This article describes the results of an assessment of the substance abuse treatment training needs of social workers working in randomly selected substance abuse treatment facilities in New England. This assessment revealed that clinical supervision related to substance abuse treatment had not been available to a significant percentage of the respondents throughout their careers. Despite limited previous training experience and considerable barriers to current training, social workers surveyed in this study reported significantly higher levels of knowledge and skill than other substance abuse treatment providers in 10 of 12 substance abuse treatment areas investigated. Despite these high levels of knowledge and skill, respondents reported considerable need for and interest in additional substance abuse treatment training. This study identified the areas of assessment, advanced clinical techniques, and dual diagnosis as priorities for future training among social workers working in substance abuse treatment facilities.
Key words: addiction; needs assessment; social work practice; substance abuse treatment; training
Because substance abuse is so widespread, social workers in most settings routinely come in contact with clients who have substance abuse problems. In many cases social workers may be the first service providers to have contact with substance abusers through major service delivery systems, such as child welfare, family service, employee assistance, schools, programs for the elderly, and community-based multiservice centers. Social workers also serve in key assessment and referral roles in many health and mental health settings.
These situations provide social workers with the opportunity to identify substance abuse problems among clients and to provide or arrange for appropriate treatment. However, social workers often have had little or no training in the delivery of substance abuse treatment (Einstein & Wolfson, 1970; Schlesinger & Barg, 1986). Lack of training of social workers may limit substance-abusing clients' access to appropriate and effective treatment and intervention. Because at least half of all hospitalized patients in urban areas have substance abuse-related problems and $240 billion of the nation's health care costs are associated with substance abuse and dependence problems, the current health care system would benefit from the development of more efficient methods of delivering substance abuse treatment services. Social workers trained in addictions would likely benefit clients in particular and the health care system in general.
Social Workers and Substance Abuse Treatment
Evidence indicates that, historically, social workers have received little training with regard to substance abuse in degree programs. For example, Einstein and Wolfson (1970) revealed that only 7 percent of the undergraduate social work programs included training in the treatment of alcoholism. Similarly, Schlesinger and Barg (1986) reported that 8 percent of the didactic content in graduate schools of social work was devoted to substance abuse and that 45 percent of the training in substance abuse treatment services was elective. Schlesinger and Barg summarized their findings by pointing out that "the amount of exposure to substance misuse which health care practitioners receive in their training may not be commensurate with the extent to which such misuse influences the health of their prospective patients" (p. 601).
As might be expected, the literature addressing the topic of substance abuse assessment, treatment, and referral by social workers focuses mainly on the shortcomings of social workers in these areas. For example, in a study by Googins (1984), only 40 percent of the randomly selected social work agencies surveyed included questions related to the drinking history of the client or the client's family as part of the intake procedure. Similarly, in a study of social workers' case records, Kagle (1987) reported that in 30 percent of cases reviewed, social workers recognized substance abuse as a problem but did not attempt to intervene with counseling or referral. Peyton, Chaddick, and Gorsuch (1980) revealed that 34 percent of the graduate social work students surveyed had a significant bias against working with clients with alcohol problems and that only 43 percent of the students reported that they were willing to treat alcoholic clients.
A number of review articles focusing on substance abuse-related training and skills among social workers support these findings. For example, Alaszewski and Harrison's (1992) literature review addressed the gap between substance-abusing clients' needs and the services commonly provided by social workers and discussed problems that contributed to this gap, such as stereotypes held by social workers of substance-abusing clients, social workers' lack of training in assessment, and social workers' pessimism about clients' ability to recover. King and Lorenson (1989) addressed the reasons traditional social work approaches fail to identify or provide effective treatment for substance-abusing clients and stressed the importance of substance abuse credentialing for social workers. Similarly, van Wormer (1987) discussed the need for more training in substance abuse for social workers.
Despite these efforts to assess substance abuse treatment training needs indirectly by examining the content of training programs, few studies have assessed directly the specific treatment skills and training needs of substance abuse treatment providers working in the field; this paucity of data exists among social workers in particular. Furthermore, to the authors' knowledge, there have been no random, regionally representative studies of the training needs of substance abuse treatment providers before now and only a few nonrandom studies that have specifically addressed training needs among social workers.
This article presents data from the first region-wide needs assessment conducted among randomly selected substance abuse treatment providers working in licensed substance abuse treatment facilities. Data are derived from the Addiction Technology Transfer Center of New England Needs Assessment Survey, which served as the needs assessment component of Addiction Technology Transfer Center of New England (ATTCNE). ATTCNE is one of 11 addiction technology transfer centers established throughout the United States by the U.S. Department of Health and Human Services Center for Substance Abuse Treatment, to improve clinical training in the addictions. This article Investigates issues related to social workers and substance abuse treatment by examining the previous substance abuse treatment training of a representative group of social workers working in licensed New England substance abuse treatment facilities, substance abuse treatment knowledge and skill among this sample, and interest in future training among socia l workers in this sample. The last two are investigated by comparing social workers with other dedicated substance abuse treatment providers in the New England sample.
Sampling Strategy for Identifying and Selecting Survey Respondents
The aim of the ATTCNE needs assessment project was to survey a random sample of substance abuse treatment …