14 Mar / Scientific Evidence based in Addiction Treatment and Reintegration
Social Trajectories of Drug Abusers After Therapeutic Process
This article is part of a larger work of evidence base on alcohol and drugs addiction treatment and reintegration. “Trajectories from addiction to reintegration” – study of the social trajectories of drug abusers after a therapeutic process (PTDC / CS-SOC / 099684/2008). Had as empirical basis the users of the Therapeutic Community Quinta das Lapas, licensed health unit part of the Dianova Portugal Association. It is a longitudinal follow-up study, covering the period from 1999 to 2009.
Methodologically, the study combined both quantitative and qualitative approaches in three distinct, but interlinked and complementary phases.
The first one was based on the analysis of the database of users. Namely, of the therapeutic community Quinta das Lapas with clinical discharge between 1999 and 2009. In this phase was carried out the socioeconomic, demographic and consumption characterization.
Second phase focus on the application of a telephone questionnaire survey. Through this first contact, it was intended, in a follow-up logic, to identify changes in the individuals’ life trajectories. As well as, identify the definitive abstinence or the relapse of the consumption of psychoactive substances. To know their paths. And to identify obstacles and facilitators of reinsertion, in the family, professional and social dimensions.
Third phase focus on in-depth interviews with a group identified as relevant to the problem due to their characteristics of reintegration trajectory.
The following is a brief summary of the main results, organized according to three main axes of analysis.
> Reinforcement and vulnerability factors associated with reintegration trajectories.
> Changes in lifestyle after a therapeutic process.
> Main support agents for the reintegration process.
Reinforcement factors associated with successful reintegration trajectories and vulnerability factors associated with unsuccessful reintegration trajectories.
The Index of Social Reintegration of Drug Abusers after treatment (ISRDA) translates into the sum of seven variables covering four dimensions.
Labor dimension integrated two variables that allow to make some distinction in the type of labor integration. Not to be unemployed or hospitalized in treatment; be self-employed or have a no-term contract.
Family dimension especially considered autonomy from the family of origin since in the moment before the internment a large part of the users lived with their parents.
Abstinence dimension has integrated two factors, not being currently using drugs and had not relapse since the end of treatment.
In the social dimension, two social capital indicators were considered, new friendships created after completed the treatment and the belonging to some types of association or group.
Each of these criteria corresponds to one point, the index of social reintegration of drug abusers consists in the sum of these points with a variation between 0, which corresponds to a minimum reintegration possible. And 7, which corresponds to a maximum reintegration (mean = 3.76; standard deviation = 1.42).
From here, we look for the relevant factors associated with the index of social reintegration based on other studies on the subject, the statistic relations are presented in the Table 1.
Table 1 – Mean and correlation coefficients of the ISRDA in the independent variables
Comparing men with women, the last had higher values in the index, but with a fine difference four tenths.
In terms of age the relation is positive in the sense that more age corresponds to higher values in the index, although the correlation is very low.
Regarding education, there is no linear relation with the values in the reintegration indicator. It observes, contrary to expectations, higher values in the subjects with the 1st cycle and lower values in the subjects with university education. Although it should be taken into account that frequencies are very low in some of the categories.
Concerning geographic terms, subjects who changed their residence had significantly higher values.
The therapeutic process vs ISRDA
In all three factors related to the therapeutic process, the relationship is always positive.
> The more years passed since clinical discharge.
> The longer the treatment duration.
> And the better the treatment evaluation, the higher the ISRDA values.
Being the correlation with the duration of the treatment the lowest.
Thus, the years that have passed since the conclusion of treatment and the subjective assessment of the treatment seems to be more relevant. Although in this case there should be no relation of simple cause effect, but more a circular effect. For example, if the subjects are better reintegrated, the evaluation of treatment should also be improved.
Regarding the main substances consumed the ex-users of alcohol have higher values and the former users of cannabinoids present lower values. The fact that it is a licit substance and, therefore, with a lower social censorship charge vis-à-vis (ex) consumers can help understand.
Likewise, in the case of cannabinoids users it may be due to an accumulation of problems that interfere with the use of this substance. Although it should be borne in mind that this is a very rare category and therefore the values of this average should be interpreted with caution. Contrary to what should be expected, more years of consumption of the main substance higher values in the index.
Finally, with regard to the legal factor, the difference between having or not judicial records only changes a tenth in the average values of the index.
Internal and external factors affecting a successful or unsuccessful reintegration
We do not observe very different differences in general. But it must be borne in mind that the empirical work base has a small sample. It is, therefore, necessary to replicate the indicator in other studies to validate its robustness.
It is also important to consider that a successful reintegration may not depend so much on characteristics a priori of the subjects like sex, age, education, etc. But more on post-treatment characteristics (little explored in this model).
Finally, the success of reintegration may not be fully measured through quantitative methodologies or the classification of subjects into large macro-sociological categories. But rather analyzing the experience of reintegration of each of the subjects in a micro-sociological perspective.
Changes in lifestyle after the therapeutic process – relationship with psychoactive substances, life projects (individual, socioprofessional), social networks, leisure activities.
In general terms we have identified a small number of relapses, as well as an increase in investment of individuals in schooling processes and formal training. However, low levels of schooling remain, which tends to represent greater vulnerability to unemployment.
As for the situation with regard to employment, the scenario is more optimistic considering a longitudinal perspective. However, it is necessary to take into account that more than a third of the users were employed when they entered treatment. Contrary to some representations that associate drug addicts with people unable to meet the demands of a job (Negura & Maranda, 2008). Most of them were and still were workers on behalf of others.
