Involuntary Termination from Substance Use Disorder Treatment: Unknown Phantoms, Red Flags, and Unexplained Medical Data

In the United States, all treatment programs receiving public funds are required by law to regularly submit admission and discharge data, inclusive of the forced/involuntary termination or administrative discharge of clients, to their local state authorities. In some states, this requirement even extends to programs not receiving public funds. The aim of collecting discharge data—collected under the auspices of the Substance Abuse and Mental Health Services Association [SAMHSA]—is to assist state and county authorities, funders, and accreditors to monitor recovery-focused program performance. However, investigation here undertaken shows that published discharge data from many state treatment settings are perennially and grossly underreported or misreported. This paper reports on evidence that point to systemic failure of regulatory supervision of treatment settings and the ethical breach in duty and consequent legal culpability in reporting medical data. Policy and practice implications are discussed

Practice-based conundrums and existentialist quandaries of a professional code of ethics

Ethical codes have long been considered indispensable tools in defining the proper conduct of counseling professionals. Revisions reflect the ideals of the industry to accommodate the evolving needs of clients and trends in treatment models, but the essence of the code is to convert principles befitting of the profession into concrete actions or considerations that abet professional decision-making. Acculturation into the profession involves ethics training intended to improve professionals’ ability to apply the code to situations that might arise in their practices, resulting in the most ethically appropriate action. However, such assumptions may be problematic. The idea of ethical competency and improvement in the code itself should be qualified to reflect the uncertainty of moral truths, including counselor training tailored to test competency, both before and during professional practice. In this article, the consideration that morals and ethics are distinct is spelled out and then challenged by drawing on Jean Paul Sartre’s existentialist critique of moral decision-making reality. In light of this critique and John Stuart Mill’s argument regarding the value of vigorous debate over philosophical ideas, suggestions are made regarding a potential approach to ethics competency education

At the pillar of the proverbial Golden Calf: Sacrificing the Need for ‘Responsible Knowing’ on the Altar of a Compliance-Based Ethic

Evidence-based practice (EBP) has been promoted and adopted broadly and has led to advances in health and human services. Notwithstanding the underlying rationale of EBP philosophy to diversify the current body of information concerning evidence-based practices, this paper draws attention to critical thinking fallacies that confound non-evidence-based “treatment as usual” practice with actual EBP philosophy. Flawed belief systems about EBP, in tandem with a compliance-based culture, fail to provide structure to the possibility of evidence-based practice philosophy and proper use of EB treatment modalities. Impediments to EBP implementation are created by lack of “responsible knowing” and this results in practitioner complacency toward means of augmenting effective treatment. However, insofar as EBP implementation confronts tension between ‘responsible knowing’ and compliance-based program culture, it gives way to confusion, misdirection, and complacency towards what can be known about EBP and the information gleaned about it. Effectively limiting important aspects of being a responsible knower in terms of the ability to embody accurate knowledge and practice philosophy. Thus, the compliance-based ethic risks incompatibility with the ethical freedom necessary for responsible knowing and is in constant conflict with the proper implementation of EBP. Keywords: compliance-based ethics, evidence-based practice, fallacies, testimonial injustice, critical thinking, human service

Power in the Counseling Relationship: The Role of Ignorance

This article explores the role of therapist self-disclosure in clinical settings. Distinctions are made between the enmeshed concepts of privacy, secrecy, and confidentiality to elucidate the role of ignorance in maintaining the power dynamics in therapeutic relationships. While some measure of privacy is essential to counseling practice, secretive behavior (in which the counselor divulges too little about themselves) can have a negative impact on the therapeutic relationship and the client’s therapeutic outcomes. There is, therefore, an under-appreciated and delicate balancing act between withholding information to protect the client and the counselor and revealing enough personal details to empower the client’s recovery. While it is difficult, if not impossible, to establish hard-and-fast rules for when and what personal details counselors should disclose, understanding the negative effects of secrecy and the nature of ignorance it engenders provides counselors with the tools to identify beneficial self-disclosure and detrimental withholding

Measurement of inclusive D*+- and associated dijet cross sections in photoproduction at HERA

Inclusive photoproduction of D*+- mesons has been measured for photon-proton centre-of-mass energies in the range 130 < W < 280 GeV and a photon virtuality Q^2 < 1 GeV^2. The data sample used corresponds to an integrated luminosity of 37 pb^-1. Total and differential cross sections as functions of the D* transverse momentum and pseudorapidity are presented in restricted kinematical regions and the data are compared with next-to-leading order (NLO) perturbative QCD calculations using the "massive charm" and "massless charm" schemes. The measured cross sections are generally above the NLO calculations, in particular in the forward (proton) direction. The large data sample also allows the study of dijet production associated with charm. A significant resolved as well as a direct photon component contribute to the cross section. Leading order QCD Monte Carlo calculations indicate that the resolved contribution arises from a significant charm component in the photon. A massive charm NLO parton level calculation yields lower cross sections compared to the measured results in a kinematic region where the resolved photon contribution is significant.Comment: 32 pages including 6 figure

