OVERVIEW OF OUR HIMS-STYLE PROGRAM FOR LEGAL PROFESSIONALS
TREATMENT
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Assessment by a licensed substance use disorder professional.
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Inpatient or Intensive Outpatient treatment (IOP) with a licensed treatment provider
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Preferably with one of the licensed treatment providers we work with who provide programs tailored for lawyers. Treatment with others in the same or similar occupation increases long-term remission success.
SUPPORT GROUP
PARTICIPATION
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A landmark 2020 study found that recovery support groups, particularly Alcoholics Anonymous, were as or more effective than other treatment modalities at reducing alcohol and drug use and at promoting abstinent remission.
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Lawyers often shy away from AA participation, fearing damage to professional reputation. Vivon facilitates group Zoom meetings amongst lawyers and tracks meeting attendance to ensure aftercare compliance.
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People who recover with those in the same or similar occupation have much better long=term, self-sustaining abstinent remission rates.
ABSTINENCE VERIFICATION
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Post-treatment daily, random abstinence verification with SobereyeTM - A portable, pupillary light reflex device that is 99% accurate in detecting impairment across the entire spectrum of psychoactive drugs. Sobereye is supplemented with EtG, PEth, urinalysis, blood, and hair follicle testing, as needed.
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Sobereye remote verification takes only one minute. It is discrete and can be performed anywhere there is Wi-Fi connection. Iris recognition ensures accurate identification of the test subject. Sobereye is far more convenient, efficacious, and much less expensive than a urinalysis centric abstinence monitoring program.
WEEKLY REPORTS
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Research and the success of HIMS-style programs prove that those suffering from substance use disorders are far more likely to remain abstinent and engage in post-treatment aftercare protocols when compliance is mandated for continued employment and/or professional licensure.
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We liaise with legal employers and/or other monitoring stakeholders to educate and provide support on SUD recovery issues, and to establish efficacious, weekly reporting protocols that support aftercare compliance and continued abstinence in early recovery.
The Pilots
Vivon is modeled upon the basic tenets of the Human Intervention Motivational Study (HIMS) program. HIMS started in the early 1970s as a joint effort of the Federal Aviation Administration, major airlines, and commercial pilot unions to identify, treat and safely return alcoholic pilots to flight duty.
HIMS has long been recognized as the gold standard in occupational substance use disorder (SUD) recovery programs. It has been astoundingly successful in achieving verified, long-term abstinence rates in pilots by utilizing structured protocols at the organizational and individual levels, emphasizing aftercare and abstinence monitoring.
90% of HIMS’ pilot participants achieve biologically verified long-term, self-sustaining abstinent remission from substance use disorders following initial enrollment in the program. The majority of the remaining cohort achieves sustained abstinence after just a few instances of relapse. In contrast, alcoholics, and addicts who participate in a standard treatment model resume active use at a rate of 85% within the first year after initial treatment. Those with SUD who reach long-term abstinence through the standard approach go to treatment an average of four to five times before achieving long-term SUD remission. Only 30% of people who have undergone treatment are abstinent after five years. Only 14% of those who have ever had an alcohol or drug problem were abstinent over the last year. Sadly, many don’t make it back to treatment and continue to suffer and wreak havoc in their familial, professional, and social relationships, ultimately dying prematurely of addiction.
Recovery from SUD takes Time and Accountability Structures
The HIMS program proves that aftercare compliance and abstinence monitoring are essential for an efficacious treatment program. The weak link in our standard addiction treatment model has historically been the lack of structured aftercare and monitoring. Frontline treatment providers bemoan this dynamic. They knowingly have to send people back into their trigger-rich environments, filled with overpowering craving cues that lead to relapse and resumption of active use cycles.
Fortunately, over the last few years, technology has been developed that is now cost-effectively available to allow for efficacious aftercare and abstinence monitoring. The stakeholders implementing these new measures are seeing astonishing improvement in abstinence rates.
Cost-Benefit
A high-quality, cost-benefit study conducted by American Airlines showed that HIMS returned $37.30 for every $1 invested in its HIMS recovery program. No such cost-benefit study yet exists for legal professionals, but it is soundly theorized that the direct return on investment through the adoption of a HIMS style program for legal professionals will be far higher, with even greater indirect benefits.
HIMS Program Elements
HIMS protocols address SUD at both the organizational and individual levels. The ABA's adoption of Resolution 105 in 2018, and Resolution 300A in 2021, provides law firms and other legal service providers with program templates similar to the HIMS protocols. The HIMS template for airline implementation consists of the following elements:
Written Structure
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A mission statement
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Written policies concerning substance use disorder
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Detailed procedures supporting the enforcement of SUD policies.
