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    Addiction and Attorneys: Confronting the Denial

    Nationwide, lawyers and other professional groups are beginning to talk openly about addiction and other mental health issues that affect their members. The authors debunk myths about addiction, and explain how addiction affects lawyers and what treatment options are available for recovery.

    Timothy D. Edwards & Gregory J. Van Rybroek

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    Wisconsin LawyerWisconsin Lawyer
    Vol. 80, No. 8, August 2007

    by TimothyALonely 
personddiction to alcohol or other drugs is a powerful and destructive problem that affects thousands of attorneys. Reliable studies show that attorneys suffer from addiction at twice the rate of the general population. Equally reliable studies show a strong correlation between untreated addiction, professional misconduct complaints, and malpractice claims. Behind the scenes, family members suffer, and employers and colleagues are forced to clean up the damage that untreated, addicted attorneys leave behind. In the media, stories about the harm done by addicted lawyers damage our professional reputation.

    Years ago, bar associations did little, if anything, to assist impaired lawyers, and institutional denial was the unspoken solution. This situation is changing at a rapid pace. Across the country, bar associations are responding to mental health issues, including addiction, by implementing lawyer assistance programs that take a proactive role in confronting the complicated problems surrounding lawyer impairment. The Wisconsin Lawyers' Assistance Program (WisLAP) is one such program, and it provides confidential assistance for lawyers struggling with addiction and other mental health problems. Acting quietly, WisLAP has assisted thousands of lawyers by providing confidential referrals, informal interventions, and a "voice in the night" when someone needs immediate, direct support.

    Understanding that education is a necessary starting point to solve any problem, this article is intended to educate the profession about lawyer addiction. First, the authors provide a brief explanation of addiction and its extraordinary, yet often subtle, power. The goal here is to break through some of the misunderstanding and rhetoric that surround this topic and to offer a workable definition of addiction that invites introspection and realistic dialogue. Second, the authors explain why lawyers are so difficult to treat and how addiction captures lawyers' most valued assets - intelligence, analytical skill, and professional reputation - and uses these assets to fuel its power. Third, the authors offer some thoughts about treatment and what we, as lawyers, can do to address this widespread and insidious problem within our profession.

    Addiction: Defining the Problem

    Tim 
Edwards

    Timothy D. Edwards, Wayne State 1989, is a partner at Axley Brynelson LLC, Madison, and a committee member of the State Bar of Wisconsin Lawyers' Assistance Program (WisLAP). He has published many artciles about addiction and is a regular presenter to law students and attorneys statewide. For these efforts, he was awarded WisLAP's Volunter Lawyer of the Year Award in 2005. He can be reached at com tedwards axley axley tedwards com.

    Greg 
Van Rybroek

    Gregory J. Van Rybroek, U.W. 1990, is director of the Mendota Mental Health Institute and cochair of the WisLAP Committee. As a psychologist and attorney, he is a regular presenter for the State Bar of Wisconsin. He also provides private forensic assessments in criminal and civil cases that involve mental health issues. He can be reached at com gregvanrybroek yahoo yahoo gregvanrybroek com.

    The words addiction and alcoholism invoke different images to different people. To some people, an alcoholic is a skid row bum who has lost everything, and an addict is a heroin junky who steals to support her habit. Many people believe that actual, physical dependence is a necessary symptom of addiction, which the popular media often portrays in the most severe terms imaginable. While these portrayals accurately describe addiction in its most extreme stages, they suggest that a person is addicted only when everything is lost and there is nothing left to do but drink or use.

    This is a myth. While a complete overview of addiction is beyond the scope of this article, several basic principles that define addiction and its extraordinary power must be understood. Symptoms are a necessary, yet superficial, starting point to understanding addiction. Once identified, these symptoms point to an important truth: An addicted person is involved in a relationship with a chemical that is very difficult to break with willpower or self-knowledge. When the power of addiction takes over the user's willpower, addiction becomes a formidable foe that often adjusts to its surroundings and takes on many faces so that it can inflict the most possible damage on the user and people around the user. When this happens, meaningful, targeted treatment may become necessary for the user and for those people who are directly affected by the user's destructive behavior.

