Drugs have been known and consumed since ancient times. However, drug abuse has reached catastrophic proportions today, disturbing the entire world community. Substance dependence entails multiple detrimental consequences for society, such as the prevalence of drug use disorders, deviance, rampant criminality, family fragmentation, social orphanhood, marginalization, homelessness, high mortality rates in drug users, and social maladjustment of drug-dependent individuals. In connection with deleterious social, legal, moral, economic, and health-related effects of drug addiction, it is necessary to design and consistently implement practices of social work for the prevention of this phenomenon, as well as re-socialization of drug users.
Today, a case management-driven approach to dealing with substance abusers is becoming one of the main practices of human services systems. Hence, it is important to determine the implications of this orientation in order to obtain sufficient knowledge ministrant to the further development of this practice. This paper will explore the history of case management related to redemptive work with substance abusers, its current status and evolvement in the USA, as well as regulatory guidelines and its future prospects. It will analyze pertaining peer-reviewed articles and scholarly publications obtained from reliable sources.
History of Case Management
Human services systems began applying case management from the early years of the 20th century. Tracing the history of case management in the USA, Dill states that this approach emerged due to service system fragmentation and society-induced needs for systematic, client-focused coordination of efforts. Public expenditures were the main funding source of case management initiatives. The Social Security Act adopted in 1974 provided case management programs with the earliest revenue sources. It increased subsidization, contributed to the development of case management initiatives and expansion of target demographics, including drug users. Thus, the implementation of this approach was predetermined by both social and economic conditions.
The practice of case management in dealing with treatment of substance abusers dates back to the 1970s when homeless, mentally ill, and elder people were provided with similar support in the United States of America. Case management was introduced as a tool for the coordination and rationalization of service delivery, service resources, and care costs. In the USA, the expansion of case management programs started in the early 1980s. In 1990, Canada officially started utilizing this practice in order to counsel drug addicts. In contrast, this practice emerged in Europe only in the early 2000s. To be more exact, the Netherlands, Belgium, and Germany were the pioneers of the European version of this practice as long as these countries were facing a fast increase in substance abuse, which was mainly related to the criminal outcomes. In such a way, case management dealing with drug addicts has become a commonplace practice, which is regarded as one of the most efficient methods of socially-based treatment of substance abusers.
Researchers focused on case management define diverse formats of this approach. Those include the rehabilitation model, the Assertive Community Treatment team model (ACT), the brokerage model, Transitional Case Management model (TCM), the Personal Strengths model, the evidence-based model, the intensive case management model (ICM), and some others. There has been a little agreement on the decision regarding an approach the practice should take finally. From the historical perspective, this diversity has evolved so that case managed care can effectively correspond to practice objectives, different programmatic variables, needs specific to target populations, types of services being delivered, forms of control, clienteles feedback, location of contacts, and extent of clients involvement. Despite the diversity of case management models, they are recognized as effective human services in comparison with other forms of intervention. Although positive outcomes contributed to wide implementation of this practice, universal methodology and guidelines have not been exhaustively corroborated yet.
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Current Status of Case Management in the Treatment of Drug Addicts
Today, case managed care of drug users is one of the key technologies of contemporary social work. It involves vulnerable populations aimed at solution of the whole complex of existing social problems. Case management focused on persons with substance use disorders (SUD) is a multidimensional process, which involves assistance in obtaining access to needed services and leads to satisfaction of health and social needs of target demographics. Case management is a methodical way of connecting specific drug abusers needs for help with available social infrastructure. This methodology assumes that socioeconomic conditions cannot make drug addicts return to a productive life. Therefore, the ultimate objective of case management oriented toward drug-dependent individuals is to ensure their social reintegration and fulfilling life.
Today, a case manager is at the intersection of clienteles needs and services provided by social and health care agencies. Case managers are responsible for helping drug addicts to cope with a variety of personal problems.Drug addiction is accompanied by a plethora of complications related to making a proper living. Those challenges include unemployment, pressure for money, unpaid debts, interpersonal conflicts, family problems, crime involvement, aggravated health status, and so forth. The more problems a client experiences, the more complicated social assistance is.
