Access to a place at River Garden Auchincruive is free if you are motivated to turn your life around. In return for your residential place, you are asked to contribute to the life of the community through voluntary work.
IFDAS – River Garden Auchincruive
Website: https://www.rivergarden.scot/
Humankind
Sheffield, Sefton, Barnsley and Durham Supported Housing
We provide housing related support to individuals
to develop the skills required to manage homes, live confidently, remain in recovery and ultimately achieve independent living.
We also deliver group-based activities to support clients to promote health and wellbeing, employability and active-citizenship.
The services are open to both men and women and provides single, self-contained accommodation.
The services focus on housing-related support and developing the skills required to sustain a tenancy, recognising this as a key factor in maintaining recovery.
Website: https://www.humankindcharity.org.uk/
Telephone: 01325 731 160
Email: info@humankindcharity.org.uk
HOPE Worldwide – ODAAT
We provide a holistic approach to their recovery that includes a combination of therapies over six months. These include psychotherapy, one-on-one and group counselling, anger management, access to sport, yoga, peer support, life skills training, family therapy and work experience – in preparation for settled independent living.
We have a capacity for 11 undergraduates in our first and second stages. When completing the six-month residential programme, graduates have the option to enter our third stage supported houses, for which our capacity is 12 beds.
Website: https://www.hopeworldwide.org.uk/
Telephone: 020 7713 7655
Holgate House
Holgate House residential unit is staffed twenty-four hours a day. It offers a structured programme, i.e. looking at dealing with unresolved, here and now issues that would be too painful to deal with. It is warm, friendly, safe and a healthy environment to live in, and as a professional team we can offer support, structure and discipline in a caring nurturing way.
We offer move on accommodation for those that do not want to return to the area they came from and are supported in the community.
Website: http://holgatehousebarrowford.co.uk/
Telephone: 01200 445200
Email: holgatehouseltd@aol.com
Help Me Stop
Help Me Stop offers the first US-style Dayhab treatment for alcohol and drug problems in the UK. Our unique non-residential treatment programme fits around daily life, meaning work, study or family responsibilities don’t have to be put on hold. And because our costs are low, we put recovery within reach of most people.
Affordable: From £2,500 – Intensive: 160 hours – Effective: Proven success rates
Accessible: non-residential
Website: https://helpmestop.org.uk/
Telephone: 0208 191 9191
Email: enquiries@helpmestop.org.uk
Hebron Trust
Hebron House has been changing lives for 30 years. We are situated in Norwich, Norfolk in two beautiful houses.
We offer a 12-step programme including: a tailored care plan; therapeutic key worker; two, one to one counselling sessions per week; group therapy; CBT; sport, leisure and gardening activities; assistance to address financial/debt problems; move on house.
Website: https://www.hebrontrust.org.uk/
Telephone: 01603 439905
Gloucester House
Gloucester House is a CQC outstanding treatment centre that recognises the damaging effects caused to individuals, families and communities through substance misuse.
Our holistic, integrated 12-Step programme is designed to empower and support every individual to attain a life free from dependency, to look beyond their issues and to explore ways of changing their lives for the better. We pride ourselves on delivering a programme that is structured, supportive and personalised, and we take clients from anywhere in the country. We also welcome referrals from veteran services and self-funded clients.
Gloucester House offers both first stage, second stage and resettlement.
Website: https://gloucesterhouse.org.uk/
Telephone: 01793 762365
Email: ros.rolfe@salvationarmy.org.uk
Gilead Foundations
Gilead Foundations Charity provides supported living accommodation for women who have experienced difficulties such as addictions, homelessness and domestic abuse. Situated on a farm work experience in milking cows, poultry and horticulture among other activities is on offer. Fees can be covered by housing benefit and we fundraise to provide the skills training and other support costs.
Website: https://gilead.org.uk/
Telephone: 01837 851240
Email: admin@gilead.org.uk
Freedom Recovery Centre
Freedom Recovery Centre is a day and residential programme for men and women 18+ who want to maintain abstinence from alcohol and drug misuse.
Website: http://www.freedomrecoverycentre.co.uk/
Telephone: 020 8314 0333
Email: enquiries@freedomrecoverycentre.co.uk
ESH Community
Fully Residential drug and alcohol treatment including medically assisted detox. CQC assessed and rated. Supported 24/7. Single rooms. Regular one-to-one counselling with experienced addiction counsellors. Ongoing comprehensive aftercare. Family support. Maximum of eleven residents to ensure we provide the best possible support with the right amount of personal dedicated time from our experienced professional staff.
Set in the heart of the Warwickshire countryside away from everyday distractions providing a safe and supportive setting to address life and addiction issues. Competitive prices for local authorities and service providers.
Website: https://www.eshcommunity.org/
Telephone: 01926 811702
Equinox Churchfield and Cherington
Churchfield Road is a 12 bed recovery focussed accommodation for individuals in active addiction whose homelessness is a barrier to accessing and or committing to treatment packages and goals. Staff work with service users to access and maintain treatment and reduce negative impact on themselves and the wider community.
Cherington Road is a 5 bed abstinence based accommodation for individuals that have completed first stage treatment but have ongoing housing and treatment needs.
Both services offer an in-house community programme, one to one key working and signposting to other services such as ETE advisers, Hepatitis screening, fellowship meetings.
Website: https://socialinterestgroup.org.uk/
Telephone: 020 3668 9270
Email: info@socialinterestgroup.org.uk
Equinox Brook Drive
Brook Drive is a CQC registered, residential community drug and alcohol detoxification unit, providing medically supervised alcohol and drug detoxification programmes for people aged 18 and above.
Many of our service users also have other needs including diagnosed mental ill health, pre-existing physical health needs and challenging life circumstances.
Brook Drive is a big and busy service with an NHS supported complex care pathway and a full time GP service integrated on site.
There is a multidisciplinary staff team of 20, including nurses, recovery substance misuse/mental health workers, complementary therapy workers and group workers.
Website: https://socialinterestgroup.org.uk/
Telephone: 020 3668 9270
Email: info@socialinterestgroup.org.uk
Equinox Aspinden Wood Centre
Equinox Aspinden Wood is a CQC registered service that provides long-term 24 hour care and support to men and women with a history of alcohol dependence, mental ill health and homelessness.
The centre supports people who have been drinking for many years and while service users can continue to drink when they live at Aspinden Wood we work with them to find ways to reduce the harm caused by their drinking.
We offer service users many options for them to improve their quality of life and wellbeing, and work with them to give them back their dignity and self confidence.
Website: https://socialinterestgroup.org.uk/
Telephone: info@socialinterestgroup.org.uk
Email: 020 3668 9270
East Coast Recovery
Since 2001, East Coast Recovery has supported thousands of people to free themselves from addiction. Our expert approach to recovery promotes personal empowerment and perseverance in a welcoming, nourishing, progressive atmosphere.
Website: https://www.eastcoastrecovery.co.uk/
Telephone: 01502 587269
Email: info@eastcoastrecovery.co.uk
Framework Edwin House
Edwin House is a unique, modern CQC registered care and reablement centre that provides high-quality, dignified care to people with complex health needs related to long-term misuse of alcohol and/or drugs.
Located in a quiet corner of Nottingham, we provide high quality care, nursing and recovery-orientated treatment and support people living with chronic physical, emotional or mental health issues.
Our home, which can accommodate up to 63 people, is made up of 48 care and reablement beds. Located within the service is a smaller 14 bed inpatient detoxification unit.
Website: https://www.edwinhouse.org/
Telephone: 0115 8504002
Email: edwinhouse@frameworkha.org
Druglink Oxygen Recovery
At Oxygen Recovery we offer a four step pathway which aims to meet the needs of clients suffering from substance misuse issues. The pathway is able to offer clients two years of supported recovery, including; Residential Detox and Rehabilitation, Second Stage Recovery, Third Stage Recovery and Sober Living. We recognise that needs differ, and as such our programme is flexible and client led. Clients can enter Oxygen Recovery at any point of their treatment journey.
Website: https://www.oxygenrecovery.co.uk/
Telephone: 01442 275 880
Email: oxygenrecovery@druglink.ltd.uk
Changes UK Clarity House
ChangesUK Clarity House provides an opportunity for detox for people to work towards abstinence and begin their recovery journey. They are supported by our Peer Mentors and specialist medical practitioners in safe and comfortable surroundings. It is an intensive residential programme with a person-centred approach to achieve a state of mental, physical, emotional, social and spiritual wellbeing. All of our homes are fully equipped and furnished to an excellent standard.
Website: https://changesuk.org/
Telephone: 0121 796 1001
Change Grow Live St Thomas Fund
St Thomas Fund is a residential rehabilitation service based in Brighton and Hove that offers a safe place for adults wanting to become free of drugs and alcohol, and make positive steps towards recovery. It is a free service for adults over the age of 18 with a local connection to Brighton and Hove; places are agreed with all parties following referral and assessment.
Website: https://changegrowlive.org/
Telephone: 01273 823762
Change Grow Live Park House
Park House is an 18-bed unit staffed by an experienced team of specialist doctors, nurses, healthcare assistants and group work specialists. The detox centre is staffed 24 hours a day, 7 days a week and supported by clinical and operational on-call systems. Park House has beds allocated to both Birmingham residents and non-Birmingham residents.
Website: https://changegrowlive.org/
Telephone: 0121 523 5940
Email: park.house@cgl.org.uk
Carlisle House
Carlisle House is a residential substance misuse treatment centre situated near the centre of Belfast.
We aim to provide a safe and therapeutic space for individuals who have substance use difficulties. A space that provides structure, enabling new choices to be explored and a rediscovery of self without the substance. This opportunity is offered within an ethos of acceptance, respect and compassion.
The Programme offers a range of interventions including – Structured Living, Individual Therapy, Group Therapy, Family Therapy, Art Therapy, Eco Therapy, Personal Development, Complementary Therapies, Peer Support, and Post Programme Support.
Website: http://www.carlislehouse.org/
Telephone: 028 9032 8308
Email: carlislehouse@pcibsw.org
CAIS Parkland Place
Parkland Place offers therapy for people with experience of alcohol addiction, drug addiction, gambling addiction and other harmful behavioural conditions. Our therapeutic programme is tailored to the needs of each of our guests, and is delivered by friendly, expert staff. This bespoke approach allows us to address the social and psychological needs underpinning your addiction, and support you as you make key lifestyle changes.
Website: https://www.parklandplace.co.uk/
Telephone: 01492 203 421
Email: info@parklandplace.co.uk
Brynawel House Alcohol and Drug Rehabilitation Centre
We are a secular organisation delivering evidence based interventions primarily as part of a residential treatment programme.
Brynawel has a unique position as we are the only residential rehabilitation centre in Wales with a programme which has Cognitive Behavioural Therapy and Social Learning at the core of its treatment programme, which includes psycho-social interventions, is client centred and offers a holistic approach. We therefore offer individuals a real choice.
Website: http://brynawel.org/
Telephone: 01443 226 864
Email: contact@brynawelhouse.org
Broadway Lodge
Established in 1974 Broadway Lodge provides 12-step abstinence based treatment supporting people into recovery from a wide range of addictive behaviours including substance misuse, sex, co-dependency, gambling and gaming; also supporting clients with secondary issues such as self-harm and eating disorders
Detoxification can be provided for alcohol, illicit drugs, novel psychoactive substances and prescribed medication including pain relief and benzodiazepines.
