Social Exclusion and Addiction

SOCIAL EXCLUSION AND ADDICTION

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Social Exclusion and Addiction: “Creating a Sense of Belonging”

The negative effects of social exclusion and isolation caused by substance addiction and methods of combating these effects by developing hope and a new sense of purpose.

Mr. David Peters

Policy Officer

Mental Health Carers ARAFMI NSW Inc.

Sydney Australia

E:

Paper Presented at the

Australian & New Zealand Addiction Conference

Gold Coast, 20 – 22 May 2015

ABSTRACT: This paper aims to outline the link between addiction and social exclusion and discuss the negative effects of social exclusion caused by addiction. The paper also contains evidence-based observations that were recorded from a semi-structured group of people at risk of homelessness, in which alcohol and other drugs (AOD) and mental health issues are prevalent. The aim of this group was to inspire a sense of belonging into a community, hence attempting to create a new sense of purpose in each participant’s life. Using specific elements from various principles of recovery, the purpose of the group is to encourage participation, inclusion and lessen the effects of isolation. The objective of the research undertaken was to ascertain whether providing inclusiveness and a sense of belonging within a community could decrease the rate of intoxication and subsequent behaviours.

Keywords: Social exclusion; addiction; sense of belonging; inclusiveness; purpose

People do not recover from addiction in isolation. Recovery is often closely related to social inclusion and being able to undertake personally fulfilling social roles within local communities. Hope is fundamental to recovery and can be heightened by each person having a more dynamic sense of control over their lives (Manchester Health, 2015). In attempting recovery, a person needs to cultivate and nurture a new purpose in life, one that may replace the previous purpose of a substance-related lifestyle, thus developing hope for the future.

This paper aims to address four major questions:

1)What is the link between addiction and social exclusion?

2)What are the negative effects of social exclusion caused by addiction?

3)How does one combat social isolation and exclusion caused by addiction?

4)Is it possible to reduce the behavioural effects of addiction by diminishing social exclusion?

This paper contains evidence-based observations that were recorded from a group of people at risk of homelessness, in which Alcohol and other Drugs (AOD) and mental health issues are prevalent. The aim of this group was to encourage participation, inclusion and a sense of belonging to a community, hence attempting to create a new sense of purpose in each participant’s life, thus building hope for the future.

Social exclusion can result from the experiences of discrimination due to one’s class, gender, ethnic group or other characteristics used to classify individuals in society, including drug dependence. A major impact of this discrimination can be social exclusion, which is a process by which people are denied the opportunity to participate in society and are therefore made incapable of contributing to society (Byrne, 1999). Social exclusion is now observed as a significant health risk factor, as revealed by the establishment of the Social Exclusion Unit by the United Kingdom Government (Social Exclusion Unit UK, 2004).

The causes of social exclusion and isolation may be linked to Western societal culture that can often be largely shaped by two distinctive factors: materialism and individualism. Individualism includes striving for independence and personal goals, competitiveness, feeling unique, and the expression of personal opinions. Materialism involves searching for happiness in material goods, although research has shown that, after serving basic needs, economic prosperity and material goods have not increased happiness and, to some extent, have contributed to perpetual dissatisfaction and an inflated work ethic as people strive to pay for material goods. This has been associated with social alienation, depression, anxiety and anger and a negative association with life satisfaction (Spooner & Hetherington, 2004).

Alternatively, collectivism is best described as sense of belonging with others; that is, by seeing oneself as part of a group, feeling a sense of responsibility towards group members, concern for group harmony, decision making in consultation with group members, respect for group members, and a preference for group work. Western societies are assumed to be more individualistic (and less collectivist) than other societies (Oyserman, Coon & Kemmelmeier, 2002), and while there are some benefits to this, as listed above, the problems they cause need to be addressed. For example, people striving for their own independence and personal goals tend to become more concerned about themselves and feel less concerned about others in society who are not doing as well, including people with drug problems. These trends can influence risk factors for drug use such as increasing social exclusion while minimalising social support (Spooner & Hetherington, 2004).

Addiction isheavily concentrated in our poorest communities. For example, the most vulnerable individuals in our lowest socio-economic communities often lack life skills and can develop networks based on their problems rather than presenting solutions. Often, their decision making is based on prioritising immediate benefit rather than considering long-term consequences. The assortment of overlapping challenges they face gives them little incentive to avoid high risk behaviours. Together these factors can often influence a decision to use the most dangerous drugs in the most dangerous ways. Furthermore, once addicted, motivation to recover is weakened by an absence of such provision as family support, poor prospects of employment, insecure housing and social isolation (Hayes, 2015).

