Lia Nower and Kyle Caler
Gambling disorder is a significant public health concern. The recent and continued proliferation of land-based and interactive gambling opportunities has increased both accessibility and acceptability of gambling in the United States and abroad, resulting in greater and more varied participation. However, there is currently no designated federal funding for prevention, intervention, treatment, or research, and states are left to adopt varying standards on an ad hoc basis. Social workers receive little or no training in screening or treating problem gamblers, though research suggests that a significant proportion of those with mental health and other addictive disorders also gamble excessively. Raising awareness about the nature and scope of gambling disorder and its devastating implications for families and children is a first-step toward integrating gambling into prevention, assessment and treatment education in social work. This, in turn, will increase the chances of early identification and intervention across settings and insure that social workers can lend a knowledgeable and credible voice to addressing this hidden addiction.
Mansoo Yu and Rachel Fischer
Tobacco use is a major public-health concern in the United States. Intervention and prevention strategies for tobacco use are an urgent public-health priority because tobacco use is the single most preventable cause of death. To help social workers better understand tobacco use problems, this entry presents an overview, including definitions of terms, the scope and impact of tobacco use problems in terms of different segments of the population (that is, age, gender, race or ethnicity, geographic location, and education level or socioeconomic status), etiology of tobacco use (for example, biological or genetic; psychiatric; psychosocial; or environmental or sociocultural factors), policy history, tobacco prevention, clinical issues (such as cessation desire, treatment and success, or screening tools for tobacco use disorder and tobacco withdrawal), and practice interventions for tobacco use problems. Based on the information, the roles of social workers will be addressed.
Shulamith Lala Ashenberg Straussner and Richard Isralowitz
Social workers commonly encounter individuals and families that have problems resulting from alcohol and other drug (AOD) misuse, abuse, and dependence. This entry provides an overview of AOD problems in the general population and within such subpopulations as young people, the elderly, women, ethnic and racial minorities, and the gay and lesbian community. Clinical and policy responses to these problems in the United States, the roles of social workers in this field, and directions for the future are addressed.
Anna Celeste Burke
Historically, U.S. policy has been characterized by long-standing ambivalence evident in the changing emphasis placed on prohibition as the aim of drug policy, and in debate about the relative merits of various approaches to drug control. Often characterized as supply reduction versus demand reduction efforts, significant changes have occurred over time in these efforts, and in the emphasis placed on them. In the last quarter of the twentieth century, U.S. drug policy adopted a more prohibitionist stance, with increased reliance on a variety of law enforcement, and even military actions, to control the supply and use of drugs, even in the face of evidence for the effectiveness of prevention and treatment, and high costs associated with the burgeoning incarceration rates.
Maryann Amodeo and Luz Marilis López
This entry focuses on practice interventions for working with families and individuals including behavioral marital therapy, transitional family therapy, and the developmental model of recovery, as well as motivational interviewing, cognitive-behavioral therapy, relapse prevention training, and harm reduction therapy. A commonality in these intervention frameworks is their view of the therapeutic work in stages—from active drinking and drug use, to deciding on change, to movement toward change and recovery. We also identify skills that equip social work practitioners to make a special contribution to alcohol and other drug (AOD) interventions and highlight factors to consider in choosing interventions.
There are a range of practice interventions for clients with AOD problems based on well-controlled research.
Flavio F. Marsiglia, David Becerra, and Jaime M. Booth
Prevention is a proactive science-based process that aims to strengthen existing protective factors and to diminish or eliminate other factors that put individuals, families, and communities at risk for substance abuse. Prevention is important because alcohol and drug abuse are a leading cause of morbidity, mortality, and health expenditures in the United States. Alcohol and other drug abuse is also associated with infectious diseases, chronic diseases, emergency room visits, newborn health problems, family violence, and auto fatalities. The comorbidity of drug and alcohol abuse with mental health disorders and HIV adds urgency to the development, evaluation, and implementation of comprehensive and effective prevention interventions. The social work profession plays a key role in substance abuse prevention, as it not only targets the use and abuse of alcohol and other drugs but also aims at reducing the related negative health and psychosocial outcomes and economic burden they produce on individuals and society at large.
