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Ethics in Addictions Counseling

Ethics in Addictions Counseling. Leigh Falls, Ed.S., LPC, NCC. What is addiction?. Abuse vs. Dependency Behaviors which can become addictive Etiology of addiction Symptoms associated with addictive behaviors Why is this relevant to you?. Addictions Counselor.

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Ethics in Addictions Counseling

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  1. Ethics in Addictions Counseling Leigh Falls, Ed.S., LPC, NCC

  2. What is addiction? • Abuse vs. Dependency • Behaviors which can become addictive • Etiology of addiction • Symptoms associated with addictive behaviors • Why is this relevant to you?

  3. Addictions Counselor • Competent and trained and experienced working with addictions in general, not just substance abuse

  4. Counselor Credentials • Personal Addictions History? • Masters or Ph.D. degree • National Certification • Licensed as a LPC/Psychologist /LCSW/LCDC • Specialty Training and Supervision • Continuing Education

  5. There is a High Correlation Between Addictive Behaviors and Criminal Activity. • Theft/Burglary • Physical Assault • Domestic Violence • Sexual Assault • Kleptomania

  6. Criminal Behavior • Offense Cycle • Criminal Thinking • Adrenalin Fix • Psychopathy vs. Sociopathy

  7. Carnes (1992) 4 Step Addiction Cycle • Preoccupation • Ritualization-Patterns of Language and Behavior • Compulsive Behavior • Despair and Powerlessness

  8. Preoccupation • May be feeling powerless, depressed, anxious • In order to regain a sense of mastery the person fantasizes to make self feel better • Individuals experience obsessions that center on obtaining gratification through the object of their addiction

  9. Ritualization • A series of behaviors designed to obtain the addictive object • Unique language, non verbal communications, or behavioral patterns that communicate membership in this special group • Grooming, casing, scoring, getting trashed etc.

  10. Acting Out on Compulsive Behavior • Craving/Urges • Unable to refrain from obtaining gratification • Poor Impulse Control • Thinking Errors – Sees self as victim of society –justifies or rationalizes behavior to self • Offenders may use alcohol or drugs before an offense in order to use it as an excuse for their criminal behavior • Adrenalin Fix

  11. Despair and Feeling Powerless • Condemning self-talk • Internalized guilt • Effort to regain sense of control and inner harmony • Return to preoccupied behavior

  12. Counseling Modalities • Detox / Outside Intervention (police/school) • Initial Assessment • Anabuse, DeproProvera, other medication • Individual Counseling • Group Counseling • Family counseling • Self-Help

  13. Crispy Creamed • High burnout rate among addiction and offender counselors • Population resistant to treatment • Systemic issues – families, court, front-line staff, managed care • Symptoms – exhaustion, depersonalization, and reduced personal accomplishment • Switching jobs, sub-par service • Impaired professionals

  14. Ethical Issues Involved in Addictions and Offender Counseling • Competence • Informed Consent • Confidentiality • Potentially Detrimental Counselor-ClientRelationship • Responsibility to Client • Values • Multicultural Issues

  15. Competence • Credentials • Differential Diagnosis Skills • Dual Diagnosis • Specialized treatment: LSOTP • Refer or get appropriate supervision and education, if you don’t have the skills

  16. Informed Consent • Patients need treatment when they are under the influence of drugs/alcohol and may not be able to think clearly • Offenders and substance abusers may be mandated to counseling: court order, probation/parole condition, CPS plan, work or licensing boards. • Competence of dual diagnosed bipolar or schizophrenic patients

  17. Informed Consent: What to do??? • Explain thoroughly all issues • Explain at length limits of confidentiality • Explore options other than treatment and consequences • Allow client to make the choice and take responsibility for the consequences • Check for understanding • Go over it again if necessary

  18. Confidentiality • Mandated reporting –child abuse, subpoena, 3rd party reimbursement • Federal Protection • Confidentiality Issues in Group • Minors

  19. Potentially Detrimental Counselor-Client Relationships • Dual Relationships • Counselor is a Recovering Addict • Small Town • Sexual Relationships • Working Outside Specialty Area • Counselor Burnout

  20. Responsibility to Client • Who is the client? Patient, court, community, family, 3rd party payment, your boss???? • Client welfare is your primary concern

  21. Values Clarification • Personal Values • Religious Values • Substance Abuse – Abstinence vs. Controlled Drinking • Heinous Crimes • Specialized Techniques: PPG, Aversion therapy, psychotropic medication

  22. What to do about value conflicts • Asses your values against the program philosophy • Supervision • Referral • Address prior to beginning counseling • Discuss with client

  23. Multicultural Issues • Therapeutic Rapport • Listen to and Process Client Feedback • Racial Differences • Socioeconomic Status • Education • Religious Differences • Street Culture • Drug Culture

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