My, how you’ve changed!

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What has the past decade meant to you and your role? What have been the most significant changes to the sector? And what will happen next? You gave it to us straight. 

shapiro‘We’ve been riding a chemical carousel’

It’s only when you step back from the day-to-day hubbub that you realise what a chemical carousel we’ve been riding for the past decade in this world of drugs.

In 2004, cannabis was regraded from class B to C after three years of wrangling from the first announcement. In 2005 the then Tory leader Michael Howard vowed that if his party won the next election, they would put it back to B and accused Labour of being soft on drugs. They didn’t win, but Labour in turn asked the ACMD to reconsider the classification once again. The ACMD resisted the political and media clamour for another change, but couldn’t in 2007 when Gordon Brown, the in-coming PM, declared his intention to reclassify whatever the evidence. At the same time, the police were uncovering previously unsuspected numbers of cannabis farms across the country; from a position in 2002 where the imported/home grown ratio was about 75:25, by the late noughties the situation was reversed. Yet all the evidence showed that cannabis use was falling. Who was/is consuming all this cannabis? We still don’t really know.

Other drugs were showing a similar trend; we began to experience an ageing heroin population, and the use of other drugs such as MDMA, amphetamine and cocaine were not at the levels of the 1990s. Other drugs were apparently tailing off in popularity, but were causing real problems for those who carried on using – ketamine being the prime example.

But overall the stats were going in the right direction. It was the quiet before the storm. In 2009, say hello to mephedrone, synthetic cannabinoids and the whole dust storm caused by the advent of new psy­choactive drugs, which still swirls on. The internet has been the game changer in this dynamic flux. And not just for buying drugs whose actions mimic club and other recreational drugs. We now have an array of per­form­ance and prescription drugs available at the click of a mouse – all driven by a well-embedded world­wide connected industry of retailers, wholesalers and chemists.

Down at the sharp end, the drug treatment field has undergone some seismic shifts – moving from a political focus on harm reduction and crime prevention to recovery, accompanied by a removal of ring-fenced funding, ferocious contract-culture and a cliff drop in public spending. The UK drug treatment system has been hailed as world class in its comprehensive coverage, its adherence to the evidence base and its basic humanity and pragmatism. No doubt new drugs will come and go and the arguments for and against law reform will rage on. But our real concerns must be for the future of services caring for our most vulnerable citizens. One can only hope that in ten years time we are not looking back and mourning what we have lost.

Harry Shapiro, director of communications and information, DrugScope

  

dudley‘Lack of funding will have a massive impact’ 

People’s needs are becoming much more complex, with increased mental health issues, general health concerns, and higher levels of medication. We’ve seen the use of new drugs such as legal highs, an increase in ketamine use, and in the last ten years an explosion of alcohol problems. There’s also a time-bomb with gambling and gaming.

With many rehabs closing, there is a move towards recovery, but it involves a less skilled workforce as community providers especially look to volunteers and support workers. There’s been more domination by big national community providers as contracts tendered are for the whole service and not the separate parts. We’re going the way of the few big supermarkets. By 2024 we’re likely to have one or two dominant market players and just a handful of specialist providers. 

The lack of funding coming will have a massive impact and set the whole field back decades, with rises in crime and deaths due to addiction. I’m sorry to paint a bit of a bleak picture, but this, unfortunately, is how I see it.

Brian Dudley, chief executive, Broadway Lodge

 

gervase‘Patterns of use are changing’

Addaction has grown as a result of market changes in the last ten years. We’ve quadrupled staff numbers since 2004 and expanded our remit into more clinical work. Our staff now includes pharmacists, 100 former NHS nurses and 20 doctors as a result of the contracts we’ve won. 

The staff profile has also changed. The numbers of former service users volunteering as recovery champions have grown and service users influence the entire organisation, including senior leadership.

During this time the sector has moved from an exclusively harm reduction model to a greater emphasis on recovery. The approach in 2004 was about getting people into treatment, whereas now it’s about getting people into recovery. There is more regulation in the sector now, most notably the Care Quality Commission, which we welcome. There’s also been a move from NHS to local authority commissioning.  

