Two-way street – service user involvement gives a chance to engage
When a Bournemouth theatre looked at putting on an educational play about addiction, the director realised she needed the input of those who had ‘been there’. The venture that emerged, Vita Nova (page 8), completely exceeded expectation, opening doors to engage not only with schoolchildren, but with police and local services.
Third sector treatment provider Turning Point has issued a statement in response to the Unite trade union’s claims that the charity is planning to sack its workforce and re-employ them on revised terms and conditions, with some set to lose thousands of pounds a year.
The charity is carrying out a consultation with staff about changes to their terms and conditions, the result, it says, of cuts in local authority and health budgets ‘starting to bite’. The proposals, which were ‘not being made lightly’, would have a ‘limited impact’ on employees the charity’s substance misuse services, it added.
‘Like many organisations in this difficult economic climate, Turning Point has to constantly review our costs and try to work out how we can make the efficiencies that will help protect jobs and services for the vulnerable people we support,’ the organisation stated. ‘We have begun discussions with our recognised union, Unite, and our staff about these difficult issues and put proposals on the table for dialogue about how we face the challenges ahead.’
Turning Point aimed to ‘protect as many jobs as possible’ by reviewing changes to its terms and conditions, it said. ‘This will affect a lot of people in different ways in Turning Point. However, we need to move towards a market rate for employees, one that protects their base pay. Indeed, we are proposing to increase base pay for those who are the lowest paid. The proposals are looking at various enhancements, including those paid for unsociable hours, many of which are no longer paid in the sectors within which we operate.’ The organisation was fully committed to the agreed formal consultation process with the union and wanted to work with them ‘to ensure a smooth process’, it said.
Unite, however, maintained the charity was ‘leading a race to the bottom’ in the voluntary sector. ‘This is devastating for staff,’ said regional officer Jamie Major. ‘Many of our 450 members stand to lose thousands of pounds a year. The Turning Point management is breaking faith with its staff, especially those transferred to the organisation with TUPE – Transfer of Undertaking (Protection of Employment) – contracts which protect their pay and conditions. Management says it is doing this so that the charity can compete with the competitive bidding process in the charity sector – but caring for vulnerable people should not be equated with the profit motive of the private sector.’
Meanwhile, Turning Point has been commissioned to deliver drug and alcohol services across Gloucestershire, Wiltshire and East Kent following a competitive tendering process. ‘It is through winning new services that Turning Point can continue to grow and maintain viability, supporting more people and strengthening our existing services,’ said Selina Douglas, managing director of substance misuse.
Treatment first – why prison should always be the last resort
The difficulties of accessing appropriate treatment are acknowledged in NOMS’ recent review of Drug Rehabilitation Requirements (DRRs), as Ros Weetman discusses on page 12. Over the page, Kelly Overton and Frankie Owens illustrate the need for the right treatment at the right time – Kelly as a young mother trying her hardest to kick addiction and Frankie, whose family life and career were jeopardised by a crippling mental health problem, and who didn’t break the cycle of prison and crime until he was sectioned under the Mental Health Act.
Season’s greetings!
Thank you for your loyalty over the past year
DO YOU REMEMBER which month saw the publication of the Health and Social Care Bill? Or when during the year a flood of new drugs made the Misuse of Drugs Act ‘increasingly unenforceable’? Or when the Centre for Policy Studies’ Breaking the habit report kicked off a row about the cost of drug use to the public purse? Looking back at the recurrent themes and thorny problems makes the year seem very short indeed. The drinks industry is among those appearing constantly in our headlines, particularly in relation to debates on minimum pricing and subliminal advertising. See our review on page 18 for a reminder of a roller-coaster year. As we head towards 2012 it’s a worrying time for all of us, and we are fully aware of budget constraints right across the field. It’s with complete gratitude then, that we thank contributors to our Christmas card appeal (centre pages), who helped towards the production costs of this issue during the traditionally lean period for advertising. You have firmed our resolve to keep DDN as a free magazine that goes to every corner of the drug and alcohol field. A happy and healthy Christmas to all our readers, contributors and advertisers.
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Teen spirit
When using inspiration makes all the difference
ON THIS MONTH’S LETTERS PAGES, Denis Joe worries that we’ve lost focus on responding to young people and are shirking relevant efforts to keep them away from substance misuse (page 10). Our cover story (page 8) is a luminous example of turning the costs of disenfranchised youth into engagement and enterprise. Not only are Amar and his team at The Small Business Consultancy giving young people life skills, adapting negative entrepreneurial skills gained from activities such as drug dealing into positives, they are turning the costs of drug and alcohol related crime into savings and community investment. Their awards evening last week was a stunning example of partnership working in action, with community workers, well-known entrepreneurs, and business investors united in the common purpose of seeing hitherto disadvantaged and disengaged young people start to realise their potential. The scheme is an effective idea that’s really beginning to take off – as demonstrated by their success rates in reducing reoffending and getting young people into training and employment. Watch out for it in areas beyond London. Talking of ideas, it’s seven years this issue since we jumped into the unknown and set up a free magazine for the drug and alcohol field. We hope you agree that DDN is still going strong!
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A new era?
