Winter 1996 Issue

Table of Contents

• CoLAP Heads to Nation's Capital
• Target Dates
• People in the News
• CoLAP Program Receives Presidential Status
• Gambling Training for LAP Directors
• Chair's Report
• Around the LAP's
• CoLAP Products
• Quality of Life is Topic of New Book
• Lawyers Leaping Onto the Net

CoLAP Heads to Nation's Capital

This Fall in Washington, D.C., CoLAP will celebrate 10 years of sharing and educating representatives from lawyer assistance programs, disciplinary agencies and the judiciary on addictions and mental health issues at the 10th National Workshop for Lawyer Assistance Programs. The Workshop will be divided into two segments: two days for the directors' training and a day and a half for bar association members, volunteers, judiciary etc. There will be a reduced fee for those attending only a portion of the Workshop. The "early bird" registration fee is $425 for the entire 3 1/2 days, and $250 for attending only a portion. The cut off for "early bird" registration is June 15, 1997. After that date, all fees are increased by $50. A registration form is enclosed in this issue for your convenience. At Tricia Heil's suggestion, we would like to encourage all LAPs to extend an invitation to bar examiners as well as other bar leaders for this year's workshop.

Plenary sessions for this program will include The Increased Awareness of Lawyer Suicide with Dr. Alan Berman, Executive Director of the American Association of Suicidology. Bonnie S. Zannini, M.S.W., will speak on being Single, Sober and In Recovery. We will also expand one of last's year's popular breakout sessions into a plenary session on Women and the 12-Steps with Cynthia Webnar returning as the speaker. Dr. Heather Fiske, an expert in the field of suicide prevention will join Dr. David Prewett for the director's training, with Barbara Harper chairing this segment of the program. The focus will be on assessment and client interaction tools as well as those clinical skills necessary for LAP directors to do their job effectively.

Other topics that are being considered include: Alternative Support Groups, Gambling, Diversity, Depression, Adult Attention Deficit Disorder, Special Issues for Treating Gays/Lesbians/Bisexual Clients, HIV and Substance Abuse, Alcoholism and Sexual Compulsivity, and Gerontology Issues in the Legal Profession. The very popular Evolution of a LAP will again be offered in 3 one-hour sessions.

For those LAP directors who have attended two or fewer workshops, the Planning Committee will assign a more seasoned director, who can answer questions and reduce the anxiety created by the enormous amount of information disseminated at this workshop. Once again, continuing legal education (CLE), continuing education units (CEU) and professional development hours (PDH) will be requested for the programs. The Roll Call will be improved and shortened. Brief written reports will be requested in advance, included in the course book and used for the oral report by Adrian Hill, CoLAP's liaison from Canada. Recognition during the Roll Call will only be given to those states that submit their report in writing, so it is very important that you follow through on this request.

It is time now to start thinking about the materials you want to include in the State Materials section of the course book. The deadline date for receipt of all course book materials is August 1, 1997. Each state's materials again will be limited to 10 pages or less and may have to be further reduced by the Planning Committee to keep expenses down. To date, our treatment center supporters include: Betty Ford Center, Menninger, Hanley Hazelden Center at St. Mary's, The William J. Farley Center, Rush Behavioral Health Center, Bellwood Health Services, Sante' Center for Healing, Father Martin's Ashley, Sierra Tuscon, The Meadows, CoPAC, Talbot Marsh and River Oaks Hospital. Several new facilities have indicated an interest in joining us, and we will again limit the number of table top displays. Space is available on a first come, first served basis. The "early bird" discount deadline for our exhibitors is March 15, 1997 (after which add $300 to the fee).

Each year the National Workshop keeps getting better and better. Bonnie Waters, Workshop Chair and Michael Distelhorst, Workshop Vice-Chair, guarantee this one will continue that tradition. On behalf of Bonnie, Michael and the rest of the Planning Committee, we invite you to join us at the 10th National Workshop for Lawyer Assistance Programs. Questions and/or requests for registration forms can be directed to Bonnie Waters (Phone: 617/227-7070 Fax: 617/227-7075 E-mail: LCL880MA@aol.com), Donna Spilis (Phone: 312/988-5312 Fax: 312/988-5280 E-Mail: spilisd@staff.abanet.org), or Gerri Sandner Phone: 312/988-5312 Fax: 312/988-5280 E-mail: gsandner@staff.abanet.org)

