Home > Drug Policy Action Group recommends co-ordinated social care for drug users.

Keane, Martin (2006) Drug Policy Action Group recommends co-ordinated social care for drug users. Drugnet Ireland , Issue 20, Winter 2006 , pp. 24-25.

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In November 2006 the Drug Policy Action Group (DPAG)1 launched two policy papers in Dublin. Policy Paper 1 deals with criminal justice drugs policy in Ireland and Policy Paper 2 raises a number of questions around the social care of drug users in Ireland. This article will focus on the latter paper, written by Gemma Cox and Fr Peter McVerry – Social care and drug users in Ireland.2

The authors acknowledge that, for a large majority of people, social care is provided by family, friends and neighbours through informal networks of mutual support and is supplemented by state-sponsored institutional care through the public health system, social care services and education, employment and housing supports. But, the paper points out, very often the most vulnerable members of society, including a high proportion of drug users, who have the most complex needs, are likely to fall between the gaps in services. When drug users present for help and support, very often to specialist drug treatment agencies, a high proportion present with multiple problems, including psychological and serious mental health problems, employment and economic issues, poor living arrangements, familial and social relationship difficulties, and legal problems. The paper claims that the way the specialist drug treatment service has evolved in Ireland (in a similar way to that of other health and social care services) means that it operates largely in isolation from other services and is generally unable to deliver a continuum of care. While the drug treatment service may be doing an excellent job in responding to people’s addiction problems, there is a lack of co-ordination between drug services and agencies and other generic social care services, such as housing agencies, national training and employment agencies and mental health services.

In particular, the authors highlight two vital components of social care, employment and housing, and argue that, because of the uncoordinated nature of social care services targeting drug users, these needs are not addressed in a meaningful manner. For example, the report highlights the strong association between unemployment and problem drug use, but rightly notes that the causal direction of the association is complex. Nonetheless, it notes that improving employability for problem drug users can be a major factor in preventing relapse. Platt’s review of treatment outcomes in the US3 also finds an association between improved employability and reduced relapse. For example:

•          Persons in treatment who are employed stay in treatment longer and achieve better outcomes than their unemployed counterparts.

•          Persons who are regularly employed have lower rates of substance misuse than those who are sporadically employed or unemployed.

 

The authors argue that work provides a sense of responsibility, personal value, independence, security, dignity and a stake in society. This is a view shared by problematic drug users interviewed by Neale (2002)4 in Scotland, who recognised the benefits accruing from employment, such as self-esteem, pride and a means of avoiding stigma. According to Neale, a job was seen by those interviewed as central to the process of recovery, since working provided a distraction and an alternative structure to their days.

On the other hand, the authors note that enhancing the employability of drug users has not traditionally been a priority for treatment and rehabilitation services, where the clinical goals of abstinence or stability and maintenance are generally given priority. This is a view partially articulated in a recent report by the National Economic and Social Forum.5 The report identifies people with drug and alcohol dependencies as one of the marginalised groups particularly prone to experiencing labour market vulnerability, and states that there is a lack of employment support mechanisms to assist their progression.

The DPAG recognises that housing is more than simply providing a roof over someone’s head. It is also about providing security, privacy and a space to develop. Housing is a vital component of social care and often the key to independent living. For many problem drug users, family and friends provide the main form of social care in terms of housing; however, living in the family home does not always work out. Research by Houghton and Hickey (2000)6 and O’Brien et al. (2000)7 highlights the association between problem drug use and family conflict and relationship breakdown in the home, often leading to those with addiction problems experiencing homelessness.

The paper concludes with five recommendations; the DPAG believes that, where a commitment is given to these recommendations, benefits will occur at policy, organisational and service-user level. The recommendations are reproduced below.

1.       The DPAG recommends an understanding of ‘complex needs’ which takes into account that each separate need interlocks with all of an individual’s other needs and cannot be adequately addressed in isolation from those other needs

2.       The DPAG recommends that social care providers prioritise the importance of, and agree upon a strategy to develop, a strong organizational commitment to interagency work, which collectively will enhance the provision of social care services in Ireland.

3.       The DPAG recommends the development of an interagency strategy to provide accessible entry to and retention within and across social care services in Ireland.

4.       The DPAG recognises the importance of service user involvement in the development and implementation of existing and emerging models of social care delivery for problem drug users.

5.       The DPAG believes that a published national audit of social care services/agencies is a necessary first step towards highlighting the current state of affairs, progress made and necessary improvements.

The presentation of this paper in a public forum provided an opportunity to discuss and debate the merits or otherwise of the central claims contained therein. The paper challenges both policy makers and service providers to consider ways of addressing the complex needs of drug users within a multidisciplinary social care model. Two elements of a social care approach are user involvement and inter-agency working.  Such an approach integrates drug treatment services with employment and housing services.

1 . For more on the DPAG, see www.drugpolicy.ie

2. Cox G and McVerry P (2006) Social care and drug users in Ireland. Policy Paper 2. Dublin: Drug Policy Action Group.

3. Platt JJ (1995) Vocational rehabilitation of drug abusers. Psychological Bulletin, 117(3): 416–433.

4. Neale J (2002) Drug users in society. Basingstoke: Palgrave Macmillan.

5. National Economic and Social Forum (2006) Creating a more inclusive labour market. Report 33. Dublin: National Economic and Social Development Office.

6.Houghton FT and Hickey C (2000) Focusing on B&Bs: the unacceptable growth of emergency B&B placement in Dublin. A Focus Report. Dublin: Focus Ireland.

7.  O'Brien J, Waldron AM, Tobin G, McQuaid P, Perot S, Pigott-Glynn L andHoughton F (2000) The mental and physical health and well-being of homeless families in Dublin: a pilot study. Dublin: Focus Ireland.

Item Type:Article
Issue Title:Issue 20, Winter 2006
Date:October 2006
Page Range:pp. 24-25
Publisher:Health Research Board
Volume:Issue 20, Winter 2006
EndNote:View
Accession Number:HRB (Available)
Subjects:L Social psychology and related concepts > Interpersonal interaction and group dynamics > Social support
HJ Treatment method > Substance disorder treatment method
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Rehabilitation
MP-MR Policy, planning, economics, work and social services > Policy > Policy on substance use

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