Section XI Social Rehabilitation
In previous sections of this report and in several of the Appendices we have referred to the importance of social rehabilitation or reintegration in the treatment and control of drug dependence. Its importance is particularly reflected in the experience with parole (see Appendix I Treatment of Opiate Dependents in Federal Penitentiaries in Canada and Appendix K Parole of Heroin Dependents in Canada), although it is also important in voluntary programs of treatment. It will be recalled that one of the reasons for the failure of the treatment program in the American hospitals at Lexington and Fort Worth was the absence of follow-up in the community. The role played in reinforcing drug dependence by the lack of the required ability or opportunity to obtain regular employment and to establish normal relations, as well as the attraction of the associations and style of life in the drug subculture is emphasized in several places in the report. (See, for example, Appendix C.4 Patterns of Use, "Termination of Use".) It would be difficult to exaggerate the importance of this problem.
Treatment and rehabilitation are overlapping processes. As treatment proceeds rehabilitation should be taking place. But the essence of rehabilitation is reintegration into the community—the restructuring of a life. Whether the goal of the treatment be abstinence or some form of management, as with maintenance or the use of an antagonist, its essential purpose is to bring the drug use under control. If this achievement is to have enduring effect there must also be a new basis for life which may strengthen the person's capacity to resist the temptations to engage in certain forms of drug use.
The drug-dependent person is frequently lacking not only in the self-confidence but in the capacity to obtain and hold regular employment and to establish and sustain normal personal and social relationships. He or she needs a lot of encouragement and assistance in these efforts. Every one of them can appear as an enormous and insurmountable challenge.
Helping a person in these circumstances requires a great deal of time, patience and energy. Frequently what the person needs most is someone to talk to who can be available for moral support at the right time. There is also a need of practical assistance in finding suitable employment and accommodation and new relationships and interests in life.
We have stressed the need for more probation and parole officers to assist with this work. There is also a need in established treatment facilities for more trained personnel to assist with social rehabilitation. It has been suggested that the effectiveness of treatment programs in stimulating the motivation of patients depends in a considerable measure on the extent to which they are themselves able to provide assistance with these practical problems? Finally, there is a large field of action here for volunteer men and women who can provide companionship, moral support and practical help for persons seeking to break from the old associations which are so closely identified with the drug dependence itself.
The number of cases to which any worker can do justice is very limited—perhaps as few as half a dozen. This gives some idea of the numbers required for the work of social rehabilitation. The numbers required cannot possibly be recruited and maintained on a regular professional basis. They must be supplemented by a large pool of voluntary effort, with some assistance in the way of minimal training from established agencies.
Persons involved in the work of social rehabilitation, whether professionals or laymen, require a good understanding of what they face, of the nature of drug dependence and the difficulties the drug-dependent person encounters in the process of rehabilitation. It is the kind of knowledge that will keep them from becoming too easily discouraged. They must be persons of optimism and faith and great patience. While being sympathetic and good listeners, they must be fundamentally "doers"—persons who are good at getting out and about and getting practical things done. Too much time can be spent examining the past in a manner that still further undermines the drug-dependent person's sense of personal adequacy. What is required is to increase the person's sense of self-confidence by success in some practical undertakings and by increased involvement with other people in a socially acceptable pattern of life. The goal of rehabilitation is an enhanced sense of personal dignity and worth and satisfactions in life which fill the need for which the drug and the former associations were sought.
1. Edward C. Senay and Matthew Wright (Illinois Drug Abuse Program, Museum of Science & Industry, Chicago), "The Human Needs Approach to Treatment of Drug Dependence," Paper presented at the 30th International Congress on Alcoholism and Drug Dependence, Amsterdam, September 1972.