Social Work Chapter 12

Racism also contributes to the fact that....

African Americans are six times more likely than whites to be arrested for AOD‑related crimes. Inner‑city areas are often targeted by the police, and offenses involving crack cocaine, which is more likely to be used in inner‑city poverty areas among people of color, carry stiffer penalties than offenses involving powder cocaine, which is more likely to be used by wealthier, usually white, individuals.

comprehensive addiction and recovery act (CARA) of 2016

CARA is the first major federal legislation dealing with addictions in 40 years and is a specific response to the opioid epidemic that has spread across the country. CARA funds ($180 million) are designated for opioid prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal.

Employee Assistance Program (EAP)

Employers were losing billions of dollars a year in productivity because of drug‑ and alcohol‑related absenteeism, injuries, and death, and employee assistance programs (EAPs) began to provide substance abuse services.

Some Statistics:

Over 15 million Americans ages 12 or older use an illicit drug or abuse a pain reliever, stimulant, or tranquilizer. ■ The misuse and abuse of prescription drugs is trending higher than any other illicit drug use, particularly pain relievers or opioids such as Vicodin and OxyContin. It is estimated that one in every three opioid prescriptions are being abused. ■ Tobacco kills almost a half-million people each year, and another 8.6 million have tobacco-related illnesses. ■ There are close to 90,000 alcohol-related deaths a year, and almost 45,000 of these are people killed by drunk drivers. World Health Organization statistics indicate that there are 2 billion alcohol users, 1 billion smokers, and 230 million drug users worldwide. World Health Organization statistics indicate that there are 2 billion alcohol users, 1 billion smokers, and 230 million drug users worldwide. World Health Organization statistics indicate that there are 2 billion alcohol users, 1 billion smokers, and 230 million drug users worldwide. The year 2016 was one of the worst years for drunk-driving deaths: it is estimated that 28 people a day were killed in DUI accidents that year.

Research suggests that Latino adolescents have an early onset of AOD use.

Latino men who have left their families behind when they legally or illegally immigrated to the United States constitute another high‑risk group. Forced separation from family results in a higher risk of intravenous drug abuse and unsafe sex practices, both of which can result in contraction of HIV/AIDS. This may be one reason why Latino men are overrepresented in the HIV/AIDS population. Drinking and driving is a serious problem among males in the Mexican American or Chicano community. When compared with Puerto Ricans, Cubans, and whites, Mexican Americans are more likely to be arrested for driving while intoxicated, and they are more likely to die in car accidents while intoxicated (65% compared to 46% among whites).

fetal alcohol syndrome (FAS)

a pattern of mental and physical defects that develops in some fetuses when the mother drinks too much alcohol during pregnancy. The alcohol circulates through the pregnant woman's bloodstream and crosses the placenta to the fetus. The alcohol interferes with the ability of the fetus to receive sufficient oxygen and nourishment. It is estimated that FAS is involved in 2 of every 1,000 live births (CDC, 2017a). A baby born with FAS may be seriously handicapped and require a lifetime of special care.

Today, with over 14,500 specialized drug treatment facilities and programs in the United States, there is still...

a shortage. People seeking AOD treatment can wait anywhere from one month to over a year to enter treatment. This is due in part to the heroin and opioid epidemic

human growth hormone

a synthetic version of the growth hormone that is administered to stimulate growth when the natural supply of growth hormone is insufficient for normal development.

Alcohol use did not become a social issue until the early nineteenth century. During the 1830s and 1840s, religious groups began to express opposition to...

alcoholic inebriation. Their efforts became known as the temperance movement. Proponents of the temperance movement developed and promoted the moral model of addiction, the belief that drunkenness was a sinful behavior and a moral failing. Public and private inebriate asylums were founded, and a variety of cures for alcoholism were explored.

Opiods

are prescription painkillers and can be incredibly useful for chronic pain sufferers. Each year over 100 million Americans are prescribed opioid drugs such as OxyContin and Vicodin. Heroin users find opioids to be less expensive and a better high if the drugs are crushed and snorted or liquefied and injected.

Drug treatment services provided by social workers include prevention, rehabilitation, individual and group therapy, behavioral therapy, medication management assistance, and...

case management. Substance abuse treatment settings that employ social workers include detoxification units; in‑patient or residential facilities; and outpatient settings in hospitals, prisons and juvenile justice agencies, schools, courts, welfare agencies, psychiatric facilities, and vocational rehabilitation centers.

Lawmakers developed a system that...

classifies drugs on the basis of their medical use and potential for abuse during the early 1970s.

People with AOD problems come from every socioeconomic category and every racial and ethnic background. They have varying degrees of....

dependence and respond differently to various types of treatment. Alcoholics Anonymous relies heavily on the disease model, in which blame is placed on the physiological incapacity to control alcohol consumption. This model seems to work well for people who have a severe dependence on alcohol

In the 1870's...

doctors first suggested that alcoholism might be inherited or caused by developmental and environmental factors.During the late 1800s, the temperance movement began to give way to the prohibition movement, the focus of which was to criminalize drug taking. Cocaine and opium were legal and were used for medicinal purposes, but there was a growing awareness of the potential for abuse. In 1906, the Pure Food and Drug Act established the Food and Drug Administration (FDA), and all drugs were required to carry labels listing ingredients, including opium or cocaine.

