Challenges of Living: A Multidimensional Working Model for Social Workers


Elizabeth D. Hutchison, Holly C. Matto, Marcia P. Harrigan, Leanne W. Charlesworth & Pamela A. Viggiani

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  • Chapters
  • Front Matter
  • Back Matter
  • Subject Index
  • Dedication

    In memory of Bill Reid, our model of lifelong learning.

    To our students, whose questions and insights facilitate our reflective practice as educators.


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    Like any writing project, the ideas in this book have been incubating for a number of years. Over those years, we have been informed by each others’ work on various other projects and by our conversations with each other. Our ideas have also been shaped by the work and contributions of many others who are far too numerous to begin to call out. For the senior author, the seeds of this book were planted during collaborative curriculum planning with colleagues at Virginia Commonwealth University and enriched, particularly, by her several years of cherished collaboration with Stephen Gilson, who is now on the faculty at the University of Maine. We are grateful to Stephen for his contributions to our understanding of biological contributions to human behavior and his keen sense of social justice. Marcia Harrigan expresses her gratitude to Drs. Kia Bentley, Janice Berry-Edwards, Rosemary Farmer, and Joe Walsh for the gracious sharing of their own scholarship and for their suggestions that helped to shape her ideas.

    We are grateful to Dean Frank Baskind at Virginia Commonwealth University and Professor Virginia David, Chair of the Department of Social Work at Nazareth College, for supporting us in all of our endeavors. The senior author is grateful to Dean Baskind and her colleagues at Virginia Commonwealth University for the opportunity to be on research leave in the final weeks of completing the book. We all owe a debt of gratitude to the library staffs at Virginia Commonwealth University and Nazareth College, recognizing that their advancements in making materials electronically accessible lightened our load and gave us more snippets of time to connect with our families.

    We are lucky to be working again with the folks at Sage. Art Pomponio was a cheerleader in the early stages of bringing our incubating ideas into written form, and Kassie Graves has been a very competent, focused, yet gentle shepherd through the last stages of turning a once unwieldy manuscript into a book. At a key point, Jerry Westby greased the wheels. Veronica Novak was a constant throughout the long months and diligently did her part to keep the project moving. When the drafting and redrafting finally came to an end, Sarah Quesenberry worked the magic of turning words into a book. We were pleased to have Barbara Coster's competent copyediting assistance once again. There are many others at Sage who work behind the scenes doing crucial tasks that are invisible to authors. We sense your presence and appreciate all that you do.

    We are also grateful for the support and encouragement of students, family, and colleagues. They enrich our lives and provide us with protective webs of connectedness. Chuck, thank you for waiting patiently weekend after weekend for Marcia to be (really) finished with her chapters. Chuck and Hutch, thank you for your good humor while assisting us with the various computer glitches.

    Finally, we are grateful to the following reviewers who read an earlier draft of the book and provided helpful feedback:

    • Parris Baker, Gannon University
    • Sandra Chesborough, St. Cloud State University
    • Ann Dannerbeck, University of Missouri
    • Dorie J. Gilbert, University of Texas at Austin
    • Richard A. Longoria, University of Texas at Austin
    • Samuel MacMaster, University of Tennessee
    • Kimberly A. Mann, Chicago State University
    Elizabeth D.HutchisonHolly C.MattoMarcia P.HarriganLeanne W.CharlesworthPamela A.Vigianni
  • Glossary

    • Absolute poverty: A term used to describe poverty in economic terms. Measures of absolute poverty utilize formulas that take into account monetary assets only. It is not affected by changing norms and needs within a society. An example of this approach is Molly Orshansky's economy food plan.
    • Acquired immunodeficiency syndrome (AIDS): A syndrome that occurs when the HIV infection has severely damaged the immune system, making the person vulnerable to becoming very ill or dying from a wide range of diseases or infections that others can fight off.
    • Adipocytes: Cells within the body that store fat.
    • Adiponectin: A protein produced by fat cells that blocks production of blood glucose in the liver and increases muscle activity to make energy.
    • Adolescent-limited group of violent offenders: A large group of people who engage in aggressive and violent behavior only during adolescence.
    • Afrocentric perspective: A cultural perspective with principles that embrace a collectivist worldview and spiritual base. The Afrocentric perspective suggests that violation of these fundamental principles (e.g., spiritual alienation and social isolation) may help to explain a community's substance abuse behavior.
