Social Work and Substance Misuse: An Unsystematic Review of the Evidence

1. Social Work and Substance Misuse: An Unsystematic Review of the Evidence Donald Forrester Professor of Social Work Research Director of the Tilda Goldberg Centre

2. Why substance misuse and social work? • Drug and alcohol problems are a common issue across social work • Social aspects of drug and alcohol issues are key and therefore social work is a crucial profession in effective responses • Examples of evidence based approaches • Improving our practice with substance misuse has the potential for professional transformation

3. Extent and Nature of Alcohol and Drug Problems • There’s a lot of it about... • Two million people use illegal drugs monthly • 130-200,000 dependent drug users in England and Wales • 33% of men and 16% of women drink at hazardous levels • c.200,000 dependent drinkers • Linked to poverty, current problems e.g. violence, family history of drug and alcohol problems etc.

4. Extent and Nature of Alcohol and Drug Problems • There is even more of it about in social work: • About a third of child and family cases • Strong association with mental health issues • Increasingly common amongst older people • Little evidence for people with disabilities • Important specialist practice area • But we lack good evidence (Goldberg Centre Survey)

5. The Social in Drinking and Drug taking • Social factors crucial in trying substances, developing a problem, maintaining a problem, resolving a problem and maintaining change • For example: • Deprivation and unemployment linked to drugs • History of abuse • Being in a violent relationship • Substance misuse a bio-psycho-social problem • Social work an essential part of the response • Quite strong evidence that not working very well

6. Evidence Based Social Work ResponsesExamples from a Systematic Literature Review • Joint Work between Goldberg Centre and Scottish Government • Led by Forrester and Galvani • Work undertaken by Michelle McCann, Georgia Glynn, Angela Thurnham, Mary Hillson, Christine Hemsley and Andy Guppy • Work ongoing and findings provisional and indicative • Systematic review methods problematic – & almost all USA

7. Evidence Based Social Work Responses Substance Misuse “Treatment” Field Case management (coordination of services) • Impact varied widely – partly because case management varies as much as social work • Effective case management approaches: • Matched needs of group to form of CM • Worked particularly well with those with most severe problems eg homeless, triple diagnosis • Relationship-based case management seemed better than CM focussed on service coordination

8. Evidence Based Social Work Responses Effective Case Management • limited number of clients per worker • An emphasis on creatively engaging people • Access to additional services rather than simply coordination of existing services • Availability when needed, for instance through 24-hour on call services or long-term consistent availability • Emphasised skilful communication, and a large number based this on Motivational Interviewing

9. Evidence Based Social Work Responses Child and Family Social Work Some evaluations of promising interventions: • Option 2 – intensive family preservation service • Family Drug and Alcohol Courts • “Recovery Coaches” with pregnant drug users • All intensive, high quality, wraparound services producing promising and cost effective service • Quality services make a difference

10. Evidence Based Social Work Responses Other areas of social work • Varied picture in relation to dual diagnosis – but some high quality interventions that had positive impact • Well designed services for those with most serious problems eg homeless, HIV promising • Very very little in relation to older people, people with disabilities and children in care

11. Evidence Based Social Work ResponsesCommon Themes and Lessons Or stuff I have learnt... • The help people with alcohol or drug problems need varies enormously – from brief interventions through to permanent services • The more serious and complex the problem the more likely social work will be appropriate • “Systems” don’t help people – people help people

12. Evidence Based Social Work Responses Common Themes and Lessons Services that worked tend to have: • Strong core values, including respect for client and belief in possibility of change • Heavy emphasis on professional excellence, and support for this (particularly Motivational Interviewing) • Willingness to work with challenges • Model for change providing structure to work • Evaluation a core part of the project

13. So what has social work got to learn from the substance misuse field?

14. Evidence Based Social Work Responses Common Themes and Lessons Services that worked tend to have: • Strong core values, including respect for client and belief in possibility of change • Heavy emphasis on professional excellence, and support for this (particularly Motivational Interviewing) • Willingness to work with challenges • Model for change providing structure to work • Evaluation a core part of the project

15. Substance misuse and social work • Social work essential for effective, humane and just responses to drug and alcohol problems • Substance misuse has the potential to help us rediscover essence of social work – which is to work in such ways • Unlocking this potential – achieving evidence based practice – requires a fundamentally different form for social work