Ethics in the Counseling Profession

A critical stage in the development of any profession is the articulation of standards of competency and standards of ethical practice. Both are intended to protect the public from the power to do harm-as well as good- that is an inherent part of the professional role.

The addictions treatment field was slow in its development of ethical standards of professional conduct. Even when professional association certification bodies, and individual agencies developed codes of ethical conduct, they often represented little more than vaguely worded inspirational values, rather than explicit codes of professional conduct

In the professional literature, scant attention was directed to ethical issues, and by 1985 there was still not a single text on this topic. On the front lines of service agencies, ethics consisted on two inconsistently followed maxims: "be careful about confidentiality," and "don’t have sex with your clients—at least not while they’re ‘clients’." Entering the mid 1980’s, the field had poorly developed ethical sensitivities, a weak foundation of ethical standards, no universally accepted model of ethical standards, no universally accepted model of ethical decision-making, and rare utilization of ethics-related disciplinary processes. The entire issue in the field’s early development focused on clinical ethics. It was virtually silent on ethical issues related to the business practices of treatment agencies. Those vulnerabilities would prove to be the Achilles Heel.

The ethical abuses that unfolded in the face of intensified competition were widespread and severe: unethical marketing practices, financially motivated and clinically inappropriate admissions, excessive lengths of stay, inappropriate re-admissions, excessive fees, and the precipitous abandonment of clients when they reached the limits of their financial resources. Treatment itself took on a more coercive quality, with a growing number of clients entering treatment under duress from courts, employers, schools and families. As competition tightened, some programs moved into questionable areas of specialized service, in an effort to sustain or increase patient census. Aggressively marketed programs for women, dual-diagnosis and cocaine treatment often masked the lack of significant expertise to conduct such services. Some programs’ migration beyond the boundaries of their education, training, and experience was further evidenced in their practice of embracing an ever-widening range of disorders under the addiction umbrella—conditions that ranged from codependency to eating disorders to sexual addiction.

As the insurance companies’ share of the cost of alcoholism treatment rose rapidly, insurance industry representatives began to focus closer scrutiny on the services they were paying for and the differences in costs between programs. Dan Anderson, former President of Hazelden, describes their conclusions: "Those paying for alcoholism treatment looked at programs whose costs ranged from $135 a day to $3,000, and on paper it looked like they were providing the same treatment. People began to ask, "My god, what kind of professional field is this?"

Efforts were made to respond to these growing breaches in conduct. In 1982, the National Association of Alcoholism Treatment Programs issued guidelines for promoting more ethical and responsible advertising of alcoholism programs. They called upon programs to refrain from criticizing alternative approaches, exaggerating success rates, and using advertisements that made recovery appear to be an easy process. There were also early voices of warning. By 1986, traditional treatment advocates such as James Kemper, Jr., were challenging the treatment industry to "get its act together." Kemper warned that the rapid proliferation of treatment programs was creating a climate ripe for "fringe operators" and "grifters and thieves" who could do great harm to the integrity of the addiction treatment industry. Alarms also came in the form of the field’s first two texts on ethics: LeClair Bissell and James Royce’s Ethics for Addiction Professionals and William White’s Critical Incidents: Ethical Issues in Substance Abuse Prevention and Treatment. By 1990, 50 out of 57 of the nation’s addiction counselor credentialing boards specifically prescribed a code of professional ethics. Under the sponsorship of NAADAC and state counselor certification bodies, ethics training increased—sometimes initiated in the aftermath of ethical explosions that placed local agencies and the field itself on the front pages of newspapers. In 1988 and 1989, a growing number of voices at professional conferences began making dire predictions about the future of addiction treatment institutions, and the addiction treatment profession, if the field could not be clinically and ethically re-centered.

In the 1980’s, it was difficult for the field to heed such warnings. A field birthed in virtual poverty found itself addicted to its own success. Whispered voices of self-confrontation began to suggest that maybe the addiction field itself needed treatment. The field was ripe for a wake up call, and fortunately for those of us in practice, the call was heeded, and we are complying with our certification/licensing boards and standards to practice in the field.