Your client is struggling with sobriety. “It’s just not worth it,” he says. “I’m going to quit therapy.” Do you respect his decision, or persuade him to stay?
Another client drives with alcohol in her system to the clinic – just under the legal limit – and is furious that you refuse to see her for a session. Do you let her drive herself home? Take the keys and call a cab?
A client sends you a friend request on Facebook. Or perhaps it’s your supervisor, or an employee. A fellow counselor repeatedly ends appointments by hugging clients – but only female clients.
These are just some of the ethical quandaries that face addictions professionals, according to Dr. Kimberly Walitzer, deputy director and senior research science at the University at Buffalo’s Research Institute on Addictions. The keynote speaker for SUNY Broome’s seventh annual Ethics Conference – the Ethics of Addiction – she detailed some of the questions and scenarios addictions counselors face.
Addiction are fairly common in our country, Walitzer noted: 29 percent of Americans will have an alcohol use disorder and 10 percent a drug addiction over the course of their lives. Addictions professions are governed by a code of ethics when it comes to treating these populations, set forth by NAADAC, the Association for Addictions Professionals.
In her own practice, Walitzer abides by certain ethical principles:
- “If it feels uncomfortable or sneaky, it probably is. Think carefully about it.”
- “Once a client, always a client. Avoid dual relationships.”
- “Think it through.”
While the answers to some ethical quandaries may be fairly clear – Don’t accept that friend request! – most are difficult, requiring us to examine our personal and professional principles.
“What’s important is that we think about it, we struggle with it and we make informed decisions,” Walitzer said.
Led by talented faculty members, the April 30 conference tackled a wide of issues during morning panel discussions.
Raymond Serowik, director of Broome County’s Opioid Overdose Prevention Program, discussed the use of the medication naloxone, or Narcan, to counter opioid overdoses and the ethical considerations that attend its use. Professor Doug Garnar and his son, Seth, discussed the impact of drug use on families, while Professor Jason Detrani showed the film “Web Junkie,” which centers on Internet addiction. Philosophy Club President Steven Burnette, Student Assembly President Heather Coggin and Philosophy Professor Irene Byrnes also led a discussion of Johann Hari’s book Chasing the Scream: The First and Last Days of the War on Drugs, which argues that society has failed to understand addicts and addiction.
Professor Rey Wojdat, chair of the college’s Hospitality programs, held a blunt and frank discussion on responsible alcohol service. It’s a timely topic for students in the college’s Bartending class who are, in essence, training on how to legally dispense a drug. They face two branches of ethical concerns: one stemming from their moral obligations, and the other from their legal requirements.
“It’s all fun until there’s metal going to the bone,” Wojdat said.
Bartenders should think twice about engaging in such practices as pouring alcohol directly into a patron’s mouth, often called a layback. That’s especially important when the legal ramifications are considered.
“I ask my students, ‘Do you want to be the person pouring alcohol into people’s mouths?’” Wojdat said.
Across the hall, SUNY Broome Executive Vice President Francis Battisti and his wife, dietician Dr. Helen Battisti, discussed the ethical dilemmas related to food. Dr. Francis Battisti, a psychotherapist in addition to his academic background, covered a range of eating disorders that could be interpreted as addictive behaviors, from anorexia and bulimia to binge-eating disorder. As with addictions, several factors place a person at risk from eating disorders, including psychological problems, biological factors and socio-cultural conditions.
“Fifty percent of elementary and 61 percent of middle school girls are currently already dieting, which we know doesn’t work,” Vice President Battisti said.
Obesity could be interpreted as the result of addictive behavior, said Dr. Helen Battisti. She noted that while one in 12 Americans struggle with drug or alcohol addiction, one in every three struggles with weight.
Studies have shown that laboratory rats will work as hard for a combination of fat, sugar and sodium as they will for stimulants, cocaine or other drugs, she noted. In a similar vein, food scientists since World War II have worked to engineer a Bliss Point in food, to create a maximum amount of craving. The science behind this food engineering was initially used during the war to create rations that soldiers would be willing to eat, Helen Battisti said.
“It’s tapping the same point in the brain that drugs and alcohol taps,” she said.
And that leads to an ethical dilemma: Is it wrong to engineer food in such a way, if obesity is the result? The Battistis brought up a real-life example of this ethical quandary: a candy sale to raise funds for diabetes research, or even the many pizza and bake sales on campus.
“Is there anything wrong with having a pizza sale when two thirds of us are obese?” Vice President Battisti asked.
While it may not be immediately obvious, gaming and gambling are just as pervasive as alcohol and food addiction. Examples run from raffles and card games to flipping coins and the lottery, according to instructor Laura Letson in her talk on “Unraveling the Truth: Gaining a Realistic Perspective on Gaming, Gambling and Ethics.”
The former executive director of the New York Council on Problem Gambling, Letson is a nationally known expert on the issue – and the daughter of a compulsive gambler who has seen the addiction’s impact firsthand. In New York State, about 5 percent of all adults experience problem gambling. And societal issues often cross streams: 30 to 50 percent of problem gamblers are substance abusers, and 10 to 30 percent of addicts in treatment are also compulsive gamblers. Nearly 35 percent of compulsive gamblers go on to commit crimes, whether cashing bad checks or robbing a convenience store.
State government both regulates and promotes gambling, which has been criticized as a conflict of interest, Letson said. And although gaming facilities have self-exclusion policies and advertise the gambling helpline number, measures to address the problem aren’t always enforced or prominent enough.
“There are plenty of places that are doing it right, but they’re not the majority of operators,” she said.
A chance to discuss
The campus community also had a chance to weigh in on the ethics of addiction during a panel discussion with Serowik, Dr. Walitzer and Communications Professor Tim Skinner. Students and faculty members asked a wide range of questions, from the impact of gender on ethical decision-making to whether an addictive personality exists, and the legalization of marijuana.
Both Walitzer and Serowik didn’t support legalization efforts, saying that making another drug more readily available could compound societal problems.
“One of the concerns about legalizing marijuana is that it becomes normative,” Walitzer explained. “Just because it’s legal, it doesn’t mean it’s safe.”
A SUNY Broome student, now clean of heroin for five years, related her own struggle with the stigma of addiction, which is difficult to overcome and often a barrier to treatment.
Serowik noted that Broome County was one of the first places in the country where addiction was treated as a disease rather than a moral failing. Back in 1859, the Castle on Robinson Street was among the first rehabilitation facilities of its kind.
“We have to try to remove the stigma. This is a disease,” Serowik stressed.