Defining Substance Abusers Using a Prism: What You See Is What You Get

Social workers work with a variety of vulnerable populations, including people who are poor; people with disabilities; victims of abuse, neglect, and discrimination; people with mental illness; and substance abusers. We attempt to empower these populations by helping them gain control over their circumstances and by assisting them in negotiating their environment. Our primary task is to develop appropriate interventions. This can be a challenge when dealing with a population that is easy to define. However, it can become especially daunting when attempting to provide services to populations that are hard to define, such as substance abusers. WHO ARE SUBSTANCE ABUSERS? Given how the media depicts substance abusers, people might think that substance abusers are primarily urban, African American or Latino, poor, or welfare-dependent people with criminal records who primarily use crack cocaine. If we provided services on the basis of these stereotypes, we would be inclined to focus only on delivering substance abuse services to disenfranchised indigent individuals, as opposed to other Americans. It is true that there is a problem of substance abuse among poor people. However, this is only part of the picture. Substance abuse is a significant problem for both low-income and upper-income populations. Lo and Stephens (2000) reported that more than half of the incoming prisoners jailed in Ohio in 1997 and 1998 were in need of treatment for at least one substance. Woolis (1998) reported that low-income women who are substance abusers frequently face discrimination because of gender, a history of addiction, criminal records, and a loss of child custody. A longitudinal study of impov erished youths reported that early, heavy alcohol or cocaine use was not directly related to persistent poverty, although it was indirectly related by limiting the chances of marriage and educational attainment (Isreal, 1998). On the other hand, it was found that the educational attainment of the youth's mother, the youth's educational expectations, and the youth's aptitude were positively related to his or her subsequent standard of living (Isreal). Smith, Haynes, and Phearson (2000), in a study of the willingness of low- and high-income rural residents to seek substance abuse treatment, found that for low-income residents, being married, receiving pressure from their employer about substance abuse, being a high school graduate, or having some college education was associated with seeking substance abuse treatment, whereas upper-income substance abusers were motivated to seek treatment because of pressure from friends. Finally, Frank, Marel, Schneider, and Lipton (1984) found higher rates of substance use am ong upper-income groups than low-income groups. Like these individual studies, national data on admissions to substance abuse treatment facilities indicate that the profile of substance abusers is diverse. Males made up the bulk of admissions in 1999 for alcohol abuse, heroin abuse, smoked-cocaine or other cocaine abuse, marijuana or hashish abuse, or methamphetamine/amphetamine abuse (Table 1). White people represented more than 70 percent of the admissions for alcohol abuse and methamphetamine/amphetamine abuse (74 percent and 79 percent, respectively). They also represented nearly one-half of the admissions for heroin abuse (48 percent) and non-smoked cocaine abuse (49 percent) and one-third of the admissions for smoked-cocaine abuse (33 percent). African Americans represented 58 percent of the admissions for smoked-cocaine abuse and 33 percent of the admissions for other cocaine abuse; they represented less than 30 percent of the admissions for alcohol abuse, heroin abuse, marijuana/hashish abuse, and methamphetamine/amphetamine abuse. Employed people made up 48 percent of the admissions for alcohol abuse, 37 percent of the admissions of marijuana/hashish abuse, and nearly one-quarter of the admissions for heroin abuse, smoked-cocaine abuse, and methamphet-amine/ amphetamine abuse. …