1.3 Core Ethical Principles

When practicing ethically, counselors balance principle ethics, virtue ethics, moral principles, and laws. Principle ethics emphasize decision-making based on obligation, cognition, and the need to act, whereas virtue ethics centers on the counselor’s ideals, character, and nature (Meara et al., 1996; Mifsud & Herlihy, 2022). Principle ethics provide a prescribed or agreed-upon framework to reach ethically sound conclusions, while virtue ethics focuses more on the aspirational traits of the counselor. When using principle ethics in practice, a counselor considers whether a situation is ethical or unethical. In contrast, when considering virtue ethics, the counselor will focus on the impact of a decision on a specific client. The debate between principle and virtue ethics does not require counselors to choose one side. Instead, the goal is to find a balance between both approaches (Meara et al., 1996; Mifsud & Herlihy, 2022).

Autonomy

Autonomy is an essential ethical principle in counseling that emphasizes respecting and supporting clients’ right to make informed decisions about their treatment. In the context of treating co-occurring disorders, the principle of autonomy is particularly significant because it empowers clients, who often feel controlled by their conditions, to take an active role in their treatment and recovery process. The ACA and NAADAC stress the importance of promoting and respecting clients’ autonomy in the therapeutic relationship in their ethical codes.

In practice, promoting autonomy involves ensuring that clients are fully informed about their condition, potential treatment options, and the benefits and risks associated with each option. Counselors must facilitate a collaborative decision-making process where the client’s preferences and values are considered and integrated into the treatment plan. This includes respecting clients’ decisions, even when they differ from the counselor’s professional recommendations, provided these choices do not result in harm to the client or others. Furthermore, autonomy involves supporting clients in building self-efficacy and self-determination, which are essential for managing their disorders and improving their quality of life. By adhering to the principle of autonomy, counselors not only comply with ethical standards but also enhance the effectiveness of treatment by fostering a sense of control and responsibility in their clients.

Counselors must also consider cultural factors that influence individuals who may not value or accept autonomy similarly. While Western cultures in the United States prioritize individualism and self-differentiation, not all cultures adhere to this belief system (Duffey & Trepal, 2016). Counseling professionals need to consider how culture impacts the emphasis on autonomy. They must assess whether a client identifies more with a collectivist perspective and would benefit from family and community support and feedback when making decisions about their treatment or program of recovery. Overlooking cultural aspects in this context would create an ethical dilemma if the counselor imposed their beliefs or values regarding autonomy on the client.

Beneficence

Beneficence is a core ethical principle that requires counselors to actively promote the wellbeing of their clients and contribute positively to their health and wellbeing. In the context of treating co-occurring disorders, this principle emphasizes the counselor’s responsibility to act in the best interest of the client, ensuring that all therapeutic interventions and actions are designed to enhance the client’s health and recovery from both substance use and mental health issues. The ACA and NAADAC reinforce the importance of beneficence in counseling, urging professionals to make thoughtful and informed decisions that benefit their clients in their ethical codes.

Beneficence in treating co-occurring disorders means that counselors must provide treatments based on the latest research and best practices tailored to each client’s specific needs and circumstances. It involves advocating for access to necessary resources and supports to improve the client’s quality of life and chances of recovery. Counselors must also proactively identify the potential benefits of various treatment options while balancing these against any risks, ensuring that the chosen interventions are most likely to benefit the client. Moreover, beneficence requires counselors to engage in continuous professional development to enhance their skills and effectiveness. Through a commitment to beneficence, counselors adhere to ethical standards and foster trust and therapeutic progress, significantly impacting the overall treatment outcomes for clients with co-occurring disorders.

Nonmaleficence

Nonmaleficence emphasizes the counselor’s obligation to avoid causing harm to clients. In treating co-occurring disorders, this principle is especially critical due to the complex nature of these conditions and the potential vulnerability of the clients. Both the ACA and NAADAC highlight the importance of nonmaleficence in ensuring that counselors do not inflict physical, psychological, or emotional harm on their clients, either intentionally or unintentionally in their ethical codes.

