Déjà vu

While numbers of crack users may be on the increase, the basics of providing an effective service for them haven’t changed, says Danny Hames.

Danny Hames is chair of the NHS Substance Misuse Providers Alliance (NHSSMPA)

I read the serious violence strategy recently produced by the Home Office (see news, page 4) with great interest. Leaving aside the debates in the media regarding police numbers and budgets, I was drawn to the growing concern regarding the increasing prevalence and purity of crack cocaine in UK markets, and its link to increasing levels of serious violence.

The report indicates that the East of England has seen an 18 per cent increase in the estimated number of users of opiates and/or crack cocaine, alongside a 21 per cent increase in the estimated number of crack cocaine users in the South East. Anecdotally, our operational colleagues in the East of England area are noticing a steady increase. As a practitioner in the noughties, both in London and Southampton, I saw the prevalence and damage caused by crack and it prompted me to reflect on what ensures a drug and alcohol treatment service meets the needs of these service users.

As NHS providers we have been at the forefront of operating services for those using crack cocaine and cocaine for many years, both in our drug and alcohol services but also alongside colleagues in mental and physical healthcare services and those in primary care. It seemed relevant at this point that we outline what NHSSMPA believes is good, solid practice when ensuring that we provide strong, effective and relevant services for crack cocaine users. Here are our five get-the-basics-right principles:

  1. Make sure your service is accessible. When a crack cocaine user presents, really take the opportunity to engage and start building a relationship, as the window of opportunity will be small.
  2. Have strong case management which is clearly shared and communicated with service users and steadily transitions responsibility for the plan from practitioner to service user. Provide stability and direction amidst the chaos.
  3. Ensure that your staff, volunteers and peer mentors are well trained and supported to understand the impact of crack cocaine. This will help them to build a relationship with the service user.
  4. Ensure your risk management is robust. It needs to be protective to all and also ensure that interventions can be provided effectively – quality psychosocial interventions in the right dose at the right time are vitally important. Close working with psychiatry and psychology is invaluable.
  5. Build strong local relationships to ensure there is a broad range of recovery interventions available to those affected – both service users and their families.

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