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Details
Author: E. SACKSTEIN
Pages: 33 to 45
Creation Date: 1981/01/01
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a more positive outlook. This paper describes the vocational rehabilitation process which can serve as a
basic tool for most drug rehabilitation programmes. The author illustrates a number of interesting and
innovative approaches, both public and private, which have all demonstrated some measure of positive
outcome. Mention is made of the need for and great value of direct involvement of the community in the
rehabilitation and re-integration process. Programmes for employed drug-dependent persons are also cited
as a preventive and highly effective approach.
Introduction
The term "drug addict" generally conjures up in one's mind an image of a depraved, amoral youth who is
not only dangerous to society but who is also incapable of changing his ways or of being helped.
Fortunately, this image is far from the truth. And yet, all too often, national policies and programmes for
the drug dependent are formulated in ways which strongly reflect this stereotype and prejudice. As a
result, and almost as a self-fulfilling prophecy, drug rehabilitation programmes have been notoriously
plagued by low success rates.
If drug addicts can, in fact, become productive members of their community then why, one must ask, has
the experience in many parts of the world been so generally discouraging? This paper takes a closer look at
the problems concerning vocational and social integration of drug-dependents, ventures to identify a
number of the main difficulties and explores several encouraging and innovative trends.
In recent years, the world has seen important technical and social progress and has simultaneously
experienced increasingly greater social and political turmoil. With little from accepted traditions and values
to guide it, the younger generation, and particularly youth from the more rapidly changing and
industrialized countries, has found itself in a position of having to seek more relevant values and has had to
structure a way of life that corresponds more to current realities. This is a profound challenge to confront
an entire generation that had cut its eye teeth in a society of potentially unlimited prospects for
achievement, and young people are proving to be least well prepared to cope with stress or to be truly
adaptable to rapid change. The causes of drug-taking behaviour are certainly complex and may vary widely
from culture to culture and country to country. Nevertheless, one tends to find that mental illness is on the
rise and occurs at an increasingly earlier age; suicide and violence are more prevalent; socially deviant
behaviour (delinquency, prostitution, criminality etc.) is spreading; and the use of substances (drugs,
alcohol etc.) to relieve anxiety and for recreation is intensifying.
Seen in this perspective, drug taking is but one of many symptoms of social ferment. It reflects
self-destructiveness but may also demonstrate a form of noncompliance with what are felt to be
unacceptable social alternatives. Drug taking is therefore more a human, personal and social problem than
a legal or medical one.
This point is fundamental; if it were accepted, its implication for policy and programme development would
be of evident importance in setting strategies at international and national levels.
With the spread of the drug abuse phenomenon the image of the typical drug taker has become more
diverse and broader. The average age of substance abusers has considerably lowered in recent years. Both
drugs and alcohol are being taken in combination, with the result that poly-drug use is increasingly
common. Substance abuse is neither the exclusive domain of either the rich or the poor, of the employed or
the unemployed, of the young or the not-so-young. Nor is it a phenomenon unique to either industrialized
or developing countries. One thing is true, however, of all drug takers. Their drug-taking behaviour is
universally seen as deviant and as a fundamental threat to the stability and future of society.
Professionals in a number of countries have explored a wide range of experimental approaches in their
efforts to tackle many of the thorny problems inherent in trying to persuade addicts to refrain from using
drugs and to find a meaningful place for themselves in their families and communities. The results have
been extremely varied - from discouraging to very hopeful. Any measure of success depends to a large
extent upon the definition of these terms and on how they are measured. In this context there have been
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great differences, not only from country to country, but also among programmes within the same country.
The more statistically successful programmes are often eyed sceptically by other rehabilitation
professionals. One should not under-estimate the extremely destructive influence that negative attitudes,
on the part of the general population as well as of rehabilitation professionals themselves, can have on the
outcome of rehabilitation efforts. Even the best-conceived assistance can result in failure if people are not
convinced that it can work.
It is also probable that some of the failures in helping ex-addicts back to life in their communities,
particularly in Western cultures, are due to the fact that the help may not sufficiently encourage their
voluntary participation or that it does not correspond to their personal needs or to the hard realities of the
labour market.
Vocational Evaluation
Vocational evaluation systematically utilizes work, whether real or simulated, as the focal point in the
vocational development and career planning of an individual. Psychological, social, educational and
vocational data are gathered to assist in this process.
