"NAADAC Basics of Addiction Counseling Desk Reference Module 1 (up to Hallucinogens)". Examinable sections covered. 100% Approved. Designer psychoactive substances -

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"NAADAC Basics of Addiction Counseling Desk Reference Module 1 (up to Hallucinogens)". Examinable sections covered. 100% Approved. Designer psychoactive substances - ✔✔-psychoactive substan... ces specifically invented with a different molecular chemical formula of similar controlled substances to evade law enforcement. half life - ✔✔-the amount of time necessary to eliminate one half of the original dosage of a psychoactive substance from the body. Central Nervous System - ✔✔-Reticular Activating System, Limbic System, Basal Ganglia Central Nervous System Depressants - ✔✔-Alcohol, Barbituates, Benzodiazepines CNS Depressant Physiological Effects - ✔✔-Impaired coordination, slurred speech, staggering gait, drowsiness, muscle relaxation, slowing of breath, slowing of heart rate, dizziness, sedation CNS Depressants Short Term Psychological Effects - ✔✔-loss ofmemory, euphoria, impaired judgement, feeling of decreased inhibition, decreased fear, confusion, irritability, paranoia, reduction in tension and anxiety, inappropriate obnoxious behavior Habituation - ✔✔-the circumstance where an individual takes daily, therapeutic doses of the prescribed medication for sleep and finds that it is difficult to induce sleep without it. BAC Limits - ✔✔-0.08 while operating a motor vehicle is illegal in most states Lethal Alcohol Toxicity (Alcohol Poisoning) - ✔✔-BAC is .40 or above ETOH Stages of Withdrawal (Stage 1) - ✔✔-Stage 1: (Tremors) 8 hrs after heavy drinking. Peak intensity is 24-36 hours after the last drink. Symptoms: tremors, slurred speech, irritability, nausea, vomiting, easily startled, face flushed, diuretic effects, sweating, rapid heart rate, increased blood pressure and temp., loss of appetite, unsteady gait, inxomnia, inattention, poor coordination, mild disorientation, poor recent memory and uneasiness. (Experience by 90% of ETOH dependent clients.) ETOH Stages of Withdrawal (Stage 2) - ✔✔-Stage 2: (Hallucinations) 25% of clients sx distorted perceptions. auditory and/or visual hallucinations. ETOH Stages of Withdrawal (Stage 3) - ✔✔-Stage 3 (Withdrawal Seizures) Grand Mall type in bursts of 2- 6. 90% occur between 7-48 hours after the last drink. Peak incidence: 13-24 hours after last drink. 1/3 will go on to develop delirium tremens. ETOH Stages of Withdrawal (Stage 4) - ✔✔-Stage 4: (Delirium Tremens) Profound confusion, delusions, vivid hallucinations, tremors, severe agitation, sleeplessness, reduction in psychomotor activity, dilated pupils, fever, tachycardia and profuse perspiration. 15% Fatality Rate in severe cases. A single episode lasts 72 hours or less in 80% of cases. FDA Approved Pharmacologies to treat ETOH Dependence - ✔✔-1. disulfiram (Antabuse) 2. acamprosate (Campral) 3. naltrexone (ReVia, Depade or Vivitrol) Barbituate Uses - ✔✔-1. anticonvulsant 2. anesthetic 3. sedative (daytime sedatives replaced by Benzodiazepines) 4. analgesic Barbituate Short Term Physiological Effects - ✔✔-muscles relax, drowsiness, slowing of breath, slowing of heart rate, slurred speech, slowing of motor activity, impaired coordination, dizziness, double vision Barbituate Long Term Psychological Effects - ✔✔-mood swings (depression), irritability, inappropriate, obnoxious behavior, manipulation, nervousness, confusion, insomnia, lack of coordination, anxiety, hyperactivity, nightmares, hallucinations. Barbituate Physical Dependence - ✔✔-Requires Hospitalization for gradual reduction of dose. Barbituate Withdrawal Symptoms - ✔✔-Within 6-8 hours of last dose: Expect nausea, vomiting, increased heart rate, excessive sweating, abdominal cramps, tremors of the extremities, anxiety, restlessness, agitation. Peak on 2nd/3rd day for short acting barbituates and during 2nd/3rd week for long acting barbituates. Sx can last from 7-10 days. During this period the following Sx's persist: severe seizures, resembling grand mal epilepsy, delirium, uncontrolled heartbeat, high blood pressure, difficulty breathing, loss of consciousness, generalized