    On the surface, symptoms of addiction are relatively easy to identify, even for a layperson. Most clinical assessment tools diagnose addiction-related disorders by reference to objective consequences, including problems with the law, failure to fulfill family or professional obligations, exposure to danger, and social or interpersonal problems resulting from chemical use. Often, this assessment is based on self-reports or the results of questionnaires, such as the one presented in the accompanying alcohol/drug self-test.

    While identifying objective consequences of addiction is a useful starting point to understanding addiction, it does not complete the picture. There are volumes of scientific literature that strongly suggest that addiction is directly connected with other, underlying problems. Many addicts turn to alcohol and other drugs to medicate untreated psychiatric or psychological disorders. Others become dependent on alcohol and other drugs because of unresolved trauma, including childhood neglect and other forms of abuse. Clearly, there are many reasons why people turn to drugs, and ultimately become addicted, that have nothing to do with addiction itself. While these reasons do not change the set of challenges that addiction presents, they do provide further insight into the process of addiction, its underlying causes, and potentially meaningful points of intervention.

    The underlying reasons also provide an opportunity for compassion and understanding. After confronting the rhetoric that often surrounds addiction, a more useful, common-sense definition of addiction comes to the surface. When reduced to its most simple terms, addiction is a relationship with alcohol or other drugs that provides a subjective, tangible payoff to the user that is pursued at the exclusion of competing obligations and priorities. In most cases, this relationship becomes so powerful that the user develops a strong cognitive defense system that protects the relationship's perceived benefit, which often is no more than a pure escape from uncomfortable or intolerable feelings. This cognitive defense system is defined by the hallmark features of dependency, including denial, justification, blame and, often, outright self-deception. As this condition worsens, the addict must convince himself that a lie is the truth in order to protect this important relationship. Unfortunately, the addict often believes the lies that he is telling himself, which is why treatment is so difficult, at least in its early stages.

    This discussion of the process of cognitive distortion raises another important point. Ironically, using is not the problem for most addicts. Many addicts can quit using, at least for a short time. The problem is that addicts ultimately convince themselves that using is a legitimate option, despite the fact that any reasonable person would tell them that using is actually destroying their lives. When addiction progresses to this point, intelligence, analytical skill, and willpower supply false information to the addict regarding the perceived costs and benefits of continued use. Viewed from this perspective, the question is not why addicts use so much, but why they return to alcohol or other drugs that cause so much obvious damage. The process of cognitive distortion is a core feature of addiction. It is extraordinarily powerful, and it can be fatal.

    One final myth requires attention. Many people believe that addiction is an either/or phenomena: that a person either is or is not an addict, and that making this determination ends the inquiry. This belief is a very dangerous misconception because it provides a quick out for people who have not suffered significant consequences from their addiction. Viewed honestly, addiction is a human condition that many people have experienced at one time or another. Addiction exists on a continuum. At one end is a person who is not prone to addiction and who never uses alcohol or other drugs. At the other end are the heavy users - the crack addict and the skid row bum who provide the stereotypical portrayal of addiction. What about those who fit in between? What about the attorney who has a relationship with alcohol because it numbs the stress and anxiety associated with her work and makes it easier to relate to her spouse when she comes home at night? What about the attorney who uses pain killers to self medicate because of the loss of a loved one or a painful divorce? It is easy to envision many scenarios in which these hypothetical attorneys would pursue a relationship with substances to the exclusion of competing priorities, including work, and how they would slowly withdraw from other people as this relationship gathers strength.

    Are these hypothetical lawyers addicted? If one accepts the either/or model of addiction, they may not qualify as addicted. After all, they have graduated from law school, they have jobs, and they are the problem solvers that people seek when they need help. However, if one accepts the fact that addiction is a progressive condition that often exists on a continuum, then these are two attorneys who are suffering, who need help, and whose behavior may be hurting other people, including their clients. If one also accepts the fact that both of these attorneys have developed a personal relationship with alcohol or other drugs that is producing an important, subjective payoff, we have potentially identified several valuab le points of intervention. Identifying this subjective pay off is so important in understanding the powerful grip that addiction has on professional populations, including attorneys.

