Ethical Issues Faced By Addictions Counselors

1. Ethical Issues Faced By Addictions Counselors HLSC 3420 – Group Assignment By Stephanie Walicki, Courtney Hierath and Alexi Frigon

2. What is ethical decision making? • Decision making by professionals that takes into account a number of factors such as: code of ethics, best interest of the client, and personal opinion. In order to provide the most beneficial and ethically sound service to clients. • In this power point we will look at some of the major ethical concerns/dilemmas in addictions counseling. We will do so by identifying the ethical issue, then the reasons why it is important, and then the implications they may have.

3. Issue 1: Personal Beliefs/Biases in Decision Making • One of the many ethical issues that can arise in addictions counselling are when a counsellors values are contradictory to the actions of a client. Some counsellors have religious upbringings for example, which may result in them being against things like alcohol and drug use, gambling, pre marital sex, abortion etc. These are all things that may go one with clients that are seeking advice from a counsellor. As the counsellor regardless of whether or not their morals are congruent with the lifestyle of their clients they must keep act unbiased finding that fine line between personal belief and ethical and practical decision-making.

4. Importance? • This is a very important issue because if a counsellor allows their personal biases to influence their decision making this can result in unethical practice which could potentially influence the client in a manner that is outside of their best interest or outside of their personal beliefs and values. It is important to keep the therapeutic environment objective.

5. Implications This could be detrimental to client-counsellor relationship because if a client feels the counsellor is trying to impose his/her beliefs and opinions on the client the client could feel insulted or disrespected. Clients in a vulnerable place may also be quick to adopt the counsellor’s value and belief system, even if it isn’t in their best interest and is not the most ideal one for them.

6. Issue 2: Confidentiality vs. Duty to Report • Confidentiality versus duty to report is a very common ethical dilemma that arises in addictions counselling. With addictions there is a high prevalence of suicidal thoughts surrounding people when they have reached the end of their rope and have had it with their addictions and the way it has destroyed their life. With suicide if a counsellor feels that a client may be likely to attempt it they are legally and ethically obligated to report this. Another piece of information that counsellors are obligated to report that may come up in addictions due to the use of needles for intravenous injections are HIV and Hepatitis. If a client has disclosed that they have an infectious disease such as this and are not treating it or still sharing needles or having unprotected sex etc. the counsellor is obligated to report this. This is due to the fact that the client is not only in danger herself but putting herself in danger.

7. Importance? • This issue is particularly important because as much as confidentiality is huge between the counsellor and client the safety of clients and others is more important.

8. Implications? • The implications of a situation like this can be tricky. In most situations a client is made aware of this ethical obligation before counselling services are received. However even if the client is aware of this, there can still be a sense of betrayal felt by the client when you must report something that is told in confidence. This can result in a lack of trust and respect from the client for the counsellor which can damage the therapeutic process and relationship. However failing to report a piece of information that results in the harm of a client or someone directly effected by the client can result in loss of your job and legal problems as well.

9. Issue 3: Dual Relationships • Dual relationships are relationships where a client and counsellor have their therapeutic relationship as well as a prior relationship or a secondary relationship that comes after they meet in the counselling setting. For addictions counselling specifically, this becomes a bit of a problem. There are many addictions counsellors that have gone through addictions themselves, so many could be members of support groups or 12 step groups such as Alcoholics Anonymous. A counsellor working with a client in a treatment program may be apart of, or work for support groups and 12 step groups. If a client runs into their counsellor in those situations they are now peers in that setting, this would be a dual relationship.

10. Importance? • This issue is very important as dual relationships are not supposed to happen and are considered unethical. We picked this issue because it seems that it would be much more prevalent for addictions counselling practitioners as opposed to other kinds of counsellors. It is a big problem because you must decide how to act ethically with the clients best interest in mind as well as keeping confidentiality and practicing ethically.

11. Implications? • The implications of a dual relationship are that you could be accused of malpractice, ad well as a plethora of others. The clients might be hurt or offended if you choose to not interact with them and have a relationship, but if you do you are violating the ethical code. A dual relationship can cause complications like conflict of interest, and new biases. It can also change the relationship in the therapeutic setting. If the client had more personal information about the counsellor than they would have just in the session, it can change the power dynamic and the therapeutic setting could be compromised.