Behavioral theory seeks to explain human behavior by analyzing the antecedents and consequences present in the individual's environment and the learned associations he or she has acquired through previous experience. This entry describes the various traditions within the behavioral perspective (classical conditioning, operant conditioning, cognitively mediated behavioral theory, and functional contextualism) and the clinical applications that are derived from them. Common criticisms are discussed in light of the ongoing evolution of behavioral theory and the fit of its tenets with the field of social work.
Cognitive therapy is a perspective on social work intervention with individuals, families, and groups that focuses on conscious thought processes as the primary determinants of most emotions and behaviors. It has great appeal to social work practitioners because of its utility in working with many types of clients and problem situations, and its evidence-based support in the literature. Cognitive therapies include sets of strategies focused on education, a restructuring of thought processes, improved coping skills, and increased problem-solving skills for clients.
Diana M. DiNitto
This entry defines comorbidity and similar terms used in various fields of practice. It addresses the prevalence of comorbidity, suggests explanations for comorbidity, and discusses integrated treatment for comorbid conditions and the importance of the concept of comorbidity in social work practice.
Carolyn I. Polowy, Sherri Morgan, W. Dwight Bailey, and Carol Gorenberg
Confidentiality of client communications is one of the ethical foundations of the social work profession and has become a legal obligation in most states. Many problems arise in the application of the principles of confidentiality and privilege to the professional services provided by social workers. This entry discusses the concepts of client confidentiality and privileged communications and outlines some of the applicable exceptions. While the general concept of confidentiality applies in many interactions between social workers and clients, the application of confidentiality and privilege laws are particularly key to the practice of clinical social workers in various practice settings.
Rudolph Alexander Jr.
The criminal justice system traces its roots to ancient times. When the 13 original colonies were formed, they brought many of the laws and legal processes from England. Traditionally, the criminal justice system is viewed as including law enforcement, judiciary, and corrections. However, state legislatures and Congress must be viewed as essential components of the criminal justice system because they pass laws that influence the other three components. A number of controversial practices and policies exist within the criminal justice system. Social work, which has had a long involvement in the criminal justice system, including spearheading the creation of the juvenile justice system in the United States, is involved in all phases of the criminal justice system.
Julie Schroeder and Bridgette Harris
Drug courts were developed to facilitate treatment for criminal offenders with substance abuse problems. Drug courts operate using dual paradigms of healing and discipline via treatment, social service resources, and case management for healing, and judicial sanctions and criminal justice interventions in efforts to initiate change resulting in sobriety and no further criminal behavior. The key goals of most drug courts are to reduce drug use and associated criminal behavior by engaging and retaining drug-involved offenders in programs and treatment services; to concentrate expertise about drug cases into a single courtroom; to address other defendant needs through clinical assessment and effective case management; and to free judicial, prosecutorial and public defense resources for adjudicating non-drug cases.
It is vital that social work students be introduced to drug courts and how they function for students to gain better understanding of how addiction can bring their clients into contact with the criminal justice system. Drug courts are ideal settings for internship placements so that students can get hands-on experience in a court setting and assist clients using a therapeutic jurisprudence model.
Tonya Edmond and Karen Lawrence
Since its inception in 1987, eye movement desensitization and reprocessing (EMDR) therapy has been the subject of lively debate and controversy, rigorous research both nationally and internationally, and is now used by licensed practitioners across six continents as an effective treatment of trauma symptoms and posttraumatic stress disorder (PTSD). The aim of this entry is to provide social work practitioners and researchers with a description of the treatment approach for adults and children, EMDR’s development and theoretical basis, a review of controversial issues, and an overview of the evidence of effectiveness of EMDR across trauma types and populations.