Recovery talk draws strength from diversity
A FEW MONTHS AGO THERE WAS MUCH TALK about whether ‘recovery’ belongs to one group more than another. Those debates still rumble on – particularly when money and politics play a significant part – but the UKRF summit brought all parties to the table to be part of the dialogue (cover story, page 8). Rather than the all-too-frequent polarised arguments, harm reduction and recovery were acknowledged as traditional bedfellows and the debate moved on to making sure everyone knew the rules of the game when taking debate to a political level. Important to many people who attended the event – and the recovery walk through Cardiff city centre the day after – was the practical discussion about recovery in the context of real life, whether related to treatment and healthcare or more general issues of living and working in the community. Other articles in this issue reflect recovery in its everyday clothes, from the thriving 12 Café (page 18) to the inspirational LCDP art project (page 14). This isn’t just theory, this is maintenance, abstinence, therapy – whatever you want to call it – but most importantly it incorporates a path to wellbeing that transcends any federation, partnership, consortium or concordat you could convene.
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Off the wall?
Fighting social networking is a losing game
TRYING TO LIMIT THE ALCOHOL INDUSTRY’S SPREAD across social media networks is an ambitious aim (news, page 4; news focus, page 6). A look at any leading booze brand’s Facebook page will show hundreds of thousands of followers – the Jack Daniel’s page, for instance, has an almighty 2,225,733 ‘likes’ (rising as I write) and their ‘wall’ shows a collage of faces, young and old. In all the fun of the virtual booze-up is a caution – ‘Your friends at Jack Daniel’s remind you to drink responsibly’. Click on the ‘responsibility’ button and there’s a statement that ‘any posts of pics that are irresponsible or inappropriate will be removed’. The pictures that remain demonstrate the widely different perceptions of ‘responsible marketing’ held by the drinks industry and public health charities. The industry is operating around ASA’s rules by not targeting alcohol at young people, nor linking it with social or sexual success. But the Facebook page is in itself an environment for bonhomie, rendering the notion of ‘responsible posting’ pretty meaningless. The industry has very little to worry about, which must help them to humour the ‘health and responsibility’ dialogue – with an army of Facebook users posting up their boozy holiday snaps, their marketing’s already in hand and out of anyone’s control.
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What price life?
Why naloxone should be everyone’s business
THE NALOXONE DEBATE seems to be taking a long time to come to a conclusion but the NTA’s report on its recent pilots provide evidence to underline what many have been calling for for more than two years – a roll-out of the easy-to-administer and cost-effective overdose antidote (page 14). There is no more simple and effective intervention to prevent fatal overdose, so bringing naloxone into mainstream drug treatment, as Danny Morris suggests, should surely follow. Certainly the policy direction in Wales is highly encouraging (page 18). The threat of homelessness takes our cover slot (page 8), because the figures are continuing to rise with no turnaround in sight. Brighton and Hove Street Services team say they are seeing a new cohort of people who have exhausted all other options. There’s good work going on down on the south coast, but are we destined to keep remodelling support services when more holes appear in the welfare net? You may or may not agree with Alex Boyt’s personal views on 12-step philosophy, but we know it’s an issue that many readers want to talk about, so here’s the invitation (page 12). And while we’re in the debating corner, Prof Neil McKeganey gives insight to his controversial views (page 16).
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Beyond definition
Recovery can mean whatever it needs to
With recovery sounding more mainstream every minute, GPs began their two-day conference in Harrogate eager to know what it meant (page 10). Audience members offered definitions at many of the sessions, but the resounding message from speakers was that one model definitely didn’t suit all and there was no handy generic patient to treat at the surgery. Recovery was a highly subjective concept and delegates agreed at the end of two days, through their consensus statement, that it should provide focus for whatever treatment journey and support each person needed. The important thing was to open up viable treatment options and make it possible for GP practices to liaise effectively with drug and alcohol workers, commissioners, pharmacists, housing workers, social services –as we all know should happen, but rarely does. With ‘joined-up’ working for maximum efficiency fully in fashion again, Westminster Drug Project tell us how they galvanised the process with their local partners (page 8); while on page 18 we report from the South East Alcohol Innovation Programme –an effective healthcare partnership in action. Both models ably demonstrate how they are keeping the service user at the heart of the process.
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Food for thought
Worldwide inspiration on harm reduction
WE ARE RIGHTLY CONCERNED ABOUT TREATMENT IDEOLOGYin this country when, more than ever, so much depends on it. In this issue’s Soapbox (page 30) Paul Hayes argues that as we move towards the new public health system, service users will be at the heart of recovery –meaning client-centred treatment in whatever format they need. Going to Beirut for the 22nd International Harm Reduction Conference offered a wider perspective on the world, and we have devoted this issue to special coverage of this fascinating and inspiring event. We heard from countries where governments and police routinely crack down on users –and from some where even families prevent their own relatives from receiving treatment. We listened to accounts of women denied healthcare for themselves and their children, and of people driven underground by their countries’ culture of persecution. You might find some of the speakers controversial for many reasons, but the case for basic human rights is undeniable, right down to homeless children on the streets of Russia, sniffing glue to curb hunger. It will give you food for thought –and as Chris Ford says in Post-its (page 25), it makes you think how lucky we are in the UK. At least we have a general acceptance of evidence-based practice.
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Spare some change
Recovery pilot offers an all-inclusive approach
Recovery is here there and everywhere, but our cover story describes how Sefton had the chance to look at what it could mean across their entire treatment system. It was not just a case of shoehorning the word recovery in to get funding, but of looking at what service users really needed by consulting them. Realising that services were not accessible enough to everyone, ex service users were trained up as peer mentors to make sure everyone had a fair chance of getting exactly the right support. This is taking a user-led needs assessment to its logical conclusion, and Sefton were lucky to be selected as one of seven pilot areas. Let’s hope the benefits of their experience can now encourage others to take a fully inclusive approach by being adopted much more widely. Much further afield, Gill Bradbury brings some tough challenges to our attention by talking to Parina Limbu Subba about her women’s harm reduction programme in Nepal (page 16). The scale of their challenge is daunting, right down to trying to run a service with daily power cuts lasting up to six hours. The attitude with which they tackle seemingly insurmountable obstacles, not least basic funding, is inspiring in itself.
