By S. Lala Ashenberg Straussner, DSW, BCD, CAS, Associate Professor and Coordinator of the Post Master's Program in the Treatment of Alchol and Drug Abuse Clients, Shirley M. Ehrenkranz School of Social Work, New York University
(February/March 1997)

What all these people have in common is that each has been impacted by alcohol or drug abuse - whether their own or that of a family member - and each is eventually seen by a social worker. According to recent national surveys, 24.4 million Americans, one in eight, have used illicit drugs, and 2.7 million of them can be characterized as dependent on such drugs as cocaine and heroin, while almost 18 million have a problem with alcohol. Additional millions of Americans are impacted by the abuse of alcohol and other drugs by a family member.

In order to provide appropriate services to clients affected by substance abuse, social workers need to be knowledgeable about the differential impact of various substances on a person's mood and behavior, the progressive biopsychosocial deterioration resulting from dependence on such substances as alcohol, narcotics and stimulants; the value of the disease concept, including the nature of relapse; the crucial function of the defense of denial in addictions; motivational interviewing; and the impact of substance abuse on the family.

Social workers play a vital role in the assessment, motivational treatment, and referral of substance abusing clients and their families in various social, medical and occupational settings, and as providers of individual, group, and family treatment to clients in substance abuse specific settings. For example, after Jennifer was treated for her overdose, she was seen by the hospital social worker. Jennifer told the worker that her overdose was accidental. Although she admitted that her drinking has increased following the recent breakup with her boyfriend and the increased pressure at her job, she did not think that she had a substance abuse problem. Nonetheless, she accepted the worker's referral to a social worker in private practice who was experienced in working with substance abusers and who encouraged Jennifer to attend Alcoholics Anonymous meetings. A year later, Jennifer, totally abstinent from alcohol and sleeping medication, is actively involved in AA and is exploring switching careers by taking a social work course at a local university.

On the other hand, Maria is still struggling to stay drug-free by enrolling in a methadone maintenance clinic and seeing her social worker to discuss her feelings about being HIV positive, her grief and anger towards her dead boyfriend, and her struggles in parenting her three year old daughter. Through the help of another social worker running the parenting group, Maria is learning appropriate parenting skills and the value of peer support in her daily struggles to survive in a violent and unsupportive environment.

Meanwhile, Roger, mandated by the court to attend a series of psychoeducational lectures run by a social worker at a local alcoholism council, is slowly realizing that his drinking is more than "social", and that it may have played a role in his lack of promotion at work, and in his strained relationship with his wife as well as in the acting-out of his teenage son who is experimenting with various drugs when attending rave parties. After a brief individual session with the social worker following one of the lectures, Roger decided to talk with his wife and son about seeking family therapy at a family agency near their suburban home.

Lastly, the school social worker seeing Billy has not been able to get his crack-addicted mother to come to see her, but did get the mother to sign a release form allowing Billy to be evaluated for a possible learning disability and attention deficit/hyperactivity disorder. The worker also put Billy in her on-going group for children of substance abusing parents in which, through the use of multimedia activities and games, the children learn about the nature of drug addiction and how to identify and express their own feelings - including accepting their inability to "save" their parents from their dependence on drugs.

As can be seen in the above examples, social workers who are knowledgeable about substance abuse work in a variety of settings with highly diverse clientele. Such diversity makes it difficult to assess the full impact of managed care on substance abusing programs and clients.

The one area in which the impact has been most evident has been the rapid elimination of in-patient chemical dependency rehabilitation facilities. The traditional 28-day inpatient rehabilitation settings have been replaced by rapid detoxification and 7-to-14 day inpatient stays, making it difficult to provide optimal treatment in a safe environment - an issue of particular concern when dealing with substance abusers with a history of traumatization and who live in drug-infested communities. On the other hand, managed care has led to the growth of outpatient treatment facilities in many previously under-served communities. It also has resulted in increased attention to client satisfaction and treatment outcome research.

Working with substance abusing clients, social workers become skilled in many areas that are important and valued in an environment that emphasizes short-term, goal orientated treatment. These include: 1. Problem focused orientation; 2. Understanding the value of cognitive, behavioral and psychoeducational approaches to treatment; 3. Appreciating the multidimentionality of causation of problems, while helping clients assume responsibility for their own recovery; 4. Understanding the value of groups and peer support; 5. Understanding the impact of family systems on both addiction and recovery; 6. Appreciating the need to stay on top of the constantly changing environment and professional knowledge and skills, and finally; 7. Accepting their own limitations in helping people.

Although managed care is having a detrimental effect on many agencies and service providers, social workers trained in substance abuse continue to obtain jobs. While social workers have long been employed in alcohol treatment settings, the merger of New York State Divisions of Alcoholism and of Substance (Drug) Abuse Services, resulting in the recently instituted credentialing of drug abuse counselors, will further open the door to social workers in the heretofore para-professional field of drug abuse counseling. Social workers with good clinical skills combined with specialized knowledge of addictions are in a great position to provide challenging, yet highly gratifying, services in today's turbulent "real world" of social work practice.