Substance Abuse Among Licensed Counselors

Substance Abuse Among Licensed Counselors and Client Contact

Today, there are numerous ethical and legal dilemmas inherent in the issue of licensed counselors and drug abuse. The ACA or the American Counseling Association Code of Ethics requires counselors to follow the guidelines under the ACA strictly, so that there would be an exercise of restraint against those counselors who are prone to using drugs, and are in no fit state of mind to offer advice to others. For example, the Standard of Practice Nineteen (SP-19): Impairment of Professionals states that "Counselors must refrain from offering professional services when their personal problems or conflicts may cause harm to a client or others." (ACA Code of Ethics and Standards of practice) In other words, the basic mission of the American Code of Ethics is to be able to augment and improve the quality of life in society, by making sure of the fact that the development of counselors takes place, as it must. (ACA Code of Ethics: The ACA Governing Council)

Counselors must also make sure that they utilize the profession of counseling, and also practice it in such a manner that dignity and respect for the human race is kept in mind at all times, and is therefore, promoted. It must be noted that the Code of Ethics starts with a small introductory passage, in which the issue of what counselors must do in order to maintain discipline and behavior in their profession is discussed. If further goes on to state that when counselors are faced with certain ethical dilemmas that they may find difficult to resolve at that particular time, then they must perforce engage in a "carefully considered decision making process," so that they may be able to find an appropriate solution to the problem at hand. Since it is a fact that everyone has different opinions about one topic, and that there may as many different opinions as here are counselors, there is no specific decision making model that can be deemed the best or the most effective; counselors, according to the American Counselors Association are therefore expected to familiarize themselves with a credible model of decision making that would be able to stand on its own while under public scrutiny. (ACA Code of Ethics: The ACA Governing Council)

The American Counselors Association is a scientific and educational and professional organization, whose numerous members work in a variety of settings. However, in general, the members are individuals, who are completely dedicated to the enhancement of human development. They also use a sort of cross-cultural approach that would support the worth, dignity, potential, and uniqueness of people within their social and cultural contexts. The Code of Ethics serves to help the members and clarify for them issues such as their ethical responsibilities and duties towards the people that they help. (Center for the Study of Ethics in the Professions at IIT)

One must remember that, according to a survey by Information Services Survey, at an average, about 67,000 counselors treat about 1 million patients who suffer from alcohol and drug induced disorders, in outpatient and residential facilities. A CSAT survey states that about half of the counselors who work in addiction treatment facilities are graduates; while the rest of them are at the present time undergoing graduate training. In the past, when financial resources were extremely limited, trained counselors would have little or no interest in dealing with individuals who were trying to cope with the difficulties and depression brought on by alcohol and substance abuse addictions. Perhaps this was the main reason that most programs started to train their own staff that would be able to rely heavily on 'recovery' as the basic criterion for recruitment. In other words, those people who were struggling with the same issues in their personal lives, it was felt, would be the best people to treat others with the same difficulties and problems. Therefore, it can be said that 'recovering counselors' have in fact been the hart and soul of several addiction programs over the past few decades. Their experiences, both with dependence and with recovery, would be able to provide patients with perfect examples of strategies that can be used for achieving sobriety and complete recovery. (Lowinson; Ruiz; Millman; Langrod, 2005)

One of the strategies that are most popularly used among counselors treating substance abuse patients is that of having two separate groups of people, running simultaneously. While one group would be comprised of patients in the early stages of recovery, the second would be made up of those individuals who are in the later stages. It must be mentioned that this type of counseling does not need trained counselors, because there is no real need to delve too deeply into one's psyche as a part of the treatment. (Velasquez; Maurer; Cathy; Diclemente, 2001)

However, it must also be mentioned that today, counselors face a variety of challenging issues like substance abuse, suicide, and other deadly problems. Therefore, counselors may also find that they are facing serious legal consequences for the manner in which they may have handled the problem. This is because of the undeniable fact that there are several 'gray' areas in these issues concerning counseling, and this means that both counselors and the teachers become extremely anxious and frightened. Books like 'Ethical and Legal Issues in School Counseling,' edited by Mary A Hermann, among others, is one reference manual that counselors today can safely use, so that they may feel free to practice and counsel as they see fit. The 'American School Counselor Association', a worldwide nonprofit organization based in Alexandria, published the book. The Association was founded in 1952 and it includes about 14,000 professional school counselors. According to Hermann, "If we can train more counselors in crisis management and get more counselors into our schools, we can be more proactive in preventing potentially deadly situations." (Geuder, 2003)

