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The substance abuse field has identified a range of evidence-based substance abuse treatment approaches. Evidence-based approaches are those that have been shown, through carefully controlled and replicated research, to be efficacious or effective. These approaches have been articulated in National Institute on Drug Abuse (NIDA, 2000b) publications and on the NIDA Web site. Research literature, newsletters, and editorials aimed at providers of substance abuse treatment services have also articulated evidence-based approaches. Organizations serving large populations of substance-abusing clients need to be aware of evidence-based practices and use them when developing client service plans. One of the largest social services systems working with substance-abusing clients is the child welfare system. Child welfare agencies have become knowledgeable about substance abuse treatment, but relatively little is known about the extent to which child welfare practice remains current with advances in substance abuse practice. This study examines the extent to which methadone maintenance (MM) is discussed in the child welfare literature and broader social work literature, and the extent to which child welfare policies mention and recommend this treatment method. Why focus on MM as an evidence-based drug treatment practice? Briefly, we know that heroin-dependent women who are parents are likely to provide inadequate care to their children and may expose their family to drug-related violence (Schilling, Mares, & El-Bassel, 2003). The American Public Health Association (1997), NIDA (2000a, 2000b), the World Health Organization (WHO) (2001), Stimson, Des Jarlais, and Ball (1998), the Center for Substance Abuse Treatment (CSAT) (1999), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (1999) identify MM as an effective treatment for heroin dependence. Many studies have shown that opiate-dependent individuals on MM are likely to exhibit reductions in HIV risk behavior and crime and violence and improvements in child rearing and employment (Kott, Habel, & Nottingham, 2001; see Sorensen & Copeland, 2000, for a review). Child welfare is arguably the practice arena most widely recognized as the domain of social workers. Social workers recognize the importance of their state-sanctioned roles in protecting children (Barth & Jonson-Reid, 2000). In this capacity, social workers are required to investigate the well-being of children who are thought to be in danger, make judgments about levels of risk, and recommend courses of action. Social workers who find evidence of abuse or neglect usually recommend some corrective action by parents. In most instances, family court judges accept all or some of these recommendations and stipulate that court sanctions, including removal of the child from the home, remain in effect until the parents at least partially complete a recommended course of action. Wielding considerable power in such matters, social workers make the initial judgment that a child is in danger. Social workers then make recommendations to the court based on their determination, through their own investigation and through assessments of mental health consultants, of the family deficits contributing to child maltreatment. Critical is the social worker's knowledge of optimal and available resources, services, supports, and treatments. In recent decades, parental substance abuse has been shown to be a large contributing factor in child maltreatment (Bays, 1990; Olsen, Allen, & Azzi-Lessing, 1996; Wolack & Magura, 1996). A National Institute of Mental Health (NIMH)-funded study found that substance abusers had three times the odds of committing physical abuse and neglect after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). Another study found that more than three-quarters of state child protection administrators across the country reported substance abuse as one of the top two problems presented by their caseloads (Wiese & Daro, 1995). …

This article depicts the changing demographic portrait of social work education in the United States from 1974 through 2000 and considers the demographic shifts in the profession of social work. During this period, BSW and joint MSW-BSW programs increased from 150 to 404, MSW programs increased from 79 to 139, and social work doctoral programs increased from 29 to 67. BSW graduates increased by 24 percent to almost 12,000, MSW graduates grew by almost 90 percent to over 15,000, and doctoral graduates increased by 44 percent to only 229. From 1974 to 2000, people of color represented increasing proportions of social work graduates to almost 30 percent of BSW graduates, 26 percent of MSW graduates, and 19 percent of social work PhD graduates. By 2000, the proportion of women earning social work degrees had grown to 88 percent at the BSW, 85 percent at the MSW, and 73 percent at the PhD levels, and women accounted for almost two-thirds of social work faculty. The most dynamic trends within the composition of the profession are the substantial increases in the proportion of women faculty, and among MSW graduates, a decrease in the proportion of men from 43 percent in 1960 to 15 percent in 2000. Findings suggest that issues of racial, ethnic, and gender representation in particular merit discussion within the profession.