Target Dates

• April 11-13, 1997 - Spring Communications Retreat with Dr. Paul & Max Ohliger Kah-Nee-Ta Resort, Warm Springs, Oregon - Contact: Linda D'Agostino, Oregon Attorney Assistance Program 503/684-7424
• April 18-20, 1997 - Gambling Counselor Training Sponsored by ABA Commission on Lawyer Assistance Programs. Proctor Hospital, Peoria, Illinois - Contact: Donna Spilis, Staff Director of CoLAP, 312/988-5359.
• April 18-20, 1997 - The Spring Networking Meeting of The Other Bar, Monterey, California - Contact: Rick E., 619/244-6196
• May 2-4, 1997 - 7th Annual New York State Lawyer Assistance Program Spring Conference, Otesaga Hotel, Cooperstown, New York - Contact: Linda McMahon, 1-800-255-0569 or 518/487-5685
• May 9, 1997 - Southeast Regional LAP Directors Meeting, Charlotte, North Carolina - Contact: Don Carroll 704/347-7801
• May 29-31, 1997 - ABA 23rd National Conference on Professional Responsibility, The Registry Resort, Naples, Florida - Contact: Brad Hoffman, 312/988-5305
• May 30-31, 1997 - ABA 13th National Forum on Client Protection, The Registry Resort, Naples, Florida - Contact: Brad Hoffman, 312/988-5305
• June 6-8, 1997 - Texas Annual Lawyers Concerned for Lawyers Conference, Houston, Texas - Contact: Don Jones, Director, Texas Lawyers' Assistance Program 512/463-1453
• July 25-26, 1997 - Florida Lawyers Assistance Annual Workshop, Naples Beach Resort Hotel, Naples, Florida - Contact: Judy Rushlow, 800/282-8981
• July 30-August 6, 1997 - ABA Annual Meeting, San Francisco, California
• August 2, 1997 - Presidential Showcase Program "Real World Problems of Judges & Trial Lawyers" (Stress, Drugs, Rock-n-Roll), Marriott Hotel, 55 Fourth St., San Francisco, California 10:00 am - noon
• August 2, 1997 - CoLAP Business Meeting, Marriott Hotel, San Francisco, California 1:00 pm - 5:00 pm
• August 26, 1997 - "Creating Balance in Your Professional Life" - Presentation by Canada's Legal Profession Assistance Conference, Canadian Bar Association Annual Meeting, Ottawa, Canada - Contact: Adrian Hill, 416/595-9935
• September 5-6, 1997 - The Second Annual Lawyers Assistance Conference 1997 Tan-Tar-A, Lake of the Ozarks, Missouri. Contact: Jim Howard, MOLAP - 573/635-4128
• September 8-12, 1997 - 10th National Workshop for Lawyer Assistance Programs,Renaissance Mayflower Hotel, Washington, DC - Contact: Gerri Sandner, 312/988-5312 or Donna Spilis, 312/988-5359
• September 12-14, 1997 - ILAA 1997, Renaissance Mayflower Hotel, Washington, DC - Contact: Marlene Tandy, 202/434-7225 (FAX: 202/783-8750)
• January 28-February 3, 1998 - ABA Midyear Meeting, Nashville, Tennessee
• January 31, 1998 - CoLAP Business Meeting, Nashville, Tennessee

Spotlight: People in the News

Awards and Congratulations

Engaged: Michael Cohen, Executive Director of Florida Lawyers Assistance, proposed to Laura Jones on Valentine's Day (and Laura said "yes"). Laura has a 7 year old son named Ian. She is a nurse at Miami Heart Institute where she works in the Cruise Line Center taking care of the crew and passengers on a number of cruise ships. No date has been set, but they are trying to come up with one between the Annual Meeting in August and the National Workshop in September.

New Coordinator Hired in England - Welcome to Barry Pritchard, the Coordinator of SolCare, England's lawyer assistance program, which is scheduled for launching at a conference on April 28th (tentative date). Mr. Pritchard was admitted as a Solicitor in 1960 after obtaining an Honours Degree in Law at Birmingham University and serving articles with Whiteley & Pickering in Redditch. He has been an active member of Lawyers' Support Group and held several offices for the organization. You can reach him at Ty'n Y Gro, Prenteg, Porthmadog, Gwynnedd, Wales LL49 9SW (Telephone 01766 51222). Jonathan Goodliffe also sent me a contact for lawyers in Ireland, namely Martin Rogers. Mr. Rogers can be contacted by phone at 441232 660123.

Farewell to Tricia Heil - Tricia will be leaving her position as Assistant Director to the Texas Lawyers' Assistance Program the end of March. She plans to go into private practice focusing on ethics, grievances and representing law students before the Board of Law Examiners. Tricia said she will miss us all, and is truly grateful for having had the opportunity to work with the LAPs and committee members, and especially the best possible director, Don Jones, who is talented, professional and dedicated. You can reach Tricia at 1903 W. 34th Street, Austin, Texas 78703 (512/454-6209).

Texas hires new assistant director - Ann Foster has been hired as the new assistant director to the Texas Lawyers Assistance Program. She will assist Don Jones in providing for identification, peer intervention, counseling, and rehabilitation of lawyers having impairments (alcohol and drug dependency and physical and mental illnesses) that adversely affect their practice of law. Her start date will be March 31, 1997. Ann has ten years experience in the practice of law, most recently as an employment lawyer and in an ethics advisor capacity with the Texas Natural Resource Conservation Commission. If you will be attending the Texas LCL Convention this June (see calendar of events) in Houston, you will have an opportunity to meet her.

