Presentation dianova cies iscte_iul_eftc prague 2013

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 1 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© 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 2 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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

4. Certifications | Acredditations Dianova Quality Management System CTQL (1st in Portugal since 2005) ISO 9001:2008 Family Responsible Entity Social Economy (1st in Portugal since 2013) EFR DGERT | CCPFC Training Entity (CFD) DGERT – MTSS | CCPFC – ME 4 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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 Social Reintegration Apartment 5 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

6. The Team Talent Retention 94% 41 Age Employees 90% Direct Contracts 10% Indirects Average 40,1 Qualifications 31% College 69% High School Areas Gender 50% Female 50% Male 77,9% Programs 22,1% Management Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal© Compromisso| Solidariedade| Tolerância| Internacionalidade… Inspirando a Mudança! Dianova Portugal© 6

7. Scientific Follow-up Study “Social Trajectories” 2013 CIES | ISCTE-IUL W W W . D I A N O V A . P T 7 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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

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

10. 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 10 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

11. Phase 1 Sociodemographic: Origin 11 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

12. Phase 1 Sociodemographic: Sex & Age Sex Ratio (%) 12% Age Structure 88% 12 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

13. Phase 1 Sociodemographic: Education 13 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

14. Phase 1 Sociodemographic: Clinical Status Health Problems 14 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

15. Phase 1 Treatment Internment Main substance (%) 15 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

16. Phase 1 Treatment Internment Main substance by age group (%) 16 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

17. Phase 1 Treatment Internment Age of beginning drug use 17 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

18. Phase 1 Treatment Internment Time of drug use in years 18 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

19. Phase 1 Treatment Internment Peridiocity in the drug use (%) 19 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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

21. Phase 3 Final Results The IRST | Ex-Drug Users Social Reintegration Index (4 dimensions | 7 variables) 35 30 25 20 % 15 10 5 0 0 1 2 3 4 5 6 7 IRST Graphic Representation 21 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

22. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index A. Sociodemographic factors B.Judicial factors C. Geographic factors D. Treatment related factors E. Drugs | Psichoactive Substance related factors 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 22 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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

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

25. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index Escolaridade: Education Level: Primary education (4) Primary education (6) Lower secondary edu Higher secondary edu 1º ciclo 2º ciclo 3º ciclo Secundário Universitário University Jurídicas: Judicial: Sem antecedentes judiciais Without criminal record Com antecedentes judiciais With criminal record Geográficas: Geographic: Mudou de residência Changed residence Não mudou de residência Unchanged residence Drugs | Substances: Substâncias: Álcool Alcohol Cannabinóides Cannabis Cocaína Cocaine Heroína Heroin 0 0,5 1 1,5 2 2,5 3 3,5 4 4,5 mean 25 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

26. Phase 3 Final Results Factors related with the IRST | Ex-Drug Users Social Reintegration Index Age Idade Anos passados desde a alta terapêutica Years after treatment completed Duração do tratamento (meses) Durantion of treatment (months) Avaliação do tratamento Treatment evaluation Anos de consumo da substância principal Years of consumption of main drug use 0 0,03 0,06 0,09 0,12 0,15 Correlation coefficient 26 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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

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

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

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

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

32. 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…) 32 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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

34. In Conclusion Guidance for Learning Take risks. Encourage Inovate Simplicity in Complexity Accept Mistakes Enjoy 34 Commitment| Solidarity| Tolerance| Internacionality… Inspiring Change! Dianova Portugal©

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