The labor stability, operationalized through the type of contractual status, seems to decrease, between the two moments – before the treatment and at the time of the interview. Since there was a decrease in the situations of contracts without term. This change may be associated with problems with drug abuse. However, we must bear in mind that, even for the majority population in Portugal, there has been an increase in the proportion of employees with a fixed-term contract (Barreto , 2000: 135).
In the case of professions, there has been an increasing trend of specialists in the intellectual and scientific professions, administrative staff and machine operators. While at the same time there has been a considerable decrease in the number of workers. However, the data are not enough for it to be affirmed that we are faced with processes of upward social mobility.
Finally, with regard to the strategies mobilized in obtaining employment, we realize that not only the jobs change, but also the strategies mobilized in obtaining them.
Main agents supporting the process of reintegration – family, friends, therapeutic team, other agents or structures of social support.
From a biographical perspective it was possible to establish the existence of both risk factors and protective factors of social reintegration.
According to the interviewees, a successful social reintegration is possible with the support of the family. Both of origin, especially parents and siblings, and formed after the treatment like marriage or civil union. In fact, this is the main source of support, either financial, moral or psychological. Or as a source of confidence or as a deterrent to psychoactive substance abuse.
However, the same family can be identified as an agent that makes it difficult to fully reintegrate, especially in situations where the stigma of ‘drug abuser’ is still present. And in situations of conflict it is quickly and repeatedly activated. We didn’t find no complete breakage situation with the family of origin. Nevertheless, there are some situations in which it is geographically distant. Specially, by options for a new project of life in a distant region, without family support.
We also highlight references to the support of the employers’ organization, the capacity for self-help, the support of friends and pets.
Obstacles to Reintegration
When we ask about the greatest obstacle to full reintegration, the most frequently was the return to the old place of residence. On the one hand, the problem of getting back in touch with the old consumption circles, which can influence relapses. On the other hand, the problem of living in small communities, where there is a high social control and where the stigma of the drug abuser is very present. Places with characteristics closer to Tönnies (2004) community ideal type.
Another of the aspects mentioned by some respondents is that they leave the treatment without feeling ready for it. Particularly, difficulty in resuming the routines of everyday life.
Another set of difficulties is economical hardship, which is early in the period following treatment but also associated with unemployment. In the same sense, we highlight the references to the economic recession, by individuals that were unemployed at the time of the interview. However, also by individuals who, although employed, express fears of losing their jobs and become more vulnerable.
In some cases, the prolonged absence of employment becomes a demotivating factor to abandon current consumption and to seek an active job search. The uncertainty and risk associated with future prospects tend to configure feelings of “existential despair” assumed as inevitability (Costa, 2012).
In conclusion, what are the strategic areas of intervention that this study indicates as critical areas? They are the promotion of measures to support the social reintegration of subjects with drug abuse and addictive behaviors.
Greater reintegration, whether institutional or at the level of the individual’s life dimensions: family, residential, work, social.
Furthermore, we need to pay attention to rapid changes in the field of psychoactive substances. The emergence of new licit, illicit and uncontrolled, synthetic and natural substances. The emergence of new consumption patterns and associated lifestyles.
In this sense, the “emergence of ‘new’ problems that challenge current political and practical models” (EMCDDA, 2013: 11). Hence, the need to rethink these models requiring action focused primarily on prevention.
Interim and Final Reports of the Follow Up Study
Barreto, A. (Ed.) (2000). Social indicators in Portugal and the European Union (the social situation in Portugal 1960-1999), vol.II, Lisbon: ICS
Costa, AF (2012). Contemporary Social Inequalities, Lisbon: Social Worlds
Negura, L. & Maranda, MF (2008). “Hiring substance abusers: attitudes of managers and organizational needs”. Drugs: Education, Prevention and Policy, 15 (2), 129-44.
EMCDDA – Europena Monitorin Center for Drugs and Drug Addiction (2013). European Drugs Report 2013: Trends and Evolutions, Luxembourg: Publications Office of the European Union.
Tönnies, F. (2004), “Community and Society”. In MB Cruz (Ed.), Sociological Theories – the founders and the classics (Anthology of Texts) vol.I, Lisbon: Calouste Gulbenkian Foundation.
PhD in Sociology – specialization in Education, Communication and Culture (ISCTE-IUL). Master in Communication, Culture and Information Technology (ISCTE-IUL). Degree in Sociology (ISCTE-IUL).
Researcher at CIES-IUL; LE@D, UAb.
Assistant Professor Department of Education and Distance Education, Portuguese Open University. She the responsible professor in subjects: graduation in Education. Post Graduation in Social Education and Juvenile Studies (where she has coordination functions). MSc Information Management and School Libraries, Pedagogical Supervision, School Administration and Management. PhD in Education. She coordinates the Specialized Training on Addictions Prevention.
Areas of interest in research: Sociology of education and communication – elearning, media literacy, educational leadership; Research Methods; Prevention and health education.
He is a PhD candidate. He has a bachelor’s and a master’s degree in sociology from the ISCTE – University Institute of Lisbon. Pedro is a researcher at the Universidade de Lisboa, Instituto de Ciências Sociais (ICS). And at the Instituto Superior de Economia e Gestão (ISEG), Research in Social Sciences and Management unit (SOCIUS/CSG). He has participated in research projects and contributed to publications on social reintegration of drug abusers, social tolerance, migrations and ethnic minorities.