All addictions:

drugs are any chemical substances taken internally that alter the body's functioning, and drug use is a general term for all drug taking. Drug misuse refers to the inappropriate use of medications or prescribed drugs. Substance abuse is the continued use of alcohol or other drugs (legal or illegal) in spite of adverse consequences. Addiction is a compulsion toward a specific behavior, such as the use of alcohol or other drugs, despite negative consequences, and a psychological or physical dependence on the behavior or substance being abused (Fisher & Harrison, 2000). Chemical dependency describes addiction to alcohol or other drugs in contrast to nonchemical addictions like gambling.

Many human service workers argue that AOD problems are secondary symptoms of...

emotional pain or mental health problems rather than a primary disease. For example, in a recent study, 69 percent of the women who reported substance abuse also reported exposure to child‑hood physical, sexual, or emotional abuse; the majority reported multiple forms of abuse

Alcohol consumption reached an all‑time high during the 1980s, and several....

grassroots movements were initiated to address the problem.

The stereotype of the drunken Indian and the myths associated with it are powerful in indigenous communities and the general American society. One myth that has been internalized by Indigenous Peoples is that they....

have a genetic predisposition or physiological weakness toward alcohol and alcoholism. Research suggests that this is not the case. In fact, Cunningham, Solomon, and Muramoto's (2016) research demonstrated convincingly that alcohol consumption rates among indigenous Americans are the same, and in some cases even lower, than in the white population. However, racism, economic, and cultural factors help explain the AOD problems that do exist in indigenous communities.

Rehabilitation

involves intense therapeutic services. Stabilization and rehabilitation generally take at least three months and include both inpatient and outpatient services. Cognitive behavioral therapy has proven to be effective in the rehabilitation stage. The client learns to identify maladaptive behavior and thought patterns and to replace those patterns and behaviors with more positive thoughts and actions. Clients are taught to self‑monitor in order to recognize drug cravings early and develop coping strategies

Although most social workers have cautiously embraced the disease model, others reject it because....

it is not consistent with social work's strengths perspective. Even some social workers in settings that accept the medical explanation of alcoholism view the disease model as only one part of the equation because of its emphasis on pathology. From a biopsychosocial, or person‑in‑environment, approach, the etiology (origin) of alcoholism or addiction includes environmental, social, psychological, and genetic variables.

Some social workers who have seen the effects of prenatal drug addiction contend that jailing pregnant drug users is the only way to ensure that they will not continue to use drugs and harm their unborn children. Other social workers argue that treatment and positive intervention are more effective than....

jail. They assert that when social workers turn clients in for their drug use, others will not come in for services, thus increasing the risk to their unborn children.pregnant client disclosed that she had been drinking alcohol, what would you do?SUBSTANCE ABUSE In 2000, the NASW took the position that professional doctors, nurses, and social workers should not be asked to assist in a campaign to arrest and prosecute their patients and clients and that drug testing without prior consent is invasive and interferes with the trust relationship between the professional and the patient. The best solution is to provide high‑risk pregnant women with increased access to prenatal drug treatment centers. Prospective mothers will be more likely to patronize a place in which they can receive treatment without fearing arrest.

"The social worker often acts as a case manager, networking with and monitoring family services, vocational services, mental health services, child‑care services....

medical and pharmacotherapy services, legal services, and behavioral therapy and counseling services. The strengths perspective requires the case management process to be driven by client‑identified goals. Clients should be asked what they need and want to accomplish in terms of life skills, finance, leisure, relationships, living arrangements, occupation, education, health, internal resources, and recovery. The answers may be general, such as improv‑ing opportunities. The social worker must help the client break the general goal into specific objectives, for example, to visit a local employment office to check out available opportunities "

Detection of drug and alcohol use in the workplace has been a subject of....

much debate in recent years. Some employers require a drug test as part of a physical examination before they will hire a new employee.

Denial

occurs when the client does not recognize or admit that there is a connection between his or her life problems and the abuse of alcohol or another substance. Therefore, a significant part of treatment is dedicated to helping clients confront the problem and break through denial.

Evidence‑based practice indicates that there are four important protective factors that need to be ad‑dressed in early intervention prevention programs:

parental investment, child-adolescent social competence, child adolescent self-regulation, child adolescent school bonding and academic achievement.

The prevalence of substance abuse issues among nondominant groups and populations at risk may be explained in....

part by such societal factors as social isolation, institutional racism, and poverty. For example, alcohol abuse by older adults is difficult to detect because of their isolation and is believed to be symptomatic of other chronic and mental health conditions. Alcoholism is more prevalent among older African Americans, Latino men, and men in general, although women's rates of alcoholism have almost caught up to men's. There is little research available on the effectiveness of substance abuse interventions among the elderly.

internalized homophobia

refers to the repulsion some people feel in response to their own feelings of attraction to other members of their sex. Shame has been found to be closely related to AOD abuse (Held, Owens, & Anderson, 2016). Those LGBT individuals who do not disclose their sexual orientation to family, friends, or coworkers often experience intense feelings of depression, anxiety, low self‑es‑teem, and even suicidal despair. Without alternative coping skills, drugs and alcohol can be very tempting.

