Intoxication
--NCBTMB Standards of Practice V (h)
"refrain from practicing under the influence of alcohol, drugs or any illegal substances (with the exception of a prescribed dosage of prescription medication which does not significantly impair the certificant.)"
Alcoholic intoxication reduces fine motor control so a therapist in that condition might find it difficult to perform. The condition can also result in profuse sweating which might prove uncomfortable to the client. At certain levels, the intoxicated person may engage in familiar or aggressive behavior which is inappropriate to the situation. This could create further ethical issues.
The first areas to be impaired are those requiring training and experience, which is to say the very touchstones of a therapist's professionalism are being attacked. Despite this, the intoxicated therapist may feel exceedingly confident, unaware that all is not as it should be.
Legal intoxication may occur between two and three drinks, although "[s]ome performance degradation is observed at any measurable alcohol level." The relative impairment caused by intoxication may be gauged from the calculation that a driver at the legal level of intoxication is 6 times more likely than a sober driver to have an accident. It is unlikely that a therapist can maintain a useful session if the therapist is six times less capable than usual.
Some antihistamines available without a prescription mimic alcoholic effects and should be avoided while working. Fatigue can also produce intoxicated-like behavior. An Australian study showed impairment after being awake 17 hours. At 24 hours without sleep, behavior was similar to that of a legally intoxicated person.
In some jurisdictions, a therapist's license may be suspended if the therapist is convicted of driving while intoxicated.
Cannabis can also impair motor function and may lead to social withdrawal. This would be counterproductive as the client did not pay to be alone. Anxiety, panic and paranoia may occur. Attention to tasks may decrease.
The therapist needs to be in charge to provide for their and the client's safety and to maintain the professionalism of the setting. Alcohol or other substances degrade the therapist's ability to perform these functions and should not be ingested prior to or at work.
The abuse of drugs or alcohol may affect the therapist's license