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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).

 
 

Annual report 2011: the state of the drugs problem in Europe
Responding to drug problems — an overview

Published: 15 November 2011

Social reintegration

The level of social exclusion among drug treatment clients is generally high, potentially preventing individuals from making a full recovery and undermining treatment gains. Data on clients who entered drug treatment in 2009 show that most of them were unemployed (59 %) and almost one in ten lacked stable accommodation (9 %). Low educational attainment is common among treatment clients, with 37 % having completed only primary education, and 4 % not even achieving this level (1). There is increasing recognition that development of services tackling marginalisation and stigmatisation will improve the chances of clients' successful social reintegration and increase their quality of life (Lloyd, 2010).

Social reintegration of drug users into their local communities is recognised as a key component of comprehensive drug strategies, setting a focus on improvement of social skills, promoting education and employability, and meeting housing needs. Addressing the social needs of clients in drug treatment can play a role in reducing their drug use and sustaining long-term abstinence (Laudet et al., 2009).

Twenty-one European countries report having specific social reintegration sections in their national drug strategies (2), mainly focusing on the housing, education and employment needs of drug users. Social reintegration services are either provided concurrently with drug treatment or after completion of treatment, relying on collaboration between specialised treatment services and health and social care institutions.

Overall, while most countries report the existence of interventions in housing, education and labour-market participation, the available data indicate that levels of provision fall short of the needs of the drug treatment population.

Housing

Ensuring access to, and maintaining, stable accommodation are key to the reintegration process, helping to retain clients in treatment and support relapse prevention (Milby et al., 2005).

In Europe, overall, levels of service provision addressing the housing needs of drug treatment clients are low. Of the 29 countries responding to a recent survey, less than a third report that a majority of treatment clients could access emergency accommodation (nine), transitional housing (eight) and supported living services (five).

Despite the low level of provision reported by European countries, most report the availability of social housing facilities targeting vulnerable groups, which are to varying degrees accessible to people in drug treatment. Such accommodation is usually provided by local authorities or non-governmental organisations. The duration of stay can vary and entry can be with conditions (e.g. being drug-free, supervision from treatment staff). In addition, a number of countries have tailored housing for people in drug treatment; for example, 18 countries report provision of emergency accommodation (e.g. night shelters, bed and breakfast), and 20 countries provide some level of transitional accommodation such as halfway houses. Independent living can be an important step towards reintegration into society, and in 12 countries, treatment clients have some access to supported living facilities, while 15 countries report programmes that facilitate access to independent living within the general housing market. In France, so-called 'sliding' tenancies are provided by specialist treatment centres. The centre pays the rent for the housing, and sub-rents it to the client, who contributes a small portion of the rental fee. The client receives tenancy support with administrative tasks (e.g. paying bills) and budget management, and after a 'probationary period', becomes the official tenant.

Training and education

The education needs of drug users in treatment can be addressed in a number of ways. While the mainstream educational system may be a first option, individual and systemic barriers, such as low expectations, stigma and fear of failure, can prevent clients from participating (Lawless and Cox, 2000). Eleven countries report the availability of supportive programmes that aim to facilitate drug treatment clients' access to mainstream education. In addition, 15 countries report that drug treatment clients can access educational programmes targeting socially vulnerable groups.

Vocational or technical training helps people acquire the practical skills necessary for employment in a particular occupation or trade, and usually leads to a vocational qualification. In most countries (20), clients obtain vocational training through interventions targeted at socially vulnerable groups. In 16 countries, vocational training interventions also exist specifically for drug treatment populations.

Employment

Employability is a key concept in social reintegration, and the employment needs of drug users are addressed by a number of European countries in their national employment strategies. Activities that increase employability may address the psychological domain (e.g. personal development, self-efficacy, self-esteem, coping skills) and can provide recovering drug users with an alternative peer group and new skills to assist successful reintegration into the wider community. In 15 countries, the employability of people in drug treatment is reported to be a regular, standard objective of individual care plans.

Evidence shows that employment and enhancing employability improve drug treatment outcomes (Kaskutas et al., 2004) and have a positive impact on health and quality of life, and reduce offending (Gregoire and Snively, 2001). Support systems, such as the intermediate labour market, which provides paid work in specially created temporary jobs, can help in bridging the gap between long-term unemployment and employment in the open labour market. These systems are generally targeted at disadvantaged individuals (e.g. through businesses created to employ the disabled or socially excluded), and may include occupational and voluntary work.

Twenty countries report intermediate labour market interventions available to socially vulnerable groups that are also accessible to people in drug treatment; in 11 countries, such interventions are available specifically for treatment clients. In Ireland, for example, Ready for Work helps homeless people, including drug users, enter training or employment by providing them with pre-employment training, unpaid work experience and follow-up support. Drug treatment clients may be eligible for other initiatives, such as supported employment, which assist people with disabilities or other disadvantaged groups to secure and maintain paid employment. While 17 countries report that supported employment interventions are accessible to treatment clients, only four report sufficient levels of provision.

Footnotes

(1) See Tables TDI-12, TDI-13 and TDI-15 in the 2011 statistical bulletin.

(2) Lithuania and Austria did not have a national drug strategy at the time of the survey.

Bibliographic references

Lloyd, C. (2010), Sinning and sinned against: The stigmatisation of problem drug users, The UK Drug Policy Commission (UKDPC) (available online).

Laudet, A., Becker, J. and White, W. (2009), 'Don't wanna go through that madness no more: Quality of life satisfaction as predictor of sustained substance use remission', Substance Use and Misuse 44, pp. 227-52.

Milby, J., Schumacher, J., Wallace, D., Freedman, M. and Vuchinich, R. (2005), 'To house or not to house: the effects of providing housing to homeless substance abusers in treatment', American Journal of Public Health 95, pp. 1 259-65.

Lawless, M. and Cox, G. (2000), From residential drug treatment to employment: final report, Merchants Quay Ireland, Dublin.

Kaskutas, L., Ammon, L. and Weisner, C. (2004), 'A naturalistic analysis comparing outcomes of substance abuse treatment programme with different philosophies: Social and clinical model perspectives', International Journal of Self Help and Social Care 2, pp. 111-33.

Gregoire, T. and Snively, C. (2001), 'The relationship of social support and economic self-sufficiency to substance abuse outcomes in long-term recovery program for women', Drug Education 31(3), pp. 221-37.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 28 October 2011