    • Amygdala: A brain structure that is responsible for assigning “emotional value” to an event. The amygdala is the filter that responds to threatening stimuli and puts the body on high alert if danger is assessed, charging the body with action. The amygdala, in some cases, may become overstimulated by innocuous stimuli that mimic an original traumatic event but yet which are not a current threat.
    • Antecedent factors: In research on risk and protection, those risk or protective factors that came before the troublesome situation.
    • Antiretroviral therapy (ART): Treatment with drugs that inhibit the ability of the human immunodeficiency virus (HIV) to multiply in the body.
    • Barebacking: The deliberate practice of unprotected anal intercourse (UAI), thought to play a role in the high rates of HIV among men who have sex with men.
    • Bariatric surgery: Surgery on the stomach and/or intestines to help the person with extreme obesity lose weight.
    • Best practices: Programs or activities considered exceptional models for others to follow. At the organizational or individual level, best practices typically have a solid body of experience or empirical support indicating that when implemented as intended, the approach reliably leads to a desired result.
    • Biosocial approach (community violence): A theoretical approach that suggests that violent behavior occurs when biological vulnerability interacts with social vulnerability.
    • Bipolar depression: A mood disorder that includes major depression interspersed with periods of mania or hyperactivity or agitation.
    • Body mass index (BMI): An index of a person's weight in relation to height with established cutoff points to designate normal, overweight, obese, and morbidly obese states.
    • Child and Family Services Reviews: Reviews of state child and family service programs to examine compliance and support overall system improvement in the areas of safety, permanency, and family and child well-being. Mandated by the 1994 Amendments to the Social Security Act (and outlined in the 2000 Federal Register), the process and products are administered by the Children's Bureau, which is part of the Administration for Children and Families within the U.S. Department of Health and Human Services.
    • Child fatality review boards: Locally administered boards that focus on systematic examination of all child deaths within a designated geographic area. They typically focus upon a systematic approach to understanding and documenting the causes and circumstances of each child death in the region. Additional goals often include enhanced cross-agency communication and development of policies and programs to improve child health and safety in order to prevent child fatalities.
    • Cholecystokinin: Hormone that signals that the meal is over and triggers the release of digestive enzymes from the gall bladder and pancreas.
    • Cognitive-behavioral therapy (CBT): A psychotherapeutic approach with known effectiveness for treating major depression; focuses on negative perceptions of the self, negative thoughts about the environment, and negative view of the future.
    • Cognitive damage: Significantly diminished capacity for judgment and reasoning due to impaired brain functioning. Among children, such damage detrimentally impacts the otherwise naturally expanding intellectual capacity to perceive, evaluate, understand, and communicate information.
    • Cognitive-neurobehavioral model of alcoholism: A model that suggests alcoholism may lead to heightened reactivity of the limbic system, which impairs the regulatory functioning of the prefrontal cortical structures that, ultimately, leads to problems in behavioral control.
    • Collective efficacy: The capacity of residents of a neighborhood to achieve social control over the environment and to engage in collective action for the common good; involves a working trust, a shared belief in the neighborhood's ability for action, and a shared willingness to intervene to gain social control.
    • Collectivist: Typically used to describe certain aspects of a culture's basic values and beliefs; refers to an emphasis on social connections, in particular the importance of prioritizing group rather than individual goals and needs and an emphasis on relationships among family and community members.
    • Colonialism: The practice of dominant and powerful nations to go beyond their boundaries utilizing military force to occupy and claim less dominant and powerful nations and to impose their culture, laws, and language upon the occupied nation through the use of settlers. The purpose of colonization is for the more powerful nation to gain control over the markets, resources, and labor within the colonized nation
    • Community violence (CV): Violence between unrelated individuals who may or may not know each other; takes place outside the home of the perpetrator.
    • Comorbidity: Substance use disorder that occurs simultaneously with another mental health condition (e.g., substance dependence and posttraumatic stress disorder).
    • Conditioning theories: Based on stimulus-response chains; suggest that drug-related behaviors are linked to specific cues that may trigger a physiological reaction that heightens craving response and ultimately drives the drug use behavior.
    • Coping: Efforts made by individuals, families, or other social systems to master the demands of stress, including the thoughts, feelings, and actions that constitute those efforts.
