Ethics Exam, Beverly Roesch

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  1. Know the NAADAC code as there wil be numerous true and false questions about this document on the exam
  2. 2. How many experience addiction in the course of a lifetime?
    1 out of 6
  3. 3.  What fraction of all mortality is attributable to drugs and alcohol?
    1 out of 4
  4. 4.  Why is there a lack of engagement in treatment?
    • It is because of addiction for its toxic ability to affect the mind, will, and emotions of a person.  
    • People with substance abuse problems often are not fully aware ofthe trouble the addiction is causing their life, family, careers, and community.
  5. 5. Why is informed consent so highly salient?
    • Because those with substance abuse or dependence often have some type of cognitive impairment enough for them to not always be able to make informed consent for themselves.  
    • Sometimes others have to do the informed consent for them, like minors.
  6. 6.  What issues complicate the therapeutic relationship?
    • -Clinicians may have personal prejudices and biases against people with addiction.
    • -The clinician may have been in treatment themselves.
  7. 7.  What are the three principles of medical ethics?
    • Confidentiality
    • nonmaleficence 
    • beneficence
  8. 8.)What are the 8 basic ethical principles?
    • Respect for persons 
    • autonomy
    • compassion
    • confidentiality 
    • privacy
    • truth telling
    • nonmaleficence
    • beneficence.
  9. 9.  How does stigma affect CD treatment?
    • It can affect it in several ways through
    • labeling,
    • prejudices,
    • social rejection,
    • inability to obtain employment,
    • etc.
  10. 10.What are the three legal implications of addiction?
  11. 11. Why is confidentiality so strongly protected in addictions treatment?
    • Because of the greater stigma attached to substance use disorders
    • So without stigma patients can discuss sensitive, painful, and often stigmatized concerns such as sexual practice, drug and alcohol use, and homicidal or suicidal impulses.
  12. 12. what are the 3 key confidentiality regulations?
    • Confidentiality of alcohol and drug abuse patient records
    • Health Insurance Portability and Accountability Act of 1996
    • Applicable state law
  13. 13.)  What are the general exceptions to confidentiality regulations?
    • Patient consent in accordance with the specified form and requirements of the regulations
    • Infectious diseases
    • Child abuse
    • Suicide and homicide
    • Medical emergencies
    • Patient information that does not disclose that the patient has a substance use disorder
    • Disclosure under special court order
    • Staff communications within a program
    • Communication with an outside entity that provided support to the program
    • Appropriately authorized research, auditing, or evaluation
    • Disclosure to a qualified service organization assisting program
    • Crimes committed on program premises or against staff members
  14. 14.)  What clinical characteristics are important in behavior change?
    • empathy
    • genuineness
    • nonpossessive warmth
  15. 15.)  Confrontational clinical styles can lead to what?
    Patient typically relapsing on what clinician is confronting them for
  16. 16.)  how does one establish a theraputic relationship?
    • Using the principles of beneficience (display accrate empathy, interact genuinely, display appropriate warmth, and deliver empirically based supstance use treatment interventions)
    • and nonmaleficence (is to anticipate, self-reflect upon, monitor, and respond appropriately to ethical dilemmas that present in the context of the therapeutic relationship.)
  17. 17.)  Be able to share 3 examples of appropriate boundaries stated in the text?
    • Starting and ending sessions on time
    • setting limits regarding patient contact with the clinician outside of scheduled appointments
    • Maintaining a professional relationship with patients at all times.  
  18. 18.  Be able to cite 3 potential boundary violations
    • self-disclosure on the part of the clinician in a therapy session
    • innocuous touching of a patient
    • conducting treatment sessions outside of the clinic
    • starting or ending sessions late
  19. 19.)  How and when should counselors disclose personal information?
    • As a clinician, you should only disclose personal information to a client if it will be beneficial for the clients recovery.
    • It can help build trust between the clinician and client, as well and show the clinician can relate to the clients struggles. 
    • “…therapists should disclose infrequently and, when they disclose, do so to validate reality, normalize experiences, strengthen the alliance, or offer alternative ways to think or act…”
  20. 20.) What is a dual relationship for a counselor?  Give three examples
    -According to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, multiple relationships can include “a psychologist [who] is in a professional role with a person and at the same time is in another professional role with the same person.”

