Writing Sample

Substance Use Disorders in Homeless Individuals

Stacie E. Hebert
December 16, 2010
Salem State University

       Rates of substance use disorders tend to be much higher in the homeless population (Jainchill & Hawke, 2000;  Scheffler, 2004).  Half of homeless people themselves report drug use with a third of those using frequently and regularly; while 20% report frequent alcohol (Diblasio & Belcher, 1993).  Homeless individuals are nine times more likely to experience alcoholism alone (Scheffler, 2004).  It is estimated that two-thirds of this group misuse alcohol and have abused drugs, while other estimates report that 30- 60% have a lifetime history of substance use disorders (Scheffler, 2004). 
      Two million people in the United States experience homelessness each year, and 700,000 people in the U.S. are homeless every day (Scheffler, 2004).  A breakdown of the urban homeless reveals that 38% are families, 25% are children, and 14% are single women (Scheffler, 2004).  The steadily rising numbers of women, the children they care for, and families among the homeless is an alarming social problem (Scheffler, 2004).  In fact, simply by being born female one is almost twice as likely to experience homelessness (Scheffler, 2004; Jainchill & Hawke, 2000).
      Substance abuse is a major concern for women who are homeless (Jainchill & Hawke, 2000).  They report higher rates of cocaine, alcohol, and heroin use, as compared to women who are adequately housed (Scheffler, 2004).  However, there were no gender differences in drug abuse rates, women did report more crack cocaine use than men did (Jainchill & Hawke, 2000).  It is important to note that women who are homeless also suffer from more mental health illnesses, though they do not use substances anymore than homeless men do (Scheffler, 2004; Jainchill & Hawke, 2000).  Yet, one positive statistic is that homeless women report using drugs for few years than homeless men and also have entered treatment earlier (Jainchill & Hawke, 2000).
      The factors leading to homelessness are myriad for this special population.  Most studies describe a bi-directional relationship between substance use disorders and in-adequate housing.  Substance use is both a cause and a consequence of homeless-ness, creating a complex web of barriers for meeting the treatment needs of these individuals (Scheffler, 2004; Jainchill & Hawke, 2000).  Yet, it is clear that individuals who are homeless experience more incidence of substance use disorders (Scheffler, 2004; Jainchill & Hawke, 2000).
      The homeless population also suffer from “multiple disabling conditions” (Tsemberis, Gulcur, & Nakae, 2004,  p. 651).  Those who are chronically homeless usually remain so because they have not been able to, or are barred from, accessing permanent housing programs because of these conditions (Tsemberis, Gulcur, & Nakae, 2004).  And, while treatment services offer a temporary respite from live on the street, strict sobriety rules can act as a barrier, leaving them without housing and all other supportive services at once if they cannot maintain complete abstinence from alcohol and other drugs (Tsemberis, Gulcur, & Nakae, 2004;  Scheffler, 2004).
      A major barrier to accessing treatment is the fact that a third to one-half of those who are homeless report having a physical illness, and HIV/AIDS is also much higher in this population (Scheffler, 2004), which also acts as both a cause and consequence of homelessness.  Women who lack adequate housing especially report having numerous health problems (Scheffler, 2004).  Homeless women using alcohol and other drugs face an "itinerant, destitute, and frequently dangerous and desperate existence" (Carroll & Trull, 2002, p. 28).  
      Mental illness is a factor that has been linked to homelessness and also to substance use disorders (Scheffler, 2004;  Jainchill & Hawke, 2000).  Nonetheless, there is a very high incidence of mental disorders in the homeless (Diblasio & Belcher, 1993; Scheffler, 2004;  Jainchill & Hawke, 2000),  which acts as a barrier to treatment  (Tsemberis, Gulcur, & Nakae, 2004).  Approximately a third of the homeless experience chronic mental disorders with half of all those categorized as having a dual diagnosis  (Drake & Wallach, 2000; Scheffler, 2004)
      Women who struggle to maintain permanent housing experience much higher rates of mental health illnesses than do men or women who have never been homeless, though it is clear that homeless men and women use alcohol and other drugs at relatively equal rates (Jainchill & Hawke, 2000; Scheffler, 2004).  For instance, depression is a serious concern for homeless women; it was found at the rate of 75% amongst homeless women, with over a third of these suffering with major depressive disorder (Jainchill & Hawke, 2000; Diblasio & Belcher, 1993).  
      The alienation, isolation, and public ridicule that this population faces works to compound one’s personal sense of failure resulting from being unable to provide for one's needs, which adversely affects self-esteem (Diblasio & Belcher, 1993;  Scheffler, 2004).  Many homeless individuals may present with symptoms that appear to be consistent with personality disorders but which are actually the result of the high stress level experience of living on the streets, so it is crucial that workers are aware of the barriers faced by this group and able to distinguish mental illness from natural reactions to high stress (Diblasio & Belcher, 1993;  Scheffler, 2004).  
      Adult trauma and child abuse are also disproportionately high among homeless individuals with substance use disorders (Drake & Wallach, 2000).  The problem is widespread amongst homeless individuals, as 75% of participants in Jainchill and Hawke’s study (2000) reported having suffered trauma, from either sexual or physical abuse.    So, it is important to consider in any treatment that child abuse has been found to be an antecedent to drug use and chemical dependence (Carroll & Trull, 1999).  This devastating experience can act as a barrier to treatment because of the resulting distrust of service providers as well as others in general (Jainchill & Hawke, 2000).  