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Seizing the day
Action from our fourth service user conference
We came back from Seize the Day!on a high. Many more questions had been asked than had been answered, but everyone seemed to agree that the spirit of solidarity this year was a force to be reckoned with. The discussions were mature and focused and the issues brought to the conference sessions deserved answers – our coverage of the event in this issue of the magazine is just a start. We’ve had a lot of feedback that delegates appreciated Andrew Selous MP’s undivided attention –not just during the conference session, but afterwards, when he stayed for a long time answering questions and hearing concerns. He said attending the conference was an education, and promised to take issues raised back to the House of Commons. We’ll be chasing for a progress report. More than anything, we soaked up a spirit of camaraderie among delegates and a keeness to learn from colleagues in other areas of the country. Service user groups have greater confidence now than ever before and this shone through, not least in the group exhibition area where there was evidence of real integration with DAATs, services and local planning groups. All power to our service users up and down the country!
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In with the new
More news and views in our new monthly format
I CHALLENGE YOU to look at this issue and not say ‘I never knew there was so much in it!’ Here we are in our new monthly format, bursting with new features and regulars.
We’ve got more news, an in-depth look at a crucial issue in ‘news focus’ (page 7), and a chance to get to know the story behind some key figures in the ‘profile’, starting with the much-respected figure of Noreen Oliver (page 20). We’ve brought in a soapbox to invite challenging views from all quarters (step up Prof McKeganey, page 19) and want you to let us know what you think (letters, page 10). We hope DDN will continue to inform you, but we also hope it will inspire, entertain and involve you. I make no apology for trumpeting Q&A’s return (page 11), as it’s one of the most popular suggestions we took on board from our DDN survey responses at the end of last year. There are plenty more new features and columns in the pipeline, so please give us your feedback. We’re all looking forward to our DDN/Alliance conference next Thursday (10 February) –hope to meet you there! See you at the beginning of March, when we’ll be sharing the highlights.
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Fresh inspiration
On the upside of change
Welcome to our first issue of the new year. We have policy updates for you – the NTAexplains proposals to replace Models of careon page 10; new resources – Alcohol Concern introduces new outcome measures for alcohol services on page 11; and a fresh look at local treatment services versus out-of-area provision on page 14. John Ryan gives insight into his experiences working with harm reduction in Australia (page 12), while Brendan Georgeson gives a motivational account of organising Bristol’s first dual diagnosis recovery conference. And we’re pleased to welcome Release’s first legal column, as Niamh Eastwood explains the complicated landscape of welfare reforms. Niamh will be among the speakers at our DDN/Alliance service user involvement conference in Birmingham on 10 February – our fourth annual event, can you believe? The DDN team will be there, and we hope to see you. The debates this year will be more crucial than ever. In the tradition of the new year, our cover story offers a motivational outlook that’s based on common sense and practical self audit, which we hope will be useful to pass on to clients as well as spurring you on in the current climate. The article might not be everyone’s cup of tea – you only have to see the letters on page 8 to realise that one person’s motivator is another’s irritant – but we hope the simple steps to empowerment offer inspiration for re-engaging clients in all kinds of situations. And talking of change, after much deliberation, we have decided to change your fortnightly magazine to a monthly frequency – so we’ll be out on the first Monday of every month, starting on 7 February. We read your survey responses, looked at the transition of much of our print advertising to online, and decided to adapt our format. We’ll be enhancing the magazine and website, bringing you everything you need to keep you up to date and informed. The most important thing to us is that DDNremains free of charge to our much-valued readers.
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Inside learning
Time for a critical look at our prisons
AT FIRST GLANCE you might wonder why we’ve devoted most of this issue to reports about criminal justice system. At second glance you might wonder why these issues are of relevance to you. But the opportunity to share experience with other countries gives fresh perspective and evidence from experience – not just on the effectiveness of incarceration, but on harm reduction measures and their effect on drug users’ behaviour and welfare. It also gives us a rare opportunity to stand back and assess what works back home. This week justice secretary Ken Clarke has been exploring the idea of alternatives to prison sentences, looking instead at community sentences and ‘payment by results’ rehabilitation. Not so long ago politicians in this country seemed fixated on the idea of American style ‘super-prisons’ to warehouse a burgeoning prison population. Is the evidence now filtering through that drug-using offenders merely go on to reoffend? ‘Prison works,’ said Michael Howard as home secretary in the 1990s. ‘Yeah right,’ I hear you say now. It was interesting to hear at several conference sessions how the UK is the envy of many other countries in its treatment of drug users, its pragmatic employment of harm reduction measures and its swift referral to rehabilitation. We could take inspiration from this – and we could choose to capitalise on it while political ears are open. At this week’s cross-party group in Parliament (page 6), MPs were keen to emphasise that expertise and advice is welcome from all quarters – a sentiment that we hear echoed in the first statements coming from the coalition. But as well as the plaudits for progress, we should seize the opportunity for critical review. This afternoon my copy of Inside Time, the national newspaper for prisoners, arrived. Its headline is ‘Prisons are awash with drugs’, a story that gives results of a readers’ survey and concludes that £100m worth of drugs are smuggled into prison every year. Is this a sign of our success?
Inspiration fix
Don’t curb your enthusiasm!
