Ethical Principles for working in the substance use prevention and treatment field.
It is important that the research, policy and practice that is undertaken in the field of substance use prevention and treatment should be undertaken within an international framework of ethical principles to guide all aspects of the work.
Ethical questions arise on a variety of levels, starting from the justification of drug prevention work itself. Professionals should not assume that drug prevention and treatment activities are per definition ethical and beneficial for its participants.
Whilst ISSUP will be developing its own standards for ethical practice I am sure it will be informed by the following two examples. They provide well researched and considered input on the matter of ethics and practice standards for those working in the field.
The following is adapted from the Position Paper that emanated as an outcome of the European Drug Prevention Quality Standards Phases I and II*. They offer ethical principles that could be seen as applicable to all aspects of substance use prevention and treatment related activity.
- Adherence to legal requirements
- Development and delivery of activities that are supported by high quality research evidence
- Respecting participants’ rights and autonomy (e.g. as defined in international frameworks on human rights and the rights of children )
- Providing real benefits for participants (i.e. ensuring that the programme is relevant and useful for participants)
- Ensuring that prevention causes no harm or substantial disadvantages for participants or the communities in which they are implemented, including no iatrogenic effects, illness or injury, exclusion, stigma or the lack of opportunity to participate in alternative, more effective, activities;
- Causing no harm or substantial disadvantages for participants (e.g. iatrogenic effects, illness or injury, exclusion, stigma)
- Providing transparent, truthful and comprehensive information
- Understanding the implications and practicalities of obtaining consent from participants;
- Respecting the confidentiality of participant data
- Tailoring the intervention to participants’ needs as appropriate
- Involving participants as partners in the development, implementation, and evaluation of any activity
- Protecting participants’ and staff members’ health and safety.
- The European Prevention Standards Partnership (2015) EDPQS Prevention Position Paper: Defining “drug prevention” and “quality”. Liverpool: Centre for Public Health. Available from: http://prevention-standards.eu/position-paper/
Brotherhood A & Sumnall HR (2011) European drug prevention quality standards: a manual for prevention professionals. European Monitoring Centre for Drugs and Drug Addiction, Manual 7. Luxembourg: Publications Office of the European Union. Available from: http://prevention-standards.eu/manual/
The second point of reference is from The Federation of Drug and Alcohol Professionals, based in the UK. It also offers helpful guidance on this matter of ethics and professional practice for those active in the drugs field. It states:
Drug and alcohol practitioners provide a wide range of substance misuse related services including: education and prevention; services to people with drug and alcohol problems; services to those affected by drug and alcohol use; and professional services to other practitioners. This Code of Practice covers all such activities.
- Drug and alcohol practitioners seek to help reduce the damage caused by substance misuse to users themselves, those close to them and the wider community, and this goal should guide their work at all times.
- Drug and alcohol practitioners should act in a professional and responsible way at all times. They should be honest and fair in their professional dealings, act with integrity, be conscientious, careful and thorough in their work, and take account of their obligations under the law and to the wider public interest.
- Practitioners must at all times respect the rights, dignity and interests of their clients. They should treat all clients equitably, and must not discriminate on grounds of lifestyle, gender, age, disability, race, sexuality, religion, beliefs, culture, ethnicity, or financial or social status against clients, colleagues, or anyone else with whom they have dealings in the course of their work.
- In making statements to clients, other professionals and the general public, practitioners should recognise the difference between fact and opinion, acknowledge where professional opinions differ, and state as fact only what has been empirically validated as such.
- Practitioners should ensure that their work is adequately covered by insurance for professional indemnity and liability, whether through their employer or independently.
- Any service provided by a practitioner should be based on an assessment of the individual's need, and take account of the practitioner's professional responsibilities and the relevant evidence base on effective practice.
- Treatment services should be based on a treatment plan, drawn up in consultation with the client concerned.
- Practitioners should provide a service only where they feel that it would, taking account of their professional responsibilities, be appropriate for them to do so, and should ensure that those concerned are aware of any alternative options open to them.
- Practitioners who receive payment or other benefits from service providers for advising people about, or referring them to, their services must make this clear to all concerned and not allow their own financial interests to compromise their wider professional responsibilities.
- Where a practitioner feels it would be inappropriate for them to provide a service they should take all reasonable steps to help find a suitable alternative where appropriate.
- Practitioners should keep their knowledge and skills up-to-date. They should not attempt to work beyond their competence.
- Practitioners should take care to present their qualifications and experience accurately and to avoid them being misrepresented.