    • Cortisol: A steroid hormone that is secreted by the adrenal cortex as part of the body's response to stress; can become disturbed by chronic stress, possibly leading to depression.
    • Craving: An intense urge to drink or take drugs, often intensified in the presence of stimuli (i.e., triggers) that are associated with substance use.
    • Cue reactivity: Physiological and psychological reactions that are directly related to drug/alcohol cues (e.g., sights, sounds, smells, visual images related to substance use).
    • Cultural relativism: The position that beliefs or behaviors in a particular culture should not be judged by the standards of another culture.
    • Culture of honor: A concept used to explain violent behavior in some cultural groups; proposes that Scotch Irish immigrants brought a culture that prescribed violence as the appropriate reaction to disrespect and insult, the appropriate defense of manhood and reputation, to the southern region of the United States.
    • Culture of poverty: A term coined by Oscar Lewis to legitimize the unique culture and way of life of those who are impoverished. The term was popularized by the Moynihan report (Senator Daniel Patrick Moynihan's 1965 report on the black impoverished family). It has changed from its original meaning to one that looks at impoverished people as having cultural deficits.
    • Declarative memory: Memory that is accessible to verbal recall and is a cognitively conscious awareness. Declarative or “explicit” memories typically involve the hippocampus and are characterized by recalling of facts and a temporal ordering of events.
    • Defense mechanisms: Unconscious, automatic thought processes that enable a person to minimize perceived psychological threats or keep them out of awareness entirely.
    • Developmental domains: Areas of growth and development; the typical major domains examined when assessing a child's developmental progress are physical/motor, emotional/psychological, social, and cognitive.
    • Developmentally appropriate parenting: Parenting that reflects understanding of and responsiveness to the child's developmental stage-related needs and abilities in each developmental domain.
    • Differential association theory: A theory that focuses on the important role of deviant peers in modeling and reinforcing aggression and violence, particularly during adolescence.
    • Diffusion of innovation model: A model of HIV prevention, in which attention is paid to how to diffuse a health behavior innovation, such as condom use or clean needle use, throughout a social network.
    • Disease concept: The “medical model” of addiction that explains substance use disorders and drug addiction as a brain disease.
    • Disorders of extreme stress (DES): Disruption in affect regulation, attention, self-perception, interpersonal relationships, and meaning schemas that occur in people who have experienced chronic and intense traumatic events.
    • Dissociation: An unconscious psychological detachment from an event, situation, person, and so on, often operating as a primitive defensive response to a traumatic event. This symptom is often found in people who have PTSD and have undergone chronic traumatic exposure.
    • Dissociative disorder: A type of mental state characterized by a sudden, temporary change in the normal functions of consciousness, identity, and memory.
    • Distal environment: The environment beyond the family.
    • Dopamine: A neurotransmitter that plays a part in mood, cognition, and motor activity.
    • Double depression: The presence of dysthymia on which major depression is superimposed.
    • Dysthymic disorder: A mood disorder that is less severe than major depression and may be more chronic.
    • Earned Income Tax Credit (EITC): A tax program that provides the working poor with a tax credit or return at the end of the fiscal year. The credit/refund varies depending on income and family size.
    • Ecological model (Swinburn and Egger): The simultaneous consideration of three major influencing factors: biological (genes, hormones, age, gender, ethnicity, and drugs), behavioral (sedentary lifestyle and overconsumption of food), and environmental (physical, economic, political, and sociocultural).
    • Economy food plan: The least expensive way to buy an adequate amount of nutritionally sound food for a family; the basis of poverty measure used in the United States; poverty is calculated as 3 times the economy food plan.
    • Electroconvulsive therapy: Administration of a mild electrical current to the brain to treat a major depressive disorder that is unresponsive to other interventions.
    • Emotional intelligence: Ability to process information about emotions accurately and effectively and consequently to regulate emotions in an optimal manner.
    • Empirical research: A careful, purposeful, and systematic observation of events with the intent to note and record them in terms of attributes, to look for patterns in those events, and to make our methods and observations public.
    • Epidemiology: The study of the distribution of disease and health in a population; can identify causal factors of diseases, social problems, and troubling situations as well as identify the different patterns of occurrence across age, gender, socioeconomic status, cultural groups, geographic regions, and so on.
