Ethical question

Odysseus

I imagine anyone who hjas ever work in an addiction setting especially a methadone programme has pondered on this at some time.

However this has landed on my desk recently and whilst I'm interested in peoples opinions I wonder if anyone knows of and papers or research on the topic of addicted therapists.

Especially I'm wondering on the ethics of a person on a stabilised methadone programme and their ability or inability to engage in clinical work.

It raises questions in that if we believe that stabilised clients can engage in work and all other activities why can they not work in the addiction field?

Is there that much of a gap in the abilities of a person in recovery and a stable person on MMT?

It is not as black and white as it first seems, so any know of any resourse on the web that I could access, I'm even interested in the topic from the viewpoint of other professionals working in the addiction area.

mark renton

Are you asking, why cant a person on methadone help someone else give up methadone?

Odysseus

mark renton wrote: »

Are you asking, why cant a person on methadone help someone else give up methadone?

No Mark it is a tad more complex than that.

Say in the addiction field many people are in recovery, working in different professions. Now say a person in recovery is also a psychotherapist or counsellor working in the addiction area. Such work is very complex and is not just about drug use.

Again say that person relapsed, now being under the influence of drugs or alcohol whilst working with client is unethical ans this is reflected in the code of ethics drawn up by most professional bodies.

However, if the person seeks methadone treatment and instead of detoxing goes from methadone maintenence, the are they under the influence? Should they be free to undertake clinical work?

Now that is just a made up example, however, does that clarify the question?

mark renton

The blind leading the blind.

Of course they shouldnt be able to treat patients. There is absolutely no integrity.

InReality

I found this article very interesting , regarding the important of meaningful work for people with mental illness.

http://www.nytimes.com/2013/01/27/opinion/sunday/schizophrenic-not-stupid.html?_r=0

I don't know anything about addiction really , but for depression having work and a structure to a day was a big part of my recovery.

Odysseus

mark renton wrote: »

The blind leading the blind.

Of course they shouldnt be able to treat patients. There is absolutely no integrity.

On what basis? Can you expand on that a bit?

MaxWig

Odysseus wrote: »

On what basis? Can you expand on that a bit?

I disagree that it is the blind leading the blind.

I imagine their might even be some insights available to such a therapist, that were unavailable to those without direct experience of MMT, its stigmas, its advantages and disadvantages etc.

However, I do think such a therapist might find it very difficult to remain objective. To the extent that true objectivity is impossible for any of us, this might be deemed irrelevant.

I was recently looking for similar material on anxiety medication.
I assume, but have yet to verify, that a significant amount of therapists might rely, or have relied upon anxiolytics for alleviation of anxiety symptoms.

Does this mean they are unfit, ethically or otherwise, to work with those suffering from anxiety?
I don't think it does.

Methadone treatment however occupies a much more complex realm.
By definition, those on MMT programmes are absolutely dependent on the drug, physically and psychologically.
In this sense, there is less connection to, or awareness of an 'inner cure'.

I hate that term, but wishy-washy as it may sound, I think it may be relevant here.

Odysseus

MaxWig wrote: »

I disagree that it is the blind leading the blind.

I imagine their might even be some insights available to such a therapist, that were unavailable to those without direct experience of MMT, its stigmas, its advantages and disadvantages etc.

However, I do think such a therapist might find it very difficult to remain objective. To the extent that true objectivity is impossible for any of us, this might be deemed irrelevant.

I was recently looking for similar material on anxiety medication.
I assume, but have yet to verify, that a significant amount of therapists might rely, or have relied upon anxiolytics for alleviation of anxiety symptoms.

Does this mean they are unfit, ethically or otherwise, to work with those suffering from anxiety?
I don't think it does.

Methadone treatment however occupies a much more complex realm.
By definition, those on MMT programmes are absolutely dependent on the drug, physically and psychologically.
In this sense, there is less connection to, or awareness of an 'inner cure'.

I hate that term, but wishy-washy as it may sound, I think it may be relevant here.

Cheers for your response. I want to think on a few points but I get back to you, but could I ask did you manage to get any references? Also did you contact any of the professional bodies?

Musefan

I once interviewed for an intern position that specified non-smokers only would be considered given that some of the clients were drug addicts. Thought it was an interesting request. It would make you question is there a certain level of addiction which is acceptable? I ask because I can't ever remember being asked if I smoke for an application before (not that it matters to me as I don't)

Odysseus

MaxWig wrote: »

I disagree that it is the blind leading the blind.

I imagine their might even be some insights available to such a therapist, that were unavailable to those without direct experience of MMT, its stigmas, its advantages and disadvantages etc.

However, I do think such a therapist might find it very difficult to remain objective. To the extent that true objectivity is impossible for any of us, this might be deemed irrelevant.

I was recently looking for similar material on anxiety medication.
I assume, but have yet to verify, that a significant amount of therapists might rely, or have relied upon anxiolytics for alleviation of anxiety symptoms.

Does this mean they are unfit, ethically or otherwise, to work with those suffering from anxiety?
I don't think it does.

