Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.     

How do substance abusers and their significant others experience the re‐entry phase of therapeutic community treatment: a qualitative study1

Transition to re‐entry (aftercare) is a stressful event for therapeutic community residents. While several authors agree on the importance of social support during reintegration, few studies have focused on the experiences of re‐entry clients themselves and their significant others during this period. Using a case‐study design, the present study examines the re‐entry process of four TC‐residents and three of their social network members during a six‐month period, starting at the time of their transfer to the halfway house. Clients and their significant others have mixed feelings about the reintegration period, although both are mainly positive. Clients report difficulties in leaving behind the TC‐mentality and building up a stable social network; they are surprised about the frequent contacts with substance (ab)use in mainstream society. Significant others misjudge clients’ feelings about transition and relapse. Many significant others have a positive attitude towards the use of substances. The tendency in mainstream society to increasingly accept the use of substances intensifies clients’ need for early guidance in building up stable supportive networks. Significant others need well‐grounded information on the reintegration process and on relapse.     

Dare to Care: Exploring the Relationships between Socio-Moral Climate,Perceived Stress,and Work Engagement in a Social Service Agency

Abstract

Human service professionals working in an interpersonal violence social service agency are at increased risk of experiencing emotional burnout, compassion fatigue, and high levels of stress, which may reduce work engagement, increase turnover, and ultimately negatively affect client outcomes. However, a positive organizational climate has the potential to buffer the negative effects of perceived stress on work engagement. Socio-moral climate is a behavioral-based organizational construct that assumes that workplace practices and procedures can impact employees’ attitudes and behaviors. This exploratory study (N?=?41) investigates the relationships between perceived stress, work engagement, and socio-moral climate in a social service agency serving survivors of interpersonal violence, comparing employees with direct interactions with clients in a shelter to those with indirect contact at a different location. Results of moderation analyses show that socio-moral climate significantly predicts higher work engagement, while perceived stress is negatively associated with work engagement; however, the interaction effect was not significant and there were no differences in perceived stress between both employees. Further research should continue to investigate the role of socio-moral climate on employee work engagement in social service agencies, which could improve the quality of services for their clients.     

Women,trauma and substance abuse: Understanding the experiences of female survivors of childhood abuse in alcohol and drug treatment

Despite the available evidence suggesting gender should be considered in the provision of alcohol and/or drug (AOD) treatment, programmes are frequently offered in an apparent ‘gender vacuum’. This article argues that the generalist ‘one size fits all’ approach of many AOD services is not gender neutral but should be understood as implicitly gendered in that it neglects the specificity of women's needs in relation to abuse, mental illness and parenting. The discussion presented in this article is based on a qualitative study of the experiences of adult women with histories of childhood sexual abuse and/or domestic violence in AOD treatment. By examining the ways in which AOD treatments effectively ignore or minimise gender, this article uncovers intervention practices that efface the complexities underpinning AOD use among women and suggests ways in which alternative models of service delivery can create more validating and supportive environments. Key Practitioner Message: ● Some of the common assumptions underpinning alcohol and drug treatment do not adequately acknowledge the specific needs of female clients and so gender‐neutral service provision can be disenabling for women; ● Punitive service cultures or behaviour change strategies have a differential impact on female clients, many of whom have prior and ongoing experiences of abuse and violence; ● Service models that acknowledge the complex responsibilities and relational histories of female clients are more likely to engender a positive response and provide the opportunity to address the multiple and complex needs that can go unmet in non‐specialist services.     

Alcohol abuse, compulsory treatment and successive aftercare: a qualitative study of client perspectives

In Sweden, the social welfare boards have a statutory duty to provide aftercare for compulsorily treated substance abusers. However, there are no data on how the aftercare is organised and how clients perceive this phase of the compulsory treatment process. The aim of the study is to analyse how a sample of compulsorily treated alcohol abusers ( n  = 12) characterise the current coercive treatment episode and evaluate previously experienced and forthcoming aftercare interventions. Qualitative interview-data were coded into themes and sub-themes encompassing relevant client perspectives. Results show that the alcohol abusers claimed to want (but be denied) adequate help for their problems, both during primary treatment and after discharge. Their perspectives on coercive care and aftercare interventions appeared related to their views on their own problems and on being incarcerated. For instance, those who recognised their own alcohol problems emphasised the importance of quitting consumption and were dissatisfied with interventions offered during and subsequent to compulsory treatment referrals.     

