EMCDDA Best practice portal update (4/2020)

Evidence updates on social reintegration and employment-focused interventions

Employment is one of the strongest predictors of positive outcomes for persons with substance use disorder. Unemployed clients in treatment often report that their current unemployment is due to substance use. They also refer to a variety of obstacles to employment. These obstacles include: lack of transport, poor work history, lack of education/skills, low job availability, stigma/lack of employer understanding, probation/treatment programme requirements, and criminal record.

In our latest Best Practice Portal update, we highlight a recent and comprehensive systematic review of interventions intended to improve employment outcomes for persons with substance use disorder at any stage of recovery. Nine programmes or models were identified, with Individual Placement and Support (IPS) and its variant Customised Employment Supports (CES) having the most studies with positive results.

Individual Placement and Support (IPS) is based on eight principles aimed at helping individuals to find and work in competitive jobs of their choosing. These principles are competitive employment, systematic job development, rapid job search, integrated services, benefits planning, no client exclusion, worker preferences, and time-unlimited support. IPS was originally developed, and is an evidence-based intervention, for individuals with serious mental illness.

Customised Employment Supports (CES) is an employment counselling intervention adapted from the IPS model. The main difference is that CES does not incorporate job development, but rather relies on available jobs in the community, and includes an emphasis on fieldwork— accompanying clients into the community for such things as looking for local job postings and making employer contacts.

The review suggests that three elements, common across most of those interventions, show significant effects: the provision of individual services, service integration among multiple providers and long-term support.

Evidence summaries are available at the Best practice portal (BPP).

Permanent housing for the homeless population

A new BPP update highlights the positive effects of permanent supportive housing in increasing long-term (6 years) housing stability in the homeless population. Permanent supportive housing has changed the sequence of treatment and housing, as access to the accommodation is no longer subject to adherence to treatment or abstinence. Permanent housing has become a strategy that is often combined with coordinated case management, resulting in small but promising evidence of recipients showing greater improvements in their subjective quality of life than those receiving standard care. Future research should focus on the long-term effects of housing interventions on physical, mental health and substance use.

Opioid Substitution Treatment (OST) initiation in Emergency Departments

Positive short-term effects on treatment outcomes have been found for Buprenorphine initiation in Emergency Departments (ED). A new entry in the BPP assessed the evidence of OST initiation in hospital emergencies and preliminary results seem to show that EDs can be an appropriate setting for initiating treatment and a key entry point for people with substance use disorders. The review highlights that in order for ED OST interventions to be scaled up and sustained, many barriers ranging from physician readiness, lack of formal training, time constraints, and absence of community-based referral networks to ensure longer-term retention need to be successfully addressed.

Webinar series:

The EMCDDA will host the last webinar of 2020 on the 16th of December, and it will address the COVID-19 induced economic recession and drug-related problems. The purpose of the webinars is to help those working in the drugs field understand how drug users, and those supporting them, are coping with the pandemic and to share knowledge and experience. The webinars give a voice to key professionals working in the drugs field and allow for a panel discussion on emerging challenges.

COVID 19 webinar registration form.