The concept of inclusive recovery cities is providing a network of inspiration, say David Best, Steven Brown, Sue Northcott, Eleanor Youdell, Dot Smith, Mark Green, Tracey Ford, Mike Crowther and Jamie Sadler.
In spite of continued lack of funding and support from central government, the recovery movement has continued to proliferate and blossom across the UK. This has become most evident in the transition from the hidden and the anonymous to the visibility and vibrancy of events such as the annual UK Recovery Walks and the fabulous Recovery Games hosted in sunny Donny each autumn.
But for communities up and down the UK, it has been most evident in the emergence of lived experience recovery organisations (LEROs) and the emergence of the College of Lived Experience Recovery Organisations (CLERO) as a voice for evidence, innovation and standards among recovery organisations.
So what are inclusive recovery cities and why do we need them? It’s been clear that treatment may be necessary for many people to resolve addiction issues, but isn’t sufficient in itself to address the challenges of mental health, housing, education, employment and relationships.
So in 2008, William White introduced the idea of recovery oriented systems of care (ROSC) to create a model of person-centred, family inclusive, holistic and strengths-based coordination between multiple agencies including housing and criminal justice to address the comprehensive integrative needs of people with multiple needs.
However, and with due respect to the great William White, this approach is still fundamentally deficits-based and too professionally focused. At its core, the inclusive recovery cities model is ROSC++, with the following key additions:
• An inclusive recovery city is a strategic partnership between a number of grassroots recovery organisations, strategic leadership from the area, and some involvement from specialist treatment providers • The aim is to celebrate recovery through at least four public-facing recovery events each year that are inclusive • These events aim to challenge stigma and build access to community resources for the recovery community • But there is a further aim of providing increased access to community resources and to act as a bridge to civics and citizenship for recovery and other marginalised groups • To create and build social enterprises and other pathways to education and employment • To be part of a national and international coalition that shares innovation and evidence and celebrates recovery achievements
So where are we up to with this approach? From our original coalition of three inclusive recovery cities – Ghent, Gothenburg and Doncaster – we now have a strong UK alliance of ten cities and have hosted meetings in Middlesbrough, Leeds, Blackpool and Nottingham, each of which has – or is nominating – a lead.
Our international coalition also involves 14 cities in the Balkans region, and the first US inclusive recovery city will launch in Beckley in West Virginia this spring. The ten UK inclusive recovery cities are Middlesbrough, Sheffield, Leeds, York, Nottingham, Newcastle, Mansfield, Blackpool, Birmingham and Portsmouth.
Why has there been such significant interest? In the UK, at any rate, this has been about taking peer-based community recovery to the next stage through not only increased visibility but a celebration of what the recovery community contributes to the wider community and its achievements in addressing exclusion and discrimination.
For a long time, in the UK and internationally, recovery has been a social movement that has generated pride, belonging and a positive identity for people. We are now recognising and celebrating that vibrancy in a way that builds communities and improves the lives of all of the citizens in our inclusive recovery cities.
Article authors: Professor David Best (Centre for Addiction Recovery Research, CARR), Steven Brown (Empowerment, Blackpool), Sue Northcott (Humankind, Leeds), Eleanor Youdell (Double Impact, Nottingham), Dot Smith (Recovery Connections, Middlesbrough), Mark Green (York in Recovery), Tracey Ford (Sheffield City Council), Mike Crowther (Empowerment, Blackpool), Jamie Sadler (DATUS, Birmingham)
There were just over 10,000 deaths from alcohol specific causes registered in the UK in 2022, according to new figures from the Office for National Statistics (ONS) – the highest number on record.
The 10,048 figure was just over 4 per cent up on the previous year, but almost 33 per cent higher than in 2019 – the last pre-COVID year. Rates of alcohol-specific deaths had remained broadly stable between 2012 and 2019, ONS points out.
Alcohol-specific death rates only include deaths from causes ‘wholly attributable’ to alcohol, such as alcoholic liver disease. ‘It does not include all deaths that can be attributed to alcohol,’ ONS points out, such as heart disease and various cancers. The figures are based on the deaths registered in each calendar year, rather than the actual date of death.
As in previous years the highest rate of alcohol-specific deaths in England was in the North East, at 21.8 deaths per 100,000 people. Scotland and Northern Ireland had the highest country rates, at 22.6 and 19.5 per 100,000 respectively. Compared to 2019 there have been ‘statistically significant increases in the alcohol-specific death rate in England, Wales and Scotland’, ONS points out. Again, as in previous years, the overall alcohol-specific death rate for men was twice that for women. However, the death rate for women also increased by almost 6 per cent between 2021 and 2022.
The Alcohol Health Alliance, a coalition of more than 60 organisations, has issued a call for mandatory health labelling on alcohol, a commitment to long-term funding of early intervention and treatment, tougher marketing regulations and the introduction of minimum unit pricing (MUP).
‘We are in the midst of a public health crisis and the lack of government action to prevent the lives lost and resulting devastation for families, friends and communities is a shameful failure in public policy,’ said alliance chair Professor Sir Ian Gilmore. ‘Despite what we are often told by the alcohol industry, the evidence shows it’s a complete myth that this is a problem for only a small minority. As the death toll reaches record levels, so do the profits of the multi-billion-pound drinks industry. With the NHS already under severe pressure, we cannot continue on the current trajectory. The warning sirens are ringing, and whichever party forms the government at the next election must prepare to step up with a comprehensive alcohol strategy. This must include restrictions on marketing, availability and pricing – all of which are proven to reduce the harm caused by alcohol.’
‘Year after year now we have seen tragic increases in deaths from alcohol, which disproportionately affect the most deprived communities in our country,’ added chief executive of the Institute of Alcohol Studies (IAS), Dr Katherine Severi. ‘The rise has also been especially high among women, with 37 per cent more than in 2019. How many more deaths are needed before the UK government wakes up?’
Alcohol-specific deaths in the UK: registered in 2022 available here
Children’s online spaces ‘can feel saturated’ with gambling adverts and content, according to a report from GambleAware. The ‘blurred lines’ between gambling and gambling-like activity – such as ‘loot boxes’ in online games – also mean that children are unaware of the risks associated with online gambling, the document states.
Children were frequently drawn in by the ‘bright, loud and eye-catching nature’ of gambling ads, the report says, with many reporting that gambling could look like gaming and vice versa. ‘The look and feel of the two worlds felt interchangeable,’ it states.
The report is based on interviews with young people aged seven and above, as well as their families – with a particular focus on children under 11, young people aged 11-17 and considered vulnerable, and children and young people affected by a loved one’s gambling.
Previous research commissioned by the charity found that although 96 per cent of 11 to 14- year-olds had awareness of gambling marketing from the previous month, less than 40 per cent were aware of any health information or warnings on gambling ads.
GambleAware – which is funded by donations from the gambling industry – is calling for stricter marketing regulation. ‘Gambling advertising (particularly online gambling) can often utilise the same visual and tonal expressions as those used in content explicitly targeting children (cartoon graphics and bright colours and sounds),’ the report states. ‘Regulation is required to ensure that operators explicitly state that this type of content is not for children and young people.’
‘This research shows that gambling content is now part of many children’s lives,’ said GambleAware CEO Zoë Osmond. ‘This is worrying as early exposure to gambling can normalise gambling for children at a young age, and lead to problems. We need to see more restrictions put on gambling advertising and content to ensure it is not appearing in places where children can see it. Urgent action is needed to protect children because they can be seriously affected by gambling harm, as a result of someone else’s gambling or their own participation.’
Qualitative research on the lived experience and views of gambling among children and young people, available here
At Change Grow Live’s south west prisons service, we see first-hand the impact that neurodivergent conditions can have on engagement with substance support. People in prison are disproportionately affected by neurodivergence, and many of them struggle to engage with or be reached by existing pathways. That’s why our team has been at the forefront of developing an innovative pathway for neurodivergent people to access support in prison settings. By making our services in prisons more accessible to neurodivergent people, they will feel more able to engage and to progress with their recovery.
As we enter a new phase of this project, we wanted to share the learnings we’ve gathered so far, and explore how these can create a roadmap for breaking down barriers and encouraging more people into life-changing support.
A 2021 evidence review into neurodiversity in the criminal justice system, led by HM Inspectorate of Prisons, suggested that more than 50 per cent of people in adult prisons had a neurodivergent condition. Since then, anecdotal estimates among professionals supporting neurodivergent prisoners believe this is more likely to be 70-80 per cent. This is compared to the 15-20 per cent of neurodivergent people living in the community.
Typically, neurodivergent service users have at some point interacted with the police and many get caught in a cycle of addiction, imprisonment and reoffending. In the south west this has led to a suite of innovative NHS commissioned initiatives aimed at improving health and justice outcomes for neurodivergent people.
In partnership with NHS England South West Region and Oxleas NHS Trust, Change Grow Live’s south west prisons team are proud to be leading a 12-month neurodiversity service redesign project to improve drug and alcohol access and support for neurodivergent people in ten prisons across the region. The project prioritises the needs of neurodivergent people, but also embraces principles of universal design that will help us to improve service accessibility on a wider scale.
The project builds on Change Grow Live’s organisation-wide commitment and celebration of neurodivergent service users, staff and volunteers. Recent investments include the development and implementation of a specialist ADHD diagnostic assessment pathway in Nottinghamshire for adults using substances within the criminal justice system.
At an organisational level, Change Grow Live has invested in building workforce capability to better understand and support neurodivergent people. This includes staff training, skill-share workshops and a dedicated neurodiversity staff/volunteer intranet page to share resources, personal stories and celebrate diversity.
Core commitment
At our south west prisons service, we’re now making sure this commitment is a core part of our approach. We’re being supported in this project by our partner Genius Within, a neurodiversity-led organisation with experience of working across the criminal justice system. The first phase of the project involved a comprehensive audit of key service delivery elements to identify barriers to access. This included assessments, recovery/clinical interventions, and Through the Gate processes and support for people leaving prison.
Through focus groups facilitated across four prisons, service users and staff spoke about the challenges they experience in accessing and delivering services. Service users told us they experienced stigma because of their substance use, and staff wanted more training and development opportunities to understand and support neurodivergent people.
Both groups told us about the impact of not having a diagnostic pathway in the prison system, particularly for ADHD. This included service users who had screened positively for ADHD but were unable to receive a more targeted clinical intervention (ie ADHD medication) without a diagnosis. Some service users told us this impacted their decision to use substances illicitly – they suggested this may be different if they took ADHD medication which could help them manage typical ADHD traits such as anger or difficulty relaxing.
At a national level, the scale of this problem is well evidenced, and untreated ADHD accounts for at least an estimated £11.7m annually in the criminal justice system. Some service users with ADHD and autism told us they didn’t feel comfortable accessing group programmes because they didn’t like being around lots of people. They said groups delivered in a classroom setting reminded them of difficult, and in some cases traumatic, experiences at school.
We also heard that some of the resources staff used to deliver targeted interventions, such as workbooks, could be ‘too wordy and confusing’ and there was too much jargon used to explain concepts like the stages of change. We collected our findings in a final report that identifies key learnings useful for project stakeholders and wider criminal justice and community drug and alcohol partners. Learnings include improved continuity of care pathways and community drug and alcohol support for neurodivergent people.
The report also includes a set of recommendations guiding phase 2 of the project – ‘design, test and learn’. This has guided us as we have developed a series of resources to help break down these barriers to support.
With the input of project representatives and lived experience experts, we are currently redesigning a suite of resources to support interventions and engagement with neurodivergent people. This includes a harm minimisation booklet that fits into a wallet, to support people with a poor working memory as they prepare for their release.
Our partners Genius Within are redesigning a set of ‘in cell’ workbooks usually completed by service users on their own or in a 1:1 with their allocated recovery worker. The redesigned resource will support harm minimisation education while also providing engaging and interactive distraction-based activities and tools. This targets service users who are unable to access groups, and responds to the many service users who told us how much they enjoy distraction packs. Each resource is tested with service users to check how effective it is before its inclusion within the finalised and improved pathway – and we will continue to explore new ways to engage with the people.
We will also be rolling out bespoke, face-to-face training to staff within each of the ten prisons, to ensure the redesigned pathway can be properly embedded into the way prisons support people. The training will equip staff with a better understanding of neurodivergent conditions, as well as build practical skills to engage and deliver interventions to neurodivergent service users.
Next steps
The third and final phase of the project will evaluate the outcomes and impact of the new pathway. We will then share our learnings via a regional roadshow, showcasing redesigned resources and best practice ‘top tips.’ We believe that sharing our learnings and contributing to system-wide change are a key part of our commitment to ensuring life-changing support is available to anyone who needs it.
If you’d like to find out more about our work creating a new neurodiversity pathway, our roadshow dates, or any other project updates, we would be glad to hear from you. Please email: elaine.wilcock@cgl.org.uk
Many neurodivergent people in prison have never been educated about their condition or how it impacts their emotions, feelings and the way they communicate. They struggle their whole lives to fit into a society that has been built for neurotypical people. Without any reasonable adjustments in place to help them navigate this neurotypical world, many people start using drugs and alcohol early in life to try and numb the impact of their unsupported neurodivergent condition. (picture Mark Harvey / Alamy)
The Scottish Parliament has approved plans to continue with minimum unit pricing (MUP) for alcohol, and to increase the rate by 15p.
When the MUP legislation was introduced in 2018 it was subject to a ‘sunset clause’, which meant that it would expire this month unless MSPs voted to retain it. The vote was passed by 88 votes to 18, with the rate now set to rise from 50p per unit to 65p from September to ‘counteract the effects of inflation’.
Despite the introduction of MUP, alcohol-related deaths in Scotland in 2021 reached their highest level since 2008, at 1,245 (https://www.drinkanddrugsnews.com/scottish-alcohol-deaths-at-highest-level-for-13-years/) and there has also been concern that some dependent drinkers were cutting back on food and other essentials to buy alcohol (https://www.drinkanddrugsnews.com/mup-having-little-effect-on-dependent-and-harmful-drinkers/).
‘I’m pleased that parliament has agreed to continue MUP legislation and to raise the level it is set at,’ said drugs and alcohol policy minister Christina McKelvie. ‘As we have made clear, the policy aims to reduce alcohol-related harm by reducing consumption at population level, with a particular focus on targeting people who drink at hazardous and harmful levels.
We believe the proposals strike a reasonable balance between public health benefits and any effects on the alcoholic drinks market and impact on consumers. Evidence suggests there has not been a significant impact on business and industry as a whole but we will continue to monitor this.’
The government’s plan to introduce legislation that would create a ‘smoke-free generation’ (https://www.drinkanddrugsnews.com/government-plans-smoke-free-generation/) moved a step closer to reality after MPs voted 383 to 67 in favour of the tobacco and vapes bill at its second reading in the House of Commons.
The legislation would raise the age at which anyone can legally smoke by one year each year to ‘prevent future generations from ever taking up smoking’, while anyone born before 1 January 2009 will be able to continue legally buying cigarettes and other tobacco products.
‘This is not about criminalising those who smoke or preventing anyone who currently smokes from doing so,’ said the Department of Health and Social Care (DHSC). ‘Smoking will never be illegal and if you currently smoke legally, retailers will continue to be able to sell you cigarettes and other tobacco products. This is about protecting future generations from the harms of smoking, saving thousands of lives and billions for the NHS.’
The bill would also introduce restrictions on the packaging and flavouring of vaping products to make them less attractive to children. ‘While vaping can play a useful role in helping adult smokers to quit, non-smokers and children should never vape,’ said DHSC. ‘The long-term health impacts of vaping are unknown and the nicotine contained within them can be highly addictive.’
‘Parliament has today begun the process of consigning smoking to the “ash heap” of history,’ said ASH chief executive Deborah Arnott. ‘However, this is only the first step. The bill must now go through committee and another vote before going through the same process in the House of Lords. The passage of the bill should be expedited to ensure it is on the statute book before the general election.’
Last year, Phoenix Futures opened an important new residential service, Ophelia House. Six months into the journey, the charity shares its insights, learning, and some of the challenges it faced along the way.
The core principle of Ophelia House is that it is designed by women, for women. For too long, many women have had to fit into treatment systems that don’t work for them. We knew that for Ophelia House to be an effective treatment option, it must meet their specific gender needs of women.
Trauma is often a factor in substance use for both men and women; however, women frequently experience additional gender-based traumas that impact their substance use and have devastating short and long-term effects. The women we support at Ophelia House come from diverse backgrounds and have individual life experiences. However, we are seeing common intersecting experiences, including co-occurring mental health support needs, domestic violence and experiences of coercive and controlling behaviour. Many women have experienced the heartbreak of losing children to the care system or are involved with child services on referral, whilst others grapple with complex inter-related family dynamics.
Of the women that we have supported at Ophelia House, 77% have survived
domestic abuse.
Sam was referred to us by a community drug treatment team that she had been supported by to safely flee an abusive relationship. On leaving the relationship, she was carefully supported directly into a secure detox placement. The team at Ophelia House worked closely with the community service and detox provider to plan a rapid assessment and admission to Ophelia House with a particular focus on comprehensive safety planning, always ensuring her security and strict confidentiality.
Sam joined the community at Ophelia House in December after completing her detox. Our multi-disciplinary staff team supported her to ensure she was at the centre of her treatment and goal setting. Supporting women at risk of domestic violence to access rehabilitation involves a comprehensive approach that prioritises their safety, empowerment, and holistic recovery.
Through a collaborative trauma-responsive approach provided within a flexible environment, she successfully completed her treatment programme in March and was supported to safely relocate back to a new, secure community environment.
‘I feel a female-only rehab provides me the time to focus on myself and have no distractions. It gives me time for myself. My illness was very much interconnected with unhelpful relationships, so having the space away from that to focus just on me is helping so much already.’
Ophelia House is an effective evidence-based treatment option designed and developed in-line with best practice approaches to trauma-informed care. We have worked with partners across the substance use sector and have seen over 50 referrals from all regions of the country, evidencing a wide need for women’s only treatment. Yet, the inequity of access to residential treatment still means that many women are being excluded from this effective treatment option.
We have continually developed our approach to referrals since opening Ophelia House to address specific barriers that women face when entering residential treatment, including visitation arrangements of children, time-sensitive admission pathways for women fleeing domestic violence and those in custody settings and multi agencies liaison for women with complex mental or physical health support needs.
Much more work is still required to open pathways and make it easier for more women to access Ophelia House. Too many barriers make the funding process unnecessarily complex and unclear; too many women are still being asked to demonstrate their commitment by working through a series of discriminatory and unfair asks.
Stigma disproportionately affects women, especially mothers who use substances. Many women that we support report experiencing a combination of highly stigmatising experiences, frequently when accessing health and social care support. Mothers seeking support fear the removal of their children, and women, more broadly, are judged and shamed for their circumstances more heavily than men.
Deaths of women who use drugs and alcohol are rising, whilst stigma creates huge barriers to women seeking support. We must work to break down the stigma and discrimination that women face and normalise access to appropriate treatment options. Ophelia House should not be seen as the exception. We have to make it the norm.
‘Ophelia House has saved my life. When I arrived, I didn’t think I wanted to live. Crippled with toxic shame, I hated my very being– yet here I am today loving life more than I ever have and learning to like the woman I am becoming. Treatment has not only kept me clean and sober, it’s changed one thing and that’s everything.’
J – Ophelia House, Community Member
Ophelia House offers a coordinated approach to drug and alcohol treatment with intensive support across a range of different needs; providing a safe and therapeutic environment, with trauma-responsive delivery, on-site counselling, and mental health support. As well as specialist interventions for women who have experienced domestic violence, there is also housing, health, and family support on offer.
As we take our learning forward from our first six months in operation and use it to inform the delivery of our other specialist services, we will continue to share best practice across the sector and continue to work together with commissioners and key stakeholders to consider how to overcome the significant barriers to accessing residential treatment that women with multiple support needs face. This way, they can experience the benefits of an environment designed by women for women.
We have put together a summary of some of the best practices in supporting women at risk of domestic violence into rehab.
Supporting women at risk of domestic violence to access rehabilitation involves a comprehensive approach that prioritises their safety, empowerment, and holistic recovery.
Safety planning: Before anything else, ensure the woman’s and any dependents’ safety. Develop a safety plan that includes strategies for accessing detox and rehab confidentially.
Trauma-informed care: Recognise that women who have experienced domestic violence may have complex trauma. Provide trauma-informed care that prioritises their emotional well-being and acknowledges the impact of trauma on their lives.
Empowerment: Empower women to make their own choices and decisions. Offer support without judgment and respect their autonomy. Encourage them to identify their needs and goals for rehabilitation.
Accessibility: Ensure that rehabilitation services are easily accessible to women at risk of domestic violence. This may involve providing transportation or accessible accommodation.
Culturally competent care: Recognise and respect the cultural backgrounds of women seeking rehabilitation. Offer services sensitive to their cultural beliefs, values, and traditions.
Integrated services: Provide integrated services that address the complex needs of women affected by domestic violence. This may include counselling, substance use treatment, mental health support, advocacy, housing assistance, and vocational training.
Collaboration and coordination: Foster collaboration between rehabilitation providers, domestic violence shelters, healthcare professionals, and community organisations. Coordinate efforts to ensure a seamless transition between services.
Education and awareness: Raise awareness about domestic violence and its impact on women’s health and well-being. Provide education and training for healthcare providers, social workers, law enforcement officers, and community members to recognise signs of abuse and respond effectively.
Long-term support: Offer long-term support to women after they complete rehabilitation. Help them access ongoing resources and support networks to maintain their recovery and rebuild their lives.
Advocacy and policy change: Advocate for policy changes and funding to support comprehensive services for women at risk of domestic violence. Work to address systemic barriers that perpetuate gender-based violence and inequality.
To find out more about Ophelia House, to make a referral, or to speak to us about working together to support women into treatment, please contact alice.smallwood@phoenixfutures.org.uk
This blog was originally published by Phoenix Futures. You can read the original 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.
AI tools are increasingly being used to generate publicly available media content producing everything from facebook posts to first drafts of books and film scripts.
Research shows that the media play a significant role in shaping stigmatising attitudes toward populations experiencing health problems, including addiction. Research also suggests that legacy and social media often depict individuals experiencing addiction, especially drug use, in a negative light.
This raises the question as to whether use of AI to generate media content will help address stigma in media representation or further perpetuate it?
Our own non-scientific brief testing of AI tools has had mixed results.
On asking Chat GPT “what does someone with a substance dependency look like?” we were reassured by the answer “substance dependency can affect people from all walks of life, regardless of age, gender, race, or socioeconomic status. If you suspect that someone you know may have a substance dependency, it’s important to approach the situation with empathy and encourage them to seek professional help.”
However, images related to substance use problems, dependency and addiction created by AI image generators such as Microsoft copilot designer tend to be stigmatising in nature as these examples show:
Images of general alcohol use tend to be less stigmatising:Images related to general drug use are blocked by the Microsoft’s “Responsible AI Guidelines” suggesting perhaps the only images generated by Microsoft’s tool on the subject related to drug use will tend to the dark/threatening stigmatising style of image.
A number of recent article highlight other issues related to AI and stigmatising health conditions.
Maria Dalton & Darien Klein highlight here that AI is not immune to bias in relation to depictions of mental health.