The landscape of substance use is changing. We have a legacy of opiate users stuck in treatment, although opiate use itself is reducing. There is an ageing population of people used to using a variety of substances but for the young, the pattern of substance use is changing with the prevalence of stronger cannabis, and new psychoactive substances creating new challenges for treatment providers. 

However it isn’t just drug use among the young that is changing. More people drink at home and the context is no longer social; it has more to do with isolation and loneliness. So the way we live our lives is also having an impact on the way we use substances and the damage they can cause.

There is also a growing acceptance of substance misuse – three or four generations of people have grown up in a world that uses drugs, and so the decriminalisation/ legalisation debate will rumble on. In addition to illegal drugs, we will probably be facing up to the legacy of inappropriate prescribing in primary care.

Services will integrate professional staff with recovery services staffed by volunteers. The commissioning landscape is changing, with increased emphasis on social value and community-led recovery. Following the pattern of our broadening remit, I predict we will increasingly be engaging with other services like housing and mental health.

Gervase McGrath, director of UK operations, Addaction

  

liddell‘We’ve changed focus in Scotland’

Over the past ten years, SDF has seen changes in its focus. There has been a great concentration on improving the quality of service response; reducing the numbers of drug deaths, including pushing for the national naloxone programme and supporting implementation; ensuring an effective user voice; and innovating means of helping people with a history of drug or alcohol problems into employment.

Recovery as a key concept and discourse has been an important change during this time. Initially in Scotland there was an over-emphasis on abstinence, taking us back to an era when the focus was on people who were ‘motivated to change’; a narrow focus on the individual and not wider societal inequalities and poverty. Thankfully, we’ve returned to a balanced approach – recovery and harm reduction are dovetailed and not separate. Competing approaches, eg naloxone, are recognised as a step towards recovery.

In England there seems to be a more fractious relationship between the evidence base and what government would like. Sticking to evidenced-based approaches and not ones driven by moralistic views is a challenge – such as UK government requests to explore time-limiting methadone. 

Going forward, we’ll see challenges dealing with an ageing group of users, with services working closely with wider care services designed for older people.

In terms of trends of drug use, how will problems manifest themselves? We see significant problems with new psychoactive substances, but this covers a range of compounds with differing effects and issues. We know that if the needs of vulnerable young people aren’t adequately addressed today they will become, sadly, the service users of tomorrow.

David Liddell, director, Scottish Drugs Forum (SDF)

 

finney‘I hope that quality will win the day’

I have been privileged to be involved in the regulation of the treatment sector over the past ten years. It all began in Weston Super Mare where, as head of inspection, I had to make sense of the concentration of treatment services in the area. 

I was constantly bombarded by services who told me in no uncertain terms that they were not ‘care homes’, but something entirely different. The legislation in the Health and Social Care Act 2008 created a new regulation, which described services as ‘accommodation for persons who require treatment for substance misuse’. Unfortunately CQC chose not employ someone to coordinate the implementation of this regulation and, as this had become my passion, I took early retirement and sought to assist services as an independent consultant. Sadly, in my view, CQC implemented this inconsistently for the first five years. However they have now decided that a policy manager for substance misuse is needed and a separate nationally recognised inspection methodology is being developed.

The last decade has seen the passing of some long-standing residential rehabs to be replaced by newer ones. Regulation has also been extended to many community-based services, many of which are doing an excellent job. My passion is that services are run respectfully and with a central focus on the needs of people using the services, with recovery as chief aim. My hope for the future is that quality will win the day and the new rating system introduced by CQC will highlight where there is good, and even outstanding, practice among treatment providers. 

David Finney, independent social care consultant

 

blakebrough‘Wales now has the best route out of addiction’ 

Kaleidoscope began its own rehabilitation by establishing itself in Wales ten years ago. What we saw when coming to Newport were huge waiting lists for treatment and a lack of support for people with drug and alcohol use in many parts of the country.

