Publish date: Dec 2014
'The Social Worker's Contribution in the Care of Alcoholics' was written in 1963 by W.A. Fransen, Director of an Out-Patient Clinic in Eindhoven, Holland. It was based on a lecture he gave on the 'prevention and treatment of alcoholism' with a particular focus on social workers' practice in an out-patient clinic.
What is refreshing and noticeable is the clarity with which Fransen describes the contribution of social workers to the out-patient clinic (OPC). In the UK in the 21st Century,social work is under threat and is having to defend its unique identity in many areas of specialist practice. Social workers, Fransen states, have two main roles; they are a "bridge" between the medics and the person's community, home and family life, and they are also part of the diagnostic and therapeutic team. He clearly values the social work role and its importance in reaching the parts that the medical experts do not reach. He describes how the social worker's role starts pre OPC attendance in demystifying the OPC, particularly given itshistorical image of temperance and punishment. He also highlights the social worker’s motivational approach to help-giving as well as their role in advocacy and after care. Fransen presents the role as incorporating "environmental clearance" and of removing or alleviating "external situative difficulties". In modern day language this equates to working with the person in their environment to consider who and what is supportive to the 'patient' and who and what is not. It also means ensuring the person's basic needs, for example, benefits, clothing, housing and food are met. The recognition of the role of the social and physical environment in helping or hindering behaviour change is as valid today as it was 50 years ago.
The author describes the role of the social worker, rather than any other professional, as including "ego enforcing/supporting" which involves "very simple, very human things - encouragement, faith, enthusiasm and belief in the client's possibilities and the adventure of giving help." In current discourse this would fit nicely within a motivational interviewing approach. As with MI, he emphasises the importance or “art” of developing skills, particularlyfor working with “people whose behaviour is unstable by nature or who are subject to severe environmental pressure" (p75).
There are many, still relevant, gems in this article once the reader moves beyond the gendered language and dated tone of the prose. It conveys a sense that social work sits in the shadow of medical experts, but it highlights many of the issues that continue to be raised today. These include the importance of training and education for skilled intervention, support for family members in their own right, the intake process as an intervention in itself, the importance of social advocacy in terms of challenging prejudicial attitudes towards the ‘patient’ resulting from “his” substance use and supporting long-term recovery.
For social work, however, the role of the specialist social worker in the intervention and support of people with alcohol problems remains an integral, but threatened, one and the quest to educate and inform all social workers about substance use is an ongoing and current challenge.
Sarah Galvani, PhD, DipSW
Prof of Adult Social Care
Manchester Metropolitan University
Wulf Livingston, PhD, DipSW
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.