Social Work with Individuals Having Alcohol Usage Problems: Overview of the Situationin Lithuania.

This article analyzes social work with individuals having alcohol usage problems in Lithuania. In this survey-based quantitative research, frequency data was gathered to examine the usage of methods, services, practices and challenges in this specific area. The results revealed a strong orientation towards individual intervention in social work with individuals having alcohol usage problems. Uncommon usage of group, community or network methods was observed in research data. Low usage of social action or social welfare methods might represent a weak policy-making function. Among services, providing information, consultation and representation are the most often applied. Lithuanian social workers also favor social skills development and family consultation in terms of specific practices, as those are the most often used. Finally, professionals acknowledge that low the motivation among clients to change is among the biggest challenges in this field. Improvements in social work with individuals having alcohol usage problems could be made through the enhancement of skills and practices that are the most effective in the substance abuse area, although relatively rarely used in social work in Lithuania.


Introduction
Social workers encounter alcohol usage problems almost on a daily basis, as this is not only a part of a social worker's statutory obligations, but it also overlaps with other directions of activities, such as domestic violence, crisis in families, clients with mental distress and other areas (Galvani, 2015). Alcohol usage problems are often connected to the client's presenting problems, and it affects every domain of personal well-being, starting from difficulties in maintaining one's basic needs, health, security, continuing into social relationships and personal achievement, and finally groving into the societal level (Begun & Clapp, 2015). Social work operates in multisectoral settings and interfaces with the populations that are the most likely to face alcohol usage problems (Begun & Clapp, 2015). A professional able to directly or indirectly detect underlying alcohol usage problems may narrow the gab between the numbers who need treatment and who receive it (NASW, 2013). Therefore, social work may be referred as the primary help source to individuals with alcohol (and other substances) usage problems.
While encountering the problem of alcohol usage routinely, social workers play an important role in its assessment, prevention, intervention, treatment and policy formuation (Begun & Clapp, 2015). A multidimensional addiction phenomenon requires a systematic approach towards the problem, and social work may provide a path in longterm recovery by influencing personal (social skills, everyday skills, etc.), biological (e.g. direction to medical centers), environmental (work habits, satisfactory life, etc.) aspects (Raheb et al., 2016). Being a care manager, service provider or policy maker, a professional in social work take a significant role in selecting, delivering and advocating for evidence-based substance abuse treatment practices (Wells, 2013). Researchers emphasize prevention as an essential domain in social work pratice, highlight intervention through education, social support management, family interventions, screening and brief councelling (Hafford-Letchfield, 2017), and point to comprehensive assessments based on social work values and skills to be highly important social work directions in this area. Consequently, social work as a profession has a unique opportunity to suppress alcohol usage problems at individual, family, community and even larger system levels.
Together with requirements for skills and evidence-based practices in social work with individuals having alcohol usage problems, the need for changes in social work education arise. The area of alcohol usage problems in social work becomes more specified and professionalized. National Association for Social Workers (NASW) provided with standards for social work practice with clients with substance use disorder (NASW, 2013). In short, NASW standards overviewed ethics, qualifications, interventions, function, decision making, collaboration and etc. in work with substance use disorders. A few years later, Manchester Metropolitan University provided the first description of a social worker's roles in work with alcohol and other substance users, which are engagement, motivation and support in making and maintaining changes (Galvani, 2015). More recently, Osborne-Leute et al. (2019) described social work practice in the field of alcohol and other substance use disorders in four core aspects: knowledge, skills, attitudes, and interprofessional practices (Osborne-Leute et al., 2019). Scholars also state that social work curricula should be extended in substance abuse knowledge and practical skills, including communicational and relational, assessment skills (Svendsen et al., 2019), research skills in social work to improve treatment services (Unegbu, 2020;Wilkey et al., 2013), risk assessment, types of interventions (Galvani et al., 2013), substance abuse recovery strategies (Urada et al., 2014), screening and motivational interviews (Munoz et al., 2019), etc. Generally, it is acknowledged that teaching and learning substance abuse topics should be a higher priority in social work programmes (Galvani & Allnock, 2014). Increased training opportunities for social work professionals that are not addiction specialists but address addiction-related issues during their standard services would enhance the ability to effectively carry out screening, education and evidence-based interventions in this field (Wolf et al., 2015).
Although social work as a profession in Lithuania has already more than 30 years of evolution, quantitative research in the area of alcohol usage problems is insufficient. A literature analysis discloses that scientific endeavor in this theme is mostly orientated toward theoretical (Ivanauskiene & Motiečienė, 2010;Zubavičius, 2019) or qualitative (Černauskaitė, 2015;Laucė, 2021;Lukaitė-Cekavičė, 2015) directions; the topic is often analyzed through the perspective of social work with families (Černauskaitė, 2015;Kutkauskienė, 2005;Stremauskienė & Žibėnienė, 2014) and often relies on an analysis of work practice in one (or few) specific organizations, e.g., addiction or rehabilitation centers (Gudžinskienė & Pozdniakovas, 2020;Jaseviciene, 2015) or Lithuania's districts (Laucė, 2021). One quantitative study which analyzed social services for people with alcohol usage issues was found; it concluded that social workers in this area often face a lack of provision of information in the society, a shortage of consistency of services, a lack of professional knowledge, practical skills, and scarcity of positive opinion upon individuals having alcohol usage problems and treatment not only among social specialists but the society as well (Jegeleviciene et al., 2012).
The importance of previous research could not be underestimated as it provided many important insights in social work with individuals having alcohol usage problems. However, nowadays it is acknowledged that social workers encounter individuals having alcohol usage issues on daily basis, not only in specialized addiction centers or rehabilitation services. Therefore there is a need to analyze more generalized situation in social work with individuals having alcohol usage problems, which wouldn't be restricted by district profile or organization specialties. This article is the very first step in uncovering the uncertainty of social work with individuals having alcohol usage problems in Lithuania, starting with a description of the nature of work in this area.
The aim of this study is to analyze social work (in terms of methods, services, practices and challenges) with individuals having alcohol usage problems in Lithuania.

