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.
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Article
Addictions: Gambling
Lia Nower and Kyle Caler
Article
Addictions: Tobacco
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.
Article
Alcohol and Drug Prevention Among Youth and Young Adults
Peter J. Delany, Jane Sanville, and Joseph J. Shields
Substance use and comorbid mental health disorders are widespread in the United States. Recent data suggests that previous declines in substance use among adolescents ages 12–17 years and young adults ages 18–25 observed between 2002 and 2014 may be abating. In fact, research suggests that alcohol, tobacco, and marijuana use may be increasing in response to the social distancing and isolation related to COVID-19 restrictions. Drug use contributes to overdoses, poor health status, loss of income, family violence, accidents, auto fatalities, removal of children from a home, and impaired mental, emotional, and behavioral development in children. Substance misuse, substance use disorders, and related comorbid mental health and social problems are not inevitable. Substance use prevention services focus on strengthening protective factors and reducing risk factors that put individuals, families, and communities at risk for substance abuse and related health and social consequences. The social work profession performs an important role in advancing and implementing substance abuse prevention, not only in preventing the use and misuse of alcohol and other drugs and related negative health, mental health and economic outcomes, but also in working to improve the overall health of communities through intervention programs and policies.
Article
Alcohol and Drug Problems: Overview
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.
Article
Alcohol and Drug Problems: Law Enforcement and Legal Policy
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.
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Alcohol and Drug Problems: Practice Interventions
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.
Article
Behavioral Theory
Beth Angell
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.
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Cognitive Therapy
Joseph Walsh
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.
Article
Comorbidity
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.
Article
Confidentiality and Privileged Communication
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.
Article
Drug Courts
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.
Article
Drug Policy Reform
Sheila P. Vakharia
Social workers are uniquely qualified to be effective drug policy advocates for effective and equitable policies through their commitment to advancing social welfare and promoting social justice. The prohibitionist antidrug policies that began at the turn of the 20th century have been a key driver for the criminalization of millions of Americans over time, a disproportionate number of whom have been people of color. The period beginning with President Richard Nixon’s “War on Drugs,” in addition to contributing to inequality and marginalization, has exacerbated a number of public health and safety harms, suggesting that past policy approaches have not met their intended aims. The North American opioid overdose crisis in the early 21st century is presented as an illustrative case study because its persistence and mounting death toll exemplify the challenges with the current model of drug prohibition. Areas for macro social work interventions include legislative advocacy through lobbying, provision of expert testimony in legislative hearings, engagement in reform through litigation, involvement in social action, and performing policy analysis and research.
Article
Eye Movement Desensitization and Reprocessing
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.
Article
Genetics
Joan O. Weiss
The recent explosion of genetic and genomic knowledge that was a product of the Human Genome Project has extraordinary implications for social workers and their client population. Genetics and genomics are interdisciplinary fields. Their scope reaches beyond the doctor’s office and beyond medical professionals. Social workers must 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 need to know the basics of genetics and genomics and take an active part in protecting their clients from genetic discrimination.
Article
Harm Reduction
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.
Article
Health Care: Overview
Colleen Galambos
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.
Article
Historical and Intergenerational Trauma
Laurie A. Walker and Turquoise Skye Devereaux
Historical trauma originated with the social construction of subordinate group statuses through migration, annexation of land, and colonialism. The consequences of creating subordinate group statuses include genocide, segregation, and assimilation. Settler colonialism takes land with militaristic control, labels local inhabitants as deviant and inferior, then violently confines and oppresses the original occupants of the land. Confinement includes relocation, restriction of movement, settlement of lands required for sustenance, as well as confinement in orphanages, boarding schools, and prisons. Historical trauma includes suppression of language, culture, and religion with the threat of emotional, physical, and sexual abuse. Original inhabitant abuse often results in issues with health, mental health, substance abuse, and generational emotional, physical, and sexual abuse. Culturally safe (engagement that respects identity) and trauma-informed social work practices acknowledge the systemic causes of disparities in groups experiencing marginalization and oppression and focus on healing and addressing systemic causes of disparities.
Article
HIV/AIDS: Overview
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.
Article
HIV/AIDS: Practice Interventions
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.
Article
HIV in an Era of Biomedical Advances: Prevention
Diana Rowan
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.
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