    • Expectancy theory: A psychological theory that proposes that individuals behave in ways because they expect their behavior will yield a certain result.
    • Externalizing symptoms: Responses to stressors that involve behaviors directed at the external world, such as aggression and delinquency.
    • Extreme poverty: A measure developed by the World Bank to count the number of poor worldwide. Extreme poverty refers to people who do not have regular access to food, shelter, clothing, health care, or education. The World Bank defines the extreme poor as having U.S. $1 per day per person or less in purchasing power. The measure for extreme poverty has been widely adopted by international agencies, including the United Nations.
    • Family preservation programs: Efforts to provide knowledge, resources, and other supports to help families stay intact. Government-sponsored family preservation programs are often crisis-oriented, home-based, intensive, and time-limited, with a focus on preventing imminent foster care placement or abandonment.
    • Family support programs: Community-based preventive services, including but not limited to child care and parenting support, designed to reduce stress and help families care for their children before crises occur.
    • Feminization of poverty: A term that refers to the trend starting in the 1970s of a disproportionate number of females (and their children) experiencing poverty as a result of gendered roles and discrimination within society.
    • Fetal origin hypothesis: The proposition that persons who experienced chronic malnutrition prior to a period of adequate nutrition are at greater risk of gaining weight as children.
    • Food insecurity: “The limited or uncertain ability to acquire acceptable foods in socially acceptable ways” (Townsend, Peerson, Love, Achterberg, & Murphy, 2001, p. 1739).
    • Gastric bypass: A surgical procedure to treat obesity that creates a pouch from the upper stomach that allows ingestation of only two to four tablespoons of food and is connected to the lower portion of the small intestine. The remaining portion of the stomach as well as up to 16 inches of the small intestine do not receive food but are reattached to the large intestine for drainage.
    • Ghrelin: A hunger hormone that stimulates appetite by signaling the hypothalamus in the brain that it is time to eat.
    • Globesity: The rising prevalence and incidence of obesity worldwide.
    • Habitus: Individual choices made within the confines of a societal structure defined by Pierre Bourdieu as a “set of dispositions developed through a personal history of self-reinforcing experiences of one's social location.”
    • Health belief model (HBM): A model for understanding health-related behaviors; proposes that people will engage in health-related behaviors if they believe that a negative health condition can be avoided, expect that taking a recommended action will avoid a negative health condition, and believe that they can successfully engage in the recommended health behavior.
    • Heritability: Contribution that heredity makes to an observed behavior.
    • Highly active antiretroviral therapy (HAART): A combination of several antiretroviral drugs given together to slow the progression of the HIV infection.
    • Hippocampus: The brain structure that helps to contextualize memory in time and place and is involved in the conscious recall of facts and events associated with memory. The hippocampus serves to facilitate linguistic evaluation of experience. Some studies have found hippocampal impairment in people with PTSD.
    • Human capital theory: Individual skills, abilities, knowledge, and health that aid an individual in gaining wealth.
    • Human immunodeficiency virus (HIV): A special kind of virus, called a retrovirus, that stores its genetic information in RNA rather than DNA form but has the ability to replicate by converting to DNA form; the virus attacks the immune system and causes AIDS.
    • Hypervigilance: A state of intense preoccupation with surrounding stimuli and a heightened alertness to one's environment, such that focal attention to other aspects of one's surroundings is limited. This is a common symptom of people who have PTSD.
    • Implantable gastric stimulation (IGS): Also called gastric pacing to treat obesity, it is a minimally invasive surgical implantation of a battery-operated pacemaker-like device that stimulates the stomach to simulate fullness.
    • Incidence: The rate of new occurrences of a troubling situation within a given time period.
    • Individual or contact racism: Discrimination based on race expressed on the individual level that results in unequal treatment and social segregation.
    • Individualistic: Typically used to classify certain aspects of a culture's basic values and beliefs; refers to an emphasis on the importance of independence and attainment of individual goals, personal initiative, and achievement.
    • Information-processing theory: A sensory theory of cognition that sees information flowing from the external world through the senses to the nervous systems, where it is coded.
    • Institutional racism: Racism carried out and perpetuated by sociocultural institutions (e.g., schools, banks, governmental agencies) that serves to exclude people of color from equal access and opportunity, serving to maintain and or worsen their societal disadvantage.
