DOUGLAS E. TUCKER, M.D.

DIPLOMATE, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

2887 COLLEGE AVENUE #108, BERKELEY, CA 94705
TEL (510) 496-6077
FAX (510) 848-8699

Susan 1. Kagan, Deputy Trial Counsel

Office of the Chief Trial Counsel- Enforcement

State Bar of California

101 Howard St.

San Francisco, CA 94 1 O

Fax: (415) 538-2220

May 7, 2007

Re:

Zachary B. Coughlin

Case No. 06-M-13755

DOB 9-27-76

DearMs. Kagan:
Pursuant to your request, I have performed a forensic/clinical assessment ofMr.

Coughlin, focusing in particular on 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 of this assessment, I interviewedMr. Coughlin at my office

for three hours and 10 minutes on 4-27-07, and reviewed the following documents:
1) Mr. Coughlin's 9-28-02 application for admission to the State Bar of

California and updates to the application;

2) transcript ofMr. Coughlin's testimony at his deposition on 3-2-07;

3) police report and toxicology results fromMr. Coughlin's arrest on 1-23-03;
4) medical reports of the following physicians and psychologists: Alan WongM.

D. ,Mujahid RasulM. D., Oliver Ocskay Ph.D., and Robert Hunter Ph.D.;

5) transcript from the informal conference on 7-8-04 betweenMr. Coughlin and

the California Committee of Bar Examiners;

6) records of the Office of Admissions of the State Bar of Nevada in connection

withMr. Coughlin's admission, including the transcript from the fonnal hearings

on 3-1-02 and 6-21-02 before the State Bar of Nevada; and

EXHIBIT

I I

Zachary Coughlin evaluation

7) Order Granting State Bar'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 by a history of ethical and legal violations, which will be
briefly summarized. In May 2000 Mr. Coughlin took $10 from the change drawer at a
library where he worked, leaving an IOU and reportedly returning the money the next

day. On 7-15-01 he was supposed to turn in hard and digital copies of a final paper for

his cyber law class, which the professor was unable to locate, and Mr. Coughlin later sent
offensive e-mails to the professor related to this issue, and eventually submitted an

unprofessional "rough draft." On 10-21-01 he was arrested after sneaking into a movie

theater, running from theater personnel after he was caught, and resisting arrest by police.
On 1-23-03 he was arrested for DUI (marijuana), pled guilty to a misdemeanor "dry

reckless" driving charge, and was court-ordered to attend Alcoholics Anonymous

meetings. In September 2005 he entered the California Lawyer Assistance Program

(LAP) after more than a year of delay caused by his resistance to submitting his medical

records, and was eventually terminated by the program in April 2006 for noncompliance
with conditions.

2. Substance Abuse
Based on the information currently available to me, it appears that Mr. Coughlin meets
diagnostic criteria for Alcohol and Marijuana Abuse, as defined in the DSM-IV-TR
(Diagnostic and Statistical Manual, 4th edition, of the American Psychiatric Association,
2000). By self-report, he has not 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, mainly at bars or parties, and this eventually became

"excessive" ("more than I wanted"). His drinking continued to escalate in law school,
especially during his second year, as he attempted to quell his chronic and progressive

back and neck pain.

He eventually joined Alcoholics Anonymous on 1-1-02 and

reportedly remained sober for a year. (However, he told me that alcohol played a role in
his arrest on 10-21-01 after sneaking into the movie theater). He returned to drinking in

January 2003 after moving to Sacramento "because I was ambivalent about whether I was

an alcoholic." He noted that attorneys in this firm drank "a lot," and that as an Associate

one of his roles was to serve drinks at their Friday afternoon meetings. He was

eventually let go from this firm in February 2003 after his DUI arrest, and he stated that

he has not had any alcohol since that time.

Mr. Coughlin received a score of 14 on the Michigan Alcoholism Screening Test, a

diagnostic questionnaire in which a score of three points or less is considered
nonalcoholic, four points is suggestive of alcoholism, and five points or more indicates a

diagnosis of alcoholism. He has an extensive family history of alcohol problems, with

Zachary Coughlin evaluation

alcohol dependence in his father, paternal grandmother, and maternal grandfather, as well
as alcohol-related DUI arrests in both sisters. Laboratory evaluation on 4-27-07

demonstrated that all liver function indices were currently within normal limits (i.e. , no

evidence of current alcohol-related liver damage). Urine toxicology screening on that

date was likewise negative for all substances tested. An additional test for the presence

of alcoholism, urinary ethyl glucuronide, is pending at the time of this report.

Other than alcohol, there is no evidence that Mr. Coughlin has had problems with any
other substances of abuse other than marijuana. He indicated that he first smoked

marijuana during college in his early 20s, smoking approximately once per month at

parties. This escalated after he moved to Sacramento in early 2003, when he smoked
once or twice weekly to cope with his chronic pain condition. As described above, he

was arrested on 1-23-03 and pled guilty to charges related to driving under the influence

of marijuana, leading to court-ordered attendance at Alcoholics Anonymous meetings as

well as loss of his job with a law firm. During our interview he denied smoking

marijuana since March 2003 because of the risk to his legal career.

3. Psychiatric Disorders Contributing to Substance Abuse Vulnerability

In addition to alcohol and marijuana abuse, Mr. Coughlin meets diagnostic criteria for
several other psychiatric disorders which contribute to his liability to abuse substances.
These include ADHD Combined Type (Attention Deficit-Hyperactivity Disorder),

chronic back and neck pain , chronic depression, and passive-aggressive and
oppositional-defiant personality traits.

