The statistics describing the use and abuse of alcohol and other mind-altering drugs ring familiar on the nightly news, find bold print in the newspapers, and flavor everyday conversations. General hospitals treat medical/surgical patients suffering from medical complications due to abuse and dependency. Emergency mental health and medical services are often faced with management of the intoxicated person.

The statistics describing the use and abuse of alcohol and other mind-altering drugs ring familiar on the nightly news, find bold print in the newspapers, and flavor everyday conversations. General hospitals treat medical/surgical patients suffering from medical complications due to abuse and dependency. Emergency mental health and medical services are often faced with management of the intoxicated person.

Community mental health centers daily confront the detrimental poly-drug use of scores of deinstitutionalized patients, including the dually diagnosed. School personnel, counselors, teachers, and administrators alike witness the ebb and flow of the season’s most preferred or most accessible substance on the school grounds. They must additionally contend with the far-reaching effects of substance use on students, families, and neighborhoods. Along with community workers and social service agency staff, law enforcement officers also struggle to overcome a gnawing defeatism when children and youth sustain, as victims, the ravages of their own or others’ use in a cycle of destruction and even death.

No age group, no socioeconomic status, no level of education, no geographic area—urban, suburban, or rural, mountain, plain, or coast—no occupation or profession, and no religious affiliation—whether church, temple, synagogue, or mosque—protects from the insidious and infectious spread of the problem. Our society’s cultural heritage of ambivalence reveals itself by the earliest promotion of the use of alcohol in the colonies and the colonial militia, combined with a primitive “righteous” response to inebriation. No time period in U.S. history, not even the years of Prohibition, provided a drug abuse–free environment for the growth and development of citizens. Nor can such an environment be anticipated for the near future. It is a dream, an idealistic vision. Human service practitioners must face the disillusionment of the present reality and continue to attend hopefully in the expectation of manageable goals realistically attainable by troubled and afflicted clients.

At-risk behaviors due to disinhibition and impaired judgment caused by mind-altering substances obligate human service practitioners to consider strategies—educational, medical, economic, political, sociological, psychological, and spiritual—to address the problems on the contemporary scene. These problems include the ones the nation shuns the most: the growing AIDS epidemic, all forms of child abuse, and the persisting plague of violence in our society. The long multicultural history of the human services teaches that the “cure” of human ills, including substance abuse problems, cannot come from logic alone but requires authentic caring. For the human service practitioner, caring in its concrete, active form means consistent and care-filled attention to the details of a realistic treatment plan.

CHALLENGES FACED BY HUMAN SERVICE WORKERS

The human service worker stands, as a generalist, in the middle of a network of providers, ready to work cooperatively with the many specialists assessing, developing treatment/service plans, delivering care, evaluations, and outcomes. In the arena of alcohol and drug abuse, the key challenge to the worker remains the same: achieving the earliest detection for possible prevention. Yet in the reality of the service delivery systems, the challenge almost always involves the detection of intoxication, the history of abuse, the possibility of dependence, and/or risk as victim or victimizer. No accurate or appropriate care can be designed and provided in any context without knowledge of the effects of drugs on a client’s life. Failure to identify the contributing and resulting connections between substance abuse and the client’s presenting problems with health, the law, money, work, school, society, family, and self will spell a decisive failure in care, however well packaged the plan and well intentioned the delivery. The old psychiatric rule “diagnosis predicts prognosis and therefore directs treatment” applies here as well.

The first challenge, then, is one of accuracy. However, much client care may be a matter of heart; it must be guided by knowledge and experience. Accurate knowledge of the psychoactive substance use disorders and their associated intoxication and withdrawal syndromes arms the worker with necessary information to intervene at the earliest possible moment. The continuum of care reaches from direct immediate crisis intervention to consultation and referral as required.

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