    • -Having sex with a client
    • -Doing business with a client
    • -Becoming friends with a client post-therapy
  21. 21.  What is "Duty to Warn"?
    • Tarasoff v. Board of Regents of the University of California mandates that clinician protect individuals from the threat of serious violence by their patients. 
    • You have to tell someone if the client threatens someone’s life.
  22. 22.) What are 2 issues in regards to scope of practice?
    • 30-60% of drug abusers have a concurrent mental illness. If clinicians are not adept at treating mental illness, they are responsible for referring patients to another professional. Similarly, clinicians should be cautious not to overlook a medical issue or to offer suggestions that fall outside of their training.
    • If patients inform clinicians that they are having medical problems, it is the clinician’s duty to refer the patients to a physician.
  23. 23.)  What is the central argument of a harm reduction approach?
    • The term “harm reduction" describes a public health approach intended to reduce risks and adverse consequences of behavioral choices.
    • It acknowledges that people always have engaged and always will engage in risky behaviors despite potential consequences and efforts to dissuade them.
    • The central argument is that given this reality, efforts should be made to prevent, or at least diminish, resulting harm to the individual and to society.
  24. 24.)  What are two examples of harm reduction approach?
    Controlled Drinking: Should people be permitted to pursue a goal of moderation rather than abstinence from alcohol if they have an alcohol problem?

    Needle Exchange: Exchanging dirty needles for clean needles to try and lower the transmission of disease.
  25. 25.) What is a co-occuring disorder?  Give two examples
    • Concurrent substance use and mental health disorder.
    • addicted to *** and having *** personality disorder
    • alcohol addiction with panic disorder
  26. 26.)  In what ways are individuals with co-occurring at higher risk?
    • People in this population are more likely to be medically involved and at increased risk of death from both medical and behavioral-health-related causes, as well as from accident and violent means.
    • Further, they experience feelings of helplessness, hopelessness, and frustration, and are often experiences negatively, acquiring labels such as “antisocial, manipulative, borderline, med-seeking, and sociopath”.
  27. 27. Discuss the concept of "welcoming" individuals with co-occurring disorders.
    Welcoming is not just being nice; it involves developing the organized framework, at both the program level and the clinical practice level, to communicate with complex individuals in such a way that they immediately feel that they are in the right place and that they made a good decision showing up to get help.

    • Welcoming is therefore a fundamental method of conveying respect and ensuring beneficence at the initial contact. Moreover, welcoming emphasizes that we have a proactive responsibility not to injure a patient (nonmaleficence) because of our lack of empathetic response to the reality of the co-occurring disorder.
    • Finally, welcoming recognizes that we have to treat the patient as an autonomous “customer” who made a choice to come to see us (even if that choice was in part coerced or strongly influenced through efforts of family, friends, other health care providers, or law enforcement.)
  28. 28.)  In terms of cultre, what 10 dimensions are historically included?
  29. What does "do no harm" mean in regards to specific cultural groups and addictions?
    • Not perpetuating erroneous negative stereotypes regarding specific cultural groups
    • and addictions. Pg 70

    • Three harmful models:
    • those not from the mainstream culture are inferior or pathological they are deficient in desirable genes they are culturally deficient
  30. 30.) What does the ethical goal of improving social justice for all involve?
    Exploring with clients how their substance use problem may be related to other sociopolitical forces, such as racism, marginalization, and powerlessness.
  31. 31.)  Be able to give three different explanatory models of addiction
    • -Spiritual possession: Alcohol is evil and/or there is a spirit of addiction that afflicts individuals
    • -Witchcraft:  addiction is caused by magical practices of individuals with malign intent.
    • -Moral weakness: substance use or addiction is viewed as a sin.
  32. 32.)  Be able to discuss why spirituality matters in addiction treatment and know the ethical principles relating to spirituality and addiction treatment
    • Highly influential- evidence that beliefs and behaviors which could be characterized
    • as spiritual/religious, have significant influences on substance use and
    • addiction. Pg 80

    Beneficence and respect for persons- include spiritual religious dimensions in treatment planning, etc.. 

