Ethical Issues in Ethical Issues in Addictions CounselingAddictions Counseling

Enobong Inyang, LPC-I, LCDC, Enobong Inyang, LPC-I, LCDC, CFAE, CSOTSCFAE, CSOTS

Sam Houston State University Sam Houston State University

What types of objects of addiction What types of objects of addiction are common in our society?are common in our society?

Addictive objectsAddictive objects

AlcoholAlcohol Drugs (illicit & Drugs (illicit &

prescription)prescription) Polysubstance Polysubstance

(gasoline, paint, (gasoline, paint, glue, paint thinner, glue, paint thinner, aerosol productsaerosol products

Addictive objectsAddictive objects

FoodFood SexSex Excessive exerciseExcessive exercise WorkWork AggressionAggression InternetInternet

Addictive objectsAddictive objects

Addictive objectsAddictive objects

RelationshipsRelationships ShoppingShopping GamblingGambling Criminal activitiesCriminal activities

Common Symptoms of Addictive Common Symptoms of Addictive BehaviorsBehaviors

Increased toleranceIncreased tolerance

WithdrawalWithdrawal

Addictive activity to feel normalAddictive activity to feel normal

Preoccupation with addictive objectPreoccupation with addictive object

Common Symptoms of Addictive Common Symptoms of Addictive BehaviorsBehaviors

Social avoidance or Social avoidance or isolationisolation

Missing work, Missing work, appointments, or appointments, or recreation in order recreation in order to use or because to use or because of useof use

Daily use (morning Daily use (morning use)use)

Common SymptomsCommon Symptoms

Continued use despite problemsContinued use despite problems Consumption pattern (gulping, Consumption pattern (gulping,

rationalization as medicinal).rationalization as medicinal). GuiltGuilt Episodic abstinenceEpisodic abstinence

Common SymptomsCommon Symptoms

Use to the point of Use to the point of blackout or blackout or unconsciousnessunconsciousness

Legal problems Legal problems (arrests)(arrests)

Why do some Why do some people become people become addicts and others addicts and others do not?do not?

Why do some become addicts & Why do some become addicts & some do not?some do not?

Genetic predispositionGenetic predisposition ChronicityChronicity Psychological Psychological Neurological componentNeurological component

Four Step Addiction CycleFour Step Addiction Cycle

Step one: Step one: PreoccupationPreoccupation

Obsessive thoughtsObsessive thoughts

about addictive object &about addictive object &

Self gratificationSelf gratification

Four Step Addiction CycleFour Step Addiction Cycle

Step Two: RitualizationStep Two: Ritualization

Use of language, nonverbal signs, Use of language, nonverbal signs, patter of behaviors to seek, obtain & patter of behaviors to seek, obtain & use object of addictionuse object of addiction

Four Step Addiction CycleFour Step Addiction Cycle

Step Three: Acting outStep Three: Acting out

Acting out compulsive behaviorActing out compulsive behavior

Unable to refrain from using & Unable to refrain from using & experiencing cravingexperiencing craving

Four Step Addiction CycleFour Step Addiction Cycle

Step Four: Despair & promise to Step Four: Despair & promise to reformreform

Feeling of powerlessness, self Feeling of powerlessness, self condemnationcondemnation

Experience internal guiltExperience internal guilt

Who should provide service?Who should provide service? Addiction model:Addiction model:

Physician may supervisePhysician may supervise

Counselor should be in recovery or consult Counselor should be in recovery or consult with those in recoverywith those in recovery

Twelve step program a mustTwelve step program a must

Who should Provide Services?Who should Provide Services?

Medical model: Physician supervised Medical model: Physician supervised treatment. treatment.

Social worker coordinates. Social worker coordinates.

Counselor must be master prepared. Counselor must be master prepared. Recovery status of staff not Recovery status of staff not importantimportant

Professional and Ethical Issues Professional and Ethical Issues Unique to Addictions CounselingUnique to Addictions Counseling

ConfidentialityConfidentiality

Clients have special protection under Clients have special protection under federal lawfederal law

Applies to any one applying for or Applies to any one applying for or receiving treatment & referralreceiving treatment & referral

ConfidentialityConfidentiality

Mere presence in a chemical Mere presence in a chemical dependency facility is considered a dependency facility is considered a diagnosis & can not be revealed diagnosis & can not be revealed without a written consent, nor can it without a written consent, nor can it be deniedbe denied

Informed Consent Informed Consent

Involuntary treatmentInvoluntary treatment Addicts enter treatment at various Addicts enter treatment at various

degree of cognitive impairmentdegree of cognitive impairment

Dual RelationshipDual Relationship

Dual role of counselor5 & peer – Dual role of counselor5 & peer – recovering counselors in AArecovering counselors in AA

