Mapping and enhancing substance use treatment for migrants and ethnic minorities
Mapping and enhancing substance use treatment for migrants and ethnic minorities
Research Period
March 2019- October 2019
Finaciering
Belspo
Researchers
Charlotte De Kock
Carla Mascia (ULB)
In close collaboration with VAD, Fédito BXL and Fédito Wallonne (Fred Laudens, Sebastien Alexandre, Lyssa Toyimbo, Inge Baeten, Pascale Hesgens)
Keyword
Migrants and ethnic minorities, drug treatment, promising practices, ethnic monitoring, registration in drug treatment
Abstract
MATREMI addresses a double caveat in literature and policy concerning migrants and ethnic minorities (MEM) in drug treatment. First, MATREMI focusses on how to register MEM service user presence in drug treatment more adequately (objective 1) and second, MATREMI will provide promising practices (aimed at reach and retention of and service accessibility for [potential] MEM service users) to drug treatment professionals (objective 2) by means of a promising practices guidebook.
In Belgium, preliminary studies among migrants and ethnic minorities (MEM) demonstrate lower retention rates in drug treatment, later first admittance, underrepresentation of females (Derluyn et al., 2008), generalized underrepresentation in therapeutic communities, overrepresentation in substitution treatment and generalized underrepresentation of intra-European migrants in drug treatment (Blomme et al., 2017) compared to their presence in the general population in the years 2012-2014. Generalized inaccessibility to drug treatment for refugees and asylum applicants (Dauvrin et al., 2012; Matthei, 2007; Suijkerbuijk, 2014) and a lack of knowledge about drug treatment among intra-European migrants, refugees and asylum applicants in particular have also been documented (De Kock & Decorte, 2017; De Kock et al., 2016).
However, a first large caveat in the literature and drug treatment policy is that statistics about the presence of MEM in drug treatment are not readily available in Belgium because scientifically sound ethnicity related proxies, indicators and variables, as studied in for example the educational (Agirdag, 2015) and labour domain (Khader et al., 2006; Verhaeghe et al. 2016), are not standardized in census nor in drug treatment data collection (Farkas, 2017). In the drug treatment domain – as is the case in the other EU member states, Turkey and Norway – Belgium applies the European Treatment Demand Indicator (TDI), a European registration instrument that allows for comparing standardized data about service users entering drug treatment across European member states (Van Baelen et al., 2018). However, in the third TDI protocol (2012), the ‘nationality’ variable has been omitted. Consequently, this variable was also omitted as an obligatory variable in Belgian national registries starting from 2015. Some European member states (e.g. Finland, the Netherlands, Norway) do apply more sophisticated ethnicity related proxies, indicators and variables which could contribute to insights in MEM presence and trajectories in drug treatment.
The second caveat relates to the availability of promising practices to increase reach and retention of and accessibility for (potential) MEM services users in Belgian drug treatment. Belgian drug treatment services face complex questions regarding reach and retention of and accessibility for (potential) MEM service users, especially regarding intra-European (Blomme et al. 2017; De Kock et al. 2017) and female MEM problem users and potential service users (Derluyn et al. 2008), asylum applicants and (recognized) refugees (De Kock & Decorte, 2017). Targeted sensitizing initiatives about problem use and drug treatment services have been recommended among intra-European migrants (De Kock, Decorte al. 2017), asylum applicants and refugees (Laudens, 2017), but also female (Derluyn et al., 2008) and ‘older’ second, third and fourth generation persons with a migration background (De Vylder, 2011; Laudens 2012). Furthermore, a focus on outreach work and mobile services for increasing the accessibility of drug treatment for injecting MEM drug users as well as the monitoring of the ‘urgent medical care’ principle among refugees and asylum applicants in need of drug treatment (Modus Vivendi, 2010: 212), have been recommended (Suijkerbuick, 2014).
Nevertheless, streamlined action in drug treatment policy and practice within the framework of an integrated and integral drug policy have not been implemented in Belgium yet (Interministerial Conference on Drugs, 2011: 21446). Moreover, a comparative European prevention analysis of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2015), considers Belgium to be one of the European member states with ‘limited preventive efforts targeting migrants’. Additionally, an EMCDDA background study reports that drug treatment is generally not prioritised in delivering healthcare to newly arrived asylum applicants (Lemmens et al., 2017: 13). Consequently, and in line with the knowledge about the underrepresentation of intra-European migrants in drug treatment, Belgian drug treatment services should focus primarily on increasing reach and retention of and service accessibility for (potential) MEM service users. Considering that most refugees in the EU and Belgium have a Syrian, Afghan and Iraqi background (CGVS, 2018), recognized refugees with these backgrounds need special attention. Lastly, the needs of female MEM and persons with a second, third and fourth ‘older’ generation migration background, should be considered.
This project is conducted in close collaboration with partners ULB, VAD, Fédito BXL, Fédito Wallonne and partnership within the framework of a fourfold research focus on ‘problem use, treatment and judicial referral among migrants and ethnic minorities in Belgium’ and builds on our previous PADUMI project.