THE ENTHUSIASM AT THE WELSH SERVICE USERS’ CONFERENCE(page 12) was infectious and refreshing, particularly in this climate of real and impending cuts. It was a reminder of what’s working for many people – and that includes some economically sound decisions on best treatment options. Chris Campbell, founder of the user group SMUG, could have taken the prize for sheer exuberance, encouraging people to be proud of their progress and applaud peers for life-changing achievements, and it was a reminder of the valuable momentum service user networks can build up. Just as impressive was the central role the Welsh Assembly Government played, invited by the service users who put together the programme. They were willing to talk about difficult issues such as waiting times and took part in the entire day, answering whatever thorny questions were thrown at them. And there was plenty of practical advice, particularly for families and carers on contributing to recovery. Adfam’s Oliver French examines other ways to capitalise on family support on page 11. From groups with a growing profile, to a population that has little visibility away from the frontline. Tony Wright (page 6) gives insight into the massive changes faced by ex-service personnel when they try to readjust to civilian life. That veterans should become homeless rough sleepers or end up in prison is a depressing enough fact – add a layer of drug and alcohol problems and you have a toxic mix of trauma and depression that makes them highly unlikely to contact services of their own volition. We owe much to these members of our community to make sure they can engage with the right support services. And on the subject of appropriate support, Ursula Brown uses evidence from the Alliance’s helpline (page 10) to highlight the need for us all to take a stand against the discrimination that all too many people with a script, or a substance misuse problem in their history, experience when trying to enter the world of paid employment.
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Cloaking device
Why prejudice is obscuring basic support
THERE HAVE BEEN 14 MURDERS OF SEX WORKERS since the Ipswich cases four years ago. The cost of initiatives to improve sex workers’ safety is a drop in the ocean compared to the millions of pounds spent on a murder investigation, so why have the dreadful events in Bradford been allowed to happen? The interview with Shelly Stoops (page 6) is illuminating. Not only does it remind us of the appalling stigma that gets in the way of communicating with women involved with this profession, it also provides highly sustainable arguments for the economics of prevention. Sadly, many outside this field won’t look as far as the economics, because the label ‘prostitute’ will categorise the subject before they’ve read as far as the bit about the grieving family. But if they do, they will start to understand that quite apart from the much needed compassion there is a strong financial case for reviewing the laws around sex work – laws that force women to put themselves at risk by working alone in dangerous surroundings. The Home Office has been funding Shelly’s post as independent sexual violence advisor – a post renewable year on year – because it fitted the ‘ensuring justice’ strand of the government’s 2006 prostitution strategy. Let’s hope that the new government is steadfast in building on this modest start. The theme of support networks comes up again in our second women-themed feature (page 10), which touches on the isolation many women feel when substance misuse gets in the way of running family life effectively. Once again, it was roundly agreed that services need to be accessible and non-judgemental before they have a hope of making contact that might lead to successful interventions. Accessibility of services failed spectacularly for Scott, as his mother describes in the wake of her heartbreaking loss (page 12). There are so many ‘whys’ for Maureen – let’s hope the questions reach out-of-hours services.
Learning curve
Lessons from global harm reduction
AFTER A TURBULENT FEW WEEKS the election is finally over, with a hung parliament a certainty as we go to press. What will happen next in terms of configuring government is still anybody’s guess – and has been, during the hours of tv coverage through the night. All we know is that a great deal of negotiation must take place before anything approaching a serious administration can take shape and start to make decisions that will affect us. This issue of DDN is going to new MPs as they take up their places in the new parliament. If they get as far as reading it, they may be surprised at the contents. What, after all, does the term ‘harm reduction’ mean to anyone outside the substance misuse field, other than harm reduction to the public by protecting them from drug users? They may be surprised to consider such matters in terms of public health – and of life and death to people in the grip of addiction. Such matters haven’t exactly featured prominently in any party’s manifesto, so we hope the magazine might offer new insight into complicated lives and inspire them to take an interest. Likewise, we hope the issue will be informative to all our readers, not just those with an obvious harm reduction remit. The IHRA conference is an opportunity to learn from experience elsewhere, informing our responses to international drug policy and its many extremes, while giving an opportunity to reassess priorities back home. During a debate on our treatment system in the UK, Nick Barton of Action on Addiction made the point that whatever we are passionate about in this field, we should all have the shared goal of maximising wellbeing and quality of life. Polarisation would not end ‘until each party looks at its own deficiencies instead of pointing the finger excitedly at the failings of the other’, he said. He might equally have been talking to the political leaders – but it’s a strong and dignified message for this field as we wait for the new political landscape to take shape.
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No patient game
Tough talking on crime as the election draws near
Election campaign sparring has brought tough talk on crime from the party leaders, ahead of concern for prisoner welfare. After all, safer communities are a hot election issue throughout the land; pleasing 85,000 incarcerated people who don’t have the vote is not. Our cover story this issue (page 6) gives insight to the slow steady progress on prison welfare reform, focusing on health and harm reduction. Practice in other countries in Europe and the US is constantly informing suggestions of radical change in our own criminal justice system. The picture is of painfully slow progress in treating drug-using prisoners as patients and giving them the standard of sustained care we would expect in any drug treatment unit in the community. How important then that we don’t interrupt this progress for the sake of tough talk from the new broom – whoever it should be. Our commentators from EATA encourage a steady view of the prospect of a hung parliament – and by the time you get our next issue, the suspense will be over. Steve Rossell and Katie Hill urge us to offer creative ideas to the parties to influence them on safeguarding services in our sector. If any politician needed convincing of the need to stop issuing knee-jerk reactions to every new drug discovered and address the massive issue of alcohol addiction, they might gain insight from reading Julian’s story on page 11. It’s a sobering reminder that drinks advertising is everywhere and in your face, quite apart from the subliminal messages in every facet of the media. Can you picture a sports team with the name of a drug dealer on their shirts? Politics is an increasingly ludicrous game this week, with the party leaders vying to show muscle against Europe, America, each other, whoever. Let’s hope the politicians don’t lose all continuity in dealing with those who most need them, in their quest to be the party of change.
