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Making a difference
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Social workers and other social care professionals regularly face the challenges of working with people with alcohol and other drug problems. Yet many receive little, if any, training for working with these issues. As substance use and its social impact on communities and families rises up the political agenda, this book offers a timely support for social workers and other social care staff working in this area.

Supporting people with alcohol and drug problems addresses the current gap in social work and social care education. It provides a combination of research evidence, policy frameworks, and practical hints and tips for good social work practice. Based around practice examples supplied by social workers from both adults’ and children’s social care, it combines knowledge with action. It also provides an important introduction to the evidence base on assessment, intervention and partnership working with specialist substance use colleagues. This book is for all those working in children’s and adults’ social work and social care settings who are working with people who use, or have problems with, alcohol and other drugs.

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Social work is a helping profession. While the organisational and policy context in which it sits changes and evolves, at its core remains a profession that seeks to help other people in need of support or at risk of harm. Among these people are those whose use of alcohol and drugs causes, or contributes to, problems to themselves or others.

It is rare that people with alcohol and drug problems are presented as vulnerable and worthy of our support and help. More often the image is of a sickly looking youth hooked on drugs and stealing to fund his habit, or the woman who is prostituted to fund her own and her boyfriend’s/pimp’s drug use. Alternatively there is the unemployed, red-faced, middle-aged man whose heavy drinking and associated embarrassing behaviour have alienated him from his family and friends. None of these images engenders an empathic or caring response without some reflection on what got people to that point in their lives. More often, the response is unsympathetic and intolerant.

These narrow, stereotypical images serve only to perpetuate the marginalisation of people with substance (alcohol or other drugs) problems and maintain the stigma and shame that prevents people from seeking or receiving help. These images may fit some people with alcohol or drug problems, but they are not an accurate picture of the people who use, or have problems with, alcohol or other drugs. There is no easy stereotype defined by age, level of education, employment status, class, income or gender.

This book provides social work students, social care practitioners and managers with information on alcohol and drug use and guidance on how to engage with, and respond to, people whose use is problematic.

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Dawn and Amy have been referred to the children and families team by Amy’s school teacher, who was concerned that Dawn had been drinking on several occasions when she arrived in the car to collect Amy from school. When you visit Dawn for an initial assessment, she thanks you for coming, states that she wasn’t drinking that day, that she does have a drink occasionally but not during the day, and she would not drink and drive. She states that she has been drinking more since her partner left two months ago, just to help herself to relax, and that while she’s ‘not an alcoholic or anything’ she would be prepared to speak to someone if you think they could help her to relax.

Andy has been referred to your team because of concerns about his mental health and related behaviour. The hostel staff understand that he has a history of drug use which coincides with a rapid deterioration in his mental health, as he increasingly forgets to take his medication. When you speak to him, he denies using drugs and says he just needs to get his medication sorted out.

Gary is an active man who is a keen gardener and is a season-ticket holder for West Bromwich Albion FC. In recent years he has developed some mobility problems and has become increasingly frustrated at his inability to do the things he normally does. You have been assessing Gary’s support needs and Helen’s ability to care for him. Helen tells you that he had not been drinking for 20 years since she threatened to leave him if he didn’t get help, but that recently he has started to drink spirits heavily in the evening for ‘medicinal’ purposes and gets angry with her when she raises the issue.

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Aquarius is a Midlands-based charity providing community and residential alcohol and drug services across the region. It uses a social model approach to substance use and works in a way that supports people to set their own goals for their substance use, that is, reducing their use or stopping altogether. It provides individual, group and family work tailored to each individual’s needs. It has outreach projects in local estates and hospitals, drink-drive and criminal justice education projects and a number of developing services, including a service for older people.

Action on Addiction offers residential care and structured day care for people with alcohol and drug problems. It operates mainly from a medical model perspective, using an abstinence-based programme that is linked to the 12 steps of the Alcoholics Anonymous and Narcotics Anonymous fellowships. It also works with families, offers training courses and actively supports research with academic partners in London and Bath.