Romantic relationship with client or Romantic relationship with client or former clientformer client

Privileged CommunicationPrivileged Communication

Forbids use of treatment information Forbids use of treatment information in prosecution & investigation unless in prosecution & investigation unless court ordered & follows federal court ordered & follows federal guidelinesguidelines

Group TherapyGroup Therapy

Clients not legally bound by Clients not legally bound by confidentialityconfidentiality

Counselor is responsible for Counselor is responsible for confidentiality & must inform group confidentiality & must inform group members of limits to confidentialitymembers of limits to confidentiality

Professional ResponsibilityProfessional Responsibility

Duty to warn:Duty to warn:

To report or not to report, that is the To report or not to report, that is the question!question!

In AIDS situations :In AIDS situations :

Couple counselingCouple counseling

Group counselingGroup counseling

Professional ResponsibilityProfessional Responsibility

Duty to warnDuty to warn

Those at risk – children of alcoholics & Those at risk – children of alcoholics & genetic predisposition argument.genetic predisposition argument.

Professional ResponsibilityProfessional Responsibility

Discrimination against those are Discrimination against those are seeking service:seeking service:

-Gay/lesbians-Gay/lesbians

-Sex offenders-Sex offenders

Professional ResponsibilityProfessional Responsibility

Counselors Values:Counselors Values:

Abstinence/controlled drinking Abstinence/controlled drinking controversycontroversy

Should recovering/recovered alcoholics Should recovering/recovered alcoholics drink socially & moderately?drink socially & moderately?

Legalization of drugs for medicinal Legalization of drugs for medicinal reasonreason

ReferencesReferences

Donavan, J.E. (1988). Assessment of Donavan, J.E. (1988). Assessment of addictive addictive behaviors: Implications of an behaviors: Implications of an emerging emerging biopsychosocial model. In D.M. biopsychosocial model. In D.M. Donavan & Donavan & G.A. Marlatt (Eds.), G.A. Marlatt (Eds.), Assessment of Assessment of Addictive Addictive Behaviors (pp3-50)Behaviors (pp3-50) New York: Guilford New York: Guilford Press.Press.

Chiauzzi, C., & Liljegren, S. (1993). Taboo topics Chiauzzi, C., & Liljegren, S. (1993). Taboo topics in addiction treatment: An empirical review in addiction treatment: An empirical review

of of clinical folklore. clinical folklore. Journal of Substance Abuse Journal of Substance Abuse Treatmnt,10, 303-316.Treatmnt,10, 303-316.

ReferencesReferences

Peele, S. (1996). Assumptions about Peele, S. (1996). Assumptions about drugs and the marketing of drugs and the marketing of

drugs drugs policies. In W.K. Bicket & R.J. policies. In W.K. Bicket & R.J. DeGrrandpre (Eds.), Drug Policy DeGrrandpre (Eds.), Drug Policy and Human Nature: and Human Nature:

Psychological Psychological perspectives on perspectives on prevention, prevention, management & management & treatment of treatment of illicite drug abuse (pp illicite drug abuse (pp 199-220). 199-220). New York Plenum Press.New York Plenum Press.

ReferencesReferences

Toriello, P.J., &Benshoff. J.J.(2003). Toriello, P.J., &Benshoff. J.J.(2003). Substance abuse counselors and Substance abuse counselors and ethical dilemmas: The influence ethical dilemmas: The influence of recovery and educational of recovery and educational level. level. JournalJournal of Addictions of Addictions and and Offender Offender Counseling, 23,Counseling, 23, 83- 83- 98.98.

Case StudyCase Study

A high-ranking of the clergy tests A high-ranking of the clergy tests positive for AIDS exposure. He has positive for AIDS exposure. He has fathered several children and expects fathered several children and expects to continue to do so. He refuses to tell to continue to do so. He refuses to tell his wife about the test results. As a his wife about the test results. As a professional what do you do? How do professional what do you do? How do you balance his right to privacy and you balance his right to privacy and confidentiality and his fear of confidentiality and his fear of repercussions if the story comes out?repercussions if the story comes out?

Case Study TwoCase Study Two

A 25 year old mother of an 18 A 25 year old mother of an 18 month old is referred to your private month old is referred to your private practice after a third DUI. She tells practice after a third DUI. She tells you that her father is a recovered you that her father is a recovered alcoholic and drinks socially. She alcoholic and drinks socially. She does not think that she has a does not think that she has a problem and does not believe that problem and does not believe that she needs treatment, or abstinence she needs treatment, or abstinence based treatment. What do you do?based treatment. What do you do?

The EndThe End