The State of Substance Use Education in Master of Social Work Programs: A Content Analysis of Course Listings and Faculty Profiles

Abstract

Background: Substance use is currently a pervasive problem among a large proportion of populations served by the social work profession. Several studies have indicated that social workers routinely provide services to clients with direct and indirect substance use needs, making knowledge of substance use interventions and public policies a necessity for social workers to operate effectively in the field. However, despite the regularity of interaction with substance using clients, previous research has suggested that a significant deficit of substance use education currently exists in Master of Social Work (MSW) programs. Methods: To determine the extent of substance use education currently offered by master's-level schools of social work, a content analysis of course listings and full-time faculty profiles was performed on all Council on Social Work Education–accredited programs in the United States (N = 263). The goals of the content analysis were (1) to identify the current prevalence and content of substance use education offered to entire cohorts of MSW students at the national and programmatic levels and (2) to examine the capacity of the full-time MSW faculty workforce to deliver substance use education to MSW students in individual programs. Results: The results of the analyses showed that a significant deficit of formal substance use education does exist in the field of social work education, and that a large proportion of programs lack the faculty personnel necessary to sufficiently offer substance use education to their students. Conclusions: The social work profession needs to make a concerted effort to improve substance use education if social work is to ethically and effectively remain at the forefront of mental health practice in the United States.

Keywords

Social work social work education substance abuse substance use

Introduction

Substance use and addiction are chronic social issues that have a substantial impact on social welfare topics in the United States. Contemporary data trends indicate that there are around 20.8 million Americans (9.4% of the US population) who currently meet the diagnostic criteria for a substance use disorder, and 3.3% of the adult population is estimated to have a co-occurring substance use disorder and mental health illness.¹^,² Recently, there has also been an acute increase in drug-related mortality rates due to a rise in the misuse and abuse of prescription opioids. This surge in fatalities is evidenced by data from 2014, which indicate that there were 28,647 opioid-related deaths in that year, a 200% increase from the year 2000, and the highest annual number of opioid-related deaths in US history.³ The dramatic increase in overdoses has since led to the declaration of a national public health crisis regarding opioid use by the federal government in October of 2017.

Due to the significant consequences associated with substance use, it is imperative that social workers, given their status as the primary professional workforce serving in the mental health field, be prepared to meet the challenges of this ongoing epidemic.⁴^,⁵ However, a large number of studies have indicated that Master of Social Work (MSW) programs are providing insufficient instruction on how to understand, assess, treat, and prevent substance use problems in the general population.²^,⁴^,⁶ –9 Consequently, many researchers, as well as the United States Surgeon General, have argued that schools of social work have left their graduates unprepared to meet this critical need.² To better understand the level of training social workers are receiving in MSW programs, this study sought to determine the current prevalence and content of substance use curriculum offered to entire cohorts of MSW students at the national and programmatic levels and to assess whether full-time MSW faculty staff have the capacity to deliver substance use education to MSW students within individual programs.

Background

Substance use practice in social work

The social work profession is currently the primary provider of mental health services in the United States, with social workers delivering an estimated 60% of all mental health services performed each year.⁵ The large proportion of social workers operating in the field of mental health is a significant factor that underscores the critical nature of social work's role in the prevention and treatment of substance use disorders in the United States. Because of the propensity of individuals with mental health needs to have co-occurring substance use problems, social workers providing clinical services can expect to routinely work with clients in need of substance use interventions.⁴^,⁵ This trend has been demonstrated in several investigations and is featured prominently in a 2006 study by Whitaker et al.,⁶ which found that social workers will likely encounter substance use disorders in nearly every clinical setting of which they are a part, as 87% of the nearly 5000 social workers they surveyed indicated that they had dealt with substance use issues in their practice in the last year. In another analysis conducted by Smith et al.,¹⁰ the researchers discovered that 71% of 1600 surveyed social workers reported taking “one or more actions in relation to a client with a substance use disorder in the past year” and that >25% of the clients seen by the social workers were diagnosed with either a primary or secondary substance use disorder.

