Transcript Brotherhood_SocialReintegration

SOCIAL REINTEGRATION:
CONCEPT, RELEVANCE, MEASURES
AND EXAMPLES OF INTERVENTIONS
P2P study tour, Brussels, 18 May 2011
INTRODUCTION TO THE PROJECT
Currently no up-to-date information available on social
reintegration in the EU → Liverpool John Moores University
(LJMU) have been commissioned by the EMCDDA to prepare a
review on social reintegration
Aims of the project:
 To produce an EMCDDA Insights publication on “Social
reintegration and reduction of social exclusion of drug users –
Improving labour market participation of drug users in
treatment”
 To provide a typology of current approaches to promote social
reintegration in the EU and in the literature, with an indication
of their evidence of effectiveness
 To construct a set of recommendations on social reintegration
for policy makers, professionals, practitioners, researchers
THE NEED FOR
SOCIAL REINTEGRATION
SOCIAL EXCLUSION AND DRUG USE

Aim of social reintegration is to prevent social exclusion

Social exclusion: “inability to participate effectively in economic,
social, and cultural life, and, in some characteristics, alienation and
distance from the mainstream society” (Duffy 1995)

Drug use is associated with social exclusion but the nature of their
relationship is complex (e.g. causality?)

Common to focus on problematic drug users (PDU) (i.e. injecting
drug users, long-term/regular users of opioids, cocaine and/or
amphetamines) as these users are most likely to be affected by
social exclusion

For 2008, the total number of problem opioid users in EU is
cautiously estimated at 1.35 million (EMCDDA Annual report 2010, EU and
Norway)
CONDITIONS FOR SOCIAL INCLUSION
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Accommodation – but homelessness affected 9% of clients
entering outpatient drug treatment and about 13% of those
entering inpatient treatment in 2008
Education – but about 40% of clients entering outpatient or
inpatient treatment in 2008 had not completed secondary
education
Employment – but 47% of those entering outpatient and 71%
of those entering inpatient treatment in 2008 reported to be
either unemployed or economically inactive
(EMCDDA Annual report 2010)


Relationship is complex (causality, individual circumstances)
Employment may have a therapeutic value for drug users but
there are many barriers to starting and maintaining
employment
WHY TREATMENT ALONE IS NOT SUFFICIENT
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Adverse outcomes related to problematic drug use are not
limited to dependence/withdrawal but drug use affects also
users’ family life, relationships, education, housing,
employment etc.
Social exclusion can undermine progress made during
treatment – increased risk of relapse
Treatment services increasingly offer also employment
counselling, vocational training etc., but there are still many
services that only follow a symptom-oriented “admit – treat –
discharge” philosophy
UNODC advocates ‘sustained recovery management’ – an
enhanced treatment approach putting greater emphasis on
social reintegration (UNODC 2008)
Aim of social reintegration is to prevent social exclusion and
to support comprehensive drug treatment approaches
EU DRUGS ACTION PLAN 2009–12

The Plan’s ultimate aim is to ‘… significantly reduce the
prevalence of drug use among the population and to reduce the
social and health damage caused by the use of and trade in illicit
drugs’.


Objective 7: “Enhance the effectiveness of drug treatment and
rehabilitation by improving the availability, accessibility and
quality of services”
 Action 14. “To deliver existing and develop innovative
rehabilitation and social re-integration programmes that
have measurable outcomes” – indicator: “Increased
availability and effectiveness, when possible, of
rehabilitation and reintegration programmes in MS”
EMCDDA’s Structured Questionnaire 28 collects data on the
provision of PDU-specific and general population strategies
WHAT IS SOCIAL REINTEGRATION?

“Social reintegration is defined as ‘any social intervention with
the aim of integrating former or current problem drug users
into the community’. The three ‘pillars’ of social reintegration
are (1) housing, (2) education, and (3) employment (including
vocational training). Other measures, such as counselling and
leisure activities, may also be used.”
(EMCDDA online glossary)
OVERVIEW OF APPROACHES
OVERVIEW
Eight broad strategy areas
 In practice services often offer more than one
intervention type

Preliminary findings from ongoing literature review
– may still require some changes and additions
 Final report will include:
 Further details on intervention types
 Information on practice in Member States (based
on Q28 and national reports)
 Information on evidence of effectiveness

1. GENERAL VOCATIONAL REHABILITATION
General interventions aimed at people with
functional, psychological, developmental, cognitive
and/or emotional impairments or health conditions
 Aim to help them overcome barriers to accessing,
maintaining or returning to employment or other
useful occupation (Scottish Executive 2007)