Website: https://www.broadwaylodge.org.uk/
Telephone: 01934 812319
Email: hello@broadwaylodge.org.uk
We back Dame Carol Black’s call for change in drug treatment
Change Grow Live has responded to Dame Carol Black’s Review of Drugs – Part 2.
Today we:
- back Dame Carol Black’s call for a step-change in the approach to drug use in the UK, and
- urge the Government to develop a new multi-agency strategy.
Dame Carol Black’s independent report on drugs calls for a radical change in the UK’s approach to drug use.
She argues for a renewed collective commitment to tackling drug use; better coordination across Government departments; an emphasis on vulnerable young people; more effective support for people who are often stigmatised, and a spending review cash injection for depleted services.
We support Dame Carol Black’s conclusions and welcome the Cross-Government Joint Combating Drugs Unit.
A new multi-agency approach to drug treatment is needed, including:
- Recognition that drug dependency is a chronic health condition, but one that must be integrated with mental health services, criminal justice pathways and housing support
- A new definition of recovery that is not limited to abstinence but recognises other measures of success
- Less fragmentation of treatment services so that more people can access recovery in the areas where it is needed
- Better accountability for services, to ensure treatment is easy to access, easy to stay in and easy to get out of
- Minimum five-year contracting cycles and a new approach to commissioning that brings statutory services and treatment providers together to deliver stable services for people who need them.
Mark Moody, our chief executive, is calling for a new approach:
“Dame Carol is right that we need urgent change. The current situation is intolerable and the people who use our services, the communities they live in, and ultimately the whole country pay the price.
We urge the government to come forward with a new strategy.
As stated in the review, for every £1 spent on treatment, we save £4 on costs of other services. A new strategy, backed by ring-fenced spending review investment, must do three things.
It must make sure effective, evidence-based treatment is available everywhere that it is needed so we can support more people.
It must have new measures of success. Recovery is much more than total abstinence. For some people, success is no longer using illicit drugs, stabilising their lives and keeping their families together. For others, success is about getting a job or going back to education.
And it must get commissioning right. We want to see an end to fragmentation of services and short-termism. All the organisations involved must come together to put stable local services in place where they are needed.”
We have the evidence about what gets people into treatment, what keeps them there and what works in the long-term. A new strategy is urgently needed to put this into practice everywhere in the UK.
Collectively, we must make a step change in treatment.”
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by Change Grow Live
Bridge (The)
The Bridge is a non-profit organisation bringing hope to men and women recovering from drug and alcohol addictions while also being able to serve the needs of those exiting prostitution. We run two supported accommodation houses in Birmingham, providing support in recovery, right through to re-engaging with employment and establishing independent living.
Website: http://www.thebridge.uk.net/
Telephone: 0121 663 0103
Email: recovery@thebridge.uk.net
Bosence Farm Community Ltd
Bosence Farm is a CQC registered (rated GOOD) charity providing residential treatment from three distinct services:
Detox and stabilisation for adults and 17 year olds who are in need of a medically led detoxification or stabilisation from illicit drugs, alcohol or prescribed medications.
Rehabilitation for adults who wish to address their drug and alcohol misuse utilising the 12-step model.
Young People offers a bespoke treatment programme for young people experiencing issues with substance misuse and related needs.
Website: https://www.bosencefarm.co.uk/
Telephone: 01736 850006
Email: info@bosencefarm.com
Birchwood Residential Treatment Centre
Birchwood is an inpatient residential treatment centre providing a range of services for drug and alcohol users in need of in-patient care. Birchwood is part of Kaleidoscope, a drug and alcohol charity that has been providing community and residential substance misuse treatment services across the UK since 1968.
We offer tailor-made treatment packages for detoxification, stabilisation and rehabilitation, providing both clinical and psychosocial interventions. Our unit comprises of 20 single occupancy bedrooms – with three DDA compliant rooms on the lower floor for those with more complex needs or mobility issues. We provide services for both men and women, including pregnant women and those with complex needs.
Website: https://www.birchwoodtreatment.com/
Telephone: 0151 670 0033
Email: enquiries@birchwoodtreatment.com
BAC O’Connor
We have supported people into abstinent recovery from alcohol and drug addiction since 1998. Our evidence-based programme is designed to provide clients with the best opportunity to move into recovery and develop improved living skills and increased enjoyment of life.
Our clients work in groups and 1-1 with their named therapist to identify and consider patterns of behaviour and gain the necessary awareness and tools to move forward. We pride ourselves on our highly qualified and experienced team of therapists who, together with our skilled house and support staff, provide a safe, supportive environment to enable recovery to begin.
Website: https://www.bacandoconnor.co.uk/
Telephone: 01283 537 280
Email: reception@bacandoconnor.co.uk
Ark House Rehab Ltd
Ark House Rehab Ltd is a fully residential abstinence based 12-Step Treatment Centre. Founded in 1993 with the basic premise of offering low cost fully residential treatment, using the most successful method of treating addiction to date (the 12-Step Model of Alcoholics Anonymous) in order to bring treatment to all, not just those that can afford it.
Website: https://arkhouserehab.co.uk/
Telephone: 01723 371 869
Email:
ANA Treatment Centres
Set by the Solent in Portsmouth, Hampshire, ANA offers residential treatment for drug and alcohol addictions and associated disorders. We provide excellent, accredited, caring, tailored programmes for men and women who want a life free from addiction and we also work closely with families. We offer three stands of services; therapy, health & well-being & life skills.
Website: https://www.anatreatmentcentres.com/
Telephone: 02392 373 433
Email: info@anatreatmentcentres.com
Amber Foundation
Based at three residential centres in Devon, Wiltshire and Surrey, we offer a supported housing environment that’s a little bit different. Not just training and support to address specific personal issues but new experiences and opportunities that raise aspiration and challenge residents to take responsibility for their lives and move forward positively.
Young people who come to Amber are aged from 16 to 30 and share their home with a community of around 30 others. The average stay is 6 to 12 months but there is no fixed limit. We have clearly enforced rules and a tight structure to the week at Amber but it’s also a fun a caring place to be – a temporary home that offers the time, space, support and encouragement that young people so often need to turn their lives around.
Website: https://amberweb.org/
Telephone: 0800 652 1081
Email: info@amberweb.org
ARC (Addiction Recovery Centre)
In 2006 we launched ARC, a new kind of UK rehab for alcohol and drugs.
We find that each individual responds better to two or three treatment methods, but not everything works for everyone. So for our desired level of deep change to be possible for every single client, ARC’s unique rehab model uses several different core treatment methods.
We monitor which methods each individual client finds helpful and then refocus their treatment. It’s a tailored approach rather than one size fits all. Each of these treatment methods is based on an understanding of the science behind addiction.
Website: https://arcproject.org.uk/
Telephone: 02392 378726
Email: info@arcproject.org.uk
With You at Chy
A 17-bed Adult Residential Centre for men and women. Based on a person-centred approach, our experienced and dedicated team will develop a tailor-made programme to support the individual within a structured package of group programmes, 1:1, life skills and drama based therapeutic intervention (RAFT). Dogs welcome. Aftercare Provision. Move on flats available. CQC rating: Good.
Website: https://chy.wearewithyou.org.uk/
Telephone: 01872 262 414
Action on Addiction – Clouds House
Clouds House has provided detoxification and residential treatment for addiction since 1983. We treat all forms of addiction in our private and tranquil setting in the heart of Wiltshire. Our specialist GP, consultant psychiatrist and 24-hour nursing team ensure safe, medically-supervised withdrawal, while our interpersonal group therapy model, alignment with the 12-step fellowships and complementary therapies help clients address the underlying causes of addiction and build a secure life in recovery.
Our aftercare programme and family work ensure clients stay connected to their recovery. Owned and managed by Action on Addiction, our services are rated good by the CQC.
Website: https://www.actiononaddiction.org.uk/
Telephone: 0300 330 0659
Email: enquiries@actiononaddiction.org.uk
Acquiesce
Acquiesce employs a combination treatment programme which incorporates both therapeutic and 12-step interventions. Acquiesce has found delivering a combination treatment programme extremely effective. The therapeutic and 12-step interventions complement each other and work well in combination.
Website: https://www.acquiesce.org.uk/
Telephone: 01204 771940
Acorn Recovery Projects
Our innovative recovery services enable individuals and their families to break free from drug, alcohol and other addictions. At Acorn we support people throughout their recovery journey in a compassionate way, focussing on the long term solution, even beyond treatment.
At Acorn Recovery clients can live in our supported housing for a temporary time with full support for a move back into the community for independent living. We also run a thriving volunteer community with in-house training schemes also on offer.
Website: https://acornrecovery.org.uk/
Telephone: 01614 840 000
Email: contact@acornrecovery.org.uk
Abbeycare
Abbeycare provide comprehensive residential detox and rehabilitation treatment for alcohol or drug addiction. We advocate an abstinence-based model, supporting clients through alcohol or drug detox, rehab, and aftercare planning. Clients work with a personally assigned addiction case manager on a bespoke care plan and treatment goals.
Abbeycare’s rehabilitation programme combines the 12-step model with Cognitive Behavioural Therapy, and structured relapse prevention planning, for the strongest possible start to recovery, and a life free from addiction.
Website: https://www.abbeycarefoundation.com/
Telephone: 01603 513 091
Email: info@abbeycare.co.uk
Phoenix Futures responds to Dame Carol Black’s Review of Drugs – Part 2
This is a highly anticipated report that arrives at a critical time for the many thousands of people directly affected by substance use problems and the millions indirectly affected as a family member, friend or carer, says Phoenix Futures.
Substance use dependency and addiction is a complex health condition but with personalised care delivered in the right setting it is treatable and many of the associated harms can be avoided. However, left untreated in an underfunded and poorly connected health and social care system those harms can be life threatening. With drug-related deaths and harms at record levels it is vital we take this opportunity to realise the huge potential of investing in improving and saving lives.
The report has identified the fault lines in our treatment system and provided a whole system approach to fixing them. Dame Carol Black has given a robust business case for the changes, including additional funding, and set out a clear narrative for why we can’t get it wrong.
There is much to support in this report.
At Phoenix we have been campaigning for many years for improved access to, and funding for, the vital health and social care services for people with substance use problems. People who use, or have used drugs, despite our knowledge of the personal and social drivers of addiction, are some of the most marginalised and stigmatised people in society. Despite these efforts, and those of others, we have a long way to go to address this life-threatening inequality.
In particular the report highlights that high-cost low-volume services like residential treatment and inpatient detox have been starved of funding and should be commissioned on a regional basis. We support the recommendation that DHSC, NHSE and the Office for Health Promotion review commissioning and funding mechanisms by the end of 2021/22.
We believe this is a once in a generation opportunity to redress the inequality faced by people from all walks of life. In particular to focus on how we can all work together to create genuinely effective, inclusive, connected and caring services and support that lead to sustainable recovery.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by Phoenix Futures
WDP response to Dame Carol Black’s Review of Drugs – Part 2
WDP has welcomed the publication of the second part of Dame Carol Black’s independent review on drugs.