Methadone treatment however occupies a much more complex realm.
By definition, those on MMT programmes are absolutely dependent on the drug, physically and psychologically.
In this sense, there is less connection to, or awareness of an 'inner cure'.

I hate that term, but wishy-washy as it may sound, I think it may be relevant here.

Cheers, tbh it's a question that the more I look into the more I am unsure where I stand.

Yes a therapist currently on MMT who have those insights, but so who one who has a history of MMT and are currently in recovery [whatever that term may imply]. Merely just looking at drug usage would be on MMT effect the objectivity of the therapist.

However as there is much more to addiction work than merely drug status the therapist will be deal ing with the usual human experience and the difficults that go with being a human subject, anxiety, panic, depression, sexual violence etc; who being on a daily dose of methadone prevent the person from being able to work with a client who has those issues?

In what way would you see there ability to be as objective as possible being comprimised?

In your own quest re: use of anti anxiety meds do you find any interesting papers/data?

Can you expand on your thoughts that methadone would effect the person from accessing "an inner cure"

sigmund.jung

I don't know if there is any evidence for this but a colleague of mine made a very strong case for GPs who are , for example, alcoholics, tend to normalise alchohol dependent behaviour and are less effective that non-alcoholic GPs at brief interventions.

For example, GP who is alcoholic, drinks a bottle of wine/ two bottles a night. Meets a patient, asks the patient how much she drinks typically, she says she drinks half a bottle a day. GP says that's not too bad were in fact she is WAY over limits.

Will try dig up some evidence / literature on it.

Also heard same about obese GPs, depressed GPs, and narcotic addicts.

Lbeard

sigmund.jung wrote: »

I don't know if there is any evidence for this but a colleague of mine made a very strong case for GPs who are , for example, alcoholics, tend to normalise alchohol dependent behaviour and are less effective that non-alcoholic GPs at brief interventions.

There is a saying, an alcoholic is someone who drinks more than their doctor.

For example, GP who is alcoholic, drinks a bottle of wine/ two bottles a night. Meets a patient, asks the patient how much she drinks typically, she says she drinks half a bottle a day. GP says that's not too bad were in fact she is WAY over limits.

It's probably not right to categorise someone who drinks excessively as being an alcoholic. Hedonism and compulsion are two different things.

Will try dig up some evidence / literature on it.

There's a great paper by a doctor in Trinity college written in the early 70s. - it's online some place, I haven't been able to find it again. But he classes an alcoholic as someone who drinks 25 pints of beer or two bottles of spirits a day. So, he probably drank 24 pints in an evening, and never went over two bottles of spirits.

sigmund.jung

Lbeard wrote: »

There is a saying, an alcoholic is someone who drinks more than their doctor.

stupid saying

It's probably not right to categorise someone who drinks excessively as being an alcoholic. Hedonism and compulsion are two different things.

i didn't though

There's a great paper by a doctor in Trinity college written in the early 70s. - it's online some place, I haven't been able to find it again. But he classes an alcoholic as someone who drinks 25 pints of beer or two bottles of spirits a day. So, he probably drank 24 pints in an evening, and never went over two bottles of spirits.

why is it great?

Odysseus

sigmund.jung wrote: »

I don't know if there is any evidence for this but a colleague of mine made a very strong case for GPs who are , for example, alcoholics, tend to normalise alchohol dependent behaviour and are less effective that non-alcoholic GPs at brief interventions.

For example, GP who is alcoholic, drinks a bottle of wine/ two bottles a night. Meets a patient, asks the patient how much she drinks typically, she says she drinks half a bottle a day. GP says that's not too bad were in fact she is WAY over limits.

Will try dig up some evidence / literature on it.

Also heard same about obese GPs, depressed GPs, and narcotic addicts.

I would imagine that the evidence might support that; however, we are different in medic in the work we do and how we approach it.

Firstly, I would say that in such cases we are talking about a person who is stablised on methadone, so for the sake of agruement I will make a few assumptons. The person is on a dose of methadone that does not make them intoxicated, they do not use any another drugs recreationally or addictively. They do not abuse their methadone.

So in cases like that, I would expect the person to be reflecting on their work in a way that I would not expect a medic to, including their own therapy and supervision.

If the only sign of their addiction is taking a prescribed dose of their medication, would or should this prevent them from engaging in psychotherapeutic work?

mathepac

Odysseus wrote: »

... However, if the person seeks methadone treatment and instead of detoxing goes from methadone maintenence, the are they under the influence? ...

Yes

Odysseus wrote: »

... Should they be free to undertake clinical work? ...

No

These types of questions can also arise for someone working in a client-facing clinical role who takes anti-depressants, anti-anxiety meds, insulin, powerful painkillers, or any other prescribed drug the presence or absence of which (e. g. insulin) can be mind or mood altering.

Lbeard

sigmund.jung wrote: »

stupid saying

Sorry....next time I'll think of a clever saying, since you don't like the stupid ones.

i didn't though

Then what do you mean by way over the limit? Recommended units are just recommended units - and the effective of alcohol on a person's body varies greatly from person to person. A blood test would show if there was a problem or not.

