Alcohol, Tobacco and Other Drug Use by Addictions Professionals: Historical Reflections and Suggested Guidelines

ABSTRACT

Alcohol, tobacco, and other drug (ATOD) use by individuals working in the addictions field has existed as a complex, controversial personal and professional practice issue for more than 150 years. The central debate within this history involves the concept of nexus—the boundary that distinguishes rights to personal privacy from professional duties and obligations. Ambiguities related to this point of demarcation have contributed to misjudgments related to ATOD use by addictions professionals that have injured multiple parties. This essay reviews the history of ATOD use as a professional practice issue in the addictions field; discusses clinical, ethical, and legal issues related to ATOD use by addiction service professionals; and offers guidance on ATOD use decision making.

KEYWORDS:

• Addiction counselors
• ethics
• impaired professionals
• countertransference
• professional practice

Notes

Acknowledgments:

Support for this article was provided by the Great Lakes Addiction Technology Transfer Center (GLATTC), which is funded by the Center for Substance Abuse Treatment (CSAT). All opinions expressed here are those of the author and should not be interpreted as reflecting the policies of GLATTC or CSAT. I would like to thank Joe Gay, Renée Popovits, Thomas Ramseyer, Jason Schwartz, Jerry Seaman, and Dave Sharar for their helpful comments and suggestions on the issues discussed in this article.

1. Such studies have continued. See Aiken, LoSciuto, Ausetts, & Brown, 1984; Blum and Roman, 1985; Galanter, Castaneda, & Salamon, 1987; McGovern & Armstrong, 1987; Stoffelmayr, Mavis, & Kasim, 1998)

2. Sobriety requirements changed during this early history, with the early OEO alcoholism programs of the 1960s requiring only one year of sobriety for their counselors.

3. The most intense period of this conceptual and organizational integration spanned the years 1975–1985.

4. All names in these incidents have been altered.

5. One's ATOD history and decisions can also influence the clinical supervision relationship (See Culbreth and Borders, 1998).

6. I would like to acknowledge the assistance of Jason Schwartz in conducting this literature review.

7. The NIAAA standard is for women to drink no more than one drink per day (total of seven drinks per week) and for men to drink no more than two drinks per day (total of fourteen drinks per week; Dufour, 1999).

8. This is not an arbitrary standard applied to those in recovery. I have argued elsewhere (White & Popovits, 2001) that any change in one's personal life that could significantly affect one's clinical work should be reported and processed in clinical supervision.