Social Work is Advancing Addiction Science Research

May 3, 2021

6 min

Tens of thousands of Americans die from drug use and addiction every year, with overdoses killing over 63,000 people in America in 2016, according to the National Institute on Drug Abuse. Add in deaths linked to alcohol overuse and tobacco, and the number climbs above half a million Americans.

The collective work of several researchers at the USC Suzanne Dworak-Peck School of Social Work, in collaboration with other USC faculty and outside organizations, is advancing knowledge of substance use disorders. Social work has become a hub where researchers and practitioners drive understanding and improve treatment for this disease that impacts millions of families each year.

“Either as a cause or consequence, addiction relates to every problem we deal with in social work,” said John Clapp, professor and associate dean for research and faculty development at the USC Suzanne Dworak-Peck School of Social Work.

Addiction’s complexity

The social work field is uniquely poised to help effect change because of its holistic approach to individual well-being and the public good. According to Clapp, substance use disorder problems are inherently ecological, impacting and being impacted by individuals, families, peers, neighborhoods, communities and public policy in complex and dynamic ways. Untangling those causes and effects and interdependencies is one part of the solution. The other part is understanding that simple solutions may stay out of reach.

“We will not find a one-size-fits-all answer,” said Clapp. Looking at addiction as a genetic, psychological or sociological issue only shows one piece of the overall cause. A comprehensive approach is essential, he said, especially when statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) show alcohol use disorders alone as the third leading cause of preventable death in the world.

A hub for addiction science

The need for a transdisciplinary response to this worldwide crisis was behind the 2018 creation of the USC Institute on Addiction Science (IAS), a joint venture between social work and the Keck School of Medicine of USC, with membership from 10 different schools, colleges and hospitals. Its vision is to strengthen the discipline of addiction science and improve the lives of those touched by the disease. Clapp is co-director of the institute and one of its founding architects.

IAS is quickly becoming the foremost place for a broad effort focused on addiction that brings together researchers from the fields of public health, social work, law, public policy, mathematicians, computer engineers and others in recognition of the promise of new approaches to longstanding problems.

The USC Suzanne Dworak-Peck School of Social Work has eight faculty making substantial contributions to the prevention of addiction-related disorders as members of the IAS: Professor Avalardo Valdez, associate professors Julie Cederbaum and Alice Cepeda, and assistant professors Jordan Davis, Shannon Dunn, Jungeun Olivia Lee, Danielle Madden, and Hans Oh.

“Social work brings one of the broadest perspectives on the underpinnings and solutions to the addiction crisis,” said Adam Leventhal, director of IAS and professor of preventive medicine and psychology at Keck. “By approaching addiction as a health condition and a social justice issue, social work brings to the table the opportunity for high-impact, multi-modal intervention and social policy approaches, which are needed to address the addiction epidemic.”

A holistic approach

Social work faculty are raising the bar in addiction science research, developing new and novel approaches to improving outcomes for those affected by addiction. In a study recently published in Addiction, a multidisciplinary team lead by Davis and Clapp found gender differences in the risk factors for relapse following treatment for opioid use disorder. The study was the first in this field to use machine learning techniques to process large data sets and identify risk factors for relapse, said Davis, who also serves as associate director of the USC Center for Artificial Intelligence in Society (CAIS). The findings may result in more personalized treatment for opioid use disorder with lasting results.

This dovetails with additional research Davis is conducting with computer science engineers at CAIS to collect and input neighborhood and census data into their models in an effort to better understand how these macro variables affect relapse. “We are finding that data points such as crime statistics, population density and concentrated poverty tend to be some of the most important predictors of relapse, over and above individual-level predictors such as impulsivity, motivation or gender,” Davis said.

These findings echo Clapp’s description of addiction as ecological and point to the need for holistic solutions. “These machine learning techniques are helping us gain an apparent picture of what the most important factors are surrounding someone’s recovery,” Davis said. “Environment matters greatly.”

Davis is also collaborating closely with Eric Pedersen, associate professor at Keck School of Medicine at USC, on several research efforts examining substance use among veterans. Most recently, they have assembled a survey group of approximately 1,200 veterans whom they survey quarterly about their well-being. A recently conducted survey of the group found that veterans with PTSD prior to the COVID-19 pandemic were now managing their symptoms with more frequent alcohol and cannabis use. Another joint research endeavor between the two is examining the use of mindfulness smart phone apps to help reduce substance use in Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD and alcohol use disorder.