In practice, applying the principle of nonmaleficence involves several key considerations. Counselors must be aware of the potential for harm from treatment interventions, particularly when integrating therapeutic techniques with diverse individuals. They need to ensure that their interventions are evidence-based and delivered with the utmost competence to minimize risks. Additionally, counselors must be vigilant in monitoring the effects of treatment and ready to adjust or discontinue counseling that may be causing unintended adverse effects. This includes recognizing the potential for harm in dual relationships or conflicts of interest that might compromise the client’s wellbeing. When tending to nonmaleficence, counselors safeguard their clients’ health and wellbeing, ensuring that the treatment provided supports recovery and does not contribute to further distress or deterioration.

Justice

As an ethical principle in counseling, justice emphasizes the counselor’s responsibility to ensure fair and equal treatment for all clients. In the context of treating co-occurring disorders, this principle advocates for providing equitable access to treatment resources, unbiased care, and consideration of each client’s unique cultural, social, and personal circumstances. The ACA and NAADAC underscore the importance of promoting fairness and non-discrimination in delivering professional services, ensuring that no client is denied help based on personal or demographic characteristics in their ethical codes.

Applying the principle of justice in a counselor’s work means striving to remove barriers clients may face in accessing comprehensive and holistic care. This involves recognizing and addressing societal, systemic, and structural inequalities affecting treatment outcomes. Counselors must work to offer consistent and unbiased advice and support, adapting their methods to meet the diverse needs of their clients effectively. Furthermore, they should advocate for policies and practices that enhance service delivery and accessibility for populations that may be underserved or marginalized. Through this, counselors enhance the therapeutic relationship and contribute to the broader goal of achieving equity in health care, which is essential for the successful treatment and recovery of individuals with co-occurring disorders.

Fidelity

Fidelity is an ethical principle that involves maintaining loyalty and commitment to the counseling profession’s ethical standards, particularly in maintaining trust and honoring the responsibilities within the counselor-client relationship. In treating co-occurring disorders, fidelity underscores the importance of honoring agreements, maintaining confidentiality, and delivering consistent, reliable care as promised. This principle is highlighted in the ACA and NAADAC ethical codes, which stress the necessity for counselors to be trustworthy and uphold the integrity of the therapeutic relationship.

Adhering to fidelity means that counselors must communicate honestly and follow through on commitments made to clients. It involves clear, consistent, and accurate reporting of treatment procedures and outcomes and ensuring no breach of confidentiality occurs unless mandated by law or agreed upon in situations where client safety is at risk. Fidelity also requires counselors to respect the client’s trust and not exploit the relationship for personal gain. Moreover, counselors treating co-occurring disorders are tasked with coordinating care among various service providers, which necessitates reliable communication and adherence to agreed-upon treatment plans and goals. By upholding fidelity, counselors reinforce the therapeutic alliance, a critical factor in successful treatment and recovery for clients with co-occurring disorders. This improves client outcomes and sustains the counselor’s professional credibility.

Veracity

Veracity is a fundamental ethical principle in counseling, requiring counselors to communicate truthfully with clients and colleagues. This involves accurately representing their services, credentials, and qualifications, as the ACA and NAADAC ethical codes outline. Such transparency is essential for building trust and supporting effective treatment, enabling clients to make informed decisions. Misrepresentation, especially in the context of co-occurring disorders, can erode trust and potentially harm the client. Additionally, counselors must clearly explain treatment plans, including goals, methods, and expected outcomes, to ensure clients are well informed and actively engaged in their treatment process.

Upholding veracity also means adhering to ethical practices, such as obtaining informed consent, documenting treatment progress accurately, and providing honest communication about a client’s condition. The ACA stresses the importance of informed consent, while NAADAC emphasizes transparency throughout the counseling relationship. When a client’s treatment needs surpass a counselor’s expertise, ethical guidelines require making appropriate referrals to ensure comprehensive care. These practices safeguard treatment integrity and ensure clients with co-occurring disorders receive the most effective support. By following these ethical standards, counselors strengthen their professional credibility and ensure that their treatment approach is ethically sound and effective for clients with co-occurring disorders.