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The Little Permissions Lead to the Big Permissions: Professional Ethics for Substance Use Disorder Counselors

The Little Permissions Lead to the Big Permissions: Professional Ethics for Substance Use Disorder Counselors

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Substance use disorder (SUD) counselors are charged with several important responsibilities, all of which ultimately have to do with promoting client welfare and protecting client rights. Many times I have asked myself why professionals become unethical, with all of the training and knowledge that a professional counselor has. Some professionals say the reason that many counselors are unethical is because their core characteristics are unethical. That means it won’t matter how much education about ethics you give them, they are just unethical people at the core. Well, that may explain some, but it doesn’t explain how all unethical counselors are unethical. Maybe some counselors want to be ethical, but somehow fall short. It seems as if they may slowly slip into being unethical and did not intended to be an unethical counselor. Maybe these little permissions of unethical behavior, as innocent as they may seem, become big permissions. This article will cover the counselor’s responsibilities including adhering to codes of ethics, standards of practice, respecting client diversity by working in a culturally sensitive manner, and engaging in supervision, consultation, and advocacy. Counselors must also continuously attend to their own wellbeing and evaluate their own effectiveness. Many counselors don’t think of self-care as the basis for being an ethical professional, but it is the most essential element.
 
Ethics are rules of conduct recognized in a particular profession; the shared standards of what is good practice. Ethical codes provide the structure for mandatory ethics, the minimal standard of conduct that is acceptable. Minimal ethics would be reading, signing, and following the code of ethics. Counselors may sometimes sign their code of ethics assuming that no changes have been made. As professionals we are responsible to comprehend everything we sign, if we don’t pay attention to the code of ethics that a counselor signs, this could be the start of a pattern of unethical behavior. Ideally, counselors practice aspirational ethics, which focuses on the spirit behind the code. For example, mandatory ethics permit a counselor to have a romantic relationship with a former client two years after the client’s treatment ends. Aspirational ethics suggest that doing so even after two years is inadvisable. Aspirational ethics is thinking beyond the minimal requirement and thinking about situations that could potentially be unethical, and setting limits of conduct for more than what is mandated. It seems as though some counselors may look at ethics as a mandated requirement. They may grudgingly get their ethical requirements every two years. It is a similarity to a mandated client completing court requirements to keep from suffering a consequence. Aspirational ethics involves challenging yourself to always push to learn more ways to be, and to continue to be an ethical counselor.
 
The statement, “If you don’t have an ethical dilemma then you might be unethical” is something I tell counselors when I talk about ethical decision-making. What that statement is intended to mean is, if you’re not self-evaluating your decisions, or you believe no matter what you do, it is ethical, you might not be as ethical as you think. Being righteous is not the same thing as being ethical. To be ethical, you have to apply a decision making model to a problem and make a self-evaluation. When faced with an ethical dilemma, a situation to which there is not an ideal response, it can be useful to refer to the principles that underline most professional codes of conduct. An ethical action will respect these principles (adapted from Demask & Washington, 2008) below as much as possible:
 
  • Autonomy: Respect the client’s independence and self-determination. 
  • Non-maleficence: Do not harm the client. 
  • Beneficence: Provide benefit for the client. 
  • Justice: Be fair to the client.
  • Fidelity: Be faithful to the client. 
  • Veracity: Be truthful with the client.

 

 
As a SUD counselor, a decision-making model need not be a model learned in school that provides framework for systematically choosing a course of action, when ethical codes do not specify how to act in a particular situation, but a functional framework that a counselor operates from. The steps of one decision-making model (adapted from Corey, Corey, & Callanan, 2011) are to identify the problem, review the code of ethics and relevant laws, consult with another professional, consider possible courses of action and their consequences, choose a course of action, and evaluate the results. 
 
Being an ethical counselor is more than saying that you are ethical. It’s adapting a decision making model, internalizing the code of ethics as your own, and striving to become a better counselor through consultation, self-care, self-evaluation, and good clinical supervision.
 
Professional Development  
 
Professional development is an ongoing responsibility. Many of the counseling profession code of ethics talks about this, and yet many counselors may not fully understand what it means. Professional development is obtained through engaging in continuing education, self-evaluation, supervision, and consultation. Becoming certified should not be the end of a counselor’s education. There is an old saying that goes, “If you always do what you’ve always done, you get what you’ve always got.” Counselors are responsible for staying current in their ever-changing profession. This can be accomplished by formal education, attending workshops and conferences, and reading professional journals and new books about substance abuse counseling. California Certification Board of Drug and Alcohol (CCBADC) stipulate the minimum number of hours of continuing education required for licensure renewal. For Certified Alcohol and Drug Counselors (CADC) it is at least sixty hours every two years. Other individuals that hold other licenses such as physicians, psychologists, Licensed Professional Clinical Counselors (LPCC), or Licensed Clinical Social Workers (LCSW), have different continuing education requirements every two years. Ethical practice requires that a counselor get the training necessary to stay sharp in one’s job, even if that means exceeding the minimum number of hours of continuing education. Good professional practice dictates that counselors should continuously evaluate their own performance. Counselors must acknowledge the limits of their knowledge and skills and take care to practice within one’s scope of competence, as well as the scope of practice described in state law. A SUD counselor must address substance abuse, dependence, and/or its impact on the service recipient as long as the counselor does not use techniques that exceed his or her professional competence. Scope of competence is different than scope of practice. I have adopted this saying that helps illustrate the difference by saying “just because you can does not mean you should.” 

