A Basic Set of Core Ethical Guidelines For Addiction Treatment Professionals

By Bill Herring, LCSW

(Originally published in "Counselor: The Magazine for Addiction Professionals", March/April 2002)

The ability to recognize and respond appropriately to ethical dilemmas encountered while treating addictive disorders is a complex task that cannot be taken for granted by even experienced counselors. Full caseloads and busy schedules provide few opportunities for in-depth examinations of ethical dilemmas that often demand an on-the-spot decision. This article sets forth a pragmatic set of principles that can help counselors to evaluate ethically challenging situations. While these ethical principles are relevant to almost any counseling situation, this article focuses on how they apply to the treatment of substance and behavioral addictions.

Numerous written codes of ethical conduct exist to guide the many different counseling professions. These documents may be more useful for giving clients and the public an assurance of the ethical parameters of professional behavior than in providing counselors with a useful frame of reference for dealing with day-to-day dilemmas. There is also an important difference between merely abiding by rules of conduct and embodying the ideals contained within them (Coale, 1998; Tjeltvelt, 1999). A set of common principles derived from these various codes must be sufficiently broad enough to take into account the rich variety of practice settings, counseling theories and treatment approaches in which addiction counselors operate. Any less inclusive formula for determining whether a counselor's behavior is ethically appropriate requires knowledge of the context in which it occurs. For example, vigorously challenging a client's beliefs or behaviors may be ethically justifiable under one set of circumstances but not another (Tjeltveit, 1999). Similarly, different counselors may respond to an identical ethical dilemma in very distinct yet equally justifiable ways.

What follows are six core ethical guidelines that are sufficiently broad and context-free to serve as a useful frame of reference in day-to-day counseling practice. These six guidelines are to provide informed consent; to operate in a competent and theoretically sound manner; to insure confidentiality of client information; to maintain appropriate relationship boundaries; to utilize adequate consultation; and to honor diverse personal and cultural values (Corey, Corey and Callanan, 1998).

Informed Consent

Informed consent is a fundamental bedrock of ethical practice, because it helps to assure the client's autonomy in matters that affect the entire course and direction of counseling. Counselors may not always fully appreciate the lengths they must go in order to insure that important decisions about treatment issues are truly made from a basis of informed choice. Rather than being a one-time event, informed consent is an on-going collaborative effort between client and counselor for establishing and continuously monitoring the goals and strategies of counseling as well as the roles, rights and responsibilities of all parties. (Tjeltveit, 1999)

A client has a right to know which treatment modalities an addiction counselor typically recommends, such as group therapy, couples therapy, family therapy, medication, support group attendance, and so forth. Counselors often don't take the time to explicitly discuss the expected benefits and potential risks of their services, as well as any alternative treatment approaches that may be available to the client. Informed consent also includes information about the anticipated duration of treatment and any situations that could result in a counselor prematurely terminating services. In addition, clients should know the policy for resolving disputes as well as all pertinent financial aspects of the counseling relationship; counselors should also be open to discussing their background and theoretical orientation (Houston-Vega and Nuehring, 1997). This is so much information that a counselor may choose to convey it by a combination of verbal and written means.

A client's informed consent is not in itself sufficient to determine whether a counselor's behavior is ethical. It's conceivable that clients might be willing to give their approval to any number of ethically inappropriate behaviors, so a counselor needs other core principles to guide the ethical decision-making process.

Competence and Established Theory

A counselor has an ethical responsibility to practice only within the scope of his or her professional competence. Some typical indicators of competence include education, experience, training, and certification (Pope and Vasquez, 1998). Competence in one clinical area doesn't necessarily translate to another. Counselors with extensive experience treating general psychiatric disorders aren't necessarily competent to meet the specific needs of addicted clients, just as addiction counselors without advanced training don't always adequately recognize signs of psychiatric disorders. Cross-referral between such specialists is necessary in such situations.

One often-overlooked component of competency is a counselor's ability to clearly describe the theoretical basis for providing a particular clinical service. Just because a client's case turned out all right doesn't necessarily justify a counselor's actions if they otherwise lack adequate theoretical support. It is important to do the right thing for the right reason, not just for the right result. Counselors operating without the benefit of a clear theory are likely to rely too much on a combination of intuition, habit, consensus and personal preference (Herring, 2001, Tjeltveit, 1999, Corey, Corey and Callanan, 1998). Clients deserve the knowledge and right to accept or reject treatment that represents a particular theoretical orientation. In the absence of information to the contrary, clients will assume that whatever form of counseling they are receiving is the only available or appropriate choice.


