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8. Professional and Ethical Responsibilities

Professional and ethical responsibilities are the obligations of an addiction counselor to adopt ethical and behavioral standards of conduct and continuing professional development. Our competencies in this area, are:

1. To adhere to established professional codes of ethics that define the professional context within which the counselor works to maintain professional standards and protect the client.

Knowledge, skills, and attitudes:

  • Federal, State, agency, and professional codes of ethics.
  • Clients’ rights and responsibilities.
  • Professional standards and scope of practice.
  • Boundary issues between client and counselor.
  • Difference between the role of the professional counselor and that of a peer
  • counselor or sponsor.
  • Consequences of violating codes of ethics.
  • Means for addressing alleged ethical violations.
  • Nondiscriminatory practices.
  • Mandatory reporting requirements.
  • Openness to changing personal behaviors and attitudes that may conflict with ethical guidelines.
  • Willingness to participate in self, peer, and supervisory assessment of clinical skills and practice.
  • Respect for professional standards.

2. To adhere to Federal and State laws and agency regulations regarding the treatment of substance use disorders.

Knowledge, skills, and attitudes:

  • Federal, State, and agency regulations that apply to addiction counseling.
  • Confidentiality rules and regulations.
  • Clients’ rights and responsibilities.
  • Legal ramifications of noncompliance with confidentiality rules and regulations.
  • Legal ramifications of violating clients’ rights.
  • Grievance processes.

3. To interpret and apply information from current counseling and psychoactive substance use research literature to improve client care and enhance professional growth.

Knowledge, skills, and attitudes:

  • Professional literature on substance use disorders.
  • Information on current trends in addiction and related fields.
  • Professional associations.
  • Resources to promote professional growth and competency.
  • Read and interpret current professional and research-based literature.
  • Apply professional knowledge to client-specific situations.
  • Apply research findings to clinical practice.
  • Apply new skills in clinically appropriate ways.
  • Commitment to life-long learning and professional growth and development.
  • Willingness to adjust clinical practice to reflect advances in the field.

4. To recognize the importance of individual differences that influence client behavior, and apply this understanding to clinical practice.

Knowledge, skills, and attitudes:

  • Differences found in diverse populations.
  • How individual differences affect assessment and response to treatment.
  • Personality, culture, lifestyle, and other factors influencing client behavior.
  • Culturally sensitive counseling methods.
  • Dynamics of family systems in diverse cultures and lifestyles.
  • Client advocacy needs specific to diverse cultures and lifestyles.
  • Signs, symptoms, and patterns of violence against persons.
  • Risk factors that relate to potential harm to self or others.
  • Hierarchy of needs and motivation.
  • Assess and interpret culturally specific client behaviors and lifestyles.
  • Convey respect for cultural and lifestyle diversity in the therapeutic process.
  • Adapt therapeutic strategies to client needs.
  • Willingness to appreciate the life experiences of individuals.
  • Appreciation for diverse populations and lifestyles.
  • Recognition of one’s biases toward other cultures and lifestyles.

5. To use a range of supervisory options to process personal feelings and concerns about clients.

Knowledge, skills, and attitudes:

  • The role of supervision.
  • Models of supervision.
  • Potential barriers in the counselor–client relationship.
  • Transference and countertransference.
  • Resources for exploration of professional concerns.
  • Problem-solving methods.
  • Conflict resolution.
  • The process and effect of client reassignment.
  • The process and effect of termination of the counseling relationship.
  • Phases of treatment and client responses.
  • Willingness to accept feedback.
  • Acceptance of responsibility for personal and professional growth.
  • Awareness that one’s personal recovery issues have an effect on job performance and interactions with clients.

6. To conduct self-evaluations of professional performance applying ethical, legal, and professional standards to enhance self-awareness and performance.

Knowledge, skills, and attitudes:

  • Personal and professional strengths and limitations.
  • Legal, ethical, and professional standards affecting addiction counseling.
  • Consequences of failure to comply with professional standards.
  • Self-evaluation methods.
  • Regulatory guidelines and restrictions.

7. To develop and use strategies to maintain one’s physical and mental health.

Knowledge, skills, and attitudes;

  • Rationale for periodic self-assessment regarding physical health, mental health, and recovery from substance use disorders.
  • Available resources for maintaining physical health, mental health, and recovery from substance use disorders.
  • Consequences of failing to maintain physical health, mental health, and recovery from substance use disorders.
  • Relationship between physical health and mental health.
  • Health promotion strategies.
  • Carry out regular self-assessment with regard to physical health, mental health, and recovery from substance use disorders.
  • Use prevention measures to guard against burnout.
  • Employ stress-reduction strategies.
  • Locate and access resources to achieve physical health, mental health, and recovery from substance use disorders.
  • Model self-care as an effective treatment tool.
  • Recognition that counselors serve as role models.
  • Appreciation that maintaining a healthy lifestyle enhances the counselor’s effectiveness.