Research Design
In this quantitative study, a survey was conducted to analyze social work with individuals having alcohol usage problems, divided into methods, services, practices, and challenges.
The descriptive type of the quantitative research method was chosen to reveal the phenomenon, while analyzing the frequencies, underlying patterns, and categories and observing trends (Kim et al., 2017). The descriptive research method is used for accurately and systematically describing a population or phenomenon and enables to gather information needed to comprise a proper understanding of what a research problem is about. Phenomenon description is the primary and fundamental step before investigating why a problem exists and before searching for associations and correlations between different variables (Nassaji, 2015).

Research Terminology
In this research, the concept of individuals having alcohol usage problems has been chosen for ethical reasons. "Alcoholism, alcohol addiction, alcoholic, alcohol misuse, abuse" and etc. are among various terms to use while discussing a person using alcohol in an personally and socially unhealthy manner. However, not every individual experiencing negative consequences of alcohol usage is alcoholic (a term which nowadays is not usable due to its disrespectful and stigmatizing nature), and not every individual with unhealthy alcohol usage is an alcohol addict. Alcohol addiction is a medical condition with concrete symptoms, and only professionals in health care may determine whether a person is afflicted with this disease or not. Moreover, not only alcohol addiction may cause biopsychosocial problems for a person; even symptoms and behavior which are not reaching medical criteria might induce personal and social challenges. Therefore, to cover the whole possible range, the term alcohol use disorder is preferred instead of alcohol addiction. It refers to an "impaired ability to stop or control alcohol use despite adverse social, occupation, or heath consequences" and is distributed into 3 categories based on symptom severity. It is important to mention that alcohol use disorder refers to such conditions as alcohol addiction, dependence, abuse or even alcoholism (National Institute on Alcohol Abuse and Alcoholism, 2021).
The terminology associated with alcohol problems has historically had a stigmatizing language -an abuser, drinker, addict, alcoholic. A systematic review, the first to analyze stigma-related substance abuse disorders, showed that stigma might not only reduce willingness to address substance abuse problems appropriately, but it might also stop an afflicted individual from seeking treatment (Yang et al, 2018). Moreover, terms and concepts, used in alcohol usage contexts, often incorporate expressions which might impose a more negative personal responsibility than an understanding that adverse alcohol usage is tightly connected to biological processes (which direct behavior) as well. For example, abuse, misuse might somehow indicate a willful behavioral act rather than an upcoming or already existing disease (Fadus, 2019). Therefore, to uphold the essential principle of respect for the individual and his/her integrity in social work, the most unstigmatized language was used.
Placing an individual in the first order and adding potential problems they might face, such as having alcohol usage problems, protects us from having negative perceptions and at the same time shows respect to a person and a problem that they might have to deal with. Such a terminology is described as recovery-orientated, because the expression "having an alcohol usage problem or disorder" excludes the assumption that drinking alcohol harmfully is a moral fault (Fadus, 2019).

