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Chapter 2: Ethical and Legal Issues in Substance Abuse Counseling
Highlight the complexity of ethical and legal issues facing substance abuse professionals.
Highlight the varied credentialing and licensing requirements for substance abuse counselors.
Identify the federal and state laws pertaining to counselors in general and specific to substance abuse
Illustrate the conflicts between and amongst federal laws, state laws, and ethical codes.
Emphasize the importance of competently serving diverse populations.
Emphasize the increased risk of dual relationships of recovered substance abuse counselors.
Provide ethical decision-making models and suggestions.
Key Terms and Definitions
Autonomy: The therapist’s responsibility to support client independence and freedom of choice.
Beneficence: The therapist’s responsibility to do what is in the best interest of the client.
Confidentiality: Confidentiality is considered the core value of mental health professionals and is intended to reduce
stigma, foster trust, protect privacy, and allow clients to control access of information they have shared.
Consent: The client’s permission to release confidential information.
Duty to Protect: The therapist’s responsibility to protect or lessen the threat by either contacting authorities or the
targeted person, but not necessarily both.
Duty to Warn: The therapist’s legal duty to warn a person who may become a victim of a violent act by a client.
Informed Consent: The legal and ethical requirement of therapists to inform the client of the potential risks and
benefits of counseling.
Fidelity: The therapist’s responsibility to remain loyal to the client.
Justice: The therapist’s responsibility to act fairly, avoid bias and stereotypes.
Nonmaleficence: The therapist’s responsibility to do no harm.
American Counseling Association, http://www.counseling.org
Association for Assessment in Counseling (AAC), http://aac.ncat.edu/
American Mental Health Counselors Association (AMHCA), http://www.amhca.org/
American Rehabilitation Counseling Association, http://www.nchrtm.okstate.edu/arca/
American School Counselor Association (ASCA), http://www.schoolcounselor.org/
Association for Spiritual, Ethical & Religious Values in Counseling,
Council on Accrediting Counseling and Related Educational Programs (CACREP),
Counselors for Social Justice (CSJ), http://www.counselorsforsocialjustice.org/
International Association of Marriage and Family Counselors, http://www.iamfc.com/
NAADAC, the Association for Addiction Professionals, http://www.nadaac.org
National Board for Certified Counselors and Affiliates, http://www.nbcc.org/
National Center on Elder Abuse, http://www.elderabusecenter.org/
Substance Abuse and Mental Health Administration Services, http://www.samhsa.org
1. Research the prevalence of drug and alcohol abuse/ dependence and family violence, including child abuse/
neglect and domestic abuse.
2. Interview a substance abuse counselor and ask about ethical dilemmas he or she faced.
3. Interview a school counselor and ask about ethical dilemmas he or she faced.
4. Research national, state, and local organizations in your profession (or future profession) and review the
5. Research your current state laws regarding any of the following:
Mandatory reporting of child abuse/ neglect
Mandatory reporting of elder abuse
Mandatory reporting of domestic abuse
Mandatory duty to warn a potential victim of violence
Minor’s ability to consent to drug and alcohol abuse treatment
Parental access to minor records and confidential information
Certification requirements of substance abuse counselors
Essay Questions/ Discussion Starters
1. Describe the diverse avenues for entering the profession of substance abuse counseling.
Answer may contain, but is not limited to, any of the following Counseling, Psychology, Nursing, or
2. Define confidentiality and privileged communication and describe common ethical limits to confidentiality.
Answer may address:
Client’s right to keep their information private. Common limits to confidentiality may include immanent
danger to self or others, valid court orders, or if the therapist is seeking supervision. Note: if therapist is
sharing confidential information under supervision, it is their duty to keep personal identifying
3. Explain the purpose of CFR 42, Part 2, the information that is protected and the information that may be
disclosed without client consent.