CoLAP Program Receives Presidential Status

ABA President N. Lee Cooper awarded Presidential Showcase status to a program proposed for the 1997 San Francisco Annual Meeting by the Commission on Lawyer Assistance Programs. The working title for the program is Real World Problems of Judges and Trial Lawyers (Stress, Drugs, Rock-n-Roll). This program will address health problems that may arise from stress, depression, other emotional problems or chemical dependency and abuse. The ABA Litigation Section and Judicial Division have signed on as co-sponsors. Program Chair and Moderator, Robert P. Cummins, has put together a panel of prominent lawyers and judges including former Ohio Supreme Court Justice Craig Wright and CoLAP Chair, Michael J. Crowley.

Gambling Training for LAP Directors

The ABA Commission on Lawyer Assistance Programs (CoLAP) has organized a Gambling Counselor Training Program for directors of lawyer assistance programs (LAPs) and other interested lawyers. With the increasing legalization of gambling in various states, more people are developing a gambling problem and many LAP directors are getting calls from lawyers suffering from this addiction. Training will provide information on identification of pathological gambling, profiles of pathological gamblers, 12 step programs, treatment approaches, family issues, issues within special populations, and financial assessment. Representatives from LAPs in Louisiana, Texas, Wisconsin, New Jersey, North Carolina and Illinois will participate in the training program that is designed to give them the classroom hours required to become certified gambling counselors. This is one of many regional programs being planned by the CoLAP as a service to the lawyer assistance programs. (April 18-20, 1997, Peoria, Illinois)

Chair's Report

Appointments: William P. Smith, III, President of the National Organization of Bar Counsel has appointed Christine Anderson as the liaison to CoLAP. Christine is Senior Counsel for the Attorney Registration and Disciplinary Commission of the Supreme Court of Illinois. This will be her second year as our liaison. For the first time, we will also have representation from the Association of Professional Responsibility Lawyers (APRL) at our business meetings. Diane Karpman of Los Angeles, California, former partner of one of our founding commission members, Ted Cohen, has been appointed by Tim Burke, President of APRL, for a one-year term as our liaison from APRL. CoLAP will be working with APRL and NOBC in the development of a joint program for the Annual Meeting in San Francisco this August. The topic will deal with reinstatement of a lawyer recovering from depression or an addiction. We were also pleased to have had our new Law Student Division liaison with us in San Antonio at the Midyear Meeting. Her name is Sophia Atcherson, and she is a third year law student at Indiana University School of Law in Bloomington, Indiana.

Around the LAPS

Note from Donna Spilis: Many thanks to the LAPs that send information for inclusion in this section of "Highlights," and also to the ABA Division for Bar Services, whose staff regularly send clips related to the work of LAPs from state and local bar association journals and newsletters.

Canada - On August 26, 1997, at the Canadian Bar Association Annual Meeting in Ottawa, the Legal Profession Assistance Conference (LPAC) will present a program on "Creating Balance in Your Professional Life." A group of experienced lawyers, including CoLAP chair, Michael Crowley, and New Jersey LAP director, William J. Kane, and health care professionals will speak on health and wellness and pursue the issues of happiness, joy and accomplishment in personal and professional life.

Colorado - Les Crispelle, Executive Director, Colorado Lawyers' Health Program, recently spoke at a Conference on Electricity Law and Regulation. He spoke on Substance Abuse utilizing the British Columbia LAP videotape, and his session was awarded substance abuse continuing legal education credit. This program was sponsored by the ABA Section of Natural Resources, Energy, and Environmental Law. This invitation may have been the result of a presentation made by CoLAP member, Briggs Cheney, to the ABA Section Officers Conference, at which he offered LAP assistance for speakers on addictions and stress.

Illinois - In the January 1997 "President's Page" of the Illinois Bar Journal, President Gabric announced that after a successful meeting with President Donald Hubert of the Chicago Bar Association, they created a joint committee to work on funding the Lawyer Assistance Program.

Maryland - CoLAP and the Maryland State Bar Lawyer Counseling Committee were recently recognized in the Baltimore "Daily Record." The article stated, "many professional associations, to their credit, have recently begun to focus their efforts to help members with problems of alcohol and drug abuse. One of these has been the American Bar Association (ABA). In 1988, the ABA took a first step and founded the Commission on Impaired Attorneys to help lawyers suffering from alcoholism . . . . Of the roughly 300 grievances acted upon yearly by the Attorney Grievance committee, a large proportion involve evidence that alcohol or drug abuse played a part in the matters leading to the grievance filing." The writer recognized Richard B. Vincent as the first state bar staff person to direct a lawyer assistance program.

Massachusetts - Lawyers Concerned for Lawyers, Inc. sponsored a free seminar on Balancing Work and Family - The Business Case for Workplace Flexibility. This two and a half hour program explained how family concerns are tied to the bottom line of business and that workplace flexibility can mean a reduction in absenteeism, less turnover, better client retention, higher productivity, and an increase in firm loyalty.

