Cynthia G. Scott
University of North Florida
Although all counselors face ethical challenges, addictions counselors encounter ethical
issues that are, in many respects, unique to their discipline. This article provides an
overview of these issues, which include but are not limited to (a) the lack of communication and continuity between research and clinical practice, (b) lack of agreement over
the necessary professional credentials, (c) the questionable propensity of group work in
the addictions field, (d) special issues of confidentiality and privileged communication,
(e) boundaries of professional practice in making treatment decisions, and (0 unusual
circumstances of informed consent. In addressing these issues, addictions counselors
must not only uphold the ethical standards of their profession, they must also be cognizant of any federal statutes that may supersede their state regulations and act in accordance with them.
the necessary professional credentials, (c) the questionable propensity of group work in the addictions field,
(d) special issues of confidentiality and privileged communication, (e) boundaries of professional practice in
making treatment decisions, and (f) unusual circumstances of informed consent.
Lack of Communication
and Continuity
Addiction treatment is an anomaly in the counseling field
and atypical of other therapeutic fields because it has
often relied more on faith than science or empirical findings (Chiauzzi & Liljegren, 1993). Although scientific understanding of addiction is still in its infancy (Thombs,
1999), the state of research, particularly in the field of
chemical addictions, is evolving at a rapid pace.
For instance, for the past decade, researchers have
viewed addiction as a complex, progressive behavior pattern having biological, psychological, sociological, and
behavioral components (Donovan, 1988). More recently,
research has pointed to chemical addiction as a brain disease triggered by frequent use of drugs that change the
Dpro-ecl
210
Lack of Agreement on
Professional Credentials
The clinical standards for providing addictions counseling
have historically been lower than those necessary to perform other kinds of counseling. In many states, the minimum formal education requirements for entry-level
addictions counselors do not even include the baccalaureate degree. Moreover, some states exempt addictions
treatment personnel from licensure or other standards,
and some states have developed separate standards for individuals counseling clients with addiction problems.
George (1990) stated.
Those who currently work as chemicaldependency counselors have tended to adopt
one of two extreme positions; that chemical
dependency counselors must be recovering addicts (or, at the very least, have a recovery program as codependents), or that chemical
dependency counselors must have a minimum
of a master's degree in such related fields as
counseling, social work, or psychology. Unfortunately, this polarization often results in unnecessary conflict among counselors and a lack
of respect and appreciation for what each
group offers to the treatment process, (p. 216)
For most counseling-related professions, the standard is
that counselors providing treatment should have a master's degree or higher, and, where required, they should
meet the licensure standards as professional counselors
(Cottone &. Robine, 1998).
As the research on addictive behaviors unfolds, its
complexity becomes increasingly evident. Because of this,
it is important that counselors working in the addictions
field have specialized training in many complex areas, including both chemical and behavioral addictions, relapse
prevention and other cognitive strategies, neuropsychological processes in addiction, assessment, and individualized treatment planning.
Further, because treatment practices have changed
very little, even though there is training available in these
areas, treatment plans are typically uniform rather than
individualized for people based on their personal needs
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Questionable Propensity of
Group Work
Most conventional treatment programs in addictions are
forced to rely heavily on group work because they lack the
resources for more individualized care. This occurs in two
separate ways: through self-help groups such as Alcoholics
Anonymous, Narcotics Anonymous, and other 12-step
groups, and through group counseling that occurs in both
inpatient and outpatient treatment programs. Both practices raise ethical concerns.
Although the growth of self-help groups validates
the idea that people who have encountered and resolved
certain difficulties possess unique resources for helping
others like themselves (Corey, Corey, & Callahan, 1998),
self-help groups are not supervised by licensed professionals. Thus, group members are not afforded the protection
of the professional license, particularly related to confidentiality and privileged communication (Cottone &
Robine, 1998). Additionally, the model of treatment put
forth in 12-step groups such as Alcoholics Anonymous is
212
ecution of a client unless a court order has been issued according to federal guidelines, even if the client gives consent. Even when consent is granted, federal guidelines
require consent forms to meet federal standards.
Gottone and Robine (1998) described confidentiality issues in group treatment settings. Because many people with addictions problems also have legal problems,
depending on the state statutes and/or federal regulations,
communication in a group setting may not be considered
confidential or privileged, even if a licensed professional
is involved. Typically, if group treatment is cited in a licensure statue, a licensed counselor or psychologist is
bound to keep communication confidential. Group members are not bound by these laws and statutes. Even if
group members sign a contract promising not to disclose
information discussed in the group, it is often not legally
binding. Group members can gossip outside the group
and report information communicated in the group to
otherseven authoritiestypically without repercussion.
Thus, if unlawful activity is communicated within the
confines of the group, the counselor may be bound to confidentiality, providing the crime does not fall under an exception to the statute's confidentiality provisions, but
group members can inform authorities and even testify as
to what was said without legal consequences. In addition,
even if the counselor is bound by licensure statutes, privileged communication may not stand because many states'
provide for privileged communication for civil, but not
criminal, court cases (Gottone & Robine).
Glearly, some methods of treatment work for certain people; however, nothing has been demonstrated to work for
all people. Interestingly, though, judgments about treatment are often made by people whose qualifications to
make such judgments are questionable, no matter how
well-intentioned they are. Judges often mandate that people convicted of driving offenses while using alcohol or
other drugs attend Alcoholics Anonymous (AA) or Narcotics Anonymous meetings. Peele (1996) described this
as the "disease law enforcement model."
Similarly, insurance companies sometimes mandate
treatment centers to require participation in AA as a prerequisite to client/patient coverage. Treatment centers
frequently make AA attendance a mandatory event and
sometimes even make continued treatment contingent on
said attendance. There is often a feeling of helplessness
from all involved about what to do in response to someone's abuse. Because of this, mandates often go unexamined. However, mandating a form of treatment and
labeling nonconformity to or questioning of the treatment
mandate as "denial" often increases resistance to treatment before the individual has an opportunity to examine
treatment alternatives that may be more cognitively and
213
Special Circumstances of
Informed Consent
Treatment services are often initiated when a person is illequipped to make an informed decision. As previously
noted, people often enter treatment with varying degrees
of cognitive dysfunction (Goldman, 1990) and frequently
under the influence of alcohol and/or other drugs. Both of
these factors affect not only their ability to absorb and
profit from treatment but also whether or not they can
make educated decisions on their own accord. For these
reasons, it is important that once clients have been
initially treated, particularly if they have gone through
detoxification, that counselors respect their rights of consent to further treatment or to withdraw from treatment
of their own volition (Gottone &. Robine, 1998).
CONCLUSION
All counselors find themselves in ethically questionable
positions at some point in their careers. Addictions counselors face some especially challenging ethical situations
that are truly unique to the discipline and the client population they serve. For this reason, addictions counselors
must be sure they understand the ethical mandates put
forth not only by their credentialing bodies but also by
any federal regulating agencies that might supersede the
statutes of their own professional organizations. Moreover,
if there is any question relating to ethical behavior, they
must err on the side of conservativism, always putting
their client's welfare and safety first.
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