Today we see Welsh-based organisations forgetting past rivalries and coming together and sharing best practice. This has best been shown by the establishment of Drug and Alcohol Charities Wales (DACW), which ensures there are Welsh solutions to the problems of substance use. Innovation has flourished, be it through Peer Mentoring (an ESF Funded Scheme) which saw hundreds of people with drug and alcohol issues obtain work; Change Step, which is a unique project supporting veterans; the development of computerised dispensing systems in our major cities; and the establishment of social enterprises for service users. Wales is fast becoming the best country in the UK to be in when looking for a route out of addiction, when it used to be the worst.

I am worried that the uniqueness of treatment in Wales will be replaced by the huge English or international companies in ten years’ time, peddling average drug services at cut-price costs. In Wales, service users have grown in confidence. In Gwent, The Voice service users group works closely with the local providers and is actively involved in how treatment works. Its voice is heard because management is close enough to hear, and is near enough to meet with. As DACW has shown, with drug services in a small country, networks with trust can be formed which simply would not happen with large faceless organisations.

Positively, I do see a change in legislation and the re-emergence of harm reduction. The Welsh Government policy of a drug and alcohol strategy is an example where all mind-altering substances are looked at rationally and not, as in the case with the UK government, on ill-informed legislation governed more by the Daily Mail than by the experts on the subject. 

Martin Blakebrough, chief executive, Kaleidoscope Project

 

ashton‘Mistaken paradigm still dominates research’

A striking aspect of treatment research from the past ten years is the realisation forced on Project MATCH researchers: that after the most sophisticated research of the most highly technically specified therapies ever seen in alcohol treatment, their therapists were in essence doing nothing different from the faith healers and witch doctors of ‘primitive’ societies – providing a culturally accepted route to recovery which gave clients permission to activate their pre-existing resolve and resources. What was critical was cultural fit, and the status it gave to the intervention and to the therapist. It was an example of the creation of new understandings from the rubble of a massively expensive and unexpected failure – in this case, to match different psychosocial therapies to different kinds of patients.1

Underlying most research is a very different preferred message – that we have found treatments that work because they embody the right psychological technology to treat a techno-medical disorder of the body and mind. The car is not working; as long as the technician uses the right spanner on the right nut and turns it in the direction and by the amount specified in the manual, then it will be restored. Despite what (in The No. 1 Ladies’ Detective Agency novels) Mma Ramotswe’s mechanic husband likes to believe, it matters not at all how the technician talks to the car, whether he loves or loathes it, shows respect or disdain, and the car itself plays no part in the process.

For substance use, this profoundly mistaken paradigm should have been shattered by the ‘failure’ of Project MATCH, but it still dominates research. In psychotherapy generally, things have decisively moved on with the American Psychological Association’s recognition that evidence-based relationships must take their place alongside evidence-based treatments:2 ‘It reflects an inexorable, evidence-based recognition that the relationship is a common denominator that brings diverse clinicians together.’

Mike Ashton, editor, Drug and Alcohol Findings

  

oconnor‘A landscape with conflicting priorities’

The National Treatment Agency had strong political support during the past decade for its very clear mission to improve the quality and quantity of drug treatment. We actively supported local areas, set targets, asked challenging questions and introduced a recovery ambition.

As Public Health England, we have a much broader interest in alcohol and drugs, in prevention, treatment and recovery and in health inequalities. Local government is now in the lead; we support them through reflecting their performance back to them, promoting the evidence and providing bespoke support to them and providers to deliver safe and cost-effective services. Some things remain constant, but the landscape is now more complex, with conflicting priorities and an un-ring-fenced treatment funding pot.

Substantial investment expanded the sector massively; many more people started treatment quickly and stayed long enough to see real health benefits. The introduction of ambitious evidenced-based prison treatment helped close the gap between prison and community drug treatment.

The centrality of links between effective treatment and crime reduction was a key driver and the emphasis on recovery introduced greater ambition, ensuring a positive shift towards more active and personalised treatment, often harnessing and enhancing mutual aid and peer-led initiatives. During this time we developed a world class data system and accumulated evidence of what works, so our guidance and support is now well developed and highly regarded, with the system delivering much improved outcomes. 

