Healthy Start Stories |
Reshmi Marhe

Addiction and crime: ‘How can we offer optimal support to young adults who are struggling with criminal behavior and substance abuse?’

During adolescence, young people discover the world around them. It’s a time of experimentation: they try a beer or a joint for the first time, explore their limits and make new friends. For most, this experimentation remains harmless, but some go further. They get involved with the wrong group of friends, start using more and more drugs and even get into trouble with the law. How can we ensure that these young people do not slip any further? This is what Reshmi Marhe, assistant professor at Erasmus University and Ambition Lead at Healthy Start, tells us.

“Crime rates are falling every year, including among young people. That’s good news. At the same time, we see that a small group of young people is getting deeper and deeper into problems. Among other things, they have debts or mental health problems and struggle with unemployment, addiction and criminal behavior. This group is in a complex situation and urgently needs help to get back on track. The problems mentioned are usually not isolated. For example, we know that substance abuse and criminal behavior often go hand in hand. There are several explanations for this. Sometimes the craving for drugs leads to young people needing money quickly. On the other hand, the wrong friends can expose young people to drugs. Despite this insight, we see that existing care often focuses on treating a single problem, rather than tackling the big picture. I want to know what every young person needs to develop optimally and stay away from a life full of crime and substance abuse. In doing so, I do not focus on a massive approach, but mainly on individual needs.”

I want to know what young people need to develop optimally and stay away from a life full of crime and substance abuse

Research into ‘real life’

“For a long time, I was interested in the behavior of large groups of people and society as a whole. That’s why I chose to study sociology. I soon discovered that my interest lays more with the individual. So I decided to make the switch to psychology. That transition went smoothly and by the end of my studies I was determined to become a researcher. At the same time, I met Ingmar Franken. Through him, I was able to work as a research assistant in an addiction clinic. This was an intense experience. Although I had never worked with a target group that was seriously addicted before, I found it incredibly fascinating.

After the internship, I started my PhD research on addiction under the supervision of Ingmar. My focus was on understanding why some people relapse into their addiction. What are the triggers that cause these intense cravings? For years, I collected data and conducted interviews with both patients and staff. It wasn’t until much later that I realized the value of those conversations. Because while the data collected certainly provided insight, it was mainly the conversations that gave me a deeper understanding of what exactly was going on.”

I have always believed in the importance of ecologically valid research, i.e. research into situations as they actually occur

”When I completed my PhD research, I was faced with a dilemma: continue in academia, or work as a practitioner in practice. Eventually, I was given the opportunity to do research at De Nieuwe Kans. This is a place where young people with complex problems receive day treatment. While the young people there followed their trajectory, I studied, among other things, the results of the treatments they received. I thought it was a fun and educational place. At the same time, I also encountered obstacles that are inherent in this type of research. We worked with a target group that had to deal with all kinds of challenges, such as debt, addiction, problems at school, and with the justice system. This made it difficult to pinpoint exactly which problem the treatment was effective for, as we are used to in traditional research. As a result, we sometimes experienced difficulties in publishing our findings. Nevertheless, I have always believed in the importance of ‘ecologically valid’ research, i.e. research into situations as they actually occur. For me, this meant researching the various problems that the young people were facing, rather than limiting myself to one specific problem.”

From group level to personal approach

”Recently, I became Ambition Lead of Ambition Project 5. In this project, we focus on young adults between the ages of 18 and 27 who are struggling with both criminal behavior and substance abuse. In recent decades, a great deal of research has been done into these problems among young people. Within our project, we want to bundle existing knowledge and apply it in a new way. Instead of developing group interventions, we focus on the individual. We do this by reaching out to young people at an early stage, because we know that substance abuse and criminal behavior often develop gradually. We then map out the specific needs of the target group. For example, what wishes does a young person have for the future? And what obstacles stand in the way? To what extent do childhood traumas, parenting problems, a mild intellectual disability or psychological problems play a role in this? There are already several treatments available for these problems. Now it’s a matter of offering the right treatment to the young person at the right time.”

Instead of developing group interventions, we focus on the individual

“As in other ambition projects, technology also plays an important role in our project. Our ultimate goal is to use a smartphone app to map out personal patterns. When does a young person engage in drug use or aggressive behavior? And what role do emotions such as anger and fear play in this? Based on this information, we can then offer personalized interventions, such as a breathing exercise or make a professional available for support. We will develop this application together with the target group.”

The challenges of collaboration

“Within Healthy Start, I can continue my passion for research that is relevant to practice. At the same time, I find the technological aspects of our project very interesting. In doing so, we go beyond just smartphones; We also want to use chatbots and artificial intelligence. It is fascinating to work with researchers from the design world, they have a completely different approach to their research.

In addition to scientists from the design world and young people themselves, I also work closely with the municipality of Rotterdam, De Nieuwe Kans and, in the long term, with other organizations, such as a forensic care institution. Of course, collaborations also bring challenges. Practitioners and policy staff often already have a full agenda and are not always keen on researchers who demand even more from them. This is understandable, but it can sometimes cause projects to get off to a slower start than desired.”

Fixated on data

”What I’ve learned in recent years is not to be blinded by data. During my PhD research and postdoc period, I discovered the value of having conversations with people. Fortunately, I can now fully apply that approach within Healthy Start.”

Don't be blinded by data; Conversations in particular help to interpret research results

“This is also a piece of advice I would like to give to young researchers: be open and don’t just focus on the data from surveys, for example. Informal conversations in particular help to interpret research results, whether with patients, young people or practitioners. Moreover, it makes your research more human and puts you in direct contact with reality.”

Reshmi Marhe’s Healthy Start perspective
“My hope is that we can really help young adults who are struggling with substance abuse and criminal behavior in a way that suits their needs. And not only that. Ideally, they should receive help exactly when they need it, with so-called just-in-time interventions. I believe that technology, such as smartphones, can play an important role in this. In addition, in the long term, I would also like to use the insights from brain research to make our approach even better. Ultimately, I hope that by combining knowledge and strengths, we can help young people create a healthy and happy future.”

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