Alcohol, Tobacco, and Other Drugs

Challenging Myths, Assessing Theories, Individualizing Interventions, 2nd Edition

Preparing Workers for a Response to the Challenges of ATOD

Ann A. Abbott

Most, if not all, social workers will encounter some forms of evidence of the effects of alcohol, tobacco, and other drugs (ATOD; whether illegal, prescribed, or over the counter). The evidence will take many forms, ranging from drug dependence, to alcohol abuse, to problematic use, to intentional or unintentional misuse, to secondary impact on innocent family members, to neighborhood fear, to crime, to child abuse or neglect, to domestic violence, and the list goes on.

The demographics presented in this volume support the fact that the effects of ATOD collectively compose one of the major social problems confronting society today (National Association of Social Workers [NASW], 2009). NASW has recognized the magnitude of the problem in a public social policy statement indicating to the professional community and policymakers the severity of the role that ATOD plays in the lives of society and, more specifically, social work clients.

It is one thing to recognize a problem; the more important issue is developing avenues for addressing the problem. NASW, in addition to the public social policy statement, has developed a specialty practice section (SPS) designed to facilitate communication and skill development among social workers dealing with clients and their families, all of whom are experiencing firsthand the ravages of substance abuse. The ATOD SPS produces frequent newsletters designed to exchange ideas and introduce best practices among section members. Members of NASW have also developed a set of standards to serve as performance expectations for those members working in the area of substance abuse treatment (NASW, 2005).

The Council on Social Work Education (CSWE) recently increased its emphasis on the importance of accredited social work education programs teaching content relevant to ATOD, including assessment, intervention, practice evaluation, advocacy, program development, and policy analysis (CSWE, 2008).

This second edition was written in response to growing demand for social workers to address problems stemming from ATOD. The demand is driven by an increase in client use of ATOD, increased recognition of clients who present with co-occurring disorders (a substance-related problem coupled with a mental health problem), and professional emphasis on best practices and evidence-based practice. This volume was written to increase knowledge for beginning professionals and update best practices for seasoned professionals.

The ongoing debate about the preferred use of the terms “substance abuse” and “substance misuse” continues. For purposes of this second edition, “misuse” will be used to denote problematic or inappropriate use of a substance, for example, use of OxyContin for recreational purposes and not for pain relief as originally prescribed, or increased use beyond dosage recommended by the prescribing physician. “Abuse” will be used to denote “the use of a drug in such a manner or in such amounts or in situations such that the drug use causes problems or greatly increases the chances of problems occurring” (Ksir, Hart, & Ray, 2008, p. G5), for example, drinking alcohol on a daily basis to the point of inebriation or interference with daily responsibilities or obligations. The authors have chosen to use the terms abuse and dependence as defined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) (American Psychiatric Association, 2000). Throughout the book, the acronym ATOD is used both as a noun, for example, the impact of ATOD use, and as an adjective, for example, ATOD misuse or abuse.

The purpose of the book is to provide the reader with an overview of the problems associated with ATOD and an understanding of the effects of ATOD use, abuse, or misuse, not only on client performance and behavior, but also on families and significant others. The authors also examine a variety of models or strategies to address ATOD abuse and the problems accompanying it. The book builds on a systems or ecological perspective incorporating a bio-psycho-social-cultural-spiritual approach to guide both assessment and intervention. It expands on information included in the first edition by addressing more recent demographic data, greater emphasis on the importance of cultural competence and understanding the role of culture in both dynamics and treatment, and current evidence-based and best practices. New developments, since the first edition, include not only much greater recognition of evidence-based practices, but also new understanding in the areas of tobacco and in the recognition and treatment of co-occurring disorders. Content on best practices is interspersed throughout the book; content on tobacco and co-occurring disorders, although mentioned throughout, is highlighted primarily in two distinct chapters. More is now known about the important role of prevention and, thus, more emphasis is directed to recognizing its importance.

The growth and influence of the Internet has exploded since the first edition. As a result, much information, including sources of demographic data, governmental reports, assessment instruments, program protocols, and research findings, is now available at the touch of a key. Use of the Internet as a major tool is evident in the references and noted resources.

