Presentation on theme: "NIAAA Social Work Education Module 9"— Presentation transcript:
1 NIAAA Social Work Education Module 9 Legal and Ethical Issues in Prevention and Treatment of Alcohol Use DisordersNIAAA Social Work EducationModule 9Lecture notes are provided in this file, they may not be visible. Go to “view” and “notes pages.”[Slide 1] IntroductionThis module delineates the special ethical and legal concerns related to the treatment and prevention of alcohol use disorders. General ethical guidelines established by the National Association of Social Workers (Code of Ethics, 1996) and state licensing laws are relevant to the area of substance abuse practice. It is assumed that social workers graduating from accredited programs are fully aware of, and compliant with, these guidelines. This module focuses on the special issues that pertain to alcohol use disorders:ConfidentialityInformed consentThe duty to careRespecting client self-determinationCredentialing mechanisms(revised 3/04)
2 Outline Background information Confidentiality Informed consent The duty to careRespecting client self-determinationCredentialing mechanisms[Slide 2] Learning ObjectivesBy the end of this module, learners should be able to:Recognize the unique confidentiality requirements for alcohol use disorder (AUD) treatment and prevention programsUnderstand the special requirements pertinent to obtaining informed consent for substance abuse treatment programsConsider the issue of ‘duty of care’ as it relates to this population and to these programsBecome familiar with those aspects of respect for self-determination that frequently arise in this areaBecome familiar with emerging requirements for documentation by practitioners of specific competencies in the field of substance abuse
4 ConfidentialityConfidentiality concerns may deter individuals from seeking needed alcohol treatment servicesDrug Abuse Prevention, Treatment, and Rehabilitation Act (21 U.S.C. 1175)Section 42 of the Code of Federal Regulations, Part 2 (CFR)[Slide 4] ConfidentialityThe Surgeon General's report on mental health (Office of the Surgeon General, 1999) cites empirical studies showing that a concern about lack of confidentiality may deter individuals from seeking needed treatment for alcohol use disorders. Increasing the self-referral into treatment of those with alcohol use disorders was the impetus for the Drug Abuse Prevention, Treatment, and Rehabilitation Act (21 U.S.C. 1175) and its specific provisions for protecting client confidentiality. The requirements of this legislation have been codified in section 42 of the Code of Federal Regulations, Part 2 (CFR). Other entities that also sanction the imperative of maintaining client confidentiality include: the NASW Code of Ethics (1996), state licensing laws conferring privileged communication, and the Americans with Disabilities Act where provisions are particularly relevant to clients with alcohol use disorders and are referred through EAP programs.
13 Practice StandardsAlcohol treatment specialists in social work (NASW specialty in ATOD)Standards for care (e.g., ASAM)Resources limit access?[Slide 13] Trend Toward Emerging Standards of PracticeIn social work, ATOD is an area of specialization. ATOD specialists can screen for alcohol use disorders, treat alcoholism, and recognize an acute need for detoxification. In the mental health area, responsibility for diagnosing within one's area of expertise constitutes a duty of care. What level of diagnostic acumen can the public expect from a non-ATOD specialist social worker in cases of acute detoxification or the presence of an alcohol use disorder?Specific standards of care are emerging for the practice of medicine. Individual physicians have much less latitude in determining the treatments offered to patients. For example, AHRQ has issued guidelines for the treatment of major depression. The APA has guidelines for the treatment of smoking cessation. Medicare specifies the number of in-patient days that will be compensated for each Diagnostic Related Group.In the area of alcohol use disorders, ASAM has issued standards for levels of care (Mee-Lee, l994; Frames.htm). These standards address, for in-patient or out-patient treatment, the number of hours of therapeutic contact per week recommended for clients in various categories. For the present, social workers should at least be aware of ASAM criteria and other relevant standards of care so that they can justify their actions if they deviate from a standard of care.The most common reason for failure to comply with an ASAM standard is the lack of a payment mechanism for treatment. ASAM recommends in-patient treatment for substance abusers who lack social support. Many homeless individuals fall into this category and the availability of in-patient treatment is dwarfed by the size of the homeless community. Managed care clients experience similar limitations on access to recommended levels of care (Galanter, Keller, Dermatis & Egelko, l999). How to be ethical when resource limitations preclude good treatment is an issue that must be addressed.
14 Factual Information Empirical support for “facts” Informed populations (internet and other media sources, public access to scientific reports)Social work responsibility to be informed[Slide 14] Factual InformationAccording to the American Psychological Association's code of ethics (l992, 3.03a, 6.03a, 7.04), ethical psychologists should have supporting data for factual statements that they make. There is no similar provision in the NASW Code of Ethics, but the question of whether or not there should be does arise. In l935, only limited data were available to support or refute the theory of alcoholism that was propounded with the advent of AA. In recent years, a great deal of empirical research has tested some theoretical hypotheses (Littrell, l991). Should an ethical social worker be required to stay apprised of data supporting and refuting various perspectives? To what extent should social workers be required to distinguish between facts and opinions when talking with clients? Again, social work guidelines have not been proffered.Quite apart from the ethical obligation to adhere closely to facts when speaking with clients, there is a practical necessity. The American community has better access to information than in the past, particularly through internet and other media sources. For example, findings from the Rand report indicating a sizable proportion of individuals who had been treated for alcoholism had achieved a controlled drinking recovery, was widely publicized (see Littrell, l99l). Given a highly informed client community, it is incumbent upon social workers to stay abreast of emerging research in their field in order to maintain credibility.
17 Additional Materials for Social Work Education Opportunities AppendicesAdditional Materials for Social Work Education Opportunities
18 Tarasoff vs. California Board of Regents Duty to warn prospective victims of a client’s intentionsPossible Tarasoff situations:HIV positive client having sex with unaware partner?Client whose intoxication/hangovers could jeopardize lives? (e.g., pilots, drivers, medical care personnel)Teenagers practicing unsafe sex?Riding with drunk drivers, driving drunk?
19 Solutions?Be proactive and preplan (e.g., develop policies for sending drunk clients home safely)Consult colleaguesKnow relevant policies (e.g., school rules, local laws)Understand duty to commit clients who are an acute danger to self or othersInform clients BEFORE beginning treatment (informed consent and limitations to confidentiality)