"Two steps forward, one step back" is an inescapable reality for substance-abuse social workers, in-demand counseling professionals who assist alcoholics and drug abusers on the road to recovery. These social workers recognize that chemical dependency is a chronic condition with a high rate of relapse, for which there is rarely a quick fix.

"I've worked with people who have been in detox 20 times," says Diana DiNitto, PhD, ACSW, a social work professor at the University of Texas at Austin. "Why do they stay sober the 20th time? I don't know. There are so many things we don't know about this disease."

While the stigma associated with chemical dependency has decreased in recent decades, some substance abusers still find themselves shunned. "The biggest reward in this job comes from reaching out to help people who others are not interested in working with," DiNitto adds.

DiNitto worked in the drug and alcohol programs at a community mental health center before becoming an educator. Substance-abuse social workers also work at inpatient and outpatient drug-treatment centers, detoxification centers, halfway houses, methadone clinics and in private practice.

These social workers are finding more opportunities in the criminal-justice system as well, because more abusers are being sent to treatment programs rather than prison, says Mickey J.W. Smith, MSW, ACSW, a public health advisor for the Drug-Free Communities Support Program at the government's Substance Abuse and Mental Health Services Administration.

Crises and Breakthroughs

A substance-abuse social worker's responsibilities vary by setting, but most perform client intakes and assessments, develop treatment plans, and counsel patients in individual or group sessions. They also help families cope with the effects of addiction and refer patients to other social service organizations. Often, substance-abuse social workers, who earn about $33,000 a year, serve on multidisciplinary teams that can include physicians, nurses, addiction specialists and other human-services workers. "It's more than a 9-to-5 day," DiNitto says. "There is a lot of routine stuff, but crises occur, too. A client could get arrested or end up in the emergency room."

Mandated clients make up most of a substance-abuse social worker's caseload. These patients are ordered into treatment by the child-welfare system, the courts or some other entity, says Peter Robbins, LCSW.

Robbins has worked in outpatient and inpatient treatment programs, as well as with the criminal-justice system, and describes his breakthroughs with resistant clients as "lightbulb moments." One such client was a laid-off alcoholic referred by his former company's Employee Assistance Program. Through counseling, the man came to realize how his drinking had affected his relationships with his wife, children and coworkers. "He was able to turn his life completely around," Robbins says.

Seeing a Person's Potential

Robbins entered the field when he took an internship at an addictions clinic while still earning his bachelor's degree in social work. This route into the field is typical, DiNitto says. Most substance-abuse social workers have either a bachelor's or master's degree in social work, and many have taken courses on and completed an internship in substance abuse. Some graduate-level social work programs offer concentrations, specializations or certifications in substance abuse. Credentials and requirements for working in substance abuse differ by state. For members who hold a master's degree and meet other requirements, the National Association of Social Workers (NASW) offers the voluntary Certified Clinical Alcohol, Tobacco, and Other Drugs Social Worker (C-CATODSW) credential.

DiNitto urges those interested in the profession to take classes on the dynamics of chemical dependency, as well as to volunteer, learn about self-help and attend open meetings of Alcoholics Anonymous or Narcotics Anonymous. "It can be a very powerful experience, even as a nonrecovering person," she says. "You shouldn't refer people to those groups without having an idea what they're like."

Professional opportunities in the field abound for creative, caring social workers interested in finding new ways to attract individuals to substance-abuse treatment and in designing treatments to which clients respond, DiNitto says. "This is a job with tremendous opportunities for improving people's quality of life," she says. "We're wasting a lot of human potential out there."

Learn more at the NASW's Alcohol, Tobacco, and Other Drugs Specialty Practice section.