Defining the boundaries: social worker assessment of sexual abuse in a cultural context – multivariate analysis of personal and professional factors influencing social workers' labelling of intimacy behaviour

To explore personal and professional factors influencing social worker assessment of family intimacy behaviour in diverse cultural groups, a 27‐item questionnaire was mailed to a random, stratified sample of MSW‐level social workers. The instrument measured rank‐order responses to 10 questions about attitudes towards public exposure to sexual stimuli and rank‐order responses to questions about three vignettes depicting culturally informed family intimacy behaviour. The instrument also measured sample characteristics such as area of social work practice and per cent of caseload involving sexually abused as well as diverse clients. Completed questionnaires (n = 387) were analysed for association between respondents' definition of intimacy behaviour (dependent variable), attitude towards sexual stimuli, and intervening variables thought to explain variance in the dependent measure. Labelling theory provided a basis for hypotheses testing. When mean attitude scores were correlated with mean definition scores, Pearson's r returned a significant low, positive association between conservative attitudes towards exposure to sexual stimuli and definitions of cross‐cultural scenarios as sexual abuse. Holding attitude scores constant, regression modelling of the sample's definition of scenarios indicated that practice area, minority status, and per cent of caseload with sexual abuse clients were significant predictors of R² change in the dependent variable. Further analysis of data through regression tree modelling showed that a small group of conservative practitioners with ethnically diverse caseloads were more likely to label culturally influenced behaviours as deviant. Among conservative practitioners with less diverse caseloads, number of hours in sexuality training had a moderating influence on deviancy labelling. Tree modelling of the data also indicated that an ethnic minority subgroup within the sample accounted for the lowest ranking of scenarios as sexual abuse. Results support earlier work on social worker assessment of child maltreatment as a function of agency setting. Another implication for social work is the need for practitioners to understand their attitudes towards human sexuality in relation to assessment of diverse patterns of childhood sexual socialization.     

Characteristics of Women Seeking Services at a Transitional Housing Facility for Women Leaving Street-Based Sex Work: Implications for Social Service Providers

ABSTRACT

Women who decide to leave street-based sex work often struggle with addiction, trauma-related mental health consequences, and exclusion from employment and housing. To offer recommendations for social service providers, this article draws upon primary data from interviews and surveys with 87 residents at a transitional housing facility for women leave sex work to elucidate: 1) a demographic profile of the women, 2) life history patterns and circumstances that encourage women to leave street-based sex work and 3) recommendations for service providers. Results indicate the need for service providers to assist women with basic needs, strengthen referral networks, and extend trauma-informed services.     

Examining Protective Factors for Dysthymia Among Individuals Attending Substance Abuse Treatment

ABSTRACT

Dysthymia affects millions of people and has been associated with impaired psychosocial and occupational functioning and poor clinical treatment outcomes. Yet few studies have examined protective factors that can be utilized to help individuals with dysthymia in clinical settings, particularly among individuals with comorbid substance use disorders. The purpose of this study was to examine the potential protective quality of adult attachment dimensions, spirituality, and meaning in life among clients with and without dysthymia in treatment for addiction. Data were obtained from 305 self-report questionnaires administered to clients attending a residential substance abuse treatment center. Approximately 25% of the sample met criteria for dysthymia. Results from logistic regression analyses indicated that purpose and meaning in life and attachment anxiety were the most important protective factors against having dysthymia. These results suggest that mental health professionals may need to integrate these protective factors into the treatment of individuals with dysthymia and substance use disorders, which may enhance treatment outcomes and maximize treatment effectiveness. Future studies should continue to explore protective factors that can assist individuals who experience these comorbid conditions and consider replicating this study using an ethnically diverse sample and other clinical settings to determine the generalizability of the findings.     

