Note from Dan Angres, MD, Medical Director of Positive Sobriety Institute
We are thrilled to announce that the Louisiana Judges and Lawyers Assistance Program (JLAP) has chosen Positive Sobriety Institute as one of its partners in providing treatment for substance use and co-occurring disorders for attorneys, judges, law students and their families.
As the founder and medical director of Positive Sobriety Institute, I’ve worked with professionals in safety-sensitive professions such as healthcare and the law for 35 years. I can say without reserve that the work being done by Buddy Stockwell, executive director of the Louisiana Judges and Lawyers Assistance Program, is astounding. JLAP has demonstrated annual programming success rates as high as 97% in abstinence for the members of the legal profession who utilize their monitoring program.
JLAP clinical standards are based on best practices from physicians’ health programs, which provide assessment, treatment and monitoring for physicians in recovery from alcohol and drug addiction. In published studies, physicians’ health programs have a proven high rate of success in helping healthcare professionals achieve long-term sobriety and continue to practice medicine.
One of the questions we have sought to answer in the addiction medicine research is whether the high rates of success among healthcare professionals is translatable to other professions. Louisiana’s JLAP has shown that they are. This is profoundly important for our field.
To help attorneys struggling with addiction understand how lawyers assistance programs can help them, Stockwell shares what attorneys entering JLAP can expect, what motivates him, and how his organization works to ensure lawyers receive the best addiction rehab.
Q: What is JLAP?
A: A nonprofit organization owned by the Louisiana State Bar Association that operates independently of the bar association to primarily provide strictly confidential and privileged assistance. If somebody reaches out to JLAP, they know the information will not get back to the bar association or the Supreme Court’s Louisiana Attorney Disciplinary Board. Lawyers can safely confide in us.
Q: Who does JLAP serve?
A: The 22,000 members of the Louisiana State Bar Association. JLAP serves lawyers and judges, and their family members and staff members as well. JLAP also serves law students and bar applicants. At any given time, we have about 700 open files and average about 120 people under formal monitoring.
Q: How do attorneys, judges, law students and their families connect with JLAP?
A: When I took over as director in the beginning of 2011, there wasn’t a lot of voluntary traffic. Most of our cases came from disciplinary referrals from the Louisiana Supreme Court’s Committee on Bar Admissions or the Office of the Disciplinary Council for the Louisiana Disciplinary Board. When there are allegations of lawyer misconduct or client complaints, the board may recommend that the individual come to JLAP.
Over the last five years, I went on an assertive campaign around the state promoting JLAP’s confidential services. There was a false narrative out there that JLAP would report folks to discipline. Nothing could be farther from the truth. But still, we had a lot of work to do to overcome those misperceptions and prove that JLAP is restorative, not punitive. We had to get people to trust us.
Today, many people reach out for help proactively before their substance use or mental health problem becomes an issue with their employer or their law license. It’s our goal that everyone finds us this way, and we’re making great progress.
Q: Do lawyers face unique barriers to seeking addiction rehab?
A: Yes. Lawyers are very high-functioning. They don’t like being told what to do. They like handling things themselves. And they are also the most professionally adept people in the world in using denial and distinguishing facts to escape consequences. They’ll say, ‘Buddy, I understand you want me to go to this place for an assessment. But I really don’t think I need that. Just let me read-up on the subject and turn me loose! I always do just fine on my own.’
But treating addiction requires a different approach than lawyers are used to. Lawyers are trained to ‘think’ their way out of all problems. But addiction simply can’t be beat that way. Instead, one’s behavior must change first, and then addiction recovery and healthy thinking can develop. It requires true surrender and following other’s directions. Lawyers often struggle with letting go of control.
Q: How similar is the JLAP model to physicians’ health programs?
A: It’s similar in both the structure and clinical standards. Physicians’ health programs have been very successful in helping physicians achieve long-term sobriety and retain their license to practice medicine.
We have learned a lot from physicians’ health programs. At JLAP we’re standing on the shoulders of giants, people like Dr. Angres of Positive Sobriety Institute, Dr. Mark Gold of RiverMend Health, Dr. Robert DuPont of Harvard, and others who have done pioneering work in addiction treatment with professionals in safety-sensitive occupations. We’re utilizing what these clinical professionals had the skill and vision to develop and translating those best practices to lawyers, judges and law students.
One difference is that in the physicians’ model, if a physician is non-compliant with the program there can be a duty to report that person to the licensing board to prevent harm to the public. We don’t ever have a duty to report in the lawyer model. Confidentiality at JLAP is mandated by state law and state supreme court rules. It’s paramount. Lawyers would be very reticent to seek help proactively from JLAP if there was any chance we could report them to discipline. The only way JLAP can report non-compliance is if the participant has signed a waiver and instructed JLAP to report non-compliance to a third party such as discipline or their employer, etc. It’s all up to the participant.
Q: What are your success rates?
A: In 2015, JLAP commissioned the first-ever audit team of national experts comprised of leaders from both physicians’ programs and lawyers’ programs. From the physician’s health program realm, Dr. Lynn Hankes and Dr. Martha Brown participated. From the lawyers’ assistance program realm Judge Sallie Krauss and lawyer/clinician Tish Vincent participated. No other professionals’ program of any kind had ever undergone such a comprehensive multidisciplinary audit.
