lauded for this important step toward addressing the issues of alcohol or drug abuse and mental illness in the legal community. In order to meet the growing need for accessible treatment for attorneys, however, more needs to be done to both educate attorneys on the benefits of voluntary participation and to provide badly need financial assistance when getting sober means having to stop earning money for a period of time in order to enter a treatment center.

Millie Anne Cavanaugh, Esq. is licensed to practice law in California and Massachusetts.She is a former insurance defense attorney and is currently an immigration attorney. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.
 

At any given moment, a typical drug or alcohol treatment center will have patients from all walks of life. Vast differences may exist in age, sex, education level, family status, job type and socio-economic status. However, the treatment center participants are all united in their addiction and the desire to get and stay sober. But, if we were permitted to take a closer look, I bet we’d find that lawyers are represented no more frequently than any other type of worker. In fact, they probably enter addiction treatment centers less often than other individuals.

Why is this bad? Why should we not applaud the fact that attorneys are not in rehab as often as everybody else? Simply put, a lawyer is twice as likely to need an addiction treatment center than a non-attorney. The fact that attorneys are not taking up their fair share of treatment center beds, and then some, should be cause for great concern.

Roughly 10% of American adults suffer from alcoholism, which is defined as a frequent intoxication that negatively impacts health, quality of life, and professional ability. However, a very conservative estimate puts the number of alcoholic US lawyers at approximately 20%. This is an enormous problem that cannot be easily solved and likely results from a combination of alcoholism risk factors and personality.

Worse still, the alcoholism often presents with other mental health issues, the most common one being depression. A 1991 Johns Hopkins University study found that lawyers were the most depressed out of roughly 12,000 workers. It has been suggested that lawyers are three times more likely (26%) to experience symptoms of clinical depression, a condition that also leads to client neglect and legal malpractice, than other workers.

So, why is it that lawyers are twice as likely to become addicted to drugs or alcohol and three times more likely to be depressed? Although genetics can clearly play a role in both depression and substance abuse, the legal profession is a magnet for people with addictive personality traits and exploits risk factors.

Lawyers are often responsible for the property, freedom, or even lives of their clients. Clients, opposing counsel and judges expect them to be an expert in their field, no matter how long they have been practicing or the depth of their experience. This is a huge responsibility that carries with it inevitable stress and burnout. Add to it constant adversarial interactions with opposing counsel, expectation of billable hours, and, unlike in other careers, the catastrophic consequences of missed deadlines or simple mistakes, it is easy to see why lawyers become depressed and turn to alcohol or drugs to relieve the constant pressure.

Career burnout is extremely common in the legal community and often results in clinical depression. High levels of stress over a period of time lead to apathy, negative feelings about the legal professional in general, a decline in productivity, increased illness, and difficulty getting along with others. These feelings are constant, affecting the lawyer’s career, performance and personal life. Given the strong connection between depression and alcoholism, it is important to be aware of the increased risk of drug or alcohol abuse in a burned out or depressed attorney.

While by no means a truism for all lawyers, certain individuals and personality types are drawn to the practice of law. Some attorneys believe that they need to be aggressive, confrontational, and downright boorish to be a zealous advocate for the client. Although I disagree that this approach actually wins cases, it doesn’t change the fact that these lawyers exist. However, when the lawyer goes home at night to deal with her family she must leave that version of her personality at the office or risk alienating or harming loved ones. This need to regulate emotion often pushes the individual toward drugs and alcohol as a way to counteract the aggressive behavior waiting just underneath the surface. If unable to make the transition between office and home personalities, the lawyer will likely experience relationship and familial issues, leading to separation, divorce and, likely, either depression, substance abuse or a combination of the two.

Given that roughly 25% of all attorneys in the United States suffer either from depression, substance abuse, or a combination of both, it is not surprising that the legal community has acknowledged that a problem exists. Each US state, as well as Canada and the UK, has established a Lawyer Assistance Program (LAP) to help attorneys deal with substance abuse or mental health issues. Many programs work with state bar disciplinary bodies to offer admission to addiction treatment centers or some sort of outpatient addiction treatment program as an alternative to suspension or disbarment for malpractice or incompetence that results from depression or addiction. While the comprehensiveness and success rate of each program varies, these Bar associations should be applauded for endeavoring to protect the integrity of the legal system, individual clients, and the careers of addicted lawyers.

Millie Anne Cavanaugh, Esq. is a Los Angeles immigration lawyer and former insurance defense attorney. She is licensed to practice law in California and Massachusetts. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.

Why did Jane’s attorney fail to show up to the hearing? It turns out that she slept right through her alarm clock. Having had his fill of the attorney’s constant lackadaisical regard for his courtroom and his calendar, the judge refused to rescind his order or grant a continuance when she finally showed up after lunch. Jane will likely have a malpractice claim against her attorney and, at the very least, should report the attorney to the State Bar. Given the history between this attorney and the judge, perhaps the judge will report her as well. Such a dereliction of duty may result in the attorney being suspended or losing her license to practice law. Not only will this require her other clients to find new counsel to handle their cases, which could be costly and harmful to them, but it will likely destroy the attorney’s career.