Review of substance use education in social work

A substantial literary base exists regarding the prevalence of substance use education in MSW programs. A 2008 study of 211 recently graduated MSW students performed by Bina et al.⁷ found that 65% of the graduates they examined did not receive any formal substance abuse training through their field work or in their academic curriculum. Smith et al.¹⁰ found that 81% of their social worker survey respondents received some type of education or training in substance use disorders, but that only 38% of that training came from formal coursework. In a national content analysis of MSW programs performed by Wilkey et al.⁸, it was determined that only 10 of 210 reviewed programs (4.7%) had 1 or more required addiction courses in their standard clinical curriculum. Quinn's 2010 examination of 216 MSW programs had a similar finding, but his results showed that only 1.9% of the programs reviewed required mandatory substance use training.⁴ Finally, Russett and Williams⁹ performed a review on 58 MSW programs and discovered that only 1 program required at least 1 course specific to substance use, and only 64% of the programs offered a substance use elective.

Effectiveness of substance use education and student preparedness

Researchers and public health officials have leveled strong criticisms at the effectiveness of social work education's approach to substance use training. In the most recent review, which originates from the 2016 US Surgeon General's Report on Substance Abuse, MSW programs were specifically referenced as failing to adequately prepare their students to deal with substance use issues following graduation.² Wilkey et al.'s 2013 study concluded that the current MSW educational system has not met the addiction workforce development needs, and that there is no evidence that substance use training will improve in the future.⁸ In the most critical review of substance use education in MSW programs, Gregorio Quinn asserted that “the lack of training and dedicated coursework in the field of substance abuse by Masters of Social Work programs is so significant that the deficiency can only be described as institutional denial or minimization.”⁴(p. 10)

In addition to assessing the prevalence of substance use content delivered by the MSW educational field, several studies have also tested the effectiveness of substance use training in MSW programs by measuring the preparedness of MSW students to deal with substance use issues following graduation. In a report compiled by Goplerud et al.¹¹ regarding the changing landscape of substance use service providers, the authors described MSW students’ preparedness for dealing with substance use issues as “significantly lacking” based on the evidence they collected. In a survey of graduating students from 3 northeastern MSW programs, Senreich and Straussner¹² found that the students’ “Knowledge” and “Total Attitude” regarding substance use issues were only “modestly higher” than entering students and that graduating students had less desire to work with the substance use population post graduation. They also found that graduating students perceived themselves to have “moderately greater” knowledge about substance use upon completing their degree, even when they only scored a half of a point higher on knowledge examinations designed to test substance use aptitude.

Methods

In July of 2017, a substance use–focused social work education study was conducted for the purpose of determining 1.

The current prevalence and content of substance use education in Council on Social Work Education (CSWE)-accredited generalⁱ MSW curriculums.

Courses available to all students.

The capacity of the full-time faculty of CSWE-accredited MSW programs to deliver substance use education to students.

To achieve these objectives, a content analysis was performed on the program handbooks and Web portals of all CSWE-accredited or accreditation-pending MSW programs (N = 263) listed in the CSWE's 2017 directory of accredited programs.¹³ The first research initiative was selected to establish the number of substance use–specific courses offered by MSW programs, the amount of exposure to substance use–specific courses entire cohorts of MSW students are guaranteed to receive within individual MSW programs, and the type of substance use content being delivered in these courses. Due to the variability of interests and experience among MSW faculty members, exposure to substance use content as part of larger course formats can vary between cohorts of students within individual programs based on students’ academic schedules. Without taking a substance use–specific course, students have the potential to have little to no interaction with professors with knowledge of substance use material during their educational training due to professor availability, individual course selections, and limitations regarding the number of professors with substance use experience available in each program. Full class cohorts were chosen for examination because of the high level of contact a large proportion of practicing social workers have been shown to have with substance-using clients.