    Addiction and Attorneys: A Difficult Combination

    A treatment center in Phoenix, Ariz., has a sign that helps to explain why attorneys often are difficult to treat:

    Rules of Recovery

    • Don't analyze
    • Don't judge
    • Don't compare
    • Don't blame
    • Don't justify

    These rules speak directly to the power of the cognitive defense system that all addicts rely on when they feel threatened. For lawyers, the rules make a more telling point. After all, lawyers are trained to analyze, to judge, to compare, to allocate blame, and to justify. This thought process begins in law school, where the law student often competes in isolation against her peers with little social interaction, and it is reinforced throughout the attorney's career. When these skills are captured by the process of addiction, the addicted lawyer becomes his or her own worst enemy, and the denial process is strengthened at a very sophisticated level. Ironically, the skills that lawyers work so hard to develop fortify the cognitive defense system that addicts invoke when they feel threatened. According to Michael Cohen, the director of Florida's lawyer assistance program, "the very skills that make us good lawyers make us terrible, terrible patients."1

    Attorneys face other specific problems that make intervention and treatment very difficult. Many lawyers and other professionals are highly competitive and, for good reason, they value their professional reputation. They fear the repercussions of disclosing personal information that might undermine their standing with colleagues, judges, and friends. Many attorneys fear that a label of "alcoholic" or "addict" is a sign of weakness or a concession of defeat. Often, the persona that attorneys pre-sent to professional colleagues and the true person are very different. When the common skills of attorneys (and other professional groups) are combined with addiction, the result is isolation and the anxiety associated with living a double life. Clinicians have recognized this significant barrier to treatment, and it is explained eloquently in a recent study:

    "The primary obstacle that prevented target group informants from accessing care (70 percent) was the belief that they could handle the problem on their own. This is a clear statement about a strong tendency toward self-reliance in the target group.

    "The second significant obstacle in making the decision to seek treatment (40 percent) was a concern regarding a potentially negative impact the decision might have on their professional reputation among peers, judges and potential clients.

    "These data present a lonely picture of suffering lawyers. They don't trust their colleagues to be understanding, and they feel that they must handle these problems on their own."2

    This study points to other serious concerns. As noted earlier, addicts protect their relationship with chemicals by erecting a powerful cognitive defense system that includes justification, blame, and outright denial. If attorneys have a "strong tendency toward self reliance," as this study suggests, it is easy to understand how addiction capitalizes on this common behavioral trait. After all, self-reliance for an attorney is a cognitive process. By believing that they can handle the problem on their own, addicted attorneys rely on a distorted, yet sophisticated, thought process, the sole purpose of which is to convince them that using is a viable option when their outside world is falling apart. As Alcoholics Anonymous (AA) members are quick to point out, "you cannot think yourself out of something you thought yourself into." Lawyers do exactly that when they battle addiction, and they suffer immensely as they try to protect their image by concealing their condition from the world that surrounds them. It is a very serious mistake to underestimate the power of addiction.

    Attorneys, Addiction, and Recovery: Exploring the Possibilities

    Even though addiction is a serious problem in the legal profession, there are solutions. While studies show that attorneys are difficult to treat, many lawyers have recovered from addiction and they lead dynamic, fulfilling lives. Recent studies indicate that lawyers who commit themselves to recovery show a remarkable recovery rate as compared to the general population. Lawyer assistance programs such as WisLAP are providing resources and assistance, including education, that are breaking traditional barriers to treatment. As the stigma surrounding addiction is confronted, and compassion replaces blind judgment, lawyers in recovery receive fewer professional misconduct complaints and fewer malpractice claims than the general population of attorneys. This fact speaks to the power of recovery and the changes that it can produce.

    What is recovery? What does it take to become clean and sober? What works? As scientists, doctors, and clinicians compile data on these interesting questions, almost everyone agrees that recovery is an individual process that requires honesty and the willingness to accept candid feedback that challenges the cognitive defense system that addicts have developed. For attorneys, this process requires treatment from highly skilled clinicians with strong verbal skills and considerable ego strength, who will not be overwhelmed or intimidated by highly intelligent, verbally acute patients. Successful treatment also requires a comprehensive psychiatric assessment that rules out or treats co-occurring disorders, such as depression, bipolar disorder, and post-traumatic stress disorder. Finally, strong recovery often involves participating in a community of other recovering attorneys, who can serve as role models and mentors for attorneys in the early stages of treatment. For many recovering attorneys, active involvement in 12-step programs, such as AA, is a key to recovery. All of these tools, in combination, enhance the prospect of meaningful recovery.

