Sex, Romance, and Dating in Treatment Recovery: Ethical Reflections and Clinical Deliberations on Challenging Addiction Decision Making

An engagement in sexual interactions or a romantic involvement between clients in addiction treatment settings can be high-stakes risks to the recovery and treatment process. This conventional wisdom is part of the social contract in a treatment setting that recognizes the potential harm that relationships can cause in early recovery - a message that prevails in the clinical literature. It would therefore be reasonable to assume that a non-fraternization policy is not uncommon to treatment settings. The latest (2011) data from the Substance Abuse and Mental Health Services Administration conservatively shows 126,000 clients or 7.3 % of admissions were expelled from addiction treatment. Treatment programs with non-fraternization policies most probably contribute to that statistic. Still, ethical streams of thought on clinical interventions to address therapeutically the ethical dilemma of clients who breach the treatment setting’s non-fraternization policy are remarkably scarce in scientifi c studies and ethical precedence. This article presents two clinical approaches of “discharge” and “couples counseling and treatment planning” with an analysis of fi ve foundational ethical principles for each. Deontological and consequentialist arguments in favour of discharge, and those opposing it, are buttressed by clinical reasoning relevant to practitioners and treatment staff . A presupposition of this article is that addiction clinicians somewhat understand ethics codes as this is a requirement of licensure and part of the (re) certifi cation process; however, clinicians are not ethicists. Therefore, applying the fi ve foundational ethical principles in clinical settings presents challenges for those with limited ethics preparation. Thus this article provides a framework to prepare clinicians to reason with and apply ethical codes in clinical practice, a primer to advocate support for or change to existing policies and procedures.