SOCIAL WORK EDUCATION: THE AVAILABILITY OF ALCOHOL‐RELATED COURSE CURRICULUM AND SOCIAL WORKERS' ABILITY TO WORK WITH PROBLEM DRINKERS

Abstract

An explanatory cross‐sectional investigation was employed to assess how well masters‐level social work (MSW) programs in the State of New York prepare students for practice with problem drinkers. The following areas were explored: (1) the incorporation of alcohol‐related coursework and field placement opportunities within MSW programs; (2) the relationship between students' completion of alcohol‐related courses and field placements and their subsequent ability to diagnose clients with alcohol problems, their willingness to work with problem drinkers, and their levels of alcohol‐related knowledge; and (3) subjects' levels of alcohol‐related knowledge in relation to their diagnostic ability and their willingness to work with problem drinkers. The sample consisted of 89 MSW‐level social work practitioners, who were active members of the New York State Chapter of the National Association of Social Workers (NASW) during the fall of 2005. Fewer than 3% of the sample reported the completion of an alcohol‐related course as a mandatory degree requirement and only 29.5% of the sample acknowledged the completion of an alcohol‐related field placement. These findings suggest that a possible gap exists in what social workers are being taught and what they need to know to successfully work with problem drinkers. The findings indicate that clients with alcohol problems are at risk of going untreated due to social workers' inability to correctly diagnose them as a result of insufficient training in the area of alcohol studies.

Keywords:

• social workers
• alcoholism
• problem drinkers
• curriculum
• practice

SOCIAL WORK EDUCATION: THE AVAILABILITY OF ALCOHOL‐RELATED COURSE CURRICULUM AND SOCIAL WORKERS' ABILITY TO WORK WITH PROBLEM DRINKERS

Although researchers (Abbott, 2000; Abradinsky, 2004; Gorman et al., 1990; Packard, 1986; Straussner, 2004) in both the United States (US) and abroad have identified a need for social workers to receive formal training in alcohol studies, little documentation exists regarding the curricula opportunities provided to social work students during the completion of their bachelors or masters programs. In preparation for the present study the researcher surveyed the social work curriculum offered at 19 New York State‐based universities. The survey revealed that only 57% of the universities in New York State offer MSW programs. Some 89% of the universities that offer MSW programs do not require that a course on alcohol and substance abuse be completed as a degree requirement and only 42% offer an alcohol and substance abuse course as an elective. Less than half (40%) of the universities that offer MSW programs avail students of the opportunity to complete an alcohol‐related field placement. Survey results imply that it is highly possible for social work students, graduating from universities based in the State of New York, to complete their MSW programs and not know any more about alcohol or alcohol‐related problems than they did when they entered the programs. As alcoholism/abuse is a global problem, it would be of prime interest to know how universities in other states within the US, and other countries overall, are going about ensuring that masters‐level social workers (MSWs) are being provided with the training they need to work effectively with problem drinkers.

Researchers (Begun, 2004; Gilbert & Terrel, 2002; Miller & C'DE Baca, 1995) believe the limited training, focused on alcoholism and alcohol‐abuse related issues, received by MSWs may be a barrier to the assessment of clients with alcohol problems. Research reviewed by American researchers Amodeo and Fassler (2000) suggests that MSWs are practicing without the education and training necessary to develop the therapeutic attitudes and skills required to successfully work with clients who have alcohol problems. Research conducted by British researchers Lightfoot and Orford (1986) revealed that MSWs' lack of alcohol‐related training leads to subsequent feelings of inadequacy with regards to their level of alcohol‐related knowledge and a belief that they lack the skills necessary to diagnose and treat clients who have alcohol problems. In line with the above findings Fewell and King (1993) found that because alcohol‐dependent clients frequently present a variety of problems MSWs who lack familiarity with alcoholism may misdiagnose them. Often untrained MSWs confuse symptoms of alcoholism as criteria for a second psychiatric diagnosis, such as depression, antisocial personality, mania, anxiety disorders, and psychosis (Jarrett & Howard, 1993). Unable to determine the exact nature of the alcoholic's problem, untrained MSWs may expose alcoholics to inappropriate treatment modalities or refer them from program to program, believing that another agency or individual could better deal with them (Peyton et al., 1980).

The present study was designed to examine the availability of alcohol‐related curriculum and field placement opportunities contained within MSW programs throughout the State of New York for the purpose of determining if there is a gap between what social workers are being taught and what they need to know in order to work successfully with alcohol‐abusing clients. Few studies have been conducted which focus solely on MSWs and the alcohol‐related training they receive. A literature review revealed that the overwhelming majority of the studies conducted for the purpose of examining students' exposure to alcohol‐related training in relation to their subsequent ability to work with clients who have alcohol problems focused on nurses, psychiatrists, psychologists, and medical doctors. Not one study was found which focused solely on the training received by MSWs and their ability to work with the alcoholic client. It is unfortunate that more attention has not been given to the area of social work education and alcohol abuse, since approximately 568,000 people, in the US, each day seek help for alcohol dependence and alcohol‐related problems and most of their initial encounters will be with social workers (Begun, 2004).

