Introduction
The demand for substance abuse disorder (SUD) therapists may increase as Canada seeks drug offenders’ counselling and treatment programs rather than serving a jail term. Substance abusers are less likely to commit an offense again if they get such services for their addiction. Consequently, sentences often require addicts to attend therapy programs. SUD can affect anyone, regardless of background, age, and gender. Even after complete abstinence, people are often at high risk for relapse, making the recovery process difficult. Individuals with drug dependency issues may have ambivalent feelings to get professional assistance and may not recognize their patterns of abuse. In other cases, their motivation to change has usually been a cause of frustration since counsellors have little control over their aspiration to change. The misconception that drug abuse is a sign of moral weakness and quitting the behavior is simply a matter of self-control also negatively impacts the judgment to secure professional assistance. The decision to seek treatment for addiction is not easy but requires counsellors to practice in an ethical manner and demonstrate certain personal qualities to build trust with their clients.
What It Means to Practice in an Ethical Manner
Counselors are required to act ethically to meet the needs of every addict. At the basic level, ethical aspects of counselling services require professionals in the field to be trustworthy when dealing with drug users (Hill et al., 2017). In addition, this would also mean respecting clients’ rights, dignity, and interests at all times. Those diagnosed with SUD are very vulnerable and susceptible to relapse. Usually, this involves a strong desire to take illicit substances, challenges in controlling the behavior, and continuous dependence despite the degrading effects. In this case, a higher priority is given to drug use than to other obligations, enhancing tolerance and withdrawal symptoms. Due to these challenges, addicts need professionals who are the more judicious and competent advocates to work on their behalf.
An ethical practice would also require counsellors to obtain the informed consent of people concerned before initiating the treatment. They must also recognize and uphold a client’s right to withdraw consent. Therefore, practitioners must also take all reasonable steps to ensure that the nature of the service and anticipated limitations are sufficiently understood to build a therapeutic relationship. If conditions are imposed upon the continuation of counselling, they must be consistent with the therapists’ professional responsibilities, or counsellors need to secure the approval of their supervisors. In addition, those terms must also be explained to the clients. Therefore, those diagnosed with SUD must be saved equitably and not discriminated against based on their age, gender, race, beliefs, or lifestyle.
The intervention and treatment measures intended to diminish drug dependency need to be based on the plan, drawn up in consultation with those concerned. The counselling process should be evidence-based, and therapists need to develop recovery programs informed by the latest research-based practices to offer quality service. This is because the effectiveness of SUD counselling usually depends on a healthy professional relationship. In this context, clients must be able to fully trust their therapists to successfully undergo counselling (Aponte, 2021). If there is any mistrust, the addicts may eventually stop seeking the service, inevitably jeopardizing the entire treatment program. Counsellors must recognize that they hold positions of responsibility, and those seeking their help will usually be in a position of vulnerability. In this case, counsellors should not abuse their patients’ trust for financial gain or any other personal advantage. This is because clients diagnosed with SUD are historically stigmatized and viewed as immoral. Thus, screening should also be an integral part of the prevention process to help identify those at risk of substance abuse.
Various skills and attributes are required to effectively practice in an ethical manner. These include behavioral competencies, which encompass attitudes, values, and abilities needed to adequately perform an addiction counsellor’s role. The Canadian Centre on Substance Abuse (CCSA) developed 18 behavioral competencies that those working with addicts should master (Csiernik, 2021). One of these includes adaptability, which requires counsellors to adjust their approach to meet the needs and demands of rapidly changing conditions and work effectively in ambiguous situations. Secondly, therapists also need to engage in continuous learning by identifying and pursuing learning opportunities to boost their professional development and the delivery of client-centered services. Another behavioral competency also requires counsellors to demonstrate ethical conduct and professionalism. In this context, they need to provide services based on the principles of integrity, respect, responsibility, and trust to safeguard themselves and others.
Complementing the above-mentioned soft skills are technical competencies, such as understanding the concurrent conditions. This implies that professionals in the field must have the knowledge to properly inform their own practice, especially when working with those experiencing co-occurring drug use. Additionally, counsellors also need to possess background knowledge of substance use to effectively serve the clients and their families. According to CCSA, these are the main foundational technical competencies the other hard skills depend on (Csiernik, 2021). The objective of all these abilities is not to be proscriptive but instead to promote expertise within the field. They are used to identify expertise and knowledge for allied professionals and used as resources to support providers in staff development and the hiring process. Finally, they are crucial in helping educators develop strategies for learning to provide Canadians with a more consistent quality of service delivery from the addiction workforce.
Ethical Dilemma
Counsellors are routinely confronted with various problems in the social work practice. Based on the case study, the ethical dilemma emanates from the tension the therapist experiences because of the need to respect the client’s confidentiality. At the same time, the counsellor has a professional legal requirement to report or warn. The Canadian Addiction Counsellors Certification Federation (CACCF) requires therapists to strictly adhere to constituted precepts of confidentiality (Csiernik, 2021). This is regarding sharing records and knowledge about clients being served. After the counsellor re-confirmed to Tina that their session details were confidential, she revealed that she was unmotivated to deal with her addiction. Her destructive drug use patterns have escalated because she lives in a group home where she can easily go out and engage in substance abuse. Although Tina is aware this is a violation of her probation, she is willing to take the risk because she reports experiencing more positives from drug use and believes it is not a concern, despite being pregnant.
