Role of Addiction Counselors in Community Prevention Programs free essay sample

Secondary prevention uses approaches available to individuals and populations for early detection within high-risk groups and prompt and effective intervention to correct or minimize alcohol abuse in the earliest years of onset. Tertiary prevention consists of measures taken to reduce existing impairments and disabilities and to minimize suffering caused by alcohol abuse. INTRODUCTION: Social workers play vital roles in assisting individuals, families, schools, workplaces, and communities to address addictions. Addictions affect people from all walks of life, and social workers in virtually all practice areas see people with these problems. Addiction is described as impulse-control disorders or compulsive (repeated) behaviors that can cause psychological, social, and sometimes physical harm, such as gambling, overeating, sex, Internet use, and shopping. Addictive disorders, broadly defined, often co-occur. For example, many pathological gamblers have alcohol use disorders (Center for Substance Abuse Treatment, 2005). In addition, a person trying to control one addictive disorder may develop another in its place. Addictive or impulse-control disorders also often co-occur with depression or other mental disorders. Social workers see individuals with addictions or impulse-control disorders in many settings. For example, social workers help parents with alcohol and drug problems in the child welfare system, and they often treat individuals who gamble pathologically as a condition of deferred adjudication for Addictions and Social Work Practice. Social workers employed as supervisors or agency administrators are also responsible for employees who come to work intoxicated or have other addictive disorders that interfere with their work. Social workers may also see colleagues impaired by these problems. In all these sit- uations, social workers need to be able to identify problems and intervene. The public generally considered alcoholism a sin or moral problem. Mary Richmond, a notable Charity Organization Societies leader, had a more enlightened view. She referred to â€Å"inebriety† as a dis- ease, encouraged early identification and treatment, and developed an alcoholism assessment instrument that contains items that social workers today continue to use. In these early days of the profession, social workers often addressed alcohol problems through the temperance movement and their work in public welfare, child welfare, and the workplace, but few alcoholics received direct help. Many died early or were confined in men- tal institutions, jails, or prisons because professionals knew little about how to treat them or had little interest in helping them. WHAT CAUSES ADDICTIONS AND OTHER COMPULSIVE BEHAVIORS? The causes of addiction or impulse-control disorders are widely debated (McNeece DiNitto, 2005). Many people have strongly held views about what causes these problems. Social workers should carefully examine their personal views of these problems before proceeding to help clients. Some people see addictions as moral problems that result from a lack of willpower or the wanton acts of individuals unwilling to change and become responsible citizens. Others see them as a lifestyle or conscious choice and believe that if individuals choose to engage in these behaviors, they can choose to stop. Many individuals with alcohol or drug disorders have a family history of these problems, suggesting a genetic predisposition. Growing evidence indicates that genetics and abnormal neurotransmitter systems (brain chem- istry) play a part in substance use disorders (National Institute on Alcohol Abuse and Alcoholism, 2000). Many report that using alcohol and drugs makes them feel â€Å"normal. † Alcohol and drug consumption in sufficient quantities and over a period of time can alter brain chemistry and promote continued use. Abnormal brain chemistry has also been identified in some pathological gamblers (American Psychiatric Association, 2000). Social workers need information about brain chemistry and medication use in treating these problems. What Causes Addictions and Other Compulsive Behaviors? 177 Chapter 08 7/13/07 3:22 PM Page 177 Having parents, grandparents, or other relatives who have had alcohol or drug disorders may suggest a biological predisposition to these prob- lems. It may also mean that using alcohol or drugs to deal with life is a learned behavior. In addition to learning theory, personality theories have been used to explain substance use and other impulse-control disorders. Prevention Many social workers enjoy working with children. Children are the focus of many efforts to prevent addictive behaviors, and school social workers are often involved in delivering prevention programs. For example, SAMHSA offers information on evidence-based prevention programs targeted to chil- dren of different ages and ethnic backgrounds. Adults also need prevention or health promotion programs. Social work- ers in public health practice and other medical and social service settings help adults recognize early indicators of alcohol and drug problems or overeating before they develop into full-blown problems, encourage them to adopt healthier habits, and instruct them on how to do so. Social work- ers have become increasingly involved in developing adult prevention pro- gramming that is culturally relevant and age appropriate. Screening and Diagnosis Social workers in nearly all practice areas need skills to screen for the problems discussed in