Frequently Asked Questions
TLAP was created by the Tennessee Supreme Court in 1999 per Court Rule 33 and it is a Supreme Court Program that operates under the auspices of the Administrative Office of the Courts.
TLAP is a comprehensive, professional mental health assistance program that serves Tennessee’s legal profession. TLAP helps lawyers, judges, and law students. Its mission is to provide totally confidential mental health and substance use disorder assistance, and also help protect the public from the damage that impaired professionals cause.
At its inception, TLAP’s mission was predominantly focused on addressing high rates of alcoholism in the profession. Today, TLAP’s confidential assistance is comprehensive and available for any mental health issue. TLAP is staffed with: 1) an Executive Director who is a lawyer in long-term recovery from alcoholism and is a professional addiction interventionist; 2) Masters-level professional Counselors with specialized skill and expertise necessary to assist legal professionals; and, 3) Administrative Staff.
TLAP’s Commission is comprised of a mixture of leaders from the profession and the public, including a Supreme Court Justice, Judges, Lawyers, Doctors, and Therapists, etc. The Commission Roster can be accessed here: https://tlap.org/commissioners/
TLAP operates in a stand-alone office in downtown Nashville, and it operates independently from any other entity. This guarantees that TLAP confidentiality is dependable on its face. TLAP’s operations are totally compartmentalized, totally discrete, and totally secure.
Most important, all contact with TLAP is confidential as a matter of law pursuant to T.C.A. 23-4-105:
“The records, proceedings and all communications of any lawyers’ assistance program shall be deemed confidential and shall not be available for court subpoena.”
Whether or not a person contacts TLAP for help personally or due to concerns of impairment in someone else, all contact with TLAP is confidential and is not subject to subpoena or any other discovery mechanism. TLAP cannot disclose any information about communications with anyone unless a written authorization is provided and TLAP is instructed to disclose information about the person to a certain party.
TLAP delivers high-quality mental health care support and services that meet industry standards for programs serving licensed professionals such as lawyers, airline pilots, nurses, and doctors. By so doing, persons coming to TLAP can confidently participate in efforts specifically designed to afford the person the opportunity to fully address any mental health issues and, if successful in so doing, objectively demonstrate through participation and cooperation with TLAP that they are fit to practice law, that it is highly unlikely that recidivism will occur, and that they pose no risk of harm to the profession or the public.
In addition, TLAP provides educational programs at CLE Conferences, Bar Association functions, Inns of Courts, Judicial Conferences, Law Schools and Law Firms to raise awareness about mental health challenges faced by members of the legal profession and encourage the utilization of TLAP’s services early on so as to minimize the damage done to the person, profession and the public in cases involving an impaired member of the profession. Early intervention is invaluable and literally save lives and careers.
TLAP is a “peer professionals” monitoring and clinical support program of the Tennessee Supreme Court. Pursuant to the directives of the Supreme Court, TLAP is specially designed to implement clinical best practices and render “gold standard” services to support health and fitness to practice in legal professionals. The expectation is that TLAP’s programming not only saves lives and careers, but also helps to protect the public from the harm that impaired legal professionals can cause.
TLAP is a top-tier program and following its clinical and monitoring recommendations renders long term no-relapse addiction recovery rates averaging 85%. Traditional care rendered to the general population does not generate anywhere near that level of reliability. In short, for many reasons, there is no equivalent service available to the profession. These are factors that make TLAP unique:
1. Legal authority: TLAP is the only monitoring entity specifically cited in the Tennessee Supreme Court Rules. TLAP’s designated roles in assisting the Court and the profession are clearly delineated in Rule 33. TLAP is the monitoring authority explicitly recognized in Rule 7 as to bar admissions. TLAP is also cited in Rule 9 as the resource for evaluations and monitoring in disciplinary matters. Moreover, in the Rules of Professional Conduct, and even in Judicial Rules, TLAP is specifically cited as a resource to be utilized.
2. Special accountability: TLAP has special accountability and monitoring obligations designed to protect the public. In cases involving a formal referral from bar admissions or discipline, TLAP may have mandatory reporting obligations. In this role, TLAP is expected to be an independent, objective, and reliable reporter on monitoring compliance. This a very different role than that of healthcare provider and patient advocate. Delivering these services requires specialized expertise and programming.
3. Trusted verification: TLAP’s monitoring program is specified in Court Rules because it is trusted by the Court and all entities in the profession to provide objective and ongoing verification that a legal professional is safe to practice. TLAP program compliance is often a requirement of continued employment, or licensure. Non-TLAP providers are often unwilling or unable to provide objective opinions regarding safety to practice, or else they are not equipped to meet the reporting needs of the involved entity. Such entities may also be reluctant to undertake a role of protecting the public instead of focusing solely on advancing the interests of their patient.
4. No treatment or other role conflict: TLAP does not provide treatment to participants and, therefore, it does not have a treatment relationship that could create a conflict of interest with TLAP’s obligation to act in the interest of public safety. TLAP seeks to balance the rehabilitative needs of the participant with protection of the public. Non-TLAP providers have a primary obligation to the interest of their patient which may help the patient feel more comfortable in disclosing worsening symptoms or very private information, but at the same time it can also foster the providers’ reluctance to report an impaired legal professional. TLAP offers another layer of confidentiality protection when treatment providers working with lawyers who are faced with the dilemma of preserving therapeutic trust and protecting the public.
5. Care management: TLAP provides oversight, communication, and coordination of health care to promote objective, effective, and sustained remission of chronic illnesses. TLAP also receives functional information from employers and key supporters which, along with other monitoring data such as toxicology testing, can optimize the care a participant receives from their treatment providers. Outside of TLAP, this level of care support is virtually unavailable to legal professionals.
Of course, TLAP supports and encourages legal professionals to proactively address health-related problems and obtain needed treatment. We hope that early intervention will prevent the progression of any mental health issue. We believe that there is “no wrong door” for a legal professional in trouble and that there are many effective, non-TLAP options available.
A lot of discussion ensues about TLAP’s monitoring in cases involving formal disciplinary referrals, but it is very important for the profession to know that those cases are by far the smallest percentage of TLAP’s case load.
The majority of TLAP’s support is rendered quietly behind the scenes in totally confidential cases wherein the person has discretely reached out to TLAP voluntarily and needs TLAP’s help. In total privacy, all of us begin working collaboratively together toward solutions and recovery.
In fact, in FY 2021-2022, fifty-six percent (56%) of TLAP’s new cases were totally confidential self-referrals, and thirteen percent (13%) were confidential cases referred by concerned third parties (such as friends, family, or law firm members). Thus, the vast majority of TLAP’s cases do not have any BLE or BPR involvement. Twelve percent (12%) of TLAP’s cases were BLE referrals, and another twelve percent (12%) were BPR referrals. Seven percent (7%) were referrals from Law School Deans, Judges, the Board of Judicial Conduct, and other state LAPs.
