1. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-1 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-2 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-3 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-4 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-5 Ethics ● Moral Principles  Justice  Beneficence  Nonmaleficence  Autonomy  Fidelity  Veracity

6. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-6 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-7 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-8 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-9 Code of Federal Regulations 42, Part 2 ● According to CFR 42, Part 2, confidential client information can be disclosed in only a few instances: a. To medical professionals in the event of an emergency b. To qualified individuals for the purposes of conducting research, audits, and program evaluations c. With an appropriate court order indicating the extent of the necessary disclosure d. With client consent

10. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-10 Code of Federal Regulations 42, Part 2 ● CFR 42, Part 2 does not apply in the following circumstances: a. Members or veterans of the armed forces under the care of military facilities b. Communications with a program c. Qualified services organizations d. Crimes on program premises or against program personnel e. Reports of suspected child abuse and neglect

11. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-11 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-12 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-13 HIPAA ● HIPAA permits covered entities to disclose protected necessary health information without client authorization in the following circumstances: a. To the individual b. To treatment, payment, and health care operations c. As part of an opportunity to agree or object d. Incident to an otherwise permitted use or disclosure e. For pubic interest and benefit activities f. As part of limited data sets for research activities related to public health or health care operations g. The reporting of abuse, neglect, and domestic violence of victims h. The release of information with a court order or for law enforcement purposes i. Health oversight activities j. In the event of the death of the client to funeral directors and medical examiners k. To facilitate organ, eye or tissue donation.

14. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-14 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-15 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-16 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. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-17 Ethic Conflicts Specific to Substance Abuse Counselors Dual Relationships Clients and Criminal Activity Conflicting Laws Ethical Codes

18. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-18 Ethical Decision Making ● Four characteristics of an ethical dilemma a. A choice between two courses of action must be made. b. There are significant consequences for selecting either course of action. c. Each decision is supported by ethical principles. d. The ethical principle of the non-selected action will be comprised.

19. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-19 Ethical Decision Making ● Steps of the ACA endorsed A Practitioner’s Guide to Ethical Decision Making 1. Identify the problem 2. Apply the ACA Code of Ethics 3. Determine the nature and dimensions of the dilemma 4. Generate a potential course of action 5. Consider potential consequences for all options, and choose a course of action 6. Evaluate the selected course of action 7. Implement the course of action

20. Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 2-20 Ethical Decision Making ● STEPS (Solutions for Ethical Problems in Schools) Decision Making Model for those working in the schools (ASCA, 2010) 1. Define the problem emotionally and intellectually 2. Apply the ASCA Ethical Standards and the law 3. Consider the students’ chronological and developmental levels 4. Consider the setting, parental rights and minors’ rights 5. Apply the moral principles 6. Determine your potential courses of action and their consequences 7. Evaluate the selected action 8. Consult 9. Implement the course of action