Post-audit, JLAP’s operations are state-of-the-art. Its clinical guidelines related to assessment, treatment and monitoring are generating truly exceptional success rates for our participants.
The audit found that JLAP’s monitoring participants enjoy a greater than 90% relapse-free success rate in maintaining recovery from alcohol and drug addiction. Last year JLAP’s success rate was 97% and the year before it was 94%.
Q: Like physicians’ health programs, the Judges and Lawyers Assistance Program asks its clients to make a long-term commitment to their recovery. Why is that important?
A: JLAP is not a ‘check the box’ program. JLAP is all about quality participation. We want to connect people with the right level of treatment from a skilled and experienced medical team at the beginning, stay with them through the recovery process, then monitor them for at least five years after treatment.
Too often people want to try what I call the “fail first” model – go to their local IOP [intensive outpatient program], and if they relapse then step up into a higher-level care. We believe in professionals’ programming and starting at the highest level of treatment and then stepping down as need be to lower levels of care while the participant becomes acclimated to a new life in recovery.
Our own statistical database reveals that in the past when we sent somebody to a lower level of treatment first, relapse was often the outcome. Relapse is not a benign event, and relapse is not part of recovery. It can mean the end of a career, or even the end of a life.
So, several years ago we began looking at standards for safety-sensitive workers and we began to figure out how to provide the truly reliable level of help that professionals really need. If we do things the right way, the individual, their family, their law firm, our profession, and the public all win.
Q: What can an attorney seeking help with JLAP expect?
A: First, we make sure that a person who needs help receives a multidisciplinary assessment that’s going to ferret out not just substance use diagnoses but also any co-morbidity. This gives us a reliable starting place of knowing exactly what this individual’s entire needs are. Is it substance abuse, anxiety, depression, personality disorders, compassion fatigue, unresolved trauma or something else in combination?
Once we’re confident that we know the entirety of the individual’s mental health and substance use issues, we can move forward and refer the person to facilities such as Positive Sobriety Institute that have skill and experience in treating safety-sensitive workers. We only work with facilities that have demonstrated that they’re top quality and have a genuine treatment track for licensed professionals. We match our clients with a highly skilled medical team, and remain in partnership with the medical team the whole way.
After treatment, the individual is monitored by JLAP for five years minimum. They undergo drug screening, attend recovery support meetings, get connected with a JLAP-trained peer-monitor who is also in recovery, and maintain contact with our professional clinical staff. We make sure they’re genuinely progressing in recovery, which is more than just abstinence. We see their outlook on life change for the better. All those things come together to help people remain happy and healthy long after they complete the program. They often become peer-monitors and remain involved in JLAP as volunteers.
Q: How do you work with facilities such as Positive Sobriety Institute?
A: We work as a team with the treatment facility. When our very skilled, dedicated staff works in concert with highly skilled clinical professionals such as those at Positive Sobriety Institute, the outcomes often exceed the sum of our skills. Some magic happens.
After clients come out of treatment, if we hit some bumps in the road during monitoring, we’ll go back to the treatment team, let them know what’s going on and collaborate on what to do to support the person through rough patches. We want to make sure that the person stays on track.
If we think there are serious problems, we will go back and consult with the treatment team for advice and updated treatment recommendations. When we all stick together as a unified support team, addiction doesn’t have the ability to start to construct some isolative, new iteration of itself within the person.
Q: Are all lawyers’ assistance programs the same?
A: There are many different state lawyers’ assistance programs providing help on various levels. But, there isn’t the same level of clinical standards coordination as is found with physicians’ health programs. That is why our JLAP looked to the Federation of State Physicians’ Health Program for reliable clinical guidelines.
Lawyers’ assistance programs began in the ‘80s when alcoholic lawyers in recovery began reaching out to other lawyers who were suffering, doing 12-step work, and getting peers into AA. There were no clinical standards. Of course, people had the best intentions and they were courageous and passionate about helping others. They did amazing work with the resources they had at the time.
Today, there’s a lot of variation in lawyers’ assistance programming from state to state. Some programs are a division of the state’s supreme court, some are a division of the state’s bar association, and some are totally independent non-profits. Some are full-service and offer formal monitoring, others don’t.
Our JLAP is now one of the most comprehensive in the nation and the only one to my knowledge that has gone through a performance audit that included national experts from both physicians’ and lawyers’ programming.
Q: What drives you to make Louisiana Judges and Lawyers Assistance Program the best it can be?
A: We are simply giving back. If someone had not been there for me 35 years ago when I hit bottom, I never would never have made it. At JLAP we have inexhaustible, unconditional love for our clients. But we also have non-negotiable clinical standards. We’re not going to negotiate with addiction. Sure, we get some pushback on our programming standards, but we know that our program works.
People underestimate the power of addiction. It’s more powerful than anything. And people think there is always more time. Our challenge at JLAP is getting folks to reach out for help confidentially and before severe consequences occur.
For more information, visit louisianajlap.com