HomesteadSchools.com - Critical Incidents: Ethical Issues in the Prevention and Treatment of Addiction

About the Authors

William L. White is a Senior Research consultant at Chestnut Health Systems/Lighthouse Institute. He has a Master’s degree in Addiction Studies and more than 30 years of experience in the addictions field as a clinical director, administrator, researcher and well- traveled trainer and consultant. He has provided ethics-related training throughout the United States. He has authored more than 70 articles and monographs, and seven books, including Slaying the Dragon- The History of Addiction Treatment and Recovery in America.

Renee M. Popvits is the founder of the Chicago-based law firm of Popvits and Robinson. She has represented a wide variety of substance abuse and mental health service agencies related to such issues as corporate transactions, regulatory and corporate compliance, confidentiality, licensure, reimbursement, contract, tax exemption, managed care, human resource, electronic records/ HIPAA compliance, and public policy matters. She has lectured extensively and published articles on many of these issues.

Learning Objectives

After completing this course you’ll be able to:

1.	Describe “common sense.”
2.	List 4 causes of ethical breaches.
3.	Define ethical sensitivity.
4.	Define beneficence, stewardship, nonmaleficence, and restitution.
5.	List the five purposes for Codes of Professional Practice.
6.	Describe the two basic components of a compliance program.
7.	List several major responsibilities of a task force.
8.	Define informed consent and the most common source of liability.
9.	Describe a serious and enduring problem with political lobbying for some not-for profit agencies.
10.	List the recommendation given for the 30 second television spot proclaiming alcoholics and addicts family that “must initiate the change process.”
11.	Discuss the ethical demands when “daily rate” fees are more than the quoted amount.
12.	Define a “billable diagnosis.”
13.	Define the ethical principle of fidelity.
14.	Discuss the acceptance of gifts as a “token of appreciation.”
15.	Describe a company’s response to “my e-mails are personal and you have no right to monitor them.”
16.	Describe “The Mike Wallace Test.”
17.	Discuss the issue of “on call” time being personal or professional.
18.	Describe the action of an employee of an addiction prevention and treatment center observing an extremely intoxicated stranger about to drive home.
19.	State why nicotine is not a drug.
20.	Discuss the role of an employee in an addictions agency who belongs to a local social organization with men or non-white members never being present.
21.	Describe self-replenishment.
22.	Discuss “professional slumming.”
23.	List the three components of professional competence according to Haas and Malouf.
24.	Define “negligent hiring” and “negligent retention.”
25.	Define “moral drift.”
26.	List three activities an employee should observe when separating a professional role from a political role.
27.	Define fiduciary, iatrogenic, and boundary.
28.	Describe family of choice.
29.	State the age at which minors are legally competent to enter into financial, relationship, or service contracts.
30.	List preference of treatment for individuals in agencies receiving Federal Block Grant Funds.
31.	List several exceptions to confidentiality that would permit disclosure.
32.	State how you would respond to questions from clients when another client is no longer involved in treatment.
33.	Discuss the ruling of Warner v. Orange County Department of Probation.
34.	List the two alternatives, according to Bok (1978) for a “noble lie.”
35.	Describe the different views of autonomy and paternalism regarding client access to records.
36.	Discuss how work therapy can be therapeutic or exploitative.
37.	List three counselor self-disclosure methods that are effective.
38.	Define the “Minnesota Model” addiction treatment program.
39.	List several factors to consider when being presented a gift from a client.(Barry 1983)
40.	List two problems when using bartering for services.
41.	Describe boundaries of physical touch.
42.	Describe Milgrom’s two forms: “The Boundaries of Physical Touch” and “Nature of Verbal Communication.”
43.	Discuss why legal consultation should be sought when a client plans his own suicide.
44.	State several functions of a client’s service record.
45.	List several guidelines for hiring a recovering person for a staff position.
46.	Describe the statement, “Drug addiction and alcoholism are recognized as disabilities.”
47.	List the two statements by White (1997) that discuss issues regarding hiring family members.
48.	State how an employer can avoid being sued for defamation of character when responding to a request for reference.
49.	List three ways sustained overload can be alleviated.
50.	List several items to be included in a sexual harassment policy.
51.	List Bowie’s six justified reasons for whistle blowing.
52.	Describe progressive discipline.
53.	List three approaches to reporting sexual abuse by a father to a 16 year-old client in addiction treatment.
54.	Discuss the now-famous Tarasoff decision of 1976.
55.	List three immediate responses the therapist should state to an acquaintance when that person maintains his neighbor and her therapist have an ongoing affair.
56.	List two ethical values that apply when a nurse refuses to administer a medication prescribed by a physician that is contraindicated and at a high dosage for the client.
57.	List several dangers of informed counseling or advice giving in the prevention field.
58.	Discuss the statement: “Committing a criminal act should never be considered within the scope of one’s employment.”
59.	Describe the Veronia School District 47J v. Acton Case.
60.	List several legal issues that can arise around Student Assistant Programs.
61.	Discuss the four positions an EAP professional would have when they discover conditions or practices that: 1) pose a threat to a worker or the public, 2) discriminate, or 3) conduct illegal business practices.
62.	List three guidelines for school searches when there is “reasonable suspicion.”
63.	Discuss the expendability of outreach workers.
64.	List three options an organizational consultant can use after the agency fails to follow through on his plan three times.
65.	Describe how tapes and transcripts should be secured and disposed of with confidentiality maintained.