Another core ethical principle is for a counselor to vigilantly guard against unauthorized disclosure of client information. The assurance of confidentiality is a fundamental guarantee, but it is not an absolute one. Several ethical dilemmas involving confidentiality commonly arise in the treatment of addictive disorders:

Duty to Warn/Protect

It is widely accepted that counselors have a general obligation to warn or protect people whom a client places in imminent harm. The right to confidential treatment is therefore balanced by the need to insure the safety of others. The beginning of the counseling relationship is the most appropriate time for a client to learn about these limits on confidentiality as well as any safeguards necessary to protect others, such as policies on notifying law enforcement personnel if a habitual DUI offender drives to a counseling appointment while intoxicated.

Clients who inject drugs or engage in sexually risky behavior while chemically impaired may expose others to the risk of HIV infection. Courts have not generally applied duty-to-warn standards to these situations (Houston-Vega and Nuehring, 1997). Balancing the counselor-client relationship with the protection of at-risk populations is a very complex and emotionally charged situation. Counselors should inform clients about their policy for dealing with HIV-related confidentiality issues, educate clients about the health risks of their specific sex and drug practices, communicate any concerns that arise during the course of treatment, offer to help communicate information to partners, and consult with colleagues as appropriate.

Minors and Families

All states require counselors to report situations in which minors are in danger of harm, although specific state statutes differ (Corey, Corey and Callanan, 1998). As most counselors know, it can be difficult to distinguish potential from probable risk. For instance, a client who admits to blackouts may deny that she places her children in any danger. A counselor who decides not to notify the designated reporting agency in such a situation should document the basis for this decision in the clinical record. Consultation in these situations is again extremely valuable in helping a counselor maintain much-needed clinical objectivity.

Counselors who treat minors for substance use disorders need to clearly establish the extent to which parents have the right to information that is disclosed by their children. A minor may be reluctant to talk honestly if confidentiality boundaries are not clear, and the therapeutic alliance may be crippled if a counselor who is unclear on the limits of confidentiality later provides information to parents. Counselors should be familiar with federal law on confidentiality of alcohol and drug abuse records for minor clients (Confidentiality of Alcohol and Drug Abuse Patient Records, 1998) as well as any applicable state laws, and should seek professional consultation whenever questions arise.

A major ethical concern that arises when counseling couples or families is how to deal with the emergence of secrets that so often accompany addictive disorders. For example, consider the situation that could arise when providing marital counseling to a couple if a husband who attends a session by himself announces that he's relapsed on cocaine but is unwilling to admit this to his wife. A counselor who keeps this information secret is not fostering a climate of honesty. On the other hand, revealing information that a client reasonably presumed would remain confidential will damage that client's trust, while threatening to summarily end treatment if the client isn't honest with his spouse is a form of coercion and potential abandonment. This again points to the necessity of informed consent: whatever approach a counselor takes in response to these types of situations needs to be thoroughly discussed at the beginning of the counseling relationship so that all clients are aware of the consequences of disclosure (Corey, Corey and Callanan, 1998; Herring, 2001).

Maintaining Appropriate Boundaries

The next core concept of ethical counseling involves the complex area of maintaining appropriate professional boundaries. Most counselors know that there are ethical risks to developing relationships outside of the therapeutic role, such as counseling a friend or pursuing business or social interactions with clients. These types of dual relationships can impair a counselor's objectivity or unintentionally exploit a client's dependence (Pope and Vasquez, 1998). Yet some subtle boundary issues present ethical dilemmas that are neither obvious nor easily avoidable.

Counselor Self-Disclosure

In order to maintain appropriate clarity of roles, a counselor should only reveal intimate personal information when doing so is clearly relevant to the client's treatment goals, carefully tailoring this information to the client and paying close attention to how such sharing affects the clinical relationship (Bloomgarden, 2000). Consultation with colleagues and supervisors can help insure that the true purpose for disclosing personal information is to meet the emotional needs of the client rather than the counselor. One helpful guideline is for a counselor to reveal information about a personal life problem only well after it has been resolved, and not while it is an ongoing issue (Hunter and Struve, 1998).