But what if it turned out that the attorney slept through her alarm on the morning of Jane’s hearing, and on the mornings of all of the other missed hearings, because she is an alcoholic or depressed? Should she be subject to the same disciplinary system as attorneys who steal client funds or commit fraud? If she admitted her alcohol abuse prior to Jane’s hearing, and entered a treatment center voluntarily, would word have gotten out that she was an alcoholic and ruined her practice? These are issues that currently plague State Bar associations and attorney disciplinary bodies who must reconcile the competing interests of encouraging attorneys to voluntarily seek treatment for alcohol and drug addiction or depression without ruining their careers, against the need to protect clients such as Jane, Dylan, and Maddie.

Studies show that there is a direct correlation between attorney alcoholism and malpractice or discipline. It is estimated that 60% of all disciplinary actions and malpractice claims involve an attorney who is addicted to alcohol. Given that depressed individuals are more likely to avoid communication with others, disregard deadlines, fail to get up in the morning, and become apathetic toward keeping appointments or life in general, it is no surprise that depression also makes an attorney vulnerable to malpractice or discipline. Case deadlines get missed, clients become angry when unable to communicate with their attorney, and entire cases are lost when an attorney is not paying attention to the minutia of the practice of law.

The harm associated with undisclosed alcohol and drug abuse or depression in the legal community is not limited to those particular clients who are directly affected by attorney incompetence or misconduct. The nature of the adversarial process hinges on the idea that each party is competent and knowledgeable about the case and the legal principles upon which the case hinges. When the scales tip in favor of one party simply because opposing counsel has a drug or alcohol problem, the system not only breaks down, but loses respectability and predictability. The public, as a whole, no longer trusts that justice will or can prevail.

In a perfect world, the answer would be to develop a system where lawyers who are suffering from alcohol and drug addiction could seek confidential help while insulating clients from potential harm. For instance, a solo attorney would feel comfortable picking up the phone and requesting that the State Bar transfer her case load to a qualified back-up attorney because she needs to enter a treatment center, telling the clients that a “medical issue” came up. There would be unlimited financial resources to pay for the treatment center, as well as the income that the lawyer would lose while not working. Or, in the alternative, the lawyer would be able to continue working under the supervision of a monitor and enroll at an outpatient treatment center or a treatment center where patients live in the facility but are allowed to leave for work.

However, as we do not live in a perfect world, the above scenarios seldom play out. A characteristic shared by both substance abuse and depression is the inability of the inflicted individual to see that there is a problem while there is still time to treat the issue with minimal harm to career or client. This burying of the head in the sand is intensified by the strong, type “A”, personality shared by many attorneys who either will nor or cannot admit that they have lost control over a situation and need to enter a treatment center or treatment program for help. In addition, other attorneys, judges, or members of the legal community are loath to “rat out” a colleague to the State Bar as they understand that careers can be ruined when the Bar becomes involved. Also, clients seldom realize that there is a problem until it is too late to do anything about it, often trusting that the attorney knows what he or she is doing, even in the face of seemingly bizarre behavior or an utter lack of communication.

Even lawyers who recognize that they should start avoiding those late drinking lunches and start searching for addiction treatment centers rarely do so voluntarily. Some lawyers believe that the stigma involved in being deemed an “addict” or “depressed” will negatively affect their career if clients, potential clients, or colleagues were to find out. And they are probably right. Also, especially with solo practitioners, the attorney will be unable to pay the bills if he or she takes 30 or 60 days to enter a treatment center, even if the cost of that treatment were covered by health insurance.

Instead of seeking badly needed rehab, attorneys continue to live and work with their alcohol and drug addiction until they hit rock bottom, often taking clients down with them. By the time the State Bar becomes involved, the authorities are unable to overlook instances of incompetence or malfeasance and thus, even if enrolling in a treatment center becomes part of the discipline plan, the attorney’s record with the Bar will not remain unscathed. Lives can be harmed or, in the case of criminal defense attorneys, even lost due to a lawyer’s depression or addiction.

Millie Anne Cavanaugh, Esq. is a Los Angeles immigration lawyer and former insurance defense attorney. She is licensed to practice law in California and Massachusetts. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.

This is the first in a series on addiction treatment for attorneys.

On September 11, 2009 twenty-year-old Elena Shapiro, a Carolina Ballet ballerina from Winston-Salem, North Carolina, lost her life to a doctor who was allegedly driving under the influence of alcohol (DUI). Dr. Raymond Cook hit Ms. Shapiro as she was getting on the highway. Cook was arrested on suspicion of DUI and was initially charged with death by motor vehicle, DUI, failure to reduce speed, and careless and reckless driving. The doctor is an otolaryngologist and plastic surgeon and an assistant professor at the University of North Carolina School of Medicine. Cook, who is estimated to have been driving at 85 mph, has surrendered his license to practice medicine. The charges have since been amended to include second degree murder.