Some people will drink a bottle of wine in an evening, to relax. And some other's will call them an alcoholic for doing so.

why is it great?

It's great because it's absurd. Anyone drinking anywhere near those quantities of alcohol would be in a very poor state of health, even imminently moribund.

Lbeard

Odysseus wrote: »

Yes a therapist currently on MMT who have those insights, but so who one who has a history of MMT and are currently in recovery [whatever that term may imply]. Merely just looking at drug usage would be on MMT effect the objectivity of the therapist.

A person on methadone is still high. They may be stabilised and high functioning, but they are still under the influence of an opiate.

The other problem, and possibly the major problem, is someone on methadone is still a drug user. They may still have the same drug seeking behaviours. A therapist on methadone may have the temptation to procure drugs from their clients. It's neither a good situation for client or therapist.

And if the therapist is a former user, what safeguards are there to protect them and their clients should they have a relapse.

A therapist who has never had the crucial subjective experience of addiction a therapist who does may have, may have less insight into addiction. But also, they don't really have the temptation of using.

Victor

Lbeard wrote: »

And if the therapist is a former user, what safeguards are there to protect them and their clients should they have a relapse.

Agreed. It is one thing to have a former addict(s) as part of a treatment programme, e.g. group therapy, but another to have them the principal point of contact or a leading part in a program. Judgement and reliability can be out the window. Having an active user as principal point of contact or a leading part is so much worse.

I think we can all relate to how person X admitted they did (or we saw them doing) Y outrageous behaviour when they were intoxicated. Many of us can think of something we did (intoxicated or not) Z that we feel was even more outrageous. Now imagine the things that a heroin user might have done to get their fix - how can an addicted mental health professional be objective about the outrageous things a client might have done (not to judge the person, but to appreciate the severity of the situation)?

Of course, there should be supports for such people and any people getting off drugs should be able to work. However, that work needs to be in a position that is suitable - to protect professional and client.

sigmund.jung

Lbeard wrote: »

Sorry....next time I'll think of a clever saying, since you don't like the stupid ones.

Please do that.

Then what do you mean by way over the limit? Recommended units are just recommended units - and the effective of alcohol on a person's body varies greatly from person to person. A blood test would show if there was a problem or not.

I don't think you know enough about the pathology of alcohol abuse to comment tbh.

Some people will drink a bottle of wine in an evening, to relax. And some other's will call them an alcoholic for doing so.

strawman. please. try harder
It's great because it's absurd. Anyone drinking anywhere near those quantities of alcohol would be in a very poor state of health, even imminently moribund.[/QUOTE]

Odysseus

Lbeard wrote: »

A person on methadone is still high. They may be stabilised and high functioning, but they are still under the influence of an opiate.

The other problem, and possibly the major problem, is someone on methadone is still a drug user. They may still have the same drug seeking behaviours. A therapist on methadone may have the temptation to procure drugs from their clients. It's neither a good situation for client or therapist.

And if the therapist is a former user, what safeguards are there to protect them and their clients should they have a relapse.

A therapist who has never had the crucial subjective experience of addiction a therapist who does may have, may have less insight into addiction. But also, they don't really have the temptation of using.

You say that a person on a stable dose of methadone is still high. I'm not sure about that, how can that be applied to every subject? Can you exp[and on that? How are they high?

I can't buy that second point either, they are at as much risk of procuring drugs of a client as another therapist who is in recovery and drug free, and there are plently of them working in services.

As to safe gaurds, the same again applie to those therapists in recovery who are working with people. Being in recovery is often sold as being a good point in working with addiction, however, these people are prone to relapse too.


Again I am greatful for peoples thoughts and opinions here, and keep them coming, however, the one thing we are lacking here is reference to papers that deal with this topic as addiction in health care is common enough. So if anyone have any references please post them

Odysseus

mathepac wrote: »

Yes
No

These types of questions can also arise for someone working in a client-facing clinical role who takes anti-depressants, anti-anxiety meds, insulin, powerful painkillers, or any other prescribed drug the presence or absence of which (e. g. insulin) can be mind or mood altering.

Could you post a bit more than yes or no, people are free to add to the thread and discuss the topic. But yes and no answers add nothing to the topic.

Odysseus

Victor wrote: »

Agreed. It is one thing to have a former addict(s) as part of a treatment programme, e.g. group therapy, but another to have them the principal point of contact or a leading part in a program. Judgement and reliability can be out the window. Having an active user as principal point of contact or a leading part is so much worse.

I think we can all relate to how person X admitted they did (or we saw them doing) Y outrageous behaviour when they were intoxicated. Many of us can think of something we did (intoxicated or not) Z that we feel was even more outrageous. Now imagine the things that a heroin user might have done to get their fix - how can an addicted mental health professional be objective about the outrageous things a client might have done (not to judge the person, but to appreciate the severity of the situation)?

Of course, there should be supports for such people and any people getting off drugs should be able to work. However, that work needs to be in a position that is suitable - to protect professional and client.