Research Procedures
Since this research was focused on descriptive purposes of the research object, it was aimed to reach a broad and beforehand unspecified part of social workers, working in various institutions, to reveal the scope of social work with individuals having alcohol usage problems in different contexts. Importantly, the main criteria to participate was outlined -a social worker working with or facing individuals having alcohol usage problems on their daily practices. Therefore, all social services centers from main cities and regions in Lithuania that are officially registered (list available on line www.rekvizitai. lt, this is a list of companies officially working in the Republic of Lithuania) were invited to participate via email. Municipality or district social services centers are main departments for managing social services across various areas: child and family centers, child care units, care centers, crisis centers, homelessness hostels and etc. An invitation to participate was also shared with the help of the Social Workers Association in Lithuania, was sent to 5 major addiction centers in Lithuania (Vilnius, Kaunas, Panevėžys, Klaipėda, Šiauliai), A list of NGOs was also covered. However, the response rate could not be calculated because it was not known how many respondents did the invitation to participate reach, and overall how many of them meet the criteria to participate.
ᵇ Respondents who chose more than one workplace, or those who chose "other" but did not specified their workplace.

Measures
An online-administered questionnaire via https://webropol.com/ (a web-based survey creation and distribution platform) was used. Respondents were asked to evaluate the frequency of applying each specific method/service/practice on scale from 1 (never) to 5 (always): • Demographics and socioeconomic variables. Data including gender, age, education, employment place, work experience were collected to describe the sample characteristic. • Social work methods. The list of classical social work methods was created based on a review of literature. • Social work services. The list of services was based on the Law on Social Services of the Republic of Lithuania (2006), which divined them into social services of general interest and special social services. • Social work practices. To analyze the broader aspects of possible social work with individuals having alcohol usage problems, an additional question posited by the study author was used to address more specific practices. • Challenges. An additional question addressing the main possible challenges social workers face in their daily practices with individuals having alcohol usage problems was comprised by the study author based on the literature review.

Analysis
Analysis was conducted using Statistical Program for Social Sciences (SPSS) version 26 software.

Social work methods, services, practices, challenges
Figure 1 presents social work methods used with individuals having alcohol usage problems. An examination of the percentage expression of baseline scores reveal that social work is the most often based on individual case analysis (45% of respondents reported to use this method "always"), and the least often used methods are social work research (38% "never") and community method (33% "never"). Frequency analysis by percentage distribution of responses by categories. The evaluation of services provided in social work with individuals having alcohol usage problems were divided into general and special (supervision and care) services (Table 2). Results show that providing information and consultation are the most often used general social work services; up to 77% of respondents use those methods always. On the other hand, transport organization and catering are among the least often applied services with individuals having alcohol usage problems -on average, around 30% of respondents do not use those methods, or do that rarely. Among special services (category -supervision) the development of social skills was the most often used (53%), and in general, accommodation services (home services, temporary accommodation or accommodation in a temporary living home) were the least or never applied services. Finally, all special services (category -care) could be reported as uncommon in this researched sample, as at least half of the respondents (at least 50%) never apply none of the three care services.
Among social work practices with individuals having alcohol usage problems, family consultation is the most often used -45% of respondents use it always (Table 3). Social skills development (39%) and everyday skills development (35%) were also among the most often used practices. On the contrary, services towards educational purposes were the least often applied -even 85% of respondents never organize professional training in the field of social work with individuals having alcohol usage problems, and 64% of respondents do not provide consultations to other professionals in this field. Table 3 lays out the frequency of applicable practices in more detail. In the figure below, the percentage distribution of challenges faced in social work with individuals having alcohol usage problems is presented.
Among the most-often faced challenges, a lack of client motivation is the most common -27% of respondents agree that this is interrupting social work process always, and 63% of respondents face this often (Figure 2). In contrast, the least-often faced challenge is the lack of the social worker's own motivation (25% of respondents never and 44% only rarely have this difficulty).