Hypotheses

Three hypotheses guided the present study. They are as follows: (1) the greater the number of alcohol‐related courses completed by MSW students the greater their subsequent ability to diagnose clients with alcohol problems, the greater their willingness to work with clients with alcohol problems, and the greater their levels of alcohol‐related knowledge; (2) the greater the number of alcohol‐related field placements completed by MSW students the greater their subsequent ability to diagnose clients with alcohol problems, the greater their willingness to work with clients with alcohol problems, and the greater their levels of alcohol‐related knowledge; and (3) the greater the knowledge MSW practitioners have about alcoholism the greater their ability to diagnose clients with alcohol problems and the greater their willingness to work with clients with alcohol problems.

Method

Study design and sample

The present study is an explanatory cross‐sectional investigation. Explanatory cross‐sectional studies are typically conducted when a researcher is interested in testing hypotheses (Rubin & Babbie, 1997). Data were gathered using self‐administered questionnaires and analyzed using version 10.0 of the Statistical Package for Social Science (SPSS for Windows, 1999). The software was selected because it is easy to use and capable of summarizing data and examining relationships between variables accurately and quickly.

The sample frame consisted of 1,067 MSWs who were members of the New York State Chapter of the National Association of Social Workers and who had been in practice for a minimum of one month and a maximum of seven years. A systematic sampling technique was employed to draw a random sample of 550 social work practitioners out of the possible 1,067. During the first week of September 2005 the researcher mailed each of the 550 social work practitioners a packet. Each packet contained a cover letter introducing the study, a questionnaire, and a postcard. The postcards had numeric codes written on them. The number on each postcard corresponded to an NASW practitioner's name. Practitioners were asked to complete the questionnaire and return it and the postcard separately. This procedure allowed follow‐up to maximize questionnaire return rate without jeopardizing subjects' anonymity.

The questionnaire

The questionnaire was comprised of several sections. Section A focused on the practitioner's demographic background, how long the practitioner has been in practice, the type of agency the practitioner works in, and the number of clients with drinking problems the practitioner currently treats. Section B focused on the practitioner's reported expertise, willingness, and confidence in working with clients with alcohol problems. Section C focused on practitioner's alcohol‐related knowledge. Section D focused on the practitioner's academic background. This section included questions about the number and types of alcohol‐related courses taken by the practitioner while working toward his/her MSW degree. Section E focused on the practitioner's ability to diagnose alcoholism. This section included six vignettes. Three of the vignettes described clients with symptoms of alcohol dependence/abuse and three described clients with various other diagnoses. The vignettes used to measure ability to diagnose alcohol‐related problems were developed utilizing information presented in the DSM‐IV‐TR (2000). The remaining questionnaire items were based on instruments developed by previous researchers (Begun, 2004; Miller & C'DE Baca, 1995; Shaw et al., 1978).

Results

Sample description

Of the 550 questionnaires mailed, 133 (24%) were returned. A review of the 133 returned questionnaires revealed that 89 (67%) of the respondents fit the study's sample frame. Forty‐four of the respondents had to be eliminated because they had more practice experience than the seven year maximum. Of the respondents, 41 (43.8%) were male and 48 (56.2%) were female. The sample ranged in age from 23 to 62. The mean age for the sample was 33.5, SD = 8.9. Over half of the subjects (51.6%) received their degree between the years 1996 and 2000. The mean year for degree completion was 1999, SD = 3.12. Of the 89 subjects, 48 (53.9%) reported not having completed any alcohol‐related courses while working on their MSW degrees. Two was the maximum number of alcohol‐related courses completed by subjects. Fewer than half (30.3%) of the 89 subjects reported completing an alcohol‐related field placement while working toward their degrees. Field placement completion rates ranged from 1 to 4, SD = 0.96. Table 1 presents frequency distributions on age, number of alcohol‐related courses completed, and number of field placements completed.

Table 1. Age, number of courses completed, and number of field placements completed

age	N	%
22–34	61	68.8
35–44	18	20.0
45–54	6	6.7
55–62	4	4.5
total	89	100
number of courses completed
0	48	53.9
1	18	20.3
>2 courses completed	23	25.8
total	89	100
number of field placements completed
0	62	69.7
1>field placements completed	27	30.3
total	89	100

Work experience ranged from one to seven years with a mean of 4.9, SD = 1.9. Respondents most frequently (33.7%) reported working in community mental health clinics, followed by hospitals (13.5%), addiction services (11.2%) and family services (11.2%). Subjects reported that their job responsibilities involved multiple tasks. The tasks most frequently reported as part of subjects' job duties were intake (56.2%), client referrals (55.1%), and individual/family counseling (52.8%). The task least reported as a part of subjects' job responsibilities was outreach (16.9%). The majority of the sample (70.8%) reported working with clients who have alcohol problems. Of the 70.8% (N = 63) of the sample that reported working with clients with alcohol problems, 67% (N = 42) reported treating between one and five clients a month with alcohol problems. Table 2 presents frequency distributions on years of practice and the number of problem drinkers treated on a monthly basis.