Of late, the most significant development has been the transfer of commissioning to local authorities, with the loss of partnership commissioning and protected funding. 

Who knows what the sector might look like by 2024, but hopefully it will be responsive to new populations of users, valued by local authorities, health and criminal justice partners and the public. It should certainly be more aligned with broader services – training and employment, housing, families, mental and sexual health – better integrated with local initiatives, and most importantly, seen to be delivering first class outcomes for the whole community.

Rosanna O’Connor, director of alcohol and drugs, Public Health England (PHE)

 

andrews‘Ten years ago it was about getting everyone on a script’

I have worked in the drug and alcohol field for the past ten years and have seen a dramatic change in not only our way of working but also in the types of drugs used. When I started, it was a case of getting everyone on a script and keeping them there. It felt as though the government believed that if drug users were on a script then crime would disappear (of course it never did). The only therapy was one-to-one key working, which on its own proved not to work for many.

The emergence of recovery started a few years ago and appears to have blossomed. Sadly not enough staff were trained in it and still few are – it’s always been a case of just running with it. Group work and peer support have gone from strength to strength. The ever-changing legal highs are now a real problem and I believe that we will need to change our way of working with clients who use them.

The one thing I hope not to see widespread in the drug and alcohol field is payment by results, which I was unfortunate enough to work with for a short period of time. This was appalling and put price tags on people’s lives.

Sue Andrews, drug worker

 

adebowale‘Integration with public health will be the norm’ 

Turning Point has been delivering services for 50 years this year. In 1964, founder Barry Richards launched a small non-profit organisation called Helping Hands – the UK’s first attempt to help those with alcohol problems, by using a community based, residential programme. 

Barry Richards was breaking new ground and that’s what we are still trying to do. It’s enabled us to grow from what was effectively a small single-issue charity to a leading social enterprise now employing more than 3,000 people and operating over 200 services in the areas of substance misuse, learning disability, mental health, primary care, employment, criminal justice and community commissioning. 

Over the past ten years we have kept growing and developing, increasing our expertise around complex needs and dual diagnosis. A very welcome change over the past decade has been the move to more integrated services, which bring together drugs, alcohol, criminal justice, and young people’s support. 

The recent move of substance misuse back into local authorities, as part of public health, is also positive, although it presents challenges for providers to ensure we’re demonstrating clearly the community benefits of investment in us. The benefit of this move is starting to come to fruition through the broadening of traditional substance misuse services to include public health priorities, such as the launch of smoking cessation pilots in six of our substance misuse services.

Integration will be the norm by 2024, so we’ll no longer be talking about drink and drugs and mental health but more readily talking about ‘public health’, with commissioning reflecting comorbidities. Health and social care are intrinsic elements of an equal society and in order to fix them we need to foster collaborative thought and practice.

The bulk of investment should be in prevention and the importance of education and early inter­vention in the substance misuse sector should not be underestimated. I hope that by 2024 we’re investing in services that reach at-risk individuals earlier so that intergenerational problems cease to exist.

Additionally I’d hope that the stigma associated with alcohol and drug dependency and dual diagnosis, which often prevents people from seeking help, would be vastly reduced, so that more people know and accept that sustained recovery is possible for anyone.

Lord Victor Adebowale, chief executive, Turning Point

 

viv‘Family support services are forced to compete’

Ten years ago Adfam was an organisation which focused its work on direct support for families affected by substance misuse in the criminal justice system – we had services in several prisons in London and we also had a national helpline.

With funding changes, taking account of new political and economic structures and constraints, we became an umbrella organisation in 2008 and now provide indirect support to families and the prac­ti­tion­ers who work with them, via our website, regional support team and policy and campaigning activities.

The word ‘family’ appeared twice in the 2002 government drugs strategy; it was included in the title of the 2008 strategy. The need for family support will probably never go away, but the current economic climate means that support services are increasingly being squeezed and forced to compete with large providers for funding.