      Trauma is a distinct and troubling concern for those in the female homeless population because it occurs in much higher proportion (Jainchill & Hawke, 2000; Scheffler, 2004).   In fact, being female alone increases the odds of having experienced physical and sexual abuse by roughly 2.5 times (Jainchill & Hawke, 2000).  Padgett, Hawkins, Abrams and Davis's study of homeless women with co-occurring disorders (2006) found extreme physical and emotional abuse, which included child sex abuse, incest, beatings, and other victimization.   These women often suffer past and present physical and emotional abuse, childhood abuse and neglect, and robbery as well as an overall sense of sexual predation (Carroll & Trull, 2002).  Professionals must be aware of their experiences and prepared to work with someone who feels angry, confused, shamed, defiled, and betrayed, and ascribes these disturbing emotions as reasons for drinking and drugging, which they describe as “numbing” (Carroll & Trull, 2002;  Scheffler, 2004). 
      Many, if not most, homeless individuals also suffer from a lack of adequate social networks to support their basic human needs (Scheffler, 2004;  Jainchill & Hawke, 2000).  Savage and Russell (2005) found that a sizable number of homeless women report have no close ties and no social support network, at all.  Likewise, Blankertz and Cnanna (1994) found that “51% reported having no friends at all, while 18% had only one friend” (p.545).  Building social support networks, starting with treatment providers as a model for support, can help these women to reach out to others who may aid and support them.
      The homeless, and especially the women among them, need integrated treatment for their many chronically-disabling conditions.  Comprehensive care becomes specifically important to meet basic human needs as well as to provide treatment for substance use disorders and mental health illnesses (Scheffler, 2004; Jainchill & Hawke, 2000).  The consistently high rates of health and mental health problems, as well as the presence of disabilities, must be addressed in any treatment that homeless individuals enter (Diblasio & Belcher, 1993;  Scheffler, 2004).
      Homeless individuals must first have their basic needs, such as housing and medical and mental health care, met in order to build a solid foundation of improved psychosocial functioning which will then support mental health and substance abuse treatment  (Tsemberis, Gulcur, & Nakae, 2004;  Scheffler, 2004).  The Housing First program is a model which emphasizes consumer choice, harm reduction principles, and establishes stable housing for the homeless so to do just this.  The program helps homeless individuals in gaining and keeping housing without worsening of substance use or mental health symptoms (Tsemberis, Gulcur, & Nakae, 2004;  Scheffler, 2004).  
      The use of harm reduction principles is probably most appropriate and helpful for individuals who are homeless because many are unable to maintain total abstinence from alcohol and other drugs immediately upon entering treatment.  Providers must remember that this special population continues to suffer from very high levels of stress as they encounter the many barriers in accessing resources and treatment (Tsemberis, Gulcur, & Nakae, 2004).  Until they learn less destructive ways of coping, like any person in recovery must, they may continue to use alcohol and other drugs as a form of self-medication (Scheffler, 2004).  Strict sobriety rules in residential treatment programs often act as a barrier, and it is often counterproductive for programs to require immediate abstinence for these struggling individuals who have their numerous basic needs met over a period of time (Tsemberis, Gulcur, & Nakae, 2004; Scheffler, 2004).
      A seamless continuum of care should be emphasized in substance abuse treatment, as it is already used in meeting the needs of the homeless’ other needs.  Likewise, Holistic treatment is necessary because of these numerous and complexly intertwined basic needs (Jainchill & Hawke, 2000).  Providers must be focused on meeting this population’s basic needs first (Tsemberis, Gulcur, & Nakae, 2004;  Scheffler, 2004).
      Especially because of the dramatic effects of the homeless’ trauma histories, homeless women are a highly vulnerable group.  Women need for helping professionals to be compassionate, gentle, and empathetic (Carroll & Trull, 2002; Jainchill & Hawke, 2000;  Scheffler, 2004).  Clinicians can help to ”prop up” these women with much-needed support as they rebuild their lives and make changes.  Social support has been found to help homeless women in reducing their substance use (Padgett, Hawkins, Abrams & Davis, 2006).  Gender-specific treatment may also be indicated, as it may provide a safe place for women to share their feelings of powerlessness and to explore internalized abuse histories, mental health concerns, and alternative methods for coping with life without the use of alcohol and other drugs (Jainchill & Hawke, 2000).  Any treatments that homeless individuals participate in need to employ an overall strengths-based perspective; as such, professionals must promote and encourage their successes, resilience, self-esteem, and self-confidence as they enter and maintain recovery (Carroll & Trull, 2002; Scheffler, 2004).  Finally, all substance abuse programs need to be prepared and equipped to manage the needs of dually-diagnosed homeless population, as a majority of this group will present with mental health illnesses as well as substance use disorders  (Tsemberis, Gulcur, & Nakae, 2004;  Scheffler, 2004).  Treatment must pay special attention in recognizing how mental health concerns and trauma histories affect the progress of treatment and recovery (Jainchill & Hawke, 2000;  Scheffler, 2004).


