From identifying ethical decision-making models to the top issues, Dr. Louise Stanger of All About Interventions provides ethical guidelines for addiction and marketing professionals

1. Ethics for the Addiction &
Marketing Professional

2. Ethics: The Addiction &
Marketing Professional
§ Louise Stanger
Ed.D, LCSW, CIP
§ Director All About
Interventions
§ Faculty SDSU
Interwork
§ Member NII, AIS
§ MINT Trainer

3. Objectives
§ Discuss and define ethics
§ Identify ethical decision-making models
§ Discuss the top ethical Issues
§ Discuss competence, confidentiality and
mandated reporting
§ Identify dual relationships
§ Discuss the use of social media as it
related to ethics

4. How do Ethical Problems
Occur ?
§ People are human, they make mistakes
§ Clients misreport
§ Inexperience
§ Ignorance
§ Unpredictable /Unforeseen situations
§ Inadequate agency policies
§ Guidelines not adequate for situation
§ Ethics in conflict with law

5. What are your top 3
Ethical Concerns?

6. PatrickMcNamee-
Benchmark Recovery
Center
§ Competence
§ Dishonesty about
services
§ Lack of
compassion

7. Christi Cessna-
Constellation
§ Misrepresenting
your capabilities
and preying on
vulnerable people
§ Overselling and
over administering
UA
§ Kickbacks

8. Paul Alexander
Northbound
§ Accreditation and
standardization of
care
§ “CURES”
promised as
opposed to
solutions

9. Nigel Green-Foundations
What do you stand for?
§ Folks that do not
understand the
laws (ignorant of
laws)
§ Folks that
understand the
laws, but lack a
strong sense of
ethics

10. Questionable Practices
§ Internet marketing
scams
§ Using Brain scans
with other
unproven
treatments and
billing the patient
§ AP, March 2013

11. Questionable Practices
§ Call centers share
patient prospect
info between
treatment providers
§ Call centers run
through 5013C non
profits

12. Paying Kickbacks
§ To Interventionists
§ Paying bounties to
for referrals
§ Claiming to take a
patient’s insurance
when
reimbursement is
low
§ To Labs

13. Questionable Practices
§ Promising a cure
§ Using nutrient
supplements that
are proprietary and
billing the patient

14. What’s most
Important ?

15. Whistleblower –False
Claim Act
§ False Claims Act
§ Unlawful for
anyone knowingly
or willingly submit
or cause a
fraudulent claim to
the government for
payment

16. Kickbacks-Federal Laws
Anti-Kick Back
Statue –criminal
offense for anyone
to give a kickback
with the intent of
influencing referral
of patients
Ex:Trips , hotels, gifts
Stark Law-
Physicians Self
referral law
Kickback occurs
when a physician
refers a patient to a
facility he owns or
family has financial
interest

17. Codes of Ethics
§ American Association of Advertising
Agencies
§ Direct Marketing Association
§ Public Relations Society of America
§ American Marketing Association
§ Foundation for Public Affairs
§ American Hospital Association
§ NATAP

18. Code Of Ethics
§ NAADAC
§ NASW- Social
Workers
§ MFT
§ NATAP
§ CARF
§ Psychologists
§ Nurses –Doctors
§ Lawyers

19. Code of Ethics
§ Association of
Intervention
Specialists ( AIS)
§ Network of
Independent
Interventionists (NII)
§ Recovery Coaches
§ Certified
Rehabilitation
Counselors

20. Historical Context
§ In Nazi Germany 1945-1946
and 1935 American Public
Health research African
American men
§ 1966 Public Health Services
established ethical regulation
§ 1979 Belmont Report
(Protection of Human
Subjects)
§ 1970s bio ethics
emerged
§ 1980s Watergate
§ 1996 Revised Codes
§ As professions grow
code of ethics are
formed

21. Philosophical History of
Ethics: Modernism
§ Modernism
§ Human reason
determines truth on
all subjects
§ Universal ethical laws
§ Individuals are similar
and rights are
supreme
§ Bio-ethics
§ Autonomy
§ Beneficence-ability to
do good
§ Nonmaleficence-the
duty to cause no
harm
§ Justice-duty to treat
all fairly and
distribute goods
equally

22. Philosophical History Of
Ethics : Post Modernism
§ Diversity, Pluralism
and questioning that
there are objective
laws
§ Situational ethics
Based on historical
and social contexts

23. What are Ethics?
§ Ethics are the beliefs
an individual or group
maintains about what
constitutes correct or
proper behavior
§ Standards of conduct
an individual uses to
make decisions.

24. Do not confuse Ethics and
Morality !
§ The word morality comes from Latin word
MORES which translates into custom or
values
§ Morality involves the judgment or
evaluation of an ethical system, decision,
or action based on socialcultural or
religious norm

25. Competence
Integrity
Importance Of
Human Relationships
Dignity of
Individual
Social Justice
Service
VALUES

26. Ethical Principles
§ Autonomy
§ Beneficence- To do
Good-To Do No Harm
§ Confidentiality
§ Fidelity _To keep ones
promise or word, Duty to
report , honesty,
trustworthiness
§ Gratitude
§ Justice ( treat all fairly)
§ Nonmalefience :The duty
to cause no harm
§ Reparation –duty to
make up for a wrong

27. Ethical Principles
§ Respect for Others
§ Universality
§ Utility- the duty to
provide the greatest
good or least harm to
greatest number of
people
§ Ordering

28. Ethical Considerations
n Fiduciary
Relationships with
Providers
n Call Centers
n Pay per click
n Truth in advertising
n Gifts & Kickbacks
n Internet Marketing
scams