- Practitioners should refrain from practice when their ability to act professionally is impaired as a result of a psychological or physical condition, eg an on-going or recent alcohol or drug related problem, illness, personal stress etc. Where a practitioner is under any doubt on this they should seek the guidance of their supervisor and should notify their supervisor & employer of any recent or on-going drug or alcohol problem.
- Except for medication taken under direction of a doctor, practitioners should not take any mood altering substance, including alcohol, prior to, or while carrying out, their work. Practitioners should never practise while their competence is impaired by the use of any mood altering substance.
- Before providing a service, practitioners should secure the informed consent of the person concerned (or their legal representatives) - and must take all reasonable steps to ensure that the nature of the service, and anticipated consequences, are adequately understood.
- Written consent must always be secured for a person's involvement in research - and information about the purpose or nature of a research study should be withheld only where this is approved by an appropriately constituted ethical committee made up of other practitioners and lay representatives.
- Practitioners must recognise that in some situations a person's capacity to give valid consent may be diminished and should take this in to account before agreeing to provide a service, Practitioners must never use any form of coercion to obtain consent.
- Practitioners must not make false or exaggerated claims about the effectiveness of the services they are providing, nor should they ascribe unusual powers to themselves.
- If conditions are imposed upon the continuation of a service, they must have the approval of a senior colleague or supervisor and be considered to be clearly consistent with the practitioner's professional responsibilities. Such conditions must always be clearly explained to the client.
- Practitioners must recognise and uphold a client's right to withdraw consent at any time.
- Personally identifiable information about clients should normally be disclosed to others only with the valid informed consent of the person concerned (or their legal representatives) - and the boundaries and limits of confidentiality should be explained clearly before any service is provided.
- Where a practitioner holds a sincere belief that a client poses a serious risk of harm to themselves or others, or where obliged by law, a practitioner may be required to disclose personally identifiable information without the client's consent. Before breaking confidentiality, however, practitioners should still seek to secure valid consent for disclosure from the person concerned and should consult with their supervisor or a senior colleague where this is not provided - except where the practitioner judges that any delay this might cause would present a significant risk to life or health, or place the practitioner in contravention of the law.
- Information identifying clients must never be published (for example in an article or book), without their written agreement (or that of their legal representatives).
- All reasonable steps should be taken to ensure that any records relating to clients are kept secure from unauthorised access and the requirements of the Data Protection Act should be complied with at all times.
- Practitioners must recognise that they hold positions of responsibility and that their clients and those seeking their help will often be in a position of vulnerability.
- Practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial or any other kind of personal advantage. Practitioners should not engage in sexual relations, or any other type of sexualised behaviour, with or towards clients.
- Practitioners should exercise considerable caution and consult their supervisor before entering into personal or business relationships with former clients and should expect to be held professionally accountable if the relationship becomes detrimental to the client or to the standing of the profession.
- Practitioners should not carry out an assessment or intervention with, or provide supervision to, someone with whom they have an existing relationship. In the event of a practitioner having an existing relationship with any person who is referred to an agency in which they work, this should be drawn to the attention of the practitioner's line manager and supervisor.
- It is recognised that some practitioners are involved in on-going self-help / peer support groups, and that they may on occasions come in to contact with existing or former clients within this context. Any such contact must be handled carefully. If a practitioner is asked by a former client to act as a 'sponsor' in such a context, the practitioner should seek guidance from their supervisor before agreeing to do so.
- All practitioners should have regular professional supervision, focusing on reviewing, guiding and supporting their practice. If such supervision is not provided by an employer it should be obtained elsewhere.
- Where a practitioner has any serious doubts about how to handle a particular situation, including in relation to this code of practice, they should discuss this with their supervisor / line manager at the earliest opportunity.
- Practitioners must disclose to their employer and supervisor any past disciplinary action taken against them by an employer or professional body in relation to unprofessional or unethical conduct.
- Practitioners must not condone, support, conceal or otherwise enable the unethical conduct of colleagues. Where they are aware of, or have good reason to suspect, misconduct on the part of a colleague this should be discussed with the practitioner's own line manager or supervisor and under their guidance should be drawn to the attention of the colleague's line manager, supervisor and/or professional body - taking account of the need to respect clients' rights of confidentiality.
- Practitioners have a duty to explain to clients their rights and options in making a formal complaint about a service they have received, whether the service was provided by the practitioner him/herself or by a fellow practitioner. Practitioners must never attempt to prevent or dissuade a client from making a complaint about a service with which they are dissatisfied.