‘While we are aware of the pervasive presence of toxic masculinity and stigma present in society when it comes to men’s mental health, we cannot treat AI as immune to bias, and must understand the limitations of such technology in serving as an unbiased resource’
And Tony Inglis looks at ‘What can AI tell us about perceptions of homelessness?‘ through Chat GPT. ‘With the rise of shockingly adept and adaptable AI, such as ChatGPT and other large language models, what can they tell us about images, stereotypes and the, hopefully, changing perceptions of homeless people?’
If you’re doing research in this area the ASN would love to hear from you, contact us at info@antistigmanetwork.org.uk
This blog was originally published by The Anti Stigma Network. You can read the original 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.
As Adfam celebrates its 40th year in 2024, the charity will be releasing a series of articles reflecting on its history, where things have improved for families, and where there is still progress to make. For this interview, Adfam speaks to Joy Barlow, the former head of STRADA (Scotland Training – Drugs and Alcohol).
Joy has, over many years, been a pioneer in developing support and improving understanding and recognition around the issue of parental substance misuse.
Addressing the support gap for women affected by substance misuse
Our conversation begins with Joy’s reminiscence of her initial inspiration, a chat on the streets of Glasgow in 1985 with a woman named Brenda. Joy was working as a drug project officer for the Scottish Episcopal Church at the time and encountered Brenda on an outreach session. Brenda was highlighting the complete sparsity of support available for mothers impacted by substance misuse, many of whom were losing their children, either into the care system, adoption or kinship care. This was a time when the issue of parental use was under recognised, and residential rehabilitation options for all, but especially mothers, were highly limited. It drove Joy to embark on a mission to bridge this gap.
Joy brought the issue to the attention of her colleagues and began conducting further research into the issue, first writing a feasibility study. She drew on American literature to get a better understanding and came across Juliet Denson-Gerber, a psychiatrist and founder of the Odyssey House. Juliet had shared some frightening insights around heroin addiction being a priority reason for the removal of children. But then Joy found another piece of research by Carolyn Eldred which emphasised how children could also be stressors and motivators of change.
The Aberlour Childcare Trust Board had put their weight Joy’s study and, along with the Episcopal Church, offered funding for her to go to the North America to find out more. In 1986, Joy visited rehabilitation centres in New York, Baltimore, Washington and Toronto. She has fond memories of a visit to a rehab in New York where one of the workers said to her, ‘McDonalds is not good enough for my ladies!’, and really pushed the women to be something different and do the best they could. However, Joy was also able to learn from some of the shortcomings in the approaches being used. At that centre, for example, the women could only stay for 90 days which was not a feasible timeline to help them cope and overcome their issues. Other practices saw family facilities being attached to long term rehabs that largely consisted of men who had fought in the Vietnam war.
Brenda House: the first residential rehab of its kind in Scotland for women and children
It was clear a long-term dedicated residential space for women and their children was needed, and upon her return to Scotland, Joy began to drive this ambition forward. By 1989, Brenda House, named after the Brenda who had provided Joy with her inspiration on the streets of Glasgow four years earlier, was opened by Diana, Princess of Wales. The residential centre used a tenement building in Edinburgh and consisted of six flats for six women and their children, plus a flat for the staff. Later that year similar projects followed; Scarrel Road, the Number One Project and Supportive Accommodation, all in Glasgow. Much of the funding stemmed from HIV/AIDS, as Scotland at that time had a very substantial population of both men and women who were infected with HIV.
The centres offered practical work, therapeutic counselling, group therapy, family therapy, along with play therapy and art therapy for the children. They were accessible to women in various stages of recovery, ensuring support for all who needed it, and providing vital and groundbreaking support that hadn’t been seen before in Scotland. Crucially there was also buy-in from the local community, including local schools, nurseries, GPs and dentists.
Brenda House unfortunately closed in the early 2000s, whilst Scarrel Road and the Number One Project were incorporated into a wider family centre, lasting until around 2015. Further funding has more recently been made available for residential treatment for women and their children by the Scottish government following the increase in drug-related deaths, with Aberlour currently in the process of opening two residential units.
Amplifying the voice of children
Joy highlights the progress that has been made when listening to children too. Initiatives such as Hidden Harm in 2003 shed a light on the challenges many children face when living with parental addiction addiction. Further key reports followed such as Juggling Harms in 2011 and Silent Voices in 2012. Training and workforce development took place around the harms to children and awareness around the importance of listening to children is now far greater than it used to be. The same can be said for relational work with families, with a much-improved understanding of the impacts of trauma, mental health and domestic violence, and an overall greater recognition within services of the impacts of substance use on women and children. We’ve also seen a better understanding of the wider socio-economic factors relating to substance use, such as housing, finance, employment.
One initiative in Scotland we certainly can’t go without mentioning is the Partnership Drugs Initiative, of which Joy was chair, a partnership between the Scottish Government and the Corra Foundation, of which Joy was a trustee. The partnership was set up to support children, young people and families affected by alcohol and drugs. Since its inception in 2000 millions have been invested into third sector services, with some amazing work being carried out as a result.
Despite the brilliant initiatives that have taken place over the years, as Joy puts it – ‘We’ve not solved it all and there’s still a hell of a lot to do.’ A particular myth that Joy is keen to dispel, is that where a parent recovers from their substance misuse, this resolves the situation. This is not the case as it in fact changes the family dynamic. You go from situations, for example, where the children are being the primary carers, to the parent becoming the parent again, telling their child what to do and what not to do, something which can complicate things considerably for the child. She points to the 2015 ‘Everyone Has a Story’ work by Corra Foundation, where children shared experiences of this and not knowing where they were, and in some cases were actually happier when things were more chaotic because it was something they had learned to deal with. Understanding when children are in need and when children are at risk is still vitally important and doesn’t go away with recovery.
Envisioning a brighter future
In spite of the challenges, Joy remains steadfast in her vision for the future. Above all else she emphasises how vital it is that we really listen to the voices of women, children and families, and advocate for services that are responsive to their lived experiences and preferences, based on what they tell us they want, not what we think they want.
‘We’ve got to go for connectedness. We’ve really got to understand that no one set of professionals is going to work this. And working alongside and with the families, hearing the lived experience, hearing the voice. Now that is incredibly challenging, but I think it also has to be said that we’re not going to get anywhere if we don’t do that.’
As we reflect on Joy’s insights, its evident that while progress has been made, the journey towards comprehensive support and understanding around parental substance use is ongoing. It requires continued investment in services but also a fundamental shift in attitudes. By putting the voices of those directly affected at the centre, we can strive towards a future where women, children and families receive the support they need to thrive amidst the challenges of substance use.
This blog was originally published by Adfam. You can read the original 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.
The powerful non-opioid tranquiliser xylazine has infiltrated the UK’s drug market and is ‘not limited to heroin supplies’, according to a new report by researchers at King’s College London (KCL).
The drug, known in the US as ‘tranq’ or ‘tranq dope’ – especially when mixed with fentanyl or heroin – has been associated with dangerous side effects such as large open skin ulcers. As xylazine is not an opioid its own effects cannot be reversed by naloxone in the case of an overdose, although it is frequently used with opioids. A sedative, painkiller and muscle relaxant, it is used in veterinary medicine as a tranquiliser for animals and can dangerously lower breathing and heart rates in humans.
KCL researchers contacted all toxicology labs in the UK to collate evidence of xylazine detections in biological samples. They found the presence of the drug in 16 people, 11 of which cases were fatalities. Many of the samples dated from last year, while May 2022 saw the UK’s first xylazine death – a 43-year-old man in Solihull.
While xylazine is usually mixed with opioids it has also been detected ‘alongside stimulant drugs such as cocaine, and found in items sold as counterfeit codeine and diazepam tablets and even THC vapes’, says KCL. This means a far wider population than people who use heroin will be exposed, warns the report, which is published in the journal Addiction.
In February, the ACMD wrote to the government recommending that although there was no ‘evidence of intended use’ of xylazine in the UK, given its acute toxicity – and ‘similarity to the enhanced toxicity seen when benzodiazepines are co-used with opioids’ – it should be made a class C drug.
‘We now know that xylazine has penetrated the UK’s illicit drug market,’ said the report’s senior author Dr Caroline Copeland from KCL’s School of Cancer and Pharmaceutical Sciences. ‘We also know that most people who buy heroin will not intend to buy xylazine and this combination increases the risk of overdose. Xylazine was designated an “emerging threat” to the United States and this public health threat is a growing concern for the UK.
There are three simple measures the UK can introduce to prevent the epidemic of xylazine use that has emerged in the USA. Cheap xylazine test strips should be made available, healthcare providers need to be aware of the signs that chronic skin ulcers are due to xylazine use, and pathologists and coroners should specifically request toxicology testing for xylazine in relevant cases to understand the true prevalence of the drug.’
‘Copeland and her colleagues bring important new information about the appearance of a new drug, xylazine, as a co-drug added to illicit heroin and also apparently as a novel drug on its own,’ commented Professor Sir John Strang.
‘This has required integration of data from different sources (from case reports, from national data-sets and from forensic toxicology) and collaboration across different disciplines and different universities alongside data collection organisations or law enforcement. Copeland and colleagues also identify possible changes in public health planning and law enforcement – a good illustration of how science can inform public policy and practice and enable valuable impact.’
NHS England is investing £4.2m to buy 25 FibroScan machines to be used in settings and facilities where there are potential hepatitis C patients, including drug and alcohol services, clinical outreach vans and special testing events at GP practices.
The FibroScans test for liver damage and provide immediate results. People can then be referred on to treatment with antivirals if necessary, as part of a two-year extension of NHS England’s deal with three pharma companies – AbbVie, Gilead Sciences and Merck Sharp and Dohme (MSD) to supply the latest drugs. NHS England is also procuring 34 Cepheid GeneXpert portable testing units – which can detect if someone is infected in less than an hour – for use in settings like prisons and GP surgeries.
The expansion in testing forms part of the ‘final phase’ of England’s hepatitis C elimination programme, which could see it become the first country in the world to eliminate hep C as a public health threat. It’s estimated that more than 60,000 people could still be unaware they are living with chronic hep C.
‘Since the elimination programme drive began in 2015, around 84,000 people have been treated for hepatitis C and it is hoped the virus can be stamped out as a public health concern in England, years ahead of the World Health Organization’s 2030 ambition,’ NHS England states.
‘Hepatitis C elimination as a public health threat is in reach if we can accelerate testing, support people to access effective treatment that clears the virus, reduce the stigma experienced by people living with hepatitis C and prevent people getting the infection in the first place – particularly for people who inject drugs,’ said head of hepatitis at UKHSA, Dr Monica Desai.
‘Since the Hepatitis C Trust was founded over 20 years ago, the progress made in patient care and treatment is beyond anything we could have imagined,’ said the trust’s CEO, Rachel Halford. ‘Not only is there now a reliable cure for hepatitis C, but we are also on the verge of eliminating the virus in England. Many people who are most at risk of hepatitis C face barriers accessing health services, but the success of the elimination programme so far proves that through innovative partnership working and keeping the patient at the centre, there are ways to reach and treat everyone.’
UK veterans who served in military operations are likely to report a significantly higher prevalence of common mental disorders than non-veterans (23 per cent versus 16 per cent), as well as alcohol misuse (11 per cent versus 6 per cent), according to a 2020 King’s Centre for Military Health Research study Mental health disorders and alcohol misuse among UK military veterans and the general population.
In 2009 the charity PTSD Resolution was created to support the mental health of forces veterans, reservists and their families across the UK. It offers a ‘clear, compassionate pathway to resolving trauma and addiction, to restore mental well-being and stability’, according to retired colonel Tony Gauvain, co-founder and chair of the charity.
PTSD Resolution delivers therapy free of charge, offering prompt, local access through its network of 200 therapists nationwide. With more than 4,000 referrals to date, the charity’s approach can resolve military trauma and other issues within an average of seven sessions, with the client and therapist both agreeing that no further treatment is required.
Holistic Approach
Since 2009, PTSD Resolution has recorded and analysed the results of every therapy session and client programme and also conducted independent studies that demonstrate the effectiveness of its pathway. It has also gained accreditation from the Royal College of Psychiatrists’ quality network for veterans mental health services.
‘PTSD Resolution supports all veterans contending with a range of mental health issues, including those who have an addiction,’ says Gauvain. ‘We only require that the client is not under the influence of drugs or alcohol during the therapy session. This contrasts with many other service providers who insist that veterans must first resolve their addiction before starting therapy for mental health problems. But the addiction is probably a symptom of the underlying trauma or other mental health issue, so we have a holistic approach to therapy and recovery and will help all veterans, whatever their issues.’
The charity’s policy of inclusion extends to the provision of help to veterans in prison, providing a lifeline to members of the ex-forces community frequently left behind. This inclusivity extends to families, acknowledging the ripple effect of trauma and offering much-needed support to partners and children affected by living with a traumatised person.
Human givens
At the heart of PTSD Resolution’s approach to addiction lies human givens (HG) therapy, a method that offers a refreshing lens through which to view and address the complexities of addiction, says Malcolm Hanson, director of therapy at the charity and a veteran himself. ‘HG therapy stems from a fundamental understanding that human beings have innate needs and resources, collectively referred to as the human givens,’ he states. ‘When these needs are unmet, or when resources are misused, individuals may spiral into addiction as a misguided attempt to fulfil these voids.’
Human givens therapy is based on the premise that addiction – whether to substances like alcohol and drugs or behaviours such as gambling – is often an unhealthy coping mechanism for underlying emotional distress. This can frequently be traced back to trauma, with affected veterans turning to addictive substances or behaviours to numb their pain or gain a semblance of control in their turbulent lives.
‘The therapy doesn’t merely focus on the addiction itself but addresses the root causes by ensuring that the individual’s emotional needs are met in balanced and healthy ways,’ says Hanson. ‘It emphasises the importance of security, attention, emotional connection, and a sense of achievement among other needs. By fulfilling them properly, the reliance on addictive substances or behaviours diminishes,’
Human givens therapy equips individuals with the resources to rebuild their lives. These include the ability to develop memory, build rapport, employ imagination constructively, and harness the power of their emotions and instincts in a positive way. The therapy sessions aim to empower individuals to find fulfilment and meaning in life beyond their addiction, using their innate capacities to heal and grow.
Strong structure
Central to the human givens approach is the premise that therapy should swiftly move individuals from a state of distress to one of empowerment and autonomy. The therapeutic journey begins with establishing a strong rapport between the therapist and the client, ensuring a safe and trusting environment, says Hanson. ‘This foundation enables effective information gathering, where the therapist finds the unmet emotional needs and misused resources contributing to the client’s addiction. Crucially, this stage also involves information giving, where clients learn about the human givens approach and how it applies to their situation, fostering an understanding of their own behaviour and its underlying causes. It’s practical and makes sense to clients.’
Goal setting then directs the therapy towards tangible outcomes, with goals defined by the client’s aspirations for recovery and wellbeing. These goals are not distant ideals but immediate and achievable steps towards overcoming addiction.
Accessing resources taps into the client’s innate capacities – such as memory, empathy, and imagination – rekindling skills and strengths that had been overshadowed by their addiction. This empowerment phase is critical for building the client’s confidence in their ability to change.
Finally, agreeing on strategies and rehearsing success involves planning practical steps towards meeting goals and envisioning a future free from addiction. This not only prepares the client for challenges ahead but also solidifies their commitment to a healthier lifestyle.
Regaining balance
Unlike many other therapies, there’s no requirement in human givens therapy for clients to explore or even talk about past events that may have traumatised them. Therapy is conducted confidentially and in private – just the client and therapist, either in person or by phone or online.
‘Neither verbal recounting of the traumatic memory nor group therapy sessions form any part of the programme,’ says Gauvain. ‘They may just reimprint the trauma and reinforce the problem. Instead, the human givens approach recognises the past and sets positive, achievable goals, activates innate resources, and rehearses successful outcomes. Veterans are guided towards regaining balance and satisfaction in their lives by assimilating past events into their life experience, rather than continuing to rely on addictive substances or behaviours to block out painful memories and associations.’
As more veterans like Jake find their way to recovery through PTSD Resolution’s therapy programme, the charity’s impact will only continue to grow, offering a path to healing and hope for those who have served their country.
Patrick Rea is trustee director at PTSD Resolution
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A veteran’s Journey: Jake’s Story
Jake is a veteran of Afghanistan who completed the PTSD Resolution therapy programme
‘I was in a dark place, drinking, drugs, not answering the phone or door. I had been treated for PTSD at a clinic, but it didn’t work. I was an addict. I was violent to my wife. I was suicidal. I went to PTSD Resolution. After the third session, I felt more positive straight away. A few sessions in I started seeing a big difference.
‘So did my mum. She said I was much calmer, and I drove on the motorway – in the rain – for the first time without having a panic attack. I got a job on a building site, only temporary but better than nothing. And I got a girlfriend. I was smoking less too, slowly. Coming off weed after years is hard. The best thing I learned in therapy was this technique that stops you from spiralling out. Turns out I needed it.’
We’re thrilled to announce that our New Beginnings service in Brent has successfully reached the impressive milestone of Hepatitis C micro-elimination!
NHS England has a target to eliminate the virus by 2025 and Via services are aiming to do this in their local areas as well.
Hep C is a blood borne virus which, left untreated, can cause liver cancer and liver failure. It usually displays no symptoms until the virus damages the liver enough to cause liver disease. People who inject drugs are at the highest risk of becoming infected.
As of February 2024, our team in Brent has reached the following targets with the people who use their service:
100% of those in treatment have been offered a Hep C test
100% of people who currently inject or have previously injected have been tested for Hep 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 Hep C at the service have started treatment
By meeting these targets, we’re proud to report that Via – New Beginnings – Brent has formally achieved Hep C micro-elimination!
In partnership with Gilead Sciences, staff and volunteers at all our Via services have been working tirelessly to promote testing and treatment with the people they work with, on their journey to micro-eliminate Hep C, and we hope to be able to announce more micro-elimination wins soon!
For this month’s column, we decided it would be best to reflect on what we learned in 2023, and spell out Release’s plans to try and do things differently in 2024 – we’ll be back with another case study in our next regular column.
Over the past year, we’ve been adapting our ways of working based on our own and our service users’ experiences of advocating for better treatment. We know that quick and low-barrier access to treatment is more important than ever, as we see increasing nitazene contamination in various drug supplies, putting many lives at risk.
We also know that for many people who use drugs, by the time they find Release’s helpline they’re already in dire circumstances, often after months of trying to cope with poor or no treatment from their drugs service. This also does not account for the many people who will never come across the helpline, or who will exit services or suffer indefinitely – unaware that they’re entitled to better treatment.
In order to increase access to knowledge about advocacy, and with that, increase the number of people who access drug services and receive high quality care from those services, Release has produced a two-part advocacy guide for people in treatment and those supporting them. We will soon announce a webinar introduction to the guides as well as formal training for drug service key workers and other support workers on how each can play their part in promoting access to advocacy, so stay tuned.
A secondary goal is for workers to be better able to support people on their caseloads, as a number of key workers have told us they were in need of such a resource.
In fact, non-clinical and clinical workers alike have told us that they weren’t aware of the breadth of tools and strategies they could be deploying to support their clients. For clinical workers, we’ve found that case studies discussed in groups of fellow clinicians have been an effective tool for promoting learning and discussions of current challenges, such as the need for refreshed guidance on working with people dependent on illicit benzodiazepines.
Staff at Release have therefore supported some practising and retired clinicians from the drugs sector to form the UK Drugs Clinical Network (UKDCN), first conceived at the 2023 Royal College of GPs’ Managing drug and alcohol problems in primary care conference.
The UKDCN is a forum for clinicians to pool knowledge, experience and resources to better meet patients’ needs and think creatively about the challenges people face and the solutions available.
Organisations must change to meet the needs of individuals and not the other way around, and the UKDCN aims to bring people together to achieve this. If you are a clinician, you can register to become a forum member at https://www.ukdcn.co.uk/home.
Of course, not everyone will want or need to enrol in drug treatment services. In fact, the majority of people who use drugs won’t need the support these services primarily offer, but would benefit from harm reduction support. Unfortunately, most harm reduction services in England are built into drug treatment services that people don’t feel comfortable accessing.
Some people who contact Release also fear that accessing their needle and syringe programme will negatively impact their script in future, so we urgently need harm reduction services that are truly low threshold. As such, Release has decided to construct our own public harm reduction hub. In one week, we managed to crowdfund our entire initial goal of £7,500 to construct the space and order supplies and furniture. The crowdfunder remains open to support us in purchasing additional supplies such as nitazene, xylazine and fentanyl test strips.
Harm reduction is much more than drug checking tools and sterile syringes. It’s about promoting a rights-based approach and ‘meeting people where they’re at,’ not only in terms of time and place but also working against systems of oppression which are causing wider harm.
In order to expand the number of people who are skilled in working this way, and to make sure that the hub itself is adequately staffed to expand its hours, Release has also launched a new volunteering programme. Find out more about it at https://www.release.org.uk/vacancies and sign up if you’re interested in taking part.
Ultimately, our goal is to contribute to bringing about conditions where we are no longer needed. We hope that we can support the rights of people who use drugs through our advocacy and policy work alike, and galvanise workers in the drugs sector and friends in our own backyard to – through a diversity of tactics – achieve a fair and just society for drug users of all backgrounds.
Meet Harry, who will be running the 2024 London Marathon in aid of WithYou.
The WithYou marathon team, made up of fourteen people, has been training hard for months to take on this incredible challenge: running 26.2 miles around the city of London on Sunday 21 April.
Harry has taken on multiple marathons to raise money for WithYou’s services, supporting people experiencing challenges with drugs, alcohol and mental health on their recovery journeys.
Feeling lost amongst the social drinking environment at university, Harry wanted to break away from the drinking culture and aim for bigger goals, so he decided to start training for marathons.
But Harry’s journey isn’t just about running. It’s his personal connection with the work we do that inspired him to run multiple marathons for WithYou. It’s about honouring his mum, whom he sadly lost to suicide in January 2020 after a long battle with medicinal substance use.
‘The thought that she believed the world would be better off without her has left a vast impression on the way I view and wish to live my life.’
Harry’s experiences have led him to understand how easy it is to take life for granted. He has decided to work towards the best version of himself, one day at a time, pushing himself to achieve all he can mentally and physically.
Having already completed the Valencia marathon back in December 2023 and raising over £1,000, Harry isn’t stopping there — he’s putting his running shoes on again this month to raise more vital funds for our recovery services.
‘I will be running in the 2024 London Marathon to help the charity further… I believe it’s extremely important that charities such as this exist to help people experiencing challenges with substance use as my mother once was.’
As well as raising money, Harry is aiming to raise awareness, so that more people feel they can reach out if they are struggling.
‘Overall, I just hope my efforts make at least one person’s life a little easier and reduce the suffering that they feel.’
Lincolnshire County Council has appointed a partnership of Turning Point, Double Impact and Framework to deliver its Substance Use Treatment and Recovery Service.
The contract, with a value of approximately £8 million per annum, will deliver an integrated all-age substance use treatment and recovery service, and went live on 1 April 2024.
The newly named Lincolnshire Recovery Partnership provides a free and confidential service for people in Lincolnshire who want support for issues related to their drug and alcohol use. A dedicated young people’s service, Horizon, offers support, information, and advice about drugs and alcohol.