In the process of case managed social support implementation, a case manager reaches the goals of treatment through personal communication with a client or in the course of solving problems caused by the necessity for a clients interactions with social agencies. Clients are taught to make optimum use of available resources. Case managers are frequently perceived by their clientele as assistants and mentors who can find solutions to all arising problems. Tolerant attitudes to representatives of vulnerable groups and professional ability to sympathize with people and empathize with their problems are preconditions of positive outcomes. In collaboration with his client, a case manager systematically assesses shifts in his behavior, situational circumstances, and the degree of a clients needs for help, recording observations and correcting methods. It is essential to involve a client in the identification of long-term and short-term objectives. Psychology-related competence of contemporary case managers is stipulated by the necessity to reveal initial causes of clienteles abusive behavior so that an individual with drug dependency can develop abilities to solve problems.
The current status of the practice presupposes therapy-based methods of treatment. Actually, a therapy should be conducted dynamically and consistently. Even more, the progress of this treatment is observed not only by a therapist and a case manager but by the entire community. This aspect is included because of the necessity to make a substance abuser feel needed by society. As a consequence, case managers usually obtain an expanded spectrum of functions as long as they are intending both to support and challenge the clientele in overcoming their problems with substance abuse. It is becoming increasingly apparent that the practice is currently attempting to formulate certain methodology by choosing problem-solving approach. However, distinct sets of activities have not been developed yet.
Thus, the main distinguishing features of contemporary case managed care of individuals with drug-related problems are as follows:
Assessment of clientele needs and problems; the priority of needs and interests inherent in an individual with drug-related problems;
Identification of objectives and expected outcomes;
Forceful motivation of the target audience to modify their behavior and the formation of assistance request;
An integrated approach to a case assuming that all problems and needs of a client are considered on the basis of his current state and characteristics of social environments;
Coordination of various specialists activities; the involvement of representatives of different disciplines;
The development of a care plan;
Interventions and the adjustment of a care plan to emerging clientele needs;
Monitoring, evaluation, and verification of expected outcomes;
Case completion after the achievement of specified objectives aimed at meeting needs identified in the assessment phase.
The Evolvement of Case Management with Substance-Abusing Individuals in the USA
In the United States, the practice of case management for substance-abusing individuals started developing in the 1970s. The US national case managed care is performed in a wide spectrum of settings and specialties, including aging, behavioral health care, child welfare and other youth-and-family-oriented services, corrections, disabilities, education, employee assistance, health care, housing, and so forth. The implementation of case management is expanding in the US social welfare and health care systems.
Case management focused on substance use is a constituent of behavioral health care. According to Kelly and White, community-based case management interventions achieve gratifying results in addiction treatment. Lower rates of drug abuse and more positive outcomes related to the involvement in the criminal justice system, employment, and social interactions are observed in individuals who receive case managed care in comparison with those provided with standard treatment. The researchers clarify potential benefits of case management, specifically the strengths-based model, for veterans with substance use disorders (SUD). Many veterans are diagnosed with posttraumatic stress disorder (PTSD), which aggravates their mental and psychological status, contributing to asocial activities and substance use. Being involved in case management, veterans have better outcomes in their employment and drug treatment as compared to a randomized group of drug-dependent individuals.
Today, substance-abusing imprisoned individuals and parolees are often assigned to case managed care in the United States. The penitentiary system is an integral part of society since it reflects its status and problems. More precisely, approximately 82% of imprisoned drug addicts were consuming drugs at the moment of committing an offense. Unfortunately, only 1% of them voluntarily ask for help and treatment. Most of these addicts recover after the treatment and lead a normal life. Transitional Case Management (TCM) and strengths-based management models are the most widely implemented interventions. However, recent research on case management provides contradictory results of its effectiveness for drug-dependent inmates. According to research findings provided by Prendergast and other investigators, the strengths model of case management used for the treatment of substance-abusing parolees did not improve outcomes overall. Therefore, this approach requires some modifications.
