Ethical Guidelines

Chief Psychologist, Department of Psychiatry

Program Director, Pediatric Psychiatry Collaborative Program

Jersey Shore University Medical Center, New Jersey

Associate Professor, Department of Psychiatry & Behavioral Health

                             and Department of Pediatrics

Hackensack Meridian School of Medicine at Seton Hall University

                                               and

Clinical Associate Professor, Department of Psychiatry

Rutgers University – Robert Wood Johnson Medical School

From the beginning of our training as psychologists, we were taught the essentials of the role that ethics plays in our careers and that it is clearly an important role in the field of psychology. There are laws, regulations, principles, guidelines, code of ethics to which we must adhere. These pertain to the licenses we have to practice in our particular states. There are also standards and guidelines that some psychologists need to follow based on their work locations, such as in hospitals or other agencies and organizations. Adherence to all these components is the responsibility of the psychologist so that we adhere to the concept of “do no harm”. An essential aspect of this is to practice within the scope of practice, meaning to have the competence to work with individuals who have an addiction.

Psychologists need to follow the APA’s Ethical Standards of Psychologists and for those clinicians in this field of addiction, being familiar with the Federal regulations – CF 42 part 2.

Much of what is included in this article is elaborated on in these documents.

“For the first time in 30 years, the Department of Health and Human Services (HHS) updated its regulations for 42 CFR Part 2 (Part 2), Confidentiality of Substance Use Disorder Patient Records. The updated regulations, which went into effect on March 21, 2017, intend to allow for better information sharing while balancing the privacy rights for people seeking treatment for substance use issues.

While the regulations make minor changes to align with the Health Insurance Portability and Accountability Act (HIPAA) in an effort to allow more Part 2 providers to take advantage of new models of care that promote value- and team-based care, the technological solutions needed to implement the final regulations are lacking. Until this issue is fully addressed, various components of Part 2 may continue to act as a barrier to integrated care efforts.”

When we talk about ethical issues, we are addressing the aspects of competence and responsible use of power. The American Psychological Association outlines five general ethical guidelines; namely,

• Beneficence and nonmaleficence – improve the welfare of others with the process of do no harm to those individuals who seek our help;
• Fidelity and responsibility to be truthful to our patients – both in treatment and in research;
• Integrity meaning that one is honest and consistent with adherence to moral and ethical principles and values;
• Justice in that one must demonstrate impartiality and equity; and,
• Respect for people’s rights and dignity.

As psychologists, we know that decisions can only be made when one identifies a number of factors, such as the clinical, legal, and cultural concerns as well as the options for that particular individual. We also need to have a clear understanding of our own values, biases, and principles. Working in this field of addiction is challenging and complex. There are co-occurring diagnoses and often times multiple systems like legal and judicial, treatment agencies, multi-disciplines,

medical concerns, and social organizations. It is important to recognize one’s boundaries and limitations, given that so often there are issues of reporting or not when one is faced with a concern of infectious disease or criminal behaviors. For one to practice with competence and a true sense of responsibility, one needs to know their local, state, and federal laws and the factors of legalities (such as receiving a subpoena). Most of us do not have prescription privileges, so one needs to be cautious when discussing medications, such a naltrexone or suboxone or any of the psychotropics.

For those psychologists who are in the field of addictive behaviors, there are a myriad number of ethical dilemmas one can encounter. To name a few – duty to warn, duty to treat, dual relationships, confidentiality, end of life issues, and scarce resources are just the tip of the iceberg as to the issues, concerns or conflicts of interest that one can find themselves handling.

Many of the psychologists in our Division conduct research. What is always necessary to consider is the aspect of the potential benefit of the research regarding the well being of the individual to that of society at large. There are guidelines for research which include that the participation is voluntary; one must obtain an informed consent; one must maintain the participant’s confidentiality and one must be permitted to withdraw from a study just to mention a few issues.

An area that also involves ethical behavior and which is often times omitted is that of professional well-being and self-care. As is well known of one does not care for one self – it will be difficult, if not impossible to help others, especially those who entrust themselves to our care.