Councillor Wendy Bowkett, Executive Councillor for Adult Care and Public Health, said, ‘The new service supports our ambition to have a high-quality treatment system in Lincolnshire that will help people to achieve positive change and reduce drug and alcohol related harms.
‘We are delighted to welcome Turning Point to Lincolnshire who will work with partners Double Impact and Framework, both of whom are both already working in the county, to build upon the strengths of the existing service.’
The service draws on the specialisms of each of the partners. Turning Point is a national organisation with 60 years’ experience supporting people with drug and alcohol issues. Double Impact is a Lived Experience Recovery Organisation supporting with 25 years’ experience of supporting people to recover from drug and alcohol dependence and reintegrate into the community. Framework has been providing accommodation and support for homeless and vulnerable people across Lincolnshire since 2011 and leads the delivery of drug and alcohol treatment services in Nottingham.
People with lived experience of recovering from drug or alcohol issues will be on hand to support people every step of the way. A dedicated mental health team will be available to support people with both mental health and substance use issues.
The service also has an increased outreach capacity and a number of mobile units which enable services to be provided closer to home for people living in some of the more isolated parts of the county.
Lincolnshire residents can self-refer online on the service’s website where there are a range of digital self-help materials available.
The service continues to be delivered from hubs situated in Lincoln, Boston, Grantham, Skegness, Spalding and Gainsborough. There is also a network of community satellite venues to ensure equity of access across Lincolnshire.
Sarah Hancock-Smith, a spokesperson for Lincolnshire Recovery Partnership, said, ‘We are delighted to have been awarded this contract by Lincolnshire County Council.
‘Lincolnshire Recovery Partnership will play to its partners’ strengths, expert knowledge and experience, to bring about positive change, reconnecting people with hope, ambition and their health, at the same time as supporting return to training, education and employment.
‘Ultimately the service will support people to move on and make vital positive contributions to society and their communities.
‘We will ensure that people are offered an expanded range of support to recover from the harm that can be caused through drug and alcohol use. Tackling these issues head on will improve the lives of people across Lincolnshire.’
This blog was originally published by Turning Point. You can read the original 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.
Nearly 100,000 drug tests on arrest have been carried out by police forces in England and Wales since March 2022, the Home Office has announced. The expansion of testing on arrest forms part of the government’s ten-year drug strategy, published in December 2021, with the number of tests increasing every quarter for the last two years.
Suspects are tested when their behaviour is ‘believed to have been driven by their drug abuse’, the Home Office states. Eighty seven per cent of positive drug tests were for cocaine, 31 per cent for both cocaine and opiates, and 4 per cent for opiates alone.
Fifty six per cent of people arrested for crimes including robbery, car theft and burglary tested positive for opiates, cocaine or both, with more than 90 per cent of positive tests resulting in an assessment by a qualified drug worker to ‘ensure those for whom treatment or other support would be beneficial are referred to an appropriate service’. Almost half of those assessed were subsequently referred, the Home Office says.
Drug testing on arrest was not used consistently across police forces until government funding was made available in 2021-22, with less than half of forces previously reporting their results to the Home Office. The government’s criminal justice bill, if passed, would expand both the range of drugs forces can test for – including ketamine and cannabis – and the offences that could trigger a test, to include violence and football-related offences.
‘The relationship between drug abuse and criminal behaviour is clear which is why we’ve sought to expand the police use of drug testing on arrest,’ said crime minister Chris Philp. ‘Suspects who are caught not only face justice, but are given the chance to turn their lives around by tackling one the root causes of their criminal behaviour and this is why we are pushing through the criminal justice bill to expand these powers.’
In May, the recovery community will be taking on the challenge of connecting Lancashire’s Red Rose Recovery with Yorkshires Connected Spaces by walking the Way of the Roses.
The Way of the Roses is a spectacular coast to coast route which passes through both the red rose county of Lancashire and the white rose county of Yorkshire.
Our core walkers, accompanied by the amazing Bee Adventures CIC, will walk the 180 mile stretch of countryside. Starting in their respective corners each county will set off on the epic journey, camping along the way to finally come together at a midway point to swap the red rose for the white rose.
Both communities are walking to show how recovery works best when done together, tackling stigma and inspiring hope in others along the way!
We would love it if our friends and supporters could help by way of sponsorship in order to raise funds for both counties’ charities, the money raised will help us to continue to support the most vulnerable people in our society and show everyone that recovery is possible!
We would also love it if our friends could support in other ways, could you join the group of core walkers? Can you help us to reach more people? Can you join us on the final leg of the walk? Or support us with equipment, space or last day celebrations?
The US state of Oregon has passed a law recriminalising drug possession.
Oregon’s landmark Measure 110, which was passed in November 2020, made the personal possession of all drugs including heroin, cocaine and methamphetamine subject to no more than a $100 fine (https://www.drinkanddrugsnews.com/campaigners-hail-monumental-victory-for-us-drug-policy-reform/). However, new legislation has been signed off by the state’s governor, Tina Kotek, recriminalising drug possession with penalties of up to 180 days in jail.
As well as making possession of small amounts of drugs a misdemeanour from September, House Bill 4002 also expands funding for drug treatment and aims to reduce barriers to access.
Measure 110 was supported by almost 60 per cent of the vote in Oregon in 2020, but polling carried out last summer found that more than half of respondents wanted the legislation repealing altogether and 64 per cent wanted at least some elements repealed. ‘Two years into their new reality, it’s clear residents are waking up to the impact these drugs are having on their communities,’ said president of the Foundation for Drug Policy Solutions, Dr Kevin Sabet, at the time.
Despite more than $260m being allocated to treatment, naloxone distribution, employment services and housing services, overdose numbers in Oregon rose faster than the national rate, with most people failing to take up the voluntary offer of treatment that formed a key part of Measure 110. There were also widespread stories in the US and international media about open-air drug markets and drug-related crime.
‘The recriminalisation of drugs in Oregon is happening in a difficult national environment where criminal justice reforms at large are under attack by special interests,’ said Kassandra Frederique, executive director of one of Measure 110’s original backers, the Drug Policy Alliance. ‘As politicians learn that criminalisation will not solve – and will worsen – the problems that Oregonians care about, opportunities to establish a true health-based drug policy should emerge. Despite this setback, the movement to replace drug criminalisation with care continues. We won’t back down until our communities are healthy.’
‘Oregon’s drug policy attracted national and international attention, and its high-profile failure will likely discourage other states and countries from pursuing maximalist decriminalisation policies, at least for a time,’ professor of psychiatry at Standford University and former drugs adviser to president Obama, Dr Keith Humphreys, wrote in the Atlantic last month.
‘But the lessons from Oregon’s troubles should not be overdrawn. One thing Measure 110 got right, at least in principle, is that Oregon’s addiction-treatment system was grossly underfunded, with access to care frequently ranking at the bottom of national indicators. The mechanism that the measure created to manage new spending was clumsy and didn’t work well, but the new law acknowledges the problem and provides extensive new funding for immediate needs.
‘Though our polarised politics tends to frame policy choices as on-off switches, in truth they are more like a dial with many intervening settings. That dial can be productively turned in many parts of the country. Many states are far more punitive toward drug users than Oregon was before Measure 110 was passed.’
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Meanwhile, Germany has legally regulated the recreational use of cannabis by adults. Anyone over 18 can now legally possess up to 25g of the drug in public, with households allowed to grow up to three cannabis plants. Cannabis clubs of up to 500 members will also be allowed to legally grow and distribute the drug on a not-for-profit basis, provided the members are German nationals. However, it will remain illegal to smoke cannabis near schools or in ‘pedestrian zones’ during the day.
‘This is the fifth European country to embrace cannabis reforms over outdated prohibitionist policies following Malta, Luxembourg, the Netherlands and Switzerland in the last three years,’ said Transform’s public affairs and policy manager Ester Kincová. ‘The country’s key role in European politics means this is not only a significant shift for the country but for all of Europe, and the wider world.’
We’ve had more than enough time to prepare for the crisis we’re facing with nitazenes and other synthetic opioids.
It’s vital we do the right things now, says Kevin Flemen.
We should be very concerned about the issue of high-potency novel opioids. While increased media coverage and the establishment of a ‘cross-government task force on synthetic opioids’ are welcome, we are yet to see anything approaching a coherent strategy for the UK. This slow progress will inevitably have fatal consequences.
Given that this crisis was foreseeable it’s unforgiveable that we are so badly prepared. Some of the interventions that people are calling for would have an impact, but will take time to deliver. In the meantime responses are needed now, at a local level.
Having started to roll out a half-day training module for drug services and other social care organisations I’ve had a little snapshot of what is and isn’t happening. This has helped refine and inform some things that are rapidly actionable, see my ten-point list opposite.
We can never be certain what the future will hold but in my opinion we are seeing a fundamental and seismic shift in the pattern of opioid use in the UK. This isn’t going to be a temporary drought with business as usual soon. We may end up with stability – one or two more popular (and hopefully less potent) synthetics becoming the substance of choice. Diluted effectively, with increased knowledge around potency, duration and routes we can reduce risk. Indeed we may end up with less risk – drugs that could be snorted rather than injected, no need to use acidifiers, less bacterial contamination?
Or conversely we could end up with a repeating cycle of enhanced risk, as compounds are replaced and changed as we saw with synthetic cannabinoids. Either way we need to prepare – and that means some systemic changes to how we engage with emergent drugs. Something that we are currently doing painfully slowly.
Kevin Flemen runs KFx which has offered training and resources on drugs and related issues since 2003. email kevin@kfx.org.uk
1:Pull together hyper-local focus groups – located within drug services, pulling in people who use, workers, housing, emergency services. Drill in to both fatalities and near misses. Detailed granular information, the way people are using and experiencing the drugs, how people responded to naloxone, duration of effect. Encourage people to send samples for testing.
2:Testing – in lieu of having an English testing service we must continue to impose on WEDINOS but we need to get greater random testing of samples, not just in response to ‘bad batches’. Support people and encourage people to send in samples so we get a proper picture of the distribution of novel opioids.
3:Consolidate our knowledge base – there’s a lot of information we don’t have that will inform harm reduction. How many fatalities or near misses related to smoking? We say ‘start low, go slow’ but with isotonitazene (for example) forming long-acting potent metabolites, what does this mean in practice? To what extent are the nitazenes rewarding and reinforcing redosing? Our focus groups are essential to build this knowledge.
4:Agree and standardise key messages – there’s literature going out about fentanyls that doesn’t mention naloxone, and some where there’s no mention of calling an ambulance. I’ve been in services where there are no posters, others where there’s a sea of them and the message is lost. Communication – posters, leaflets, verbal input from reception staff, key workers, groups is imperative.
5:Naloxone – There needs to be rapid and proactive examination of the pros and cons of nasal v injectable naloxone, and while the primary message has been to ‘get naloxone to people’, in some areas this has seen nasal formulations being the more acceptable option. But if the lower number of doses this affords could be a risk, it needs to be reviewed. What would the gold standard look like? We urgently need an evidence base for this – or a nasal preparation with more doses.
6:Hostel policy – there’s an ongoing clamour for drug consumption centres but with the best will in the world these will take time and significant cost to deliver. In the meantime hostel policy work developing high tolerance policies and effective in-house overdose responses can have a real impact immediately. Their effectiveness in areas where they are established is well developed and needs to be expanded without prevarication.
7:Training! Well, while you would expect this from a trainer, recent courses have highlighted some significant issues that need to be urgently addressed. This has included people excluded from OST as they’re testing negative for opiates, with clinicians unaware that some ‘brown’ heroin may contain no diamorphine and that nitazenes won’t show up on an OPI screen. There is a colossal training need – for drugs services, wider healthcare and other related services including housing, mental health and criminal justice.
8:Widening the message – as novel opioids are being found in a growing range of substances – benzos, fake Oxys and vapes, we need to widen awareness and harm reduction beyond heroin users based on evidence. Benzo users need to be a key target, many of whom may not be in touch with drug services. Given the growing prevalence of bromazolam/nitazene benzos, consideration needs to be given to refining messages (‘don’t mix’ isn’t useful when the pills are effectively ‘pre-mixed’). Messaging needs to be via channels other than drug services – chemists, mental health services, GPs – to reach people using grey-market benzos but not in touch with drugs agencies.
9:Benzo treatment – we’ve been talking about this for too long and the unwillingness to offer effective benzo substitute prescribing has been an issue for a long time. The idea of directing people to wean themselves off illicit benzos has always been less than ideal, but now that we know those benzos could contain novel opioids to offer such a message is unconscionable.
But not only do we need effective prescribing options for people using street benzos, we need to recognise that such patients may have developed opiate/benzo habits due to mixed pills and will need treatment options for both.
10:Trauma support – even with our best efforts people will die and this has a huge impact both on those endeavouring not to use and those still using, as well as people working in support services. Bereavement, grief, helplessness, survivor guilt – we need to ensure that we bake in the support all affected parties will need to cope when people die. On a recent training course we were looking at one small catchment area where the worker was describing seven people being acutely unwell or dying in December. The impact on them and the people they were supporting was colossal.
(Partner Updates, September 2023): Release, alongside EuroNPUD and other drug treatment service colleagues in the UK, have produced harm reduction advice on nitazenes.
At the end of February, the Ministry of Justice (MoJ) published its updated projections for the prison population in England and Wales.
The number of prisoners is set to increase to ‘between 94,600 and 114,800 by March 2028, with a central estimate of 105,800’, it says – last year it was less than 84,000.
This huge increase is ‘predicated on several factors’, says MoJ, including changes in sentencing policy and courts working through their case backlogs. The projections may seem surprising given lord chancellor Alex Chalk’s announcement last October that the government intended to legislate for a ‘presumption against prison sentences of less than 12 months’ – to be replaced by community sentences, alongside better access to drug treatment and mental health services.
However the government also intends to ‘put the worst offenders away for longer’ – as part of an overall strategy to make the best use of prisons and give lower-risk offenders the ‘greatest chance’ to turn their lives around. The adult female prison population, meanwhile, stood at 3,611 in November 2023 and is projected to have reached 4,200 by November 2027, although the MoJ stresses this doesn’t include ‘any future impact’ of the government’s female offender strategy, which aims to treat custody as a last resort.
Human cost
Many commentators have pointed out that the prison system can barely cope with the current numbers, and while criminal justice charity organisation Clinks welcomed the presumption against short sentences and consequent reduction in the ‘financial and human cost’ of this revolving door, it warned that with MoJ anticipating an increase in anything up to 6,800 in community caseloads there were also real concerns over the additional pressure on ‘probation services, commissioned rehabilitative service providers, and the wider voluntary sector working with people in the community’. These would all need to be adequately resourced to meet the increased demand, it stressed.
The move away from short prison sentences is undoubtedly a welcome one, however. As Professor Dame Carol Black pointed out in the first part of her Independent review of drugs, more than a third of the-then 82,000 people in prison were there for – mostly acquisitive – crimes related to their drug use. Most were serving short sentences, which obviously gave little time for any kind of effective treatment and created a situation where drug users were ‘cycling in and out of our prisons, at great expense but very rarely achieving recovery or finding meaningful work’. There were also ‘significant problems with the transition of prisoners to community treatment on release’, she added, with most people highly likely to reoffend. While the overall reoffending rate is 25 per cent, the rate for those serving sentences of under 12 months is more than 50 per cent, rising to 58 per cent for sentences of six months or less.
Custodial alternatives
So what are the best alternatives to short sentences? Last year’s report from the House of Commons Home Affairs Committee (DDN, September 2023, page 4) recommended improved use of diversion schemes – where the police don’t involve the courts in cases of low-level offending – as an ‘important tool’ in reducing drug-related crime as part of a wider shift to ‘public-health based interventions’, but added that provision was at present a postcode lottery.
‘It definitely is, but there’s work underway to correct that,’ Jason Kew, senior innovative practice officer at the Centre for Justice Innovation and combating drugs partnership lead for Berkshire, tells DDN. ‘Professor Alex Stevens is leading the national diversion evaluation for the Cabinet Office, so next year we should see a recommended model from that learning and that should encourage all forces.’
Until 2021 Kew was detective chief inspector at Thames Valley Police, and it was there that he helped to develop that force’s successful diversion scheme (see box, page 8). Several organisations are currently involved in making the evidence-based case for a move to a diversion model, he says, adding that most forces probably already operate some kind of diversion scheme, even if only on a de facto basis.
And in February this year MoJ reported on the progress of its ‘intensive supervision courts’ which have been piloted with almost 60 offenders in Birmingham, Liverpool and Teesside since last summer. As well as engaging with treatment, offenders meet regularly with the same judge and are also subject to random drug testing by probation officers. A study into the effectiveness of the courts is currently being undertaken by Revolving Doors in partnership with CFE Research and the University of Greenwich.
Significant impact
A move away from short sentences should also help to address the not inconsiderable issue of people developing a drug problem while actually in prison. A 2020 report from Reform stated that almost 15 per cent of prisoners said they’d developed a drug problem while in prison – double the rate from a decade ago – with a ‘significant’ impact on violence levels. Reducing the use of short custodial sentences to ease overcrowding was one of its recommendations at the time, with Forward chief executive Mike Trace commenting that more and more prisoners were getting ‘pulled in to the prison drug market’ with ‘fewer opportunities for them to use their time in prison to turn away from drugs and crime,’ (DDN, February 2020, page 4).
The scale of the problem was recently illustrated in the alarming March 2024 report from HM Inspectorate of Prisons on HMP Hindley near Wigan, which found a ‘near tsunami ‘of illegal drugs, with a positive test rate of more than 52 per cent – ‘meaning that well over half the population were active drug users while we were inspecting’, it stated.
One encouraging development, however, is the growth of drug-free wings in prisons – as of a year ago there were drug-free wings operating in 45 establishments in England and Wales (DDN, March 2023, page 5). But while the latest OHID figures show more than 46,500 adults in drug and alcohol treatment in prisons and secure settings in 2022-23, with 3 per cent year-on-year increases for the last two years, links with community treatment post-release can still leave a lot to be desired.
Mental health
The same goes for prison-based mental health treatment. A 2021 report from the UK Parliament’s Justice Committee pointed out that while up to 70 per cent of the prison population were estimated to be suffering from mental health issues, only 10 per cent were receiving any treatment. Poor data collection meant that the true scale of the problem was unknown, but only likely to get worse, it said.
A huge number of those mental health problems will of course be trauma-related, with people turning to drugs to self-medicate. ‘Someone in recovery told me, “You can’t recover unless you know what you’re recovering from”,’ says Kew. ‘And that trauma might take years of counselling. It’s not just a quick fix.’
A widespread shift to a more public health-based approach will of course mean fundamentally challenging parts of the wider culture in law enforcement, something that reflects his own journey.
‘I joined the navy at 16 because I didn’t have any qualifications – the relevance of that is I had no critical thinking,’ he says. ‘I was just taught what I was taught and I joined the police with that mentality. In training I digested the law book, and I came out of training school like RoboCop – I was arresting so many people, and at first I didn’t really care too much about the impact of that. I was doing what I was employed to do.
‘But then you see the harm that criminal justice can cause, the labelling, the stigma, the punitive approach in every part of the system. It was only when I got to know some of the people that I began to really understand trauma and addiction, that people are often self-managing serious trauma.
So it’s about treating human beings as human beings. It doesn’t matter about the past, it’s the future that counts. It’s about preparing and enhancing all the skills, social capital and recovery and everything else to help that individual into the community. Why do we have this fixation on prison? Public health approaches work.’ DDN
We looked at evidence for diversion schemes and decriminalisation around the world, as well as more local examples like Operation Turning Point in the West Midlands, which had a really good evidence base, Checkpoint in County Durham, and others, and we cherry-picked the learning, says Jason Kew. We needed to reduce deaths and reduce stigma, but we also needed to have an effective model – personally, I’d decriminalise overnight, but we had to be careful about what we were going to implement.
Not all my colleagues were keen so we had to go back to basics with the reasons why. Reducing deaths was simple – everybody got that – and people understood a public health approach to drugs. It was actually the process that was the most challenging, because we needed to make it as easy as possible for cops. When you’re a police officer you can be dealing with road traffic one minute, domestics the next, then missing kids, shoplifting – the demands are wide, so it was vital that we make it effective for the police.
So what we were able to do was find a mechanism within the law which enabled that, and that’s the community resolution. That precludes the need for an arrest, and we were able to then get the drug services to take over from the police on the street – so it’s the drug services that the person hears from next. And for many people it’s the first contact they’ve ever had with services, so it’s a game changer, it really is.
What we wanted to try to do was to give everybody who came into contact with the police an opportunity for some form of education or awareness, but that’s not one size fits all. You could have someone living on cardboard using spice who might not benefit too much from any kind of education around drug use at that point, but they might benefit from assertive outreach or connection with housing or benefits professionals, or some other kind of social capital.
So it was principally about education and awareness, but also an open door to harm reduction according to that person’s needs, and the drug services were really keen. We had a working group – as well as our partner Druglink we had our local commissioned services like CGL, Turning Point, Cranstoun. We had big national charities with lots of experience, which meant we were able to bring lots of people around the table, including people with lived experience who helped to shape it all. And that’s how we ended up with our scheme.
The challenges faced by the criminal justice system are significant, headlined by a burgeoning prison population with seemingly no place to go. But alongside the desperation that can set in when looking at the statistics, an evidence-based body of work is flourishing. In this issue we look at the alternatives to custodial sentences, the opportunities for successful diversion schemes, and the positive impact of moving away from short sentences.
Our contributors this month provide vital knowledge – on the trauma suffered by many veterans who find themselves self-medicating with alcohol and drugs; on neurodivergent conditions; on safe spaces for women; and on ways to connect with peer support and recovery communities. The more we understand about why people are ‘cycling in and out of our prisons’ (Prof Dame Carol Black) the better position we are in to provide appropriate interventions and support.
News of more sudden deaths, including clusters in prison, further underlines the emergency we are facing with nitazenes. This is not a remote problem. See the action plan on p10 – we need to understand the risks, act quickly, and coordinate locally to make sure everyone is prepared.
Read the April issue as an online magazine (you can also download it as a PDF from the online magazine)
At the end of 2023, the team at Via Redbridge invited valued local partners, service users, and colleagues to the launch celebration for their Women’s Safe Space.
Attendees were able to learn about and recognise the significance of the women-only space.
A roundtable discussion took place which was incredibly impactful and led by women sharing inspiring stories about their experiences with the space. Everyone also had the opportunity to give important feedback about the space, such as how it can be improved, and how more can be provided within the community.
The conversation was chaired by Service Manager Helen O’Connor, who’s a White Ribbon Champion and part of the organisational steering group. Our organisational White Ribbon Ambassador Tom Sackville was also delighted to listen and take part.
Many women spoke about how the space is somewhere they can relax, and speak openly with other women in the group.
Here are what some of the women said about the safe space:
‘I like coming to the safe space because I enjoy the company, joining a craft, encouraging one another and hearing everybody’s progress.’
‘This is what I look forward to throughout my week. Coming here on a Wednesday, sharing experiences, love, and stories with one another.’
‘I come to the women’s safe space because it’s somewhere that I feel comfortable, it’s good to keep busy and socialise with others. It’s just a good space to come if you feel down. Everyone’s really supportive and the staff are amazing as well.’
