Dame Carol Black's review into the effects on employment outcomes of drug or alcohol addiction and obesity has been released by the Department for Work and Pensions.
The review sets out a series of recommendations to improve options and support for those with drug and alcohol dependence, and does not endorse restricting benefits as was speculated in 2015.
Whilst the scope of the report covers also the role of obesity on employment outcomes, it states the issue is 'different' to substance addiction and 'is treated seperately'. Specifically on alcohol, the report states:
'Alcohol misuse may also be a cause or a consequence of unemployment. It is certainly a predictor both of unemployment and of future job loss, but evidence also suggests that increased alcohol consumption may follow job loss. Unlike dependence on heroin and crack cocaine, alcohol dependence is not strongly associated with lower socioeconomic status although the resultant health harms are. Nevertheless, the employment rate for those who develop problematic dependence is less than half that of the rest of the population'.
Overall the review describes the importance of employment in supporting addiction 'recovery', but neither drug and alcohol or job support services are sufficiently meeting the needs of service users. As such it recommends 'practical interventions, including changes in services, practices, behaviour and attitudes.'
Three main areas where action is needed in relation to drugs, alcohol and employment are identified:
- Addiction treatment does not, in itself, ensure employment, though it brings other social gains. Work has not hitherto been an integral part of treatment, and it needs to be if progress is to be made.
- The benefits system, which has a central role in helping people enter or return to work, requires significant change. The system is hampered by a severe lack of information on health conditions, poor incentives for staff to tackle difficult or long-term cases, and a patchy offer of support for those who are reached.
- Employers are the gatekeepers to employment and, without their co-operation employment for our cohorts is impossible. Employers are understandably reluctant to hire people with addiction and/or criminal records. They have told us that they need Government, quite simply, to de-risk these recruitment decisions for them.
Specific challenges are also identified, including 'fractured commissioning responsibilities and lines of accountability' that undermine efforts to develop co-ordinated responses. Whilst recognising low waiting times for alcohol treatment, stakeholders reported that alcohol services were 'still inadequate to meet need in a number of areas'. The Government’s 2010 Drug Strategy, which listed a series of recovery-focused aims, 'has yet to be realised', in part owing to the 'failure of the benefits systems to identify addiction (and indeed other relevant health conditions)'.
A series of recommendations include 'the introduction of an expanded recovery measure that includes work and meaningful activity (including volunteering)' as part of the outcomes monitoring for drug and alcohol treatment. It also proposes to trial discussions with a healthcare professional for welfare claimants to discuss 'the impact of their health condition on their ability to work'. Initiatives to support employers in actively recruiting those in recovery will need to 'de-risk' companies from doing so, as explored in an FT blog.
David Best, Professor of Criminology, commented:
“How to read policy reviews? It correctly identifies a gap in supporting the employment needs of alcohol and drug users in employment, and also identifies two key issues – DBS checks and the ‘benefit trap’. The Black Review correctly identifies gaps in provision and joined up working and makes some interesting suggestions around including employment and volunteering in outcome measurement; suggests the use of peer mentors; and has some interesting ideas about collocating workers. But it all feels a bit tame and safe. There is no real drivers for the inter-agency working and pathway modelling that would be required of each workforce and the idea of partnership seems optimistic. There is also little adequate differentiation of the needs of problem drinkers who will typically have a different work history from problem drug users. Individual examples of good practice and innovation are all very well but what is lacking in the review is suggested mechanisms for making these more than beacons of hope in the darkness. So the review is encouraging in as far as it goes… but that is not very far”
A Collective Voice post said the report was a 'real opportunity for the alcohol and drug treatment sector which we must seize'. According to LocalGov, the Local Government Association (LGA) welcomed the report but warned it was not ‘radical’ enough. See also reports in the Telegraph and Guardian.
Earlier this year the BMA released an updated briefing for medical and other professionals on addressing alcohol and drug use in the workplace, including guidance on supporting or recruiting employees with histories of substance misuse.
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