Also, of important note, fifty-three percent (53%) of TLAP’s new cases were limited to mental health issues such as depression and anxiety. These cases did not have any component of alcohol or drug issues.
Only thirty-three percent (33%) of TLAP’s new cases last year included Substance Use Disorders. The other fourteen percent (14%) of cases presented with a myriad of issues such as marital conflict, financial distress, performance productivity, cognitive impairment, stress, eating disorder, domestic abuse, and compulsive behaviors.
These statistics bear witness to the fact that issues such as depression, anxiety, compassion fatigue, burnout, vicarious trauma, and others have outstripped alcohol and addiction issues in our profession.
The good news is that TLAP is providing help and assistance in all such cases. Most important, TLAP is well-known as a trusted, free, confidential, and anonymous resource for legal professionals. By design, the bulk of TLAP’s support is rendered quietly and discretely behind the scenes.
TLAP provides, above all else, a totally safe haven within which to reach out for immediate help and stabilization while exploring reliable options for mental health help . . . all without initially creating any medical records and without anyone else ever knowing.
It’s free, it’s safe, it’s totally confidential, and there are no barriers whatsoever to simply picking up the phone and calling TLAP or emailing TLAP to access TLAP’s free and confidential advice and support.
In many cases, a person who is suffering has become isolated and withdrawn. Fear and frustration run high. A sense of shame and guilt often sets in, especially for smart and accomplished professionals, because they feel as if they should have been able to think their way out of the problem or otherwise use willpower to get back on solid mental health ground.
It can also feel as if there is simply nowhere to turn for answers and help. Every avenue can seem too burdensome and onerous. A feeling of being trapped in an unhappy and miserably painful existence is a true indicator that the person needs immediate help.
But, for many people, striking out on their own to seek help from a psychiatrist or psychologist is very daunting. There is a fear of turning control of a frightening mental health concern over to a doctor. And then there is the very real fear of being diagnosed with a mental health issue. Stigma and fear run high.
In alcoholism and addiction cases, the person’s addiction does not want help . . . ever . . . even when the person is fed up with the cycle of unhealthy alcohol or drug use. Denial and a lack of insight are very difficult barriers to tackle in these cases.
Alcoholics and addicts suffer in that the rational person wants to stop suffering from the repeated consequences of substance abuse, but their addicted brains mandate that they must concurrently find a successful way to continue to use alcohol or drugs.
This often results in repeated, failed, internal mediations within the mind of the person who wants to stop substance abuse and the addicted brain that demands to keep using substances. Halfway measures and easier and softer ways are generally not successful.
Even when reaching out for help to TLAP, people with substance abuse are often very angry in addition and very fearful of taking real action and being accurately diagnosed. Often described as akin to a situation wherein “a bird dog is caught in a fence” the person is in real trouble and needs help but will bite its rescuers and resist help while being untangled.
Even if a person has surrendered and is ready to reach out and seek help on their own, it is sometimes difficult to know how to go about selecting a mental healthcare professional. How does one get a referral to a dependable provider? Mental health issues are often uncomfortable to discuss and many people don’t feel that it is appropriate to ask friends and colleagues for references to good mental healthcare providers in the same way they might ask for ideas on selecting a good surgeon for a physiological medical issue.
In that vein, TLAP is a safe and compassionate place to discretely discuss whatever mental health issue is troubling you or a loved one and obtain specific feedback on various ways to address the issues presented, including referrals to top-notch mental health professionals who currently deliver services that meet the needs of licensed professionals.
Treatment at any given facility is only as good as it was last week and TLAP keeps abreast of recent developments so as to ensure its advice is as timely as possible. Also, TLAP only recommends providers and facilities that it has inspected personally to verify the quality of the services rendered.
To the person calling TLAP for help, know this: although you may feel isolated, you are not alone!
TLAP receives hundreds of calls each year regarding issues with depression, anxiety, compassion fatigue and burnout, alcohol and drug abuse, gambling issues, and other issues all of which occur at high rates in the stressful legal profession. Practicing law is not getting easier and no lawyer or judge is immune to developing mental health issues over time.
From the first conversation with TLAP, the person no longer has to go it alone. TLAP provides ongoing support to the person through all phases of addressing the issue(s) and into long-term recovery. In many cases, persons who have successfully addressed their mental health issues through TLAP become volunteers for TLAP and stand ready to help the next generation needing assistance.
Conversely, it is also important to know that the person calling TLAP is always free to decline further assistance from TLAP and to confidentially go their own way. If in the future the person decides to resume a relationship with TLAP, they are always welcome. One can never do anything to get on TLAP’s “bad side” and TLAP is always welcoming to the person no matter what has transpired in the past. In such cases, TLAP stands ready to provide its advice and assistance anew and meet the person where they are in the process of addressing their mental health issues.
It does not ever cost a penny to call TLAP. Confidential, professional mental health consultations with TLAP are always available. Unlike Employee Assistance Programs (EAPs) that typically limit the number of visits per year, there is no limit whatsoever to your access to TLAP. All of TLAP’s internal services are absolutely free.
These free services also include professional addiction interventions in cases deemed appropriate by TLAP. Such intervention services in substance cases can often cost $5,000 or more, but TLAP provides all of these services for free.
Bottom line: there is never any charge for TLAP’s support and facilitation of evaluations, assessments, treatment. No matter who calls, how many times they call, or why, TLAP’s professional clinical advice is always available free of charge and without limit to members of the profession, law students, and bar applicants.
In cases where the person requires a formal TLAP Recovery Monitoring Agreement, those services are also free no matter how long the monitoring program is for any given individual. In many cases, TLAP provides these free services over the course of many years.
In short, TLAP has never sent an invoice to anyone in its history, and TLAP never will.
Of course, however, TLAP is not an addiction treatment center, psychiatric clinic, or hospital, etc. Many times, however, TLAP’s professional clinical staff can provide all of the intervention, support and resources a client may need. In more severe cases, however, TLAP refers clients to TLAP-approved medical facilities and mental health providers as may be indicated by the severity of the issues.
Again, TLAP is not a free hospital or free treatment center. In the event that a person needs comprehensive diagnostics, treatment, or long-term therapy, etc., TLAP facilitates referral to appropriate, quality TLAP-approved providers that specialize in assisting licensed professionals. TLAP then collaborates with those providers to ensure that TLAP can continue to support the individual going forward with TLAP Monitoring and other modalities of support in concert with the all other providers.
