Preface
Prologue: Preparing Workers for a Response to the Challenges of ATOD
Ann A. Abbott

Chapter 1: Context of Practice: Myths, Realities, and Quagmires Related to Alcohol, Tobacco, and Other Drugs
Ann A. Abbott

Chapter 2: Selecting Perspectives and Theories for ATOD Practice
Gwenelle S. O’Neal

Chapter 3: Values, Ethics, and Ethical Dilemmas in ATOD Practice
Ann A. Abbott

Chapter 4: Dynamics and Physiology of Drug Use
Raymond Bolden, Jr.

Chapter 5: Tobacco Use and Nicotine Dependence
Raymond Bolden, Jr.

Chapter 6: The Challenges of Co-Occurring Disorders
Laura Blankertz and Gwenelle S. O’Neal

Chapter 7: The Journey of Planned Change
Sharon C. Lyter and Ann A. Abbott

Chapter 8: Assessment: Tools for Successful Navigation of Planned Change
Ann A. Abbott

• Appendix 8.1: Short Michigan Alcoholism Screening Test (SMAST)


• Appendix 8.2: Alcohol Use Disorder Identification Test (AUDIT)

Chapter 9: New Strategies for Intervention with Individuals
Langdon Holloway

Chapter 10: Group Strategies in ATOD Treatment
Sharon C. Lyter and Lloyd L. Lyter

• Appendix 10.1: The Twelve Steps of Alcoholics Anonymous


• Appendix 10.2: The Twelve Steps of Al-Anon Family Groups


• Appendix 10.3: Women for Sobriety: "New Life" Acceptance Program


• Appendix 10.4: Rational Recovery


• Appendix 10.5: SMART Recovery


• Appendix 10.6: Moderation Management


• Appendix 10.7: The Twelve Steps of Nicotine Anonymous

Chapter 11: Family Intervention Strategies
Steven M. Granich and Michael D. Paulus

Chapter 12: The Important Role of Prevention
David I. Siegel

Epilogue: Where Do We Go from Here? Confronting Upcoming ATOD Challenges
Ann A. Abbott

About the Authors
Author Index
Subject Index

This second edition of Alcohol, Tobacco, and Other Drugs: Challenging Myths, Assessing Theories, Individualizing Interventions is dedicated to the pioneers who helped make the first edition so successful: Christine Boyle, Sondra Burman, Irene Bush, Patricia C. Dunn, and Katherine M. Wood. A special note of recognition is directed to Eileen Corrigan, who served as principal investigator for a Rutgers University five-year (1990-1995) Faculty Development Grant from the Public Health Service, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, which served as a stimulus for faculty interest in the study of substance dependence and abuse. The sign of a good teacher such as Eileen is the far-reaching influence of her or his knowledge. Although Eileen died shortly after publication of the first edition, the majority of authors contributing to this second edition were influenced by her knowledge and enthusiasm for the topic, either as her colleagues or her students.

Special thanks are given to everyone who in a variety of ways contributed to this volume. Not only did the authors from the first edition and the current authors contribute to this volume, but numerous students, clients and consumers, and colleagues also added significantly to the depth and breadth of the discussion by raising questions, debating issues, analyzing theories, suggesting alternatives, and, perhaps most important, stimulating the authors to move forward with their work.

As editor, I offer my personal thanks and appreciation to my colleagues who gave their valuable time and wisdom to making this volume come to life. To Laura Blankertz, Raymond Bolden Jr., Steven Granich, Langdon Holloway, Lloyd L. Lyter, Sharon C. Lyter, Gwenelle Styles O’Neal, Michael D. Paulus, and David I. Siegel, you’re the best.

To my husband, Arthur C. Huntley, MD, who served as self-acclaimed assistant editor, chief critic, and major source of support, an A+.

I greatly appreciated being selected for sabbatical leave during fall 2008 by West Chester University of Pennsylvania to devote more time to the completion of this second edition. Without the extra time, this volume would have been an insurmountable challenge. Many thanks also go to the staff of NASW Press, in particular, Sarah Lowman, senior editor, for their patience, expertise, and support. None of your efforts went unnoticed.

Greatest thanks and admiration go to the many individuals who struggle daily with the challenges posed by alcohol, tobacco, and other drugs. They are the heroes and driving force behind this book. I truly hope the work presented here does justice to their daily struggles and unique needs.

Ann A. Abbott, PhD, LCSW (NJ), LCSW (PA)

Editor

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.

Social Workers are keenly aware of the challenges involved in the abuse of alcohol, tobacco and other drugs (ATOD) and the escalation of public and mental health problems as a consequence. Issues of co-morbidity saturate the burgeoning literature on this topic in social work and related fields. In Ann Abbott’s new book, we enter a lucid and timely discussion on ATOD that extends and broadens our professional knowledge in many important and compelling ways. It untangles realities from myths and assumptions that lead to inappropriate interventions. It provides significant insights into value/ethical challenges, and clarifies the bio, psycho-, and sociocultural issues that undergird substance abuse. It promotes a trans/theoretical perspective, and, most important, articulates a broad scope of intervention strategies that focus on different sized client systems. Alcohol, Tobacco and Other Drugs: Challenging Myths, Assessing Theories, Individualizing Interventions is truly a unique book that is a "must" for social workers who serve client population affected by these substances.

Paula Allen-Meares, PhD, MSW
Dean, Norma Radin Collegiate Professor of Social Work, School of Social Work
University of Michigan

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Alcohol, Tobacco and Other Drugs: Challenging Myths, Assessing Theories, Individualizing Interventions is a conceptually sophisticated text with penetrating observations on current policy dilemmas and emerging ATOD practice issues. Ann Abbott has assembled an outstanding group of social work scholars who offer pragmatic, cutting-edge perspectives on an often neglected field of professional practice.

Paul A. Kurzman, PhD, ACSW
Professor and Chair
Work, Employment and Rehabilitation Specialization
Hunter College School of Social Work

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Ann Abbott and her colleagues have produced a strong and eclectic collection of chapters on addictions. The authors comprehensively cover assessment, intervention, change processes, and prevention, as well as practice with individuals, families, and groups. Social work has long needed a textbook that integrates addiction policies, theories, practice, and research. This book is welcome and much-needed addition to the literature.

Joan Berzoff, EdD
Professor & Co-Director, Doctoral Program
Smith College School of Social Work

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Social work has relied too long on addiction theories grounded in the orientations of other disciplines. In doings, it inadvertently abandons its distinct value base and person-in-environment emphasis that is the profession’s unique strength. Alcohol, Tobacco and Other Drugs: Challenging Myths, Assessing Theories, Individualizing Interventions calls to our attention the necessity of a social work perspective for practice with clients who abuse information. This revealing volume is essential reading for social workers who practice in this area.

William A. Cloud, PhD
Associate Professor, Graduate School of Social Work
University of Denver

Ann A. Abbott, PhD, LCSW, professor and chair/director, Department of Graduate Social Work, West Chester University, served as editor for this second edition, having previously served as editor of the first edition, which grew out of a faculty development grant from the U.S. Department of Health and Human Services--Public Health Service, Substance Abuse and Mental Health Services Administration (DHHS-PHS-SAMHSA). Prior to her current position, Dr. Abbott was an associate dean and faculty member at Rutgers University, School of Social Work for 20 years. In addition to substance abuse issues, her interests include social work values and ethics, professional socialization, social worker safety, supervision, and risk management. Dr. Abbott is a past national president of NASW. Currently she serves on several social work editorial boards and on the board of the Eastern Evaluation Research Society.