Table 2. Years of practice and problem drinkers treated

years of practice	N	%
1–2	13	14.6
3–4	31	34.8
5–7	45	50.6
total	89	100
number of problem drinkers treated monthly
none	26	29.2
1–5	42	47.2
6–10	11	12.4
11 or more	10	11.2
total	89	100

The dependent variables

Alcohol‐related knowledge

Fifteen questions from the Knowledge of Alcohol Problems: A Questionnaire (KNAPSAQ) were used to develop an alcohol knowledge scale. The KNAPSAQ (1995) is a self‐completed rating scale created by Dr William R. Miller and Janet C'DE Baca. The number of correct responses subjects' made to the 15 questions was summed to obtain their alcohol knowledge score. There were no missing data. Table 3 presents data pertaining to the alcohol knowledge scale.

Table 3. Dependent variables: scale‐related data

scale	source	mean (SD)	(range)	Cronbach alpha
alcohol knowledge — based on knowledge of alcohol problems: a questionnaire	Miller and C'DE Baca (1995)	6.7 (12.8)	(1–14)	0.62
willingness to work with clients with alcohol problems — based on motivation and work satisfaction subscales from the AAPPQ	Chappel and Veach (1987)	4.24 (1.37)	(1.60–6.90)	0.93
Diagnostic ability	Developed by researcher (2005); based on DSM‐IV‐TR (2000)	2.80 (1.93)	(0–6)	0.57

Diagnostic ability

Subjects' diagnostic ability was measured using a scale, referred to as the diagnostic ability scale. The scale was developed based upon subjects' ability to accurately diagnose clients with alcohol problems presented in three vignettes. Each vignette had the following codes: 0 = totally incorrect, 1 = partially correct, and 2 = correct. A totally incorrect assessment was assigned when: (1) the practitioner listed a diagnosis, other than alcoholism as the primary and/or the secondary diagnosis, when the indicators included in the vignette indicate alcoholism/alcohol abuse; or (2) when the practitioner failed to assign a diagnosis. A partially correct assessment was assigned when a practitioner listed alcoholism/alcohol abuse as a secondary diagnosis when it was presented as the primary diagnosis. Subjects' diagnostic scores were obtained by summing the scores they received based on their responses to the three vignettes. Missing data were handled as follows: two of the subjects did not respond to any of the three vignettes; they were excluded. Two subjects responded to one of the three vignettes. Their score for that vignette was assigned as their score for each of the two unanswered vignettes. Two subjects responded to two vignettes. The scores they received on the two vignettes were summed and divided by two; the resulting number was assigned as their score for the missing vignette. Eighty‐three of the 89 subjects answered all three vignettes. Visual inspection of the data revealed that subjects most frequently (32.2%) misdiagnosed alcoholism as depression. Other frequent misdiagnoses included antisocial personality and anxiety. Data pertaining to the diagnostic ability scale are shown in Table 3.

Willingness to work

Two subscales (each comprised of five items) from the Alcohol and Alcohol Problems Perceptions Questionnaire (AAPPQ) were administered to determine subjects' willingness to work with clients who have alcohol problems. The AAPPQ (1978) was developed by Shaw et al. and has been used internationally (Gorman et al., 1990; Lightfoot & Orford, 1986). The instrument is a self‐completed rating scale, comprised of statements to which respondents indicate their levels of agreement or disagreement on a seven‐point scale (1 represents ‘strongly agree’ and 7 ‘strongly disagree’). For the purpose of the present research, subjects' willingness scores were derived by obtaining a mean score for their individual responses to the 10 items taken from the AAPPQ. Table 3 shows data pertaining to the index developed to measure subjects' willingness to work with problem drinkers.

The hypotheses

H1: The greater the number of alcohol‐related courses taken by MSW students the greater their subsequent:

H1a: ability to diagnose clients with alcohol problems.

A one‐way ANOVA was performed to test this hypothesis. The hypothesis was confirmed [F = 36.76, (df = 2.84), p<0.001].

H1b: willingness to work with clients with alcohol problems.

A one‐way ANOVA was performed to test this hypothesis. The hypothesis was confirmed [F = 41.51, (df = 2.86), p<0.001].

H1c: alcohol‐related knowledge.

