Iceland

Icelandic legislation has certain laws pertaining to labour market services for individuals with substance use problems. The Labour Market Measures Act No. 55/2006 aims to provide individuals with appropriate assistance to enable them to become active participants in the labour market. When jobseekers apply to participate in labour market measures, their capacity to work shall be assessed by an advisor at the Directorate of Labour. The jobseekers shall submit all information available regarding their work capacity to make it possible for the labour market services to help them obtain suitable employment and enable them to avail themselves of individual labour market remedies (Lög um vinnumarkaðsaðgerðir, 2006). 

Participation in labour market measures may require that the jobseekers seek the assistance of other services, either first or at the same time. The Minister may entrust the Directorate of Labour to make agreements with companies or institutions by which they employ persons in receipt of an invalidity pension, invalidity allowance, rehabilitation pension, or occupational injury benefit of under 50%, whose working capacity has not been utilised on the labour market, and who have no substantial income for their sustenance other than social security benefits (Lög um vinnumarkaðsaðgerðir, 2006).

Section XIII in the Municipalities’ Social Services Act No. 40/1991 includes articles on assistance for substance use problems. The law stipulates that social services committees shall support preventive measures in alcohol and drug use matters in cooperation with the relevant parties, such as the police, health services, and schools. The social services committees shall also provide appropriate treatment of and assistance to individuals with substance use problems. Furthermore, counselling and assistance shall be made available, as applicable to the relatives and families of individuals with alcohol use problems. It also states that after receipt of treatment for substance use problems, social services committees shall provide for the necessary support and assistance so that a person with substance use problems can live a normal life (Lög um félagsþjónustu sveitarfélaga, 1991).

Many individuals who have suffered from substance use problems have retained rehabilitation pensions. A rehabilitation pension may be paid for up to 36 months when it is not yet possible to ascertain the permanent working capacity after an accident or illness of a person aged 18–67. Payments shall be made on the basis of the rehabilitation schedule. The applicants are required to undergo rehabilitation which strives to recover working capacity (Lög um félagslega aðstoð, 2007).

The Act on Vocational Rehabilitation and Activities of Rehabilitation Funds No 60/2012 is intended to secure individuals with partial working capacity, following an accident or illness, job-related employment rehabilitation in a rehabilitative system offered jointly by job rehabilitation funds and the institutions of the government and municipalities. This vocational rehabilitation is based on an individual counselling and resources programme that aims to increase the working capacity of the individuals and enable them to return to the labour market, either partly or full time. All employees and those who work independently and are between 16–70 years old are secured the right to job-related employment rehabilitation with a payment of a fee to the job rehabilitation fund every month. A fee is also paid every month by the employer to the employees’ pension fund (Lög um atvinnutengda starfsendurhæfingu og starfsemi starfsendurhæfingarsjóða, 2012).

The Directorate of Labour, under the Ministry of Social Affairs and Labour, oversees the employment service in Iceland and the day-to-day administration of the Unemployment Insurance Fund. The Directorate of Labour operates according to Act no.55/2006 on labour market measures and Act no.54/2006 on unemployment insurance. The law on labour market measures provides individuals with appropriate assistance to become active participants in the labour market and to promote a balance between supply and demand of labour in Iceland (Vinnumálastofnun,2023). According to Act no. 54/2006 on unemployment insurance, the Directorate of Labour has the authority to reduce unemployment benefit payments if, for example, a person refuses to participate in labour market measures, does not provide correct information, refuses a job offer or a job interview, does not disclose being employed, deliberately provides false information, and so on (Lög um atvinnuleysistryggingar, 2006). The Directorate of Labour, has eight service offices around the country and provides job-seeking services, registration, advice, assessment of skills and resources, and job placements (Vinnumálastofnun, 2023). 

Municipal social services are responsible for assistance and providing services in accordance with the Act on Municipal Social Service. According to article 1 of the law, municipal social service is to ensure the financial and social security of individuals and to promote welfare. Municipal social service is overseen by the Welfare Quality and Inspection Authority (GEV) (Lög um félagsþjónustu sveitarfélaga, 1991). There were 64 local authority areas in Iceland in June 2022, and the individuals who need social service and support seek assistance at their official domicile (Samband íslenskra sveitarfélaga, 2023).

Iceland has two institutions that offer a detox process from alcohol or drug use under supervision. Most people turn to SÁÁ (National Centre of Addiction Medicine), which operates a detox clinic (Vogur) and is the leading substance use treatment institution in Iceland. SÁÁ runs inpatient clinics and outpatient rehabs for individuals and families. According to the SÁÁ annual report in 2018, the detox clinic registered 1,624 people. As some people came more than once, the total number of registrations was 2,275 (Tyrfingsson, 2019). The numbers from Vogur show that 10.4% of men aged 15–64 and 4.6% of women of the same age in Iceland have sought treatment for alcohol and drug addiction at SÁÁ (Tyrfingsson, 2019).

SÁÁ is an NGO with a service agreement under the Icelandic state health authorities. The SÁÁ annual report from 2019 notes that official information is not available on the supply and sale of illegal drugs. It would be possible to keep track of the numbers by making a precise diagnosis and counting the number of treatment centres in Iceland that deal with substance use problems. The numbers of those seeking assistance at emergency departments and being admitted to different hospital units due to legal and illegal drug use could tell us something, but such numbers have not been regularly recorded in Iceland (Tyrfingsson, 2019).