29. Ethical Principles
§ Veracity –To tell the
Truth
§ Herein lies dilemmas
§ Between self, IP,
agency and outside
world

30. Ethical Responsibilities
§ To Clients
§ To Colleagues
§ To Practice Settings
§ As Professionals
§ To Professional
Affiliations
§ To Broader Society

31. 8 Step Model for Ethical
Decision Making
§ 1. Identify the
Problem or Issue
- Clinical
- Legal
- System (polices etc)
- Cultural
- Ethical -
counselors own issues

32. Steps 2-4
§ Apply a code of
ethics
§ Determine Nature
and Dimensions of
Dilemena
§ Pros and Cons

33. Steps 5-8
§ Choose Course of
Action
§ Implement a
Course of Action
§ Evaluate the
Outcome
§ Evaluate the
implications

34. Congress Ethic Model
§ Examine
§ Think
§ Hypothesize
§ Identify
§ Consult

35. CONFIDENTIALITY
§ Hallmark of Therapeutic
Relationship
§ Consent Forms
§ Mandated Reporting- Duty to
Warn
§ Exceptions ( Drug Court,
federally assisted treatment
programs

36. Confidentiality and Minors
§ Age of Consent
§ Being Familiar
with state laws
§ Can Clara or
parents know
everything if they
are under 18?

37. Informed Consent
§ Informed Consent:
Description of any reasonable foreseeable risks or discomforts
Description of any benefits to the subject or others
Disclosure of any alternative treatments, including medications
Statement describing extent to which confidentiality of records
identifying client will be maintained
Explanation on limits of confidentiality
Explanation on who to contact in emergency
Costs to client
Consequences of early withdrawal

38. Record Keeping
§ Client prior hx of services
§ Present reason for call
§ Dx of bio-psycho-social
§ Documentation of any changes
since assessment
§ Treatment plan goals &
objectives (changes in Tx)
§ Duration & frequency of service
§ Progress notes
§ Rec for further treatment-
discharge plans
§ Doc. Of fees charged and paid
§ HIPPA Forms

39. Competence
§ How do you
achieve and
maintain
§ Cultural
competence
§ Is it ok to practice
outside of ones
competence?

40. Wireless Devices
n How are these used
to protect
confidentiality?
n Laptops, ipads,
Phones, Earpieces,
& other devices

41. Advertising
§ Clear, objective
truthful statements
§ “Number 1 ,
Unique, Cure “

42. Visual Wrong doing
§ Websites that are
misleading
§ Fake addresses
§ Toll free numbers
§ Posting of photos
on misleading
websites
§ Certificates

43. Social Media
n Written Materials
n Business Cards
n Letterhead etc
n Website
n Mailings
n Texting
n Facebook, Twitter
and Linked In

44. BOUNDARIES
§ Length of counseling, self disclosure by counselor,
confidentiality, giving of gifts, touch or personal
communication between counselor and client and
client, counselor and supervisor’
§ Intimate relationships
§ Personal benefit ( monetary goods , services)
§ Emotional dependency needs of counselor
§ Altruistic gestures which can be misinterpreted
§ Unexpected situations such as meeting sisters new
boyfriend who turns out to be a client

45. DUAL RELATIONSHIPS
§ Friendships between client and
counselor, supervisor and
supervisee
§ Sexual Relationships
§ Professional –where client and
counselor are professional
colleagues
§ Business dual relationships
where counselor and client are
business partners or have an
employee/employer relationship
§ Communal –where both belong
to same community (AA, NA,
Alanon, SA etc.)

46. Case Examples
§ 25 year old. mother is
referred after 3rd DUI.
She tells you father is a
recovered alcoholic and
drinks socially. She does
not think she has a
problem and does not
believe she needs
treatment or to be
abstinent
§ What do you do?

47. Employer Relationships
§ A handsome
admissions person is
your subordinate. He
is also in a 12 step
program. You invite
him for coffee after
the meeting.
§ ?? Ethical
Considerations

48. Hiring Practices
§ Former counselor
calls to ask if she/
he can hire a
former client of
hers and mine
from a different
treatment center
that has less then
a year recovery

49. Business Temptations
§ Business
Temptations>>>
§ What do you do???

50. Money for Admits
§ An admissions
officer offers you
money for
referrals

51. Consent and HIPPA
§ Mother wants to
know what daughter
is saying about their
relationship
§ 19 yo daughter has
not signed consent
form for mother

52. Other Considerations
§ You are a substance abuse/mental
business professional and are attending
the same 12 step meeting as your client
do you need to share, what do you do??
§ Organizations referral practices
§ Organizations billing practices
§ Other Examples

53. Case Example
§ Someone has had an
extramarital affair.
Son saw. You are
husband’s counselor
§ What do you do ??

54. Gifts
§ A former client gives
you a $100.00
Starbucks card
§ A client gives you
courtside Laker
tickets
§ A center offers you
referral fees
§ ??What do you do

55. “There is safety in a
multitude of counsel”

56. Resources
§ The Ethics of an Addiction Counselor
§ NAADAC , The Association of Addiction Professionals
§ NASW Code Of Ethics
§ NII Code of Ethics
§ AIS Code of Ethics
§ Ethics Updates http://ethics.sandiego.edu
§ The Elements of Ethics for Professionals-Brad Johnson
§ APA Ethics Office
§ Center for the Study of Ethics in the Professions
§ National Board for Certified Counselors; The Practice of Internet
Counseling
http://www.nbcc.org/assest/ethics/internetcounseling.pdf

57. Dr. Louise Stanger Ed.D,
LCSW, BRI II, CIP
§ Faculty SDSU Interwork Institute
§ Member NII
§ Member AIS
§ MINT Trainer of Trainers
§ Director All About Interventions
§ http://www.allaboutinterventions.com