Substance Abuse

This Web page provides an overview of social work research, practice, and education related to substance abuse.  It includes links to national research and resource centers and to research findings in recent publications. A reference list of articles pertaining to substance abuse and related comorbidities is also provided for practitioners.

Substance abuse is defined as:

A maladaptive pattern of using certain drugs, alcohol, medications, and toxins despite their adverse consequences. Barker, R.L. (1995). The social work dictionary, 3rd edition (pp. 370). Washington, DC: NASW Press.

Social workers have long worked with people who abuse substances, from caring for New York City Bowery dwellers in the profession’s beginnings to developing self-help, consumer-driven programs such as Alcoholics Anonymous, to designing inpatient detoxification programs, and to applying youth-oriented prevention and education programs.  Often social work researchers have been on the forefront of work involving comorbidity, the presence of interconnected substance abuse and mental illness and/or physical illness, health disparities and substance abuse, as well as the impact of substance abuse on families.  In recent years, social work researchers have conducted substance abuse research with support from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute of Mental Health (NIMH).   

Social Work Abstracts since 1977 includes nearly 570 articles relating to substance abuse, although many articles are not research-based, and some social work research on substance abuse is published in journals not listed in Social Work Abstracts.  However, this resource is a good starting place to identify social work researchers working in this area.  Of the most recent 100 articles abstracted, dating from 2002 to 2004, 65 were reports on research studies relating to substance abuse.  Given that much work in substance abuse is interdisciplinary, one may find social work articles in a variety of professional journals, from medicine and nursing, to journals devoted specifically to addiction. The entire issue of Health and Social Work. 28(2): 126-136, May 2003 was devoted to substance abuse.  An entire issue of the Journal of Social Work Practice in the Addictions 2(3-4): 1-5, 2002 was dedicated to examining current social work practice in the addictions in different countries.

NIDA Social Work Infrastructure Development Programs
NIDA has funded seven Social Work Infrastructure Development Programs to advance social work research in substance abuse and to develop future researchers in the field.  Each of these centers has a unique focus, addressing HIV and substance abuse, prevention, comorbidity with mental illness, and work with underserved populations.  Listed below is information about these programs as well as contact information.  Web site URLs are provided for more information.

National Center on Substance Abuse and Child Welfare
The National Center on Substance Abuse and Child Welfare (NCSACW) is an initiative of the Department of Health and Human Services and is jointly funded by the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT), the Administration on Children, Youth and Families (ACYF), and the Children's Bureau's Office on Child Abuse and Neglect (OCAN). NCSACW's goals are to develop and implement a comprehensive program of information gathering and dissemination, to provide technical assistance, and to develop knowledge that promotes effective practice, organizational, and system changes at the local, state, and national levels. Visit http://ncsacw.samhsa.gov/

NIDA Funded Social Work Infrastructure Development Programs

(Information adapted from Center Web sites and CRISP retrieval [www.nih.gov])

The Comorbidity and Addictions Center
http://gwbweb.wustl.edu/users/cac/

Arlene Rubin Stiffman, PhD
CAC
Campus Box 1196
Washington University
One Brookings Dr.
St. Louis, MO 63130
Phone: 314-935-8386
Fax: 314-935-7508
E-mail: arstiff@gwbmail.wustl.edu

Focus of the Center:  Multisector addiction interventions for underserved populations with comorbid mental health and HIV risk problems

The mission of the Comorbidity and Addictions Center (CAC) is to increase knowledge related to multisector addictions interventions for underserved populations with comorbid mental health and HIV risk problems.  The CAC, housed at the George Warren Brown School of Social Work, is the first social work research development center funded by the National Institute on Drug Abuse (NIDA).  The center’s research agenda includes: 1) The delivery or coordination of multisector addiction services ;  2) The evaluation of addictions prevention and treatment programs;  3) The costs and burdens of addictions and comorbidity services from different sectors (alcohol and drug, mental health, primary case, social services, juvenile justice education, and informal) and their relationships to service use and outcomes.