Tom Sackville, Executive Director of Services at Via said: ‘It is brilliant to hear how what the women in the service said they needed has become the fantastic space that we saw. We heard from the women how important it was that they had somewhere they felt safe and able to be themselves, and it was incredible to see how they support each other in that space.’
This blog was originally published by VIA. You can read the 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.
Working in prisons can be challenging, but a prison based therapeutic community can bring about genuine change, say Claire Illingworth, Kate Cookson, Monica Sumner and Rachael Ashcroft.
Delphi Medical is a leading independent provider of drug and alcohol treatment in the UK, ensuring excellent clinical and psychosocial provision as part of a recovery pathway. We are a part of the larger Calico group, an organisation made up of charities and businesses that focus on improving lives and creating a social profit.
Delphi specialises in drug and alcohol recovery services in prisons, including the HMP Wymott therapeutic community (TC). A therapeutic community is a community-led, living and learning environment that helps to promote social, psychological and behavioural change. HMP Wymott TC addresses substance use and is an intensive structured programme where residents live and work together. TC residents are encouraged to challenge and unlearn addiction and offending-related attitudes and behaviours – therapeutic communities use the community itself as a way to change.
HMP Wymott TC is a 70-bed unit separated from the wider prison. Residents will have access to healthcare, gym, visits and chapel in the main prison. The TC, a 12-month programme, is 24/7 and residents work together, live together and learn together. New residents will be given a buddy, and recovery peers help to support and mentor residents throughout their time in the programme.
Our aims:
Put responsibility on individuals to recover from their dependency and lead a substance-free and more fulfilling life.
Reduce substance-related offending.
A holistic approach tailored to individual need and aspiration – to tackle wider physical and psychosocial needs.
To prepare clients for living and working back in society.
Stages of treatment
Connect – three months In the Connect stage, new residents participate in the welcoming stage where job roles are shadowed, and attend five group sessions specifically about the TC programme. At this stage, new residents receive a buddy and settle into the community. Once a new resident is in Connect, they are expected to fully engage in the community. The Connect stage is an introduction to recovery and TC treatments, with residents participating in group sessions, peer support, feedback pledge groups and social prescribing groups alongside other Connect residents.
Dependence – five months In the Dependence stage of the programme residents focus on relapse prevention techniques, the self, communication, personal values, positive routines, and introduce new patterns of behaviour. Dependence residents will share their life story and take on more responsibilities in their job roles and through mentoring and supporting Connect residents.
Freedom – four months In the final stage of the TC programme, Freedom, residents focus on progression from the TC by looking at what’s next, transitioning from the TC, resettlement needs, relationships, and exploring the recovery peer offer. Freedom residents take on more responsibility by mentoring, and delivering SMART Recovery groups as well as social prescribing groups. At the end of a resident’s journey on the programme, a celebration is held with the whole community and an end-of-treatment review with other agencies such as prison offender managers, prison key workers and family members can also be invited.
HMP Wymott DARS Service
The DARS team stands for the drug and alcohol recovery service. The service has a service manager, care coordinators, recovery practitioners and recovery peers to offer prisoners at HMP Wymott the best opportunities to reach their personal recovery goals.
There are three different stages of support:
Connect – When clients are first referred into our service, a DARS duty worker will visit them and assess their immediate needs. They will be allocated a recovery practitioner who will complete their triage assessment with them.
Dependence – Once clients have completed their initial and triage assessment, they will be moved to Dependence. Their recovery practitioner will work with them in a client centred way, to form a holistic recovery plan. During Dependence they can engage in group work and one-to-one work with their recovery practitioner and refer to the TC if they need to. Clients will stay in Dependence until they feel they have completed all their goals.
Freedom – The Freedom offer is available to all clients being released from custody with an option to refer to community services if they wish. This can be their local drug and alcohol service, community groups, rehab and supported housing. Freedom clients can also apply to become a recovery peer to support others and continue to engage in peer support sessions.
What else can clients get involved with?
The DARS team understands that everybody’s recovery journey is unique to them. It offers a service that tries to reach as many people as possible, and can provide even more support through the following group sessions:
Lancashire release • Life skills
Mutual aid • Acupuncture therapy
Recovery gym • Creative therapy
Awareness • Relaxation
Peer support • Recovery peers
Family days • SMART recovery
Motivational speakers
Claire Illingworth
Delphi Medical, area operations manager – central
Having worked in prison substance misuse treatment for over 20 years I sit here pondering the changes in the offer I’ve seen, and our clients have experienced, over the years.
I often describe working in prisons as Marmite – you either love it or hate it. It’s a restrictive and challenging environment, and equity of treatment is vital. In the prison, treatment is not mirrored to the community in my experience. One example is that community-based rehabs are all over the country, but when we look at our prison offer there’s only one and we’re fortunate that it falls in the Northwest – HMP Wymott TC.
We have other options across the country including supportive environments, enhanced living, drug-free environments, recovery wings – these are having a good impact, but this isn’t mirroring the community offer.
———–
Rachael Ashcroft
Delphi Medical, care coordinator DARS lead – HMP Wymott
Having worked in HMP Wymott for 18 years in various roles it’s been interesting to see services develop over time and see the different drug trends throughout the establishment.
At times, it can be challenging due to the ever-changing selection of psychoactive substances and their effects. But for me, I enjoy working in Wymott as no two days are the same.
Working in substance misuse brings variety as you get to engage with many different people from different backgrounds who are wanting to achieve different goals, but all wanting to recover from substance misuse and really change their life.
———–
Kate Cookson
Delphi Medical, service manager health and justice – HMP Garth, HMP Wymott, HMP Manchester, Barton Moss and Marydale
Working within prisons is not everyone’s cup of tea, and for some it can be too restrictive while others thrive.
Prisoners are able to engage with services and get a top-quality service, but we must remember this is voluntary and change happens when someone wants recovery, not when forced. This is often forgotten in the prisons, and it can be pushed on from various places – often meaning recovery is not genuine, and we can see a lot of revolving doors. But when it is genuine it works and it’s amazing. Having more TCs, recovery wings and funding for prison substance misuse services would support this journey and allow the amazing work being done by our teams all across the country to be even more successful.
Why work in prisons? Because change can and does happen!
———–
Monica Sumner
Delphi Medical, therapeutic community care coordinator lead – HMP Wymott
I’ve worked on the therapeutic community at HMP Wymott for over five years, starting as a volunteer, and now managing the programme.
From my experience, I can say this is an extremely challenging, yet extremely rewarding, field to work in. We face different obstacles each day regarding drug use and offending behaviours, right down to prison regime restrictions. Nevertheless, being able to say that as a team we deliver an intense structured treatment programme for 70 men, daily, is something we’re very proud of.
Being one of the only prison-based drug and alcohol rehabilitation programmes left in the UK is a very sad statement to make. Further intensive support within prisons, in my opinion, is urgently needed.
There were at least 467 drug-related executions in 2023, according to the latest report from Harm Reduction International (HRI).
The figure is 44 per cent higher than the previous year and does not account for the ‘dozens, if not hundreds’ of executions believed to have taken place in China, Vietnam, and North Korea, HRI points out. Ninety-eight per cent of known drug-related executions took place in Iran.
Drug offences accounted for more than 40 per cent all confirmed global executions last year, the highest proportion since 2016, with drug-related executions also confirmed in Kuwait, Saudi Arabia and Singapore. Almost 60 of those executed for drugs belonged to ethnic minority groups – in Iran and Singapore – while 13 were foreign nationals, and six were women. ‘These figures confirm that these groups are uniquely vulnerable to capital punishment as a tool of drug control,’ says HRI.
At the end of 2023, 34 countries still retained the death penalty for drug offences, the report states, although Pakistan took the ‘landmark’ decision to remove the death penalty for ‘certain violations’ of its Control of Narcotic Substances Act. Malaysia – which has more than 700 people on death row for drug offences – also abolished the mandatory death penalty for all offences.
There was also a 20 per cent rise in the number of confirmed death sentences for drug offences, almost half of which were passed by courts in Vietnam and a quarter in Indonesia. More than 30 of the 375 people sentenced to death were foreign nationals and 15 were women. ‘Most notably, no accurate figure can be provided for China, Iran, North Korea, Saudi Arabia and Thailand,’ says HRI. ‘These countries are all believed to regularly impose a significant number of death sentences for drug offences.’ At least 3,000 people are estimated to currently be on death row for drugs, across almost 20 countries.
Last year Singapore carried out what was believed to be first execution of a woman for two decades, which Amnesty International called ‘unlawful and shameful’. The authorities in Singapore ‘must stop their unlawful and increased resort to executions in the name of drug control,’ said the charity’s death penalty expert Chiara Sangiorgio at the time. ‘There is no evidence that the death penalty has a unique deterrent effect or that it has any impact on the use and availability of drugs. In fact, it has the effect of disproportionately punishing and further discriminating those with disadvantaged socio-economic backgrounds or belonging to marginalised groups.’
The death penalty for drug offences: global overview 2023 at hri.global
Fifteen more synthetic opioids, including 14 nitazenes, have been controlled as class A substances, the Home Office has announced.
While the government’s priority is to ‘engage with vulnerable people at risk of being sold these lethal drugs and divert them towards treatment’, anyone caught in possession could face ‘up to seven years imprisonment, an unlimited fine, or both’, it states.
The 15 new synthetic opioids to be made class A drugs under the Misuse of Drugs Act are metonitazene, protonitazene, isotonitazene, butonitazene, flunitazene, metodesnitazene (metazene), etodesnitazene (etazene), N-pyrrolidino-etonitazene (etonitazepyne), N-piperidinyl-etonitazene (etonitazepipne), N-pyrrolidino protonitazene, ethyleneoxynitazene, N-desethyl protonitazene, N-desethylisotonitazene, N-desethyl-etonitazene and brorphine. Three stimulants – diphenidine, ephenidine and methoxyphenidine – have also been controlled as class B drugs along with a synthetic cannabinoid, with a short-acting benzodiazepine made a class C drug.
The government is also enhancing its surveillance and early warning system, it has announced – including analysing wastewater or recording overdose spikes in specific locations – with the information passed on to public health and criminal justice agencies to enable rapid action.
‘Synthetic opioids are significantly more toxic than heroin and have led to thousands of deaths overseas,’ said crime and policing minister Chris Philp. ‘We are determined to ensure these destructive and lethal drugs do not take hold in our communities in the UK. We are enhancing our early warning system to ensure the right agencies can respond rapidly if these drugs are detected in communities.’
The government has also introduced its tobacco and vapes bill, with the aim of fulfilling its commitment to create a ‘smokefree generation’. Alongside powers to restrict vape flavours and packaging to make them less attractive to children there will also be on-the-spot fines for people selling the products to anyone underage. Under the proposals anyone turning 15 this year, or younger, will never legally be able to buy tobacco in the UK. ‘If passed, this will be a major public health measure which will reduce illness, disability and premature deaths for children today and future generations,’ said chief medical officer for England, Professor Chris Whitty.
See the April issue of DDN for a feature on tackling nitazenes
Related articles:
(Features, March 2024): Testing the limits – Harm reduction experts make the case for more drug checking for nitazenes and other substances.
(Partner Updates, September 2023): Release, alongside EuroNPUD and other drug treatment service colleagues in the UK, have produced harm reduction advice on nitazenes.
As we respond to an increasingly complex health and social care landscape, a renewed approach to partnership working can enable us to address people’s needs and make sure no one is left behind.
At Change Grow Live’s Manchester service, we are very aware of how complex and diverse these challenges can be. Our outreach team alone works with around 280 people at a time, including people with complex needs ranging from homelessness to mental and physical health issues.
That’s why we are proud to be a part of the city’s Street Engagement Hub, an innovative partnership based at local homelessness charity Mustard Tree. Together, the various organisations that make up the hub provide a one-stop-shop and gateway into support for anyone that needs it.
As the hub expands to offer vital support to people leaving prison, we look at how it is helping to meet people’s complex needs, challenge stigma, and empower more people to change their lives.
The people who access our services often face a multitude of challenges – drug use, neurodiversity, homelessness, poverty, abuse, as well as the stigma that comes with all of these.
The Street Engagement Hub is a multi-agency partnership that brings together the organisations with the knowledge and specialities to address these challenges – from St John Ambulance and specialist NHS teams to local housing support agencies and adult social care.
Initially, the hub was aimed at providing support for people who were involved in street-begging and had come to the attention of the police. Instead of giving sanctions for this, a new approach was trialled where a person could attend the hub instead and receive a bespoke offer of care.
As this has evolved, the Mustard Tree charity in Ancoats hosts the hub for two days every week on an ‘open door’ policy. It doesn’t matter if someone has found out about it from a flyer, if they’ve been referred by another agency, or if they’ve simply wandered in off the street – everyone is welcome to access some level of support!
By working together to support people in a holistic way, the hub partners can address the various factors that affect people’s lives, help them to gain a level of stability and security, and empower them to grow.
Change Grow Live has been a permanent part of the hub’s team since its early days, providing people with support and guidance around drugs and alcohol.
The hub has played a crucial role in enabling us to deliver ‘rapid treatment’ – the aim of providing safe, fast access to same-day prescribing and treatment options.
Once someone has completed their initial assessment, we can help them right away with things like testing for blood-borne viruses and harm reduction interventions including free naloxone kits and training.
If we’re able to secure a GP summary, and with other relevant tests completed, we can safely prescribe them medication that same day.
Within a single session at Mustard Tree we have conversations about people’s journeys and goals, provide harm reduction advice and tools, prescribe medication, and refer on to any of the other relevant agencies that they may benefit from during their time at the hub.
This streamlined approach has enabled us to support over 650 people at Mustard Tree since January 2023, with interventions ranging from nursing appointments and testing for blood-borne viruses, to psychology appointments and support with employment.
The feedback we’ve had is that people like the ease of access offered by the hub. They like that everything is agreed at their first meeting, and that they don’t have to keep telling their story over and over again.
Now, we see people attending the hub at Mustard Tree not just because they’ve been advised to by the police to avoid a conviction, but also because they’ve heard about everything the hub has to offer. On some days, we’ve seen people queuing out the door for an initial assessment!
Now, we’ve expanded our offer to include support for people leaving prison. Every Friday, people who have recently left prison can access the hub’s full range of support services in a single location. The hub can address the challenges people often face when leaving custody: a multitude of appointments across the city on a Friday, many with different opening hours, all while trying to reconnect with friends and loved ones.
By streamlining their reintegration into their community and helping them to overcome many of the barriers they might otherwise face, we can help to break the cycles of behaviour that prevent people from achieving positive change and empower them to grow.
The hub is a proactive example that health and social care providers are stronger when we work together. The organisations that make up the Street Engagement Hub have transformed the way we offer support and are creating new pathways to reach some of the most vulnerable and underserved people in our communities.
If you would like to find out more about how the Street Engagement Hub operates, we would be happy to hear from you.
There were 1,197 suspected drug deaths in Scotland last year, according to police figures – a 10 per cent increase on 2022.
Almost three quarters of the deaths were among men, 14 per cent up on the previous year, while deaths among women fell by 1 per cent. Two thirds of the deaths were among people aged between 35 and 54.
The Police Scotland data is based on reports from the observations and enquiries of officers attending scenes of death, and are distinct from the official figures published by National Records of Scotland, which are based on death certificates and supplementary information from forensic pathologists. The police divisions with the greatest number of suspected drug fatalities were Greater Glasgow, Lanarkshire and Edinburgh City.
Scotland’s drug death total for 2022 was down by a fifth on the previous year, but was still almost four times higher than in 2000. The provisional figures for 2023, however, suggest that the confirmed statistics due to be published in the summer will show that ‘Scotland’s public health emergency continues’, said the Scottish Drugs Forum (SDF).
‘This is the latest sign that our response to this emergency has been inadequate’ said CEO Kirsten Horsburgh. ‘We have made progress, but there is a long way to go and what we need is a consistent and national approach. Full implementation of the Medication Assisted Treatment Standards would be a basis for moving forward. However, what we are witnessing and hearing from people using services suggests there is some way to go.
We need to broaden treatment to address the needs of people experiencing harms related to cocaine, benzodiazepines and other drugs. People need to be empowered to make choices in terms of their treatment and their support. Our immediate concern is with local funding decisions. This is not a time to cut core services or commissioned services that treat or otherwise support people at risk.’
In 2023, our Stayin’ Alive campaign stated that drugs are changing, and this is even more true in 2024.
A range of drugs across the UK continues to be contaminated with nitazenes, synthetic cannabinoids, novel benzodiazepines and occasionally xylazine. The risk of overdose leading to death or other adverse consequences remains very high.
Nitazenes can be up to 500 times more potent than heroin and there have been at least 65 deaths involving nitazenes across the UK, with many more yet to be confirmed via the coronial process. Nitazenes are not universally tested for when someone dies from drug-related causes – this means there are likely to be many more deaths than we are aware of where nitazenes have been involved. It’s also likely that deaths involving nitazenes will continue to rise as heroin supplies in the UK dwindle as a result of the Taliban’s ban on growing the opium poppy in Afghanistan.
WEDINOS
We are very grateful to WEDINOS and other drug checking facilities such as The Loop and MANDRAKE for their work identifying these contaminants. We’ve encouraged people to test their drugs via WEDINOS, a free service available across the UK. To meet the needs of people using illicit drugs in the face of changing drug markets, however, changes in process and allocation of resources are urgently required.
With the high potency of nitazenes, it’s essential that we can get drugs checked before they’re used. Currently, there is a delay of at least several days or sometimes weeks. It’s highly unlikely that people who use drugs will wait this long for results before consuming them and an unrealistic expectation for people who may be dependent on the drugs they use.
Positive Developments
One recent positive development is the wider availability of self-test lateral flow immunoassay tests for nitazenes and xylazine. While these are welcome, they are only part of what’s needed. Technology exists to make mobile, hand-held testing devices that give instant results and, importantly, an indication of purity levels – something self-tests are unable to provide. Armed with these devices, our dedicated teams and outreach workers could make a much bigger difference to the safety of people at such severe risk of overdose.
We must get upstream of the use of these drugs if we are to prevent more needless deaths. A range of unnecessary obstacles prevent us from achieving more effective drug checking and saving lives. Difficulties obtaining Home Office licences and restrictive legislation leaves our workforce with their hands tied. Supporting people to get their drugs tested opens them up to the risk of prosecution for possession and supply (when handing over for testing) of illicit drugs.
Barriers to effective checking
We are deeply frustrated by the barriers preventing more effective drug checking and are devastated by the continued deaths from contaminated drugs. Worse still, we know that we can prevent more deaths with proactive service or outreach-led drug checking – we’re frequently told by people who use drugs that they are worried they will die, that they want to have their drugs checked, and would adapt their drug use according to the results. We must change this. And we can.
We urge the Home Office to work with our sector to allow for more easily obtainable drug testing licenses. We would also welcome the chance to work with local authority commissioners to discuss how the current supplementary treatment grant could be used to fund this vital work. This funding would cover the cost of making handheld testing devices and lab testing more readily available. Furthermore, we believe OHID should underline drug testing as a national priority in our collective effort to save lives.
Working together
Together, we can remove the unnecessary barriers to drug testing, capitalise on the unique access and contact our services have with people who use drugs, and ensure people are equipped to be kept safer from the increased risks posed by contaminated drug supplies.
We’ve come a long way in some respects – widespread naloxone availability is a great example of progress, as is some police forces enabling their officers to carry naloxone. We work every day to attract, engage and retain people in treatment, a system well known to also reduce the risk of death. But we’re all too aware of the reality that some people will continue to use illicit drugs. There must be swifter, more radical progress on drug checking if we want to reduce drug overdose deaths in the UK.
Peter Furlong is national harm reduction lead at Change Grow Live; Chris Rintoul is innovation and harm reduction lead at Cranstoun; Iain ‘Buff’ Cameron is project manager, harm reduction services at Extern; Maddie O’Hare is deputy director of HIT; Jon Findlay is national harm reduction lead at Humankind, and Deb Hussey is national safer lives lead at Turning Point.
(Partner Updates, September 2023): Release, alongside EuroNPUD and other drug treatment service colleagues in the UK, have produced harm reduction advice on nitazenes.
Turning Point’s Hammersmith & Fulham service explains what the Swap to Stop scheme is and what it offers to people in the London Borough of Hammersmith & Fulham.
What is Swap to Stop?
The government has set an ambition for England to be smokefree by 2030, taken to indicate adult prevalence of smoking of 5% or lower. On 11 April 2023, the government announced a range of actions to speed up progress towards smokefree 2023, including offering free vaping starter packs to one million smokers by March 2025. Offering the dependent starting pack is dependent on the person wanting support with smoking agreeing to access behavioural support and is only available to people who current smoke cigarettes. The use of e-cigarettes is far less harmful than smoking tobacco. See our Stoptober blog for more information around the evidence of using e-cigarettes to stop smoking.
Turning Point Hammersmith & Fulham Stop Smoking Service
Turning Point offer a combination of stop smoking support that is tailored to each individual. This can include free vaping starter packs, one-to-one sessions with our stop smoking specialists, groups with likeminded people wanting to stop smoking and nicotine replacement therapy.
Hammersmith & Fulham’s support offer is targeted to people and groups in the community who are at a greater risk of smoking related harm. The support is targeted at those struggling with drugs and alcohol, people with a mental health diagnosis, people referred via criminal justice and pregnant women.
Thanks to the Swap to Stop programme, we have been able to offer more people e-cigarettes and have seen more people stop smoking. Turning Point have supported 212 people in Hammersmith & Fulham in the last year; 53 of them we’ve supported with e-cigarettes.
Grace’s story of using a vape to stop smoking with Turning Point
Grace found out about Turning Point’s stop smoking service, whilst receiving support for drugs and alcohol with us. Grace was smoking 20 cigarettes per day when she first reached out for support. We assessed her dependence to nicotine on the Fagerstrom Test for Nicotine Dependence and it indicated she had a medium dependency. Grace was surprised by this and together we explored the different support options for her. Grace decided that a vape would help her quit smoking and was prescribed a 1.6% nicotine strength vape, with the plan of gradually reducing the nicotine strength until it reaches 0%, after which she will quit vaping all together. With the help of the nicotine vape, Grace was able to transition from smoking to vaping in the very first week of using the vape.
Grace said. ‘Turning Point were so compassionate, understanding and extremely effective at helping me stop smoking. I will never smoke again, and I’ll always remember Turning Point as the organisation that helped me to quit smoking for good!’
This year’s theme for International Women’s Day is #inspireinclusion. It’s a call to action to challenge stereotypes, call out gendered assumptions and actions, and to maintain an inclusive mindset.
It is also about recognising the unique perspectives and contributions of women from all walks of life, including those from marginalised communities, writes Ketiwe Anjorin, Head of Equality, Diversity and Inclusion at The Forward Trust.
These outdated norms that limit expectations of what women (and often men) can or should do are all around us – and they are deeply ingrained. Since having my own kids I have become all too aware of this. Even today, it’s still so common to hear phrases like ‘boy’s don’t cry’ and ‘you throw like a girl’. Parents continue to teach their boys not to cry and to highlight the ‘stigma’ of femininity in everyday language. On the surface these kind of comments may seem harmless, but these limitations start very early, and can hold girls and women back and cause significant problems across society later in life.
