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DOU t-<LAS E. TUCKER, M.D.

DIPLOMATE, AMERICAN IBOARD OF PSYCHIATRY AND NEUROLOGY


2887 COLLEGE}, VENUE #108, BERKELEY, CA 94705
TEL (510) ~96-6077
FAX (510) 848-8699

Susan 1. Kagan, Deputy Trial Coul1sel


Office of the Chief Trial Counsel Enforcement
State Bar of California
101 Howard St.
San Francisco, CA 9410~
Fax: (415) 538-2220
May 7, 2007
Re:

Zachary B. Cougblin
Case No. 06-M-l 755
DOB 9-27-76

Dear Ms. Kagan:


Pursuant to your request, I have erformed a forensic/clinical assessment ofMr.
Coughlin, focusing in particular bn whether he currently suffers from alcohol abuse or
other drug abuse or dependency, and if so, what if any monitoring, testing or treatment
are recommended. As part ofth s assessment, I interviewed Mr. Coughlin at my office
for three hours and 10 minutes (In 4-27-07, and reviewed the following documents:
1) Mr. Coughlin's 9-28-b2 application for admission to the State Bar of
California and updates t4 the application;
2) transcript ofMr. Co"\: ghlin's testimony at his deposition on 3-2-07;
3) police report and toxlcology results from Mr. Coughlin's arrest on 1-23-03;
4) medical reports of the following physicians and psychologists: Alan Wong M.
D., Mujahid Rasul M. I ., Oliver Ocskay Ph.D., and Robert Hunter Ph.D.;
5) transcript from the il formal conference on 7-8-04 between Mr. Coughlin and
the California Committ~e of Bar Examiners;
6) records of the Offic~ of Admissions ofthe State Bar of Nevada in connection
with Mr. Coughlin's a( mission, including the transcript from the formal hearings
on 3-1-02 and 6-21-02IlJefore the State Bar of Nevada; and

EXHIBIT

~,

Zachary Coughlin evaluation

7) Order Granting State ar's Renewed Motion to Require Applicant to Submit to


a Medical Examination, State Bar Court of California Hearing Department - San
Francisco, 4-17-07.

Conclusions

1. Violations
This evaluation was triggered b a history of ethical and legal violations, which will be
briefly summarized. In May 20 0 Mr. Coughlin took $10 from the change drawer at a
library where he worked, leavin an IOV and reportedly returning the money the next
day. On 7-15-01 he was suppo d to turn in hard and digital copies ofa finalpaper for
his cyber law class, which the p ofessor was unable to locate, and Mr. Coughlin later sent
offensive e-mails to the profess r related to this issue, and eventually submitted an
unprofessional "rough draft."
10-21-01 he was arrested after sneaking into a movie
theater, running from theater pe sonnel after he was caught, and resisting arrest by police.
On 1-23-03 he was arrested fot VI (marijuana), pled guilty to a misdemeanor "dry
reckless" driving charge, and w s court-ordered to attend Alcoholics Anonymous
meetings. In September 2005 h entered the California Lawyer Assistance Program
(LAP) after more than a year of elay caused by his resistance to SUbmitting his medical
records, and was eventually te inated by the program in Apri12006 for noncompliance
with conditions.

2. Substance Abuse
Based on the information curren ly available to me, it appears that Mr. Coughlin meets
diagnostic criteria for Alcohol a d Marijuana Abuse, as defined in the DSM-IV -TR
(Diagnostic and Statistical Man aI, 4th edition, of the American Psychiatric Association,
2000). By self-report, he has no had any alcohol or marijuana since March 2003. He
reported first drinking alcohol in his early 20s in college, rarely more than 3 days per
week, any day of the week, mai ly at bars or parties, and this eventually became
"excessive" ("more than I wante "). His drinking continued to escalate in law school,
especially during his second yea, as he attempted to quell his chronic and progressive
back and neck pain. He eventu lly joined Alcoholics Anonymous on 1-1-02 and
reportedly remained sober for a ear. (However, he told me that alcohol played a role in
his arrest on 10-21-01 after snea ing into the movie theater). He returned to drinking in
January 2003 after moving to Sa ramento "because I was ambivalent about whether I was
an alcoholic." He noted that atto eys in this firm drank "a lot," and that as an Associate
one of his roles was to serve dri s at their Friday afternoon meetings. He was
eventually let go from this firm i February 2003 after his DVI arrest, and he stated that
he has not had any alcohol since hat time.
Mr. Coughlin received a score 0 14 on the Michigan Alcoholism Screening Test, a
diagnostic questionnaire in whic a score of three points or less is considered
nonalcoholic, four points is sugg stive of alcoholism, and five points or more indicates a
diagnosis of alcoholism. He has
extensive family history of alcohol problems, with

Zachary Coughlin evaluation


I.~

alcohol dependence in his fathe , paternal grandmother, and maternal grandfather, as well
as alcohol-related DUI arrests i both sisters. Laboratory evaluation on 4-27-07
demonstrated that all liver funct on indices were currently within normal limits (i.e., no
evidence of current alcohol-rela ed liver damage). Urine toxicology screening on that
date was likewise negative for a I substances tested. An additional test for the presence
of alcoholism, urinary ethyl glu uronide, is pending at the time of this report.
Other than alcohol, there is no e idence that Mr. Coughlin has had problems with any
other substances of abuse other an marijuana. He indicated that he first smoked
marijuana during college in his arly 20s, smoking approximately once per month at
parties. This escalated after he oved to Sacramento in early 2003, when he smoked
once or twice weekly to cope wi h his chronic pain condition. As described above, he
was arrested on 1-23-03 and pIe guilty to charges related to driving under the influence
of marijuana, leading to court-o ered attendance at Alcoholics Anonymous meetings as
well as loss of his job with a la firm. During our interview he denied smoking
marijuana since March 2003 be ause of the risk to his legal career.

