6186358The field of substance abuse treatment is fairly new.  Prior to the 1950’s, people who were living with addiction were sent to hospitals and mental institutions to dry out or die.  For many years, there was little to no oversight in the addiction treatment field.  Most of the work was based on the Alcoholics Anonymous premise of one alcoholic helping another.  It wasn’t until 1972 when the Joint Commission on Accreditation of Hospitals (JACHO) developed accreditation standards for alcoholism treatment programs that the field was legitimized.   In 1974, the National Association of Alcoholism Counselors and Trainers (NAACT) began to create a field of professional counselors with professional qualifications and backgrounds. The organization evolved and became the National Association for Alcoholism and Drug Abuse Counselors (NAADAC) in 1982.
Although people entered this field with a desire to help others, with no training required people were doing some harm in an attempt to provide treatment.  In addition to the education requirements that NAADAC requires to become certified, ethics is a primary part of the training and testing to become certified in any state.  The Code of Ethics gives treatment providers clear guideline related to patient care.  It is imperative that when choosing a treatment facility, you seek a program that has certified staff and are operating under this Code of Ethics.  Although there are 10 Ethical Codes with multiple subsections, for the purpose of this article, I chose the ones I felt were crucial to our clients and their families.

  1. The Counseling Relationship:  Counselors will only see clients they believe can benefit from their expertise and this service should only be provided for the length of time necessary.  This means that treatment programs should not just keep a client “on the books” until their insurance runs out.

 

  • Informed Consent: The addiction professional understands the client’s right to be informed about treatment in a language that is understandable to the client including the purpose of the services, risks related to the services, limits of services due to requirements from a third party payer, relevant costs, reasonable alternatives and the client’s right to refuse or withdraw consent within the time frames covered by the consent. This means that clients should be told what their insurance carrier has approved of and what type of information is being shared with their insurance carrier.  It also means that clients can “retract” a consent form at any time during treatment and if clients do, they need to fully understand there insurance carrier will deny payment to the treatment provider and the client will be responsible for services rendered.  This is also an issue with treatment providers who say they will not charge for one service, such as sober living, while you are participating in their outpatient program. 
  • Dual Relationship:  Because a relationship begins with a power differential, the addiction professional will not exploit relationships with current or former clients, for personal gain, including social or business relationships.  This means a treatment provider should not elicit a current or past client to promote their program for them; providers should not contract with previous clients for business purposes; and it also means that there should be no sexual relationships with those current or past clients. 
  • Preventing Harm:  The addiction professional counselor will refrain from using any methods that could be considered coercive such as threats, negative labeling and attempts to provoke shame or humiliation.  This means that clients shall be treated with dignity and respect at all times.  The goals of the client (not those of the treatment provider) are the center of the treatment process. 
  1. ConfidentialityAddiction professionals shall provide information to clients regarding confidentiality and any reasons for releasing information in adherence with confidentiality laws.  This means that clients seen outside of treatment sites should not be acknowledged by the provider unless the patient initiates a greeting.  This also means that no information will be given to anyone, not mothers, fathers or collaborating partners unless a specific consent is given by the client and the client knows the scope of what will be shared. 
  • Professional Responsibility: The addiction professional espouses objectivity and integrity and maintains the highest standards in the services provided.    This means that a provider should not provide any treatment they are not qualified to provide such as a Licensed Marriage and Family Therapist that states they provide art therapy, but have not received formal training in that modality. 
  • Working in a Culturally Diverse World:  Addiction professionals do not discriminate either in their professional or personal lives against other persons with respect to race, ethnicity, national origin, color, gender, sexual orientation, veteran status, gender identity or expression, age, marital status, political beliefs, religion, immigration status and mental or physical challenges.  This means that no client shall be “assessed as not appropriate” due to a marginalized status or difference in beliefs from the provider.
  1. Workplace Standards: The addiction professional recognizes the need for ongoing education as a component of professional competency and development. This means that if an issue arises that staff are not qualified to work with, such as transgender issues, they will be honest with their client if they are willing to learn about this area and give the client the choice to be referred out as opposed to pretending they know the research and best practice model of working with transgender folks.

Lastly as you are trying to secure treatment for yourself or a family member here is a list of unethical practices the Addiction Professional has highlighted to look out for:

  1.  Using call centers to share patient prospect information with and between treatment providers.
  2. 1-800 numbers that promise to connect you with treatment only will connect you with providers who pay them.
  3.  Paying bounties for referrals.   Giving large gifts to interventionists with whom a program works.
  4. Claiming to take a patient’s insurance, when in fact the anticipated reimbursement is very low.
  5. Paying kickbacks to labs that are overcharging insurance companies for drug tests performed on a facility’s patients.
  6. Promising a cure.
  7. Using nutrient supplements that are proprietary and billing the patient.
  8. Using brain scans and other unproven treatments and billing the patient.
  9. Internet marketing scams.

References:
http://www.naadac.org/code-of-ethics#i
http://www.addictionpro.com/article/special-report-addiction-treatment-ethics-crossroads