Job Preparation
Job preparation aims at (re)acquainting a person with the conditions and demands of the work world and
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environment. This can include training with different materials, tools, machines and methods of working, as
well as the promotion of the standards expected at work, It should also include the development of those
personal factors that can enhance an individual's employability, e.g. work habits, physical or emotional
tolerance of work, and appropriate inter-personal skills. This type of assistance to ex-addicts who have
never worked before can be of crucial importance in adapting to their first jobs. Lack of preparation could
easily spell failure for reasons that are not related to the person's former addiction.
Vocational Training
Vocational training should take into consideration both the persons' abilities and their interests. Training
must be based on realistic employment opportunities in the current labour market. This point cannot be
overemphasized in view of today's increasing unemployment. Solid job training can put a former
drug-dependent person in a more competitive position in an increasingly competitive and tightening labour
market.
Selective Placement
The techniques of selective placement can be extremely effective in assisting individuals to find
employment that is suited to their experience as well as their physical, mental and other characteristics. It
involves good knowledge of the job seeker's positive attributes and skills, knowledge of the job and its
requirements and, finally, matching the candidate to the job. A trained placement counsellor usually makes
direct, on-the-spot contacts with personnel departments and managers in industry, with businessmen and
labour representatives, for the purpose of identifying prospective job openings. This direct approach also
serves the important function of trying to overcome the inevitable prejudices that employers might have in
engaging a former drug dependent.
This type of service can be provided within the rehabilitation programme itself. However, those programmes
that lack the placement expertise or manpower can sometimes benefit from special services that are set up
specifically for that purpose.
It is worth mentioning in this context that in a demonstration project undertaken in the United States which
developed strong placement services for exdrug abusers, participating employers were questioned about
their experience after having employed a client from the programme. The majority of the clients (71 per
cent) had been involved with heroin or heroin and cocaine. Over 69 per cent had been using drugs for over
two years, with 47 per cent having used drugs for over four years. With regard to overall job performance,
77 per cent of the employers rated the programme clients as the same, or better than regular employees.
With regard to punctuality, 79 per cent of the employers rated clients the same or better than regular
employees. Approximately 86 per cent of the clients were rated the same or better than regular employees
concerning attitudes towards their job and their ability to relate to co-workers. On the subject of
absenteeism, clients were rated by 66 per cent of the employers as the same or better than regular
employees. Most programme clients were placed in entry-level positions. Their occupation distribution is
shown in table 1.
Professional/technical/managerial
14.7
Clerical
22.4
Stiles
2.9
Craftsman/foreman
15.3
Operatives/semi-skilled
13.5
Services
Labourers
Total
7.7
23.5
100.0
Follow-up
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The last phase of the vocational rehabilitation process, the follow-up, is not, as many believe, a statistical,
head-counting exercise to determine how many ex-addicts benefited from their rehabilitation. Instead,
follow-up aims to ascertain for given individuals whether their placement in a job or social adaptation has
proved to be satisfactory. It also serves a second, preventive, function in that it attempts to detect and
rapidly resolve difficulties or obstacles to satisfactory adaptation to work so that these would not
unnecessarily lead to dismissal.
Wildcat
Created in New York City in 1972, Wildcat is a drug rehabilitation programme that was conceived as a
corporation which provides services to local communities. The corporation employs ex-addicts or
ex-offenders to provide these services and bas shown that through supported work these people can break
out of the pattern of drugs and crime. By offering them meaningful jobs and salaries on which they pay
taxes, Wildcat has demonstrated that they can become self-sufficient, contributing members of society.
Wildcat was designed to provide a structured environment in which ex-addicts can be encouraged and
supported in their adjustment to employment through group work, peer supervision, "feedback" and
rewards for good performance. Most Wildcat projects perform public services for the city, although there
are some projects undertaken for non-profit community agencies. Crews are assigned to about one
hundred job sites which include clerical, social services, maintenance and construction work. The main
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programme goal is to provide a transition from. subsidized to competitive employment. There were as
many as 1,400 clients within the programme in 1975, prior to New York City's financial crisis. An analysis
was made of 149 clients who left Wildcat before the end of three years (see table 2).
1 - 26 ( n = 45)
20
27 - 52 ( n = 38)
45
25
53 - 104 ( n = 45)
51
23
Flexible work policies have been developed to deal with the work problems of employees while they are
within the programme's supported employment. These policies relate to punctuality, attendance and time
off. This flexibility does not mean that there are no regulations but rather that the (ex-drug abusers)
workers may temporarily be permitted some margin for deviating from norms of work conduct with the
understanding that they will eventually have to comply with these. This therapeutic approach can often
help ex-addicts make the personal and crucial adjustments that are essential to their being able to function
socially and at a place of work.
