CAADC Professional Ethics and Confidentiality 2 — Questions and Answers
Question 1: How does 42 CFR Part 2 compare to standard HIPAA protections for SUD records?
- Less protection than HIPAA
- Heightened protections that generally prohibit disclosure without specific written consent, even where HIPAA would allow it (Correct answer)
- Identical to HIPAA
- Only applies to federal programs
Correct answer: Heightened protections that generally prohibit disclosure without specific written consent, even where HIPAA would allow it
42 CFR Part 2 provides stricter confidentiality reflecting the understanding that disclosure fears deter treatment-seeking.
Part 2 requires specific consent forms, prohibits re-disclosure, protects against use in criminal proceedings, and even protects acknowledgment that someone is a patient.
Question 2: A counselor discovers a colleague is practicing while impaired by alcohol. What is the ethical obligation?
- Ignore to protect privacy
- Address through appropriate channels such as speaking with the colleague, supervisor, or certification board, prioritizing client safety (Correct answer)
- Publicly confront at a staff meeting
- Wait for it to resolve
Correct answer: Address through appropriate channels such as speaking with the colleague, supervisor, or certification board, prioritizing client safety
Ethics codes require action when impairment may harm clients.
Follow a graduated process: speak directly with the colleague, report to supervisor if unreceptive, contact the certification board if needed. Document observations and actions. Many boards have confidential monitoring programs.
Question 3: What constitutes a 'dual relationship' and why is it ethically problematic?
- Seeing two clients who know each other
- Having both a therapeutic and another relationship (social, business, romantic) with a client, creating exploitation potential (Correct answer)
- Only romantic contact
- Dual relationships are encouraged
Correct answer: Having both a therapeutic and another relationship (social, business, romantic) with a client, creating exploitation potential
Dual relationships create conflicts of interest and exploitation risk due to the therapeutic power differential.
The power differential can be exploited, objectivity is compromised, and confidentiality boundaries blur. In addiction treatment, counselors in recovery may encounter clients at meetings, requiring careful boundary management.
Question 4: A court orders release of a client's SUD treatment records. What should the counselor do?
- Immediately comply
- Verify the order meets 42 CFR Part 2 requirements and consult legal counsel before disclosure (Correct answer)
- Refuse all court orders
- Only release if client verbally agrees
Correct answer: Verify the order meets 42 CFR Part 2 requirements and consult legal counsel before disclosure
42 CFR Part 2 requires court orders for SUD records to meet specific criteria beyond standard subpoenas.
A valid order requires fictitious names, sealed filing, patient notification, and specific judicial findings. A standard subpoena does not meet Part 2 requirements. Always consult legal counsel first.
Question 5: What is 'nonmaleficence' in advanced addiction counseling?
- Never saying no to clients
- The obligation to avoid causing harm, including practicing beyond competence, using harmful techniques, or maintaining dangerous relationships (Correct answer)
- Providing maximum services
- Only applies in medical settings
Correct answer: The obligation to avoid causing harm, including practicing beyond competence, using harmful techniques, or maintaining dangerous relationships
'Do no harm' requires avoiding actions that carry risk of harming clients.
Applications include not practicing beyond scope, avoiding harmful confrontational approaches, maintaining boundaries, staying current with evidence, and recognizing when personal issues could compromise care.
Question 6: How should a counselor handle discovering a client's relapse through social media?
- Post a public response
- Consider ethical implications of monitoring social media, address therapeutically within the clinical setting, and reflect on boundaries (Correct answer)
- Discharge immediately
- Share the post in group therapy
Correct answer: Consider ethical implications of monitoring social media, address therapeutically within the clinical setting, and reflect on boundaries
This raises questions about social media boundaries and should be addressed within the therapeutic relationship.
Consider whether monitoring was appropriate, address clinically relevant information therapeutically without mentioning the source directly, consult supervision, and establish clear social media policies.
CAADC Professional Ethics and Confidentiality 2
How does 42 CFR Part 2 compare to standard HIPAA protections for SUD records?