Ethics in Addictions Counseling Leigh Falls, Ed.S., LPC, NCC

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?

Addictions Counselor Competent and trained and experienced working with addictions in general, not just substance abuse

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

There is a High Correlation Between Addictive Behaviors and Criminal Activity. Theft/Burglary Physical Assault Domestic Violence Sexual Assault Kleptomania

Criminal Behavior Offense Cycle Criminal Thinking Adrenalin Fix Psychopathy vs. Sociopathy

Carnes (1992) 4 Step Addiction Cycle Preoccupation Ritualization-Patterns of Language and Behavior Compulsive Behavior Despair and Powerlessness

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

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.

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

Despair and Feeling Powerless Condemning self-talk Internalized guilt Effort to regain sense of control and inner harmony Return to preoccupied behavior

Counseling Modalities Detox / Outside Intervention (police/school) Initial Assessment Anabuse, DeproProvera, other medication Individual Counseling Group Counseling Family counseling Self-Help

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

Ethical Issues Involved in Addictions and Offender Counseling Competence Informed Consent Confidentiality Potentially Detrimental Counselor-Client Relationship Responsibility to Client Values Multicultural Issues

Competence Credentials Differential Diagnosis Skills Dual Diagnosis Specialized treatment: LSOTP Refer or get appropriate supervision and education, if you don’t have the skills

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

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

Confidentiality Mandated reporting – child abuse, subpoena, 3 rd party reimbursement Federal Protection Confidentiality Issues in Group Minors

Potentially Detrimental Counselor- Client Relationships Dual Relationships Counselor is a Recovering Addict Small Town Sexual Relationships Working Outside Specialty Area Counselor Burnout

Responsibility to Client Who is the client? Patient, court, community, family, 3 rd party payment, your boss???? Client welfare is your primary concern

Values Clarification Personal Values Religious Values Substance Abuse – Abstinence vs. Controlled Drinking Heinous Crimes Specialized Techniques: PPG, Aversion therapy, psychotropic medication

What to do about value conflicts Asses your values against the program philosophy Supervision Referral Address prior to beginning counseling Discuss with client

Multicultural Issues Therapeutic Rapport Listen to and Process Client Feedback Racial Differences Socioeconomic Status Education Religious Differences Street Culture Drug Culture