Much has been written lately about the opioid epidemic in the United States. By and large, the vast majority of current opioid users are young, white males who use either heroin or fentanyl, a potent synthetic opioid. But these opioid users are not only our clients, or potential clients. They are also service providers, such as social workers and other health and mental health professionals. In order to learn more about our social work colleagues and their use of substances, as well as other health and mental health problems and workplace issues, we developed a survey, Social Workers’ Self-Reported Wellness: A National Study.
This IRB approved online survey consisted of 75 open- and closed-ended items, and was administered in Fall of 2015 to randomly-selected licensed social workers in the 13 states that were able to provide us with e-mail addresses of these professionals: Arkansas, Connecticut, Florida, Minnesota, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, Washington, West Virginia, and Wyoming. These states are located in all four federal regions, as designated by the U.S. Census Bureau. We obtained responses from 6,112 individuals, and since social workers can be licensed in more than one state, social workers from all 50 states were represented in this study. The overall study’s response rate was 28%, taking into account the number of e-mails that bounced back. More information about the study and some preliminary findings are located at: https://wp.nyu.edu/socialworkers.
Social Workers with Alcohol and Other Drug Problems
One of the study’s aims was to assess the nature and scope of respondents’ substance use and misuse. The survey examined a variety of factors related to this topic, including the timing of respondents’ alcohol and other drug (AOD) problems and the types of substances that had been used. Of the study’s 5850 respondents who responded to the substance misuse questions, 873 individuals (14.9%) reported that they had experienced AOD problems at some point in their lives. Regarding the timing of these issues, approximately two-thirds of respondents (65.3%) with AOD problems experienced these issues before becoming social workers, over one-half (52.5%) encountered these issues over the course of their social work careers, and about one in six (16.1%) reported current substance misuse.
Among respondents with lifetime AOD problems, alcohol (92.6%), marijuana (65.6%), and cocaine or crack (27.5%) were the most commonly-used substances. Nearly a fifth of these respondents (18.9%) had ever used painkillers in a non-prescribed manner, and 5.2% had ever used heroin. The questionnaire, however, did not provide respondents an option to indicate whether the painkillers they used were classified as opioids or non-opioids. Therefore, to best address the theme of the current issue of this newsletter, the remainder of this paper examines data from the 47 respondents who indicated that they had ever used the opioid drug, heroin. Because of the relatively small number of respondents, no statistical data are presented.
Social Workers with A History of Heroin Use
Respondents who had ever used heroin differed from our larger sample of licensed social workers in a number of interesting ways. For example, they were more likely to be male (41% vs. 11%) and gay, lesbian, or bisexual (13% vs. 8%), and they were slightly older than respondents who had not used heroin (49 years old vs. 46 years old). Respondents who had ever used heroin were less likely to identify as Christian (31% vs. 58%) and more likely to indicate being spiritual but not religious (40% vs. 23%), agnostic/atheist (16% vs. 8%), or Buddhist (4% vs. 1%). Similar to the demographics of the full study group, respondents who had ever used heroin were overwhelmingly White (81% vs. 83%), with self-identified Black (6% vs. 6%) and Latino social workers (4% vs. 4%) comprising a very small portion of the sample. They were slightly more likely to be single and never married (21% vs. 18%) or separated/divorced (17% vs. 15%). Overall, although the personal characteristics of social workers who reported elevated rates of substance use differed from our larger sample of licensed social workers in terms of gender and sexual orientation, they are consistent with findings from studies in the general substance misusing population in the U.S. (Grant et al., Epidemiology of DSM-5 drug use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry, 73, 39-47, 2016; McGuire & Miranda, New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Affairs, 27, 393-403, 2008).
Regarding professional characteristics, a majority of respondents with a history of heroin use held a master’s degree in social work (83%), which was similar to degree attainment among respondents from the full sample of licensed social workers (81%). The vast majority of respondents were currently engaged in direct practice/clinical social work (70% vs. 77%), and their most common field of practice was mental health (66% vs. 61%).