this chapter and refer to treatment providers. Screening tools are generally short questionnaires administered by the social worker or completed by the client. There are many alcohol- and drug-problem screening tools. For example, the CAGE is a four-item screening device for alcohol problems that social workers can administer in less than a minute (Ewing, 1984). But helping requires more than a ing clients questions about whether they have tried to reduce their drink- ing or have felt guilty about their drinking. Developing rapport, asking questions in a nonjudgmental way, and ensuring confidentiality (to the extent possible) are also important. Social workers also use questionnaires or inventories based on DSM criteria, such as the South Oaks Gambling Screen, to help screen clients for gambling problems (Lesieur Blume, 1987). Social workers assess the validity and reliability of screening and diag- nostic tools and select those appropriate for their clientele based on age, gender, ethnicity, and whether the client has a disability. For example, the South Oaks Gambling Screen has adult and adolescent versions. The Problem Oriented Screening Inventory for Teenagers screens for alcohol and drug problems as well as social, behavioral, and learning problems (Winters, 1999). The Alcohol Use Disorders Identification Test is available in several anguages and can be adjusted for drinking norms in different cultures (Babor, Higgins-Biddle, Saunders, Monteiro, 2001). You can search the Internet to learn about tools for helping people consider whether they are overeaters, sexually compulsive, or have other problems, but they may not have been subjected to reliability and validity testing. Screening may suggest an individual has a particular problem, but the social worker needs additional knowledge and skills to support or confirm a diagnosis. Social workers must usually have a master’s degree and cre- dentials such as a clinical license to make diagnoses. A clinical license may also be required to obtain payment for making diagnoses and providing treatment Brief Interventions Brief interventions can take many forms, such as having clients attend one or several short counseling sessions, asking clients to read educational materials and keep logs to monitor their behavior (e. g. , number of drinks consumed; cigarettes smoked; amount of time or money spent gambling, shopping, or using the Internet), and providing cards to remind clients what to do should alcohol or drug cravings or urges to gamble, eat, or engage in compulsive sexual behavior occur. Research indicates that brief interven- tions are often, but not always, effective in reducing risk drinking (National Institute on Alcohol Abuse and Alcoholism, 2000). It may be a sign of the times and current insurance policies that brief interventions are now used to address many problems discussed in this chapter, particularly those that have not reached very serious proportions. One framework for brief interventions is the FRAMES approach, which stands for giving feedback to the client on his or her problem behavior such as exceeding safe drinking limits or screening positively on the South Oaks Gambling Screen), recognizing the individual’s personal responsibili- ty to change, providing clear advice about how to alter the behavior of con- cern, offering a menu of choices about how to change, counseling in a warm and empathic way, and emphasizing self-efficacy —that the client can do it (Miller Sanchez, 1994). Social workers delivering brief interventions also hel p clients establish goals for behavior change, follow up to assess progress, and provide ongoing encouragement. Of course, some clients need interventions that are more intense or of longer duration Motivational Enhancement Therapy Approaches more consonant with social work practice have replaced the heavy confrontation once used in alcohol and drug treatment programs. Research suggests that alcohol and drug therapists’ interpersonal skills are key factors in treatment effectiveness (Najavits Weiss, 1994). Among the approaches that stress a supportive, empathic counseling style are motiva- tional interviewing and motivational enhancement therapy (Miller Rollnick, 2002). Motivational enhancement therapy is usually short term and can be applied to a variety of problem behaviors (Center for Substance Abuse Treatment, 2005). The therapist helps the client weigh the advantages Evidence-Based Addictions Practice 181 Chapter 08 7/13/07 3:22 PM Page 181 and disadvantages of changing (decisional balance) in order to resolve the client’s ambivalence about changing. Motivational approaches can help move clients along the stages of change, from precontemplation , where they may not recognize a problem â€Å"I drink like everyone else,† â€Å"I can control my gambling†) or its cause (â€Å"I wouldn’t drink like this if my work weren’t so stressful†), to contemplation , where they recognize the problem and consider changing, to preparation , where they make plans to change, to action , where they make behavioral changes, and maintenance , where they continue to change and prevent relapse (Prochaska, DiClemente, Norcross, 1992). Depending on the stage of the intervention and the individual client, social workers may use education, consciousness-raising, role-playing, positive reinforcement (e. g. rewards), community involvement, and many other techniques to help clients move on in the process of change Relapse Prevention Individuals usually make more than one serious attempt before they suc- cessfully abstain from alcohol