Course Contents

1.	Introduction
		Ethics for a New Century
		Ethical Issues in the Addictions Field: Special Concerns
			The Composition of the Field
			The History and Transience of the Field
			The Industrialization of the Field
			The Changing Context of Addiction
		Rethinking Our Assumptions about Personal and Professional Ethics
		Systemic Approaches to Professional Practice Issues
		How to use this Book
		A Review of Ethical Values
		A Note on the Relationship Between Ethics and Law
		A Note on Legal Annotations
2.	The Code of Professional Practice
		What is a Code of Professional Practice (CPP)?
		What purposes are such code designed to achieve?
		Are all employees of the organization bound by the standards set fourth in the code?
		Why is there a need for a CPP?
		Our agency is considering implementing a Corporate Compliance Program, how does this relate to the CPP?
		How can we integrate the CPP and a Corporate Compliance Program?
		Why should we implement a compliance program and integrate the CPP?
		How is the CPP developed?
		How long does it take to develop a CPP?
		How is the CPP updated?
		An Introduction to the Critical Incidents
		A model for Ethical Decision-making
3.	Conduct Related to the Practice of Business
		Macro-Planning
			Stewardship of Resources
			Planning
		Lobbying
			Misrepresentations of Information
			Exploitation of Clients
			Utilization of Staff Time for Political Lobbying
		Advocacy: Interest of Field Versus Agency Self-Interest
		Fundraising
			Use of Professional Fundraisers
			Staff/Board Support
			Solicitation of Funds from Clients/Families
		Marketing
			Misrepresentation of Scope or Intensity of Services
			Misrepresentation or Misallocation of Costs
			Exaggeration of Treatment Success
			Exploitation of Family Members
			Financial Management
		Fee Structure and Billing
		Referrals
		Dual Relationships
			Conflict of Interests
		Management of Facilities, Property and Supplies
		Sale of Non-Profit
		Merger Mania
		Due Diligence Discovery
		Fraud & Abuse
		E-mailing Price Information
		Telecommuting
		Staff/Managerial/Executive Compensation
4.	Personal Conduct
		Use of Alcohol/Drugs
		Relapse
		Moral and Legal Standards
		Financial Investments
		Discrimination
		Personal and Agency Reputation
		Personal Replenishment
5.	Professional Conduct
		Self-development
		Personal Appearance
		Recognition of Limitations
		Representation of Credentials
		Use of Agency Resources
		Secondary Employment
		Publishing
		Respect for Proprietary Products
6.	Conduct in Client/Family Relationships
		Definition of Client
		Informed Consent
		Labeling: The Ethics of Diagnosis
		Right to Treatment
			Refusal to Treat
		Refusal to Treat
		Respect
		Respect for Personal/Religious Beliefs
		Honesty
		Right of Privacy
		Empowerment Versus Paternalism
			Cultivating Dependency Versus Autonomy
		Restrictiveness of Treatment Environment
		Stewardship of Client Resources
		Experimental Counseling Techniques
			Special Treatment Procedures
		Freedom from Exploitation
		Self-Disclosure
		Countertransference
		Dual Relationships
			Casual Encounters
			Therapeutic Bias
			Social Relationships
			Mutual Aid Relationships
			Financial Transactions and Gifts
			Physical Touch
			Verbal Intimacy
			Sexual Relationships
			Verbal/Physical Abuse
			Assisted Suicide
			Documentation
			Referral
			Responsibility to Terminate
			Responsibility to Refer
7	Conduct to Professional Peer Relationships
		Internal Professional Relationships
		Management of Human Resources
			Staff Hiring
			Nepotism
			Patronage
		Issues in Authority Relationships
			Confidentiality
		Mandatory Training
			Right to Privacy
		Socializing Outside of Work
		Role Stressors
		Obedience and Conscientious Refusal
		Sexual Harassment
			Abuse of Power
		Impaired Co-worker
		Team Relationships
		Managing Conflict
		Professional or Ethical Misconduct/ Whistle Blowing
		Staff Termination
		External Professional Relationships
		Value of External Relationships
		Multiple Service Involvement
		Commenting on the Competence of Other Professionals
		Allegations of Unethical Conduct
8	Conduct Related to Public Safety
		Child Abuse Reporting
		Duty to Warn
		HIV/AIDS Duty to Report
		Physical/Sexual Abuse
		Duty to Warn (Threat of Physical Violence)
		Allegations of Misconduct
		AIDS and Risks to Third Parties
		Threats to Public Safety
9	Professional Standards Related to Special Roles
		Prevention
			Personal Conduct
			Role as Change Agent
			Relationship Boundaries
			Confidentiality and Limits of Competence
			Alliances
			Iatrogenic Effects
			Honesty
			Social Action/Civil Disobedience
			Freedom of Access Versus Harmful Use of Information
			Restriction of Speech
			Intrusive or Abuse Interventions
		Early Intervention: Employee Assistance Programs (EAP) and Student Assistance Programs (SAP)
			Integrity of Organizational Structure
			Independence and Objectivity of Professional Judgment
			Definition of Client/ Conflicts of Loyalty
			Environmental Stressors
		Early Intervention: Student Assistance Programs (SAP)
			Confidentiality
			Disposition of Contraband
		Outreach
			Confidentiality/ Duty to Disclose
			Worker Vulnerability
			Relationship Boundaries
			Compensation
		Training
			Use of Agency Resources for Personal Gain
			Self-disclosure
			Relationship Boundaries
			Marketing of Seminars
			Professional Impairment
			Use of Clients in Training
		Consultation
			Confidentiality
			Support of Toxic Organizational Conditions
		Research
			Sponsorship of Research
			Research with Human Subjects
			Confidentiality, Security, and Disposition of Data
			Scientific Role Versus Clinical Role
			Honesty in Reporting Findings
			Responsibility for Use of New Knowledge

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