Mississippi - The Mississippi Bar, through its Lawyers and Judges Assistance Program, received recognition from the National Conference of Bar Presidents as a "Best Project of 1996." "Law & Life - Enjoy Both" is an education and awareness program addressing lawyer dissatisfaction; stress and burnout; work related health problems; family and relationship discord; and lawyers high risk for depression. The campaign for 1996 involved: a CLE seminar entitled Re-Imagine the Law with Benjamin Sell, author of "Soul of the Law"; a monthly support group for lawyers experiencing depression; a speakers bureau of lawyers and a judge speaking to law schools and bar organizations about depression and its effects on the profession; and a special issue of the Mississippi Lawyer that focused on the possibilities of Law & Life - Enjoy Both. The seminar explored deeper aspects of the legal profession. The participants examined how the ideals of the law—objectivity, order, due process and adversarial system—so fundamental to our legal system, form and shape the psyche of all lawyers.

Missouri - MOLAP had a good year considering that 1996 was the first year the program was directed internally. MOLAP had been out-placed with an external EAP from 1991 through 1995. Utilization increased to 111 cases in 1996, primarily due to increased visibility and promotion of the program. Effective January 1, 1997, services were expanded to include family members. In addition, MOLAP now provides consultation and coordination of psychological assistance in the event of a critical incident.
The First Annual Lawyers' Assistance Conference was a success. In addition to Intervention Training, modules included: Alcoholism; Depression; Women and Substance Abuse in the Legal Profession; Substance Abuse, Recovery and Sexuality; Substance Abuse and the Family; Gambling and Substance Abuse; Lawyers in Recovery; Spiritual Solution; Relapse Prevention; Gerontology Issues in the legal Profession and Ethical Considerations in the Intervention on Impaired Attorneys. The Second Annual Lawyers Assistance Conference will be held at Tan-Tar-A, Lake of the Ozarks on September 5-6, 1997.
MOLAP now has a home page on the Internet. You can access it at http://www.mobar.org.

New Hampshire - The December 18, 1996 issue of the New Hampshire Bar News carried an article on "Substance Abuse and Mental Health Assistance." The New Hampshire Bar Association's Lawyers' Assistance Committee (LAC) has provided assistance to lawyers in need for over 15 years. The LAC is designed to match impaired lawyers with the many excellent resources in their community available to help, including other lawyers who have experienced and successfully dealt with the same problems. A second organization offering help to lawyers in need is Lawyers Concerned for Lawyers (LCL). LCL hold two monthly meetings and has no formal affiliation with the New Hampshire Bar Association. Through LCL, lawyers are given an opportunity to discuss their problems with experienced lawyers and judges, some of whom have personally confronted substance abuse and mental health issues. A list of LAC members and their telephone numbers was included in the article.

New Jersey - The December 1996 issue of the New Jersey Lawyer published an article by LAP director William John Kane and Cheryl Baisden, managing editor of the magazine. The article is entitled Use and Abuse: Are You Controlling the Substance, or Is the Substance Controlling You? It is beautifully written and contains information on the LAP, myths and misconceptions about alcoholism, diagnosing dependency, seeking help, and women and substance abuse. I especially like the statement, "Stress, tension and anxiety do not cause alcoholism, although they may be wonderful excuses for drinking. There is no persuasive evidence that alcoholics suffer from more stress before the onset of the disease than do non-alcoholics. Once the disease has progressed to a certain point, however, the alcoholic is bound to experience more stress than the non-alcoholic as a result of withdrawal symptoms and life's problems."

North Carolina - In February, North Carolina's PALs program sponsored a forum for five law school deans. The invitation was extended by the Governor, Chief Justice and the President of the Bar. Professor Michael Distelhorst, CoLAP member, was in attendance. It was entitled the Chemical Dependency Curriculum Infusion Project. The purpose was to get the deans to take a fresh look at the law school curriculum based on statistics showing the influence of chemical dependency on family law, criminal law, tort law, domestic violence cases and other areas of law that are being taught in the law schools.

Oklahoma - The cover story in the December 14, 1996 issue of The Oklahoma Bar Journal was entitled "They Gave Me Hope: An Oklahoma Lawyer's Personal Story." This article is not about a lawyer suffering from an addiction, but about a lawyer with a disorder called Tourette's Syndrome and how he was helped through the Oklahoma Bar Association's Lawyers Helping Lawyers program. This volunteer-driven program, with some support from the Bar, is now reaching out to lawyers suffering from such problems as mental illnesses, neurological problems and physical health problems, such as cancer, heart disease and other incapacitating or limiting disorders that interfere with the performance of the lawyer's duties.

Pennsylvania - Effective April 1, 1997, the Lawyers Concerned for Lawyers of Pennsylvania, Inc. will provide new expanded Helpline Services to include: alcohol and drugs, compulsive gambling, stress and anxiety, depressive illnesses, and other emotional and mental illnesses. LCL has developed a new, user friendly system that offers a varied menu of responses to a broader range of symptoms. There is no charge to the caller for the initial consultation. The LCL Helpline will also refer the caller to volunteer lawyers who have experienced and overcome these illnesses. The new, 24-hour, 365 days The strictly confidential Helpline number is: 1-888-999-1941.
I also heard a rumor that Lawyers Concerned for Lawyers of Pennsylvania is producing a film on the problems of depressive illness and the abuse of prescription drugs by the elderly. I am awaiting an overview of the film, and will share more information in the next issue of Highlights.