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Family fortunes
Let’s not play roulette
Despite family support being a central part of the current drug strategy, it has for years been poorly funded and sporadic. Whatever election promises are being made to make family life easier, they’re unlikely to relate to substance misuse. It doesn’t fit the billboards or the Saatchi campaigns and family services know they will continue to fight for attention – yet there will be no let-up in demand for them. Adfam’s manifesto (cover story, page 6) offers a survival kit for working smarter, to make sure the essentials of family support are not tossed overboard in a turbulent climate. Tightened budgets need not compromise clever commissioning and appropriate training to make sure workers can tune in properly to families’ needs. Active data collection and monitoring must take place to make sure services provide the best value they can. And a concerted effort to influence and share knowledge with the services we connect with is an opportunity not to be ignored when everyone’s looking for better ways to to run services on a shoestring. The UKDPC estimates that there are at least 1.5m people in this country who are significantly affected by a relative’s drug use – and these are the ones who live with the effects day by day. It doesn’t even include the many other family members and friends that you feel powerless to get near. We all know that the scale of the problem is a howling mismatch with the level of service provision. As Adfam’s manifesto suggests and their conference reinforced, only tight working partnerships and continual knowledge about this complicated area of work will help families get the help they need, right from the crucial early stages. Carole Sharma’s suggestion to skill up and specialise in every way you can is a good one – and a timely reminder that waiting for a new government to sharpen its axe will help no one at all. See you again on 26 April after a break of one issue. Keep the letters coming and have a great Easter!
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Visiting London this week his deputy drug czar, Thomas McLellan, explored some unpalatable truths. Incarceration has been shown to be as ineffective a ‘solution’ for addiction as it is here. Prevention and screening are non-existent or missing the mark.
Options for recovery have been hampered by prejudice against essential types of treatment and medication. GPs are ignorant about addiction or not interested enough to make referrals to specialist services. It all sounds very familiar, yet if Professor McLellan has his way there will be change afoot and a determined campaign to broker a marriage between addiction services and mainstream healthcare.
At the heart of this is the vital recognition that treatment cannot be effective without follow-up support, and the initiatives will also reach right through the prison service to make sure prisoners get the vital preparation for community life right up to their release. During our conversation, he drew on evidence that showed the massive difference that treatment and support made to prisoners in preventing them from returning to jail within a year.
Of course we know all of this in this country – don’t we? So why don’t we see prison drug treatment and community integration as essential – in economic terms as much as for humane reasons? Why aren’t all our GPs well-versed in addiction, rather than just the good souls who take a special interest? Why aren’t we prioritising resources for young people’s prevention and treatment when we know that this is the greatest ‘at risk’ period in life? It’s a brave step to declare that all parts of the healthcare field, including addiction, need to work together with a shared aim – then to do something about it. It’s a dialogue we could learn from if we share the common goal of recovery
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We were right there!
Respect and inclusivity were order of the day
Welcome to our special issue, celebrating our recent DDN/Alliance service user involvement conference. Right here, right now! felt like the right title for it, as hundreds of delegates – three quarters of them service users –surged through the doors of Birmingham’s Holiday Inn.It was a truly vibrant and enjoyable day. The special thing about this conference is its inclusivity – so crucial at this politically delicate time. With a conference programme that challenged everyone from the outset with its very different perspectives (enter Theo van Dam talking about making sure drug dealers were socially responsible, followed by Jacquie and Eve from SHARP who were discussing the ‘recovery movement’) the audience listened with respect to views they didn’t necessarily agree with. It might not have worked, but it did,because the speakers reminded their audience of common goals. Recovery is about choice, said Jacquie Johnston Lynch, and not about forcing everybody into abstinence before they are ready. Her words were a reminder that we should never champion one group over another, but that it is our responsibility to listen to people and protect their interests and their right to treatment – whatever form that might take.We should savour the respect shown in that room full of people with different views – views that the pushbutton voting system showed were diverse. This mutual respect doesn’t happen in some other environments,where the recovery agenda in particular is being used as a propaganda tool to lobby politicians in waiting.We have to take the positivity beyond one day in a conference room and use it to champion inclusivity throughout this field. I would propose that a respect agenda goes hand in hand with any recovery agenda,because the inspiring work going on all round the country, shared between delegates from all kinds of services and support groups, should never be overlooked.
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Too hot to handle?
Why we have to take on the headline writers
The issue of stigma is so familiar to the drug and alcohol field it almost feels too big to tackle. Yet that’s the task of the UKDPC and partners, as they launch the first phase of a project to understand stigma (page 14).Partnering with the mental health field, housing and young people’s charities is giving an opportunity to put heads together and share experience. As daunting as the prospect of changing public opinion might be,hearing from colleagues in the mental health field about how attitudes to people with psychotic depression have changed ought to give us courage that the media and their audiences are educable.At DDN we are privileged to have insight to the circumstances behind addiction and be constantly educated by our readers. But five and a half years ago, starting up the magazine, we were on a very steep learning curve, which began with learning the pitfalls of using the ‘wrong’ language. (And this is still a minefield, with readers disputing words such as ‘addict’ which represents an offensive label to some, but which is a symbol of recovery to others taking the 12-step route.) We had the advantage of being able to learn from people who have shared their personal stories with us, as well as those who work with them – which makes me believe that educating the mainstream media is not a lost cause. Many of the people at the UKDPC’s seminar last week demonstrated that their lives were a complicated crossover between personal experience of addiction and professional expertise in the field – so surely it can’t be impossible to tap into the fact that most people,whether they write the papers or read them, have experience of addiction in some form. If prejudice is born of ignorance, we have to press on with educating the press.And before you get on with reading the issue… a quick thank you to everyone who came to the ‘Right here,right now!’ conference in Birmingham last week. Highlights will be in our special issue, out on 1 March.