As a third sector provider of recovery treatment and support services, we took part in the consultation and are supportive of the recommendations being outlined and feel there is a lot of potential for positive change.
We are grateful to see a strong recognition of the disinvestment in our sector over the past few years, as well as the recommendations for increased and protected funding. The acknowledgment of the complexity and challenging nature of recovery worker roles and the recommendations around workforce development and investment are also appreciated.
The recurring themes around the importance of holistic care, supporting individuals who use drugs with their health and wellbeing (mental and physical), housing needs, and opportunities for education, training and employment, are especially pleasing to see. It is also encouraging to read that the review includes input from and highlights the value of including people with lived experience in shaping the support available for those who need it.
As an additional next step, we would advocate for a similar independent review to look at alcohol or a formal recognition that many of the report’s findings around drug prevention, treatment and recovery issues also overlap with sector and public health concerns about alcohol use.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by WDP
Government commits to new drugs unit
A new drugs unit will be set up to help ‘end illegal drug-related illness and deaths’, the government has stated, following the publication of the second part of Professor Dame Carol Black’s Independent review of drugs.
The Joint Combating Drugs Unit will bring together multiple departments of state – the Department of Health and Social Care, Home Office, Department for Work and Pensions, Ministry of Justice, Department for Education, and Ministry of Housing, Communities and Local Government – as recommended in the report, and in recognition that ‘treatment alone is not enough’.
‘When I first commissioned Dame Carol to do this review as home secretary, we knew the sale and use of drugs drives serious violence and homelessness but this review shows that the health implications are just as devastating,’ said health secretary Sajid Javid. ‘Tackling this issue requires strong collaboration across government and the new specialist Joint Combating Drugs Unit will help us to do just that.’
Among the reports other recommendations were appointing a single, responsible minister for drug policy to hold the government to account, introducing a national commissioning quality standard, ringfencing treatment funding and boosting treatment staff numbers, along with diverting more people from the criminal justice system into treatment and making sure everyone leaving prison has easy access to treatment. The government would look closely at the recommendations, and ‘publish an initial response shortly’, said Javid.
‘Drug treatment services save lives and help many people recover from drug dependence, improving not only their lives but those of their families, their communities and wider society,’ said PHE’s director of drugs, alcohol, tobacco and justice, Rosanna O’Connor. ‘We know treatment works and so it’s essential that everyone can easily get the treatment they need. We welcome Dame Carol Black’s recommendation for increased funding that is protected and prioritised for treatment and recovery services to ensure that everyone can get the support they need to move forward with their lives.’
Tom Woodcock joins The Calico Group as new director of treatment and recovery
The Calico Group is pleased to welcome Tom Woodcock in a new role as director of treatment and recovery.
Calico’s Treatment and Recovery services include Acorn Recovery Projects and Delphi Medical, both leaders in their field of providing drug and alcohol treatment and rehabilitation. Between them, Delphi and Acorn deliver community and residential treatment, prison and community services and supported accommodation across the North West.
The new role will oversee the collaboration and delivery of these services, maximising positive outcomes for individuals, their families, and wider communities.
Tom is a proven leader with extensive experience of working within substance misuse, homelessness, criminal justice and mental health having occupied key roles within the NHS, local authorities and voluntary, community and social enterprise organisations.
He brings to The Calico Group a track record of improving outcomes and delivering system level change for individuals and their families
Tom said: ‘I am really excited about joining The Calico Group and becoming part of an organisation that is making such a positive impact across so many communities in the North West.’
Welcoming Tom to the role, Helen Thompson, executive director of operations said: ‘I am delighted to be welcoming Tom to Calico. Supporting people going through difficult times is what Calico is about and we know the need for vital support services is only growing. Tom’s role will support our existing services and teams, meaning we can do more, for more people into the future.’
‘This role is a key investment, demonstrating the importance of these services as part of The Calico Group, and combines service strengths and specialisms within the group to further enhance the positive impact for its customers and service users.’
Find out more at www.calico.org.uk
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
Forward responds to the Dame Carol Black Review on addiction treatment
Mike Trace, The Forward Trust CEO, responds to the long-awaited review into drugs policy by Dame Carol Black.
The independent review commissioned by the government considered the effectiveness of the current treatment system.
It considered how steps introduced in the local commissioning environment have responded to growing complexity and scale of drug addiction in the UK. Conducted during the pandemic, the review considered how to improve an already pressured system and escalating drug deaths across, alongside reports of pandemic related increases in addiction rates.
Speaking on the review, Mike Trace, The Forward Trust CEO said:
“The Carol Black review is an important moment, not just for drug policy but for addiction treatment. For some time, the addiction treatment system in the UK has been struggling with the ‘perfect storm’ of rising demand and funding cuts. The opportunity to get help towards long-term recovery has become more and more scarce, inequitable, dependent on where you live and increasingly whether you can afford to pay for residential treatment or not.
“The current treatment system isn’t sustainable. Reducing budgets have resulted in diminishing and inconsistent access to treatment from one local area to another. It means that the experience of individuals, families and children struggling with an addiction is too often one of frustration and isolation when they most need help.
“Last week, we published a You Gov poll which indicates a continued rise of addiction following the pandemic. As we emerge from Covid and make decisions on future health priorities it is vital that addiction treatment, access to recovery, early intervention and support for families and children are firmly on the agenda so that we avoid a continued increase in avoidable deaths from this devastating illness.”
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by The Forward Trust
The Black Review: A shared mission for transformational change
Adfam, Collective Voice, English Substance Use Commissioners Group and NHS Addictions Provider Alliance look at how Dame Carol Black’s Review of the UK’s drug policies represents an opportunity to renew and reset the treatment and recovery system.
As organisations which see the impacts of drugs and alcohol on people, families and communities on a daily basis, we have come together to advocate collectively for change.
We welcome the scope and ambition of Dame Carol Black’s Review which represents the best chance to reset and renew our treatment and recovery system in over a decade. Dame Carol has engaged with our field with admirable rigour and heard the many challenges brought about by the profound disinvestment of recent years – as well as the passion, skill and tenacity used to support thousands of people every year into recovery.
It offers an evidence-based, person-centred response to drug and alcohol addiction, laying out the full array of challenges facing people with drug and alcohol problems. We commend the author’s wide focus on the inter-connected systems which support people with drug and alcohol problems. Efforts to address ‘addiction’ without work with partners in criminal justice, health, homelessness and mental and physical health fields are futile. The recommendation of increased funding for young people’s services is welcome, however we do believe there should be wider recognition of the harms to others, including children, drug and alcohol problems can bring. Families deserve recognition as a vital source of recovery capital but, equally, require support in their own right.
We wholly endorse the Review’s call for strong, sustained local and national political leadership. The proposed Drugs Unit should be created as soon as possible and used to bring together the six key departments of state with a crystal-clear structure of accountability and action. This must be mirrored at the local level through the health, justice and crime partnership mentioned.
Compassion and political leadership are essential ingredients – but so is funding. Our field has lost more than one pound in every four since 2013 with a proven association with falls in numbers entering and completing treatment. Real impact requires real investment – Dame Carol is right to make a call for major, sustained and protected investment over the next five years. With the right resource we can together support many more people (and their families) into recovery and help deliver the Government’s commitments to levelling up our poorest areas.
Vivienne Evans, chief executive, Adfam
Oliver Standing, director, Collective Voice
Chris Lee, chair, English Substance Use Commissioners Group
Danny Hames, chair, NHS Addictions Provider Alliance
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by Adfam, Collective Voice, English Substance Use Commissioners Group, and NHS Addictions Provider Alliance
More than £550m needed to save treatment system, says Black report
The government needs to invest an additional £552m in the drug treatment system over the next five years through the Department of Health and Social Care (DHSC), says the second part of Professor Dame Carol Black’s Independent review of drugs – one of more than 30 recommendations in the long-awaited document.
An additional £15m in employment support through the Department for Work and Pensions (DWP) is also urgently needed, it says, along with extra funding for housing support through the Ministry of Housing, Communities and Local Government (MHCLG).
Drug dependency issues need to be recognised as ‘a chronic health condition’ like diabetes or hypertension, with the necessary long-term follow-up, it states. While discharge after short-term treatment is currently used as a measure of success this should be stopped as it ignores the fundamental relapsing nature of the condition. Meanwhile, physical, sexual or psychological trauma and mental ill-health need to be fully recognised as ‘the drivers and accompaniment’ of drug issues and classed as co-morbidities rather than separate problems for dual diagnosis, with more done to make sure people don’t ‘fall through the cracks’.
The report into the first part of the review was published eighteen months ago and looked at drug supply and markets (DDN, March 2020, page 4), with the second part focusing on treatment, recovery and prevention. The public provision for these is ‘not fit for purpose, and urgently needs repair,’ says the new document, with the government now facing ‘an unavoidable choice: invest in tackling the problem or keep paying for the consequences.’
A whole-system approach is needed with coordinated action by multiple departments, it stresses, with Dame Black telling a recent Westminster Social Policy Forum event that the government’s response to drug dependency was uncoordinated and ‘not owned by any one department of state’ (DDN, July/August, page 8). The government needs to establish a ‘national drugs unit’, says the report, which would then develop a national outcomes strategy to hold departments to account. DHSC needs to ensure that local authorities spend treatment funding ‘on these services and not on other things’, and introduce a national commissioning quality standard that requires local authorities – as a condition of their funding – to work together with health, housing, employment and criminal justice partners to develop joint needs assessments and publish commissioning plans.
Although departments would obviously have competing priorities they needed to work together to improve treatment, employment, housing support and the way that ‘people with addictions are treated in the criminal justice system’, Dame Black states, with increased funding insufficient on its own. ‘Greater co-ordination and accountability at national level must also flow through to the local level, where responsibility sits for the delivery of drug treatment and wider recovery outcomes.’
Capacity in the system also needs to be ‘significantly’ rebuilt, it says, including ‘recruiting many more professionally qualified staff and trained support workers’, with a recommissioning of depleted inpatient detox and residential rehab services to ensure national coverage. More investment in interventions to help reduce demand was also needed, it adds, while other recommendations include that DWP recruit peer mentors in every Jobcentre Plus area to encourage people with drug issues to access employment support and equip its staff to do more outreach work in the community.
Although the report is calling for significant investment ‘the payoff is handsome’, it says, with £4 saved for every £1 spent ‘from reduced demands on health, prison, law enforcement and emergency services’.
Launching the report on 8 July Dame Black announced to the sector and partners, ‘I hope you feel it’s your review.’ Engaging many stakeholders, including people with a very wide range of lived experience, Dame Black and her team had ‘examined treatment and recovery in detail and found it to be broken and wanting’. Funding had decreased against ‘a backdrop of increasing harm and widening inequalities’, resulting in ‘a great deal of unmet need’.
The conclusion was that ‘whole system change underpinned by additional investment’ would be the only effective option, and this involved strong government leadership supported by effective local partnerships, ‘together with clear accountability’.
‘We can’t do this without investment,’ she emphasised, beginning with £552m invested in treatment over the next five years. ‘It seems a lot but it only takes us back to the levels of 2012.’
