Social Work Strategies for Substance Use

Abstract

 When any individual looks into bettering themselves they turn to the help of a social worker. Whether it be a psychologist, case worker, counselor, or any other type of outside help, all of these people come from the social work field.  However, when it comes to substance use disorder, does a person turn to a social worker, or turn to the self help group of Narcotics Anonymous?  Up until very recently social workers haven’t had much education or training on how to address an individual suffering from substance use disorder. But, with recent studies and trainings, an individual who looks to the social work field as well as their self help group has a better chance of a positive and successful outcome.  There is almost always more than one option for a positive outcome, and in this paper you will read and understand helpful approaches from the social work field, and why it is important for social workers to become more involved in the growing drug epidemic in the United States.

Substance use has been a growing issue throughout the years. According to the Diagnostic and Statistical Manual of Mental Disorders, there are 10 separate classes of drugs. These classes include; alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, tobacco, and other or unknown substances. However, the focus within this paper will be opioids, due to the dramatic increase in use (Zinic 2012).  In a community population, the 12-month prevalence of opioid use disorder is somewhere around .37% among adults ages 18 and over.  Rates are also higher in males vs. females, .49% vs. .26% (DSM-5 2013).  And, along with the increase in use, there has also been an increase in overdoses and deaths. Since 2000, opioid overdoses have gone up from 137% to 200% (2016).

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 There are several things to factor into why a person uses drugs which include; social disadvantage, parental drug use/psychopathology, childhood abuse/neglect, early onset psychopathology, antisocial behaviors, and developmental sequence of drug onsets. Not every opioid user will experience these risk factors although they do tend be the main ones (Addiction 2008). Another article, from Human Behavior and the Social Environment goes on to say that once a person has become addicted to the opiate, they no longer have any interest in their what was normal everyday life. They will push family away, lose jobs, and eventually lose all income which could leave them homeless, and ultimately alone (2006).

Substance use is a social work concern because it deals with people and their ability to live life properly. Harm reduction is a growing approach being seen in the social work field. It is promising and has had a more positive affect than some traditional approaches (Clinical Social Work Journal 2017). Harm reduction is a technique used to address risky behaviors of drug users. Since this approach generally leaves the treatment up to the client, it is best to meet with them in their natural environment. This approach was initially used in the 1980’s with the AIDS epidemic but has been increasingly successful when dealing with substance use.  (Lessard 2014).  Along with social workers becoming involved, there are also self-help groups such as Narcotics Anonymous. While NA is not directly linked to social work, it is a successful group consisting of addicts who support each other in their journey through recovery (Narcotics Anonymous).  Although the social wok field and Narcotics Anonymous are not directly linked to one another, if the two referred addicts to each other this may help with the success of a person’s recovery. 

It is important to understand the term Substance Use Disorder.  Since there is such a large population of people who use or have used illicit drugs, it is likely to have any social worker work with clients who may need their help, whether it be to go into full recovery, get counseling, or maybe find a self-help group.  Following the definition of Substance Use Disorder, you will see the effects, and risk factors. After understanding these things about substance use, you will then continue reading to see the different views on substance use disorder being a learned behavior or a social disadvantage, and how social work and narcotics anonymous are a great deal of help with the issue.

SUBSTANCE USE DISORDER

Definition

Although the DSM-5 does not use the word addiction to describe substance use disorder, The National Institution on Drug Abuse still uses the term.  Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works.  These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.

Effects

 Since the focus of this paper is opioids, the effects and criteria given will be based on information solely on opioids. There are certain criteria one must meet to qualify as an individual that suffers from substance use disorder. A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, 4-5 is moderate, and 6-7 is severe (APA 2013).  The following is a list of criteria from the DSM-5 needed to diagnose an individual;

1.Opioids are often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

3.A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

4.Craving, or a strong desire or urge to use opioids.

5.Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.

6.Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

7.Important social, occupational, or recreational activities are given up or reduced because of opioid use.

8.Recurrent opioid use in situations in which it is physically hazardous.

9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated the substance.

10.Tolerance, as defined by either of the following:

  a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect.

  b. A markedly diminished effect with continued use of the same amount of an opioid.

11.Withdrawal, as manifested by either of the following:

 a. The characteristic opioid withdrawal syndrome

  a-1. Presence of either of the following; cessation of opioid use that has been heavy and prolonged or administration of an opioid antagonist after a period of opioid use.

  a-2. Three or more of the following developing within minutes to several days after criterion a-1:

• Dysphoric mood
• Nausea or vomiting
• Muscle aches
• Lacrimation or rhinorrhea
• Pupillary dilation, piloerection, or sweating

 b. Opioids or a closely related substance are taken to relieve or avoid withdrawal symptoms.

 Along with the criteria to diagnose one with this disorder, you can also expect a history of drug-related crimes, marital and other family difficulties, unemployment, and irregular employment and other risky behaviors (APA 2013).

 When it comes to risky behaviors, the Journal of Evidence-Based Social Work suggests that while people are active in their addiction they participate in risky sexual behaviors, without thinking of the consequences- which include HIV and other sexually transmitted diseases.  While a person is using illicit substances, they are less likely to use protection, or even care of the consequences not using protection may carry. However, the statistics from a sexual outreach program have shown that when an individual stops their drug use, they are more cautious about their sexual behaviors and using protection, even if they are in a sexual relationship with one person (Lauby 2010).

