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Addiction Counselor Exam Review Podcast
Episode 21
Host: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review

~ Define ethics
~ Review the rationale for ethics
~ Explore ethical issues that counselors need to be aware of
~ Learn a model of ethical decision making.
Professional and ethical responsibility
~ Ethics is designed for the protection of four distinct groups:
~ The client
~ The clinician
~ The profession
~ The community
~ When they are unclear or conflicting needs between the four groups ethical conflicts arise
~ The primary responsibility for ethical practice and for identifying ethical breaches rests with the addiction counselor in the clinical supervisor
~ Scope of Practice
~ Activities and procedures that can be performed legally by members of a licensed or certified profession
Professional and ethical responsibility
~ Addiction professionals have a responsibility for self governance
~ Many questions of professional ethics rely on subjective interpretation
~ Clear communication is essential in the counseling relationship to avoid ethical problems
~ Ethical standards both prescribed and prohibit specific behaviors on the part of a professional
~ Often more attention is paid to the ethical breaches that deal with prohibited behavior than to prescribe behaviors
~ Counselors have a professional responsibility to seek in utilize appropriate supervision and complete continuing professional education
Ethics continued
~ The code of ethics defines a standard of expected behavior
~ Codes are helpful for giving clients and the public in a sense of the level of professional behavior
~ Codes may not provide a practical or detailed guidance needed
~ Simply following a list of specific rules of conduct is not ensure that a counselor will practice and ethical manner

Ethics continued
~ Contracts defined provider duties and responsibilities
~ Negligence is a failure to uphold ones contractual duties
~ Requirements must be treated in the following order of precedence:
~ Law
~ Precedent by case law
~ Reasonable person test
~ Regulations or administrative rules
~ Contracts
~ Use of public funds creates an obligation to fulfill the public trust and result in higher standards than those required in private industry
Ethics continued
~ Ethics can be thought of as a set of principles that define our actions
~ Seven criteria for defining ethics
~ Require other people, they’re about relationships
~ Intense makes a difference
~ Ethics and result the lemons
~ Thinking is necessary for ethics and morality
~ Ethics ask you to be impartial
~ Ethics require us to care about the suffering of others
~ Ethics judge human behavior
~ Columns reflect what most members of the profession have agreed on in some kind of formal process rather than reflecting ideal standards
Ethics Principles
~ Autonomy
~ Fidelity
~ Justice
~ Beneficence
~ Including efficiency and effectiveness
~ Nonmalfesience
Personal Qualities
~ Empathy
~ Sincerity
~ Integrity
~ Resilience
~ Respect
~ Humility
~ Competence
~ Fairness
~ Wisdom
~ Courage
~ Commitment
~ Concern
Ethics continued
~ Published codes of ethics may lag behind the needs and demands of dated a practice this is why it’s important for professionals to understand the principles that lie behind their respective codes
~ Most code to general in nature and reflect the consensus of professionals in a given field and a single point in time
~ There may be inconsistencies within code of ethics or between codes of ethics that govern the same profession
~ While there is no universally accepted code of ethics for the addiction field clinician should be familiar with the ethics codes from his or her state territory or tribe

Ethics continued
~ Foundations of ethics
~ Ethics are based on moral values, a sense of what is right and wrong
~ Professional ethics focus is on the intersection between client rights and professional duties
~ Ethical conflicts or dilemmas occur when the perception of what is appropriate conduct within a particular context is not shared between the parties of bad interaction
~ Ethical conflicts arise and three basic contexts:
~ Failure to comply with the law, governing policies, or codes
~ Personal dilemmas where an individual knows what is right that is tempted to do wrong, such as dual relationships
~ Moral dilemmas when there are conflicting rights or conflicting wrongs
~ When compliance with the law or policy is mandatory failure to comply becomes an ethical issue
~ When both positions in an ethical question are wrong one will prevail, the lesser of two evils