Again I'm not sure, can I ask are you in any way familiar with addiction treatment in any of its formats.

I ask because in order to make some points I may need to refer to certain modalities and it is helpful to know if you are aware of them and the issues that may arise from the.


I would ask you why not, why can a person on MMT which is different to being an active user [to a lot of people] not be objective in that case. Well as objective as is possible, since objectivity in psychotherapy is up for question.


Can you clarify your first point, I'm not sure exactly what you are saying.

It is ok for such a person to be part of a programme, but not the lead???

Goimg on form this then should we have some form of limit then as to when a person who is "clean" can engage clients in psychotherapeutic work? 6 months, 1 year, 2, 5 years?

So far I have not found any literature to suggest that it is unethical, professional bodies state a therapist should not be under the influence whilst seeing a client that is all.

It makes me wonder if a person who was refused the right to work on those grounds could take it to the high court. Am I wrong? The could be a case for discrimination.

mathepac

Odysseus wrote: »

Could you post a bit more than yes or no, people are free to add to the thread and discuss the topic. But yes and no answers add nothing to the topic.

Odysseus wrote: »

... It is ok for such a person to be part of a programme ...

Not as a therapist / counsellor or in any form of client-facing role.

Odysseus wrote: »

...
Goimg on form this then should we have some form of limit then as to when a person who is "clean" can engage clients in psychotherapeutic work? 6 months, 1 year, 2, 5 years?

So far I have not found any literature to suggest that it is unethical, professional bodies state a therapist should not be under the influence whilst seeing a client that is all. ...

Most professional organisations and in some cases employers, specify a minimum "sober time" of e.g. 2+ years for recovering clinical staff. When I worked in the US, counsellors / social workers / therapists applying for licence renewal in some States had to produce drug test / drug screen results if appropriate.

Odysseus wrote: »

... It makes me wonder if a person who was refused the right to work on those grounds could take it to the high court. Am I wrong? The could be a case for discrimination.

Yes you are wrong IMO and No there is no case for discrimination.

If membership of a professional organisation (licecensing by another name) is a prerequisite to employment, and "clean and sober time" of X years is a prerequisite of professional body membership, then the employment contract stands or falls on proper licensing.

Odysseus

mathepac wrote: »

Not as a therapist / counsellor or in any form of client-facing role.
Most professional organisations and in some cases employers, specify a minimum "sober time" of e.g. 2+ years for recovering clinical staff. When I worked in the US, counsellors / social workers / therapists applying for licence renewal in some States had to produce drug test / drug screen results if appropriate.
Yes you are wrong IMO and No there is no case for discrimination.

If membership of a professional organisation (licecensing by another name) is a prerequisite to employment, and "clean and sober time" of X years is a prerequisite of professional body membership, then the employment contract stands or falls on proper licensing.

Why should a person on MMT not have a client facing role?

None of the Irish professional bodies as far as I know speficy any type of clean time minimun.

I'm not sure that I am wrong, can you supply any references or statements that would show that I'm incorrect?

Being a member of a professiuonal body is indeed a prerequisite for a lot of jobs, however, I have not as yet either seen or heard of any other person encountering clean time [a terrible use of language that term] being required in order to be a member of any of the professional bodies.


If you know of any lit on the topic I would be interested in any refs you might have.

mathepac

Odysseus wrote: »

Why should a person on MMT not have a client facing role? ...

Because s/he is taking an intoxicant as pointed out above and is not in recovery; they are in early phase I detox and have clocked up zero "clean and sober time".

Odysseus wrote: »

... None of the Irish professional bodies as far as I know speficy any type of clean time minimun. ... .

I know; it seems anyone can hang out a shingle claiming to be anything (other than a medic or a nurse) and there is nothing can be done at the moment. My references were to the US.

Odysseus

mathepac wrote: »

Because s/he is taking an intoxicant as pointed out above and is not in recovery; they are in early phase I detox and have clocked up zero "clean and sober time".

I'm not sure if that in and of its self is enough to state a person cannot engage in clinical work as a therapist.

The notion of "clean time" or "of being in recovery" involve much more than the presence or absence of any chemical.

So in those terms I don't see how we can take that stance on the mere fact of them showing postive for methadone in a drug screen.

A friend and team mate of my died from cancer this year, she was on opiates during her treatment and until she felt she could not longer work.

Most people would concur that "clean time" or "recovery" have little to do with drug status, now a lot would say that it is the fundamental cornerstone that you can't have recovery unless you are "clean".

Do you work in a clinical sense in treatment or rehab yourself?

I am currently unsure on my answer to it, I have of course had lots of various discussions on the topic over the years, but I guess this time I said I would try do some proper research on it.

You haven't any links to any of the material from the states have you?

mathepac

Odysseus wrote: »

I'm not sure if that in and of its self is enough to state a person cannot engage in clinical work as a therapist.

IME it means exactly that.

Odysseus wrote: »

The notion of "clean time" or "of being in recovery" involve much more than the presence or absence of any chemical.

"Clean and sober time" for an addict / chemically dependent person means the elapsed time since a mind / mood altering chemical was last ingested, IME.