Center for Intervention and Prevention Research on HIV and Drug Abuse
http://www.columbia.edu/cu/ssw/projects/ciprhda/

Nabila El-Bassel, DSW
Columbia University School of Social Work
The Interchurch Center, Suite 184
275 Riverside Dr.
New York, NY 10114
Phone: 212-870-2047
Fax: 212-870-2930
E-mail: ciprhda@columbia.edu

Focus of the Center:  Drug abuse and HIV/AIDS intervention and prevention research

The center's mission is to advance intervention and prevention research on HIV/AIDS and drug abuse by training the next cadre of social work researchers in the development, testing, and dissemination of empirically-validated intervention and prevention approaches that address contemporary social problems.  While focusing on HIV/AIDS and drug use, the center's research program also recognizes and addresses a range of comorbid issues found in urban communities. Current scientific activities examine  HIV/AIDS, drug abuse, violence, and health and mental health.

Substance Abuse Research Development Program for Underserved Populations
http://www.utexas.edu/research/cswr/nida/rdp.html

James Alan Neff, PhD, MPH
Center for Social Work Research
School of Social Work, University of Texas at Austin
1925 San Jacinto Blvd.
Austin, TX 78712-1203
Phone: 512-471-8627
Fax: 512-471-9514
E-mail: JNeff@mail.utexas.edu

Focus of the Center:  Substance abuse among underserved populations and factors at the individual, family, organizational, societal, and cultural level that influence substance abuse and treatment

The Substance Abuse Research Development Program is the third program in the country funded as part of a NIDA initiative to stimulate the development of federally funded social work research on substance abuse. The program focuses specifically on substance abuse among underserved populations (particularly African Americans and Mexican Americans) and emphasizes factors at individual, family, organizational, societal, and cultural levels that influence substance abuse and substance abuse treatment.  Two pilot projects will examine:

• factors related to adherence to anti-retroviral therapy between HIV+ African American and Mexican American substance abusers
• treatment retention among Anglo, African American, and Mexican American substance abusing juvenile offenders
• spirituality in faith-based substance abuse treatment, substance abuse among gays and lesbians, and brief interventions for minority substance abusers

Southwest Interdisciplinary Research Consortium
http://sirc.asu.edu/

Flavio Marsiglia, PhD
Southwest Interdisciplinary Research Consortium
School of Social Work, College of Public Programs
Arizona State University
PO Box 873711
Tempe, Arizona 85287-3711
Phone: 480-965-4699
Fax: 480-727-6058
E-mail: sirc@asu.edu

Focus of the Center:  Multi-disciplinary, community-based social work research on drug use prevention and services for families and youth

The purpose of the Southwest Interdisciplinary Research Consortium (SIRC) is to conduct multi-disciplinary community-based social work research on family and youth drug use prevention and services under two priority areas:
1) culturally grounded drug use prevention, and
2) culturally responsive and resiliency-focused drug abuse services research.
Researchers study the relationship between drug use and the strengths, competencies, and other protective factors buffering against drug use and risk processes of families and youth. The center was developed to be inclusive of and responsive to the research needs and priorities identified by community-based social workers, and to work in partnership with them throughout the research, dissemination, and skill-building processes.  The consortium strengthens the institutional infrastructure of the School of Social Work by enhancing the capacity of its faculty members and social workers in the community to design, develop, and implement drug abuse prevention and services research in partnership with the social work community outside the university and with colleagues from other disciplines within the university.

Dual Disorders Research Program
http://msass.case.edu/centeronsami/

Mark I. Singer, PhD
Center on Substance Abuse and Mental Illness
Mandel School of Applied Social Sciences
Case Western Reserve University
10900 Euclid Avenue
Cleveland, OH 44106-7164
Phone: 216-368-6176
E-mail: mxs12@cwru.edu

Focus of the Center:  The Dual Disorders Research Program will support a multidisciplinary study team to address the theme of facilitators and barriers to treatment in individuals with dual diagnoses (co-existing drug abuse and mental disorders).