Blankertz, L.E., & Cnaan, R.A. (1994).  Assessing the impact of two residential programs for dually diagnosed homeless individuals.  Social service review, 68, 536–560.

Carroll, J. J., & Trull, L. A. (1999). Homeless African-American women’s interpretations of origins of chemical dependence. Early child development and care, 155, 1-16.

Carroll, J., & Trull, L. (2002).  Drug-dependent homeless African-American women’s perspective of life on the streets.  Journal of ethnicity in substance abuse, 1(1), 1-27.  

Diblasio, F., & Belcher, J. (1993). Social work outreach to homeless people and the need to address issues of self-esteem.  Health & social work, 18(4), 281-287. 

Drake, R. E., & Wallach, M. E. (2000).  Dual diagnosis: 15 years of progress. Psychiatric services, 51, 1126-1129. 

Jainchill, N., & Hawke, J. (2000). Gender, psychopathology, and patterns of homelessness among clients in shelter-based TCs. American journal of drug & alcohol abuse, 26(4), 553. 

Padgett, D. K., Hawkins, R. L., Abrams, C., & Davis A. (2006).  In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness.  American journal of orthopsychiatry, 76(4), 461-467. 

Savage, A., & Russell, L.A. (2005). Tangled in a web of affiliation: Social support networks of dually diagnosed women who are trauma survivors. Journal of behavioral health services & research, 32(2), 199–214.

