Our Erasmus+ Trainee from Estonia, Mikk Oja, has written a second installment of his ‘Wee Blog’ which contains reflections on his placement with Scottish Drugs Forum and also of the drugs field here in Scotland.
Before joining us, Mikk recently graduated from Tallinn University, Estonia with a Master’s degree in Social Work where his thesis dealt with the reintegration issues faced by people with experience of substance use in Estonia. After graduating, he wanted to learn more about substance use issues and so enrolled in the Erasmus+ Traineeship where he was linked-in with SDF. Now back in Estonia, he has started working at the National Institute for Health Development.
In this blog post Mikk shares his observations and thoughts on Drug Treatment and Testing Orders.
Drug courts with Drug Treatment and Testing Orders (DTTOs) is a model previously unknown to me and to understand this intervention better, it seems relevant to try and place them into the wider context of substance use service provision. Trying to compare the services in Scotland to the ones back in Estonia has been a constant challenge for me because the systems as a whole, are built quite differently. DTTOs are a possibility for persons who have extensive prior criminal histories that are related to substance use. It’s an expensive and intensive method, a sort of last step before custody, for people whose complex needs haven’t been solved in previous steps. Even though it is expensive, it’s a cheaper alternative to actual custody and already that makes its provision reasonable.
Persons under a DTTO have to attend a very strict treatment plan which addresses their complex needs through a dedicated team of specialists that lasts from 6 to 36 months. The program is intensive with appointments to different specialists multiple times a week. I’m glad that the initial assessment for the eligibility for a DTTO is also done very carefully to keep it available to people who are actually ready and motivated to go through this very demanding program. One of my fears was if this intensive monitoring and control really helps people reintegrate to the community or will it actually prevent it, as sometimes seen with different OST programs. But I’m happy that it’s only so strict in the initial phase of the order, where it is necessary to bring structure into very chaotic lives, and can be more flexible later when the person is doing well. What surprised me was the persistence in the lack of support for people with dual diagnosis even in a high level treatment program like this.
During my visit to the drug court all the treatment interventions underneath remained still unclear to me. The meeting was very theatrical at first impression (I didn’t know then that this model originates from the US which makes a lot of sense) and it was dominated by announcing test results accompanied by encouragement to stop using drugs. We all know that just saying “don’t do drugs” is not enough and it was good to see later that there really is hard work done behind the scenes. In addition, seeing other people succeed and graduate and having your family and friends around you is certainly a very motivating moment as their support is of key importance.
When comparing DTTOs to services in Estonia, I’d say it is more similar to our residential rehabilitation programs, especially when the residentials in Scotland are now reduced to only 12 weeks. To me this change seems to create imbalance in the continuum of care. The needs and problems of people on DTTOs are very complex, but these problems develop over a long period of time. Isn’t there a lack of longer and intensive treatment programs that people could attend before things get so complex? Something that doesn’t necessarily have custody as an alternative. And even when the orders aren’t always successful in keeping people from custody, I start to wonder if it is an intervention that has come too late? Would it be better to provide them more services and treatment options in an earlier stage of their lives? I was really impressed with the work done in the courts, but these wider questions remain.