Capability expansion: A socially-engaged approach to alcohol and other drug treatment for young people

This paper draws on a Capability Approach to reframe young people’s experiences of Alcohol and Other Drug (AOD) treatment. With its focus on self-determination and opportunity, rather than diagnosis and treatment, the Capability Approach has potential to widen the focus of AOD treatment to consider the conditions that enable a “good life.” Drawing on in-depth interviews with 17 young people with experience of treatment, we explore their aspirations, perceived opportunities to realise them, and the place of substance use within these trajectories. Participants conceptualised the “good life” through four domains: safety and security (primarily via stable housing); participation (through meaningful employment); balance (grounded in mental health); and recognition (feeling respected and responsible). However, participants’ capabilities to achieve their aspirations for a ‘good life’ were constrained by restricted choices for housing and an inability to refuse unsafe placements; the inadequacy of employment services and the immediacy of survival needs; difficulties in accessing appropriate and responsive mental health care; and experiences of recognition that were largely confined to specialised youth services rather than broader social inclusion. Capabilities to manage substance use strongly derived from capabilities to achieve safety, participation, wellbeing and belonging. As a result, expanding the capability to secure housing worked to also foster the capability to find work, establish a daily routine, and in turn reduce substance use. We argue that a capability-oriented framework invites a reorientation of AOD policy and practice towards expanding young people’s substantive opportunities, rather than treating individual disorders.