title: Work and the journey to recovery: exploring the implications of welfare reform for methadone maintenance clients.
abstract: BACKGROUND
  An emphasis on welfare reform has been a shared concern of recent UK governments, with the project of transforming the provision of welfare gathering pace over the past six years. Replicating active labour market policies pursued across the globe, successive governments have used welfare-to-work programmes as mechanisms to address worklessness. Since 2008, problem drug users (PDUs) have been added to a list of groups for whom intervention is deemed necessary to encourage, enable, and sometimes coerce them into paid employment. This approach is underpinned by three beliefs relating to paid work: it sustains recovery, has a transformative potential and should be the primary duty of the responsible citizen. Using policy developments in the UK as a case study, the article explores the implications for methadone maintenance clients of connecting drug policy (premised on the belief that work is central to recovery) with welfare policy (which at present is preoccupied with reducing worklessness).
  
  
  METHODS
  A critical analysis of policy documents, including drug strategies, Green and White papers and welfare reform legislation, alongside a review of relevant academic literature.
  
  
  RESULTS
  The 'work first' approach which underpins current labour market activation policies in the UK and elsewhere is insufficiently flexible to accommodate the diverse needs of PDUs in recovery, and is particularly particular problematic when combined with a 'social deficit' model which concentrates on individual rather than structural barriers to employability. The use of payment-by-results mechanisms to provide employment services, coupled with the use of sanctions for those who do not engage, is likely to be particularly problematic for methadone maintenance clients.
  
  
  CONCLUSIONS
  Welfare reform in the UK is likely to undermine the recovery of methadone maintenance clients. Further research is urgently needed to explore its impact on this sub-group of PDUs, alongside comparative studies to determine best practice in integrating drug and welfare policies.
authors.affiliation: School of Sociology and Social Policy, University of Leeds, LS2 9JT, UK. Electronic address: m.p.monaghan@leeds.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Monaghan
authors.affiliation: School of Law, University of Leeds, Liberty Building, Leeds LS2 9JT, UK. Electronic address: e.l.wincup@leeds.ac.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Wincup
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D003153:Community Health Services / Q000331:legislation & jurisprudence; D055030:Drug Users / Q000331:legislation & jurisprudence* / Q000523:psychology; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D004651:Employment / Q000331:legislation & jurisprudence*; D033161:Government Regulation; D040261:Harm Reduction; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006556:Heroin Dependence / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D011050:Policy Making; D012946:Social Welfare / Q000331:legislation & jurisprudence*; D013222:State Medicine / Q000331:legislation & jurisprudence; D016320:Substance Abuse Treatment Centers / Q000331:legislation & jurisprudence; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone