Jobs, Friends & Houses: A Community Organization Challenge Addiction-related Stigma
The Centers for Disease Control and Prevention (CDC) defines stigma as an “attribute that is deeply discrediting…the trait sets the bearer apart from the rest of society, bringing with it feelings of shame and isolation.”
Illicit drug use disorders may be the most stigmatized conditions in the world, followed closely by alcohol use disorders, according to studies conducted by the World Health Organization.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
How to best address this stigma among individuals with susbtance use disorder (SUD) remains a key unanswered question in the field of recovery science.
The stigma of having an alcohol or other substance use disorder (SUD) can negatively impact individuals’ willingness to be open about their condition and to seek treatment and other recovery support services. It may also hinder an individual’s motivation and ability to obtain resources that help them initiate or sustain recovery, such as employment, housing, and recovery supportive relationships, also called “recovery capital.”
It is hypothesized that two pathways may help:
- First, facilitating individuals’ involvement in social networks supportive of recovery may help them cultivate a positive recovery social identity, protecting against any stigmatizing reactions and attitudes from others.
- Second, if those in recovery who have become respected, productive, members of their community are open about their status as a person in recovery, it may help dispel stigma-infused beliefs about, and reactions towards, individuals with substance use disorder (SUD) over time.
This study by renowned addiction researcher David Best describes an organization in Blackpool, England, called “Jobs, Friends & Houses”, intended both to:
- challenge stigma through the visible, advertised provision of a specific service to the community
- employ individuals with histories of substance use disorder (SUD) and/or criminal justice involvement
HOW WAS THIS STUDY CONDUCTED?
“Jobs, Friends & Houses” (also called JFH) builds and renovates property, that is then available for sale or rent by those working on the properties. Ultimately JFH also aims to link its employees with building apprenticeships, thereby providing them with skills for obtaining and maintaining employment. Founded by a local, long-time police officer and a person in long-term recovery, JFH is intentionally visible, with branding on t-shirts and company vehicles.
This study used individual and focus group interviews with 7 members of a Jobs, Friends & Houses (JFH) team to begin to explore the following questions:
- “How does a visible social identity of recovery impact on personal and social identity of participants in the project?”
- “How does a visible recovery identity impact on stigma and exclusion?”
- “How is this influenced by a pro-social event that challenges stigmatized and discriminating perceptions of addicted offenders?”
WHAT DID THIS STUDY FIND?
The study described an organization employing only individuals with substance use disorder (SUD) and/or ex-offenders that became well known in the community in which they worked. This, in part, was accomplished through the creation and dissemination of a specific brand (e.g., using a logo). In general, members reported feeling they were providing a meaningful service to the community.
This study found that being a member of JFH helped them cultivate a new valued, social identity, moving away from their older identities as an “addict” or “offender”.
The study also described a specific event where, near a Jobs, Friends & Houses (JFH) work site, there was a serious domestic violence incident. Members of the JFH team, and one in particular (the “unlikely hero” mentioned in the title of the article), intervened until the police could arrive. The article describes the positive reaction to JFH by the local police and other community members, specifically regarding pro-social actions of the members during the well-publicized domestic violence incident.
Several prior RRI monthly Bulletin articles have highlighted the stigma associated with substance use disorder (SUD):
- among the general public, that drug addiction is more stigmatized than mental illness
- individuals with substance use disorder (SUD) in remission are more stigmatized than active cigarette smokers
- treated opioid use disorder is more stigmatized than untreated depression and/or schizophrenia. One important finding in this third study was that, despite the stigma of SUD relative to mental illness, when opioid use disorder was described as a treatable condition – that is, where recovery is possible – individuals endorsed significantly less stigmatizing attitudes.
While more research is needed on JFH and organizations like it, it is possible that group members may also experience increased self-esteem – which could reinforce their recovery efforts – because they are participating in a productive activity that benefits the community.
An organization that provides a key service to the community in a highly visible way, and is known to employ individuals with substance use disorder (SUD), such as Jobs, Friends & Houses (JFH), may be an innovative approach to enhancing the recovery social identities of its members while reducing the collective stigma of addiction in the community.
WHY IS THIS STUDY IMPORTANT
The study describes an innovative approach to increasing the recovery capital while also working to reduce the stigma associated with substance use disorder (SUD) recovery.
Along with other recent studies highlighted by the RRI (see here, for example), this study focused on Jobs, Friends & Houses (JFH), highlights the potentially key role of social identity change in the recovery process. Clinicians may wish to explore and process their patients’ identities as related to their addiction and recovery, in the service of helping build recovery capital, and sustaining recovery over time.
- As the study author noted, these findings are limited in several ways including use of a sample of Jobs, Friends & Houses (JFH) members chosen due to convenience, and the absence of quantitative data about the sample and their behaviors.
While this study constitutes an important first step to describe the Jobs, Friends & Houses (JFH) program, future quantitative and qualitative studies are needed to understand the impact of the program on its members and attitudes of other individuals in the community.
- For individuals & families seeking recovery: This study highlighted the potential of an organization that fosters affiliation with a group of recovering individuals performing an important role in the community to help build self-respect and esteem, and to develop positive, recovery social identities among its members. Consider the various ways to increase affiliation with other recovering individuals, including but not limited to mutual-help organizations and recovery community centers.
- For scientists: The conclusions that can be drawn from this study are limited due to its use of a convenience sample, and lack of qualitative or quantitative analyses. However, this study constitutes an important first step to describe the Jobs, Friends & Houses program, and to inform and foster further research.
- For policy makers: Stigma is a major barrier to help-seeking and to long-term recovery. This study described an organization that may help challenge stigma by visibly employing individuals with history of substance use disorder and/or criminal justice involvement. Observing the ability of individuals in recovery to contribute to their communities may help challenge stigma. Consider funding that helps develop organizations such as these, and research to test the effectiveness and impact of these approaches.
- For treatment professionals and treatment systems: This study highlighted the potentially key role of participating in pro-social, community activities that may help build personal recovery capital including self-esteem. The resultant social identity change might enhance the chances of long-term recovery. Clinicians may wish to explore ways of facilitating engagement with these or similar activities to help patients build self-esteem and positive social identity, and in the service of helping build recovery capital, as well as sustaining recovery over time.
Best, D. (2016). An unlikely hero? Challenging stigma through community engagement. Drugs and Alcohol Today, 16(1), 106-116. doi: doi:10.1108/DAT-09-2015-0054