Substance Abuse Treatment

Vol. 4, No. 4
September 1999

Substance Abuse Treatment and Prevention

On the face of it, child welfare workers have little to do with the prevention and treatment of substance abuse. Beyond making a referral and monitoring the situation, there is little else you can do, right? After all, if attending treatment is part of what parents must do to hold on to their kids or get them back, what happens is really up to them.

Yet as a child welfare worker, you know what a big issue this is. You may not know the statistics, the ones that say 40 to 80 percent of all parents investigated for child abuse or neglect use drugs or alcohol (BHRP, 1998), or that children of substance-abusing mothers are more likely to experience multiple placements and to stay in foster care longer than other kids (Curtis & McCullough, 1993). But you know from your own experience that drug and alcohol abuse has a devastating effect on families and kids. And you want to do something about it.

Identification

A first step is recognizing substance abuse as a problem in individual families. Sometimes the symptoms can be difficult to recognize, and many child welfare workers do not ask about substance use explicitly. As a result these problems go unacknowledged and untreated.

One way to inquire about alcohol abuse in a nonjudgmental and open way is the CAGE method, which involves asking:

C Have you ever felt the need to Cut down on your drinking?

A Have people Annoyed you by criticizing or complaining about your drinking or drug use?

G Have you ever felt bad or Guilty about your drinking?

E Have you ever had a drink first thing in the morning to steady your nervers and get rid of a hangover (Eye-opener)?

Getting a "yes" answer on two or more of these questions suggests that a more thorough assessment should follow.

Confidentiality

If it is an open fact that a family member has substance abuse issues, you can help by offering to refer his person to someone who has experience working with substance using clients. To do this, you need permission from the individual abusing drugs or alcohol. You cannot simply call the police or the detoxification center and report the parents of your clients. To do so would be a gross violations of social work ethics, no matter what your opinion of substance abuse.

In fact, substance abuse issues are given special status in matters of confidentiality. Even if a clients signs a standard "release of information" form, revealing the presence of substance abuse is not permitted. Only when an individual gives written consent specifically regarding substance abuse may a practitioner reveal the problem to other professionals (Burke & Clapp, 1997). Many agencies have forms solely for the release of substance abuse information. On the other hand, if substance abuse by a caretaker is putting a child at risk, a report can (and must) be made to CPS (Mason, 1996).

Referral

There are many places to turn to refer someone for treatment. Some DSS's in North Carolina now have a Qualified Substance Abuse Professional (QSAP) in the agency. This person is available to provide additional screening and make appropriate substance treatment referrals.

In addition, all mental health centers have substance abuse clinicians--just call the clinic and ask for a substance abuse counselor. If you can, get to know the substance abuse clinicians in your community on a personal level--this will help bridge the barriers that often exist between agencies.

If you are making the referral directly to the treatment agency, as much as possible, look for programs that focus on client strengths and encourage the client to participate in his or her treatment goal planning. For more on this topic, see "Women Who Abuse Substances May Benefit from a Different Approach to Treatment."

Treatment Strategies

Although as a child welfare worker you role in substance abuse treatment will be limited, it is important to know about the different types of treatment out there. Unfortunately, many communities do not have a broad continuum of treatment options. As a result, clients sometimes end up in whatever treatment program is available, rather than in one that meets their individual needs. This can hurt a person's chance of quitting successfully.

Treatment options include detoxification, inpatient and residential settings, and outpatient treatment. An individual's treatment generally depends on the severity of the problem.

Detoxification is a 5 to 30+ day treatment intended to wean the user from his or her substance. This can be done in a hospital-like setting or in a community-based program. Inpatient and residential settings (halfway houses, recovery homes) usually treat clients for 14 to 28 days.

Outpatient. Frequently addiction is treated in an outpatient setting. Some people receive care in day treatment programs, where they attend treatment for part of the day but spend the night at home. Self-help groups are another form of outpatient treatment. Twelve-step programs are available nationwide and are run by group members. The best known of these are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

Group treatment has been identified by substance-abuse clinicians as the treatment of choice. This method tends to be effective because it uses peer feedback, modeling, confrontation, and support. Group treatment can also be used to teach coping and interpersonal skills.

Biological treatment, a form of outpatient treatment, involves using drugs (e.g., antabuse, methadone) to reduce a person's physical need for substances.

Family treatment (e.g., couple counseling, multifamily therapy, single-family therapy) focuses on stabilizing the family and helping them set boundaries with the substance user.

Outpatient counseling/therapy can be used in inpatient treatment programs or in the community. The goal is to help clients gain insight into their substance-using behaviors, to address problem behaviors, teach social skills, and provide support.

