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“Trajectories, from addiction to reintegration 3 Stages of Analysis Study of Drug Addicts Social Trajectories
After therapeutic Process” (PTDC/CS-SOC/099684/2008)
18th September, 14th EFTC Conference on Rehabilitation and Drug Policy, Prague, 2013 Rui Martins, Head of Communications at Dianova | Susana Henriques, Study Coordinator at CIES-ISCTE-IUL
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 2
MISSION | to develop actions and programs that will contribute to the Personal Autonomy and Social Development
Dianova Network & International Public Affairs Hub
3 Continents | 11 Countries
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PRO
TOC
OLS
Education and Health
Promotion
Drug Abuse Treatment
Socio and Professional
Reintegration
Psychosocial Support
Training &
Empowerment (Hard | Soft
Skills)
AFF
ILIA
TIO
NS
Organizational & Social
Innovation Agent
Cooperation & Learning
Culture Oriented
Social and Solidarity
Agent
Social Change Promoter
Dianova recognized as Private Institution for Social Solidarity, Public Utility Association and Non-Governmental Organization
for Development
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Certifications | Acredditations Dianova
ISO 9001:2008
EFR
DGERT | CCPFC
Quality Management System CTQL (1st in Portugal since 2005)
Training Entity (CFD) DGERT – MTSS | CCPFC – ME
Family Responsible Entity Social Economy (1st in Portugal since 2013)
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Dianova | Operational Units (Lisbon | Oliveira Azeméis | Torres Vedras)
HEADQUARTERS Dianova Portugal
Therapeutic Community
Quinta das Lapas
Training Center Dianova
Social Reintegration Apartment
Social Enterpirse Nursery Plant
University Students Residencial
Emergency Center Project
Casa Azul
Psychosocial Support Center
+Health
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Areas
77,9% Programs 22,1% Management
Gender
50% Female 50% Male
Age Average 40,1
Qualifications 31% College 69% High
School
The Team Talent Retention
94%
41 Employees 90% Direct Contracts
10% Indirects
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Scientific Follow-up Study “Social Trajectories” 2013 CIES | ISCTE-IUL
WWW.DIANOVA.PT
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Coordination Prof.ª Doutora Susana Henriques, CIES-ISCTE-IUL Main Goal
• To capture Social regularities and singularities present on social reintegration of individuals associated with social, family and individual patterns to acquired skills during the therapeutic process on
individuals who have completed between 1999-2009 the program at Dianova Therapeutic Community Quinta das Lapas (Management Quality System ISO 9001:2008 implemented since 2005, with empirical control over quality indicators).
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 9
• Main questions to be addressed: – Which are the reinforcement and vulnerability factors
associated with the reintegration trajectories? – Which changes occurred in the life style after the therapeutic
process (regarding relationship towards drugs, life project, social networks, activities…)?
– Which were the agents of support to the reintegration process (family, friends, therapeutic team, other social support structures…)?
Coordination Prof.ª Doutora Susana Henriques, CIES-ISCTE-IUL Main Goal
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Methodology
• 3 Main Phases (developed between 2010 and 2013) 1. Analysis of administrative processes (178) of the Therapeutic
Community users that have completed program between 1999-2009, including individual records filled regarding life history, criminal records and medical examinations, in order to characterize the socioeconomic demographic and drug consumptions
2. Phone interviews (63) in order to follow-up and identify changes on life trajectories of individuals such as the stop of drug use, to know the social trajectories, identify obstacles and facilitators of family, professional and social reintegration
3. In-depth interviews (17) – partial life stories through life grid, ethnographic notes and auto-photographic studies – to a specific group identified as relevant to the problem of the study according to its reintegration trajectories’ characteristics
Note: All scientific Follow-up Studies demonstrate the difficulty in maintaining the individuals under participation along the years, s tudy limitation due to the subject and the studied population
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Phase 1 Sociodemographic: Origin
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 12
Phase 1 Sociodemographic: Sex & Age
12%
88%
Sex Ratio (%)
Age Structure
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Phase 1 Sociodemographic: Education
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Phase 1 Sociodemographic: Clinical Status
Health Problems
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Phase 1 Treatment Internment
Main substance (%)
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Phase 1 Treatment Internment
Main substance by age group (%)
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Phase 1 Treatment Internment
Age of beginning drug use
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Phase 1 Treatment Internment
Time of drug use in years
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Phase 1 Treatment Internment Peridiocity in the drug use (%)
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A. Work 1. Not being unemployed nor in treatment
2. Being a worker employed by others or hired without a term
B. Family 3. Autonomy regarding family of origin
C. Abstain from use 4. Not being using drugs | psichoactive substances
5. Haven’t had relapses
D. Social 6. Having created new friendships
7. Associativism
Note: Each factor counts one point in the Index, in a range between 0 (none reintegration) and 7 (full reintegration), mean=3,76, standard deviation=1,42
Phase 3 Final Results The IRST | Ex-Drug Users Social Reintegration Index (4 dimensions | 7 variables)
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0
5
10
15
20
25
30
35
0 1 2 3 4 5 6 7
%
Phase 3 Final Results The IRST | Ex-Drug Users Social Reintegration Index (4 dimensions | 7 variables)
IRST Graphic Representation
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A. Sociodemographic factors
B. Judicial factors
C. Geographic factors
D. Treatment related factors
E. Drugs | Psichoactive Substance related factors
Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index
Note: • for categorical variables = frequency and percentage and for quantitative variables = mean and
standard deviation • Factors then crossed with IRST, for categorical variables = IRST mean and for quantitivative
variables = Pearson correlation coefficient
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 23
A. Sociodemographic factors 1. Age 2. Education level
B. Judicial factors 3. Criminal record situation when entering treatment
C. Geographic factors 4. Having changed residence since treatment completed
