By: Mindy Barnes
Although only a small percentage of the social work population—roughly 3 percent—focus primarily on substance abuse, “nearly three-quarters of NASW members report having helped a client with an alcohol or drug problem in the last year (O’Neill, 2001)” (DiNitto & McNeece, 2008, p. 171). This is because substance abuse can affect anyone and everyone. It does not discriminate based on age, gender, race, sexual orientation, or socio-economic status. Social workers in the fields of health care, child welfare, domestic violence, and military and veteran affairs often work with individuals who have substance use disorders. Here are a few other reasons why social workers in all areas should be trained and competent in the diagnosis and treatment of substance abuse:
#1. Mental Health
The majority of those with a substance abuse disorder also have a mental illness. The goal of social workers who are working with individuals with dual diagnosis should be two-fold: “1) assess and diagnose the mental health issue and 2) address the addiction” (Grobman, 2012, p. 216). This is a complicated task. It is often difficult to determine if the mental illness preceded the addiction or vice versa, if the mental illness is a substance-induced disorder, or if the two are coexisting conditions. Unfortunately, as Doweiko points out, “only 8% of MI/CD patients received treatment for both disorders in the preceding 12 months, and 72% received no treatment at all (Prochaska et al., 2005)” (2009, p. 281). Thus, it is imperative that social workers recognize and treat both of the factors–substance abuse and mental illness–that are each affecting the client in different ways.
Doweiko mentions that, “[r]esearchers have found that 45% to 78% of those who are homeless have a substance use disorder (Arehart-Treichel, 2004; Smith, Meyers, & Delaney, 1998)” (2009, p. 255). They may have become homeless as a result of their addiction, or their addiction may be a result of their trying to cope with being homeless. Social workers can help these individuals, “locate more permanent shelter in a halfway house or other residential program, find a job, apply for food stamps, and get health care from a free clinic and substance abuse and mental health care from a community mental health center of similar program” (DiNitto & McNeece, 2008, p. 183). Social workers should also recognize that this population faces the dual stigma of being homeless and being an addict.
LGBTQ individuals are more likely to have a substance use disorder than non-LGBTQ people. It is also important to remember that they are at greater risks for contracting and transmitting HIV through higher rates of substance abuse. For social workers, “[t]o understand substance use disorder (SUD) among lesbian, gay, bisexual, and transgender (LGBT) people, a number of environmental concerns need to be examined, namely, the state of the research on SUD in the LGBT communities, the adequacy of training of health care providers about LGBT health, and the impact of systematic oppression on LGBT communities in terms of disparate levels of psychosocial distress, violence, and access to health services” (Silvestre, Beatty & Friedman, 2013, p. 366). LGBTQ individuals with substance abuse disorders are particularly vulnerable in that they are already marginalized for their LGBTQ status, but on top of this are faced with the stigmas surrounding substance abuse.
#4. Criminal Justice
There is much debate as to whether it is substance abuse that contributes to criminal activity or vice versa, or if the two are even related other than substance abuse being an illegal activity. However, it is a major problem that, “less than 15% of inmates with a substance use disorder (SUD) receive some form of treatment for their SUD while incarcerated (Aldhous, 2006)” (Doweiko, 2009, p. 428). These individuals are then sent back out into streets, still suffering from an SUD or even a mental disorder, usually with no money, and are expected to successfully reintegrate back into society. This lack of awareness (or concern) about the problems these individuals face on behalf of the criminal justice system on the one hand, and the inability of physicians and other professionals to properly address these problems on the other, only perpetuate this vicious cycle (mental disorder-substance abuse-homelessness-incarceration). It is up to social workers to advocate for social justice.
While I focused on alcohol and drug addiction here, it is also important to remember that there are many other types of addiction. Different forms of addiction can include, “gambling, overeating, sex, internet use, and shopping,” and many often co-occur (DiNitto & McNeece, 2008, p. 171). It is also important for social workers to think about what causes substance abuse and how other factors come into play in order to properly diagnose and treat individuals with a substance abuse disorder. They need to, “consider whether and how biological, sociological, and psychological factors may contribute to an individual’s addictive or impulse-control disorders” (DiNitto & McNeece, 2008, p. 178). The field of addiction needs social workers to promote social justice, create effective practice, and take a holistic, strengths-based approach in working with individuals who have addictive disorders.
DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.
Doweiko, H. E. (2009). Concepts of Chemical Dependency (7th ed.). Belmont, CA: Brooks/Cole Cengage Learning.
Grobman, L. (2012). Days in the Lives of Social Workers (4th ed.). Harrisburg: White Hat Communications.
Silvestre, A., Beatty, R., & Friedman, M. (2013). Substance Use Disorder in the Context of LGBT Health: A Social Work Perspective. Social Work in Public Health, 28, 366-376.