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Lives first – always
Public health’s no follower of fashion
The language of recovery can be exciting. It enthuses, it galvanises, it stirs people into action. Most of all it can make us feel we’re doing something very positive to counter the negative energy of addiction. But as the storyon public injecting demonstrates (page 14), many of the challenges of drugs work are much less visible and no less vital for it. The recent anthrax outbreak among Scottish heroin users demonstrates these challenges at their most extreme (cover story, page 6). Why was the public health response so inadequate? Would it have been an entirely different scenario if the sufferers were in danger of infecting the public, rather than contained within the injecting drug user population? Why was the official advice to those at risk so impractical? Any drugs worker knows the impossibility of long-term heroin users being able to stop injecting immediately, let alone to push themselves forward for emergency treatment, so why was this patient group not supported through this crisis as intensely as society’s most vulnerable?Positive initiatives are great for the morale of this field but they should never introduce an either/or option to fundamental treatment rights. We know that – but do our politicians? Never has the tired old harm reduction versus abstinence debate seemed so hollow and we must insist on public health policy that learns from this tragedy. As Andy Stonard points out (page 8), now is the time to lobby from an informed perspective to make sure the politicians of each party understand the policies they are moulding around their voters. Public health is everyone’s business and whichever way the political winds blow over the next few months, we should never forget we’re talking about the right to life and not just how we choose to live it. Talking of debate, there will be some very different views aired at our DDN/Alliance service users conference on Thursday 4 February (still time to book… just) – we hope we’ll have the chance to meet you there!
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Staying grounded
Can legislation be meaningful to tackle highs?
The dangers of ‘legal highs’ have been hitting the headlines over the past few months, and the issue has inevitably brought with it its share of myth and conjecture. You only have to think about the storm in the ACMD’s teacup at the end of last year to see why the experts are circling the issue warily on all sides. Mephedrone, known as miaow (or meow), is prolifically available online in such innocent guises as plant food – little wonder then that it’s prone to experimentation, with the drug and alcohol workers featured in our cover story reporting users as young as 12. Can an attempt to ban these drugs have any effect? Release has already voiced scepticism, accusing the government of chasing its tail in announcing that such drugs will become illegal. It will be interesting to see how the newly chaired ACMD’s work on mephedrone is received – as well as that of Prof Nutt’s new Independent Council on Drug Harms (page 4). In the meantime, as trainer Renato Masetti says in our article, it’s important that drug teams know the specifics about these drugs so they are confident in treating clients and know how to dispense essential harm reduction advice. As we begin a new year in which ‘recovery’ is the only flavour for many, the anthrax cases among heroin users in Scotland are a stark reminder that whatever culture changes are taking place or being proposed, basic safety in public health policy can never be neglected. Alongside Peter Martin’s optimistic case for recovery orientated treatment on page 10, Sara McGrail reminds us that political point-scoring must never threaten to unpick the vital progress in drug treatment over the past ten years. As she says, choice in treatment is vital, and we must resist every echo of the old abstinence v harm reduction divide. Whatever vote-courting drug policies are being drafted, it’s vital that such complex issues are not distilled to public-pleasing soundbites.
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In this issue: Have you voted in our website poll yet? Online voting has opened up a whole new world of instant feedback for us.
This issue’s poll: Should medically unsupervised detox be allowed?
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In this issue: Dr Fitzgerald highlights the opportunities of schools and outside agencies working more closely together to give pupils (and families) different levels of support.
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In this issue: Two years ago we started Drink and Drugs News to provide information to the drug and alcohol field.
We’d like to take this opportunity to thank our partners for their support and contributions – and to thank all our advertisers over the past two years. Every advert you place funds the production of the magazine and keeps it free of charge.
And of course huge thanks to readers for all your much valued correspondence, feedback and encouragement.
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In this issue: Once again this country’s prisons have been declared at bursting point this week, to the point where we’re looking at shipping prisoners abroad or extending the experiment of holding them in police custody suites, in a desperate bid to reduce overcrowding. It seems as appropriate as ever then, to look at how we help people out of the system and hold them in society – whether they’ve been in the criminal justice system or in residential treatment.
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In this issue: We’re back from our August break, and it’s good to be hearing from you again! As the heatwave becomes a dim memory the conference season is revving up with new vigour and planning is underway for next year. With this autumnal burst of energy in the air, it seemed appropriate to feature the theme of empowerment.
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In this issue: Nottingham- it’s not what you say, it’s the way you say it.
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In this issue: how does it stack up? DDN interview Paul Hayes from the National Treatment Agency.
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In this issue: can we make sense of a system that criminalises illness?
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In this issue: Residential rehab in urgent need of clarity and action.
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In this issue: aftercare provision in the real world.
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In this issue: tackling the postcode lottery in Primary Care?
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In this issue: tough questions for tough choices.
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In this issue: rebuilding service delivery from the ground up.