I’ve been amazed at how early my kids begun to develop a clear sense of what is expected of boys and girls and how they are ‘supposed’ to behave. My daughter (aged five) still adamantly insists that ‘pink is for girls’ and loves anything to do with princesses. I’ve also had many interesting conversations with my eldest son (aged seven) about what kind of jobs he thinks are for women and men, mainly based on what he’s seen on TV and how my husband and I split tasks at home, which was a bit of a reality check!
Research shows that by the age of seven, children’s attitudes towards gender are fully formed, with kids latching onto stereotypes as a way to categorise and make sense of the world. Gender roles and stereotypes are constantly reinforced to them in the media and commercial sectors, with many films, TV programmes and adverts still showing outdated and limited representations of gender and sending messages to them about what is deemed appropriate for boys and girls. Most retailers still market children’s toys, books, cards and clothes based on gender too. As a parent or caregiver it can therefore be very difficult to challenge these stereotypes, despite one’s best intentions.
The reality is that gender stereotypes affect so many aspects of life for women. They contribute towards limiting career choices, poor mental health, low self-esteem in girls and issues with body image, and a culture of toxic masculinity and violence against women going unchecked. The impact for boys and men can be just as damaging. Gender stereotypes typically teach boys not to express their emotions, particularly those that are considered feminine, such as empathy, sensitivity and connection, with expectations around the male provider and ‘stoic men’, often cited as a factor contributing to higher male suicidal rates later in life. Not to mention, the impact for those who don’t conform to the ‘traditional roles’ of society i.e. male/female. Such emphasis on stereotyping and discrimination can exacerbate their struggle to feel accepted because they don’t fit into the rigid traditional gender structures.
When I think about how we can inspire inclusion for women and ultimately advance gender equality, for me it fundamentally starts with challenging the biases and preconceived notions that have for centuries confined women to predefined roles. This work starts needs to start early on at home and in our schools, and our media and commercial sectors have a key role to play too. I want my daughter to grow up and embrace her individuality, rather than making her choices through a gender filter. I really don’t have an issue with her loving the colour pink or wanting to be a princess – I just want to make sure that she knows that there’s a whole rainbow of colours out there and that she is more than capable of saving herself!
This blog was originally published by The Forward Trust. You can read the original 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.
On International Women’s Day, national charity WithYou urges women to come forward for free confidential advice and support with drugs and alcohol
Women and men’s experience of using drugs and alcohol, in accessing support, and in engaging in treatment are often very different.
Men make up the majority of the drug and alcohol treatment population and services are often designed and centred on their needs. For many women, services with male-dominated service user populations can be daunting and intimidating places.
A proportionately higher number of men experiencing drug-related harm means women are being side-lined in policymaking and service development, despite their specific needs. Women often face additional stigma as the ‘primary caregivers’, are disproportionately disadvantaged in the criminal justice system, and face barriers entering services which can trigger memories of abuse and trauma.
WithYou’s research,A System Designed for Women?, shows how women who have already faced traumatic experiences and set-backs throughout their lives – such as abuse, domestic violence, cultural stigma and family breakdown – are held back from getting support by services and a system that often lacks the capacity and flexibility to cater for their needs.
We aim to continuously improve our own understanding of what interventions and models of support are most effective in engaging and providing treatment that fits women’s needs, and that women want to engage in.
Research by Agenda found that women who have experienced domestic abuse are also eight times more likely to develop a problem with drugs then women who haven’t.
Sarah Allen, WithYou Executive Director, said: ‘Accessing mainstream services can be difficult for certain groups and to help more people, we need to reach out to different communities, including women, tailoring the services we provide.
‘Throughout WithYou services, we continue to take steps to improve women’s experience of accessing treatment. However, we know there is more we can do to improve our own services, ensuring they are inclusive and accessible to all women in need of support and treatment.
‘In order to help combat this, female voices must be acknowledged and centred across the health and care system.
‘It might seem overwhelming to others who find themselves in a similar situation to Kelly, but there is help, there is light and we are ready to support you – without judgement.
We really want to encourage anyone who’s struggling with alcohol or drugs, to reach out for help. We are withyou, every step of the way.’
WithYou understands that reaching out and accessing support for drug and alcohol use can be difficult with some women preferring to access materials digitally, often looking for self-help online.
WithYou’s Webchatavailable from wearewithyou.org.ukoffers free, expert advice on issues relating to drugs, alcohol and mental health, staffed by a specialised team of advisors trained to offer brief interventions, advice, signposting and emotional 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.
‘When I phone an ambulance, if I say “heart attack” I can get one out in four minutes,’ says Derek Monaghan. ‘If I say “overdose” I could be waiting an hour.’
Monaghan works for ScotRail at Glasgow Central station, where there are ‘quite a large number of overdoses and suspected overdoses’, he says. This is what gave him the idea for NaloFly, a new app designed to enable peer-to-peer delivery of naloxone when needed.
The app enables people to get hold of naloxone by alerting a registered responder – someone nearby who’s carrying it. ‘I talk to people who carry naloxone and are trained in it but say they hardly ever use it – because they don’t know there’s an overdose happening,’ he says. ‘You’re carrying it for a reason – you want to save a life – so now there’s an app to alert you if someone is having an overdose in the vicinity.’
Monaghan developed the app, while the tech side is handled by Lewis Gianello, a physics student at Glasgow University. The two originally met when they partnered on a proposal for a suicide prevention app, and are using some of the same principles for NaloFly. ‘If someone presses that button we’re alerting the people who carry it to say “you’re nearest”. And when someone calls for help it automatically contacts 999 as well,’ says Monaghan. In the event of a suspected overdose, the app will choose the nearest live carrier who will receive an alert to say help is needed. When they accept they’re instructed by GPS to make their way by foot, bike or vehicle.
Development began in 2020, and while the Scottish Government has been supportive there’s so far been no official funding. ‘We’d love to get some investment so we’re looking to the private sector to develop the next stages,’ says Monaghan. ‘There are about three or four phases in all, but we need to build a team to make that happen.’
An Android version was successfully trialled in Glasgow and provided invaluable feedback, says Monaghan, with ‘medical staff, people in the street teams telling us what they liked and didn’t like.’
One subject of early discussion was the option to call either an ambulance or a responder – ‘ambulance staff were saying “call us first” but other people said we could get responders there faster. It was 50-50 on it, so we decided we’d go with calling an ambulance and a responder at the exact same time, which means we’ve got a better chance of saving someone’s life before the emergency services turn up.’
There are two sides to the app – the recently launched carrier side, and the forthcoming public side. Naloxone carriers can download the app from a web link or QR code designated for carriers only – once they sign up they’ll be live, but with the option to turn off the app if they’re not available. After the carrier side has been up and running for a while the next stage will be a version for the public. ‘For every thousand members of the public who have it, we want 5,000 carriers,’ Monaghan states. ‘We want everybody in the UK who carries naloxone to download the app so when we go to the public we’re ready. We didn’t launch them at the same time because we wouldn’t want somebody pressing the help button and there’s no carriers in the area.’
So were there any issues of responders being uneasy about giving away their location? ‘We didn’t have any complaints about that,’ says Gianello. ‘I think people understand that we need to know their location if this is going to work – if I don’t know where you are I could be contacting you in London to come to Glasgow. We also let them delete all their data if they want to, so I can’t see any problems with that.’
‘Most smartphone apps will ask for GPS location permission,’ adds Monaghan. ‘But it will only be when using the app, so we won’t have people thinking they’ll be tracked.’
So how many downloads are they aiming for? ‘As many as possible, but if five people download it and a life is saved, then bingo,’ he says. ‘Someone presses that button and the responder says “that’s me”, and goes to save a life.’ DDN
Extreme drug-related violence in Europe is ‘putting a strain on local communities and society’, says a new report from EMCDDA and Europol.
The vastly profitable drug market across EU countries – estimated to be worth at least EUR 30bn a year – intersects with other organised crime activities like firearms trafficking and money laundering, says EU drug markets: key insights for policy and practice, with the continent occupying a ‘central position’ in drug supply and trafficking.
Not only do ‘huge’ volumes of cocaine arrive in ports like Antwerp and Rotterdam – with record seizures last year (https://www.drinkanddrugsnews.com/record-cocaine-seizures-across-europe/) – but there is also a growing trend towards cocaine production within the EU itself, the report says. Evidence indicates that Latin American and European networks are collaborating in production involving ‘the (rarely detected) smuggling of large quantities of coca paste and cocaine base to Europe for further processing into cocaine hydrochloride’. There is also large-scale domestic production of synthetic drugs and cannabis, it adds, with widespread corruption helping to facilitate trafficking.
Some EU member states are now seeing ‘unprecedented levels’ drug-related violence, the document says, including kidnappings, killings and torture. While this usually remains between criminal networks, innocent people can also be involved, increasing the ‘perception of public insecurity’ alongside corruption’s ‘corrosive effect on the fabric of society’. Drug gangs rely on corruption across all levels of the market to mitigate risks, it states, including ‘those posed by the criminal justice system’ – as well as targeting people with access to key infrastructure such as ports and other logistics hubs.
Based on 2021 data, the EU cannabis market is estimated to be worth EUR 12.1bn annually, cocaine 11.6bn, and heroin EUR 5.2bn, with MDMA and amphetamines together accounting for just over EUR 2bn. Recent shocks to the drugs market, such as COVID, the war in Ukraine and the Taliban’s opium ban, have only served to demonstrate how ‘adaptable, innovative and resilient’ criminal networks are, says the report – diversifying their methods and changing trafficking routes. European countries need to boost international cooperation, improve the monitoring and analysis of drug-related violence, and prioritise crime prevention policies focused on young people at risk of exploitation and recruitment by drug networks, the document urges.
‘Violence and corruption, long witnessed in more traditional drug-producing countries, are now increasingly seen within the EU,’ said EMCDDA director Alexis Goosdeel. ‘Violence can occur at all levels of the market. It is both a by-product and facilitator of the drugs trade – a trade that is often secured through fear and force. We need a holistic European approach to tackle this problem through strengthening our communities, building resilience and preventing the recruitment of young people into crime, providing them with long-lasting alternatives.’
‘Criminal networks infect the very core of our communities, weaving through the fabric of our democracy and economy,’ added Europol’s executive director Catherine De Bolle. ‘They erode trust, fuel violence, and create cycles of addiction and poverty. A vigilant, unified response is needed to safeguard our citizens and society from the omnipresent influence of this invisible enemy.’
A new excise duty on vaping products will be introduced from 2026, chancellor Jeremy Hunt has announced in his spring budget.
The move is to discourage non-smokers from taking up vaping, he said, with a 12-week consultation on the duty’s design launched today. The rates will be linked to the level of nicotine in the product, with a £1.00 per 10ml rate for nicotine-free e-cigarette liquids, £2.00 per 10ml for liquids containing up to 10.9 mg nicotine per ml, and £3.00 per 10ml for liquids containing 11mg or more.
‘Because vapes can also play a positive role in helping people quit smoking, we will introduce a one-off increase in tobacco duty at the same time to maintain the financial incentive to choose vaping over smoking,’ he added.
ASH said the excise duty would give additional powers to the Border Force to stop the import of illegal vapes that are ‘flooding the market and need to be brought under control’. The additional increase in tobacco taxes was also welcome as keeping vaping cheaper than smoking was ‘vital to encourage smokers trying to quit to switch to vapes, which are the most effective stop smoking aid available over the counter’, said chief executive Deborah Arnott. ‘However, it’s smokers and those trying to quit and stay quit who will be paying these extra taxes. It takes the average smoker thirty attempts before they successfully quit, and specialist support and anti-smoking campaigns can increase the likelihood of success many times over. These new taxes should be used to plug the cuts in prevention measures and help the government achieve its smokefree 2030 ambition.’
Free market think tank the Institute of Economic Affairs called the plans ‘scientifically and economically illiterate’, however. ‘Vapers did what the government wanted and gave up smoking,’ said its head of lifestyle economics, Christopher Snowdon. ‘They are now being punished for it. Combined with the ban on disposable vapes, it seems the government is intent on keeping people smoking. Not only will the tax close the price gap between vapes and cigarettes, it will send a message to the public that the health risks are similar. Since most people in Britain already wrongly believe that vaping is at least as dangerous as smoking, the government’s reckless greed will cost lives.’
The chancellor’s decision to extend the duty freeze on alcohol until next year, meanwhile – having previously frozen it in last year’s autumn statement (https://www.drinkanddrugsnews.com/alcohol-duty-frozen-until-august-2024/) – amounted to a real-terms cut, the Institute of Alcohol Studies (IAS) stated. ‘Alcohol duty freezes over the past decade have led to alcohol becoming much more affordable, with it now being at its most affordable level since before Rishi Sunak was born,’ said IAS chief executive Dr Katherine Severi. ‘This is a political choice that has directly led to increases in alcohol consumption and subsequent deaths. Let’s be clear, this is a tax break for the multinational alcohol industry, meaning the government has chosen big business over the taxpayer. It also harms pubs, as freezing duty allows supermarkets to maintain much lower prices on alcohol compared to pubs, encouraging people to drink more at home.’
Since 2019, Via’s award-winning Individual Placement and Support (IPS) Into Work service has supported people with experience of drug or alcohol issues into sustainable employment across West London.
An external evaluation of the service was recently conducted by the University of Strathclyde covering the period January 2019 to March 2022. The study combined a quantitative analysis of data from 718 clients with 27 qualitative interviews, carried out primarily with Via team members, co-located drug and alcohol service staff, and IPS clients.
We hear from three key stakeholders about the importance of (IPS) for people with substance issues, and why the evaluation has been so crucial in helping the service go from strength to strength.
Kim Archer, IPS lead at West London Alliance
Why did we apply for funding to deliver an IPS service for people with experience of drug and alcohol issues? I’ve worked with a range of people who’ve fallen out of mainstream society and found it hard to step back in. It was difficult for them to stabilise their lives and make their aspirations – such as a long-term home, stable relationships and improved wellbeing – a reality. That’s the heart of what I have to say.
But my head said, we spend a significant amount of money on treatment and recovery and the consequences of addiction in A&E, prisons and with children in care. One of the key planks to achieving sustained recovery and reintegration is growing self-esteem, earning money and having wider sets of relationships through work and social interaction.
But any support to deliver health and work outcomes needed to be scaled and replicated. I also knew this would be better delivered by people familiar with the ups and downs of people in recovery.
I’d previously commissioned an IPS service for people with mental health issues so when I read Professor Dame Carol Black’s Independent review of drugs recommend that IPS be trialled with people with experience of drug and alcohol issues, I was very keen to find ways of funding a service.
We achieved this through intensive collaboration and compromise. Gaining additional funding for people with drug and alcohol issues is not easy, as other groups of people can be seen as more ‘deserving’. But we were successful in applying to the Life Chances Fund (LCF), which allowed us to create a social impact bond. This paid for the running of the service while different outcomes were funded by some eight London boroughs, seven NHS CCGs and Jobcentre Plus.
If this sounds complicated, it was – especially as shortly after the service started COVID presented more challenges. Part of the agreement for LCF funding included undertaking an evaluation, and this is where it gets interesting. While we had fewer participants than expected initially, even during COVID 30 per cent of them found work. In some boroughs, 38 per cent of clients found work.
We’ve learnt so much from this evaluation. But key, from a commissioner point of view, is that it’s not enough to leave it to well-trained frontline teams to set up and deliver the service. You need a systems approach. All the organisations involved at all relevant governance levels need to understand and support service delivery.
Professor Adam Whitworth, professor of employment policy at the University of Strathclyde
The quantitative evaluation found that the IPS Into Work service supported a wide variety of clients and achieved a 30 per cent job entry rate overall. Most jobs were 16+ hours per week and around half of them lasted for at least 13 weeks. This is a strong performance for a new IPS service operating through the COVID pandemic.
When controlling for other factors, statistical modelling shows large, consistent and statistically significant positive impacts on clients’ employment outcomes. There is notable local variation in referral volumes and employment impacts across the eight local authorities, and this maps onto qualitative evidence of the strength of integration between the IPS service and host drug and alcohol teams.
The service delivered impressively consistent positive wellbeing benefits to clients across a wide range of wellbeing measures relating to substance recovery, physical and mental health, resilience, relationships, and positive behaviours and attitudes.
The qualitative evaluation identifies four critical success factors for a high-quality IPS service – integration, fidelity, employer engagement, and the employment specialist’s personal qualities and interactions.
Effective local integration between the IPS service and drug and alcohol teams was essential to referral volumes and job outcomes performance, and commissioners of drug and alcohol services can play an important role in facilitating effective integration where challenges exist.
Via staff showed a good understanding of IPS fidelity and were convinced that high fidelity aided service quality, client experiences and job outcomes. The quality and interactions of employment specialists were key to all aspects of service success.
Clients were overwhelmingly positive about their experiences and the quality of the support received. They particularly valued the consistency, intensity, and flexibility of support, the continual encouragement and supportive challenge, being listened to and the positive and person-centred support in response – as well as the broader commitment to their wellbeing:
‘This for me is a service that says we will help you get back into working and how does that work? I think it’s about confidence. I think it was the way he listened really… we will accept it and we will support. What you need is that feeling of being respected and believed.’
‘I lost my confidence completely. You know, I was at the very, very bottom. I was thinking that I was never going to be able to pass a job interview again. But I got a job in my career. I’ve got a plan. I’m studying this course… because they gave me the confidence.’
Rebecca Odedra, head of reintegration at Via
When IPS for addiction services was to be trialled in West London in late 2018, alongside the PHE trials across the country, it was an exciting time. It presented an opportunity to make a real difference in sustainable recovery outcomes by focusing on getting people into paid employment.
It differed from traditional education, training and employment models in the sector, using an evidenced-based model which shifted thinking to ‘work first’. It felt novel and innovative, and we could see the real benefits.
We’ve been running this service since 2019 across several London areas and it’s evident that this approach works. This has been further cemented by the IPS model being endorsed by Dame Carol Black and the government’s drug strategy, as well as additional funding from OHID and the Department of Work and Pensions. IPS has grown substantially and is intended to be in every local authority by 2025.
This study has really helped us identify areas of good practice and learning. It’s also demonstrated the real impact on individuals, services, and communities. The client perspective was one of the areas that really struck me the most. Ultimately, delivering a high-quality service requires multiple interdependencies to work well, and the strength of collaboration, joint working and relationships with clients, stakeholders, and partners are really key to this.
Via and West London Alliance would like to thank Professor Adam Whitworth and his team for carrying out the IPS Into Work service evaluation
Kim Archer is IPS lead at West London Alliance; Professor Adam Whitworth is professor of employment policy at the University of Strathclyde, and Rebecca Odedra is head of reintegration at Via
Earlier this year the University of Bedfordshire and Care Quality Commission (CQC) published a report on alcohol policy and practice in care homes. Funded by the NIHR School for Social Care Research (NIHR SSCR), it was the first study of its kind in England and the first internationally to include input from residents, families, care staff and inspectors.
Based on interviews with more than 220 people, the consensus was that while people should be allowed to drink in care homes, there was also an ‘urgent need to improve the quality of care in relation to alcohol, particularly for people with alcohol dependence, including inreach from community alcohol services’.
Alcohol was considered to be a source of pleasure for people who may not have many others, and who may be struggling with ‘deteriorating physical function and cognition’. It helped to foster a sense of community and allowed people to maintain some continuity with their life before entering the care home, the report says. Policies varied across the care homes surveyed, however, with some imposing a blanket ban and others only giving the ‘appearance’ of allowing drinking – one inspector described a facility with its own ‘pub’, complete with bar stools, Velcro dart board and fake fire. The alcohol in the pub’s optics was also fake, however – coloured water that was ‘just for show’. At the other end of the spectrum was a care home with an open bar, and one with an unattended drinks trolley accessed by someone in recovery who was then admitted to hospital with alcohol poisoning.
Safety concerns
In some premises the residents’ own alcohol was taken away to be served by staff, with its use ‘routinely monitored and recorded,’ says the report. While policies like this were the result of concerns over health and safety – the potential effects of combining alcohol with medications or liability for negligence – they also ‘may conflict with a resident’s right to self-determination, privacy and to have care tailored to their preferences’, it states.
‘We were originally approached by CQC who said they were concerned that there was less than good practice around alcohol in care homes,’ says director of the substance misuse and ageing research team (SMART) at the University of Bedfordshire’s Tilda Goldberg Centre for Social Work and Social Care, Sarah Wadd. ‘Most care staff were doing what they thought was best, and even those who were really prohibitive were doing it for the right reasons. They’d just gone a little bit too far.’
Some homes prohibited people with limited mental capacity or a diagnosis of dementia from drinking, while others admitted residents without realising they were alcohol-dependent – with the attendant risks of withdrawal. Others simply refused to admit – or evicted – people with an alcohol dependency, with managers saying that caring for residents with alcohol issues was a ‘huge workload’ or ‘legal nightmare’.
It’s hard to gauge exactly how many people are being evicted for alcohol issues, Wadd explains. ‘We looked at CQC data on evictions, and it didn’t show up too much in there. But when we interviewed staff they often talked about people being evicted, so the two didn’t match up. The problem is that if people are evicted it’s really hard to get another care home to take them, so they end up getting stuck, and it’s obviously very traumatic to be evicted or moved from one home to another.
‘Most care home managers said they wouldn’t accept people who were dependent on alcohol, and in many cases that was right – for the other residents, staff and the individuals who are alcohol-dependent,’ she continues. ‘Most care homes are caring for very frail and vulnerable people. Often they have dementia, and would get distressed if they saw someone intoxicated because they just couldn’t make sense of that behaviour. The staff often didn’t have sufficient training, so it really isn’t great for people with complex needs related to their substance dependence to be in one of these mainstream care homes.’
Harm Reduction Model
While some homes tried to care for people with alcohol dependence using a harm reduction model – without requiring them to stop drinking as a precondition of care – other issues alongside lack of training are that CQC doesn’t include management of alcohol as a mandatory part of its inspections, and residents, families and staff ‘don’t always know what good care in relation to alcohol should look like in this setting’, the document says. It also points out the significant gap in specialist residential care places for people with alcohol dependence.
Aspinden in South-East London is one of the UK’s few ‘wet’ care homes. ‘They have a lot of these in other countries – particularly the Nordic countries – but in the UK there are very, very few,’ says Wadd. ‘One of the problems with not having enough specialist homes is that often people will get stuck in either hospital or a homeless hostel because they can’t find a home that will accept them.’ Families may also minimise their relatives’ use, she points out. ‘They won’t tell the care home that they’re drinking so much because they’re desperate to get them into a home, and then the person experiences withdrawal because the staff didn’t know they were physically dependent. We also saw cases of people being coerced into stopping drinking when they weren’t ready. No one else would take them and they couldn’t live at home anymore, so they had no choice, and that’s really a breach of their rights.’
When it comes to mainstream homes, if someone ‘doesn’t want to discuss or change their alcohol use, you should not try to force the issue,’ says guidance for care staff produced by the study’s authors. With the resident’s permission, however, staff can ask someone from the local alcohol service to visit, carry out an assessment, and provide talking therapy or arrange a detox if necessary, it says, adding that it’s also important that anyone who has stopped drinking is fully supported.
Stronger Links
What mainstream care homes should be doing is recording alcohol preferences in residents’ care plans along with a risk assessment, the guidance states. So should they also be fostering stronger links with their local alcohol services?