12. Issue 4: Informed Consent • As an addictions counsellor you are going to encounter lots of clients who you take in for treatment while they are ill equipped to make an informed decision. There could be all sorts of different cognitive dysfunction going on but especially intoxication either from alcohol or drugs and even mental health issues. This greatly affects a person’s ability to make informed consent. An ethical dilemma around this situation is that once a person has been some what treated, especially if they have gone through detoxification, you must have regard for the clients right to informed consent and must let them decide if they would like to continue treatment or withdraw.

13. Continued.. • The ethical dilemma here is that you must decide if you will listen to the patients right to informed consent or if you will do what has the patient’s best interest. If the client decides to leave treatment and you know that it will be harmful to the client himself or herself as well as others that puts you in a very sticky ethical dilemma and you must decide which route to take.

14. Importance? • This is an important issue especially for addictions counselling. It is because clients may often be under the influence of drugs and alcohol, as well as there is a larger proportion of addictions in people with mental health issues. It is also important because respecting the client’s rights to informed consent may not be in the best interest of the client and/or society. Informed consent also protects the counsellor, when clients are informed of what will happen and what is or is not okay before hand, the counsellor cannot be accused of any malpractice as long as they are sticking to what was consented to.

15. Implications? • Implications of this ethical issue are that a client may leave treatment when they should stay, but as the counsellor you cannot do anything about it. If you do not follow the rules of informed consent you could be accused of malpractice and charged with various offences.

16. Case Example: Sarah and Trixie Sarah is an addictions counsellor who works for a local agency here in Lethbridge. She is unmarried, young, friendly, and eager to make a difference in the world of addiction. Sarah grew up in a very religious family with very strong Christian beliefs. She herself does not drink alcohol; engage in sexual activity, drug use, or any type of illegal activity. It is her belief that it is her mission in life to help all those who are in need. She is very passionate about both her beliefs, and her career and often time struggles with ethical decision-making.

17. Continued.. A few months ago Sarah took on a new client, a 23 year old female named Trixie. Upon reading over Trixie’s history and through conversation with her; Sarah has discovered that Trixie has been living on and off the streets since she was 18 years old. She was born and raised in Manitoba before she ran away at age 18. As a result Trixie has no friends or family in the Lethbridge area. She often feels lonely and depressed and turns to drugs and alcohol for comfort. She has battled with a comorbid addiction of both heroin and alcohol for the past four years. Through the usage of unhygienic needles, due to her heroin addiction, Trixie has also learnt that she contracted HIV. Due to Trixie’s addiction she has been unable to maintain a steady job and has resorted to prostitution as a means of income.

18. Continued… Trixie has become very trusting of Sarah, and is beginning to confide in her some very personal information. Yesterday she explained to Sarah that she had engaged in unprotected sex with a male client approximately one month ago and now believes herself to be pregnant. She knows only the last name of the man she had sex with and has not since spoken to or seen the gentleman. She also hasn’t told anyone else of her current situation. She has expressed to Sarah that she does not intend to keep the child and is planning on scheduling an abortion sometime in the next week or two. She has asked that Sarah not tell anyone of her situation and has threatened that if she does, she will harm both Sarah and/or herself.

19. Case Study Questions • 1) What types of ethical dilemmas is Sarah faced with? • 2) In what way do you think Sarah should go about handling this scenario? • 3) What steps should she take?

20. Summary • Addictions counseling is a very ethically demanding profession as many of the addictive populations carry multiple issues along with their drug use. Knowledge of ethical principles and rights and responsibilities for clients and counselors is essential to ensure as professional helpers we provide clients with the best service we can provide to help them, to improve the systems we work in, and continue to help positively impact our society.

21. References • Miller, P. (2007). Ethical Decision Making In Social Work and Counseling. (1st. ed), Toronto, ON: Nelson Education Limited • CCPA Code of Ethics • Scott, C. (2000) Ethical Issues in Addictions Counseling. 43(4), 209-214