Many professionals in the field of addiction counseling have struggled with their own addiction issues and are now in a position of serving others in addiction treatment. In May 2009, Anne Hatcher, EdD, chair of the ethics committee at NAADAC, The Association for Addiction Professionals and co-chair of the Addiction Studies program at Metropolitan State College of Denver, posted a blog on the Addiction Professional Web site (http://www.addictionpro.com) entitled “What is our standard?”
Hatcher noted, as credentialing requirements for certification are progressively being altered across the country, “An issue that keeps coming up in discussions as addiction counselors become more active members of the mental health counseling arena is whether or not addiction counselors should be held to a higher standard on behaviors relating to substance use/abuse/dependence than professionals in other mental health disciplines.”
This issue led to a discussion addressing the pros and cons of establishing a specific number of years of sobriety required for a counselor in recovery to be eligible for certification. Respondents generally opposed any arbitrary abstinence limits, arguing that demonstrated sobriety requirements would be discriminatory if the standard were not applied across the board for all mental health disciplines. Furthermore, respondents argued that sobriety alone does not equal recovery, or sound emotional health for that matter. A person can be sober for many years and still not be fit to counsel others in a professional capacity.
Consensus in the blog discussion emerged on one important point. All respondents think addiction counselors have a moral and ethical obligation to seek continued counseling, consultation and supervision for their own therapeutic issues as long as they work with others in a clinical setting. For recovering addiction professionals this ethical responsibility extends to include a sound program of recovery. Seen in this light, length of sobriety might not be the only indicator of a person's fitness for duty as an addiction counselor.
Inferences drawn from this discussion became the basis of this article, which attempts to explore the idea of ethically responsible recovery.
What constitutes recovery?
The current addiction treatment model focuses on brief biopsychosocial stabilization and often generates sustainable abstinence, but not long-term recovery.1 This generalized outcome equally applies to addiction professionals who have completed treatment to arrest their own addictions. The current acute care treatment model might initiate recovery, but sustainable recovery is an individual responsibility following treatment, and for the recovering addiction professional an ethical one. What is required to sustain sobriety is qualitatively different from what is required to sustain recovery.
Recovery is the presumed goal of treatment, yet the term has remained somewhat ambiguous. An expert consensus panel convened at the Betty Ford Institute in 2006 to propose a definition of recovery; the issue was revisited in 2009. Expert panelists included a number of nationally prominent leaders from the treatment and research communities. The panel's consensus resulted in this statement: “Recovery is the best word to summarize all the positive benefits to physical, mental, and social health that can happen when alcohol- and other drug-dependent individuals get the help they need.” More specifically, the panel stated that addiction recovery is “a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.” The panel noted that while sobriety is a necessary part of recovery, the two are not synonymous.
The panel refrained from prescribing a recovery process, stating, “Recovery is not synonymous with a specific method of attaining it.” Although it would be easiest to define recovery as “abstinence attained through adherence to 12-Step principles,” such an approach would limit a description of recovery to the most familiar method of achieving it, confining it to a single strategy.2
Counseling others in addiction treatment in no way qualifies as working a sound program of recovery.
It is interesting to note, however, that when professionals in other health-related fields (social workers, doctors, nurses, psychologists, etc.) are identified as impaired due to alcohol or drug problems, specific criteria must be adhered to following treatment in order to retain licensure and resume practice. Across the board, attending a self-help program is a professionally mandated requirement.3,4
William L. White, senior research consultant at Chestnut Health Systems, who has practiced and taught in the addiction field since 1969, defines recovery as “the experience (a process and sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) use and related problems mobilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by these problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.”1