Minister for crime and policing Kit Malthouse welcomed the ‘insightful’ report that was ‘filled with evidence and the product of a lot of collaboration’, which included input from recovery champion Dr Ed Day, Prof Keith Humphries, and people with lived experience. ‘It is our moral duty as a government to do something about drug-related deaths,’ he said, and called the Central Drugs Unit a ‘coherent and strategic’ way of linking health, housing and employment with crime prevention. Part one of Dame Black’s report had ‘laid out in horrific detail’ the scale of the drug problem and the prime minister was receptive to the proposed solutions in part two, he said, which would include expanding successful initiatives to dismantle county lines and supply chains and continue partnerships between health, police and social care, such as Project Adder.
Jo Churchill, minister for public health and primary care thanked Dame Black for her ‘commitment to public health’ and said the report championed evidence-led policy and the importance of empathy. The proposed budget, the largest increase in the last 15 years, signified a moment of change, but was necessary because ‘drugs wreck lives’ – of families and everyone around, as well as the person with an addiction.
She welcomed the joined-up approach as ‘addiction doesn’t exist in isolation’ and related to past traumas and complex morbidities. Many people with addiction problems didn’t make it past 40, so ‘intervention needs to be smart and it needs to be early,’ she said. ‘If COVID has taught us anything, it’s that we don’t have to do things the same way,’ she added. ‘The review presents us with an opportunity for action.’
Reactions from the sector
‘Dame Carol is right that we need urgent change,’ said Change Grow Live chief executive Mark Moody. ‘The current situation is intolerable and the people who use our services, the communities they live in, and ultimately the whole country pay the price.’ The government needed to come forward with a new strategy, he said, including new measures of success as recovery was ‘much more than total abstinence’, and it also needed to ‘get commissioning right. We want to see an end to fragmentation of services and short-termism. All the organisations involved must come together to put stable local services in place where they are needed.’
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The review represented ‘a potentially defining moment in the course of drug treatment in the UK’, added With You’s executive director for services Jon Murray. ‘At a time when drug-related deaths have reached record levels, its recommendations provide a clear way forward for getting more people the help and support they need, whilst reducing the harm of drugs in our communities. The focus on trauma-informed service delivery is crucial and we are pleased to see recognition of the interconnected nature of problematic drug use and mental health issues.’
While the document could ‘signal a long overdue turning point’ it needed the government to commit to ‘major financial and political investment and a truly collaborative approach to delivery, drawing on the strengths of a wide range of partners’ he added.
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The treatment system had long been struggling with the ‘perfect storm’ of rising demand and funding cuts, said Forward Trust CEO Mike Trace. ‘Reducing budgets have resulted in diminishing and inconsistent access to treatment from one local area to another. It means that the experience of individuals, families and children struggling with addiction is too often one of frustration and isolation when they most need help. As we emerge from COVID and make decisions on future health priorities it is vital that addiction treatment, access to recovery, early intervention and support for families and children are firmly on the agenda so that we avoid a continued increase in avoidable deaths from this devastating illness.’
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‘There is much to support in this report,’ said Phoenix Futures chief executive, Karen Biggs. ‘We believe this is a once in a generation opportunity to redress the inequality faced by people from all walks of life. In particular to focus on how we can all work together to create genuinely effective, inclusive, connected and caring services and support that lead to sustainable recovery.
‘The report highlights the need for reform and repair of the system can only be solved through coordinated action by multiple departments including the Home Office (HO), Department of Health and Social Care (DHSC), Department for Work and Pensions (DWP), Ministry of Housing, Communities and Local Government (MHCLG) and the Ministry of Justice (MoJ).
‘It will take improved coordination between national and local government departments, the NHS and voluntary sector and many others, including the media and business worlds, to realise this opportunity. This is an opportunity not just for inclusive, effective services but to realise the potential of an inclusive society that works for everyone.’
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We welcome the scope and ambition of Dame Carol Black’s Review which represents the best chance to reset and renew our treatment and recovery system in over a decade. Dame Carol has engaged with our field with admirable rigour and heard the many challenges brought about by the profound disinvestment of recent years – as well as the passion, skill and tenacity used to support thousands of people every year into recovery.
The time for political action is now. Following years of disinvestment and a lack of political leadership, we are now experiencing a drug death crisis. We implore the new Health Secretary to urgently respond to the report’s recommendations – to reduce the harms caused by drug use, stem the flow of deaths, and enable thousands more citizens – and their families – to recover.
As a sector, we stand ready to work together with government and wider partners – both local and national – to make the most of this vital opportunity. The hundreds of thousands of people touched by addiction in this country are counting on us all to get this right.
Vivienne Evans, CEO Adfam
Oliver Standing, Director Collective Voice
Chris Lee, Chair English Substance Use Commissioners Group
Danny Hames, Chair NHS Addictions Provider Alliance
Read the full joint statement here
Review of drugs part two: prevention, treatment and recovery at www.gov.uk
Substance misuse treatment: the NHS and the third sector both have important roles to play
Dr David Bremner, consultant addictions psychiatrist and medical director at Turning Point, explains why the NHS and the third sector both must play a part in providing safe, effective substance misuse services.
Recent articles in the Health Service Journal and the Guardian expressed concerns about the quality of drug and alcohol treatment in this country, calling for a greater role for the NHS in the commissioning and delivery of services.
Today, the third sector (primarily large, national, specialist organisations run on a not-for-profit basis) deliver the majority (approximately two thirds) of drug and alcohol services with the remainder delivered by the NHS. Services are commissioned by local authority public health teams.
Between 2001 and 2008, investment in drug treatment rose from £250 million a year to £750 million a year. During this period, many local services transferred from the NHS across to the third sector. Numbers in treatment increased from 80,000 to 230,000 and waiting times reduced from nine weeks to five days.
There were steady improvements in treatment quality with reduced early dropout, increasing successful completions and a dramatic reduction in drug related crime. Ready access to treatment is responsible for a third of the overall reduction in crime this century according to Home Office research.
Substance misuse services delivered by the third sector are clinically robust and, importantly, are judged on the very same quality standards as NHS services with regulation from the Care Quality Commission (CQC). At Turning Point, 93% of our services are rated Good or Outstanding by the CQC.
More than this though, third sector providers are strongly rooted in their local communities. They see the person not just the problem and work collaboratively with partner agencies – including NHS Trusts – to help people access support on a range of issues, whether that be education, employment or training, benefits, housing or mental health, all crucial ingredients in a person’s recovery from addiction.
The HSJ and Guardian articles argued that the unit cost of inpatient detox and residential rehab services has increased. This may be the case, although there is no nationally published information on the costs of residential treatment and the authors acknowledge the data they have gathered is potentially unreliable. We currently have a mixed market with a range of different providers providing different types of treatment.
It is certainly the case that the NHS is best placed to provide hospital based detox for patients with complex needs. However, the third sector provide high-quality, medically-managed detoxes at a lower cost for lower risk patients with lots of options to choose from. We need to ensure we deliver the right intervention for each individual while balancing cost and service user choice.
Both pieces correctly highlight the fact that there is a public health crisis at play here. The number of drug related deaths increased by 52% over the past 10 years. The Institute for Government concluded that “a decade of budget pressures meant that public services entered the [COVID] crisis with ailing performance levels, severe staffing pressures and having underinvested in buildings and equipment.”
This is certainly the case for the substance misuse sector, which has been underfunded for many years. Nationally, funding reduced by 24% between 2014 and 2019. Inflation over this period was 13%, which means that the effective real term cut to drug and alcohol service budgets over this time period has actually been 37%. This public health crisis is the making of a decade of cuts, not the shift to local authority commissioning.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by Turning Point
Michael’s story
Army veteran Michael discusses his journey into addiction, and how Change Grow Live’s veterans service offered him support when he needed it most.
My story starts with a patrol in Afghanistan and an explosion. the roadside bomb exploded under my vehicle which killed my friend who was driving and caused me to be medically evacuated to my barracks in Germany.
The next few months meant numerous operations and rehabilitation whilst also struggling to make sense of what had happened. Each month I was given more pain relief, which helped not only with the pain but how I felt. I began to drink more and more alcohol to increase the feelings of being able to switch off and not think or care about anything.
Unfortunately, this meant I ended up having a few problems on barracks and this led to my administrative discharged from the British Army. To become a fully qualified senior non-commissioned officer within the British Army required years of training and numerous tours on operational duty. The transition to becoming a civilian took me the one drive from my barrack in Germany to my mum’s house in the UK; roughly 11 hours.
Within the first month of being a civilian, my drinking increased, and the amount of prescription pain relief medications began to reduce. Registration with a civilian GP failed to get me a new prescription for the codeine, apomorph, pregabalin, and gabapentin I had become used to it. This started to unravel.
Following an argument, I had to leave my mum’s house and I ended up sleeping in my car. I started buying the medications off the street. For 17 years the Army had clothed, fed, and watered me, now at 34 years old I was sleeping in my car in an abandoned mill and popping prescription medications like they were Smarties. I was socially isolated and could not see how to help myself.
Over time I struck up a relationship with my dealers; eventually, they offered me a chance to stay in a bedsit. In less than three months I had been introduced to heroin and crack and I ended up selling my car to continue to pay for my new habit. My money ran out and once again I was homeless, this time without a car to sleep in and with an appetite for heroin.
I remember sleeping in one of the back rooms of that mill during winter. Freezing cold nights followed by my new daily routine, stealing from local shops on a morning to score and use in the afternoon before waking up and doing it again. I lost my self-respect, pride, and hope for the future, and the endless grind made the thought of suicide an easier option than continuing to live. I began planning how to end it all.
Luckily, my stealing had not gone unnoticed in the village and the village rumours got back to my family. one day my mum turned up at the mill and took me to my local service and booked me in with the local housing authority. This is when things began to change for the better. Being a veteran, I was provided emergency hostel accommodation and provided a methadone prescription which provided much-needed stability and a break away from the madness.
During an appointment, I was given a leaflet about Change Grow Live’s March veterans service. This service was the turning point in my life.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by Change Grow Live
Mutually beneficial
Mental health and substance use treatments can complement each other in vital ways, says Peter Lindsayhall.
I am a dual-qualified mental health nurse and psychotherapist, and I’ve worked across NHS Scotland, NHS England and the private sector. My focus has been on primary care mental health providing broad access care for all, and my practice comes from a modern cognitive-behavioural approach recognising relational, attachment and systemic factors as well as intrapsychic processes.
In his 2004 article The origins of addiction, Vincent Felitti focused on adverse childhood experiences (ACEs) and the link with substance use. The results were as predictable as they are tragically painful – Felitti concluded that ‘…the basic cause of addiction is predominantly experience-dependent during childhood, and not substance-dependent’. In other words, what has happened to people in their life has a greater predictive power on the development of addiction than the psychoactive properties of the drugs themselves.
Further research highlights the links between addiction, mental health and ACEs. Traumatic effects disrupt our ability to regulate our emotions, feel safe, connect with others and understand ourselves. Whilst we are learning and developing through our lives, disruption has significant ripple effects. When all of this is coupled with Giano et al’s 2020 study showing that 57.8 per cent of people have at least one ACE, and 21.5 per cent have at least three, we can see that ACEs are not uncommon – but have powerful effects across social, emotional and physical health.
