… Suppose that your patient is a commercial airline pilot who tells you that he has begun to occasionally snort cocaine, but not when he is flying (the plane). His identified problem is his deteriorating relationship with his wife and his feeling of sexual inadequacy. Must you keep the information about cocaine use confidential? Are you under any obligation to report this information to a governmental agency or to anyone else? Are you permitted (but not required) to break confidentiality and if so, should you?
The general rule that applies to most psychotherapists in private practice is that the patient is entitled to confidentiality. In order to properly break confidentiality, the therapist must either be mandated by law to do so or permitted by law to do so. Each state’s law (whether statutory, case law or other legal authority) may vary in fine nuance when it comes to confidentiality and “dangerous patients,” so care must be taken when making a decision on the course of action to be taken. Consultation may be necessary, and documentation of records is essential in order to support the therapist’s ultimate decision. Therapists may find themselves in a similar situation when they find out that their patient, perhaps a police officer or a surgeon, uses drugs.