The study of substance use treatment and prevention in social work practice can be a moving target in many ways. Pictured at left: Harm reduction as a strategy for confronting substance misuse gained momentum when widespread opioid addiction began sweeping through the American middle class in the 1990s, but some believe it may be even more effective with low-income, at-risk substance users.
“It’s an ever-evolving field because new problems, new issues emerge and require our response,” says Dr. Diana DiNitto, the Cullen Trust Centennial Professor in Alcohol Studies and Education at the Steve Hicks School of Social Work, University of Texas at Austin. Indeed, trendy drugs will suddenly appear, such as marijuana and LSD in the 1960s and 1970s, cocaine and crack cocaine in the 1980s, and heroin and opioids in the 1990s and 2000s. Nowadays the focus is on fentanyl and Xylazine, and recently returning in popularity are marijuana (this time fully legal in many states) and LSD.
Even so, alcohol and tobacco remain the biggest substance use culprits by far, says Dr. John D. Clapp, professor of social work and preventive medicine, University of Southern California. “All the other drugs combined wouldn’t equal one of those in terms of public health impact, with alcohol-related problems the third leading cause of death globally.”
Course Correction
USC has the MSW course “Substance-Related and Behavioral Addictive Disorders”—which also covers treatment—and a master’s in addiction science, whose courses MSW students can take as electives. The University of Texas at Austin has a new MSW certificate program—“Social Work Practice in Substance Use Disorders”—and two dedicated MSW electives.
At Sacred Heart University in Fairfield, Conn., substance use disorder is briefly covered in social work practice courses, says associate professor Dr. Victoria Osborne, “but there’s only one dedicated MSW course—‘Mental Health and Addictions.’”
Since more and more social work schools are doing away with MSW concentrations, students interested in substance use disorder will often take related courses in other disciplines, as at USC. When North Carolina social worker Jessica Holton, MSW, LCSW, LCAS, was getting her MSW at East Carolina University, the program didn’t have much in the way of substance use disorder education, so she got a certificate toward becoming a licensed clinical addiction specialist (which is in fact mandatory for doing any substance use counseling in North Carolina). Pictured at right: North Carolina social worker Jessica Holton presents at the North Carolina Foundation for Alcohol and Drug Studies Winter School Conference in February 2020.
Saying No to ‘Just Say No’
However they get their substance use disorder education, one thing social work students will learn a lot about now is harm reduction. Back in the 1980s, the mantra from the Reagan White House on drug use was “Just Say No.” Yet many clinicians, counselors and educators have long had other ideas about that, not only because sudden abstinence can cause mental or physical damage, even death, but also because often, it simply doesn’t work.
The No. 1 priority is making sure the user doesn’t die, says practitioner Holton, who does an intensive, three-hour client assessment covering every substance ever used, amounts, frequency, age of onset, any trauma, possible abuse. Then it’s up to the client. “And if their goal is not abstinence, then we’re not going to focus on abstinence. We’re going to focus on, ‘Can you drink maybe four beers instead of six beers when you get home?’” Pictured at left: Members of the Health Behavior Research and Training Institute at the Steve Hicks School of Social Work at the University of Texas at Austin discuss plans for a student training event on motivational interviewing.
When the opioid crisis—stemming in large part from over-prescription of legal medication—broadly hit the U.S. middle class, it involved people who weren’t thought of as drug users and helped propel harm reduction as an option, says Dr. Bridget Freisthler, professor at the College of Social Work, Ohio State University. “So if a star football player is having a substance use problem because of pills, that’s treated differently than someone who’s living in poverty.”
Nevertheless, Katie A. McCormick, a social work doctoral candidate at the University of Texas at Austin, now sees harm reduction as key to serving marginalized and vulnerable communities as well. “It’s a movement for social justice that prioritizes people who use drugs,” she says. “It’s also a range of person-centered services, policies and strategies that aim to reduce drug-related harm by employing such tools as syringe programs and fentanyl testers.”
Cultural Ties
As with other areas of social work, educators stress cultural humility in the practice of substance use treatment and prevention. Says Osborne, “The mission of the [Sacred Heart University] School of Social Work has an antiracist perspective, and we really strive to ‘walk the talk’ not only about racism but all the ‘isms’—sexism, ageism, ableism.” Pictured at right: NASW has long been active on the substance use treatment and prevention front with policies, booklets, a special credential and other efforts.
Honoring religious sensibilities and differences is also emphasized, Osborne adds. For example, Mormonism, the Baháʼí Faith and Buddhism strictly forbid alcohol or drug use except by doctor’s prescription. On the other hand, according to a 2020 Medical News Today article, more than 40 Indigenous tribes in the U.S. and Western Canada still follow their tradition of using the hallucinatory drug peyote in religious ceremonies.
And the culture doesn’t even have to be about race, ethnicity or religion, says Holton. It can also be about family. She had a cannabis-using client whose whole family would smoke marijuana together when he was a teenager. “So something I had to keep in mind was his family culture and whether or not he wanted to quit and whether or not that was a goal.”
Substance Use Disorder and Social Work: Innovative Research
Sudden developments in substance misuse, like the scourge of crack cocaine in the 1980s and of opioids in the 1990s and 2000s, wreak havoc in many realms, including social work education and research. “What makes it a little difficult is when something new comes out, oftentimes the data lags behind the media,” says Dr. John D. Clapp, professor of social work and preventive medicine, University of Southern California. “So trying to have the course research-based or evidence-based becomes a challenge.”
Still, comprehensive research continues, targeting such dramatic developments and many other substance use topics. At Ohio State University, for instance, Dr. Bridget Freisthler, professor at the College of Social Work, teaches an honors student research course that involves a study called “Observations of Public Drinking,” where students “get a sense of what it’s like, who’s there, who’s drinking and other behaviors.” Pictured at left:At the Ohio State University College of Social Work, professor Bridget Freisthler (left) and undergraduate Ciera Feucht review data from the “Observations of Public Drinking” study, part of an honors student research class Freisthler has taught.
And at the University of Texas at Austin, social work doctoral candidate Katie A. McCormick, for her dissertation, explored how the increasingly popular strategy of harm reduction is affecting harm reduction workers themselves. “They’re operating under nearly insurmountable stress and are often exposed to considerable amounts of trauma and adversity,” she says. “And this can have lasting and negative effects on their own health and well-being, not to mention their clients’.”
Following are examples of published research on substance use disorder:
- “Associations of Healthcare Service Utilization with Cannabis Use Status, Use Reasons, and Use Characteristics Among Those Age 50 and Older” by Namkee G. Choi, Diana M. DiNitto, C. Nathan Marti and Bryan Y. Choi
- “Harm Reduction in the Social Work Practice” by Kayla Lessard
- “Parenting Attitudes and Behaviors Among Parents Involved With the Child Welfare System and Affected by Substance Use Disorders” by Susan Yoon, Alexa Ploss, Margaret Hutzel, Robin Webb, Ally Hatfield, Joyce Y. Lee, Additti Munshi, Angelise Radney and Jen McClellan
- "Profiles of Behavior Change Constructs for Reducing Alcohol Use in Women at Risk of an Alcohol-Exposed Pregnancy” by Kirk von Sternberg, Carlo C. DiClemente and Mary M. Velasquez
- “Unpacking the Parallel Effects of Parental Alcohol Misuse and Low Income on Risk of Supervisory Neglect” by Margaret H. Lloyd and Nancy Jo Kepple
- “Utilizing Screening, Brief Intervention, and Referral to Treatment: Teaching Assessment of Substance Abuse” by Victoria A. Osborne and Kalea Benner