A new role for social workers in drug and alcohol treatment

Published by Professional Social Work magazine, 9 August, 2023

There has long been an emphasis within political discourse on the relationship between substance use and crime.

The government’s 2021 ‘ten-year drugs plan to cut crime and save lives’ plan strengthened this association, and was criticised for contextualising alcohol and drug use as criminal activity without addressing the economic and social drivers of alcohol and drug use.

The plan, From Harm to Hope, states that social workers in England must play a part in “combating drugs” in local areas. The government announced an increase in spending, particularly to fund treatment services through the criminal justice system, such as project Adder, which diverts people coming into contact with the criminal justice system into treatment.

This additional funding came after years of funding cuts to the social work workforce, signaling to some experts that this could be the start of a new understanding of drug and alcohol treatment that puts social work at the core.

How drugs and alcohol are framed by policy has historically determined how workforces, including social work, are designed, and how issues are responded to, says Wulf Livingston, professor of alcohol studies at Glyndwr University.  

But while drugs and alcohol have been widely understood as a criminal – and medical – problem for many years, he adds, they’re increasing being understood through a social justice lens. The probation service, for example, states that recovery is best supported through social relationships.

“When you think about what might enable people to change or sustain change, medical treatment is immensely valuable, but it isn’t the bit that helps develop long-term change,” Livingston says.

“Social work brings a different lens through which to view an experience and helps develop an understanding for people, and it brings a different set of skills, solutions and interventions that might help an individual sustain drug and alcohol change.

“People need secure housing, to reconnect with family and rebuild their lives. This is much more akin to the skills of social work professionals than medical professionals,” he says.  

But there is also an increasing focus on whole-society approaches to drug and alcohol treatment from the government, argues Harry Sumnall, professor of substance use at Liverpool John Moores University.

From Harm to Hope stipulates that each local authority must develop Combating Drugs Partnerships, for example. These are local, multi-agency, muti-disciplinary groups with representatives from health, social work and police that identify, develop and respond to drug activity locally.  

Several of the initiatives introduced by From Harm to Hope could increase demand for social workers within drug and alcohol services, believes Sumnall, including ‘problem-solving courts’, which are currently being trialed in Liverpool, Teesside and Birmingham.

Offenders with substance use issues will see a judge at least once a month, and have access to wraparound support for housing, family issues and education – which is where social workers could play a key role.

“There is currently a whole suite of responses to possession offences, depending on the drugs and circumstances, and the police are delivering so-called diversionary responses, trying to divert people away from the criminal justice system to other forms of support,” says Sumnall.

The government is proposing that diversionary responses include offering the offender education and support and monitoring.

“Social workers could be involved in this, too, particularly around supervision and advice,” Sumnal adds.

But while Dame Carol Black’s Independent Review of drugs in 2021 highlighted the already stretched social work workforce, and called for more social workers in drug and alcohol services – some experts criticised the government’s subsequent ten-year plan for lacking detail on how workforce numbers will be increased.

There are currently 167 social workers working directly within drug treatment services in England, according to the national workforce census conducted in February 2023. In addition to this, many more social workers frequently support people with drug and alcohol issues in their daily working lives.

“It’s difficult to define the role of social workers in the context of alcohol and drugs because there are numerous types of social workers,” says Livingston.

This includes, he says, social workers dealing with alcohol and drugs in their everyday work, social workers with specialist drug and alcohol roles, and those working within drug and alcohol agencies who have social work qualifications but aren’t registered social workers.

Many experts argue that there needs to be more clarity around the roles of social workers within drug and alcohol services. A 2015 paper by researchers at Manchester Metropolitan University stated that the workforce has “struggled to respond adequately to substance use within its service user groups and many social workers are not clear what they should be doing in relation to substance use”.

In response to this confusion, there is a growing resolve among social workers to define this role. Ellie Reed, head of social work at the charity Change Grow Live, has been working to collate a social work working group to help social workers understand their role in the design and delivery of drug and alcohol services.

She argues that, as well as a clearer defined role, working within drugs and alcohol requires individual social workers being able to prioritise strong working relationships.

“While service providers are working hard to innovate, they’re still being measured by the number of people in drug treatment, and often, funding is measured and reliant upon this data.

“This background is contributing to the workforce feeling tired, over-assessed and struggling with a lack of autonomy,” Reed says.

“There’s been such a strong and dominant paradigm of money, competition and metrics for so long that people are feeling stuck, and it’s hard to do something differently when people often don’t have the time to reflect.  

“Social workers are well placed to challenge some of these deep-rooted hierarchies and powers of inequality that exist. We can co-create new conditions for relationship-based practice, but it requires a mind-shift.”

This mind-shift calls for every social worker to listen, actively collaborate and self-reflect on their own values of social work and their relationships within that, Reed says.
As the workforce makes efforts to more clearly define its role in drug and alcohol recovery, and the rollout of new services shows a rising need for social workers in this field, Livingston emphasises the importance for qualified social workers to maintain their connection with the profession by continuing to be registered.

“Someone who is a drugs and alcohol worker with a social work qualification might not be registered because their employer doesn’t require them to do so. But the most important starting place is for everyone to be supported by employers to retain their social work identity.

“Otherwise, this is a denial of identity, and if you don’t have social work identity, it cuts off the link between social work and drug and alcohol use,” he says.

What does social work in drugs and alcohol treatment look like across the UK?

Scotland

Scotland has its own drugs mission plan and drugs policy. But there are numerous challenges that overlap with England’s workforce. Austerity in Scotland has also added stress to social workers’ working lives, and there is also a lack of training around supporting those with drug and alcohol issues, according to a 2018 report by Peter Hillen, lecturer at Edinburgh Napier University's School of Health and Social Care.

Wales

The Welsh Government priorities a health approach to drug and alcohol treatment. Its substance misuse delivery plan (2019 to 2022) only mentions drugs and alcohol in the context of child protection.

Northern Ireland

Northern Ireland published a 10-year plan in 2021, which involves both prevention and enforcement. The country’s social work review, published in 2022, states that problem-solving courts will be rolled out over the subsequent five to 10 years, and will require an additional 75 social workers.