‘Yes, and to a certain that really wasn’t happening,’ says Wadd. ‘First, many of the people weren’t ready to reduce or stop drinking, and alcohol services often don’t want to work with a group who aren’t ready to change. Also a lot of the people we’re talking about had alcohol-related brain damage or other cognitive impairment, as is very common in older people, and drug and alcohol services are really not very good at working with that group yet – some are, but most aren’t.’
While silo working has long been an issue in both treatment services and the care sector, it doesn’t need to be, she states. ‘We know that people can work with those who have both cognitive impairment and alcohol dependence. It takes a little bit of skill, but sometimes it seems people are being rejected from services when there’s no reason why people shouldn’t be able to work with both. We can never remove risks altogether, but what we would say is that they can be minimised. It takes a specific skill set to work with this population, and we did detect some stigma among staff who hadn’t necessarily chosen to work with this group. Some people with alcohol dependence can be cared for perfectly well within a mainstream care home, but for others with complex needs there need to be more of these specialist homes.’
The university has now applied for funding to look at the issues in more depth – as well as talking to people with alcohol dependence about their experience of being cared for in mainstream homes, it will also include drug use as the cohort of people with substance problems grows ever-older. ‘People in care homes have told us this is increasingly an issue,’ she says. ‘And it’s obviously going to become more and more of one.’ DDN
Robert is a resident at Aspinden Care Home, a CQC-registered facility in South East London. Operated by the Social Interest Group (SIG), its staff are fully trained to look after people with long-term alcohol issues.
Robert came to Aspinden in April 2021 after he was evicted from a supported living service. They were unable to manage his high alcohol intake, erratic and anti-social behaviour and deteriorating mental health. He presented with very challenging behaviours and non-engagement for the first few months. However through our harm minimisation model and our caring, supportive and stigma-free environment, Robert was able to develop trust in our service and staff. We were able to work closely in partnership with our local GP, on-site nurses, and community mental health teams to stabilise Robert. He has an agreed daily plan for his alcohol, which he adheres to, and he participates in many of the home’s activities, keeps his environment clean and is independent with his personal care. There have been no signs of him going into crisis or evidence of any anti-social behaviours and he is a joy to work with.
At Aspinden our client group tends to be older adults who’ve been known to social services for many years and ‘bounced around’ due to their complex health conditions and support needs. This is a barrier we have to overcome with most new residents as they tend to have lost faith and trust in professionals. Our aim is to be the long-term, stable environment that they’ve never had but ultimately all deserve.
‘We’re at a pivotal point… there’s a lot to do.’The vice chair of the Royal College of General Practitioners says that addiction involves many complex problems and ‘the solutions won’t come from medicine alone’. She was speaking at the RCGP’s joint conference with Addiction Professionals (AP) and throughout two days there was animated discussion about addressing all the other things going on in a person’s life – the things that profoundly influence health.
We’re at a pivotal point. Prof Dame Carol Black tells us that we need to make our case for why a boost in funding has not had the desired impact on drug-related deaths. We have the evidence to fight for more funding – synthetic opioids are flooding the market, prison aftercare is under-resourced and inadequate, alcohol strategy is in its infancy, mental health and addiction services are not working in harmony as they should be, vital specialisms are draining away when they’re more needed that ever, the workforce is demoralised… to say there’s a lot to do is an understatement.
So I’ll point you in the direction of inspirational initiatives on every page of this month’s issue and urge you to get involved. Feedback to your DDN community about what’s working well – and share your challenges.
Read the March issue as an online magazine (you can also download it as a PDF from the online magazine)
The number of people estimated to be sleeping rough in England on a single night in Autumn 2023 was up by more than a quarter on the previous year, according to the latest figures from the Department for Levelling Up, Housing & Communities.
The estimated figure of 3,898 was 27 per cent higher than 2022’s total, according to Rough sleeping snapshot in England: Autumn 2023. While the government points out that the figure is 9 per cent lower than in 2019 – before the introduction of its ‘Everyone In’ scheme during COVID – and 18 per cent lower than the peak figure in 2017, it is still an increase of 120 per cent since 2010 when the ‘snapshot’ approach was first introduced.
London saw the largest increase in the number of people estimated to be sleeping rough, at 1,132 – more than 30 per cent up from 2022’s figure of 858. Almost half of all people sleeping rough are in London and the South East, consistent with previous years, although rough sleeping increased in every region compared to 2022. The majority of people sleeping rough in England are male, over 26 and from the UK, the report states. However, the number of women sleeping rough was also up by 22 per cent to 568.
St Mungo’s chief executive Emma Haddad said the government’s ambition to end rough sleeping had been ‘undermined by a string of policy decisions that are not about prevention but more a quick fix – we need a new political approach that takes a strategic view across the whole housing system and beyond’.
Shelter pointed out that the new figures are likely to be an underestimate, as ‘people who sleep in less visible locations can be missed’ while Crisis chief executive Matt Downie called the figures ‘a source of national shame’. They constituted a sign of extreme inequality that must ‘prompt a rethink at the highest levels of government’, he said. ‘It cannot be overstated how dehumanising sleeping on the streets is. Through our frontline services we hear directly from people who have been spat at, urinated on or attacked simply because they do not have the security of a safe home. Things have got to change. To bring these numbers down, we urgently need the Westminster government to put long-term funding into the proven solutions we know help people to leave the streets behind, such as Housing First.’
The ‘appalling’ spike in rough sleeping pointed to a situation that was ‘out of control’ and demanded emergency action, added Homeless Link’s director of social change Fiona Colley. ‘Sleeping rough is a deeply traumatic experience that severely impacts people’s mental and physical health. If a healthy society is judged by how it supports its most vulnerable citizens, then today’s statistics are truly shameful. A range of long-term factors are behind this steep increase, including a severe shortage of affordable homes, a punitive welfare system and insufficient mental health support. We urge the chancellor to use the spring budget to safeguard essential homelessness support by announcing an emergency backdated inflationary uplift to homelessness funding.’
Steps Together Group provides private residential and outpatient services for individuals, families, employers and communities to confront the devastating impact of addiction or poor mental health.
FOUNDED IN 2017, Steps Together was created when CEO Darren Rolfe found his own recovery from addiction and poor mental health using the 12-step abstinence-based model in the 1990s. Darren’s passion for recovery inspired the creation of Steps Together with its mission to create a range of services that would truly make a difference.
Private healthcare
At Steps Together UK, we offer a range of private treatment and therapy programmes providing the very best in private care. Supporting our colleagues in the NHS alongside community services, we can reduce the impact that addiction and poor mental health have on individuals, their loved ones and our valuable NHS resources.
Some of the benefits of choosing private support with Steps Together are:
Rapid access to responsive clinical treatment at home, or at one of our expert UK-based residential and outpatient centres.
Expertly designed and delivered counselling and therapy programmes that really change lives, thinking and behaviour – ensuring lasting change and recovery.
Homely, welcoming and safe residential care options at our UK-based range of treatment centres, ensuring the most comfortable treatment and care.
An extended range of therapy and treatment for the whole family, ensuring recovery from addiction and mental health is available to all those affected by the devastating impact of these illnesses.
What we treat
Drug- and alcohol-related addiction affect more than 1m adults in the UK every year, and countless families, loved ones, communities and public services.
At Steps Together we have dedicated, expert multi-disciplinary teams that work with evidenced-based therapy programmes. Combined with professional clinical care, they meet the unique needs of each individual.
We provide residential and outpatient solutions for addiction to alcohol, illicit (illegal) drugs and prescribed medication.
Allied addictions
Addiction to either drugs or alcohol doesn’t happen in isolation, and there can be many underlying reasons for becoming addicted.
Our range of programmes is designed to treat:
gaming or gambling addiction
sex, pornography, love or relationship addiction
work addiction
digital and technology addiction
Mental health
Poor mental health affects nearly one in six people weekly and often leads to unhealthy use of drugs, medication, or alcohol. We support individuals and their families to secure excellent emotional and mental health and wellbeing through our range of specialist residential and outpatient services, for experiencing difficulty with:
anxiety, stress and burnout
depression or low mood
attention deficit hyperactivity disorder (ADHD)
personality disorders
obsessive compulsive disorders (OCD)
trauma and post-traumatic stress disorder
Clinical care
Our psychiatry and clinical treatment programmes match the very best clinical excellence. They closely follow guidance from the National Institute of Clinical Excellence (NICE) and support our core values of safety, effectiveness and responsive care and treatment.
Managed by our dedicated inpatient and outpatient clinical teams, they are monitored by the Care Quality Commission (CQC) and operate in line with the most up-to-date Public Health England (PHE) and UK Government Department of Health and Social Care (DHSC) regulations.
Therapy care
Our range of inpatient and outpatient psychiatry, therapy and counselling programmes are key to help you on this journey to recovery, and we will stay by your side every step of the way while you and your loved ones explore the thoughts, feelings and behaviours that need to be understood and changed for a successful outcome.
Our evidence-based range of programmes, expertly designed and delivered by a fully qualified team of psychiatrists and counselling therapists, are registered with the British Association of Counsellors and Psychotherapists (BACP). This ensures that our clients, their families and others receive the very best regulated and ethical therapy to ensure a successful recovery from mental health problems, poor wellbeing and addiction.
Email or call us today to secure your free and confidential assessment with one of our expert treatment advisors.
Rainford Hall provides a sanctuary, for luxurious and discreet private treatment for addiction or poor mental health and wellbeing.
Perfectly positioned on the outskirts of Lancashire & Merseyside, Rainford Hall Estate provides circa 600 acres of woodland and open countryside, a perfect luxury retreat for recovery.
St. Helen’s, Merseyside: Fenny Bank Cottage is quietly positioned on the South West corner of the estate, surrounded by beautiful fields, woodland, wild game birds and extensive views across the rolling countryside of St Helen’s borough beyond.
Fully refurbished, sympathetically restored and modernised, this cottage offers discreet, bespoke packages of accommodation for up to 10 people across four beautifully dressed bedrooms.
Bank House, the first Steps Together treatment centre to open its doors in 2017, is a testament to the commitment of Steps Together to providing affordable, quality, and effective addiction treatment to those in need.
Located in Nottinghamshire, Bank House has been providing treatment to individuals and families for over six years, and remains one of the most affordable treatment centres in the country.
Located in the idyllic rural village of Arnesby in South Leicestershire, The Chestnuts provides an oasis of calm for those looking for relief from stress, anxiety and addiction, with the perfect place to retreat, relax, unwind and soak up the peace and tranquillity, whilst undergoing treatment and therapy.
George House is a recovery hub located in the suburb of Sutton-in-Ashfield in Nottinghamshire. It’s been designed as part of Steps Together’s Bank House residential service and is less than 10 minutes’ walk away.
The building has been designed as a stand-alone facility providing private healthcare services to all those affected by the impact of addiction or poor mental health issues.
Elizabeth House, a unique second phase rehabilitation service situated in the Nottinghamshire neighbourhood of Mansfield Woodhouse. It provides a semi-independent approach to rehabilitation therapy together with a committed staff of project workers and therapists for support.
It can be daunting to leave primary residential treatment services, many clients find that a short-term treatment plan is insufficient because they are not yet prepared to return home and deal with the numerous problems and temptations that formerly made their addiction possible.
‘THERE ARE TWO KEY PARTS to coming off and staying off drugs,’ says Kim Hager, joint commissioning manager and drugs strategy partnership lead at Cornwall Council. ‘One is medical – coming off the actual drugs people are dependent upon. The other is improving social functioning, so that people can sustain their recovery successfully.’
With this in mind, the council has increased funding for WithYou in Cornwall’s Life Skills team, enabling it to work with more than 300 people across the county who are experiencing challenges with drug or alcohol use. The aim is to provide expert advice – but also the ‘structure, stability and human interaction’ that are so vital. ‘We’re starting to see the positive impact that this is having on people’s lives,’ says Hager.
Alongside drop-in groups, the team provides advice on benefits, debt and housing, and digital skills training to help people back into employment. They give ‘cooking on a budget’ classes to help improve physical health and walks to support mental wellbeing, as well as specialist sessions, including for members of the armed forces community.
The women-only support group The Fabulous Flamingos provides a safe space for women to talk to other women about their trauma and explore other forms of support through an integrated and reassuring approach – an environment that’s ‘very inclusive’ and where ‘everyone is embraced’, according to an attendee, Kim. ‘There wouldn’t be much variety in my life without the group,’ she says. ‘I always leave feeling much better than when I arrived.’
Hager knows that ‘for many people, drugs have become a solution to the problems they are experiencing, which can include housing, employment or mental wellbeing’ and hopes that investing in life skills will play a dynamic role in reducing drug deaths. Feedback from participants shows the initiative is making a difference by working in partnership to get people feeling back on track.
‘I’d be in a pretty vulnerable state right now if it wasn’t for the support of the Life Skills team,’ says Sophie. ‘I’ve been supported, understood and empowered through completing life skills around accessing benefits. They also consistently update me about groups and events and try to help reduce my social isolation. I really appreciate that they haven’t given up on me.’
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WELCOMING HUB
A NEWLY REFURBISHED RECOVERY LOUNGE is providing a much-improved community hub in Yeovil. Peers from Turning Point’s Somerset Drug and Alcohol Service (SDAS) renovated and refurbished the lounge, adding bespoke artwork by a talented SDAS client.
Named Matt’s Recovery Lounge in memory of their much-missed peer Matt, the warm and welcoming space was generously funded by Matt’s parents, Sue and Peter Ricketts, with additional support from Somerset Council.
The idea stemmed from needing somewhere to offer support and friendship to people who are struggling all year round, not just a drop-in at Christmas. ‘We’re thrilled to be able to offer this greatly improved space to the community in memory of Matt,’ said Joseph, peer mentors and volunteers team leader.
‘It is a place where everyone is welcome to come and have a warm drink, play a game, read a book or engage in friendly conversations with our SDAS key workers or peer mentors. We will strive to make this a space where everyone feels safe, valued and respected.’
This week, The Forward Trust put out a national alert to its staff on synthetic opiates – CEO Mike Trace explains why.
Week after week, alert after alert to frontline drug services – it’s clear that synthetic opiates are here and are entering the UK drug supply with more frequency than any of us would like.
Look across the pond at the US and the devastation of synthetics dominates illegal drug supply. The scale of the US public health crisis is notably different to the UK, but this disparity should not be a cause for complacency. A UK-specific response is required and it’s important to raise the alarm. Whilst treatment services are starting to warn their clients about the dangers of new synthetics hitting the UK, the rising scale of the problem means the message needs to go out much more widely to the public.
That this isn’t just a drug services problem. The earlier we trigger a comprehensive response the better. Impactful measures rolled out in some services need to be factored into a national response and they need to be factored in quickly. We need:
A national public health campaign to alert drug users (and wider public) on the rise of synthetic opiates in UK drug supply.
Accessible and simple ways to check drugs for synthetic opiates, through drug checking services in healthcare settings, in the nighttime economy and core community settings.
A continued and accelerated role out of naloxone to key frontline public servants such as police, prison officers, GP’s and wider charitable services – with dosage required to address synthetic opiate overdose.
Ease of access to naloxone in UK towns and cities, focussed on key at risk groups such as street homeless population.
Accelerated data collection, and rapid testing/screening on any suspected overdose that results in naloxone treatment, or any suspected overdose death – triggering urgent public health response in local areas.
Continued and increased access to drug treatment and recovery support services, demonstrating to people in a cycle of addiction that another way is possible.
There is no doubt that the drug market in the UK is shifting in a worrying direction. Yet, we know there are measures we can take. Accessible and accurate safety advice, harm reduction services, and always offering people living with addiction a practical way out. At policy level, the government and local authorities have to get over their squeamishness about ‘tolerating drug use’, and facilitate the interventions that will reduce the risks of overdoses and deaths.
Ultimately, the long term solution to this challenge is to reduce demand for opiates in the first place. Addiction, no matter how entrenched, is a treatable condition. Recovery from it is possible, with the right levels of support and access to specialist interventions.
It would be a great tragedy if our response to synthetic opiates missed the most important element to disrupting a drug market – taking people out of it and giving them the chance of a different life. We believe this is not only possible, but fundamental to any response.
If you are worried about drug use for you or your family, Forward’s Reach Out chat service is available Monday to Friday, 9am-3pm. If you suspect you have or someone in your company has taken or is experiencing an overdose, this is a medical emergency. Call 999 immediately.
This blog was originally published by The Forward Trust. You can read the original post here.
Related articles:
(Features, November 2023): Stayin’ Alive, Now’s the time to get out strong messages on nitazenes – Information and resources.
(Partner Updates, September 2023): Release, alongside EuroNPUD and other drug treatment service colleagues in the UK, have produced harm reduction advice on nitazenes.
(Features, June 2017): Meet the Fentanyls, a guide to the fentanyl family by Kevin Flemen.
Codeine linctus is to be reclassified as a prescription-only medicine, the Medicines and Healthcare products Regulatory Agency (MHRA) has announced. The move is the result of the medicine’s ‘risk of abuse, dependency and overdose’, it says.
Codeine linctus is an opioid medicine used as an oral solution or syrup for treating dry coughs, and has previously been available to buy under the supervision of a pharmacist. Following a consultation with almost 100 healthcare professionals, patients and independent experts, however, it will now only be available on prescription after assessment by a medical professional.
‘Patient safety is our top priority,’ said MHRA’s chief safety officer, Dr Alison Cave. ‘Codeine linctus is an effective medicine for long-term dry cough, but as it is an opioid its misuse and abuse can have major health consequences. We would like to thank all the patients, independent experts and health professionals who responded to our consultation. As a result, and taking into account the reports we have received in relation to abuse, we have reclassified codeine linctus to a prescription-only medicine for the benefit of patients, carers and healthcare professionals across the UK.’
A report from ACMD has also recommended that the non-opioid tranquiliser xylazine should be made a class C substance. While approved for use as a sedative, muscle relaxant and analgesic in veterinary medicine, xylazine is ‘increasingly being used illicitly by humans internationally and in the UK’, the report states. The drug is often combined with fentanyl in the US as ‘tranq’ or ‘tranq dope’, with the Food and Drug Administration (FDA) issuing an alert related to the increased prevalence of overdose deaths involving xylazine in 2022.
The Forward Trust has announced it has been awarded the contract to deliver an integrated substance misuse services for adults and young people in Thurrock, in partnership with Open Road.
The service, which will go live on 1st April 2024, will support people in Thurrock and the surrounding areas who have issues with drugs and/or alcohol. Open Road, which specialises in empowering a diverse range of people to lead healthy and more meaningful lives, will provide the young person’s service, which will support children and young people up to the age of 29 with tailored interventions.
The service will build upon Forward’s existing support for people in the surrounding areas with substance misuse issues, as the charity already delivers community substance misuse services in Medway (also in partnership with Open Road), Southend-on-Sea and East Kent.
Service users are at the heart of everything Forward does. As such, co-design, a process which involves clients in the design and delivery of services, will form a crucial part of this new contract. Forward will also embed peers with lived and living experience throughout service delivery. This new service will also be ‘trauma-informed,’ an approach that seeks to address the barriers that people affected by trauma can experience when accessing health and care services.
Other partners will include charities such as Open Door and the Essex Recovery Foundation, as well as local partners in mental health, primary and secondary care, adult social care and children’s services, criminal justice services and housing services.
Forward Trust executive director of substance misuse Jason Moore said, ‘I am thrilled that Forward have been awarded this contract, and the opportunity to support the people of Thurrock who need help to address drug and alcohol issues. We know first-hand how, with the right support, people can and do transform their lives, and are excited to work with local partners to deliver this life changing work.’
Open Road CEO Sarah Wright added, ‘We are delighted to be working in partnership with Forward to help young people and young adults up to the age of 29 in Thurrock who have drug and alcohol problems. This service will help change the lives of young people, young adults, and their families.’
This blog was originally published by The Forward Trust. You can read the original 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.
In this piece, we look at the case of a previous drug treatment service user, Sarah, who experiences chronic pain related to long-time disabilities and has been penalised for seeking to treat her severe pain while also looking for assistance with opioid dependence.
Sarah was only five years old when she first began experiencing chronic pain. Despite this, she didn’t receive a formal diagnosis until the age of 15, and by this point she was already using heroin to manage the condition. Using illicit opiates on top of her prescribed medication soon became untenable, and Sarah entered drug treatment at the age of 19.
Patients who report chronic pain can be treated with suspicion at the best of times – when also accessing drug treatment, that suspicion is compounded. When she first presented at her local treatment service, Sarah was being prescribed a range of pain medications including opiates, diazepam and gabapentin. In order to begin methadone treatment, however, she was told that she would have to give up all of these medications – no effort was made to factor her disability into her treatment plan.
Part of the problem comes down to the fact that substance dependence and pain management are dealt with by different doctors sitting within different institutions, making it much harder to take a holistic approach.
After several years without sufficient pain medication, Sarah was fortunate enough to see a consultant at a specialist orthopaedic hospital. The consultant had particular experience working with patients with a history of illicit drug use and dependence, working from an assumption that pain patients are telling the truth and are generally not exhibiting ‘drug-seeking behaviour’. As such, the consultant prescribed Sarah an adequate amount of medication to control her pain, and took the view that to not do that would be more risky as it would leave her under-dosed and forced to top up through the illicit market.
Unfortunately for Sarah, this principle was not well understood by her other doctors, despite it being stated in the NICE guidance. Prescribers would often seek to reduce her pain medication even when she was being seen by them for entirely unrelated reasons. On one occasion in 2022, Sarah saw her GP regarding recurring eczema.
With little discussion, the doctor made the decision to completely stop Sarah’s diazepam prescription, without tapering and despite Sarah’s objections on the grounds of dangerous withdrawal. Sarah went on to experience symptoms including delusions, hallucinations, and three or four seizures every day. By the fourth day of withdrawals, Sarah turned once again to the illicit market out of desperation. After a week the prescription was quietly reinstated.
Sarah is now in recovery – for her, this means no longer using non-prescribed illicit drugs. For others in the recovery world, however, this is insufficient – Sarah has continued to encounter hostility and suspicion in recovery support spaces that deem any substance use, prescribed or not, to be unacceptable.
She’s found that a lack of understanding of chronic pain and disability is widespread across all levels of the drug and alcohol field. Since then she’s gone on to work in treatment services herself, and has worked hard to advocate for improved accessibility and inclusion for disabled and chronically ill clients.
Drug treatment services have a difficult task ahead of them, as the fractured health and social care system makes it more and more challenging to provide any person with holistic care. These services have a greater responsibility to do better by people experiencing chronic pain, as we know that without addressing the pain itself, many of the goals people come to drug treatment with will not be realised.
While structural changes are ultimately needed to address the fragmentation of healthcare, we can start to do right by patients with chronic pain by advocating for them to get the person-centred treatment they need, and – above all else – by believing them when they tell us what the problems are.
Fraser Parry is drugs advocacy and support adviser at Release
There are still barriers to accessing residential rehab in Scotland, according to a Public Health Scotland (PHS) report.
Perceptions of residential rehabilitation among referrers is the first evaluation of the Scottish Government’s five-year residential rehabilitation programme, which was launched in 2021 to improve access to residential facilities. While there was some evidence of progress, ‘barriers to accessing residential rehab do still exist’, the document concludes.
