Editorial To Our Health! . . . Social Work and Alcohol Problems
The topic of alcohol problems is a perplexing and disturbing one. It is perplexing because the causes of problem drinking and its less common manifestation, alcohol dependence (alcoholism), are so poorly understood; it is disturbing because an alarming proportion of death, illness, injury, family breakdown, violente, and downright human misery is associated with alcohol use. This bleak picture is made more puzzling because alcohol use is also associated with some of the most joyous and the most solemn moments of human existence. DEFINING ALCOHOL PROBLEMS The rapidly proliferating "alcohol literature" presents a bewildering array. If one message emerges, it is simply this: problem drinking is not a unitary phenomenon. With no pretensions to exhaustive coverage, the articles in this issue of HEALTH AND SOCIAL WORKall filtered through the perspectives of social work au3 Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
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The simple title for this issue—"Alcohol Problems"—did not come simply. In fact, it represents a compromise. Our original title was "Problem Drinking," a broad term that focuses on behavior and considers all relationships of alcohol, society, and health that might concern social workers. Others preferred "Alcoholism" or "Alcoholism and Alcohol-Related Problems," language contained in the proposed policy statement that comes before the NASW Delegate Assembly in San Antonio even as this this journal goes to press. Advocates for retaining the term "Alcoholism" in the title wished to emphasize the disease of alcoholism and the problems flowing from it. They noted that treatment is often directed toward assisting clients to accept their alcoholism and that promoting an informed public awareness of alcoholism is an important general goal; any other language was perceived as a missed opportunity to dramatize the seriousness of "alcoholism." "Problem Drinking" particularly seemed to carry unacceptable connotations, mincing words and downplaying alcoholism. Finally, "Alcohol Problems" was selected. Athough similar to "Problem Drinking" in its comprehensive approach, our final choice apparently did not have the same overtors. This search for a title illustrates the controversy in the field. The debate is more than semantic. It raises issues about the way the general problem should he conceptualized and has wide-ranging implications for treatment goals and techniques. The editorial, which begins on page 3, presents this social worker's framework for viewing alcohol problems and relating them to the broad field of social work in health. Five members of the Editorial Committee of HEALTH AND SOCIAL WoRK—Rosalie A. Kane (as committee chair), Beatrice Phillips (then editor-in-chief), Emanuel Hallowitz, Barbara Henley, and Peter J. McNelis—were joined by two members of the NASW New York City Chapter's Alcoholism Committee—David Cook and David Lerner —to form a subcommittee to guide the development of this special issue. (Six of the articles included in the issue were originally presented at an alcoholism symposium sponsored by the latter group.) Collectively, our working group encompassed many perspectives including alcoholism treatment, alcohol-related research, military social work, and hospital social work. Out of this rich blend we hope a product has emerged that is useful to a wide variety of social workers. The dedicated work of this group is gratefully acknowledged. —R.A.K. Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
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thors—attest to the various ways that alcohol is misused and, in turn, to the various untoward consequences of that misuse. The articles depict the following profiles: skid row alcoholics whose physical and psychological dependence on alcohol takes precedence over and depletes their human relationships and worldly goods; family breadwinners who gradually illustrate the signs of heavy, steady drinking by deteriorating job performance; housewives, often young mothers, who imbibe at home; elderly retirees who begin drinking heavily with the role changes of later life; and youths in their teens and early twenties whose episodic bouts of heavy drinking at parties and bars translate into tragic automobile accident statistics. The clinical picture and social situation differ among these examples, and social workers should tailor the proposed interventions to fit the nature of the problem drinking. This editor prefers the more general term "alcohol problems" or "problem drinking," to the narrower designation of "alcoholism" as an organizing concept. Alcoholism has proved difficult to distinguish operationally from other forms of sustained heavy drinking or binge consumption, and yet the term evokes images of winos, drunk tanks, and social misfits. The stereotype is so vivid that it can interfere with the prompt identification of the broad spectrum of problem drinking. In contrast, the concept of alcohol problems emphasizes the adverse consequences of alcohol use; if excessive alcohol consumption is linked to social, psychological, legal, economic, or health problems for self, family, or community, an alcohol problem may be said to exist. Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
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HEALTH AND SOCIAL WORK
ROLE OF SOCIAL WORK The social worker's task becomes, then, the determination of whether and in what way a given individual's drinking practices are harmful to the self or to others. From such individualized assessment, specific behavioral goals can emerge. Lifelong abstinence from alcohol might not be a realistic or appropriate goal for every 19-year old arrested for driving while intoxicated but might be considered a very desirable objective for those people who show physical signs of alcohol dependence (tremors, blackouts, morning drinking, or severe liver damage). Between these two extremes, adverse consequences of drinking form a continuum. In each instance, specific details about the amount, the pattern, and the circumstances of alcohol consumption as well as the nature of the deleterious consequences should dictate goals and strategies of intervention. For social workers in alcoholism clinics, inpatient alcoholism treatment centers, halfway houses, courtaffiliated "drunk driving" programs, or industry-based employee assistance programs, the prevention and treatment of alcohol problems in some form or other are the primary focus of their work. But for many other social workers (and perhaps, unfortunately, to a greater extent than they appreciate) some form of problem drinking is an intervening variable complicating the achievement of professional goals with a client. Problem drinking, for instance, often contributes to child and wife abuse, delinquent behavior, marital friction, economie dependence, and noncompliance with medical regimens. As one article illustrates, alcohol abuse by one or more parents may even be an unsuspected conDownloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
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tributor to the poor performance in school of children in the caseload of a school social worker. Taken together, we social workers are in frontline positions to identify problem drinking in a family constellation and to make' appropriate referrals for special help or to incorporate goals on drinking practices into our own work with clients. Important, too, is recognizing the problems associated with alcohol consumption and assessing when alcohol use creates no problem or even has therapeutic benefit. In the British equivalents to nursing homes, residents are often permitted to continue with moderate drinking practices, beer is a commonplace sight in institutional kitchens, and staff have been known to escort residents so inclined to the neighborhood pub for a drink on a hot summer day. The visible results of such socializing might include enhanced cameraderie and self-respect. Certainly it seems presumptuous to expect elderly persons in a dependent living situation to alter nonproblem drinking. Leadership in correcting such restrictive institutional behaviors is consistent with the social work objectives of humanizing institutional care.