The cost of services from third-party providers must be paid by the individual via their insurance or out of pocket, etc. For those in true financial need, support is available such as grants or scholarships from treatment providers, or low-cost loans.
In the last two years, much effort and industry has been dedicated to creating a new non-profit corporation to help TLAP’s participants afford diagnostics and treatment that may be required for TLAP participant and to establish that they are fit to practice law.
This is especially important when a participant has been officially referred to TLAP by the Board of Professional Responsibility or Board of Law Examiners with a demand by those regulatory authorities that the person establish via TLAP that they are fit to practice law.
In these instances, the person referred to TLAP may not have the insurance or funds to complete diagnostics and treatment that is required to objectively establish fitness to practice by clear and convincing evidence.
In such cases, the TLAP Foundation can provide low-cost loans to support TLAP’s participants.
Of note, TLAP has no connection to the TLAP Foundation which is a stand-alone non-profit. Thus, one hundred percent of all donations, proceeds and interest from loans generated by the TLAP Foundation are dedicated to supporting its mission to help insure that funds are available and that no legal professional is deprived the opportunity to be successful in TLAP and establish their fitness to practice.
As a matter of law, TLAP can never disclose your identity or any information about you without a formal written waiver signed by you. It is solely up to you to decide whether or not it is your best interest to waive confidentiality in any given circumstance.
Common scenarios that result in the person deciding to a waive confidentiality is their need to show a third party that they are “compliant” in TLAP and thus safe to practice law. It could be that an employer has concerns due to the employer’s duty to report unethical conduct. Or, it could be that, pursuant to Supreme Court Rule 9, the person may have been officially referred by to TLAP by the Board of Professional Responsibility to TLAP for an evaluation due to allegations of mental health-related unethical conduct. Another example is that the person may have been formally referred to TLAP pursuant to Supreme Court Rule 7 by the Board of Law Examiners due to a history of mental health or substance use-related conduct that may call into question a bar applicant’s character and fitness in the bar application process.
It is paramount to recognize that TLAP never refers cases out to employers, regulatory authorities, or anyone. All such traffic comes in to TLAP via referrals from outside sources.
In these types of cases, per Supreme Court Rules, the person coming to TLAP needs to establish that they are “complaint” in TLAP so as to objectively demonstrate by clear and convincing evidence that the person has been objectively and reliably assessed, diagnosed, treated if indicated and monitored by TLAP if indicated.
The mission in these regulatory and employment type referral cases is simple: through appropriate diagnostics, rule out any impairment and make no further recommendations; or, if diagnoses result and need attention, TLAP facilitates appropriate treatment and then provides Recovery Monitoring. At all junctures, TLAP adheres to clinical standards that reflect best practices in supporting fitness to practice in licensed professionals.
A TLAP-approved assessment and treatment effort indicates that the person has contacted TLAP and worked cooperatively with TLAP as a team in the facilitation of an independent and objective mental health evaluation (or a more-extensive full assessment as the case may be) so as to reliably determine whether or not a mental health issue exists, and if so, identify the root cause(s) of any potential impairment.
Thereafter, if further clinical response or treatment is indicated, TLAP facilitates TLAP-approved clinical efforts that meet the needs of licensed professionals such as lawyers, doctors, nurses, airline pilots and others who hold the public’s trust.
TLAP recommends and facilitates interaction with TLAP-approved clinicians, doctors and treatment providers that are skilled and experienced in treating licensed professionals and offer “professionals track” programs with proven success records in working with professionals’ programs. This effort involves providing assessments and treatments that, when coupled with TLAP Recovery Monitoring post-treatment, result in exceptionally dependable long-term recovery rates with very little chance of relapse or recidivism. Clients are always provided with several choices as to TLAP-approved providers.
During this entire process, any and all previous treatment, therapy, or other actions completed by the person prior to TLAP involvement is recognized and acknowledged in the TLAP diagnostic process. All clinical processes and protocols are designed to meet the client where they are and, on a case-by-case basis, objectively establish the person’s current clinical situation.
No one disputes that illnesses such as chemical dependency and other physical and mental disorders can impair a judge’s or lawyer’s ability to perform his or her professional duties in an ethical manner. Accordingly, across the country, Supreme Courts, Discipline, and Admissions are becoming more attuned to the presence of these conditions as well as to the fact that recovery from these conditions is possible. Recovery must be objectively dependable, however, and at rates that reflect it safe for the public when allowing the individual in Recovery to practice law.
Unfortunately, the question of whether a lawyer or judge is, or has been, impaired is often more easily answered than are the questions of whether he or she is recovering from the impairment or whether the quality of that recovery is such that it will likely arrest the misconduct. In answering these questions, examination and close supervision over time is invaluable in both discerning the quality of the recovery and in providing objective assurances to any third parties that may be involved.
Depending on the type of case being monitored and the needs of the participant, the participant often requires TLAP to provide monitoring and monitoring compliance reports to the Supreme Court, Bar Admissions, the Office of the Disciplinary Counsel, employers such a law firms, or any other interested parties that the participant desires so as to assure them that the participant is in Recovery and safe to practice law. A well designed and implemented Recovery Monitoring Program offers an efficient and effective vehicle for this examination and close supervision.
Aside from any given participants’ potential need to objectively demonstrate sustained remission and satisfy third-party concerns, monitoring programs have been identified as therapeutically critical to long term recovery without relapse.
Thus, even if the person has no external need to prove recovery to anyone else, the TLAP monitoring program is still recommended when clinically applicable and to provide the structured support that is critical to long-term success after mental health treatment for alcoholism, addiction, or other mental health issues that require long-term therapy. Monitoring is always recommended by treatment facilities as part of their discharge recommendations.
To learn more about TLAP Monitoring services and whether it could personally benefit you or a colleague, please contact TLAP for more information.
TLAP compliance overall, and the statistical long-term success rates that it provides, is comprised of three basic phases: 1) TLAP-approved assessments that provide a reliable diagnosis; 2) TLAP-approved treatments that address all diagnoses on a level that is commensurate with treating licensed professionals; and 3) structured recovery monitoring for a duration of time post-treatment.
The components of a TLAP Recovery Agreement in a substance use disorder case reflect the individualized discharge recommendations for the person who has just successfully completed TLAP-approved treatment. The written agreement is a template for success and long-term remission and it requires the person to follow through with all of the post-treatment recommendations of the facility. It also requires random drug and alcohol screens to support total abstinence.
Studies have shown that long-term structured recovery and formal monitoring by a professionals’ program such as TLAP for a period of five (5) years greatly increases the odds that the person will not suffer any recidivism and that recovery will be the expected outcome as opposed to relapse.
