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An independent review into the impact on employment outcomes of people with drug or alcohol addiction has been set up and will be led by Dame Carol Black. The idea is to support those facing barriers to employment, a keen area of focus during the RSA’s Whole Person Recovery project.

The following aim, if taken forward, is one that has been met with a great deal of concern:

Explore the support provided by the existing benefit system and the incentives/barriers related…considering the case for linking benefit entitlements to [taking] up appropriate treatment or support.” (Find out more)

An argument in favour of this type of coercion is that it could expose some people to treatment services and peer-support groups for the first time. For a treatment naïve group it could be a positive move, although pushing people into treatment is unlikely to be the best start. I would guess also, looking at the numbers quoted in the review, that most individuals that are both in receipt of benefits and cite problematic drug or alcohol use as a reason for being unavailable to work, will have had some exposure to treatment services already.

Coercion through welfare sanctions could have a negative effect on recovery, both for individuals and in a wider sense. Recovery is a journey and one that should be owned by the individual from the outset. It is the norm for individuals to relapse several times before reaching stability in their recovery and any discussion that led to a policy that forces people into treatment needs to take this into account. Punishing someone for not attending treatment, or dropping out entirely is likely to increase their problems and potential desperation. There is also little evidence that coercion reduces problematic drug use, which is surely the primary aim, and the ethics are questionable.

For this reason, and others, a change like this is likely to hit the most challenging individuals hardest. A much-quoted statistic from a Lankelly Chase report puts the issue into perspective: “Each year, over a quarter of a million people in England have contact with at least two out of three of the homelessness, substance misuse and/or criminal justice systems, and at least 58,000 people have contact with all three.” Dealing with multiple and complex issues is the norm, rather than the exception and the evidence suggests that, for a variety of fairly straightforward reasons these individuals who lead fairly chaotic lives are much more likely to be affected by sanctions.

From a behavioural science perspective, it could be argued that taking money away from people will contribute to their ‘scarcity effect’. That is, when you have insufficient resources (e.g. money, time) to cover all your requirements, this creates the need to make trade-offs, and trade-offs are particularly mentally taxing. As an example, if you don’t have enough money to pay all of your bills and buy new shoes for your children, you have to decide whether rent, electricity, water, food, or the shoes get priority. Eldar Shafir and Sendhil Mullainathan examine this idea in their book ‘Scarcity’. They argue that when people lack sufficient resources they tend to ‘tunnel’ which means they focus all their mental energy on solving the most immediate problem. In this case that is unlikely to be an individual’s recovery. Indeed, when drug or alcohol use becomes the means to survive the day, adding to somebody’s burden would seem to be counter-productive.

Such an approach also risks changing the nature of a recovery worker’s job. Will they have to report to the Job Centre when a client doesn’t attend a group, for example, and how would this impact upon building a therapeutic relationship? In my experience recovery workers already spend a great deal of time helping clients navigate their way through the benefit system. It seems particularly inefficient for them to have to take on more of this. In addition, it is not clear that services are equipped to support people who are resistant to treatment, potentially a substantial number of the individuals affected by this. A recent report from the Recovery Partnership states that “72% of survey respondents felt that working with treatment resistant service users was a training gap”. This need would have to be addressed and at a time where services are expecting significant cuts, it is unlikely they will have the extra resources for this.

Similarly, the work of mutual aid groups such as SMART Recovery, AA and the hundreds of smaller organisations like Aspire2Be who operate in West Kent has been very effective in supporting recovery and Public Health England strongly advocate of these types of approaches. I would suggest that the presence of people in these groups that have no wish to be there can damage the group and hinder the recovery of others, though I’d be interested to hear from others with more experience of this than me.

Outreach work, a core function of treatment services, is a much more effective way of getting people into treatment and helping those who are not appropriately supported by the system. It also encourages collaboration with other services such as the criminal justice system, homeless charities and mental health services. Sanctions, which act as a form of arbitrary criminal justice, risk turning people against the system, a system that has worked extremely hard over recent years to become one that is open and friendly and also one that is, where possible, led by current and former service users.

Over the last 20 years the language of drug addiction has shifted significantly, framing it as a health matter as opposed to a criminal justice issue. There is still a lot of work to do but through a culture shift towards recovery the blaming and stigmatising of individuals that suffer from addiction has started to reduce and the systems now in place are much more supportive. However, the kind of policies that could come out of this review risk feeding into a wider rhetoric that blames and punishes individuals rather than supports them.

The RSA’s Whole Person Recovery team will be releasing a report in November and this is a topic we will be looking at more closely. For the reasons above, I feel strongly that this is the wrong approach and I hope the review will consider all of the potential, unintended consequences. I’d be very interested in hearing other views though. Either email me here, or better still, comment below.

'Whole Person Recovery' Project

 

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