Interestingly, compared to the larger sample of respondents, individuals with a history of heroin use were more likely to work in the fields of substance abuse (55% vs. 26%) and housing/homelessness (26% vs. 14%), and much less likely to work with children/adolescents (34% vs. 51%) or in schools (11% vs. 22%).
Wellness of Social Workers with a History of Heroin Use
The study included numerous items assessing respondents’ personal histories, including Adverse Childhood Experiences (ACEs), physical health, and behavioral health problems. The ACE scale is a widely-used, 10-item inventory of childhood maltreatment (Felitti et al., Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine, 14(4), 245-258, 1998) that has identified strong associations between childhood abuse, neglect, and household challenges and later-life behavioral health problems, including increased AOD misuse (Dube, S. R., et al. Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviors, 27(5), 713-725, 2002), and opioid use (Stein, et al., Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug and Alcohol Dependence, 179, 325-329, 2017).
Regarding results from the Social Workers’ Self-Reported Wellness study, the average number of ACEs among all study respondents was 2.1. Among study respondents with a history of heroin use, the average number of ACEs was much higher – 3.3. The finding that respondents who had ever used heroin reported higher rates of childhood maltreatment than those who had not used heroin is consistent with results from previous studies that examined illicit drug use and ACEs in the general population (Dube, S. R., et al., Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564-572, 2003). Among respondents who indicated that they had been exposed to at least one ACE, 55% indicated that these events influenced their decision to enter the social work profession, and 54% reported that ACEs affected their work as social workers. For example, according to one respondent, “I think that I am more perceptive of nonverbal behavior and follow my instincts more often than some people might. I have tried to channel my experiences into something positive and at times have self-disclosed a measure of my experience in order to help a client. I also don’t allow myself to be bullied by an aggressive client.”
Regarding problems with wellness, in comparison to other social workers, respondents with a history of heroin use were just as likely to report physical health problems (60% vs. 61%), but were more likely to report mental health problems (63% vs. 52%). Specifically, they had significantly higher rates of depression (60% vs. 32%), PTSD (23% vs. 11%), ADHD (19% vs. 5%), bipolar disorder (17% vs.1%), eating disorders (9% vs. 2%) and learning disabilities (9% vs. 2%), but only slightly higher rates of anxiety disorders (37% vs. 32%). They also had a much higher tobacco use (21% vs. 12%) over the course of their social work careers. In addition, compared to other study participants, respondents with a history of heroin use had much higher rates of alcohol problems (74% vs. 10%), and problems with other drugs (89% vs. 6%). Interestingly, 89% of respondents who ever used heroin indicated that they utilized behavioral health services to treat their mental health and/or AOD problems. This figure is higher than rates of service use among other study participants (69%), and in the general population. As reflected by one respondent, “I have been fortunate to have had wonderful and supportive professionals provide me the care I needed. That informs my work and modeled for me some of the attributes of effective treatment.”
Conclusion
Additional research is needed to assess the ways in which opiate use is impacting the behavioral health workforce in general, and social workers in particular. Our study of over 6,000 licensed social workers found that only a small number of respondents had ever used heroin, while over 23%.had ever used non-prescribed painkillers, some of which may have been opioids. Compared to the other licensed social workers who participated in this study, the 47 respondents who reported heroin use were more likely to be male and gay/lesbian/bisexual. They also reported higher rates of behavioral health problems, and were also more likely to have utilized professional services to treat these issues. While these findings cannot be generalized to the entire profession or other helping professionals, the study results suggest that social workers with a history of heroin use may be disproportionately affected by histories of childhood maltreatment, mental health issues, and AOD misuse; experiences that may have influenced their decision to enter the field and that may affect their performance in the workplace.
About the Authors
- 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, New York University Silver School of Social Work. She can be reached by email at: sls1@nyu.edu.
Jeffrey T. Steen, PhD, LCSW, is Assistant Professor, Bridgewater State University, and a Training Fellow, NIAAA Alcohol and Other Drugs Education Program for Social Work Faculty at Boston University. He can be reached by email at: jsteen@bridgew.edu.
Evan Senreich, Ph.D., LCSW, is an Associate Professor of Social Work at Lehman College, City University of New York Department of Social Work. Email: evan.senreich@lehman.cuny.edu