Treatment Continuum
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Identification
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Intervention
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Diagnostic Assessment
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Treatment
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Continuing Care
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Relapse Contingencies
FAA Medical Certification
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Rehabilitation Standards
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Pre-Special Issuance Procedures
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Post-Special Issuance Treatment/ Monitoring
Education and Training
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Training Specific Groups
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Educating the Line Pilot
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Promoting the Program
Program Evaluation
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Periodic Meetings
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System-Wide Review
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Monitoring
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Data Collection
The individual pilot protocol consists of the following elements:
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Evaluation
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Inpatient Treatment
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Intensive Outpatient or Individual Therapy
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Aftercare and 12 Step Program Participation.
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Biologically Verified Abstinence Monitoring
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Peer and Company Sponsors
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Psychological and Psychiatric Examinations
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FAA Examination and Submission
For more information, visit the HIMS website.
The HIMS Advantage
HIMS has inherent structural advantages that are lacking when contrasted with the current paradigm for addressing SUD afflicted legal professionals. The most notable is the FAA's centralized licensure system. This dynamic is a powerful fosterer of the loss-aversion psychological construct as a motivator for change. The only way an impaired pilot can remain employed is to comply with the mandates of the HIMS program. The other predominant factor is the understanding amongst the tripartite stakeholders in the HIMS system (FAA, unions, and airlines) that SUD is very treatable if approached in the right way, and impaired pilots once treated and effectively monitored, are valuable assets. The power of these three stakeholders working in concert has led to laudable results in the early identification, treatment, and monitoring of impaired pilots into sustained SUD remission.
In contrast, there has been no standardized, national approach to identify, treat, and monitor impaired legal professionals. The emphasis has been to retroactively punish addicted attorneys for conduct that inherently arises out of active use SUD, rather than to proactively implement measures to arrest SUD before serious, detrimental conduct occurs.
The culture of the legal profession is another primary impediment. The law has long been awash in booze. Alcohol-fueled socializing is encouraged, and drinking to relieve stress is accepted. Many of the attorneys with managerial authority in legal service organizations are themselves heavy drinkers, resistant to recognizing and addressing their own SUD issues.
What We Can Learn from the Physicians
Like the law, the practice of medicine is regulated by each state, creating the potential for disparate protocols and programs to address SUD, but the medical profession has successfully integrated effective protocols to treat SUD impaired physicians.
In 1991, following the lead of HIMS, the Physicians Health Program (PHP) was established. It is administered by the Federation of State Physician Health Programs (FSPHP), a national organization that has been instrumental in establishing uniform legislative and regulatory mandates in all states to address SUD afflicted doctors.
Like HIMS, PHP programs focus on rehabilitation as an alternative to discipline and require mandatory biological testing and aftercare monitoring for program participants. High-quality studies show that physicians in PHP programs recover at rates far greater than the general public, and close to success rates of the HIMS program. A 2008 longitudinal study showed that 81 percent of physicians in a PHP protocol program did not fail a drug or alcohol screen during the five years after entry into the PHP program. Of the 19% who did fail a screen, only 26% of that cohort had a repeat positive test. Only 10% of impaired PHP participants had their medical licenses revoked over the five-year longitudinal study. (See Study)
The Legal Profession's LAP Centric Approach
Historically, the legal profession has relied upon Lawyers Assistance Programs (LAPs) to address SUD. Each state bar association, or state supreme court, administers its confidential LAP. LAPs are wonderful resources, staffed by dedicated people, and supported by caring volunteers, but they are associated with bar associations. The prevailing perception amongst lawyers, especially lawyers suffering from SUD, is that bar associations exist primarily to punish and revoke law licenses. This perception is not unfounded given the legal profession's historical emphasis on ex-post-facto punishment for maladaptive behavior caused by SUD, rather than proactive intervention to provide treatment. Most addicted lawyers will not voluntarily seek help through a LAP. Nor is early identification and mandatory participation in diversion programs adequately emphasized, even though we know that those who suffer from SUD, especially lawyers, are loath to self-report and voluntarily seek help.
Another profound limitation of the disparate LAP-centric approach is the lack of adequate resources devoted to these programs. The latest comprehensive report commissioned by the ABA Committee on Lawyers Assistance Programs (COLAP) was issued in 2014. This bi-annual survey has since been discontinued. LAPS reported annual budgets between $0 (relying on volunteers) and $1,350,000 (California). The largest number of programs fell within the $0-$50,000 and the $100,001-$150,000 ranges, with nine programs each. This was followed by six programs in the $200,001-$250,000 range. Only two programs reported budgets over $1,000,000; 82% reported annual budgets less than $500,000, and almost half (49%) of the programs reported budgets of less than $200,000 annually. Funding for LAPS does not appear to have materially changed since 2014. This lack of adequate funding prevents LAPs from implementing educational, identification, treatment, and monitoring programs on a scale requisite to address the magnitude of the SUD problem in the legal profession.
