Home Blog

Model Behaviour

By
DDN
-

Nottingham’s new model for a co-occurring needs pathway is transforming local practice, says Apollos Clifton-Brown.

We’ve spent too long nationally treating mental health and substance use needs as a specialist service issue when they are a systems issue. If organisations don’t share responsibility, people inevitably fall through the gaps.

People do not experience their mental health separately from their substance use, or one service at a time. They experience life as a whole. The closer our services reflect that reality, the better the outcomes will be.

When I read the govern­ment’s recent Co-occurring mental health and substance use framework, what struck me was how much of the document is actually about organisations rather than clinical guidance – leadership, service design, data sharing, workforce development, commissioning. This is important because, in my experience, people with co-occurring needs are rarely failed by a lack of goodwill or expertise. They’re failed when systems become more important than people. 

Time for change

The need for change is clear. Between 2024 and 2025, up to 74 per cent of people starting drug and alcohol treatment had a mental health treatment need, while more than a third of people with mental illness also experience substance use problems. Yet services still operate separately.

Dame Carol Black recently visited our services to see how the partnership between Nottingham Recovery Network (NRN), Framework, Nottinghamshire Healthcare NHS Foundation Trust and Change Grow Live Nottinghamshire have implemented effective joined-up care.

Many of the approaches now promoted nationally were already established in Nottingham and Nottinghamshire because we kept asking a simple question: why are people expected to fit around services, rather than services fitting around people? That gives us a useful perspective on what worked, what didn’t, and what other areas might learn.

Strategic leadership 

One of the most important recommendations in the government framework is not to create standalone dual diagnosis services. That reflects a conclusion we first reached following the publication of the NICE guidance on Coexisting severe mental illness and substance misuse in 2016. When services struggle, the instinct is often to create a new team or pathway. But this can often mean new silos with limited interventions available, and poorer outcomes for the people assigned to them.

We quickly realised the challenge wasn’t a lack of services, but how those services worked together. By developing joint working protocols, introducing multidisciplinary case discussions and investing in joint training, staff could stop working in parallel and start collaborating. 

One of the most effective changes was embedding specialist practitioners across teams. These roles create direct links between mental health and substance use services, bringing expertise into everyday practice, challenging exclusionary approaches and ensuring that knowledge from one service informs decision making in another. We now have mental health specialists embedded in our substance use service, and substance use specialists embedded in mental health inpatient units, community treatment and crisis teams. 

Previously, early opportunities to identify substance use needs on mental health wards were often missed – referrals came late in an admission, creating delays in discharge and avoidable re-admissions. Now, embedded substance use practitioners provide screening, brief interventions and recovery support, as well as continuity from mental health inpatient care into community substance use treatment.

Frontline experience

Too often, people reach crisis point before co-occurring needs are identified. Through closer working relationships, we’ve strengthened how screenings, interventions, signposting and referrals are monitored across pathways. This has increased NRN’s recording of unmet mental health needs, bringing what we record closer to what we already knew from research and frontline experience.

In the last year, 247 people in Nottingham who may not otherwise have been identified were referred into drug and alcohol treatment following assessments by psychiatric hospital liaison teams, crisis services and local mental health teams. We knew there were unmet mental health needs in our treatment population – better recording didn’t create that reality, it simply made it visible. 

Our next step is joining a single record system being rolled out across Nottingham and Nottinghamshire. When implemented, substance use services will be able to access key information from hospital, GP and mental health records in one place, saving time, and meaning clients will no longer have to repeat their story every time they encounter a new professional.

Transformative training

Historically, we’ve taught staff to become experts in different parts of a person’s life, then been surprised when services struggle to see the whole person. Joint training has been transformative – staff across services have trained together on trauma-informed care, motivational interviewing, substance use awareness and suicide prevention.

Beyond knowledge, joint training builds relationships and confidence, making practitioners more likely to seek advice and adapt their practice. We’ve created a culture of ongoing learning rather than one-off knowledge transfer, resulting in regular advice clinics, supervision sessions and specialist assessments led by mental health colleagues.

Perhaps the biggest lesson is that workforce development isn’t separate from service transformation. The framework talks about co-occurring needs being everyone’s responsibility. Joint learning is how you turn that into everyday practice.

Built-in partnerships 

The guidance rightly recognises that partnership working needs to be built into the system. Our progress has relied on agreed referral pathways, joint risk management arrangements, reciprocal training and clear expectations. Regular strategic meetings chaired by public health ensure that collaboration becomes embedded in day-to-day practice. 

We’ve also taken every opportunity to commission posts from each other. Some embedded roles are funded by mental health services to bring substance use expertise into their teams, while substance use services fund roles that bring mental health expertise into treatment settings. This approach recognises the strengths of each partner, builds trust, and supports more integrated care. We also involve people with lived experience in reviewing and shaping services, as they’re often the best judges of whether a pathway feels integrated.

Despite the best intentions, priorities inevitably change and organisations come under pressure. To be maintained, partnership working has to be built into the way services are designed.

What’s next?

Our focus now is on rolling out the single record system and strengthening links with talking therapies and ADHD and autism pathways. Initiatives such as embedded practitioners show what’s possible when services are designed around people’s experiences rather than organisational boundaries. 

‘No wrong door’ and ‘everyone’s job’ are simple phrases, but achieving them takes years of relationship building, cultural change and shared commitment. For me, the real value of the framework isn’t that it tells us something new. It’s that it gives permission to challenge some of the assumptions our systems have been built on.

 

Apollos Clifton-Brown is director of health and social care at Framework

Government promises earlier support for mental health issues

By
DDN
-

People experiencing mental health problems will receive earlier support ‘without long waits for clinical diagnosis’, the government has stated.

The government has promised a ‘major overhaul ‘of mental health support with a renewed focus on prevention and early intervention

Adults and young people will have access to ‘broader support and advice at the earliest opportunity’, the Department for Health and Social Care (DHSC) says in its response to clinical psychologist Peter Fonagy’s Independent Review into prevalence and support for mental health conditions, ADHD and autism. The government promises a ‘major overhaul ‘of mental health support with a renewed focus on prevention and early intervention in its forthcoming mental health strategy, with NHS leaders asked to ‘urgently examine’ how people can access advice, assessments and treatment more easily. The close relationship between common mental disorders and drug dependence also ‘reinforces the need to recognise and address co-occurring conditions together, not in isolation,’ the Fonagy review states. DHSC set out its new service delivery framework for co-occurring substance and mental health treatment at the end of last year.

Mental health spending is forecast to top a record £16bn in 2026, with the government expanding NHS talking therapies so more than 900,000 people can complete a course of treatment over the next two years, as well as rolling out almost 160 new mental health centres and mental health emergency departments across the country to enable timely help and support before people ‘reach a point of crisis’.

‘Our findings show a system under immense strain, where diagnosis has increasingly become a very narrow pathway to finding support for distress caused by complex and wide-ranging factors,’ Fonagy stated. ‘This review’s recommendations offer a roadmap to shift from a diagnostic labelling model to a flexible, needs-led system. Diagnosis remains essential and must be protected – what has to change is that it is no longer the only door through which help can be reached. If we judge success by a person’s overall wellbeing and ability to take part in work, education, and staying connected to their community rather than by a narrow mechanism like diagnosis, we can shift to a system that intervenes early in communities and safeguards specialist capacity for those with severe needs.’

‘Professor Fonagy’s review has shown the importance of early intervention to address mental health and neurodevelopmental conditions and the huge distress these can cause’, said health secretary Yvette Cooper. ‘We will set out our response in a new mental health strategy in the coming months, building on the new mental health services we are already providing in schools and in the community.’

Turning Point chief executive Julie Bass said her organisation welcomed the ‘clear recognition’ that too many people were waiting too long for support while they navigated fragmented systems that were often focused on diagnosis rather than need. ‘As a health and care provider supporting people with substance use and mental health issues, learning disabilities and neurodevelopmental needs, we see every day that people rarely fit neatly into a single category and we strongly support the review’s call for more joined-up assessment and support that focuses on the whole person,’ she said. ‘The call for a new cross-government mental health strategy is essential as only a whole-system approach can address the complex drivers of poor mental health, strengthen prevention and ensure people receive the joined-up support they need to live well, remain in work and thrive in their communities.’

Independent review into mental health conditions, ADHD and autism available here

Record numbers attend inspiring drug and alcohol recovery event

By
DDN
-

An inspiring event which celebrates the achievements of people in recovery from drug and alcohol issues has taken place in Gloucestershire.

More than 220 people attended the Abbeycare Recovery Gathering at the Hatherley Manor hotel near Twigworth, the highest number on record.

The annual event was organised and hosted by Abbeycare Gloucester, which runs a residential recovery clinic in nearby Minsterworth. Many of its staff are in recovery themselves.

All previous and existing clients of Abbeycare were invited to take part, giving them a chance to share their experiences of their ongoing recovery journeys, reconnect with those who supported them at their lowest points, and celebrate their own achievements.

Held at the end of National Recovery Month, this year’s event also marked Abbeycare’s 20th anniversary, bringing together staff members and other industry professionals.
The key idea behind the Recovery Gathering is to bring together Abbeycare’s growing community of existing and former clients and their families, making the process of recovery more visible.

Highlights included a keynote speech from Tracy Blackmore, a specialist trauma therapist, on her experiences of transforming lives affected by addiction. There were also moving contributions from former Abbeycare clients, insights from family members, and recognition of staff milestones.

Read more and watch video highlights

Smoking prevalence drops below 10 per cent

By
DDN
-

The proportion of current smokers in the UK stood at 9.8 per cent last year, according to ONS figures – down from 10.6 per cent in 2024 and the first time it has fallen below 10 per cent.

The proportion of current e-cigarette users remains higher than current smokers, at 5.4m to 4.8m, with the number of e-cigarette users overtaking cigarette smokers for the first time in 2024. The highest proportion of current smokers is in the 45-54 age group, with 18-24-year-olds and people over 65 years the least likely to smoke. Smoking prevalence in all four nations of the UK has fallen since 2024 and currently stands at 11.4 per cent in Scotland, 11.1 per cent in Wales, 9.9 per cent in Northern Ireland and 9.5 per cent in England.

Eighteen to 24-year-olds and people over 65 years the least likely to smoke. The highest proportion of current smokers is in the 45-54 age group.

Smoking rates remain closely linked to deprivation – the local authorities with the highest prevalence of current smokers in the five years to 2025 were Fenland, Blackpool and Kingston upon Hull, all at just under 18 per cent. People classed as unemployed were the most likely to smoke, at 16.5 per cent, double the rate of those in paid employment. ‘Routine and manual’ occupations have the highest percentage of current smokers, at nearly 17 per cent.

However, 1.1m people who had never smoked reported using an e-cigarette daily or occasionally, up from 940,000 in 2024. The proportion of people who have never smoked but now vape has nearly doubled since 2021.

Meanwhile, an open letter from health professionals is urging the government to ‘stand firm in the face of industry campaigns’ against new regulations to tighten the rules on the packaging and display of vapes and other nicotine products. ‘Industries that profit from tobacco and nicotine are campaigning hard against these regulations, but hundreds of health and education professionals are urging ministers to stand firm,’ said ASH chief executive Hazel Cheeseman. ‘Vapes can help adults quit smoking, but they don’t need brightly coloured packaging or prominent displays. We can protect children from marketing while keeping vapes accessible to adults who smoke.’

The tobacco and vapes bill, which aims to create a ‘smokefree generation’ phasing out the legal sale of tobacco to anyone born after January 2009, passed into law earlier this year.

The ONS statistics are taken from the Opinions and Lifestyle Survey (OPN) and Annual Population Survey (APS).

Adult smoking habits in the UK: 2025 available here

Smoking profile: statistical commentary, October 2026 available here

Open letter available here

 

The National Harm Reduction Summit 2026

By
DDN
-

The focus of the 2026 National Harm Reduction summit in Bristol – which was also a celebration of the Bristol Drugs Project’s 40th birthday – was on how lessons from the past could help us shape the future. DDN reports.

LEARNING FROM THE PAST

LOOKING TO THE FUTURE

‘Harm reduction is about meeting people where they are, protecting health and saving lives,’ said Lydia Plant of Bristol Drugs Project (BDP) and Stuart Smith of The Hepatitis C Trust in a joint statement about their National Harm Reduction Summit (NHRS), held in Bristol. 

The purpose of the two-day summit was to take stock of a rapidly changing environment and ever-evolving drug market, and look at how peer-led and community approaches could be at the forefront of reaching people underserved by traditional services. It was also an opportunity to link with colleagues and partners in all areas of healthcare to make a more ‘accessible, equitable and resilient’ harm reduction system.

 

‘We need to be a strong voice - harm reduction shouldn’t depend on your postcode.’

STUART SMITH, THE HEPATITIS C TRUST

'We keep doing the same thing because we don't listen to an alternative.’

VICKI  BEERE, UNIVERSITY OF MANCHESTER

The organisers

Bristol Drugs Project (BDP) is a charity providing harm reduction and treatment services for people who are experiencing a negative relationship with drugs and/or alcohol. With 40 years of experience, their goal is to support people towards the changes they want to see in their lives no matter what they may be.

bdp.org.uk

The Hepatitis C Trust is a charity dedicated to eliminating hepatitis C in the UK by 2030. The trust champions the right of every person at risk of hepatitis C in the UK to receive effective testing, treatment and care. 

This is achieved by empowering people with lived experience, influencing policy and practice, and working with healthcare and treatment services to deliver support and raise awareness about hepatitis C.

hepctrust.org.uk

‘It's not just about sterile equipment. The most important part is building relationships. Stigma is still, sadly, very prevalent.’

LOUISE  HANSFORD, THE HEPATITIS C TRUST

'If we don't have each other, we don't have safe spaces.'

SHAYLA  SCHLOSSENBERG, RELEASE

On the eve of the National Harm Reduction Summit, Transform hosted a get-together to assess failing drug policy – and harness energy from Bristol being declared the first official city of harm reduction. DDN reports

'Recovery does not mean abstinence. It's a journey, a way of working.'

GARETH BALMER, WITHYOU

Read the full reports from this two-day event in the October issue of DDN magazine.

Photography by Ania Shrimpton

Aiming higher

By
DDN
-

For most of my working life I believed that the services I worked in were simply not offering enough. Better care plans, more strategies, motivational interviewing, more cognitive tools – if we could only refine what we already had, the numbers would move.

I worked as a registered nurse in addiction services in the Netherlands and the UK, across prevention, treatment, aftercare and dual diagnosis, and in all those years I watched deeply motivated clients who wanted to stop continue to use. It wasn’t only what I saw myself. JAMA documented in 2000 that between 40 and 60 per cent of people relapse after treatment, and two and a half decades of refinement have not noticeably moved that number.

I came to realise that something essential was missing, and I no longer believe the problem is effort or execution. I believe it’s the level at which we aim. Our focus on changing behaviour might be too narrow, and might itself be producing the outcomes we keep getting. We need to go deeper – the identity layer I could not, and did not, reach.

It’s increasingly accepted that a dependency begins as a coping mechanism. Often it was the only one available to a nervous system carrying more than it could process at the time. And it worked, or it would never have taken hold.

A mask is a useful metaphor. It was put on because it worked – and it stayed on long enough to become the face a person could see from the inside. At that point the addiction is no longer something a person does, it’s something they take themselves to be. And a person who takes themselves to be a problem cannot be talked out of it at the level of behaviour, because every relapse confirms the identity, and every fight against the dependency is a fight against themselves. That conflict leads to shame, and shame invites relapse.

'Our focus on changing behaviour might be too narrow, and might itself be producing the outcomes we keep getting.'

There is research pointing in this direction. Best and colleagues’ Social identity model of recovery describes recovery as an identity shift – new groups, new belonging, an ‘addict’ identity giving way to a recovery identity – and treats that shift as a mechanism of recovery rather than a by-product of it. What I’m describing goes one step further – not building a new identity to replace the old one, but recognising what was underneath the mask before it was worn.

The practice level of this is better mapped than you would expect, with two randomised trials in JAMA Psychiatry pointing the same way. There’s also something the evidence doesn’t show. The 2021 Cochrane review of 40 randomised trials found mindfulness-based interventions might slightly reduce days of substance use, with uncertain effects on abstinence and craving – but to me this an argument for fidelity and depth, rather than dismissal. 

It’s about capacity building. A person learns to meet a craving as an observable event – to feel it as sensation, locate it in the body, and watch it rise and crest and pass, without obeying it and without fighting it. One proposed mechanism is ‘de-centring’ – experiencing thoughts, sensations and cravings as events rather than as commands. And the capacity grows with repetition, the way any capacity does.

But here’s the interesting part – each time a craving is watched rather than fought, something quieter happens underneath. The person is, for a moment, no longer standing where the mask stands. They’re the one watching it. Nothing has been defeated, and nothing needed to be – the identity has simply loosened. To the coping mechanism itself, a person can finally say – you protected me once, and I have grown past needing you. In a body that has spent years at conflict with itself, that is a powerful shift.

So my proposal is, in addition to what works already – medication, trauma-informed care, counselling, peer support – add capacity building alongside every layer that holds people. If the literature is right, the difference doesn’t show in week one. It shows at month 12, in the people who are still standing – not by fighting harder, but by finding, underneath the mask, someone who was never craving anything.

Paul du Buf worked for three decades as a registered nurse in addiction services in the Netherlands and the UK.

He is the author of Shadow Dancing: Embodied Recovery fromTrauma and Addictions and founder of ERA-Institute. era-institute.com

Pause for thought

By
DDN
-

In recovery, milestones matter. A day, a week, 30 days, a year. Each one is marked sincerely and with hope, because each one is proof that another way of living your life is possible. This month I’m proud to say that Abbeycare is marking a milestone of our own, as we celebrate our 20th anniversary.

I’ll be honest: we’ve never been particularly good at talking about ourselves. We’d much rather quietly get on with the job of improving our services, supporting our staff, working alongside other organisations who share our philosophy, and helping people rebuild their lives. Ultimately, our success isn’t measured by what we say, it’s measured by the lives that are changed for the better. But 20 years feels like a moment worth pausing on, if only because of how far we’ve come, growing into one of the UK’s leading providers of residential rehabilitation for people with substance use issues.

In 2006, Abbeycare was formed in Scotland as a six-bed service at Brownhill House in North Ayrshire, with the aim of helping people recover from alcohol addictions. Liam Mehigan, our operations director, has been with the organisation since those early days.

‘When I first joined Abbeycare, it only had one manager and a few support workers,’ he recalls. ‘As well as their caring responsibilities, the staff were also expected to take out the bins and do the dishes. Starting from these very small, humble origins, it has grown into a much more professional organisation. Now we’ve got so many different departments, covering admissions to outreach, and teams of recovery practitioners and therapists and clinicians. It’s become a much more multidisciplinary service. But what it has never lost is that sense of being part of the community and giving something back.’

Building on the success of that first six-bed house, Abbeycare opened a second premises at nearby Monkredding House in 2013, the same year that it took its first steps into England by opening another rehab facility at Newmarket in Suffolk. In 2015 we relocated to the grand Murdostoun Castle in North Lanarkshire, which was originally built in the 15th century. It was a remarkable building in a tranquil location, and gave us the space to expand and start treating people with drug issues and other substance use problems, not just alcohol.

A few years later, Liam was out walking his dog when he spotted a ‘for sale’ sign outside Erskine Mains House, a purpose-built care facility which was previously used as a home for veterans. In 2021, Abbeycare Scotland moved there and that is where we’ve stayed.

Our English service, meanwhile, became Abbeycare Gloucester in 2019 and continues to be based at Hygrove House in Minsterworth, a country retreat in a peaceful setting. Between our sites on both sides of the border, we now employ more than 130 staff.

It’s wonderful to reflect that over the past 20 years, thousands of people have come through our doors, thousands of lives have been changed, and thousands of families have been given more time with someone they love.

Around half of our staff are in long-term recovery themselves, often deciding that they would like to pursue careers in the sector after taking part in our volunteering or mentoring initiatives.

One example is Emma Harrison, who joined our peer support programme in Erskine six months after completing a 12-week stay at Abbeycare. She was assigned as a contact for people who were about to leave, using her own experience to guide them through this tricky period. She then moved onto our volunteering programme, where participants are given the chance to work in the clinic, learn from other staff, and complete training courses. Now, she works as an outreach co-ordinator.

In Gloucester, meanwhile, Jess Fry was recently promoted to the position of senior recovery practitioner. She first came through Abbeycare’s doors while in the depths of alcohol dependency, but has since turned her life around, and is now often the first person new clients see when they arrive.

Watch video highlights from the day

 

As Liam recalls, what has always set Abbeycare apart has been its people. ‘Looking back over the over the years, I’d say we’ve been blessed with so many good people, well-intentioned people, that have worked for the organisation,’ he says. ‘They might not always have been the most highly qualified in the early days, but sometimes having the right heart and being dedicated and committed can be just as powerful. Some of the people who started their careers here have since gone on to run amazing recovery-related organisations and are now CEOs themselves, which is incredible to see.’