Interestingly, the research of neuroscientist Jaak Panksepp showed that infant bonding and intimacy triggered the opioid receptors in the brain – leading to further connections being identified between opiate addiction and deficits in experiencing close, nurturing and fulfilling relationships throughout our lives, particularly in early childhood. So, the need is clear – people who experience addictions are very likely to have experienced trauma, anxiety and depression, had difficulty with emotional regulation and struggled with interpersonal and intrapersonal relationships.
This means services that guide and support people in resolving their substance dependency are ideally suited to, and enhanced by, evidence-based mental health treatments and interventions to establish understanding, skills and alleviation of psychological and emotional suffering. The mental health strategy being implemented at Phoenix Futures is progressive, compassionate and exciting, and the organisation exudes a sense of care and responsibility to provide holistic support to everyone who is part of delivering or receiving help.
The work to further enhance the mental health support available begins by focussing on residentials, and the plan is to then roll out initiatives across all services provided by Phoenix. The Scottish Residential service provides treatment that is already adept at supporting the multifactorial nature of the people they work with, and the staff, peers, programme and environment combine to provide a safe space to understand the experiences of the residents and utilise their own sense of self-efficacy. The house has also been designed to be accessible for those with additional mobility support needs.
We plan to ensure that the core therapeutic community treatment processes remain strong, and are aided by the mental health treatments. Where additional support may be needed for a particular individual, we can respond proactively. For example, a resident may present with issues around emotion regulation – the ability to respond adaptively to our feelings, urges and beliefs about what is going on in a way that is productive. Difficulties in emotion regulation cut across trauma, mental health and substance use. People may feel powerless, overwhelmed or confused by the emotions they experience. Offering one-to-one interventions will help them to understand their emotions, develop the ability to be aware, curious and separate from their urges, choose their responses before, during and after powerful emotions, and cultivate acceptance and learning from each experience.
This should improve outcomes across all areas of the person’s life, and provide a feedback improvement loop within the therapeutic community. It’s an exciting time for mental health within Phoenix Futures, and I am grateful to have the opportunity to be a part of it.
My role as clinical mental health lead is a new and developing one.
Just as the physical environment is designed to ensure mobility is no barrier to treatment, my position seeks to ensure that psychological and emotional problems are also not a barrier to the curative effects of the therapeutic community.
The role has three main areas of focus:
- Developing a core mental health treatment programme for all residents
- Higher intensity intervention for those with specific and acute mental health needs
- Support, training and guidance for the staff
We must tackle the rise in addictions caused by the pandemic
The Forward Trust’s CEO Mike Trace comments on the charity’s new poll showing the rise in addictive behaviour during the pandemic, and the steps Forward is taking to address it.
In June 2020, Action on Addiction published its first poll results which explored the impact the pandemic was having on addictive behaviours. It was a first of many polls that exposed creeping consumption of alcohol during lockdowns.
Following the merger of Action on Addiction with The Forward Trust in May 2021, we want to understand whether the effects of the second and third lockdowns continued to have a worrying impact on rates of alcohol/drug use and related problems.
A year on, we have repeated the survey of over 2,000 people with YouGov. Taken from a broad and representative sample of the adult population, the results have highlighted compelling and concerning patterns that require urgent investigation and response from across the sector, and wider healthcare professions, in policy and spending decisions.
The results are not a surprise to many working in the addiction field. We know addiction feeds off isolation, a sense of hopelessness and disconnection. The pandemic in many ways is a perfect breeding ground for it. What starts with increasing consumption – reaching out for something familiar – is, for an increasing number of people, moving into a habit that they cannot control. And for many people, this creeps into an addiction will take them by surprise.
This path to addiction doesn’t happen overnight. Dependency and its consequences emerge gradually, until the substance or behaviour become the most important part of someone’s life.
Before work, sleep, health, friendships, relationships and children. The perception of an addiction is in many minds of the park bench, the crack den, the needles in an alley – isolated and away from normal life. It’s true those lives do exist – however, the vast majority of people living with addictions are living their lives among us; some noticeably, others hidden and unnoticed.
Whatever a person’s reality, a slide into addiction can be gradual and unexpected rather than a deliberate choice. From the 20-something saying, ‘it won’t happen to me’, to the retired couple drinking heavily every night – or, as Bryony Gordon told us in the recent In Conversation with Clouds House: ‘I run marathons; I do Pilates; I can’t be an alcoholic’. What’s more, our survey highlights that this unexpected nature of addiction will be playing out now, at scale, in homes, families, workplaces, Zoom calls, school gates across all our lives at an increasing level.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by The Forward Trust
Sexual healing
It’s no secret that the COVID-19 pandemic has presented challenges for patients living with addictive behaviours. There has been widespread coverage of escalating rates of alcohol and substance misuse alongside ‘behavioural addictions’ such as gambling and shopping, but the lesser-reported sex and love addiction, cybersex or problematic online pornography usage has also seen an explosion in numbers globally.
Recent media reports indicate that half of UK adults watch porn. According to Ofcom’s 2021 Online nation document, Pornhub was accessed by 15m people in September 2020 while OnlyFans saw a 75 per cent increase in new subscribers from May 2020. The pandemic has led to people becoming more introspective about their sexual behaviours, and for some this shift will develop into pathological addictive-type sexual behaviours. The problematic consumption model of online pornography benefits from the ‘triple A’ factor – anonymous, accessible and affordable.
Addiction/Compulsion?
Love and porn addiction isn’t recognised as a mental health condition by the recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, sex addiction, masturbation addiction, and porn addiction are usually referred to as compulsive sexual behaviour, hyper sexuality disorder or out of control sexual behaviour. Sex addiction can also be characterised by multiple sexual partners or interaction with sex workers, while love addiction behaviours can include returning to damaging relationships or craving attention from new or multiple relationships.
Clouds House, our residential addictions rehab, has seen an increase in enquiries for sex, love and pornography treatment. A year of lockdowns has created conditions whereby people who are feeling isolated turn to sex and porn as a method of coping, just as it has for other addictions. In addition, the fact that sex, sex and love, and porn addiction are becoming more recognised within society as a set of behaviours which culminate in destructive consequences has meant that men – and, slowly, more women – are starting to reach out for help.
Increasing numbers
Over the past five years, Clouds House has experienced an increase in people accessing treatment for sex and love or porn addiction as their primary addiction. Historically it’s emerged within the context of other addictions. Access to porn anytime, anywhere is problematic and a significant challenge – those with an addiction to pornography will access porn content in a continued quest to alter moods by searching for newer, more stimulating and sometimes violent/coercive content, and with an escalating habit their tolerance and choice of more extreme pornography increases.
This a manifestation of someone’s journey to dependency, and measurement of the true scale of the problem is challenging given the associated stigma. The shame surrounding this addiction is considerable, with significant impact on family and relationships as this dominant relationship with the online pornography behaviour takes increased salience and control.
Recovery from addiction to sex, sex and love, and pornography is possible and the community aspect of therapy is a vital part of treatment, examining how emotional experiences of addiction can often be similar regardless of how the addiction manifests. Treatment for sex/love and porn addictions is as challenging for individuals as treatment for any other addiction, and our clinical team engage patients throughout the pre-admission process. Compulsive sexual behaviours can be comorbid with mental health conditions such as depression, anxiety and bipolar affective disorder, and a robust psychiatric assessment assesses for the presence of such comorbidities in this patient group.
Abstinence from sexual behaviours during treatment impacts positively on treatment outcomes. We ask all those joining the treatment community to abstain from all sexualised behaviour including masturbation. The withdrawal experience can be similar to those more commonly recognised with substances – it can be intense and visceral. People do not always anticipate going into withdrawal and therefore need emotional support to understand what they are experiencing. It’s common for patients to experience disorientation, headaches, low mood, anxiety, irritability or depression.
Long-Term Recovery
Long-term recovery from sex and love addiction or porn addiction is different from substances or gambling. Sex is a human need the same as eating or sleeping, so abstinence from sex is more complex. A person needs to identify a sense of positive sexuality and be able to move forward with positive relationships, and preparing patients for different types of relationships is key to successful outcomes. Therapists look to realign behavioural reinforcers with meaningful ‘reality-based’ relationships and not the ‘online’ cybersex virtual reality.
For instance, those addicted to pornography are engaging in ‘fantasy’ rather than the reality of physical and emotional intimacy and therefore it is vital to help patients understand how sex might feel different, perhaps even disappointing, within the context of their real-life relationships. Clients can find themselves trying to substitute care, support and nurture for emotional or sexual dependence with sometimes devastating consequences – these might include engaging in physically or emotionally abusive and harmful relationships devoid of emotional intimacy.
It’s also important to consider that there may be cultural and diversity issues revealed during the therapeutic assessment, for example the subculture of ‘chemsex’ in gay communities. A social norm gives the person a sense of belonging to such a community despite the potential risks, harms and consequences. If there are chemicals involved there can be additional important questions to ask, such as what is the client’s relationship with the substances and/or the sexual behaviours? Understanding from a wider perspective than that which fits with binaries of heteronormative culture is important, and what is normal for one person, might not be for another.
Barriers to Women
There is a tendency for more men to seek treatment than women, and more needs to be done to understand the barriers to seeking treatment by women and to find better ways to support women to open up more about sex, love and pornography addictions. As conversations emerge during treatment, therapists find more women open up to their peers about their experiences.
Asking for help with a sex, sex and love, or porn addiction requires a huge amount of courage, and those who make contact with services should be treated with care and respect. Families are often deeply traumatised by their loved ones’ behaviour and it’s important that family support is given throughout the treatment period and beyond where necessary. Mutual support is vital, sustaining recovery through fellowship meetings such as Sex and Love Addicts Anonymous and Sex Addicts Anonymous, in the same way as with attendance at AA or NA.
This type of behavioural addiction is largely unspoken and misunderstood across health and social care. It needs to be recognised and understood more broadly to improve treatment and enable people to reach out for support. Recognising it can go some way to validating the experiences of those engaging in these behaviours and instil some hope that change is possible.
The sector spent many years trying to get gambling addiction properly recognised in the DSMV to legitimise treatment and lower barriers to accessing support. It is now time for sex, love and porn addiction to also be categorised as a behavioural addiction.
Clouds House and Action on Addiction are part of The Forward Trust. Find out more at www.forwardtrust.org.uk or www.actiononaddiction.org.uk/addiction-treatment/clouds-house
Pamela Walters is clinical director at Clouds House
DDN July/August 2021
We need to be sensitive to factors for wellbeing
We’re living with uncertainty – will things return to some sort of normality? When will the long-awaited Dame Carol Black report be published (p4, p8, p10)? One thing we can rely on is that issues relating to addiction are complex. Furthermore, we know that a public health approach demands that we work with and try to understand the many influences on our behaviour.
Substances, gambling, sex – they’re all part of life, so if we’re to strive for holistic treatment we need to look at the whole picture.
