Outpatient case of severe alcohol dependency. How does it violate the scope of practice?
Hello to all peers, I need a peer consult on an ethical boundary and practice issue in one of my outpatient clients.
I have been working with a 35 year old man with generalized anxiety and work burnouts at a remote workplace for the past six weeks. But in the recent two visits, the client revealed his hiding of a severe alcohol dependency which he was drinking heavily since waking up in order to stop himself from shaking. His request was immediate quitting from alcohol dependency and that I should help him white-knuckle through the behavioral side of his issue in our weekly sessions.
Immediately I noticed a huge danger regarding his safety. In light of his described volume and period of drinking, the dangers of his withdrawal issues, seizures, or DTs are very likely. I explained the importance of his stabilization, but he is not accepting any hospitalization due to his medical trauma in the past.
From a clinical perspective I am fully aware that managing a patient who is currently experiencing severe withdrawal would be entirely out of my scope of practice as an outpatient therapist. I am unable to safely monitor his vital signs and ensure his physical safety. For all those who have managed SUD patients who were particularly challenging, how do you ethically maintain your boundaries without abandoning the patient?