Where well-being and inequalities intersect

Jungeun Olivia Lee also seeks to decode the network of relationships between socioeconomic status, adverse childhood experiences and drug use. Her experience as a social work practitioner working directly with clients drives her motivation to demonstrate to policymakers what she sees as a linkage between unemployment, economic stress and substance use disorders. She is lead author on a paper published in Nicotine & Tobacco Research that found unemployment may advance nicotine addiction among young adults, rather than the idea that nicotine addiction may lead to unemployment.

Lee’s research interests lie at the intersection of substance use and co-occurring mental health, social inequalities (such as poverty and low socioeconomic status), and adverse childhood experiences. She is interested in combining these three areas of inquiry to explore their influence on addictive behavior that can persist over generations of at-risk families, such as adolescent mothers and their children.

Her memories of working directly with clients struggling with the impact of addiction remain clear in her mind. When Lee hears policymakers and others suggest that individual willpower will solve substance use disorder problems, she has a straightforward response: “People are not born with addiction.” In her view, many factors contribute to the triggered distress, including socioeconomic status and adverse childhood experiences.

Lee is exploring an idea with other IAS researchers to investigate the relationship between financial strain and employment uncertainty and addiction. “Individual circumstances, such as losing a job, certainly influence substance use, but policy-level decisions, such as the generosity of unemployment insurance, can mitigate the impact,” she said.

Transdisciplinary collaboration with social scientists, psychologists and medical researchers at IAS and across the USC campus enriches and amplifies her work. “We are breaking down discipline-specific silos and bringing new and valuable perspectives to this work,” she said. “The synergy is both useful and inspiring.”

Looking ahead

Researchers also hope to spark interest in the field among the next generation. A new minor for undergraduate students in addiction science was introduced at USC in Fall 2020. The minor is an interdisciplinary collaboration of the Keck School of Medicine, the USC Suzanne Dworak-Peck School of Social Work, the USC School of Pharmacy and the USC Dornsife College of Letters, Arts, and Sciences. It is designed to provide students with a transdisciplinary approach to understanding and treatment of the broad spectrum of addiction-related problems.

The goal of addiction science research and education is to improve the long-term effect of addiction treatment and save lives. As society’s understanding of the cause of addiction grows, researchers like those in the school of social work and the IAS strive to bridge the gap between science, practice and policy to positively impact outcomes for those affected by addiction.