Since a significant proportion of clients with addictive disorders have a history of childhood trauma (Briere, 1992), even a simple act of touch can convey a variety of ethically ambiguous messages. The history of addiction support is replete with reassuring hugs. It's very important for a counselor who engages in any form of physical contact with clients to have a highly developed sense of boundaries and an astute awareness of the clinical implications of this behavior. The initial stages of the therapeutic relationship may not provide sufficient emotional safety to insure that a client can discuss any uncomfortable feelings involving counselor touch (Hunter and Struve, 1998).

Sexual Attraction

Sexual involvement with a client constitutes a profound ethical violation with severe emotional consequences. However, occasional sexual feelings are not in themselves either unethical or even particularly abnormal in the context of an intimate therapeutic relationship (Pope and Vasquez, 1998). Counselors must acknowledge and appropriately process the existence of these feelings when they emerge in order to successfully understand and redirect them. The presence of intense preoccupation or sexual fantasies involving clients needs to be forthrightly discussed in consultation and supervision.

Recovery Boundaries

Counselors who have successfully dealt with addictive disorders in their own lives can often relate to their clients with profound understanding, empathy and clarity. However, they may also be overly devoted to the treatment approach they personally found successful (Johnson, 2000). For instance, counselors who are strongly 12-step oriented may discount non-abstinence models for addressing substance abuse, such as risk reduction strategies, which threatens to place clients into a one-size-fits-all philosophy of care.

A counselor who is candid about being "in recovery" may give clients hope and reduce the shame that inevitably accompanies addiction. However, too much disclosure can be intrusive and distracting for some clients, and can even inadvertently generate unrealistic expectations or a sense of inadequacy (Bloomgarden, 2000). Counselors should therefore carefully reveal information about their personal addiction experience only in as much detail as is necessary to meet a compelling and clearly defined clinical need.

A counselor who is treating clients with substance use disorders should not be unsuccessfully fighting the same battle. Sustained abstinence from addictive behavior is an inescapable ethical responsibility for anybody working in this field. Counselors with less than several years of recovery time may easily lose objectivity when dealing with clients whose clinical picture mirrors their own personal experience. Heightened levels of consultation and supervision are highly advisable in such circumstances.

Nobody is immune to relapse, regardless of the length of time in recovery. A counselor who reverts to a previous pattern of addictive behavior must face the ethical dilemma of whether to limit, suspend or terminate clinical duties. Abruptly withdrawing services from a client due to this (or any other) form of counselor impairment is likely to be deeply disruptive to the client's healing process (Bissell and Royce, 1994). Clients in such situations must be given the opportunity to continue counseling with another provider. There is no one answer to the problem of counselor relapse that is completely satisfying. In this regard the difference between a temporary "slip" that can result in increased self-awareness and an unrestrained relapse may be useful in determining a counselor's overall level of clinical impairment. These decisions should be made in a process of supervision and consultation so that the counselor is not relying on his or her personal judgment which may be impaired.

All counselors who are in recovery from addictive behavior must establish whatever safeguards are necessary to insure the maintenance of a personal program of sobriety. This may include establishing boundaries around support group meetings that clients are asked not to attend. It is not ethically appropriate for counselors in 12-step recovery to sponsor their own patients or chair meetings where they are employed (Bissell and Royce, 1994).


The next core ethical concept is for counselors to have a structured process for discussing formulations, interventions, reactions and inevitable difficulties with supervisors and colleagues. There is a heightened need for supervision and consultation for counselors who are working on the outer limits of either personal competence or established theory (Corey, Corey and Callanan, 1998). For example, a counselor attempting to implement a new technique should utilize close supervision until it becomes fully integrated into his or her set of skills.

It's an unfortunate reality that not all clinical supervisors have adequate experience or knowledge in the treatment of addictive disorders. In such cases a counselor needs to seek out additional sources for case consultation. One solution is to set up and utilize informal telephone and e-mail networks which can be established fairly easily with colleagues and contacts made through professional affiliations. When consultation is not available for discussing a clinical or ethical dilemma, a counselor should document in the clinical record a summary of the relevant issues as well as any action taken in response to it.

