California State University, Northridge Certificate in LGBTQ+ Health

Co-Occurring Disorders Among Social Workers

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2015 National Survey on Drug Use and Health (NSDUH), co-occurring mental health and substance use disorders (SUD) affected an estimated 8.1 million adults or 3.7% of the total adult population in the United States. This marked a slight increase from the 2014 findings, which indicated that 7.9 million adults were affected by co-occurring disorders (Center for Behavioral Health Statistics and Quality, Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. HHS Publication SMA 16-4984, NSDUH Series H-51, 2016). However, no data have been available regarding the rates of co-occurring disorders among mental health professionals, particularly social workers. The purpose of this paper is to provide such data as obtained in a 2015 survey titled “The Social Workers’ Self-Reported Wellness” (SWSRW) study and to provide some comparison of these findings to national data regarding these problems.

The SWSRW survey collected data on mental health conditions and substance use from over 6,000 licensed social workers from 13 states across the U.S. The study was developed and administered by Drs. S. Lala A. Straussner, Evan Senreich, and Jeff Steen. It received IRB approval from New York University and City University of New York, Lehman College (more information regarding the methodology can be obtained in Straussner, S. L. A., Steen, J. T., & Senreich, E. What Do We Know About Social Workers’ Use of Heroin? Behavioral Health News, 5(2), Fall 2017, and by visiting  https://wp.nyu.edu/socialworkers).

In the survey, the question inquiring about mental health problems was phrased, “At this point in my life, I am experiencing one or more mental health problems” with participants then selecting the response of agreement with that statement. The scale for response was “strongly disagree,” “disagree,” “agree,” and “strongly agree.” Participants later selected mental health problems they were currently experiencing and could select more than one.

Similarly, the question inquiring about substance use problems stated “At this point I my life:” with participants then selecting the appropriate response of either “I am experiencing serious problems with alcohol or other drugs most of the time,” I am sometimes experiencing problems with alcohol or other drugs,” I use alcohol or other drugs but this does not cause me any significant problems,” or “I rarely or never use alcohol or other drugs.” Participants were later asked to identify which substances they were using and that were not used as prescribed by a health care provider.

Mental Health Disorders: National Data vs. Social Worker Study Participants: According to the National Institute of Mental Health (NIMH), in 2015 there were approximately 43.4 million adults (17.9%) in the U.S. population with any mental illness (AMI) in the previous 12 months (NIMH. Any Mental Illness (AMI) Among U.S. Adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-us-adults.shtml). Kessler, Chiu, Demler, and Walters estimate that percentage to be as many as 30% of the U.S. population and specify that 18% of the population had an Anxiety Disorder, 6.7% had a Depressive Disorder, 3.5% had Post-Traumatic Stress Disorder (PTSD), 2.6% had Bipolar Disorder, 1% had Obsessive-Compulsive Disorder (OCD), 1.1% had Schizophrenia, and 9.1% have a Personality Disorder (Kessler, R.C., Chiu, W.T., Demler, O., Walters, E.E. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617-27, 2005, as cited by NIMH Prevalence Fact Sheets).

Among SWSRW study participants, the reported prevalence of Anxiety Disorders, PTSD, and OCD are similar to the national data, with 17% of SWSRW participants reporting currently experiencing an Anxiety Disorder, 4% experiencing PTSD, and 1.4% experiencing OCD. However, SWSRW participants differed with regard to Depressive Disorders, Bipolar Disorder, Schizophrenia, and Personality Disorders, with participants reporting lower rates of Bipolar Disorder (1% vs. 2.6%), Schizophrenia (0.1% vs. 1.1%), and Personality Disorders (0.2% vs. 9.1%). On the other hand, the rate of Depressive Disorders among SWSRW participants was almost twice the national data (14% vs. 6.7%).

Substance Misuse: National Data vs. Social Worker Study Participants: The NSDUH reports that in 2015, 66.7 million people aged 12 or older reported binge alcohol use defined as four or more drinks for women and five or more drinks for men on the same occasion in the past 30 days. The NSDUH also states 17.3 million reported heavy alcohol use defined as binge drinking on 5 or more days in the past 30 days. Therefore, binge drinkers and heavy alcohol users account for 24.9% and 6.5% of the population, respectively, for a total of 31.4% collectively. Additionally, 13.6 million adults aged 26 or older (6.5%) were current users of marijuana, 1.1 million adults aged 26 or older (0.5%) were current misusers of tranquilizers, and 1.9 million people aged 12 or older were current users of cocaine (0.7%) and crack (0.1%) (Center for Behavioral Health Statistics and Quality, Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. HHS Publication SMA 16-4984, NSDUH Series H-51, 2016).