3. Ps chiatric Disorders Contri utin to Substance Abuse Vulnerabilit


In addition to alcohol and marij ana abuse, Mr. Coughlin meets diagnostic criteria for
several other psychiatric disorde s which contribute to his liability to abuse substances.
These include ADHD Combine Type (Attention Deficit-Hyperactivity Disorder),
chronic back and neck pain, chr nic depression, and passive-aggressive and
oppositional-defiant personality raits.
Mr. Coughlin reported that he h had ADHD since childhood, though it was never
treated at that time. Symptoms fhyperactivity, impulsivity and attention-deficit have
persisted into adulthood, and ha e affected him personally, professionally and
academically. These have inclu ed difficulty sitting through classes and meetings,
difficulty starting and finishing mework assignments, seeking out high-stimulation
activities, frequent restlessness a d boredom, avoidance of detailed and meticulous
activities which feel mundane an boring, "workaholism," "hyperfocus on some areas
and inadequate focus on others," .mpaired social functioning with frequent missing of
social cues, lack of patience or at ention required to maintain social relationships,
disorganization, and feeling "spa ed-out" or "in a fog." His family history is significant
for identical ADHD symptoms d impairment in his father and a maternal uncle. He
was officially diagnosed with
HD by Dr. Rasul in 2003 and prescribed Adderall
(prescription amphetamine) with ood result, but this was tapered and discontinued in
September 2006 because of conc rns about substance abuse voiced by his father and the
California LAP. Since stopping dderall he has felt more restless, less focused, and
more fatigued and depressed. Ot er medications he has taken for ADHD include
clonidine for two years, and Well utrin XL 300 mg daily which he continues to take.
Mr. Coughlin reported chronic pr gressive neck and back pain since age 19 caused by a
variety of sports and automobile ccident-related injuries. There is also a family history
of back pain on both sides of his
ily. This pain has fluctuated over the years, but has

Zachary Coughlin evaluation

generally been significant enoug to affect his mood and functioning. He was first
treated with narcotics for this co dition after law school in 2002, and has received a
variety of agents including hydr codone (Lortab) and OxyContin (long-acting
oxycodone). He is currently on 0 pain medications other than as-needed ibuprofen, and
experiences ongoing moderate p in as a result. He has used both alcohol and marijuana
in the past to cope with this pain and denied ever abusing his prescription narcotics.
Mr. Coughlin indicated that he s had problems with chronic, low-grade depression for
many years, which causes gener I malaise and decreased interest in activities. He noted
that this often worsens in conju tion with his pain. He has had about 5-10 episodes of
more severe depression in his li ,but was never hospitalized for these. He is currently
receiving the antidepressant We lbutrin XL as described above, which is effective both
for depression and ADHD.

Finally, it is apparent that Mr. C ughlin has clinically significant pathological personality
traits which have led to distress s well as psychosocial and professional impairment. He
has demonstrated a variety of p sive-aggressive and oppositional-defiant behaviors
throughout his academic and ea y professional careers, which were evident as well at
clinical interview. These have I d to a self-defeating pattern of interactions with others,
including authority figures in pa icular, contributing in part to the need for the current
evaluation. It is likely that thes maladaptive traits are related to the conflicted and
emotionally intense relationship he has had with his father throughout his life, as well as
other conditions including chro .c pain, chronic depression, ADHD, and possibly
ongoing substance abuse.

4. Treatment Recommendation
Mr. Coughlin indicated that he urrently attends AA meetings an average of 3-4 times
per week, but does not have an
sponsor. He experiences "rare" cravings for alcohol,
especially when his back and ne k pain worsen. He reported to me that he is still "not
sure" ifhe has any problems wit substance abuse, or if vulnerability to alcoholism is a
lifelong condition. "I'm not sure if I'm not sure if I have a problem with alcohol, it's a
very subjective thing. I don't kn w if anyone can be sure that they're an alcoholic." His
only current medications includ the antidepressant Wellbutrin XL (also moderately
effective for ADHD) and as-nee ed ibuprofen for pain.

It seems clear that Mr. Coughlin uffers from a variety ofinterrelated psychiatric
conditions, each of which may s rve to exacerbate the others. For example, chronic pain,
ADHD, depression, and malada tive personality traits are all well-recognized as factors
which may precipitate and maint in substance abuse. Substance abuse, in tum, often
exacerbates these other conditio s. Effective treatment generally involves simultaneous
attention to all of these problems In Mr. Coughlin's case, assuming that he is not
currently abusing substances, I ould recommend that he receive outpatient collaborative
care from an established pain m agement program as well as an experienced addiction
program. (If he were currently a using substances, he would likely require a residential
rehabilitation program.) A high- uality pain center will be equipped to provide a range

Zachary Coughlin evaluation

of modalities to address his chro ic pain, including long-acting narcotic medications such
as methadone if appropriate. Th addiction program should either function within the
pain program, or have experienc collaborating with pain programs. An addiction
psychiatrist in one of these pro ms should be designated as his primary physician, who
could safely and effectively man ge Mr. Coughlin's ADHD, depression, personality
issues, and substance abuse, incl ding the prescription of potentially problematic
m'1dications such as stimulants Ii r ADHD. I anticipate that Mr. Coughlin would benefit
from more aggressive medicatio treatment of his ADHD, depression and pain, as well as
individual and/or group psychot erapy (including 12 step meetings) which focus on
substance abuse and long-standi g personality issues. Appropriate monitoring would
include regular urine toxicology creening and a worksite monitor.

Please do not hesitate to contact


my findings in this case.

e if I may be of further assistance, or to discuss any of

Sincerely,

Douglas E. Tucker, M.D.