Mental Health Agreements are applicable in TLAP cases not involving substance use disorders but instead requiring that persons maintain their ongoing relationships with treating professionals, take medication as prescribed, and follow the advice of mental health care professionals so as to remain unimpaired, fit to practice, and in long term stability in the management of their mental health challenges.
TLAP’s formal monitoring support is designed to support recovery and mental health, objectively verify that the person is currently fit to practice, and that when the monitoring period is completed it is highly likely that the person will remain fit to practice thereafter.
I. Overview
TLAP is a program of the Tennessee Supreme Court. Pursuant to the Court’s directives, and informed by national medical experts and clinical studies, TLAP’s programming reflects the “gold standard” for assisting licensed professionals and protecting the public.
Confirming the success of TLAP’s program, in FY 2021-2022 TLAP’s monitoring program generated an unprecedented 85% no-relapse success rate in alcoholism and addiction cases.
While astonishing, and perhaps even unbelievable to some (considering relapse is often accepted as the likely outcome of addiction treatment in the general population), an 85% no-relapse recovery rate is in fact an expected outcome in monitoring programs that implement clinical best practices for assisting licensed professionals.
At the core of TLAP’s current programming, individualized services are key. The facilitation of objective and reliable diagnostics and treatment is provided on a case-by-case basis. It is imperative that individualized diagnostics, and treatment if indicated, are facilitated at levels that provide a solid foundation that precedes TLAP monitoring. TLAP monitoring agreements and lengths of monitoring reflect clinical best practices, and include individualized components as needed.
Monitoring is purely clinical. It is not punishment or probation. It is clinically designed to support long-term recovery without relapse, not only during the monitoring period but going forward in life thereafter.
“Think of monitoring as post-surgery antibiotics that should be fully completed even if you are feeling better.”
A number of TLAP’s monitoring participants are totally confidential and voluntary, and are not involved in any bar admissions or disciplinary matter. They are not bound to TLAP and are fully protected by confidentiality. They enter monitoring because their treatment provider and TLAP have explained very valuable health benefits, including lowering relapse risks.
Voluntary monitoring participants are never trapped in TLAP. They can always quit monitoring at any time with no questions asked, but the majority of voluntary monitoring participants complete the program because they have been educated about the clinical benefits of TLAP and its 85% no-relapse recovery rate on average.
Of course, in addition to supporting recovery and mental health, TLAP monitoring also provides the participant with an opportunity to generate an independent and objective record of fitness to practice if need be in licensing or employment matters. TLAP compliance supports the possibility of licensure, reinstatement, and/or continued employment despite a prior history of impairment and/or impairment-related unethical conduct.
II. Scientific Studies and Reports That Support Length of Monitoring Protocols
TLAP’s role in the profession is mandated by Tennessee Supreme Court Rule 33. TLAP provides confidential mental health support and does so at levels that reliably and objectively generate fitness to practice law. In fact, the expectation is that successful TLAP participation and compliance will generate “clear and convincing evidence” that any impairment has been removed and the participant is in stable remission and safe to practice law. This requires a very dependable level of clinical intervention, accountability, and objective verification.
No longer limited to Substance Use Disorder (SUD) cases involving alcoholism and drug addiction, TLAP now also offers an additional type of monitoring tailored to mental health issues that have no SUD component at all. TLAP’s monitoring services are now comprehensive and more complex in order to support the entire spectrum of mental health recovery.
The following history of scientific studies, subsequent reports, and recommendations provide a solid foundation for what is now considered the “gold standard” as to appropriate lengths of monitoring to render support and evidence of full remission and expected long-term recovery.
Of course, these are medical issues, not legal issues. All of the advancements in monitoring SUDs have been accomplished by top addiction doctors, treatment providers, medical experts, and those providing professional monitoring services in the medical profession. These efforts in the field of medicine originated long before Lawyer Assistance Programs were formed.
Some people may become confused and think that the doctors’ programs and studies generated in conjunction therewith are not applicable to any other licensed professionals. On the contrary, all of these medical efforts are singularly focused upon reliably arresting diseases and establishing evidence of full remission. It is ancillary that resultant high recovery rates also support safety to practice a licensed profession be it medicine or law, etc.
In other words, this medical work and monitoring is not at all occupation-specific; it is disease-specific. SUDs, like cancer, diabetes, and other chronic and potentially deadly diseases, do not distinguish between doctors, carpenters, musicians, short-order cooks, stay at home parents, homeless persons on the streets of your downtown, or even the First Lady of the United States (Betty Ford). Cancer is cancer. Addiction is addiction. And these diseases can be extremely powerful adversaries irrespective of one’s perspective and station in life.
TLAP’s mission is unified with the missions of all other monitoring programs for lawyers, doctors, nurses, and airline pilots, etc.: support truly reliable recovery outcomes so that the professional’s personal health is fully restored, and concurrently render objective and reliable monitoring evidence that proves the professional is in recovery, safe to practice, and does not pose a risk of harm to the public.
The universal challenges in SUD recovery monitoring are:
More simply put, in satisfying these completely aligned missions, how long does someone with SUD diagnoses have to remain clean and sober under monitoring to objectively demonstrate that the risk for relapse has been suitably extinguished in a licensed professional?
What has definitively emerged in the last two decades, both in the general population and for professionals, is the diagnostic significance of successfully remaining clean and sober for five (5) years in moderate to severe SUD cases (what used to be deemed “chemical dependency”).
A five (5) year time period without relapse is of major importance to ALL persons recovering from SUDs, not just licensed professionals.
The following studies and guidelines are a sampling of scientific data that provide support for various lengths of TLAP monitoring:
2003 Study: “A 60-year Follow-up of Alcoholic Men” (1)
This Harvard medical study focuses on recovery rates from alcoholism in the general population over the course of a 60-year period of time. It established that alcoholism is, just like cancer, a chronic disease that cannot really be considered in complete, full remission until there has been no relapse for a period of five (5) years:
“In short, analogous to cancer patients, a follow-up of 5 years rather than of 1 or 2 years would appear necessary to determine stable recovery.”
2005 Study: “Risk Factors for Relapse in Health Care Professionals with Substance Use Disorders” (2)
This is one of the first studies ever completed to confirm the efficacy of monitoring programs for medical professionals. It examined no-relapse rates and successful outcomes in the Washington State Physicians Health Program via the analysis of 11 years of outcome data from its monitoring program.
It revealed that 75% of participants had no relapse while participating in five (5) year monitoring periods.
“Seventy-four (25%) of 292 individuals had at least 1 relapse. Fourteen (5%) had exactly 2 relapses and 10 (3%) had 3 or more relapses”
The study also confirmed that as the length of the monitoring period increased, the risk of relapse significantly decreased.
