Archive for June, 2008

Listening to Clients is the First Step in Mitigating Health Disparities


June 23rd, 2008

By Maurice Fisher, PhD, NASW Chair of ATOD Specialty Practice Section

June 23, 2008

Substance use disorders, in their many forms, have always been a more confounding social problem for people in minority groups than for others. Substance use/abuse treatment is complicated, owing to the many psychosocial, financial, health, mental health, and environmental challenges that clients face.

Several years ago, I was the clinical director of a large inner city residential substance abuse program where 98 percent of clients were racial and/or ethnic minorities. Seven out of ten of these patients happened to be men. There, I learned the complexities of substance abuse intervention through my lived work experience. No matter what I thought I had learned and what I thought I knew, my experience was taught by the clients themselves—through their stories and their experiences.

My minority clients taught me that there is an enormous difference between being “culturally aware” (i.e., recognizing that someone is different from you) and being “culturally sensitive” (i.e., actually using this awareness to intervene effectively). Moreover, I quite quickly learned that though minority clients may well be evaluated and diagnosed as having a substance use disorder, either abuse (e.g., a judgment and/or decision-making problem) or dependency (e.g., a physiological or psychological addiction), the vast majority were de facto self-medicating for extremely painful emotional and situational issues.

In 2006, the Central Registry of Drug Abuse noted that roughly 8 out of 10 people in minority groups diagnosed with a substance use disorder were men. This statistic speaks volumes about the needs for cultural competency and gender-specific interventions in social work practice with our clients. Let us begin the therapeutic process by first listening to what they are saying.

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Social Work Interventions Help Soldiers Survive Trauma


June 12th, 2008

By Lynn Hagan, LCSW

June 20, 2008

As a clinical social worker in Kuwait during the initial phases of the Iraq war, I had the opportunity to counsel soldiers, diplomats, and contractors coming from the front lines. They had experienced trauma on a grand scale, witnessing and sometimes experiencing kidnappings, mutilation, incendiary explosive devices (IEDs), torture, and rape.

Their spouses and children in the Middle East, who had also seen the events of 9-11 on television, were harassed at school and work. More and more, we are seeing the effects of these repeated exposures to traumatic experiences, which can be devastating to families.

In Kuwait, the US Embassy contacted me regarding a high ranking official, who we’ll call “Don” for purposes of confidentiality. Don was referred by his primary care physician due to physical complaints that seemed to be medically unfounded.

At his first psychotherapy session, three weeks after the 9-11 terrorist attacks, he disclosed that he had seen the catastrophe on television and was gathering intelligence about the incidents. Many years before, he had witnessed acts of murder, torture, terrorism, and genocide. In the Bangladeshi army, he worked for subversive organizations that gave assistance to people who were oppressed by radical factions.

Don’s primary physical complaint was foot pain that worsened after 9-11. He was also troubled by feelings of helplessness, despair, panic attacks, the inability to experience pleasure, social isolation, and poor concentration. He said that he was fixated on news coverage of the attacks and could not take his eyes off the television. He declared, “Since September 11th, I have no safe haven.” He said that he wanted to retaliate with a terrorist act of his own for the 9-11 attacks.

Don was diagnosed with post traumatic stress disorder (PTSD), acute anxiety disorder, and major depression. His threat of retaliation was taken seriously, although he said that he did not believe he was powerful enough to carry out this plan. After a consultation with the primary care physician and the psychiatrist, it was recommended that Don return to the U.S. for psychiatric treatment.

The point of this story is that trauma experienced in the past, coupled with recent traumatic events, can lead to what is known as secondary trauma. Don experienced trauma upon trauma without getting the mental health treatment that he desperately needed. It was fortunate for Don, and the other people in his life, that his primary care physician recognized the signs of secondary trauma in his symptoms of pain (which are not normally associated with trauma) and referred him for mental health services.

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