The program, part of the Center on Substance Abuse and Mental Illness at the Mandel School of Applied Social Sciences, will link faculty from the Mandel School and the School of Medicine  with national experts to establish research on treatment barriers and facilitators in dual diagnosed individuals and their families.  Researchers will:

• generate pilot research and ensuing RO1 proposals in the identified core areas to promote educational experiences for faculty
• produce a special issue of the Journal of Social Work Practice in the Addictions on the topic of dual diagnoses

Jane Addams Substance Abuse Research Collaboration

Larry Bennett
Jane Addams College of Social Work
University of Illinois at Chicago
M/C 309
1040 W. Harrison Street
Chicago, IL 60607-7134
Phone: 312-996-4577     E-mail: lwbenn@uic.edu
http://www.uic.edu/jaddams/college/

Focus of the Center:  Funded in 2003, this new program at the University of Illinois at Chicago will study the impact of drugs and the societal response to drugs on women and their children to provide a fuller understanding of the link between substance abuse, criminal justice, and women

The specific aims of the program are:

• Develop a community-based, multidisciplinary substance abuse research program focused on the confluence of substance abuse, criminal justice, and women
• Provide an organizational focus which will support multi-disciplinary teams pairingsenior faculty, junior faculty, and research assistants in pilot research efforts in the core area
•  Increase active collaboration with Treatment Alternatives for Safe Communities (TASC), BRASS/HRDI, and other substance abuse providers to enhance the generation of practitioner-useful research, consistent with the mission of the Jane Addams College of Social Work
•  Promote culturally competent and practice-useful substance abuse research through a Minority Researcher Development Program and a Community Scholar Program
•  Utilize an advisory panel consisting of providers, consumers, and senior researchers to provide conceptual guidance and specific expertise, critique research proposals, and identify applications for research
•  Support professional development plans, including multidisciplinary research seminars, conferences, technical assistance, and broad exposure to substance abuse research culture to prepare social work faculty to become fully collaborative and independent substance abuse researchers, and make pragmatic and distinguished contributions to the substance abuse field.

Child Welfare, Drug Abuse and Intergenerational Risk
http://www.albany.edu/ssw/research/index.html

Philip McCallion
School of Social Welfare
University of Albany
135 Western Avenue
Albany, NY  12222
518-442-5347
PI E-mail: mcclion@albany.edu  

Focus of the Center: A program of research on Child Welfare, Drug Abuse and Intergenerational Risk (CWDAIR) based in the School of Social Welfare (SSW) at the University at Albany

The goal is to advance research on the development and delivery of coordinated, evidence-based and theoretically-oriented services for parents in the child welfare system with addiction and co-occurring problems, including HIV/AIDS. The focus on substance abuse in conjunction with HIV/AIDS within child welfare families is timely, appropriate, and significant since children in these families face significant barriers to healthy development. Improved and more integrated services for parents will reduce the risk of drug abuse and other negative outcomes in the next generation.

The CWDAIR Program has two specific aims: first is to build an infrastructure for conducting interdisciplinary research on drug abuse and HIV/AIDS in child welfare families, including the development and support of interdisciplinary research teams based in SSW. The second aim is to develop collaborative partnerships with state agency leaders and professionals from child welfare, HIV/AlDS, and substance abuse services to improve the design of services to address substance abuse and co-occurring problems among high-risk parents. The research program will support high-impact collaborative research leading to R01, R03, and K awards, better services for high-risk families, and reduced intergenerational transfer of risk.

REFERENCES

The following articles were selected to present a range of social work research related to substance abuse and related comorbidities. They are listed in descending order from most recent date of publication.

Women's experience of co-occurring substance abuse and mental health conditions.
Stromwall,L.K. & Larson,N.C. (2004).
Journal of Social Work Practice in the Addictions., 4(1), 81-96.
This study explored the relationship between gender and co-occurring substance abuse and mental health conditions among a sample of 754 consumers of behavioral health services in the Southwest U.S. Logistic regression was used to determine factors that would predict women's unique experience of dual diagnosis. Women were almost seven times more likely than men in this sample to have a diagnosis of posttraumatic stress disorder in conjunction with substance abuse. Women were also significantly more likely to experience anxiety and mood disorders and to have been married. Implications of these findings for social work practice are suggested.