tonic-clonic movements of body&extremities, toxic psychosis, disorientation and confusion, auditory and visual hallucinations. More die from barbituate withdrawal than from overdose. The majority who abuse are women and older adults. CNS Stimulants - ✔✔-1. Amphetamines 2. Cocaine 3. Caffeine 4. Nicotine Stimulant Medical Uses - ✔✔-narcolepsy, weight loss, ADD in children, edema and respiratory problems. They are also used as an anesthetic and to reduce fatigue. Also used infrequently for the chronically depressed elderly client who has been unusually resistant to more standard treatments. Short Term Physiological Effects of Stimulant - ✔✔-inc. in blood pressure, heart rate, irregular heartbeat, inc. heart muscle tone, inc. metabolic rate, construction of blood vessels, sudden cardiac arrest, changes in hormone levels, inc. in blood sugar, elevated temp, respiratory failure, insomnia, loss of appetite, inc. in motor activity, inc. in speech, dilated pupils, dry mouth, runny nose, muscle twitching, sexual stimulation, sweating, seizures, inc. urination, flushed face, rambling speech, chills, nausea, clumsiness, fining in ears, flashes of light, increase in saliva, increase in bronchial secretions, deadening of taste buds. Short Term Psychological Effects of Stimulants - ✔✔-euphoria, inc. alertness, inc. arousal, excitation, stereotype, inc. in energy, inc. concentration, perceived inc. in strength, ramblind thoughts, restlessness, feelings of enhanced mental ability, inc in tension, anxiety, irritability, aggression, paranoid ideation, delusions, auditory hallucinations. Examples of Amphetamine Abuse - ✔✔-Ritalin (Methylphenidate) by college students to stay awake longer/focus, weight loss. Crank or crystal (methamphetamine) Schedule II substance. Easily obtainable by internet. (Breaking Bad example - meth lab) Amphetamine Short Term Physiological Effects - ✔✔-IV - 3 to 4 hours of effects, 8 to 10 hours when taken orally. Effects include: insomnia, loss of appetite, inc in motor activity, inc. in speech, dilated pupils, dry mouth, inc in blood pressure, inc in heart rate, inc alertness, inc in strength. Amphetamine Short Term Psychological Effects - ✔✔-excitability, anxiety, irritability, auditory hallucinations, aggression, stereotype, paranoid ideation, delusions, euphoria. (Identical to the sx of paranoid schizophrenia) Cocaine - ✔✔-Schedule II, most potent CNS stimulant and most widely used. Current rage: freebasing and crack (cocaine, water and baking soda made into a paste and dried; hard mixture broken into "rocks" which are smoked. Average binge: 12-36 hours. Cocaine Short Term Physiological Effects - ✔✔-inc. heart rate, blood pressure, runny nose, muscle twitching, sexual stimulation, insomnia, loss of appetite, inc in motor activity, inc in rate of speech, dilated pupils, elevated temp, sweating, dry mouth, seizures, sudden cardiac arrest. Cocaine Short Term Psychological Effects - ✔✔-euphoria, excitation, restlessness, anxiety, inc arousal, inc alertness, irritability, auditory hallucinations, delusions, paranoia, perceived inc. in strength, feelings of enhanced mental ability. Cocaine Warning Signs of Overdose - ✔✔-1. vomit/headache/cold sweats/muscle twitches 2. convulsions/rapid, gasping breaths/decreased blood pressure 3. dilated pupils, paralyzed, unable to breath, cardiac arrest and death Cocaine Withdrawal Phases - ✔✔-1. Intense emotional "crash" evidence by marked depression, anxiety, exhaustion and cravings 2. General fatigue, lethargy, muscle twitching, decreased attention span, poor recall, irritability, weakness, hypersomnia. loss of concerntation, increased appetite. 