By Shulamith Lala Ashenberg Straussner, DSW, BCD, CEAP
Social Work in Addictions: A Historical Perspective
By Shulamith Lala Ashenberg Straussner, DSW, BCD, CEAP
Professor and Director, Post-Master's Program in Treatment
of Alcohol and drug Abusing Clients, New York University,
Ehrenkranz School of Social Work
The abuse of alcohol, tobacco and other drugs places an enormous burden on individuals, families, communities and society as a whole. It’s a rare social worker who does not come in contact with a substance abusing or addicted individual or an affected family member. Nonetheless, social work education on this topic remains minimal and few schools have integrated sufficient content regarding this pervasive problem. Yet, the profession of social work and the treatment of substance abusing individuals in the U.S. have a long historical interconnection. Both of the major founders of our profession, Mary Richmond and Jane Addams, were concerned about substance abuse, in particular about the abuse of alcohol, which was and remains the main substance of abuse in our society.
The first institutional programs for alcohol dependent individuals, or “inebriates”as
they were called, started prior to the Civil War with the establishment of “industrial
homes.” Most of these were staffed by volunteers associated with the temperance
movement. One of these homes, in Chicago, has a particularly interesting association
with our profession. It was here, in the years following the end of the Civil
War, that the wealthy Charles Hull donated his home to serve as a residence
for the care of inebriate women. In 1869 it a larger facility and they moved
to the Martha Washington Home, a new institution built just for them. After
serving as a home for elderly women, Hull house was then taken over by Jane
Addams and her associates and became the first settlement house in the United
States.
Another author noted that, “…as a seventeen-year-old seminary student”
Addams herself experimented with the use of opium, although she later became
an important advocate for prohibition of alcohol and against the sale of pure
cocaine. We don’t know about Mary Richmond’s personal use of substances,
but we do know that her experience with the Charity Organization Society at
the turn of the 20th century made her question the prevailing moral view of
“drunkards” as sinners. In Richmond’s groundbreaking book,
Social Diagnosis she stated, “inebriety is a disease” and provided
a description that is entirely consistent with one in the latest version of
the American Psychiatric Association’s Diagnostic and Statistical Manual
of Mental Disorders. Based on her clinical observations, Richmond stated that:
• The ‘disease’ of inebriety differs from excessive drinking
by those who still have ‘power of will to remain sober if they choose
to exercise it;’
• The diagnosis of this disease should be based both on a physical and
a mental examination;
• This diagnosis applies to individuals who ‘are habitually overcome
by alcohol;’
• This disease is not curable since those who have it will relapse if
they drink again;
• Better success is achieved if ‘the malady is dealt with when its
manifestations first appear;’ and
• The inebriate is a ‘patient’ and not a ‘culprit,’
but his success in treatment does depend ‘upon [his] co-operation’.
Richmond also created a diagnostic questionnaire for inebriety that assessed
current drinking patterns and duration of problems; family history of drinking,
drug problems, and “mental or nervous trouble,” as well as a number
of other critical factors. This diagnostic instrument, formulated almost a century
ago, is similar to those commonly used today. Moreover, Richmond viewed social
workers as having an “important role to play in gathering the pertinent
social data,” offering the assistance necessary to supplement the medical
treatment, and “providing the long period of after-care which is usually
necessary”.
Richmond’s recognition of the important role of social workers has been
validated over the years. Social workers were an integral part of the interdisciplinary
team at the Yale Plan Clinics that started in 1944. They addressed the growing
alcohol problems among returning soldiers through a model of inpatient treatment
that was a precursor to contemporary alcoholism treatment programs. Gladys Price,
a social worker at the Washingtonian Center for Addictions in Boston during
the 1940s, created the first alcoholism field placement for social work students
and did pioneering work with wives of alcoholic men. At approximately the same
time, Margaret Cork, a social worker at the Addiction Research Foundation in
Toronto, Canada, established a treatment program for children of alcoholics,
and in 1969 wrote, The Forgotten Children, which remains a classic in the field.
In 1955, the Yale (now Rutgers) Summer School of Alcohol Studies began its first
formal training seminar for social workers. The faculty included both Gladys
Price and Margaret Cork, as well as Margaret Bailey, the social work author
of the 1968 highly regarded book Alcoholism and Family Casework. Between 1964
and 1968, Bailey, who worked for the National Council on Alcoholism in New York
City, headed an innovative alcoholism training project that involved three family
casework agencies under the sponsorship of the Community Council of Greater
New York. She also established the Alcoholism Committee under the auspices of
the New York City Chapter of the National Association of Social Workers (NASW).
Initiated in 1969 and continuing today, the New York City Chapter’s Addictions
Committee has sponsored an annual institute that has become one of the major
national providers of addictions training for social workers. (See Institute
announcement on p.7) This Committee published a number of special journals and
books on the treatment of alcohol and other drugs; wrote a substance abuse policy
statement that has been adopted by the National Association of Social Workers;
developed a guide on how to confront a colleague with a substance abuse problem;
and also provides a hotline for social workers concerned about their own, familial,
or a colleague’s use of substances.
Currently, social workers are not only one of the most important providers of
addictions treatment, but also play crucial roles as alcohol and other drug
program developers, administrators, researchers, educators and policy makers.
Our profession’s unique biopsychosocial and systemic perspective make
it particularly well suited to the ever-changing field of addictions. From Charles
Currie, the current head of SAMHSA [Substance Abuse Mental Health Services Administration]
to Dr. Mary Ann Amodeo, who recently became the first social worker to head
AMERSA [Association for Medical Educators and Researchers in Substance Abuse],
social workers are being recognized for their leadership role in this field.
It is time that the important role of social workers in addictions, both past
and present, is more widely recognized and that social workers be encouraged
to further contribute to this field in the future.r