    • Internalizing symptoms: Responses to stressors that involve internal symptoms such as withdrawal, somatic complaints, anxiety, or depression.
    • Interpersonal intelligence: Understanding other people.
    • Interpersonal neurobiology: An approach to understanding trauma that focuses on the relationship between brain structure development and functioning and interpersonal relationships.
    • Interpersonal therapy (IPT): A psychotherapeutic approach with known effectiveness for treating major depression; focuses on the relationship between depression and interpersonal relations.
    • Intrapersonal intelligence: Having an understanding of yourself.
    • Leptin: A naturally occurring protein produced by fat cells that signals the brain (hypothalamus) that there is sufficient fat in the body and therefore appetite decreases.
    • Life-course-persistent group of violent offenders: A small group of people who continually engage in a high level of aggressive and violent behavior across the life course and across social contexts.
    • Macro-level general strain theory (MST): A theory used to explain the differential levels of community violence in different neighborhoods. The major thesis is that the aggregate level of strain within a neighborhood affects the level of violence in the neighborhood.
    • Macrophages: Immune system cells that are found in fat tissue that provide a link between obesity and inflammation that underlie certain cancers and heart disease.
    • Major depressive disorder (MDD): Also termed unipolar depression, a mood or brain disorder characterized by persistent feelings of sadness or emptiness that must meet additional criteria established by the American Psychiatric Association.
    • Masked depression: Attributing the behaviors, thoughts, and mood of major depression to developmental characteristics of children and others.
    • Men on the down low (DL): Men who have unprotected sex with both men and women.
    • Metabolic syndrome: A combination of both obesity and coronary factors that place a person at higher risk of major health consequences that are life threatening.
    • Metacognition: Thinking about one's own thinking.
    • Minor physical anomalies (MPAs): Very minor structural deviations found in many areas of the body. Common examples are asymmetrical ears, curved fifth fingers, wide-set eyes, and large gap between the first and second toes. They indicate disruption in fetal development and are thought to be observable indicators of central nervous system dysfunction.
    • Moderate poverty: A measure developed by the World Bank to measure the number of poor worldwide. Moderate poverty refers to people who are just barely able to meet their basic needs of food, shelter, and clothing. The World Bank defines the moderately poor as having between U.S. $1 and $2 a day per person of purchasing power. The measure for moderate poverty has been widely adopted by international agencies, including the United Nations.
    • Neocolonialism: The practice of dominant and powerful nations to go beyond their boundaries utilizing international financial institutions such as the World Bank and the International Monetary Fund to exert influence over impoverished nations by imposing their culture, laws, and language upon the occupied nation through the use of financial incentives (loans) and disincentives. The purpose of neocolonialism is for the more powerful nation to gain control of the markets, resources, and labor within the less powerful nation.
    • Neuroimaging tools: Methods and techniques used to obtain images of the structure and functions of the nervous system, include magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), and proton spectroscopy.
    • Neurotransmission: The process of transporting nerve signals from brain cell to brain cell.
    • Neurotransmitters: Chemicals that transport signals between nerve cells or between nerve cells and muscles.
    • Nondeclarative memory: Memory that is not accessible to verbal recall and is not in cognitively conscious awareness. Nondeclarative or “implicit” memories exist in sensory format, such as visual images or bodily sensations.
    • Norepinephrine: A neurotransmitter that is secreted by the adrenal glad that helps to regulate mood as well as impacting learning and memory.
    • Obesity: The point at which an adult's BMI is > 30.0, and/or WC > 40 inches for men, 35 inches for women, and/or WHR is > 1.0; and for children, weight falls in the > 97 percentile.
    • Obesogenic environment: Factors external to a person who is obese that create or foster obesity, such as lack of a variety of foods, prohibitive food costs, easier access to high-fat and salted foods, lack of safety to engage in outdoor activities, and other ecological contributing factors.
    • Orbitofrontal cortex: A brain structure that is responsible for linking the limbic system (emotional material) to the prefrontal cortex (cognitive capacities) and helps a person to self-regulate. This structure has been found to be influenced by interpersonal relationships and attachment processes.
    • Pandemic: An epidemic that is spread over an especially wide area.
    • Paradigm: A scientific discipline's general orientation or way of seeing its subject matter.
    • Perinatal complications: Complications of pregnancy and childbirth such as pregnancy complications, low birth weight, and delivery complications.