In addition, counselors must also evaluate how their personal beliefs and concerns affect the counseling process, so that they do not pursue personal agendas with clients, thereby reducing treatment quality. An unaware counselor may not present all potentially helpful options to clients, or fail to support clients’ choices of which the counselor disapproves. Many times counselors may show disappointment if their client relapses or becomes angry if their client is dishonest to them. Counselors can usually recognize this as countertransference in others, but may not see it in themselves. There is the saying that relates to this subject, which is “Counselor Know Thy Self.” For example, consider a counselor who believes that there is only one path to recovery for all clients, or that abstinence is the only proper goal for all clients, or that only counselors in recovery themselves can work effectively with addicted clients. Counselors are expected to monitor their own wellness and make healthy lifestyle choices, because this directly affects their professional effectiveness. If personal problems threaten a counselor’s effectiveness, the counselor is responsible for securing whatever assistance is needed. The National Association of Alcohol and Drug Counselors (NAADAC), states in their code of ethics (n.d.): 

 
“Addiction professionals, whether they profess to be in recovery or not, must be cognizant of ways in which their use of psychoactive chemicals in public or in private might adversely affect the opinion of the public at large, the recovery community, other members of the addiction professional community, or most particularly, vulnerable individuals seeking treatment for their own problematic use of psychoactive chemicals. Addiction professionals who profess to be in recovery will avoid impairment in their professional or personal lives due to psychoactive chemicals. If impairment occurs, they are expected to immediately report their impairment, to take immediate action to discontinue professional practice and to take immediate steps to address their impairment through professional assistance.” 
 
This applies to counselors who are in recovery from substance abuse or dependence and those who are not. 
 
Sometimes counselors violate ethical standards not because their motives are bad, but because their judgment has become impaired from poorly managed stress. Many codes of ethics use the term “impaired.” For example, the California Board of Alcohol and Drug Abuse Counselors (CCBADC) Code of Ethics, principle 3d, states the following (n.d., pp. 2): 
 
“The alcoholism and drug abuse counselor/registrant must recognize the effect of professional impairment on professional performance and must be willing to seek appropriate treatment for oneself or for a colleague. The counselor/registrant must support peer assistance programs in this respect.” 
 
Are they talking about just drug and alcohol impairment? Are they talking about other impairments? The National Association of Social Workers (NASW) states in their code of ethics (1999, pp. 5): 
 
“(a) Social workers who have direct knowledge of a colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties that interferes with practice effectiveness should consult with that colleague and assist the colleague in taking remedial action. (b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.” 
 
The American Association of Counselors states in their code of ethics (2005, pp. 9) that:
 
“Counselors are alert to the signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until such time it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.” 
 
Should it be that any impairment potentially resulting in client harm is the standard and not just impairment do to drugs and alcohol? Also when we think recovery can it be recovery from work-a-holic-ism or internet addiction. What would that impairment look like? We should look at it from the stand point of recovery from impairments. What ever has caused you enough problems in your life that interferes with your personal and professional life? This is where clinical supervision plays a helpful role in the development of the counselor and assists in the counselor’s wellness as a professional.
 
Clinical Supervision and Advocacy  
 
An essential tool for an ethical counselor is not only self-evaluation, but also good clinical supervision. The purposes of supervision are to promote the counselor’s growth, protect the welfare of clients, monitor counselor performance, and empower the counselor to self-supervise and carry out their responsibilities as an independent professional (Corey, Corey, & Callanan, 2011). The late Dr. David Powell describes four emphases of supervision: administrative, evaluative, clinical, and supportive. Administrative supervision focuses on matters such as case record maintenance and performance evaluation. Clinical supervision focuses on the clinical skills of the supervisee; someone who has authority over the counselor usually provides supervision. In peer supervision, experienced counselors provide supervision to one another. There are several models of clinical supervision. One way of categorizing them is a developmental approach, a psychodynamic model, a skills model, a family therapy model, and a blended model (Powell, 1998). In addition, Nielsen’s leadership models (2008) of clinical supervision for drug and alcohol counselors can be added to Powell’s blended model for a complete approach to clinical supervision. Adapting a leadership model to clinical supervision will help the clinical supervisor to develop the supervisee. Whichever model of supervision is used, the exact responsibilities of the supervisor and supervisee should be spelled out, and supervisees should be informed at the outset how their performance is going to be evaluated. Providing competent supervision requires specialized knowledge and skills that differ from those required for counseling. Clinical supervisors are held legally responsible for the actions of counselor interns they supervise. A counselor seeks consultation in order to apply the expertise of another person toward better serving a client. Consulting is another way to build competence as a professional. When this happens the counselor learns from other professionals what they would do and help build knowledge and self efficacy in the counselor. They also need to be familiar with services available in the community, such as legal services, emergency services, Alcoholics Anonymous, SMART Recovery, and other mutual-help groups. Examples of people with whom counselors might consult are a client’s physician, a marriage and family therapist, or a religious leader. In order to make proper referrals, counselors need to be able to recognize symptoms in clients that require assessment by other professionals such as physicians, psychologists, or licensed professional counselors. It is good practice to be personally familiar with the philosophy, programs, and personnel of the services to which clients are referred and to be active in the referral; for example, to make the appointment for clients rather than just provide a phone number for them to call (Kinney, 2012, p. 243). Advocacy is any activity designed to obtain a service, practical help, support, or information for a client. Advocacy requires that counselors maintain effective relationships with other professionals, government organizations, and groups in the community that might be helpful to their clients’ recovery or quality of life. It is important for the counselor to come from an inquisitive place in order to receive information from the other professional and create a partnership with that professional so that they may better help the client get their needs met. 
 