Therefore, social exclusion and isolation may be caused by societal values such as individualism and materialism, which can create social categories such as socio-economic classes, educational ranks and employment hierarchies. Social category can influence access to resources, exposure to marginalisation and social exclusion, which in turn can affect health and social outcomes as well as drug use and drug outcomes (Spooner & Hetherington, 2004). It can be argued that as a society, we should strive for a more collective attitude, wherein people can feel an increased sense of belonging to their community. If one feels more socially included, one may be more willing and able to participate in the community at large.

A clear definition of social exclusion was stated in the Social Exclusion Unit (SEU) report in 2001 saying social exclusion is ‘A shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime and family breakdown’ (Social Exclusion Unit Report, 2001). From this we can assume that the definition for social inclusion would be ‘a shorthand term for when people or areas have a combination of acceptable employment, a good skill set, fair income, adequate housing, low crime and strong family ties’ (Field, 2015).

Social exclusion is a multi-faceted problem which influences a person’s individual views of the world, the environment that they live in, the relationships they make with others and their contribution in society and participation in social situations. One of the major symptoms of social exclusion can be depression due to lack of social interaction, and a key effect of depression is drug use, therefore, the treatment of social exclusion lies principally in resolving addiction problems caused by drug and alcohol use issues (Field, 2015). This might be further explained by Mathieson, et al. (2008), wherein social exclusion is described from a relational perspective, which defines social exclusion as the estrangement of relationships between people and the community, thus resulting in a lack of social participation and social integration (Mathieson, et al., 2008). In other words, when a person is socially alienated and fails to have meaningful and productive relationships with others, there may be a greater risk of poor mental health which can often lead to addiction problems.

In the Australian policy context, the concept of social inclusion is described as the opportunity to:

• participate in society through employment and access to services;
• connect with family, friends and the local community;
• deal with personal crises
• be heard (McDonald, 2010).

Alternatively, social exclusion is defined as the "restriction of access to opportunities and a limited capacity to capitalise on these opportunities" (Hayes, Gray, & Edwards, 2008, p. 6). Rather than being defined as the equivalent of poverty or deprivation, social exclusion is fundamentally focused on a lack of connectedness and participation. (McDonald, 2010).

Hence, it can be argued that the negative effects of social exclusion caused by addiction are multi-faceted. On one hand, there are the physical ‘side-effects’ of being socially excluded, for example lack of access to services, poor education and housing conditions, low income and poor health. On the other hand, the underlying social issues are concerned with lowered general well-being, such as lack of self-esteem, depression, anxiety, and the person’s general outlook on life from the perspective of social exclusion. According to McDonald (2010), “social exclusion is fundamentally about a lack of connectedness and participation”, and this paper suggests ways of creating a sense of belonging; to be discussed further in this paper.

Addiction problems caused by drug and alcohol use could be viewed as either a consequence or a cause of social exclusion. On one hand, alcohol and other drug use can cause a deterioration of living conditions, but, on the other hand, the very processes of social marginalisation can be a reason for commencing alcohol and other drug use (EMCDDA, 2003). In order to look at this issue comprehensively, we must discuss the stigma surrounding both addiction and social exclusion. The Western Australian Drug and Alcohol Office (2013) states that the experience of stigma can have wide ranging impacts on an individual’s health and general quality of life, including limiting one’s social participation and willingness to access AOD treatment. It can also discourage one’s desire to access support for other health and social concerns, such as physical and mental health problems, and homelessness issues. Addiction problems can stem from individual and environmental factors including family functioning, childhood trauma or neglect, poor living conditions, social marginalisation, and emotional problems. The impacts of stigma and discrimination relating to addiction are wide ranging, and can include low self-esteem and self-worth, feelings of isolation, exclusion from local communities, physical and psychological distress, unemployment and loss of income and difficulty obtaining adequate housing. In other words, there is significant limited social opportunity which can affect the person’s quality of life (Government of Western Australia Drug and Alcohol Office, 2013).

Schneider (2009) argues that it is possible to combat exclusion by changing the nature of communications between individuals and groups. A way of achieving this is to encourage ‘social capital’ or interdependence. It is difficult, if not impossible, to sustain stigma and social exclusion when people are meeting mutual needs, building trusting relationships and binding together to help each other. Reducing stigma involves linking people and local services together, and developing new opportunities and resources including community-led activities (Schneider J. 2009).