Odysseus wrote: »

So in those terms I don't see how we can take that stance on the mere fact of them showing postive for methadone in a drug screen.

It's black and white for someone operating in a clinical environment IMO & IME; either you're clean & sober or you're not.

Odysseus wrote: »

A friend and team mate of my died from cancer this year, she was on opiates during her treatment and until she felt she could not longer work.

I'm sorry to hear about your friend but what has a since-deceased cancer-patient / clinician on pain-killing meds got to do with an intoxicated addict working in a clinical environment?

Odysseus wrote: »

Most people would concur that "clean time" or "recovery" have little to do with drug status ...

99.999% of clinicians I know who work in clinical environments would disagree with you and would say they are mutually exclusive.

Odysseus wrote: »

... now a lot would say that it is the fundamental cornerstone that you can't have recovery unless you are "clean".

99.999% of clinicians I know would agree with that statement.

Odysseus wrote: »

Do you work in a clinical sense in treatment or rehab yourself?

I see private clients on a referral basis from medics. I only work with clients have been through detox as I'm not qualified to over-see a medical detox myself. I've worked in residential, community and hospital settings previously.

sigmund.jung

seems quite obvious to me.

You're saying a Therapist can't work who is on MMT but a Therapist on morphine PCA can?

Explain yourself.

Odysseus

sigmund.jung wrote: »

seems quite obvious to me.

You're saying a Therapist can't work who is on MMT but a Therapist on morphine PCA can?

Explain yourself.

Who is that directed to SJ?

mathepac

sigmund.jung wrote: »

... Explain yourself.

I'm not really sure to whom you are addressing your rather rude and abrupt directive, but as the last relevant post seems to be mine, I'll take the initiative.

It seems patently obvious to me.

The cancer sufferer is, with all due respect to her, a red herring in the discussion based on how OP framed the original question, unless of course she also happened to be chemically dependent.

I never suggested it was OK for her to continue to work in a client-facing role, I was presented with a fait accompli. Had I been a team-member I'd have raised serious concerns.

Just to be clear, I'm not an advocate of anyone taking methadone long-term either. It's a foul drug, highly addictive and can be more difficult to get off than the (presumably) heroin it replaces. So MMT and me are not bed-fellows as IMHO it's not treatment, it's not recovery, it's enslavement with a high mortality risk (in Scotland - 25% of all deaths by drug overdose had methadone as a common factor). But that's all a separate argument and OT, sorry.

Odysseus

mathepac wrote: »

IME it means exactly that.
"Clean and sober time" for an addict / chemically dependent person means the elapsed time since a mind / mood altering chemical was last ingested, IME.
It's black and white for someone operating in a clinical environment IMO & IME; either you're clean & sober or you're not.
I'm sorry to hear about your friend but what has a since-deceased cancer-patient / clinician on pain-killing meds got to do with an intoxicated addict working in a clinical environment?
99.999% of clinicians I know who work in clinical environments would disagree with you and would say they are mutually exclusive.
99.999% of clinicians I know would agree with that statement.
I see private clients on a referral basis from medics. I only work with clients have been through detox as I'm not qualified to over-see a medical detox myself. I've worked in residential, community and hospital settings previously.

See the problem is you are asuming that a person on MMT is intoxication, I don't think that is the case. I think this is where a case of discrimation could be raised.

I also think it is something treatment facilities and profesional bodies are going to have to face within a few years.

The therapist on legal opiates is doing the same work as the therapist on MMT, both have legally prescribed opiates in their system. They actually have a lot to do with each other, both ben taken under the care of a doctor.


Out of interest apart from the above context, what is you view on MMT?

sigmund.jung

mathepac wrote: »

I'm not really sure to whom you are addressing your rather rude and abrupt directive, but as the last relevant post seems to be mine, I'll take the initiative.

It seems patently obvious to me.

The cancer sufferer is, with all due respect to her, a red herring in the discussion based on how OP framed the original question, unless of course she also happened to be chemically dependent.

I never suggested it was OK for her to continue to work in a client-facing role, I was presented with a fait accompli. Had I been a team-member I'd have raised serious concerns.

Just to be clear, I'm not an advocate of anyone taking methadone long-term either. It's a foul drug, highly addictive and can be more difficult to get off than the (presumably) heroin it replaces. So MMT and me are not bed-fellows as IMHO it's not treatment, it's not recovery, it's enslavement with a high mortality risk (in Scotland - 25% of all deaths by drug overdose had methadone as a common factor). But that's all a separate argument and OT, sorry.

are you a clinical psychologist working in addiction? I would be interested to know what clinical experiences your opinions are based.

I won't target your Scotland anecdote yet as it is off-topic, will keep that for another thread.

Ulysses I was questioning the man himself above.

mathepac

Odysseus wrote: »

See the problem is you are asuming that a person on MMT is intoxication, I don't think that is the case. I think this is where a case of discrimation could be raised....

I don't have a problem as I think I've already responded to that point, not based on assumptions, but based on my experience.

