Ethical Issues faced by Addiction Counselors

Codes of ethics and standards of practice are set forth by professional associations such as the American Counseling Association (ACA) and the National Association of Alcoholism and Drug Abuse Counselors (NAADAC). Such codes define principles of ethical behavior required by the profession. Additionally, treatment centers such as the Hazelden Foundation defines requirements for employees designed to ensure consistent ethical behavior across the organization (Hazelden.org). However, practicing as a professional also requires judgment, ethical decision-making, and regular introspection and clarification of a personal code of ethics.

The effective helper is one who has a sense of self-awareness, an investigative approach, a desire to strive for competence, emotional objectivity, and facilitative attitudes and values. Self-awareness refers to a counselor having insight into who they are, what is important to them, their unique gifts, and limitations they bring into a helping relationship. From a Twelve Step perspective, this involves a regular, Step Ten, personal inventory (Alcoholics Anonymous, Basic Text, 1995). The counselor needs to be cognizant of the power differential in the counselor: patient relationship and "avoid actions that seek to meet personal needs at the expense of clients" (ACA, A.5)

To be effective, the counselor must take regular stock of their attitudes and values. Employees of Hazelden are required to provide "fair and just practices" and to treat all patients with "dignity and respect". As a professional member of ACA and NAADAC, the counselor is commitment to "avoid imposing (their) own values on clients" (ACA, A.5) and to "espouse objectivity and integrity" (NAADAC, 2). This means practicing patience, tolerance, and unconditional regard for each individual client and being cognizant of personal views, which, in many cases, are shaped by a Euro-American, protestant, middle-class, traditional, nuclear family cultural experience.

This is especially important as counseling is rooted in and reflects the dominant values of the larger society, thus reflecting a primarily Eurocentric worldview. As a result, treatment has the potential to represent cultural oppression and cause harm to clients. In 1991, the Association for Multicultural Counseling and Development called upon the counseling profession to minimize this risk by adopting ethical standards that would encourage the development of competencies in multicultural counseling. The present Code of Ethics of the National Association of Alcoholism and Drug Abuse Counselors stipulates that the counselor not discriminate against clients based on race, religion, age, gender, disability, national ancestry, sexual orientation, or economic condition (NAADAC, 2001). While the standard is clear, the competencies required to fulfill the expectation are less so. The lack of clarity is exemplified by, and due in part to, the inconsistent and confusing terminology such as culturally appropriate, multicultural, ethnically sensitive, and cultural diversity. A unifying construct is required for conceptualizing the problem at an individual level and for identifying and implementing solutions.

The therapeutic relationship between client and addiction counselor is a special one based upon mutual respect and trust. Both are enhanced by the counsellor's consistent attention to such ethical considerations. An ethical breach stands to irrevocably destroy trust. With addiction being a potentially fatal disease, full compliance with all ethical considerations on the part of the therapist or counselor then becomes a matter of life and death.
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