2005 Monitoring Guidelines: “Physician Health Program Guidelines” (3)
These guidelines were established in 2005 as clinical best practices in monitoring SUD cases per the Federation of State Physicians’ Health Programs (FSPHP):
A) The minimum period of monitoring for substance dependence is 5 years which is consistent with the FSPHP Public Policy Statement on Length of Monitoring.
B) The minimum period of monitoring for substance abuse is 1 year and a maximum of 2 years assuming no additional concerns are raised during the monitoring period.
C) The minimum period of monitoring for diagnostic purposes is 1 year and a maximum of 2 years when there has been a significant incident involving drugs/alcohol, a SUD has not been diagnosed and abstinence is recommended.”
2008 Study: “Five Year Outcomes in a Cohort Study of Physicians Treated for Substance Use Disorders in The United States” (4)
Various leaders in the medical profession began to conduct studies to track the efficacy of appropriate monitoring lengths and refine the parameters of effective monitoring:
“It is important to emphasize that the physician health programs do not treat physicians. They provide evaluation and diagnosis, develop a contract detailing treatment or monitoring, coordinate and facilitate formal treatment and ongoing professional support, and carry out regular monitoring through random visits to places of work and regular screenings for alcohol and drugs— typically for five years”
“From a clinical perspective we interpret these results as evidence that the combination of identification, intervention, formal treatment, professional support, and monitoring by physician health programs is effective in rehabilitating most of these addicted physicians, over at least five years.”
“We examined the laboratory and medical records of the physicians during the five years.”
“Physician health programs seem to provide the best available measures for protecting patients and for recovering physicians’ careers.”
“Conclusion: About three quarters of US physicians with substance use disorders managed in this subset of physician health programs had favorable outcomes at five years. Such programs seem to provide an appropriate combination of treatment, support, and sanctions to manage addiction among physicians effectively.”
2009 Study: “How Are Addicted Physicians Treated? A National Survey of Physician Health Programs” (5)
This national, watershed study (often referred to as the “Blueprint Study”) was conducted by top medical doctors who are leaders in the field of addiction and treating licensed professionals. The purpose was in part to verify and expand upon the data initially generated by the 2005 Washington State Physicians Health Program study.
With robust monitoring programs emerging pursuant to the FSPHP’s 2005 Clinical Guidelines and otherwise, more data began to appear and independently validate the efficacy of these programs.
Per the Blueprint Study:
“Addicted physicians receive an intensity, duration, and quality of care that is rarely available in most standard addiction treatments: (a) intensive and prolonged residential and outpatient treatment, (b) 5 years of extended support and monitoring with significant consequences, and (c) involvement of family, colleagues, and employers in support and monitoring. Although not available to the general public now, several aspects of this continuing care model could be adapted and used for the general population.”
“A specific and important feature of these PHPs was the development of a formal, signed contract that specified in detail the care, support, and monitoring activities that the participant would have to participate in over the (usually) 5 years of the program.”
The results of this national study confirmed that monitoring for five (5) years (after the completion of appropriate diagnostics and treatment), generates stellar no-relapse recovery rates:
“Physicians then receive randomly scheduled urine monitoring, with status reports issued to employers, insurers, and state licensing boards for (usually) 5 or more years. Outcomes are very positive, with only 22% of physicians testing positive at any time during the 5 years and 71% still licensed and employed at the 5-year point.”
2009 Report: “Setting the Standard for Recovery” (6)
This report (and several other scholarly reports) were soon published in the wake of the exciting findings in the 2009 “Blueprint Study” and cite valuable information on applicable monitoring lengths, such as:
“Most physicians (88%) met diagnostic criteria for substance dependence, and most of these had a minimum monitoring period of 5 years. Remarkably, 78% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring.”
2014 Report: “The New Paradigm for Recovery: Making Recovery – Not Relapse – the Expected Outcome of Treatment” (7)
This report also emanates directly from data generated in the 2009 Blueprint Study and it provides a plethora of data and commentary on the efficacy of professional monitoring programs, and then it takes those findings a giant step forward. It promotes the application of “gold standard” outcomes for everyone, not just doctors, lawyers, and pilots, etc.
If a lay-person seeks to broadly understand professional monitoring programs, why these programs are so amazingly effective, and how protocols for professional monitoring programs like TLAP can actually benefit SUD treatment for the general population, this report is arguably one of the most comprehensive and informative written to date. It is of direct interest to all people who suffer from a SUD diagnosis.
Often referred to simply as the New Paradigm, if only one report is read, it should be this one.
The report is authored by Robert L. DuPont, M.D. and backed by scores of national experts and scholarly studies, (primarily the 2009 Blueprint Study which DuPont also completed and published as part of a team of top doctors). Dr. Dupont is one of the most respected and accomplished addiction doctors in the world.
The New Paradigm report first recognizes the “near-universality of relapse” in the addiction treatment industry, where at best there is only a 50/50 chance (or less) at avoiding relapse.
Then it chronicles and explains the stunning relapse-free success rates of professionals’ monitoring programs for doctors, lawyers, and airline pilots, etc., and promotes this type of effective addiction recovery programming for the general population.
Dupont’s overall position is that it is not equitable for the general public to be insufficiently treated for SUDs such that relapse is the expected outcome, while at the same time doctors, lawyers, and pilots are treated and monitored at higher levels such that recovery without relapse is far and away the expected outcome:
“Professional organizations first adopted monitoring programs for their members that were suffering from substance use problems who were working in safety-sensitive positions. Subsequently and not surprisingly, many of the individuals who developed the professional monitoring programs of the New Paradigm were, themselves, in long-term recovery.”
“Although monitoring for compliance is conducted for other chronic illnesses, such as diabetes and hypertension, the monitoring of substance use disorders by organizations of professionals is unique in that it is mandatory, intensive and prolonged. Unlike other chronic disease monitoring programs, in these substance use disorder monitoring programs, there are serious consequences imposed for non-compliance.”
“Following evaluation, the PHP oversees and manages the treatment, long-term monitoring and advocacy of the participants, for a period of five years or longer. A monitoring contract is signed, holding the participants to the standards of the PHP including abstinence from alcohol and drugs, with immediate and serious consequences for non-compliance.”
“Among physicians monitored for five years following treatment, 78% never had a positive test for alcohol or drugs.”
“When considering the New Paradigm for Recovery, it is important to consider fairness and equitable access of care. If an effective diabetes management program was only available to certain groups of people (in the way that the New Paradigm programs of HIMS, PHPs, and LAPs are available to pilots, physicians and lawyers, respectively to treat substance use disorders), the nation would not stand for it.”
“The same standard should apply to those suffering from substance use disorders; the effective system of care management of the New Paradigm should be accessible to all in need. It is encouraging that many programs, such as those featured in this report, have created care management programs of the New Paradigm but there remains a large gap in availability of this care management to the masses.”