The second study objective selected was formulated to measure the capacity of programs to offer substance use–specific education within larger course formats and to assess their ability to implement new substance use classes and integrate new substance use content into their curriculums. According to the National Association of Social Workers (NASW), “Working with clients with substance use disorders is a distinct specialty and scope of practice within the social work profession. Social workers working with clients with substance use disorders shall possess specialized knowledge and understanding of psychological and emotional factors, physiological issues, diagnostic criteria, legal considerations, and co-occurrence of mental health disorders and substance use. This knowledge shall include an understanding of family dynamics, the effects that substance use disorders have on parenting abilities, and the resulting consequences for children. Social workers shall also be knowledgeable about current evidence-informed approaches and best practices for service provision to clients with substance use disorders. Social workers shall actively seek to remain current with specialized training, as appropriate.”¹⁴(p. 11)

The NASW definition of substance use practice describes the provision of substance use services as a highly specialized field. This description necessitates that the instructors providing substance use training to MSW students also meet the rigorous qualifying criteria identified by the NASW in order to deliver this type of educational material to students. To be consistent with the standards prescribed by the NASW definition, this study identified a specific reference to substance use research or practice experience in a MSW faculty member's academic profile as evidence of a faculty member having the training needed to deliver substance use content to students.

The content analysis performed in the study was conducted in 2 stages. Stage 1 addressed the first listed objective of determining the current prevalence and content of explicit substance use education in general MSW curriculums by examining the course listings and descriptions of individual curriculums provided in program handbooks and Web portals. Stage 2 addressed the second objective of assessing the capacity of the full-time faculty workforce of each MSW program to deliver substance use education to students by examining the faculty profiles of all full-time MSW faculty members listed in MSW program handbooks and Web portals.

Course listings and descriptions

Course catalogs were located within program resources for each of the 263 identified MSW programs. Each catalog was assessed for the date of last update and the completeness of the catalog (lists including both the core curriculum and electives). Qualifying catalogs were then utilized to identify explicit substance use course offerings as distinguished by course title and educational content. Individual course listings provided in the course catalogs were used to determine 1.

The number of mandatory, substance use–specificⁱⁱ courses listed in the foundational curriculumⁱⁱⁱ of each program.

Courses where substance use is the primary topic.

iii

Core/required courses for all MSW students.

The number of mandatory, substance use–specific courses listed in the advanced curriculum^iv of each program.

Courses required in the second year of coursework for all MSW students (programs with a division between clinical and macroconcentrations for second-year students were noted and included in the evaluation).

The number of elective, substance use–specific courses offered by each program.

The classification of substance use courses offered by each program (Prevention, Treatment, or Policy).

Substance use courses that were only required as part of a specialized program track, or not offered to students outside of the specialized track, were not counted as mandatory or included in the analysis. This distinction was made because the targeted questions of the content analysis were formulated with the intention of creating a data collection tool capable of compiling information regarding how substance use education is implemented for entire MSW student cohorts (or students with a general clinical focus) rather than a specific subsection of programs. In total, 237 of 263 MSW programs (90%) provided course descriptions for their programs and were assessed for substance use curriculum.

Faculty profiles

MSW program faculty directories were identified for each of the 263 MSW programs listed by the CSWE as accredited or in the accreditation process. The contents of each directory were assessed for the presence of faculty biographies or curriculum vitae links, and identified descriptions within the directories were screened for specific listings of the background or research/practice interests of each faculty member. If a faculty member's background, research, or practice interest was not identifiable in the information provided, the faculty member was excluded from the analysis. The operational objectives of the faculty analysis were to determine 1.

The number of full-time faculty members per school who explicitly referenced a substance use–focused academic interest or practice background in their academic profile per individual program.

The specific area of substance use focus for each faculty member identified.

The identified faculty member's professional status within the program.

Only programs with directories that provided a biographic profile for a minimum of 70% of the program's listed full-time faculty members were assessed in the faculty analysis. The 70% limit was instituted for missing profiles in order to increase the odds that the workforce capacity analysis performed on the individual programs would accurately reflect each program's status as it actually exists in practice. Programs with <70% of profiles listed created too high a degree of variability as to the actual workforce status of the program given the number of missing faculty profiles. Additionally, adjunct faculty members were excluded from the assessment due to the fluid nature of their employment, and because of an overall lack of reference to adjunct professors or their research interests in a large percentage of MSW program faculty directories. In total, 57% of program handbooks and Web portals provided sufficient information to perform faculty profile analyses.

