Commentary on Day <i>et al</i>.: Singapore's approach toward drug rehabilitation

Singapore's approach toward drug rehabilitation incorporates components of recovery support services described by Day and colleagues [1]. Singapore embraces the concept of recovery capital as an essential component of drug recovery and abstinence as recommended by Day and colleagues [1]. Differentiated pathways to support recovery from illicit drug use include (i) providing psychological treatment services to reduce risky cognition, enhance emotional regulation and encourage behavioural change in residential treatment; and (ii) enhancing the individual's social and community capital. Evaluation studies of Singapore's Enhanced Supervision Scheme (a throughcare approach of providing residential psychological treatment and aftercare supervision and case management) support this approach, demonstrating improvements in attitudes about crime and substance use contributing to reduced recidivism and increased employment in the community [2]. Illicit drug use can impair work performance and make securing sustainable employment difficult. In Singapore, persons undergoing treatment at the drug rehabilitation centres are provided with upskilling opportunities (e.g. vocational skills training) to build their human capital. In 2023, more than 2300 individuals with criminal histories and/or illicit drug use were provided with employment assistance, with 95% of them subsequently securing jobs [3]. This was made possible through Yellow Ribbon Singapore (YRSG), an agency under Singapore's Ministry of Home Affairs, whose mission is to uplift individuals who have committed crimes and/or have histories of illicit drug use through skills and career development. YRSG partners with over 6500 employers in various industries to provide job opportunities for individuals with histories of criminal involvement and/or illicit drug use [3, 4]. These employment assistance efforts are key for building recovery capital, reducing recidivism and promoting abstinence [5]. Singapore recognises the significant role of peers in comprehensive recovery support services. In 2023, Singapore Prison Service set up the Desistors Network to bring together like-minded desistors (individuals with former criminal involvement and/or illicit drug use) to leverage one another's strengths to bolster support for recovery from illicit drug use. Desistors provide motivational talks for the individuals in the drug rehabilitation centres. Individuals recovering from illicit drug use are also connected to organisations that facilitate peer-led groups as part of the community ecosystem of support. The Singapore Anti-Narcotics Association (SANA) engages former illicit drug users as peer leaders to provide such support. Consistent with Day and colleagues' findings [1], there are differences in the modality and approach of the various organisations in peer-based recovery support services (P-BRSS) in Singapore. Stable accommodation is the cornerstone of illicit drug use recovery [6, 7]. Recovery housing, also known as Halfway Houses (HWHs) in Singapore provide time-limited intervention and support for recovery. For example, Highpoint, a substance-free HWH for males reported that 55% of their residents secured employment within 3 months of starting residence at Highpoint and 50% of their discharged residents secured permanent housing in 2023 [8]. A qualitative study in Singapore of people with criminal histories found that step-down care such as HWHs acts as a stabilising factor in recovery and provides an opportunity for a change in environment, away from old influences [9]. Aligned with the use of recovery-oriented systems of care (ROSC), the Community Action for the Rehabilitation of Ex-Offenders (CARE) Network was set up in 2000 to provide an inclusive and supportive environment for individuals with criminal histories and those seeking recovery from illicit drug use. The CARE Network now works with over 100 community partners, including religious groups, HWHs, grassroots organisations, corporations and schools to link people with a history of criminal behaviour and illicit drug use to resources that build the social and community capital that sustains their recovery. Agencies that are part of the CARE Network provide family support and intervention especially after the completion of residential treatment to augment the recovery process. Families are engaged throughout the residential phase and upon the individual's completion of the programme, as community and family reintegration are key to sustained recovery. In 2004, the CARE Network also started the Yellow Ribbon Project, a national movement to foster a more inclusive society by changing society's mind-set to give people with histories of criminal behaviour and illicit drug use a second chance [10]. As a multicultural society, Singapore's practices reflect the cultural adaptations in illicit drug use treatment to ensure contextual relevance [11]. For example, the Malay/Muslim Organisations Rehabilitation Network, comprising various Malay/Muslim organisations working together with other community and government agencies, was formed in 2021 to provide holistic support to Malay/Muslim persons with criminal history and illicit drug use and their families through community engagement and programmes. This culturally-nuanced support has played an important role in helping to reduce the number of individuals with illicit drug use in the Malay community [12]. Current evidence shows the importance of the effect of employment support approaches, peer-based recovery support services and continuing care and recovery check-ups as individuals with a history of illicit drug use who have been abstinent for longer periods of time have greater social capital [13]. Although Singapore's approach toward drug recovery is congruent with some elements of recovery capital highlighted by Day and colleagues [1], targeted research will likely reveal some differences as well. This collaborative effort will elicit the nuances of recovery capital and its impact on sustaining recovery from illicit drug use in Singapore. By continuing to build on the elements of recovery capital that are applicable in Singapore (i.e. P-BRSS, employment support services, recovery housing and continuing care and recovery check-ups) and studying the elements that can be further developed, Singapore can further enhance the drug rehabilitation efforts and support individuals in their journey toward sustained recovery and reintegration into society. Salina Samion: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Jasmin Kaur: Conceptualization (equal); writing—review and editing (equal). Chi Ching Leung: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). None. Research data are not shared.