Alcohol, Tobacco, and Other Drugs

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1 A~cohoI 12/28/Il 10:36 PM Page 28 Alcohol, Tobacco, and Other Drugs BACKGROUND The U.S. government uses a two-pronged approach to address alcohol, tobacco, and other drug (ATOD) problems. One prong focuses on supply, the other on demand. Supply Attempts to reduce the supply of illicit sub stances include interdiction and enforcement of laws that criminalize the sale and posses sion of certain substances. Other supply-side efforts include regulation of the production and sale of alcohol, tobacco products, pre scription drugs, and over-the-counter drugs. The Office of National Drug Control Policy (ONDCP), headed by a cabinet-level official, dubbed the drug czar, coordinates both the federal government s supply- and demandside efforts. Some special initiatives, such as the High Intensity Drug Trafficking Area Pro gram, fall under ONDCP. The federal government spends billions each year to control illicit drug production and dis tribution in the United States and other coun tries. Trial judges may use judicial discretion in sentencing opportunities when defendants are found guilty of drug offenses. Whether the offense is major drug (cocaine) distribution or street distribution of less than a gram of mari juana, federal government statutes mandate sentencing of the offender. Many inner-city minority youths, males and female, are impris oned for lengthy mandatory periods, instead of receiving penalties appropriate for their crimes. Demand Federal government attempts to address the demand for illicit drugs were first widely addressed in 1970 with the passage of Compre hensive Drug Abuse Prevention and Control Act (P ), popularly known as the Con trolled Substances Act, which expanded the definition of a drug dependent person to enable more people to obtain treatment (Na tional Institute on Drug Abuse [NIDA], 2003). That same year, Congress also passed the Com prehensive Alcohol Abuse and Alcoholism Pre vention, Treatment, and Rehabilitation Act (FL ), establishing the federal National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIAAA along with NIDA, estab lished in 1974, became leaders in the federal fight against substance use on several fronts. The missions of the organizations were to focus on research and education and help establish community-based treatment programs. Today NIAAA and NIDA are part of the National Institutes of Health and maintain a strong research focus. The Substance Abuse and Mental Health Services Administration (SAMHSA), estab lished in 1992, is another federal entity vitally concerned with reducing ATOD problems through applied research, prevention, and treatment. SAMHSA administers the Substance Abuse Prevention and Treatment Block Grant, which channels money for services to the states. Single state agencies distribute the funds to community- and faith-based programs that provide prevention and treatment services. Many of these programs serve individuals who would otherwise be unable to obtain services because they lack health care coverage. Other federal agencies also have a role in ATOD pre vention and treatment, including the Depart ment of Education, which operates and pro motes programming to keep schools drug free 28 SOCIAL WORK SPEAKS

2 Alcohol 12/28/li 10:36 PM Page 29 and provides mental health services to stu dents and their families; and the Department of Veterans Affairs, which operates the coun try s largest substance use treatment program for veterans. The federal drug control budget has favored law enforcement and interdiction over preven tion and treatment approaches, although treat ment funding has increased (ONDCP, 2004). The federal government s policy role is impor tant, but states carry most of the responsibility for ensuring that services are delivered to in dividuals and families experiencing ATOD problems. The self-help or mutual help movement also plays a major role in addressing alcohol and other drug problems in the United States. Alco holics Anonymous (AA), the first 12-Step pro gram, was founded in 1935 and predated many attempts by professionals to assist individu als with alcohol problems. AA has had an important influence on the philosophy of treat ment programs in the United States. Narcotics Anonymous began in the 1950s. Al-Anon, a mutual-help group for families and friends of those who have alcohol problems, and Nar Anon for those with family members and friends who have drug problems also devel oped through the movement. Other self-help groups have emerged to assist people with alcohol