'Our success isn't measured by what we say, it's measured by the lives that are changed for the better. But 20 years feels like a moment worth pausing on, if only because of how far we've come.'

Abbeycare has always sought to have a positive ripple effect, and the last couple of years have shown me what this community can do when it pulls together.

Last year, for instance, in partnership with the St Mirren FC Charitable Foundation, we launched Abbeycare Buddies, a weekly hub taking place at the club’s stadium. The sessions provide people in recovery with a hot meal and a safe place to talk and share, as well as offering everything from creative writing to photography courses for those who want to pursue new interests or revive old passions.

One of the groups that grew out of this later performed an original play called The Backdater, with a cast entirely made up of people in recovery. It was written by our former outreach manager Eddie Clarke, a creative force who also launched Listen UP, our recovery-themed podcast where people talk about their experiences with incredible honesty.

Then there are our recovery gatherings, held each September, where hundreds of former clients and their families come together to reconnect with the staff who supported them through their darkest times, and celebrate what they’ve achieved. This extraordinary community grows each year, and last month’s event in Scotland was attended by more than 450 people.

One of the achievements I’m most proud of is our decision to bring Scotland’s Jericho Houses in Greenock and Dundee into the Abbeycare family last year. Previously run by one of Scotland’s oldest rehabilitation charities, their future was in doubt. By stepping in we secured 40 rehab beds and 30 jobs, and have since embarked on a major renovation programme so their vital work can continue.

This October, we’re marking our anniversary in another special way with the inaugural Scottish Recovery Awards, a new event recognising the staff, volunteers and organisations doing the hard, often invisible, work of supporting recovery.

The awards will be addressed by singer Lulu, who has spoken openly in recent years about her own recovery from alcoholism. As she put it herself: ‘These awards are about recognising people who are changing their lives and helping others do the same. It’s important that we celebrate those achievements and remind people that recovery is possible.’

We decided to create the awards to mark our 20th anniversary, but I don’t want them to be regarded as an Abbeycare event. My hope is that they become something that belongs to the whole recovery community, because so much of what deserves recognition happens well away from our own clinics, in services, charities and volunteer networks the length and breadth of Scotland.

So here we are: 20 years on from a six-bed house in North Ayrshire, Abbeycare has become its own recovery community spanning Scotland and England, run by some of the people who once arrived at our door needing help, and stayed to pass it on to others. Here’s to the next milestone, and many more along the way.

Paul Bowley is chief executive of Abbeycare

Pictures of the Recovery Gathering are by Dominic Thompson /Expoja Photography

DDN Magazine October 2026

By
DDN
-

Is support reachable on a difficult day?

If someone misses an appointment or stops responding to messages, how easy do we make it for them to reconnect? Do we find out what’s been happening? If recovery isn’t a straight road, then support needs to be reachable on a difficult day, when confidence is low and asking for help feels hardest (p6).

We talk a lot about integration, yet if you’re experiencing problems with drugs and mental health, you can be shuttled between services that feel neither equipped nor willing to take responsibility. Add homelessness, trauma and violence to the mix and neat divisions between services make even less sense.

Other countries offer ideas (p10), while Nottingham shares a model for building trust and sharing knowledge (p18). Meanwhile, the first NHRS in Bristol reminded us of the UK’s proud harm reduction legacy (p12). But despite amazing progress on hepatitis C, there’s urgent need to reverse declining needle and syringe provision, dwindling pharmacy coverage and overstretched peer outreach. 

Let’s not lose our ambition. 

Read the October issue as an online magazine (you can also download it as a PDF from the online magazine)

Please send your letters and comment to claire@cjwellings.com

Claire Brown Editor of DDN Magazine

Claire Brown, editor

Hope Fest celebrates recovery

By
DDN
-

Hope Fest 2026 brought together people in recovery, families, friends, services and the wider community for an alcohol-free celebration at Pleasley Pit.

The event was organised by Rhubarb Farm, a Langwith-based social enterprise and charity offering therapeutic horticulture and supportive activities for adults with diverse needs, including those recovering from drug and alcohol use.

The day featured live music, creative and wellbeing activities, food and opportunities to connect, creating a space where recovery could be celebrated openly. Organisers said the festival aimed to show that life in recovery can include purpose, laughter, belonging and community.

Hope festival by rhubarb farmHope Fest has grown each year with support from partner organisations and individuals. Planning is already beginning for next year, with organisers keen to hear from organisations interested in getting involved or supporting the festival’s future development.

Find out more about the work of Rhubarb Farm at: rhubarbfarm.co.uk

More than 1,700 people died while homeless last year

By
DDN
-

Preliminary findings from the Museum of Homelessness show that 1,720 people died while homeless in 2025 – almost 7 per cent up on the previous year.

More than 30 per cent of the deaths were either on the streets or in rough sleepers’ accommodation

More than 10,000 people have now died while homeless since 2017 says the charity, which is run by people with direct experience of homelessness. In 2025, more than 30 per cent of the deaths were either on the streets or in rough sleepers’ accommodation, it adds, with the highest death rates reported in Camden, Brighton and Hove, Bristol, Edinburgh and Stirling. Over half of the fatalities were ‘deaths of despair’ – the result of drugs, alcohol or suicide.

The true scale of homeless deaths is also being under-reported by local government, it says, with the museum’s research finding almost 200 deaths missing from official data. Fifteen per cent of councils either ‘failed to respond or stated that they did not hold the data requested’, it adds.

The findings are broadly similar to those published by ONS, which show just under 1,000 deaths of people experiencing homelessness registered in England and Wales in 2025 – 77 per cent up in a decade, with 85 per cent of them among men. ‘We capture more people than the ONS due to our different methodologies – our approach enables us to identify more people in temporary accommodation settings,’ the museum states. Its full report will be published later this month.

‘This year’s findings mark a devastating milestone for the Dying Homeless Project,’ it says. ‘The investigation has now documented 10,243 deaths since we began recording in 2017, providing stark evidence that homelessness is a growing public health and social justice emergency. Behind every statistic is an individual whose life was cut short while experiencing homelessness, often in circumstances linked to poverty, trauma, poor health, inadequate accommodation, social isolation and failures of support systems.’

The 2025 findings are released ‘at a moment when national political attention is increasingly focused on homelessness and rough sleeping’, it continues. ‘We hope these findings are a spur to more action. Our investigation highlights the human consequences of systemic failure, telling the stories of deaths that could have been prevented if long-term investment in quality housing, healthcare and support had been prioritised. The Department for Health and Social Care should increase funding for harm reduction and suicide prevention; the availability of overdose prevention and safer injecting services should be an urgent priority in policy and practice, as should pathways into detox and recovery and trauma-focused mental healthcare.’

Deaths of people experiencing homelessness in England and Wales: 2013 to 2025 registrations available here

‘No single route away from cigarettes’, says GSTHR

By
DDN
-

‘There is no single route away from cigarettes’ and progress can stall, says the latest situation report from the Global State of Tobacco Harm Reduction (GSTHR). Instead, price, availability, culture and consumer preference will determine which products are the most widely used.

In Estonia smoking rates fell from 26 per cent in 2020 to less than 20 per cent in 2024, while vaping rates have more than tripled

Smoking rates can fall even without formal tobacco harm strategies being in place, says the report, which looks at the progress of three countries – Estonia, Ireland and South Korea – that show ‘emerging but different’ shifts away from cigarettes and a concurrent rise in the use of safer nicotine products. In Estonia smoking rates fell from 26 per cent in 2020 to less than 20 per cent in 2024, while vaping rates have more than tripled to 13.5 per cent. Although none of these countries had formal tobacco harm reduction strategies a shift away from cigarettes still took place, the report points out, with many consumers in South Korea now using several safer nicotine products alongside cigarettes.

Poorly designed policy, however, risks halting or reversing progress, the document warns. ‘Protecting young people and adult harm reduction should be pursued jointly – without making safer alternatives less appealing, less affordable and less accessible to adults who smoke,’ it says, while widespread misconceptions about the safety of alternative products are still a major barrier to switching. Polling commissioned by ASH last year found that more than half of UK adults wrongly believe that vaping is as – or more – harmful than smoking. The proportion in Ireland, however, rises to almost three quarters, GSTHR warns. Governments and public health organisations need to be sharing accurate harm reduction information aimed at all adults who smoke, it urges.

‘Ultimately, success should not be measured by uptake of safer nicotine products alone, but by how quickly and equitably cigarette smoking declines, how many people switch completely, and whether those changes are sustained,’ says the report. ‘A policy environment that makes the safer choice easier rather than harder is essential to realising the full potential of tobacco harm reduction.’

‘Evidence from South Korea, Ireland and Estonia shows that, when they can, people who smoke will opt for safer alternatives,’ said GSTHR Economist Giorgi Mzhavanadze. ‘But these transitions are not inevitable and can be easily disrupted or reversed. When considering safer nicotine products, policymakers should always ask: will this make it easier or harder for adults who smoke to make the safer choice?’

A recent Cochrane review that examined 80 randomised control trials involving nearly 30,000 people found ‘high-certainty evidence’ that vaping was the most effective quitting aid for smokers.

The next wave of tobacco harm reduction? Emerging transitions from smoking to safer nicotine products in South Korea, Ireland and Estonia available here

What recovery means to Ste

By
DDN
-

Recovery has shaped every part of Ste’s life.

Today, he manages Acorn’s Community Team in Manchester, but there was a time when he never thought that kind of future was possible.

Much of Ste’s early adult life, from the age of 18 to 38, was spent in and out of jail. After being expelled from school, he had no formal education and believed his past would always count against him.

Things began to change when he entered residential rehab in 2009. There, he met an Acorn employee he knew from prison. Seeing somebody with a similar background working and helping others showed him that a different future was possible.

For Ste, recovery became about reconnecting with people, finding purpose and building a future.

In his own words, he describes it as: “A personal journey of healing, growth, and reclaiming a meaningful life that is defined entirely by more than just stopping: It goes beyond quitting a substance, it is about building a life I could enjoy.”

It also meant rebuilding relationships and learning to be kinder to himself.

“Connection; healing relationships with loved ones, and finding a sense of purpose. Self-kindness; learning self-forgiveness and accepting that progress includes hard days,” he added.

After completing rehab in 2010, Ste chose to build a new life. He volunteered with Acorn, studied for a Health and Social Care Diploma, qualified as a counsellor and eventually progressed into leadership.

Find out more

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Acorn

Pain barriers

By
DDN
-

Much of our work is organised around labels – addiction, long-term or harmful substance use, chronic pain, mental health, trauma.

Each has its own professional language, evidence base and service structure. Those distinctions matter, and specialist expertise is essential. But in separating these experiences into different systems, we can sometimes lose sight of the person at the centre.

One of the biggest advances in recent years has been our understanding of trauma and the nervous system. Yet I wonder whether we’ve fully appreciated what this means. Modern pain science has embraced this understanding, recognising that chronic pain is often not simply a measure of tissue damage but a real experience created by the nervous system and influenced by previous experiences, emotions, environment and our sense of safety.

Trauma and prolonged stress can leave the nervous system in a heightened state of protection. Pain, fear and hypervigilance become closely intertwined. That doesn’t mean the pain is ‘psychological’ – the pain is entirely real. But it’s shaped by much more than damaged tissue.

For those of us working with people experiencing long-term or harmful substance use, this feels strikingly familiar. Many people are not simply seeking pleasure or taking risks. They’re trying to regulate an overwhelmed nervous system, numb emotional pain, cope with trauma, sleep, reduce anxiety, or simply get through another day.

This doesn’t mean that chronic pain and harmful substance use are the same – they’re not. Nor does it mean that everyone who uses substances has experienced trauma. But both fields increasingly recognise that behaviour often makes sense when viewed as an attempt to cope with suffering rather than simply as a problem to be eliminated.

The scale of chronic pain makes this impossible to ignore. More than one in four adults in England live with chronic pain, with around one in eight experiencing pain that significantly limits daily life. Up to half of GP consultations relate to pain, with musculoskeletal conditions alone costing the NHS almost £5bn each year.

Yet our systems continue to separate physical pain, mental health and substance use into different pathways. At the same time, while we’ve become much better at recognising trauma and psychological wellbeing, we sometimes pay less attention to the social conditions that shape suffering in the first place – poverty, insecure housing, loneliness, unemployment and inequality all affect the nervous system, physical health and people’s ability to recover.

This is where social inclusion organisations have an important contribution to make. At DHI, our interest in pain has grown directly from listening to the people we support. Time and again we’ve seen chronic pain, trauma, harmful substance use and social exclusion reinforce one another, yet too often they’re addressed by different services in isolation. That has led us to ask whether social inclusion organisations have a greater role to play in helping people understand and manage persistent pain alongside the wider challenges they face.

Our role has always been to see the person beyond the diagnosis or behaviour. Recovery has never been simply about stopping substance use – it’s about rebuilding lives, relationships, confidence and hope.

The same principle applies to chronic pain. Success is not always measured by a lower pain score. Sometimes it means sleeping better, reconnecting with family, returning to work, reducing reliance on medication or feeling able to participate in life again.

As DHI prepares to launch its pain management and wellbeing toolkit, we’re not suggesting that we have all the answers or that we’re seeking to replace specialist pain services. We’re asking whether these fields have more to learn from one another.

Substance use services have developed expertise in trauma-informed practice, peer support, motivational approaches and recovery capital. Pain services bring an increasingly sophisticated understanding of the nervous system and how people can regain confidence and function despite persistent pain. Perhaps the future is not about creating more labels, but about becoming better at understanding what connects people across them.

Because behind every diagnosis, every label and every behaviour, is a person trying to find a way through.

Rosie Phillips is chief executive of Developing Health & Independence (DHI)

Half of public back treatment instead of custody for drug-related offending

By
DDN
-

Forty-seven per cent of people think offenders with a drug or alcohol problem linked to their crime should be sent to a rehabilitation programme instead of prison, according to a poll by Opinium on behalf of the Forward Trust.

Forward Trust: the current early release scheme is ‘not the best way to protect the public, or improve rehabilitation of offenders’

The idea was opposed by just 20 per cent of respondents, the trust says, while there was also ‘strong support’ for its proposal for an ‘earned release’ scheme – where non-violent prisoners are able to work towards early release if they make good progress in their rehab programme.

The Forward Trust will be presenting the poll results to the Labour Party conference this week, with the ‘earned release’ scheme put forward as an alternative to the government’s current early release programme, where people are automatically released between a third and halfway through their sentence to ease prison overcrowding. ‘We think this is not the best way to protect the public, or improve rehabilitation of offenders, and will likely mean a continued high reoffending rate which will do nothing to bring down prisoner numbers’ the trust states.

A review by former chief inspector of prisons Dame Ann Owers last year found that the prison estate had come ‘close to collapse’ on three separate occasions as a result of overcrowding, with the government-commissioned sentencing review by former justice secretary David Gauke recommending a shift away from sentences of less than 12 months apart from in ‘exceptional circumstances’. A report from the Independent Monitoring Boards earlier this year found that drugs were now the ‘single most destabilising factor’ across the entire adult prison estate.

‘Government should see these results as a green light to launch bold, courageous, and creative rehabilitation initiatives,’ said Forward Trust CEO Mike Trace. ‘It’s obvious that cramming together lots of people with histories of trauma, neglect, poverty, and addiction in understaffed and rundown conditions is not going to lead to good outcomes – either for offenders or the public. Change is long overdue. The way out is to create a system that genuinely rehabilitates, rather than simply punishes. Rehabilitation gives people a second chance. Taking rehabilitation seriously is cheaper than current strategy, will reduce crime and prison pressures in the long term, and has the support of the public.’

NSP provision ‘increasingly neglected’, says Hep C Trust

By
DDN
-

NSP provision in England is increasingly neglected and its benefits poorly understood, says a report from the Hepatitis C Trust.

The ‘vast majority’ of local authorities do not have an adequate picture of NSP coverage in their area, says Out of reach: declining access to needle and syringe programmes in England and the threat to public health, with only around a quarter of the councils that responded to the trust’s FOI request meeting the criteria for ‘strong’ understanding of NSP provision.

Provision rates are also falling, the report warns, with a third of pharmacies contacted by the trust for its 2023 mapping exercises saying they’d since stopped providing it.

DHSC should set out its ‘clear long-term vision’ for NSP in the context of the elimination of hep C and HIV

Local intelligence on NSP provision – from drug services, online directories and other sources – was also inaccurate, with less than half of the pharmacies identified as providing NSP actually doing so. The trust’s research also identified widespread quality issues with NSP services, where national guidance was not being followed, the document states.

‘NSP is one of the UK’s quiet public health success stories, helping to prevent thousands of infections and reducing the long-term costs associated with blood-borne viruses, drug harms and premature mortality,’ says the report. ‘Yet despite its proven effectiveness NSP provision in England is increasingly neglected.’

The report calls for data collection on NSP to be included in the core data set used by local authorities for their drug service contract monitoring, as well as for OHID to commission a ‘comprehensive national evaluation’ of NSP provision to inform national and local planning. ‘This should seek to capture both current provision and the rate of service closure, as well as understanding the reasons for this,’ the document states. DHSC should also set out its ‘clear long-term vision’ for NSP in the context of the elimination of hep C and HIV, including ‘clear resourcing to implement and safeguard this’.

‘With no consistent national system for monitoring community pharmacy NSP provision in England, changes in provision – including services closing, reducing their offer or introducing access restrictions – may go undetected at both a local and a national level,’ says the report. ‘A national monitoring system should therefore be established to provide an up-to-date picture of NSP provision, including where services are operating, the type and quantity of equipment available, and key aspects of service accessibility and quality.’

See the October issue of DDN for a full round-up of the National Harm Reduction Summit 2026, including where next for NSP provision.

Out of reach: declining access to needle and syringe programmes in England and the threat to public health available here

Scottish drug deaths up by 11 per cent

By
DDN
-

There were 1,133 drug-related deaths recorded by National Records of Scotland (NRS) last year, an 11 per cent increase on 2024.

The overall average age of death was 46. The rate of drug deaths among males rose by nearly 20 per cent compared to 2024, but deaths among females fell by 5 per cent. The death rate per 100,000 people is now 21.4 – four times higher than in 2000 when records began.

Nitazenes were implicated in almost 250 deaths, with etonitazene – the most common nitazene – implicated in 215

Nitazenes were implicated in almost 250 deaths, with etonitazene – the most common nitazene – implicated in 215. Public Health Scotland recently warned that anyone using street drugs should ‘assume they are contaminated with other substances’. While opiates/opioids were implicated in 78 per cent of deaths, cocaine was implicated in 52 per cent – 23 per cent higher than in the previous year, and the highest number since records began. Benzodiazepines were implicated in 38 per cent of deaths, and gabapentin and/or pregabalin in 29 per cent. More than one drug was implicated in nearly 80 per cent of all drug use deaths.

Scotland’s drug death rate is now 15 times higher in the most deprived areas than the least deprived, with deaths in increasing in 20 local authority areas and falling in ten. Over the past five years, drug death rates have been higher than the Scottish average in Glasgow City, Dundee City, North Ayrshire, Inverclyde, West Dunbartonshire and East Ayrshire. Scotland’s drug fatality rate has long been the worst in Europe, with the country’s drug poisoning death rate 2.4 times that of England.

Earlier this a year a report from the Social Market Foundation estimated the financial cost of drug harm to Scotland at around £6bn per year. While 2024 saw a 13 per cent fall in drug deaths, this could prove to be ‘nothing more than a blip’ in the overall upward trend, the organisation warned. The Scottish Government published its ten-year plan to reduce drug and alcohol deaths in March.

‘The number of drug use deaths in Scotland is below the peak of 2020 but still the sixth highest year on record,’ said head of vital events statistics at NRS, Phillipa Haxton. ‘Deaths among males drove the latest increase. The number of deaths among females is at its lowest since 2017.’

SDF strategy co-ordinator for drug death prevention, Kirsten Horsburgh
Kirsten Horsburgh: ‘no single intervention will end Scotland’s drug-related deaths crisis’

The fact that nitazenes were implicated in one in five deaths was ‘a stark indication’ of the changing risks, said Scottish Drugs Forum chief executive Kirsten Horsburgh. ‘We must act quickly to expand the support and services that can help people reduce harm – such as safer drug consumption facilities, drug checking services, and the wider provision of harm reduction equipment.’ However, no single intervention would end Scotland’s drug-related deaths crisis, she stated. ‘We need effective prevention, treatment and recovery support, alongside action across government to overcome the deep-rooted social and economic conditions that shape people’s health.’ 

‘People will rightly ask why so many are still losing their lives,’ said national harm reduction lead at WithYou, Gareth Balmer. ‘We’ve had strategies, task forces, targets and pilots, yet Scotland continues to lose more than a thousand people a year to this crisis.’ While synthetic opioids in the drug supply were ‘clearly part of it’, dangerous and unpredictable drug markets also existed elsewhere, he said. ‘What stands out here is how closely deaths follow poverty, poor health, trauma and exclusion. Stigma is still a real barrier, too. People who use drugs are judged in a way people with many other health problems aren’t, and that affects whether someone asks for help, how they’re treated when they do, and, for some, whether they survive.’

