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