Termination of Supplemental Security Income benefits for drug addiction and alcoholism: Results of a longitudinal study of the effects on former beneficiaries.
Swartz, J.A., Baumohl, J. & Lurigio, A.J.  (2004, March).
Social Service Review., 78(1), 96-124.
This article reviews the results of a multi-site cohort study on effects of terminating Supplemental Security Income benefits for drug addiction and alcoholism. Within two years of the program's termination, 35 to 43 percent of participants requalified for disability benefits for another impairment. Regardless of requalification status, substance abuse treatment participation declined sharply and illegal drug use was prevalent. Although many of those who did not requalify lost income, medical benefits, and housing, these losses lessened over time and were not associated with increased psychological or medical problems or with declines in other aspects of participants' lives.

Co-occurring disorders among jail inmates: Bridging the treatment gap.
Young-D.S. (2003).
Journal of Social Work Practice in the Addictions., 3(3), 63-85.
This paper presents findings based on a retrospective review of health and mental health records of 359 mentally ill jail inmates. Regardless of demographic group, substance-related disorders are the most prevalent disorder. Sixty-seven percent of the sample had a substance-related disorder, 37 percent an adjustment disorder, 23 percent a mood disorder, and 12 percent had schizophrenia or another psychotic disorder. Comorbidity was extensive with close to 45 percent of the sample having both a substance-related disorder and an additional major mental illness. Study findings indicated that there is a great need to strengthen services and create jail-community linkages for inmates with comorbid mental health and substance abuse disorders. Innovative program and resource information are provided.

Integrating a brief motivational treatment for problem drinkers in a private outpatient clinic: Client characteristics, utilization of services and preliminary outcomes.
Cisler, R.A,  Barrett, D.,  Zweben, A. & Berger, L.K.  (2003).
Alcoholism Treatment Quarterly, 21(3), 1-21.
The integration of brief alcohol treatment into an array of existing treatment services has been a challenge for clinical administrators despite the mounting evidence supporting brief treatment approaches. This study examined the utility of a brief alcohol treatment program through an evaluation of client characteristics, use of program services, and preliminary program outcomes. Subjects were 256 clients receiving a Drinking Check-Up (DCU) program within a large, for-profit, private-practice-model, behavioral health services clinic. A process and outcome evaluation was conducted that included: (1) a detailed description of all clients enrolled in the DCU program; (2) a description of client utilization of DCU and other program services; and (3) a preliminary outcome evaluation of a subset of DCU participants. Analyses revealed nearly all (98 percent) clients who attended an initial screening/assessment session also attended a feedback/treatment planning session with about 59 percent attending at least one and 36 percent attending at least two drinking "check-ups." Finally, follow-up data revealed abstinence or low-to-moderate drinking by nearly all DCU clients, few negative consequences, low levels of subsequent alcohol and psychiatric service utilization, and relatively high levels of satisfaction with the DCU. Implications of findings for behavioral health services administrators and researchers are discussed. (Journal abstract.)

An ecological model of maternal substance abuse and child neglect: Issues, analyses, and recommendations.
Cash, S.J. & Wilke, D.J.  ( 2003, October).
American Journal of Orthopsychiatry, 73(4), 392-404.
This study examined an ecological model of maternal substance abuse and child neglect. Data identified an interplay among family history, interpersonal risk factors, current family functioning, and community networks in examinations of child neglect in a sample of substance-abusing women entering treatment.

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: Individuals with symptoms of attention-deficit/hyperactivity disorder and conduct disorder are uniquely at risk.
Flory, K., Milich, R., Lynam, D.R., Leukefeld, C. & Clayton, R.  (2003, June).
Psychology of Addictive Behaviors, 17(2), 151-158.
Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully accounts for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms. Individuals with high levels of both ADHD and CD had the highest levels of these outcomes.