In comparison, the 873 SWSRW study participants who identified as ever having a problem with alcohol or other drugs (AOD) indicated a higher prevalence of current alcohol misuse when compared to the combined national sample of binge and heavy drinkers (46% vs. 31.4%) and a higher prevalence of marijuana misuse when compared to the national sample of marijuana users (8.4% vs. 6.5%). Additionally, the SWSRW participants who identified as ever having an AOD problem indicated a much higher prevalence of current tranquilizer misuse compared to the national sample (2.7% vs. 0.5%). Lastly, the participants indicated a lower prevalence of cocaine or crack misuse compared to the national sample of current users (0.5% vs. 0.8%).

Social Workers with Co-Occurring Disorders – Study Results: According to Straussner, Steen, and Senreich, 873 (14.9%) SWSRW participants identified as having experienced AOD problems at some point throughout their lives and about one in six (16.1%) of those study participants reported currently misusing substances (Straussner, S. L. A., Steen, J. T., & Senreich, E. What Do We Know About Social Workers’ Use of Heroin? Behavioral Health News, 5(2), Fall 2017). Of those who reported current substance misuse, alcohol, marijuana, and tranquilizers and sedatives such as Valium, Librium, and Ativan, were the most highly reported substances misused out of a possible selection of 12 possible substances.

Of the total respondents to the study, 27% (n=1665) reported they are currently experiencing one or more mental health problems. When indicating which mental health problems they were currently experiencing, Anxiety Disorders (51.7%), Depressive Disorders (45.2%), and PTSD (11%) were most reported out of a possible selection of 13 possible mental health problems.

When examining reported mental health disorders and substance misuse together, there were 85 participants who reported both. Therefore, study participants had a rate that was less than half of the co-occurring disorders that were found in the general population (1.5% vs. 3.7%). Three co-occurring disorders stood out as the most common combinations reported by all social worker participants: Anxiety disorder with alcohol misuse (22.6%), Depressive disorder with alcohol misuse (20.7%), and PTSD with alcohol misuse (6.6%).

Limitations: In addition to the generalizability issues of the SWSRW study sample to other social workers, it is important to keep in mind the limitations that exist when trying to compare data from the SWSRW study sample of licensed social workers to the general U.S. population. The SWSRW survey did not ask questions in the same way as national surveys. As identified earlier, the SWSRW survey asked questions on mental health and substance use problems in the form of a scale of agreement but did not collect or assess diagnostic criteria. Consequently, the above comparisons need to be viewed with caution. Nonetheless, they provide a first step in looking at the mental health and substance use problems among social work professionals within the context of the general population in the U.S.

Conclusion: Based on the findings of the 2015 survey of licensed social workers, we see that SWSRW study participants reported lower rates of Bipolar Disorder, Schizophrenia, and Personality Disorders than the general U.S. adult population. However, the SWSRW study participants reported a similar prevalence of Anxiety Disorders and a much higher prevalence of Depressive Disorders than the general U.S. adult population. SWSRW participants who reported they had experienced AOD problems at some point throughout their lives were found to be experiencing somewhat higher rates of current substance misuse when compared to the general U.S. adult population. Additionally, the SWSRW participants reported Anxiety Disorders, Depressive Disorders, and PTSD combined with alcohol misuse, as the top three most experienced co-occurring disorders. Given the above findings it is critical that both the fields of mental health and substance misuse services address the needs of their social work services providers with co-occurring disorders, particularly those with depressive disorders, and not just their clients.

The authors would like to acknowledge and thank Dr. Evan Senreich and Dr. Jeff Steen for their contributions.

S. Lala A. Straussner, PhD, LCSW, is Professor and Director, Post-Master’s Program in the Clinical Approaches to the Addictions, and Founding Editor, Journal of Social Work Practice in the Addictions. You may reach her at the New York University Silver School of Social Work (sls1@nyu.edu). Josey Madison, LCSW, is with the Stonington Institute Starlight Military Program, and a PhD Student at New York University Silver School of Social Work (jm6577@nyu.edu).

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