Despite a slowing of the rates of human immunodeficiency virus (HIV) infection among intravenous drug users, this group remains at high risk for contracting acquired immune deficiency syndrome (AIDS). Promising reports of safer drug use patterns among addicts notwithstanding (Coleman, Lodico, Evans, & DiClemente, 1992; Sorensen, Batki, Coates, & Gibson, 1988; Watters et al., 1988), untreated drug users continue to share needles (Neaigus et al., 1992; Ortiz et al., 1992; Robles, Matos, Cancel, & Colon, 1992). Moreover, there is as yet little evidence of sustained safer sexual practices among drug users and their partners (Abdul-Quader et al., 1992; El-Bassel et al., 1992). In an ongoing series of studies, the authors are testing a small-group skills-training approach to reducing HIV-risk behavior among methadone patients. Earlier reports of these investigations have described the study methodology and preliminary outcomes (El-Bassel & Schilling, 1992; Schilling, El-Bassel, Schinke, Gordon, & Nichols, 1991). This article describes the conceptual components and strategies of a skills-building intervention model consisting of 13 weekly sessions followed by six monthly booster sessions. Social workers, many trained in group work and cognitive-behavioral approaches, would be positioned to initiate, and possibly carry out, such groups in chemical dependency treatment settings. Methadone Maintenance Methadone maintenance has been shown to be an effective approach to treating large numbers of heroin addicts, thereby reducing the risk of HIV infection associated with the sharing of intravenous drug paraphernalia (Ball & Ross, 1991; Murphy & Rosenbaum, 1988; Sorensen et al., 1988). Paradoxically, studies in the past several years have at once revealed both the protective effects and critical shortcomings of methadone maintenance treatment programs (MMTPs). Opiate relapse, alcohol and cocaine use, program attrition, and sexual risk-taking all present serious challenges to such programs (Obuchowsky & Zweben, 1987; Roszell, Calsyn, & Chaney, 1986; Schilling, El-Bassel, Gilbert, & Schinke, 1991). These challenges underscore the need for enhancing the nonpharmacological services of methadone clinics (Rounsaville & Kleber, 1985; Sorensen, 1991; Weddington, 1991). Most methadone patients receive medication several times per week. Their attendance is usually predictable. Counseling services would seem to be a natural extension of MMTP programs, and indeed federal regulations require programs to provide supportive services along with medication. Unfortunately, MMTPs have always had limited counseling components, and resources for supportive programs, including social work services, have eroded in recent years (Ball & Corty, 1988; Hubbard et al., 1989). Even if AIDS were not a consideration, MMTPs might benefit from sociobehavioral interventions that help clients to anticipate relapse, avoid high-risk situations, and recover from temporary lapses (Stark, 1989; Weddington, 1991). The AIDS crisis brings the need for MMTP program enhancements to the foreground. In response to this need, we developed and tested a set of theoretically and empirically derived intervention strategies designed to reduce drug use and high-risk sexual behavior among MMTP patients. Theoretical and Empirical Foundations of Training The underpinnings of the intervention are drawn from social learning theory (Bandura, 1977), health behavior models (Bandura, 1977; Cronkite & Moos, 1984; Wesson, Havassy, & Smith, 1986), theories of expectancy (Christiansen & Goldman, 1983; Marlatt & Roshenow, 1980) and self-efficacy (Baer, Holt, & Lichtenstein, 1986; Bandura, 1977; Donovan & Chaney, 1985; Heather, Rollnick, & Winton, 1983), relapse prevention (Marlatt & Gordon, 1985; Nurco, Stephenson, & Hanlon, 1991; Wesson et al., 1986), problem solving (Larson & Heppner, 1989; Nezu & D'Zurilla, 1981; Platt, Taube, Metzger, & Duome, 1988), skills training (Hawkins, Catalano, Gilmore, & Wells, 1989; Zackon, McAuliffe, & Ch'ien, 1985), self-regulation (Rehm & Rokke, 1988), social support (Fraser & Hawkins, 1984; Wesson et al. …

The black population is disproportionately affected by acquired immune deficiency syndrome (AIDS). Among those black people most at risk of becoming infected with the human immunodeficiency virus are black men who use intravenous drugs and black men who are gay. This article explores the complex cultural, economic, and social factors obstructing the reduction of the AIDS rate among these men. Implications and recommendations are made for developing effective AIDS prevention efforts by highlighting race-specific resources and supports for high-risk black men.

Untreated substance users remain beyond the reach of most acquired immune deficiency syndrome (AIDS) prevention efforts. In an effort to describe the risk behavior and attitudes of this population, the authors conducted interviews with 148 drug users in an urban soup kitchen. The study focused on subjects' risk-taking and risk-reduction behavior related to injection drug use, perceived changes in risk behavior, perceived risk for contracting AIDS, and socioeconomic and attitudinal correlates of injecting and sharing needles. Study findings underscore the need for community-based AIDS prevention strategies to intervene with high-risk populations beyond the reach of drug treatment and AIDS prevention programs.

THE RELATIONSHIPS between so cial workers and physicians have always been ambivalent, although social workers have sought to improve their pro fessional status by emulating physicians.1 They still criticize the medical model and object to the status and authority of physi cians, and, according to Kane, use large amounts of energy to assert the legitimacy and importance of their role in health care.2 Physicians have long espoused the importance of social factors in the preven tion and treatment of disease, but for the most part, they have not welcomed social workers as major allies. Changes within social work and medicine, however, may point toward an increasing collaboration between the professions. Citing recent developments in health care, the present authors argue that social workers and phy sicians have much to gain by emphasiz ing their mutual concerns and comple mentary roles.