Bed capacity has increased by 8 per cent and the last financial year saw more than 800 rehab placements approved for public funding. However, only a quarter of referrers thought residential rehab was easily accessible, and less than a fifth of people who used drugs ‘felt reasonably well informed’ about residential provision. Alongside structural barriers like long waiting times or lack of space were lack of time or resources to help clients prepare for rehab and lack of facilities near to where clients lived, the document states.
Other barriers identified included lack of suitable provision for people with caring responsibilities or mental health issues, long waiting times for detox, and concerns about aftercare, says PHS. The agency will publish its final report on the programme in 2026.
‘This report is the first output of our independent evaluation of the Scottish Government residential rehabilitation programme – we hope its baseline findings can support important discussions on residential rehabilitation in Scotland,’ said director of population health and wellbeing at PHS, Ruth Glassborow. ‘Our report found evidence suggesting some progress towards increasing access to individuals, however, there are still significant barriers that people face. There is also a risk of uneven progress across different parts of the country which may exacerbate existing health inequalities.’
‘I can’t change anything that happened but it’s not what defines me – today is what defines me.” From spending £300 a day on crack cocaine to working with a charity that helped save her life.
Kelly from Darlington began ‘experimenting’ with drugs in her late teens, using a mix of substances including cannabis and LSD. She was first introduced to crack cocaine at the age of 22, using it alongside other drugs and alcohol.
Having started to use crack cocaine, Kelly found the strength to reconsider her decision and stopped. It was after a family-related bereavement, a difficult relationship which included domestic violence and post-natal depression that Kelly began taking crack cocaine again alongside cocaine and alcohol in 2022. She was spending up to £300 a day on crack cocaine and she worked to support her family and to help fund her drug use.
Kelly was able to mask her substance use for a time but after deep struggles with her mental health alongside drug use, her children were placed into care.
After reaching breaking point, Kelly sought support from local drug and alcohol support service, WithYou in Darlington at STRIDE. She built a strong relationship with her key worker, Heather and other members of the team who helped Kelly find a path to recovery.
Kelly’s children have been legally returned to her care and she is now working within the Darlington team and partners Recovery Connections, to support others through their own recovery journey.
Kelly said: ‘I’d gone through postnatal depression – almost died from giving birth to my little boy. I had to be strong, so I just masked everything that was going on with me and drugs.
‘There was so much going on with my mental health – so much hurt. My sister’s partner died in 2015, I was in a toxic relationship – he was a heavy drinker, there was domestic violence. The person that I was, was very chaotic; I dealt with things in the wrong way. I was irrational and up in the air.
‘The day I ruined myself was by picking up crack cocaine again. It was just a release for me. It just took away all those emotions and those feelings. It had such a detrimental effect on my mental health – I didn’t want to be here any more. In April 2022, my children were temporarily removed from my care.
‘I came to WithYou absolutely broken. It was the hardest time of my life. I wanted my children home. I wanted to do anything I had to do – I had to reach out. I wanted anything and anyone to help me sort my life out, and thankfully I got that help.
‘I saw Heather and she was my WithYou key worker. She was amazing – such a mother figure and someone who understands and had that belief in me. I ended up being part of the furniture. As opposed to running to a drug or running away, I’d come here to talk and get some clarity rather than knocking on a dealer’s door. I knew I was getting better and healing and making the right choices and decisions. I had to get my head down and push through under difficult circumstances.
‘It’s being around people who understand you, who aren’t judging you, who have got the answers – you have to do the work but you’ve got guidance. It’s not about people looking down on you for your mistakes or choices – they’re giving alternatives. They’re giving you that second chance when you need it the most.
‘I’m proud of myself. I’m grounded and content and positive and I love myself and the people around me. I want to be able to support others. It is achievable and doable and I know I’m living proof of it. I wouldn’t have gotten to where I am today without WithYou.’
Thanks to the determination and support of Kelly and WithYou, it has been nearly two years since the last time Kelly used crack cocaine. Despite a number of huge challenges and legal processes, her children were legally returned to her care; a “beautiful” time for Kelly and her family.
Gary Besterfield, Head of Service Delivery at WithYou in Darlington at STRIDE, said: ‘Every single member of staff including our partners are proud of Kelly. From being in the place she was to being able to fully engage with the help offered and achieve what she achieved through sheer determination, is incredible.
‘It might seem overwhelming to others who find themselves in a similar situation, but there is help, there is light and we are ready to support you – without judgement.
‘We really want to encourage anyone who’s struggling with alcohol or drugs, to reach out for help. We are with you, every step of the way.’
Kelly is concerned about similar challenges faced by others, especially mothers and wants to advocate for them, addressing the stigma often associated with addiction or accessing support. Kelly is grateful for the support of WithYou and partners like Recovery Connections, and proud of her strength and determination which helped heal her family and herself.
Kelly added: ‘Visible recovery is massive, especially from people with lived experience who are relatable and not going to hide. I can’t change anything that happened but it’s not what defines me – today is what defines me.’
If you or someone you know is struggling with alcohol or drugs in Darlington contact call 01325 809 810 or visit the website wearewithyou.org.uk for more information or to use our free, confidential webchat service.
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.
2024 marks a special year for Adfam, as the charity celebrates its 40th year.
Adfam was established in 1984 by Simon Ann Dorin, who could not find the support she needed to deal with her son’s heroin use. In its early years, Adfam was run by volunteers using the vestry at the back of St George’s Church in Campden Hill, West London. Over time, Adfam has evolved, adapted, and changed – but our mission has always remained the same: to improve life for families affected by substance misuse.
Over the course of 2024, we will be releasing a series of monthly articles, reflecting on Adfam’s 40 years, where things have improved for families, and where we still have progress to make. We’ll be speaking to key people that have been active in supporting families affected by substance misuse throughout those years, including professionals, people with lived experience, academics, and policy makers. We want 2024 to be a year of conversation, where we talk openly, honestly, and freely about the impact of substance misuse on families, and to overcome the stigma.
For our first Adfam at 40 article, we speak with Adfam’s chief executive Vivienne Evans OBE, who has led Adfam since 2001 – over half of the charity’s life.
In conversation with Viv
When Viv joined Adfam as chief executive in 2001, a key feature of Adfam’s work was its projects in prisons, having teams situated in prison visitor centres, delivering support to people with a loved one that was incarcerated because of their substance misuse. This support was groundbreaking at its time and provided a vital lifeline that offered guidance and clarity to families affected in this way.
Viv’s strategy and ambition was to grow the charity further to become a campaigning organisation too, and one that influenced policy. One of the first new projects under her stewardship was the development of Guidance and good practice in working with families, which was made available to professionals in health and social care sectors. The resource was co-produced with people with lived experience, something which became a key feature of Adfam’s philosophy moving forward.
At that time, there were many smaller, local, family support groups based in most local authorities in England, largely run by people with lived experience and offering peer support to families affected in this way. Adfam gradually took on the role of an infrastructure organisation, bringing together and representing those different groups as one. Sadly in 2010, a lot of the funding for family support groups disappeared, with many either being absorbed into drug and alcohol treatment services or having to close altogether.
Adfam itself has had to navigate the ever-changing funding environment, previously receiving core funding from the Department of Health until 2007 and in 2010 losing the funding for most of its prison services. In more recent years, funding from trusts and foundations has also become increasingly harder to attain, and Adfam has adapted by offering services to local authorities whilst utilising its training offer. Despite being under pressure to survive, Adfam continues to be flexible in an increasingly difficult environment and continues to provide the vital support that families need.
Adfam’s trajectory has seen its work take various forms, from delivering direct services, influencing policy, promoting good practice, working with officials to represent and give a voice to family members, working with local family groups, promoting our training, and working in co-production with people with lived experience. Once again, the delivery of direct services has become a key part of Adfam’s work, and this has never been more evident than with our Adfam@Home service which offers family members remote 1:1 support with a trained family support professional.
Whilst Adfam is no longer an infrastructure organisation, it continues to be the voice for families within the sector and plays a key role bringing together others and campaigning for change by facilitating the Alcohol and Families Alliance (AFA), and Alliance of Family Support Organisations.
How experiences of families have changed over time
Whilst lots has changed over Adfam’s forty years, the experiences of family members affected by substance use are still very much apparent. There are still thousands of people using drugs and alcohol problematically, with many more family members who are affected by their use. The need for support for families hasn’t gone away and never will.
Viv suggests that despite this, the needs of families have become more complex and long-lasting in recent years, highlighting links with financial difficulties and the cost of living, links with domestic abuse and violence, and mental health to name but a few. What’s needed, but has so often been lacking, is an integrated approach to supporting these families, as the substance misuse almost always isn’t the only problem.
Furthermore, families’ voices continue to be stigmatised. Whilst there has been a gradual shift in recognition and understanding of the issues, there’s still not enough; more needs to be done to raise awareness of the issues facing families affected by substance use to get their voices heard. Viv stresses that the above doesn’t just apply to adult family members and friends either, we must ensure the needs of children are not forgotten too.
Adfam’s major landmarks
When asked about Adfam’s major landmarks as a charity throughout the years, Viv spoke about the ways Adfam has always tried to break new ground, by identifying the experiences of specific groups and ways people can be affected by someone else’s substance misuse and improving their lives.
Examples of this include the BEAD project supporting those bereaved through substance misuse, working with families of veterans with substance misuse problems, families of gamblers, families of people with hepatitis C or who inject drugs, those experiencing child-parent violence and abuse, families supporting a loved one with a dual diagnosis, or Foetal Alcohol Spectrum Disorder (FASD). Throughout these various initiatives, Adfam has always believed in working in partnership with others and sharing expertise and knowledge.
Adfam has consistently been an organisation that uses its expertise to share guidance and good practice around families and substance use, along with training courses that have been developed in response to the changing needs of the workforce. Adfam’s training courses often attract attendees from across health and social care sectors, and Viv believes that training on children, families, drugs and alcohol need to be incorporated into the training that’s available to all professionals, to ensure families receive the best support to meet their needs.
Furthermore, Adfam has had a high degree of success with its policy and influencing work. Viv shares recent examples of where families are now included in the Drug and Alcohol Treatment and Recovery Workforce Transformation Programme, the Commissioning Quality Standard, and in the Drugs Strategy. Previously, families would not have been mentioned or considered, but because of Adfam’s persistence and resolve in the policy sphere this is now changing.
Above all else, Viv stresses how fortunate she has been in always working with a committed group of people; committed to Adfam’s cause and committed to putting the needs of families at the heart of everything that Adfam does, which makes a huge difference.
Ultimately, Adfam has survived by being flexible, adapting to the external environment, adapting to changes in funding opportunities, but all the while refusing to be driven from its course.
Reflections for the future
When asked for her reflections for the future, and what she would like to see happen and change, Viv was reluctant to state the obvious in calling for more services for families. However, it is hard to escape the importance of families receiving support in their own right. Whilst we know all too well the huge impact substance use can have on others, we also recognise that family members contribute to and are a key component in people’s recovery, and they are a very important and cost-effective benefit to the welfare state and the economy of this country by providing support to their loved one.
Viv attains that more recognition of families is also needed within existing health services, and the specific needs of families affected by substance misuse should be integrated across all welfare services. And ultimately, we need more recognition across society, with more sympathy and understanding, and less stigma.
From a personal point of view, Viv reflects on how she has learnt such a lot since coming to Adfam and remains committed to improving the lives of families. Whilst we know there are 5 million people affected by this issue in the UK, it continues to be striking that due to the shame and stigma, all too often they don’t speak out and are hidden in plain sight.
Viv concludes by saying, ‘Whilst we’ve come a long way there’s still more to be done. Over the next year we want to give people the agency and opportunity, the courage, to speak out, because only then will we get the real change that we want.”
This blog was originally published by Adfam. You can read the original post here.
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Plans to continue with the minimum unit price (MUP) for alcohol in Scotland, and to increase it by 15p to 65p per unit, are to go before the Scottish Parliament for approval.
When the MUP legislation was introduced in 2018 it was subject to a ‘sunset clause’, meaning it will expire in April unless MSPs vote to keep it in place.
If the Scottish Parliament agrees, the new price will come into force at the end of September, with the aim of countering the effects of inflation, the Scottish Government states. Despite the introduction of MUP, however, the most recent Scottish alcohol death statistics showed the highest number of fatalities since 2008 (https://www.drinkanddrugsnews.com/small-increase-in-scottish-alcohol-deaths/), and there have also been concerns that some dependent drinkers are cutting back on food and other essentials in order to buy alcohol.
‘We believe the proposals, which are supported by Scotland’s chief medical officer, strike a reasonable balance between public health benefits and any effects on the alcoholic drinks market and impact on consumers,’ said deputy first minister Shona Robison. ‘Alongside MUP, we will continue to invest in treatment and a wide range of other measures, including funding for alcohol and drug partnerships which rose to £112m in 2023-24.’
‘We welcome this uprating, which will keep prices in line with inflation and ensure that minimum unit pricing continues to be an effective measure in tackling our nation’s complex relationship with alcohol,’ said WithYou’s policy lead for Scotland, Graeme Callander.
‘However, we know that minimum unit pricing will not help or protect some of the most vulnerable people in our society – those who are already drinking harmfully and will find a way to keep drinking, regardless of the cost. In order to reach these people, and ultimately save lives, the Scottish Government needs to ensure that well-resourced alcohol treatment and support services are available in communities across Scotland.’
Progress towards achieving the government’s drug strategy objectives risks being wasted without funding certainty for local authorities, warns a report from the Public Accounts Committee (PAC).
The fact that the government has only committed to funding until 2024-25 will make it difficult for councils to ‘rebuild’ the treatment workforce, it says. ‘The PAC is disappointed that government departments seem unwilling to explore how to provide local authorities with more confidence over long-term funding,’ it states.
Efforts to reduce drug-related harm were seeing ‘mixed’ progress, according to the committee. The report welcomes the achievement in recruitment so far, with more than 1,200 new drug and alcohol workers already recruited by last year against a target of 950 by 2024-25 (DDN, November 2023, page 4), but finds ‘less progress in reducing drug use and related harms’.
The 80 per cent increase in drug-related deaths in the decade to 2021 was unacceptable, it states, with the sharp rise in drug use among younger people also ‘particularly concerning’. Although the latest OHID figures show a 10 per cent increase in the number of young people in contact with treatment services (DDN, February, page 4), the number fell by 50 per cent between 2010-11 and 2021-22, the report states.
Annual spending on treatment services fell by 40 per cent in real terms between 2014-15 and 2021-22, a ‘significant erosion of councils’ capacity and capability to deliver in this area’, and creating variations in local outcomes that have yet to be properly addressed. ‘Despite high drug use in particular amongst young people, the government’s strategy makes little reference to age, gender, ethnicity, or how people with different characteristics may experience drug misuse and treatment,’ says the committee.
‘The report therefore calls for the government to properly understand the barriers facing differing cohorts of people who use drugs and ensure that councils are sufficiently targeting these groups.’ Departments will also need to work collaboratively and adapt to evolving threats, it adds.
‘The tragic deaths and harms caused by illegal drug use are a desperate blight on our whole society,’ said committee chair Dame Meg Hillier MP.‘As with our previous alcohol treatment services report, our committee is having to remind government that local authorities need long-term certainty to carry out what is some of the most challenging treatment there is to provide.
Some progress has been made, in particular in recruiting 1,200 new alcohol and drug workers and bearing down on county lines drugs supply. But deaths continue to rise, drug use showed no reduction in the last ten years, and the harm caused by illegal drugs is growing. The government must now dig deep and prove that it is serious about delivering the long-term change implicit in its own strategy.’
While government investment had enabled the sector to increase the number of treatment places and to strengthen the workforce, short-term funding commitments made delivering sustainable support challenging, agreed Turning Point’s chief operating officer, Clare Taylor.
‘It is important that the government remains committed towards building up skills and capacity in the sector, through continued and sustained investment. We need to work hard to make sure that substance use services are inclusive to groups underserved, including young people, working with specialist organisations to improve support and increase the number of people receiving treatment.’
‘Given the tragic levels of drug-related deaths in our communities, changing trends in drug use among young people, and the increasing use of synthetic opioids, long-term funding must be put in place so local authorities and treatment providers can deliver the breadth and quality of treatment and recovery services that our communities need and deserve,’ added Change Grow Live’s deputy chief executive Nic Adamson.
‘We can only tackle the harms from drugs with a multi-agency approach, and it’s going to take time – facts that are recognised in the government’s own ten-year drug strategy. But long-term planning only works if we know we have the funding, and without sustained investment we risk undermining the early, encouraging progress that has been made.’
GP patients are not being ‘sufficiently warned’ about the dependence risks or withdrawal symptoms associated with prescribed drugs like opioids, benzodiazepines, gabapentinoids, anti-depressants and ‘z-drugs’ such as zopiclone, according to a two-year study by researchers at Oxford Brookes University.
Among the concerns highlighted by patients were a lack of detailed information about the drugs when first prescribed, along with a lack of information about alternative treatments. Many stated that they were unaware of the dependence risks, with problems in continuity of care also exacerbated by issues like lengthy waiting times and not being able to see the same clinician.
Making sure that patients receive detailed information at the point of prescription is vital, says the National Institute for Health and Care Research (NIHR)-funded study, which is published in the journal BMC Primary Care. Patients could be signposted to information online or by automated texts, it says, adding that continuity of care should be prioritised for patients prescribed medications that carry a risk of dependence or withdrawal. ‘One of the ways this could be achieved is by creating small teams of two to three clinicians working in partnership,’ it states.
A 2019 review by Public Health England found that a quarter of adults had been prescribed an opioid, benzodiazepine, ‘z’ drugs, gabapentinoid or antidepressant during the previous year, with half prescribed the drugs for a year and a third for three years or more – despite benzodiazepines not being recommended for use of more than a month (https://www.drinkanddrugsnews.com/prescription-drug-addiction-phe-review/).
Last year NHS England published a framework for action stating that health professionals needed to regularly discuss prescriptions with their patients and offer alternatives where appropriate. Services for people experiencing withdrawal symptoms and alternative treatments should also be built into service specifications, it stated (https://www.drinkanddrugsnews.com/nhs-england-publishes-new-action-framework-for-prescription-drugs/).
‘Significant concerns have been raised by Public Health England and the British Medical Association regarding how medications with a risk of dependence or withdrawal are managed and how care is experienced by patients,’ said study lead Dr Jennifer Seddon. ‘This study not only highlights the main areas of concern from the perspective of patients and healthcare professionals, but also suggests ways to address these concerns to improve the patient experience of care. We hope that the results of this study will lead to change in the way these medications are managed within primary care, and will result in wider improvements to the patient experience.’
‘There’s so much to be gained by getting tobacco harm reduction to the highest-risk groups,’ says David MacKintosh, director at Knowledge Action Change (KAC). And one of the highest-risk groups of all is the rough sleeping population. KAC runs the Global State of Tobacco Harm Reduction (GSTHR) project, which is funded by a grant from the Foundation for a Smoke-Free World.
While smoking rates in the UK have been falling for decades now, it’s estimated that up to 85 per cent of homeless people still smoke – more than six times the rate in the general population. Not just that, but they’re smoking in riskier ways.
A study by homelessness charity Groundswell found that not only were most smoking the equivalent of more than 20 cigarettes (including rolled tobacco) per day, they were also smoking ‘dogends’ and sharing cigarettes – increasing their exposure to infectious diseases – with two thirds regularly making roll-ups from discarded cigarettes.
Poor lung health is a serious – and inevitable – problem for homeless populations, with chest infections, pneumonia and unmanaged COPD often requiring hospital admissions. Smoking sits alongside constant exposure to vehicle emissions as ‘one part of that horrible tapestry that leads to absolutely appalling respiratory health in this population – the cold, damp, poor diet,’ says MacKintosh. ‘And to this appalling life expectancy statistic’ – currently 44 for men, and 42 for women.
But while a far higher proportion of people experiencing homelessness smoke than the general population, the proportion who actively want to quit is around the same – 50 per cent, according to a health audit by Homeless Link. The stumbling block, however, is the lack of appropriate services. ‘Even during periods of more generous funding in the UK for smoking cessation services, few have specifically focussed on the needs of people who are rough sleeping,’ says a December 2023 briefing paper by the GSTHR.
An earlier report from the Society for the Study of Addiction, Leaving no smoker behind, found that at least two thirds of rough sleepers who smoked would be willing to try vaping devices if they were free, and would access smoking cessation support if their homelessness services provided it. But it was COVID-19 that proved overwhelmingly that the demand was there.
The GSTHR document points out that while there had been small-scale, local initiatives to help rough sleepers quit, it was the pandemic that provided the stimulus for large-scale action. The ‘Everyone In’ strategy, which required local councils to move everyone sleeping rough into temporary accommodation, was also an ideal opportunity to deliver tobacco harm reduction interventions – mainly through the provision of free vaping devices. ‘Whether the result of formal commissioning or more informal support’, the briefing states, it demonstrated the ‘potential of tobacco harm reduction for an extremely vulnerable client group’.
‘It’s a shame that it took a global pandemic to make people think about harm reduction, but it did,’ says MacKintosh. ‘You’ve got thousands of people you need to get into accommodation fast, many of whom have drug and alcohol issues, and more than three quarters of them smoke – what are you going to do?’ The answer was a ‘whole range of pragmatic interventions’, he says. ‘People from homelessness services were very aware that often a big problem keeping people indoors was that they light up a fag. Whether they’re in a hostel or they’ve been put in the Travelodge it causes trouble, so in a very pragmatic way it was a case of, “Why don’t we try some of these new-fangled vape things?”’
The Pan-London Homeless Hotel Drug and Alcohol Service (HDAS) recognised the importance of harm reduction to address the risks associated with sharing cigarettes during the pandemic – as well as minimising fire risks and reducing the likelihood of evictions – and supplied more than 3,000 vape starter kits, 20,000 refill pods and nicotine replacement products like gum or oral spray. It then produced leaflets signposting people to smoking cessation support and provided education and training for hotel and healthcare staff, and soon found that hotels were regularly requesting further tobacco harm reduction supplies.
‘If you wanted proof of concept at scale, that was it,’ says MacKintosh. ‘Very quickly you could see people at frontline level accepting that this seems to work. There were all sorts of things going on around it – incentivisation, the engagement stuff – but it happened really quickly, and until very recently there was no system of guidance to support a lot of this work, and real issues about who was funding it and where you sourced the kit from.’
Models over the pandemic period ranged from ‘begging and borrowing from people who ran vape stores through to some areas where the director of public health said, “Here’s the money, go out and do it”,’ he says. Although the impetus was largely lost afterwards, it did offer commissioners and service providers ‘valuable real-life examples of what could be achieved for this population over the longer term,’ says the GSTHR paper. The National Institute for Health and Care Research is now funding work with London Southbank University, UCL and homelessness services that will trial the provision of vape starter kits and provide direct comparisons with smoking cessation care pathways.
Smoking, however, remains something of an elephant in the room for drug and alcohol services as well. According to the latest OHID figures, around half of people in treatment are smokers, but less than 5 per cent have even been offered a smoking cessation referral (www.drinkanddrugsnews.com/ten-per-cent-increase-in-people-entering-treatment-for-cocaine).
‘There is a massive mismatch,’ says MacKintosh. ‘Think about dual diagnosis. We’ve been banging on about this for a quarter of a century, but often it’s still, “Sorry, you need to go up the road for that”. We like dealing with one problem at a time, although that isn’t how they tend to manifest in individuals. Helping people around their smoking is actually quite simple, but how many services even know where their local smoking cessation services are?’