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In this issue: Special edition! Life beyond prison- support and services inside and out.
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In this issue: alternative therapies and empowerment in recovery.
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At a prison conference in Leicester this month, colleagues from all areas of the prison and probation services, and those who work with them, declared their need to work more closely together. If their services were to appear cohesive to the client then remote communications were not enough. Links that began at their first brush with the criminal justice system would need to support them
when they came out, and join them to housing, social services and everything else that qualified them as a member of society again.
For many prisoners, coming into contact with their CARAT worker is a revelation that a dedicated professional will be there for them throughout Counselling, Advice, Referral, Assessment and Throughcare. But are CARAT workers getting enough help in paving their client’s way to the outside world?
RAPt – the Rehabilitation for Addicted Prisoners Trust – knows all about helping prisoners off substances and back into society, not least through running CARAT services in 17 prisons. Their recently opened Island Day Programme in Tower Hamlets takes their knowledge and experience of what works in rehabilitation and plants it squarely in the community, responding to the needs and diversity of the area.
Early signs from those who have been involved in the programme for a few months reflect not only the strength of the programme, but the support of their family and community. Clients talk about relating the service to real life from the word go. There is no escapism, no recuperating in a backwater miles from temptation. When they live the programme at Island, they know they will have to wake up with the same pressures as when they used drugs or alcohol. Surely this – and services like this – are a cost effective and practical rehearsal for going it alone
.
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There’s a great deal you can’t do without money – but there’s a lot to be said for a ‘can do’ attitude. Kevan Martin (page 12) went further with a ‘must do’ approach to setting up NERAF, a forum for alcohol service users in the North East.
Kevan’s determination to go out and find service users before they leave treatment and spend years wrestling with the lonely reality of alcoholism – as he did – has given him the basis for an active and responsive network. The individuals and services who have helped him along the way, with ideas, support, use of a room – and all the small things that make a huge difference when you’re trying to turn an idea into practice – are testament to those who listen and respond to what’s needed by service users.
Alongside the inevitable frustrations about the lack of funding for alcohol services and refusal to recognise the escalating scale of damage to the nation’s health, there is a rallying cry to unite in influencing future planning. To be heard above the constant noise of the criminal justice system is going to take a clear and united message from alcohol services and service users throughout the country.
Why shouldn’t alcohol service users have a strong and co-ordinated voice representing groups around the country, in the same way that drug service users are participating in dialogue and contributing to the future direction of services? Alcohol Concern are, of course, right up there in the front line – supporting Kevan and other groups around the country and lobbying government for the crucial underpinning finance. With the deadline due now for responses to their ‘Spend £1, get £5 free’ campaign, to make spending on alcohol treatment a priority, there’s a reminder on page 6 to add your support while you still can.
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Welcome to our first issue of the year. I hope you’ve managed to get back into routine without too much of a struggle.
With every newspaper and TV programme telling us what we should and shouldn’t eat at the moment, we decided to ask a nutritionist for sound advice for drug and alcohol clients. Helen Sandwell’s approach makes very logical reading – but is frequently not considered as part of the treatment plan. We concentrate a lot on the best way to respond to a substance problem, but might find inspiration from considering Helen’s straightforward ways to improve the body’s entire machinery, helping it towards recovery and a
renewed sense of wellbeing.
Advocacy has become a welcome buzzword throughout services, with many current and former service users filling an essential communicating role between clients and services. But there’s still a long way to go in breaking down barriers between some GPs and their drug or alcohol dependent patients, to ensure adequate and appropriate treatment. Alan Joyce of the Alliance looks at the growth of user advocacy and why trained advocates are needed more than ever.
If the new year means a review of your job prospects, keep an eye out for our occasional ‘working lives’ features. Elizabeth Flegg tells us how she got into personnel and HR on page 14 and gives an insight to her role. And for a heartening snapshot of an energetic service user group determined to grow, visit The Roundabout Factfile on page 15. A very healthy new year to you.
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The crucial issues won’t wait. The diamorphine crisis, spelled out in our 27 June issue, is getting worse by the minute for those caught up in it, and it’s affecting more than just a handful of patients.
The medical profession, user groups and the DAT joined forces months ago in Cornwall, to campaign for swift resolution, and the stalemate is astonishing (page 9). Can anyone shed light on why it’s taking so long to get supplies resumed?
This edition’s bursting at the staples with pressing policy issues – not least why the government’s findings on drug policy effectiveness have been shuffled past us. Steve Rolles from the Transform Drug Policy Foundation raises a challenge for clarity – and where necessary – revision.
The NTA has taken care to involve service users in feedback to the strategy, and there is enthusiasm for its dedication to putting service users’ needs first. But Anna’s comment does sum up the need for continued consultation.
Leaving the conference there was appreciation among service-using delegates of the open presentation of plans; but the big PS to the event has to be the need for continued dialogue to take the exercise beyond paper and into joint planning over the next three years. We’ve already had feedback from one delegate (letters, page 9).
There’s no doubt that if you want it, you can get it – which is where websites like ‘the vaults of erowid’ (www.erowid.org) come in. The two Americans who created this site now constantly update 30,000 documents covering 250 psychoactive substances, funded by donations and no advertising.
Where many organisations, particularly in the US, have failed to get the kids to ‘just say no’, this pair have gone for the practical option of information provision – and a very impressive archive it is too. This surely comes close to an online harm reduction manual.
There’s everything to play for in giving up, but the conditions are made harsher by the absence of family support and the usual optional distractions of modern life. On the 12-step RAPt programme, inmates are brought face to face with the most painful acknowledgment that they have put family and friends in second place – see our feature on page 6.