The way the problem is defined and assessed is critical because problem definition determines the type of intervention that will be used. For example, if AOD is defined as a moral failing, the intervention might be....

spiritual or moral counsel. If the problem is defined as a disease, the intervention will be geared toward legitimate medical treatment and the goal of abstinence. If the problem is defined as an adaptive response to a difficult situation, the goal of treatment will be to help the addict unlearn the adaptive response and replace it with a more functional response

The stages of treatment include....

stabilization, rehabilitation, and maintenance. During stabilization, the client often needs to be forcefully confronted about the addiction and the need for treatment. In the Johnson model of intervention, family and friends, with the help of a trained facilitator, confront the addict about the negative personal and financial consequences of his or her behavior The stabilization period includes detoxification and abstinence from drugs and alcohol, acceptance of the problem, and a commitment to permanently overcome the addiction.

african americans

start drinking later and have lower rates of alcohol use. But are more at risk for legal problems when drinking. White Americans are more likely than black Americans to have used most kinds of illegal drugs, including cocaine, marijuana, and LSD; and whites are also more likely to abuse prescription drugs. However, blacks are far more likely to go to prison for drug offenses

During the early 1970s....

the Nixon administration began a war on drugs. That war dramatically expanded during the 1980s and 1990s. Its focus has been to stop the flow of drugs into the United States and to impose stiffer penalties for drug offenses. These approaches address the supply side of the drug problem, meaning that they attempt to decrease the supply of available drugs. The assumption is that reduced availability will result in less use.

The struggle against AOD‑related problems takes place on three main fronts:

the elimination of AOD from the workplace, the prevention of HIV/AIDS, and the decriminalization of addiction.

maintenance

the priority is to engage the client in therapy and skill building focused on relapse prevention. Other interventions utilized during the rehabilitation and maintenance phases include self‑help groups such as Alcoholics Anonymous, aversion therapy, social skills training, and therapeutic community programs.In addition to providing treatment interventions, social workers should also be on the forefront of substance abuse prevention programs.

Alcoholism is the...

third leading cause of preventable mortality and morbidity in the United States (after smoking and obesity). The AMA defines alcoholism as "a primary, chronic disease [not a symptom] with genetic, psychosocial, and environmental factors influencing its development and manifestations.

The person‑in‑environment, or biopsychosocial, framework is the foundation on which social workers base successful diagnosis, assessment, and....

treatment of AOD problems. Social workers using this model evaluate each individual on the basis of his or her unique circumstances.

In addition to the drugs described earlier, a case can be made that Americans also struggle with....

what might be termed "addictions" to sugar and caffeine. The average American consumes 66 pounds of sugar a year. Researchers do not all agree on whether sugar is addictive; some studies have produced evidence of sugar addiction. Caffeine is the most commonly used drug in the world. Approximately 87 percent of adults and 76 percent of children in America regularly consume caffeine in their diets.

The fact that 30 percent of children with alcoholic parents develop alcoholism themselves, whereas only....

10 percent of children with nonalcoholic parents develop alcoholism, suggests that both environmental and genetic variables are in play. For example, children from disengaged, rigid families who repress emotions and have a lot of conflict, as well as children from rigid, moralistic families, are more likely to have AOD problems as adolescents. Without treatment, they continue to have AOD problems as adults

Alcohol and drug addiction can destroy the lives of women. Twelve to...

15 percent of women are heavy drinkers, and women are the largest group to abuse benzodiazepines or tranquilizers. This may explain why female alcoholics have a death rate that is more than 50 percent of the male death rate. Women are less likely than men to seek treatment. There is a strong correlation between sexual or domestic violence and substance abuse in women. This correlation seems to indicate that women have more of a problem with shame than with guilt, which is the focus of many male‑driven rehabilitation programs. Most rehabilitation programs do not emphasize women's developmental needs and the importance of healthy relationships in their lives.

Variations in the effects of the drugs can be explained by physiological, psychological, and social factors, including body weight, gender, age, ethnicity, genetics, and emotional and physical health. For example, about....

50 percent of people of Asian descent carry a gene that leads to an unusual increase in heart rate, facial flushing, sweating, and nausea when they consume alcohol. These symptoms are not as prevalent or as intense in other ethnic groups. Women tend to develop higher blood alcohol levels than men who drink the same amount because women have a lower percentage of body water and a higher percentage of body fat, which causes alcohol to be metabolized faster. As a result, women have more AOD health-related problems and deaths.

dependence

The variability of drug effects may leave some individuals more vulnerable than others to developing an addiction to or a dependence on a sub‑stance, and some may be able to use the same substance with no problematic effects. Dependence can be psychological or physical. Not all people who use drugs develop dependence or addiction.