3. Intense cravings and anhedonia. Caffeine Uses - ✔✔-Stimulant effect on CNS but least potent until 650 mg (5 cups) then experience "Caffeinism" with measurable sx. Mild anlagesic: In Midol, Excedrin and common cold. In NoDoz and Red Bull. Nicotine Short Term Physiological Effects - ✔✔-inc heart muscle tone, heart rate, metabolic rate, blood presuure, constriction of blood vessels, changes in hormone levels, inc in saliva, bronchial secretions, reduction in hunger, inc in blood sugar, deadening of taste buds. Nicotine Dependence - ✔✔-Nicotine is considered to be one of the most physically and psychologically addictive psychoactive substances available on the market. Nicotine Withdrawal Sx - ✔✔-(W/I 24 hours) 1. Coughing 2. Lack of concentration 3. Dizzines 4. Fatigue 5. Nervousness 6. Stomach Disturbances 7. Throat Problems 8. Sleep Disturbances 9. Skin Problems 10. Mood alterations Narcotics - ✔✔-Natural Opiates: Opium poppy, morphine, codeine Synthetic Examples: oxycodone,, Darvon, OxyContin, Percodan, Percoset, MPPP (new heroin), Vicodin, heroin, Demerol Used in medical practice to eliminate severe pain. They also reduce anxiety and depression, sedate decrease respinration, cause constipation and constrict the diameter of the pupils. Wide use for suppressing coughing and controlling diarrhea. Narcotics Short Term Physiological Effects - ✔✔-bobbing head, flushing of skin of face,neck and chest, constricted pinpoint pupils, suppression of cough, reduction of respiratory functions, decrease in blood pressure, drowsiness, slurred speech, constipation, nausea, sedation, vomiting, itching, inability to urinate, elimination of pain. Narcotics Short Term Psychological Effects - ✔✔-lethargy, euphoria, mental clouding, impaired judgment. Heroin - ✔✔-Most Common Street Narcotic. Schedule I, made from morphine. IV admin (shared needles)= HIV/AIDS increase, tuberculosis and Hep B&C Heroin Short Term Physiological Effects - ✔✔-Same as Narcotics general with the exception of it also causes dry mouth, eyes and nose. Heroin Short Term Psychological Effects - ✔✔-Same as Narcotics general except is also decreases anxiety. Heroin Long Term Physiological Effects - ✔✔-Metered by 1. pharmacological properties of heroin, effects from route of administration and effects due to adulterants added as follows: inc. risk of infection due to a decrease in immune system response, irregular levels of sex hormones in men (decreased libido/erectile dysfunction) and women (abnormal ovarian functioning), inc bronchial irritation and asthma, inc risk of pneumonia, liver disease, collapsing of veins, related to IV admin, irregular level and release of cortisol, fetal damage, chronic constipation, cardiovascular malfunctions, severe skeletal muscle cell breakdown. Heroin Withdrawal - ✔✔-Withdrawal: 6-8 hours after last dose - peak 12-48 hours after last dose lasting 4-5 days. Residual Withdrawal for extremely heavy users= "Protracted Abstinence Syndrome" present for 8-12 months. See page 79 for details. Opposite of Short Term effects. Characteristics: inability to tolerate stress or overcome discomfort, tiredness, weakeness, anxiety and decreased pain threshold. Opioid Replacement Treatment Considerations - ✔✔-Treatment (Opioid Replacement Therapy): Methadone (travel to clinic 7 days a week or use "take home" bottles which risks abuse. LAAM is longer lasting (72 horus) and 3 days a week administration however it has adverse side effects. Buprenorphine - agonist and antagonist and blocks effects of other opioids taken simultaneously - abuse potential small. Some require lifelong treatment. Useful in improving employment, reducing crime and reducing HIV/AIDS transmission. Narcotic Antagonist Treatment - ✔✔-"opiate blockers" successfuly block or reverse the euphoric effects of opioids, including heroin. Attractive alternative to opioid replacement tx. Most common naltrexone (Depade/ReVia) and naloxone (Narcan). Admin 3X a wk. Except new injectible form of naltrexone (Vivitrol) admin is 1X a month. Setbacks for use: 1. do not delay onset of withdrawal sx 2. Must be detoxed from all opiates before starting treatment and it requires continued client compliance after detox. Street Names for Narcotic Interactions with Other drugs - ✔✔-hydromorphone and cocaine ="Speedballing" Pentazocine and antihistamines "T" or "Blues" Most dangerous: Narcotics and Alcohol Narcotic Withdrawal - ✔✔-restlessness, anxiety, teary eyes, runny nose, nausea, diarrhea, gooseflesh, dilated pupils, stomach cramps, vomiting, a subjective feelingn of uneasiness and a sense that withdrawal is about to occur. Hallucinogens - ✔✔-LSA, PCP (Phencyclidine), MDMA (Ecstasy) and Others - with the exception of PCP, there is no approved us in general