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Shulamith Lala Ashenberg Straussner and Richard Isralowitz

Most social workers will encounter individuals and families who have problems resulting from excessive use of tobacco, alcohol, and other drugs, commonly referred to as substance abuse or, increasingly, as substance misuse problems. This article provides an overview of problems related to substance use worldwide, focusing on the United States population and selected subpopulations, such as young people, the elderly, women, ethnic and racial minorities, and the lesbian, gay, bisexual, and transsexual communities. It discusses the DSM-5 diagnostic criteria for Substance Use Disorders, evidence-based treatment approaches, and relevant policy issues relating to substance use problems. The roles of social workers in addressing these problems are identified.


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.


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.