Texas - In the December 1996 issue of the Dallas Bar Association's "Headnotes," there were two interesting articles that focused on coping with stress and curing burnout. The author,Catherine Burton, said, "Regular work with clients who are involved in crisis, such as legal problems, creates a situation of chronic stress for the practitioner. The individual who must cope with angry and vitriolic clients as well as those who are fearful, depressed, anxious, vindictive, suspicious, and jealous are at particular risk of burnout. These conditions have a built-in frustration factor as the practitioner must deal with the fluctuating emotions, irrational demands, and unrealistic expectations of their clients (or judges and opposing counsel). The psychological aspects of their work make them prone to burnout symptoms particularly when the work involves intense effort without forthcoming results."

Virginia - On September 18, 1996, the Virginia Supreme Court approved an amendment to the Disciplinary Rules that provides expanded confidentiality protection to persons being assisted by Lawyer Helping Lawyers. The new version of the Disciplinary Rule states that: "Any lawyer in the performance of authorized activities under the auspices of the Lawyers Helping Lawyers Program, or The Virginia Bar Association's Committee on Substance Abuse, which administrators the Lawyers Helping Lawyers Program, shall not be considered to have violated any Disciplinary Rule or Ethical Consideration of the Virginia Code of Professional Responsibility...by reason of his failure and/or refusal to disclose any investigating, counseling or intervening with a lawyer for possible substance abuse pursuant to the guidelines of the Lawyers Helping Lawyers Program, and for purposes of this paragraph, DR 4-101 shall apply to the preservation by any such lawyer of the confidences and secrets of any other lawyer learned while performing such duties to the same extent that DR 4-101 applies to the confidences and secrets of a lawyer's client."
Virginia's second annual Lawyers Helping Lawyers Conference was held on October 17 and 18 and was a great success. CoLAP member, Judge Sarah Krauss of the Kings County Civil Court in Brooklyn, New York, was a guest speaker and inspired everyone with her story of becoming a judge while acknowledging her personal struggles.

Independent Living Community: A Successful Alternate to the Residential Treatment Model

by Betty Reddy, CEAP, James F. Costabilo, MA, CEAP, CADC, Carl L. Anderson, MS

Any professionals involved with the referral and treatment of patients with chemical dependency problems feel that treatment in the late 90s is considerably diminished both in quality and availability compared to the "heyday" of the 80s. Then, it seemed, insurance benefits covered a wide array of alcoholism treatment centers, most of them residential. Treatment admissions were not restricted by managed care precertification requirements, and lengths of stay of 4-6 weeks were more or less accepted as the norm. In part, because of the abuse of this system by aggressive treatment providers, especially on the psychiatric side, and due to the overall growth of medical expenses, the managed care industry grew rapidly. Mental health was seen as an area of overspending that could and should be controlled by external review and controls.

Most reputable treatment centers had begun modifying their systems even before the pressure from managed care organizations forced the issue. These modifications included utilization of criteria to place patients in a level of care system that included outpatient treatment as a primary option and a variable length of stay according to patient need. Many managed care organizations (MCOs) simply removed residential or inpatient care as an acceptable treatment modality except for medically necessary detox. Outpatient treatment either at the day hospital or Intensive Outpatient Program (IOP) level became the highest level of care acceptable by MCO criteria. Even detox was moved to an ambulatory modality when possible.

Although these changes have been the center of considerable controversy both in the treatment provider arena, as well as with many EAPs, for the most part they have been accepted as the norm. There continues to be some debate between treatment providers and managed care organizations as to the need for intensive program treatment at the level of day hospital (6-8 hours per day), and IOP (3-4 hours per day). It has become clear that some MCOs do not see much need for intensive treatment at all, or at the least for very brief periods (3-5 days is typical). There is a growing consensus among the provider community, EAPs, and many of the better MCOs that many alcoholics and other drug dependent people need an intensive treatment program as a basis for successful recovery, and that this intensity can be delivered best on an outpatient basis for most people. Treatment providers have discovered that there are advantages to the day hospital and IOP levels that make them a superior modality compared to inpatient/residential for many patients.

The model of using apartments as an independent living community to provide a supportive living experience while participating in an intensive treatment program started in the early 80's as a cost effective and clinically superior model of providing treatment for impaired professionals. We have discovered that this model applies very nicely to other patients as well, and meets the demand of MCOs for cost efficiency and appropriate intensity.

The model of treatment includes:

• A comprehensive initial evaluation to determine the most appropriate level of care
• Inpatient or ambulatory detox if necessary
• A complete continuum of outpatient services
• Independent living community - a therapeutic living community which provides a surrogate family type of support that extends the treatment process into the full 24 hour period each day

Even though this model predates the present managed care environment, it has been embraced by most of these cost conscious entities.

Program Design

In a treatment program designed for professionals by Dr. Dan Angres, intensive programmatic care at the day hospital or IOP level is not only cost effective, but it also challenges the patient's unrealistic expectations and discourages the dependence and regression often seen in inpatient settings. The combination of being in the intensive day program and living in a therapeutic community is the optimal situation for treatment. Patients are able to live in the residence, become a part of the peer community and deal with issues that arise in both the treatment program and in their living together. At the same time, they are learning about the disease process and their own personal recovery needs.