2. GENERAL DRUG TREATMENT
Substitute prescribing
 Psychosocial interventions
 Residential detoxification/assisted withdrawal
 Case management approach
 Residential rehabilitation
 Community/outpatient
 Contingency management
 Therapeutic communities
 Speciality residential
 Heroin maintenance
 Centralised treatment access

3. CRIMINAL JUSTICE
Parole management
 Arrest referral / diversion programmes
 Prison treatment
 Prison release programmes

4. HOUSING
Emergency accommodation (hostels, shelters)
 Social housing
 Transitional housing (half-way houses)
 Supported housing
 Support in finding long-term accommodation

5. EDUCATION/TRAINING
Job skills training
 Life skills training
 Retraining as drugs workers
 Possibility to gain formal qualifications

6. EMPLOYMENT
Supported employment
 Contingency management
 Employee Assistance Programmes
 Pre-employment drug screening
 Volunteering, temporary placements

7. GENERAL POLICY
Welfare (benefits), and ‘Welfare to work’ type
programmes
 Tax reduction for employers
 Disability Discrimination Acts

8. REMOVING SOCIAL/STRUCTURAL BARRIERS
Advocacy
 Reducing stereotyping and stigmatisation of
(former) drug users among employers
 Training (employment) service staff
 Making treatment services work friendly

SOCIAL REINTEGRATION IN THE EU
THE AVAILABILITY OF INTERVENTIONS IN THE EU

All countries reporting to the EMCDDA mention the
availability of housing, education, and employment
programmes or services

Targeted specifically at drug users or at socially
excluded groups in general

Examples of interventions are available:


Exchange on Drug Demand Reduction Action (EDDRA)
database
Compilation of National Focal Point Reports (available on
http://www.emcdda.europa.eu/html.cfm/index1573EN.html)
UNITED KINGDOM: PROGRESS2WORK (P2W)
2002 – 2011?
 Supports recovering drug users who are drug free
or stabilised in gaining employment
 Voluntary – drug users can self-refer
 Jobcentre assigns a specialist caseworker
 Caseworker:

Supports client through treatment process if necessary
 Helps client find job skills and life skills training
opportunities
 Helps client to search and apply for jobs
 Stays in touch with client for up to 13 weeks after they
have started work or training to help with any problems

BEST PRACTICE
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Need comprehensive review of extent to which existing
programmes in the EU are evidence based, subject to
evaluation, or are indeed effective – addressed in final report
Evidence of effectiveness primarily from USA – need to
improve European evidence base by evaluating ‘good
practice’ and ‘promising’ interventions
Example guidance:
 UNODC (2008) Drug Dependence Treatment: Sustained
Recovery Management.
 EQUS Minimum quality standards in the prevention,
treatment/social reintegration and harm reduction of drugs
(forthcoming)
Limited benchmarks and guidance on social reintegration
available, often subsumed under treatment
FURTHER ISSUES, CONSIDERATIONS,
CONTROVERSIES …
THE SPECIFIC NATURE OF SOCIAL
REINTEGRATION
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1.
2.
3.
4.
5.
6.
7.
8.
There are many domains of recovery capital, for example:
Physical and mental health
Family, social supports, and leisure activities
Safe housing and healthy environments
Peer-based support
Employment and resolution of legal issues
Vocational skills and educational development
Community integration and cultural support
(Re)discovering meaning and purpose in life
(UNODC 2008)
Relevance for social reintegration?
SHOULD WE DISTINGUISH SOCIAL
REINTEGRATION FROM TREATMENT?

Purpose: can support treatment and/or prevent relapse – and
treatment can support social reintegration

Content: does not need a psychosocial or medical component

Timing: can take place during and/or after treatment, or
without treatment

Provision: can be provided by the treatment provider or by a
separate institution

Setting: some measures can be implemented by improving
existing treatment services, other measures take place
“outside” of treatment facilities

Ideally social reintegration should be an integral part of the
treatment process
THE “ETHICS” OF SOCIAL REINTEGRATION
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Welfare benefit conditionality → “forcing” drug users into
treatment or employment
Expectation in some programmes that users must become
drug free before they can take up employment or receive
welfare support
Contingency management in the workplace – provision of
negative urine toxicology acceptable in the EU?
Recent UK policy emphasis on abstinence and full “recovery”
as the goal of treatment – but is complete abstinence a
condition for participation in society?
NEXT STEPS IN OUR PROJECT
EMCDDA INSIGHTS
The EMCDDA’s Insights are volumes conveying the findings of study and
research carried out by the agency on topical issues in the drugs field.
Target groups: Policymakers and their advisors; specialists and practitioners in
the drugs field.
CONTACTS
Angelina Brotherhood
Public Health Researcher
[email protected]
Dr Harry Sumnall
Reader in Substance Use
[email protected]
Centre for Public Health
Liverpool John Moores University, UK