Grupo Abbele
Grupo Abbele developed in Italy. It was created by a young priest to respond to some significant social
problems within the industrial city of Turin. In addition to drug abuse, these included delinquency,
alcoholism, prostitution, lack of recreational activities for Turin's youth and a lack of assistance for its older
population. Situated in a residential facility (a renovated old building on a sizeable tract of land) within the
city limits, the Grupo Abbele employs young people who suffer from various problems to assist in the
upkeep and maintenance of the building, and to raise animals and vegetables for sale as well as for their
own use.
The Grupo also organizes activities that respond to important needs within the community. In so doing, its
programme aims at changing those social conditions that may be the cause of the difficulties of its clients.
For example, the lack of recreational activities for the city's youth can be an element contributing to
delinquency. The young people are directly involved in these community improvement projects. In this way,
they develop certain vocational skills. The significance of the responsibilities they are given cannot be
underestimated, for none can deny that their work has a socially useful function.
The clients are not encouraged to stay longer than necessary. Employment assistance is offered when
needed. The Grupo is not a closed institution. Rather, its uniqueness and originality come from it being
open and sensitive to the quality of life and needs in the community around it. It may be worth
emphasizing that the Grupo does not cater to any one category such as the drug-dependent or the public
offender.
Burma
The Government of Burma has requested technical assistance from the ILO, financed through the United
Nations Fund for Drug Abuse Control, in the formulation of a national strategy and the development of a
national programme of vocational rehabilitation and social reintegration services for drug-dependent
persons. This assistance is part of a multi-sectoral international programme including, among others, crop
replacement, preventive education, and treatment.
In line with government policy, the Department of Social Welfare is seeking to create a network of
rehabilitation services (i.e. craft training centres and social support centres) for drug-dependent youth
throughout the country. These services are being set up in relatively small facilities within and near the
affected towns and cities. The most unique feature of this programme is, perhaps, the use of what are
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known as volunteer social workers. These are young people who have recently terminated their education,
and are engaged at the local level in identifying, registering and bringing known addicts for treatment and
rehabilitation. After a short introductory course and, later on, a refresher course, these volunteers work in
close collaboration with village and community leaders.
As the programme develops the youth workers gather practical knowledge and insight into the causes of
drug abuse. They learn how the addicts and their families can be assisted, and what solutions can be
developed with regard to job training, placement and employment. Some have taken the initiative, for
example, in contacting prospective or former employers for the purpose of placing an addict or convincing a
reluctant employer to take back a formerly drug-dependent worker. As a result, the ILO has been
increasingly encouraged to seek the advice and guidance of this corps of youth volunteers in finding
solutions to questions concerning the further direction and development of this experimental programme.
This joint project is only at the midpoint of its work and it is, therefore, not possible to evaluate its results
at this stage. However, the ILO is quite hopeful that the present pragmatic and community-oriented
approach will bear fruit.
Therapeutic. Communities
The therapeutic community (TC) as a system of rehabilitation is extensively developed in various parts of
the world. This approach was developed at a time when it was realized that out-patient treatment and
hospitalization had little impact on an addict's remaining drug free. Therapeutic communities have tended
to be somewhat controversial internationally in that, while some have succeeded in getting their members
to conform to the subculture of the community, the ex-addicts were often unable to make an adequate
transition and adaptation back into the regular mainstream of society. Those therapeutic communities
became more or less permanent substitutes for drug dependence.
Fortunately, this is not true of all therapeutic communities, among them the Centre du Levant. This may be
due, at least in part, to the fact that greater efforts were made to get the addicts to conform to the more
realistic demands of the work environment and of society at large.
The Centre du Levant is a fairly traditional type of TC at Lausanne, Switzerland, which offers a residential
programme to some 20 ex-drug abusers. Like many, it has a strict, regulated, three-phased, one-year
programme that promotes the evolution of the individual in terms of group participation and responsibility,
vocational preparation and eventual reintegration within the traditional community. Members must be
involved in some form of vocational training and activities. These include the upkeep and maintenance of
the residence, cooking and kitchen work, as well as performing services within the neighbouring
community. For those members who, at the completion of their one-year stay, are not ready for full social
reintegration, a farm activity outside Lausanne has been created. The final objective of the Centre du
Levant, however, is the return of the ex-addict to a useful social and economic role.