The increasing complexity of services delivery to the target population of drug users has stipulated the application of an interdisciplinary team approach to case managed care. Multidisciplinary case management methods have been appraised in international practice and recognized as an efficient and cost-effective approach to social work with the most maladjusted clientele. Drug-dependent individuals are provided with social support by a group of professionals and experts in different disciplines, including outreach workers, psychologists, physicians, lawyers, counselors, and others. This model envisages attracting drug-abusing individuals, supporting their socialization, motivating them to change their behavior, and providing comprehensive treatment.
Regulatory Guidelines and Policies
Social work practice oriented towards drug users is regulated by the Diagnostic and Statistical Manual of Mental Disorders designed by American Psychiatric Association in 2012, the Patient Protection and Affordable Care Act, SAMSHA/CSAT Treatment Improvement Protocol, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Case managed care of substance-abusing clients is performed in conformity with the NASW Code of Ethics.
The US National Association of Social Workers (NASW) defines standards for case managers involved in social work. It encompasses standards of ethics, cultural competence, qualifications, knowledge relevant to interventions, and skills necessary to conduct ongoing assessment of clientele, make appropriate decisions, keep records, collaborate with other professionals, and so forth. Among official requirements for the treatment of substance abusers, it is necessary to highlight the obligation of social workers to possess a baccalaureate or masters degree in social work from a school or program accredited by the Council on Social Work Education. A person who seeks help and treatment should be given a necessary counseling and assistance. The functions of social work professionals dealing with drug addiction and the body of knowledge they need for effective interventions are defined by their job responsibilities. Those vary within different settings and institutions, depending on target demographics, the duration of interventions, economic conditions, and location of services delivery.
Future prospects for implementation of case management in addiction treatment depend on a wide range of possible changes in the US health care system, legislation, national and federal funding, programmatic standards of case management, orientation of human services, participation of nonprofit organizations, among other things. Such modifications can make both positive and negative impacts on a case management approach. Although it is difficult to predict changes on a nationwide scale, positive outcomes observed in drug-dependent individuals assigned to case managed care contribute to expanding utilization of this model.
In order to increase the degree of the target populations involvement in case management programs, social workers should improve and develop their communicative skills. Case management practices require social workers to be culturally competent and possess well developed social skills since they interact with individuals of different ages, social environments, education levels, racial groups, and cultures. Inappropriate communication strategies result in the emergence of false expectations concerning clients and case managers. They turn into unproductive social support, unresolved social and personal problems, emotional burnout, and preservation of dependence on drugs. Thus, an increase in social workers proficiency and communicative competence is one of future prospects of case management.
Taking into consideration adolescents involvement in drug consumption, it is essential to expand antidrug case managed services in educational settings. Teenagers that begin using drugs before age 15 are more likely to develop drug addiction afterwards. Adolescents peculiar physiological and psychological characteristics, underdeveloped system of values, unawareness of detrimental effects of drug consumption, complex relationships with peers and adults, and other conditions specific to puberty increase risks of the development of drug dependence in children. Collaborating with teaching staff, school psychologists, medical professionals, surrounding communities, and parents, case managers will be able to forestall drug use by adolescents.
Being broad-based, meaningful social advertising campaigns will inform the U.S. citizens about the scope of services provided by case managed antidrug programs. It is recommended to initiate social movements, public presentations, actions, and meetings, which will demonstrate opportunities of case management to the community. In addition, proactive promotion via social media platforms can increase the target audience of drug users and engage them in case managed care. According to Sapra and other researchers, sources of informational support serve as mechanisms by which drug users decide to utilize mental health services.
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Case management focused on drug-dependent individuals is a steadily developing practice of human services. Having examined the US historical context, current status and evolvement, and existing regulatory guidelines of this approach, future prospects for case managed care of drug addicts were identified, including requirements for appropriate case managers skills and competences, the target audience, and promotion initiatives. The focal point of future prospects is the expansion of antidrug case management practices in school environment due to increasing rates of drug addiction in adolescents.
Case management practices of social services delivery to drug-abusing individuals can be evaluated as an effective and flexible approach. The diversity of case management models allows social workers to select and consistently implement interventions corresponding to various needs of target demographics.