In 2016, The ABA and the Hazelden Betty Ford Foundation commissioned a study to assess the severity of SUD in the legal profession. Krill, Patrick R. JD, LLM; Johnson, Ryan MA; Albert, Linda MSSW. The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys, Journal of Addiction Medicine: January/February 2016 - Volume 10 - Issue 1 - p 46-52. This study found that 20.6% of attorneys engage in hazardous, harmful, or potentially alcohol-dependent drinking (SUD), almost twice the rate of the general population. Of the 1.33 million lawyers in the US, over a quarter of million are estimated to fall somewhere on the SUD spectrum. In 2014, LAPs throughout the country opened less than 10,000 files to assist attorneys suffering from SUD, indicating that LAPs are only reaching roughly 3% of the estimated number of legal professionals who engage in hazardous, harmful, or potentially alcohol-dependent drinking.
What are the Paths to Recovery for Legal Professionals?
Although we don't have much data, we anecdotally know that there are many lawyers in recovery. The law is a well-represented profession throughout the meeting rooms of Alcoholics Anonymous. We hope to soon have a statistically valid analysis detailing the various ways that legal professionals recover from SUD. It's likely that most utilize the same pathways as the general public, and are subject to the same high rates of relapse given the lack of systemic biological and aftercare monitoring protocols that have made the HIMS and PHP approaches so successful.
Many addicted lawyers start their recovery journeys in a standard treatment facility. Of the 14,500 treatment programs in the US, there are only a few that specifically address the unique treatment needs of legal professionals. In contrast, there are dozens of treatment programs specifically designated for physicians. HIMS has specific program element requirements for the treatment facilities serving its pilot participants. A lawyer seeking a treatment facility usually has little understanding or guidance in choosing a program best suited to address the unique needs of legal professionals.
Many attorneys forego formal rehab and start directly with AA or other 12-step groups. AA is a popular recovery pathway for many legal professionals. Lawyers tend to be very guarded about their SUD. Alcoholism and addiction are still widely stigmatized, which creates profound professional reputation risk. This stigmata of addiction, coupled with AA's penchant for anonymity, has led to a dynamic where lawyer-centric recovery support tends to be comprised of "off the books" communities of recovering attorneys. These groups are often difficult for those new to sobriety to find. Vivon has the expertise, experience, and contacts to find and tap into these invaluable support resources.
One of our top initiatives at Vivon is to bring greater numbers of recovering legal professionals together. Occupation-centric recovery support reduces relapse. The recent, widespread adoption of video conferencing services like Zoom is making this goal a reality.
A New Path Forward for Law Firms and Legal Service Organizations.
The legal profession is nearly fifty years behind the pilots, and lags the medical profession by three decades, but we're finally implementing measures to address the unacceptably high rates of SUD amongst attorneys. The ABA's adoption of Resolutions 105 (2018) and 300A (2021), create protocols for law firms and other legal service providers to implement to confront SUD in the profession. There is also a corollary emphasis gaining great momentum amongst state bar associations to invoke and enforce ethical mandates requiring that partners and supervisory attorneys in law firms implement efficacious programs to proactively address and resolve lawyer impairment. (See Ethics Compliance). These initiatives coincide with another profound development; we are on the cusp of revolutionizing the standard treatment model. New technology now provides for cost-effective monitoring of abstinence and aftercare compliance. Monitoring dramatically lessens the phenomenon of craving, allowing the addicted brain enough abstinent time to cement neuroplastic changes and develop healthy coping mechanisms. Efficacious aftercare and abstinence monitoring have been proven to lead to far greater success in extinguishing craving, leading to long-term, stable recovery.
Onus on the Legal Employer
Given the current paradigm, the legal employer is by default, and ethical mandate, the primary lynchpin in addressing SUD in the profession. Yet, very few legal employers, whether large private law firms, government agencies, or smaller partnerships, have implemented a HIMS style program to address SUD. Vivon bridges the gap by effectively assisting legal employers with all facets of addressing the SUD epidemic. We have developed a HIMS style program designed to address the unique characteristics of the practice of law. Our protocols are designed to reduce SUD at the organizational level and provide highly effective support for lawyers in recovery.