medicine for hallucinogens. Hallucinogen Short Term Physiological Effects - ✔✔-dilated pupils, inc heart rate, inc. in blood pressure, inc. in body temp, impaired short term memory, sweating, inc in salivation, muscular weakenss, ausea, vomiting, incoordination, slurred speech, rapid eye movements, loss of appetite, headache, convulsions, seizures. Hallucinogen Short Term Psychological Effects - ✔✔-intense euphoria, visual hallucinations, perc'd inc in creativity, relaxation, inc in outward emotion, per'd inc in knowledge, feelings of inc strength, inc fanasy production, extreme emotional volatility, subjective slowing of time, generalized loss of boundaries, depersonalization, confusion, disturbed judgment, auditory hallucinations, reduced sensitivity to pain, exaggerated responses to lights and sounds, disorganized thought processes, reduction of inhibitions, excitation, amnesia for the episode, delirium, restlessness, anxiety, panic attacks, paranoid psychosis, homicidal/suicidal behaviors. *bad trip = 24 hour + anxiety/fear, paranoid, panic, depression especially in the case of PCP. Code of Federal Regulations Title 42, Part 2 - ✔✔-Client Confidentiality Code of Federal Regulations Title 42, Part 2, Subpart E - ✔✔-a subpoena signed by a judge is insufficient to breach confidentiality unless a qualified hearing is first held in court The goal of Clinical Supervision is - ✔✔-to impact on the counselor's clinical behavior. Dominant Models of Clinical Supervision in the 1930-1960's - ✔✔-Psychodynamic or Psychoanalytic Models According to ___________, positive and negative feedback must be paired together. - ✔✔-Abraham Maslow The facilitative model of supervision was based on which of the following models of psychotherapy? - ✔✔-Rogers's client centered therapy Yalom's Curative Factors - ✔✔- Uppers - ✔✔-CNS Stimulants: cocaine, amphetamines & meth, caffeine, nicotine Downers - ✔✔-CNS Depressants: alcohol, benzos, barbituates, opiates, sedative- hypnotics, muscle relaxants, antihistamines All-Arounders - ✔✔-psychedelics (LSD, mushrooms, MDMA/Ecstacy, PCP, DXM) and Cannabis Acute intox Sx of uppers - ✔✔-Increased: heart rate, blood pressure, breathing, alertness, activity, anxiety, aggression, confidence, constriction of blood vessels, body temperature, dilated pupils, runny nose, dry mouth, muscle twitching, sexual stimulation Decreased: appetite for both food and water Acute intox sx of depressants (general) - ✔✔-Decreased: heart rate, blood pressure, breathing, digestion, basic psychological functions such as motor coordination and mental awareness, restricted pupils Specifics of alcohol - ✔✔-effects every organ in the body, impacts GABA, dopamine, glutimate and serotonin; electrolite imbalances can lead to life threating seizures Habituation - ✔✔-repitition of behaivors until they are established into daily life Acute Alcohol withdrawal Sx - ✔✔-High Risk: tremors, slurred speech, nausea and/or vomiting, flushed face, dehydration, sweating, rapid heart rate, insomnia, poor coordination, poor memory, halluninations, grand mal seizures, delirium tremens (DT's) Barbituates & Benzodiazapines - ✔✔-work on GABA, "standard" depressant effects, withdrawal sx can be toxic and present almost identical to alcohol Tolerance - ✔✔-Increased need for markedly more of the same substance in order to acheive the deisred effect (decreased need without a change in the substance is reverse tolerance) Can occur in as little as 3-4 weeks of use Dependence - ✔✔-aka Addiction: behavioral pattern of complusive substance use; consistent involvement with the use of substances, high tendency to relapse after withdrawal Detoxification - ✔✔-Process of eliminating all psychoactive substances from the body Methods of administration - ✔✔-oral- mouth via swallowing or smoking; Nasally- snorting or inhaling; IM- injection into a muscle; IV- Injecting into a vein; Subcutanious- injecting beneith the skin; Topicalapplyed on top of the skin; Sublingually- dissolving under the touge; rectally- inserted into the anus; Vagionally- inserted into the vagional opening Physiological dependence - ✔✔-continued use of the substance is needed in order to prevent withdrawal symtoms Psychological