Scheffler, S. (2004).  Substance abuse in homeless persons.  In S. Straussner (Ed.), Clinical work With substance-abusing clients. (pp. 423-442).  NewYork, NY: The Guildford Press.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American journal of public health, 94(4), 651-656. 


                                                                                                  Running head:  CBT for Anxiety

Thematic Literature Review of the literature concerning
The Use of Cognitive Therapy (CBT) in Reducing Symptoms of Anxiety

Stacie E. Hebert

Salem State College

Anxiety disorders are some of the most common mental health disorders (James, Soler, and Weatherall, 2005).  As well, Hunot, Churchill, Teixeira, and Silva de Lima (2007) add that Generalized Anxiety Disorder is highly prevalent among the population. James, et al. (2005) writes that 5 to 18% of all children and adolescents experience anxiety disorders.  This literature review examines how cognitive therapy (also known as CBT) is used to reframe negative cognitions, especially about oneself, and thereby works to reduce or alleviate symptoms of anxiety.   Specifically, it is designed to address how cognitive therapy techniques work to change negative self-statements, so that people experiencing symptoms of anxiety may find relief? 
After the success of Dr. Aaron Beck's development of cognitive therapy to help depressed patients, he later adapted cognitive therapy to treat anxiety disorders as well (Reilly, Sokol, and Butler, 1999).  Cognitive theory of anxiety maintains that negative thought structures (cognitions), if not cause, at least accompany emotional disorders, and may function to maintain symptoms of anxiety.  By reframing distorted cognitions, and challenging beliefs associated with these self-defeating thoughts, cognitive therapy can bring clients relief from the symptoms of emotional disorders (Riley et al., 1999; Wenzel, 2004). 

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a psychological treatment used to identify feelings of anxiety, to clarify the negative thought structures accompanying these feelings, and then to learn use more effective coping skills to manage one's thoughts and emotions.  The aim of cognitive behavioral therapy is to specifically have patients reality-test distorted cognitions, and then these thoughts and beliefs.  Usually, the patient and practition agree that these negative thoughts are irrational and illogical.  Then, the client learns skills about how replace these negative irrational thoughts, which will help the client to cope with her/his environment and to manage his/her self better  (James et al., 2005).  The techniques are learned by the clients so that exaggerated negative thoughts about externally-perceived dangerous situations are replaced by rational thought structures; also, the probability that these threatening situations may occur, and the perceived unmanageable costs may be reshaped into a more realistic and positive personal schema (Rosser, Issakidis, and Peters, 2003).
            As an example, a client may have repeated thoughts that s/he will make a fool of him or herself.  The client may assume that all the people among her companions will then ostracize her because of it.  By challenging these distorted beliefs (namely, that the client is bound to make a fool of herself, that all people will reject her if she does, and that she will not be able to cope with her feelings), the client gains confidence in observing those situations that are positive more often than she expects.  She also notices that, further, she is able to manage her feelings and behavior when/if the situation does happen.
            Typically, cognitive behavioral therapy is brief, so that the client can learn and practice techniques learned in therapy in order to cope better with distorted thought about perceived negative events.  Brief therapy also discourages dependency on the practitioner.  These are real world practices and independent skills that the client must use on her own (Reilly et al., 1999). 
Reilly et al. (1999) found that distorted cognitions help to maintain already present anxiety and, further, to perpetuate it.  One can imagine a circular reinforcing relationship in which a client has these disturbing symptoms, and unintentionally but actively creates more symptoms of anxiety -- being anxious about being anxious, if you will.  These additional distorted cognitions make the client more prone to experiencing a self-fulfilling prophecy in which the potential cost becomes truly unmanageable as her worst fear becomes reality.
            Cognitive therapy has good outcomes in the treatment of panic disorder, and has at present reached the efficacy level of cognitive therapy used in the treatment of depression -- the majority (77-85%) of subjects of find that short-term treatment leaves them actually free of symptoms, with results remaining the same for up to 15 months later (Reilly et al., 1999)!
In addition, James et al. (2005) asserts that cognitive therapy explored with children and adolescents will be used more widely in the future, especially considering the safety issues of this population using anti anxiety in anti-depressant medications (James, 2005).
            In work with clients who experience social phobia, cognitive theory lends itself to teaching clients about negative self-cognitions they hold.  A client will learn in cognitive behavioral therapy to focus attention outside of her self in order to modify those distorted beliefs she may have about herself (Voncken and Bogels, 2006).  Clients experiencing anxiety are hyper- vigilant toward the danger of threats in their environments; they perceive and tend to interpret information as more threatening than non-anxious people do (Wenzel, 2004).  People experiencing symptoms of social phobia tend to perceive themselves as social objects and generally experience more negative self-images, which directly produces feelings of anxiety (Vassilopoulos, 2005).  Again, using cognitive theory as a basis, people with anxiety perceive that they are not only more often in danger, but that the likelihood they will be harmed is higher; anxious people also estimates his or her ability to cope with the danger or potential harm more poorly than is probably realistic (Reilly et al., 1999; Wenzel, 2004).  For clients suffering with social phobia, negatively-interpreted events are the basis of the fear experienced in social situations (Voncken and Bogels, 2006).
Highly socially-anxious individuals also see their negative self-images as fairly accurate of their true characteristics; and, the experience of feeling anxious about social situations only reinforces negative self-perceptions and fear (Vassilopoulos, 2005).  A self-fulfilling prophecy can be the result which will only "prove" to the client that s/he is incapable of handling the situation.  These distorted self-perceptions and negative self-appraisals are targeted when using cognitive therapy in order to help an anxious client with concerns over making mistakes; fear over making a mistake will only add to the anxiety the client feels (Rosser et al., 2003).