Counselors providing substance abuse screening or treatment services are legally bound to additional
confidential restrictions under the federal law known as Code of Federal Regulations (CFR) 42, Part 2;
CFR 42 strictly protects the confidentiality of “records of the identity, diagnosis, prognosis, or
treatment of any patient” which are maintained by a program that provides screening or treatment of
drug or alcohol abuse and receives funds (directly or indirectly) from the federal government (CFR 42,
Part 2). The purpose of CFR 42 was to encourage substance abusers to seek treatment without fear of
discrimination, legal ramifications, or fear of losing one’s job. The information shared in this section is
only a summary of the federal regulation; substance abuse counselors need to review and follow the
Answer: According to CFR 42, Part 2, confidential client and former client information can only be
disclosed in a few instances: (1) to medical professionals in the event of an emergency; (2) to qualified
individuals for the purpose of conducting research, audits, and program evaluations, however such
personnel may not directly or indirectly identify any individual patient; (3) with an appropriate court
order indicating the extent of the necessary disclosure; and (4) with client consent. However, the federal
confidential regulations do not apply in following circumstances: (1) to members or veterans of the
armed forces under the care of military facilities; (2) communications within a program; (3) to
qualified service organizations (such as blood work laboratories conducting drug testing); (4) crimes on
program premises or against program personnel; and (5) reports of suspected child abuse and neglect.
Clearly the law does not permit the disclosure of information in the event of preventing imminent danger
to a third party, preventing the transmission of communicable diseases, or the reporting of elder abuse
or domestic violence.
4. Explain the typical laws that pertain to the confidentiality of minors, both in and out of school settings.
Typical limits to confidentiality reflect the same limits imposed on adult clients, including: consulting
with other professionals; preventing imminent danger to the client or others; court orders; and
preventing a third-party from contracting a communicable disease from the student/ client. In the event
that the counselor must disclose confidential information, it is recommended that the counselor inform
the student before disclosing the information; and remind the student of the limits of confidentiality that
were outlined at the onset of the relationship. They should also describe the purpose for disclosing and
the type of information that will be shared.
In regards to the school counselor’s obligation to the parent, the ethical code states that although the
counselor’s primary obligation is to the student, the counselor “…balances that obligation with an
understanding of the legal and inherent rights of parents/ guardians to be the guiding voice in their
children’s lives” (A.2.g). The ethical code also indicates that it is the counselor’s responsibility to
inform parents of the counselor’s role and the confidential nature of a counseling relationship that is
afforded to the student. However, ASCA’s Code of Ethics states that counselors may need to collaborate
with parents in order to serve the best interest of the student, particularly though the sharing of
accurate, comprehensive, and relevant information that is appropriate and consistent with the ethical
responsibilities that the counselor has to the student. Students should also be informed that the school
counselor will contact the parent(s) in the event that the student indicates a clear and imminent danger
to oneself or others. Imminent danger refers to a serious threat but is often the counselor’s values and
beliefs influence the perception of danger (Glosoff & Pate, 2002). Finally, although school counselors
are ethically bound to keep student information confidential, possibly from parents, school counselors
must adhere to Family Educational Rights and Privacy Act (FERPA)/ Buckley Amendment, Individuals
with Disabilities Education Act (IDEA), and Protection of Pupil Rights Amendment (PPRA), which are
all summarized in the textbook.
According to the federal regulation CFR 42, Part 2, counselors must maintain confidentiality of the
client, with few exceptions. In fact the counselor may not be able to share information with the parents
of a minor. The entire CFR 42, Part 2 law applies to any person, regardless of age; the law protects any
information about a minor who has received any substance abuse related services or referrals from a
program that receives any federal funding, this would include public schools. Information may be
shared with parents if the minor provides written consent (Schwartz & Smith, 2003). The written consent
must have all of the elements that CFR 42 requires, including the minor’s signature. The minor may
verbally revoke this consent at any time. The exception is if the counselor believes that the minor lacks
the capacity to disclose or if there is a substantial threat to life or well-being of the minor.
Multiple Choice Questions
1. Which of the following does not contribute to the complexity of ethical and legal issues in substance abuse
(a) Ethical Codes
(b) Personal Recovery
(c) Agency/ Worksite Regulations
(d) Federal Laws
2. Which of the following is not one of Kitchener’s moral principles?
3. Who is not bound by confidentiality?
(a) The client
(b) The substance abuse counselor
(c) The supervisor
(d) The insurance company
4. Which of the following does not allow for the reporting of child abuse?
(b) CFR 42, Part 2
(c) ACA Code of Ethics
(d) None of the above
5. Which law does not allow for a breach of confidentiality to warn a third party in imminent danger?
(b) CFR 42, Part 2
(c) State Law
(d) None of the above
6. When faced with conflicting laws or ethical codes the substance abuse counselor should always defer to:
(a) Federal laws
(b) State laws
(c) Ethical codes
(d) The most restrictive regulation or code
7. According to CFR 42, Part 2, confidential information may be disclosed with client consent:
(a) For a third party payment
(b) To medical professionals in an emergency situation
(c) To family members in an emergency situation
(d) None of the above
8. According to CFR 42, Part 2, disclosure of confidential information requires written consent with several
elements; which of the following is not one of the required elements?
