The social worker's role

Advantages of our discipline and approach
Social workers are trained to work with people as individuals but also to look beyond the individual and the individual’s presenting problem. Perhaps the key advantage our profession has over others is its emphasis on the individual within a particular environment and context. The majority of substance use treatment focuses solely on the individual and that individual’s substance problem without seeing the individual within a relationship, a family, a neighbourhood, a cultural context, and a broader environment, all of which may contribute to their presenting problem.

Much social work contact with substance users is likely to have been triggered by a different presenting problem, eg. concerns about health issues or parenting capacity. However, the added value social work should bring to work with substance users is our ability to take a holistic view of the service user’s life and relationships, and intervene or support improvements in several aspects of their lives at any one time. Further, good social work practice remains rooted in on our shared professional values and ethics. We should not, and hopefully do not, make judgements about people due to their use of substances – only about its impact on their behaviour when such behaviour is harmful to others. Social work qualifying and post-qualifying training not only focuses on knowledge and skill development but also continually emphasises critical self-reflection about how our value base and attitudes influence our work. Many people with substance problems are treated badly by professionals. Such experiences can prevent people coming forward for help even when they know they and their families need it.

Don’t need to be an expert
Social workers are not expected to be specialists in substance use in the same way alcohol and drug specialists are not expected to be social workers. An increasing number of social workers appear to be moving into the substance use field, but most social workers currently work in specialist adult or children and families teams. Whatever the specialist area of social work, we do need to know enough to:

Supporting individual through treatment
Supporting individuals following a referral and admission to a substance use service is an important contributing factor to the success of that treatment. Evidence shows that the more support and services the person has, the more stable their environment. The more stable their environment, the better the chances of dealing with their substance problems (Azrin 1976, Costello 1980, Dobkin et al. 2002, Powell et al 1998). Rightly or wrongly, one of the criticisms social workers face is the fact we are too ready to close a case rather than supporting people through the referral and treatment process. Thus, people risk falling through the gaps in service if the treatment is inappropriate or breaks down.

People with problematic drinking or drug use will often have many attempts at changing or stopping their substance use. This can be frustrating to both the professionals working with the person and the family living with them. However, the feeling of failure experienced by the service user will be compounded if those around him stop their support. Even people who reach their treatment goals need support in maintaining that after treatment. Although the pressure to close files is high, it can be a false economy with someone with substance use problems. There is increasing evidence to show that working with the family in their own right prior to, during and post treatment may help the person avoid the revolving door familiar to social workers and substance use services alike (Copello et al. forthcoming) or prevent the home environment and relationships from deteriorating even further.

Openness about process and outcomes
There can be real conflict for a social worker who wants to support the individual but, for example, has concerns for the welfare of the children or adults around him. One of the skills social workers have is being open about such concerns even when we are communicating things we know the service user will not be happy to hear. These skills are transferable to working with substance using individuals. Informing someone of your concerns about their substance use and asking them how they plan to keep their loved ones safe while they are using (or during attempts to change this use) will be better met if you ask them how you can support them to do this. Of course, this needs to be appropriately coupled with openness about the possible outcomes if they are not able to work with you (and other professionals as appropriate). This is particularly the case where children are at risk of harm.

Links between social work and substance use - introduction | Extent of substance use
Why people use substances | Barriers to good practice and how to overcome them
Frequently asked questions | Examples of good practice