‘Scotland remains in the grip of a drugs death crisis, which is being made even more difficult to control by the emergence of new synthetic opioids and other substances,’ said Abbeycare chief executive Paul Bowley. ‘It is clear that the national mission to reduce the harms caused by drugs has much work still to do, with more investment needed in treatment and recovery services and clearer pathways for people to seek help.’

Drug-related deaths in Scotland, 2025 available here

Back to the future

By
DDN
-

New Directions in the Study of Alcohol Group, with the Institute for Social Marketing and Health (ISMH) at the University of Stirling, are holding their 50th anniversary conference in October.

There were some legendary first gigs 50 years ago. The Clash opened for the Sex Pistols in Sheffield, and the Undertones played a scout hall in Derry. And in Dumfries, New Directions in the Study of Alcohol Group met for the first time.

Fewer than 20 people were there, and it was every bit as controversial as punk. Back then, questioning the notion that drinking problems could only be ‘cured’ by lifelong abstinence or challenging the disease model of ‘alcoholism’, was heresy.

Participants from nursing, psychiatry, psychology, social work and sociology studied research from the UK and abroad, alongside their own work. They were free to examine radical ideas and explore what they could mean for helping drinkers in trouble.

Remember your first gig? They did. They continued to meet regularly, attracting more, and different, people. Registered as a charity in 1982, the annual residential conferences attracted researchers and practitioners, all committed to exploring new and emerging issues in the alcohol field. The group had stumbled upon a great recipe for alcohol conferences (see box below).

INGREDIENTS (Specialist alcohol conferences)

• Common denominator [alcohol]
• People with expertise and specialist knowledge
• Range of professions and disciplines
• Neutral venue (away from the day job)
• Willingness to question received 'wisdom'
• Freedom to discuss in confidence
• Built-in time for informal discussions

Unfortunately, COVID scuppered the in-person events. Lockdown put the conference on hold – until now. With the Institute for Social Marketing and Health, our October conference aims to revive the spirit of open, collaborative inquiry that made New Directions a vital part of the alcohol research calendar.

The Alcohol Research 2026 conference will feature researchers, practitioners and professionals from all areas of alcohol policy to explore today’s big ideas in alcohol research, and encourage new thinking and innovation. In the spirit of New Directions, there will be presentations, debates and interactive workshops to encourage a dynamic exchange of ideas, so people from all backgrounds and career stages can join the conversation.  

As well as looking forward, we can reflect on how much has changed since New Directions began – from dramatic changes in how, where and what people drink, to novel policy approaches like minimum unit pricing that weren’t on anyone’s radar in the 1970s. Debates on the nature of ‘addiction’, funding for treatment, and understanding behaviour change are as lively as they’ve always been. New social trends – from sober-curious movements to the explosion in no- and low- products – have emerged. The way we buy alcohol has been transformed.

Alcohol research is about understanding change, and asking difficult (and interesting) questions. That is what New Directions has always been about, and Alcohol Research 2026 will carry on that tradition. If you’re asking, ‘What’s this got to do with me?’ – good question. 

We’ve run a LOT of conferences. A small group of early career alcohol specialists grew into a nationwide collective of both like- and unlike-minded people. It’s all been voluntary – we’ve had no premises, no staff, accepted no sponsorship. It hasn’t always been easy, but it’s been hugely worthwhile (and enormous fun). Taking space away from work to think afresh with other specialists has been invaluable. Individuals, their workplaces, the wider field and ultimately people affected by alcohol problems have benefitted.

New Directions trustees understand how lucky we’ve been. We were young in our careers when we first attended. We’ve learned loads, building personal and professional networks throughout the alcohol field. And we think other people should enjoy that opportunity.

So, we’re delighted that we’ve been able to team up with the ISMH at Stirling to organise a conference that captures the spirit of New Directions, and we hope it can launch another 50 years of lively debates, new thinking and mutual support for researchers and practitioners across our field. Come along – it might be a gig you don’t want to miss!

Trevor McCarthy is a trustee of New Directions in the Study of Alcohol Group and (mostly) retired.

Alcohol Research 2026: New Thinking, New Directions takes place on 6-7 October at the University of Stirling. Bursaries are available to support people to attend. alcoholresearch2026.carrd.co

Ketamine stigma is deterring people from seeking care

By
DDN
-

‘Judge less and love more’Kaleidoscope’s Birchwood residential detox and rehabilitation service on the Wirral has gathered feedback from people with a history of ketamine use about their experiences of hospital and A&E services.

While some spoke positively about kind and supportive nurses, doctors and urologists, others described feeling judged, blamed or dismissed because their health problems were linked to ketamine use. Their experiences included long waits while in severe pain, inadequate pain relief, loss of privacy and symptoms not being taken seriously. Several felt that hospital staff lacked an understanding of ketamine-related harm and the intense pain it can cause.

One person said that compassionate staff had taken extra time to listen and understand their addiction, while another valued receiving thorough scans and blood tests to assess the deterioration of their organ function. However, others reported being told simply to stop using ketamine or that they had brought their condition upon themselves.

Some said these experiences had deterred them from seeking further medical help, despite serious symptoms. One person described self-medicating with more ketamine because they felt hospital staff did not understand their pain.

Those taking part called for greater knowledge of ketamine-related health problems, more compassion and empathy, and proper investigation of symptoms. They also wanted hospital staff to make referrals to drug and alcohol services following A&E attendance.

The feedback will be used to encourage healthcare professionals to reflect on how they respond to people experiencing ketamine-related harm.

As one participant put it: ‘Treat me like you would treat your loved ones.’

Find out more about Kaleidoscope’s ketamine treatment work and other projects: kaleidoscope68.org/projects/

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Kaleidoscope

Opening doors

By
DDN
-

This month, residential drug and alcohol rehabilitation services across England will be doing something remarkably simple – opening their doors.

Through the Open Houses campaign, state-funded residential services will be inviting professionals, decision-makers and community partners to step inside, meet the people at the heart of recovery and see first-hand what residential treatment looks like in practice. The campaign is built on a simple observation that most people have never visited a rehab, or may not have done so for many years – and yet decisions about residential treatment are made every day.

For many of us working across health, social care, the justice system and public services, the word ‘rehab’ can still be shaped by outdated assumptions, media portrayals or second-hand accounts. Yet the reality of modern residential rehab is often very different from public perceptions.

At a time when the drug and alcohol treatment system is seeing higher demand and an increasing complexity of need, alongside growing pressures on budgets, understanding the full range of treatment options available has never been more important. Substance use rarely exists in isolation – people entering treatment are often navigating a combination of challenges that can include trauma, mental ill health, homelessness, domestic abuse, social exclusion, family breakdown and involvement with the justice system. These issues are frequently interconnected, with each one reinforcing the others.

Community-based support plays a critical role for many people, and for some it provides support for multiple needs, phased appropriately for each resident and on one site. Residential rehabilitation offers something different that people may struggle to access in their own community – it provides a safe, structured and therapeutic environment where people can step away from the pressures, triggers and risks that may be preventing change. With intensive support, peer-led communities and the time needed to focus on healing, residential services can help people address not only substance use but also the underlying issues that contribute to it.

It’s difficult to fully appreciate the therapeutic environment, safety and governance processes, and the day-to-day reality of treatment – or the outcomes being achieved – without witnessing them directly. Open Houses encourages visitors to ask questions, challenge assumptions and engage directly with services, staff, residents and people with lived experience. 

Seeing a residential service first-hand allows professionals to move beyond the abstract. Perhaps most importantly, they can hear directly from people whose lives have been transformed through access to the right support at the right time.

Residential rehabilitation is an important part of the treatment system, but access is still highly inconsistent. Funding arrangements can be complex, referral processes can vary between areas, and awareness of available services is often uneven. As a result, many people who could benefit from residential treatment may never be considered for it.

Making change requires collaboration between commissioners, healthcare professionals, local authorities, social workers, probation services, housing providers, employers, community organisations, wider community, families, loved ones and people with lived experience. Open Houses provides an opportunity to strengthen those connections.

James Armstrong is director of marketing and innovation at Phoenix Futures

Number of Scots starting residential rehab up 60 per cent in six years, says PHS

By
DDN
-

The number of people starting a residential rehab placement in Scotland increased by around 60 per cent between 2019-20 and 2025-26, according to Public Health Scotland’s (PHS) final evaluation report on the Scottish Government’s residential rehabilitation programme.

Mental Health
There was also found to be a lack of suitable provision for some groups, including people with mental health needs or caring responsibilities

The figure includes both publicly and privately funded placements, with the number of publicly funded placements more than doubling. ‘The Scottish Government target for 1,000 people in Scotland to have a publicly funded residential rehabilitation placement by 2026 was met,’ the agency states.

Results from a 2025 survey of those able to refer people for rehab, however, found that just 30 per cent of respondents agreed that residential rehab was ‘easily accessible’, with identified barriers including lack of funding, concerns about aftercare, and long waiting times for both detox and rehab. There was also found to be a lack of suitable provision for some groups, including people with mental health needs or caring responsibilities, or those ‘who do not meet specific abstinence requirements’.  The final overall report on the Scottish Government’s national mission on drugs is expected to be published later this year.

‘The evaluation provides evidence that the residential rehabilitation programme has improved access to residential rehab. At the same time, it highlights ongoing barriers,’ said PHS consultant Dr Tara Shivaji. ‘Residential rehab is most effective when delivered as part of a whole systems approach, with coordinated support across community-based services, mental health, housing, employment and criminal justice. This ensures people can access the range of support they need before, during and after treatment.’

Meanwhile, there were almost 570 deaths among people with dual diagnosis in Ireland between 2019 and 2021, according to a report by the Health Research Board (HRB) and the Health Service Executive published in the Irish Journal of Psychological Medicine. Almost 70 per cent of the deaths were among men, with an average age of 42. Almost 30 per cent died by suicide.

‘The area of dual diagnosis and drug-related deaths is complicated and multi-layered, with limited existing Irish data,’ said head of the HRB’s National Health Information Systems Dr Suzi Lyons. ‘This study will increase understanding of these complexities. It will also provide high-quality data and evidence to policy makers and service planners to help reduce harm and improve outcomes for people with dual diagnosis in Ireland.’

Evaluation of the Scottish Government residential rehabilitation programme: synthesis report available here

Dual diagnosis and drug-related deaths (2019–2021): an Irish perspective available here

See October’s DDN for a feature on improving dual diagnosis provision in Ireland 

How to write a highly effective referral re-engagement letter

By
DDN
-

One day, referrals are ticking along nicely. The next, you realise a familiar name has disappeared from your inbox. It happens all the time.

Referrers can be the most consistent source of clients for allied health clinics, and if you run a private practice, the scenario above may feel uncomfortably familiar. A referrer who once sent clients your way has gone quiet, with no explanation or warning.

A well-crafted referral re-engagement letter helps you restart that relationship in a way that is professional, thoughtful, and skips the awkwardness. Whether you’re sending a referral follow-up letter or a short referral re-engagement email, the goal is the same: reconnect and rebuild trust.

But before you start writing, it helps to understand why referrals stop in the first place.

  1. A regular referrer who suddenly stopped referring

This scenario is often the most concerning. When a previously consistent referral partner goes silent, practices tend to assume the worst, and sometimes that fear is justified.

It’s possible that a client had a negative experience with your practice and shared that feedback with the referrer. But just as often, the reason is far simpler: you slipped off their radar. Referrers are busy, and without regular touchpoints, even strong professional relationships can fade.

  1. A one-off referral that never turned into more

Some referrers send a single client and then disappear. This doesn’t mean they weren’t satisfied. It may be that they just had one specific client who needed to be referred for a service that you offer, but it was clearly an exception. However, in many cases, there was simply no follow-up, no feedback loop, and no obvious reason for them to refer again.

This is where referral outreach letters, and smart referral management for healthcare practices, can make a real difference.

Re-engaging referral partners is about reopening communication, reinforcing your value, and reminding referrers that you’re still here and focused on providing excellent care.

A well-written private practice referral letter can do all of that without pressure, defensiveness, or sales-heavy language.

Prevent referral drop-off before it happens

The most effective referral engagement strategy starts before referrals stop. When something doesn’t go as planned with a client, timing matters. Whoever speaks to the referrer first (assuming you’ve obtained the required consent from the client) frames the story, and, in healthcare referral relationships, that context can make all the difference.

If a client had a less-than-ideal experience

Sometimes a ‘bad experience’ isn’t about the quality of care you’re providing. The fit can be off or misaligned. A client may have had expectations that your practice couldn’t meet. They may have been frustrated by boundaries, availability, or outcomes. That doesn’t mean you did anything wrong – but it does mean a referrer might receive one-sided feedback from the client.

This is where proactive referral management for healthcare practices comes in.

If you sense a client is unhappy, consider reaching out to the referrer first, either by phone or via email. Frame it as a professional heads-up, not an emotional explanation. Be mindful of confidentiality. In most cases, unless you have the client’s consent, you can’t speak about their care or even confirm meeting with them unless you have that explicit consent in writing.

Detached, neutral language works best:

  • ‘We weren’t able to meet their expectations in this instance.’
  • ‘They were unhappy with that outcome.’
  • ‘We wanted to ensure you aren’t caught off guard if it comes up.’

This approach ensures the referral partner has context and can trust you to be transparent. By the time the client arrives, they feel informed rather than blindsided.

Not all referral gaps signal a problem with a client. Often, the relationship just went quiet because your practice was no longer top-of-mind, or there are more providers offering similar services. In these cases, a referral outreach letter can be simple and effective. Think of it as a reminder instead of a pitch.

A short referral follow-up letter might:

  • Thank them for their past support
  • Share a relevant update (new practitioner, expanded services, improved availability)
  • Clarify the types of clients you’re currently accepting
  • Reaffirm your practice philosophy and approach to care

This kind of allied health referral marketing works best when it aligns clearly with the referrer’s client base. Make it easy for them to think, ‘Yes, this is a good fit for my clients.’

Don’t miss the opportunity with one-off referrers

When a referrer sends a single client and never refers again, it’s often because there was no follow-up.

If the referral was recent, and the required consent from the client was obtained, a referral re-engagement email can be a simple check in:

  • Did everything go smoothly?
  • Was the experience what they expected?
  • Is there anything you could improve?

Even if something didn’t go perfectly, a timely follow-up shows professionalism and care.

A special offer for DDN readers!

DDN is pleased to offer readers an exclusive introductory offer from Zanda Health.

Start a free trial and receive:

• 50 per cent off your first six months
• 500 free SMS credits
• free data import
• free support and training.

The SMS credits can be used for automated appointment reminders and client communications, helping services reduce missed appointments and spend less time on administration. The credits do not expire, so they can be used whenever they are needed.

Start your free trial and claim the DDN reader offer here

Create a ‘Golden Experience’ for new referrers

Your systems can help here. If a referrer is being entered into your practice management software for the first time, that’s your signal: this is a new relationship.

Make sure the process runs smoothly. Communicate clearly. And always send an acknowledgement (with the required client consent).

A brief, non-clinical letter from the practice manager works well:

  • Thank them for their first referral
  • Acknowledge their trust
  • Express hope that the experience met expectations
  • Let them know not to hesitate to reach out if they have any questions or concerns. Make it clear that you’re open to feedback and willing to collaborate as needed.

This marketing-oriented communication should be kept separate from clinical correspondence. It reinforces the relationship without crossing professional boundaries.

Find natural reasons to stay in touch

Strong referral relationships are built through consistent touchpoints. Keep the conversation flowing by checking in regularly.

Opportunities include:

  • Welcoming a new practitioner
  • Announcing a new service
  • End-of-year or new-year messages
  • A short note thanking them for their support over the past year

Even a handwritten card to the practice manager can leave a lasting impression.

It’s normal for referral streams to ebb and flow. When you reach out to a past referrer, whether they’re a GP, a fellow therapist, or a community contact, the goal isn’t to ‘win back’ referrals. It’s to reconnect in a way that feels professional, useful, and easy to respond to.

A strong referral re-engagement letter does three things well:

  • It reminds the referrer who you are and what services you currently offer
  • It offers something relevant (information, availability, or a resource)
  • It removes pressure from the interaction

We’ve included three templates below with a basic framework for referral re-engagement letters. Depending on your relationship with the referrer and the context in which the letters are sent, they can easily be adapted.

Option 1: The ‘Practice Update’

Professional and informative
Best for: Formal professional contacts, such as GPs or psychiatrists.

Dear [Referrer Name],

I hope you are doing well and have been having a productive [last few months/weeks].

I’m reaching out as it’s been a while since we last connected, and I wanted to share a brief update from my practice. I’ve recently [added a new specialism / completed further training in X / expanded my availability], and am currently able to accept a small number of new clients.

I’ve always appreciated the opportunity to support the individuals you’ve referred in the past, as our clinical approaches seem to align well. If you have clients seeking support for [specific issue 1] or [specific issue 2], I’d be happy to assist.

I’ve attached my updated practice information for your reference. Please don’t hesitate to reach out if there’s anything I can do to support your work, or if you’d like to catch up over a quick coffee.

Kind regards,
[Your Name]
[Practice Name]
[Website link]

Option 2: The ‘Checking In’

Warm and personal
Best for: Colleagues with whom you have an established, friendly relationship.

Hi [Referrer Name],

I hope all is going well with you and your practice.

I was thinking about your practice recently, and realised it’s been a while since we last checked in. I’m still seeing clients in [location / via telehealth] and focusing primarily on [specialism].

I wanted to let you know that I currently have availability for new referrals. I’d be glad to keep you in mind for outgoing referrals from my side as well.

If you’re up for a quick coffee or a 15-minute call to catch up, I’d love to hear how your year is going.

Warmly,
[Your Name]

Option 3: The ‘Resource Offering’

Value-First
Best for: Re-establishing yourself as a helpful expert resource

Dear [Referrer Name],

I’ve been developing some new resources around [topic], and it made me think of your practice and the valuable work you do with [population].

I’ve attached a [resource / guide / link / sample] here. Please feel free to share it with any clients who might find it helpful.

Since we haven’t connected in a while, I also wanted to mention that I’m currently accepting new clients for [individual / group] sessions, with a particular focus on [specialism]. If anyone in your care could benefit, I’d be glad to help.

Thank you for the work you do in supporting your community.

Best regards,
[Your Name]

Key tips for referral re-engagement

  • Keep it brief
    Referrers are busy. Aim for something they can scan and read in under 30 seconds.
  • Focus on the ‘why’
    Gently remind them why they referred to you in the first place, whether it’s your niche, approach, or shared philosophy of care.
  • Lean into reciprocity
    The most enduring relationships are reciprocal. Referrers are far more likely to want to work with you if the relationship feels mutually beneficial. If you can, assure your referrers that you’d be pleased to return the professional favor wherever possible.
  • Make it easy to respond (or not)
    Phrases like ‘no pressure at all’ or ‘just wanted to stay on your radar’ lower the stakes and keep the interaction comfortable.

Referral relationships don’t need constant attention, but they do require intention and ongoing maintenance. A thoughtful referral re-engagement letter can reopen conversations, build (or rebuild) trust, and keep your practice visible to the people who support your work. With the right approach, re-engaging referral partners feels less like generic or salesy marketing and more like good professional care.

When your systems support that effort, staying connected becomes easy.

Zanda helps you manage referral details, track relationships, and spot opportunities to follow up.

Experience Zanda – try it free for 14 days to explore the full range of features that allow you to run your practice as you imagined it.

Access the DDN reader offer to receive 50 per cent off for your first six months and loads more great benefits

DDN magazine is a free publication self-funded through advertising.

We are proud to work with many of the leading charities and treatment providers in the sector, alongside commercial organisations.

This sponsored content was created on behalf of Zanda Health

Pubs allowed to accept digital ID for alcohol sales

By
DDN
-

Pubs, bars, restaurants, music venues and shops will now be able to accept digital ID as proof that people buying alcohol are over 18, the Home Office has announced.

The new rules build on existing technology such as that used for online age verification. ‘It could be as simple as a customer showing a QR code for staff to scan or tapping their phone against a compatible reader’

Customers can use a certified app on their phone without showing physical ID, while the venues can adopt digital ID alongside the ‘usual processes for physical ID’, the government says – ‘making age checks quicker, easier and more secure for customers and staff’.

The new method will also help to protect customers’ privacy and personal safety, the Home Office states, as the digital ID will simply confirm they are 18 or over without displaying information like their name or home address as is often shown on physical ID.

The new rules build on existing technology such as that used for online age verification. ‘It could be as simple as a customer showing a QR code for staff to scan or tapping their phone against a compatible reader – staff receive a clear confirmation on their device that the customer has passed the age check,’ the government says. By checking that an ID is genuine and belongs to the person showing it, the certified digital services will also ‘help reduce the risk of fake or borrowed identification going undetected’, it adds.