Odysseus wrote: »

... I also think it is something treatment facilities and profesional bodies are going to have to face within a few years. ...

I sincerely hope not. It is my hope that the use of long-term methadone "treatment" for chemically dependdent people will be seen for what it actually is and have ceased long before then. To me it's just substituting one addictive substance for anoither.

Odysseus wrote: »

... The therapist on legal opiates is doing the same work as the therapist on MMT, both have legally prescribed opiates in their system. They actually have a lot to do with each other, both ben taken under the care of a doctor. ...

But it is my decision in a group / team setting based my experience, my ethical and moral codes whom I choose to work with as co-counsellor, team-member, etc. The fact that they are legal drugs, prescribed by a doctor, etc has no relevance for me here and sways my informed opinion not one iota.

Sorry but you'll need to find another argument to convince me.

Odysseus

mathepac wrote: »

I don't have a problem as I think I've already responded to that point, not based on assumptions, but based on my experience.
I sincerely hope not. It is my hope that the use of long-term methadone "treatment" for chemically dependdent people will be seen for what it actually is and have ceased long before then. To me it's just substituting one addictive substance for anoither.
But it is my decision in a group / team setting based my experience, my ethical and moral codes whom I choose to work with as co-counsellor, team-member, etc. The fact that they are legal drugs, prescribed by a doctor, etc has no relevance for me here and sways my informed opinion not one iota.

Sorry but you'll need to find another argument to convince me.

Actually I think it is the other way around, all you state above is opinion based on your personal and professional experienced.

Mime differs so who is right?

Now is a person on MMT was to take a case, it would be up to employers and professional bodies to show they are unfit to work.

I don't think any of the above would stand up in court do you?

I have seen the HSE back down on a few treatment issues around MMT over the years, once it looked like it was going to court. Would the same happen here? I don't know?

As I have said before, I'm unsure of my position why? Because I see people on doses of methadone doing college courses, working in good jobs, clearly not intoxicated, clearly able to engage in their own "recovery" processes.

I started the discuission to see if anyone could show me any research or evidence to show a person on MMT is unfir to practice, so far I'm still waiting on it.

As to a person on MMT taking up that position, to be honest I am surprised it has not happened yet. The first person on MMT I was aware of who got their psychology degree got it in 99 IIRC.

mathepac

Odysseus wrote: »

Actually I think it is the other way around, all you state above is opinion based on your personal and professional experienced. ...

I seem to be going around in circles here. I have stated the situation for board certification & licensing in the States where I worked.

Odysseus wrote: »

... Mime differs so who is right?.

I choose to work alone paying for my own clinical supervision, professional memerships, ongoing education and development, insurance, etc. so I can't answer your question for you. My answer is right for me and my circumstances, but I couldn't work in the circumstances you describe (maybe in the past I have but unwittingly).

Odysseus wrote: »

... Now is a person on MMT was to take a case, it would be up to employers and professional bodies to show they are unfit to work.

I don't think any of the above would stand up in court do you?

I have seen the HSE back down on a few treatment issues around MMT over the years, once it looked like it was going to court. Would the same happen here? I don't know?

As I have said before, I'm unsure of my position why? Because I see people on doses of methadone doing college courses, working in good jobs, clearly not intoxicated, clearly able to engage in their own "recovery" processes.

I started the discuission to see if anyone could show me any research or evidence to show a person on MMT is unfir to practice, so far I'm still waiting on it.

As to a person on MMT taking up that position, to be honest I am surprised it has not happened yet. The first person on MMT I was aware of who got their psychology degree got it in 99 IIRC.

I've already given my answers to the above questions framed differently.

Over and out, I have no more to add other than to say our understandings of "intoxicated" seem to differ.

Odysseus

Ineed they do, but if your out, you are out. Sound.

mark renton

Odysseus wrote: »

Ineed they do, but if your out, you are out. Sound.

Ok this will simplify, when it comes to addiction, is your preferred approach for the client to overcome their particular addiction or to assist with making the clients life more manageable whilst still being addicted?

Odysseus

mark renton wrote: »

Ok this will simplify, when it comes to addiction, is your preferred approach for the client to overcome their particular addiction or to assist with making the clients life more manageable whilst still being addicted?

If only it could do that Mark. There are no simple answers when working with such complex states.

Your question re: perferred approach implies that I am the one best suited to choose that option for the client.

That is a question about my desire, and what I would wish for the client.

My desire for the client, should be left outside of my consulting room. The desire of a therapist should be for the client to engage and stay engaged in the therapeutic process.

So really it is up to the client to decide whether they want to go, it is their therapy, their choice and their life.

I am there to facilitate a process for the, not to act as a fount of wisdom who knows what is best for them.


I am assumming that when you say overcome their addiction, you are talking about a state of being drug free, however, the drug part of addiction is only a part of it. Being drug free does not equate "overcoming" ones addiction.

I would see my role as "assiting with making a clients life more managable" either. Now some of that may actually happen as a result of the client evaulating their lifestyle through threapy, but I would not see that as my role.

