As I was doing research for this article, I was chatting with a friend online. I told her I was preparing to write about ethics in the practice of addictions counseling, around 1,500 to 2,000 words. Her response: “All you need is five words: Don't sleep with your clients!”
While I laughed, I also began to think. I considered the coursework I have had in this area. I have attended “trainings” in ethical decision-making for addictions counselors. I have had undergraduate coursework in ethical issues in the human services professions. And I have had graduate coursework in counseling issues and ethics. While these experiences shared some obvious commonalities (such as my friend's tongue-in-cheek distillation of the entirety of ethical practice), there were significant differences as well.
In the paragraphs that follow, I will address some of the differences that exist in ethics education at the three levels. I also will consider what the differences mean to us as addictions counselors, what the differences mean to other mental health professionals, and what the differences could very well mean to our clients. Finally, I will propose a change in how the average addictions counselor approaches ethical decision-making-a change that could have long-standing positive consequences for the field and, more importantly, for those we serve.
The ethics education I received on the “training” level was what I would call “proscriptive” ethics. In a two-day, generally 14 clock-hour session, with the NAADAC Code of Ethics in one hand and the state of Colorado's mental health statute in the other, an instructor went over a list of prohibited activities and related the consequences that could result from a breach. There are, of course, parts of the list that get repeated over and over: confidentiality of client information, dual relationships with clients, sexual relationships with clients, and duties to report in cases of suicidal/homicidal (with an identified target) ideation.
The goal of such training seems to be quite specific: “Chemical Dependency counselors can reduce the risk of malpractice [suits] by understanding and following the ethical codes and legal laws to the best of their ability.”1
Despite the approach of such training, some evidence suggests that counselors with minimal required ethics training have “difficulty extending ethical principles to situations that they were not taught to deal with”2, and some research indicates that they are not as prepared to deal with ethical dilemmas as are those who receive more stringent ethics training.3
In my baccalaureate education, ethics training was presented in a “prescriptive” manner. Rather than a negative presentation of what is forbidden, there was more of a positive presentation of what to do in a given circumstance-a prescription for each ethical conundrum presented in a case scenario. While the mental health statute and the “avoidance of malpractice” tenets were taught, more emphasis was placed on the codes of ethics, which the instructor reviewed in detail with us. There were a great many cases presented, and students were expected to be able to relate which sections of the ethics code applied in each case.
This prescriptive method of ethics education has a number of advantages over the proscriptive training done in workshops. It is generally 45 clock-hours in length (a three semester-hour course length), which affords much more time for examining case studies and addressing ethical concerns that arise for students over the period of the course. Another significant advantage is that it is generally less adversarial. The proscriptive method can create a belief that ethical behavior is done to avoid punishment rather than to offer the best possible care; the prescriptive method promotes the client's best interests and welfare.
Still, the prescriptive method relies more on an “event-response” sort of training and might limit appropriate responses in unfamiliar situations, as also noted above. Cynthia Scott4 addresses some of the special situations arising in addictions counseling where this might occur, and Toriello and Benshoff note that training in critical thinking and “rational decision-making” aids in developing sensitivity to ethical dilemmas.3 The critical thinking and rational decision-making aspects tend to be left out of prescriptive teaching approaches.
Finally, at the graduate level of ethics education, a “descriptive” method was used. Again, the proscriptive and prescriptive aspects of counseling ethics were incorporated. The mental health statute was reviewed and prohibited activities were clearly communicated and discussed. The code of ethics (in this case, the code of the American Counseling Association, which is considerably longer and more detailed than that of NAADAC) was parsed and its principles taught. Additionally, though, there was significant instruction about the theoretical underpinnings of not only the code of ethics, but of the basics of ethical decision-making. These principles (taken for this article from the American Psychological Association's Web site at http://www.apa.org) include:
Beneficence and nonmaleficence;
Fidelity and responsibility;
Respect for people's rights and dignity.