NEED FOR SOCIAL REFORM Finally, the front-line positions of social workers with regard to alcohol problems also enable us to make recommendations for the kinds of structural and policy measures that might lessen the individual and societal costs of problem drinking. Far-reaching changes on a societal level, such as stringent enforcement of drivingwhile-intoxicated laws, coupled with alternative transDownloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
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HEALTH AND SOCIAL WORK
portation arrangements, might go a long way toward reducing the major cause of death for a large segment of the American people. Education about the fetal alcohol syndrome and the effects of heavy drinking on pregnant women (perhaps accompanied by warning labels on alcohol bottles) might indeed help eliminate a preventable disability among children. It is not suggested that social workers can or should be the ones to implement all such changes, but they could use their experience to speak loudly, insistently, and practically in behalf of social reform. Historically, social workers have led social movements and articulated the need for legislative changes. We have done so when clinical judgments told us that individual maladjustment is insufficient to explain the extent of a social problem. Our professional progenitors were in the forefront in the fight against child labor; more recently, social workers have been involved deeply in attesting to the damages caused by racial and sexual discrimination. Should we not also become insistent on the reform of conditions that exacerbate the devastating effects of alcohol problems? —R.A.K.
Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
The topic of alcohol problems is a perplexing and disturbing one. It is perplexing because the causes of problem drinking and its less common manifestation, alcohol dependence (alcoholism), are so poorly understood; it is disturbing because an alarming proportion of death, illness, injury, family breakdown, violente, and downright human misery is associated with alcohol use. This bleak picture is made more puzzling because alcohol use is also associated with some of the most joyous and the most solemn moments of human existence. DEFINING ALCOHOL PROBLEMS The rapidly proliferating "alcohol literature" presents a bewildering array. If one message emerges, it is simply this: problem drinking is not a unitary phenomenon. With no pretensions to exhaustive coverage, the articles in this issue of HEALTH AND SOCIAL WORKall filtered through the perspectives of social work au3 Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
4
HEALTH AND SOCIAL WORK
The simple title for this issue—"Alcohol Problems"—did not come simply. In fact, it represents a compromise. Our original title was "Problem Drinking," a broad term that focuses on behavior and considers all relationships of alcohol, society, and health that might concern social workers. Others preferred "Alcoholism" or "Alcoholism and Alcohol-Related Problems," language contained in the proposed policy statement that comes before the NASW Delegate Assembly in San Antonio even as this this journal goes to press. Advocates for retaining the term "Alcoholism" in the title wished to emphasize the disease of alcoholism and the problems flowing from it. They noted that treatment is often directed toward assisting clients to accept their alcoholism and that promoting an informed public awareness of alcoholism is an important general goal; any other language was perceived as a missed opportunity to dramatize the seriousness of "alcoholism." "Problem Drinking" particularly seemed to carry unacceptable connotations, mincing words and downplaying alcoholism. Finally, "Alcohol Problems" was selected. Athough similar to "Problem Drinking" in its comprehensive approach, our final choice apparently did not have the same overtors. This search for a title illustrates the controversy in the field. The debate is more than semantic. It raises issues about the way the general problem should he conceptualized and has wide-ranging implications for treatment goals and techniques. The editorial, which begins on page 3, presents this social worker's framework for viewing alcohol problems and relating them to the broad field of social work in health. Five members of the Editorial Committee of HEALTH AND SOCIAL WoRK—Rosalie A. Kane (as committee chair), Beatrice Phillips (then editor-in-chief), Emanuel Hallowitz, Barbara Henley, and Peter J. McNelis—were joined by two members of the NASW New York City Chapter's Alcoholism Committee—David Cook and David Lerner —to form a subcommittee to guide the development of this special issue. (Six of the articles included in the issue were originally presented at an alcoholism symposium sponsored by the latter group.) Collectively, our working group encompassed many perspectives including alcoholism treatment, alcohol-related research, military social work, and hospital social work. Out of this rich blend we hope a product has emerged that is useful to a wide variety of social workers. The dedicated work of this group is gratefully acknowledged. —R.A.K. Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
EDITORIAL
5