and other drug problems. Social workers, too, are vital to preventing and treating ATOD problems. Although only 2 percent of NASW members cite ATOD prob lems as their major practice area ( 72 percent work, 2001), ATOD issues are pervasive prob lems encountered in social work practice. Prac titioners address ATOD problems in child welfare, health care, criminal justice, schools, nursing homes, and many other settings. NASW, therefore, must maintain a comprehen sive ATOD policy statement. ISSUE STATEMENT Prevalence and Consequences of ATOll Problems Significant numbers of Americans are af fected by ATOD problems. In 2002, approxi mately 22 million people (9.4 percent of the US. population age 12 and older) met criteria for substance abuse or dependence (SAMHSA, 2003). Most (14.9 million) met criteria for alco hol use disorders alone, 3.9 million met criteria for drug use disorders alone, and 3.2 million met criteria for both alcohol and drug use dis orders. Alcohol, tobacco, and other drug problems have severe consequences for all members of the family system, especially children (Huang, Cerbone, & Gfroerer, 1998; National Center on Addiction and Substance Abuse [CASA] at Columbia University, 2005). Children affected by parental alcohol and other drug problems in this country are largely overlooked. Approx imately one in four American children (19 mil lion) is exposed at some time before age 18 to familial alcohol dependence, alcohol abuse, or both. More than one in 10 children (9.2 million) live with a parent or other adult who uses illicit drugs (CASA; Grant, 2000). Very few children from these families ever receive help for the psychological consequences of growing up under these circumstances. In the 1970s and 1980s, several comprehen sive reviews of empirical findings documented a wide range of problems encountered by chil dren of alcoholics (COAs), such as emotional problems and hyperactivity in childhood, emo tional and conduct problems in adolescence, and alcoholism in adulthood (El-Cuebaly & Offord, 1977; Russell, Henderson, & Blume, 1985). There is strong consensus in the scientific literature that alcoholism runs in families (Chas sin, Jacob, Johnson, Shuckit, & Sher, 1997; Cot ton, 1979; Goodwin, 1979), and that male COAs are four to 10 times more likely to develop alco holism than children whose parents do not have an alcohol problem (Heath, 1995). Although there have been some indications of decreased incidence and prevalence of ATOD problems among youths, significant prevailing risk factors still exist. In 2003,28 percent of high school students reported episodic heavy drink ing, and 22 percent indicated marijuana use (Crunbaum et ai., 2004). Also, among youths ages 12 to 17 in 2000, 92 percent had used an illicit drug within a 30-day period before their interview, and nearly 10.7 million adolescents ages 12 to 20 were underage alcohol drinkers. ALCOHOL, TOBACCO, AND OTHER DRUGS 29

3 Alcohol 12/28/I I 10:36 PM Page 30 Among the youths who were reported heavy drinkers in 2000,65.5 percent of them were also current illicit drug users. Among non-drinkers, only 4.2 percent were current illicit drug users. In addition, 71.5 million Americans age 12 and older reported use of a tobacco product. Among youths who smoked cigarettes, the rate of the past-month illicit drug use was 42.7 percent, compared with 4.6 percent for non-smokers. These facts underpin evidence of alcohol and tobacco being gateways to the use of illicit drugs. More than 40 percent of people who begin drinking alcohol before age 13 will dev elop alcohol dependence some time in their lives (SAMHSA, 2001). Likewise, the younger people are when they begin smoking cigarettes, the more likely they are to become addicted to nicotine (Centers for Disease Control and Prevention [CDC], 1994). Cigarette smoking is the addictive behavior most likely to become established during adolescence. Several stud ies have found nicotine to be additive in ways similar to heroin, cocaine, and alcohol (CDC, 1994). Barriers to Treatment Most people with alcohol and other drug problems do not receive treatment. Of those who needed treatment for an alcohol problem in 2002, only 8.3 percent received help from a specialty alcohol treatment program (SAMHSA, 2003). Of those who did not get treatment, only 4.5 percent felt they needed care. About 35 per cent of the latter group said they tried but were not able to get help; 65 percent did not attempt to obtain treatment. Of the estimated 7.7 mil lion who needed help for a drug problem in 2002, only 18.2 percent received help from a specialty drug