One issue is that many service staff are still smokers themselves. ‘At one time smoking was a bit of an engagement tool, and that wasn’t unique to drug services,’ he says. ‘Probation workers, mental health workers, these are jobs where you still see higher than average-population smoking rates. If you’re trying to engage with a guy on a cardboard box in a shop doorway then a cigarette isn’t a bad way of doing it.’
An obvious challenge is that drug services are inevitably focused on their core business, he says. ‘I think it’s improving, but until relatively recently the idea of smoking hadn’t crept into the consciousness much. And who was going to fund it? It’s not coming out of your pot of money for drug and alcohol work.
‘We’re hopefully in a position now where that could change quite rapidly. We know that drug services are an important step in keeping people alive – there’s that big protective factor just by someone being engaged – but the reality for most people is the drug that’s likely to kill them probably isn’t heroin or crack cocaine. Fifty per cent of our heroin users will not die from heroin, but 50 per cent of smokers will die because they smoke. So whether it’s smoking cessation or helping people find an alternative, there’s a huge potential win there for the individuals and services.’
It’s also something that can be done relatively cheaply with a significant impact, he points out. ‘So I hope we’re moving towards a situation where people are thinking more about it. There’s going to be central guidance from OHID about how areas can commission and buy the stuff, which is going to be helpful, and the money is being put money out there. So I’m hopeful we’ll see this going from projects dealing with dozens or hundreds of people to thousands. In a couple of years we could have evidence at scale, which could fundamentally change the argument.’ One scheme in Yorkshire includes external monitoring of people’s health from the outset, and ‘we know that some of the improvements in people’s lungs are really, really quick’, he states. ‘I think it will be a very powerful argument for why people should be doing this.’
A key aspect of harm reduction has always been how pragmatic it is, he says. ‘It’s often a lot cheaper than any other intervention, and you can do it at scale – the moving people on comes later. This really is something services should be looking at in terms of long-term benefits to their clients, and potentially their staff. It’s an easy win, and it really shouldn’t be controversial. You’re helping adults move from something that 50 per cent of them will die from. You put in all this investment to save people from the wicked world of drugs, so why let cigarettes carry them off?’ DDN
Smoking is the elephant in the room for drug and alcohol services, David MacKintosh tells DDN (p6). Many staff are smokers themselves and ‘if you’re trying to engage with a guy on a cardboard box in a shop doorway then a cigarette isn’t a bad way of doing it.’ When we started DDN 20 years ago you could spot a drugs conference venue from the large group of smokers outside. The difference is that many of us with a choice are vaping these days.
It’s a different story for people who are homeless. The choice may have been offered briefly during COVID to keep people indoors in emergency hotel accommodation and stop them from sharing cigarettes. But back on the streets now, the smoking level is six times higher than in the general population, with all the previous risky practices in evidence. We know the devastating effects of dire respiratory health – COPD, chest infections, pneumonia. Combined with cold, wet living conditions and a poor diet, the appalling life expectation of early 40s should be no surprise. So why aren’t we focusing more on tobacco – the drug that’s most likely to kill them?
Do we still have a problem with tackling smoking? Thoughts, feedback and ideas welcome.
Read the February issue as an online magazine (you can also download it as a PDF from the online magazine)
Making progress on stigma means taking a long hard look at our own sector. Are we prepared for the challenge, asks DDN.
‘Millwall fans used to sing “no one likes us, we don’t care.” That’s how it feels to live with a substance use disorder, and I should know after 25 years of opiate addiction. I identify as being in recovery and have done for many years, but I remember.’ Tim Sampey is CEO of Build on Belief (BoB), a peer-led charity that’s developed a dynamic and interactive form of mutual aid. He is also a founding member of the Anti-Stigma Network (ASN). Sharing his story focuses the mind; it’s one person’s history, but it represents the isolation of many.
‘I pretended I didn’t care, but of course I did. Shouted at in GP surgeries, people standing rather than sitting next to you on the bus, never meeting your eyes in a shop. Judged, despised, and marginalised for something I didn’t understand, couldn’t control and which was, slowly inch by inch, killing me. How could I challenge my own self-hatred when the whole world seemed to make a point of agreeing with me? I might have been permanently stoned, but I still had feelings.
‘Of course I committed criminal acts – people like me do. It’s the only way to feed the monster, but it never felt like a choice, nor was it something I was proud of. My substance use disorder was a health problem and not a criminal one. I have watched my community die for decades – overdose, suicide, underlying health problems and simple self-neglect. I’ve had enough.
‘I’ve worked with LEROs and service providers for 20 years. I’ve met hundreds of kind, compassionate, caring people who want nothing more than to do the right thing. I would suggest it’s time we collectively stood together and challenged this absurd stigma for once as for all.’
So here we are, a diverse group calling ourselves the ASN, keen to challenge. We’ve been putting our heads together for the best part of a year now, gathering resources, discussing a campaign, listening to everyone who’s got in touch with us. We know we’ve only started to scratch the surface – but to change hearts and minds we need you to get involved.
Breaking out
‘For many years the sector has been discussing the issue of stigma, how it impacts people who use our services (and the people who don’t), the staff that work in them, the funding we’re given and the communities we work in,’ says Karen Biggs, chief executive of Phoenix Futures and the network’s chair. ‘We’ve tended to do that within our own huddles – our own localities or modalities, our own stakeholder groups or interest groups. When I first started to discuss the idea of the Anti-Stigma Network, someone asked me how ready I thought the sector was to look at itself. How ready were we to identify, and have identified to us, the thoughts, attitudes and behaviours held by us all that inadvertently stigmatise?
‘And that made me think of those huddles we’re in, or sometimes we’re put in, or we put others in. And how hard it is to break out of them, take time to listen and think hard about how we communicate so we’re understood.’
Ambition for change
The university environment demonstrates the scale of the challenge – and also the potential for progress. Universities often reflect their communities very poorly, with under-representation of non-white people and those from working class backgrounds, Prof Harry Sumnall of Liverpool John Moores University tells us. This carries through to senior roles and the academics who lead research groups and set research priorities – and representation can be even harder in the drugs research field, which is small compared to other disciplines.
‘But there’s been a real ambition for change in recent years in the ways that affected communities and those with lived experience are involved in research processes, including setting research priorities and questions, delivering research activities, and helping to interpret and disseminate findings,’ he says. ‘Researchers have also been encouraged to think about how they can work with communities to assess impact, and how affected groups can be empowered to use research findings to support their own activities. I was particularly pleased to see the recent guidelines from the University of Bristol and Transform on research around drugs issues, including the people who use them (https://transformdrugs.org/publications/best-practice-guidelines-for-research-around-drugs-issues).’ He recalls other initiatives – a model of peer research involvement developed by the Scottish Drugs Forum and community expertise at the Sheffield Addiction Recovery Partnership.
‘This is not perfect of course,’ he says. ‘But it does reflect at least an ambition to move away from the old model whereby researchers would “parachute” into a community, collect their data, and then disappear afterwards to enjoy the prestige of publications and conference invitations.’ Most universities and large research networks have now established community groups to help with engagement and involvement, he adds.
Generosity of spirit
Effective engagement is the perpetual challenge, agrees Danny Hames, who is part of an NHS foundation trust as well as chair of the NHS APA. ‘How do we as a sector view ourselves and engage with the broader healthcare community? How do we work with, and alongside, these broader health services to address stigma?’
He calls for a ‘generosity of spirit’ and an acknowledgement that many healthcare colleagues have minimal training in addictions. Mental health clinicians are often working in a crisis – there’s an opportunity for us to ‘come alongside our colleagues in the NHS’, understand the challenges, see what we have in common and offer the lived experience perspective. ‘We’ve got this potentially bigger workforce working across mental health roles – they need us as a sector to wrap around and support them,’ he suggests. If we can ‘take the currency we’ve built in the drug and alcohol sector and start to nudge others we connect with’ we can create opportunities for change.
Through the ASN we talk about reaching beyond drug and alcohol services to all those people who use drugs and alcohol have contact with – health, mental health and support services, criminal justice agencies, local authorities. We recognise that the people who need those services the most won’t engage if they feel ‘looked down on’, whether that’s because of how they’ve been treated or talked to, or because of the environment – such as a health service that looks more like a police custody suite. Consequently, having drug and alcohol specialists contribute to service design, delivery, strategy and action plans is crucial. Many organisations want to become more culturally competent around stigma but don’t yet have the workplace skills and knowledge. We can help fill in the gaps, while learning ourselves.
Public Debate
Adfam have been a rich source of knowledge where families are concerned, informing us about the entrenched stigma they experience. In many cases the stigma directed at them by neighbours, colleagues, services and the media was compounded by their own family and friends. Guilt, self-blame and low self-worth silenced them and reinforced their isolation. Even their grief at losing a family member was not acknowledged or validated in the same way as a ‘regular’ death. ‘We must take collective encouragement from the progress made with mental health over recent years, and how mass media campaigns have successfully encouraged public debate on this topic, making it easier for people to talk about what they’re going through and to reach out for help,’ suggests Robert Stebbings, Adfam’s policy and communications lead (DDN, Dec/Jan 2024, p12).
It’s all too easy to shelve the topic of stigma – to tuck it away until the policy document needs writing or to shrug off opinions that don’t align with our own. But let’s be brave with the conversation and take it to new territory. As Tim Sampey says: ‘I have spent my entire life watching the only community I ever had die year on year. Perhaps we need to be brave and stick our heads above the parapet. Enough now. They were our brothers, sisters, mothers and fathers, our children. They deserved better. Perhaps we should fight for them, or their memory.’ DDN
When it comes to supporting people away from dependency and towards recovery, detox and rehab services have a vital and life-changing role to play. The time people spend as a resident at a detox or rehab service can be the first step in real and lasting change that transforms their lives.
Change Grow Live has been working with a range of providers to create a more open, accessible route into recovery as part of our National Detox and Rehab Framework. In 2023, the framework expanded to include an online portal that allows people to fully explore their detox and rehab options, and have informed conversations about their journey and personal goals.
Our aim is to make sure that rehab and detox aren’t seen as last-chance options. We want to ensure that these interventions are recognised for their life-changing potential, and that the people we support are empowered to make choices that will enable that change – and we are welcoming collaboration from across the sector to help achieve this.
POWER AND CHOICE
The foundations of the national framework were laid back in 2017, with the aim of putting power and choice in the hands of the people we exist to serve. Our vision was to create an overarching framework where people could find a detox or rehab option that was right for them and feel safe in the knowledge that their chosen service offered the highest quality of care.
The initial steps involved convening a multidisciplinary panel, which included doctors, nurses, operational directors, people with lived experience, and procurement specialists. Together, they established a set of standards for providers, drawing inspiration from the standards of the Care Quality Commission and incorporating key questions about the living wage, policies and processes, staff training, and feedback from people with lived experience.
Everyone was in agreement that the framework must prioritise dignity and respect for the people accessing these services, with the framework taking a position against controversial measures such as strip searches of residents. The framework became an open invitation to service providers across the sector, encouraging them to join together in a shared set of commitments and standards. The result was a network of providers offering a wide range of high-quality detox and rehab options, all with the assurance that residents would be treated with the dignity and respect that they deserve.
OPEN ACCESS
Ensuring quality was an important first step, but the national framework is also about empowering people to make their own choices and achieve their own goals in a way that works for them. In 2023 we launched our online national framework portal – an interactive platform where providers and people accessing support can explore detox and rehab options, and have informed conversations about them. The portal features an online directory of rehab and detox services, including information about location and wait times, an overview of the support on offer, and photos of each service’s facilities.
The national framework webpage draws on the success we’ve already seen with the West Midlands framework, a regional network of providers made accessible via a central online portal hosted by Change Grow Live. The West Midlands Framework has already been well received by both providers and people accessing support services, and has supported more than 800 referrals since June 2022.
NATIONAL ROLLOUT
We’re now replicating this model on a national scale. People across the country will be able to fully explore their detox and rehab options and make more informed decisions about their journey and personal goals, while providers will be supported through the referral process in a more efficient and streamlined way. Within Change Grow Live, our staff are supported by our national lead, and have the opportunity to connect, share experience, and ask questions via a regular national forum.
As we respond to the challenges of a changing health and social care landscape, partnership working and collaboration will help us to make sure that no one who needs our support is left behind.
By working together, we can dispel the idea that detox and rehab are last-chance options for when all other avenues of support have been exhausted. Instead, these services should be considered as viable options at various stages of an individual’s journey, and detox services can also play an important role in enabling people to stabilise on their community delivered treatment options.
UPTAKE TARGETS
Improving treatment outcomes, reducing drug-related harm and death and increasing the number of people in treatment are at the heart of the UK’s ten-year drug strategy – including a 2 per cent target for uptake of rehab interventions by people engaged in community treatment services.
Innovative partnerships like the national framework can play a crucial role in breaking down barriers to treatment and ensuring we reach these targets. Between November 2022 and October 2023, we have already seen five partnerships in which Change Grow Live deliver community treatment services achieve this 2 per cent target. Across the same period, we saw more than 2 per cent of people engaged in community treatment with us access an inpatient detox.
Crucially, the framework is continuing to evolve and grow to help us meet and surpass these milestones. We would be delighted to hear from any detox or rehab providers who are interested in joining the national framework, or from any professionals who simply want to find out more about this way of working. You can find more information about the National Framework on our website, or get in touch with me by email.
Together, we are committed to collectively shaping a future where detox and rehab are seen as empowering steps on the path to recovery.
The main potential barriers to the successful operation of drug-checking services are concerns over confidentiality and criminalisation, according to a study by the University of Stirling.
The policing response and trust in frontline staff would be crucial considerations, said participants in the research, which was funded by the Scottish Drug Deaths Taskforce. Aberdeen, Dundee and Glasgow are all working towards applications to the Home Office for licences to run their own pilot drug checking services, with levels of demand high in all three locations, according to researchers. The UK’s first regular, Home Office-licenced drug checking service launched earlier this year in Bristol.
The Scottish study was carried out between 2021 and 2023 in partnership with Public Health Scotland, Edinburgh Napier University, NHS Tayside and harm reduction charity Crew. Participants – who included charity and NHS staff, police, and people with experience of drug use and their families – were interviewed about a range of potential models for drug checking services. These included delivery within NHS drug treatment services, pharmacy settings, or fixed sites run by third-sector organisations, such as the Bristol facility, which is located at the headquarters of Bristol Drugs Project (BDP). Participants ‘generally preferred’ the last model, the document states.
The facilities would need to have ‘knowledgeable, non-judgemental staff’ as well as fast turnarounds, participants stressed. ‘Active community dialogue and engagement’ and positive harm reduction messages would also be important, while people with lived and living experience should be involved in both planning and delivering the services.
‘Research into the community dynamics surrounding fixed site drug checking services is limited, so this study is important in understanding the desired outcomes, challenges and potential barriers, and ways to move forward,’ said study lead Professor Tessa Parkes of the University of Stirling. ‘The fear of being charged by police when accessing drug checking services (DCS) was high among the people we spoke to who had experience of using drugs. And although the police officers we interviewed were generally supportive of DCS, our findings suggest that strong messaging and assurances are needed about DCS and policing at national as well as local levels.’
‘Our results show that drug checking services in Scotland need to be adaptable to local needs,’ added Dr Hannah Carver, of the University of Stirling. ‘There clearly isn’t a one-size-fits-all solution. People will also want a quick turnaround of results and trusted and knowledgeable staff. It is essential to include key stakeholders in the planning of the services, including those with experience of drug use.’
Meanwhile, Northern Ireland’s drug death total fell by almost 30 per cent in 2022 compared to the previous year’s figure of 213, according to the latest data from the Northern Ireland Statistics and Research Agency (NISRA). However, the total is still 40 per cent higher than a decade ago, the agency points out, adding that delays in registrations and processes can also lead to fluctuations in the statistics. More than 80 per cent of the deaths were classed as drug misuse deaths.
Steven shares the story of his journey to recovery with support from WithYou.
‘Recovery isn’t just about stopping, it’s also about what comes after stopping.’
Raised by his dad and granddad after his mother left at age five, Steven had a challenging childhood. He began drinking at a young age, and this escalated during his teenage years and into adulthood. Around a year ago, Steven decided he wanted to break the cycle and make a change. He came to WithYou with this as his goal, and today, he’s been without a drink since March last year.
‘At senior school, I got in with the wrong crowd of boys and was always getting up to mischief, causing trouble, pinching from the shops. I started drinking around this age.
‘I was rejected to play for a football club when I was a teenager, and I turned to drinking to forget about it. I could’ve tried it again, but instead, I chose to drink. Before I turned 18, I got an apprenticeship. I remember constantly thinking that the money I earned could be used as “beer tokens” – I could drink as often as I wanted.’
It was around this time that things took a turn for Steven. He began visiting the local workman’s club, and from then on, his alcohol consumption increased dramatically. This took a toll on his professional life, causing frequent absences and discussions with his employer about his drinking habits. His own business suffered as well.
‘I would be out on Fridays in the club, Saturdays would be match day drinking, and then on Sundays, I’d be back in the club telling stories about football – drinking again. Eventually, I ended up at the club every day.
‘I’d be having a lot of time off work because of alcohol use. My employer had several talks with me about my drinking. I also owned my own business, but it all dwindled away because I wasn’t showing up and spending all my money on drink.’
Despite previous attempts at rehab, Steven recognised the need for a different approach. He really wanted to make a change. From this, he found WithYou, and together we helped him to set goals and make slow reductions.
‘Deep down, I knew I needed help. I’d paid for rehab in the past, but I’d just discharge myself and be back onto drinking again. I needed to try something different. I thought, at my age, if I don’t stop now I’ll never stop. It’ll be a continuous cycle. This was my last chance to save myself.
‘I really wanted to do it. Just coming into WithYou every week to have a chat and do a breathalyser meant a lot to me, because I could challenge myself to get a lower reading each week. Doing the drinks diary alongside this really helped. I’ve never praised myself for anything before. But hearing that my readings were getting lower each week was like hearing “Steven you’re doing brilliant”.’
With the guidance of his recovery worker, Steven began to see noticeable changes. The encouragement and positive affirmations only fuelled his determination, and before long, Steven looked forward to the weekly meetings.
‘A lot of the support WithYou gave me was around setting goals and slow reductions. As hard as it was, I stuck to it. They helped me understand how much to reduce safely. My recovery worker’s face was always over the moon when I’d give him my weekly diary and update – I was proud as punch. Coming down to WithYou each week, I could see I could get there, bit by bit.’
Reflecting on his journey, Steven acknowledges how far he’s come. Now, he enjoys looking after himself and this is reflected in how he goes about his life. This positive shift in his daily routine motivates him to continue leading a life that is truly his own, independent from his past challenges with alcohol.
‘I think of who I am now and how happy I am compared to who I was before, and it spurs me on. I have a laugh, I talk to people. I enjoy life. I thought I had no hope, that my life was going to continue in a cycle of drink until I was dead. But I changed it around. I’m learning how to cook now, I’m making lasagne from scratch. I’m learning how to look after myself, and enjoying being social again.’
With the right support, Steven was able to make a change and live a life he didn’t think was possible. It’s proof that, with determination and by taking it one step at a time, anyone can reshape their life.
If you or someone you know is seeking support on the path to recovery, With You is here to help. Wherever you are in your recovery journey, we’re here to work alongside you.
This blog was originally published by WithYou. You can read the original 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.
The theme for LGBT+ History Month 2024 is medicine, celebrating LGBT+ peoples’ contribution to the field of medicine and healthcare both historically and today. Here’s how Forward will be marking this year.
For our staff, clients and wider networks, LGBT+ History Month is an opportunity to share the rich and diverse history of the LGBT+ community and is a chance for everyone, no matter their identity, to learn more.
At The Forward Trust, we are celebrating LGBT+ History Month in our services and across the organisation, showcasing the amazing work of our staff providing care for the LGBT+ community in our services. From running LGBT+ recovery groups to wearing Pride lanyards, our teams are working towards making The Forward Trust an inclusive, welcoming and caring place where anyone can access support.
Internally, our employee resource group are sharing recommendations for books and podcasts to encourage staff to take time to listen to LGBT+ peoples’ stories and learn about the history of LGBT+ people’s rights in the UK. Forward staff will also be taking part in a film club, watching and discussing the 2014 film Pride later in the month.
Most importantly, whilst we take time to recognise the achievements of the people who have helped fight for LGBT+ rights in the past, we are also having conversations about how we can make our services and workplaces more inclusive going forward. This February, staff will be taking part in LGBT+ training, running workshops in prisons and taking time to learn from our clients and colleagues in the LGBT+ community.
Here at Forward we are proud to provide a dedicated, year-round service for anyone.
You are free to be yourself, without fear of judgement or stigma.
Forward is a safe place for everyone.
This blog was originally published by The Forward Trust. You can read the original 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.
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Release is opening a Harm Reduction Hub in London – here the charity explains how you can help.
Why we need a Harm Reduction Hub in London
The spread of synthetic opioids and their contamination of multiple drug supplies across the UK means they are here to stay. The UK is the deadliest country in Europe for people who use drugs, and this is only set to get worse. We are not prepared: we do not have a structure to test drugs before consumption and drug services aren’t adapting to truly meet people where they are at – we know this because they are ringing our helpline instead. We are at a point where we need to intensify our struggle for real harm reduction, and fight against the forces preventing change around us to truly bring change.
We have tried to do what we can with our current resources:
We’ve created harm reduction advice on nitazenes, partnering with organisations to increase their reach
We’ve spoken on national media to raise awareness on the dangers of synthetic opioids and what needs to be done to reduce their harms
We’ve written to public health professionals on how to improve health system resilience to new psychoactive substances
We offer free training to workers in our local homelessness partner services to ensure workers can double as drug treatment advocates – as we know that OST greatly reduces the likelihood of experiencing a fatal opioid overdose.
We are tired of begging people for piecemeal changes – and seeing our people die while the Government refuses to take action. We have reached a point where we want to take control and fight against the forces preventing change with our own model of action and community care. Along the way, we hope to build evidence of good harm reduction practices which can be implemented across the country.
For that reason, we are repurposing a part of our building into a harm reduction centre – and we need your help.
What the Hub will contain
We need 7,500 GBP as quickly as we can gather it in order to turn our ground floor meeting room into a public-facing drop-in space. This money would be used to:
Rebuild the room, including expanding the walls to increase its capacity
Refit the space with new electrical wiring and fire detection system
Furnish the space
Paint a shopfront externally so that we can be found easily on the street.
Any additional funds would be used to print harm reduction literature, as well as ordering harm reduction materials such as nitazene and xylazine strips, and/or drug testing kits for consumer purchase. The literature would include our new advocacy guide to help people who do want to go to drug services to access the treatment that works for them, as well as leaflets on nitazenes and sample testing forms for people to send drug samples to WEDINOS for analysis.
Once open, the space will offer:
A warming space for anyone, with access to tea, coffee, and phone chargers
Signposting to relevant health and social services
Legal referrals
Basic legal one-off advice (similar to our National Helpline)
Public health literature available for takeaway (such as info on BBV prevention and treatment, support with GP registering, and drug alerts)
‘Know your rights’ literature, as well as work from other allies
Merchandise and harm reduction materials for sale
A welcoming local community space to have a friendly conversation.