Cultural Sensitivity  
 
Counselors are required to be respectful of clients of all cultures. Many people call this cultural competence, but for the purposes of this article we will call this cultural sensitivity. Competence would mean that someone fully understands the position or culture of another. While it is possible to be sensitive to a culture that is not your culture, it is almost impossible to be truly competent in another culture. Cultural differences exist in clients’ socioeconomic status, racial or ethnic identification, gender, sexual orientation, physical and cognitive ability, and religion. The first step in culturally sensitive counseling is to be aware of one’s own lack of information about other cultures and one’s prejudices. When a counselor encounters a client whose culture is unfamiliar, the counselor is responsible for obtaining the education and guidance necessary to understand their culture, and to process any feelings that could interfere with counselor empathy. Otherwise, a counselor might unintentionally behave in a racist, ethnocentric, ageist, sexist, or heterosexist manner. If the counselor is unable to work effectively with a client, a referral should be made. SUD counselors need to be comfortable acknowledging and exploring the influence of culture with individual clients, as well as not make assumptions about individual clients based on the client’s cultural identifications. 
 
What makes counseling a profession is that its members share a common body of knowledge, a code of ethics, and a concern for their peers (Bissell & Royce, 1994, p.1). Ethics are not just a code that is followed; it is an adopted way of being and perceiving the world that puts principles in place to protect the client and the counseling profession. The title of the article is that “the little permission lead to the big permissions,” which means that counselors must adhere to codes of ethics, follow the standards of practice, respect client diversity, and engage in supervision, consultation, and advocacy.  
 
The counselor must adopt a “Do no harm” philosophy and follow the four basic characteristics of a professional counselor, which are genuineness, respect, empathy, and warmth. This means that people cannot be warm, empathic counselors by day and serial killers by night. Professional conduct results in quality service to clients, personal satisfaction, protection from burning out, and enhancement of the substance abuse counseling field’s visibility and reputation in the community.
 

 

 
References  
 
American Association of Counselors (ACA). (2005). ACA code of ethics. Retrieved from http://www.counseling.org/Resources/aca-code-of-ethics.pdf
 
Bissell, L. C. & Royce, J. (1994). Ethics for addictions professionals (2nd ed.). Center City, MN: Hazelden. 
 
California Certification Board of Alcohol and Drug Counselors (CCBADC). (n.d.) Registered recovery worker (RRW) application/packet. Retrieved from https://www.caadac.org/site_media/media/attachments/flatpages_flatpage/92/RRW%20pkt.pdf
 
Corey, G., Corey, M. S., & Callanan, P. (2011). Issues and ethics in the helping professions. Australia: Brooks/Cole/Cengage Learning.
 
Demask, M. & Washington, D. A. (2008). Legal and ethical issues for addiction professionals. Center City, MN: Hazelden. 
 
Kinney, J. (2012). Loosening the grip: A handbook of alcohol information (10th ed.). New York, NY: McGraw Hill. 
 
National Association of Alcohol and Drug Counselors (NAADAC). (n.d.) NAADAC code of ethics: IV. Professional responsibility. Retrieved from http://www.naadac.org/code-of-ethics#iv
 
National Association of Social Workers (NASW). (1999). The national association of social workers (NASW) code of ethics. Retrieved from http://www.sp2.upenn.edu/docs/resources/nasw_code_of_ethics.pdf
 
Neilsen, P. (2008) Transformational leadership: Helping solve the leadership puzzle. Counselor, 9(5), 40–1. 
 
Powell, D. J. & Brodsky, A. (2004). Clinical supervision in alcohol and drug counseling. San Francisco, CA: Jossey-Boss, Wiley Imprint.
 
Remley, T. P., & Herlihy, B. (2001). Ethical, legal, and professional issues in counseling. Upper Saddle River, NJ: Merrill Prentice Hall.
 
Royce, J. (1989). Alcohol problems and alcoholism: A comprehensive survey. New York, NY: The Free Press.
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