    Understand belief and values of pt so can provide care that is respectful.

    • Follow 4 recommendations:
    • -Ask pt about their spiritual beliefs
    • -Avoid expressing bias for or against spiritual/religion 
    • -Include spiritual/religious aspects in treatment planning 
    • -Address counter therapeutic beliefs with factual information and respect
  33. 33.) Be able to discuss three forensic issues relating to the treatment of addictions
    • Court orders for treatment of addiction,
    • work place drug testing and confidentiality
    • the duty to protect the public from the actions of a addicted individual
  34. 34.) Be able to give an example of benevolent sexism and hostile sexism
    • benevolent sexism: A seemingly favorable attitude that puts women on a pedestal but sometimes conveys an assumption that women need men's protection. infantilizing pt 
    • hostile sexism: Antagonistic attitudes toward women,.overestimating pt’s autonomy pg 109
  35. 35.)  Be able to discuss risk factors for substance abusing women
    • 5% of American women meet criteria for alcohol abuse/dependence, while 1.5%
    • are abusing illicit drugs

    • White women drink more 
    • Develop substance use disorders and experience childhood/adult sexual violence and domestic violence 
    • Higher to become abusers of or addiction compared to men
  36. 36.)  What are the core concepts around the ethical issues in the treatment of women with substance abuse?
    • Voluntarism
    • Beneficence
    • compassion and harm reduction
    • Confidentiality
    • and truth telling
    • Respect for persons and justice
    • Informed consent
  37. 37.)  Know the stastics on adolescent substance abuse sited in the text
    • 22% youth smoke
    • 9.9% use illicit drug
    • 35% died in motor crash;
    • 40% drown due to drug and alcohol use
    • Twice as likely to commit suicide if drink alcohol 
    • 2.6 million teens need treatment but only 7% get treatment
  38. 38.)  Know three clinical treatment issues in the treatment of adolescent substance abuse
    • Informed consent
    • confidentiality
    • evidence-based practices
    • familial and cultural elements
    • professional competence
  39. 39.)  Know five of the 10 steps in the Ethical management of Chronic Pain
    • Step 1: Establish the pathophysiology of pain where possible and appropriate
    • Step 2:  Begin with nonpharmacological treatments and move to medications only if these do not provide sufficient relief
    • Step 3:  Maximize use of non-narcotic adjunctive medications before utilizing opioids
    • Step 4:  minimize risk of addiction by using long-acting opioid preparations and scheduled dosing rather than short-acting drugs on an as-needed basis
    • Step 5:  Employ a multimodal approach including physical therapy, twelve-step work, acupuncture, family therapy, and vocational therapy for an integrative approach to the whole person
    • Step 6:  Keep in mind that patients with a history of addiction often require higher doses of opioids for adequate control of pain
    • Step 7:  Teach patients that there is no cure for addiction.  It is a lifeling struggle with expected relapse and recovery.
    • Step 8:  Help patients set realistic expectations and goals regarding benefits and side effects of medications: "not 'No pain,' but functional gain.
    • Step 9:  Utilize objective pain ratings, addiction assessments, and quality of life measures to evaluate response.
    • Step 10:  Judiciously employ opioid contracts and toxicology screens to prevent and monitor aberrant behavior within the context of a trusting provider-patient relationship.
  40. 40.)  Be able to discuss a population that you would struggle working with.  How would you ethically handle the client?  This will be a short essay question
  41. 41.)  Be able to state 5 attributes of the "Good Counselor" in your Parkinson text.
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Ethics Exam, Beverly Roesch
2013-09-20 04:49:42
Ethics Exam Beverly Roesch SW3716 Sroka

Test I Beverly Roesch Introduction to Professional Development: Applied Skills and Professional Ethics SW3716
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