treatment program (SAMHSA, 2003). Of those who did not get treatment, only 5.7 percent felt they needed care: 24.4 percent of this group said they tried but were not able to get help; 75.6 percent did not attempt to obtain treatment. In addition, managed care has taken a toll on the ability to obtain alcohol and drug treat ment services through private health plans (Hay Group, 2001). Publicly supported services wax and wane depending on state and local budgets. Thus, people in need do not receive care because they cannot find help, they do not seek treatment, or they do not recognize that they have a problem. They also may be pain fully aware of the stigma attached to being an addict or alcoholic or even being a person who seeks out help, particularly mental health services. The labels, too, have become a significant obstacle to people seeking resolution. The focus shifts from the problem to the fear of the label and its stigmatizing consequences. Disease first language, as opposed to peo ple first language, obliterates individual dif ferences and depersonalizes those to whom the label is applied. Such terms as alcohol abuse, drug abuse, and substance abuse can be perceived as springing from religious and moral conceptions of the roots of severe alcohol and other drug problems. Continued use of these terms with their emotional over tones, may serve only to perpetuate misguided public attitudes about drug-using behavior. To refer to people who are addicted as alcohol, drug, or substance abusers misstates the nature of their condition and calls for their social rejec tion and punishment. Although the inclusion of the terms sub stance abuse and dependence in the DSM-IV has had the positive consequence of allowing these conditions to be recognized as mental disorders deserving of reimbursed treatment, social workers should endeavor to drop such objectifying labels as substance abuser and addict for more respectful and less stigmatiz ing people-first language. NASW supports the rejection of labeling language and embraces a people-first language. Terminology that is more respectful and less stigmatizing and suggests that if a person s alcohol or drug consumption is creating problems, then the person should do something about it. Such a stance might help to focus on a more concrete and verifiable ques tion of whether alcohol and other drugs are cre ating problems in a person s life for which he or she might seek help (White, 2001). In addition, many individuals with ATOD problems have co-occurring disabilities and often encounter increased difficulties in ac cessing appropriate treatment. In 2002, about 20 percent of adults who met criteria for sub stance abuse or dependence also had a serious 30 SOCIAL WORK SPEAKS

4 Alcohol 12/28/Il 10:36 PM Page 31 mental illness (SMI) compared with a 7 per cent rate of SMI for those without substance abuse and dependence (SAMHSA, 2003). Indi viduals with co-occurring ATOD problems and SMI may not receive services that are appropriately integrated to meet their needs (DiNitto & Webb, 2005; Mee-Lee, Shulman, Fishman, Gastfriend, & Criffiths, 2001). Many people who have a cognitive or physical dis ability (for example, intellectual disability, spinal cord injury, traumatic brain injury, or who are deaf, hard-of-hearing, blind, or visu ally impaired) and a co-occurring ATOD prob lem also experience substantial difficulties in obtaining treatment that appropriately accom modates their needs, despite requirements of the Americans with Disabilities Act ([ADA], [FL J, de Miranda, 1999). Criminal Justice and Social Welfare Many people are arrested and incarcerated for alcohol or drug offenses, and many incar cerated individuals have ATOD problems. In 2002 there were an estimated 1.5 million arrests for drug law violations (more than 80 percent were for possession), 1.5 million arrests for dri ving under the influence, and 573,000 arrests for drunkenness in addition to 654,000 liquor law violations (Dorsey, Zawitz, & Middleton, 2003). Between 1990 and 1999, 61 percent of the growth in the federal prison population was due to drug offenses (U.S. Department of Jus tice, Bureau of Justice Statistics [BJSJ, 2001). In 2002, 20 percent of men and 30 percent of women in state prisons were serving time for drug offenses (BJS, 2003). In 1999, 53 percent of the women in state prisons were using alcohol and drugs at the time of the offense for which they were incarcerated, and one in three women had engaged in the crime to obtain money to get drugs (Creenfeld & Snell, 2000). Alcohol and drug treatment in prisons and jails has