As our cover story says (page 6), this type of behavioural addiction is largely unspoken and misunderstood across health and social care at a time when the pandemic has ‘added to escalation of introspective behaviours’. Dame Black is calling for wholesale system change right across the sector, which could affect all of us. To throw ourselves into grasping this opportunity for change with the energy that Collective Voice suggests (page 10) we need to be sensitive to all contributory factors to an imbalance in wellbeing, from early trauma to ways of coping with the pandemic. Acknowledging the blurred lines between ‘good’ and ‘bad’ behaviour is a vital component.
Read the July/August issue as an online magazine or download the PDF
Claire Brown, editor
Our next print issue is out on 6 September but we’re here all summer online for news and views, so stay in touch!
Sector specific
On the eve of the publication of the second part of the Carol Black review, delegates at a Westminster Social Policy Forum event debated the state of the sector and where we go from here. DDN reports.
People with drug dependency were ‘almost the equivalent of the cast-out lepers of former times,’ Professor Dame Carol Black told the told the Westminster Social Policy Forum’s Tackling drug addiction and substance misuse – latest thinking on prevention, supporting recovery, policy and findings of the independent review event (see news, page 4).
Drug dependency was a ‘complex, stigmatised problem’, she said. ‘Those dependent on drugs are not owned by any one department of state. You might say it’s too messy, too difficult, while at the same time of course creating personal, familial and societal misery and costing the government, we calculated, some £19bn per year.’
Failing system
Part one of the review had addressed supply and demand (DDN, March 2020, page 4), revealing a ‘failing’ system and increasing levels of drug supply, county lines activity and violence – a ‘dire situation’ that had then ‘met austerity’. Since 2014 there had been a 17 per cent fall in funding for adult drug services and a 25 per cent fall for young people’s services. ‘And in a few areas of the country, that fall for adult services has been as much as 40 per cent.’
There was ‘obviously a lot to do’, she stated. ‘This is a report about system change, and reflects the fact that drug dependency has never been tackled in a determined and coordinated way by six departments of state’ – the Department of Health and Social Care, Home Office, Department for Work and Pensions, Ministry of Justice, Department for Education and Ministry of Housing, Communities and Local Government. Rather it was each department trying to do a small amount but not in a way that was joined up, she said.
‘I spent many hours talking to people who are drug-dependent, and they tell you what they need to achieve recovery. Medicine is part of this, but then so much is jobs, friends and housing. I also want to ensure that thriving communities of recovery are a component of every drug treatment system, and this needs to be country-wide. People with lived experience offer so much to the recovery journey that clinicians are simply not equipped to do.’
Support and engagement
There were multiple ways that people in recovery contributed, but a critical one was creating and leading support organisations, said advisor to the review, professor of psychiatry at Stanford University and former drug policy advisor to Barack Obama, Dr Keith Humphreys (DDN, June 2012, page 16). ‘For most people, this is the work of years, which means there’s a need for organisations that persist in people’s lives and engage with them for a long time.’
Talking about recovery was the ‘exciting, positive, happy thing that happens in this field’, when so much discussion was around issues like illness, violence and death, he said. ‘It’s not just “I’m no longer using heroin”, but “I have a job, I’m back together with my family, I feel valued, I feel I’m contributing.” Those things take a long time to develop, but are critically important for health and quality of life.’
Recovery organisations had a different rationale for what made someone an expert, he said. ‘The helping is reciprocal. When a doctor sees a patient it’s not appropriate to ask the patient for help with the doctor’s problems, but in these organisations one moment you can be the helper and in the next the helpee. One of the interesting findings in social support literature is that giving support is probably as good for our health as receiving it.’
Crucially, these services were also free, he said, or operated on a voluntary ‘coin in the basket’ model. ‘That makes them available to anyone, regardless of their economic situation.’ While some had a designated programme or philosophy, others were more general and by no means all were abstinence-orientated. ‘It’s good that there’s so much diversity, so people can find something that works for them. And it’s not just all about services, it’s also about cultural and political influence. We had a saying in the White House – “if you don’t have a seat at the table, you’re probably on the menu.” It’s very important that people in recovery are at the table in all discussions, and Dame Carol did a huge amount of outreach and involvement of people in recovery throughout her work. We need that expertise and that wisdom.’
The public component was also vital, he said, as could be seen with recovery walks. ‘If you’d said 20 years ago there’s going to be 500 people with drug problems marching down the street most people probably would have locked their doors. Now they come out and applaud. Seeing people who they previously might have crossed the street to avoid as successful parents, workers, citizens is very powerfully destigmatising and hope-inspiring.’
Key Ingredients
To deliver high quality, well-led services needed three key ingredients, said Dr Linda Harris, chief executive and clinical director of Spectrum Community Health CIC and chair of the health and justice clinical reference group at NHS England. ‘But they’re huge. We need a positive culture, a capable workforce with the capacity and headspace to care safely and with compassion while being able to train and supervise the workforce of the future, and we need a team of teams. There’s no one agency that can solve this issue, so we need to collaborate to continually improve and innovate.’
There was also a ‘post-pandemic societal context’, she added, with the move to remote and flexible working and the digitisation of service offers. Competition for talent was a key issue, with an ongoing health and social care workforce crisis – ‘we really have to get those sharp elbows out.’ Successful recruitment and retention meant competitive rewards and competitive terms and conditions. ‘We want substance misuse services to be that great place to work, and that also means training and development.
‘I think we can market our strengths,’ she told the event. ‘COVID has shone an enormous light on health inequalities and their root causes, and I think we can take our rightful place leading some of these population health interventions. I’m optimistic because I think this is a pivot moment and providers are ambitious and poised to push to new heights in quality improvement and achievement in the sector. But we do need to invest now.’
The Next Chapter
‘We’re really at the start of the next chapter in the history of our field,’ agreed director of Collective Voice, Oliver Standing. There was not only the second part of the Black review, but also technological innovation and the fact that the sector was becoming much more informed about the links between trauma and addiction.
‘We’ve had the £80m in funding, the Black review’s dominating all of our thoughts, PHE has been cut in twain with the senior jobs at the Office of Health Promotion being recruited at the moment,’ he said. ‘Then there’s the Comprehensive Spending Review in the autumn, the NHS reforms, and an addiction strategy probably at the start of next year.’ And all were contingent on each other to a greater or lesser extent, he stated.
‘Politics is all about momentum and we’ve got a window of opportunity here, but we need that political leadership. We need a robust political response to the review, and we need the funding to continue to support the work. We mustn’t forget we’re in the middle of a drug-related death crisis. This is a morally catastrophic thing, and we can’t ever forget that.’
Professor Dame Carol Black
Professor Dame Carol Black DBE FRCP FMedSci chairs the boards of the Centre for Ageing Better and Think Ahead, the government’s fast-stream training programme for Mental Health Social Workers. She is expert adviser on health and work to NHS England/Improvement and Public Health England and until August 2019 was principal of Newnham College Cambridge. She is a member of Rand Europe’s Council of Advisers, the board of the Institute for Employment Studies, the board of UK Active, and the advisory board of Step up to Serve.
She has authored three independent reviews for the UK government: of the health of the working-age population in 2008 as national director for health and work; of sickness absence in Britain in 2011 as co-chair; and of employment outcomes of addiction to drugs or alcohol, or obesity, in 2016. She is currently working on a fourth independent review for government, of illicit drugs in England.
Dame Carol is a past-president of the Royal College of Physicians, of the Academy of Medical Royal Colleges, and of the British Lung Foundation, and past-chair of the Nuffield Trust for health policy. The centre she established at the Royal Free Hospital in London is internationally renowned for research and treatment of connective tissue diseases such as scleroderma. She has been a trustee of the National Portrait Gallery.
As principal of Newnham, Dame Carol was on several committees in Cambridge University, and she remains a patron of the Women’s Leadership Centre in the Judge Business School, and a member of the university’s advisory board on student mental health. In 2018 she was appointed chair of the British Library Board. Biography at bl.uk/people/experts/carol-black
Make it stick
Making sure naloxone is in the hands of everyone who needs it, whenever they need it, requires far more than simply handing it out from drug treatment services. DDN reports.
Despite all the good work that’s been done over the last couple of decades to fight the battle for naloxone and tackle the associated stigma, one key fact remains. As Judith Yates told DDN last month, ‘You need to have it with you’ (DDN, June, page 15).
Release’s landmark Finding a needle in a haystack report made headlines when it revealed that while all but three of the local authorities who responded to the charity’s FoI request were supplying naloxone, they were doing it in such small quantities that the impact was negligible (DDN, March 2019, page 4).
‘This life-saving medication is not reaching those who most need it’, Release stated, with the document stressing the need for naloxone to be made easily available to people not in contact with mainstream treatment services, for example via pharmacies or peer networks. In many areas, take-home naloxone was only available ‘through the main drug treatment provider’, the report found, with a quarter of councils failing to provide kits to people in contact with outreach services for homeless populations, for example. If there was ever any doubt over the need for this, a St Mungos report from last year stated that in 2018 around 12,000 rough sleepers had gone without drug or alcohol treatment – the same year that recorded a 55 per cent increase in drug deaths among people sleeping rough. It also found that the number of rough sleepers with a drug problem had increased from 50 per cent to 60 per cent in just four years.
It’s about Harm Reduction
‘Getting out as much naloxone as possible to people who don’t necessarily engage with standard services is really important,’ says Megan Nash, team leader for WDP’s Redbridge outreach service, where all workers have carried it since the service’s inception. ‘That’s both because it’s getting a life-saving drug to the people most at risk of drug-related deaths, but it’s also starting a conversation about harm reduction. It allows you to have a short conversation about how to use it and about risk of overdose – what to look out for and how to prevent it.’
Crucially, it’s also about ‘giving someone something’, she points out. ‘I think that can be a really nice engagement tool. It just feels friendlier to give someone a little present, and people can then spread the word.’ This kind of harm reduction approach can be transformative when dealing with people with very complex needs, such as the Redbridge team’s clients. ‘It’s a way of showing you care about people, and a way of getting them in contact with services, which they may have struggled to engage with in the past as they’re expected to turn up at a specific time, and not intoxicated. I absolutely appreciate that it can be difficult for a lot of mainstream services to manage these kinds of clients, but just having that positive engagement and being told “we care about you”, that someone genuinely is worried about your safety and whether you live or die, is crucial for us.’
None of her team have ever had to administer naloxone themselves, she says, an illustration of how important it is to ‘get it distributed – because a lot of people will be using in hidden places. Often our service users tend to use in groups – in temporary accommodation and squats and things like that. It’s not as easy to see as an outreach worker, and you can’t be there all the time, so it’s really important that it gets out through people who will be in that situation.’
This kind of peer-to-peer distribution model is vital agrees her colleague Dave Targett, WDP’s operations manager. ‘We had a massive squat in the city centre in Chester a year or so ago and we kept giving it to people to take in there to give to others – targeting those high-population areas is really important.’
Inadequate supply
Another alarming finding from the Release document was that only half of prisons and one in five young offender institutions were actually providing naloxone to those leaving custody – this despite the up-to-eightfold increase in risk of a drug-related death the first two weeks after release, as a result of reduced tolerance levels. The amount of take-home naloxone being given out to people on release in 2017-18 was ‘wholly inadequate’, it said, with kits and training provided to just 12 per cent of opiate clients as they left custody. The report also called for take-home naloxone programmes to be extended to immigration removal centres and policy custody suites. A pioneer when it comes to the latter has been Durham Constabulary, where more than 200 police officers and civilian staff have so far received naloxone training (DDN, May, page 13).