Most regions in the UK have community alcohol and/or drug teams. In some areas these will be a combined team, in others they will be separate. While services can be contracted out to charitable organisations, the community teams can be statutory teams too. What services are offered will differ in structure and availability according to local need, but they will usually include assessment, individual counselling, group work and a substitute medication prescribing service. The models used usually include both abstinence and harm reduction approaches.

Specialist alcohol and drug services take many forms. These range from the two-person outreach team contacting people in the community, to the office-based community service delivering counselling, family or prescribing services, or the residential service that combines medical detoxification and intensive rehabilitation.

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Dilshad (aged 19) has been using cannabis daily for two years. He lives at home with his mother, elder sister and grandparents and does not like to leave the house. His father is not at home and is only ever mentioned in passing by his mother, and in a negative way. Dilshad is unemployed and has been experiencing some mental health problems. He refuses to take prescribed medication. He reports hearing voices at times and the family are concerned that these are bad spirits. Dilshad refuses to go to any drug or alcohol agency and believes that Allah will help him. Mum is trying to support him and has been taking him to see the imam in another city, who prays with him. Dilshad and his family live within a tightly knit Asian community, members of which are starting to comment to his family that he should be working and that he needs to get himself sorted out.

Those interested in drug use within the black community are continually torn between unveiling the nature of black problem drug use and avoiding the promotion of racial stereotyping. (Kalunta-Crumpton 2004)

In social work training and practice, emphasis is placed on understanding the needs and differences of individuals within their families and communities. Learning to think about values, cultures and life-styles that are different from our own and how that difference impacts on our practice is part and parcel of basic training (Department of Education 2011). The same learning and reflection is necessary for considering how to work with people from black or other minority ethnic groups whose use of substances is problematic.

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Jackie and Ian have been using heroin for some time. The referral to social services was made by Ian’s parents, who are worried about their grandchildren and don’t know what to do next. Both Ruby and Lily have disabilities that require them to have regular feeding and attentive care. The grandparents live in the tower block next to their grandchildren. Jackie and Ian have sold all the furniture in the flat except for the baby’s cot, but they still feel very committed to their children and want to look after them. They are clearly not managing to do this and have a lot of their own problems that they need help to address. The grandparents are willing to look after Ruby and Lily.

Billy was referred to social services by his school, who reported that he was not attending and expressed concern for his welfare. Billy is a young carer for his father, who has been drinking heavily for many years and has brain damage as a result of his drinking, that is, Korsakoff’s syndrome. Eric clearly loves Billy and spends lots of time with him, giving him a great deal of love and affection. However, he is unable to take care of Billy at all. Billy is skilled beyond his years in all adult tasks and has stated very articulately that he wants to look after his dad.

Sarah is a single mum and controlled heroin user. Because of Sarah’s heroin use, Pauline has removed the children without Sarah’s consent and contacted social services for help.

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Brigid suffers from depression. She is divorced and has a long history of suffering domestic abuse, of living in hostels and of street homelessness. She has been drinking heavily for many years and also gambles what little money she has. She is in contact with a number of services, including mental health and housing services. She has periodically attended alcohol services and Alcoholics Anonymous self-help groups. She is in danger of being evicted from her housing association accommodation.

Kayleigh and Solomon have been referred to social services by the police, who have made several visits to their home address as a result of incidents of domestic violence during which the children were present. Mum, Sonia, disclosed that she is worried about her partner, Wayne’s drinking and the effect it is having on the family. Wayne was made redundant a year ago and has recently been drinking very heavily. Sonia has made unsuccessful attempts to stop him drinking by taking away his bank cards and controlling the money. They have huge arguments that have involved Wayne being physically violent to Sonia. Solomon has become scared of Wayne and doesn’t like to go near him. Kayleigh often takes care of Soloman and does chores around the house when her Mum is too tired. Sonia has an elder daughter, Toni (15), who has taken to staying out overnight at friends’ houses. Sonia is very worried and doesn’t know what to do.

