Critical Incidents: Ethical Issues in the Prevention and Treatment of Addiction

critical_incidents

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 esploitative.
  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

Comments:

"Very good book! Personally helpful."

- M.B., LISW, OH

"I was expecting the text to be very boring but it was very interesting and I learned a great deal from it."

-J.B., Counselor, MH

"I really enjoyed the book. Very useful case studies."

- R.E., LCSW, OR