Intervention | Vivon Recovery

Intervention Process

An intervention is a confrontation with an alcoholic or addict, orchestrated by those who have a strong desire to help the individual suffering from a substance abuse disorder. The goal is to convince the afflicted person to begin a treatment regimen resulting in sustained, long-term recovery. Interventions are often the critical starting point of the recovery journey, but the process can be perilous if not orchestrated carefully. Interventions involving lawyers are particularly challenging. The traditional intervention models often aren't the most efficacious methods to confront an addicted attorney.

Legal professionals are very intelligent, highly trained, and skilled in persuasion. When confronted, we utilize our tool kit to effectively argue ourselves out of getting the help we need, in our attempt to convince others that we're OK. The traditional intervention models also don't address the unique professional ethics requirements that addicted lawyers and their colleagues must consider in formulating a treatment protocol, fitness to practice evaluation, and return to work plan.

Precipitating Crisis Event - PCE

Most alcoholics and addicts suffering from substance use disorder (SUD) will rarely seek or be amenable to treatment absent a Precipitating Crisis Event (PCE) prompted by substance abuse. A PCE is associated with fairly severe negative consequences caused by behavior while intoxicated or seeking to become intoxicated. The PCE jeopardizes a core functional area of the alcoholic or addict's life, usually related to employment or financial security, legal status, social standing; physical health, or family relationships. The PCE becomes widely known to the people important to the alcoholic/addict. Viewed in the context of general past behavior, the various stakeholders in the addict's life conclude that the afflicted has a substance abuse problem that needs to be addressed and treated. The PCE causes the alcoholic/addict to assess his or her use as problematic, requiring treatment. The alcoholic/addict is more amenable to accepting help and entering treatment during the immediate aftermath of a PCE.

PCEs take many forms: DUIs; intoxication during work hours; hidden use; morning drinking; disappearing for days; volatile mood swings; inappropriate social and sexual behavior; marked decreased productivity; repeated patterns of failing to meet commitments, etc. An addict's life in active use is filled with chaos. Enormous amounts of energy are misdirected and wasted managing and compartmentalizing the dysfunction caused by substance abuse. A PCE disrupts business as usual. The addiction is outed and the denial mechanisms of the addicted professional, and those close to the addict, are weakened in the immediate aftermath of the crisis.

The intervention should occur promptly following a PCE. This window is usually fairly short. The alcoholic/addict will almost always make promises to cease using that are sincerely intended. Those close to the alcoholic/addict will want to accept those promises and the PCE quickly slips out of focus. The addicted professional uses self-will to temporarily cease using, but typically begins another, more secretive use cycle within a short time frame. The resumed use is eventually discovered after more damage is done. Those close to the addict then tend to actively disengage, often leading to divorce, legal problems, job loss, ostracization from colleagues, family, and friends. The addicted professional slips further into the despair, desperation, and isolation of active use, creating more wreckage. A compassionate intervention, if conducted timely with firm boundaries in place, is often the beginning of the end of the spiral of addiction.

Challenges in Helping Lawyers

The law is a demanding profession with practitioners who usually view themselves as indispensable and lacking the time to invest to successfully begin the recovery process. Lawyers also perceive the stigma of being branded an alcoholic or addict as a career death sentence. Receiving help is not a career-ender. It's quite the opposite, risky behaviors diminish while productivity and effectiveness soar when alcohol and/or drugs are removed as a life limiter. Yet, these deeply ingrained misperceptions are often serious impediments to convincing legal professionals to begin the recovery process. Overcoming stigma is a critical component of helping the addicted attorney move onto a fulfilling, healthy, and productive life in recovery.

Many lawyers in need of help also believe that entering a treatment program must be reported to the bar, leading to inquiries jeopardizing their professional licenses. In the vast majority of cases, getting help won't invoke a bar investigation, but continuing to practice impaired almost always leads to conduct and behaviors that can result in serious sanctions or disbarment.

Unfortunately, the fallout from an impaired lawyer's dysfunction is never limited to the addicted attorney. It also lands squarely on the addicted lawyer's colleagues, co-workers, partners, firm, or legal organization. It is in the best interests of all stakeholders in the legal work environment that the addicted professional enter a recovery program to elminate the destructive behaviors caused by SUD and to comply with professional ethics mandates.

Each of the traditional intervention approaches, discussed below, has limitations when applied to lawyers. Vivon has developed an intervention approach tailored specifically for legal professionals – The Legal Professionals Intervention Model.

