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.
Shulamith Lala Ashenberg Straussner and Richard Isralowitz
Janet B. W. Williams and Michael First
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association is referred to as DSM-5 ™ . DSM-5’s early predecessor, DSM-III, differed considerably from the first two editions. Its innovative incorporation of specified diagnostic criteria had a major impact on the field of mental health. In DSM-5, these criteria have been further updated to reflect the important gains in our understanding of mental disorders.
Traumatic events have permeated our lives throughout history and across the globe, inflicting profound losses on individuals, families, and communities during warfare, armed conflict, natural disasters, and relational violence. Although many survivors of these events harness their resilience and cope without long-term negative mental health effects, others experience a range of physical and mental health conditions, including trauma- and stress-related disorders. With an emphasis placed on adult trauma survivors, the conditions of posttraumatic stress disorder, acute stress disorder, adjustment disorders, complex trauma, and other stress-related conditions have been explored within a social context. Starting with a historical context, the following topics were addressed. The typologies of trauma were introduced including the definitions of Type I trauma—a single discrete event including natural catastrophes; Type II trauma—chronic and repetitive traumatic physical, sexual, and/or emotional abuse; and Type IIII—severe and multiple abusive events with multiple perpetrators. Historical and intergenerational trauma reflect a collective of complex traumatic events throughout generations that resonate in subsequent generations in terms of ungrieved losses and survivor guilt, among other psychosocial issues. Cultural and racial trauma include chronic verbal and/or physical assaults that involve racialized bigotry. Combat trauma involves a combination of deployment stressors that have affected servicemembers in distinct ways with “signature injuries” associated with different wartime conflicts. The next section addresses the current typology of the Diagnostic and Statistical Manual of Mental Disorders—V, noting the changes in diagnostic criteria, in particular related to the diagnosis of posttraumatic stress disorder (PTSD). Mental health responses to trauma vary a great deal based on a balance of risk and protective factors, often revealing noteworthy resilience and the absence of negative aftereffects. The neurobiological effects of trauma are addressed along with mental health conditions or disorders (e.g., acute stress response, PTSD, complex trauma, and anxiety disorders). Specific phase-oriented and multimodality treatment interventions are reviewed that focus specifically on the mental health conditions presented. These approaches are research-informed, culturally responsive, and theoretically grounded Finally, the responses experienced by clinicians who work with traumatized clients are outlined along with recommendations for ways to minimize the effects of secondary, or vicarious, traumatization. Clinical vignettes based on case composites have been utilized to illustrate central points.
Dorie Gilbert and Katarzyna Olcoń
Research indicates that practitioners’ cultural biases are a barrier to effective cross-cultural assessment; thus, social work practitioners must demonstrate the ability to appraise a client’s cultural context in assessing and treating mental health concerns. The Cultural Formulation Interview (CFI) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides practitioners with a standardized cultural assessment method for use in mental health practice. This article provides a comprehensive overview of the CFI with a focus on its four domains: (a) cultural definition of the problem; (b) cultural perception of cause, context, and support; (c) cultural factors affecting self-coping and past help-seeking; and (d) cultural factors affecting current help-seeking. Conceptualizations of mental health and mental illness vary across cultural subgroups, and the nation’s changing demographics underscore the need to give particular attention to how the CFI can be useful for improving cross-cultural assessment with historically excluded or marginalized racial and ethnic groups. The CFI is an important step towards culturally grounded assessments; however, it has several conceptualization and implementation limitations, including its narrow focus on individual-level cultural explanations of distress while the effects of social inequities remain masked. The article concludes with additional considerations for cross-cultural assessment and implications for social work education and practice.