Counselors in general are expected to adhere to certain rules and regulations as specified under the American Counselors Association and its Code of Ethics. These are therefore the primary issues that a counselor has to deal with at the very outset in order to maintain a stable relationship with his patient, and set him on the right path towards a cure for his substance abuse and addictions. Confidentiality, informed consents, the basic duty to care for the patient, no matter what, respecting the patient's self-determination to try to overcome his problems, and credentialing mechanisms are the code of ethics. One must remember that ethical concerns and dilemmas in alcohol and substance abuse treatments are, more often than not, completely complex and multi-dimensional, and at times, these issues may or may not be actually addressed in laws and in professional ethic codes. (Module 9, Legal and Ethical Issues in Prevention and Treatment of Alcohol Use Disorders)

However, these codes of ethical practice would help in educating and informing a counselor about basic and sound ethical behavior, and also mandate a certain code of ethics for practice. This may certainly not be the best or the highest form of ethics, but it would help a counselor immensely if he were to know exactly what consequences his actions would bring on. Moral principles, for example, form the basis of social work's professional code of ethics, and they are: autonomy, which would including the client's self-determination, nonmalfeasance or avoiding harm, beneficence or in other words, promoting good for others, justice and fair and equitable treatment to all, fidelity, which in other words may mean honoring commitments, and veracity, or in other words, truthfulness. According to the Surgeon General's report on mental health, 1999, the very fact that their case may not be kept under the srtictest confidentiality may very well deter an individual from seeking out medical treatment and counseling for his alcohol and substance use and addictions. This was the reason why the Substance Abuse and Mental Health Services Administration, or SAMHSA has issued several technical reports mentioning the requirements relating to CFR confidentiality. (Module 9, Legal and Ethical Issues in Prevention and Treatment of Alcohol Use Disorders)

The consequences in general for drug abuse and other related problems, for the government, can be an expensive affair, both monetarily, as well as in human terms, like for example, the mental discord and trauma that it can cause, and the family breakups that inevitably result when one member of the family becomes addicted to alcohol or to any other substance. Children are neglected, the user develops mental and physical problems, and he also undergoes severe financial constraints, because of the pressure that he faces in order to pay for his addictions. Legal problems, automobile accidents, HIV infection, incarceration, lower work productivity, and job loss are some of the other problems that a substance user may have to face, as a result of his addiction. A counselor's job is to handle the drug user in such a way that he would be able to overcome his addiction to a certain extent at least, so that he may be able to face all these several different problems with a minimal level of confidence. However, a different kind of problem may arise, when the counselor himself was a user and an addict, and has recovered fully from his addictions, to move on to become a legal counselor of others like him. (NIDA, Introduction and overview)

Take for example, the case of when a drug abuse and substance abuse counselor was among the fifteen people who were arrested recently in Harlem. The police charged this particular individual with being a part of a fifteen-member gang of cocaine and crack distributors on Long Island. Andrew J. Maloney, the United States Attorney for the Eastern District of New York, identified the counselor as Al Richardson, 40 years old, who was allegedly a distributor in a drug-selling ring, in which each 'runner' in the enterprise, or in other words, the individual who makes the actual sale of the drug, cocaine or crack, sold as much as $2,000 a week. The unfortunate part of the entire affair was the fact that Richardson had been working as a counselor at the 'Addict Rehabilitation Center' at Park Avenue, with a clientele of almost three hundred odd patients addicted to drugs and alcohol and other similar substances. (Morgan, 1998)

What made it even worse was the truth that Richardson had been a counselor at three other clinics before he joined the Harlem clinic as a counselor, and he had brought along excellent references from his previous jobs. However, stated the police chief, there was no real evidence that Richardson had bee engaged in buying or selling drugs at the clinic, but the arrests were a culmination of a two-month long investigation by the Long Island Drug Task Force, a joint operation of a team comprised of state, local and Federal law-enforcement agencies, during which numerous telephone calls that had been made by Richardson to his wife, also a part of this illegal operation, were intercepted by the police. This drug counselor was also charged with making threats to shoot those customers who had failed to make drug payments on time. (Morgan, 1998)