Legal Professionals Intervention Model

The Legal Professionals Intervention Model (LPIM) includes six primary elements, modified as necessary to address particular circumstances. They are:

Compassionate confrontation, with firm boundaries, conducted by appropriate authority figures as soon as possible after the occurrence of a Precipitating Crisis Event (PCE).
Plan for immediate professional assessment and initiation of treatment as soon as possible following the compassionate confrontation.
Limitation of family and work colleagues in the compassionate confrontation.
Addressing the relevant Rules of Professional Responsibility and formulation of an ethics plan.
The legal employer's commitment to suspend or terminate the employment of the afflicted lawyer unless treatment is initiated.
The legal employer's commitment to a fitness to practice evaluation, return to work support plan, and long-term recovery support protocols.

1. Compassionate confrontation, with firm boundaries, conducted by appropriate authority figures as soon as possible after the occurrence of a Precipitating Crisis Event.

The use of appropriate authority figures in the confrontation is critical. Addicts and alcoholics respond best to other addicts and alcoholics who have successfully engaged in a treatment program and demonstrated long-term sobriety. A lawyer with a substance abuse problem is far more likely to relate to another lawyer, or group of lawyers, who have been through the recovery process.

Immediate relatability makes it more likely that the afflicted lawyer will view the initiation of treatment as a positive action that should be taken. Legal professionals in long-term recovery also have an innate understanding of the addict's mental and emotional state, and know that too much emphasis on anger, threats, shame, guilt, and fear are ultimately destructive strategies. It may seem counterintuitive to the non-addict, but a compassionate approach is the best way to confront an alcoholic or addict. At a core level, we addicts understand that our affliction wreaks havoc upon those in our lives. We shoulder extreme shame and guilt that are often primary emotional triggers that promote active use cycles. The vast majority of us truly do crave to be beneficial participants in our own lives and in the lives of those we love and care for, but the incredible power of the dopaminergic neural pathways, overtaken by addiction, is just too great for most addicts to overcome alone. We need others like us, who have suffered and overcome, both at the initiation of treatment and throughout the recovery journey.

Compassionate authority figures also provide powerful evidence of the pathway out of addiction and impress upon the afflicted professional that there are others who "have been there too" and who will support the addict with dignity, kindness, and love. This strategy significantly reduces the addict's fear and defensiveness. It takes the power out of the isolation and stigma, making it more likely that the afflicted legal professional will agree to enter treatment with an openness and willingness to fully engage in the recovery process, rather than resentfully conceding to appease or manipulate, which isn't a mindset conducive to maintaining long-term recovery after the initial treatment phase.

Compassion and relatability alone, however, are often not enough to convince an addict to commence treatment. There must be consequences for those unwilling to accept help. Addiction is a progressive disease that gets worse over time, subjecting the afflicted professional, and potentially his colleagues, to ethical sanctions and malpractice claims unless immediately and properly addressed. This is one facet where fear can be a positive motivating force for change.

Humans are loath to lose what we have and are highly motivated to profoundly modify our behavior when faced with the genuine prospect of losing something very meaningful to us. For most addicted legal professionals, the specter of losing a stable venue to practice law and earn a living is typically a strong enough incentive to instill a willingness to make the monumental change to live a clean and sober life.

Most Lawyer Assistance Programs (LAPs) throughout the country have volunteer legal professionals in long-term recovery that will compassionately engage with those suffering from substance abuse disorders, and share their own stories of treatment and recovery. We at Vivon are happy to share our experience, strength, and hope with those professionals struggling with substance abuse problems, and arrange for appropriate engagement for those individuals in need of treatment.

2. Plan for immediate assessment and initiation of treatment as soon as possible following the compassionate confrontation.

Before the intervention, a qualified substance abuse treatment professional should be on standby to perform an assessment, preferably the same day of the intervention. The assessment is used to determine whether an intensive outpatient (IOP) or a residential inpatient treatment program is appropriate. An assessment may also be mandated by health insurers before coverage will be approved.

Appropriate treatment facilities should be contacted in advance of the intervention and arrangements made for the addicted legal professional's attendance. Insurance coverage issues need to be coordinated and addressed. Most importantly, not all treatment programs are created equally. The addicted legal professional needs to start the recovery process in a program that provides the greatest chance of fostering long-term sobriety after discharge. Vivos has vetted various treatment programs throughout all regions of the United States and collated a list of those programs that offer the most efficacious treatment for addicted legal professionals.

To the greatest extent possible, treatment programs that have a strong family program should be utilized. Addiction not only impacts the individual addict, it also severely disrupts the entire family dynamic. Nearly all families with an addicted member have some level of dysfunction. Involving other members of the family in their own recovery protocol promotes the healing of all affected and affords the addict a stronger chance of avoiding relapse.