By 2024 the drug sector may be comprised of a few, large treatment providers with family support included or just tagged on. This ignores the need for support for families whose loved ones are not in treatment. There will be a much larger recognition of the needs of families, achieved through a community led movement, not dissimilar in character and influence to the user recovery movement.

Vivienne Evans, chief executive, Adfam

  

yasmin‘Things can only get better!’

Like many organisations in this field, WDP has grown significantly over the past ten years. We now provide more services to a larger number of users over a wider geographical area. Quality remains a key component of our service, reflecting our staff team who are always prepared to go that extra mile.

There have been a number of significant changes in our sector over the past ten years. The nature and type of drug use is changing, with legal highs becoming increasingly common and a reduction in individuals using heroin and cocaine. There are greater numbers of ageing users presenting with more complex health problems than perhaps ever before. 

On the positive side, the public perception of illicit drug misuse is starting to shift. It is slowly being seen as a healthcare issue, rather than as a criminal one. The politics of alcohol has also come into play, with government ministers willing to talk, albeit cautiously, about the links between the price of alcohol and its abuse.

There will be important changes ahead that will impact on the planning, commissioning and delivery of services resulting in a very different landscape of service provision. The reality is that it is likely there will be fewer specialist treatment services available – ‘choice’ of service by the user, which has been systematically eroded, will become even more so.

The resident government, regardless of political persuasion, is likely to be amenable to discussion on UK drugs policy – not because it wants to, but because it has to in order to keep up with current thinking. This may lead to the state regulation of illicit drugs becoming a possibility.  

The substances misused will continue to change and the dynamics of treatment versus prevention will be played out in the public arena. The short-term future appears somewhat bleak, but strangely this gives cause for optimism: things can only get better!

Yasmin Batliwala, chair, WDP 

 

weeding‘We’ll build on successes’

This year DISC is celebrating 30 years of being at the forefront of service delivery to those facing the most challenging circumstances.

We’ve expanded from a charity focused on training to the development of our current organisation – one of the north’s most successful charities, with over 400 staff, 100 volunteers and peer mentors, and an annual turnover of £16m.  We’re committed to supporting people and communities to achieve their goals and helping people reach their potential.

Our anniversary has caused us to reflect on what we’ve achieved. We can look back on some amazing successes; contracts won, jobs created and partnerships improved. But what we really care passionately about is the number of people, year on year, whose lives we’ve helped to improve. Through initiatives developed by DISC, we have supported more than 100,000 people in the last ten years alone.

We’re an innovative organisation and we are constantly developing diverse ways to meet the needs of current and future service users. By investing in new programmes, developing new partnerships and leading with innovation, we will continue to support healthy communities to bring about change and provide inventive services to help those with problems of alcohol and drug addiction overcome challenges in their lives.

Mark Weeding, CEO, DISC

 

annette‘We’re in a social inequality war’

The past ten years have seen remarkable changes: the years of expansion in drug treatment, the stall, then a chill wind of austerity biting in many areas. 

The massive influx of cash driven by the Blair government’s wish to reduce drug-related crime came hand-in-hand with what the Scots call the ‘English disease’ of targets, data collection (forms, damn forms!) and increasing performance management by commissioners. The NTA quango, with its `delivery assurance’ role and armed with `toolkits and guidance’ pushed the sector hard and fast with a mantle of assumed power (all ‘fur coats and no knickers’!). 

The bubble was burst by a groundswell of people in recovery (rightly) wanting more, and a new coalition government wanting something different. The vibrant recovery movement is a fabulous legacy of this decade, but growing stigma against those who cannot reach abstinence is a deeply worrying sign of a society that increasingly disapproves of all state dependence.

By 2024 there will be a lot more old people: one in three over 65 by 2015 and increasing at 4 per cent a year. There will be less money – with a per capita spend on health and welfare less than the USA by 2018. My cynical self thinks this will drive funding to ‘mandated groups’ only (eg the elderly and children) OR those doing the most harm to others – where interventions are cost-effective. Our ‘lifestyle diseases’ may be left to ‘mutual aid’, web-based health intervention, volunteers and  a postcode lottery of services. 

