16-Year-old discloses substance abuse

Question:
If a therapist is working with a 16 yr old and they disclose substance
use, do we have to keep it confidential or is there a duty to warn the
parent?


Answer:
Given the basic information there is no Tarasoff duty to warn the parents.  The short
answer is, there is no ethical violation attached to telling the parents. You can disclose
the substance use to the parents simply because the child is under the age of 18 and
the substance use is illegal.

One issue you have to wrestle with involves balancing the drug use against how the
parents will respond, as well as how the client will respond to the disclosure and
whether they will continue to work with you after this incident.

Your question brings up many issues. The first issue that needs to be considered is the
way the 16 -year-old client came into therapy. Are they under court order? Did they
seek help on their own? Were they pushed into the sessions by their parents?
The second issue involves the type of substance that is abused, as well as the
environment surrounding its abuse.

First, let’s tackle the type of substance abused.  If it is marijuana or alcohol, which have
a much less damaging physical toll on the body, then disclosure may be less needed.  If
it is something more serious like cocaine, crack, methamphetamine, or inhalants, all of
these are possibly life-threatening and require immediate intervention. There would be a
greater need to report these to the parent.

Second, let’s look at the environment of the abuse.  If they are abusing in their room or
back porch, there is relatively little chance of damage to the client or others.  This would
allow you to argue against a need for disclosure.  If they use/abuse were occurring in
public, in cars being driven or in other areas, then the possibility that someone else
could be hurt raises the stakes and makes the need to report much greater.

This situation may invoke some of the concepts around Tarasoff, even thought there is
no chance of identifying a specific person who could be dead.

Any substance abuse which could cause imminent harm or danger to the client probably
needs to be reported to the family. The concern again is the risk of having the family I'll
come down on the client in such a way that they do not come back to therapy for you, or
they refused to disclose in therapy.

One of the things, I would think would be good practice, is to let them know you are
concerned and want to notify the parents.  You might sit down with your client and
explain to him your concern.  Then let him know notifying his parents or you have the
option of notifying his parents. You then state that you would prefer that he notified his
parents and that you will set with him while he talks to his parents about the drug use.
There also many over-the-counter drug tests that can be used in the home by the
parents. Cost is around $25 a test. It would not be a violation of confidentiality if you
simply reach out to the parents and said, “I think it may be beneficial to go down to Walgreens and buy a home drug test that tests for marijuana, cocaine and amphetamines, etc. and drug test your child tomorrow morning when he gets out of bed without telling him you're going to do it.” They will get the information they need on their own and it will have less chance of jeopardizing the therapeutic relationship between
you and the client.