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Ethics in Addictions Counseling
Leigh Falls, Ed.S., LPC, NCC
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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?
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Addictions Counselor
Competent and trained and experienced working with addictions in general, not just substance abuse
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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
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There is a High Correlation Between Addictive Behaviors and Criminal Activity.
Theft/Burglary Physical Assault Domestic Violence Sexual Assault Kleptomania
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Criminal Behavior
Offense Cycle Criminal Thinking Adrenalin Fix Psychopathy vs.
Sociopathy
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Carnes (1992) 4 Step Addiction Cycle
Preoccupation Ritualization-Patterns of
Language and Behavior Compulsive Behavior Despair and
Powerlessness
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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
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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.
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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
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Despair and Feeling Powerless
Condemning self-talk Internalized guilt Effort to regain sense of control and inner
harmony Return to preoccupied behavior
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Counseling Modalities
Detox / Outside Intervention (police/school)
Initial Assessment Anabuse, DeproProvera, other
medication Individual Counseling Group Counseling Family counseling Self-Help
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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
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Ethical Issues Involved in Addictions and Offender Counseling
Competence Informed Consent Confidentiality Potentially Detrimental
Counselor-Client Relationship
Responsibility to Client Values Multicultural Issues
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Competence
Credentials Differential Diagnosis Skills Dual Diagnosis Specialized treatment: LSOTP Refer or get appropriate
supervision and education, if you don’t have the skills
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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
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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
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Confidentiality
Mandated reporting –child abuse, subpoena, 3rd party reimbursement
Federal Protection Confidentiality Issues in
Group Minors
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Potentially Detrimental Counselor-Client Relationships
Dual Relationships Counselor is a
Recovering Addict Small Town Sexual Relationships Working Outside
Specialty Area Counselor Burnout
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Responsibility to Client
Who is the client? Patient, court, community, family, 3rd party payment, your boss????
Client welfare is your primary concern
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Values Clarification
Personal Values Religious Values Substance Abuse –
Abstinence vs. Controlled Drinking
Heinous Crimes Specialized Techniques:
PPG, Aversion therapy, psychotropic medication
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What to do about value conflicts
Asses your values against the program philosophy
Supervision Referral Address prior to
beginning counseling Discuss with client
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Multicultural Issues
Therapeutic Rapport Listen to and Process
Client Feedback Racial Differences Socioeconomic Status Education Religious Differences Street Culture Drug Culture