With regard to the general outcome of TC programmes, a 1976 review of experience in the United States
showed that half or more of the graduates of traditional therapeutic communities were employed in drug
treatment or social service activities. The proportion of addicts that returned to employment in the usual
sense appears small.
A Municipal Project
New Orleans, in the southern United States, has a local government municipal project for socially
disadvantaged youth, including the drug-dependent, but it has no residential facility as its base. Rather, its
main emphasis is on the economic sector of the community. In a dynamic and aggressive approach, local
managers and businessmen are contacted with a view to enlisting their participation. This consists in
agreeing to provide on-the-job training to a detoxified youth for a determined period of time. A subsidy
may be offered to the employer during this period to compensate for the lower productivity of the trainees
during their stay. It is understood that the participating employer is under no obligation to engage the
trainee at the termination of the programme.
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However, many employers were quite willing to offer regular employment to trainees once they were
convinced that their prior drug dependence was no obstacle to the performance of their job.
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countries in North America and Western and Eastern Europe. This is somewhat surprising in view of the
great potential of these programmes. For example, in the United States some firms that had dismissed as
many as 95 per cent of their alcoholic employees before instituting special services, were able to claim up
to 80 per cent recovery and retention of this group as the direct result of having set up these services.
Occupational drug abuse and alcoholism programmes, therefore, have a highly preventive function.
A more recent development within this field has occurred in Canada and may well mark an important new
stage. The Canadian Labour Congress, a trade union, is setting up services that aim at the spectrum of
behavioural problems that impair job performance. In this way they will not concentrate only on the
alcoholic or drug-dependent employee, for it can be observed that work performance may also be seriously
affected by a range of psycho-social problems other than substance dependence. Known as "employee
assistance" or "employee recovery" programmes, such generalized services are considered more effective
in that they do not cater for any one group and, in so doing, do not place the stigma or label of "alcoholic"
or "addict" on those seeking help.
Conclusion
We have briefly reviewed several recent and innovative trends in helping drug-dependent youth to
reintegrate in their communities. Training for employment has proven to be of enormous therapeutic and
practical value to help ensure a more favourable outcome for their re-entry and their attempt to survive in
an increasingly competitive and complex world. National planners, treatment and rehabilitation personnel
and the general public must all be better informed about the nature, objectives and usefulness of
vocational rehabilitation. It should also be stressed that a vocational component in rehabilitation should not
and cannot be used merely to help pass the time in the addict's daily schedule. In order to develop a
realistic vocational service, personnel with experience in training, placement, employment and the business
world are absolutely essential.
When setting up rehabilitation services for youthful drug abusers, it is equally important to bear in mind
that this group has generally little or no job training, work experience or survival skills. The present
world-wide economic downturn makes these factors even more crucial. These individuals' opportunities for
and abilities in obtaining jobs on their own are limited, particularly if they are from socially disadvantaged
groups. If our efforts to reintegrate former drug-dependent youth fail, perhaps we should not hasten to put
the blame on their shoulders. We should ask ourselves two questions: "Where have we missed the boat?"
and "How can we do something differently, and respond more effectively to the problems of those we are
responsible for helping?"
Bibliography
Arkin, S. Jobs for ex-addicts. Manpower (Washington, D.C.), July 1975.
Caplovitz, D. The working addict . Journal of psychedelic drugs (Madison, Wisconsin), October - December
1976.
Double, W. and L. Koenigsberg. Private employment and the ex-drug abuser: a practical approach. Journal
of psychedelic drugs (Madison, Wisconsin), January-March 1977.
Friedman, L. The Wildcat Experiment: an early test of supported work in drug abuse rehabilitation.
Rockville, Maryland, 1978. 147 pp. (Services Research Monograph Series)
Hubbard, R., H. Harwood and A. Cruze. Impacts of drug use, drug treatment, and vocational services on
employment-related behaviours of drug abusers and addicts; Final report. North Carolina, Research
Triangle Park, 1977. 246 pp. International Labour Organisation. Basic principles of vocational rehabilitation
of the disabled. Geneva, 1973. 53 pp.
-------------Glossary; Vocational rehabilitation and employment of the disabled. Geneva, 1981. 182 pp.
Lieberman, L. The receptivity of large corporations to employ ex-addicts. Journal of psychedelic drugs
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