Social Workers Should Be More Involved in Substance Abuse Treatment
Magura, Stephen, Health and Social Work
There are numerous reasons why substance abuse has emerged as a major concern in the United States. The widespread distribution and use of cocaine among all social classes and the introduction of crack cocaine during the 1980s clearly have alarmed our society; witness the many crack cover stories in the mass media and the creation of a national Office of Drug Control Policy. Illicit drug use and the associated drug trade are major contributors to crime and violence. Injection of illicit drugs is a major source of infection with the human immunodeficiency virus (HIV) in the United States. The various forms of substance abuse have other serious health consequences that contribute to the current cost crisis in the nation's health care system. Finally, alcohol and drug dependency are frequently implicated in individual and family dysfunction. Increases in substance abuse at all levels of society have made the roles of social workers and other helping professionals that much more complex and demanding.
As a volunteer on a citizens' panel reviewing foster care placements, I have been disheartened to observe the increasing numbers of children and families harmed by substance abuse. When I began as a reviewer in 1986, my impression was that substance abuse, mainly alcohol, came up rather infrequently in the agency's reports, whereas today substance abuse, often cocaine or heroin, seems to be involved in dose to one-quarter of the cases, including the especially sad situation of HIV-positive infants. The caseworker's usual recommendation is that the substance abusing parent or youth enroll in treatment. Certainly there is a great deal of implicit faith in treatment. But how effective are substance abuse treatment programs, and could the skills of social workers be better used to increase the programs' effectiveness? On any day there are at least 800,000 clients in about 9,000 substance abuse treatment units in the United States, with 45 percent of these clients receiving alcoholism services, 29 percent receiving drug abuse services, and 26 percent receiving both (U.S. Department of Health and Human Services, 1993). Little hard effectiveness data exist for most substance abuse treatment programs (methadone maintenance may be an exception), but few in the field would dispute that considerable room for improvement in client outcomes remains. It is no secret that client dropout rates are high for all modalities and that relapses are common even after treatment participation (Brownell, Marlatt, Lichtenstein, & Wilson, 1986; Hubbard et al., 1989; Marlatt & Gordon, 1985). Across all treatment programs nationally, 6 percent of total staff are social workers at the master's level or higher, including both administrators and direct care staff (U.S. Department of Health and Human Services, 1993). Social workers do not appear to be well represented in substance abuse treatment programs when one considers the problems of the client populations and the program functions that need to be performed. Expanding the participation of social workers in substance abuse treatment programs would improve the effectiveness of this vital service area. The rationale for such expanded participation includes improvement in direct services to clients, evaluation and accountability of programs, research on practice issues, and development of new treatment models. Alcohol- and drug-dependent clients have multiple emotional, family, interpersonal, and environmental problems. Any one of these problems may be a causal factor in substance abuse, may be a consequence of substance abuse, may coexist with substance abuse to complicate the situation, or may involve all of the above to some degree. Thus, a high degree of assessment and diagnostic skills are required to begin disentangling the client's situation and to develop a workable case plan. In addition, specialized training and skills are needed to implement a case plan successfully, which may involve such diverse tasks as serving as the overall case manager or providing individual or family psychotherapy. …