thors—attest to the various ways that alcohol is misused and, in turn, to the various untoward consequences of that misuse. The articles depict the following profiles: skid row alcoholics whose physical and psychological dependence on alcohol takes precedence over and depletes their human relationships and worldly goods; family breadwinners who gradually illustrate the signs of heavy, steady drinking by deteriorating job performance; housewives, often young mothers, who imbibe at home; elderly retirees who begin drinking heavily with the role changes of later life; and youths in their teens and early twenties whose episodic bouts of heavy drinking at parties and bars translate into tragic automobile accident statistics. The clinical picture and social situation differ among these examples, and social workers should tailor the proposed interventions to fit the nature of the problem drinking. This editor prefers the more general term "alcohol problems" or "problem drinking," to the narrower designation of "alcoholism" as an organizing concept. Alcoholism has proved difficult to distinguish operationally from other forms of sustained heavy drinking or binge consumption, and yet the term evokes images of winos, drunk tanks, and social misfits. The stereotype is so vivid that it can interfere with the prompt identification of the broad spectrum of problem drinking. In contrast, the concept of alcohol problems emphasizes the adverse consequences of alcohol use; if excessive alcohol consumption is linked to social, psychological, legal, economic, or health problems for self, family, or community, an alcohol problem may be said to exist. Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
6
HEALTH AND SOCIAL WORK
ROLE OF SOCIAL WORK The social worker's task becomes, then, the determination of whether and in what way a given individual's drinking practices are harmful to the self or to others. From such individualized assessment, specific behavioral goals can emerge. Lifelong abstinence from alcohol might not be a realistic or appropriate goal for every 19-year old arrested for driving while intoxicated but might be considered a very desirable objective for those people who show physical signs of alcohol dependence (tremors, blackouts, morning drinking, or severe liver damage). Between these two extremes, adverse consequences of drinking form a continuum. In each instance, specific details about the amount, the pattern, and the circumstances of alcohol consumption as well as the nature of the deleterious consequences should dictate goals and strategies of intervention. For social workers in alcoholism clinics, inpatient alcoholism treatment centers, halfway houses, courtaffiliated "drunk driving" programs, or industry-based employee assistance programs, the prevention and treatment of alcohol problems in some form or other are the primary focus of their work. But for many other social workers (and perhaps, unfortunately, to a greater extent than they appreciate) some form of problem drinking is an intervening variable complicating the achievement of professional goals with a client. Problem drinking, for instance, often contributes to child and wife abuse, delinquent behavior, marital friction, economie dependence, and noncompliance with medical regimens. As one article illustrates, alcohol abuse by one or more parents may even be an unsuspected conDownloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
EDITORIAL
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tributor to the poor performance in school of children in the caseload of a school social worker. Taken together, we social workers are in frontline positions to identify problem drinking in a family constellation and to make' appropriate referrals for special help or to incorporate goals on drinking practices into our own work with clients. Important, too, is recognizing the problems associated with alcohol consumption and assessing when alcohol use creates no problem or even has therapeutic benefit. In the British equivalents to nursing homes, residents are often permitted to continue with moderate drinking practices, beer is a commonplace sight in institutional kitchens, and staff have been known to escort residents so inclined to the neighborhood pub for a drink on a hot summer day. The visible results of such socializing might include enhanced cameraderie and self-respect. Certainly it seems presumptuous to expect elderly persons in a dependent living situation to alter nonproblem drinking. Leadership in correcting such restrictive institutional behaviors is consistent with the social work objectives of humanizing institutional care.
NEED FOR SOCIAL REFORM Finally, the front-line positions of social workers with regard to alcohol problems also enable us to make recommendations for the kinds of structural and policy measures that might lessen the individual and societal costs of problem drinking. Far-reaching changes on a societal level, such as stringent enforcement of drivingwhile-intoxicated laws, coupled with alternative transDownloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
8
HEALTH AND SOCIAL WORK
portation arrangements, might go a long way toward reducing the major cause of death for a large segment of the American people. Education about the fetal alcohol syndrome and the effects of heavy drinking on pregnant women (perhaps accompanied by warning labels on alcohol bottles) might indeed help eliminate a preventable disability among children. It is not suggested that social workers can or should be the ones to implement all such changes, but they could use their experience to speak loudly, insistently, and practically in behalf of social reform. Historically, social workers have led social movements and articulated the need for legislative changes. We have done so when clinical judgments told us that individual maladjustment is insufficient to explain the extent of a social problem. Our professional progenitors were in the forefront in the fight against child labor; more recently, social workers have been involved deeply in attesting to the damages caused by racial and sexual discrimination. Should we not also become insistent on the reform of conditions that exacerbate the devastating effects of alcohol problems? —R.A.K.
Downloaded from https://academic.oup.com/hsw/article-abstract/4/4/3/628873 by Rutgers University Libraries/Technical Services user on 12 January 2018