You watch that person transform and lose control, and you wonder why they don’t notice what they’re losing – but you don’t want to tell friends, neighbours, the rest of the family.
Gradually they slip out of view at family gatherings, and you are left wondering if you will ever get them back before it’s too late.
If you’re lucky, someone will point you in the direction of one of the excellent family support groups around the country. The work of these services cannot be underestimated – if you are in any doubt, read a mother’s story on page 8.
A very warm welcome to SMMGP this issue, who join our merry band of partner organisations. The ten-year-old organisation for Substance Misuse Management in General Practice has done much to put GP involvement on the map.
Ten years ago, the relationship between service users and their GP was often an uneasy one. These days SMMGP see a bright future for primary care drug treatment, and if the enthusiasm of delegates at the recent RCGP is anything to go by, there’s every reason to be optimistic. The
workshop which found a meeting of minds between GPs and service users is particularly encouraging – see page 12.
There’s been no shortage of opinion on the rights and wrongs of drug testing in schools, and the concept of ‘sniffer dogs’ brings with it its own set of issues.
Visiting Buckinghamshire for a report on their pilot scheme (page 8), I was not at all comfortable about the thought of children being lined up and investigated by dogs that had been trained to detect drugs on them. But the pilot exercise had been very carefully planned and constructed, with opinions canvassed every step of the way with parents and pupils. Head teachers reported that the schoolchildren enjoyed having the dogs visit school – but for some of the grammar schools in leafy Buckinghamshire I suppose it’s a bit of a welcome diversion.
Addaction’s pilot services, sending trained family workers out on home visits, will join the network of dedicated services throughout the UK.
Addaction’s CEO, Peter Martin, is hopeful that the work could transform drug treatment in Britain but making a difference depends on a co-ordinated approach. At the moment there is a lack of national data on the scale of the problem and, as yet, no overarching co-ordinating body. Let’s get past laying bureaucratic tarmac, and onto making a real difference says Rosie. There’s no time to hang about – childhood is all too short for many.
For starters, nobody was ‘badged up’, so we didn’t know from the outset who was a service manager, who was a service user and who (heaven forbid) was from a publication. We were sat at round tables throughout the day, speakers took the floor with a microphone but no platform, and answered questions as they came up, and we were all involved in the charge for the chocolate cake at lunch.
Talking to people in treatment services, and the service users themselves, has been a crucial part of Srabani’s induction, and has informed her strategy planning for the coming months. All very logical. So when do we stop listening?
When we’re busy, and pressured, and under- resourced and over-targeted.
The Wired team make a solid case for listening on page 8. Listening to service users’ views is surely the best way of finding out what will ring the right bells in changing patterns of behaviour and arming people with devices for coping.
In case we start to believe that binge drinking is only about the Saturday night lads down the pub, we’ve considered who else might make up the staggering statistics on alcohol related illness. Surprise surprise, most of us can manage to binge quite easily in our own homes, without so much as the radio on.
Views range from ‘why is it taking so long to legalise it..?’ to worries about the long-term health risks and concern that the law has gone too far already. Is it really dangerous? Was it reclassified to reduce paperwork?
Are we storing up a health timebomb? Is it no more dangerous than having a few drinks? Do your views differ from those represented on page 6?
The other day I bumped into neighbours who began chatting about Christmas.
The kids would be away from home for the first time, and they were at a bit of a loose end. ‘We were thinking about working with the homeless… but then our son’s friend said he knew someone who’d tried it, and it’s not all it’s cracked up to be. We’ll probably go to Paris or Wales instead.’
How amazing then, that 3,000 volunteers will be turning their backs on the easy option and heading for the Crisis Open Christmas hostels next week – at least half of them ‘regulars’, who have returned year after year to take pride in creating a ‘family’ Christmas for people who would otherwise be on the streets.
Claire Brown – Editor
I was fortunate this week to be invited to a lecture, arranged by the National Association for the Children of Alcoholics (NACOA), which really got me thinking about the three-way relationship between child, parent and alcohol.
The highly successful journalist and broadcaster, Fergal Keane, was talking about his experiences as the child of an alcoholic father – and then as an alcoholic himself. What struck me most was how such a high profile professional could manage to stay focused on such a demanding job, while hiding his evening drinking binges from friends, colleagues and the public.
Claire Brown – Editor
Tacked on to a number of major drug reports as a reference – ‘this could also apply to alcohol’ – the needs of those who have drifted from using alcohol for regular relaxation and social confidence to desperate dependency, have been neglected.
The DATs who have become DAATs may be doing their best, but it seems up to the persistent minority to remind government that targets are not set for shifting, and that a report on alcohol services due on such and such a date means that there are services looking out for a framework and a promise of commitment.
Claire Brown – Editor
You’ll see that we’ve teamed up with the partner organisations listed on this page to bring news and features from very different perspectives. The other part of the equation, to make this magazine a successful communication tool, is you. The magazine will work best if you let us know what’s happening in your workplace and region. Let us know your experiences with clients, and practical solutions that will help other readers.
This issue we catch up with Caroline Flint at the Home Office, who shares some interesting thoughts on drugs and crime. On the professional side, we summarise FDAP’s revised code of practice, which gives some helpful advice on those less than clear work situations. But we’re not all about the official side of work. Natalie’s story (page 6) and Dave’s day in the life’ (page 12) illustrate what we’re all about: demonstrating that treatment and support services can, and most definitely do, make a real and lasting difference to people’s lives.
Claire Brown – Editor