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5 min

Local neighborhood conditions are important for children’s brain development

Growing up in a disadvantaged neighborhood is related to children’s brain structure and neurocognitive performance, according to a study published May 3, 2021 in the journal JAMA Pediatrics. It is associated with the brain’s cortical structure and volume as well as how children pay attention, their executive function, reading, flexible thinking, and other tasks that support learning. These differences could potentially contribute to other inequities during adolescence as well as later in life for these children, though there is no evidence that such neighborhood-related differences are fixed or immutable. Children’s brains exhibit plasticity, meaning that they can change and grow in response to learning and experience. The study’s findings shine a spotlight on the larger population trend and do not serve as a predictor of any individual child’s outcome. “This points to the importance of investing in policies and programs that help improve local neighborhoods and to support and empower communities to promote children’s neurodevelopment and long-term health and well-being,” said Daniel A. Hackman, assistant professor at the USC Suzanne Dworak-Peck School of Social Work and lead author of the study. Researchers from the USC Suzanne Dworak-Peck School of Social Work and the Keck School of Medicine of USC used data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from October 2016 – 2018. The ABCD Study is the largest long-term study of brain development and child health ever conducted in the United States. “Disadvantaged neighborhoods may lack quality health services, access to nutritional foods, and well-maintained parks and rec facilities,” said Megan Herting, assistant professor in the department of preventive medicine at the Keck School of Medicine at USC and senior author of the study. “They may also expose residents to more pollutants or social stressors.” In addition to Hackman and Herting, study authors include Dora Cserbik, Jiu-Chiuan Chen, and Rob McConnell of the department of preventive medicine at Keck School of Medicine; Bita Minaravesh of the USC Dornsife Spatial Sciences Institute; and Kiros Berhane of the Department of Biostatistics at Columbia University Mailman School of Public Health. Neighborhood disadvantage and the brain The study participants were 8,598 nine- to eleven-year-old children in 21 sites from the ABCD Study, and includes youth from diverse backgrounds, family income levels and neighborhood environments. Using this ABCD data, the multidisciplinary team of researchers tested whether neighborhood disadvantage is associated with neurocognition and brain structure through the National Institute of Health Toolbox Cognition Battery and magnetic resonance imaging (MRI) scans. Neurocognition refers to specific cognitive functions related to particular neural systems, such as executive function, memory, problem-solving and perception. Executive function is the set of cognitive functions that allows people to select behaviors, make efforts to regulate or control their behavior or thinking in given situations, and to focus on goals despite distractions. Brain structure refers to global and regional measures of the brain’s cortex and subcortex, such as volume and surface area. The researchers found that neighborhood disadvantage was associated with worse neurocognitive performance on nearly all tasks and smaller cortical surface area, as well as cortical volumes and subcortical volumes, across the whole brain. The associations remain after adjusting for family socioeconomic status and largely remain after adjusting for perceptions of neighborhood safety. “Our findings aren't specific to the child's home life, as we accounted for socioeconomic factors at each child's home,” Herting said. “But the research suggests neighborhoods may have different levels of social and educational resources and opportunities that can impact a child's neurodevelopment.” Disadvantaged neighborhoods are those in which people generally have lower levels of income, employment and education. Growing up in these conditions can be stressful for children and adults. However, comparing disadvantaged neighborhoods across the country is challenging to social work researchers, who understand that when looking at national samples they may pick up regional differences for which they must account. Neighborhood similarities and differences The impressive scope and scale of the ABCD study made it possible for these researchers to delve into rich local data that enabled them to understand the similarities and differences of disadvantaged neighborhoods within the context of their cities. Hackman, whose research interests include understanding neighborhoods and the context that children and adolescents grow up in, wanted to be able to look at the research question from both the national perspective as well as the local perspective. “This is the first large, national study of neurodevelopment to determine that the role of neighborhood disadvantage is similar across all regions of the country, and we found that what mattered most were the local differences in neighborhood disadvantage within each city, rather than how cities differ from each other overall” Hackman said. “This highlights the broad relevance of neighborhood disadvantage, and the importance of unique local conditions. His interest was even more piqued when he saw a clear narrative emerge from the data. “The consistency of the data was so compelling,” Hackman said. Though disadvantaged neighborhoods may vary from city to city, the researchers found the associations were largely consistent across 21 metropolitan areas within the U.S. For policymakers, a takeaway is that neighborhoods were related to these important aspects of child development everywhere, and that though each city is different, the unique local conditions are important to address. In addition, the global relationship between neighborhood and overall brain structure and neurocognitive performance suggest that intervention approaches may be most successful if they are comprehensive and focused on improving children’s contexts, rather than narrowly targeted to the development of particular cognitive skills. “This research is important as it not only highlights that neighborhoods matter, but it also suggests that promoting neighborhood equity based on the unique local conditions within cities could be important for the short and longer-term health and overall development of children and adolescents,” Hackman said. According to the study, although the magnitudes of association between disadvantaged neighborhoods and neurocognition and brain structure are statistically small, they are potentially meaningful. One reason is because even small effects may have large consequences as they accumulate over time at a population level. Another reason is because these are comparable to, but smaller, than effect sizes for family socioeconomic status in these models. “There is also considerable evidence of resilience,” Hackman noted, as the authors caution that these associations are not predictive at the individual level. In particular, many youth from disadvantaged neighborhoods outperform their peers from more affluent neighborhoods, and also have larger cortical surface area and subcortical volume as well. In other words, living in a disadvantaged neighborhood is not deterministic and does not automatically predict any pattern of neurocognition and brain structure for any individual. Instead, the association uncovered by these researchers points to more reasons why improvements to neighborhoods can bring positive change. “Future research is needed to determine if our findings are, in fact, attributable to differences in community-based resources or differences in quality of schooling,” Herting said. “However, our findings do add to a growing literature suggesting the importance of neighborhoods and how they may contribute to place-based disparities in health and well-being in America.”