Joan O. Weiss
The recent explosion of genetic knowledge that was a product of the Human Genome Project has extraordinary implications for social workers and their client population. It is imperative that social workers recognize how vital their role is in helping clients come to terms with being at risk for a genetic condition or facing the uncertainty of a genetic diagnosis in the family. Understanding the psychosocial and ethical implications of genetic testing is important for all social workers, no matter where they are practicing. Social workers must take an active part in ensuring that clients are protected against genetic discrimination and learn more about basic genetics and genetic resources.
Diane Rae Davis
Harm reduction is a helping strategy that attempts to alleviate the social, legal, and medical consequences associated with unmanaged addiction, and in so doing, limit the harms, such as infectious disease (HIV, hepatitis), violence, criminal activity, and early death, without necessarily attempting to “cure” the addiction. While abstinence may be an ideal outcome from a harm reduction standpoint, abstinence is viewed as only one of several means of improving a person's life. Harm reduction strategies are well known in the U.S. through methadone maintenance and syringe-exchange programs, and are increasingly relied on in the treatment of co-existing disorders.
This entry provides an overview of the state of health care in the United States. Service delivery problems such as access and affordability issues are examined, and health care disparities and the populations affected are identified. A discussion of two primary government-sponsored health care programs—Title XVIII (Medicare) and Title XIX (Medicaid), and the Patient Protection and Affordable Health Care Act—are reviewed along with various health care programs and major existing service delivery systems. Ethical conflicts in providing health care, and new directions and challenges are discussed, along with future roles for social workers.
Peter A. Newman
AIDS (acquired immunodeficiency syndrome) is the most deadly epidemic of modern times. Since HIV (human immunodeficiency virus), the virus that causes AIDS, was first identified in the United States in 1981, nearly 1 million Americans have been diagnosed with AIDS and 530,756 have died. Forty million people are living with HIV worldwide. Although AIDS is still a fatal disease, new drug therapies have greatly slowed the course of disease progression and enhanced quality of life for persons living with HIV. Nevertheless, monumental disparities persist within the United States and between the developed and developing worlds in this two-tiered epidemic.
Kosta N. Kalogerogiannis, Richard Hibbert, Lydia M. Franco, Taiwanna Messam, and Mary M. McKay
For over 20 years, social workers have been involved in service delivery for HIV and AIDS infected and affected individuals. It is estimated that more than 1 million people are living with HIV or AIDS in the United States. The rates of HIV infections continue to rise, with more than 40,000 individuals being diagnosed each year in the United States. This entry explores the current trends in HIV primary prevention, secondary prevention, and counseling and psychotherapy services for people living with or affected by HIV/AIDS.
Since the start of the human immunodeficiency virus (HIV) pandemic, numerous biomedical advances have caused the social-work response to shift from management of a crisis to prevention of an incurable, but treatable chronic disease. About 1.3 million people in the United States and more than 33 million people worldwide are estimated to be living with HIV. Rates of incidence in impoverished, marginalized communities are highest, with the rates continuing to increase among young African American gay and bisexual men. Other communities at high risk are people who are incarcerated, engage in sex work or other kinds of exchange sex, and participate in risky injection-drug use. Minority groups are often impacted because of reduced access to quality medical care and HIV testing. Social workers in HIV prevention work are challenged to educate clients and communities on the sexual risk continuum, provide more interventions that are culturally tailored for disadvantaged at-risk groups, and implement evidence-based HIV prevention and testing programs worldwide. The National HIV/AIDS Strategy now provides structure to funding opportunities for HIV prevention programs, and there is disparate access to effective treatments worldwide for those living with HIV.
Yin-Ling Irene Wong
This entry provides an overview of contemporary homelessness as a major social problem in the United States, focusing on the definition of homelessness and its prevalence, as well as on the composition and characteristics of the homeless population. It then discusses the dynamics and causes of homelessness and examines policy responses toward homelessness since the McKinney–Vento Homeless Assistance Act of 1987. The entry points to the multifaceted nature of homelessness and highlights promising interventions that have shown to be effective in addressing homelessness among members of special needs populations.