Ethics continued
~ There are three elements to ethical or moral decision-making
~ The counselor as a person with a sense of self awareness
~ Moral sense which means having a conscience and an understanding of the difference between right and wrong
~ And values that reflect what we believe in our life
~ Counselor value show up in their choice of theories strategies and interventions
~ It is neither possible nor desirable for counselors to be neutral in the values they demonstrate
~ It is important for counselors to be clear about their own values and how the info as the therapeutic relationship
~ Counselor should not try to persuade clients to adopt their values and should it knowledge and label their own values
Ethics continued
~ Six general guidelines for daily ethical conduct
~ Provide informed consent
~ Operate in a competent and theoretically sound banner
~ Ensure confidentiality
~ Maintain appropriate relationship boundaries
~ Utilize adequate consultation
~ Honor diverse personal and cultural values
Ethics continued
~ Operating in a confident and theoretically sound manner
~ The scope of practice defines the actions that a member of the profession a strained and authorized to perform
~ Counselors have an ethical responsibility to identify and evaluate client issues that are outside of their scope of practice and refer to other professionals as indicated
~ Competence can be indicated by education, experience, training and certification
~ Understanding your strengths and weaknesses and having the level of self awareness about why you do things you do in your counseling practice and strengthen your professional competence
~ Competence and one clinical area doesn’t necessarily translate to another
Ethics continued
~ Operating in a confident and theoretically sound manner
~ Continuing professional development through education, self a valuation, clinical supervision, and consultation helps addiction counselor to maintain confidence and enhance professional effectiveness
~ Counselors have an ethical responsibility to understand the theory in research that underlies their work and to know how to choose appropriate interventions on the basis of that theory
~ Counselors were making their own choices about the theoretical approach they will use must examine ethical considerations including cultural appropriateness, counselor training and competence anclient needs
~ One of the highest ethical charges for the addiction counselor is maintaining confidentiality
~ This includes protecting the client’s privacy and guarding information contained in the clinical record
~ Federal law 42 CFR outlines the provisions which must be followed
~ Unauthorized disclosure of client information is prohibited regardless of whether the person is seeking disclosure already has the information sought, has other means of it obtaining it, is a law enforcement officer or other official, has attained a subpoena, or asserts any other justification or basis for disclosure not expressly permitted by this regulation
~ The regulations apply equally to present and former program personnel
~ Violation will result in a fine up to $5000
~ The prohibition of disclosure covers all records and communications, whether written or not, about clients who apply for or have been diagnosed, treated, or referred for treatment
~ Federal law 42 CFR outlines the provisions which must be followed cont…
~ Written records must be kept secure
~ At the time of admission each program is required to tell clients that the records are confidential and protected by the Federal law and regulation. Clients must be given a written summary of the laws and regulations
~ If state law permits a minor acting alone to apply for and obtain treatment that are written consent for the release of confidential information may be given only by the minor client. In many states minors must sign all informed release consents
~ Client information can be released in three ways: with clients written consent, without clients consent as specified in the regulations, or with a court order.
Confidentiality continued
~ A written consent form us contain all of the following elements
~ The name or general designation of the program making the disclosure
~ The name of the individual or organization who will receive the disclosure
~ The name of the participant who is the subject of the disclosure
~ The purpose of or need for the disclosure
~ A description of how much and what kind of information will be disclosed
~ The pages right to revoke consent in writing and any exceptions to the right to revoke

Confidentiality continued
~ A written consent form us contain all of the following elements, cont..
~ The program’s ability to condition treatment, payment, enrollment, or eligibility of benefits on the patient’s agreeing to sign the consent
~ The date event or condition upon which the consent expires if not previously revoked
~ The signature of the patient in or other authorized person
~ the date on which the consent assigned
~ Each disclosure must be accompanied by a written statement prohibiting further disclosure of the information unless authorized in the original release-and in in

Confidentiality continued
~ There are special provisions for the release of information were a client has involvement with the criminal justice system
~ State laws may differ
~ In general a signed release of information is still required
~ Releases of information for criminal justice clients differ in the following ways:
~ Information made a release to those persons within the criminal justice system who have a need for information in connection with their duty
~ The release must state an end date. It will remain in effect taking into account the length of treatment and type of criminal proceeding
~ The provider may RE disclose information to those within the criminal justice system to carry out official duties
~ Criminal justice client information may be disclosed to those persons within the criminal justice system when participation in the program is a required condition and to those individuals who need the information in connection with their duty to monitor the client’s progress including prosecutors, court officials, and probation and parole officers
Confidentiality continued
~ Disclosures without client consent
~ Reports of suspected child abuse and neglect
~ Crimes on program premises or against program personnel
~ Medical emergencies
~ Research activities conducted by qualified researchers
~ Audit and evaluation activities including third party payers and peer review organizations
~ Qualified service organizations
~ Court order in
Informed consent
~ Informed consent is one of the most basic and important concepts and ethical practice because it established as the client’s independence and right to self determination in receiving services
~ Client director treatment focus is on the assumption that the client has the right to choose or refuse treatment, to set goals for treatment outcomes and to define his or her recovery
~ To make good decisions the client is to fully understand what will happen in the treatment process, the proposed length of treatment, the conditions for termination, the policy for making complaints or resolving disputes, the cost of services, how to access third party payments, the risks and benefits of accepting or refusing treatment and the possible outcomes of treatment
~ They have the right and the power to consent to and more importantly to refuse to consent to treatment
Informed consent continued
~ Informed consent is more than signing the right forms
~ Informed consent is an ongoing collaborative effort between client and counselor for establishing and continuously monitoring the goals and strategies of counseling
~ Critical elements:
~ Clients rational capacity to provide consent
~ Clients comprehension
~ Clients sense of self determination or voluntariness
~ Cultural issues are important considerations in determining whether truly informed consent has been obtained. Lack of understanding of professional terminology, linguistic barriers, and pour literacy skills may inhibit a client’s a true understanding and may also affect a client’s willingness to ask questions

Counselor self-disclosure
~ In in order to maintain appropriate boundaries and clear roles, a counselor should limit sharing personal information the circumstances when doing so is clearly relevant to the client’s treatment goals
~ Choose the parts of their experience there helpful to the client and monitor how this disclosure effects the clinical relationship
~ Only reveal information about a personal life problem well after it has been resolved
Dual Relationships
~ Dual relationships are common, although not ethical in substance abuse counseling
~ Counselors in recovery cannot
~ Sponsor or be sponsored by a client
~ It is discouraged when possible to attend the same meetings as clients
~ See, in a clinical capacity, a client whom they have known as a sponsee or fellow person in recovery
~ Ethics is aspirational and encourages clinicians to reach beyond legal mandates
~ Ethics helps ensure counselors are doing things in the best interest of the client
~ Ethical violations can lead to fines, suspensions or license revocation by the board
~ It is imperative for counselors to observe the principles of: Beneficence, nonmalfesience, fidelity, justice, and autonomy