Independent studies and information, wholly unrelated to the New Paradigm, confirm and underscore the comparatively dismal relapse rates experienced in the general population. Only 35% to 50% of individuals treated in the general population remain abstinent for 1 year or more. (8,9)
The bottom line: everyday SUD treatment in the general population on average renders unsuccessful outcomes to the extent that it is more likely than not that the person will soon resume alcohol and/or drug use.
Such outcomes can be disastrous. Relapse is not benign. Every incident of relapse is a treacherous “roll of the dice” that invites risks such as accidental overdose, car accidents, DUI, other criminal prosecutions, incarceration, death, and even suicide. One single relapse can generate permanent damages that cannot be mitigated.
As for licensed professionals and protecting the public, personal health is not the only consideration. Regulatory authorities cannot be expected to ignore risks to the public and license an individual with an insufficient treatment and monitoring history that is expected, on its face, to most-likely generate a return to active addiction and potential impairment.
2016 Study: “Risk of Relapse Declines Significantly After 5 Years of Abstinence from Alcohol” (10)
In concert with the first study cited on this FAQ response (the 2003 Harvard medical study on the relevance of 5 years of continuous recovery in establishing full remission from alcoholism), this new 2016 study is also focused on managing SUDs in the general population, and it is not focused upon or limited to licensed professionals.
It states that at five (5) years of continuous sobriety, not only is a person’s recovery deemed to finally be stable, the five (5) year length of continuous sobriety actually reduces a risk of relapse to the same level of developing a SUD as any other member of the general population.
This five (5) year milestone in the stability of recovery in the general public is also strikingly important in the context of seeking to be licensed, or be reinstated, as a lawyer, doctor, or pilot. With five (5) years of reliable and objective TLAP monitoring, regulators can be comfortable and very confident in licensing a person with a SUD history:
“Various additional studies have provided further evidence that after 5 years of abstinence, only about 15% of individuals with a historical diagnosis of alcohol use disorder (AUD) will relapse.”
With five (5) years of successful TLAP monitoring, the lawyer literally poses no greater risk of alcoholism and addiction, or harm to the public, than any other member of the profession.
“Now that we have established the validity of 5 years as a milestone in recovery, let’s turn to the second part of our proclamation. We claimed that the percentage of individuals formerly diagnosed with AUD [Alcohol Use Disorder] who would be expected to relapse after 5 years of abstinence was similar to the prevalence of AUD in the general US population.”
“After 5 years of abstinence, a recovering alcoholic has approximately the same chances of lifetime relapse as a randomly selected member of the general US population has of experiencing alcoholism in the coming year.”
2019 Monitoring Guidelines: “Physician Health Program Guidelines” (11)
After almost twenty years of analyzing and studying the results of clinical best practices across the nation in supporting and monitoring recovery from SUDs, the FSPHP updated its Clinical Guidelines to reflect all that has been learned.
As to monitoring lengths, here are the updated recommendations for SUD cases:
The period or time frame for monitoring substance use disorders is generally determined by the severity of the disorder:
2. Substance Use Disorder, mild: generally, 2 to 5 years.
3. Substance Use Disorder, moderate/severe: generally minimum of 5 years.
Compared to the 2005 FSPHP Guidelines, and based upon the analysis of monitoring outcomes since that time, these new guidelines actually expand the application of five (5) year monitoring lengths.
Five (5) years is still the minimum length of monitoring in moderate to severe SUD cases, but now five (5) years is also recommended as an option in mild SUD cases.
On a final note about SUD monitoring lengths: on a case-by-case basis, current trends also include the option of increasing monitoring lengths to periods longer than five (5) years. Relapse under monitoring as a licensed professional is a very serious event. Some programs are recommending a new ten (10) year monitoring agreement in the wake of a relapse under monitoring. If yet a second relapse occurs during the new ten (10) year monitoring period, then it is an option to recommend lifetime monitoring during the time the person is licensed, all so as to support the person and protect the public. Finally, if multiple relapses continue, then permanent revocation of licensure may occur as regulatory authorities see fit.
2021 Study: “Essential Components of Physician Health Program Monitoring for Substance Use Disorder: A Survey of Participants 5 Years Post
Successful Program Completion” (12)
Of course, the overall expectation of completing monitoring for five (5) years is that the participant has objectively achieved full remission, is entrenched in practices of good recovery hygiene, and has fully become comfortably enmeshed in the fabric of their local recovery community, both generally and among peer professionals’ groups. But what happens next? Do these program graduates remain in recovery?
This recent study reveals data on success rates long after the five (5) year monitoring program is completed. The outcomes remain excellent even five (5) years after the monitoring program has been finished:
“Using their own definition, (97%) of respondents reported that they currently considered themselves to be ‘in recovery.’ Additionally, 79% of respondents reported no use of alcohol since the completion of their PHP monitoring agreement.”
“Notably, 88% of respondents endorsed continued participation in12‐step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was ‘money well spent.’”
“When asked whether they would have been able to maintain sobriety under a ‘monitoring only’ agreement, 76% of physicians reported they would have been unsuccessful without formal SUD treatment.”
“Most participants reported continued participation in mutual support groups 5 or more years after completing their monitoring agreements. In addition, self-reported recurrence of substance use and recovery rates were extremely encouraging: 89% self‐reported that they completed their agreement without any recurrence of use during the monitoring period, with nearly 10% reporting only one recurrence. This is comparable to outcomes reported in a previous national PHP study and slightly better than reported outcomes in a large single-state study. Notably, 97% of respondents reported that they currently considered themselves to be ‘in recovery.’ This recovery rate and those in other PHP studies (consistently near 80%) far exceed the SUD remission rates in studies of other clinical populations (typically 35%–50%), most of which relied on far shorter follow-up periods and/or a less-rigorous definition of recovery.”
Against the backdrop of all the foregoing, it is now very clear: in moderate to severe SUD cases, numerous studies and resulting reports confirm that appropriate levels of diagnostics and treatment, followed by five (5) years of high-quality monitoring, generates exceptional rates of reliable long-lasting recovery that remain long after completion of the monitoring program.
This category of monitoring is new to TLAP and is now available to address “grey zone” cases. These cases involve a history of conduct (DUI, etc.) related to substance use, but after the person has completed a TLAP-approved evaluation and/or assessment, it is still not clear whether the person has a diagnosis and current clinical situation.
