The Dublin North East Drugs Task Force recently published a review of FÁS Special Community Employment (CE) programmes in the area.1 FÁS Special CE was designated the main vehicle through which vocational and employment skills training would be delivered in local drugs task force (LDTF) areas.2 The review by Lawless1 reflects the views of staff and participants engaged in CE and includes a number of key learning points that merit attention from policy makers, service providers and other relevant stakeholders engaged in responding to the needs of drug users.                           

How is FÁS CE perceived: Rehabilitative or vocational?

The primary aim of FÁS Special CE projects in LDTFs is to provide vocational and employment skills training to improve the chances of clients finding employment. Yet, Lawless reported that the majority of respondents in the Dublin North East area continued to view CE as the main mechanism for delivering drug rehabilitation, with therapeutic functions as the primary role. Education and training were viewed as the least important role. An overall review by Bruce3 of FÁS CE in LDTF areas reported a similar finding, with project staff and participants expressing the view that CE was being used to provide personal development and relapse-prevention skills, with little attempt to provide vocational training options.

Critique of health services as part of inter-agency approach

Lawless reported that all respondents cited the lack of inter-agency work as one of the main barriers to the full effectiveness of CE. The majority of respondents expressed the view that the Health Service Executive (HSE), which they felt should be responsible for drug rehabilitation work, had abdicated its responsibility and transferred this work to FÁS, which was not equipped for the task. Many felt that, without the strategic involvement of the HSE, local community groups were out of their depth in trying to do the work they were involved in. The review by Bruce identifies a similar experience among project staff, who expressed their frustration at the lack of HSE involvement in their work with clients.

The role of methadone, dosage reduction and detoxification

Lawless reported that staff and participants had strong views on the role of methadone in the overall context of FÁS CE. Methadone was viewed as a key part of the initial stages of stabilisation; however, it was felt that, more often than not, it had become the sole and final solution. The criticism was not of methadone treatment but of the lack of options available to clients. This ‘one size fits all’ approach was heavily criticised and, indeed, runs counter to the central premise of the National Drugs Strategy 2001–2008, which holds that drug misuse is the result of a complex interplay of factors and will not be alleviated by any one approach, but requires an array of options. Some respondents to the research survey by Lawless viewed the methadone programme ‘as a form of social control’ and ‘an abdication of the state’s responsibility’ (p.68) to provide a properly funded and structured treatment programme of options and pathways to rehabilitation.

Additionally, clients reported that when they tried to take some responsibility for their own treatment, they very often got an adverse response from medical staff. Across the four special CE projects in the Dublin North East Task Force area, clients spoke of themselves or others being treated with disrespect by the medical staff, of not being involved in their own treatment plans and of feeling frustrated in their attempts to reduce their dosage or to detox from prescribed medication.

The option of threatened sanctions as favoured by clients as a demand reduction tool

Lawless reported that clients favoured the option of urine samples being taken for testing twice or three times a week, despite the sanctions that a failed test would entail. Clients expressed the view that they could ‘get round’ having one test per week and continue to dabble in drugs if they wished, but having to submit to two or three tests would prove more difficult and so reduce the likelihood of their using illicit drugs. Clients felt that this would strengthen their motivation to stay off drugs. Research by Ginexi et al.4 found that by far the greatest barrier to labour force participation and employment for persons in treatment for drug use over a three-year period was continued use of illicit drugs.

The need for more intensive vocational input to enable client progression

Clients expressed the view that participation in the CE programme had enabled them to further their personal development, but were frustrated at how little progress they had made in terms of education and training and how few move-on options were open to them. Most of all, they wanted to leave the project with more formal qualifications. They wanted to see more work placement and work experience built into the programme and felt that structured move-on options were essential. Research by Lidz et al.5 reported that where a relaxed rather than an intensive approach is taken to vocation training, the results can be quite discouraging for clients.

An alternative approach to CE, based on the findings of the evaluation

Taking the three components of dosage reduction, use of sanctions and intensive vocational inputs that have been requested by clients, service providers can use an approach that is showing promise in improving employment opportunities for clients on methadone. Research by Kidorf et al.6 suggests that reducing methadone dosage, the threat of sanctions and the application of intensive vocational training support can be effectively combined to help clients in methadone treatment progress to employment. The Motivated Stepped Care (MSC) approach requires all patients who complete one year of treatment to secure work, with continued methadone treatment contingent upon securing employment. The approach includes a highly intensive Job Seekers Skills Training group where specialists motivate clients to tackle the personal barriers between them and employment, with the objective of developing the self-efficacy of the client so that he or she can take responsibility for their job seeking behaviour. Based on preliminary evaluation of this approach, Magura et al.7 suggested that it is one of the few in the vocational training field to demonstrate promise when applied to people in methadone treatment. The adoption of this approach in LDTF areas is a feasible option and should at least be piloted to test its applicability in an Irish context. However, such an approach will require the development of inter-agency co-operation and much greater involvement of clients in the design and management of a structured care plan, with buy-in from all relevant stakeholders. As we approach the final stages of the current National Drugs Strategy, it is incumbent on both policy makers and service providers to invest in the progression needs of clients who have been maintained on methadone for some time.

1.    Lawless K (2006) Listening and learning: evaluation of Special Community Employment programmes in Dublin North East. Dublin: Dublin North East Drugs Task Force.

2.    Ministerial Task Force on Measures to Reduce the Demand for Drugs (1996) First report of the ministerial task force on measures to reduce the demand for drugs. Dublin: Stationery Office

3.    Bruce A (2004) FÁS Community Employment schemes in local drug task forces: a review. (Unpublished).

4.    Ginexi EM, Foss MA and Scott CK (2003) Transitions from treatment to work: employment patterns following publicly funded substance abuse treatment. Journal Of Drug Issues, 33(2): 497–518.

5.    Lidz V, Sorrentino DM, Robinson L and Bunce S (2004) Learning from disappointing outcomes: an evaluation of prevocational interventions for methadone maintained patients. Substance Use and Misuse, 39(13–14): 2287–2308. 

6.    Kidorf M, Neufeld K and Brooner RK (2004) Combining stepped care approaches with behavioural reinforcement to motivate employment in opiod-dependent outpatients. Substance Use and Misuse, 39(13–14): 2215–2238.

7.    Magura S, Staines GL, Blankertz L and Madison EM (2004) The effectiveness of vocational services for substance users in treatment. Substance Use and Misuse, 39(13–14): 2165–2213.