FOCUS Newsletter - December 1997
Reprinted with permission from the New Jersey Chapter of NASW.
The field of substance abuse poses unique challenges to social workers, including the constant need to reaffirm the social work value base, the importance of shaping service delivery to incorporate social work values, and the task of recruiting and educating others in the critical importance of ethical decision-making. Social workers have a clearly defined Code of Ethics (NASW, revised 1/1/97) to guide their professional conduct. The Code emphasizes such critical concerns as the client's right to self-determination, the parameters of confidentiality, the importance of guarding against dual relationships, and the necessity of limiting service to areas of worker competence. Social workers have been primed to incorporate ethical decision-making in all areas of their professional practice. In spite of this targeted focus, even the most ethically responsible workers have experienced or witnessed lapses in ethical practice.
In the field of substance abuse, the dangers of ethical misconduct appear to be even more challenging. Vulnerability derives from the heterogeneous pool of workers, many of whom are not privy to a shared value system, do not belong to a professional organization, and as a result, are not subject to any specific code of ethics. Like social workers, most certified addiction counselors complete a specified number of training hours in ethics; unlike social workers, they are certified, not licensed, and therefore not subject to the same sanctions stemming from ethical misconduct.
Additional challenges surface from quick turnover in the workforce, and the fact that a number of workers are former service recipients turned providers. As in other areas of health care, substance abuse treatment has experienced the impact of managed care in which non-professionals and business people are playing an increasing role in determining policy and procedures affecting the scope of practice, frequently focusing more on the bottom line than the outcome of an ethical audit.
In addition to being continually vigilant of on-going challenges to our ethical base, we must remind those who have responsibility for the system that all workers do not arrive with the same ethical standards and training in ethical problem-solving. Many program administrators relegate ethical responsibility solely to direct practitioners, frequently overlooking their own responsibility for establishing overall ethical standards for the programs they design and oversee. In many instances, not only must the social worker be actively monitoring her/his own professional practice but she/he must also be actively advocating for an overall agency ethical code (see White (1993) for suggestions).
Unique ethical challenges involve the myriad of dual relationships inherent in the field and include dilemmas stemming from recovering workers attending AA meetings with clients or with their supervisors, or the changing role of some individuals to service providers within the very programs in which they had recently been clients. Dual relationships are a concern frequently addressed in the substance abuse literature (e.g., see Bissell and Royce, 1989). Additional challenges arise from the increased use of physical contact in treatment among clients and service providers, the hinging of services to abstinence, and the debates surrounding abstinence versus controlled drinking and harm reduction, such as that generated by needle exchange.
The primary challenge centers on increasing the overall sensitivity and responsibility of all staff involved in a given program to identify and commit to a common core of ethical principles, to develop skill in ethical decision making around the vast array of ethical dilemmas surfacing in everyday practice, and to recognize the importance of seeking outside help if the challenges are too great to address independently. In general, there is movement toward greater professionalization among substance abuse service providers with increased standards for education, including ethics training and continuing education. Unfortunately, at present in many states, certification is not necessary for employment. In fact, many mental health technicians work in the field while completing the requirements for certification. Licensure remains a long-term goal.
In 1987, the National Association of Alcoholism and Drug Abuse Counselors adopted a Code of Ethics (NAADAC, 1987). The challenge remains for getting that Code to be universally implemented within all major avenues of substance abuse treatment. It is important to remember that not all certified addiction counselors or administrators belong to NAADAC. Overall, the NAADAC Code of Ethics is compatible with that of NASW. In instances where differences may be noted, the more stringent interpretation is recommended.
As social workers, we have a well-developed mechanism for peer review and adjudication designed to protect the rights of clients and to help promote ethical social work practice. State licensing boards also contribute to assuring high-quality professional practice. Given our history, we should be poised to make significant contributions to promoting ethical standards for all substance abuse providers, to developing mechanisms for monitoring ethical misconduct and violations, and to teaching ethical decision-making to those newly entering the field. We are not alone in our mission; other professions are founded on a solid ethical foundation. We must collaborate with our professional peers in achieving this essential common goal. In the process, we all will be revitalizing our own commitments to ethical practice, exercising our professional responsibilities and making a significant contribution to the well-being of our clients.
Bissell, L. & Royce, J.E. (1989) Ethics for Addictions Professionals
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