Results

Course listings and descriptions

The data compiled for the course prevalence and content objectives were analyzed to show course curriculum and content totals at the national and programmatic levels (Table 1 and Figure 1).

Figure 1

Courses per program.

Table 1

Course analysis results.

Course item	No.	%
MSW programs assessed	263
MSW programs with course descriptions	237	90%
Total SUF courses	228
Average SÜF courses per program with SUF courses available	1.47
Maximum no. of SUF courses per program	7
Programs with at least 1 SUF course	155	65%
Programs with no SUF courses	82	35%
Programs with at least 1 mandatory SUF course	8	3%
Programs with no mandatory SUF courses	229	97%
Treatment SUF courses	151	66%
Prevention SUF courses	41	18%
Policy SUF courses	38	17%
Other SUF courses	21	9%
Unspecified SUF courses	55	24%

Note. SUF = substance use focused.

The analysis of MSW program course listings indicated that there is currently a shortage of substance use education in MSW programs. The results of the analysis showed that 34% of the programs evaluated did not offer a substance use–specific course, and only 3% mandated that their students take a substance use–specific course. For programs that did offer a substance use–focused course, 66% of the courses were identified as treatment focused, 18% prevention focused, 17% policy focused, 9% other, and 24% were listed as unspecified. These results indicate that the domains of prevention and policy are receiving considerably less attention in MSW programs than treatment, which is a significant issue considering the impact that substance use prevention and policy has on social work populations and practitioners. Finally, the finding that MSW programs only offer 1.47 substance use–specific courses per program (with substance use–focused course offerings), and just 17% offer 2 or more substance use–specific courses, raises significant concerns regarding the accessibility and availability of substance use–specific courses to MSW students with consideration to MSW cohort sizes per individual program.

Faculty profiles

The data compiled for the second objective, faculty workforce capacity, were analyzed to show faculty capacity totals at the programmatic level (Table 2 and Figure 2).

Figure 2

Faculty per program.

Table 2

Faculty analysis results.

Faculty item	No.	%
MSW programs assessed	263	100%
No. of programs with faculty profiles	149	57%
No. of programs with at least 1 SUF faculty member	109	73%
No. of programs without an SUF faculty member	40	27%
Faculty members analyzed	3456
No. of SUF faculty members identified*	276
Average SUF faculty per program analyzed	1.85
Average SUF faculty per program with identified SUF faculty	2.53
Range of SUF faculty per program	8
Faculty professional status
Assistant/associate professor	185	67%
Director/administrator	60	22%
Professor	21	8%
Unknown status	10	4%
Total	276	100%
Faculty substance use background or research interest
Treatment SUF	90	27%
Prevention SUF	50	15%
Policy SUF	36	11%
Unspecified SUF	153	47%
Professors’ substance use background or research interest
Treatment	7	27%
Prevention	2	8%
Policy	4	15%
Unspecified	13	50%
Directors’/administrators’ substance use background or research interest
Treatment	16	25%
Prevention	8	12%
Policy	3	5%
Unspecified	38	58%
Assistant/associate professors’ substance use background or research interest
Treatment	67	29%
Prevention	40	18%
Policy	29	13%
Unspecified	92	40%

Note. *SUF = substance use focused.

The results of the faculty analysis identified the existence of a workforce capacity deficit in MSW programs. The finding that 27% of the programs analyzed did not employ a full-time faculty member with a substance use practice background or research interest indicates that a large proportion of MSW programs lack the faculty personnel necessary to deliver substance use content to students at a sufficient level. From an implementational standpoint, this result suggests that a significant proportion of MSW programs are unable to implement new substance use–focused courses, and it is unlikely that they are able to adequately integrate substance use material into their current curriculum. Additionally, the analysis outcome regarding the number of full-time, substance use–focused faculty members employed in programs (30% of programs employed only 1 full-time faculty member with a substance use background, 15% employed 2 full-time faculty members, and 28% employed 3 or more faculty members) showed that, with consideration to course size limits, scheduling, and professor availability, the percentage of students who are able to interact and take courses with a professor with a substance use practice background or research interest is significantly restricted for students in the majority of MSW programs.