or drugs, quit smoking, stop gambling, or reduce other behaviors to nonproblem levels. Those in recovery from alcohol. hol dependence often say, â€Å"It is easier to get sober than to stay sober. † People who have lost weight know how easy it is to regain weight. Lifelong work is often needed to remain free of an addictive or compulsive behavior. Lifestyle changes are generally needed. Many individuals do not sustain the desired change indefinitely, but social workers continue to help them achieve pro- gressively longer periods of abstinence or other desired behaviors. Some professionals may be dissuaded from specializing in addictions practice because they perceive clients’ resistance to be strong and relapse rates to be high. Treatment compliance and relapse in clients with alcohol disorders are similar to treatment compliance in individuals with other chronic illnesses like type 2 diabetes, hypertension, and asthma (McLellan, Lewis, O’Brien, Kleber, 2000). Helping clients prevent relapse is an important task. Social workers use relapse prevention approaches to help clients identify triggers, or high-risk situations, for problem behavior and ways to avoid or defuse these situations and adopt healthier lifestyles (Marlatt Gordon, 1985). For example, socializing with old buddies may be a trigger for drinking for one client, or failed relationships with men may be a trigger for shopping sprees for another. Social workers help clients avoid triggers and make plans to adopt other behaviors in their place— counting to ten and going for a walk, exercising, talking with friends, or engaging in other healthy and rewarding behaviors Social Workers and Mutual-Help Groups Some individuals recovering from addictive disorders utilize professional assistance; others utilize mutual-help groups; some use both. In 1935, a stockbroker and a doctor both struggling with alcoholism founded Alcoholics Anonymous. The number of AA groups has grown tremendous- ly. Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, Gamblers Anonymous, Overeaters Anonymous, Sexual Compulsives Anonymous, and Debtors Anonymous are all patterned after AA. These are all twelve-step programs that have a spiritual orientation and make refer- ence to God. The Lord’s Prayer is generally recited at meetings. Atheists, agnostics, and those of non-Christian religious persuasions have recovered through twelve-step programs, perhaps due to the camaraderie and sup- port. Those who do not want a spiritually based program may prefer pro- grams like Secular Organizations for Sobriety or Rational Recovery. The loose organization and emphasis on voluntary participation and anonymity make studying mutual-help groups’ effectiveness difficult, but many individuals attribute their recovery to these programs. Some clients need a relatively short course of professional treatment and use one or more of the many mutual-help groups for longer-term assistance. Others report that they do not find these groups useful. While many social workers embrace these groups, others have a more reserved view of them and for whom they may be most helpful. Since little hard research is available, social workers need to learn about mutual-help groups and attend meetings before they make their own judgments. Many groups have open meetings where professionals and other visitors are welcome. Social workers generally educate clients about mutual-help groups; sug- gest they attend; and consider which, if any, they might find useful. Social workers also keep group literature and Internet addresses handy for clients. Mutual-help group members may offer help that professionals do not pro- 186 Chapter 8 Addictions and Social Work Practice Chapter 08 7/13/07 3:22 PM Page 186 vide and may be available at times when professionals are not. Some AA groups operate clubs that are open twenty-four hours a day, seven days a week. Many mutual-help groups have twenty-four-hour phone lines or answering services. Continued attendance at meetings may help avert relapse UTURE OF ADDICTIONS PRACTICE AND SOCIAL WORK Social workers specialize in addictions practice for many reasons, includ- ing the challenge of the work (DiNitto, 2007). The field needs social work- ers’ systems and strengths perspectives to develop new and improved approaches that will prevent people from developing addictions, motivate those with addictions to enter treatment, and produce better treatment results. Social workers are also needed to press for policy changes that will increase treatment access and promote more rational and effective approaches to drug offenders and others with impulse-control disorders and compulsive behaviors. SUMMARY Social workers play important roles in addressing addictions. Some do this by specializing in addictions prevention or treatment. Others work in set- tings like probation, corrections, child welfare, emergency rooms, and col- lege campuses, where alcohol and drug problems are prominent and inter- ventions must be conducted or service referrals made. Others are employe in medical settings where patients present with conditions like diabetes related to being overweight and with lung cancer, emphysema, and other health problems caused by smoking. Many of them need social work ser- vices as well as health care. In addition to developing skills in screening, intervention, and treatment, social workers can work to ensure that every- one with an addictive disorder, broadly defined, has access to affordable and effective treatment. More social workers are needed to address the growing problem of addictions.