Over the last year, I have been working with my colleague Matthew Bacon on an ESRC-funded project studying the growing use of contract-like agreements with drug users in treatment settings. It’s been one of the most fascinating studies I’ve ever been involved in, as it raises all kinds of theoretical, conceptual, empirical and ethical questions. There are intellectual puzzles and normative challenges all over the place!
We’re now starting to turn our attention to making sense of our data and publishing our findings. Our first scene-setting paper is currently in draft form and I thought I would share the draft introduction. Comments will be very welcome.
‘One of the abiding challenges for drug treatment services is how to engage drug users effectively: to identify and attract them, to keep them coming and to ensure they comply with what is required of them. Services which are unable to do this will obviously struggle to contribute to important drug policy objectives, such as, reducing mortality rates, curbing the spread of blood-borne viruses and supporting recovery. Effective engagement is the sine qua non of effective treatment.
Over the years, many innovations have been introduced to deal with engagement and retention problems, including reducing access thresholds (Finch et al, 1995; Millson et al, 2006), establishing rapid prescribing services (Keene et al, 2007), rewarding attendance and compliance (Prendergast et al, 2006; Petry, 2012), developing outreach services (Needle et al, 2005) and making case management more ‘assertive’ (Vanderplasschen et al, 2007). In recent decades, for certain groups of drug users, there has been a particular emphasis on using the leverage of the criminal justice process to do this (Seddon, 2007; Seddon et al, 2012). Inevitably, there is a mixed picture of success from this diverse range of efforts and the challenge has far from disappeared. Indeed, to the contrary, in an ‘age of austerity’ with public spending budgets across Europe (and beyond) being squeezed tighter than for many decades, the problem has arguably become even more acute. The need for drug treatment to demonstrate that it can engage effectively with its target group is greater than ever.
This paper examines one particular strategy or practice for enhancing engagement that appears to have spread quite rapidly in recent years: the use of contract-like written agreements between treatment service providers and users. Although, as we will see, these agreements can take on many different forms, typically they set out the responsibilities and requirements placed on users and, somewhat less frequently, what the service commits to providing for them. This novel practice of contractual governance of drug users in treatment may be viewed as having considerable potential, not only to address the engagement challenge we have described but also to underpin efforts to provide more personalised social and health care (HM Government, 2007). On the other hand, it may also be seen to raise serious ethical issues and concerns about human rights, as it appears based on a model of autonomy and responsibility that may seem at odds with conventional notions of addiction (West, 2006; cf Foddy and Savulescu, 2006).
It is significant that if we look beyond the drug policy field, the emergence of contractual governance is clearly part of a wider set of developments in the realm of politics and government at the turn of the twenty-first century. As we will show, in recent years, the use of contractual or quasi-contractual mechanisms to regulate behaviour has arisen in diverse domains, from school education to public housing to youth justice (see Crawford, 2003). A key part of our purpose in this paper will be to locate the contractual governance of drug users in treatment in this wider context of new social control strategies and practices. In particular, we will draw theoretical, conceptual and empirical insights from the largely socio-legal literature which has begun to examine this phenomenon.
The paper is organised as follows. In the first section, we introduce some of the key conceptual building blocks for our enquiry: contracts, contracting and contractual governance. We then turn, in the second part, to a consideration of some of the specific issues that may arise in relation to the contractual governance of drug users in treatment settings and include a review of the small body of literature in this area. In the third section, we present some preliminary findings from the first stage of an empirical study we are currently conducting. Finally, in conclusion, we map out a research agenda to advance our understanding of what we believe to be a significant development in the field.’
Let me know what you think!
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Great to read this Toby! It really highlights just how significant an aspect of drug treatment these ‘contracts’ have become. From even this short piece I can get a sense of those puzzles and challenges you talk about. I’m really looking forward to reading more!
Maybe it could be of interest to you, that we have had ‘Contract wings’ in Dansih prisons for drug users since 1991. They sign a contract agreeing to abstainn for drugs and as a reward they are given extra attention, sports facilities, and naturally, a drug free internment. There are some litterature…in Danish
Thanks, Torsten. That sounds very interesting. If there’s any literature in English at all, please do email me. Cheers.