Wearing a Double Hat in Addiction Recovery

By K. Smith MSW 09/22/16

A clinician in recovery struggles with the challenge of attending 12-step meetings with current and former clients.

Wearing a Double Hat
It doesn't have to be weird.

A professional dilemma that may be unique to addiction therapists can occur when a clinician who is in recovery attends a support group at which one or more of his or her therapy patients is also in attendance. Such situations may be extremely common and difficult to avoid, especially in smaller communities where there may only be a few treatment and meeting options. These situations raise a variety of professional and personal hurdles for the clinician. Social worker Kristen Smith describes her experience and her choices…Richard Juman, PsyD

Born with the genetic predisposition to addiction, coupled with an ADHD diagnosis and an overarching defiant nature, I was headed for a seat in a 12-step meeting long before I knew what one was. From the time that I was a child I also knew that I would end up in the helping profession, but I knew that I could not help anyone else until I helped myself. Fast forwarding past addiction to the good life, I am now clean and sober, and have graduated with a master’s degree in social work. I have been working in the field of addictions for the past six years, and have been attending NA meetings for the past 10 years.

Working in the recovery world, in many different capacities, has been rewarding as well as disheartening. In the midst of the opiate epidemic that is affecting our community at astounding rates, I am beginning to see treatment providers and NA groups filled to capacity. A part of me is overcome with joy when I see a client that I helped at one point in time sitting in a seat of a meeting “sharing and caring the NA way.” At the same time, another part of me feels a sense of fear that my own recovery status will be exploited. And I need to be constantly vigilant that I am not engaging in what the National Association of Social Workers Code of Ethics could consider a “dual relationship,” where the clinician “relates to clients in more than one relationship, whether professional, social, or business” and where “there is a risk of exploitation or potential harm to the client.” The Code goes on to advise that “in instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries.”

My NA home group was a place that I could go to see my friends in recovery every Sunday, take a chairing commitment, and share about my personal dilemmas, achievements, and struggles in my recovery journey. Throughout my career in the field of addictions and my educational pursuits, I have overcome many personal obstacles. Recently, I decided to end a tumultuous relationship with a fellow addict that was toxic for me, and I reached a crippling level of professional and personal burnout that translated into somatization, and eventually multiple medical ailments. Although I have a few trustworthy supports in my corner, I have not felt safe enough to share such personal issues on the floor of any local NA meetings or my home group. A former client from years past is now attending my NA home group, and it feels like a safe haven has been taken away. A part of me is sincerely happy that he has managed to get off of a methadone maintenance program, and he seems to have a much brighter demeanor and outlook than when I first met him. But the other part of me feels essentially ostracized from the group and unable to share anything personal. And I did not feel it was ethically “correct” to even receive my annual NA coin due to his attendance.

This is not the first occurrence of seeing former or current clients in NA meetings, and I have begun to feel a sense that they are equally as uncomfortable as I am sharing or participating. My professional duties have included working for the child welfare system and testifying as an expert drug and alcohol witness, as well as working with the probation department. I have managed to separate my professional duties from what I hear in meetings, even though the two often intertwine. What is shared in meetings is to remain anonymous, even if it potentially conflicts with my duty to report and might include helpful knowledge to the court system or child welfare system. When fellow addicts run up to me outside of an NA meeting inquiring about their child welfare case or probation issue, I quietly grow more resentful while spouting out my generic response that the conversation is inappropriate for me to engage in and places me in a poor position. This translates into mental turmoil for me, as a clinician and an addict in recovery. I’ve been in meetings where I have felt unsafe because my previous testimony on behalf of the court system against a fellow addict that resulted in their children being placed in state care. I have sat in silence when “old-timers” collected their multiple year key tag while knowing that they have recently relapsed and entered into treatment. What was a simple program for complicated people is now a complicated program for an even more complicated and conflicted person.

When contacting the ethics board with general questions regarding my role as an addictions professional intermingling with my role as an addict in recovery, the response from committee members was as follows:

"This has been a theme and concern through the ages. I have known recovering therapists who have been asked to do their lead as they have had much success in recovery and their stories have been inspiring. I think that if the recovering clinician is comfortable with sharing their lead and current or previous clients may be in the audience, this would be acceptable. But also knowing that when the lead is done, they keep healthy boundaries in conversations after the meeting. But if the recovering clinician needs to be able to share to seek help, support or guidance at a meeting, they may want to seek a meeting without clients or work on this with their sponsor. I think that there are times recovering clinicians are not able to escape seeing a current or past client at a meeting, but how they handle conversations and discussion becomes the focus. They are not there to counsel."

I think that those who are “new” in recovery and also “new” in the field find it is very difficult to maintain professional boundaries inside and outside of a 12-step program and their work place. It is a conflict of interest, especially if you are employed as a CRS or CPS. Through trial and error, they often learn what is best when it comes to self-disclosure, even if it happens in an anonymous program. Although recovery is personal and one must take responsibility for it, in most cases, only those with substantial clean time, substantial work history and really good work ethics are able to maintain professional boundaries, if they go to the same meetings clients go to (if they go at all). It is a real slippery slope that most recovering people dare not go down. At the end of the day, although personal recovery and employment are equally important (with recovery being THE most important because it allows for employment), meetings are everywhere and that is why it is suggested to get a sponsor and build a support network, because some feel that everything isn’t for group level anyway.

As it pertains to the Code of Ethics:

Is sharing at a 12-step meeting a “dual relationship”? Is what happens after what is shared at a 12-step meeting a dual relationship? What happens will be the sole responsibility of the professional who made the decision to disclose at a 12-step meeting. For the professional who does share at meetings where clients may attend, it is important for them to question their motives for the disclosure, as they would do in a professional setting. If they answer honestly, they probably would not use the meetings to get what they need because they would realize that there are better, safer and more appropriate avenues they could take that would keep them clean, but more importantly, keep them employed. What is safe? Find another meeting, turn down a commitment and leave THOSE meetings for the clients.

I have learned that not only do my clients see me in a professional capacity, but other addicts are starting to attempt to utilize me as a case worker, therapist, psychiatrist, activist, legal counsel, or interventionist. The overwhelming and constant “need” from other addicts (without reciprocation) has left me with a sense of feeling used, pigeonholed into a role (rather than being seen as a fellow addict), and resentful. I now unfortunately view a lot of NA members at meetings as habitual and professional con artists that have given new meaning to the term “learned helplessness.” An old co-worker cynically termed the local meetings to be “an echo chamber of chronic victimhood, shared toxicity, and denial.” My sponsor has started to utilize me as a crisis hotline, even though we discussed that I should not be “helping” anyone in my professional capacity, and yet she rationalizes her behavior by stating two of the old NA adages: “the therapeutic value of one addict helping another” and “sponsorship is a two-way street.” Unfortunately, I am left with the unanswered question of “who helps the helpers?” For this helper, I am learning to revert back to my toddler days of saying “no” when I feel a sense of being taken advantage of or when a resentment is more than likely to form. Just for today, I have moved my program over to the plush seats of AA, where I am rarely confronted with ethical quandaries, the topics of conversation seem more intellectual and solution-focused, and it seems to be more of a professional, and—dare I say—classy group.

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K. Smith is a Licensed Social Worker who has been working in the field of addictions for six years. She attended York College of Pennsylvania for Behavioral Science and graduated with her MSW from Widener University. She works with clients with co-occurring disorders, with incarcerated juveniles and specializes in trauma.