dependence - ✔✔-percetion that the effects produced by a substance, or the associated condtions of use, are needed to maintain optimal well- being. Cross- Tolerance - ✔✔-the ability of pharmacologically similar substances to substiture for the other in relation to tolerance and to prevent withdrawal Abuse Liability - ✔✔-risk potential associated with a substance becoming repeatedly used and/or dependence inducing designer psychoactive substances - ✔✔-Substances specifically invented with a different molecular formula to evade law inforcement Central Nervous System (CNS) - ✔✔-Brain & spine Limbic system - ✔✔-Within the CNS, Controls Emotions Reticular Activating System - ✔✔-Within the CNS, responsible for the state of arousal Basal Ganglia - ✔✔-Within the CNS: responsible for involuntary and fine motor skills Cerebral Cortex - ✔✔-within the CNS: part of the limbic system that controls voluntary motor skills and sensory input Hypothalamus - ✔✔-Part of the limbic system: liaison between CNS & ANS Autonomic Nervous System (ANS) - ✔✔-montiors unconscious bodily functions such as heart rate, breathing, and digenstion Sympathetic Nervous System - ✔✔-secondary within the ANS- when activated increases breathing, heart rate, etc. Parasymphathetic Nervous System - ✔✔-Secondary within the ANS- when activated decreases breathing, heart rate, etc. Neurotransmitters most affected by AOD - ✔✔-acetylcholine, norepinephrine, epinephrine, dopamine, serotonin, GABA, glutamate, endogenous opioids Inhibitory Neurotransmitters - ✔✔-Dopamine, serotonin, GABA Excitatory Neurotransmitters - ✔✔-glutamate, epinephrine Inhibitory and Excitatory Neurotransmitters - ✔✔-Acetylcoline, norepinephrine Endogenous Opioids - ✔✔-Natural peptides that combat pain and stress Agonist - ✔✔-substance that binds to a neuron and elicits a reaction as if it was that neurotransmitter Antagonist - ✔✔-substance that binds to a neuron and prevents other neurotransmitters from binding to it Two ways AOD's impact reuptake - ✔✔-prevent reuptake OR prevent the metabolizing process that would remove the substance- both result in continued stimulation of the neuron Withdrawal Sx - ✔✔-the oppopsite of intoxication sx Amphetamines - ✔✔-increase release and prevent reuptake of norepinephrine, dopamine, adrenaline and serotonin. Not metabolized in the liver but excreted in urine unchanged, can have a half-life of more than 10 hours. High risk of overdose which can lead to cardiac arrest, stroke, brain hemorrage (and other concerns associated with increased blood pressure) Sterotypy - ✔✔-common with stimulants: repeating the same behavior over and over again Cocaine - ✔✔-blocks reuptake of dopamine, norepinephrine and serotonin. dopamine in the nucleus accumbens produces the euphoric effect. High risk of overdose though the dosage is unique to each individual. No medical treatment to reverse effects Code of Ethics: Covers what 10 topics: - ✔✔-1. Counseling relationship 2. Evaluation, assessment & interpretation of client data 3. Confidentiality/privileged communication, privacy 4. Professional responsibility 5. Working in culturally diverse world 6. Workplace standards 7. Supervision & consultation 8. Resolving Ethical issues 9. Communication & published works 10. Policy and political involvement Ethics = - ✔✔-- standards that govern the conduct of the person. - "human reflecting self-consciously on the act of being a moral being." Considerations in making ethical decisions (17): - ✔✔-1. Autonomy. 2. Obedience. 3. conscientious refusal. 4. beneficience. 5. gratitude. 6. competence. 7. Justice. 8. Stewardship. 9. Honesty and candor. 10. Fidelity. 11. Loyalty. 12. Diligence. 13. Discretion. 14. Self-improvement. 15. Non-malfeasance. 16. Restitution. 