Amid the overdose epidemic, universities and especially schools of social work education have inadvertently been tasked with the responsibility of educating the next generation of substance use and behavioral healthcare providers. With an estimated 9.2 million people misusing opioids in 2022, the need for evidence-based and stigma-free addiction counseling education is paramount.
One innovative way that schools of social work are uniquely positioned to combat the overdose epidemic is providing education that is in line with modern medicine and legal precedents to the next wave of substance use professionals. I have seen firsthand the use of stigmatizing language and policies in course content and university practices. The use of carceral social work policies and practices — or coercive and punitive practices that rely on logics of social control to manage marginalized communities in schools or in health and mental health treatment — are at odds with the social work core value of social justice. Schools of social work education have an ethical responsibility in educating their students. The next generation of behavioral healthcare providers must be equipped with up-to-date knowledge and information pertaining to the treatment of people with substance use disorder, and failing to provide such education is antithetical to the accrediting body on social work education.
Schools of social work can take several actions to address the need for graduate education that is reflective of modern medicine and standards of care with respect to substance use disorder treatment. These include a program wide curriculum review, a transparent internal review of policies and procedures, and working collaboratively with their local recovery community and advocacy organizations. In leading by example, schools of social work can help set the bar for institutional policy reform in higher education and addiction counseling education.
Curriculum Review and Modernizing Language
In preparation for this undertaking, schools of social work should first perform a program-wide curriculum review, to ensure that any material used in the classroom is using up-to-date language and information. The National Institute on Drug Abuse provides a clinical resource entitled Words Matter – Terms to Use and Avoid When Talking About Addiction. Using stigmatizing language and non-evidence-based perspectives can perpetuate harmful myths about substance use treatment and could potentially have a direct effect on the health outcomes of future clients. Using person-first language and avoiding terms that have negative connotations is one way in which schools of social work education can work to actively change the way that substance use is treated in the United States.
Internal Policy Review: Aligning with Standards of Care, Ensuring Non-Discrimination, and Congruent Mission and Vision Statements
The effects of stigma and discrimination against people who use drugs and people with a substance use disorder are well-documented. Discrimination and stigma impact access to, and quality of care; can promote unsafe drug use; and dehumanize the person experiencing a chronic and treatable medical condition. Schools of social work can promote person-first language and evidence-based care in their curriculum and policies — leading the way for other agencies to do the same.
Schools of social work can also proactively review their own internal policies to identify and address discriminatory policies. Examples of problematic policies include:
- Policies that require degree or certificate applicants to disclose their recovery status: For example, requiring an applicant to answer the following question: “are you currently in recovery from a substance-based or behavioral addiction, and how long have you been completely abstinent from the substance or behavior?”. Policies that require people to disclose their recovery status may increase stigma against addiction professionals in recovery from opioids and other substances. Policies that require mandatory disclosure disincentivize self-disclosure of recovery, as the reason for disclosure is potentially punitive — thereby increasing shame and stigma. They also perpetuate the false belief that people in recovery must be completely abstinent in order to be competent behavioral healthcare providers.
- Policies that reflect an “abstinence-only” approach, or an approach that is not reflective of the latest science and evidence: Examples include a requirement that “applicants in recovery from addictions must be abstinent from all substances, including maintenance medications” and questions such as “how long have you been completely abstinent from all substances?”. Perceptions that abstinence-based pathways are the only means of recovery are outdated, as they essentially gatekeep recovery, and prevent access to life-saving treatment for people who use drugs. There is a significant body of research that shows the efficacy of medication-based models, including methadone and buprenorphine being designated as essential medicines by the World Health Organization.
- Punitive policies, up to and including dismissal from the program, if a student experiences a recurrence of use or “tests positive for the use of maintenance medications”: Retaliation for using evidence-based treatment reinforces old treatment myths that complete abstinence is the only road to recovery and that the use of medication for opioid use disorder (MOUD) is not a viable pathway of recovery. Punitive policies reinforce the false stereotype that people who use drugs are a danger to society. This especially impacts already marginalized groups, and can reinforce disparities in access to treatment.
These types of policies are not only contrary to evidence-based treatment and best practices, but they are also illegal. Some of the policies listed above, besides adding barriers to substance use treatment, violate the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973. Specifically, it is disability discrimination to prohibit people who are legally prescribed MOUD and are no longer using illegal drugs from entrance, engagement, or dismissal from a school of higher education. These institutional policies are also in direct conflict with the Council on Social Work Education’s (CSWE) Mission and Vision and the National Association of Social Workers’ (NASW) Code of Ethics, and likely the mission and vision of the school itself. Imagine if a school asked prospective students if they were taking antidepressants or anti-anxiety medications, on the grounds that their use of effective, evidence-based treatment would predispose them to not be an efficient social worker when working with the mental health population. The idea that people in early recovery from substance use may be more personally affected by social work education coursework and field placement experience is largely unfounded and policies upholding this idea fulminate against scientific literature’s finding and recommendations regarding MOUD and recovery. There is no research or literature that supports the claim that social work clinicians taking MOUD are less effective behavioral healthcare providers when compared to those who do not.
Schools of social work should perform an internal policy review to ensure that institutional policies are congruent with the CSWE Mission and Vision and the NASW Code of Ethics. Many schools of social work include aspects of social justice and reducing stigma and discrimination in their own mission and vision statements. Schools of social work should ensure that internal policies are reflective of both the school’s mission and vision, as well as those of the governing bodies on social work and social work education.
Actualization: A New Vision for Social Work Education
In all these proposed activities, schools of social work should consult with people in recovery, harm reduction agencies, and recovery community organizations. Using this as an opportunity to promote the voices of people who use drugs and people in recovery, schools of social work can set a precedent for substance use education policy by creating a seat at the table of institutional policy reform for them. In doing so, schools can work to actively protect marginalized students who identify as being in recovery from substance use, improve their relationship with the recovery community, and effectively rebuild institutional policy and social work education around MOUD and recovery. To combat stigma and honor the missions, values, and code of ethics of social work governing agencies and institutions of social work education, evidence-based addiction education and non-discriminatory policies must become a top priority for every higher education institution.