Working in Social Work

The Real World Guide to Practice Settings

Jessica Rosenberg

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781135889296
• Edition: 1
• Topic: Psychology
• Subtopic: Education in Psychology
• Index: Psychology

After graduating, students in social work are faced with the daunting and stressful decision of choosing their specialty from the many that are available to them. JessicaRosenberg has designed this guidebook to make this process easier, providing students with real world and practical information about what it is really like to work as a social worker.Each chapter covers a different practice setting, such as child welfare, gerontology, and addictions, and follows the same format.

The Field Overview and Forecast describes the social worker's role, scope of services, and emerging issues and employment trends.The Critical Issues section consists of an interview with an established professional in his or her chosen field, offering a look into their personal journeys as they progressed through their careers. A vignette written by a practitioner in their area of specialty makes-up the First Person Narrative, providing the reader with a look at the joys and challenges of working in that particular field.Each chapter then concludes with helpful resources to learn more, such as books and websites, as well as information about specialty credentials and educational programs and centres.Those entering the social work field will find this an indispensible guide as they select their specialty and begin their career.

1

Social Work in Addictions

Section One: Field Overview and Forecast

Scope of Services

Substance abuse is a serious and widespread problem in the United States, one that either directly or indirectly affects a large segment of society. In 2006, an estimated 22.6 million persons age 12 or older were diagnosed with a substance- or alcohol-abuse problem. If one adds to this number the multiple stressors related to having a friend or family member who is struggling with a drug or alcohol problem, it truly is a problem of epidemic proportions (Substance Abuse and Mental Health Services Administration, 2008).

Among the most troubling aspects of substance and alcohol abuse is the damage caused to children. Many children grow up in homes where drugs or alcohol are abused, with estimates suggesting that 1 in 4 children is impacted by familial alcohol abuse and that 1 in 10 children lives with a parent or another adult who is a drug abuser. As children grow older and start school, they are at increased risk of exposure to illegal drugs. According to a National Survey of American Attitudes on Substance Abuse conducted by Columbia University’s National Center on Addiction and Substance Abuse (2000), 11 million high school students and 5 million middle school students regularly come into contact with illegal drugs, dealing, and drinking on school grounds.

Alcohol and drug abuse are major health and social problems that cut across age, race, gender, and class. Regardless of the practice setting, social workers will encounter clients and client systems where abuse of drugs or alcohol is a problem. The need for social workers in all practice settings with the necessary skills and knowledge to effectively work with clients who have an alcohol or drug problem cannot be overstated. It is extremely important that social workers seek specialized training in working with addictions, either while enrolled in their degree programs, in continuing education courses, or in supervision.

Settings

Addiction settings hire social work staff with varying levels of education, with some settings requiring a master’s degree and others requiring a bachelor’s degree. Frequently, specialized addiction certifications, such as a certified alcohol- or substance-abuse credential, are preferred and will significantly strengthen a resume.

In residential programs, such as a therapeutic community (TC) or a group home, social workers use generalist practice skills, primarily case management and counseling. Generally, these positions can be obtained with a bachelor’s degree in social work and/or specialized addiction training, such as a certified alcohol and addiction credential.

Employment in inpatient centers, partial hospitalization centers, and outpatient treatment programs generally requires a master’s degree. In these settings, social workers provide clinical treatment, often running therapy groups. Social workers in private practice frequently treat clients with addiction problems. The requirements for independent private practice vary from state to state, but the standard is that a master’s-level social work degree with licensure at the clinical level is needed. At the macro level, social workers are employed as administrators and are hired to develop and implement programs, conduct research, and develop public policy. Advanced training and prior experience is usually required to move into an administrative position.

The Social Worker’s Role

The social worker’s role varies based on the practice setting. Since many clients with an alcohol or substance-abuse problem initially present themselves in nonaddiction settings, such as a mental health center or a medical clinic, the social worker is often the first professional to identify and diagnose a substance-abuse problem. Frequently, the initial social work task is identification of the problem. The key social work skills are assessment, screening, and referral (Hanson, 2001).