Although, initially designed for healthcare professionals, the patient population has always included others in various life and work situations. Other professionals such as lawyers, airline pilots, and corporate executives have been treated successfully in the model. The general criteria for placing a patient in the independent living community (ILC) are:

• Patients' living situation is unstable and non-supportive; i.e., living alone, poor family structure or living with drinkers/users
• Geographic access to the treatment center is difficult
• Patient has difficulty maintaining abstinence in a home setting
• Patient displays a need for socialization; needs to break isolating, needs to learn and accept boundaries
• Patient is in a high risk work situation

In addition to intervention as early as possible, the majority of addicted professionals need intensive treatment plus extended aftercare. Their treatment plans should include:

• Longer term treatment with specialized phases
• Strong peer group support
• Structured long-term monitoring system
• Strong group settings in both the initial treatment phase and in long-term aftercare
• Peer groups containing a mix of patients with the same disease, but also others in their own profession

All professionals seem to share the following issues which are more easily confronted and addressed in group settings with peers who are in similar circumstances:

• Massive denial compounded by a fear of the consequences to their ability to continue active practice in their profession
• Grandiosity with high degree of defensiveness and a need to be in control
• Image of superiority based on their profession - accustomed to being in charge, being decision makers, controlling others
• High accountability for the safety or management of others
• Dual diagnoses

In treatment, patients who live in the ILC quickly bond with their peer professionals. In the community of their peers they lose their sense of isolation and uniqueness and find it easy to share their professional fears with each other. Because the occupants of the apartment residences are in various stages of treatment, they model and mirror recovery for each other. By integrating treatment with residential living and adding a strong family program, outpatient programming isallowed to be even more intense than the traditional residential model.

Phases of Treatment

There are four phases of treatment. Phase I includes the diagnostic evaluation, stabilization of the patient's condition medically and a determination of the individualized treatment plan. This may occur in an inpatient setting or may be done as an outpatient.

Phase II of the program can take from 4-6 weeks. It contains a focus on primary care goals and includes working through denial and exploring triggers to relapse. Each patient is seen regularly by an individual counselor but small groups are the key treatment modality. Their groups are co-led by a primary care counselor and a family counselor. The family counselor for each group is the one who also meets with the families of that group.

There are an average of four groups per day in the day hospital; two in the IOP program. These are an educational group; an experiential group with focus on coping skills, a process group where feelings and other such issues are addressed and one offering special assistance with professional issues. In addition, if a patient has any dual diagnosis complications, they are addressed and treated concurrently throughout the program. There are four levels possible in this phase:

• Patient is in the evening IOP while living at home and working
• Patient is in the evening IOP, lives at the residence and works
• Patient is in the day hospital program while living at home and may work evenings
• Patient is in the day program plus the ILC and is not working

Phase III is an optional extended treatment phase that can last up to four weeks. This phase is designed primarily for physicians and other healthcare professionals, but occasionally attorneys and other professionals benefit from this extension as well. During this time, professionals are assigned some routine duties. They act as senior patients, such as orienting new patients or mentoring others. They are directed to examine their own needs versus the needs of others. These patients look at the risks they face as a professional; i.e., how much is their self-esteem based on their profession or do they routinely work excessively long hours. They are prompted to examine how their professional life reinforced the danger of denial and increased their resistance to face their need for help. This also gives them the opportunity of seeing themselves as they were a few weeks earlier. During this phase professionals begin attending the special groups for professionals which continue throughout the fourth phase.

Phase IV is a structured aftercare plan designed for the individual. Each patient is required to sign a contract for twenty months of specific aftercare activities. They are expected to participate in the 12-step recovery program and to have a sponsor. There is also family involvement at least one night a week for twelve weeks and 20 months of weekly support and monitoring groups for this "significant other" of professionals.

The contract stipulates there will be no absence without staff approval. An unapproved absence is followed by a warning letter that one more will be cause for an administrative discharge with referral to other appropriate treatment. Random urine screens average two per month and a missed screening counts as a "positive." These stipulations are particularly effective with professionals whose license to practice is at stake.

Providing a Therapeutic Community

Recovery depends on reaching maturity through fellowship. This is accomplished best through the "tough love" within a surrogate family in a recovery setting. It encourages and facilitates processing real world issues in an intensive group experience. It is a confrontive milieu with high peer expectations. Non-chemical coping skills are learned in a setting that fosters integrating them into all of a person's life; family, social and work. Licensure issues often add a healthy coercion to succeed.

Several apartments in a complex close to the treatment center constitute the location of each independent living community. Each apartment houses 3-4 residents. Residents are expected to live together cooperatively and with respect for each other. They are taught to express their needs and respond to each other in a caring but also confrontational way. They are encouraged and led to communicate openly and honestly. Weekly resident group meetings at the residence and at the treatment center are mandated.

Residents are responsible for supervising their own goal-setting contract for living together in the community. They are expected to carry out their own goals and also to help others do the same. Since a balanced spiritual, physical and mental lifestyle is important to recovery, they are expected to be involved in a 12-step group, practice the recovery principles and read daily from a 12-step based daily meditation book.