Mr. Coughlin reported that he has had ADHD since childhood, though it was never

treated at that time. Symptoms of hyperactivity, impUlsivity and attention-deficit have

persisted into adulthood, and have affected him personally, professionally and

academically. These have included difficulty sitting through classes and meetings,

difficulty starting and finishing homework assignments, seeking out high-stimulation

activities, frequent restlessness and boredom, avoidance of detailed and meticulous

activities which feel mundane and boring, "workaholism," "hyperfocus on some areas
and inadequate focus on others," impaired social functioning with frequent missing of
social cues, lack of patience or attention required to maintain social relationships,

disorganization, and feeling "spaced-out" or "in a fog." His family history is significant

for identical ADHD symptoms and impairment in his father and a maternal uncle. He
was officially diagnosed with ADHD by Dr. Rasul in 2003 and prescribed Adderall

(prescription amphetamine) with good result, but this was tapered and discontinued in
September 2006 because of concerns about substance abuse voiced by his father and the
California LAP. Since stopping Adderall he has felt more restless, less focused, and

more fatigued and depressed. Other medications he has taken for ADHD include
clonidine for two years, and Wellbutrin XL 300 mg daily which he continues to take.
Mr. Coughlin reported chronic progressive neck and back pain since age 19 caused by a

variety of sports and automobile accident-related injuries. There is also a family history

of back pain on both sides of his family. This pain has fluctuated over the years, but has

Zachary Coughlin evaluation

generally been significant enough to affect his mood and functioning. He was first
treated with narcotics for this condition after law school in 2002, and has received a

variety of agents including hydrocodone (Lortab) and OxyContin (long-acting

oxycodone). He is currently on no pain medications other than as-needed ibuprofen, and

experiences ongoing moderate pain 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 has had problems with chronic, low-grade depression for

many years, which causes general malaise and decreased interest in activities. He noted
that this often worsens in conjunction with his pain. He has had about 5-10 episodes of

more severe depression in his life, but was never hospitalized for these. He is currently
receiving the antidepressant Wellbutrin XL as described above, which is effective both

for depression and ADHD.

Finally, it is apparent that Mr. Coughlin has clinically significant pathological personality
traits which have led to distress as well as psychosocial and professional impairment. He

has demonstrated a variety of passive-aggressive and oppositional-defiant behaviors

throughout his academic and early professional careers, which were evident as well at

clinical interview. These have led to a self-defeating pattern of interactions with others,
including authority figures in particular, contributing in part to the need for the current

evaluation. It is likely that these maladaptive traits are related to the conflicted and

emotionally iritense relationship he has had with his father throughout his life, as well as
other conditions including chronic pain, chronic depression, ADHD, and possibly

ongoing substance abuse.

4. Treatment Recommendations
Mr. Coughlin indicated that he currently attends AA meetings an average of 3-4 times

per week, but does not have an AA sponsor. He experiences "rare" cravings for alcohol,
especially when his back and neck pain worsen. He reported to me that he is still "not

sure" if he has any problems with 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 know if anyone can be sure that they're an alcoholic." His

only current medications include the antidepressant Wellbutrin XL (also moderately

effective for ADHD) and as-needed ibuprofen for pain.

It seems clear that Mr. Coughlin suffers from a variety of interrelated psychiatric

conditions, each of which may serve to exacerbate the others. For example, chronic pain,
ADHD, depression, and maladaptive personality traits are all well-recognized as factors

which may precipitate and maintain substance abuse. Substance abuse, in tum, often

exacerbates these other conditions. 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 would recommend that he receive outpatient collaborative

care from an established pain management program as well as an experienced addiction

program. (If he were currently abusing substances, he would likely require a residential

rehabilitation program.) A high-quality pain centerwill be equipped to provide a range

Zachary Coughlin evaluation

of modalities to address his chronic pain, including long-acting narcotic medications such
as methadone if appropriate. The addiction program should either function within the

pain program, or have experience collaborating with pain programs. An addiction

psychiatrist in one of these programs should be designated as his primary physician, who
could safely and effectively manage Mr. Coughlin's ADHD, depression, personality

issues, and substance abuse, including the prescription of potentially problematic

mdications such as stimulants for ADHD. I anticipate that Mr. Coughlin would benefit

from more aggressive medication treatment of his ADHD, depression and pain, as well as

individual and/or group psychotherapy (including 12 step meetings) which focus on

substance abuse and long-standing personality issues. Appropriate monitoring would

include regular urine toxicology screening and a worksite monitor.

Please do not hesitate to contact me if I may be of further assistance, or to discuss any of

my findings in this case.

Sincerely,

Douglas E. Tucker, M.D.

-vulof'.....

",,",,,VI t

.,
"

..., .

2887 College Avenue #108

Berkeley, CA 94705

rLn\ \g e \.- n '\{! r.Pn!'.)

1 .J
In

ti L

c_"

.,j

.....

" ,'o.v. , J, 1 ?fiff1i

i'i,f'
t.UI.U

" I'

CJ,

STATE BAR OF CALFOF\Ni I},

ENFORCEMEN"Y

Susan Kagen, Esq.

State Bar of CA
Office of the Chief Trial Counsel
180 Howard Street
San Francisco, CA 94105-1639

..<-.

(
./