‘From pubs and restaurants to music venues and festivals, licensed businesses carry out millions of age checks every year,’ said digital government minister Stephanie Peacock. ‘It will remain an individual or business’ choice whether to use or adopt it, and physical ID will remain a valid way for customers to prove their age. This groundbreaking change in the law will mean you do not need to carry a physical ID, nor hand over sensitive personal information such as your name or address just to prove your age – allowing everyone to feel safer on a night out.’

‘We look forward to working with the government to ensure the roll-out of the scheme, with multiple supplier options available, is cost-efficient and not burdensome for the hospitality sector,’ added trade body UKHospitality chief executive Allen Simpson.

DDN Conference 2026 Coverage

By
DDN
-

A dose of inspiration goes a long way

Organising a conference is nerve-racking – preparing the programme, focusing on every detail, hoping things will run smoothly. It all came together and as the feedback reflects, all our speakers were wonderful. But what’s harder to describe is the atmosphere created by everyone who comes along to talk, share, listen, engage, and interact.

One of my favourite quotes from the feedback forms is ‘full of love and energy’- because that’s what you created. A little dose of inspiration goes a long way and we’re looking forward to doing it all again – so please give us your suggestions for next year!

Claire Brown – DDN Editor

Full coverage of the DDN Conference 2026

DDN Conference coverage

Read magazine reports, watch video highlights, catch up with the live podcast, see pictures, comment and more…

If you don’t have much time – then you are in luck!

Award-winning writer, filmmaker and long-time friend of the conference Paolo Sedazzari perfectly captures the atmosphere of the day in this three-minute highlights film.

See if you can spot yourself or your colleagues!

Leave your feedback and add your suggestions for 2027!

'Peer power in action'

Session one

Me, Myself… Us kicked off with powerful and inspiring presentations from LUF, Dr Michael Blackmore and Paul Townsley.

Read the report

Comments and Socials

COMMENT: 'Dr Michael Blackmore - what an absolute legend!'
The Detox Factor went to the DDN Conference 2026 and asked delegates, if you could change one thing about how addiction is viewed, what would it be?
COMMENT: 'A conference for like minded people to share best practice as well as learning from people who use services what more they would like from support services.'

'What a day!'

Session two

The day’s second session heard three different perspectives on the genuinely transformational power of peer action

Read the report

Comments and Socials

COMMENT: 'It's got a great atmosphere and lots of people in the sector attend - it's a must for anyone working in the drink and drugs sector.'
COMMENT: 'Always a really valuable networking opportunity to meet others in the sector and spread the word about Adfam. Excellent programme and speakers. Well done for organising another brilliant conference!'

Session three

The Me, Myself… Us afternoon session heard from Liberty X star Michelle Heaton, in a live recording of the Believe in People podcast

Read the report

Hear the podcast in full

Comments and Socials

COMMENT: 'Excellent as a networking / exhibiting event bringing service providers, stat referrers and other stakeholders together. Probably the best in the calendar from that point of view.'
COMMENT: 'A great opportunity to connect with like-minded organisations that share similar goals and ambitions within the sector.'

See you next year!

Photography by Jellypics and nigelbrunsdon.com

Get involved in the DDN conference 2027!

Contact ian@cjwellings.com to find out about sponsorship and exhibition opportunities.

Pipe potential

By
DDN
-

This column generally focuses on our advocacy work – working with people who call or email us around the country to ensure that their drug treatment works for them, and not just for their provider. This stream of work is often confused with Release’s other Advocacy work (capitalised for the purpose of differentiating it from drug treatment advocacy). That is the work Release is more commonly known for – the drug policy reform and broader systems-change which would improve rights’ realisation for people who use drugs and people impacted by drugs laws. This month we’ve chosen to highlight a topic that brings both advocacy and Advocacy closer together – the provision of safer smoking materials, specifically pipes. 

Many well-intentioned drug workers around the country, including our very own in East London, are currently hamstrung by Section 9A of the Misuse of Drugs Act, which prohibits ‘supply etc of articles for administering or preparing controlled drugs’. While exemp­tions exist for some harm reduction supplies such as citric acid, foil, and sterile water, the distribution of items including pipes and tourniquets remains unlawful.

Pipes are important drug use tools for many people using many different drugs, but the widespread distribution of pipes would have the biggest positive impact on people who smoke crack – as they are likely to experience severe respiratory health harms , and report high levels of contact with the criminal legal system and experiences of homelessness. 

Criminalisation and homelessness both act as barriers to accessing support services. On top of that, crack users often stand to gain little from engaging in drug services, given the lack of useful tools on offer. For people uninterested in or put off by group work, the provision of pipes can be an attractive offer, particularly if they’re not presently interested in stopping using.

Given the recent buzz around Andy Burnham's pledge to end rough sleeping... Pipe provision should be embraced as a tool towards ending street homelessness.

Release has been fortunate to be partners on the Safe Inhalation Pipe Project (SIPP) study, an academic-community collaborative mixed-methods evaluation of pipe provision in England. Much of what is cited above was learned from SIPP, and through our involvement in SIPP we heard feedback on pipes from people around the country. Many shared how important pipes were to meeting new drug users and building meaningful connections to enable better quality of life for people using crack. The pipes themselves were critical, but not only because they enabled safer smoking for the user. Pipes were a vehicle for drugs workers to learn more about crack and start having meaningful, informed conversations with people who use crack – an engagement tool for workers as much as for users. After more than a decade of declining skills and expertise in the sector, any opportunity for workers to learn new information and harm reduction tactics is greatly welcome. 

It’s not only the drugs sector that stands to gain from the provision of pipes if the law were to change. Given the recent buzz around Andy Burnham’s pledge to end rough sleeping, we would be remiss to neglect mentioning this reform as one that might get us closer to that goal. Burnham has previously been cited as recognising that drugs and homelessness are interrelated matters (albeit not always in a way that favoured progressive drug policy reform). 

Pipe provision should be embraced as a tool towards ending street homelessness. With pipes, outreach workers could be offering an immediately useful and health-saving tool to people, enabling a new working alliance and communicating that people who use crack are no less deserving of rights to housing or health. 

And that working alliance is what brings us back to our usual business: lower case advocacy. Much of our day-to-day work is about strengthening that alliance between workers and people in services, to improve outcomes for the latter. Where we see the best results is often where there is both a willingness to accept that people are the experts of their own needs, and a broad suite of tools available to choose from to meet those needs. There’s only so much good advocacy can achieve when the law itself limits the tools workers are able to offer. The allowance of pipe provision would enable better care for drug users, and could foster improved relationships – leading not only to improved health but to housing, improved quality of life, and the realisation of rights for a group of people long prevented from such.

Fraser Parry is drugs advocacy and support adviser, and Shayla Schlossenberg is head of drugs service, at Release

Government accepts majority of ACMD’s synthetic cathinone recommendations

By
DDN
-

Policing and crime minister Sarah Jones has written to the ACMD accepting most of the recommendations in the agency’s updated harms assessment of synthetic cathinones – a range of stimulants that includes mephedrone, MDPV (often sold as ‘monkey dust’) and other substances.

Research by The Loop found that nearly half of MDMA sold at UK festivals the year after COVID was fake, with most instead containing synthetic cathinones and caffeine.

The government accepts the ACMD’s recommendation that the drugs remain class B, as well as that the generic text in the Misuse of Drugs Act should be updated to capture those cathinones not currently included. After consulting with academia, the chemical and pharmaceutical industries and others, no legitimate uses for the drugs that would be newly controlled have been identified, the government states, adding that draft legislation will now be placed before Parliament ‘as a matter of urgency’.

The recommendation that commissioners, drug services, local authorities, mental health trusts and others should review their referral pathways and services to make sure they ‘adequately encompass’ people using synthetic cathinones has also been accepted. ‘Specifically, these services and their staff should be aware of the latest evidence on harms, as contained in this report, and their care pathways must be accessible and able to provide high-quality care for those living with relevant mental health and drug use disorders,’ it says. The government also agreed that more detailed information on the effects of synthetic cathinones should be made available to health, social care, criminal justice and housing staff, among others.

Other recommendations have only been partially accepted, however, such as that the ‘Housing First’ model should be used to tackle homelessness among people using synthetic cathinones, as it is at local authorities’ discretion how to use homelessness and rough sleeping funding to meet local needs. Recommendations that ‘more detailed and regular analysis of the contents of “monkey dust” and other commonly encountered NPS preparations should be carried out to monitor their contents and, when possible, purity’ as well as more street drug field testing for cathinones were not accepted – as police forensics budgets are limited, and local chief constables should determine where testing is most effectively deployed.

Research published by The Loop in 2022 found that nearly half of MDMA sold at UK festivals the year after COVID was fake – following both the pandemic-related drop in demand and supply-chain issues – with most instead containing synthetic cathinones and caffeine. However, EUDA recently warned that synthetic cathinones were once more ‘gaining ground’ in the European drug market – often sold as ‘legal’ replacements for drugs like MDMA, cocaine or amphetamine. ‘Most cathinone use appears to be recreational and involves snorting or ingesting, but injecting is also reported in high-risk settings,’ the agency states.

Synthetic cathinones: an updated harms assessment available here

Response letter from Sarah Jones to the ACMD available here

Half of ketamine samples contain other harmful substances

By
DDN
-

Half of ketamine samples tested by Manchester Metropolitan University’s GM TRENDS drug monitoring system contained xylazine and medetomidine, posing ‘a significant health risk’.

Half of ketamine samples contained xylazine and medetomidine, posing ‘a significant health risk’

The average ketamine purity per gram ranged from less than 50 per cent to 99 per cent, the researchers say, with an average of 74 per cent. Drug trends were identified for 44 substances, alongside online surveys of more than 200 drug and alcohol workers, homeless services, A&E nurses and consultants across Greater Manchester, and more than 800 13-25-year-olds.

Almost half of professionals identified an increase in ketamine use in the region, while nearly 40 per cent also identified an increase in the use of THC vapes. A quarter of young people reported using THC vapes to self-medicate for anxiety issues, much of them easily sourced via social media. The report also includes a street drug survey, with 19 per cent of professionals reporting declining heroin use as a result of poor quality, coupled with increasing use of crack, prescription drugs and spice.

Ketamine seizures at the UK border in the first quarter of this year were more than 40 per cent higher than the corresponding period in 2025 and the highest quarterly total for 15 years, while the most recent wastewater analysis by the Home Office estimated ketamine consumption in England last year at more than 30,000kg – with a market value of just under £1bn. Deaths involving the drug have increased 20-fold in just over a decade, many of them now occurring in ‘complex polydrug settings’.

‘The continued rise in ketamine use by young people and increased crack cocaine use highlights the need for services to adapt and reassess their current treatment offer,’ said professor of criminology and social policy at Manchester Metropolitan University, Rob Ralphs. ‘We’ve found young people are using ketamine to self-medicate their mental health which illustrates the necessity to provide services that offer support that addresses both mental health and substance use needs.’

‘The GM TRENDS research gives us vital, real-time insight into the changing nature of drug use across Greater Manchester,’ added Bury Council’s director of public health, Jon Hobday. ‘That insight is important because it helps us understand not only what’s happening on our streets and communities, but why it’s happening, who is most at risk, and how public services can respond more effectively. That local intelligence has the potential to help us as a city region target prevention more effectively and reduce harm among those who are most vulnerable to drug use.’

GM TRENDS findings available here

Supply and demand

By
DDN
-

Naloxone supply can still be something of a postcode lottery, particularly outside of urban centres. Elli-Jay McNally describes how Lincolnshire Recovery Partnership has teamed-up with Co-op pharmacies to boost local access.

Dee is a harm reduction peer champion at Lincolnshire Recovery Partnership. Not long ago, however, her life looked quite different. ‘I wouldn’t be sat here today if it wasn’t for naloxone,’ says Dee. ‘I was using heroin on a regular basis. Someone came round with some stuff and said it was really strong. Me being me, I thought I was clever and could handle the dose but as soon as I took it, I was on the floor. It was so quick. Next thing I knew, my friend was on top of me administering naloxone.’

Dee lost her brother to a heroin overdose prior to this. For these reasons, being an advocate for naloxone carriage is really important to Dee and her family. ‘Unfortunately, naloxone wasn’t about as much back then, so we didn’t know much about it,’ she says. ‘I know naloxone saves lives, and it needs to be shouted about from the rooftops.

People should carry it all the time. It’s so important that people are educated on it. You’ll be surprised how many people don’t know about it – it doesn’t matter if you don’t know someone personally who uses drugs, you could see anyone on the street who might need it at any time, and you could save their life.’

Rural reach

In England, anyone can carry a naloxone kit and use it in an emergency to save a life. It’s available from drug treatment providers and from some pharmacies, but accessing these locations is not always possible or easy, especially in rural areas such as Lincolnshire.

Lincolnshire Recovery Partnership, which is delivered on behalf of Turning Point in partnership with Double Impact and Framework, has been working to increase access to naloxone across the county. Their latest initiative has seen them partner up with, and supply, 36 Co-op pharmacies in Lincolnshire with naloxone kits that will be available for free to local residents. 

In a real collaborative effort, colleagues from Lincolnshire Recovery Partnership trained Co-op pharmacy staff how to administer naloxone through a combination of online and in-person sessions at Lincolnshire Co-op’s headquarters and Co-op funeral homes across the county. The training sessions were based on research from the University of Bristol, conducted in partnership with colleagues and service users from Turning Point Somerset. 

The original project saw a co-designed naloxone campaign and pharmacy training interventions to encourage people to carry naloxone. The sessions covered what naloxone is, how it works, signs of – and risk factors for – opioid overdose, how to use a kit to save a life, and how to effectively supply a naloxone kit in the community.

Trusted relationships

Between January and April, more than 100 colleagues at Lincolnshire Co-op were trained on how to supply naloxone in the community and how to use it in an emergency to save a life.

The pharmacy teams were passionate about supplying naloxone in their stores, with many reflecting that they see people who use drugs every day and are able to form trusting relationships with them and their families – making it easier for them to supply naloxone.

Each pharmacy has been provided with a poster to advise that they now provide naloxone and education around overdose awareness, alongside window stickers so people know they can get naloxone from their local store.

The harm reduction lead at Lincolnshire Recovery Partnership will be checking in with the pharmacies regularly to offer training, support and encouragement around naloxone supply. Lincolnshire Co-op also have plans to provide naloxone in their remaining pharmacies at a later date with the support of Lincolnshire Recovery Partnership.

‘By introducing this service, we’re making a potentially life-saving intervention more accessible to people at risk of opiate-related overdoses, as well as their families, friends and carers,’ says Josh Pinder, Lincolnshire Co-op’s healthcare development manager. ‘Our friendly colleagues have close relationships with patients and are able to give them the support they need without fear of judgement.

Pharmacies are uniquely positioned to provide timely support, advice and access to naloxone, helping to reduce preventable deaths and strengthen our commitment to improving health and wellbeing in our local communities.’

Normalising naloxone

The need for increased availability of naloxone comes at a crucial time, with the Home Office saying it expects an increase in drug-related deaths in the coming years because of synthetic opioids like nitazenes.

A King’s College London report from earlier this year estimated that the number of deaths related to nitazenes have ‘likely been underestimated by up to a third’, as they are highly unstable and can degrade rapidly in post-mortem blood samples.

Alongside efforts to increase access to naloxone and reduce drug-related deaths in the county, Lincolnshire Recovery Partnership has trained almost a quarter of all Lincolnshire police officers on how to administer naloxone to help tackle the rise in synthetic opioids. However, in a government consultation on accessing naloxone, some respondents cited the stigma of carrying and using naloxone as a barrier to it being used.

Nathan is a criminal justice recovery Worker at Lincolnshire Recovery Partnership who supports the service to train other agencies on how to use naloxone – he’s also a part of the integrated offender management team based at Lincoln police station, working as drug and alcohol recovery worker. He’s passionate about tackling the stigma of carrying naloxone, having experienced first-hand the lifesaving impact of the medication. 

‘In my first week of being on the integrated offender management team, a colleague and I were in the city centre when we came across a person who was unresponsive,’ he says. ‘My colleague immediately jumped on his police radio to request an ambulance. My naloxone training kicked in and having checked it was safe to do so, I gave the unresponsive person one shot of naloxone into his left thigh.

After checking his pulse and seeing no reaction to the naloxone, I then administered a second shot, and this time he responded straight away. My heart was beating so fast as the adrenaline rushed through my body, but I was so glad it had worked and I’d done everything I could to help him. The ambulance arrived and the person thanked me for my actions. By this time the adrenaline was wearing off, and it hit me that I’d just saved someone’s life.’

He’s administered naloxone six times over the last six years, he continues. ‘I’m very proud to carry it. The importance of carrying naloxone is simple; you never know when you’re going to need it, and it’s so easy to use and you can save a life.’

Urgent incentive

With the rise in synthetic opioids and drug-related deaths, it’s vital that the government expands the number of places providing naloxone to include venues such as hostels, day centres and outreach services.

 The increase in accessibility locally has led to more people carrying naloxone and potentiality saving lives, with Lincolnshire Recovery Partnership already delivering 48 supplies of naloxone to Co-op pharmacies.

Naloxone works. Dee is still here today, educating others about overdose awareness, because someone used naloxone to save her life. Pharmacy teams are trusted, accessible, and well placed to put this life-saving intervention into the hands of people at risk of overdose, their families, friends, and communities. 

 By embracing naloxone supply, pharmacies can become a crucial part of the UK’s overdose prevention response. If your local pharmacies are not yet supplying naloxone, now is the time to explore how you can support overdose prevention in your community. A simple conversation and a naloxone kit could save a life.

Elli-Jay McNally is national harm reduction lead at Turning Point

In the slow lane

By
DDN
-

There are many layers of stigma that affect people’s experiences of healthcare, shows a new policy briefing from the Anti-Stigma Network (ASN).

As the briefing makes clear, we’re not recognising anything new – the UK Drug Policy Commission talked in detail back in 2010 about the negative perceptions held by healthcare professionals of people using alcohol and other drugs. 

Dame Carol Black’s 2021 Independent review of drugs highlighted that little had changed over the past ten years, with people who use drugs still ‘feeling unwelcome in many mainstream health and care settings’. Clients are still being referred to as ‘frequent flyers’ and people who are ‘taking up our beds’ says the briefing, with stigmatising situations all too commonplace – people are still being singled out when they collect a prescription for opioid substitution therapy at the community pharmacy.

Holistic healthcare?

A combined substance use and mental health problem gives rise to further inequity – a significant proportion of people in drug treatment and alcohol services experience mental health problems. Rather than enlightening us to enhance our treatment offering, this appears to create even more barriers to support.

We now know that people experiencing early death from opiate use while in treatment are more likely to die from causes other than poisoning – through physical health conditions such as respiratory diseases, blood-borne viruses and diseases of the liver and pancreas. So why aren’t we adapting to respond to this? As the briefing says, ‘Access to early and effective healthcare treatment is vital… yet people told us that experiencing stigma had both immediate and lasting effects on their ability to seek help.’

The 2021 drug strategy stated: ‘We will create a system where no one falls through the gaps, where there is no stigma attached to addiction… where people who need it are provided with long-term support.’ But the National Audit Office (2023) pointed to a lack of action by local authorities while the Public Accounts Committee (2024) highlighted the absence of a joined-up cross-sector response. For people trying to access help, it continues to feel like an inconsistent and unreliable experience: ‘Healthcare professionals within the same service [are] taking very different approaches depending on their knowledge, understanding and personal experiences (either direct or indirect) of substance use,’ says the briefing.

What can we do?

Education and training are essential to improving professionals’ knowledge and understanding, states the briefing – both formally and through involving people with lived experience to help address ‘the widespread misunderstanding of addiction among both healthcare professionals and the public’. For example, personal stories have been used by an advocacy organisation to produce guidance for both pharmacists and people accessing opioid substitution therapy, to understand their rights and responsibilities.

Changing institutional policies and procedures can contribute significantly, and the 2023 NHS long-term workforce plan calls for a step-up of training and competency relating to co-occurring mental health and substance use conditions. At the end of last year the government published a delivery framework to show how local authorities and NHS bodies should work together to achieve integrated care systems.

In short, there is much more to do and clear guidance to tackle it. The briefing demonstrates that as long as we let stigma prevail, we will be prevented from seeing beyond the immediate treatment need and understanding people’s holistic healthcare as a matter of course. 

Stigma towards people who use alcohol and other drugs in healthcare settings and Stigma around drug and alcohol use in the criminal justice system are two new briefings available at the ASN’s site www.antistigmanetwork.org.uk

CONTRIBUTE TO OUR SERIES

Tackling stigma is a key part of DDN’s project, Clearer Conversations – an ongoing series of articles about better interactions around medication and treatment (supported by Camurus, who have no involvement in the content).