A drug worker/project worker may focus that aspect, but I would see it as part of my clinical work per se

mark renton

Sorry Od, but I do believe you are vastly overcomplicating this. Yes the approaches may be complex, however the goals are very very simple, to overcome addiction or to make life comfortable for the addicted while remaining addicted. Yes, the client gets what they pay for, if the want insight to the complexities of addiction then you give it to them, if they want to find out why they are addicted then you assist them in the search, if they want to enter rehabilitation to overcome the physical aspect of addiction then you refer them. The first two of these may assist the client with the third, and actually overcoming physical addiction, however if the first two of these do not lead to the third then they are merley an assistance for a lifestyle in a particular addiction...

hotspur

I can't make my mind up on this one.

Are there no HSE guidelines for whether they consider methadone to constitute drug use relating to their (is it 4 year?) period of required recovery before being employed by them in counselling for addiction?

Not that the answer to that would settle the ethical question as such. But then there are non-MMT formerly addicted people working in addiction who shouldn't be let within a country mile of working clinically with people. I suppose I am more on the Odysseus side of the Odysseus v mathepac issue of focus on the chemical as the problem.

I haven't read anything on this topic before.

Certainly it isn't ideal. Whether it is indefensible, ethically and legally, is another issue. And I can't make my mind up on that.

sigmund.jung

mathepac wrote: »

I seem to be going around in circles here. I have stated the situation for board certification & licensing in the States where I worked.
I choose to work alone paying for my own clinical supervision, professional memerships, ongoing education and development, insurance, etc. so I can't answer your question for you. My answer is right for me and my circumstances, but I couldn't work in the circumstances you describe (maybe in the past I have but unwittingly).
I've already given my answers to the above questions framed differently.

Over and out, I have no more to add other than to say our understandings of "intoxicated" seem to differ.

I'd love to pick your brain on your attitudes to addiction / mmt / substance abuse in general would you be up for that? Also, would you be an advocate against SSRI/TCA use?

Odysseus

hotspur wrote: »

I can't make my mind up on this one.

Are there no HSE guidelines for whether they consider methadone to constitute drug use relating to their (is it 4 year?) period of required recovery before being employed by them in counselling for addiction?

Not that the answer to that would settle the ethical question as such. But then there are non-MMT formerly addicted people working in addiction who shouldn't be let within a country mile of working clinically with people. I suppose I am more on the Odysseus side of the Odysseus v mathepac issue of focus on the chemical as the problem.

I haven't read anything on this topic before.

Certainly it isn't ideal. Whether it is indefensible, ethically and legally, is another issue. And I can't make my mind up on that.

Cheers for your input Hotspur, I am unsure of my position. I don't want to get caught up in the abstinence vs MMT debate, but I remember a time when counsellors, [well tbh any staff that worked in a clinic] where being called drug pushers by people against MMT. Thankfully that has changed.

As to the HSE and policy there is none that I am aware of and I'm there 17 years now.

What did you get this period of "recovery" being required before being employed by the HSE?

I agree the are a number of people who work in the services who are in recovery and I would not send a client to them either, so drug status alone doesn't cut for me.

I think the lack of quality reserach available shows that the topic hasn't been addressed and basically needs to.

I would love to sit down with a legal rep and see where it would stand. There still are issues around treatment services in Ireland that if a legal challenge was to occur on certain issues that the person would win their case. However, that is going way outside my area.

Odysseus

mark renton wrote: »

Ok this will simplify, when it comes to addiction, is your preferred approach for the client to overcome their particular addiction or to assist with making the clients life more manageable whilst still being addicted?

mark renton wrote: »

Sorry Od, but I do believe you are vastly overcomplicating this. Yes the approaches may be complex, however the goals are very very simple, to overcome addiction or to make life comfortable for the addicted while remaining addicted. Yes, the client gets what they pay for, if the want insight to the complexities of addiction then you give it to them, if they want to find out why they are addicted then you assist them in the search, if they want to enter rehabilitation to overcome the physical aspect of addiction then you refer them. The first two of these may assist the client with the third, and actually overcoming physical addiction, however if the first two of these do not lead to the third then they are merley an assistance for a lifestyle in a particular addiction...

I can't agree, however, to try remain on topic, even if I said yes to either of the options you gave. How would that simplify the difficult question we are struggling with here?

mark renton

Odysseus wrote: »

I can't agree, however, to try remain on topic, even if I said yes to either of the options you gave. How would that simplify the difficult question we are struggling with here?

You are asking an ethical question and unless I've missed it, you havent put forward your stance on whether you believe MMT to be right or wrong.

Odysseus

mark renton wrote: »

You are asking an ethical question and unless I've missed it, you havent put forward your stance on whether you believe MMT to be right or wrong.

I don't think I need to Mark, I'm not being funny here. However, in order to research a such a question I'm not sure I have to state that, and how that fits into your last few posts.

However, with having experience in various treatment facilities I am as supportive of MMT having its place as a treatment modality as I am of having detox facilities for those would wish to detoxify.