As noted in the Preface, the first edition grew out of a five-year (1990–1995) faculty development grant sponsored by the U.S. Department of Health and Human Services, in particular the Public Health Service and the Substance Abuse and Mental Health Services Administration. The grant provided funding for five social work educators to participate in concentrated study, clinical experience, and curriculum development in the area of ATOD. Three of the original five educators developed material for the first edition, and all served as mentors for the majority of authors participating in the second edition. It is safe to state that the intent of the grant has been achieved, with the editor being one of the original five and eight out of the nine other authors having been influenced by one or more of the original grantees.

The original grant contained a research component that clearly illustrated that, given appropriate knowledge and opportunity, social workers can learn to be more effective in helping clients, agencies, and service providers address substance-related problems and treatment issues. This volume is intended to continue the expansion of knowledge and positive outcomes in addressing ATOD issues.

This second edition reflects the professional experience and knowledge of 10 social workers who collaborated on developing a vehicle for helping other professionals gain a better understanding of the dynamics and complexities associated with ATOD.

Chapter 1 presents an overview of the context of ATOD practice—its challenges, existing myths, partial truths, exaggerations, and quagmires confronting workers in the field. Chapter 2 presents criteria for assessing the theories proposed for guiding practice related to ATOD issues. In addition, it focuses on a systems perspective and problem solving as important guides for successful practice.

Chapter 3 emphasizes the importance of recognizing values in working with clients struggling with substance-related issues and identifying ethical dilemmas that surface in working with a variety of professionals in addressing ATOD issues. This chapter also presents several formats for analyzing and addressing ethical dilemmas.

Chapter 4 delineates the dynamics of alcohol and other drug use. It contains information about the range and impact of various substances. Chapter 5 does the same for tobacco-related substances. This enhanced emphasis on tobacco is new to the second edition and is consistent with the increased recognition of the problems that use of tobacco poses for members of society.

Also new to the second edition, is the content of Chapter 6, which focuses on the dynamics and challenges of co-occurring disorders. This chapter addresses not only the complexity of identification and treatment issues, but also the role of stigma and the challenges of reshaping existing mental health and substance abuse treatment systems to accommodate the new focus on integrated treatment.

Chapter 7 addresses the journey of planned change, focusing on the challenges of how one proceeds from denial to embracing change. Chapter 8 provides guidance for facilitating planned change by assessing client needs, including useful instrumentation for supplementing the content gained from interviews with clients and their significant others, often including family.

Chapters 9, 10, and 11 focus on specific strategies to facilitate planned change. Chapter 9 introduces the reader to new strategies of intervention primarily used with individuals. Chapter 10 focuses on group strategies of intervention, which include self-help groups and professionally led interventions. Chapter 11 informs the reader of best practice with both family members who are using substances and those who are affected by the use of substances by other family members.

Chapter 12 focuses on the important role of prevention. It highlights the positive impact of a number of programs that have been helpful in reducing the use of substances or the severity of use.

The epilogue summarizes the content of the volume, but more important, identifies the wave of the future. The field of ATOD is a vibrant, vital one that is definitely not static. New ideas are surfacing daily and new trends are being born as this book goes to press. The wave of the future seeks the input of everyone involved in the field—consumer and client, family member, practitioner, researcher, policymaker, agency administrator, educator, and government official. Together, we must commit to greater understanding of the dynamics associated with ATOD use, abuse, and misuse; the role of drug treatment; law enforcement; international drug trade; and the importance of education and prevention. The scope of the emotional and financial impact is tremendous. It is the hope of the authors that this volume will be a start in preparing readers to enter the debate and to become better prepared practitioners, better researchers, and informed contributors to enhance programs, interventions, and solutions to a major social problem.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Council on Social Work Education. (2008). Educational policy and accreditation standards. Alexandria, VA: Author.

Ksir, C., Hart, C., & Ray, O. (2008). Drugs, society, and human behavior (12th ed.). Boston: WGB/McGraw-Hill.

National Association of Social Workers. (2005). NASW standards for social work practice with clients with substance use disorders. Washington, DC: Author.

National Association of Social Workers. (2009). Alcohol, tobacco, and other substance abuse. In Social work speaks: NASW policy statements, 2009–2012 (8th ed., pp. 29–37). Washington, DC: NASW Press.