Ethical Issues in Substance Abuse Counselling

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Ethical Issues in Substance Abuse Counselling

Traditional ethics are often based heavily on reason, logic, and individual autonomy, with no stock put into human emotion or relationships as they can often be unstable in their permanency. Care ethics are also based on reason, logic, and autonomy, but allow emotional connections and relationships with other humans to guide decision-making when it comes to right and wrong. A recent struggle of ethics in healthcare revolves around addiction services. Traditionally ethical people might say that someone with a substance abuse disorder is able to make their own decisions and that they are not owed any extra care or compassion, often citing that they chose this life. Another, whose decisions are based on care ethics, might have a sibling who struggles with addiction, who knows that they do not always act in their own best interest, and who knows that this is not a choice. When addiction is recognized as a disease, the importance of helping and caring for those with substance abuse disorders starts to become easier to understand. In the same sense that one with a chronic or terminal illness could depend on others to act in their best interest, one with a substance abuse disorder should be able to expect the same. Basing addiction services on care ethics as opposed to traditional Kantian ethics allows for individualized treatment and encourages substance-abuse clinicians to connect with their patients, is more effective in terms of success with long-term sobriety and encourages integrated care, and helps to push society farther away from the inexact idea that addiction is a choice.

To understand care ethics in addiction services, there should be an understanding of addiction in general. Addiction is just as likely to impact the life of one human as it is another, no matter their situation, and every single person who struggles with addiction is at different points of their lives, with different circumstances, cultures, and experiences. Addiction services, including inpatient, outpatient, and medication-assisted treatment options, are able to be molded to fit specific patients needs if clinicians are willing to take the time and effort to do so. Care ethics takes this into account by placing importance on generating relationships with these patients and making an effort to understand all of the things that make them different from the next one. Addiction services are often coupled with mental health services, as they tend to be co-occurring disorders. Mental health services are typically very involved, meaning that the clinicians can truly get to know everything about their patients. Placing this type of relationship into addiction services is the most successful way to personalize treatment and encourage long-term success with sobriety by providing patients with a stable support system of professionals who show through effort that they genuinely care about them and are willing to work hard to make a difference.

The ability to care about someone stems from compassion for that person. Compassion and sympathy are two things that are integral to the success of long-term sobriety for those who struggle with addiction. As a result, care ethics is the most proof-driven theory to base these services and relationships on. One of the most important things that someone struggling with addiction can have to avoid a lapse or relapse is a stable and sober support system. If not found in their personal lives, whether due to familial discord or a variety of other issues, it is important that it can be found through seeking out treatment. A stable support system is one thing that someone can fall back on time and time again, either to avoid a lapse or to get back into recovery. Creating a supportive relationship like this cannot stem from anything other than care ethics. If the clinician just treats based on research and reason without forming a relationship with their patient, the trust needed for success in treatment will never be built. A trusted clinician also becomes a resource for someone with a substance abuse disorder, as they can be the person to ask about a variety of related issues, which again helps to encourage long-term sobriety. In an ideal setting, this leads to integrated or whole care for the patient, as the clinician’s compassion or willingness to help their patient can encourage the patient to seek change in other areas of their lives. Not only can it motivate the patient to find other clinicians or support systems that care about them, but it also encourages healthcare facilities to begin offering a larger variety of services available that would be useful to the patients. This is ultimately beneficial for both parties, as the facilities expand and drive more revenue, and the patients have easier access to necessary services. Things like primary care, social services, counseling, and psychiatric care are all things that are ultimately necessary for successful addiction treatment. If a patient is struggling with their mental health, or struggling with life stressors such as illness, relationship discord, legal issues, or financial issues, it becomes increasingly difficult for them to maintain sobriety. By providing these services in an integrated way, it encourages success in all facets.

By encouraging clinicians and service providers to engage with their patients in a way that will allow them to create the relationships needed for success, misunderstandings about substance abuse and addicts, in general, can begin to resolve themselves. Addiction treatment is always a collaborative effort between the clinician and the patient, requiring equal effort from both sides for long-term success. This working relationship garners an ever-growing understanding of addiction, leading clinicians who pass this empathy along to others through education. The only way that knowledge about addiction from a scientific standpoint can grow is through research and exposure. As long as there is a stigma revolving around substance abuse, addicts will always be hesitant to reach out for help, often because they blame themselves entirely for their addiction. Growing general knowledge about addiction and those who struggle with it will result in more people being exposed to addiction, which will result in less of a stigma about addiction services. This could eventually lead to more research, more available programs, more funding, and more education.

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