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

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

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

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

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

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

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

9. Four Step Addiction Cycle Step one: Preoccupation Step one: Preoccupation Obsessive thoughts about addictive object & Self gratification

10. Four Step Addiction Cycle Step Two: Ritualization 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 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 Step Four: Despair & promise to reform Feeling of powerlessness, self condemnation Experience internal guilt

13. Who should provide service? Addiction model: 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. 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 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 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 Involuntary treatment Addicts enter treatment at various degree of cognitive impairment Addicts enter treatment at various degree of cognitive impairment

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

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

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

21. Professional Responsibility Duty to warn: 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 Duty to warn Those at risk – children of alcoholics & genetic predisposition argument.

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

24. Professional Responsibility Counselors Values: 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. 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. 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. 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. 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? 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? 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