D. Treatment related factors 5. Years after completed treatment 6. Treatment duration 7. Treatment evaluation
E. Drugs | Substances related factors 8. Main substance of use 9. Years of consumption of main substance
Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 24
A. Sociodemographic factors 1. Age (being older, higher values on IRST | the better, successful the reintegration) 2. Education level (nonlinear relation, higher values in the extremes)
B. Judicial factors 3. With pending criminal record process when entering treatment (not relevant)
C. Geographic factors 4. Having changed residence after completing treatment (higher values in those who have changed
residence)
D. Treatment related factors 5. Years after completing treatment (more years, higher values) 6. Duration of treatment (longer treatment in months, higher values) 7. Treatment evaluation (better treatment evaluation, higher values)
E. Substances related factors 8. Main substance (users with alcohol with main substance of use, higher values) 9. Years of consumption of main substance (more higher of use, higher values)
Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 25
0 0,5 1 1,5 2 2,5 3 3,5 4 4,5
HeroínaCocaína
CannabinóidesÁlcool
Substâncias:Não mudou de residência
Mudou de residênciaGeográficas:
Com antecedentes judiciaisSem antecedentes judiciais
Jurídicas:Universitário
Secundário3º ciclo2º ciclo1º ciclo
Escolaridade:
mean
Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index
Education Level: Primary education (4) Primary education (6) Lower secondary edu Higher secondary edu
University Judicial:
Without criminal record With criminal record
Geographic: Changed residence
Unchanged residence Drugs | Substances:
Alcohol Cannabis Cocaine Heroin
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 26
0 0,03 0,06 0,09 0,12 0,15
Anos de consumo da substância principal
Avaliação do tratamento
Duração do tratamento (meses)
Anos passados desde a alta terapêutica
Idade
Correlation coefficient
Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index
Age
Years after treatment completed
Durantion of treatment (months)
Treatment evaluation
Years of consumption of main drug use
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Family as supporting factor:
“Had psychological help from my family and that aspect was as important as helping me in the matter of food, because I vented a lot with my father, I would open up everything, anything I vented to speak with him, now I get along very well with him, if I need to vent or need advice I have it on hand or my sisters.”
…and as complicating factor:
“One can change, but the family does not change or changes very little, is always doubting on you, and now and then they remind it to you "eh that was fifteen years ago, I've paid for it all!" It is not this way that they will help me to move on.”
Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors
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The change of residence
1. support on work environment or among friends
2. autonomy:
“I am my own therapist ... and since 2007 that I'm out here, free of alcohol, and drugs [...] Myself alone, therefore without my parents, without my brother [...] There were times in which I was at home on the computer, playing a game, and I felt like a beer, so I picked on me and went to the coffee bar, grabbed a bottle of water, took a coffee and left.”
Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 29
The return to the old residence place
1. contact with old use habits
2. residence in small towns or villages with high(er) social control:
“When I came they only talked about “ when will she relapse?” A guy comes in to the coffe bar and listens: hein!... And one fakes it did not ear”
3. Return to a close environment in which the user was raised when
drug addict: “[Do you believe if You would not be here it would be easier?] I do, because I
was in Alpiarça for 6 months (…), it was I to have to go to the pharmacy (…) and people around knew that it belonged to Dianova and they always treated me well… always with respect.”
Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors
Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 30
1. Completing treatment without feeling fully ready
2. The shock of returning to the old residence place:
“I was dropped off, I had the feeling that my house was strange to me, I was almost a year there, and because of fear they left me stay there a little longer, only that there was a time when I was told “You have to go, have to go”
3. Take use to the new routines:
“And then it's into the routine, prepare my children to go to school, prepare lunch and all those little things that I had forgotten there”
4. Economic difficulties and unemployment periods
Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors
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Phase 3 Final Results Trajectories, from drug addiction to reintegration Conclusions
• Five main social trajectories: Residencial, Marital status, Work, Capabilities (Education or Training), Substance consumption
• Residencial trajectories emerge as most relevant (change residence to get away from use environments)
• Capability is crucial to the reintegration process (rights of access, social freedom and mobility, recognition of identities and merit reward)
• Regarding the 3 factors related with the therapeutic process the correlation is always positive: the more years have passed since the clinical discharge, the longer the duration of the treatment and the much better the treatment evaluation is, the higher the values of the IRST (Ex-Drug Users Social Reintegration Index)
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Future Research
• Due to the reduced sample and lack of statistical representativeness of the empirical basis of work,
as well as to the need of replication of the proposed Index, • More in-depth interviews (qualitative analysis) are
crucial to enrich the study, • and future research should be developed in order to
validate its strength and to confirm whether a successful reintegration depends more on the post-treatment process than on the individuals’ characteristics (such as sex, age, education…)
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Download Preliminary Reports EN (I and II)
• The Full Scientific Study Reports can de downloaded from Dianova’s website: http://dianova.pt/publicacoes/estudo-follow-up-trajectorias-sociais
• Report I (Phase 1) http://dianova.pt/images/stories/publicacoes/estudos/trajectories_report_I_en_2011.pdf
• Report II (Phase 2) http://dianova.pt/images/stories/publicacoes/estudos/trajectories_report__II_external_en_2012.pdf
• Report III (Phase 3 and Final) will be available from October | November 2013
• Prof.ª Doutora Susana Henriques http://www.cies.iscte.pt/investigadores/ficha.jsp?pkid=67&a=1956703120
• CIES-ISCTE-IUL Project http://www.cies.iscte.pt/projectos/ficha.jsp?pkid=428
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Accept Mistakes
Enjoy
In Conclusion
Simplicity in Complexity
Guidance for Learning Take risks.
Encourage Inovate
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