(picture – tell tale signs: assessing service users for substance misuse. Click here for large readable image)
Experts have consistently warned of a knowledge gap in social work concerning substance misuse. Amy Taylor reports on efforts to help practitioners provide a more holistic approach
Social work values encourage practitioners to treat all clients equally, but people who misuse substances find this isn’t always the case. According to experts, some social workers’ ignorance, which stems from a lack of training, is leading to prejudice and alienation of clients.
The British Association of Social Workers agrees that there are knowledge gaps on substance misuse within the profession, and published a pocket guide last month in partnership with Bedfordshire University in a bid to increase awareness.
Scott Haines, family development manager at drug and alcohol charity Addaction, says social workers’ understanding of substance misuse is inconsistent. Practitioners have varying levels of experience, he says, and the quality of relationships between social services and local drug and alcohol action teams also differs. Haines says that in the worst cases social workers’ prejudiced attitudes can have a devastating effect.
“When I was a practitioner I found that lack of knowledge was sometimes detrimental to people’s treatment. They did not always receive the compassion and the understanding that would have helped at the time. One of my clients had done quite well and spent a lot of time getting clean but was told by a social worker ‘once a druggy always a druggy’.”
Haines says some social workers feel that their role in drug and alcohol cases is finished once they have referred someone to a specialist service – one of the common pitfalls highlighted by BASW’s guide. “Some people see it as the targeted services’ responsibility first and foremost,” he says.
Another failing cited by BASW is that social workers forget to ask about drugs during assessments. Jonathan Phillips, joint chair of the Association of Directors of Adult Social Services’ mental health, drugs and alcohol policy network, says that social workers with little knowledge of drugs might not think to question people about them. “What is valuable about the BASW guide is that it says we need to be thinking about drugs and alcohol in every assessment that we do,” he says.
Drugs and alcohol don’t discriminate and experts have warned that alcohol dependency among older people is a growing problem. Phillips says that older people who have managed their alcohol or drugs intake for a long time may have become skilled at hiding it and that social workers have to ensure they make proper enquiries. “Older people should be given the same chance to access services as anybody else, if they have a problem with alcohol and drugs,” he says.
The social work degree curriculum is governed by three separate standards: the Department of Health’s requirements for the social work degree, the National Occupational Standards for Social Work, overseen by Skills for Care, and the Quality Assurance Agency standards. These only cover generic skills such as communication and assessments, and don’t contain requirements for subject areas. Beyond this it is up to universities to decide what is included.
Hilary Burgess, senior academic adviser at the Social Policy and Social Work Subject Centre, a body aiming to enhance social work students’ learning experience, says this may have contributed to substance misuse’s low profile in social work training. “People are covering it in different ways and probably with different levels of success,” she says.
The Social Work Reform Board is undertaking a review of the degree curriculum in England. Burgess, who is on the social work education working group reporting to the board, says it will consider making substance misuse a compulsory part of initial training.
Formal training opportunities for practitioners in this field are rare, but Debby Blakebrough, staff training co-ordinator at the Kaleidoscope Project, a charity supporting people with drug and alcohol problems is in talks with Newport University about developing a post-qualifying award. She, Haines and Burgess argue that training on drugs and alcohol needs to be introduced throughout social workers’ careers.
The prevalence of substance misuse issues in child protection cases is one of the main drivers behind the calls for social workers’ knowledge to improve. But Blakebrough says that when drug users also happen to be parents, social workers’ prejudices can be at their worst and practitioners need to consider the bigger social picture.
“When there are children involved people with drug problems can be stigmatised and the problem isn’t understood in its entirety. Just looking at the signs and effects is only a small part of the picture. You need to look at why people are involved in drugs,” she says.
Guidance from Basw’s pocket guide
Common pitfalls highlighted in social workers’ approach to drugs and alcohol:
●Forgetting to ask about drugs during assessments, including prescription drugs
●Overlooking alcohol misuse as a potential problem
●”Not my job syndrome”- failing to realise that substance misuse is everyone’s business
●Passing cases on to specialist services and not ensuring everyone understands what services the social worker will continue to offer.
Key questions to ask during assessments
●When assessing women: Do you ever drink more than six units a day?
●When assessing men: Do you ever drink more than eight units a day?
●If they say “never” they are unlikely to have an alcohol problem; however, to explore further:
●How does your drinking help you?
●Does drinking ever cause problems for you?
●Would you like to change your drinking?
●Have you successfully made changes before?
●How confident are you that you could change your drinking if you wanted to?
●What help do you need to change?
The key information to ask about includes:
●What are people using?
●How much are they using?
●How often do they use?
●How do they use (smoke, swallow, inject)?
●What are the effects for them – positive and negative – of using drugs?
●What happens if they stop using?
Slang is often used to describe drugs. If you don’t understand, ask the person to explain.
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