Self-help or mutual aid has significantly shaped the social worker’s role in working with addictions. The defining characteristic of self-help and mutual aid is that people with similar problems and experiences come together to provide help and support for each other. Sharing personal stories and learning coping skills is a key part of the recovery process (Seebohm, Henderson, Munn-Giddings, Thomas, & Yasmeen, 2006). Alcoholics Anonymous (AA), founded in 1935, is the prototype for mutual-aid groups, and numerous groups such as Gamblers Anonymous (GA), Narcotics Anonymous (NA), and Overeaters Anonymous (OA) subsequently modeled themselves on AA. Mutual-aid groups are widely viewed as an important method for building a positive community that promotes and supports recovery (Van Wormer & Davis, 2008).

In addictions treatment programs, the influence of the self-help and the mutual-aid movement can be found by the prevalence of treatment staff who are themselves in recovery. In particular, the development of the therapeutic community, which grew in prominence and popularity in the mid-1960s and 1970s with programs such as DayTop Village and Samaritan Village, is based on the principle of mutual aid and peer support. Within this context, social workers and other professionally trained staff who worked in addictions programs frequently found themselves on the defensive with clients and other staff who were recovered addicts and alcoholics, as their credibility was questioned because they could not provide personal stories of their own addiction and recovery. Staff members who were recovered addicts and alcoholics often resented professionally trained staff because they had the educational training and credentials that enabled them to move into betterpaying, supervisory positions. Whereas tensions between staff who are recovered addicts and alcoholics and professionally trained social workers still persist in some agencies, the organizational culture of substance-abuse programs has evolved and is characterized by mutual respect for and appreciation of respective roles. This is partly the result of an increased emphasis on credentialing and professional training by accrediting bodies, as well as implementation of reimbursement policies for training, as more and more professionally trained staff enter this field.

Credentialing

There are a number of specialized credentials for working in addictions, and social workers who obtain dual credentials in social work and the addictions are significantly more competitive in the job market. At the national level, there is the National Certified Addiction Counselor Credential (NCAC) and the National Association of Certified Clinical Alcohol, Tobacco, and Other Drugs Social Worker (C-CATODSW), which is offered by the National Association of Social Workers. Many states offer their own credentials, and the requirements vary from state to state. Typically they include: (a) basic competency and ethical conduct requirements, (b) work experience requirements, (c) education and training requirements, and (d) passing a written examination and/or oral exam.

Emerging Issues and Employment Trends

Social work in the addictions is a growth area for social workers. According to a study of the social work workforce conducted by the Association of Social Workers (Whitaker, Weismiller, & Clark, 2006a), less than 3% of licensed social workers currently identify addictions as their primary practice area, with men more likely to work in addictions than women. However, the demand for social workers in this area is likely to outpace the supply. The Bureau of Labor Statistics (2008) projects that jobs for social workers trained to work with substance abusers is likely to increase at a faster rate than for other occupations. In particular, employment opportunities will exist for social workers to work with people who have been arrested and convicted of a drug-related offense. There is a growing trend (in part spurred by the overcrowding of prisons) to provide individuals convicted of a drug charge with treatment programs as an alternative to incarceration or as a condition of probation. Consequently, there will be an increased demand for social workers to work with substance abusers who have been court-mandated to obtain treatment.

Working in addictions is a field of practice that presents many challenges. Substance-abuse clients are one of the most difficult populations to work with. They are difficult to engage, often resistant to treatment, and tend to go from one crisis to the next. Good clinical skills are important, as is a good sense of humor. However, for the savvy social worker, this is an exciting growth area with great potential.

Activities to Learn More

• Attend a local Alcoholics Anonymous and a Narcotics Anonymous meeting. Afterward, ask yourself what it would be like to work with this population, and if you think you would find it rewarding and challenging.
• Log on and explore the NAADAC Web site at http://www.naadac.org. This is the largest national association for addictions professionals and provides a wealth of information about working in the field of addictions.
• Log on to the National Association for Social Workers Web site at www.socialworkers.org and read the publication “Choices: Careers in Social Work.” Review the section about addictions.

Section Two: Critical Issues

Stanley G. McCracken, PhD

Stanley McCracken is a senior lecturer in the School of Social Service Administration. He is a licensed clinical social worker and a registered dual-disorder professional with over 30 years experience. His practice and teaching interests lie in the areas of mental health, substance abuse, co-occurring disorders, behavioral pharmacology, multicultural mental health, aging, and implementation of evidence-based practice.

Professor McCracken has published a number of articles and book chapters in such diverse areas as behavioral medicine, behavioral pharmacology, psychiatric rehabilitation, substance abuse, and evidence-based practice. He is coauthor of two books, Practice Guidelines for Extended Psychiatric Care: From Chaos to Collaboration and Interactive Staff Training: Rehabilitation Teams That Work. He also is coauthor of the Council on Social Work Education Gero-Ed Advanced MSW curriculum in mental health and aging.