Tracey uses crack-cocaine and heroin and occasionally exchanges sex for drugs. Her ‘boyfriend’ (James) has recently come out of prison and has moved into her flat.

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Barrie was admitted to hospital following seizures. He was referred to the hospital social work team by the ward staff, due to his evident self-neglect and in the hope of finding him support to improve his health and hygiene. A social work assessment found that Barrie lives at home with his wife but has started to live and sleep only in the living room. His personal hygiene and health are poor. He has very limited mobility and is often unable to get on and off the sofa. Barrie’s wife, Anne, is his main carer. He has two sons, one of whom has no contact with him. Anne has also suffered serious health problems and is unable to cope, particularly when Barrie is abusive to her. He also keeps her awake at night by shouting. Barrie has refused services in the past. His seizures and other health problems are thought to be related to his heavy drinking and smoking. Barrie says that he has always drunk and is not going to stop, although he promised to cut down when he left hospital. There is a suspicion that he suffers from depression alongside his heavy drinking.

Michael is single and has no children. He has been accessing services for a long time for his heroin use. He has a history of polydrug use, including benzodiazepines. He is currently using cannabis as well as heroin. He is struggling to support his drug use financially and has presented to services asking for methadone. His brother, who is also a drug user, has been taken back into prison.

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Christopher has been using alcohol and other drugs since the age of 12. He was belatedly taken into care, aged 14, when he lived with his mother, who uses heroin, and a grandmother who drinks heavily. He repeatedly ran away from the care home and is now living in supported independent accommodation. He is estranged from his father, who was also a heavy drinker. Christopher has not had any positive adult family role models in his life. He has some mental health problems, including a history of self-harm and suicide attempts. He was repeatedly raped and sexually abused when younger as a result of relatives’ ‘exchanging’ him for drugs. There is also a suspicion that he has a brain injury or other learning difficulties. He is gay, has two older siblings, both in prison, and few interests outside his drug use, although has expressed an interest in a college course and joining a church group.

Kirsty lives with a friend who is 17 years old. She has a two-year-old child who lives with her mother and stepfather, against her wishes. They claim benefits for both Kirsty and her daughter, so Kirsty has no income. She has starting drinking regularly and becomes very emotional and upset when she talks about her child. She reports that her mother and stepfather drink heavily and that her stepfather is violent and abusive. She was in and out of care herself, when she was younger, because of their abuse and neglect. She is afraid to talk to them about sole custody of her daughter and doesn’t know what to do.

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Andrew is a man of Jamaican descent who has a diagnosis of paranoid schizophrenia. He has been in and out of prison for a range of offences, including assault and possession. He has engaged with mental health and other support services on an erratic basis, usually when his mental health is stable after leaving prison. He is currently homeless and living in a direct access hostel for homeless men. He smokes cannabis on a regular basis and has some history of other drug use. As his illicit drug use increases, he reduces or stops taking his medication and becomes increasingly mentally unwell. He is eventually arrested for committing an offence, which sometimes involves violence.

Mary is of Irish descent and has an 11-year-old son. She has a history of depression and anxiety, for which she has previously received medication through her GP. She doesn’t like the effect of the drugs, as they make her feel drowsy in the morning. Her husband works long hours and she has no close friends. She has a strained relationship with her older children from a previous marriage, seeing them only occasionally. They believe that she has an alcohol problem, but she denies it. She had been having her alcohol delivered by the local supermarket and the local off-licence until a recent visit to hospital, when she became very ill and eventually admitted that she drank daily – and possibly a little too much.

Substance use and mental health are inextricably linked. For many people the whole point of using alcohol or drugs is to create an altered perception of reality, be it short term or longer term, and an experience that is physical, mental and emotional.

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