The ERANID-funded project D.U.R.E.S.S. focuses on the experience of people suffering from addiction during recovery and reintegration. Or, in the words of Giuseppe Carrà of Italy, ‘it’s about their personal subjective perspective’.
D.U.R.E.S.S. stands for Drug Use Recovery Environment and Social Subjectivity. The aim is to establish whether certain individual, rather than contextual factors play a role in successful rehabilitation and reintegration. Three countries – Italy, France and Portugal – are participating in the study. According to Professor Carrà, of the University of Milano-Bicocca, the unique thing about this study is the use of original and mostly unexplored sources.
One such source is health diaries kept by subjects with addiction while in treatment. Clients from the three countries in the study will keep a daily diary for six months, in which they will describe their personal experiences before, during and after treatment. ‘We want to learn from their subjective experiences’, Carrà explains. ‘How is treatment working for them? How is their mood? How do they feel?’ The original thing about this is that the researchers will use qualitative research data, while addiction research is generally based on quantitative data. ‘It’s a radically different view,’ says Carrà. ‘These personal diaries will provide the basis for data collection in our study. They will of course be analysed and we will conduct additional interviews with some of our diarists.’
The next step will then be to organise focus groups with eight or nine members, all of them former or current drug users, based on the analysis of the diaries. These meetings will again focus on personal experiences, with researchers discussing with participants the main themes that emerge from their journals. ‘For these groups we will use trained and experienced research moderators,’ says Carrà. ‘It’s extremely important to ensure confidentiality and comfortable, quiet and private surroundings free from distractions.’
Another source of information is people who have a lot of contact with clients during the project. ‘These societal actors can be relatives, members of services staffs or NGO volunteers’, explains Carrà. In-depth interviews will be conducted with these individuals to establish their experiences of the period when clients are in rehabilitation. What did they think of the treatment? How did they think the clients responded? ‘Of course we will compare these statements with the subjective experiences of the clients. Is there a gap? Do they think or interpreted differently?’ says Carrà. ‘For example, we want to know if the clients did get what they felt they needed. And if not, why not.’
All these qualitative data will of course be linked to quantitative data about local contextual factors. ‘Social circumstances differ,’ says Carrà. ‘There may be social environmental factors involved. For example the area where people live. Is it a deprived area or an affluent area? Does this influence the subjective experiences during treatment?’ Finally, the study will also look at differences between the three participating countries. ‘We will try to understand how different cultures, national environments and countries' specific policy settings interact with recovery and socioeconomic reintegration.’
Analysing all the data will be a huge task, which will be tackled on an interdisciplinary basis by scientists with expertise in qualitative addiction research working with clinical and mental health researchers. Ultimately, the question is how the integration of socioenvironmental aspects into therapeutic processes can improve recovery outcomes and the reintegration of former drug users. For example, what is the role of social capital, of family, community, informal care, work and housing, self-regulation or self-stigma?
Carrà says that in the end it is all about evidence-based treatment. ‘Of course we hope to find ways to improve or reshape existing therapeutic services. Client experiences will give clues for more human and more effective treatment.’ He is also very pleased with the research team. ‘We are lucky to be working with so many distinguished members of the international research community, in particular Tim Greacen from France, Marta Pinto from Portugal and Giovanni Viganò from Italy. The scientific quality of our research partners is extremely high. We can learn from the differences between our countries. In the end, this research programme will help both the EU bodies and single member states understand how to improve the effectiveness of treatment.’
The European Research Area Network on Illicit Drugs (ERANID) aims to improve cooperation in drug research in order to allow well-founded policy decisions, prevention and harm reduction interventions. Several scientific disciplines and various European countries work together in this network. ZonMw is one of the partners in the cooperation on behalf of the Netherlands and is coordinator of ERANID.