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How Do We Define Treatment?

September 4, 2009
by Dr. Anne
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This posting relates to a previous one on how much recovery time an individual should have prior to becoming a counselor. As our profession moves towards using more medications to control addictive behaviors and substance abuse, we might find persons who are on those medications wishing to be certified as counselors. If the abstinence standard is applied, the decision must be made about the use of medications that aid recovery as well as those that are essential for health reasons. Is the person not abstinent when taking any medication? Is a person who chooses to continue counseling to work on personal issues still in treatment and thus not eligible for certification as an addiction counselor? A lively discussion on this topic occurred among counselors and in some addiction studies classes. Is a person taking a medication for depression as prescribed in treatment and then not eligible for certification? One example that made the discussion particularly lively was a case study in which someone abused opiate analgesics for 15 years, participated in methadone treatment for 3 years and continued on maintenance doses of methadone. Does methadone maintenance for 6 years mean the person is still in treatment and thus not eligible for certification? Another possible scenario is the addiction professional experiencing pain who elected to use medical marijuana and does so under the supervision of an MD, is that grounds for suspending the counselor’s certification?

The standard that might apply to these situations is found in Principle 4: Trustworthiness. “I understand the effect of impairment on professional performance and shall be willing to seek appropriate treatment for myself or for a colleague.” If the persons described in the previous paragraph are evaluated by an addiction professional/clinical supervisor found to be competent to practice as certified addiction professionals, can other persons object to certification on the basis of medication or continued counseling? The underlying question is “What constitutes treatment, when does it begin and when does it end?



The question of the quantity of "recovery" time someone should have before entering the counselor ranks is, although perhaps an interesting one, is at the end of the day missing the point. The real questions have more to do with the quality of ones recovery, not the quantity - which is ultimately unmeasurable anyway given that we pretty much take someone at their word in the field that they are in fact abstinent on any given day. Another pertinent question is how are we defining "recovery"? How "healed" or, "how far down the road" do we expect counselors to be before we believe they can be of help in counseling someone else?. These, and many others, are the intriguing ones for me as I continue my professional and personal journey in this field.

If a person is using a mind-altering chemical that is known to produce impaired reasoning/judgment, they should not be practicing. If that substance eases the effects of depression or anxiety in the right dose without affecting judgment, then that's fine. If the substance is addictive - like, say, nicotine, sugar, caffeine - that should be set apart from addictive AND prone to impair reasoning and judgment. I think that reasoning and judgment - not to mention IQ and good clinical skills - period - are what are important factors. This speaks to the importance of solid clinical supervision which is all too often lacking.

On the issue of continuing one's own counseling for personal issues while making an effort to become certified - Let's keep in mind that other counseling professions encourage personal therapy while the candidate is in training for certification as a clinician, and also give support for counselors being in their own therapy if needed while carrying out a counseling practice. Of course, the issue here focuses on the severity of the practitioner's own problems, and if there is impairment in professional functioning. This then becomes a supervision issue someone needs to review how the clinician is doing in counseling others.

Concur with Jim Jenson. As addiction professionals, we need to ensure that as therapists, we can function in a capacity that will not adversely affect the client. There is a reason why we take an exam, complete an internship and obtain the clinical hours to become a addiction counselor. This is why we all need clinical supervision and confer with our colleagues for support.

I think one important issue that gets ignored is " What is the standard for other health care professionals and should addiction professionals be held to a different standard?" i believe performance and ability to perform professionally is the standard we should require.

I concur with your other readers, but as we know to do what is needed to take care of one self is a part of recovery. So, yes many professional are in some kind of treatment on a continueus bases, but this does not say that they are not conpetent to do their job as a behavioral health professional. And yes, it does fall back to having good clinical supervision to review the work that is being done.

Of course if a health professional is addicted to some kind of meds, I'll think twice before being his or her patient. But if this person is really good at what he or she does (even way better than any other health professional), why can't I be one of his or her patients? Surely, the meds this person is using may be painkillers. Still, they may lead to addition. But if the pain is too much to take. I guess it is acceptable, at least morally. Of course, according to a research from case study writing service around 10 to 14 percent of medical professionals abuse drugs like sedatives and painkillers. Still, I personally believe there's a small percentage of med staff taking drugs because of a real pain (for example Dr. House..kidding..still there might be real doctors like him who are incredible but dependent on painkillers) and they should be given a chance to be doctors.

Dr. Anne

Anne S. Hatcher, EdD, CAC III, NCAC II, is Co-Director of the Center for Addiction Studies at...

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