Keywords Used to Search Studies
I did a number of searches of major peer-reviewed articles available through the EBSCO and Academic Search Premier databases.  I focused on studies reported in "Social Work Abstracts," "SocINDEX with Full Text," "PsycINFO," and "Psychology and Behavioral Sciences Collection."  I explored closely within a periodical named Cognitive Therapy and Research.

Search Terms:
                        Cognitive Therapy
                        Cognitive theory AND anxiety
                        (DE COGNITIVE therapy) AND anxiety
                        (CBT or Cognitive) AND anxiety
                        Beck AND (Aaron or A.T.)
                        Anxiety AND review
                        Anxiety AND (self-statements OR self-talk OR "automatic thoughts")

Research Findings
            In cognitive therapy trials, clients are asked to determine whether their negative assumptions are realistic.  Social phobia clients are guided in challenging their negative thoughts about themselves in social situations, putting thoughts like "these people hate me" to the test of reality; subjects learn to form more realistic and statistically more probable self-statements (Voncken and Bogels, 2006; Wenzel, 2004).  Cognitive therapy is useful for clients coping with negative self-images.  Vassilopoulos (2005) asserts that cognitive therapy is most effective in helping clients manage negative self-images; he found that highly socially-anxious subjects were capable of maintaining positive self-images when cued by the practitioner.  Significant results were found that cognitive therapy reduces social phobia to levels where therapy is no longer needed.  Voncken and Bogels (2006) found that eighty percent of the subjects in the study no longer needed treatment after a brief nine-session cognitive therapy treatment, and that the treatment significantly reduces interpretation bias in the clients' personal schema.
Cognitive therapy may be the most effective of all psychotherapies.  Reilly et al.'s study compared the effects of cognitive therapy to the effectiveness of other psychotherapies.  Even brief cognitive therapy treatment with clients who suffer from panic disorder found outcomes significantly higher than relaxation or meditation treatment.  Cognitive Therapy was found to be the most effective of all psychotherapies, especially for social anxiety, in which case, cognitive therapy is as effective as psycho- pharmacological treatment (Reilly, 1999).  CBT is also very effective in reducing the symptoms associated with Generalized Anxiety Disorder (Hunot et al., 2007).   In work with children and adolescents, cognitive behavioral therapy is effective in relieving symptoms of anxiety disorders; however, only about fifty percent of subjects recover using CBT alone (James, 2005). 
            The most comprehensive literature review I located was performed by Hunot et al. in 2009 and published in the Cochrane Database Collaboration.  The review included twenty-five studies about Generalized Anxiety Disorder, and had over 1,300 participants.  Further, meta-analysis was performed on twenty-two of the studies, with a total of 1,060 participants adding data.  The participants represented a wide range of adult ages: from 18-75 years old.  The study set out to compare CBT with other psychotherapies, as well as to determine which are most effective in relieving symptoms of Generalized Anxiety Disorder.  The studies in this literature review used comparison groups consisting of clients on waiting lists.  Psychodynamic and supportive therapies were compared to the effectiveness of CBT in only a few studies, but results failed to show significant differences.  As well, none of the studies looked at the long-term effectiveness of CBT.  Overall, though, CBT was more effective in reducing anxiety symptoms, most notably those of worry and depression, for clients receiving treatment than waiting list groups who received no treatment or treatment as usual. 