Social work practice with the elderly substance abuser.
Memmott, J.L.  (2003).
Journal of Social Work Practice in the Addictions, 3(2), 85-103.
 A surprising number of elderly people suffer from substance-related disorders. Many more are at risk for developing polydrug problems due to their misuse and abuse of alcohol in combination with prescription medications and over-the-counter preparations. The purpose of this article is to update social workers on advances in geriatric addictionology by reviewing current epidemiological studies and extracting practice principles. Particular emphasis is placed on what the social work practitioner needs to know about screening elderly clients for substance abuse. The article concludes with specific recommendations to advance social work education and research in the field of addictions treatment.

Substance abuse, homelessness, developmental decision-making and spirituality: A women's health issue.
Greene, J.A., Ball, K., Belcher, J.R. & McAlpine, C.  (2003).
Journal of Social Work Practice in the Addictions, 3(1), 39-56.
A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision making.

Integrating pharmacotherapy and psychosocial interventions in the treatment of individuals with alcohol problems.
Zweben, A.  (2001).
Journal of Social Work Practice in the Additions, 1(3), 65-80.
Both research and clinical experiences suggest that there are separate and overlapping benefits of medications and psychosocial treatments for alcohol problems. Evidence has shown that medications combined with a moderate intensity psychosocial therapy can produce outcomes beyond what each of these interventions can produce alone. Taking medication can be helpful in facilitating longer periods of abstinence that, in turn, affords practitioners a greater opportunity to enhance patients' individual and social coping resources and to increase their motivation to change. Combining effective pharmacological and psychosocial interventions may provide the impetus to integrate alcoholism treatment into the general health care delivery system, thereby helping to increase the accessibility of care and well-being for individuals seeking or needing help with alcohol problems.

Childhood and adolescent predictors of alcohol abuse and dependence in young adulthood.
Guo, J. Hawkins, J.D., Hill, K.G. & Abbott, R.D.  (2001, November).
Journal of Studies on Alcohol, 62(6), 754-762.
 This study provided a comprehensive examination of childhood and adolescent predictors of alcohol abuse and dependence at age 21, theoretically guided by the social development model. Data were taken from an ethnically diverse urban sample of 808 students (51 percent male), surveyed at age 10 and followed prospectively to age 21 in 1996. Potential predictors of alcohol abuse and dependence at age 21 were measured at ages 10, 14, and 16. Relationships between these predictors and alcohol abuse and dependence were examined at each age to assess changes in their patterns of prediction over time. Results indicated strong bonding to school, close parental monitoring of children, and clearly defined family rules for behavior, appropriate parental rewards for good behaviors, high level of refusal skills, and strong belief in the moral order predicted a lower risk for alcohol abuse and dependence at age 21. Of these, strong bonding to school consistently predicted low alcohol abuse and dependence from all three ages. By contrast, youths who had a higher risk of alcohol abuse and dependence at age 21 engaged in more problem behaviors, had more opportunities to be involved with antisocial individuals and spent more time with and were more bonded to those individuals, viewed fewer negative consequences from antisocial behaviors, and held more favorable views on alcohol use. Of these, prior problem behaviors and antisocial opportunities and involvements at ages 10, 14, and 16 consistently predicted alcohol abuse and dependence at age 21. These important malleable predictors, identifiable as early as age 10, provided potential intervention targets for the prevention of alcohol abuse and dependence in early adulthood.

Preventing alcohol use among urban American Indian youth: The Seventh Generation Program.
Moran, J.R.  (1999).
Journal of Human Behavior in the Social Environment, 2(1/2), 51-67.
 In comparing alcohol use between American Indian and non-Indian youth, the age at first involvement with alcohol is younger, the frequency and amount of drinking are greater, and negative consequences are more common for Indians. The Seventh Generation Program described in this article is unique in that it blends mainstream prevention approaches with American Indian culture to produce a program that is culturally sensitive to and appropriate for the urban Indian community in which it was developed. A quasi-experimental research design was used to evaluate the Generation Program.