Honoring Diverse Values

All of the preceding ethical principles involve some specific actions for a counselor to take. However, the ethical dimension of counseling goes far beyond merely abiding by a procedural checklist. An ethical counselor consistently demonstrates respect for the client as a person by honoring diversity and appreciating the degree to which his or her personal values influence the entire process of counseling. Since counselors are in the business of helping clients change some aspect of their lives, the great ethical challenge is to effectively guide the process and direction of this change without undermining the client's autonomy. This ethical use of a counselor's influence is a skill that cannot be taught as much as developed.

Since every person's view of the world represents a unique combination of diverse personal and cultural perspectives, it is inevitable that counselors will sometimes hold views that are very different from their clients. No counselor is ethically justified in assuming that the way he or she views life is the way everybody else does, is the right way, or is the only way. However, some counselors act as if the way to avoid imposing their personal values is to simply not talk about them. But biases don't lose their influence just because they're not discussed; in fact they often become less amenable to change. It is often more ethically beneficial for a counselor to invite discussion about his or her personal values while conveying an ability to respect and work with many alternative positions. A counselor doesn't need to be neutral about his or her values in order to be nonjudgmental (Coale, 1998; Tjeltveit, 1999).

When a client and a counselor hold fundamentally incompatible value orientations, the counselor should either refer the case or strive to help the client achieve the goals of counseling within the context of the client's value system rather than attempting to change those values. If a counselor finds it necessary to attempt to modify a client's values, this should be done to no more extent than is necessary to address that client's particular focus of treatment.

Counselors often avoid initiating discussion with clients about the ethical dimensions of clinical issues. Sometimes this reluctance stems from the fear of appearing moralistic, but it also reflects a general tendency of the counseling profession to be ethically inarticulate. It takes considerable effort and skill to engage in thoughtful dialogue about the ethical aspects of life, but doing can have great benefit for clients whose history of addiction is marked by diminished personal integrity. While this does not guarantee a positive clinical outcome, it does foster the kind of therapeutic environment for a client to utilize the counseling experience to its fullest potential.

These guidelines are not an exhaustive review of every ethical issue related to addictions counseling and they cannot substitute for a counselor's knowledge of his or her professional code of conduct. Many clinical situations require a more detailed examination of the ethical issues involved or compliance with specific codified procedures, such as guidelines for research involving human subjects. Although counselors almost always operate within ethical parameters, these principles can serve as a helpful reminder of some of the important points to consider when evaluating the proper ethical stance to take when dealing with the many complexities of addictions counseling.


Bissell, L. and Royce, J. (1994). Ethics for Addiction Professionals. Center City, MN: Hazelden.

Bloomgarden, A. (2000). Self-disclosure: is it worth the risk? The Renfrew Center Foundation Perspective, 5 (2), 8-9.

Briere J. (1992). Child abuse trauma: Theory and treatment of the lasting effects. Newbury Park, CA: Sage

Coale, H. (1998). The Vulnerable Therapist: Practicing Psychotherapy in an Age of Anxiety. New York: Haworth.

Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR 2.14 (1998)

Corey, G., Corey, M. and Callanan, P. (1998). Issues and Ethics in the Helping Professions. Pacific Grove, CA: Brooks/Cole.

Herring, B. (2001). Ethical guidelines in the treatment of compulsive sexual behavior. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention, 8, 13 - 22.

Houston-Vega, M. and Nuehring, E. (1997). Prudent Practice: A Guide for Managing Malpractice Risk. Washington, DC: National Association of Social Workers Press.

Hunter, M. and Struve, J. (1998). The Ethical Use of Touch in Psychotherapy. New York: Sage.

Johnson, C. (2000). Been there, done that: the use of clinicians with personal recovery in the treatment of eating disorders. The Renfrew Center Foundation Perspective, 5 (2), 1-4.

Pope, K. and Vasquez, M. (1998). Ethics in Psychotherapy and Counseling: A Practical Guide. San Francisco: Jossey-Bass.

Tjeltvelt, A. (1999). Ethics and Values In Psychotherapy. NY: Routledge.



Bill Herring, LCSW, CSAT is a psychotherapist in Atlanta.  In addition to counseling individuals and couples for a wide range of issues he specializes in the treatment of sexually addictive, compulsive and excessive behaviors.