Socialization and recreation without mood altering drugs must be integrated into their recovery. Fitness centers are convenient to the residences for their use. Residents are expected to exercise appropriately to their age and health and to engage in competitive sports for both health and fun each week.

In a therapeutic setting all residents are encouraged and expected to take the responsibility to confront each other on any concerns they may have about problems that disrupt community living. That responsibility is a focus throughout their treatment in their group sessions, one-to-one counseling with their primary counselor and through their daily interaction with each other. To add another safeguard to their living together, a staff member is on call at all times. The residents' handbook specifies the events which require contacting staff. In addition there are inspection visits from a staff member to check on the apartment environment.

Rules and Regulations

The rules and regulations governing behavior in the residences are based on a consistent, fair framework of personal accountability for recovery and for contributing to a supportive environment. The rules are clear there is to be neither alcohol or drugs on the premises nor individual alcohol or drug use. The men and women live separately in the apartments and can be together only in planned program events or in groups of three or more. "Pairing" and sexual relationships are not allowed. They are to participate in all activities as a group; i.e., grocery shopping, using food vouchers and attending 12-step meetings or a fitness center. Violence of any kind and all weapons are prohibited. Residents have commitments to observe the curfews and give time to the community by attending all planned activities and by sharing equally in all the chores of living.

The residential settings are designated and designed to be therapeutic experiences. Each must contribute his/her share in time, work and expenses. Patients involved with evening programming only are still expected to attend the weekly resident groups and the Sunday activity. They are also to follow the rules and live in the spirit of a therapeutic community.

Family Programs

Throughout the treatment from phase I through IV, a family program takes place. There is a monthly education day for families and significant others on a Saturday from 9:30 a.m. to 4:00 p.m. It includes children from age 12 and up. Topics cover the disease of chemical dependency, its progression and the effects on the family and others in the person's life. Participants learn about the unhealthy responses from family and others that contribute to the illness and about rigid family rules which can trap whole families into negative ways of living. They are taught about and recommended to become involved in recovery through appropriate 12-step programs. They are taught about how and why relapses occur.

In addition to the family education day, there is multi-family program which occurs every fourth week each month. During that week, Monday through Thursday, 9:30 a.m. - 3:30 p.m., participants are provided the same education and also two days of multi-family groups which included the patients. This program is especially for the spouses and immediate family. For children 8 to 13-years-old, there is a Kids Wellness Program. It occurs once each month from 9:30 a.m. to 3:00 p.m. on the first two days and from 9:30 a.m. to noon on the third day. To attend this program, the children's parents have to have participated in the Multi-Family Week. During the first two days, the children are helped at their level and through games to learn about chemical dependence and the need for them to express their feelings and take care of themselves. On the third morning their parents join them and the families are introduced to and assisted in the process of open and honest communication.

Outcome Research

The research data covers the patients beginning treatment as far back as 1984 and continues through 1989. The study included 278 professionals who completed primary and aftercare programs. Although most were in health care, there were also a number of attorneys, educators, pilots and members of the clergy. Favorable outcome in this study is defined as continuous uninterrupted abstinence from all mood altering substances.

• 67% were in day hospital - 33% in an intensive evening program
• 79% were in the Independent Living Community
• 44 of the 278 relapsed, which reflects an 85% success ratio

In analyzing the data on the relapsed patients the following conclusions were made:

• No significant demographic factors influenced relapse
• No significant factors relating to program type influenced relapse
• No statistical significance in the drug of choice or in the route of administration

For patients who rebounded, the involvement of family or significant others in the Family Program and in a 12-step recovery program was most significant. Dual diagnosis was significant and narcissistic personality disorders were overly significant. Some study conclusions were:

• Specialized treatment is needed for chemically dependent professionals.
• Family involvement and support is critical to the recovery of patients.
• Extended treatment and long-term monitoring are essential elements necessary to deal with issues of:
• Accountability
• Denial
• Access to drugs

Summary

This model, combining long term, phased out-patient treatment with an integrated independent living community experience, was devised by Dr. Angres and brought to Chicago in 1984. Clinical experience in treating professionals and research on outcomes have validated the model and resulted in refinements that make it a design well positioned to meet the specific needs of professionals including lawyers and their families. It also is well positioned to replace the more traditional residential program for other successful outcomes and cost effectiveness.

1997 LAP Directory Tops List of New CoLAP Products

The 1997 Directory of State and Local Lawyer Assistance Programs is available. This new directory includes all the new directors and address changes that we have received to date. You can order a copy by sending your check for $25.00 payable to the ABA, to Gerri Sandner, ABA CoLAP, 321 N. Clark Street, Chicago, IL 60610.

CoLAP T-Shirt - Black with CoLAP logo, Sizes L and XL - $15.00 CoLAP Tote Bag - Black canvas "beach" bag with CoLAP logo. $15.00. Help support the Commission on Lawyer Assistance Programs by wearing their T-Shirt or carrying their Tote Bag. Please send your check payable to the ABA, to Gerri Sandner, ABA CoLAP, 321 N. Clark Street, Chicago, IL 60610.

