Why ALL Social Workers Need To Understand Substance Abuse

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.


#2. Homelessness


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.

10 Things You May Not Have Known About Substance Abuse in The Context of LGBT Health

lgbt equality

History & Politics of LGBT Research/Criminalization of The LGBT community

  1. Historically, research on those who identity as LGBT has been approached within a criminological framework, such that scientists would associate health disparities with criminal behavior, thus labeling ones sexuality identity and same-sex behavior as unnatural, disorderly and destructive to societal norms.
  1. In the United States, around the mid-late 1900s, most research efforts to describe LGBT people were rejected & underfunded. In addition, political pressure made it difficult to conduct such studies (Silvestre, Beatty & Friedman p.368)
  1. Although there is a great amount of research about gay men driven by the HIV pandemic, the literature reflects little focus on gay men experiencing multiple dimensions of marginalization such as minority race and/or ethnicity, young or old age, rural residence, and low socioeconomic status (Silvestre, Beatty & Friedman p. 369)

Lack of Education/Training

  1. Due to the lack of research available in regards to the LGBT community, there is not a sufficient amount of knowledge to effectively design and implement appropriate medical and health-related academic training programs (Silvestre, Beatty & Friedman p. 370)
  1. Professionals often feel inadequate in providing care to LGBT clients. Data suggest that most physicians receive just 2-4 hours of training on LGBT issues in medical school, and about 30% admit to being nervous around homosexuals (Silvestre, Beatty & Friedman p. 371)


Prevalence & Risk Factors for Substance Use Among LGBT & MSM with HIV

  1. Stall et al.’s 2001 findings found from the urban Men’s health study reported that 52% of urban MSM had sued drugs in the previous 6 months and 85% used alcohol. (Silvestre, Beatty & Friedman p.369) Lim et al’s 2012 findings found that almost 10% of gay and bisexual men used three or more drugs regularly each week after age 50 (Silvestre, Beatty & Friedman p. 369)Additionally rates of using club drugs, such as Ecstasy, PCP, Ketamine and inhalants, among gay and bisexual males are disproportionally higher than among hetero men (Silvestre, Beatty & Friedman p. 369)
  1. Studies found that parental substance abuse, a violent home of origin, and childhood sexual abuse were all related to increased depression, higher rates of HIV and hepatitis, and increase substance use (Silvestre, Beatty & Friedman p. 369) These findings are particularly relevant because data shoes higher rates of depression, parental rejection, bullying, and increased suicidal ideation among LGBT youth (Silvestre, Beatty & Friedman p.369)
  1. Among the few studies done on lesbians, bisexual women and transgender people, many find that there are increased rates of drinking among lesbians, particularly older lesbians, elevated rates of alcohol use and other health problems, and high rates of concurrent substance use and sex among bisexuals (Silvestre, Beatty & Friedman p.370)


  1. Social workers should seek to further educate themselves on LGBT related issues/subjects in order to further enhance their ability to provide the best intervention methods/treatment for LGBT clients

10. As researchers, social workers can work to add variables related to sexual identity   orientation and gender identity in every study they fund, monitor, or carry out (Silvestre, Beatty & Friedman p. 373). As teachers, social workers can integrate LGBT content into their curriculum, and support students and other faculty interested in this issue (Silvestre, Beatty & Friedman p. 374). As advocates, social workers can work to advocate within their professional associations and public and private funders; to hire staff who have knowledge about and concern for LGBT health (Silvestre, Beatty & Friedman p. 374). Social workers can do an assessment of LGBT-related policies and practices and work to make them more inclusive (Silvestre, Beatty & Friedman p. 374).

rainbow gay daily show flag lgbt


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.

Seven Facts about Substance Abuse and Social Workers – Julie S.

Who Is Effected

  1. Only 3% of Social workers primarily focus on addiction and substance use. However, 75% of NASW social workers report having helped a client with addiction. Every avenue of social work can contain situations with substance use (DiNitto & Mcneece, 2007, p. 171).

Substance abuse can be found in ANY population of people. All socio-economic, gender and race groups can fall victim to the disease.

Definition  of Addiction:

2. “The American Psychiatric Association (2000) does not use the term addiction”. Rather they use the terms substance use disorder or substance abuse regarding the abuse of alcohol or drugs (173).


Types of Addiction

4. “Approximately 9-10% of the U.S. population currently meets the criteria for substance abuse or dependence; about 15 million have an alcohol use disorder, about 4 million have a drug use disorder, and about 3 million have both alcohol and drug disorders” (175).

Addictions do not always include abuse of alcohol or drugs, either. Many people face other addictions including gambling or even food.

5. 61% of adults and 13% of children are considered overweight or obese in the United States. About 1.5% of adults in the United States are estimated to fit the criteria for pathological gambling (176).

Causes of Addiction

6. Science suggests that alcohol and drug related addictions can stem from genetic predisposition (177). Drawing a genogram with a client can help a Social Worker learn more about the family of the client thus allowing for more information about potential predisposition for addictive behaviors.

How Social Workers Intervene

3. Social workers in all areas and fields can work with clients facing substance use disorders. Many techniques that are helpful in empowering the client to seek rehabilitation and become clean include motivational interviewing and cognitive behavioral therapy (Merrit Hartblay).

Motivational Interviewing encourages the client to consider their concerns and conflicts while ensuring and affirming the care that the social worker has for the patients behalf through reflective listening.

Cognitive Behavioral Therapy is a tool used by many counselors and social workers to help teach people to change their thoughts in a way that can ultimately change their lifestyle and empower them to overcome their personal obstacles in a new way of thinking.

