Current research has determined that a larger percent of social workers and other counselors are affected by PTSD types of symptoms when working with traumatized clients than the general population. While much of this research addresses workers in specific trauma areas like sexual assault centers or child welfare agencies, little specific thought has been given towards the special stress that working with Substance Abuse Disorders (SA) and trauma may present. This paper takes a brief look at the issues of vicarious trauma and compassion fatigue with SA practice and describes future investigation pathways toward this goal.

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The Unbearable Fatigue of Compassion: Notes from a Substance Abuse Counselor Who Dreams of Working at Starbuck’s

Social workers are needed to implement science-based treatments for alcohol and other drug (AOD) problems. Changes in insurance coverage through the Affordable Care Act will increase the demand for licensed Master of Social Work (MSW) clinicians. This national study of MSW programs (N = 210) examines prevalence of addiction courses and specializations. Web-based analyses showed that only 14.3% of accredited schools offered specialization; only 4.7% of accredited schools had one or more required courses. Social work education has not met addiction workforce development needs; there is no evidence this pattern will change.

Addiction Training in Social Work Schools: A Nationwide Analysis

Practice-based research networks (PBRNs)—collaborations of practice settings that work together to generate research knowledge—are underused in mental health services research. This article proposes an agenda for mental health services research that uses a variety of PBRN structures and that focuses on what really happens in practice, the effectiveness of practice innovations in real world care, the challenges of implementing evidence supported interventions, modification of clinician behavior, and assessment of the effect of mental health policy changes on practice. The challenges of conducting research within PBRNs are substantial, including difficulties in maintaining positive member relations, securing ongoing funding, sustaining productivity, overcoming IRB entanglements and achieving both scientific excellence in recruitment and measurement validity and utility for practitioner members. However, the awareness of these challenges allows researchers and practitioners to build networks that creatively overcome them and that infuse mental health services research with heavy doses of the realities of everyday clinical practice.

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Revisiting practice-based research networks as a platform for mental health services research.

BACKGROUND: The robust evidence base for the effectiveness of alcohol screening and brief interventions (ASBI) in primary health care (PHC) suggests a widespread expansion of ASBI in non-medical settings could be beneficial. Social service and criminal justice settings work frequently with persons with alcohol use disorders, and workplace settings can be an appropriate setting for the implementation of alcohol prevention programs, as a considerable part of their social interactions take place in this context. METHODS: Update of two systematic reviews on ASBI effectiveness in workplaces, social service and criminal justice settings. Review to identify implementation barriers and facilitators and future research needs of ASBI in nonmedical settings. RESULTS: We found a limited number of randomized controlled trials (RCTs) in non-medical settings with an equivocal evidence of effectiveness of ASBI. In terms of barriers and facilitators to implementation, the heterogeneity of non-medical settings makes it challenging to draw overarching conclusions. In the workplace, employee concerns with regard to the consequences of self-disclosure appear to be key. For social services, the complexity of certain client needs suggest a stepped and carefully tailored approach is likely to be required. DISCUSSION: Compared to PHC, the reviewed settings are far more heterogeneous in terms of client groups, external conditions and the focus on substance use disorders. Thus, future research should try to systematize these differences, and consider their implications for the deliverability, acceptance and potential effectiveness of ASBI for different target groups, organisational frameworks and professionals.

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Alcohol Screening and Brief Intervention in Workplace Settings and Social Services: A Comparison of Literature

Role adequacy (feeling knowledgeable about one's work) and role legitimacy (believing that one has the right to address certain client issues) have long been key theoretical constructs regarding explanations why various helping professionals are reluctant to address drug misuse problems with clients. This study examines these concepts in a sample of social workers and social work students. Using regression analysis, it was determined that the social workers who had more clients with drug problems, had taken a course in drug work and had support for their role were more likely to feel legitimate in their work with drug-using clients. Training in drug use identification and intervention, being male, having more clients with drug problems and role support predicted role adequacy. Having a Master's degree, work setting and job function were not related to role adequacy or role legitimacy. Implications for social work education are discussed.

Predictors of role legitimacy and role adequacy of social workers working with substance-using clients.

The impact of substance abuse on society is wide ranging and costly. According to a Robert Wood Johnson Foundation (RWJF, 2001) report, substance abuse, including tobacco use, is the cause of more deaths, illnesses, and disabilities than any other preventable health condition. This same report indicates that approximately 25 percent of the more than 2 million deaths each year in the United States are attributable to alcohol, illicit drugs, or tobacco. The Department of Health and Human Services (HHS) estimates that drug and alcohol abuse contribute to more than 120,000 deaths in the United States each year (HHS, 2002). According to Healthy People 2010 (HHS, 2000), alcohol and illicit drug use are associated with a wide range of health and social welfare problems, including child and spousal abuse, sexually transmitted diseases, teenage pregnancy, school failure, motor vehicle crashes, low worker productivity, increasing health care costs, and homelessness. Furthermore, long-term heavy alcohol use can lead to heart disease, cancer, liver disease, pancreatitis, and fetal alcohol syndrome (HHS, 2000). In 1995 the cost of alcohol and drug abuse to society was conservatively estimated at more than $275 billion per year (RWJE 2001). These figures reflect costs associated with illness, deaths, medical care, crime, other related costs (for example, motor vehicle crashes), and special conditions related to substance abuse (for example, HIV/AIDS attributable to substance abuse). According to a Substance Abuse and Mental Health Services Administration (SAMHSA) report, it is estimated that 18 to 26 million Americans were in need of substance abuse treatment in 2002 (SAMHSA, 2003). The 2002 National Survey on Drug Use and Health estimated that 22 million people age 12 or older were classified with substance abuse or dependence, supporting the need for substance abuse treatment in the United States. Estimates from SAMHSA indicate that the need for substance abuse services for individuals with an illicit drug problem are increasing (SAMHSA, 2002a). Furthermore, abuse of alcohol and drugs (both legal and illicit) affects nearly 17 percent of adults age 60 or older (SAMHSA, 2002b). Although the need for treatment is documented, it is estimated that only 3 million people actually received substance abuse treatment in 2002 (SAMHSA, 2003). Literature Review: The Role of Social Workers A Bureau of Labor Statistics (BLS) report indicates that there were 477,000 social work positions in 2002 (BLS, 2004). Of these positions, 95,000 were in mental health and substance abuse. A 1993 HHS report suggested that only 6 percent of all staff in substance abuse treatment programs in the United States were social workers at the master's level or higher. According to the BLS report, employment of social workers is expected to increase faster than the average for all occupations through 2012, and employment of social workers in substance abuse settings will grow rapidly between 2002 and 2012 (BLS).This projected increase is due to a variety of factors, including placement of substance abusers, particularly abusers of illicit drugs, into substance abuse treatment programs instead of into the criminal justice system; recognition of the need to provide substance abuse treatment in the United States; and increased comorbidity of substance abuse disorders with other problems (for example, mental health disorders, HIV/AIDS and other sexually transmitted diseases, child welfare cases). For instance, Hall and colleagues (2000) found that at least half of all hospitalized patients in urban areas have substance abuse--related problems. Often, social workers are the first service providers to come in contact with substance abusers in the various service delivery systems, including child welfare, employee assistance programs, hospitals, schools, programs for elderly people, and community-based services. Social workers often provide key assessment and referral services in an array of health and mental health care settings (Hall et al. …

Mickey J. W. Smith

Papers

Social Workers in the Substance Abuse Treatment Field: A Snapshot of Service Activities