2 min

A Message from Dean Sarah Gehlert on the Derek Chauvin Verdict

When I heard the verdict read at the trial of Derek Chauvin, I was relieved that a change had been made in how excessive violence by police officers has been viewed and treated in courts. This gave me some hope that a door had finally been opened to create change. A single verdict does not even begin to erase all the lives lost over decades of police violence based on prejudice and discrimination. It does however signal that change is happening, or is at least possible, if we are vigilant. It can be a step taken toward ending systemic discrimination by race in how our judicial system considers the actions of police. The wisdom of George Floyd’s seven-year-old daughter, who stated that her dad “changed the world,” has been validated. We also recognize the wisdom and courage of Darnella Frazier, the Minnesota teenager who filmed the event, knowing that what she was witnessing was wrong. When the verdict came in, I was with a group of community activists from three California counties around Los Angeles. While group members expressed some elation for an episode of justice realized, some cautioned that this victory does not mean that all is well. Racism, and the discrimination that it engenders, continues to run rampant through our judicial system. Within the last week we have added the names of Daunte Wright and Adam Toledo to our protests and vigils. We hope this verdict is a turning point, but we will need to work to assure it. It is worth reading a publication from 2018 to understand the role that social work needs to play in ensuring effective and lasting change to our judicial system. In their paper entitled “The Futile Fourth Amendment,” Professor Osagie Obasogie and Postdoctoral Researcher Zachary Newman examine the Supreme Court case that established the standard for court adjudication of excessive force by police, and how this has perpetuated excessive use of force in many communities of color. Protesting alone will not create the change we want to see. It will require change in policy and practices to establish equal protection for all under the law. This is a moment for us as social workers to seize. We must not wait to act until there is another incident of police brutality or an unfair trial. We should use this moment to move forward with renewed conviction in our beliefs, using our training in policy, community organizing, management and planning, and clinical practice. We should always be the voices demanding equality under the law, saying that an end to systemic racism is possible. The world is ready for change and social work should be leading it, with those whom we serve. We should be the champions of social justice for the well-being of individuals, families and communities through innovative teaching of evidence-informed and practice-based skills, and pioneering transformative research. If not us, then who? Sarah Gehlert Dean

6 min

New CBS Sitcom "United States of Al" Taps Experience of Social Work Student and Veteran