    • Posttraumatic stress disorder (PTSD): An anxiety disorder resulting from exposure to a life-threatening traumatic event characterized by reexperiencing symptomotology, intrusion of trauma-related stimuli, a numbing or restriction in affect, and hypervigilance.
    • Prefrontal cortex: The part of the frontal lobe of the brain responsible for motivation, attention, and sequencing of actions.
    • Prevalence: A rate of the number of existing cases (of a troubling situation) at a particular point in time divided by the total population studied.
    • Primary prevention: Efforts that are universal in scope and target the general population; applied to child abuse and neglect, such efforts can be thought of as attempting to prevent maltreatment from ever occurring.
    • Protective factors: Resources that decrease the probability of developing and maintaining problem conditions.
    • Proximal environment: The family environment.
    • Psychobiological attachment theory (PAT): Theory that proposes that the infant's nervous system requires attachment to a dependable and nurturing caregiver to develop normal regulatory systems and that disruptions in early attachment lead to disruptions in neurobiological regulatory systems.
    • Relapse prevention model: A substance abuse treatment model that helps clients to identify and successfully manage high-risk situations related to substance use, in order to prevent relapse.
    • Relative poverty: A term used to describe poverty in economic terms. Measures of relative poverty utilize formulas that include changing norms and needs within a society and are responsive to these changes.
    • Religion: A systematic set of beliefs, practices, and traditions observed within a particular social institution over time.
    • Residual social welfare programs: Social welfare programs that target citizens most in need of resources.
    • Resilience: Healthy development in the face of risk factors.
    • Resistin: A hormone produced by fat cells that is thought to regulate insulin and energy storage.
    • Restorative justice: An approach to public criminal justice policy that treats crimes as wrongs against individuals and communities, rather than against society, and emphasizes making amends to wronged parties.
    • Retributive justice: An approach to public criminal justice policy that focuses on paying one's “debt to society” matching the severity of the punishment to the seriousness of the offense; the type of justice on which criminal justice policy is based in the United States.
    • Risk factors: Events or situations that increase the probability (likelihood) of developing and maintaining problem conditions.
    • Safety net or social safety net: A set of governmental policies intended to prevent citizens from experiencing severe poverty. The social safety net often includes but is not limited to governmental health, income support, jobs, and educational programs.
    • Satiety: The inhibition of food consumption at the end of a meal and before the next meal.
    • Secondary prevention: Programs that target individuals or families identified as at heightened risk of maltreatment; this type of prevention work focuses on early identification in an attempt to limit the extent or severity of the maltreatment.
    • Self-efficacy: Personal beliefs in the ability to accomplish a goal; in the area of substance abuse, one's personal beliefs in being able to effectively resist using drugs.
    • Self-efficacy model of safer sex behavior: Model proposed by Albert Bandura; proposes that safer sex behaviors are not simply a result of knowledge or skills but of a process of integrating knowledge, expectancies, emotional states, social influences, and past experiences to develop a judgment about one's ability to master the challenges of sexual decision making and negotiating sexual relationships.
    • Self-regulation: The capacity to self-soothe and manage emotions under extreme stress conditions or high-risk situations.
    • Serotonin: A neurotransmitter that is a derivative of an amino acid that helps to regulate mood as well as motor activity, anxiety, and thought processes.
    • Sex trafficking: Movement of persons—typically girls and women—across borders for the purposes of sexually exploiting those persons. Diversity in form and definition exists; may include the recruitment, harboring, transportation, provision, or obtaining of a person for the purposes of any type of sexual exploitation.
    • Social capital: A network of relationships between people and various institutions that serves to financially advantage or disadvantage individuals.
    • Social exclusion: The political, economic, social, and cultural marginalization of a group of people based on a group characteristic such as class, race, or gender.
    • Social learning theory (community violence): A theoretical approach to community violence that suggests that some children develop a pattern of cognition that supports social aggression.
    • Social location: Where a person fits in a system of social identities such as race, ethnicity, gender, social class, sexual orientation/sexual preference, religion, ability/disability, and age.
    • Social network approach (to HIV transmission): An approach that is interested in how HIV is transmitted through sexual and drug networks and how to change the pattern of sexual and drug behavior in HIV high-risk networks.