A one‐way ANOVA was performed to test this hypothesis. The hypothesis was confirmed [F = 23.53, (df = 2.86), p<0.001].

H2: The greater the number of alcohol‐related field placements completed by MSW students the greater their subsequent:

H2a: ability to diagnose clients with alcohol problems.

A t‐test was performed to test this hypothesis. The hypothesis was confirmed [t = −8.87, (df = 85), p<0.001].

H2b: willingness to work with clients with alcohol problems.

A t‐test was performed to test this hypothesis. The hypothesis was confirmed [t = −9.23, (df = 38), p<0.001].

H2c: alcohol‐related knowledge.

A t‐test was performed to test this hypothesis. The hypothesis was confirmed [t = −9.01, (df = 87), p<0.001].

H3: The greater the knowledge practitioners have about alcoholism the greater their subsequent:

H3a: ability to diagnose clients with alcohol problems.

A Pearson correlation was performed to test this hypothesis. The hypothesis was confirmed (r = 0.57, p<0.001).

H3b: willingness to work with clients with alcohol problems.

A Pearson correlation was performed to test this hypothesis. The hypothesis was confirmed (r = 0.71, p<0.001).

Discussion

An examination of the overall patterns of the findings suggests that masters‐level coursework at schools of social work in New York State may not be effectively preparing students for practice with clients who have alcohol problems. Though the majority of the subjects sampled reported that the social work schools they attended offered a substance abuse course, only two subjects reported the course to be mandatory. This finding supports the research of Elinstien and Wolfson (1970 ) and Schlesinger and Brag (1986) who reviewed social work curricula at schools of social work throughout the United States and found that courses on alcohol and substance abuse, if offered, where typically offered only as electives. Little more than a quarter of the sample reported completing an alcohol‐related field placement. This means one of two things: the social work schools that students are attending are not offering field placements centering on alcohol problems or that students are not electing to participate in said field placements. This is unfortunate because the results of the bivariate analysis revealed that subjects who completed at least one alcohol‐related field placement during their MSW programs were subsequently better at diagnosing alcohol problems, were more willing to work with clients with alcohol problems, and had higher levels of alcohol‐related knowledge than subjects who completed no alcohol‐related field placements.

The fact that schools of social work are not making the completion of a course on alcoholism and practical experience with problem drinkers mandatory degree requirements is problematic as the majority of the sample reported working with clients who have alcohol problems. It is difficult to find a social work agency that does not have a substantial number of problem drinkers among its client population (Wechsler & Rohman, 1982). An estimated 25% of the caseloads at public assistance agencies consist of families in which one or more member is dealing with an alcohol‐related problem (Begun, 2004). Social workers at psychiatric hospitals, domestic violence centers, and in correctional settings report working with problems drinkers (Abbott, 2000). In addition to the programs mentioned above, not specifically designed to treat problem drinkers, social workers make up a large portion of the staff at alcoholism clinics, rehabilitation centers, and halfway houses (Amodeo & Fassler, 2000).

Furthermore, more than half of the subjects sampled reported client intake as a part of their job responsibilities, but only 13.5% were able to accurately diagnose the clients presented in the three vignettes which included alcohol indicators. Similar to the findings of Jarrett and Howard (1993), subjects in the present study frequently mistook alcoholism for depression. In addition to intake, client referrals also ranked high on the list of job responsibilities undertaken by the sample. According to Cooley (1990) the true measure of training effectiveness in alcohol issues is the number of drinkers that workers are able to successfully refer. How will social workers be able to treat or refer clients with alcohol problems if they are unable to accurately diagnose them?

In conclusion, the results of this study showed alcohol‐related knowledge to be positively related to subjects' diagnostic ability and their willingness to work with problem drinkers. These results are in line with those obtained by past American researchers (Bailey, 1970; Peyton et al., 1980; Rabinowitz et al., 1987) who established that mental health practitioners who had higher levels of alcohol‐related knowledge demonstrated greater familiarity with the subject, were better able to diagnose clients with drinking problems, and were more willing to work with them. In line with the findings of the American researchers mentioned above are the findings of British researchers Gorman et al. (1990) and Lightfoot and Orford (1986) who found that when social workers were provided with alcohol‐related training their subject‐related knowledge increased and they were more comfortable with and subsequently more willing to work with problem drinkers than social workers who were not provided with such training. According to Bailey (1970), one of the primary purposes of education is the replacement of lay prejudice by therapeutic knowledge and values, and alcoholism education appears to provide an excellent vehicle for such attitude transformation. It is imperative that educators in the United States and abroad provide social work students with alcohol training opportunities. Educators have been charged with the responsibility of preparing future practitioners to work with clients from all walks of life, with various ailments, and a vast array of problems. Inasmuch, educators need to nurture students' willingness to work with problem drinkers, make them aware of their personal bias regarding alcohol abuse, and teach them how to identify and treat problem drinkers.