Discussion
The aim of this study was to analyze social work (in terms of methods, services, practices and challenges) with individuals having alcohol usage problems in Lithuania. Study results could help in uncovering the strengths and weaknesses in nowadays social work in this concrete area, and based on analysis, improvements may occur. The results of this research indicate that in social work with individuals having alcohol usage problems, individual case analysis is the most often applied method -that is, social work in this area is focused on an individual solution for an individual problem. Being the oldest method in social work practice, the individual case method is a method of direct and individually orientated support in a concrete situation (Chukwu et al., 2019). Despite the undeniable need and applicability of the individual case method in social work, scientific research shows the great effectiveness of the group method for individuals having alcohol usage problems (Uranta, Ogbanda 2017), a method of low incidence in this research. The group method in the addiction field may be successfully applied due to some of the method's properties: it helps raise awareness through changes in communication skills due to reality assessments between similar reality members (Uranta, Ogbanda 2017).
Additionally, the community approach could also be a central preventative method by social workers in problematic alcohol usage circumstances (Haggerty & Shapiro, 2013). Wolf (2018) even claims that people recover not in the therapist's office but in communities, with the help of professional social worker (Wolf, 2018). However, this research shows a rare use of this method. Another low usage social work method called the "social network" is also highly applicable in problematic alcohol usage situations, as network-based recovery trough supporting the strategy of abstinence. An earlier study in Lithuania showed a successful application of the social network method as a secondary prevention of drug addiction with a focus on reconstructing, mobilizing, maintaining the same constructive, and forming new networks in recovery (Žydžiūnaitė et al., 2010).
Study findings also show that secondary social work methods (welfare, action, research), which serve the primary methods and are aimed at supporting their implementation (Chukwu et al., 2019), were a highly unpopular choice of social work form in this research. This might be explained by the fact that social action or social welfare administration are action models for the organization leaders and initiators, as it requires varous skills to influence processess at the political and social levels (Chukwu et al., 2019), and this research was not focused on leadership agents in social work organizations; therefore, the percentage of leaders at this particular case might have been low. On the other hand, a low acquisition of secondary social work methods may reflect the overall situation in social work professionalizing in Lithuania. Secondary methods are the ones of change in society, influencing political decision, providing the voice for unheard societal issues, and which work extensively with communities (Parmar, 2014). And it could only be presumed that such a still young profession in Lithuania needs to build its own professionalism, quality and self-confidence not only in practical (direct methods) but also in broader, academically based methods aimed to achieve social progress and construct social welfare.
Scientific research, as social work method, is also spotlighted in the substance abuse area and might be named as a competence that is underestimated and unreasonably rarely used. Foreign authors highlight the inclusion of the research methodology and research implementation in social work education (Unegbu, 2020;Wilkey et al., 2013). However, study findings show a low usage of this method. Social work research informs polity, programs and interventions, form routine practices, examine evidence-based strategies, identify problems, and evaluate techniques (Depanfilis, 2014). Evidence-based practices, driven by scientific enquiry, constitute a process of seeking better outcomes for clients; it also includes the client in the search for effective solutions and involves them in decision-making (Drisko & Grady, 2015). Lundgrenn and Krull (2014) claim that integrated care provided by social workers in addiction field should be based on interdisciplinary research and practice (Lundgren & Krull, 2014). Evidence-informed social work will provide opportunites to improve performance or intervene on low performance in substance abuse recovery, or will supplement the course of help with real-time knowledge for successful client empowerment (Wolf, 2018).