The spouse of an addicted professional will need to be consulted and participate in the process. The logistics of family schedules will need to be coordinated before an addict starts a treatment program. It's also important that the spouse of an addict commits to being a part of the treatment process and gains an understanding that addiction is best addressed when all family members get the help to restore well-being to the entire family unit.

3. Limitation of family members and work colleagues in the intervention.

It is Vivon's philosophy that family members, work colleagues, and others who have close personal relationships with the addict should have minimal participation in the compassionate confrontation. By the time an addict has reached the need for an intervention, family and work relationships are abnormally strained. Most addicts irrationally conjure resentments and utilize projection strategies when confronted by family, work colleagues, and other close relations. The addict has usually been confronted by these constituencies on numerous previous occasions and has managed to placate, bully or manipulate his way out of dealing with the addiction. The addict will know the weak points of close relations and work colleagues and utilize this knowledge to dismiss concerns – "I may drink a bit, but you have this issue, deal with your problem and leave me alone. I'm fine."

Emotions also run high during an intervention. Addiction causes great damage to interpersonal relationships. Those close to the addict are justifiably angry and often use the intervention to express their frustration and anger. This anger often creates additional long-lasting resentments amongst all participants, further damaging important relationships going forward.

These lingering resentments, intertwined with the addict's feelings of shame and guilt, tend to keep an addict stuck in isolation, fueling the addiction and creating more anger amongst family and co-workers. Confronters who are relatable legal professionals in long-term recovery, and not work colleagues of the afflicted lawyer, eliminate the potential for further straining relations that the confrontation can create between the addict and those who will be an ongoing, integral part of the addict's everyday post-treatment life.

4. Addressing the relevant Rules of Professional Responsibility and formulation of an ethics plan.

Ethics are discussed more fully in the ethical compliance section. There are two primary ethical concerns at the intervention phase: 1) ensuring that the afflicted lawyer's workload is properly managed while he or she is in treatment; and 2) investigation into the impaired lawyer's pending matters to determine what corrective action may be necessary.

Whether the addicted professional starts the recovery process in an IOP program or at a residential inpatient facility will have an impact on workload adjustment. An IOP program is usually conducted in the evenings, for three to four hours a night, typically four or five days a week, for three to four months. It is often possible for an attorney to continue practicing at a reduced workload in an IOP setting. The assessment professionals and IOP treatment providers will provide recommendations concerning workload. The legal employer should have a liaison with the IOP facility to coordinate fitness to practice protocols to ensure the legal employer is complying with professional ethics mandates during the pendency of IOP treatment.

If the afflicted professional enters an inpatient program, the lawyer will have virtually no opportunity to work or interface with his office while in residence at the inpatient facility. A standard inpatient program lasts four weeks, but depending on the severity of the SUD a program of up to three months may be recommended. Pending matters must be quickly assessed and workload allocated appropriately to other staff. This requires the legal employer to invest crisis time resources to ensure the proper reassignment of time-sensitive work.

A plan needs to be developed that addresses both the privacy rights of the afflicted lawyer that is compliant with HIPPA and other medical privacy regulations, balanced with clients' rights to disclosure to ensure competent representation. Frequently these two noble aims are in direct conflict, requiring a great deal of effort, thought and consultation to sort through particular situations.

The right-hand file drawer: The place where fear is put to fester. Addiction is marked by dysfunctional behavior caused by dysfunctional emotional responses to everyday life. Outsized fear responses and extreme anxiety frequently result in avoidant behaviors. The right-hand file drawer is the metaphorical space where an addicted attorney puts his or her "messes." The vast majority of addicted legal professionals who get to the intervention stage have some matters that have problems. Addicted lawyers are loath to disclose these problematic issues to their employers or partners, even when they are capable of being fixed because the fear and avoidance dynamic caused by addiction have become ingrained reactions in the addict's life.

One of the main focuses of the LPIM is to discover problematic matters so that a non-impaired attorney at the firm or legal services organization can sort them out, or if necessary, another attorney brought in to protect the client's interests. Sometimes, the damage has already been done, but in many instances, problems are fixable or capable of being mitigated. It is always best to address these problems up-front, as quickly as possible. An addicted lawyer is more apt to disclose issues with interveners who are third-party peer professionals in long-term recovery - "I've been there too, and I got through it." Relatability and compassion are extremely powerful paradigms that tend to prompt disclosure of problematic matters, reducing additional damage for the lawyer and the employer.