Risk of Bias in Studies
  • Controls:  Rosser et al. (2003) used no control or comparison group to measure response of subjects against; instead, the research design used pre-treatment and post-treatment measures as a comparison.  Hunot et al. (2009) note that of the studies they report on, those chosen for review used randomized allocations to groups, but that none of the studies reported on the methods they chose to achieve the randomization.
  • Application:  Results of the James et al. (2005) study is applicable to children and adolescents; the results are not meant to apply to young children under the age of six, or adults aged eighteen and above.
  • Sample size:  Voncken and Bogels (2006) initially used a sample size of only 13 subjects, which was further reduced by drop-out rates to a total of 10 subjects lending data to the study findings.
  • Measurement Instruments:  Additionally, Voncken and Bogels (2006) used instruments that they themselves had designed to interpret the data, which could be a risk of bias.

For Further Study
Many of the intricacies between variables in these studies and causation needs further research.  James et al. (2005) points out that there needs to be more research on CBT's effectiveness with different groups of anxiety disorders, wherein the comparison of results across the whole spectrum of anxiety disorders occurs.  More research needs to be done, as well, in order to tease out the effects of observing one self, when testing for social anxiety; Vassilopoulos (2005) posits that the simple act of observing oneself may be cause for social anxiety just as surely as having a distinctly negative self-image.  James et al. (2005) notes that because of concerns over safely administering medications, children and adolescents experiencing anxiety disorders need more treatments.  It would also be important to explore whether social phobia develops based on early it negative self-images, which then itself maintain social anxiety over time (Vassilopoulos, 2005).  Finally, the researchers in this area generally suggest that more follow-up studies examine the effects of the treatment on a long-term basis.  James et al. (2005) questions whether "booster" CBT sessions help to maintain effects over time. 


Hunot, V., Churchill, R., Teixeira, V., & Silva de Lima, M. (2007).  Psychological therapies for generalized anxiety disorder.  Cochrane Database of Systematic Reviews 2007, Issue 1.  Article number: CD001848.

James, A., Soler, A., & Weatherall, R. (2005).  Cognitive behavioral therapy for anxiety    disorders in children and adolescents.  Cochrane Database of Systematic Reviews 2005, Issue 4.  Article number: CD004690.

Reilly, C. E., Sokol, L., & Butler, A.C. (1999).  A cognitive approach to understanding and treating anxiety.  Human Psychopharmacology: Clinical and Experimental, 14, S16-S21.

Rosser, S., Issakidis, C., & Peters, L. (2003).  Perfectionism and social phobia: Relationship between the constructs and impact on cognitive behavior therapy. Cognitive Therapy and Research, 27(2), 143-151.

Vassilopoulos, S. (2005).  Social anxiety in the effects of engaging in mental imagery. Cognitive Therapy and Research, 29(3), 261-277.

