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Substance Use Disorder Treatment
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ISSUE STATEMENT
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Substance Use
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Millions of Americans are affected by substance use disorders (SUDs) every year. According to
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SAMHSA's National Survey on Drug Use and Health (NSDUH), 23.2 million persons (9.4 percent of the
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U.S. population) aged 12 or older needed treatment for an illicit drug or alcohol use problem in 2007
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(SAMHSA, 2013.)
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system, and can have severe social, psychological, physical and economic consequences. Issues relating
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from SUDs have a profound impact on society, as well. Abuse of tobacco, alcohol, and illicit drugs is
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costly to our Nation, exacting over $600 billion annually in costs related to crime, lost work productivity
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and healthcare (NIH, 2013.) Substance use disorders are now widely regarded as complex diseases that
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require treatment, not punishment.
These issues affect not only the person using substances, but the whole family
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Substance use disorders (SUDs) are often exhibited with co-occurring disorders—the use of more than
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one substance and/or one or more psychiatric disorders simultaneously. Data show that persons
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diagnosed with mood or anxiety disorders are about twice as likely to suffer also from a drug use
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disorder (abuse or dependence) compared with respondents in general (NIH, 2013.) A co-occurring
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disorder may also be a medical condition. Clients with SUDs may also display polysubstance patterns, in
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which they experience physical or psychological effects from more than one substance. In the field of
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addiction treatment, there is recognition that addictive behaviors may be linked and that treatment for
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substance use disorders and other addictive behaviors (for example, gambling, overeating) may overlap
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(NASW, 2013).
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Treatment
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Scientific research since the mid–1970s shows that treatment can help patients addicted to drugs stop
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using, avoid relapse, and successfully recover their lives (NIH, 2013.) There is a growing emphasis in
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the professional fields working with clients with SUDs on using short-term, limited interventions.
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However, many clients who are dependent on substances require longer term interventions that
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recognize that substance use can be a chronic disorder— one that includes relapse and may not resolve
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for months or even years (NASW, 2013).
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Consistent with a change in conceptualization in the Diagnostic and Statistical Manual of Mental
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Disorders (5th edition) (DSM–5) (American Psychiatric Association, 2012), addiction is no longer
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viewed as an “either/or” phenomenon. That is, substance use is no longer dichotomized into separate
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categories of dependence and abuse; rather, is viewed as existing along a continuum. This paradigm shift
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opens up the possibility for larger numbers of clients meeting the criteria of having substance use
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disorders and being eligible for treatment (NASW, 2013).
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Related to this shift, harm reduction is increasingly emphasized today in federal funding and treatment
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services. The harm reduction approach is consistent with the social work value of self-determination and
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“meeting the client where the client is.” Harm reduction principles are applied in the interests of
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promoting public health—for example, to reduce homelessness or prevent the contraction of HIV/AIDS
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in populations affected by substance use disorders (NASW, 2013).
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Barriers to Treatment
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Most people with SUDs do not receive adequate treatment. An estimated 20.8 million persons (8.4 percent of the
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population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive it
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(SAMHSA, 2013.) This is due to a variety of reasons, including:
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lack of available service provision due to shortage of inpatient beds.
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financial resources as managed care providers restrict the length of inpatient treatment stays.
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willingness to engage in treatment as resistance to treatment is a main factor of the nature of substance
use.
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social stigma and consequences of seeking treatment as being labeled with substance use disorders can
affect a person’s social standing including child custody and employment.
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POLICY STATEMENT
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NASW supports and advocates for policies that promote:
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evidence-informed methods of prevention, treatment and recovery.
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increased access to affordable services and include treatment coverage under health care reform
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requirements.
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mandatory inclusion of behavioral health parity regarding health care coverage.
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the elimination of stigmatizing language and labels and the promotion of respectful,
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supportive, strengths-based language regarding SUD issues.
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the use of a holistic approach considering all treatment options to determine the best course of
treatment for the individual including, but not limited to clinical intervention, medication therapy,
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harm-reduction approaches, and alternatives to incarceration.
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access for individuals with SUDs and co-occurring mental, physical, and other disorders to
receive treatment in an integrated, supportive manner.
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comprehensive treatment in addressing compounding issues a person with SUDs may
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experience such as health, employment, family, housing, legal, and other problems that may impede
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recovery.
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comprehensive, ongoing training and development of social worker’s knowledge and skills in
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culturally competent, evidence-informed methods of assessment, intervention, and evaluation of
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prevention and treatment approaches relating to substance use disorders.
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the collaboration between social workers and other professionals, organizations, etc. to enhance
the research base of effective treatment methods for best practices.
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References
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American Psychiatric Association (2012). DSM–5 development: R substance use disorder. Retrieved from
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http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=431
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National Association of Social Workers (2013). NASW Standards for Social Work Practice with Clients with
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Substance Use Disorders. Washington DC: NASW Press.
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National Institute of Health (2013). National Institute on Drug Abuse: The Science of Drug Abuse and Addiction.
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Retrieved from http://www.drugabuse.gov/.
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Substance Abuse and Mental Health Services Administration (2013). Data Outcomes and Quality: National
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Survey on Drug Use and Health (NSDUH). Retrieved from http://www.samhsa.gov/data/NSDUH.aspx.
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