    • Social welfare programs: Governmental policies and programs intended to care for citizens’ needs. Policies and programs can range from health care to education. Nations structure their social welfare programs differently, based upon history, culture, and political will. Some nations favor universal social welfare programs, while others favor means-tested programs.
    • Socially constructed: An approach focusing upon how people socio culturally learn and label the meaning of self, others, and all phenomena; linked to the social constructionist theoretical perspective.
    • Somatization: Psychological material that becomes expressed as physical problems or symptomotology. This is a common symptom in people who have experienced extreme stress and/or have PTSD.
    • Spirituality: A personal search for meaning, purpose, connection, and morality.
    • Stomach banding: A surgical procedure typically done laparoscopically that places a band around the upper portion of the stomach, creating a small pouch that is then connected to the lower intestine.
    • Stress vulnerability model: A model that proposes that stress impacts the body's physiological response system (e.g., produces changes in stress hormones and brain structure function), which leads to drug craving. This model suggests that stress operates along a similar neural trajectory as direct exposure to the drug itself, and therefore stress in isolation from the drug can produce drug-like cravings and subsequent behavioral response to use.
    • Structural racism: Institutional policies that appear to be race neutral but which, in effect, work to maintain the status quo because of the inequalities created by historical institutional racism.
    • Substance abuse: Impairment in major life areas such as work, interpersonal relationships, educational, recreational, financial, health, and so on related to continued substance use and an inability to quit despite experiencing adverse consequences.
    • Substance dependence: Impairment in major life areas such as work, interpersonal relationships, educational, recreational, financial, health, and so on related to continued substance use and an inability to quit despite experiencing adverse consequences. Substance dependence is also marked by tolerance and withdrawal.
    • Syndemic: A set of linked health problems that interact synergistically
    • Telescoping: The phenomenon that women develop more physical symptoms and problems from substance use, and in a shorter period of time, as compared to men.
    • Tertiary prevention: Programs that target families in which a problem like child maltreatment has already occurred or is occurring. This type of prevention generally focuses on stopping the maltreatment, facilitating recovery from its effects, and developing supports and strengths to prevent its return.
    • Theory: A system of concepts and hypotheses designed to explain and predict phenomena.
    • Theory of reasoned action: A theory of health-related behaviors that assumes that humans are usually rational, use information in a systematic way to solve problems, and consider the implications of their behavior before taking action; focuses on intentions rather than beliefs and attitudes.
    • Tolerance: A body's need for higher dosages of the drug to achieve the same effects, in a person who is substance dependent.
    • Traditional masculinity ideologies: A theory that suggests that traditional beliefs about appropriate masculine behavior can put men and their sexual partners at risk for sexually transmitted diseases such as HIV. These traditional beliefs are thought to encourage men to be sexually assertive, always ready to have sex, view sex primarily as pleasurable and recreational, perceive penetration as the goal of sex, control all aspects of sexual activity, and have multiple sex partners.
    • Transtheoretical model (TTM): A readiness to change model that explains movement toward behavioral change as progressing through various stages, to include precontemplation, contemplation, preparation, action, maintenance, and relapse.
    • Triple reuptake inhibitors (TRIs): A class of pharmacological agents currently under development that target serotonin, norepinephrine, and dopamine for the treatment of major depression.
    • Twelve-step program: A self-help program with wide membership that is based on sponsorship and a careful following of the guiding 12-step principles that undergird the program.
    • Type I trauma: Trauma that is characterized by one event.
    • Type II trauma: Trauma that is characterized by more than one event, such as ongoing or continuous child sexual abuse.
    • Unipolar depression:Seemajor depressive disorder.
    • Universal social welfare programs: Social welfare programs that benefit all citizens regardless of income, age, gender, race, and so on. Examples include universal health care, universal child care, and universal free education.
    • Variable expressivity: Differences in the way a gene manifests itself in one person in comparison to another person who has the same gene.
    • Vertical transmission: Transmission of HIV from an HIV-infected mother to a fetus or infant.
    • Waist circumference (WC): The measure of a person's waist in either centimeters or inches.
    • Waist-to-hip ratio (WHR): The measure of the waist in relation to the measure of the hip circumference as a risk indicator of overweight or obesity when it is > 1.0.
    • Withdrawal: The body's physical reaction to stopping use of a drug when a person has become drug dependent.


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