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Ethical Issues in Addictions Counseling

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Missing work, appointments, or recreation in order to use or because of use ... New York Plenum Press. References. Toriello, P.J., &Benshoff. J.J.(2003) ... – PowerPoint PPT presentation

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Title: Ethical Issues in Addictions Counseling


1
Ethical Issues in Addictions Counseling
  • Enobong Inyang, LPC-I, LCDC, CFAE, CSOTS
  • Sam Houston State University

2
What types of objects of addiction are common in
our society?
  • Addictive objects
  • Alcohol
  • Drugs (illicit prescription)
  • Polysubstance (gasoline, paint, glue, paint
    thinner, aerosol products
  • Addictive objects
  • Food
  • Sex
  • Excessive exercise
  • Work
  • Aggression
  • Internet

3
Addictive objects
  • Addictive objects
  • Relationships
  • Shopping
  • Gambling
  • Criminal activities

4
Common Symptoms of Addictive Behaviors
  • Increased tolerance
  • Withdrawal
  • Addictive activity to feel normal
  • Preoccupation with addictive object

5
Common Symptoms of Addictive Behaviors
  • Social avoidance or isolation
  • Missing work, appointments, or recreation in
    order to use or because of use
  • Daily use (morning use)

6
Common Symptoms
  • Continued use despite problems
  • Consumption pattern (gulping, rationalization as
    medicinal).
  • Guilt
  • Episodic abstinence

7
Common Symptoms
  • Use to the point of blackout or unconsciousness
  • Legal problems (arrests)
  • Why do some people become addicts and others do
    not?

8
Why do some become addicts some do not?
  • Genetic predisposition
  • Chronicity
  • Psychological
  • Neurological component

9
Four Step Addiction Cycle
  • Step one Preoccupation
  • Obsessive thoughts
  • about addictive object
  • Self gratification

10
Four Step Addiction Cycle
  • Step Two Ritualization
  • Use of language, nonverbal signs, patter of
    behaviors to seek, obtain use object of
    addiction

11
Four Step Addiction Cycle
  • Step Three Acting out
  • Acting out compulsive behavior
  • Unable to refrain from using experiencing
    craving

12
Four Step Addiction Cycle
  • Step Four Despair promise to reform
  • Feeling of powerlessness, self condemnation
  • Experience internal guilt

13
Who should provide service?
  • Addiction model
  • Physician may supervise
  • Counselor should be in recovery or consult with
    those in recovery
  • Twelve step program a must

14
Who should Provide Services?
  • Medical model Physician supervised treatment.
  • Social worker coordinates.
  • Counselor must be master prepared. Recovery
    status of staff not important

15
Professional and Ethical Issues Unique to
Addictions Counseling
  • Confidentiality
  • Clients have special protection under federal law
  • Applies to any one applying for or receiving
    treatment referral

16
Confidentiality
  • Mere presence in a chemical dependency facility
    is considered a diagnosis can not be revealed
    without a written consent, nor can it be denied

17
Informed Consent
  • Involuntary treatment
  • Addicts enter treatment at various degree of
    cognitive impairment

18
Dual Relationship
  • Dual role of counselor5 peer recovering
    counselors in AA
  • Romantic relationship with client or former client

19
Privileged Communication
  • Forbids use of treatment information in
    prosecution investigation unless court ordered
    follows federal guidelines

20
Group Therapy
  • Clients not legally bound by confidentiality
  • Counselor is responsible for confidentiality
    must inform group members of limits to
    confidentiality

21
Professional Responsibility
  • Duty to warn
  • To report or not to report, that is the question!
  • In AIDS situations
  • Couple counseling
  • Group counseling

22
Professional Responsibility
  • Duty to warn
  • Those at risk children of alcoholics genetic
    predisposition argument.

23
Professional Responsibility
  • Discrimination against those are seeking service
  • -Gay/lesbians
  • -Sex offenders

24
Professional Responsibility
  • Counselors Values
  • Abstinence/controlled drinking controversy
  • Should recovering/recovered alcoholics drink
    socially moderately?
  • Legalization of drugs for medicinal reason

25
References
  • Donavan, J.E. (1988). Assessment of addictive
    behaviors Implications of an emerging
    biopsychosocial model. In D.M. Donavan G.A.
    Marlatt (Eds.), Assessment of Addictive
    Behaviors (pp3-50) New York Guilford Press.
  • Chiauzzi, C., Liljegren, S. (1993). Taboo
    topics in addiction treatment An empirical
    review of clinical folklore. Journal of
    Substance Abuse Treatmnt,10, 303-316.

26
References
  • Peele, S. (1996). Assumptions about drugs and
    the marketing of drugs policies. In W.K. Bicket
    R.J. DeGrrandpre (Eds.), Drug Policy and
    Human Nature Psychological perspectives on
    prevention, management treatment of illicite
    drug abuse (pp 199-220). New York Plenum Press.

27
References
  • Toriello, P.J., Benshoff. J.J.(2003). Substance
    abuse counselors and ethical dilemmas The
    influence of recovery and educational level.
    Journal of Addictions and Offender Counseling,
    23, 83- 98.

28
Case Study
  • A high-ranking of the clergy tests positive for
    AIDS exposure. He has fathered several children
    and expects to continue to do so. He refuses to
    tell his wife about the test results. As a
    professional what do you do? How do you balance
    his right to privacy and confidentiality and his
    fear of repercussions if the story comes out?

29
Case Study Two
  • A 25 year old mother of an 18 month old is
    referred to your private practice after a third
    DUI. She tells you that her father is a recovered
    alcoholic and drinks socially. She does not think
    that she has a problem and does not believe that
    she needs treatment, or abstinence based
    treatment. What do you do?

30
The End
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