As part of the continuation of an ongoing multi-disciplinary diagnostic process, there may be a need to “diagnostically” monitor the participant in one of these two categories:
1) The assessment detected a substance use disorder diagnosis that appears to be in stable remission and there is no current recommendation for any treatment; however, the person’s history shows inadequate treatment (or even no treatment at all, etc.) such that the person’s sustained remission and abstinence needs objective verification; or,
2) The assessment indicates it is strongly suspected that the patient currently has a substance use issue and a diagnosis, but the inpatient testing has not detected it, so there is a need to objectively “rule out” and verify there is no diagnosis.
In such cases, monitoring lengths of one (1) to two (2) years of frequent random drug screening are indicated to objectively verify that the participant can remain clean and sober as necessary to demonstrate solid long-term recovery, or else rule out a diagnosis.
This category of monitoring has no SUD component at all. In these cases, such as bipolar, depression, or anxiety, etc., the person has completed the TLAP-approved evaluation and assessment process and it has been established that they do not have any issues with alcohol or drugs. Instead, their needs are centered upon establishing an objective record of their responsible medication management with a TLAP-approved psychiatrist, and possibly participating in TLAP-approved therapy as well if indicated.
These monitoring agreements typically range in lengths of one (1) to (2) years. Because these cases do not involve an addiction factor, the monitoring agreement does not require abstinence, random drug screening, or recovery meetings, etc. Instead, mental health monitoring primarily requires reports from a TLAP-approved treating psychiatrist to verify that the person is showing up for all scheduled appointments, continuing to take their medication as prescribed, and to alert TLAP if there is a change in medication, diagnosis, or stability. Moreover, it requires updated reports from therapists, etc., if applicable.
In these cases, the TLAP Case Manager (professional clinician) serves as the TLAP Monitor because these pure mental health cases are outside the scope of support experience traditionally supplied by TLAP peer volunteers as lay persons in recovery from alcoholism and addiction.
Against the backdrop of all the above and foregoing, TLAP’s current monitoring lengths are based upon definitive, irrefutable, and validated clinical evidence that has been reinforced by almost two decades of medical experience in supporting and monitoring fitness to practice for licensed professionals.
These lengths of monitoring have long been implemented in other LAPs as well. For example, in Louisiana’s LAP, five (5) year SUD monitoring agreements have been utilized for three decades and since its inception in 1992, all based upon best practices and recommendations by top doctors and treatment centers for licensed professionals. For many years now, the Louisiana program has generated an average 95% no-relapse rate in alcoholism and addiction cases.
Over and above the information generated by monitoring programs and medical experts, the American Society of Addiction Medicine (ASAM) Criteria (13) also specifically validates the work of LAPs and PHPs, etc. The ASAM Criteria manual includes a detailed chapter on the specialized clinical needs of attorneys and other licensed professionals who hold the public’s trust.
ASAM has long recognized that certain subgroups of licensed professionals, specifically including attorneys, require higher levels of diagnostics, treatment, and objective monitoring to support reliable recovery from SUDs. By greatly reducing the odds of relapse via specialized services through LAPs and other such programs, licensing authorities can consider allowing attorneys with these chronic illnesses to objectively achieve reliable remission and safely practice a profession again.
This ASAM level of care not only provides appropriate support for the rehabilitation of lawyers and doctors, etc., but it is also considered by ASAM to be “the ‘gold standard’ of addiction care in the United States” and is directly applicable to benefit the general population and all persons with SUDs. ASAM specifically references PHPs, LAPs, and other such monitoring programs for professions as leading the way in pioneering very effective levels of SUD support and recovery.
III. Witnessing the Miracle of TLAP Monitoring
The disease of addiction always seeks to negotiate “an easier, softer, way” and bristles when it is denied. This tension comes to bear in cases where the Board of Law Examiners (BLE), the Board of Professional Responsibility (BPR), or the Tennessee Supreme Court has ordered the person to establish compliance with TLAP.
Some of these official referrals to TLAP do not think they have a problem, do not want any help, or else want no part of TLAP. Others may admit having an issue but then want to design their own attenuated monitoring program and have TLAP endorse it, rather than adhering to objective best practices. Still others try to bully and attack TLAP, instead of cooperating. A fair amount of fragmented, negative, and inaccurate misinformation gets spread around about TLAP in these cases. Behind the scenes, however, you can rest assured that there is always a complete record that supports TLAP’s recommendations.
It is heartwarming to witness the progress of TLAP’s successful monitoring participants. In the fullness of time, even formal BLE and BPR referrals who were initially angry about TLAP monitoring can and do come to understand and appreciate TLAP’s invaluable support. The following is a sampling of feedback from a person formally referred to TLAP (presented anonymously and with permission). This person has completed a journey that began in resistance, transitioned to cooperation, and arrived at appreciation and gratitude:
TLAP provides all of its top-tier services, including appropriate lengths of monitoring, as the direct result of strong leadership and specific directives from the Tennessee Supreme Court on the efficacy level it expects the profession to receive from TLAP programming. TLAP remains dedicated to best practices and the integrity of its programming, educating the profession on mental health challenges that lawyers face, and providing accurate information about TLAP’s mission to provide the best and most effective life and career-saving services possible to the lawyers, judges, and law students in Tennessee.
Works Cited
1) Vaillant, G. E. (2003). A 60-year follow-up of alcoholic men. Addiction, 98(8), 1043–1051. https://doi.org/10.1046/j.1360-0443.2003.00422.x
2) Domino KB, Hornbein TF, Polissar NL, Renner G, Johnson J, Alberti S, Hankes L. Risk factors for relapse in health care professionals with substance use disorders. JAMA. 2005 Mar 23;293(12):1453-60. doi: 10.1001/jama.293.12.1453. PMID: 15784868.
3) McCall, S., Carr, G. D., Gundersen, D., Pendergast, W., Ramirez, M., Bedient, T., Gehrke, C., Hankes, L., & Gendel, M. (2005). Physician Health Program Guidelines. Federation of State Physician Health Programs, Inc.
4) McLellan, A. T., Skipper, G. S., Campbell, M., DuPont, R. L. (2008). Five Year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ, 337(nov04 1). https://doi.org/10.1136/bmj.a2038 Neuraptitude – NCPHP. (n.d.).
5) DuPont, R. L., McLellan, A. T., Carr, G., Gendel, M., Skipper, G. E. (2009). How are addicted physicians treated? A national survey of Physician Health Programs. Journal of Substance Abuse Treatment, 37(1), 1–7. https://doi.org/10.1016/j.jsat.2009.03.010 Neuraptitude – NCPHP. (n.d.).
6) DuPont, R. L., McLellan, A. T., White, W. L., Merlo, L. J., Gold, M. S. (2009). Setting the Standard for Recovery: Physicians’ Health Programs. Journal of Substance Abuse Treatment, 36(2), 159–171. https://doi.org/10.1016/j.jsat.2008.01.004 Neuraptitude – NCPHP. (n.d.).