Vogur, a detox clinic and hospital, has a register of those diagnosed with substance use disorders (alcohol and drugs) in Iceland and who have sought specialised treatment over the past three decades. What makes the numbers even more valuable is that Vogur has been the most comprehensive treatment facility in Iceland for a long time. Almost everyone with serious substance use problems seeks help at SÁÁ sooner or later (Tyrfingsson, 2019).

People seeking treatment for the first time have always had a certain priority, and they have never had to wait for entry for longer than a few days. Others may wait for a few weeks (Tyrfingsson, 2019). People under 25 years of age are prioritised in treatment.

Research has shown that having a job during and after treatment is indicative of an effective outcome from substance use treatment. Other social factors such as housing, education, and relationships/marriage also have an impact on long-term recovery. Studies also show a positive relationship between assistance in getting employment and success in abstaining from drug use. This suggests that employment participation can prevent relapse. Job-focused training for individuals who are not employed or in education during and after treatment, along with housing assistance, increases the likelihood of sustained, long-term recovery (NIDA, 2020; Sigurðardóttir & Þorvaldsdóttir, 2014).

Activity-based rehabilitation (virknihús in Icelandic) started in 2021 and is intended for individuals 18 years and older who live in the Reykjavík municipality and receive financial assistance. Individuals who are admitted must have an interest in becoming more active and taking control of their own lives. Virknihús is intended for individuals who have impaired working capacity but are motivated to change. The aim of Virknihús is to increase their quality of life, empower them, and make them stronger individuals as a whole. Virknihús runs the Grettistak, IPS, and AVM rehabilitation programmes. 

There is one rehabilitation programme in Iceland designed for people who are unfit for work due to problems with substance use. The main goal is to help them regain full work capacity through an 18-month long rehabilitation programme called Grettistak, one of the four work modes in Virknihús and organised and run by the municipality of Reykjavík. This work/education-related rehabilitation centre seeks to increase each participant’s recovery capital index, which involves sobriety, health, social support, social skills, quality of life, financial factors, meaningful activity, housing, and housing security (Þorleifsdóttir, 2021). The participants, 18 years or older, are expected to be able to work/study part time to promote full work capacity after the rehabilitation. They must have finished at least one full rehab, and before they start rehabilitation, it is made certain that they have some security in housing. Many of them live in halfway houses (housing with support). The Grettistak programme requires daily attendance during the first 3–4 months, followed by attendance once a week, along with school, work, or other activity. During the first 3–4 months, the programme provides lectures, work in groups, and physical activity. The lectures deal with a range of topics, including nutrition, self-esteem, social skills, financial guidance, empowerment, communication, and so on. In group work, the participants are supported by their peers and the social worker in charge of the group work. 

Atvinnu- og virknimiðlun (AVM) assists and supports individuals as they attempt to enter or re-enter the labour market. This assistance is available to individuals who receive financial aid from the Reykjavík municipality and are fit to work.

The team consists of job counsellors with a wide range of experience. The first step is to get to know the individual’s strengths and the challenges they face as they attempt to find work. This is done by screening their work experience and finding out what their interests are, what fields they would like to work in, and what types of work they are unwilling or unable to do. Some individuals have been away from the labour market for a long time; in these cases, the possibility of a slow re-entry to the labour market is discussed. However, this can be difficult for those who need a full salary to live on. The team utilises its connections to employers in both the private and the public sectors, assisting individuals with applications to advertised positions and reaching out to potential employers on their behalf.

The team oversees courses which include topics such as mental wellbeing, how to write a CV and a cover letter, and the benefits of participating in the labour market. The course reviews circumstances that can prove challenging in the labour market, such as not having a clean criminal record – a common circumstance for people who have a history of substance use problems. This can limit their job prospects, as some sectors, including childcare or assisting the elderly and the disabled, require a clean criminal record. It is the team’s job to assist the participants to find a field where they can work despite their criminal record so that they can participate more fully in society (Bjarnadóttir,2023). 

For her study, Bjarnadóttir (2023) interviewed eight participants receiving assistance and support through AVM. Her conclusions indicate that the participants had a positive impression of the service and found it helpful. After six months’ participation, most participants were doing well and felt that the programme had provided them with experience and increased social capital, had empowered them, and improved their wellbeing. The principal function of the programme was in helping participants enter the labour market, which they had been absent from for varying amounts of time.

The IPS model (see Fact box 1) of employment support has been utilised in Iceland since 2013, when it was first introduced in Laugarás, a hospital treatment centre for young people with a mental illness. In 2019, the municipality of Reykjavík adopted the model for people receiving financial aid and for individuals from various intervention programmes, including single parents and people recovering from substance use problems. A recent assessment of the IPS work done by a team (consisting of two IPS full-time employment specialists and one part-time IPS project manager) in Reykjavík showed that 63% of people who gained competitive employment through the programme in 2022 were still employed at the end of the year (internal review). 

While Icelandic legislation includes articles on assistance for individuals with substance use problems, it does not contain many provisions regarding labour market services for this target group. The main assistance programme for people with a history of substance use is Grettistak, an 18-month rehabilitation programme, which mainly operates in the municipality of Reykjavík and is intended to increase the participants’ recovery capital index. The end goal is to enhance each person’s quality of life and assist them in either starting to work job or pursue education.

The municipality of Reykjavík has two teams to assist individuals who receive financial aid in finding work. One uses the IPS model and the other provides courses and individual assistance. During autumn 2023, participants in the rehabilitation programmes are asked to respond to a survey, which will be sent annually. These surveys will provide information about how these programmes help the participants, how satisfied they are with programmes, and how they could be improved.