(a) The name of the person or program permitted to make the disclosure
(b) The name of the person or program receiving the disclosed information
(c) The purpose of the disclosure
(d) A statement indicating that the client may revoke consent at any time but only if he or she states that in
9. According to HIPAA, client consent is not required for disclosure of confidential information for all the
(a) To the client’s employer
(b) For the opportunity to agree or object
(c) For treatment, payment, and health care operations
(d) For public interest and benefit activities
10. Which of the following regulations restricts parental access of their children’s confidential information
without the minor’s consent?
(c) CFR 42, Part 2
11. Culturally competent counselors do not:
(a) Have an awareness of his or her own cultural values and biases
(b) Have an awareness of client’s worldview
(c) Utilize culturally appropriate intervention strategies
(d) Accept expensive gifts because it’s polite
12. Problems may arise if a substance abuse counselor and former client attend the same AA meeting for all the
following reasons except:
(a) The former client will benefit more than the substance abuse counselor
(b) It risks the substance abuse counselor anonymity
(c) It risks the former client’s confidentiality
(d) The substance abuse counselor may need censor what they share in the meeting
13. Which of the following is not a characteristic of an ethical dilemma?
(a) A choice between two courses of action must be made
(b) There are significant consequences for not selecting either of the options
(c) Each decision is supported by ethical principles
(d) One of the decisions is supported by state regulations
14. The ACA endorsed A Practitioner’s Guide to Ethical Decision Making. Which of the following is not one of
(a) Determine the nature and dimensions of the dilemma
(b) Generate potential course of action
(c) Consider potential consequences for all options and choose a course of action
(d) Consult with a friend before making a decision
15. Regarding professional conduct, substance abuse counselors need to be aware of requirements delineated in:
(a) Federal and state laws
(b) Local laws and regulations
(c) Codes of ethics
(d) All of these
16. Which of the following groups do not have specific licensure/certification for substance abuse counseling?
(a) National Board of Certified Counselors
(b) National Association of Alcoholism and Drug Abuse Counselors
(c) US Department of Transportation
(d) None of these
17. The legal and ethical requirement to inform clients of the potential risks and benefits of counseling is:
(a) Informed consent
(b) Duty to warn
(c) Privileged information
(d) Duty to protect
18. In recognizing diversity, counselors need to work to meet the needs of clients, while also seeing that values are
_______________ clients, which can result when the counselor does not understand the world view of the
(a) Clearly explained to
(b) Fluid for some
(c) Unchanging in
(d) Not imposed on
19. Lipari V. Sears, Roebuck & Co. was a federal case that further extended the duty of counselors to
(a) Warn victims
(b) Protect unknown victims
(c) Protect identifiable victims
(d) All of the above
20. The purpose of HIPAA is _______________.
(a) To protect individually identifiable health information
(b) To increase the flow of information between health care providers, health plans, or third party on behalf
of the party
(c) To encourage substance abusers to seek treatment without fear of discrimination, legal ramifications, or
fear of losing one’s job.
(d) Both a and b
21. HIPPA does not apply to _______________.
(a) Health information contained in health care provider records or in health plan records
(b) Health information contained in health care clearinghouses.
(c) Health information contained in employer records or in educational records
(d) None of the above
22. Personal counseling notes are considered a school record ______________.
(a) The moment they are created
(b) The moment anyone other than the counselor knows of their existence
(c) The moment they are placed in the “permanent” school record file
(d) None of the above
1. B (p. 27) 8. D (p. 34) 15. D (p. 27) 22. B (p. 39)
2. D (p. 30) 9. A (p. 36) 16. D (p. 28-29)
3. A (p. 32) 10. C (pp. 37, 40) 17. A (p. 38)
4. D (pp. 34, 36) 11. D (p. 41) 18. D (p. 41)
5. B (p. 34) 12. A (p. 42-43) 19. D (p. 33)
6. D (p. 44) 13. D (p. 44) 20. D (p. 35)
7. B (p. 34) 14. D (p. 44-45) 21. C (p. 35)