Discussion

The findings from the analysis of faculty profiles and course listings served to confirm what was reported in the literature regarding the low prevalence rate of substance use education in MSW programs. Master's-level social work institutions appear to be offering a minimal amount of substance use–specific courses to students, and there is virtually no mandatory substance use education required by programs across the entire academic landscape. The lack of faculty members identified within programs with an academic focus or professional experience with substance use also further contributes to the deficit of substance use education in social work, as it reduces students’ opportunities to interact with experts in the field and restricts programs’ abilities to introduce and integrate new substance use content into their curriculums. Given the scarcity of faculty, lack of devoted coursework, and lack of mandated content, it is likely that a sizeable proportion of MSW students are able to complete their MSW degree with very little exposure to substance use content, which is problematic for a number of reasons. First, the studies conducted by Whitaker et al., M. Smith et al., and C. Smith et al. firmly established that a large proportion of social workers are assessing for substance use issues and taking actions with substance using clients.⁶^,¹⁰^,¹⁵ Because of the minimal amount of substance use training in MSW programs that has been established both in this report and in previous studies, a case can be made that many of the social workers delivering these interventions could be found to be in violation of the NASW Code of Ethics due to their lack of “specialized training” in the area of substance use. If this concept of social worker qualifications is placed in a broader context, a case can also be made that social workers in general are not qualified to deal with substance-using clients due to the educational deficit identified, and this poses a significant risk of harm to the populations receiving these services from social work clinicians. This finding is a significant concern for a profession that currently provides the majority of mental health services in the United States and regularly deals with clients with substance use disorders. The ethical and quality-of-service issues surrounding the provision of substance use services by untrained social workers is a very real and pressing issue that needs to be addressed by social work if it is to remain at the forefront of the US mental health system in the future.

Limitations

The findings discussed in this report are subject to the limitations of the data collection methods utilized to generate the study's results, and the reliability of the content analysis is directly bound to the accuracy of the course listings and faculty descriptions available in the program handbooks and Web portals of MSW programs. The exclusion of adjunct faculty members from the analysis, as well as the lack of full course listings and descriptions for some MSW programs, also produces the potential for skewed findings regarding course availability and faculty capacity. However, the results of the content analysis reflect the results of several previously conducted studies, which provides it with a significant degree of measurement validity.

Conclusions

Given the established significance, scope, and prominence of substance use issues across a large proportion of social work areas of focus, a clear case can be made that to inadequately train MSW students to assess and intervene in substance use–related problems is to inadequately train them to operate in the vast majority of social work settings in which they will potentially be employed following graduation. To ensure that the social work profession continues to have the capacity to (1) fulfill its obligations as the primary provider of mental health services in the United States and (2) meet its ethical obligation to deliver competent services to clients, it is of critical importance that this prominent social and public health concern is properly addressed by social work education. This can be accomplished through a concerted effort by MSW programs, social work regulation associations, social work academics and practitioners, and substance use organizations and agencies to address the educational and workforce capacity deficits identified, and by building a sustainable infrastructure for substance use education in social work academic institutions moving forward.

Footnotes

Acknowledgments

The author thanks Ashley Hudson-Stabin, Sean Hardrick, Vincent Brooks, Katie Minnick, Dr. John Yu, and Dr. Deborah Chapin for their contributions to this work.

Funding

This article was developed (in part) with funding from contract number HHSS283201200059I/HHSS28342001T from the Substance Abuse and Mental Health Services Administration (SAMHSA), US . Faculty per program. SUBSTANCE ABUSE 199 Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the author and do not necessarily reflect those of SAMHSA or HHS. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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