Addiction-Specific Laws and Ethics
The legal core
Counselors must know confidentiality rules specific to substance use disorder (SUD) treatment. Federal regulations (42 CFR Part 2) historically provided stricter protection than HIPAA for records of federally assisted SUD programs; they limit disclosure of patient-identifying information without valid written consent, with narrow exceptions. Know that consent must be specific (who, what, purpose, expiration) and revocable. Understand duty to warn/protect where state law imposes it when a client poses serious danger to an identifiable person. Be familiar with mandated reporting of child abuse or neglect and with limits on confidentiality generally.
The ethical core
Apply the professional principles: autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. Recognize boundaries and dual relationships, informed consent, competence and scope of practice, supervision and consultation, and documentation accuracy. Understand that a counselor does not practice outside their training, does not abandon clients, and does not exploit the power differential.
Traps in questions
A frequent distractor treats SUD records like ordinary medical records. Another assumes a client's general consent covers every disclosure. Watch for scenarios where a counselor shares information with family without proper consent, or where the "helpful" answer violates a boundary. Also distinguish legal obligation (mandated reporting, court order) from ethical aspiration.
Rule of thumb
Before disclosing any SUD information, ask: is there valid written consent, a legal mandate, or a recognized exception? If unclear, do not disclose; consult a supervisor and, where appropriate, legal counsel.
Worked example
A probation officer calls asking whether a client is in treatment. Without a valid consent or court order meeting the applicable standard, the counselor should decline to confirm and document the request and response.