AUDIOTAPE - During the ABA 1996 Annual Meeting in Orlando, the National Conference of Bar Presidents presented a panel on "Depression Among Lawyers: How to Identify It and Where to Get Help." Mike Crowley (TX), Don Jones (TX), and Judy Rushlow (FL) were speakers and did an outstanding job. Copies of the tape are available by calling "Teach Em" at 312/467-0424. The tape number is ABA 6333, and the cost is $12.00.

Quality of Life Topic of New Book for Lawyers

Life, Law and the Pursuit of Balance - A Lawyer's Guide to Quality of Life
Edited by Jeffrey R. Simmons
Reviewed by Clifford A. Dougherty

Could it be, that in our zeal and diligence to improve our image and restore public confidence in the legal profession, we have overlooked one fundamental element, essential to the success of this effort? Have we overlooked the career development and satisfaction of the individual lawyer?

A book, just released, entitled, "Life, Law and the Pursuit of Balance: A Lawyer's Guide to Quality of Life", suggests this. This book was edited by Jeffrey R. Simmons. The book states the problem as being, every lawyer is on an inexorable course, leading to burnout or balance. Surveys of lawyers for career satisfaction documented an alarming high number headed down the burnout course.

The study and the effort that produced this book were undertaken by the young lawyers of the Maricopa Bar Association in cooperation with the Young Lawyers Division of the Arizona Bar Association, Young Lawyers Division and Practice Management Section of the American Bar Association.

After clearly stating and documenting the problem, the book then, through a series of papers comprising the chapters, suggests ways to interrupt the course to burnout and to effect changes that will result in a return to balance and a more satisfying life. This is not a theoretical, fantasy presentation. These chapters contain the personal experiences of the authors. There are down to earth human experiences that have actually occurred.

The book has an excellent bibliography in which the curriculum vitae is clearly presented for each contributor. For those authors not personally known to the reader this information about the contributor will be valuable in forming a judgment on the validity of the suggestions. And finally, the book is written in such a way that it would be a good text for several CLE Programs. I commend the book to bar associations for CLE and a copy for the bar library.

Study Proves Lawyers Leaping onto the Net

[New York, NY] - Lawyers were among the last to use computers, often viewing the devices as glorified typewriters. But times are changing. Some 500,000 (52%) lawyers now use computers to access the Internet for e-mail, research and marketing, according to a new study released here today. The Internet Lawyer - Microsoft Corporation Survey was conducted by GoAhead Productions publisher of The Internet Lawyer newsletter, in conjunction with the Microsoft Corporation, and is debuting at Legal Tech New York, the largest legal/computer exhibition in the world.

"The study reveals a number of startling results," according to Josh Blackman, Esq., editor of The Internet Lawyer." For example, despite the hundreds of millions of dollars poured into marketing campaigns by online giants like America Online and CompuServe, the majority of legal pros use small local access companies to get onto the Net. Those completing the survey indicated that 32% use local ISPs, while only 18% use America Online, and only 6% use Counsel Connect, the proprietary online communication service for lawyers."

"The conclusion we draw from these results is that most legal professionals, are willing to do without the value-added services provided by large national providers, like telephone tech support and local dial-up access anywhere in the country," says Blackman. "It also suggests that there is more interest in the free content on the Internet than the proprietary content offered by private services like America Online and Counsel Connect."

Perhaps the most anticipated study results relate to how often the Internet is used for legal research purposes. Since 1975, Lexis-Nexis and Westlaw have dominated the computer-assisted legal research industry. Recent technologies, including CD-ROM and the Internet, however, have begun to erode the market penetration of these two large online services.

The Study indicates that overall, 72% of legal professionals (54% of whom are lawyers) use the Internet for legal research. Federal information is the most commonly accessed Internet legal material. Forty-eight percent of the respondents are using the Net to retrieve federal court opinions, statutes and regulations. State legal materials are accessed by 34% of those who use the Net for legal research.

Many of the legal pros who use the Net for research are not looking for traditional legal materials like court opinions and state codes, but rather, are in search of other information. They use the Net to find missing people, to investigate trademark infringement or to conduct medical research. Forty-four percent of those using the Net for research are conducting company research. The survey was conducted during the Fall of 1996 by mailing some 21,000 questionnaires to randomly generated lists of legal professionals provided by the American Bar Association, the Association of Legal Administrators, the American Association of Law Libraries and the National Federation of Paralegal Associations. In addition, the questionnaire was included in the September 1996 issue of The Internet Lawyer trade publication and was posted on The Internet Lawyer Web site at http://www.internetlawyer.com. Finally, a series of four focus groups were conducted at the Atlanta Legal Tech conference in September, 1996.

The Internet Lawyer is a monthly trade publication focusing on the practical use of the Internet by the legal industry. The Internet Lawyer is published by GoAhead Productions, a publishing and technology consulting organization serving the legal industry, with offices in New York City and Gainesville, Florida.

For more information contact: Joshua Blackman, Esq., 212-463-6261, Fax 212-645-7681, E-mail: joshb@internetlawyer.com, or Andrew Z. Adkins, III, 352-371-3191, Fax 352-371-9528, E-mail: aadkins@internetlawyer.com.