increased, but many individuals do not get ser vices while incarcerated or after release. The economic costs of ATOD problems are high. Costs of alcohol problems were estimated at $184.6 billion in 1998, with two-thirds due to losses in current and future earnings (Har wood, 2000). Costs of drug problems in 2000 were estimated at $160.7 billion (69 percent in productivity losses, 22 percent due to criminal justice and social welfare costs, and 9 percent in health care costs) (ONDCP, 2001). Medical costs of smoking are about $75 billion annually and productivity losses are about $80 billion (National Center for Chronic Disease Preven tion and Health Promotion, 2004). The greatest toll of ATOD, however, comes in the form of human suffering. Confounding Issues There is lack of agreement about how to define, prevent, and treat ATOD problems. Professionals in the ATOD field view alcohol and drug dependence as a brain disease (Lesh ner, 2001) or a chronic medical illness with treatment compliance and relapse rates similar to other chronic medical illnesses (McLellan, Lewis, O Brien, & Kleber, 2000). The ADA and other public policies treat ATOD problems dif ferently from other mental and physical ill nesses (DiNitto, 2002; McNeece & DiNitto, 2005). Alcohol or drug disorders alone are no longer sufficient to qualify for Supplemental Security Income (SSI) or Social Security Dis ability Insurance (SSDI). Those who use illicit drugs or are convicted of drug law violations may be denied access to public assistance pro grams such as Temporary Assistance for Needy Families (TANF), food stamps, publicly spon sored housing, and student loans. People with other chronic illnesses or criminal convictions are not treated in this mannet Evidence indicates that every $1 spent on alcohol and drug treatment results in about $12 saved in crime, criminal justice, and health care costs (NIDA, 1999). Yet much of the national, state, and local drug control budgets go to law enforcement or interdiction, although there is little to suggest that such efforts reduce alcohol and drug abuse or dependence (McNeece & DiNitto, 2005). In fact, the so-called war on drugs has escalated violence in the United States and other countries as drug lords com pete for the lucrative drug trade and poor peo ple succumb or are forced to produce, trans port, or sell drugs to survive. Congress and state governments are loath to try harm reduction approaches that other coun tries have adopted to reduce the consequences 4 ALCOHOL, TOBACCO, AND OTHER DRUGS 31 4-

5 Alcohol 12/28/11 10:36 PM Page 32 of ATOD problems. For example, Congress has failed to approve needle exchange, even though the U.S. Department of Health and Human Services (HHS) has recognized [hat appropri ately conducted needle exchange programs can reduce HIV transmission and do not encour age injection drug use (HHS, 1998). Decrimi nalization of drug use has largely been rejected, although approaches such as drug courts and Proposition 36 in California, which provides treatment instead of jail for certain convictions of nonviolent drug offenses, attempt to divert individuals to treatment in lieu of incarceration. Furthermore, people of color are often dis proportionately affected by ATOD problems and the drug war. African Americans in partic ular are overrepresented among inmates serv ing time for drug sentences. In 2001,57 percent of drug offenders in state prisons were African American (BJS, 2003). Penalties under the Con trolled Substances Act are much stiffer for crack cocaine, which can be purchased more cheaply than powdered cocaine. This stratify ing of penalties disproportionately affects peo ple who are poor and people of color. Among male adults and adolescents in 2001, 43 percent of all AIDS cases among African Americans and the same percentage among Hispanic Americans were due to injecting drug use, having sex with men and injecting drugs, or having sex with a heterosexual injecting drug user. Just 18 percent of cases were similar among white men (Centers for Disease Control and Prevention, 2002). In 1997, the alcoholrelated cirrhosis death rate for white Hispanic men was 12.6 per 100,000, compared with 7.3 for non-hispanic African American men and 5.1 for non-hispanic white men (Stinson, Grant, & Dufour, 2001). Cirrhosis mortality is 2.8 times higher among American Indian men than among non-hispanic white men and 1.5 times higher among American Indian women than among non-hispanic white women (Singh & Hoyert, 2000). From 1995 to 1997, across Alaska, Arizona, Colorado, and New York, the rate of fetal alcohol syndrome per 