Presentation dianova cies iscte_iul_eftc prague 2013

Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 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


MISSION | to develop actions and programs that will contribute to the Personal Autonomy and Social Development

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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


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)


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

Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 6 Compromisso| Solidariedade| Tolerância| Internacionalidade… Inspirando a Mudança! Dianova Portugal©

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


Scientific Follow-up Study “Social Trajectories” 2013 CIES | ISCTE-IUL

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http://www.dianova.pt/















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).


• 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


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

http://dianova.pt/images/stories/publicacoes/estudos/trajectories_report_I_en_2011.pdf



http://dianova.pt/images/stories/publicacoes/estudos/trajectories_report__II_external_en_2012.pdf



Phase 1 Sociodemographic: Origin


Phase 1 Sociodemographic: Sex & Age

12%

88%

Sex Ratio (%)

Age Structure


Phase 1 Sociodemographic: Education


Phase 1 Sociodemographic: Clinical Status

Health Problems


Phase 1 Treatment Internment

Main substance (%)



Main substance by age group (%)



Age of beginning drug use



Time of drug use in years


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


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)


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


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


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



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)



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


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


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


Age

Years after treatment completed

Durantion of treatment (months)

Treatment evaluation

Years of consumption of main drug use


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


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.”



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.”



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 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)


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…)


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

http://dianova.pt/publicacoes/estudo-follow-up-trajectorias-sociais





http://www.cies.iscte.pt/investigadores/ficha.jsp?pkid=67&a=1956703120

http://www.cies.iscte.pt/projectos/ficha.jsp?pkid=428


Accept Mistakes

Enjoy

In Conclusion

Simplicity in Complexity

Guidance for Learning Take risks.

Encourage Inovate

Quinta das Lapas, 2565-517 Monte Redondo Torres Vedras Telf.: +351 261 312 300 Fax.: +351 261 312 322 E-mail: [email protected] | [email protected]

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mailto:[email protected]

mailto:[email protected]

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Health & Medicine

Presentation dianova cies iscte_iul_eftc prague 2013