While, admittedly, a driver does not have to be a doctor wreak such havoc while driving drunk, what if Dr. Cook had been in the operating room instead? Dr. Castro-Moure, the chief of neurosurgery at a California hospital, had to be wrestled to the operating room floor one night before being arrested by police. Staff reported that the surgeon had thrown a fit when he was barred from operating by a nurse who suspected that he was drunk.

Castro-Moure initially became combative while attempting to begin surgery on the spine of a man who had fallen two stories. Although two other doctors had declared the injuries to be not life-threatening, and thus not requiring immediate surgical intervention, Castro-Moure disagreed and began yelling and swearing when told that the necessary equipment would need to be transferred from a different hospital. Once the equipment got to the operating room, however, a nurse refused to proceed with the surgery until the instruments were sterile. The surgeon then physically resisted efforts to subdue him; the 45-year-old Highland Hospital doctor was arrested on suspicion of being under the influence of alcohol and interfering with the duty of police officers. The consequences of a drunken surgeon operating on the spine of an injured man are almost too horrific to even contemplate.

However, medical boards all across the country must address these and other disasters waiting to happen on a daily basis. Studies have found that illicit drug use among doctors is lower than in the general public. According to a recent story in the Harvard Review of Psychiatry, however, doctors are five times more likely to misuse prescription medication. Specialties that place doctors in contact with addictive drugs, combined with ease of access to drugs and stress, result in a nightmare scenario for those susceptible to addictive behavior.

Substance abuse, alcoholism, and mental illness among doctors are not a new phenomenon. In 1958, the Federation of State Medical Boards (FSMB) declared that drug addiction and alcoholism among physicians was a disciplinary problem that needed to be addressed administratively. The FSMB requested that a program be developed for the monitoring and rehabilitation of substance abusing doctors that would serve as a model for state medical boards. The request was ignored.

Years later, the AMA Council on Mental Health produced a paper entitled “The Sick Physician: Impairment by Psychiatric Disorders Including Alcoholism and Drug Dependence” which called attention to this growing public health crisis. In 1974, a model was developed that offered a treatment-based alternative to discipline in recognition of that fact that drug and alcohol addiction is an illness. Today, the Federation of State Physician Health Programs (FSPHP) also focuses on the rehabilitation and monitoring of addicted doctors.

Once upon a time, any doctor who behaved like Castro-Moure would likely have lost his license to practice medicine permanently. Not only would such forfeiture have clearly destroyed his career, but it also would not have encouraged the surgeon to seek treatment for his alcoholism. By 1980, most states had implemented a physician health program to address the substance abuse crisis among the medical community, with a focus on managing and monitoring practicing doctors who are addicted to drugs or alcohol. The programs seek to save the lives and careers of doctors suffering from drug or alcohol addiction and protect the public by ensuring that only clean and sober doctors are licensed to practice medicine. A study of these programs has shown that doctors who are drug addicts or alcoholics actually can be treated and allowed to resume the practice of medicine.

The physician health programs (PHP) are based on a model of intervention, followed by a combination of referral for enrollment in a treatment center and random monitoring. Doctors who fail to comply, however, require quick redress in order to eventually beat their addictions. A recent study by the University of Florida found that over seventy-five percent of enrolled doctors stayed off drugs or alcohol, regardless of the particular type, during a five year monitoring period. Enrollment in the programs is almost equally divided between those who are required by medical boards, employers, or malpractice agencies to participate and those who self-refer or are referred by friends and family.

Once enrolled and under contract with a PHP, the doctor must attend group and individual therapy sessions for both the addiction and any accompanying mental health issues, residential and outpatient treatment center programs, be subjected to random visits from monitors at work, and participate in 12-step programs. Doctors are responsible for paying for the cost of the treatment center and treatment programs, drug testing, monitoring, and follow-up care.

The UF study evaluated roughly 900 doctor participants in 16 state PHPs over a six year period, which is an unprecedented scope. Successful participation in the program required abstention from drugs or alcohol for five or more years, along with random drug testing. Failures were reported to medical boards quickly; approximately 20% experienced at least one incident of failure during the study. Researchers found that, at least within the physician community, best results were achieved by a combination reward-and-punishment system. For instance, a clean drug test resulted in permission to return to work while a positive test called for immediate suspension and put one in danger of losing their license. In the five to seven years after starting treatment, three quarters were actively practicing medicine without drug abuse or malpractice. In the end, researchers determined that longevity of treatment had the most lasting effect on the level of success.

Sources:

http://spotlight.vitals.com/2009/09/dr-raymond-cook-causes-fatal-accident-and-charged-with-dwi/

http://www.huffingtonpost.com/2009/09/16/raymond-cook-doctor-kills_n_288337.html

http://findarticles.com/p/articles/mi_qn4176/is_20060309/ai_n16160545/

Millie Anne Cavanaugh, Esq. is a Los Angeles attorney specializing in immigration and naturalization law; she is a former insurance defense attorney. She is licensed to practice law in California and Massachusetts. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.