The force began having naloxone onsite at its custody suites after a spate of opiate-related overdoses in 2018-19, and it’s now offered on release to anyone over the age of 18 who has a problematic drug issue, has had one in the past, or lives with someone who has one. ‘It’s no strings attached,’ temporary chief inspector Jason Meecham tells DDN. ‘They’re offered an opportunity to watch a video on how to assemble a kit but they don’t have to, and we run through a quick checklist of basic first aid stuff. We also provide them with details of local treatment services, but there’s no catch.’
So does everyone who’s offered it accept? ‘No, they don’t,’ he says, and while the force is looking at ways to drive up acceptance levels they’re also not expecting to be ‘giving away dozens’ every week. ‘Some people don’t want one. They’ve either already got a kit – and we’re more than happy for them to have another – or it’s not what they want, so we’re working with the county council to try to drive that up. The majority of people we’re in contact with are also in contact with local treatment services, which are very good, so they’ve probably already got access to it. There’s only a limited number of individuals we see in custody who don’t deal with GPs or drug treatment services.’
These, however, are precisely the people who need naloxone the most, and overall provision has ‘gone fantastically well, as you’d expect from a drug that’s simple, proven and effective,’ he says. ‘We now have a stock of it in all of our custody suites throughout the county’.
If we’re going to create a widespread culture of supplying naloxone in custody suites a key element is effective communication between forces to get it out there, he says. ‘I’ve got a phone call later this week with another force who are looking to introduce it, and what we also need is more widespread understanding over the legality of it, the guidance, the litigation issues, safety.’
While the force’s frontline staff could see the need for naloxone on the streets and had been asking for it, with some custody staff there had been ‘a bit of a lack of understanding, which is to be expected. We just had to provide that clarity over the safety, the integrity of it, the efficacy of it, just going over those worries people had about something unknown. But overwhelmingly it was, “We want this and can we as an organisation make it happen?” For the staff, it’s been overwhelmingly positive.’
One important factor for any other force looking to introduce it is Durham Constabulary’s close working with the public health team at the county council, he says. ‘Other forces could look at how that relationship is managed. We took a partnership approach and really worked hand-in-hand, and we really learned a lot because they were very familiar with naloxone. At the moment it’s about trying to ensure a continuous supply from the county council, and trying to ensure that when cops see someone in the street possessing it it’s not grounds for a stop-and-search. We have to make sure they know what it is even if they don’t carry it themselves – raising that level of awareness and confidence.’
But if we’re going to be successful in making sure naloxone is in the hands of everyone who needs it – whenever they need it – then people working in the sector need to be the standard bearers, Dave Targett believes. ‘Ultimately, it starts with us. I was at a drug-related deaths conference a couple of years ago and when someone asked how many people were carrying naloxone only half a dozen or so put their hands up. Those are professionals in the sector who weren’t carrying it. We are the carriers of the message in the first instance, and I think we have to act how we want others to act. You can’t use it if you haven’t got it, and I think the best way to get people to carry it is for us to lead the charge.’
This article has been produced with support from Ethypharm, which has not influenced the content in any way.
Force of nature
The healing power of the natural world is helping people in recovery in Devon to reach their full potential, say Kerrie Clifford and Allysa Hornbuckle.
‘When you look outside on a sunny day you can see that the world is a beautiful place. Before, my eyes weren’t open to that.’ Flourish in Nature is a project led by EDP Drug & Alcohol Services and funded by Sport England that focuses on people in recovery, encouraging them to volunteer their time while training to become activity leaders and/or peer mentors.
The programme helps people see and realise their full potential, engage with new hobbies, and discover what really matters to them, all while embracing the beauty of nature. Most of the much-needed face-to-face support that people in recovery were used to came to a standstill as a result of lockdown, but Flourish in Nature continued because they were able to maintain their nature walks as a group while keeping social distancing. The outdoor activities such as walking, cycling, tai chi, wild swimming, forest bathing and boxing have been hugely impactful for everyone involved because they’ve been able to continue with their support system and communicate in person with others who are experiencing similar challenges.
Flourish in Nature also offers Zoom meetings twice a week, where anyone can join to talk about what’s on their mind or issues they’re facing, and when there is a larger group of people they often engage in teamwork-based games. This helps them to stay connected with one another and encourages step-by-step development of their community. The programme has benefited a great many people, one of whom is Kelly.
Kelly was approached around nine months ago to see if she fancied trying out some new experiences and maybe gaining a few new skills. She was at a point in her life where there was a void and she was at a loss as to how to fill it. ‘But when Flourish in Nature came along it was a huge game-changer,’ she says. She thought to herself that there really wasn’t any other service quite like Flourish in Nature and that she ought to become a part of it. So for the past nine months she has been working hard to pursue her goals, and while Kelly has been in EDP’s Together service for the past 18 months, in just two months’ time she will be a fully qualified yoga instructor.
She began her activity training as a walk leader at the same time as training to become a peer mentor, and then pushed on to become an activity lead while juggling a yoga instructor qualification. This training has given her the necessary skills to be able to help other people. She already has a client base for when she accomplishes her yoga instructor training and is beyond excited to be able to help people with both mental health and overall wellbeing.
Kelly’s unique blend of skills in peer mentoring as well as in outdoor leadership has given her the confidence to speak up in situations where people may be displaying or talking about their risky behaviour and guide them towards safer habits and better decisions. Kelly knows that she has a way to go with her recovery but she continues to strive to be the best version of herself and thrive through sheer perseverance. ‘I have not wanted to use drugs now because I spent the past 25 years suffering from depression because what I was doing wasn’t making me happy,’ she says. ‘But I didn’t have a choice. Where now I am saving my money and I am planning things for the future.’
She has changed the course of her life and because of Flourish in Nature, her mental health has turned a corner. ‘I’m happy now. I see the world differently now and I don’t have a chance to get bored. When you look outside on a sunny day you can see that the world is a beautiful place. Before, my eyes weren’t open to that.’ With the walks that she leads she tries to instil the importance of becoming one with nature, embracing the soil under her feet and breathing in the clean air. ‘It creates a sense of solitude while being surrounded by others that perceive no judgement.’
Having the ability to have a support system that is present and non-judgmental helps to motivate everyone involved in Flourish in Nature. Recovery can mean many people being faced with a choice of giving up their past life, and this can include giving up friends. Very quickly an individual’s usual support system is gone but with this programme there is the opportunity to engage with a new support system, where everyone has the same goal – to become the best version of themselves within their recovery journey.
Kelly’s family and friends have all been affected by her journey and are extremely proud of her for what she’s accomplished and her determination for a better future. She will not settle for anything less. ‘I wish that perhaps something like this was around 20 years ago, then maybe life could have been different,’ she says.
‘In the past, my background would have always gone against me, and I thought instead of swimming against the current, I should go and run with it, use my past as a plus point and use it to help others.’ There has always been a stigma around addiction and the idea that a person’s history will always be held against them but with Flourish in Nature, Kelly is using her history positively to speak her truth and help others through their recovery journey. ‘I used to hide my background and wasn’t able to be honest with others because I always thought I would go back to it… Flourish in Nature has made me be more honest with myself, now I know I won’t go back so I can be proud of where I came from,’ she states.
‘Something bad would have happened and that would have been an excuse to go back to it, but now I am not risking all that. I have accomplished and built so much because I have so much going for me.’ Flourish in Nature offers endless growth and continuous training allowing individuals to grow and connect with themselves through nature. It will also continue to tackle the stigma around addiction – as Kelly says, ‘People witness the members of this programme walking around and it is normalising the stigma and showing that we can do some good.’ This powerful message is a small but wonderful way of breaking down barriers. A last comment from Kelly, ‘I am so thankful and grateful for all the tools that they have given me. I kind of owe them to really do my best so that others can benefit too.’
Tracey McMahon is a Delphi nurse
Tracey McMahon is a Delphi nurse who has developed her interest in mental health by working in a prison environment.
Read Tracey’s story in DDN Magazine
As a child travelling on the train with my mum, we would go past a large mental health hospital. In the ’80s this was referred to as an asylum and this intrigued me. I would ask questions and tell my mum I wanted to work there one day.
As I grew up I forgot about this and wanted to teach English in Africa, but at 18, returning from travelling and waiting to start university, I started working in an elderly care home with nurses. Inspired by their commitment, I decided I wanted to be a nurse.
I started my training at Salford University in 2005, qualifying in 2008. I then started working as a mental health nurse at a medium secure unit, where I worked for the next ten years with various client groups at various stages of their mental health recovery. It was during this time that I developed an interest in substance misuse. I started a new programme co-facilitating psycho-education groups.
With my ongoing interest in substance misuse, I applied for a job as an alcohol nurse in a prison, which became recovery nurse when the healthcare provider changed. I was helping patients within the prison who had varying substance misuse needs, mainly focusing on those who were new into prison and had self-identified as being dependant on alcohol or opiates.
I saw a job advert at the mental health hospital I’d been obsessed with as a child and applied. I was working with patients who had been detained for over 20 years, and they continued to struggle with their mental health. During my time there I saw many changes including the patient group changing dramatically – they became younger, substance misuse became more prevalent, and within the service it was identified that there was a lack of substance misuse knowledge and support. I, along with a few colleagues, became involved in offering interventions for those with substance misuse needs.
I attended various training courses and spent time with specialist substance misuse services. I also did a level 6/7 course in psychosocial interventions to complement the substance misuse knowledge I had gained.
Throughout my nurse training I had always felt better suited to secure settings and working with this client group, seeing their mental health improve, was rewarding. Many of them would spend time in the hospital setting, away from their families and community for many years, and being able to work with the same person for this long really does allow you to build up a rapport and help them holistically.
Seeing the dramatic change in a patient once they had stabilised on their opioid substitute treatment or completed their medically assisted alcohol detox was extremely rewarding. Not only was there a change to their physical appearance, but their whole outlook on life and positivity towards the future.
I completed the non-medical prescribers’ course in 2019 and started prescribing. I have enjoyed this new aspect to my role and the challenges it brings. I attend an inpatient detox twice a month to prescribe and gained a lot from working in a new environment with completely different challenges to secure environments, focusing on my clinical skills – an area of my nursing I hope to keep developing.
As team leader of the service, I find that each day – each hour! – is different. I can be prescribing one minute, offering clinical advice next, having a consultation with a patient or offering an intervention. I might then have a staffing or service issue that I need to look into, involving risk assessments, action plans and service improvements. Looking at the service and patient care and improving standards are a massive part of the role I play within the team.
The favourite parts of my job are my nursing/NMP role – spending time with clients, building a rapport, and getting to a place where you can have a laugh, be open and honest about their treatment, what they want and what is realistic. Talking is so important yet often underrated by services – I’m lucky enough to work for a company that realises how important the small things are and the huge impact they can have on a person’s recovery.
Working in the prison environment can be quite oppressive with its restrictions, but having a good team really makes your working day easier. Making a difference to patients is so rewarding, as are the challenges and problem-solving aspects of the job – from linking patients up with community support to transferring care from a secure setting to the community.