    Employers confront a unique challenge when a colleague is struggling with addiction. A lawyer who is using presents a risk to the firm and its clients. That lawyer also is in the grip of a powerful disorder that makes it virtually impossible to have a meaningful discussion regarding realistic solutions and outcomes. By providing support and back-up for the addict to meet the addict's professional obligations when the addict is using drugs or alcohol, the firm can serve as an enabling force that actually facilitates and supports the process of addiction. These problems become more difficult when the impaired lawyer is a high-ranking decision maker in the firm. The fear of confronting the behavior invites silence, as does the fear of overreacting. What are the options?

    Here, truth and compassion work together as guiding principles. Often, the most effective way of confronting addiction is an intervention that involves a skilled clinician who is capable of breaking through the addict's defense system. In an intervention, several people are chosen to sit down and present their concerns to the impaired lawyer in a direct and truthful fashion. Often, friends, family members, and decision makers within the law firm are involved in the process. If the attorney is significantly impaired, treatment options should be discussed. If necessary, the firm should consider a leave of absence for an attorney who needs the time off to pursue treatment. On returning to the firm, the attorney must understand that the firm will not tolerate further using and that it is fair to ask for confirmation of participation in treatment as a condition of continued employment. All of these issues should be negotiated and outlined with the assistance of a skilled clinician and with respect for the recovering attorney's privacy and autonomy.

    What about sole practitioners? Without question, sole practitioners take the hardest hit when they suffer from addiction. Unlike their addicted counterparts in larger firms, sole practitioners tend to not have the resources needed to clean up the mistakes that their addiction invites. In addition, sole practitioners often practice in particularly high-stress areas of the law, such as family law and criminal defense. When left alone with the demands of a rigorous calendar and the drain of an addiction, sole practitioners are ripe candidates for a disproportionate number of professional misconduct complaints and malpractice claims that are directly tied to their addiction.

    The legal community can provide assistance. Oftentimes, judges will recognize that an attorney is struggling when the attorney misses deadlines or court appearances. In small communities, such behavior is easily identified and often is the subject of courtroom gossip. It is easy for colleagues to back away, do nothing, and hope that the impaired lawyer seeks help. While silence is an individual choice, there is an alternative - it is called communication. It is fair to express honest concern to a colleague, and it is fair to offer help. In this situation, WisLAP is an invaluable tool that can provide guidance and support and, in the proper circumstances, intervene on behalf of a family member or colleague who steps up to confront the impaired lawyer.

    How effective is treatment for alcohol and other drugs? The answer to this question often is confounded by rhetoric and, at times, false promises. Many treatment centers proclaim high success rates for their patients. Some treatment providers rely exclusively on a single model of treatment that applies to all of their clients, such as AA's 12-step model. Facilities that rely on a single treatment model should be avoided because there are no simple, cookie-cutter solutions when it comes to treating addiction. As briefly explained earlier, there are many roads to addiction. People use alcohol or other drugs for different reasons, and thus it logically follows that treatment is an individual process that is different for everyone. Ultimately, the best treatment process is one that allows the addict to rebuild a meaningful life with the necessary support, a sense of purpose, and a commitment to honesty.

    Conclusion

    Even though addiction is a powerful, destructive problem, there is hope. The scientific community is making daily discoveries regarding addiction, its causes, and its proper treatment. Nationwide, lawyers and other professional groups are beginning to identify and talk openly about addiction and to confront the unnecessary judgment and stigma that stand in the way of meaningful recovery. In Wisconsin, WisLAP provides valuable resources to law students, attorneys, judges, and their families. For every tragic incident that hits the media, there are countless attorneys who are recovering from addiction and making significant contributions to the legal profession. They lead meaningful lives and, in many cases, those same attorneys provide guidance and strength to colleagues who suffer from addiction.

    Endnotes

    1Jeffrey Friedman, An Assessment of the Needs of Lawyers in Behavioral Health Treatment 6 (Cottonwood, 2003) (manuscript on file with the authors).

    2Id. at 10 (emphasis added).




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