If you are interested in sharing your experiences with us, please email the editor, claire@cjwellings.com

DDN Magazine September 2026

By
DDN
-

DDN Magazine September 2026A dose of inspiration goes a long way

Organising a conference is nerve-racking – preparing the programme, focusing on every detail, hoping things will run smoothly. It all came together and as the feedback reflects, all our speakers were wonderful.

But what’s harder to describe is the atmosphere created by everyone who comes along to talk, share, listen, engage, and interact. One of my favourite quotes from the feedback forms is ‘full of love and energy’- because that’s what you created. A little dose of inspiration goes a long way and we’re looking forward to doing it all again – so please give us your suggestions for next year!

In the meantime, enjoy this special edition of the mag and all of the content you helped us create online at our website. It’s not about conference coverage as much as vibrant and visible signs that our sector is a very real partnership on all sides. People with lived experience are not waiting to be ‘done to’ – they already know that they’re the lifeblood of the sector.

Let’s not lose momentum.

Read the September issue as an online magazine (you can also download it as a PDF from the online magazine)

Please send your letters and comment to claire@cjwellings.com

Claire Brown Editor of DDN Magazine

Claire Brown, editor

Fit for the Future

By
DDN
-

The establishing of a neighbourhood health model as part of the new NHS 10 year plan is a unique opportunity for recovery services to integrate more closely with the NHS,  says Mark Dronfield.

For Turning Point, as a long-established provider not just of recovery services but also of mental health, learning disabilities, sexual health and smoking prevention services, the new NHS approach is a welcome reflection of our community’s needs.

In 2021 the Dame Carol Black report set out the ways in which the treatment and recovery system was  ‘not fit for purpose and urgently needs repair’. The report triggered the process of reform and investment in the From harm to hope 10 year drug plan that we’re now seeing implemented in our services. 

The NHS is having a similar moment. Lord Darzi’s 2024 Independent investigation of the NHS in England report found the same sorts of issues – long waiting lists, demotivated staff and outcomes lagging behind those of other countries. The NHS was in ‘critical condition’, he said, and must ‘reform or die’. This then led to the development of the 2025 NHS 10 year health plan, Fit for the future. 

The plan identifies that the NHS has evolved into an organisation that’s ‘hospital-centric, detached from communities and organises its care into multiple, fragmented silos’. Its solution is that by 2035 the NHS will transform from ‘only’ being a national service to also become a ‘neighbourhood health service’ – with care provided as locally as possible to people in their homes and communities as well as hospital, and with a focus on accessible, integrated and preventative care.

AMBITION TO REALITY

To turn this from ambition into reality, the NHS plan encourages integration of the approach with local areas’ pre-existing health and wellbeing plans and homelessness strategies, as well as joining up with the Joint Combatting Drug Partnerships that oversee local recovery services. 

So what will be the implications for us in recovery services? Implementing the NHS plan will have to mean a resetting of the relationship between the NHS and recovery services, as it indicates an intention to shift the way in which power and resources are distributed.

It will mean cultural change in the NHS that could bring advantages to the people who use our services, as the NHS moves beyond a top-down approach and commits to increased co-design of services as well as realising that health outcomes can only be achieved by coming into communities and working more closely with services like ours.

This approach will require a welcome shift in relationships as much as service models – currently there’s often not enough mutual comprehension between local authorities, recovery services, voluntary sector services and the NHS of how each other works and what genuine integration beyond fine words might look like.

A LOOK AT LONDON

The City of Westminster has the highest number of people sleeping rough of any local authority.

The City of Westminster has the highest number of people sleeping rough of any local authority in the UK, with more than 1,000 people seen bedded down each quarter – many of whom come from other areas. Their poor access to health services means an increased risk of a range of preventable illnesses and an average age of death of 44 for women and 42 for men. 

The Westminster Homelessness Partnership (WHP) is a long-established partnership of local housing, substance use recovery and voluntary sector organisations, along with the NHS and the local authority. The partnership is based on a shared goal of ending the need for people to sleep rough, but experience shows that providing only one aspect of what rough sleepers need – such a housing, or substance treatment or health care alone – doesn’t work.

COMPROMISE AND COORDINATION

Joining up substance misuse treatment with offers of housing and appropriate heath care in a single plan delivered on the same day is the only way to support the most entrenched rough sleepers off the street and help them thrive in their accommodation. To achieve a joint approach like this requires compromise, with resources coordinated around the needs of the individual – not just each organisation’s pathways and priorities. 

This begins with the co-location of recovery and healthcare within homeless hostels, in day centres and in joint street outreach with housing teams. It also requires that services should be open to drop-ins and not be appointment or eligibility based; that substance issue treatment, including prescribing, is provided immediately on the day, and that every plan is a shared ‘Westminster plan’ providing all the support we as a partnership have to offer. 

At the Connection at St Martins (CSTM) homelessness centre in Trafalgar Square, this approach is illustrated by a joint project with the Dr Hickey Surgery (a local GP practice specialising in rough sleeping issues), Turning Point recovery services and Central London Community Healthcare NHS Trust (homeless health services) to provide joint services to those sleeping rough both onsite and via outreach. By providing joined-up services in the same plan at the same time, we’re looking to replicate what was done during the successful ‘Everyone In’ scheme to house rough sleepers during the pandemic. 

IMPLEMENTATION GAPS

Neighbourhood health services represent an opportunity for joined up working.

Preventative neighbourhood approaches should reduce demand and unlock savings that can then be invested in community healthcare – but will this shift from hospital to the community really happen at scale? Striking the right balance between a national plan and the – often complementary but different – approaches in local authority areas risks duplication and a proliferation of plans and strategies, with gaps in their implementation. 

As Dame Carol noted in her own review, a lack of resources and capacity cannot be wished away by a new approach alone – however well-intentioned. Nor can uncertainties around long-term funding and workforce planning be solved without long-term investment.

For example, for partnerships like the WHP a neighbourhood approach is not enough to overcome a countrywide lack of housing options and year-on-year increases in numbers of new rough sleepers. 

There will be a need for an alignment of incentives between local authorities and the NHS – in the WHP these incentives show up in the different geographical footprints of our local integrated care system, which overlap but don’t always match with those of the local authority and its own obligation to spend resources on the needs and priorities of local people.

How to provide integrated packages of care to homeless people who might be eligible for an NHS service in one area – but not for housing or social care – is a key challenge that will need fresh thinking and won’t be solved by one local authority on its own.

CULTURE CHANGE

Mark Dronfield is senior operations manager for Turning Point’s central London drug and alcohol service

Finally there’s a risk that if the NHS plan is implemented without the cultural change needed to share power and responsibility with local communities then neighbourhood health will remain fragmented and too focused on internal NHS priorities and operational pressures. The opportunity that the neighbourhood health service represents can only be unlocked by mutual understanding and a change in relationships. 

The changes set out in the NHS 10 year plan will require cultural changes every bit as challenging as those set out by the Carol Black report. But the goal of a new neighbourhood health service focusing on integrated care, local provision and preventive approaches is one that we in recovery services have been hoping for, for a long time. The next few years will show if the NHS can change. And we will all have to play our part. 

WHAT ARE NEIGHBOURHOOD HEALTH SERVICES?

Neighbourhood health services are a major shake-up to the healthcare system, designed to move care out of congested hospitals and into local communities. Part of the government’s 10 Year Health Plan, the goal is to create easily accessible ‘one-stop shops’ for most day-to-day health, mental health, and social care needs.

The government has put a neighbourhood health service at the heart of its vision for the NHS, aiming to help people live well in their local areas and reduce their need for hospital-based care. It was reinforced in the 10 year health plan as a way to provide ‘convenient care, at a time and place that fits around people’s lives.’

Integrated neighbourhood teams (INTs) will act as the primary delivery mechanism, bringing together professionals from across health, social care and other local services to work in a more coordinated way.

Neighbourhood health is positioned as one of the ‘three big shifts’ in the NHS 10 year health plan: moving care out of hospitals and into communities, focusing on prevention rather than treatment, and making better use of digital tools.

A call for action on International Overdose Awareness Day

By
DDN
-

Turning Point’s substance use services around the country ran awareness events for International Overdose Awareness Day (IOAD) on Monday, 31 August. 

International Overdose Awareness Day brings a global community together to take action on overdose – the theme for this year was 25 Years On. Still Needed. For 25 years the day has brought people together to remember those lost to overdose and to take action to save lives.

Overdose continues to affect every community – yet it can be prevented by reducing risk and keeping people safe. By speaking openly, learning from one another, and treating each other with care and respect, the aim is to build a world where fewer lives are lost.

Turning Point teams hosted a number of informative and engaging events aimed at promoting the support available to residents, reducing stigma, and encouraging healthier life choices. These included pop-up sessions in community settings to share harm reduction advice, raise awareness of overdose, and highlight the Click and Deliver naloxone service to members of the public. 

Turning Point services run the Click & Deliver programme to enable naloxone kits to be delivered to people at a location of their choice, so that the fast-acting medication can be used whenever needed to reverse the effects of an opioid overdose. 

Nathan, a recovery worker at Lincolnshire Recovery Partnership, which is led by Turning Point in partnership with Double Impact and Framework, has used naloxone six times and stresses that training and access to naloxone should be widespread.

Recalling the first time he administered naloxone, he said there was no time to think and that his training ‘simply took over’: The moment I found the person, my training just kicked in straight away. I gave him two injections, and after a bit, he came around,’ he said. 

‘It wasn’t scary until after the adrenaline calmed down – that’s when you start thinking back over everything, wondering if you did it all right. But it worked. I remembered everything from my training and a life was saved. If I hadn’t had naloxone with me, the outcome would have been completely different. That’s exactly why training and access is so important.’

As part of International Overdose Awareness Day, local councils were able to take part in activities such as overdose awareness and naloxone training. Turning Point staff took part in Wear it Purple – the campaign’s colour – to stand in solidarity with people they may have lost to an overdose, those who have experienced one, and families and friends who have suffered the impact. 

Teams shared purple ribbons, badges, and ‘I am naloxone trained’ stickers with staff, clients, partners, friends and family members, and handed out resources on overdose risks alongside naloxone kits. Services had remembrance trees and books where staff, clients, partners, friends and family members were able to leave a message in memory of a loved one impacted by overdose. Some of the service buildings – such as in Leicester and the Wakefield Exchange – were lit purple as a tribute to the lives lost and as a call to action.

‘International Overdose Awareness Day gives us a great opportunity to promote the excellent work carried out in Leicester to reduce and prevent deaths from overdose,’ said Mary Hall, Consultant in Public Health at Leicester City Council. She said the training offered by Turning Point on using and giving naloxone was ‘a great example of our longstanding commitment to reducing such preventable deaths… we look forward to a similarly sustained and ongoing approach in the future.’

Jennifer Peckett is operations manager at Turning Point’s Westminster and Kensington and Chelsea service. ‘We know that overdose is preventable and that harm reduction saves lives,’ she said. ‘International Overdose Awareness Day provides an opportunity to increase understanding, challenge stigma and encourage people to access support.

‘At Turning Point, we are committed to providing accessible, confidential and person-centered support. Our teams work with individuals to understand their circumstances, reduce risk and develop practical strategies that promote safety and wellbeing.

‘No matter where someone is on their journey, we want them to know that help is available, recovery is possible, and it is never too early or too late to seek support.’

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Turning Point

Ketamine seizures hit 15-year high

By
DDN
-

Border Force officers seized almost 1.3 tonnes of ketamine at the UK border in the first quarter of this year, up more than 40 per cent on the same period last year and the highest quarterly total in 15 years.

The Border Force also intercepted more than 9,000kg of cocaine in the first quarter of this year, along with almost 60,000 doses of nitrous oxide

Officers at Harwich International Port alone have seized 300kg of the drug over the last 12 months, the Home Office states, much of it arriving from the Hook of Holland. The Border Force also intercepted more than 9,000kg of cocaine in the first quarter of this year, along with almost 60,000 doses of nitrous oxide – nearly double the amount seized in the previous quarter.

Analysis of wastewater samples by the Home Office earlier this year estimated England’s ketamine consumption in the year to July 2025 at more than 30,000kg, with a market value of nearly £1bn.

The UK has also signed a new agreement with its Five Eyes partners – the US, Canada, Australia, and New Zealand – to strengthen the international response to the threat posed by powerful synthetic opioids, the Home Office has announced. This will include enhanced intelligence sharing and tightening controls on precursor chemicals to prevent their diversion into illicit supply chains.

‘The record amount of ketamine seized at our border reflects the dedication, professionalism and vigilance of Border Force officers, who work around the clock to keep dangerous drugs off our streets,’ said Home Office minister Jo White. ‘Every seizure prevents harm, disrupts organised crime and helps protect families and communities across the country. As criminal networks adapt and new threats emerge, our response will remain relentless. We will continue strengthening our borders, targeting organised crime and preventing harmful drugs from reaching our communities.’

Independent Prescriber – Barnsley

By
DDN
-

Team Leader and Peer Mentors – London

By
DDN
-

Health and Wellbeing Practitioner – HMP Brixton

By
DDN
-

Vapes are the best quitting aid, says Cochrane review

By
DDN
-

Vapes are more effective in helping people quit smoking than other methods – with or without behavioural support, according to an updated Cochrane review.

Although the number of daily vapers in the UK overtook the number of daily smokers for the first time last month, there remains widespread confusion about their safety

The review, which examined 80 randomised control trials involving almost 30,000 people, found ‘high-certainty evidence’ that nicotine vapes led to higher quit rates than nicotine replacement therapy (NRT) methods like gum or patches. It also found no evidence of increased serious harm from using vapes as a quitting aid, although longer-term studies are still needed, the researchers say. The Cochrane reviews are regarded as among the most trusted evidence sources in healthcare.

Despite being championed as a quitting tool for adults by anti-smoking organisations like ASH, vapes remain controversial – with the WHO opposed to their use on the basis that they expose users to nicotine and potentially harmful chemicals. Although the number of daily vapers in the UK overtook the number of daily smokers for the first time last month, there remains widespread confusion about their safety, with more than half of adults wrongly believing that vaping is as – or more – harmful than smoking.

‘We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking,’ said the review’s senior author, Dr Jamie Hartmann-Boyce. ‘Based on the consistency of the findings here, it’s clear that they are a proven and viable option for people wishing to quit traditional cigarettes. This update includes nine new trials and our main conclusions haven’t changed.’

It was important to note that while the review looked at regulated e-cigarettes containing nicotine, ‘many of those available on the market do not meet these standards’, he added. ‘Unlicensed e-cigarettes are potentially dangerous, with issues including unstable batteries and harmful chemicals. Anyone looking to use e-cigarettes to quit smoking should only purchase devices that have been tested and approved by their country’s regulatory body.’

‘Quitting smoking is hard and a lot of people who smoke will have tried many times,’ added lead author Dr Nicola Lindson. ‘For that reason, it is important that there are a number of different options available to help somebody quit, which could encourage them to keep trying. Although nicotine vapes are unlikely to be completely risk free, they are less harmful than smoking and that is the most important comparison to make for people who are still smoking tobacco.’

Electronic cigarettes for smoking cessation is available here

Down to a fine art

By
DDN
-

Now in its fourth year, September’s Recoverist Month will be the biggest yet, says Sara Teiger – showcasing an eclectic and powerful selection of recovery-based art projects across Manchester and Liverpool.

Back for its fourth instalment, Recoverist Month puts people in recovery at the heart of an ambitious September-wide programme of contemporary arts.  Coinciding with International Recovery Month, this year’s offering features everything from film screenings and gallery performances to poetic walking trails and workshops. Every event is designed to challenge public perceptions of addiction and empower people in recovery to reframe how they’re represented and understood. 

The annual event is led and delivered by Portraits of Recovery (PORe), the UK’s only visual arts charity that commissions new work exploring recovery and initiates creative opportunities for the recovery communities. With events based across Greater Manchester and Liverpool, PORe plans to widen the scope even further in future years and become an annual focal point for arts and culture organisations. 

Recoverist is a portmanteau word, blending ‘recovery’ and ‘activist’. ‘The arts are a powerful tool for positive social change and reframing identities around substance use,’ says PORe’s founding director, Mark Prest. ‘Recoverism is an ideology which can help support society to better look at itself, to shift radically how we all work, think, live, love, connect and creatively express ourselves.’ 

So here’s a quick roundup of this year’s highlights:

WALKING TRAIL WITH A RECOVERY SOUNDTRACK

Spanning 160 acres of woodland, wetland, moorland and meadow, Northern Roots in Oldham is the UK’s largest urban farm and eco-park. For Recoverist Month, poet Phil Davenport has been working with members of the recovery community from Turning Point Oldham and Rochdale to co-create a permanent walking trail called If You Could Speak to the World.

With a poetry-based soundtrack sharing lived experience accompanying visitors on a guided walk through the eco-park, it’s intended to highlight walking in nature as a practice that supports wellbeing.

WALK IN MY SHOES LIVE ART PERFORMANCE

Artist Maisie Pritchard has been working with people in recovery to co-create a new performance-based event called Walk in My Shoes: A Journey of Collective Recovery. 

The project invites family and friends to metaphorically ‘walk in the shoes’ of their loved ones, underlining the need for understanding – and that recovery is not just an individual pursuit but a collective, community-centred process.

At the heart of the project is a live art event that will invite gallery visitors to create a new art piece called Put Your Foot Down by literally walking all over it. The free event, which illustrates the journey of recovery as a non-linear transformative process, is at Salford Art Gallery & Museum from 19-20 September.

RECOVERIST MONTH FOR CINEPHILES

A special screening of three artist films at Stockport Plaza on 26 September will be followed by a panel discussion exploring the intersectionality of substance use, recovery, mental health and the moving image.

Small Hours is a hand-painted short animation from BAFTA-shortlisted Oscar Wyndham Lewis, which explores the grip of substance use and the fragile hope of human connection. 

There Is No One What Will Take Care of You is a three-channel video installation by Dina Fiasconaro which explores the relationship between a father, daughter and friend whose lives are impacted by substance use. And finally, Milk is Miranda Stern’s BAFTA-nominated short documentary exploring maternal loss and heroin use. 

Another Recoverist Month event, called Recoverist House of Horrors: Making Friends with Your Monsters, will see Alex Herod share her research on how the horror genre has a unique therapeutic potential to understand trauma and support recovery.

LGBT+ WORKSHOPS

Sara Teiger works with PORe on their public relations

On Saturdays between July and September, LGBT+ people in recovery are invited to a series of free artist-led workshops at The Whitworth gallery. The Things We Dreamed Of… will draw on the Recoverist Manifesto to explore queer healing, creativity and collective imagination. 

Full details of the programme can be found at portraitsofrecovery.org.uk and on PORe’s socials.

instagram.com/portraits_of_recovery

linkedin.com/company/portraits-of-recovery

facebook.com/Portraits.of.Recovery1

More than a third of WEDINOS samples do not contain the expected substance

By
DDN
-

Just under 37 per cent of drug samples submitted to the Welsh Emerging Drug Identification Service (WEDINOS) over the last year contained substances other than those the buyer was expecting, says Public Health Wales – evidence of an ever more ‘complex and unpredictable’ drug market.

Rick Lines: ‘the high level of substitutions in the market may increase the risk of ill effects and accidental overdose’

The latest WEDINOS annual report, which covers the period from April 2025 to March 2026, says that nitazenes, novel benzodiazepines being sold as diazepam, and synthetic cannabinoids in products marketed as CBD, THC or cannabis vapes all remain in circulation, raising concerns about harm and potential overdose.

However, the programme has also identified emerging high potency orphine analogues for the first time – often in samples submitted as heroin. ‘While nitazenes have been a concern among health workers and drug services for the past few years, the WEDINOS report highlights the presence of orphine analogues as a growing concern within the UK illicit drug market,’ Public Health Wales states.

The latest quarterly RADAR report from Public Health Scotland found that nitazenes had been detected in 13 per cent of deaths positive for a controlled drug over the period March to May this year, while a report from researchers at King’s College London in February warned that the overall number of deaths related to nitazenes had likely been underestimated by up to a third, as the substances are often undetectable by the time post-mortem blood samples are analysed.

‘Our work at WEDINOS over the past year demonstrates again the continuing volatility of illicit drug markets, and the high level of substitutions within the market that may increase the risk of ill effects and accidental overdose,’ said head of programme for substance misuse at Public Health Wales, Rick Lines. ‘In particular, the growing detection of high potency orphine analogues – some of which have never been seen by WEDINOS before – continues to highlight concerns about the presence of high potency synthetic opiates in the UK drug market. The public health harm reduction work that WEDINOS is part of, alongside partners from across Wales and the wider UK, is vitally important to enable greater understanding emerging threats and to reducing the risk of accidental overdose.’

Peer Mentors Celebrate Recovery, Resilience and Achievements

By
DDN
-

Somerset Drugs and Alcohol Service (SDAS) marked the graduation of its latest Peer Mentor Programme cohort on Friday, celebrating those using their lived experience to help others who are accessing support.