5. The legal employer's commitment to suspend/terminate the employment of the afflicted lawyer unless treatment is initiated.

Loss aversion is a very powerful motivator for change. A primary characteristic of evolutionary human psychology is a deeply ingrained desire to avoid losing the things that have the greatest value to us. Addicts in general tend to have a very strong desire to keep their jobs. This is especially true of legal professionals. We invest a great deal of time, effort, and money into getting our law degrees. Our perceived declarative identity, value, and self-worth are highly intertwined with our standing in society as lawyers. Popular conceptions of addicts as incapable of employment are erroneous. 95% of us who suffer from SUD are gainfully employed, but as the disease of addiction progresses it becomes far more difficult for the addict to function professionally at an acceptable performance level. This is especially so for afflicted lawyers.

The valid threat of job loss is usually a sufficient motivator for an addicted attorney to agree to commence treatment, but this aspect of the process is often complex. If the addicted attorney is a senior partner who controls a significant amount of firm business, he or she is likely to use that leverage to avoid getting help. The implosion of a firm or partnership isn't ideal, but neither is providing an addicted professional with a venue to continue practicing impaired. Careful approach planning is key to successfully implementing this component of the LMIP.

6. The legal employer's commitment to a fitness to practice evaluation, return to work plan, and long-term recovery support protocols.

Addiction is a chronic disease. Approximately 85% of people who complete a standard model addiction treatment program will relapse following discharge. Relapse often leads to resumption of destructive and debilitating long-term active use cycles. We know that these dismal relapse rates can be reversed with proper, structured aftercare and compliance monitoring. Recently developed technology now exists to implement efficacious aftercare and compliance monitoring. Its critical that monitoring protocols be in place during the initial phases of SUD recovery to both support the recovering professional, and to ensure that he or she isn't practicing while impaired by relapse.

A common misconception is that an addict should be "fixed" following treatment, and any relapse is an indication the afflicted person has made a conscious choice to continue down the path of destruction. Not true. The vast majority of us have relapsed thousands of times before ever entering treatment. Nearly all of us struggled in early recovery, but most of us do reach long-term abstinence, and immediately reduce harmful behavior, with the proper aftercare structure, supportive recovery communities, and enough time to allow our brains' neural pathways to readjust and become healthy.

The LPIM is specifically designed for legal professionals. Other approaches may also be effective in convincing an addicted legal professional to enter treatment, but professional ethics considerations unique to lawyers must be incorporated into any intervention model involving an afflicted legal professional. Descriptions of the most common, standard intervention models follows.

Classic Approach

The most common traditional intervention model is the classic approach. An interventionist arranges and supervises an ambush-style gathering of the addict's family, friends, and sometimes - employer. The addict is lured to a meeting where he or she is surprised by the various confronters. Typically, prepared written statements are read to the addict by the gathered supporters, who affirm their love, while describing in varied detail how the addict's disorder has negatively impacts their lives. The addict is presented with a list of negative consequences that will occur if he or she doesn't agree to treatment. This fear-based motivational strategy centers around ostracizing the alcoholic/addict from family, friends, and other support if the group's demands aren't met.

The classic approach was developed by Dr. Vernon Johnson in the 1960s. Dr. Johnson believed that it was dangerous to allow alcoholics and addicts to "hit rock bottom." The classic approach is effective at getting an alcoholic or addict into treatment if the confrontation stage is reached, but it has major deficiencies, and subsequent research shows that it isn't as effective as other models in promoting long-term abstinence.

It also takes an inordinate amount of time to plan an elaborate ambush confrontation. Significant resources are invested in planning classic interventions, and studies show that 70% of Johnson style interventions fail to reach the confrontation stage because momentum is lost as the PCE loses focus over time.

The classic intervention also doesn't address the critical professional ethics component specific to lawyers entering treatment. It is highly unlikely that a classic interventionist will have sufficient knowledge of professional ethics mandates to address requirements unique to addicted lawyers. The legal services organization must ensure that these critical professional ethics issues are addressed if the classic approach is used.

Family Systemic Model

The family systemic model follows a transparent, non-ambush style approach. The family of the addict arranges for counseling. The alcoholic/addicted family member is invited and encouraged to attend. Typically, multiple sessions are held that focus on the need to change, and the benefits that will result from eliminating substance abuse from the family dynamic. The sessions tend to focus more on compassion and positivity, without the classic approaches fear-based mandates.