Constructing women in child protection work

This paper is based on an ethnographic study of the occupational culture of a social work team in the UK. It is a discussion of some key aspects of social workers' construction of women as clients. Data were collected from observation of routine case talk, reading of case files and in-depth interviews with social workers. The conclusion of the research is that three defining discourses can be identified in the culture of the social work office: women as oppressed, women as responsible for protection, and women as making choices.     

The Compassion Fatigue Scale: Its Use With Social Workers Following Urban Disaster

OBJECTIVE: The present study has two goals: to assess the difference between secondary trauma and job burnout and to examine the utility of secondary trauma in predicting psychological distress. METHOD: The data come from a survey of social workers (N = 236) living in New York City 20 months following the September 11 terrorist attacks on the World Trade Center (WTC). RESULTS: Social workers' involvement in WTC recovery efforts is related to secondary trauma but not burnout. Analyses also reveal that both secondary trauma and burnout are related to psychological distress after controlling for other risk factors. CONCLUSION: This study supports the importance of compassion fatigue as a risk factor for social workers counseling traumatized clients and its association with psychological problems.     

An inquiry into the significance of nail‐biting 1

Substance abuse is connected to considerable suffering and symptoms. Neuropsychological assessment supports understanding of the distress and the symptoms of the individual client and therefore is increasingly requested in substance abuse treatment. Substances, however, influence neuropsychological functions and emotional states. Therefore, assessment often needs to be postponed. Conducted at a suitable point of time, with respect to abstinence and treatment planning, assessment might provide understanding of the needs and possibilities of the client. This work contributes with suggestions on how neuropsychological assessment might be conducted in substance abuse treatment. Because the effects of substances are considerable, an overview of the effects of varying substances on neuropsychological functioning is presented. It is also suggested that assessment should be understood as a collaborative process that should support clients’ understanding of themselves.     

Gender and Illicit Drug Use

Correspondence to Dr Joanne Neale, Department of Social Policy and Social Work, University of York, Heslington, York Y010 5DD, UK. E-mail: jsn3{at}york.ac.uk Summary There has been no recent large-scale systematic UK investigationof differences between male and female drug users seeking treatment.Equally, there has been no debate within the social work fieldregarding how best to address any gender-specific needs of drug-usingclients. This is despite the fact that social workers frequentlywork with both drug-dependent individuals and members of theirfamilies. This paper examines differences between men and womenbeginning a new episode of drug treatment in Scotland and considerssome of the implications of the findings for social work practice.Data were collected from structured interviews conducted with1,033 individuals (715 males and 318 females) in a range oftreatment settings. Chi-square statistics were computed to investigatesex differences on key categorical variables relating to: (i)patterns of drug use; (ii) education, employment and income;(iii) offending behaviour; (iv) housing circumstances; (v) healthstatus; and (vi) personal relationships. Analyses identifiedmany differences between the men and women interviewed, butalso many common difficulties faced by respondents of both sexes.Additionally, the extensive range of problems and stressfullife circumstances encountered suggested that the lives of individualsseeking drug treatment were extremely heterogeneous. It is concludedthat social workers can employ a range of practical interventionsand theoretical approaches when working with both male and femaledrug-using clients.     

The effect of characteristics of human service workers on subsequent morale and turnover

The authors examine the relationship of sociopsychological characteristics of human services workers to their subsequent morale and continuance on the job. Eighty-two intensive case managers (half of them social workers) who had caseloads of clients with severe mental disorders were invited to participate in a four-wave panel study. Explored are the relationships between 16 predictors (general background, prior work experience and training, and social psychological variables) and worker outcomes (beliefs, attitudes, perceptions, and turnover). The major finding was that better personal well-being at the time of hiring was the most consistent and significant predictor of lower burnout, higher job satisfaction, and generally higher worker morale at later points in time. Those from higher social class backgrounds and those with lower starting salaries were more likely to leave the job. Those workers with more experience had a tendency to perceive greater client improvement.     