1,000 population for American Indian/Alaska Natives was 3.2 com pared with 1.5 for the general population of those states (Miller et al., 2002). To address and bridge the gap between re search and treatment (see Lamb, Creenlick, & McCarty, 1998), NIDA established the Clinical Trials Network to increase knowledge ex change between researchers and practitioners. SAMHSA established Practice Research Col laboratives to increase communication among treatment providers, researchers, policymakers, consumers, and other stakeholders. SAMHSA also funds 13 regional Addiction Technology Transfer Centers (ATTCs) and a national ATTC office to increase practitioners access to stateof-the-art research and education. Professional Directives Social workers also experience ATOD prob lems, although prevalence rates are not well established (Elpers, 1992; Fewell, King, & Wein stein, 1993; Siebert, 2005). There is no reason to believe that social workers experience rates lower than the general population, and because they perform work that often exposes them to the effects of secondary trauma, there is reason to believe that social workers may be at higher risk (Stamm, 1999). For those in the helping professions, the issue of impairment involves the potential for impinging on patient care in addition to personal consequences. NASW rec ognizes that social workers have an ethical duty to help colleagues who are experiencing ATOD problems and other physical and emotional impairments (NASW, 2000). Social workers, however, are frequently reluctant to approach a colleague with an ATOD problem (Fewell et al.). A survey of social workers at high risk of ATOD problems showed that only 24 percent sought help for their problems (Siebert). Only a small number of NASW chapters provide assistance to members with ATOD problems. POLICY STATEMENT To improve the response to ATOD problems, NASW s position is that Social workers must advocate for an ap proach to ATOD problems that emphasizes prevention and treatment. Social workers must advocate to eliminate objectifying and stigmatizing language and labels and promote a more respectful, non stigmatizing strengths-based language. 32 SOCIAL WORK SPEAKS

6 Alcohol 12/28/Il 10:36 PM Page 33 The ADA, SSJ program, TANF, and other federal, state, and local legislation, policies, and programs must treat ATOD disorders in the same manner as other physical and mental disabilities. More efforts are needed to eliminate health disparities that accrue from ATOD problems and discriminatory practices from the criminal justice system. Individuals with ATOD problems need access to appropriate treatment. The risk of relapse or continued ATOD use is too great to do otherwise. To accomplish this goal, private and public health care plans need to offer treatment for ATOD problems in parity with other physical and mental health problems. Systems of care should be made available for those lacking insurance coverage, and public and private care should be of equally high quality. Providers of ATOD prevention and treat ment services need to assess their approaches and use those with demonstrated effectiveness. All reasonable avenues to address ATOD problems must be considered, including psy chosocial treatments, medications, alterna tives to incarceration, and harm-reduction approaches. Treatment for individuals with ATOD prob lems and co-occurring mental, physical, and other disorders must be offered in an inte grated manner, and treatment programs must be fully accessible. Treatment for ATOD problems must be comprehensive given that patients, clienls, and consumers often present with additional prob lems (health, employment, family, housing, legal, and other problems) that may impede recovery. Social workers in all settings need knowl edge of ATOD problems and the skills neces sary to screen for ATOD problems, to educate at-risk drinkers and tobacco users about the options available for reducing or eliminating consumption, to refer those who need ATOD treatment to appropriate services, and to moti vate patients, clients, and consumers to take appropriate action. Social workers also need to be capable of offering family members and friends services or referrals to appropriate ser vices, including mutual-help groups. Social workers need to work with other groups and professional organizations to iden tify and support efforts that are evidence based, grounded in best practices, and improve treat ment outcomes. Schools of social work need to be encour aged to incorporate more information about the knowledge and skills needed to intervene with ATOD problems