Ethics Standards through a Co-Occurring Lens

The new co-occurring disorder professional (CCDP) certificate announced by CCBAC in California this week prompted me to consider unique ethical issues that might be raised in working with this population. In fact, CCBAC has developed a separate co-occurring disorder Code of Ethics for new specializing professionals. This column will briefly address two of the codes: Nondiscrimination and Professional Standards.

The familiar nondiscrimination clause is so familiar to me that it was refreshing to review it again against the backdrop of mental illness as a specific disability that might encounter discrimination and stigma in chemical dependency treatment settings. Co-occurring mental health conditions and substance abuse affect nearly 8.9 million people yearly, and when only 44 percent received appropriate treatment in the past year, I wonder about the role of stigma in a client’s reluctance to seek treatment (American Psychological Association, 2014). I am particularly interested in the stigma mental illness may carry with counselors and treating professionals. To explore stigma in more depth, I would recommend an article from the Advances in Psychiatric Treatment journal titled “Stigma of Mental Illness and Ways of Diminishing it” by Peter Byrne (2000).  

 

Both mental health counselors and chemical dependency counselors are often attracted to their specialties for personal reasons. We often have a kinship with the clients we treat, and the co-occurring specialty is no exception. It is our personal experience and success facing the co-occurring challenge that will often compel us to see out specialized training and education, and when this is so we bring a wealth of intuitive wisdom to the process.  

We also bring to the process an imperative need for self-care. Much like the co-occurring clients we are treating, we have the dual focus of mental health and chemical dependency self-care tracks that can quickly be derailed in the face of unaddressed countertransference reactivity in the face of client denial, poor boundary setting with clients and colleagues, and overwork. Like most recovering people under stress our first response is often to decrease our self-care, hoping to use the time to rest. It rarely works out this way.    

Self-care for the counselor with co-occurring issues is not a luxury; it is an ethical requirement. The service we deliver is a direct result of what we bring to the process as a person, and we could either be a wonderful role model of healthy dual-diagnosis recovery, or a terrible episode of “what not to do.”  

• Keep your regularly scheduled personal therapy and psychiatric appointments. Try not to reschedule, because appointments have a way of stretching out over time. 
• Stay on top of your medication refills. It is too common to lose track of time in our busy weeks, and time slips away. Write the call-in date on your calendar when you get your new refill as a reminder. 
• If you are going through a medication change, let your supervisor know if you are having trouble with the side effects. 
• Take every single day off and vacation day you have coming to you. Try not to “bank them” because you feel guilty taking time off when the team is already stretched too thin. This is a management issue, not your issue. It is their responsibility to hire appropriately. 
• Continue to attend your recovery support group, and consider adding Al-Anon. Working in treatment to support other people’s recovery is not the same as working your own program and getting the support you deserve. 
• Consider not sponsoring newcomers if you are working a Twelve Step program. You will have long days, and they will often be peppered with crisis. You will need stress-free down time, and 2:00 am calls from sponsees in trouble are not going to be best for you or the people you treat on your caseload. 
• Be realistic about your limits. Know you energy levels and plan your work day accordingly. If you need to take a cat nap on your lunch hour do so. If you function better in the afternoon, try not to take an early morning shift. Play to your strengths instead of fighting your limitations.   
• Monitor your sense of humor, it will save you. It will be important to hold yourself and the people you work with lightly. Keeping things in perspective and using humor will provide the balance this challenging job requires.   

American Psychological Association. (2014). Data on behavioral health in the United States. Retrieved from http://www.apa.org/helpcenter/data-behavioral-health.aspx

Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72.