On April 1, 2021, CBS premiered United States of Al - a new comedy from producer Chuck Lorre (Two and a Half Men, Big Bang Theory) about a Marine combat veteran struggling to readjust to civilian life and the interpreter who served with his unit in Afghanistan and has just arrived to start a new life in America. The show explores the relationship between these two men and how they help each other adjust to their new lives. So, what does a CBS sitcom have to do with the USC Suzanne Dworak-Peck School of Social Work? Enter Master of Social Work (MSW) student Josh Emerson, who landed in the right place at the right time through his field internship at No One Left Behind. No One Left Behind (NOLB) is an all-volunteer, national nonprofit organization that supports recipients of the Special Immigrant Visa (SIVs), and those pursuing an SIV. The founders of No One Left Behind believe the U.S. has a moral obligation to protect these interpreters, and their families, who served side-by-side with American soldiers. Emerson, a veteran of the U.S. Army who deployed to Iraq and Afghanistan, is very familiar with Iraqi and Afghan interpreters. “I went on missions with these interpreters, got to know them, built relationships with them,” he said. “I was so very happy to be able to work with them in this capacity. In addition to providing resources for SIV ambassadors living in the United States, NOLB advocates on behalf of the SIV population to the executive and legislative branches of government provides subject matter expertise to the media, and partners with U.S. businesses to provide opportunities for what they call “this next generation of Americans.” Alea Nadeem, MSW ’15, is a board member of NOLB and reached out to USC with a field internship opportunity for social workers to do macro-level clinical work in a nonprofit setting. Nadeem became Emerson’s field instructor. “What Josh has brought to No One Left Behind has never been brought to the board before,” Nadeem said. “They now see the value in social work.” Bringing the issue to a larger audience Chase Millsap, a consultant and writer on United States of Al, is a former board member of No One Left Behind. “I am still very supportive, impressed and proud of all the work the NOLB team does on a daily basis,” he said. A veteran of the U.S. Marine Corps and U.S. Army Special Forces, he holds a master’s degree from USC Sol Price School of Public Policy. "USC helped me to learn the tools about how to connect entertainment and policy,” Millsap said. “United States of Al is a perfect example of those two worlds coming together in a powerful (and funny) way.” Millsap’s idea was to bring the issues around SIVs into America's living rooms, in a way that would make them relatable. Emerson’s experience as a veteran, his clinical and project management skills obtained through his social work studies and his stellar ability to work one-on-one with SIV recipients and applicants allowed him to inform the show’s stories with a wide breadth of knowledge. Emerson joined James Miervaldis, chairman of the NOLB board, in helping the writers and actors on the show understand the SIV issues, the ways in which NOLB provides assistance and advocacy, and sharing funny stories of cultural differences between Afghans and Americans. Emerson and Miervaldis have also been able to include some of NOLB’s SIV ambassadors in the process, those with an SIV who have already established themselves in the U.S. and are contracted by NOLB to help others assimilate. “They’re talking to the exact people they're portraying,” Emerson said. Nadeem sees Emerson’s contribution to the show as another platform through which to educate. “There are a lot of different tentacles to social work, and it may not seem like the most obvious place in TV and film, but it is,” she said. The show itself touches on everything social workers value ― service, challenging social injustice, dignity and worth of a person, the importance of human relationships and integrity. “This just makes so much sense that a social worker would be involved in this show because that's what we're always trying to communicate to a larger audience,” Nadeem said. “Through this show, you can make a greater impact for these folks to sort of assimilate them to be American citizens, and then also have the whole world appreciate their culture and appreciate what they've done for our nation to keep U.S. service members safe.” A valued member of the team Emerson, a father of five who resides in New Hampshire, knew he wanted to work with veterans after leaving military service. He felt that an MSW was the most versatile degree for this and chose the USC Suzanne Dworak-Peck School of Social Work because of its military social work track. “I think to be a good social worker you need to have experience in life,” Emerson said. “To have seen some things, or been through some things, to understand the population you're dealing with and what they're going through.” When Emerson began his internship at NOLB in 2020, Miervaldis immediately began working with him to focus on SIVs who recently had come to the United States. The first case Miervaldis assigned to Emerson was an SIV family with two young children who needed emergency surgery at a specialty hospital in Washington D.C. “This SIV packed up his family, his pregnant wife and the two kids, used up all his money to take them by bus from Texas to D.C. in the middle of a pandemic and ended up in a bad part of town,” Miervaldis said. As the SIV’s assigned caseworker, Emerson established a relationship and trust with the SIV, helped him obtain safe housing and a job interview, and coordinated details for the children’s surgery with the hospital. “He’s gone and done everything,” Miervaldis said. “We are very proud of Josh’s initiative and empathy for a family in such need. No One Left Behind is the safety net for our allies.” Last year, NOLB helped over 600 families with visas and resettlement. “Josh has exceeded all our expectations and done so while communicating with clients who speak in broken English, Dari and Pashtu, struggling during a pandemic,” Miervaldis said. “His professionalism and empathy are great credits to USC. We would not be where we are today without him. That is not hyperbole.” Miervaldis hopes NOLB will have more social work interns from USC to continue Emerson’s work. For him, Emerson’s project management skills have been the greatest asset, creating a new process for how NOLB provides help for SIV families. “We told Josh, you're a pathfinder, you're a pioneer,” Miervaldis said. “We need to figure out very quickly what works, what doesn't work, and he took it and said, ‘okay, point me in the right direction.’ He’s very much valued as a member of the team.” From advocacy to TV No One Left Behind gets about 20 messages every day from Iraqi or Afghan interpreters who served with U.S. forces in their countries, and who now receive daily death threats from the Taliban. “They're not allowed to live in their homes or their neighborhoods anymore because they helped the U.S.,” Emerson said. “Now the U.S. is withdrawing from all these countries, and the Taliban and terrorist activities in general are picking up, and these people are getting pressured and killed. NOLB has over 300 cases of SIVs who have been killed waiting for their visas.” Emerson hopes that the added exposure from United States of Al will bring awareness particularly to service members about what these interpreters are experiencing and how they can help. One of the requirements for an SIV is a letter of recommendation from the U.S. service member with whom they served, and those have been the most difficult items for SIV applicants to secure. “I have been able to provide some input to what should be addressed in the show,” Emerson said. “It's interesting to see how advocacy on an issue can turn into something this large scale.” See more news from USC Suzanne Dworak-Peck here.

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