in all areas of the cur riculum. The training received toward the BSW and MSW degrees needs to be promoted as providing sufficient knowledge for interven ing with ATOD problems. ATOD prevention and treatment strategies must address the characteristics and needs of individuals with regard to gender, sexual ori entation, ethnicity, culture, religion and spiri tual beliefs, socioeconomic status, disability, and other factors. NASW must assist and encourage chapters to provide services for all social workers who are personally affected by ATOD problems. REFERENCES Americans with Disabilities Act of 1990, Pub. L , 42 USC et seq. Centers for Disease Control and Prevention. (1994, March 11). Preventing tobacco use among young people: A report of the Sur geon General (Executive Summary). MMWR Reco,n,nendatious and Reports, 43(RR-4), Centers for Disease Control and Prevention. (2002). U.S. HIV and AIDS cases reported through December HI V/AIDS Sur veillance Report, 13(2). Retrieved May 26, 2004, from hasrl3o2.htm Chassin, L., Jacob, T., Johnson, J. L., Shuckit, M. A., & Sher, K. J. (1997). A critical analy sis of COA research. Alcohol, Health & Research World, 21, ALCOHOL, TOBACCO, AND OTHER DRUGS 33

7 Alcohol I 2128/11 10:36 PM Page 34 Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970, Pub. L , 84 Stat. 1848, 42 U.S.C et seq. Comprehensive Drug Abuse Prevention and Control Act of 1970, Pub. L , 84 Stat. 1236, 21 U.S.C. 801 et seq. Cotton, N. S. (1979). The familial incidence of alcoholism: A review. Journal of Studies on Alcohol, 40, de Miranda, J. (1999, May/June). Treatment services offer limited access for people with disabilities. Counselor, 27(3), DiNitto, D. M. (2002). War and peace: Social work and the state of chemical dependency treatment in the United States. In S.L.A. Straussner & L. Harrison (Eds.), Interna tional aspects of social work practice in the addictions (pp. 7 29). New York: Haworth Press. DiNitto, D- M., & Webb, D. K. (2005). Substance use disorders and co-occurring disabilities. In C. A. McNeece & D. M- DiNitto (Eds.), Chemical dependency: A systems approach (3rd ed., pp ). Dorsey, T. L., Zawitz, M. W., & Middleton, P. (2003, December). Drugs and crime facts. Washington, DC: U.S. Department of Jus tice, Bureau of Justice Statistics. Retrieved May 26, 2004, from El-Guebaly, N., & Offord, D. R. (1977). The off spring of alcoholics: A critical review. American Journal of Psychiatry, 234, Elpers, K. (1992). Social work impairment: A statewide survey of the National Association of Social Workers. Indianapolis: NASW Indi ana Chapter. Fewell, C. H., King, B. L., & Weinstein, D. L. (1993). Alcohol and other drug abuse among social work colleagues and their families: Impact on practice. Social Work, 38, Goodwin, D. W. (1979). Alcoholism and hered ity: A review and hypothesis. Archives of General Psychiatry, 36, Grant, B. F. (2000). Estimates of U.S. children exposed to alcohol abuse and dependence in the family. American Journal of Public Health, 90, Greenfeld, L A., & Snell, T. L. (2000). Women offenders [Bureau of Justice Statistics Special Report]. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics. Retrieved May 26, 2004, from Grunbaum, J. A., Kann, L., Kinchen, S., Ross J., Hawkins J., Lowry, R., Harris, W. A., McManus, T., Chyen, D., & Collins, J. (2004). Youth risk behavior surveillance-united States, Morbidity and Mortality Weekly Report, 53(SS-2): Harwood, H. (2000). Updating estimates of the economic costs of alcohol abuse in the United States: Estimates, update methods, and data. Washington, DC: National Institute on Alcohol Abuse and Alcoholism. Retrieved May 24, 2004, from Hay Group. (2001). Employer health care dollars spent on addiction treatment. Chevy Chase, MD: American Society of Addiction Medi cine. Retrieved May 26, 2004, from Heath, A. C. (1995). Genetic influences on drink ing behavior in humans. In H. Begleiter & B. Kissin (Eds.), The genetics of alcoholism (Vol. I, pp ). New York: Oxford Uni versity Press. Huang, L. X., Cerbone, F G., & Gfroerer, J. C. (1998). Children at risk because of parental sub stance abuse [OAS Working Paper]. Rock ville, MD: Substance Abuse and Mental Health Services Administration. Lamb, S., Greenlick, M. R., & McCarty, D. (Eds.). (1998). Bridging the gap between prac tice and research: Forging partnerships with community-based drug and alcohol treatment. Washington, DC: Institute of Medicine, National Academies Press. Leshner, A. 1. (2001, Spring). Addiction is a brain disease. Issues in Science and Tech nology. Retrieved June 4, 2002, from McLellan, A. T., Lewis, D. C., O Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evalu ation. JAMA, 284, SOCIAL WORK SPEAKS