I have a very wide treatment profile, I work with those using, those looking to stabilise, those looking to reduce, those looking to detox, those in early recovery 1-2 years, those up to 20 years clean [that was the long abstinent client I worked with], CPs and finally ACOAs.

I would try avoid a basis in favour of one or the other as they are both essential modalities in treating addiction.

I would fight stongly for the person who wishes to stay on MMT for the foreseeable future even the rest of their life; however, I would have the same conviction for the person who wants to detox and stay off drugs for the same time periods.

I would avoid term like right or right in debates like to as the are highly loaded terms.

However, with avoiding those terms does the above answer your question?

mark renton

Best of luck with avoiding the terms right and wrong whilst asking an ethical question.

Morally / ethically I dont believe it is right for a person who is chemically dependant to treat a person in a more vulnerable state, at best it would be hypocritical.

Odysseus

mark renton wrote: »

Best of luck with avoiding the terms right and wrong whilst asking an ethical question.

Morally / ethically I dont believe it is right for a person who is chemically dependant to treat a person in a more vulnerable state, at best it would be hypocritical.

That's another point.


However, this thread has asked people to come up with with published research or papers on whether a person on MMT is fit to practice as a therapist.

This question can only be address in terms of fitness to practice, right or wrong should not come into it, especially if that is base upon individual opinion. Should we not be looking for some form of "objective facts", I know if my fitness was to be evaulated I would be looking for some proceed like that

Can you expand on the you opinion on why you think it is "wrong" or why it is hypocritical?

mark renton

Odysseus wrote: »

That's another point.


However, this thread has asked people to come up with with published research or papers on whether a person on MMT is fit to practice as a therapist.

I would be very surprised if there were enough cases to actually write a research paper on.

Odysseus wrote: »

This question can only be address in terms of fitness to practice, right or wrong should not come into it, especially if that is base upon individual opinion. Should we not be looking for some form of "objective facts", I know if my fitness was to be evaulated I would be looking for some proceed like that

I would argue that anything outside of legal obligations constitutes judgements based on individual opinions

Odysseus wrote: »

Can you expand on the you opinion on why you think it is "wrong" or why it is hypocritical?

In a case where a client on MMT visits a therapist on MMT, seeking assistance on obtaining a drug free state, does this therapist volunteer their own status?

mathepac

hotspur wrote: »

... I suppose I am more on the Odysseus side of the Odysseus v mathepac issue of focus on the chemical as the problem...

I never used the words you attribute to me or implied that I "focus on the chemical as the problem". The substance(s) of choice or their replacements are symptoms of a condition (chemical abuse or chemical dependency).

Some "therapeutic", detox or replacement drugs may impair a client's ability to engage in therapy at meaningful level, thereby reducing client benefits, goals or anticipated outcomes and I inform my clients (and referrers) of the fact that I will not (cannot) work with clients who are at this stage.

I worked briefly in the acute psychiatric wards of two Irish hospitals, seeing clients individually and for group therapy. I was horrified to have in-patients referred to group therapy, clients whom we'd agreed at team meetings were not at a stage to engage in 1-2-1, but were showing up for group medicated within an inch of unconsciuosness, nodding off, wandering out - just not capable of engaging at all.

I raised the issue at team meetings and was informed my job was to run group - whether participants got any benefit from it was irrelevant. I changed that but it caused deep resentment amongst other disciplines in the teams.

Odysseus

mark renton wrote: »

In a case where a client on MMT visits a therapist on MMT, seeking assistance on obtaining a drug free state, does this therapist volunteer their own status?

Well, I would imagine that would be up to the individual to decide.

I personally never supply personal information. If a client asks me if I ever took drugs I may respond along the lines of "Why do you ask such a question?"


If the come to discuss issues around child sex abuse, should they ask a similar question?

I do some work with sex offenders, do I need to have committed such atcs, of course not, no more than I need to have experienced sexual violence to work with those who have experienced it.

Clients do not need to know anything of me as a person, they need to know of me as a therapist, as I qualified, am I experienced, etc

Clients come to do work, not to excahnge info, have a cup of coffee etc. You see some of that type of stuff happening alright, but I wouldn't consider it therapy.

As to it not being researched due to a lack of cases, if it hasn't being correctly researched can a professional body or an employeer stand over a decision like that?

So it comes down to a medical and a legal question, in order to say a person is unfit to practice, surely there needs to be objective data their to be assessed. You would have to show that the dose of methadone a person is on interfers with the subjects cognitive functions enough to show they are incapable of practicing.

I don't know; which is why I'm asking the question?

You argument seems to be...if there is NOT a strong legal/medical reason why a therapist on MMT should not practise as a therapist, then it is not "wrong" for the therapist to be providing therapy and if its not "wrong" maybe it is acceptable that a therapist on MMR be a therapist.

Apart from the legal/ethical considerations if you are working in therapeutic situation that has abstinences as core principle of the program then at the very least you are being dishonest...avoidance of the question is not a substitute for honesty.. so the rest of you argument is that you do not need to be personally honest with clients and this can be dealt with by avoiding the question.

Moral relativism maybe.