AN ONGOING PERVASIVE CHALLENGE
The matrix of substance misuse knows no ethical, social, gender, racial, economic, or geographical borders (Abbott, 2000, 2002). When pondering the enormity of its challenge, it is easy to describe its magnitude as being even more monumental than that confronting little Hans trying to stop the force of the ocean by putting his tiny finger in a hole in the dike. Its treatment at times is deemed as being more difficult than managing to dance on the head of a pin. Despite the power of the water or the need for skillful balance, we cannot become discouraged by its strength or the pervasive need for coordination. As Glen Hanson (2002a), acting director, National Institute on Drug Abuse (NIDA), noted in a recent editorial, substance abuse demands a multifaceted approach:
Researchers focus on outcomes, while treatment providers promote recovery: clinicians work one-on-one to make a difference for individual patients, while researchers tend to compare the experiences of groups, looking for widely applicable insights into drug abuse and its treatment; the time frame in the clinic is as immediate as human emotion or personal emergency, while research--of necessity--moves painstakingly toward the goal of advancing human understanding to realize future improvements. (p.2)
Social workers must join ranks with other caring professionals and continue to chip away at the micro level by helping clients stave off or minimize their personal pain, and at the macro level by joining the research army in identifying the scope of the problem and the effectiveness of various interventions. We must recommit to our role as advocates, recognizing the importance of social policy, empowerment, and political action. Every time the hole in the dike gets bigger, the tide begins to turn, or we fall off the head of the pin, we must be ready with new strategies, renewed strength, and different dance steps to continue on our slow, but important, journey.
LEARNING THE LAY OF THE LAND
We know the magnitude of the problem (Abbott, 2000, 2002), and each day we discover new obstacles or detours challenging our progress. The impact of September 11,2001, resulted in major shifts with serious increases in depression, posttraumatic stress disorders, substance misuse, and a pervasive sense of threat to personal security (Leshner, 2001; Strozier & Shafer, 2002; Williams, 2002). As a result, an already overburdened delivery system has been challenged beyond previously imagined levels. The financial tidal wave emanating from the horrific series of events resulted in a gross reduction of resources, accompanied by an increase in unemployment and a decrease in the well-being that accompanies financial security and personal work satisfaction. The shredding of our social safety nets, especially economic-and health-related ones, has also contributed to our decreased sense of security and well-being.
Before September 11, problems of substance misuse already were of serious magnitude. More than 100,000 lives had been lost each year because of alcohol misuse. Nearly $184.6 billion, or about $638 for every man, woman, and child in the United States, were spent annually because of alcohol misuse (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2000). Fourteen million Americans, or 7.4 percent of the population, met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) criteria for alcohol abuse or alcoholism; in almost one of four instances of violent crime, the offender had been drinking before committing the crime; in 1997, traffic accidents involving alcohol resulted in more than 16,000 individual deaths (NIAAA).
The data are equally staggering for drug abuse. Nearly 15 million Americans reported using illicit drugs at least once in the month before being surveyed; 3.5 million of them were identified as being dependent on illicit drugs. Alarmingly, these figures did not include misuse of or dependence on prescription or legal drugs (Substance Abuse and Mental Health Services Administration, 1999). …