1.2 The Role of Ethics in Mental Health and Substance Disorder Counseling

Unique Ethical Challenges

There is no question that many ethical challenges are present in the art of counseling. Counselors face issues in practice daily, including, but not limited to, concerns surrounding privacy and confidentiality, professional boundaries, scope of practice, informed consent, and cultural competence. Compounding these already-experienced challenges is the treatment of comorbid conditions that require significant knowledge, skills, and awareness to successfully and appropriately treat. Unique ethical challenges, many of which we will discuss in this textbook, are abundant. For example, providers treating co-occurring disorders must use an integrated treatment approach that includes the development and implementation of treatment plans that address both mental health and substance use disorders simultaneously, a task that can be incredibly complex. When coordination at this level is required, the counselor typically becomes the intermediary between many healthcare services and providers, consuming additional time and resources.

Additionally, assessment and diagnosis become a heightened challenge in the treatment of co-occurring disorders. Clients often present with overlapping symptoms of mental health and substance use disorders, making it difficult to diagnose and differentiate between the two accurately. If counselors are not mindful and careful during the assessment and diagnosis process, this can lead to misdiagnosis or underdiagnosis. A final example is that clients with co-occurring disorders often face dual stigma from both mental health and substance use perspectives, which can impact their willingness to seek help and engage in treatment. Stigma can lead to social isolation, reducing the client’s access to support networks and resources necessary for recovery. Coupling this with the higher risk of recurrence (Andersson et al., 2023) for individuals with co-occurring disorders, counselors must be adequately and appropriately prepared for more frequent and severe crises, such as psychiatric emergencies or substance-related incidents, requiring robust case management and crisis management plans.

Importance of Ethical Practice

Ethical practice in the treatment of co-occurring disorders can have significant benefits on client outcomes. It is widely known that the therapeutic relationship is a prominent component of a client’s change process in counseling (Stargell, 2017). Tending to ethics in treating co-occurring disorders can promote and strengthen the therapeutic relationship. For example, adhering to ethical standards regarding confidentiality helps build trust between the client and the counselor. Trust is imperative to counseling, as clients are more likely to share openly and honestly when they feel the counselor protects their privacy. Additionally, when a counselor engages in a robust and effective informed consent process, clients are more likely to understand their treatment options better and the potential risks and benefits of participating in the counseling process.

Client autonomy and empowerment are at the center of ethical practice as well. As mentioned in the previous section, an integrated approach to treatment for co-occurring disorders is integral to rendering effective services. When a counselor takes an integrated approach, they are more likely to individualize the care to the client’s specific needs. Ethical treatment involves tailoring interventions to meet those unique needs, which can lead to more effective outcomes and client satisfaction. Client outcomes improve when conditions are treated simultaneously (Andersson et al., 2023). Ethical practice in treating co-occurring disorders requires adherence to established professional standards. In this textbook, we reference the ethical guidelines the ACA and NAADAC set forth to guide our discussion of ethical concerns. Following these standards strengthens the credibility of counselors and the organizations they represent and reflects a commitment to maintaining high levels of professional accountability. By adhering to ethical guidelines, counselors are better protected from legal risks, and as a result, their reputation within the healthcare community and among clients is often enhanced.