Risk Factors of Becoming Addicted to A Substance

When looking into how a person may have become addicted to a substance, there are several things to look at, but the five main risk factors include; social disadvantage, parental drug use/psychopathology, childhood abuse/neglect, early onset psychopathology, antisocial behaviors, and developmental sequence of drug onsets (Darke 2016). There are also people who will debate substance use being a learned behavior rather than being brought on by another factor (Sociology Compass 2011). Whether a person learned the behavior, or they were a victim of circumstance, the bottom line is that they have still somehow become addicted to a substance and need to find the help to recover.

• Learned Behavior Verses Social Disadvantage

According to an article about advertising drugs and alcohol, they say that substance use typically begins in the adolescence stage. They go on to stay that use is confined to social situations and is a socially learned behavior (Effects of Alcohol & Tobacco Advertising on Adolescents 1989). Another article says that deviance, such as drug use, just like any other action is learned through socialization process in interaction with others (Schaffer 2015). Both would be examples of social disadvantage. Basically, if the option is there, a person will either choose to do to the drug or not, but in a social situation there are factors such as per pressure which in many situations will affect a person’s decision (Social Work Review 2014).

 On the other hand of social disadvantage, there is also the argument of substance use being a learned behavior. An article by Shahram Heshmat (2015) questions if an addict has free choice or have they cued their body/brain to need the drug. He says that substance users have an altered learning system and will make the same mistakes repeatedly.  Our brain releases a chemical called dopamine, and this is like a reward in our brains, it makes us feels good. When a person uses a substance, dopamine is released and it sensors that reward or good feeling, triggering you to want to do this drug again. After a while, your brain has learned to use the drug to get the good feeling, it has replaced other things you once felt good about doing. Your brain now only focuses on the reward sensation when you have taken the drug.

    Social Workers Verses Narcotics Anonymous

 So, is substance use learned, or are their just some negative circumstances that cause people to become addicted to a substance?  Research is continuously being done to figure this out, and therefore there are social workers and self-help groups for people who are ready to leave the life of illegal substances. Social workers consist of people who can direct an addict to different resources within their community. These resources could be drug and alcohol counseling, parenting groups, financial assistance, medical assistance etc. While the social worker will direct you and help you to get the recourses you need, Narcotics anonymous is there to aid you in your recovery.

• Harm Reduction Based Approach

There are several ways a social worker can help their client. A very successful approach has been through Harm Reduction.  Harm reduction is a growing approach being seen in the social work field. It is promising and has had a more positive affect than some traditional approaches (Clinical Social Work Journal 2017). Harm reduction is a technique used to address risky behaviors of drug users. Since this approach generally leaves the treatment up to the client, it is best to meet with them in their natural environment. This approach was initially used in the 1980’s with the AIDS epidemic but has been increasingly successful when dealing with substance use.  (2018). 

• Narcotics Anonymous

Narcotics Anonymous is a self-help group developed not by the social work field, but by an addict. People associate the program with Bill W, the man who founded Alcoholics Anonymous many years ago. He had an addiction and with the help of another man they had realized that with the support of eachother they were able to maintain sobriety. Today NA consists of thousands of people who suffer from substance use.  They work together in keeping each other clean. Some people don’t believe in this self-help group, but it is extremely successful. It’s believed that the support of one addict to another will help each other to stay off drugs, and so far, it has helped many in their recovery (Delucia 201              5).

Resources

• Darke, S., Torok, M., & Ross, J. (2017). Developmental trajectories to heroin dependence: Theoretical and clinical issues. Journal of Applied Social Psychology,47(3), 165-171. doi:10.1111/jasp.12434
• Delucia, C., Bergman, B. G., Formoso, D., & Weinberg, L. B. (2015). Recovery in Narcotics Anonymous from the Perspectives of Long-Term Members: A Qualitative Study. Journal of Groups in Addiction & Recovery,10(1), 3-22. doi:10.1080/1556035x.2014.969064
• Diagnostic and statistical manual of mental disorders DSM-5. (2013). Arlington, VA: American Psychiatric Association.
• Heshmat, S. (n.d.). Addiction as a Learning Disorder. Retrieved March 20, 2018, from https://www.psychologytoday.com/blog/science-choice/201501/addiction-learning-disorder Hayhoe, C. R. (2006). Helping Families in Transition Due to Unemployment. Journal of Human Behavior in the Social Environment,13(1), 63-73. doi:10.1300/j137v13n01_04
• Macleod, J., Hickman, M., Bowen, E., Alati, R., Tilling, K., & Smith, G. D. (2008). Parental drug use, early adversities, later childhood problems and childrens use of tobacco and alcohol at age 10: Birth cohort study. Addiction,103(10), 1731-1743. doi:10.1111/j.1360-0443.2008.02301.x
• Narcotics Anonymous. (2008). Place of publication not identified: Narcotics Anonymous World Services.
• Schaefer, B. P., Vito, A. G., Marcum, C. D., Higgins, G. E., & Ricketts, M. L. (2014). Heroin Use among Adolescents: A Multi-Theoretical Examination. Deviant Behavior,36(2), 101-112. doi:10.1080/01639625.2014.910066
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