Therefore, it can be argued that a method of combating social isolation and exclusion caused by addiction is to create a sense of belonging to a community. This is not attempting to achieve specific results of recovery from addiction, merely opening the door to the alternate possibilities for consideration. For many people, ceasing or reducing their drug use is neither desirable nor necessary, but if a person feels included within a community, they may be more willing and able to participate in that community. This sense of belonging can create a higher level of self-esteem and confidence in one’s abilities, and can also help to promote communication between other members of the community, thus helping to reduce the stigma that is involved which may lead to reduced drug and alcohol use.

The Australian Drug Foundation (2013) states that communities can support individuals, parents and families through programs that build confidence and good communication (Australian Drug Foundation, 2013). Communication is the key. By communicating effectively with a person, a level of trust and rapport can be established, and a sense of belonging can begin to develop. With this, a person can feel ‘included’ into a particular group and once this inclusiveness is established, self-esteem and confidence in one’s own abilities can increase.

This is evident in a group of people at risk of homelessness, targeting those living in boarding houses in Sydney’s Inner West, whose aim is to develop a sense of belonging in participants by combating social exclusion and isolation. This is achieved by using recovery based principles such as working alongside the person at their own pace, celebrating achievements along the way, focusing on what the person can do rather than what they cannot do and therefore developing a higher sense of self-esteem and self-worth and enhancing hope for the future. People experiencing social exclusion can often have a low sense of self-worth. Supporting the recovery journey of these people is in essence building upon their self-confidence and their abilities.

This program is semi-structured and has a primary group of 20 participants who attend each week. Here, they can talk about their issues, connect and enjoy time with other participants, engage in activities such as playing pool or table tennis, or simply relaxing in a lounge area and watching television. These participants all come from a demographic that is essentially based within a socially excluded environment. Many of these participants have experienced numerous set-backs and problems in life, and have complex needs and issues such as addiction problems, mental health issues, housing and accommodation issues and financial issues. It is a combination of these issues that creates a sense of marginalisation for these people, and due to this, they tend to isolate themselves. When one feels excluded from society, a natural course of progression can be to isolate oneself from the society that is in essence excluding them.

The program has been running now for 18 months. As the program progressed, it became obvious that the main issues for observing improvements were intoxication levels, inclusiveness in terms of volunteer work and feelings of belonging within the group.

Many of the participants from the beginning stages of this program reported having “no sense of hope” and “a feeling of no purpose” (personal communications, 2014). At the beginning of the program, there was a high rate of intoxication within the general cohort who attended each week. By providing a place that is non-judgemental, non-threatening, open and welcoming, it was hoped that these feelings of hopelessness may begin to subside. From personal observations of the behaviours within the group, the rate of intoxication significantly decreased from almost 50% at the beginning to minimal and at times nil to the present time. Additionally, those who reported having no sense of hope began to make friendships and provided feedback that their lives appeared more manageable. Figure 1 shows the intoxication rates in the group versus the number of participants attending the group since its inception.

Fig. 1

(Participation rate based on an average of the record of total number of attendees compiled over the time period. Intoxication rates based on observation of behaviour of each participants over the time period.)

While the average number of participants declined somewhat from the period of inception of the group, the above graph clearly indicates that the rate of intoxication decreased significantly over time, often reporting no instance of intoxication in the group whatsoever. This may be due to the fact that each participant reported feeling a growing sense of belonging to a group of others, where they were able to make friends and cultivate positive social connections. Participants advised that they feel ‘a sense of purpose’ in coming to the group each week, and that this helps create some hope for the future for these people, in the fact that they can look forward to coming back each week (personal communications, 2015).

The point is, all participants willingly come back each week, and this may be because they feel a real sense of belonging and inclusion in the group. They know that they can be themselves and feel comfortable and at ease while there. Accordingly, they can work at their own pace, celebrating individual strengths and achievements. In this way, we are developing a higher level of self-esteem and a sense of hope. With hope comes a better chance at recovery.

People experiencing social exclusion can often lack confidence in their abilities to perform tasks, and working towards a recovery for these people is essentially acknowledging and recognising their abilities. When the program initially began, there was just one person operating and managing the program in its entirety. Over the course of 18 months and to the present day, the program now employs 6 volunteers. These volunteers have all progressed from being participants themselves, and now hold a level of responsibility within the operations of the program. They are involved in such activities as preparing food, kitchen and cleaning duties, and all have an input into the general running of the program through regular staff meetings. Figure 2 shows the increase in instances of volunteer participation in the group since its inception.

Fig. 2