17. Self-interest. Considerations in making ethical decisions: AUTONOMY = - ✔✔-To allow others the freedom to choose their own destiny Considerations in making ethical decisions: OBEDIENCE: - ✔✔-The responsibility to observe and obey legal and ethical directives Considerations in making ethical decisions: CONSCIENTIOUS REFUSAL - ✔✔-The responsibility to refuse to carry out directives that are illegal and/or unethical Considerations in making ethical decisions: BENEFICENCE: - ✔✔-To help others Considerations in making ethical decisions: GRATITUDE: - ✔✔-To pass along the good that we receive to others Considerations in making ethical decisions: COMPETENCE: - ✔✔-To possess the necessary skills and knowledge to treat the clientele in a chosen discipline and to remain current with the treatment modalities, theories and techniques. Considerations in making ethical decisions: JUSTICE - ✔✔-Fair and equal treatment, to treat others in a just manner. Considerations in making ethical decisions: STEWARDSHIP - ✔✔-To use available resources in a judicious and conscientious manner, to give back. Considerations in making ethical decisions: HONESTY AND CANDOR - ✔✔-Tell the truth in all dealing with clients, colleagues, business associates and the community Considerations in making ethical decisions: FIDELITY - ✔✔-To be true to your word, keeping promises and commitments Considerations in making ethical decisions: LOYALTY - ✔✔-The responsibility to not abandon those with whom you work. Considerations in making ethical decisions: DILIGENCE: - ✔✔-To work hard in the chosen profession, to be mindful, careful and thorough in the services delivered Considerations in making ethical decisions: DISCRETION: - ✔✔-Use of good judgement, honoring confidentiality and the privacy of others Considerations in making ethical decisions: SELF-IMPROVEMENT: - ✔✔-To work on professional and personal growth to be the best you can be Considerations in making ethical decisions: NON-MALFEASANCE - ✔✔-Do no harm to the interests of the client Considerations in making ethical decisions: RESTITUTION - ✔✔-When necessary, make amends to those who have been harmed or injured Considerations in making ethical decisions: SELF-INTEREST: - ✔✔-To protect yourself and your personal interests I. Counseling relationship - ✔✔-= safeguarding integrity of counseling relationship to ensure services that are most beneficial by providing services or referral. - specific legal obligations may supersede loyalty to clients. I. Counseling relationship: Standard 1: CLIENT WELFARE: # 1 of 4: LIFE IMPROVEMENT: - ✔✔-= professional supports actions that assist client in better quality of life, greater freedom & independence I. Counseling relationship: Standard 1: CLIENT WELFARE: #2 of 4: CLIENT AUTONOMY: - ✔✔-= professional support clients in doing what they can for themselves. Will not insist on pursuing goals w/o incorporating what clients perceives as good, necessary I. Counseling relationship: Standard 1: CLIENT WELFARE: #3 of 4: PERSONALIZED TX: - ✔✔-= Prof will take action to relieve the unique suffering, and actions will be uniquely suited to the individual, not by universal prescription I. Counseling relationship: Standard 1: CLIENT WELFARE: #4 of 4: Equal service regardless of pay: - ✔✔-= Services will be provided equally regardless of clients paying reduced fee, full fee or waived fees. I. Counseling relationship: 5 STANDARDS = - ✔✔-1. CLIENT WELFARE 2. CLIENT SELF-DETERMINATION 3. DUAL RELATIONSHIPS 4. GROUP STANDARDS 5. PREVENTING HARM I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION = - ✔✔-- Client has fundamental human right to selfdetermination & making decisions in their own best interest - Counselor must provide clear information about probable effectiveness & costs of care to allow informed decision. - Must be specially mindful in "fiduciary" relationships where special trust is given the pro due to client's inability to judge competence. I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #1 of 11: Complete disclosure - ✔✔-Pro must provide complete, accurate info re: extent of relationship, including Code of Ethics, & documentation re: professional loyalties & responsibilitoies I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #2 of 11: info re: TX effectiveness - ✔✔-Pro must provide accurate info on efficacy of TX, and referral options available I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #3 of 11: termination of service - ✔✔-Pro will terminate services when no longer required or in client's best interest I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #4 of 11: avoid abandonment - ✔✔-- Pro will take reasonable