When not at SSA, Professor McCracken spends a good deal of time providing staff training as well as clinical and program consultation to a variety of public sector and nonprofit service providers. Most of his current work is in assisting community programs to implement evidence-based practice.

My path to professional social work has taken a few twists and turns. In 1969, I entered the United States Army and served in Vietnam. After returning from the war, I wasn’t sure what I wanted to do with my life, but after a few years, I decided to enroll in a master’s of social work program, largely because I was influenced by an interest in Carl Jung, and because I enjoyed working with people. Upon graduation, I worked in behavioral pharmacology research and later in direct practice with substance abusers. I subsequently earned a PhD from the School of Social Service Administration at the University of Chicago.

How does Social Work with Addictions Differ Today from in the Past?

There have been significant changes in the evolution of social work practice with addictions. In the past, few social workers worked in substance abuse programs, and few social work students identified addictions as a career choice. Social work education, heavily influenced by the psychoanalytic movement, focused its clinical content largely on a psychodynamic orientation and, for the most part, paid scant attention to the treatment of addictions. Working in addictions was viewed by the social work profession as a step down from mental health and regarded as a lower status career choice. Those that chose to work in substance abuse programs often had a personal history of drug or alcohol abuse and were themselves in recovery. Some measure of mutual mistrust existed between professionally trained staff and those who had a personal past as an addict and came up through the treatment ranks. Today, working with addictions is widely recognized as a legitimate area of social work practice, and many schools of social work offer courses or have concentrations in substance abuse.

What Kinds of Settings do Social Workers in Addictions Work in?

We can conceptualize addictions treatment as taking place along a continuum, with a completely controlled environment, such as a closed unit at one end, and outpatient treatment in a private practice setting at the other end. The social work role differs depending on the setting. The residential programs are staffed mainly by preprofessionals who are not social workers. Hospital-based programs, day treatment, and outpatient programs employ MSWs and BSWs.

Medical detoxification is a short-term inpatient hospital stay in which clients who are physically addicted are medically assisted through the withdrawal process. In medical detoxification, the social work role is focused on gathering data, conducting assessments, and developing discharge plans. Medical detox units have highly stratified and hierarchical power structures, with physicians at the top, and social workers have to learn to negotiate both formal and informal power structures.

Inpatient rehabilitation programs are usually 21–28-day hospital stays, often on a closed unit. In these settings, the major treatment modality is group work and milieu treatment. In milieu treatment, therapy is going on all the time, often informally in the hallways and recreation room. Social workers will spend the majority of their day with clients, utilizing treatment techniques that include modeling and reinforcing client behaviors. In these settings, social workers are challenged by having limited opportunities for privacy, where they can go to an office and close the door. Social workers need to be self-aware of how they interact with their coworkers on the unit; everything is out in the open. Self-care strategies become paramount for social workers, since they have limited opportunities to get away to a private office and relax. In day-treatment programs, clients live independently, attending day programs 5 days a week for several hours a day. Group work is the preferred treatment modality, with a strong milieu component. Intensive outpatient therapy programs treat clients several times a week with a combination of group and individual treatment.

Residential care is provided along a continuum in the wet, damp, and dry housing model. In wet housing, residents may be actively using substances, but they must refrain from using on the premises. In damp housing, it is expected that addicts will relapse occasionally. In dry housing, sobriety is expected and required.

In Your Opinion, What is the most Important Policy or Trend Impacting Social Work in Addictions?

Historically, managed care contains costs by limiting access to substance abuse services—a policy that is changing due to recent legislation. We know that addiction is a chronic lifelong disorder, that addicts traditionally were viewed as always recovering and never recovered, and yet we routinely talk about addicts graduating from treatment programs. If we know that 10% of our population has a long-term problem with chemical dependency, why is treatment funded on a short-term basis? The mental health system funds long-term services for clients, primarily for serious mental illness. In substance abuse, treatment is typically funded for a greater number of people, but for comparatively less time. This funding approach does not take into account that engagement with substance abusers is a long, slow process. Most substance abuse clients enter treatment unwillingly, often under pressure from a court order, an employer, their family, or due to a health issue or other serious consequence. When treatment is a...