Alcohol and Other Drug Abuse: Challenge Social Workers Face
By Paula Caplan, CSW, CASAC, Chair NYC-NASW Addictions Committee
Problems associated with the abuse of alcohol and other drugs are so widespread that they are evident in every aspect of life. However, supported by scientific advancements and evidence based practice, social workers are more equipped than ever to treat problems of alcohol and other drug (AOD) abuse effectively. Numerous research studies conclude that appropriate social work interventions are cost-effective and produce positive outcomes, particularly when compared to those associated with alternatives such as incarceration or psychiatric commitment. For example, money is saved through decreased expenditures on preventable medical interventions, increased productivity in business, and reduced rates of recidivism when restorative services rather than punitive measures are applied. A 1997 Rand study found that drug treatment was 15 times more effective at reducing serious crimes committed against people and property by drug offenders than were mandatory minimum sentences.
Incarceration is expensive and less effective than treatment interventions.
The cost of housing an individual in a NYC prison was estimated to be roughly
$64,000 for one year. A 2001 NYS Assembly report offers testimony of a chief
administrative judge who estimates that graduates of drug court diversion programs
operated by the court system commit 2/3 fewer crimes than drug offenders who
are simply incarcerated for a period of time. Although the benefits of
intervention (often by social workers) are well documented, many needed services
are being cut or are inadequately funded.
Challenges in AOD services
Inadequate funding presents one of the most significant challenges facing social
workers providing AOD services. Barriers also arise due to policy and procedural
regulations, a fragmented system that allows treatment gaps, and increased external
control over treatment decisions. Ignorance about the nature of AOD abuse, and
stigma associated with AOD clients are key factors in this increased external
control.
Woefully inadequate funding contributes to difficulty in maintaining sufficient
staffing levels, positive work environments, and retention of highly qualified
staff, and it negatively impacts quality of care. High staff turnover, changes
in treatment structures or insurance coverage disrupts treatment and prevents
positive outcomes. Many individuals have had difficulty obtaining appropriate
treatment or overcoming their fears in order to access the health care system.
Once clients overcome this hurdle, their treatment accrues benefits when they
establish a rapport with a provider. It can have devastating implications for
client health and well being if the insurance coverage changes. Client care
may be interrupted or discontinued, possibly exacerbating the client’s
condition. “At risk” clients may fall into life and death situations.
Short term cost savings can become increased expenditures in the long run. Program
cutbacks, treatment denials, and uninsured workers often appear to offer cost-saving
opportunities. In reality, increased expenses often result from emergency room
visits, and “revolving door treatment” in AOD programs and the criminal
justice system, as well as the cost of recruiting and retraining staff.
Policy and procedural obstacles, such as excessive accountability and documentation
requirements, intertwine with funding issues. The pressures of maintaining economic
viability and meeting regulatory mandates lead to tension and often results
in a distancing between agency staff and administration, despite a commitment
to similar goals. This can result in a more authoritarian management style,
as well as working at cross-purposes.
In some agency settings, frustration and resentment build when funding streams
appear to drive practice. An example is found in shifts to group treatment with
a concurrent drop in individual treatment rates.
On one occasion a social work disability benefit administrator informed me that
I was suddenly assigned as a client’s primary support. Her insurance benefits
for more intense treatment had been exhausted, thus excluding her from other
programs. I became the only mental health provider in this woman’s life.
This client was diagnosed with a chronic history of substance abuse, bi-polar
disorder and past suicide attempts. Utilizing core social work values enabled
me to forge a strong therapeutic relationship with her. She then went to the
emergency room and was admitted.
Unfortunately, these daily challenges, are familiar. They are embedded in questions
about bed availability in an appropriate setting. Challenges are found in other
questions like, “will I meet my quota of billable units of service if
I provide a needed, but non-billable service,” or, “how do I cope
with burn-out – not compassion fatigue - due to pressures from systemic
issues?”
A colleague suggested a book by Simon Head, The New Ruthless Economy: Work and
Power in the Digital Age, that so aptly captures the essence of current trends.
Professionals are facing conditions that he calls “digital assembly lines”
or white-collar factories where skills and professional autonomy wither due
to bureaucratic demands for time.
Since social worker training prepares us to work in a number of roles, from
mediator to organizer, and provides skills to work in every community and system
where AOD’s exist, we are uniquely positioned to apply social work principles
to mitigate social injustice. The National Institute of Health (NIH) acknowledged
the significance of social workers’ training in declaring that it would
“…fully incorporate social work’s unique perspective into
the NIH research portfolio and...to build the scientific base to be used by
allied health professionals.”
The future is at stake if we don’t educate ourselves politically and organize
campaigns to maintain ethical and professional primacy in three areas: determining
the course of client care; increasing accurate representation of the benefits
of social work in AOD services; and bringing the nature and impact of AOD’s
into public awareness. Advocacy efforts played a vital role in passage of the
new Chemical Regulations in August 2002. Those changes enabled treatment providers
to access treatment for AOD abuse in one program, critically improving client
care, especially for “cross-addicted” individuals.
Social workers are critical to effective service delivery, particularly when
combining the basic principles and skills underlying our profession with knowledge
of AOD. As we fulfill our professional obligations, we must take opportunities
to acknowledge publicly our AOD field of practice and participate in shaping
the debate’s framework. Our Code of Ethics charges us with the responsibility
to advocate for changing societal problems and injustice. Peter Gilbert writes
that mental health is a crucial issue for a healthy and productive nation and
for the regeneration of communities. It is critical that social workers commit
to positive actions that promote social justice, equality of treatment and access
to care. Our collective well-being depends on it.r