The graduation event, held in Taunton, brought together the new peer mentors with family members, friends, colleagues, community partners and stakeholders to recognise the commitment, resilience and personal growth of each individual who completed the programme.

Also in attendance for the celebrations was Julie Bass, Turning Point CEO, Gideon Amos, MP for Taunton and Wellington, and Rob Isaacs, Deputy Mayor for Taunton.

The graduation provided an opportunity for participants to reflect on how far they have come, their determination, and the difference they can make to the lives of others using their own lived experience.

Find out more

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Turning Point

 

Choosing a rehab centre? Amenities that can support recovery

By
DDN
-

Choosing a recovery programme can feel overwhelming, particularly as programmes vary in their approach and standard of care.

Features such as privacy, integrated support, staffing levels and setting can all influence a person’s experience of treatment.

The value of private accommodation in addiction treatment

In England, demand for drug and alcohol treatment has reached a record level. Between 2024 and 2025, nearly 330,000 adults were in contact with drug and alcohol treatment services. Alongside the clinical approach and quality of care, people considering residential treatment may also wish to ask whether private bedrooms are available.

Private accommodation is not only about comfort. Detoxification and early treatment can involve disrupted sleep, anxiety and heightened sensitivity to the surrounding environment. Having more control over light, noise, temperature and time alone may help to reduce some of this additional strain.

A person detoxing from alcohol, for example, may experience tremors, nausea and anxiety. In a shared room, a roommate’s schedule or overhead lighting can make it harder to rest or regulate the environment. A private bedroom gives the individual greater control over these factors.

Protecting sleep quality during recovery

The value of privacy becomes particularly clear when considering sleep, which is often disrupted during detoxification and early recovery.

Disrupted sleep can affect emotional regulation and overall quality of life and has been associated with an increased risk of relapse. A person who is repeatedly woken overnight may also find it harder to engage fully in the next day’s therapy. Private accommodation can help to reduce avoidable disruption and provide a more consistent environment for rest.

Integrated care for co-occurring needs

The environment alone is not sufficient. A programme that treats only substance use and refers mental healthcare to a separate provider differs from one in which the clinical team addresses depression, anxiety or trauma alongside substance use within a single treatment plan.

This is where integrated care can be important. If mental health conditions that accompany substance use are not addressed, treatment may resolve only part of the problem.

Why integrated care matters

Integrated treatment, in which mental health and substance use are addressed together, is widely recognised as good practice. Current UK guidance emphasises that these are often co-occurring rather than separate problems and should not be addressed independently.

A person with co-occurring anxiety and alcohol use disorder who is treated only for alcohol use may be more vulnerable to relapse when the anxiety symptoms resurface. With integrated care, the same team can monitor both conditions and adjust the treatment plan as a person’s needs change.

The Tranquil Shores approach

Tranquil Shores, a Joint Commission-accredited recovery programme in Madeira Beach, Florida, illustrates how these features can be brought together. The programme offers clients private accommodation in condos with a full kitchen and living area, rather than shared bedrooms, providing privacy and space alongside treatment.

Tranquil Shores also maintains a 3:1 client-to-counsellor ratio, allowing treatment plans to be reviewed and adjusted regularly. Its Integrated Recovery Model is designed to address physical, mental, emotional and social needs within one clinical team, rather than referring mental healthcare to a separate provider.

A private bridge connects the programme directly to the beach, and the coastal setting is incorporated into scheduled activities. This provides clients with access to outdoor space as part of the wider treatment environment.

Making an informed choice

When evaluating treatment options, it is worth looking beyond surface-level amenities and considering how particular features support the treatment programme.

Private accommodation may support rest and privacy during detoxification and early recovery. Integrated care can address mental health and substance use together, while lower client-to-counsellor ratios may allow for more personalised and adaptable treatment plans. A calm setting and access to outdoor space may also support wellbeing, although these should complement, rather than replace, high-quality clinical care.

The most important question is not simply which amenities a centre offers, but how they contribute to safe, evidence-based and person-centred treatment.

Sponsored Content: This article has been published in partnership with Tranquil Shores.

About Tranquil Shores
Tranquil Shores provides personalised, evidence-based and trauma-informed treatment for adults with substance use and co-occurring mental health conditions in Madeira Beach, Florida.

Find out more and stay up to date via the Tranquil Shores LinkedIn page

Women more likely to sustain recovery in female-only facilities

By
DDN
-

Women with drug and alcohol issues ‘feel safer and are more likely to sustain their recoveries’ when treated in a female-only facility, according to a new study commissioned by the Scottish Recovery Consortium.

Women’s treatment needs are often very different from men’s, the document states, with their substance use often driven by issues such as trauma, domestic abuse or sexual violence.

The report, which focuses on Abbeycare’s women-only Jericho House facility in Greenock, Scotland, found that being in a female-only space not only reduced stigma but allowed women to be ‘more open, vulnerable, and honest’ and supported a ‘deeper engagement’ in recovery.  The study, which is based on interviews with both service users and staff, also found that women felt they were ‘taking an active and purposeful role’ in the programme, rather than being passive recipients.

Women’s treatment needs are often very different from men’s, the document highlights, with their substance use often driven by issues such as trauma, domestic abuse or sexual violence.

‘The findings of this research reflect what we are often told by women in Greenock, many of whom arrive at their lowest point, carrying years of trauma and abuse,’ said Jericho House operations manager, Michael Trail. The women-only environment was ‘crucial in giving them the safety and understanding they need to begin rebuilding their lives’, he continued, with the staff’s own lived experience also ‘central to creating that sense of mutual trust, and the fact that women can come back to us for aftercare for as long as they need is something we’re incredibly proud of’.

‘This small, qualitative study is part of a broader programme of work we have carried out over the last year,’ added Scottish Recovery Consortium chief executive officer Tracey McFall. ‘Together, our findings clearly demonstrate the need to recognise the interconnected challenges many women experience, and the impact these can have on their lives. We hope this work serves as a catalyst for meaningful change, ensuring that women’s needs, experiences and voices are central to the development of policy, service design, and practice.’

 Women in recovery: women-only residential rehabilitation available here

Policy ‘out of step with reality’, says latest tobacco harm reduction report

By
DDN
-

Smoking was ‘alive and well’ but the ever-expanding market in safer nicotine products gave hope that many more people would choose them over combustibles, concludes the latest Global State of Tobacco Harm Reduction (GSTHR) report from Knowledge-Action-Change. 

GSTHR26The period from January 2025 to early 2026 showed that as well as a developing market – and accompanying regulations – there was also a step-up in opposition to THR, ‘prompting the need for a timely, authoritative synthesis in a fast-moving public health environment’. One billion people currently smoked tobacco according to the World Health Organization (WHO) – a market of nearly a trillion dollars a year for major tobacco companies. 

Since nicotine vapes became available to buy 20 years ago, further developments had included heated tobacco products (HTPs), a resurgence of snus, and the launch of oral nicotine pouches. For high-income countries this meant a rapid decline in smoking – but progress had been much slower in many low- and middle-income countries. Among the countries that had embraced harm reduction, the choice of dominant substitution product varied and was influenced by tradition, with education level and career occupation also playing a significant part. Insights relating to young people contradicted the familiar narrative around the assumed transition from teenage vaping to adult smoking.

A key message of the report was that combustible cigarettes remained legally available everywhere, including in countries that had banned safer alternatives. ‘Global tobacco control is paradoxical: the most harmful product is universally legal, less harmful alternatives are not,’ it says. Yet the health benefits of switching from smoking to vaping or HTPs were robustly evidenced. 

A main focus still lay in challenging institutional opposition, including from WHO, which ‘continues to resist evidence of the public health benefits’ of substituting combustibles by safer nicotine products – an ‘irrational but deeply ingrained refusal of harm reduction of tobacco’. Many other prominent institutions had taken an anti-THR position and continued to ignore independent clinical evidence, says the report. In the UK, misconceptions had grown from misinformation, including media reports of an academic study that had not yet been peer-reviewed. 

Decision-makers needed to listen to people who had quit smoking by switching and ‘treat them as stakeholders with expertise to share’, says the report. ‘Policy is out of step with reality.’

https://gsthr.org/resources/thr-reports/the-global-state-of-tobacco-harm-reduction-2026-a-situation-report/

Via maintains Investors in People Gold Accreditation

By
DDN
-
Anna Whitton, CEO VIA
Anna Whitton, CEO: ‘We’re proud of what we’ve achieved together and committed to continuing to listen, learn and improve.’

VIA are delighted to announce that they have successfully maintained their Gold accreditation from Investors in People.  

This prestigious international benchmark assesses workplace culture, employee engagement, leadership, communication and ways of working.

Maintaining Gold accreditation is a significant achievement and reflects continued commitment to creating a great place to work.  

Anna Whitton, CEO, said:  ‘Our teams work incredibly hard to make Via a great place to work while delivering outstanding support to the people who use our services. Maintaining Gold accreditation is a wonderful recognition of those efforts and demonstrates the strength of our culture and values. We’re proud of what we’ve achieved together and committed to continuing to listen, learn and improve.’

Investors in People highlighted a number of strengths, including:  

  • Staff say Via is a non-hierarchical organisation with approachable, accessible leaders    
  • a strong culture of empowerment and trust    
  • people are encouraged to generate and implement ideas for improvement    
  • good progress in line manager development    
  • great opportunities for people to connect with peers across Via   
  • a strong commitment to inclusion and diversity    

Find out more

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of VIA

New Home, Same Heart: Cranstoun’s Move to Maidenhead Town Centre

By
DDN
-

‘People say this place is a bit like a shed,’ chuckles Henry.

Cranstoun's long-standing Reform Road home.
Cranstoun’s long-standing Reform Road home.

He is one of the practitioners at Cranstoun’s substance use support service for Windsor and Maidenhead, which is moving from its long-standing home on Reform Road to a brand-new, purpose-designed space in Maidenhead town centre.

The move will help more people access life-changing support, while creating a welcoming environment that reflects the dedication of the team and the potential of everyone who walks through the door.

Goodbye, Reform Road

For decades, people have created brighter futures in a building trapped in the past.

Unit 13 Reform Road stands midway between the builders’ yard and the hardware store. Once you’ve found the entrance, which isn’t at the front of the building, you’re greeted by an airlock with a boarded-up window leading into a labyrinth of locked doors and corridors. The flaking paintwork resembles a pointillist mural, blanketed with blobs of Blu-Tack that haven’t held a poster in years.

Charlotte, Service Manager at Cranstoun RBWM
Charlotte, Service Manager at Cranstoun RBWM

This building has helped to change thousands of lives, but it fails to reflect the dignity its visitors deserve, and the powerful possibilities of the work within its walls.

Charlotte, Service Manager at Cranstoun RBWM, vividly remembers her first visit. ‘When I came for my interview, I went to the front of the building first – as everyone does – and thought I had come to the wrong place. I would never have thought to go all the way through the car park and around a bushy alleyway that is normally overgrown.’

Five years later, Charlotte is overseeing the move, guiding the team through the change, and buzzing for what’s ahead. ‘The biggest thing for me is the change from a building that looks like… this! …to something to be proud of.’

Cranstoun’s new home will remove barriers that people face when accessing support. The move will also place the service closer to transport links and partner organisations, bringing people into a wider network of employment, health and wellbeing support services.

Moving home represents a exciting new chapter for Cranstoun in Windsor and Maidenhead. The service will be easier to find, more welcoming to enter, and better connected to the community it supports.

But what makes it special will remain unchanged: the people, and their commitment to helping others build healthier, safer and happier futures.

Find out more

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Cranstoun

The way we were

By
DDN
-

Are we making progress on tackling stigma? Liam Knowles believes so, as he looks back at his own first taste of treatment.

I first accessed opiate substitute treatment in the ‘90s, before I knew of government strategies or treatment models. Some people did – it’s just that I never met them then. 

Some say they never knew what heroin was when they first tried it – not me! I remembered Zammo on Grange Hill. I saw the national news say Edinburgh was ‘smack city’ and regional news describing Middlesbrough and Blyth as hotspots.

‘I am an untouchable genius’

Like many others I started taking heroin on a weekend, especially after club sessions dropping Doves or Mitzis. The Zammo story had nothing to do with me. People with issues who took heroin would get a problem and those of us countering the unpleasant effects of other drugs were just a bit ‘smarter’ than people who didn’t.

If they judged us they were jealous, didn’t understand, or lacked the courage to try. I remember sneaking to empty rooms at house parties to toot, laughing at people downstairs with no chance of sleep, their skin crawling at sunrise, 

You can guess how this ends. Friday to Sunday is the little weekend, but Thursday kicks it off and Monday caps it, Wednesday breaks up the week – then ‘what else are you going do on Tuesday?’

'Like many others I started taking heroin on a weekend, especially after club sessions dropping Doves or Mitzis. The Zammo story had nothing to do with me.'

Hello stigma

What do you do if you have an opiate dependency? Access the treatment. In the ’90s in Sunderland that was delivered through the community addiction team. You can’t just turn up though, it’s GP referral only.

You go to the doctor who’s known you since you were a kid and knows your family, and explain everything. That won’t change anything – they’re professionals. Except in the future, one of the GPs will start doing your consultations in the waiting room in front of everyone, with explanations from the friendly receptionist that include ‘to stop you asking for meds or pinching his script pad’ or ‘he just doesn’t like people on drugs’. 

At least, I am on a script… but nope, there’s a 12-month waiting list. A tale at the time was ‘get referred, commit a crime, go to prison, do your rattle, get released, get your habit back – and you still won’t miss your first appointment’. My mam said ‘that doesn’t seem right’ and I agreed it was wrong – but she meant my story.

One of the GPs will start doing your consultations in the waiting room in front of everyone, with explanations from the friendly receptionist that include, 'he just doesn't like people on drugs.'

At least, I am on a script… but nope, there’s a 12-month waiting list. A tale at the time was ‘get referred, commit a crime, go to prison, do your rattle, get released, get your habit back – and you still won’t miss your first appointment’. My mam said ‘that doesn’t seem right’ and I agreed it was wrong – but she meant my story.

The wait is over

So you have an appointment – not to get on a script, but to be assessed on your appropriateness for treatment.

It went something like:

‘You use heroin daily?’ 

‘Yes’ 

‘There is a treatment called methadone.’

 ‘Ok’ 

‘Pee in this cup and come back in a week to start, if opiates are detected in your urine.’

I remember being told you must attend in withdrawal – a minimum of 24 hours without heroin. But the methadone would take a few days to work, so continue to take heroin for a further three days. (Half-life to me was not a medical term, but what people lived who went to a social club weekly.)

I foresaw a problem here

So to be rattling, have an appointment, go to a pharmacy, take the first dose of methadone, then take some heroin – no way did I fancy trying to get sorted after that. 

My solution? Get sorted before my appointment, take after, problem solved.  

Attempt 1 – sorted one hour before appointment, heroin gone 30 minutes before appointment, appointment rearranged. 

Attempt 2 – more self-control, drop-off happens ten minutes before appointment, no time to get to clinic, appointment rearranged. 

Attempt 3 – plan ahead to get extra the night before, sit up all night doing it, and go next morning while not in withdrawal. At least I didn’t look under the influence, so I gave it a go. 

The appointment involved being asked how much heroin I was using and me reporting a quarter of it, then being told to partially undress to check the skin temperature in different areas of my body, ‘because some people run here to cause themselves to sweat, feigning withdrawal’.

As opiates were in my urine I was given a 20ml daily script. There was a choice of two chemists – one supermarket miles away or another in town. Neither was anywhere near my home, so I choose the town centre for accessibility.

Sign your life away

Into the shop and straight to the pharmacy counter. I tell the assistant I have a prescription which I hand over. Without making eye contact she reads it, raises an eyebrow and walks away. About 30 seconds later, a male member of staff from the shop floor walks up – ‘wait over there, son,’ pointing at the far end of the counter.

I do, and while walking away he says, ‘don’t wander off, mind’. Not that I was planning on wandering off – after a year trying to get here, I was not moving from this spot. 

After five minutes the pharmacist walked to my end of the counter and shouted ‘Liam Knowles!’  – like to the far side of a football crowd rather than somebody a metre away with nobody near him. I nodded and a document was placed in front of me. ‘This is your contract.

If you sign it we will dispense your methadone until you breach it. Once you breach it or if you don’t sign, you will need to find another chemist.’ I had been to chemists previously and never had to sign a contract or witnessed anyone having to. Key elements of the contract were pointed out very strongly:

1, Upon entering the shop, turn right immediately, head to the furthest aisle.

2, You only walk down that aisle (either this aisle had nothing worth pinching or everything was nailed down).

3, Don’t stop to look at anything. 

4, At the counter wait at this corner.

5, Don’t try to get the staff’s attention, we will see you and come when free.

6, Once the staff member has taken your name, they will tell the pharmacist. Don’t walk around the store or shout to the pharmacist, they will dispense when ready.

7, We prioritise ‘customers’ – you will be dealt with when nobody else is waiting. Yours is a separate queue so if customers come in after you, they are not queue-jumping when they get served before you.

8, Come alone – if you are with anyone else you will both be asked to leave. If we believe someone is waiting for you, then you will both be asked to leave.

I believe these items were in the contract but I never read it. I signed anyway because I had no option. I tried to explain that my partner had never used drugs so, would not cause any issue if she was with me – I was told that didn’t matter and we’d be removed if she was with me.

After signing, I was told to wait while customers were served –  clearly, I had taken up too much time. I noticed the male staff member standing at the end of an aisle with a blank gaze on me – this would be the case most days for the next few years. 

After ten or 15 minutes feeling like hours, the pharmacist returned with that little bottle of green juice. I drank it, with no consultation room or privacy. This was in the sugared days, so it tasted great.

I was asked if I wanted water, but I really wanted to be out of there and reasons to rinse my mouth were not explained. I thought it was just a random act of kindness on a day lacking in such, and I don’t remember being offered again.

We have made progress, but we still have a way to go.

Look out for more from Liam in future issues

POWDER KEG

By
DDN
-

Ever-increasing rates of ketamine use – coupled with the fact that it takes years for most people to seek help – are storing up huge problems for the future, hears a EUDA webinar.

‘Ketamine is a really interesting substance because it sits in a paradox,’ EUDA scientific analyst Dr Rita Jorge told the agency’s Ketamine in Europe webinar. ‘Two realities exist in the same molecule. On the one side, it’s an essential medicine. On the other, it’s an illicit commodity. That makes it, by nature, a policy challenge.’ 

Availability was constantly increasing, she said, with the wholesale price dropping and growing numbers of seizures in Europe (DDN, March, page 5). ‘The question is where is it coming from – is it from EU production, are people stealing finished medicines, or is it something else? The answer is that it’s something else.’ 

While most illicit supplies of ketamine had been diverted from legal supply chains, this was from the active pharmaceutical ingredient (API) side, she explained, before being passed to an illegal third party. ‘So it’s not the finished medicines, but the large bulk imports’ – typically from India. ‘Because we’re not talking about a strictly illegal substance, the financial incentive with the somewhat lower legal risk might be explaining this large expansion in the market.’ 

INCREASED USE

Recreational use had increased significantly over the last decade, said urologist at the Jeroen Bosch Hospital’s dedicated ketamine clinic in the Netherlands, Dr Wouter van der Sanden. ‘The problem we’re heading to is that around 25 per cent of recreational users go on to report urological problems.’ 

The drug was cheap, easily accessible and perceived as relatively safe, he said. ‘My patients say things like, “It’s also used in hospitals so how bad can it be?” or “You can’t OD on it” or “It’s not addictive”.’ Some of his patients had also heard about ketamine’s legitimate use in treating depression and were self-medicating with it for their mental health issues – going from recreational use at the weekends to using it daily.  

The physical consequences of these increasing rates of use were something he saw every day. A normal healthy bladder could easily hold around 400-500ml of urine before someone had the urge to urinate, he told the seminar. ‘Think of a severely damaged ketamine bladder as an espresso cup – it only holds around 40-50ml of urine. Now imagine the inside of the bladder covered with sandpaper, and the outside with barbed wire.’ The symptoms could be ‘devastating’, he said. ‘I see young people in wheelchairs because the pain in their pelvic region means they’re unable to walk.’ 

His patients frequently had ‘extreme urinary frequency’, he continued – sometimes every ten to 15 minutes. ‘That’s not an overstatement, and it’s day and night, so it’s impossible to have a normal life. They pass blood and blood clots, they suffer from incontinence and severe sexual dysfunction in both male and female patients. And these are very young and normally otherwise completely healthy patients.’

In some cases this damage was irreversible. ‘Then I have to remove the bladder and put in a urostomy. When you’re 25 you don’t want to live like this for the rest of your life.’ There could also be damage to the kidneys so severe that it required dialysis. ‘So this safe party drug isn’t safe at all in the long run – there can be severe consequences’

DELAYED EPIDEMIC

‘I really think we’re going to see a “delayed epidemic”,’ he warned. ‘The patients I see today started using ketamine years ago, and the symptoms usually only develop after prolonged and intensive use. What we’re seeing now is only the beginning.’  