One must remember that substance abuse counseling is a serious and responsible task, and that the counselor must never attempt to misuse his position and take advantage of the situation in order to seek gains for himself. He must follow the American Counseling Association Code of Ethics with the utmost sincerity and caution. It can be stated therefore, that Substance abuse counseling is a form of community outreach that would need plenty of patience and a keen sense of compassion and a desire to help others who have landed themselves in great difficulties. Most of the time, drug abusers do not have any idea of whom they must approach to sort out their problem and overcome it, and the duty of a counselor is to refer a patient to a wide variety of other services that would apply to other areas in an addict's life in which he may need help, and thereby help to provide a safe and stable platform upon which they can stand when they are making a serious and concerted attempt to overcome their addiction problems. (Career Profiles, Career: Substance Abuse Counselor)

The substance abuser may therefore be directed to a family agency, or to a food pantry, or to a physician or psychiatrist, or to a vocational training center, to a lawyer, a welfare agent or any other professional, depending on his personal and immediate needs. Says one counselor, one of the most frustrating areas of their work is that even after an addict is reasonably cured of his problem, and he approached an individual for a suitable job, so that he would be able to live a stable and independent life, he would be refused on the basis of the fact that he was an ex-addict. Said one reformed addict and drug abuser, "People hold addicts more responsible for their problems," and most of these people find it difficult to gain a suitable position. However, about a twenty percent do get jobs, and a good counselor feels an immense sense of satisfaction and happiness at having made this possible for this particular individual. (Career Profiles, Career: Substance Abuse Counselor)

However, staying 'clean and sober' would require a lot of vigilance and watchfulness on the part of the patient, and this means that 'recidivism' or backsliding' would become a major hurdle to overcome. An effective and watchful counselor would be able to keep a close guard on the patient's condition, and when backslide does happen, as it does in numerous cases, it can become a major source of disappointment and depression for the counselor, who feels that he has failed. The counselor may also be face with the prospect of having to watch his patient die, which may happen due to a combination of various circumstances, like for example, homelessness, mental illness, and AIDS. (Career Profiles, Career: Substance Abuse Counselor)

For the counselor, who may at times be a recovering abuser himself, this can be one of the most traumatic events to deal with, because he would not only have to face the deterioration and eventual death of his patient, but also learn to control the various emotions of anger and frustration that he may feel when faced with these stressful circumstances. It is often said that this is the stage when one would have to be very careful, because the counselor, who may be actually in the recovery stage himself, may become depressed, and resort to his old habits of alcohol and drug dependency. This may be the one of the main reasons why the burnout rate for a counselor of drug abuse is extremely high. (Career Profiles, Career: Substance Abuse Counselor)

Doug Butler was one individual who had lost everything: his home, his family, his job, and his position in society, all because he was busy looking for either his next fix, or for his next drink. By the time he 'hit bottom' he knew that he would either have to change and find a solution for all his problems, or die. Somehow, Butler not only cleaned himself up, but went on to complete a course in college and became a hero to many others as a drug and alcohol counselor, because he was able to see himself in everyone he helped. He also became an individual, grimly determined to beocme sober and remain sober for the rest of his life, and therefore, he went about piecign all the lost bits and pieces of his previous life together. Soon enough, his life became seemingly whole and beautiful and normal again, and he assumed that he was finally free form his painful past life. However, he did not take into account the damage that the addictions had done to his physical body, and one fine day, he sufferede form a masive cardiac arrest, and died on the way to the hospital. He is even today, hailed as a hero. (Robertson, 2004)

The resaon is because of the fact that Doug Butler found the courage and determination to overcome all the hurdles in his path, and find the solution to the problem, for others in the same situation. Reports say that Doug Butler went back time and again to the streets of Sacaramento, where he had lived and become a drug abuser, and from where he hadeventually escaped, to beocme a normal and whole person and a counselor for others like him. He would advise and counsel others who were living in the same traps as he had lived in, and told them who he was and where he had been and what he had suffereed through his bleak and dismal years as a drug and alcohol addict. He would stand by the addict when it seemed like they had no one else to turn to, and he dedicated his life to them, in trying to counsel them and save them from a life of dgradation and misery. Said one recovering drug addict, Frank Fawcett, aged 47, "He made an absolute mess of his life, and he turned it all around, that's why he worked so well with people who needed help. They knew where he was coming from.." This is one of the best reasons why many people prefer counselors to have 'been there and done that', so that he would be able to empathize better with others in the same position as he was at a previous time in his life. (Robertson, 2004)