I sincerely hope we don’t have another heroin epidemic or a new methamphetamine epidemic. I hope synthetic drugs become even less moreish and cannabis CBD levels rise. Who knows, maybe we will follow the USA on cannabis, as we have in obesity.  

In 2024, I aim to still be around, championing the cause. We are not in a drugs war, we are in a social inequality war – and we need more troops. 

Annette Dale-Perera, strategic director:addictions and offender care, CNWL

 

moncrieff‘Steep challenges for the gay drug-using community’

Ten years is a long time in drug treatment. In Antidote – London Friend’s specialist service for lesbian, gay, bisexual & transgender people (LGBT) – some changes have been quite astonishing. 

Our data from a decade ago shows most clients experienced problems using alcohol and cocaine, with a handful having partied too hard on ecstasy. Generally though, most people managed their party drugs reasonably safely. 

We had already heard rumblings from other major cities that crystal meth was a-coming. The mainstream media sprang into a panic predicting the next pandemic, but for the most part it never came. Quietly though, away from view in private houses, crystal was making itself known among a small group of gay and bisexual men.

Fast forward a decade and it’s become one of three main problems we deal with – the others, GHB/GBL and mephedrone, having similarly appeared as if from nowhere. A typical user tells us how they ‘slam’ (the colloquialism for injecting, perhaps coined to avoid associations with IV drug use) and attend weekend-long sex parties with several other men.

Of course, gay men, sex and drugs are hardly strange bedfellows, but a decade ago you partied and maybe then fell into bed if you’d got lucky on the dancefloor; now the norm is to get app-y on smartphones where ‘chemsex’ is readily found on ‘dating’ sites without even needing to leave the house. 

The fallout is harsh: we’re seeing significant mental health concerns, psychosis, and a group of previously stable men whose lives, relationships, jobs and housing are falling apart around them. Men whose self-esteem has plummeted. Men who are contracting HIV as heterosexual infections are falling.

It’s been a challenge for us to adapt to new drugs and trends, such as slamming, that were never common within our communities. As these patterns make their way into mainstream services it’s important for them to consider how to meet this challenge too. Our recent report Out of your mind has some resources to support this. 

Monty Moncrieff, chief executive, London Friend

 

flemen‘Hang on to user-led initiatives’

Ten years ago, KFx was in its terrible twos. Using the waybackmachine I can see how, in some respects, things haven’t changed. Cannabis had been reclassified and the ACPO guidance was the source of much discussion. As housing providers were still concerned about the fall-out from the Wintercomfort Trial, I was busy with housing and drugs policy work, which still remains an issue today. The legal issues still haven’t been addressed.

GHB had earlier been made a controlled drug, but since then GBL emerged as a successor and ten years on we’re dealing with a slew of newer psychoactive compounds.

Ten years ago, the paraphernalia laws were slowly being amended, allowing distribution of acids and other paraphernalia. It’s taken a further decade for the law on foil to be amended. The farcical nature of the paraphernalia laws forms part of my safer injecting training. Sadly over the past couple of years, there has been a sharp decline in requests for this course. I hope that in ten years time we aren’t paying a huge price in injuries and infections from not ensuring staff delivering injecting interventions are adequately trained.

More than 1,000 workshops and 16,000 participants later, I think my passion for and interest in the subject hasn’t dimmed. Sadly, not all the organisations that I worked with ten years ago still exist, and have perished in the new world of competitive tenders. A huge change therefore has been a reduction in the number of small, local service providers and a growth in larger national ones. In sharp contrast to the increasingly corporate nature of provision, the grass-roots emergence of user-led initiatives has been amazing and inspirational to behold. Ensuring that this does not in turn become incorporated, co-opted and neutered will be one of the key challenges in the next ten years.