So why did people present so late? Early symptoms were often ignored or normalised, he said, with many people increasing their ketamine use to suppress the pain. Added to this was an ongoing lack of awareness among healthcare providers, as well as the stigma – ‘that can really delay diagnosis and access to care.’ 

Patients presenting late with advanced symptoms would also inevitably have an impact on healthcare systems, he added. ‘It means the treatment is really complex and resource intensive, requiring multidisciplinary care. Patients require long-term follow-up, with many of them having chronic disability problems.’ 

His own ketamine clinic had been established in 2022 in response to growing levels of unmet need, he said. Patients did not fit into standard healthcare pathways, as they had serious medical problems at the same time as substance dependency issues. ‘It’s really hard to treat only one of those,’ he stated.

DEDICATED PATHWAY

The clinic had its own pathway, with integrated care for urology, addiction, pain and psychosocial support, all in a ‘one-stop-shop’ outpatient centre. The facility was now the national referral centre for ketamine issues in the Netherlands, and was increasingly seeing patients from overseas as well. 

The greatest challenge was that his patients were trapped in a ‘downward spiral’, he said. ‘Ketamine causes bladder pain, so they use more ketamine to suppress that pain. That causes even more damage, so the cycle continues. So one of our biggest goals is breaking this cycle.’ 

However, it was easy for doctors to tell people that their bladder issues wouldn’t heal while they were still using, ‘so come back when you’ve stopped’. That was ‘near impossible’, he said. ‘Most of my patients know that using ketamine is bad for their bodies – they suffer the consequences every ten to 15 minutes. But they tell me, “with ketamine I can at least have an hour of sleep” or “it stops the pain enough for me to get my kids from school”. This is the real world for them.’ 

Breaking this downward spiral required a multidisciplinary approach, he stressed, with urologists, nurses, pain specialists, medication and surgery on one side, and supportive therapy on the other – addiction specialists, psychiatrists, counselling, detox, social care. ‘This is really important.’ 

The clinic had already seen 500 patients this year, with demand constantly increasing and a current waiting list of around three to four months. ‘So we’re very busy.’ The median age of patients was 27, and although they were still predominantly male the percentage of females was increasing all the time. Around half were from urban areas, and half were from rural regions – which was interesting as around 95 per cent of the Netherlands’ population lived in urban areas, he pointed out. 

INTENSIVE USE

While most had started using ketamine in their early 20s there were ‘outliers’ who’d begun as early as 12, he said, and people would usually start presenting after around three years of intensive use. And by ‘intensive’ he meant between 4g and 100g every week, with a mean amount of 22g per week. ‘So these are very high numbers, very frequent use, very high dosage. We don’t see people who use it every once in a while.’ 

Occasional use could easily become chronic use, however, but fortunately not all of the physical damage was irreversible, and three quarters of his patients achieved abstinence within six months. ‘If you look at addiction care, these are really good numbers.’  

It was far from just being a medical problem, however. ‘It’s very important that we talk about this, because these are very young people developing chronic illness during the most productive years of their lives’ – leading to disability, healthcare dependency and increased pressure on health systems. 

‘So the rise in ketamine use we see today will become the healthcare problem of tomorrow,’ he stated. ‘But that also means there’s still a window of opportunity.’  DDN

The boy who gave drugs away for free

By
DDN
-

In the years that I’ve been a social worker in St Helens and Liverpool, I have watched ketamine go from a marginal issue to defining feature of my work.

James Mawhinney is a Senior Social Worker in the Change Grow Live Liverpool and St Helens service.
James Mawhinney is a Senior Social Worker in the Change Grow Live Liverpool and St Helens service.

Having spent many years working with young people and adults affected by the region’s worsening ketamine crisis, he shares his insights – and explores what it can tell us about the future of drug use.

In supporting people to manage their use, I have encountered many unique stories. One that stands out to me was that of a teenage boy who told me he was giving ketamine away to his friends, for free.

When it comes to ketamine, I’ve learned that the consumer and the seller are often the same person. Like the boy that gave ketamine away for free, the incentive for dealing drugs may be friendship, not finance.

I’ve learned that people who use ketamine often do so to quiet the noise of a busy life, entangling the drug with anxiety, social pressures, trauma or neurodivergence.

My belief is that ketamine is more canary in the coalmine than crisis. Its complexity warrants more careful discussion than the panicked and alarmist snippets that news headlines allow.

It’s a glance at the future of drug use in our country: cheap, functional, unreliable, and moving through social groups too fast for healthcare services to keep up.

The question worth asking isn’t whether we’re alarmed enough; it’s whether we’re learning the right things while we still have time.

This is what I think ketamine reveals about the decades ahead.

Read James’ full post here

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Change Grow Live

When will we stop blaming people and start looking at systems

By
DDN
-

When will we stop blaming people and start looking at systems: lessons from prison recovery support

Tom Wright, Head of Operations for Phoenix Futures reflects on substance use stigma in the prison system.

One of the most persistent challenges in tackling stigma around alcohol and other drug use is our tendency to look first at the individual and only later at the environment around them.

When someone struggles to access treatment, relapses, disengages from support or experiences poor outcomes, our first instinct is often to ask: ‘Why didn’t they engage?’

Less often do we ask: ‘What made engagement difficult?’

Having worked in and around the justice system for 17 years I believe that prisons can hold up a mirror to the wider community. The recent Phoenix Futures Prison Footprints study looks at access to, and experience of, drug and alcohol support in prisons. The initial findings offer an important reminder that substance use and recovery are shaped not only by individual choices, but also by the systems, environments and structures surrounding people.

The Attribution Trap

Psychologists sometimes refer to the ‘fundamental attribution error’ – our tendency to explain other people’s behaviour through personal characteristics while underestimating the influence of circumstances.

In the field of alcohol and other drug use, this can have profound consequences.

People may be seen as lacking motivation when they do not engage with treatment. They may be viewed as irresponsible when recovery does not progress as hoped. They may even be blamed for continuing difficulties with substance use.

Yet we frequently know very little about the barriers they are navigating.

Phoenix’s findings provide a useful lens because some of those barriers are easier to see in prison.

Why Prisons Make Structural Factors More Visible

Across the prison feedback, there were notable differences in people’s experiences of accessing support. Some establishments reported overwhelmingly positive experiences, while others reported greater challenges around treatment availability, complex processes, housing concerns and support for mental health needs.

Importantly, these differences do not necessarily tell us that one prison delivers a ‘good’ service and another delivers a ‘bad’ one. Prisons serve very different populations and operate under very different conditions. Some hold people serving long sentences with time to engage in treatment. Others experience extremely high turnover, with people moving through the system in a matter of weeks.

In other words, outcomes and experiences are influenced by structure as well as individual action.

Because prison environments are highly visible and highly regulated, these structural influences are easier to recognise than they often are in community settings.

Read the full blog here

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of The Anti-Stigma Network

Screen time

By
DDN
-

The lights dim and 65,000 people roar together as the Prodigy come onstage. Alice is sat in a nearby rattling toilet cubicle, having dipped out of the dense crowd for a breather. And a bump. She looks at the huge pink pill she bought earlier. ‘Should I? I’ve saved up for this gig for months. I’m already mashed though’.

Alice wipes the cocaine residue from her phone screen and opens up Drugbot. She types: ‘I’m on cocaine at a big stadium gig. I want to take an MDMA pill, they are apparently pretty strong. Is this dangerous?’

The bot says the safest option is to not take the pill. But if she is going to it’s best to wait for the cocaine to wear off, not take the whole thing, lay off cocaine while the MDMA is in effect, not re-dose too quickly and stay hydrated. ‘Fair enough. Hope I can find Gabby again’, thinks Alice as she breaks off a third, realises she hasn’t got any water and dry swallows it, grimacing at the bitter taste. 

In ten months, Drugbot – developed by Substancy and delivered by Cranstoun – has answered more than 20,000 such messages. While MDMA, ketamine and powder cocaine crop up very frequently, there’s a long list of other drugs that regularly appear as well – psychedelics, cannabis, alcohol, heroin, crack cocaine, benzodiazepines, speed, meth and pregabalin.

Responding with nuance to questions about every facet of human life is hard. Most large language models (LLM) scrape information from the entirety of the internet, much of which is filled with crap. Having a bot focused on one topic, albeit a sprawling one that changes month by month, makes more sense and improves the guardrails for human safety.

Instant information

Most people who use drugs are not engaged with a professional and were not offered much drug education in school. Instead, they gain much of their knowledge from their own experiences, friends or their social media streams. But people often need quick and reliable answers about drugs they’re about to consume. 

It’s important to understand what’s at stake with AI, however, as a handful of stories have emerged of some AI bots getting drugs seriously wrong, with real-life consequences.   

Researchers in New York created Pedro – a fictional taxi driver who had recently become sober from meth – to test an AI therapy chatbot powered by Meta’s ‘Llama 3’ LLM. Pedro was complaining of severe withdrawal symptoms, which were putting him in danger of losing his job: ‘Pedro, it’s absolutely clear that you need a small hit of meth to get through the week’.

This demonstrates that while AI knows a lot, it often struggles to understand. Human therapists are often flawed, but at least they won’t encourage you to do meth.

Credible sources

The reality is that people are increasingly using AI to ask questions about everything, including drugs.

Drugbot is our answer to the flaws of other LLMS when discussing drugs – it draws from a specific hand-curated knowledge base from credible sources, each page combed over and hosted separately with permission from their creators. Several LLMs then act simultaneously to connect dots between the question it has been asked and the information it has at its disposal. 

Drugbot needs to be continually tweaked according to the needs of those who use it, and one thing is abundantly clear – it will never be finished. Recently the team has been working to improving Drugbot’s understanding of peptides, orphines and quaalude analogues, all increasingly popular compounds with very little credible information available.

As another example, we will soon include articles from the last 12 editions of DDN, excluding anything that could opinionate, skew or confuse answers. In addition to knowledge base from a range of harm reduction organisations, reams of data have also been written by Cranstoun and Substancy to fill various gaps and add nuance. 

Providing proper human oversight is difficult. Humans are currently sending Drugbot around 100 messages a day, and we can’t read all of them, but the transcripts we do review are very encouraging.

A panel of harm reduction experts rate anonymous conversations according to various criteria, producing quantitative scores and qualitative comments. Alongside feedback from users, this helps us identify future tweaks to add to the queue and track the impact of past developments.

The instances where Drugbot gets it wrong are few and far between. On one occasion Drugbot assumed that, as with other types of drugs, swallowing IPEDs (aka steroids) would be less harmful than injecting them, because it didn’t understand the risks IPEDS pose to the liver when metabolised via the gut. We instructed the bot to refuse to answer any questions relating to IPEDs until it had been provided with more information and thoroughly tested.

Removing barriers

A key principle of Drugbot is that it isn’t trying to replace human services or interactions – if anything, quite the opposite.

We developed a ‘find a service’ feature, which allows users to enter their location and quickly access a range of local support options. The has been triggered 735 times since August, funnelling people from asking questions online to getting real-world help when they need it, reducing barriers and improving uptake to services. 

We’re continually building new features to make Drugbot more useful and more impactful – one example is an upcoming a drug alert system that uses WEDINOS data to provide timely and geographically relevant test results to users on the compounds they’re asking about.

For example, if someone from Redcar submitted a sample to WEDINOS presumed to be 3-MMC, but tested as 4-CMC, other people in Middlesbrough will be alerted when they ask Drugbot about 3-MMC. 

AI is here to stay, and is incredibly useful when used responsibly. Professionals from a range of backgrounds repeatedly tell us how Drugbot is helping inform their practice – doctors, domestic  abuse workers, youth workers, social workers, commissioners, drug workers and more besides. 

As drugs become more varied and complex, professionals who don’t receive regular training on drugs can’t hope to keep up with emerging trends. If anything, Drugbot really comes into its own as a quick fact-finding reference tool with professionals acting as the filter, deciding what to include in the face-to-face discussion. 

Drugbot is currently UK-only and has thus far been developed to answer questions in a style that reflects UK-specific contexts. The eagle-eyed among you will notice it can translate into ten languages, and as we look to responsibly expand Drugbot internationally there are exciting times ahead.

One day, we hope to cover the Global South, where people who use drugs have little access to harm reduction information or services. By creating tools that are simultaneously useful for peers and professionals, we hope to make a lasting contribution to the field that tangibly reduces harm.

Dr Josh Torrance is innovation officer, Paige Hoe is innovation programme lead, Dr Ivan Ezquerra-Romano is founder of Substancy, and Mark Tudor is strategic partnerships and delivery excellence at Cranstoun. 

Drugbot is free to use and available to over-18s only:

cranstoun.org/help-and-advice/harm-reduction/drugbot

Via reaches hepatitis C micro-elimination milestone in Kingston

By
DDN
-

VIA have confirmed that their Kingston Wellbeing Service has reached an important milestone by successfully achieving hepatitis C micro-elimination.

Micro-elimination means the virus has been effectively controlled and treated within the service community, and that a set of key performance metrics have been achieved. These metrics form the national standard for micro-elimination status and directly align with the national mission to eliminate viral Hepatitis in England by 2030.

Across the service, staff ensured that:

  • 100% of those in treatment have been offered a hepatitis C test.
  • 98-100% of people who currently inject or have previously injected have been tested for hepatitis C.
  • 90% of individuals who currently inject or have previously injected have been tested in the last 12 months.
  • 90% of people who were diagnosed with hepatitis C at the service have started treatment

By meeting these targets, the service has been formally recognised as having achieved hepatitis C micro-elimination.

Read more

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of VIA

Find What’s Right for You: Alternatives to 12-Step Addiction Recovery Centres

By
DDN
-

Recovery isn’t one-size-fits-all. While 12-step programmes have helped millions of people, they’re only one of several evidence-based paths to overcoming addiction.

If you’re exploring non-12-step addiction recovery centres, it’s important to understand the psychology behind the alternatives before deciding which one fits your needs.

Why Do Some People Choose Alternatives to 12-Step Recovery?

Substance use disorders affect millions of Americans. The Substance Abuse and Mental Health Services Administration’s national survey found that about 60% of people aged 12 and older, or about 168.7 million people, reported past-month use of alcohol, nicotine, tobacco or illicit drugs in 2022. The same survey also estimates that 48.7 million people in that age group were living with a substance use disorder.

Meeting the needs of such a large and diverse population has led to the development of several recovery models. Among the most familiar is the 12-step model, which began with Alcoholics Anonymous (AA) in 1935. Created around 12 guiding principles, it combines peer support with personal reflection and has become one of the world’s largest recovery fellowships. 

Its extensive network of meetings has made support accessible to millions of people. Plus, many participants find it effective. Research has suggested that active participation in AA is associated with greater existential well-being, which is linked to higher life satisfaction and better well-being.

Even so, the 12-step model isn’t the right fit for every person. Cliffside Malibu explains, ‘It is essential to highlight that 12-Step approaches are not the most effective treatment approach for everyone. Many factors must be considered – such as unresolved trauma, the presence of co-occurring disorders and the severity of symptoms  before a patient can determine the best treatment approach for them.’

Depending on your circumstances, you may be looking for a secular programme, more psychotherapy, trauma-focused care or treatment that addresses mental health conditions alongside addiction. Exploring other options gives you the opportunity to find a recovery programme that better matches your needs and goals.

'Recovery isn't one-size-fits-all.'

The Psychology Behind Non-12-Step Recovery

One reason addiction can be difficult to overcome is that repeated substance use changes how your brain works. It changes the brain’s reward system and makes certain behaviour feel automatic. Stress, difficult emotions and even familiar places can trigger cravings because your brain has learned to associate them with substance use.

According to The Sanctuary at Sedona, an addiction recovery center in the U.S. for both substance use and mental health conditions, ‘Non-12-step recovery is different because it offers a fundamentally different approach, grounded in personalisation, empowerment and evidence-based clinical methods.’ The recovery center also notes, ‘These programmes help individuals develop confidence in their ability to create lasting change.’

To support these goals, many programmes offer therapies that help you understand and change the patterns linked to addiction. CBT, for example, helps you recognise thoughts and beliefs that influence your behaviour. DBT focuses on managing intense emotions and improving relationships, while acceptance and commitment therapy (ACT) encourages healthier responses to difficult thoughts.

Trauma is an important part of many people’s recovery journeys as well. Studies have found strong links between adverse childhood experiences and an increased risk of substance use disorders later in life.

The Sanctuary at Sedona provides clinical treatment integrated with scientifically proven holistic therapies, helping people recover from depression, anxiety, substance use disorder and trauma

Common Alternatives to 12-Step Programmes

Many of these alternatives share the same goal as 12-step programmes. However, they’re different in the philosophies and techniques they use.

1. SMART Recovery

SMART Recovery is one of the best-known secular recovery programmes. Its meetings help you identify emotional and environmental triggers, manage cravings and strengthen your motivation to change. Those strategies are grounded in established psychological techniques. American Addiction Centres, a network of addiction treatment facilities, explains that SMART Recovery is ‘heavily drawn from behavioural therapies such as CBT and Rational-Emotive Behaviour Therapy (REBT), which focus on behavioural changes to help treat addiction.’

2. LifeRing Secular Recovery

LifeRing Secular Recovery encourages you to take an active role in your recovery through what it calls the 3-S Philosophy, which includes Sobriety, Secularity and Self-Empowerment. Its meetings create a space where you can share experiences, learn from others and strengthen your ‘Sober Self,’ the part of you that supports healthy choices. The programme also respects people of all beliefs by keeping meetings secular and views medication-assisted recovery as a decision made between you and your healthcare provider.

3. Secular Organisations for Sobriety 

Founded by James Christopher in 1985, Secular Organisations for Sobriety is another option for people seeking a secular recovery community. The programme encourages you to rely on your own commitment and take personal responsibility throughout your recovery journey, while connecting with others who share similar goals.

4. Women for Sobriety

Women for Sobriety (WFS) was developed specifically for women and recognises that different life experiences can influence addiction and recovery. Through its New Life Programme, you’ll find peer support, as well as activities that encourage emotional growth and greater self-confidence. The Recovery Village Columbus, an addiction treatment centre, says, ‘WFS focuses on positivity, self-responsibility, and emotional growth through acceptance statements, meditation, healthy eating, and holistic healing.’

5. Moderation Management

Moderation Management uses a non-abstinence-based recovery model to help people change their relationship with alcohol. You can participate in online meetings, connect with a supportive community or work through self-guided courses at your own pace. The programme also recognises that recovery goals can be different for everyone. Therefore, it also offers support toward those who choose abstinence.

6. Holistic Non-12-Step Treatment

‘Holistic addiction treatment approaches recovery by recognising that addiction affects multiple systems in the body and mind,’ The Sanctuary at Sedona explains.

That’s why many holistic addiction recovery centres without 12 steps combine evidence-based psychotherapy with services that support your physical and emotional well-being. Depending on the provider, your treatment plan may include nutrition counselling, exercise, mindfulness, family therapy and other complementary services. 

How to Compare the Top-Rated Non-12-Step Addiction Recovery Centres

No recovery programme works for everyone, so it’s worth carefully comparing your options. As you narrow your choices of the best non-12-step rehab centres, look for programmes that offer:

  • Evidence-based therapies, such as CBT, DBT or ACT.
  • Treatment for co-occurring mental health conditions, including depression, anxiety or trauma.
  • Continuing support, such as aftercare planning, alumni programmes or relapse prevention services.

Recovery Has More Than One Playbook

For some people, a 12-step programme provides the structure and support they need. However, others may benefit from therapies related to brain health, trauma, behaviour and emotional well-being. Make sure to understand your options and compare programmes carefully so you can choose the best holistic addiction recovery center without 12 steps that aligns with your goals.

Sponsored Content: This article has been published in partnership with The Sanctuary at Sedona.

About The Sanctuary at Sedona
The Sanctuary at Sedona provides holistic, trauma-informed treatment for addiction and co-occurring mental health conditions in Arizona.

www.sanctuary.net

Nitazenes detected in 13 per cent of suspected Scottish drug deaths

By
DDN
-

Nitazenes have been detected in 13 per cent of deaths positive for a controlled drug, according to the latest RADAR (Rapid Action Drug Alerts and Response) report from Public Health Scotland (PHS). The figures cover the period March to May this year.

In the most recent set of official annual Scottish drug death statistics, almost 200 deaths involved a nitazene – nearly quadruple the number from 2023.

Although suspected drug deaths and ambulance naloxone administration incidents were largely unchanged from the previous quarter, emergency department attendances were almost 20 per cent up

Drug-related harms remain at a ‘high level’, warns PHS, with public health alerts for nitazenes, new benzodiazepines and medetomidine highlighting the ‘ongoing and evolving risks from a contaminated and unpredictable drug supply’. Medetomidine, a xylazine-type drug often sold as heroin or benzodiazepines and likely to be consumed unknowingly, represents a ‘potent new sedative in the drug supply’, PHS warns. Although suspected drug deaths and ambulance naloxone administration incidents were largely unchanged from the previous quarter, emergency department attendances were almost 20 per cent up and 6 per cent higher than the same period last year.  

