Fewer than a handful of books have been published on the ethical dimensions and challenges in treating and helping persons living with an addiction. Therefore, this book is a welcome contribution to the literature almost from the start. The contributors in this 9-chapter text range from community- and hospital-based professionals to behavioral program directors to ethics center directors and researchers to psychology, neurology, and psychiatry professors and fellows. The book aims to provide general advice on central issues encountered routinely by those experienced in addiction services and research. Contrary to the book’s rather biblical and authoritative title, the editors “offer this work modestly,” given the relative newness of focused ethical analysis in addiction treatment and care.
The contributors are familiar with the lived experience and reality of addictions in contemporary US society, available therapeutic alternatives, and contextual complexities in everyday encounters between client and professional. At just 150 pages, the book is more likely to be read by its target audience—busy practitioners. Another strength is the depth and breadth of the text. Each chapter stands alone and provides relevant information, analysis, and advice. Furthermore, each chapter concludes with a series of “core concepts” that are then highlighted by several cases. After an introductory chapter on ethical foundations, the chapters focus on the therapeutic alliance, harm reduction, culture and spirituality, forensic settings, children and adolescents, chronic pain, concurrent disorders, and women.
Selecting principles and developing decision-making models are common fare for the ethics community in their efforts to help practitioners identify ethical considerations more explicitly and to include them in their decisions. The first chapter duly presents a decisional model and 6 guiding principles, which is in line with the book’s target audience (“professionals who treat addiction”). However, the chapter gradually loses some of its cogency. The principles of confidentiality and truthfulness are given much more attention than the other principles; the principle of compassion is omitted from a table. The principles are not explicitly linked to the decision model’s 3 factors. There is no explanation about why justice, a noted worry in addiction treatment and care, is not a principle. The decision model is not used to tackle a particular case in depth. Five cases at the chapter’s end are analyzed using just 1 or 2 of the core concepts that immediately precede them, and the concepts are not identical to the principles. Subsequent chapters do not use the model. In fact, various chapters offer different principles and decision-making frameworks. A concluding chapter synthesizing these disparate analyses and approaches would have been useful.
The book’s content represents an unclear mixture of health care ethics. There are ethical principles and discussions pertinent to any health scenario—others are unique to mental health situations, and there are still others unique to addictions. It is helpful to demonstrate more explicitly how working with people with an addiction can be the same as or very different from working with persons with physical or mental illness.
A chapter on one of the more controversial issues (ie, methadone maintenance programs, safe injection sites, heroin research using those addicted to heroin, government-sanctioned and taxed gambling, or emergent addictions in a consumer-focused society) would have highlighted the added societal challenges in addiction treatment and research.
Nonetheless, this condensed book is a useful primer on health care ethics in the context of serving people living with an addiction. Each chapter will help addiction professionals new to health care ethics or those wanting to confirm their foundational knowledge. The content is grounded in the realities of contemporary addiction treatment and research, the writing is clear, and the focus is practical.