8 Alcohol 12/28/11 10:36 PM Page 35 McNeece, C. A., & DiNitto, D. M. (2005). Chem ical dependency: A systems approach (3rd ed.). Boston: Allyn & Bacon. Mee-L~ee, D., Shulman, C. D., Fishman, M., Gastfriend, D. R., & Criffiths, J. H. (Eds.). (2001). ASAM patient placement criteria for the treatment of substance related disorders (2nd ed.-rev., PPC-2R). Chevy Chase, MD: American Society of Addiction Medicine. Miller, L., Tolliver, R., Druschel, C., Fox, D., Schoellhorn, J., Podvin, D., Merrick, S., Cunniff, C., Meaney, F. J., Pensak, M., Dominique, Y., Hymbaugh, K., Boyle, C., & Baio, J. (2002). Fetal alcohol syndrome- Alaska, Arizona, Colorado, and New York: Morbidity and Mortality Weekly Report, 51(20), National Association of Social Workers. (2000). Code of ethics of the National Association of Social Workers. Washington, DC: Author. National Center for Chronic Disease Preven tion and Health Promotion. (2004). Reduc ing tobacco use. Atlanta: Centers for Disease Control and Prevention. Retrieved May 23, 2004, from bbtobacco National Center on Addiction and Substance Abuse at Columbia University. (2005). Fam ily matters: Substance abuse and the American family. New York: Author. National Institute on Drug Abuse. (1999). Prin ciples of drug addiction treatment: A researchbased guide. Bethesda, MD: National Insti tutes of Health. National Institute on Drug Abuse. (2003, April 11). Congressional and legislative activities. Retrieved May 25, 2004, from logy/html Office of National Drug Control Policy. (2001). The economic costs of drug abuse in the United States, (Publication No. NCJ ). Washington, DC: Executive Office of the President. Retrieved May 23, 2004, from /www.whitehousedrugpolicy.gov Office of National Drug Control Policy. (2004, March). National drug control strategy, Fl 2005 budget summary. Washington, DC: Executive Office of the President. Retrieved May 25, 2004, from housedrugpolicy.gov/publications/policy/ budgetsumo4/index.html Proposition 36, Substance Abuse and Crime Prevention Act of 2000, California Penal Code 1210 et seq. 72 percent work for private organizations. (2001, January). NASW News, p. 8. Russell, M., Henderson, C., & Blume, S. B. (1985). Children of alcoholics: A review of the literature. New York: Children of Alcoholics Foundation. Siebert, D. C. (2005). Help seeking for AOD misuse among social workers: Patterns, barriers, and implications. Social Work, 50, Singh, C. K., & Hoyert, D. L. (2000). Social epi demiology of chronic liver disease and cirrhosis mortality in the United States, : Trends and differentials by eth nicity, socioeconomic status, and alcohol consumption. Human Biolo4gy, 72, Stamm, B. H. (Ed.). (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, & educators (2nd ed.). Baltimore, MD: Sidran Press. Stinson, F. S., Grant, B. F., & Dufour, M. C. (2001). The critical dimension of ethnicity in liver cirrhosis mortality statistics. Alcoholism: Clinical and Experimental Research, 25, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2001). Summary of findings from the 2000 National Household Survey on Drug Abuse. Rockville, MD: Author. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2003). Overview of findings from the 2002 National Survey on Drug Use and Health. Rockville, MD: Author. U.S. Department of Health and Human Ser vices. (1998, April 20). Research shows nee dle exchange programs reduce HIV infections without increasing drug misc. Washington, DC: Author. Retrieved May 28, 2004, from /www.hhs.gov/ news/press/ I998pres/980420a.html U.S. Department of Justice, Bureau of Justice Statistics. (2001). Prisoners in Re- ALCOHOL, TOBACCO, AND OTHER DRUGS 35

9 Alcohol 12/28/li 10:36 PM Page 36 trieved May 26, 2004, from U.S. Department of Justice, Bureau of Justice Statistics. (2003). Prisoners in Re trieved May 26, 2004, from White, W. L (2001). The rhetoric of recovety advo cacy: An essay on the power of language. Peo ria, IL: Behavioral Health Management Pro ject. Available at advocacy/rhetoric.pdf Policy stat en,e,lt appivved by the NASW Delegate Assenibly, August This statement supersedes the statement on Alcohol, Tobacco, and Other Substance Abuse app,vved by the Delegate Assembly in 2996 and refen-ed by the 2002 Delegate Assembly to ti,e 2005 Delegate Assembly for revision. Foi-fin-ther iiifonnation, contact the National Association of Social Workers, 750 First Street, NE, Suite 700, Washington, DC ; telephone: ; 36 SOCIAL WORK SPEAKS

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