By Martha Adams Sullivan, DSW
Deputy Commissioner, Bureau of
Community Liaison and Training,
Division of Mental Hygiene, NYC
Dept. of Health and Mental Hygiene
Do Not Pass
Me By
Social Workers and the Chemically Dependent
By Martha Adams Sullivan, DSW
Deputy Commissioner, Bureau of
Community Liaison and Training,
Division of Mental Hygiene, NYC
Dept. of Health and Mental Hygiene
Chemical Dependency is a Major Public Health Problem
An estimated 75 percent of people with alcohol and substance abuse problems
do not receive help. Yet, chemical dependency problems are treatable and preventable.
The social work profession plays important roles in advocacy, policy development
and research; in the provision of treatment and supportive services for affected
individuals and families; and in individual and community-oriented prevention.
Social work as a discipline is uniquely situated to advance the detection of
untreated chemical dependency problems and to motivate those affected to seek
help.
Alcoholism and drug addiction are diseases that result in significant personal
and family suffering and tremendous social and economic burden. Indeed, according
to a national report by the Surgeon General, alcohol use ranks fourth in years
of healthy life lost due to disability or premature death. In NYC, 575,000 individuals
are estimated to suffer from alcohol and drug addiction. Each year, over 1,500
of these individuals die from alcohol-related causes, including alcohol cirrhosis,
violence, injury and accidents. Approximately 900 additional drug-related deaths
occur in NYC each year.
Further examples of the burden associated with alcoholism and drug addiction
include the following:
• Intravenous drug use places people at risk for HIV. Approximately 20
percent of intravenous drug users in NYC are HIV positive.
• Alcohol and drug abuse are highly associated with domestic violence
and elder abuse.
• Nearly 50 percent of individuals with severe mental disorders are affected
by substance abuse.
• Between thirty and fifty percent of homeless people have an alcohol
or drug problem.
• Approximately 80 percent of male arrestees in the City test positive
for drugs.
• Nearly seven of every ten cases of child abuse or neglect involve parental
alcohol or drug abuse.
Chemical dependency problems present a major obstacle to obtaining and maintaining
gainful employment and thereby achieving self-sufficiency. Chemical dependency
affects people of all racial and ethnic backgrounds; however, there are apparent
variations in the patterns and consequences of use.
The Role of Social Work
The impact of chemical dependency problems is broad, affecting health and many
areas of psychosocial functioning, such as employability, educational/vocational
capacity, parenting and family functioning. As a discipline, social work is
uniquely positioned to address problems of chemical dependency, as social workers
provide services in many settings far beyond those of addiction treatment and
prevention.
The Division of Mental Hygiene (DMH) of the NYC Department of Health and Mental
Hygiene (DOHMH) funds and/or monitors a $50 million portfolio of chemical dependency
programs and services to assist youth and adult populations and their families.
These programs are sponsored by a host of community-based organizations, hospitals,
clinics, and schools. Social workers comprise most of the supervisory and administrative
staffs of these programs.
Our systems perspective emphasizes strengths, and the person-in-environment
context. Our skill working with families, and our biopsychosocial framework
are also useful in helping clients recover from addictions. Furthermore, advocacy
skill is critical in developing policies and services to address the needs of
addicted individuals and families. Social workers in all fields of direct service
practice are challenged to develop proficiency in detecting chemical dependency
problems. A recent NASW survey of social workers indicated that, in one year,
71 percent had acted at least once on behalf of clients with substance abuse
issues. However, more is required.
Stigma places an undue burden on those who need help, and often creates barriers.
Despite all the scientific evidence that addictions are diseases with genetic
and environmental determinants, we respond too often as if addictions result
from moral weakness.
Unfortunately, even within professional arenas, and among clients themselves,
a status hierarchy of disabilities is evident. People who suffer from addictions
may be the most stigmatized. Even those who espouse recovery for people with
mental illness may view individuals with addictions as hopeless, and the mental
health professionals who treat them as less sophisticated. As social workers
who believe in the inherent worth and dignity of all individuals, it is important
that we examine our attitudes and behavior toward people with addictions. Similarly,
we need to respond with compassion and support to social workers seeking their
own recovery.
Treatment Works
A growing body of research now demonstrates positive outcomes from chemical
dependency treatments. It is important to keep in mind, however, that alcohol
and drug addiction are chronic, relapsing conditions. Both improvement over
time and the extent of remission are therefore just as salient as outcomes during
or at the end of treatment.
Social workers need to be aware of new developments in chemical dependency treatment.
For example, Buprenorphine, recently approved for treating opioid addiction,
can now be prescribed in a clinic or office setting. While there are approximately
38,000 methadone patients in treatment in NYC, an estimated 200,000 additional
individuals abuse heroin but are not in treatment. As many as double this number
are estimated to be abusing prescription opiates. While methadone remains the
optimal treatment, we hope that the additional treatment option of Buprenorphine
will help many opioid users who currently avoid treatment. Social workers in
all fields of practice may encounter clients or family members who could benefit
from Buprenorphine treatment.
It is best to prevent a problem before it develops. The field of chemical dependency
is a forerunner in the development and use of prevention science. Social work
skills and services such as family strengthening and community development comprise
key components of prevention; and social work researchers are playing a major
role in developing prevention science. Social work education should also include
prevention theory and practice.
The NYC DOHMH offers a number of initiatives and resources. That information
is found in the full text of this article, posted on the NASW website: www.naswnyc.org.
Also, see the NYC DOHMH website at www.nyc.gov/health.
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