This case presents a unique scenario because the client has disclosed that she has been telling her support worker and probation officer what they want to hear in order not to be admitted to a residential treatment program. Therefore, acting in such a situation may prove difficult because a therapist’s duty to protect and uphold the client’s right to privacy is fundamental. Nonetheless, a counsellor also has a legal obligation to report or inform other professionals like the probation officer about the potential harm that may result from Tina’s risk-taking behavior with drugs (Canadian Counselling and Psychotherapy Association, 2020). Even if this is important to ensure that she gets the needed assistance, it may lead to a significant breach of trust and negatively influence her continuous participation in the program. In this case, the counsellor may experience stress because failing to take action may also place Tina in a position where she may hurt herself or her unborn child.
There are actions that a counsellor can undertake to help resolve this dilemma. In this case, it would be essential to be aware of professional responsibilities and liabilities and the state laws related to the practice. In this case, when the counselling is initiated, it would be vital to inform Tina about the service’s purpose, benefits, and limitations. This may ensure that she understands the implications of the counselling process. She also needs to be informed of her right to seek a second opinion, decline the recommended service, and be advised of the consequences of such refusal.
There are certain circumstances where a counsellor can share information without the client’s consent. These include instances where the disclosure is vital to avert preventable risk to oneself and others (The Canadian Counselling and Psychotherapy Association, 2020). For example, Tina indicated that she has been dishonest to her parole officer and support worker in regards to attending treatment and refraining from using drugs. Despite being aware this is an offense of her bail terms, she is inclined to take the risk. Therefore, breaching confidentiality may enable authorities to take necessary action and facilitate care across multiple providers, which help improve her own health and the unborn child.
Recommendations on Working with Tina
Tina tested positive for several illicit substances, which would require a multifaceted treatment approach suitable for polydrug users. Therefore, a counsellor can employ harm reduction strategies while working with the client. This addiction intervention has been recognized as more pragmatic and holistic. It can help the client limit the adverse consequences of substance abuse without necessarily reducing consumption or abstaining from substance use (Taylor et al., 2021). Tina has reported consuming more than one drug for the past two months. In this case, her drug habits have also become problematic because she has also been described as unmotivated to seek treatment. Therefore, harm reduction strategies would aim to decrease the irreparable damage associated with drug use or, if possible, achieve complete abstinence. For example, methadone and suboxone maintenance and treatment techniques, which are some of the harm reduction approaches, can be utilized (Csiernik, 2021). This is because suboxone and methadone remain the most popular used substances for opioid substitution, eliminating withdrawal symptoms. Therefore, this may be suitable for Tina, a polysubstance user.
Methadone maintenance (MM) is also recommended because the fetus may be at risk if withdrawal occurs during pregnancy. Similarly, infants exposed to methadone while in the womb have been shown to have better outcomes than those exposed to heroin or other illicit drugs (Csiernik & Rowe, 2017). Therefore, reduced incidence of premature birth and infant mortality rate have been linked to MM programs. MM is a better alternative for Tina, who exhibits levels of drug dependency. She is not concerned about her drug use but instead believes that she has continued to experience more positives from her drug habits. Other harm reduction strategies that may be utilized may focus on the provision of counselling, mental health services, education, advocacy, and linkages to community-based supports and services, such as housing (Csiernik & Rowe, 2017). Other initiatives associated with these techniques include nutrition, improved prenatal care, and the needle exchange program to reduce the spread of these blood-borne infections, like HIV and AIDs (Csiernik & Rowe, 2017). For these reasons, these strategies are essential for Tina, for whom abstinence may remain a goal but difficult to achieve immediately.
Pros and Cons of the Legalization of Cannabis in Canada
Conclusion
Clients’ decision to seek professional assistance for addiction may not be easy. However, it requires counsellors to behave ethically and use their personal qualities to establish trust with their clients. A strong bond or a therapeutic relationship may enable a client like Tina to feel comfortable discussing her challenges with illicit drugs and collaboratively solve them. Such positive alliances ensure that clients view their therapists as trustworthy and individuals acting in their best interests. This permits them to work together even during the whole treatment process.
References
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Csiernik, R. & Rowe, S.W. (Eds.). (2017). Responding to the oppression of addiction. Canadian Scholars.
Csiernik, R. (2021). Substance use and misuse. Canadian Scholars.
Hill, C., Spiegel, S., Hoffman, M., Kivlighan, D., & Gelso, C. (2017). Therapist expertise in psychotherapy revisited. The Counseling Psychologist, 45(1), 7-53. Web.
Rotermann, M. (2020). What has changed since cannabis was legalized? Health Reports, 31(2), 11-20. Web.
Taylor, J. L., Johnson, S., Cruz, R., Gray, J. R., Schiff, D., & Bagley, S. M. (2021). Integrating harm reduction into outpatient opioid use disorder treatment settings: Harm reduction in outpatient addiction treatment. Journal of General Internal Medicine, 36(12), 3810–3819. Web.
The Canadian Counselling and Psychotherapy Association. (2020). Codes of ethics. Web.