Kevin Flemen, KFx

  

barton‘Society doesn’t take addiction seriously’ 

Good things happen, progress is made, people do get good help and lives are transformed. Whatever the turn of the political and funding wheels and the system they drive have taken, over the last ten years that has undoubtedly been the case. Whether the good has happened because of the system or in spite of it, I am not so sure. 

The bad also happens both because of systemic flaws and in spite of them. Progress is thwarted and undermined as too often we take two steps forward and then a couple or more back. Just as we seem to be getting somewhere the operating environment changes, the seeds of progress are ploughed up and obstacles strewn in our path.  That’s when we’re not getting in our own way and tripping ourselves up for one reason or another. 

I could explore changes to funding and political structures, degrees of workforce competence, the adequacy of investment in research and whether sufficient priority is given to families. I could discuss recovery and treatment modalities and the tensions between them and examine the commissioning and providing relationship and more.

But I think the fundamental problem is that unlike other life-threatening conditions we simply do not yet as a society really take addiction seriously in its own right. We only address it because of its costly nuisance effect. Empathy for addicted people remains in pretty short supply.

It’s not treated like every other major life-threatening ailment; cancer, diabetes, heart disease, for instance. Why? The answer is stigma. Society looks at our client group through the lens of the consequences of addiction and projects conveniently onto it. It loses sight of the people; the human beings.

Until, as a society, we adjust our way of looking at addiction and thereby remove the stigma, we will never properly understand it or be able to respond in a fully rational way that moves beyond the kind of uncoordinated tinkering that characterises much of what we do now.

Once we have done that we can begin to look bravely at the question as to why addiction flourishes in our society in the first place. Maybe in another ten years we will have got there. 

Nick Barton, chief executive, Action on Addiction

  

collingham‘The heart of the matter’

With the help of supportive commissioners, Nottingham’s service users have made sure they’re now at the heart of decision-making.

May’s meeting of Nottingham’s Recovery Forum celebrated ten years of meaningful service user involvement. Over the years the forum has had numerous names, but the function has always been the same – not only for service users to feed into the commissioning process, but also development of services, as well as being a catalyst for many members to go on to paid employment, and not just in substance misuse and mental health.  

As was recognised quite early on, clients in recovery, be it on medication, in aftercare or not even engaging, have many complex needs and it was decided other groups would be set up with active user involvement at their heart. 

Through the Recovery Forum (and its various names) other forums have become established, such as the Dual Diagnosis Forum (DDF), Alcohol Service Users’ Forum (ASUF) and Substance Campaigns User Friendly – formerly Shared Care User Forum – (SCUF). These forums were set up not only to give shape and input into needs assessments, service provision and delivery, but also to give participants a time to check in with their peers for things such as self help and support, as well harm reduction and awareness education and access to training.

The forum and its members have always been integral to anything that has happened within substance misuse in Nottingham City and several members sit on various steering group and strategy meetings and working groups.

One thing that has been key to the Recovery Forum’s success is its desire to do partnership work with all the agencies and support services within the city to ensure not only cost effective, but also successful, services that are fit for purpose. 

Members of the group have been involved with various agencies producing DVDs around needlestick injuries, safe returns and overdose response, and have produced consistent award-winning work around stigma.

Members of the forum were involved when it came to relocating and rebuilding our current detox unit to become a state-of-the-art unit called The Woodlands, whose statistics speak for themselves. The building and fittings are still as new three years on as when it was built – all down to service users and staff respecting the environment.

The Recovery Forum continues to be at the forefront of what is done in Nottingham’s treatment system, and in November last year two organisations came together for ‘Recovery Rocks’ (DDN, January, page 10) where more than £400 was raised to provide food parcels at the homeless drop-in.

Although it took four years and many meetings  – as is often the case with strategic stuff – it was because of the service user relationship and power that naloxone is now being distributed, with 64 kits being issued since it was launched in December last year.

Among many many other things besides The Woodlands and the provision of naloxone, service users are where they should be – at the heart of what’s happening, thanks to a forward-thinking commissioning team, a dedicated involvement worker and a committed group of service users refusing to be pushed aside and ignored.

Lee Collingham, service user activist, Nottingham