Measurement of Jet Shapes in Photoproduction at HERA

The shape of jets produced in quasi-real photon-proton collisions at centre-of-mass energies in the range $134-277$ GeV has been measured using the hadronic energy flow. The measurement was done with the ZEUS detector at HERA. Jets are identified using a cone algorithm in the $\eta - \phi$ plane with a cone radius of one unit. Measured jet shapes both in inclusive jet and dijet production with transverse energies $E^{jet}_T>14$ GeV are presented. The jet shape broadens as the jet pseudorapidity ($\eta^{jet}$) increases and narrows as $E^{jet}_T$ increases. In dijet photoproduction, the jet shapes have been measured separately for samples dominated by resolved and by direct processes. Leading-logarithm parton-shower Monte Carlo calculations of resolved and direct processes describe well the measured jet shapes except for the inclusive production of jets with high $\eta^{jet}$ and low $E^{jet}_T$. The observed broadening of the jet shape as $\eta^{jet}$ increases is consistent with the predicted increase in the fraction of final state gluon jets.Comment: 29 pages including 9 figure

Measurement of the F2 structure function in deep inelastic e+^{+}p scattering using 1994 data from the ZEUS detector at HERA

We present measurements of the structure function \Ft\ in e^+p scattering at HERA in the range 3.5\;\Gevsq < \qsd < 5000\;\Gevsq. A new reconstruction method has allowed a significant improvement in the resolution of the kinematic variables and an extension of the kinematic region covered by the experiment. At \qsd < 35 \;\Gevsq the range in x now spans 6.3\cdot 10^{-5} < x < 0.08 providing overlap with measurements from fixed target experiments. At values of Q^2 above 1000 GeV^2 the x range extends to 0.5. Systematic errors below 5\perc\ have been achieved for most of the kinematic urray, W

Measurement of the Diffractive Cross Section in Deep Inelastic Scattering using ZEUS 1994 Data

The DIS diffractive cross section, $d\sigma^{diff}_{\gamma^* p \to XN}/dM_X$, has been measured in the mass range $M_X < 15$ GeV for $\gamma^*p$ c.m. energies $60 < W < 200$ GeV and photon virtualities $Q^2 = 7$ to 140 GeV$^2$. For fixed $Q^2$ and $M_X$, the diffractive cross section rises rapidly with $W$, $d\sigma^{diff}_{\gamma^*p \to XN}(M_X,W,Q^2)/dM_X \propto W^{a^{diff}}$ with $a^{diff} = 0.507 \pm 0.034 (stat)^{+0.155}_{-0.046}(syst)$ corresponding to a $t$-averaged pomeron trajectory of \bar{\alphapom} = 1.127 \pm 0.009 (stat)^{+0.039}_{-0.012} (syst) which is larger than \bar{\alphapom} observed in hadron-hadron scattering. The $W$ dependence of the diffractive cross section is found to be the same as that of the total cross section for scattering of virtual photons on protons. The data are consistent with the assumption that the diffractive structure function $F^{D(3)}_2$ factorizes according to \xpom F^{D(3)}_2 (\xpom,\beta,Q^2) = (x_0/ \xpom)^n F^{D(2)}_2(\beta,Q^2). They are also consistent with QCD based models which incorporate factorization breaking. The rise of \xpom F^{D(3)}_2 with decreasing \xpom and the weak dependence of $F^{D(2)}_2$ on $Q^2$ suggest a substantial contribution from partonic interactions

Measurement of Elastic ϕ\phi Photoproduction at HERA

The production of $\phi$ mesons in the reaction $e^{+}p \rightarrow e^{+} \phi p$ ($\phi \rightarrow K^{+}K^{-}$) at a median $Q^{2}$ of $10^{-4} \ \rm{GeV^2}$has been studied with the ZEUS detector at HERA. The differential$\phi$photoproduction cross section$d\sigma/dt$has an exponential shape and has been determined in the kinematic range$0.1<|t|<0.5 \ \rm{GeV^2}$and$60 < W < 80 \ \rm{GeV}$. An integrated cross section of$\sigma_{\gamma p \rightarrow \phi p} = 0.96 \pm 0.19^{+0.21}_{-0.18}$$\rm{\mu b}$has been obtained by extrapolating to {\it t} = 0. When compared to lower energy data, the results show a weak energy dependence of both$\sigma_{\gamma p \rightarrow \phi p}$and the slope of the$t$distribution. The$\phi$decay angular distributions are consistent with$s$-channel helicity conservation. From lower energies to HERA energies, the features of$\phi$ photoproduction are compatible with those of a soft diffractive process.Comment: 23 pages, including 6 post script figure

Comparison of ZEUS data with standard model predictions for e+p→e+Xe^+ p \rightarrow e^+ X scattering at high xx and Q2Q^2

Using the ZEUS detector at HERA, we have studied the reaction e(+)p --> e(+)X for Q(2) > 5000 GeV2 with a 20.1 pb(-1) data sample collected during the years 1993 to 1996. For Q(2) below 15000 GeV2, the data are in good agreement with Standard Model expectations. For Q(2) > 35000 GeV2. two events are observed while 0.145 +/- 0.013 events are expected, A statistical analysis of a large ensemble of simulated Standard Model experiments indicates that with probability 6.0%, an excess at least as unlikely as that observed would occur above some Q(2) cut. For x > 0.55 and y > 0.75, four events are observed where 0.91 +/- 0.08 events are expected, A statistical analysis of the two-dimensional distribution of the events in x and y yields a probability of 0.72% for the region x > 0.55 and y > 0.25 and a probability of 7.8% for the entire Q(2) > 5000 GeV2 data sample. The observed excess above Standard Model expectations is particularly interesting because it occurs in a previously unexplored kinematic region