Ethically responsible recovery

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 (https://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

The components of personal (mental) health and the healing of wounds contained within these definitions imply that recovery includes working through one's therapeutic issues. The underlying causes of addiction cannot be fully resolved in treatment, and susceptibility to relapse is often due to failure to make the transition into recovery maintenance.5 Recovery occurs on a continuum and the despair, grief/loss, resentment, blame, guilt and shame associated with surviving addiction requires continued professional clinical guidance, especially for the recovering addiction professional working with others.

Counselors' obligations

While exploring what constitutes the concept of ethically responsible recovery for recovering addiction professionals, it is helpful to clarify what it is not. In the course of researching this topic, an interview was conducted with Donald R. Hays, behavioral health counselor at the Center for Dependency, Addiction and Rehabilitation (CeDAR) in Colorado. Hays is a former criminal defense attorney and has worked as an addiction counselor for the past 27 years. He stated emphatically, “I have worked with several counselors who have relapsed and sought treatment at a facility where I was working. In each case we had them self-report as part of their treatment. The underlying problem for all of them was they tried to use their job as their recovery program. It does not work and is unethical.”

Clinical work with others does not safeguard a recovering counselor's sobriety. Addiction is a “disease of denial,” and using clinical work with clients as one's program of recovery substantially increases a recovering counselor's chances to minimize his/her own disease.6 White offers the following suggestion: “If you are in recovery, cultivate and sustain mechanisms of recovery maintenance separate from your professional life. Working in service roles within the addictions field is not a viable program of personal recovery and may even undermine defense structures that have previously served to maintain sobriety.”

Counseling others in addiction treatment in no way qualifies as working a sound program of recovery. Worse, it potentially puts clients in harm's way. Substance abuse counselors operate within an extremely complex environment, and the services they provide may have a profound impact on a client's life.7 Addiction counselors need to be professionally accountable and they owe it to their agencies, organizations, profession and, most importantly, their clients to act within a framework of professional values and integrity. Ultimately, they need to practice what they preach.

Recovering counselors who use their clinical work as their program of recovery are not only putting themselves at risk for relapse, but are using their clients for their own self-interest and are violating ethical principles. The NAADAC ethical standard that applies to this issue is found in Principle 9, Duty of Care: “I shall operate under the principle of Duty of Care and shall maintain a working/therapeutic environment in which clients, colleagues and employees can be safe from the threat of physical, emotional, or intellectual harm.”

Although this article primarily addresses the idea of ethically responsible recovery for the recovering addiction counselor, Principle 8 (Preventing Harm) of the NAADAC code of ethics implies an ethical obligation for all addiction counselors to work through their therapeutic issues. The principle states, “I understand that every decision and action has ethical implication leading either to benefit or harm and I shall carefully consider whether any of my decisions or actions has the potential to produce harm of a physical, psychological, financial, legal or spiritual nature…”

References

1. White WL. Recovery: Old wine, flavor of the month or new organizing paradigm? Subst Use Misuse 2008; 43:1987-2000.
2. Betty Ford Institute Consensus Panel. What is recovery? Revisiting the Betty Ford Institute Consensus Panel defi nition. Int J Mental Health Addiction. Retrieved Sept. 10, 2009 from www.springerlink.com/content/119974/?p=55aa4dc755134a94af46d51a39170 528andpi=0.
3. Boisaubin EU, Levine RE. Identifying and assisting the impaired physician. Am J Med Sci 2001 Jul; 322:31-6.
4. Clark C, Farnsworth J. Program for recovering nurses: an evaluation. MedSurg Nurs 2006 Aug; 15:223-30.
5. White WL. The mobilization of community resources to support longterm addiction recovery. J Subst Abuse Treat 2009 Mar; 36:146-58.
6. White WL. Alcohol, tobacco and other drug use by addictions professionals: historical refl ections and suggested guidelines. Alcoholism Treat Q 2008; 26:500-35.
7. Toriello PJ, Benshoff JJ. Substance abuse counselors and ethical dilemmas: the influence of recovery and education level. J Addictions Off ender Couns 2003 Apr; 23:83-98.
8. Krystal H, Moore R. Who is qualifi ed to treat an alcoholic? A discussion. Q J Stud Alcohol 1963; 27:449-59.