7) Baxter, L., Demitor, M., DuPont, C., DuPont, H., Fortner, N., Gitlow, S., Gold, M., et al. (2014). The New Paradigm for Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment (pp. 1-34) . A report of the John P. McGovern Symposium hosted by the Institute for Behavior and Health, Inc.
8) Fleury, M.-J., Djouini, A., Huỳnh, C., Tremblay, J., Ferland, F., Ménard, J.-M., & Belleville, G. (2016). Remission from Substance Use Disorders: A systematic Review and Meta-analysis. Drug and Alcohol Dependence, 168, 293–306. https://doi.org/10.1016/j.drugalcdep.2016.08.625
9) White, W. L. (2012, March). Recovery/Remission from Substance Use Disorders an Analysis of Reported Outcomes in 415 Scientific Reports, 1868-2011. Retrieved February 2, 202 Neuraptitude – NCPHP. (n.d.).
10) Neuraptitude – NCPHP. (n.d.). Retrieved February 2, 2023, from https://www.ncphp.org/wp-content/uploads/2017/06/Relpase-declines-after-5-years.pdf
11) Federation of State Physician Health Programs (FSPHP), Inc. (2019, April 16). Physician Health Program Guidelines. www.fsphp.org. Retrieved February 2, 2023.
12) Merlo LJ, Campbell MD, Shea C, White W, Skipper GE, Sutton JA, DuPont RL. Essential Components of Physician Health Program Monitoring for Substance Use Disorder: A Survey of Participants 5 Years Post Successful Program Completion. Am J Addict. 2022 Mar;31(2):115-122. doi: 10.1111/ajad.13257. Epub 2022 Jan 17. PMID: 35037334; PMCID: PMC9303734
13) Mee-Lee, D., Shulman, G.D., Fishman, M., Gastfriend, D. R., Miller, M.M., & Provence, S. M. (2013). In The Asam Criteria Treatment For Addictive, Substance-Related, And Co-Occurring Conditions (pp. 340–349). Essay, American Society of Addiction Medicine.
All contact with TLAP is confidential as a matter of law pursuant to T.C.A. 23-4-105:
“The records, proceedings and all communications of any lawyers’ assistance program shall be deemed confidential and shall not be available for court subpoena.”
Regardless of how or why a person or entity contacts TLAP, all such communications are strictly confidential and only the person or entity calling can waive confidentiality. You do not have to give your name or identify yourself and can call TLAP, if you so desire, anonymously.
TLAP receives direct, confidential self-help calls from people who are in distress and want TLAP’s help. TLAP also receives calls from other people such as family members, peers, law partners, judges, who have become concerned about a person’s mental health wellness and ability to practice law.
In all of these cases of confidential contact, TLAP’s response is simple: a full discussion ensues so that TLAP’s professional staff can collect all available information that is clinically relevant and would support either assisting the person directly calling TLAP or else identifying from a concerned party as to whether or not there may be a productive way to approach the person who may need help.
TLAP never requires a person concerned about someone else to become involved. It is always the person or entity’s unilateral and confidential choice to decide, after a full discussion with TLAP, whether or not they wish to be involved in any effort or intervention to reach out to the person and help facilitate TLAP’s help.
As such, there is no downside to placing a confidential call to TLAP. The person calling remains protected by confidentiality and retains full control of whether or not they ultimately decide to participate in TLAP’s efforts.
TLAP is not affiliated in any way with the Board of Professional Responsibility.
TLAP is not affiliated in any way with the Board of Law Examiners.
In some disciplinary cases investigated by the BPR, the person’s alleged unethical conduct appears to the BPR to have emanated in whole or part from a mental health issue such as alcoholism, addiction, or depression, etc. Thus, pursuant to Supreme Court Rule 9, the person in trouble is can be officially referred by the BPR to TLAP for an independent, objective evaluation or assessment in order to determine whether or not there is an impairment issue that impacts the person’s fitness to practice law.
In some bar admissions cases investigated by the BLE, the person’s history of past and/or current conduct (such as an arrest or academic discipline) appears to the BLE to have emanated in whole or part from a mental health issue such as alcoholism, addiction, or depression, etc. Thus, pursuant to Supreme Court Rule 7, the person in question can be officially referred by the BLE to TLAP for an independent, objective evaluation or assessment in order to determine whether or not there is an impairment issue that impacts the person’s fitness to practice law.
TLAP’s standards are designed to meet the needs of licensed professionals who must objectively demonstrate to a third party, by clear and convincing evidence, that they are fit to practice. TLAP can provide reliable and objective services to assist the person in their efforts to procure an objective and reliable diagnosis, effective treatment as is appropriate for licensed professionals who hold the public’s trust, and TLAP Monitoring to objectively demonstrate over time that impairment has been removed and the chance for recidivism is remote. The designation of “TLAP compliant” is generally recognized as a reflection that the person has cooperated with TLAP, completed all clinical recommendations, and is objectively and reliably safe to practice law from a clinical standpoint.
TLAP itself has no disciplinary or punitive function, does not render legal advice, and is purely clinical in all of its services. TLAP’s standards are designed to clinically meet best practices for supporting legal professionals, and TLAP’s standards provide an opportunity for the person in trouble to meet TLAP’s clinical standards and objectively demonstrate fitness to practice law despite issues that have raised concerns with the BPR or BLE.
Successful TLAP compliance and participation does not provide an outright defense to charges of unethical conduct or concerns about past conduct, but TLAP compliance can serve as a valuable mitigating factor in cases where there has not been substantial harm to the public and the alleged unethical conduct emanated from a mental health fitness to practice issue rather than from dishonesty rooted in bad character.
TLAP volunteer candidates must contact the Executive Director of TLAP and inquire about opportunities that may be appropriate based upon their qualifications and ability to provide direct, confidential services. TLAP Monitors customarily have experience in recovery as to the issue being monitored, either personally or through involvement with friends and family, etc.
Others who have no direct experience with recovery or mental health issues but are interested nonetheless in supporting the life-saving work of TLAP can help TLAP raise funding and raise awareness of mental health concerns in the profession. Please contact TLAP’s Executive Director for opportunities.
TLAP welcomes and encourages all inquiries and feedback.
All suggestions, concerns, and complaints may be submitted directly to TLAP’s Executive Director, or to the Chair of the TLAP Commission. All such submissions will be answered timely.
J. E. “Buddy Stockwell III
Executive Director, TLAP
Buddy.Stockwell@tncourts.gov
615-393-3619
Hon. Michael E. Spitzer
TLAP Commission Chair
Judge.Micheal.Spitzer@tncourts.gov
931-295-3500