Ethics and Professional Practice: Confidentiality, Boundaries, and Scope
Ethics and Professional Practice
This domain tests the legal and ethical scaffold around recovery work: what you may disclose and to whom, how lived experience is used without blurring roles, what informed consent must cover, and how documentation and supervision protect both participant and specialist.
Confidentiality
- 42 CFR Part 2 protects substance use disorder records held by federally assisted programs and is stricter than HIPAA. Disclosure generally requires written consent naming the recipient, the purpose, the specific records or date range, an expiration, the right to revoke, and the participant's signature.
- Every disclosure carries the anti-re-disclosure notice; redisclosing Part 2 records without proper authority is a violation.
- HIPAA adds the minimum-necessary standard. Recognize the narrow exceptions: medical emergency, valid court order, and state-mandated reporting of child or elder abuse.
- Explain the limits of confidentiality in plain language at intake, not after a family member calls.
Boundaries and role clarity
- Lived experience is a tool, not a license. Disclose purposefully, briefly, and only when it serves the participant's recovery.
- Avoid dual relationships, romantic or financial involvement, loans, and gifts of significant value. Keep contact on agency channels and consult a supervisor early.
- Stay in scope: no diagnosing, no medical or legal advice, no prescribing opinions. Refer and coordinate.
Practice standards
Obtain informed consent; document promptly, objectively, and factually; use person-first, non-stigmatizing language; maintain cultural humility; and know your state's duty-to-protect standard, which derives from Tarasoff but varies by jurisdiction.
Worked example
A participant who lives on your street asks for a ride to a meeting and offers gas money. Reasoning: the neighborhood connection already strains confidentiality and role clarity; accepting payment creates a financial relationship. Check agency policy, consult your supervisor, decline the payment, and document the conversation and the decision.
Traps that cost marks
Assuming HIPAA permits telling family; posting recovery stories about participants; using self-disclosure to seek approval; accepting gifts or loans; diagnosing outside scope; and treating group confidentiality as automatically enforceable.