Voncken, M. J., & Bogels, S. M. (2006).  Changing interpretation and judgmental bias in social phobia: A pilot study of a short, highly structured cognitive treatment.  Journal of Cognitive Psychotherapy: An International Quarterly, 20(1), 59-73.

Wenzel, A. (2004).  Schema content for threat in social phobia.  Cognitive Therapy and     Research, 28(6), 789-803.



Social Work in Genetics
Stacie E. Hebert

Comprehensive information on genetics has serious and far-reaching effects for clients and the social workers who work with them.  The National Association of Social Workers identifies several areas in which genetics play an important role in social work: discriminatory labeling, higher insurance costs or outright denial of coverage, and lack of testing services available to the poor (NASW, 2005).
It is important for social workers to know the role the biophysical dimension plays in the overall social functioning of human beings because the biophysical is the foundation upon which all other dimensions build.  Nonetheless, “biology is not destiny” (Ashford, et. al., 15), and the Biophysical dimension can be influenced or altered in combination with other dimension of social functioning.  All levels of the multidimensional framework contribute to picture of the whole person when social workers assess social functioning; they interact in a manner to form unique individuals in our social environment.
                        There are a variety of reasons why genetic counseling would be important and useful in working with families.  Taylor-Brown & Johnson point out that social workers may perform counseling before and after genetic testing (1999).  The function of social work is to aid clients in areas of social functioning, and to enhance their overall well-being (NASW, 1999).  Social workers are charged with helping clients to make the best choices for him- or herself. The NASW Code of Ethics also mandates that social workers be competent in the areas in which they practice (1999).  If a practitioner provides services in the area of genetic counseling, he or she is bound to be competent in that area of practice.
Minimally, a social worker must understand the types of genetic conditions,
including single gene disorders, chromosome anomalies, and multifactorial
disorders,  and the effect of harmful environmental toxins on development.
Furthermore an understanding of the patterns of inheritance between
generations (autosomal dominant, autosomal recessive, and X-linked recessive)
is essential in working with families (Taylor-Brown & Johnson, 1999).

One major area of practice which utilizes genetic counseling is in family planning.  Heterosexual couples may benefit from the genetic information they receive from testing.  The aim is to discover the genetic components each partner possesses, along with possible combinations of recessive and dominant genes.  Some clients may know much about their genetic history, and some may know very little; genetic testing can show, without a doubt, the genetic makeup of an individual, and thereby what possibilities combinations between partners may produce in their offspring.  With this information in hand, couples may decide upon other parenting options should testing reveal the likelihood of a serious genetic disorder in their future biological children.  At the very least, couples will be more prepared to deal with the consequences of their mating choices. 
            Genetics counseling may also used in work with families in which children have a diagnosed disability.  Social workers educate families on the disease or disorder.  In addition, practitioners may also counsel on the causes of the particular disorder affecting the family.  The social worker can also normalize the disorder’s presence so that the family does not feel so isolated or alone in the process; the social worker can put the family at ease by assuring them that they are not the only ones going through this difficulty.   Additionally, the social worker can refer the family to groups in which they can get support from other families in similar situations.  Social workers can also refer clients to other services which may be helpful.   Finally, the social worker can work with the family to advise them of expectations, necessary procedures, life expectancy, and future life conditions for the child diagnosed with a disability.


Ashford, J. B., Lecroy, C. W., & Lortie, K. L. (2006). Human behavior in the social  environment: A multidimensional perspective (3rd ed.). Stamford, CT: Wadsworth

National Association of Social Workers. (1999). Code of ethics. Washington, DC: NASW.

National Association of Social Workers. (2005). Social work speaks abstracts. Retrieved September 21, 2006, from  http://www.socialworkers.org/resources/abstracts/abstracts/genetics.asp

Taylor-Brown, S., & Johnson, A. M. (1998).  Social work’s role in genetic services.   Retrieved September 20, 2006, from  http://www.socialworkers.org/practice/health/genetics.asp