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“Trajectories, from addiction to reintegration

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  1. “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

  2. Dianova Network & International Public Affairs Hub MISSION | to develop actions and programs that will contribute to the Personal Autonomy and Social Development 3 Continents | 11 Countries

  3. Dianovarecognized as Private Institution for Social Solidarity, Public Utility Association and Non-Governmental Organization for Development Education and Health Promotion Drug Abuse Treatment Socio and Professional Reintegration Psychosocial Support Training & Empowerment (Hard | Soft Skills) PROTOCOLS AFFILIATIONS Organizational & Social Innovation Agent Cooperation & Learning Culture Oriented Social and Solidarity Agent Social Change Promoter

  4. Certifications | Acredditations Dianova ISO 9001:2008 Quality Management System CTQL (1st in Portugal since 2005) EFR FamilyResponsibleEntity Social Economy (1st in Portugal since 2013) DGERT | CCPFC Training Entity (CFD) DGERT – MTSS | CCPFC – ME

  5. Dianova | Operational Units (Lisbon | Oliveira Azeméis | Torres Vedras) HEADQUARTERS Dianova Portugal University Students Residencial Psychosocial Support Center +Health Therapeutic Community Quinta das Lapas Emergency Center Project Casa Azul Social Enterpirse Nursery Plant Training Center Dianova SocialReintegration Apartment

  6. The Team Talent Retention 94% 41 Employees 90% Direct Contracts 10% Indirects Age Average 40,1 Qualifications 31% College 69% High School Areas 77,9% Programs 22,1% Management Gender 50% Female 50% Male

  7. Scientific Follow-up Study “Social Trajectories” 2013 CIES | ISCTE-IUL WWW.DIANOVA.PT

  8. 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).

  9. Coordination Prof.ª Doutora Susana Henriques, CIES-ISCTE-IUL Main Goal • 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…)?

  10. Methodology • 3 Main Phases (developed between 2010 and 2013) • Analysis of administrative processes (n=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 • Phone interviews (n=63) in order to follow-up and identify changes on life trajectories of individualssuch as the stop of drug use, to know the social trajectories, identify obstacles and facilitators of family, professional and social reintegration • In-depth interviews (n=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

  11. Phase 1 Sociodemographic: Origin

  12. Phase 1 Sociodemographic: Sex & Age Age Structure

  13. Phase 1 Sociodemographic: Education

  14. Phase 1 Sociodemographic: Clinical Status Health Problems

  15. Phase 1 Treatment Internment Main substance (%)

  16. Phase 1 Treatment Internment Main substance by age group (%)

  17. Phase 1 Treatment Internment Age of beginning drug use

  18. Phase 1 Treatment Internment Time of drug use in years

  19. Phase 1 Treatment Internment Peridiocity in the drug use (%)

  20. Phase 3 Final Results The IRST | Ex-Drug Users Social Reintegration Index (4 dimensions | 7 variables) • 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

  21. Phase 3 Final Results The IRST | Ex-Drug Users Social Reintegration Index (4 dimensions | 7 variables) IRST Graphic Representation

  22. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index • Sociodemographic factors • Judicial factors • C. Geographic factors • D. Treatment related factors • E. Drugs | Psichoactive Substance related factors • Note: • for categoricalvariables = frequencyandpercentageand for quantitativevariables = meanand standard deviation • Factorsthencrossedwith IRST, for categoricalvariables = IRST meanand for quantitivativevariables = Pearsoncorrelationcoefficient

  23. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index • 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

  24. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index • 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)

  25. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index EducationLevel: Primaryeducation (4) Primaryeducation (6) Lowersecondaryedu Highersecondaryedu University Judicial: Without criminal record With criminal record Geographic: Changedresidence Unchangedresidence Drugs | Substances: Alcohol Cannabis Cocaine Heroin

  26. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index Age Yearsaftertreatmentcompleted Durantion of treatment (months) Treatmentevaluation Years of consumption of maindrug use

  27. Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors 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.”

  28. Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors 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.”

  29. Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors 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.”

  30. Phase 3 Final Results Understanding Reintegration on Individuals’ perspective Reinforcement factors vs Limiting factors 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

  31. 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)

  32. Future Research • Due to the reduced sample and lack of statistical representativeness of the empirical basis of work, • more in-depth interviews (qualitative analysis) are crucial to enrich the study • as well as to the need of replication of the proposed Index, • 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…)

  33. 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

  34. In Conclusion Guidance for Learning Take risks. Encourage Inovate Simplicity in Complexity Thank You! Accept Mistakes Enjoy

  35. www.apoiopsicossocial.dianova.pt www.formacao.dianova.pt www.dianova.pt http://aprendercrescerconcretizar.wordpress.com dianovaportugal dianova-portugal Quinta das Lapas, 2565-517 Monte Redondo Torres Vedras Telf.: +351 261 312 300 Fax.: +351 261 312 322 E-mail:rui.martins@dianova.pt| susana_alexandre_henriques@iscte.pt