CHAPTER 2: Ethical and Legal Issues in Substance Abuse Counseling

1. CHAPTER 2:Ethical and Legal Issues in Substance Abuse Counseling Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter • Introduction • Education and Training of Substance Abuse Counselors • Ethics • Confidentiality • Multiculturalism, Diversity, and Ethics • Ethical Conflicts Specific to Substance Abuse Counselors • Ethical Decision Making

3. Introduction • This chapter provides an introduction and awareness of the complexity of legal and ethical issues in substance counseling. • It is the responsibility of the substance abuse counselor to be aware of the current federal, state, and local laws, regulations, and ethical codes governing his/her profession.

4. Education and Training of Substance Abuse Counselors • Substance abuse counseling field is comprised of counselors with an array of educational and experiential differences. • Mental health counselors typically complete a Master’s degree to be credentialed; Substance abuse counselors can be recognized after a few specialized courses

5. Ethics • Moral Principles • Justice • Beneficence • Nonmaleficence • Autonomy • Fidelity • Veracity

6. Ethics • Codes • ACA (American Counseling Association) • NAADAC (National Association of Alcohol and Drug Abuse Counselors) • NBCC (National Board of Certified Counselors) • AMHCA (American Mental Health Counselors Association) • ASCA (American School Counselors Association)

7. Confidentiality • Confidentiality belongs to the client • Confidentiality cannot be entirely protected • Counselors responsibility to inform the client of the limits of confidentiality. • Duty to warn/Duty to protect • Counselors are responsible for reporting abuse or neglect of children, the elderly, and/or persons not competent to care for themselves. • Codicil phrase: “Unless you tell me that you’re going to hurt yourself or others”

8. Code of Federal Regulations 42, Part 2 • Strictly protects the confidentiality of “records of the identity, diagnosis, prognosis or treatment of any patient” that are maintained by a program that provides screening or treatment of drug or alcohol abuse and receives funds (directly or indirectly) from the federal government • Purpose is to encourage substance abusers to seek treatment without fear of discrimination, legal ramifications, or fear of losing one’s job.

9. Code of Federal Regulations 42, Part 2 • According to CFR 42, Part 2, confidential client information can be disclosed in only a few instances: • To medical professionals in the event of an emergency • To qualified individuals for the purposes of conducting research, audits, and program evaluations • With an appropriate court order indicating the extent of the necessary disclosure • With client consent

10. Code of Federal Regulations 42, Part 2 • CFR 42, Part 2 does not apply in the following circumstances: • Members or veterans of the armed forces under the care of military facilities • Communications with a program • Qualified services organizations • Crimes on program premises or against program personnel • Reports of suspected child abuse and neglect

11. HIPAA • Purpose is to protect individually identifiable health information while increasing the flow of information between health care providers, health plans, and healthcare clearinghouses. • Healthcare providers: any provider, or third party on behalf of the provider, who electronically transmits health information for the purpose of claims submissions, inquires about patient eligibility benefits, and authorizing referrals. • Health plans: health insurance companies, HMO’s, Medicare, Medicaid, and other health carriers. • Healthcare clearinghouses: billing services, community health management information systems, and other processing systems.

12. HIPAA • Individually identifiable health information that is protected by HIPPA includes: • Demographic data regarding an individual’s past, present, or future physical or mental health condition and payment for the health care provided; • Information related to the provision of health care to the individual. • HIPPA does not apply to: • Health information contained in employer records in in educational records.

13. HIPAA • HIPAA permits covered entities to disclose protected necessary health information without client authorization in the following circumstances: • To the individual • To treatment, payment, and health care operations • As part of an opportunity to agree or object • Incident to an otherwise permitted use or disclosure • For pubic interest and benefit activities • As part of limited data sets for research activities related to public health or health care operations • The reporting of abuse, neglect, and domestic violence of victims • The release of information with a court order or for law enforcement purposes • Health oversight activities • In the event of the death of the client to funeral directors and medical examiners • To facilitate organ, eye or tissue donation.

14. Confidentiality in Group Counseling or 12-Step Groups • Limits to confidentiality • Confidentiality and privileged communication laws do not protect 12-step members that are not run by licensed, credentialed professionals. • Counselors are obligated to screen clients for group appropriateness for the safety and benefit of all clients. • Not all clients are appropriate for group counseling settings, as many clients have coinciding mental conditions.

15. Confidentiality of Minors • Confidentiality of Minors • FERPA: Family Educational Rights and Privacy Act • IDEA: Individuals with Disabilities Education Act • PPRA: Pupil Rights Amendment Act • HIPAA: Health Insurance and Portability Act • CFR 42, Part 2 (Code of Federal Regulations)

16. Multiculturism and Diversity • Ethical counselors do not discriminate based on: • Age, • Disability, • Religion, • Ethnicity/Race, • Socioeconomic status, • Sexual orientation, • Gender/Gender identity, • Any other bias that would impact the person or the counseling relationship negatively

17. Ethic Conflicts Specific to Substance Abuse Counselors

18. Ethical Decision Making • Four characteristics of an ethical dilemma • A choice between two courses of action must be made. • There are significant consequences for selecting either course of action. • Each decision is supported by ethical principles. • The ethical principle of the non-selected action will be comprised.

19. Ethical Decision Making • Steps of the ACA endorsed A Practitioner’s Guide to Ethical Decision Making • Identify the problem • Apply the ACA Code of Ethics • Determine the nature and dimensions of the dilemma • Generate a potential course of action • Consider potential consequences for all options, and choose a course of action • Evaluate the selected course of action • Implement the course of action

20. Ethical Decision Making • STEPS (Solutions for Ethical Problems in Schools) Decision Making Model for those working in the schools (ASCA, 2010) • Define the problem emotionally and intellectually • Apply the ASCA Ethical Standards and the law • Consider the students’ chronological and developmental levels • Consider the setting, parental rights and minors’ rights • Apply the moral principles • Determine your potential courses of action and their consequences • Evaluate the selected action • Consult • Implement the course of action