Ethics in Addictions Counseling

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