TAP 21

3. Referral

Referral is the process through which the counselor helps the client find available support systems and community resources to meet the needs identified in the clinical evaluation and treatment planning. As competent counselors, we must be familiar with the mission, function, resources, and quality of services of:

  • civic groups, community groups, and neighborhood organizations
  • health and allied healthcare systems (managed care)
  • employment and vocational services
  • cultural enhancement organizations
  • faith-based organizations
  • governmental entities
  • criminal justice systems
  • child welfare agencies
  • housing administrations
  • childcare facilities
  • crisis intervention programs
  • abused persons programs
  • self-help groups
  • advocacy groups

We must be familiar with the criteria to be eligible to receive community services, including fee and funding structures; how to access community agencies and service providers; and community resources for both affected children and other members of the family.

Since some of the resources in the community might end or be closed down, we need to continuously evaluate the available resources and make sure they are appropriate for our client. We also need to evaluate the motivation and ability of our client to make use of the referrals.

Remember, it is not enough with being a counselor and making the referral; how we do it, is also very important. The skills we need in this area, are:

  • Professional oral and written communication for successful referrals
  • Use of appropriate technology to access, collect, and deliver necessary documentation
  • Document the referral process accurately

Just as with everything mentioned in previous topics, we want to explain to our client, in clear and specific language, the necessity for referral  and process of it. If our client understands this step, there is an increased likelihood the she/he will follow through.

Finally, we want to evaluate the outcome of the referral. We must know the methods and procedures used to assess the client’s progress toward treatment goals.

TAP 21

I. Clinical Evaluation

In order to provide a competent practice, addiction counselors need to learn and understand the 8 Practice Dimensions and the knowledge, skills, and attitudes associated with each of them.

Clinical Evaluation

Clinical evaluation is a systematic approach to recognizing and diagnosing substance abuse problems, including the potential for co-occurring mental disorders.

There are two elements included in the clinical evaluation process:

  • Screening
  • Assessment

Screening

Screening allows us to review the client’s current situation, including symptoms and other information, in order to determine the most appropriate course of action, taking into consideration the needs and characteristics of the client and the resources available within the community.

This is basically the first interaction between the client and significant others, and the counselor. It is very important how this first interaction is conducted.

Our goal is to establish rapport with our client and her/his significant others. We need to know:

  • Why it is important to build rapport.
  • The purpose of building rapport.
  • The range of human emotions and feelings.
  • What constitutes a crisis.
  • How to prevent and manage a crisis situation.
  • How to identify situations and conditions when additional professional assistance is necessary.
  • Sources of assistance available.

The way in which we interact with our client is very important. The client may be experiencing anxiety, anger, fear, going through withdrawals, etc. Here is what we need to do:

  • Demonstrate effective verbal and nonverbal communication.
  • Identify the client’s beliefs.
  • Reflect the client’s feelings and message –Active listening.
  • Recognize dangerous situations.
  • Treat the client with empathy, respect, and genuineness – Unconditional positive regard.

Gathering Information

Screening is a data-gathering process. Data is gathered from the client and other sources such as family, friends, employer, and coworkers. There are different screening instruments and we must select the ones that are sensitive to age, developmental level, culture, and gender. The data we will gather should include a history of current and past substance use/abuse and  substance abuse treatment; physical and mental health; mental and functional statuses; and current socio-economic and environmental problems.

A competent substance abuse counselor must have knowledge in the following:

  • Validated screening instruments for substance abuse and mental status.
  • Purpose, application, and limitations of those instruments.
  • Reliability and validity.
  • How to administer and score screening instruments.
  • Interpretation of results.
  • How to communicate effectively during emotionally charged situations.
  • How to write accurately, concisely, and legibly.

The screening process includes determining whether a client is appropriate and eligible for admission into a particular program, so we need to be familiar with:

  • Symptoms of intoxication, withdrawal, and toxicity for all psychoactive substances, alone and in combination with others.
  • The physical pharmacological, and psychological effects of substance use.
  • Acute and Chronic effects.
  • Available resources for help with drug reactions, withdrawal, and violent behavior.
  • Options, limitations, and legal implications of toxicity screening.
  • Meaning of toxicology reports.
  • Toxicology language.
  • Relationship between psychoactive substance use and violence.
  • Diagnostic criteria for suicide risk and danger to others.
  • Mental and physical conditions that overlap symptoms of drug intoxication and withdrawal.

Working with  the client during the screening process includes helping the client identify the effects of substance use or abuse on her/his current life problems. A very useful tool is Motivational Interviewing (MI). MI will help us assess the client’s readiness to address substance abuse issues; interpret the client’s perception of her/his experiences; and assess the client’s stage of change.

Substance abuse counselor must be familiar with:

  • Denial and other defense mechanisms.
  • Stages of readiness.
  • Stages of change
  • Treatment options and their philosophies.
  • The client’s needs and preferences.
  • Available resources for admission and referral.

Assessment

TAP 21

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