Withdrawal, Relapse, & Risk

An effective treatment program will help most people deal with the physical and psychological challenges of quitting and staying off drugs. However, as a child welfare worker, it is important for you to remember "that the withdrawal experienced by parents who cease using alcohol or other drugs presents specific risks. The effects of withdrawal often cause a parent to experience intense emotions, which may increase the likelihood of child maltreatment (Zuskin & DePanfilis, 1987). During this time, lasting as long as two years, it is especially important that resources be available to the family" (Prevent Child Abuse, 1996).

Relapse. From your work with families, you probably know that people attempting to quit drugs or alcohol often backslide. Relapse should be viewed as a normal and natural part of the recovery process for many clients. Recovery from drugs and alcohol is the process of learning how to live a meaningful and comfortable lie without the need for alcohol or drugs. Abstaining from drugs or alcohol alone does not mean a full recovery has occurred.

Prevention

Your role as a child welfare worker may give you an opportunity to help prevent substance abuse from occurring at all. To do this it will be helpful to know two things: the factors that reduce the likelihood of substance abuse ("protective factors") and the resources in your community that help people develop these protective traits.

Protective Factors. Research tells us that there are a number of factors that can protect individuals against substance abuse. On an environmental level they include adequate housing and income, stable employment, low neighborhood crime and drug use, good health care, access to adequate social services, and good schools. On the family level they include marital harmony, close relationships with siblings, family rituals and traditions, and the presence of an extended family.

Protective personal factors include positive self-esteem, flexibility, creativity, the ability to make friends, independence, a sense of humor, and good problem-solving skills (OSAP, 1990; McCullough et al., 1993).

At first glance, these protective factors may read like a laundry list of the things that many clients of social services lack. But rather than despairing for the families you work with, look to their strengths. Indeed, since identifying family strengths is already part of what you do to help families address the issues that brought them to the attention of DSS, spend some time talking with them about how their strengths can be enhanced to ensure family members don't run into trouble with drugs or alcohol.

It will help if you can refer families to the programs in your community aimed at helping individuals improve on their protective qualities. Because so many resources fall into this categoy, from job training to family therapy, it is not feasible to list them here. If you are lucky enough to have a choice between different programs specifically designed to reduce an individual's risk of substance abuse, choose one that uses an approach called "competency enhancement." The most effective substance abuse prevention approach, competency enhancement focuses on developing personal and social skills that help guard against substance using behaviors, as well as on addressing other personal and developmental issues (Botvin & Botvin, 1992).

For ideas on how you can improve your work with families affected by substance abuse, see "Treatment and Prevention: What You Can Do".

References

Behavioral Healthcare Resource Program. (1998). Gender-specific substance abuse treatment: A curriculum for North Carolina treatment professionals. Chapel Hill, NC: University of North Carolina at Chapel Hill School of Social Work.

Botvin, G. J. & Botvin, E. M. (1992). School-based and community-based prevention approaches. In J. H. Lowinson, P. Ruiz, R. B. Millman & J. G. Langron (Eds.). Substance Abuse: A Comprehensive Textbook (2nd ed.). Baltimore: Williams & Wilkins, 910-927.

Burke, A. C. & Clapp, John. (1997). Ideology and social work practice in substance abuse settings. Social Work, 42(6), 552-564.

Chaffin, M., Kelleher, K. & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from propective community data. Child Abuse and Neglect, 21(7), 631-636.

Curtis, P. & McCullough, C. (1993). The impact of alcohol and other drugs on the child welfare system. Child Welfare, 72(6), 533-542.

Fisher, G. L. & Harrison, T. C. (1997). Substance abuse: Information for school counselors, social workers, therapists, and counselors. Needham Heights, Massachusetts: Allyn & Bacon.

Mason, J. (1996) Reporting child abuse and neglect in North Carolina. Chapel Hill: Institute of Government of the University of North Carolina at Chapel Hill.

McCullough, C., Polowy, M., Zeizel, J., DeWoody, M., Gutterman, F., & Brin, M. (1993). Act 1: Alcohol and other drugs. In A Competency-based Training: Child Welfare and Chemical Dependency, A Core Curriculum Trainer's Guide. Washington, D.C.: Child Welfare League of America.

National Center on Addiction and Substance Abuse at Columbia University. (Jan. 1999). No safe haven: Children of substance-abusing parents. New York: Author.

Office of Substance Abuse Prevention. (1990). Monograph 5: Communicating about alcohol and other drugs. Washington, D. C.

Prevent Child Abuse America. (1996). The relationship between parental alcohol or other drug problems and child maltreatment. On-line. <http://www.childabuse.org/fs14.html> [Aug. 31, 1999]. (Web address no longer functional.)

Smyth, N. J. (1995). Substance abuse: Direct practice. In R. L. Edwards (Ed.). Encyclopedia of Social Work. Washington, D.C.: NASW Press, 2328-2337.