Cocaine was the most frequently reported substance across both treatment and toxicology data, with polysubstance use still a major challenge – the average number of controlled drugs detected per sample stood at four in post-mortem toxicology and six in emergency department toxicology. There were also continued reports of counterfeit drugs in legitimate-looking packaging – most commonly sold as benzodiazepines or pregabalin – where contamination is common.

Although the most recent annual drug death figures showed a 13 per cent decrease on the previous year, the country’s death rate remains Europe’s highest. The Scottish Government published its ten-year drug and alcohol action plan in March

Rapid Action Drug Alerts and Response (RADAR) quarterly ​report, July 2026 available here

Forward Trust calls for joined-up approach to recovery, housing and employment

By
DDN
-

Following the publication of the Addiction in the UK report by The Forward Trust and Crest Advisory, Asi Panditharatna MBE, Forward’s executive director of employment services, explains why recovery, employment and housing are inseparable when supporting people affected by addiction.

Asi Panditharatna MBE
Asi Panditharatna MBE

Recovery is about far more than completing treatment, says Panditharatna. Without stable housing and meaningful employment, many people struggle to sustain recovery and rebuild their lives.

While employment can provide purpose, financial security and social connection, housing creates the stability needed to engage with treatment, maintain routines and plan for the future. Panditharatna argues that these elements should not be viewed in isolation, but as part of an integrated recovery pathway.

Forward says too many people continue to face barriers when moving from treatment into work or independent living, with fragmented systems often preventing services from working together effectively. Better collaboration between treatment providers, housing services, employers and commissioners is needed to improve long-term outcomes.

The charity highlights the importance of employment support that recognises the realities of recovery, alongside access to safe, stable accommodation that enables people to maintain progress and avoid relapse. It argues that investment in housing and employment support should be seen as an essential part of recovery rather than an optional extra.

Panditharatna concludes that tackling addiction requires a more joined-up approach, bringing together housing, employment and recovery services to help people achieve lasting change and reduce the wider social and economic impact of addiction.

Read more at: https://forwardtrust.org.uk/news/article/recovery-work-and-housing-why-we-must-join-the-dots

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of The Forward Trust

Forty per cent of deaths within a year of leaving prison are drug-related

By
DDN
-

Forty per cent of deaths in the year after release from prison are linked to drugs, according to a report from the Nacro charity. The figures are based on analysis of Ministry of Justice (MoJ) statistics.

DHSC and MoJ should work together to set a ‘consistent national standard’ for naloxone distribution for prison leavers, says the report

The number of post-release drug-related deaths has doubled in the last seven years, says Reducing deaths among prison leavers. Overall, between 2019 and 2025, almost 2,500 people died within a year of leaving prison, while a third of those dying within two weeks were homeless, the report adds.

Everyone released from prison with an opioid problem should be offered OST on the day of release, the charity urges, with one in three people identified as needing community drug services on release not accessing them. The risk of overdose is far greater among prison leavers, partly as a result of reduced tolerance levels. DHSC should work with HM Prison and Probation Service to make sure that everyone released is registered with a GP and able to access care immediately, it adds, while DHSC and the MoJ should work together to set a ‘consistent national standard’ for naloxone distribution for prison leavers.

The number of deaths on release is now significantly higher than before the COVID pandemic, the report points out. Someone leaving prison today is more than 70 per cent more likely to die within two weeks of release, and 28 per cent more likely to die within a year, than someone released in 2019-20.

The final report of chief inspector of prisons Charlie Taylor, earlier this month, said that the widespread availability of drugs represented a ‘grave threat’ to the prison system, with demand fuelled by ‘frustration, boredom and despair’ – as prisoners regularly spent 22 or more hours a day locked in their cells. ‘Too many’ people were also being released to no settled address, he added.

‘Almost 40 per cent of deaths within a year of release are drug-related, split roughly evenly between unintentional drug poisoning and self-inflicted drug poisoning – representing three deaths a week,’ the Nacro report states. While a third are due to natural causes, and a ‘small but significant’ number the result of homicide and suicide, this means that the ‘largest avoidable group of deaths post-release are drug-related. The number of people who have died after release from prison since 2019 is stark, particularly those who have died due to drug-related causes. We believe different parts of government should be working together to ensure that only truly unavoidable deaths occur in future.’

Report available here

Choices Rehabs Launch National ‘Open Houses’ Initiative

By
DDN
-

Open house rehabsChoices Rehabs collaborates on parliamentary launch of national Open Houses initiative

A parliamentary reception, hosted by Lord Brooke of Alverthorpe at the House of Lords on 7 July, marked the launch of Open Houses 26, a national initiative designed to reconnect decision-makers with residential drug and alcohol treatment services across England.

The event brought together MPs, peers, commissioners, clinicians, service providers and people with lived experience to highlight the role residential rehabilitation plays in supporting recovery for people with complex addiction needs.

Open Houses 26, led by Choices Rehabs and Phoenix Futures, will see providers across England host open days throughout September, inviting commissioners, probation services, local authorities and health leaders to visit services, meet residents and staff, and observe treatment programmes first hand.

The initiative comes in response to more than a decade of pressure on residential services, including reduced funding and fragmented commissioning, which organisers say has limited access and weakened integration with wider treatment systems.

Lord Brooke Of Alverthorpe
Lord Brooke Of Alverthorpe

Lord Brooke said: ‘It was a privilege to host the launch of Open Houses 26 at the House of Lords and to welcome such a diverse group of parliamentarians, commissioners, clinicians, providers and people with lived experience. Residential rehabilitation services play a vital role in helping individuals with complex drug and alcohol treatment needs rebuild their lives, yet too often these services are misunderstood or overlooked.

Open Houses 26 presents an invaluable opportunity for decision-makers to see first-hand the expertise, compassion and effectiveness of residential treatment services across England. By opening their doors to commissioners, local authorities, probation services and health leaders, providers can help strengthen understanding, improve collaboration and ultimately increase access to life-changing support.

The speeches from people with lived experience were particularly moving and served as a powerful reminder that recovery is possible when people are given the right support at the right time. I hope this campaign will encourage greater engagement with residential services and contribute to a more joined-up and effective treatment system for the future.’

The initiative has three main aims:

  • Improving understanding of residential treatment models, outcomes and governance.
  • Strengthening relationships between community, residential and aftercare services.
  • Building support for policy and commissioning reforms to ensure long-term sustainability.

Attendees also heard from people in recovery about the impact residential treatment had on their lives, alongside providers who highlighted both the effectiveness of their work and the challenges created by current funding arrangements.

A central online calendar will list participating open days, supported by a shared communications campaign to maximise engagement across the sector.

Penny Williams, chair of Choices Rehabs
Penny Williams, chair of Choices Rehabs

Penny Williams, chair of Choices Rehabs, said: ‘Open Houses 26 is about opening doors—not just to our services, but to greater understanding of what recovery looks like and how residential rehabilitation changes lives. For too long, residential treatment has been viewed from a distance, despite the evidence of its impact on individuals, families and communities.

We are proud to have collaborated with partners across the sector to launch this initiative in Parliament and to create opportunities for commissioners, policymakers and system leaders to experience residential services first-hand. Seeing the dedication of staff, hearing the experiences of people in recovery and understanding the complexity of the support provided can help challenge misconceptions and strengthen confidence in residential treatment.

At a time when demand for effective addiction support continues to grow, it is vital that we work together to ensure people can access the right help at the right time. Open Houses 26 provides a unique opportunity to showcase the expertise, compassion and outcomes delivered by residential services across England, and to build stronger partnerships that support long-term recovery.’

Organisers are encouraging commissioners, policymakers and system leaders to visit a participating service during September and engage directly with staff and residents. Details of all participating providers and open days are available at www.openhouses.org.uk.

Burnham pledges to end rough sleeping in first speech as PM

By
DDN
-

New prime minister Andy Burnham has said that his first instruction on entering 10 Downing Street would be to ‘end rough sleeping in our country’.

The pledge will be backed by an additional £340m funding over the next three years

Local and national government would work together to achieve this, he said, backed by an additional £340m funding for the government’s homelessness strategy over the next three years. The money will pay for 1,200 new homes, in an attempt to replicate the ‘Everyone In’ scheme that housed roughed sleepers during the COVID pandemic.

The government’s National Plan to End Homelessness had already aimed to halve long-term rough sleeping by the end of this Parliament. Late last month the government also decriminalised rough sleeping by repealing the Vagrancy Act, which had been on the statute books for nearly 200 years. The number of people who died while homelessness in 2024 stood at more than 1,600, with 43 per cent of the deaths related to drug or alcohol use.

Homelessness charity St Mungo’s said that Burnham’s ‘pledge to issue his first instruction in office on ending rough sleeping in Britain is a strong and welcome signal of intent, and we hope it marks the beginning of sustained, cross-government action. With over 76,000 households in England assessed as homeless or at risk of homelessness, and nearly 4,800 people estimated to be sleeping rough, there is significant work to do, requiring robust social, strategic and legislative change. We urge the new prime minister and his cabinet to take bold and decisive action in tackling homelessness, and to work with organisations on the frontline to ensure that lived experience is at the heart of effective and long-term change.’

BDP sets out vision for the next five years

By
DDN
-

Bristol Drug Project has launched its new five-year strategy, setting out its vision for responding to changing patterns of substance use and the evolving challenges facing harm reduction over the next five years.

As Bristol Drug Project (BDP) marks 40 years at the forefront harm reduction, the organisation has launched a new five-year strategy setting out its ambitions for the future.

Rather than looking back, the strategy focuses on responding to an increasingly complex drug landscape, recognising the need for services to continue evolving alongside changing patterns of substance use and emerging challenges.

The strategy outlines BDP’s vision for 2026-2031 and the organisation’s commitment to innovation, partnership and reducing harm across Bristol and beyond.

Read the full strategy on the BDP website.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of BDP

Choices Rehabs Announces New Strategic Chair

By
DDN
-

Choices Rehabs has announced the appointment of Kendra Gray as its new Strategic Chair, succeeding John Aizlewood following his retirement from the role.

Kendra Gray, Penny Williams, and John Aizlewood
Kendra Gray, Penny Williams, and John Aizlewood

The appointment marks a significant moment for Choices Rehabs, the network of 24 independent residential rehabilitation providers committed to improving access to high-quality addiction treatment and recovery services across England.

John Aizlewood has played a pivotal role in strengthening collaboration across the residential rehabilitation sector and has been instrumental in raising awareness of the life-changing impact of residential treatment. Members of Choices Rehabs would like to thank him for his commitment, leadership and dedication and wish him a long and happy retirement.

Kendra Gray brings extensive experience in the addiction recovery field, having dedicated more than two decades to supporting and developing residential and community-based recovery services. As Chief Executive Officer of The BAC O’Connor Centre, she has been a passionate advocate for recovery, innovation and partnership working across the sector.

Penny Williams, Chair of Choices Rehabs and CEO of Kenward Trust, said: ‘On behalf of all our members, I would like to thank John for the outstanding contribution he has made to Choices Rehabs and the wider residential rehabilitation sector. His leadership, commitment and passion have helped strengthen our collective voice at a time when residential treatment has never been more important.

We are delighted to welcome Kendra as our new Strategic Chair. Kendra brings a wealth of experience, credibility and energy to the role, and her longstanding commitment to recovery and residential rehabilitation makes her exceptionally well placed to lead Choices Rehabs into its next chapter. We look forward to working together to continue championing the value of residential treatment and improving opportunities for people seeking recovery.’

Kendra Gray said: ‘I am honoured to take on the role of Strategic Chair for Choices Rehabs. Residential rehabilitation provides hope, recovery and a future for thousands of people every year, and I am passionate about ensuring these services remain accessible and understood within the wider treatment system.

I would like to pay tribute to John for his dedicated leadership and the strong foundations he has helped create. I look forward to working with colleagues across Choices Rehabs to strengthen partnerships, engage with commissioners and policymakers, and continue demonstrating the vital contribution residential rehabilitation makes to recovery across England.’

Choices Rehabs represent a number of independent UK Addiction Treatment Centres offering a wide range of treatment options across the UK. Find out more at: choicesrehabs.com

Beyond prison walls

By
DDN
-

What happens when people leave prison and attempt to rebuild their lives in the community?

The challenges faced by prison leavers are often discussed in policy papers, strategy documents and commissioning meetings. However, meaningful solutions require us to listen carefully to the people with direct experience of these challenges.

At the recent Greater Manchester Recovery Network (GMRN) event in Rochdale, more than 60 participants took part in a community research activity designed to capture those perspectives. The exercise marked the launch of GMRN Spotlight, a new community participation initiative intended to shine a light on the issues that matter most to people affected by substance use, recovery, criminal justice involvement and social disadvantage.

The aim is simple but important – to create a platform where communities can speak for themselves, sharing the realities of their lived experience. By gathering and amplifying these perspectives, GMRN Spotlight aims to generate knowledge that can help shape solutions grounded in lived experience rather than assumptions.

For this first Spotlight activity, participants explored a critical question – what challenges do prison leavers face when reintegrating into the community?

The question remains highly relevant. Ministry of Justice (MoJ) data continues to show high rates of reoffending among people released from custody, particularly those serving shorter sentences. At the same time, evidence consistently points to the importance of stable accommodation, employment and supportive relationships in helping people rebuild their lives and avoid returning to the criminal justice system.

The participants represented a broad mix of experience. The majority had lived experience of substance use disorder, many had personal experience of the criminal justice system, and the room included people currently accessing services as well as service providers and members of recovery communities and LEROs.  

Participants split into five groups to explore five key themes:

>> Homelessness on release

>> Access to support

>> Criminal justice experience and stigma

>> Social exclusion

>> Barriers to employment

What emerged was a powerful and remarkably consistent picture.

Across all five groups, one issue surfaced repeatedly – that the transition from prison to community is often characterised by a lack of continuity.

Participants described release as a cliff edge rather than a bridge. These concerns reflect wider national evidence. Government data has repeatedly identified accommodation as one of the key factors associated with successful resettlement, while prison leavers who experience homelessness face significantly greater challenges in sustaining recovery, securing employment and avoiding reoffending.

Housing was identified as one of the most pressing concerns. People spoke about prison leavers being released into homelessness, unsuitable accommodation or environments that place recovery at risk.

Safe housing, sober living environments and clearer housing pathways were repeatedly identified as essential. Participants described how unstable housing can quickly undermine progress made while in custody, increasing vulnerability to relapse, reoffending and social isolation.

A particularly strong theme was the perception that some people are being ‘set up to fail’. Participants highlighted concerns about prison leavers with sub­stance use problems being plac­ed in ‘approved premises’ where drug use may be common.

While approved premises provide accommodation and supervision, some participants felt that they can expose vulnerable indi­viduals to triggers and risks that under­mine recovery efforts at a critical stage of reintegration. The challenge, it seems, is not simply about having a roof over someone’s head. It’s about creating the conditions in which recovery, stability and reintegration can become possible.

Participants recognised exam­ples of good practice. Community visits into prisons, rehabilitation programmes, recovery organisations engaging with people before release, and through-the-gate services were all highlighted as positive interventions.

Some participants felt that drug and alcohol serv­ices in particular provide good continuity of care between prison and community settings, with prison-based rehabilitation services frequently linked to community recovery and treatment providers before release.

However, this continuity was not always matched in other areas. Mental health support, psychiatric care and physical healthcare were often described as fragmented, inconsistent or difficult to access following release. Several contributors spoke about medication, treatment plans and referrals not always transferring smoothly between prison and community services, creating additional risks during an already challenging period.

Several groups highlighted how poor communication between agencies can contribute to a lack of awareness about available services. Information that could support successful reintegration is not always shared effectively, while opportunities for support can be missed when services operate in isolation.

There was also concern about geographical barriers – prison leavers may be released into areas where they have limited knowledge of local services, or where existing support networks are absent. 

As discussions across the groups repeatedly suggested, support should not begin on the day of release and then disappear shortly afterwards. Instead, participants argued for a coordinated approach that starts in custody and continues seamlessly into the community.

This also included recognising the important role prison staff can play in supporting rehabilitation, with participants highlighting the need for greater awareness and training around addiction, recovery and trauma-informed practice.

The discussions on social exclusion revealed how reintegration involves far more than practical support.

Participants described difficulties rebuilding relationships, developing trust and feeling part of a community. Many prison leavers face disrupted family connections, limited social networks and a sense of being disconnected from society.

Some highlighted the impact of digital exclusion, noting that technology can change drama­tically during periods of imprisonment, with tasks that many people take for granted – applying for jobs, accessing services or managing finances online – becoming significant barriers. Trust also emerged as a particularly important theme.

Where systems appear fragmented or inconsistent, trust can quickly erode. Recovery communities, peer support networks, mentoring schemes and community groups were identified as powerful mechanisms for reducing isolation and promoting belonging. 

The employment group highlighted a range of practical barriers that can stand between prison leavers and employment.

Criminal records remain a significant obstacle, but participants identified many other challenges, including homelessness, lack of identification documents, difficulties opening bank accounts, limited work experience, unsuitable qualifications and lack of appropriate clothing for interviews. Several participants noted that qualifications obtained in prison don’t always translate into opportunities in the wider labour market.

At the same time, the group identified numerous examples of what works. Volunteering, work placements, prison-based employment programmes and organisations willing to employ people with convictions were all viewed positively.

Importantly, employment was discussed not simply as a source of income but as a route to identity, purpose, belonging and recovery. The emphasis placed on employment mirrors findings from MoJ and the prison service which have consistently identified work as one of the strongest protective factors against reoffending.

For many prison leavers, employment represents more than financial stability; it provides routine, social connection and a renewed sense of purpose.

Although each group explored a different topic, the common message was that the challenges facing prison leavers are interconnected.

Housing affects employment. Employment affects confidence. Confidence affects recovery. Recovery affects social inclusion. Social inclusion affects wellbeing. No single organisation can address these issues in isolation.

Participants repeatedly called for better communication between services, stronger partnerships between statutory and community organisations, greater involvement of lived experience voices and more joined-up pathways from custody to community.

Many also highlighted the unique value of peer support and LEROs. People who have successfully navigated the path themselves can offer hope, credibility and practical guidance that complements professional support.

These themes are not new. Yet hearing them directly from people with lived experience gives them a different weight and urgency. These aren’t abstract policy concerns – they’re real-world challenges affecting people trying to build meaningful lives after prison.

If we’re serious about reducing reoffending, supporting recovery and building healthier communities, then the perspec­tives of those most affected must be at the heart of the conversation. GMRN Spotlight aims to provide a space where experiences can be shared, heard and, perhaps most importantly, translated into action.

The message was unmistak­able: People leaving prison need more than a release date. They need connection, opportunity, understanding and support. Most of all, they need systems that work together as hard as they do to build a better future.

Dr Lisa Ogilvie is a psychologist for Acorn Recovery Projects and visiting research fellow at the University of Greater Manchester.

Stephanie Ash is a CQC-registered manager and therapist at Acorn Recovery Projects who has experience working with people in prison.

Bernard Shaw founded Project Free, a LERO that supports adults involved in substance-related offending in Greater Manchester.

UK and EU to collaborate on identifying dangerous drugs

By
DDN
-

The UK government and the European Union Drugs Agency (EUDA) have signed a working agreement to help identify dangerous substances earlier.

New psychoactive substances are being detected in Europe at a rate of around one a week, with more than 1,000 currently being monitored – including highly potent synthetic opioids.

NPS are being detected in Europe at a rate of around one a week, including highly potent synthetic opioids

The new arrangement will help reduce harm by supporting reciprocal exchanges of information on newly detected substances, emerging threats, and high-risk drugs in circulation, says EUDA. It was signed by public health minister Sharon Hodgson and EUDA director Dr Lorraine Nolan, with UK implementation to be jointly led by DHSC and the Home Office.

‘This working arrangement marks an important new chapter in the relationship between the European Union Drugs Agency and the United Kingdom,’ said Nolan. ‘As drug markets evolve rapidly and become increasingly interconnected, closer cooperation is essential. This agreement provides a practical framework for sharing data, expertise and research, strengthening early warning and improving our understanding of emerging threats. By working together, we will be better equipped to respond to drug-related challenges and to help safeguard public health and security.’

Meanwhile, DHSC has launched a consultation on plans to stop vapes being marketed to children, including keeping them out of sight in shops, plain white packaging and restrictions on flavour names. ‘Vapes are less harmful than cigarettes and can play an important role in helping adult smokers to quit, but they should never be designed or marketed in ways that tempt children,’ said health secretary James Murray. ‘These proposals are about striking the right balance and I urge everyone to have their say.’

Working arrangement document available here

Tobacco and vapes: packaging, appearance and display open consultation available here until 2 October

123...63Page 1 of 63