steps to avoid abandoning clients who need services. - Referrals will be made after considering how to minimize adverse effects. I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #5 of 11: When services are not effective for specific client.... - ✔✔-- There may be clients with whom pro cannot work effectively. - In such cases, make arrangements for consultation, co-therapy, or referral. I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #6 of 11: termination for non-payment - ✔✔-- termination possible for nonpayment IF contractual arrangements have been made clear to client & if client does not pose imminent danger to self/others - Pro will document discussion of consequences of non-payment with client I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #7 of 11: When client has inability to pay - ✔✔-- when Pro must refuse service due to inability to pay, must attempt to identify other care options. I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #8 of 11: when client's needs are beyond Pro's scope of practice - ✔✔-- Pro will refer client to appropriate resource for TX of mental, spiritual, physical, or chemical impairment. I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #9 of 11: foster self-sufficiency - ✔✔-- Pro will foster self-sufficiency in clients, students, employees and supervisors, to manifest mature, independent functioning 1. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #10 of 11: Informed Consent - ✔✔-- Pro understands client right to be informed re: TX - must be in clear, understandable language to client/guardian - must present purpose of services, risks related to service, limits of services due to 3rd party payer, relevant costs, reasonable alternatives, client's right to refuse services - if services via telephone/web: limits and risks must be disclosed I. Counseling relationship: Standard #2: CLIENT SELF-DETERMINATION: #11 of 11: Disclosure of confidentiality - ✔✔-- Clients must be provided statement of full disclosure re: confidentiality if/when working with person in training (supervisee). Consent to treat will outline boundaries of client-supervisee relationship, supervisee's training status and confidentiality issues. - clients can opt to refuse services by training as determined by agency policies. - disclosure forms will provide info about grievance procedures. I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #1 OF 11: Maintain non-exploitative relationships: - ✔✔-= due to power differential, pro will not exploit relationships for personal gain, including social or business relationships I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #2 OF 11: Conflict of interest & gifts - ✔✔-= avoids situations that could be interpreted as conflict of interest. No gifts from clients, unless it causes irreparable harm to others. Gifts over $25 are never permitted I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #3 of 11: Do not engage in dual relationships - ✔✔--Pro will not form pro relationships w/ family members, friends, close associations or others whose welfare might be jeopardized by dual relationship I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #4 of 11: Sex & clients - ✔✔-No sex with current or former clients under any circumstances! I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #5 of 11: Past romantic involvements - ✔✔-Pro will not accept client with whom they've engaged in romantic or sexual relationships. I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #6 of 11: Requests outside treatment - ✔✔-- Pro will not request any action that doesn't pertain to treatment (e.g.: giving testimonials or participating in interviews) I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #7 of 11: when Dual Relationships are inevitable - ✔✔-When dual relationships are inevitable (e.g.: in rural areas), pro will take steps to distinguish counseling relationship with other interactions. I. Counseling relationship: Standard #3: DUAL RELATIONSHIPS: #8 of 11: When Pro is working in other capacity - ✔✔-When pro works for dept of corrections, military, an HMO, or client's employer: obligations to extern [Show More]

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