In practice, the family systemic model is difficult to orchestrate. Frequently, by the time this kind of intervention is organized, adult children have suffered through years of their parent's addiction and many don't see sacrificing significant effort and their time as worthwhile. Invariably, their hopes have already been dashed multiple times and out of resentment, or a lack of faith, they choose not to participate.

Involving minor children in the direct intervention process creates a heightened sense of fear in them and unfairly allocates intervention success responsibility to youngsters. This dynamic can cause severe and long-lasting damage to minor children.

This model requires the addict to attend multiple sessions. Frequently, addicts will just choose not to participate. Addicted lawyers have the tried and true excuse of being too busy to have the time to commit to the process. This model also doesn't address professional ethics issues. Addicted attorneys, while in the grips of active use cycles, should not be practicing. This method's long-term approach to gradually encourage the substance abuser to accept treatment provides no mechanism to ensure that the addicted attorney does not continue to practice impaired during the interim.

ARISE Model

This model brings together the various constituencies affected by the addict's use. ARISE is an acronym for A Relational Intervention Sequence for Engagement. It consists of three levels.

Level 1 is initiated by a concerned person contacting an ARISE interventionist. The Interventionist works with the concerned person to organize a group of people. The addict is then contacted and encouraged to attend a meeting. If the addict attends, he or she is encouraged to enter treatment.

Level 2 is initiated if the addict doesn't accept treatment after the initial meeting. A broader support base of those close to the addict is enlisted to participate in the escalated Level 2 meeting. Subsequent meetings are held if progress is being made, with the interventionist strategically utilizing the various stakeholders until the addict agrees to enter treatment.

Level 3 occurs if the addict has still not accepted the need for treatment after the Level 2 protocol has been exhausted. At this meeting, firm boundaries are drawn and consequences implemented if the addict still refuses treatment. The escalating nature of the ARISE model tends to lessen damage to family and close personal relationships in its initial phases.

This approach shies away from the up-front harsh consequences and shame and guilt associated with other models. There is good empirical evidence that this approach is successful in convincing addicts to seek treatment before the escalation to the firm boundaries and consequences phase of Level 3. But, as with all the other traditional intervention models, the ARISE approach doesn't address the unique professional ethics concerns which must be considered when confronting a legal professional impaired by a substance abuse disorder. Like the Family Systemic Model, ARISE is a longer timeline approach, leaving the addicted professional in the untenable position of continuing to practice impaired.

Employer Centric Approach

In many instances, the employer is the entity who initiates the intervention. Larger employers with human resources departments, or employee assistance programs, will often contact an interventionist who will then use one of the traditional models to orchestrate an intervention. Often, however, the employer-centric approach is far simpler, especially in smaller companies. The employer simply demands that the afflicted individual enter treatment or be terminated. This simple, blunt approach tends to be very effective. For most suffering with a substance abuse problem, the concrete prospect of job loss is perhaps the strongest motivator for most addicts and alcoholics to agree to treatment.

This model has the same limitations seen in Johnson approach. Imposing boundaries with addicts must be done carefully. While many addicts confronted with a treatment ultimatum demanded by the non-addicts important in their lives will go to treatment, they tend do so so resentfully. This resentment hinders willing engagement with the treatment process. Evidence shows that imposing harsh ultimatums as the stand alone motivational tool to promote enrollment in treatment results in much higher rates of relapse upon discharge.

Prior to considering the employer centric approach, It is advisable for any legal employer to consult with those with knowledge of addiction pertaining specifically to legal professionals. Legal services employers should, at a minimum, consult with either their lawyer's assistance program (LAP), or other treatment professionals specializing in addiction treatment related to legal professionals. As with all intervention models used with legal professionals, professional ethics requirements must be addressed.

Take Action

The crux of any intervention, no matter how conducted, is to get the addict help. Lawyers faced with confronting substance use disorder and the prospect of going into treatment require special considerations, but the primary consideration is to get the afflicted help.

We addicts are exhausting and giving up often seems like the only feasible alternative, but millions of seemingly unredeemable addicts and alcoholics have recovered, and gone on to live incredibly fulfilled, healthy, productive and enriched lives in recovery. This paradigm applies to lawyers as well.

The majority of us are either too deluded or too fearful to take the initial step to initiate recovery. It is vitally important for all constituencies involved in the addict's life to help initiate the recovery process. The addicted attorney's loved ones, colleagues, and the legal profession are far better off when an addicted lawyer's substance abuse is property confronted and efficaciously treated. Implementation of a post-treatment aftercare program, with the proper structure and supportive recovery communities, substantially improves the odds of long-term remission, and significantly reduces the harm caused by alcoholism/addiction.

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