Impact of Social Work Practice in Public Defense

Public defenders are increasingly welcoming social workers into their practice, but there is little understanding of the impact of social work services in this context. This study used propensity score matching to determine the effect of social work services on public defense clients in terms of the number and severity of criminal charges when statistically controlling for pre-existing criminal history and demographic characteristics. Findings indicate that social work and non-social work clients were similar in terms of demographics and that clients in both groups were more likely to have incurred misdemeanor charges, but clients in the social work group experienced more, suggesting greater life disruption. When comparing clients who did and did not receive social work services, results indicate that the number of misdemeanor charges incurred during a two-year time period was lower for clients who received social work services. Implications for practice and future research are discussed.     

Using Photovoice to Identify Service Needs of Older African American Methadone Clients

ABSTRACT

This article presents findings from a photovoice project designed to identify service needs of older-adult African American methadone clients, as well as their current barriers to and supports for abstinence. The project involved 10 participants (aged 53 to 63 years old) recruited from a methadone maintenance program in a large Northeastern U.S. city. Thematic analysis techniques were used to analyze participants’ narratives of their pictures. Transportation emerged as a significant challenge to accessing services, and caregiving was a motivation for remaining abstinent. Future research should use similar participatory methods and engage a broader group of aging people struggling with substance abuse.     

Work satisfaction, burnout, and turnover among social workers in Israel: a causal diagram

This study developed a causal diagram addressing the predictors of work satisfaction, burnout and turnover among professional social workers in Israel. A random sample of 218 social workers completed self-administered surveys. Multiple regression and canonical correlation analyses were conducted to estimate a causal model that best predicts work satisfaction, burnout, and turnover among social workers. The results indicated that higher satisfaction, lower burnout, and lower turnover were a function of higher collegial relationship, greater supervision, adequate working conditions, greater opportunities for promotion, and Jewish ethnicity. In addition, higher satisfaction and lower burnout were a function of higher education and greater autonomy, whereas higher turnover was related to a lower salary and the social worker's relative youth. Limitations of the study and recommendations are discussed.     

Negative Aspects of Therapy: Client Perceptions of Therapists' Social Influence, Burnout, and Quality of Care

This study investigated the relationships between client perceptions of therapist use of social influence strategies, therapist burnout, and clients' perceptions of the quality of their therapy. Scales were developed to measure personal coercive power, personal reward power, various forms of expert power, and compromise strategies. A scale was also developed to measure clients' perceptions of their therapists' burnout that contained a combination of modified items from the Maslach Burnout Inventory (Maslach & Jackson, 1986) and original items based on stereotypical burnout behaviors. Research participants were 131 undergraduate students at the University of Pittsburgh who reported their experiences as therapy clients. Therapist use of personal coercive influence strategies and certain types of expert influence strategies were negatively associated with clients' perceptions of the quality of their therapy. Therapist use of personal reward influence strategies, compromise, and the therapist's reputation as an expert were positively related to clients' perceptions of the quality of their therapy. Perceived therapist burnout was positively associated with therapist use of personal coercive influence strategies, direct expert influence strategies, and indirect expert influence strategies. The implications of these findings are discussed.     

Implementing a Gero-Infused Curriculum in Advanced-Level MSW Courses in Health,Mental Health and Substance Abuse: An Evaluation

This article presents evaluation results from a curricular innovation aimed at increasing the capacity of social work graduates to serve older adults in health, mental health, and substance abuse settings. Working as a team, faculty developed, incorporated, and evaluated gerontology-infused syllabi and teaching modules in multiple sections of the 3 courses, with 2 sections serving as a comparison group. Results indicated that students exposed to the gero-infused curriculum increased their age-related knowledge and self-competence from pre- to posttest, and achieved a greater increase in knowledge than did the comparison group. Implications of the findings to social work education are discussed.     

Using a Student-Led Support Group to Reduce Stress and Burnout Among BSW Students

This study evaluates the efficacy of using a student-led support group to decrease levels of stress and reduce burnout among BSW students. The exploratory mixed-methods study used a 10-item Perceived Stress Scale measuring levels of stress, a single item measuring burnout, and narrative journal entries submitted by students. This was part of a larger study that also explored the efficacy of using a student-led group to increase students' knowledge of group work. Although limited in its scope, this research suggests that student-led group work increases the knowledge process and reduces level of burnout among social work students.