How do Clients Change


7. It is not an easy task ahead for anyone trying to change their life and recover from substance abuse. Relapse can be, and often is, a part of the process. Merrit Hartblay made an excellent point when he said that often it is not the moment when a client picks up the drug again that they face relapse, rather it is the moment months before that their mindset changes to desiring to go back to old ways. This is why a Social Worker can play a significant role in the life of a recovering addict because they can allow a client to truly understand themselves while seeking to empower their thoughts to conquer the challenges of recovering and changing their lifestyle.

DiNitto, D., & McNeece, Carl Aaron. (2008). Social work : Issues and opportunities in a challenging profession (3rd ed.). Chicago, Ill.: Lyceum Books.




The Treatment Approaches to Substance Abuse-Carly Danowitz

  1. Pharmacotherapy: Medications help to decrease cravings for drugs and help establish normal brain functioning. Drugs used to treat opiates addictions are methadone and buprenorphine. Drugs used to treat alcohol addiction are Disulfiram, naltrexone, and acamprasate. (Straussner, 2012, p. 128-129)


  1. Behavioral therapies: Many of these therapies are used for the treatment of substance abuse. These help people engage in treatment and in their recovery process. They also provide incentives to remain off drugs, modify their substance behaviors, and improve skills to handle stress and environmental cues that triggers cravings. (Straussner, 2012, p. 129)


  1. Contingency Management: This form of behavioral therapy involves giving incentives to patients for meeting their behavioral goals. This is especially effective for people who are abusing marijuana, alcohol, narcotics, and stimulants. (Straussner, 2012, p. 129)


  1. Cognitive Behavioral Therapy: Another type of behavioral therapy, which attempts to decrease self-defeating behaviors by means of modifying maladaptive beliefs and teaching thought control techniques. Essentially tries to enhance patient’s self-control. This teaches the patient to weigh the costs and benefits of their continued substance use, and to specifically pay attention to their thinking as well as their cravings. The patient will learn to identify high-risk situations as to not ruin their recovery, and will learn effective strategies to prevent relapse. (Straussner, 2012, p. 129)


  1. Motivational Enhancement Therapy: This is associated with the Stages of Change model and the techniques of Motivational Interviewing. This therapy emphasizes techniques such as avoiding argumentation, expressing empathy, and developing discrepancies. MET is especially successful in engaging substance abusers into treatment, and some use MET as a preparation for other, more intensive therapy. (Straussner, 2012, p. 129-130)


  1. Twelve Step Facilitation Therapy: TWF is a structured approach to bring in early recovery from substance abuse. It stems from cognitive, behavioral, and spiritual principles from Narcotics Anonymous and Alcoholics Anonymous. Being able to accept that addiction is a chronic disease that the person is powerless over and which has become unmanageable, as well as active involvement in the 12 steps is a central principle in this type of therapy. (Straussner, 2012, p. 130)


  1. Harm Reduction: This treatment approach is a range of evidence-based public health policies that are created to decrease harmful consequences that are associated with drug use. This includes needle exchange programs and therapies of opioid substitution. This is in line with traditional social work values. (Straussner, 2012, p. 130)




Straussner, S. (2012). Clinical Treatment of Substance Abusers: Past, Present and Future. Clinical Social Work Journal Clin Soc Work J, 40, 127-133.


10 Surprising Facts About Substance Abuse

1. The LGBT population, on average, experiences substance abuse disorders more frequently. (Silvestre, Beatty, & Friedman, 2013) This could be due to the fact that many in the LGBT community have un-supportive families, and are the victims of hate crimes, bullying, and social isolation.

2. As of 2012, it is estimated that 9% of the US population, or 22.5 million people, have a substance abuse disorder. (Straussner, 2012)

3. Despite being a prevalent issue in the US, and many social workers experiencing substance abuse issues in their family growing up, many social workers choose to not work with this population due to fear. Additionally, many social work schools do not even require students to be knowledgeable about substance abuse. (Straussner, 2012)

4. Veterans experience substance abuse disorders at higher rates, as well. This could be attributed to the fact that some veterans may feel the need to self medicate. (C. Studgeon, personal communication, 2016)

5. Illegal drug use costs the United States approximately 181 billion dollars annually. (Get the Facts on Substance Abuse, 2011)

6. In 2010, 60% of drug overdoses that resulted in death were due to prescription pain killers. (Get the Facts on Substance Abuse, 2011) This is probably contradictory to public knowledge on substance abuse overdoses. The general public is very aware of the dangers of harder drugs such as heroin, but it is lesser known that prescription pills can be just as dangerous if not used properly.

7. After alcohol, the most commonly abused drug is marijuana. (Get the Facts on Substance Abuse, 2011)

8. As of 2006, only 3 percent of licensed social workers list addictions as their specialty. (DiNitto & McNeece, 2008)

9. Currently, the US government is putting millions of dollars towards research to identify regions of the brain that could be stimulated in order to prevent addiction, or lessen the likelihood of an addiction to develop. (Straussner, 2012)

10. Younger people are more likely to abuse “designer” drugs. Designer drugs usually refers to inhalants, ecstasy, or anabolic steroids. On the other hand, older adults are more likely to abuse prescription drugs. (DiNitto & McNeece, 2008)


DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a
challenging profession (3rd ed.). Chicago, IL: Lyceum Books.
Get the Facts on Substance Abuse. (2011). Retrieved March 14, 2016, from http://drugabuse.com/library/get-the-facts-on-substance-abuse/
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.
Straussner, S. (2012). Clinical Treatment of Substance Abusers: Past, Present and
Future. Clinical Social Work Journal Clin Soc Work J, 40, 127-133.

Studgeon, Connie. Personal communication. March 10, 2016.