Foreign literature also highlighted the importance of mixed method incorporation in social work in substance abuse area. For example, Australian social workers perform roles which incorporate a mix models of methods (Fraser & Jarldorn, 2018). A case manager can run groups, participate in social policy discussion, conduct studies in search for evidence of good practice or solutions to practical problems. Social work intervention based on case and group work may result in multiple outcomes, as, e.g., opioid addiction after systematic social work intervention resulted on improvement in general health, social functioning and reduced depression (Raheb, 2016). Perhaps mixing the methods used may supplement the whole social work process with a particular client group and support the client empowerment process from various perspectives.
Among general social services used with individuals having alcohol usage problems, providing information, consultation and mediation/representation (general services) and developing social skills (special services) are the most often used. In previous research in Lithuania, just in a different context (social work with crisis families), the same three general services were found to be the most prominent (Augustavičius, Sadauskas, 2018). Social services as a mean of assistance provision to a person who has lost the ability or opportunity to take care of personals or his family life independently, are directed at developing or strengthening abilities to solve the client's social problems, maintain social relations, and help overcome social exclusion (Ministry of Social Security and Labor of the Republic of Lithuania, 2020). The study results also showed the importance of family consultations and social or everyday skills development in this field researched. Alcohol usage problems affect the whole family; therefore, the support oriented to it is an important line in social work (NASW, 2013). Family support should be focused on councelling (providing change to talk about the problem), providing information, exploring coping skills with drinking problems, enchanging social support, and exploring the need for referral to further treatment options (BASW, 2012).
Assisting a person with low motivation to change may be challenging; however, motivational factors are the main chaining indicators to which all helping professionals should be aimed at (Waite, 2018). As indicated by study findings, the lack of client motivation is the main challenge in working with individuals having alcohol usage issues. Not without reason great attention worldwide is paid towards motivational interview skills as an essential practice in social work in substance abuse area. Motivational interview skills (Munoz et al., 2019), together with knowledge and skills in evidencebased substace abuse recovery strategies (Urada et al., 2014), could enhance social work practice in this specific area. Evidence-based practices in substance abuse counseling, which contains motivational interview skills (Hodorowicz et al., 2020;Putney et al., 2017;Sacco et al., 2017), as well as skills in making and maintaining changes (Galvani, 2015), and expertise in communicational, assessment practices (Svendsen et al., 2019) are among the most important topics to include in social work education, which are recognized worldwide. It could be assumed that professional skills development in motivation interview, and other areas mentioned, may help to overcome this tension sphere. It is important to note, that research respondents indicated a lack of effective help methods as a second leading challenge in this case. And it is even more important to further investigate what reasons underlie this result.

Conclusion
Except indefinite, but probably a rather small number of social workers whose professional specification is exclusively work with individuals having alcohol usage problems and whose activities were not captured by this research or reflected only at a small number of incidence; this study may be referred as a detailed and up-to-date picture of social work with individuals having alcohol usage problems in Lithuania.
In general, social work with individuals having alcohol usage problems in Lithuania is more individual intervention-orientated. That is, through the most often used individual case method, direct intervention, provision of information, consulting and mediating general services are most often applied. Intervention orientation also reflects on a high incidence of such special services as social skills development or family consultation. Low acquisition of community, group or network methods show a direction towards individual intervention as well. However, the prevention and policy making functions are relatively weak in this case, considering the low usage of secondary social work methods, such as social action, social welfare, or social research methods.

Limitations
This research is presenting generalized results; therefore, social work in certain organizations providing specialized services to individuals having alcohol usage problems may diminish under a majority trend. It is also important to mention that study data do not represent the individual/personal efforts of social workers in this area. Although, keeping in mind a high tendency towards qualitative research tendency in social work, capturing a more generalized picture, as seen in this quantitative study, is necessary.