Nursing will throw many challenges at you and at times you will question if nursing is for you. But the positives outweigh any negatives and it’s such a rewarding job.
Better Together
It’s been just over two years since Blenheim CDP merged with Humankind across London. In that time, a lot has gone well, but a lot hasn’t been as straightforward as planned – not least due to the pandemic. We’ve moved our service delivery forwards and I’m really excited about what the future holds for Humankind across the region.
Joining a new organisation during a pandemic has presented some challenges and at times, I’ve felt too far removed from services – I would normally have been sitting in on groups, having a stint on reception and getting to know our staff in person. Instead, I’ve done my best to connect online and have been in awe of the remarkable response from our London teams.
Our staff, commissioners and NHS partners have all been amazing in the way they’ve looked after one another and the people who use our services. Everyone has been incredibly adaptable, and it’s really brought home the untapped potential of our sector. Call me biased but I truly believe drug and alcohol workers are amongst the unsung heroes of the pandemic, showing tremendous resilience and commitment to keeping services running while also transforming the way we deliver services as we go.
Building on Blenheim CDP’s legacy of social action, Humankind are ambitious for our services in London and what we can achieve together with our service users. I’ve thoroughly enjoyed my first year with Humankind and looking forward, as restrictions continue to ease (fingers crossed!), there are three key areas of focus in the year ahead.
Firstly, we’re continuing to build on what we’ve been learning as a result of the pandemic. Our blended approach to service delivery, combining what works well online with what works well face-to-face is really exciting. Taking a people-led approach has made a huge difference to our delivery – really taking the time to listen to the people who use our services has helped us to make significant strides in terms of how our services have adapted to the challenges that the last year has brought us. We’ve recently recruited two regional recovery programme coordinators to further support the development of our response across London, and I’m eager to see even more co-produced initiatives to ensure people who access our services can benefit from everything that’s on offer in their local community.
Secondly, here at Humankind we’re known for our collaboration and our ability to work in partnership with a broad range of other organisations. In London, we have particularly strong partnerships with a range of NHS trusts and this is something I want us to strengthen over the course of the next year. Working closely together we can deliver a lot more, and I’m very proud of the relationships we share. The third sector is well placed to support people with complex needs and multiple vulnerabilities and aligning with our NHS colleagues can help make the sum greater than the parts.
Thirdly, Humankind plans to further build and develop our multi-thematic offer across London. We deliver housing support services, social enterprises, and significant employability work in other areas of the country. An early example of this is our expansion of our More Time social enterprise across the London boroughs where we work – providing social value and employment opportunities for local people. We’re committed to doing more of this kind of innovative work, and thanks to the universal funding grant we now have some additional resources to help meet the diverse needs of the communities we serve.
For me, innovation and working together will have a big impact in the year ahead. As part of this I’m really keen to promote the environment at Humankind where the most talented staff across the region can put their skills and passion to use for the benefit of the people accessing our services.
If you want to be part of our journey in London you can find out more at humankindcharity.org.uk/careers
Services now ‘on their knees’, says Carol Black
Funding cuts have left treatment and recovery services ‘on their knees’, commissioning has ‘become fragmented with little accountability for outcomes’ and partnerships between local authorities and health and criminal justice agencies have deteriorated across the country, Professor Dame Carol Black told the Westminster Social Policy Forum’s Tackling drug addiction and substance misuse – latest thinking on prevention, supporting recovery, policy and findings of the independent review event.
The workforce, meanwhile, was ‘depleted and demoralised’, with a falling number of professionally qualified people and ‘insufficient support to peer workers who are so crucial to the recovery process’.
Part two of her review currently ‘sits with Number 10’, she said, and she ‘very much’ hoped it would be published in July: ‘I cannot of course give you the exact recommendations but I can address the areas I’m going to be focusing on.’ Services had been cut back, particularly inpatient detox, residential rehabilitation, specialist services for young people and treatment for cannabis and stimulant users, and ministers in different departments had not worked sufficiently well together ‘in a determined and sustained way’, she said. ‘I’ve said in the report that the current situation is intolerable and that significant changes need to be made in four big areas’.
These were radical reform of funding, commissioning and leadership; rebuilding of services and developing integrated systems of care and support; increased focus on prevention and early intervention, and improvements to research and science. Part two of her report offered concrete proposals, she said – ‘I hope many of them deliverable in this parliament.’
‘This government must strengthen its national leadership of work to tackle drug misuse’ and hold departments to account, she said. Also essential was an increase in funding to provide an effective treatment and recovery system. ‘Funding at this time is of course difficult – it would be foolish of me to pretend otherwise – but we’ve been doing everything we can to ensure the Treasury understands that it would be money well spent with a substantial and early return on investment’ – leading to less crime, fewer murders, a safer society and better treatment outcomes.
‘I’ve said very clearly in the review that the money must be targeted and spent only on this area. Ringfencing isn’t popular but I believe it’s absolutely necessary,’ she said, while acknowledging that ‘ensuring coordinated local delivery encompassing several different elements was ‘extremely difficult’.
‘I think some people think that treatment is just about clinical services, but that’s only part of the story. We need a strong recovery community, trauma-informed services, and good mental health services.’ Good housing and employment opportunities were also ‘absolutely part of the treatment package,’ she said. ‘You only have to talk to those who are drug-dependent to understand that. We also need to acknowledge that drug dependency deserves parity with other conditions such as diabetes.’ The comorbidities associated with drug issues, including lung disease, liver disease, infections and mental ill-health also needed to be dealt with ‘in a timely manner’ she said. ‘I would go so far as saying that trauma-informed care is woefully lacking, and if you can’t provide that then it’s very, very difficult for people to come off the drugs they’re taking.’
It was also vital to improve the offering to non-opiate users, she stated. Many people thought there was ‘nothing available for them’ and that services were exclusively about heroin and crack. ‘That cannot be the case,’ she said. ‘I also want to ensure that thriving communities of recovery are a component of every drug treatment system, and this needs to be country-wide. People with lived experience offer so much to the recovery journey that clinicians are simply not equipped to do. We must also improve the pathways in criminal justice settings and enable diversion of drug users into treatment,’ maximising use of community sentences with treatment requirements and making sure that prisoners were able to access treatment ‘during the very vulnerable period’ immediately after release.
‘Finally, we need to improve research and science and have informed policy, commissioning and practice,’ she said. ‘I was really shocked to see how poorly served we are compared to countries like the USA, Canada and Australia. This needs to change, and it needs to be not only for the clinical service but for the recovery community which has had virtually no structured research.’
Recommend vaping to help people quit smoking, says NICE
Health professionals can recommend e-cigarettes as tools to help stop smoking, according to new draft guidance from NICE and PHE.
‘The evidence shows that nicotine-containing e-cigarettes can help people stop smoking and are similarly effective to other cessation options such as a combination of short- and long-acting nicotine replacement therapy,’ NICE states.
People should be able to use e-cigarettes as ‘one of several options’ to help quit smoking, said NICE’s expert panel, recommending that they are most likely to be effective in combination with ‘behavioural support’. The draft recommendations stress that people should be advised where to find information on e-cigarettes and that they are ‘substantially less harmful’ than smoking, but that their long-term health effects are unknown.
There are currently no medically licensed e-cigarettes and they are not available on prescription, with their efficacy and safety remaining controversial. While PHE has long maintained that e-cigarettes are around 95 per cent less harmful than smoking tobacco (DDN, September 2015, page 4), and that there is no evidence that they act as a ‘gateway’ to smoking for younger people, WHO’s position is that they are harmful and there is ‘insufficient data to understand the full breadth of their impact on health as devices have not been on the market long enough’.
The NICE committee recommends that further research be carried out into the short- and long-term health effects of e-cigarettes, particularly for groups such as younger people and pregnant women.
According to a survey commissioned by anti-smoking charity ASH, just 12 per cent of smokers were aware that that e-cigarettes were much less harmful than smoking, with a third believing they were ‘more or equally harmful’.
‘This new guidance offers a welcome “how-to guide” for reducing the harm caused by smoking including helping smokers to quit and preventing a new generation of smokers from starting,’ said PHE’s director of drugs, alcohol, tobacco and justice Rosanna O’Connor. ‘This consultation is an important opportunity for all our partners to help shape these recommendations.’
The draft guidelines were a ‘renewed effort to reduce the health burden of smoking and to encourage and support people to give up’, added director of NICE’S Centre for Guidelines, Dr Paul Chrisp. ‘Smoking continues to take a huge toll on the health of the nation and accounts for approximately half the difference in life expectancy between the richest and poorest in society. It is therefore vitally important that we reduce the level of smoking in this country. We need to use every tool in our arsenal to reduce smoking rates, including education, behavioural support, financial incentives, and e-cigarettes if people are interested in using them. Combined, we hope that people who smoke will feel enabled to give up tobacco products once and for all.’
Draft guidelines available for consultation until 6 August at www.nice.org.uk/guidance/indevelopment/gid-ng10086
Related articles
(Features, August 2023): DDN visited the Global Forum on Nicotine in Warsaw to hear about the challenges of mainstreaming tobacco harm reduction.
(News, August 2023): 40 per cent of smokers in the UK think that vaping is ‘as or more risky’ compared to smoking up from 27% last year.
(Features, February 2023): The genie’s out of the bottle – embracing tobacco harm reduction could end smoking within a generation, says Knowledge Action Change.
Read more articles on tobacco harm reduction, vaping and smoking cessation in the DDN archive.
A year on from launching our LGBTQ+ webchat service, what have we learned?
Steph Keenan discusses how With You has evolved its offering to the LGBTQ+ community over the last 12 months, and built a more inclusive service.
Launching in 2017, With You’s Webchat offers a free confidential space for people to talk about their alcohol and drug use with a qualified professional. In 2020 we had over 21,000 people access our online support.
We know that webchat is an easier channel for people who have never accessed help before to reach out. People who are struggling with their alcohol or drug use have a plethora of reasons they wouldn’t want to access help, stigma and shame being the things we hear a lot.
Alcohol and Drug use among LGBTQ+ groups is higher than among their heterosexual counterparts, irrespective of gender or the different age distribution in the populations. However, this is not reflected in the people accessing our in-person services. In one of our services, only four people had identified as gay or bisexual since the beginning of the year out of 1490 registered. Evidence is limited as to why this is but it suggests there are specific barriers to accessing support.
There are limited available programmes able to address culturally specific LGBTQ+ issues within services. In a 2018 survey for the LGBTQ+ equality charity Stonewall, almost one in four patients (23 per cent) had witnessed negative remarks about LGBTQ+ people from healthcare staff while accessing services. When someone does access support there can be heteronormative side conversations that exclude LGBTQ+ people. The default questions if they are in a relationship, or who your next of kin forces the ‘am I safe to come out to this person’ thought process. Often they don’t see themselves reflected in the other people who access support. If there is a specialist service, it can be quite a distance to individuals in rural areas.
As part of a wider ongoing project to improve our offering to the LGBTQ+ community, we looked at how webchat could be more inclusive. Webchat gives a confidential space where a person can disclose as much or as little as they want to a trained professional. The team offers service without borders or the barriers sometimes found in our commissioned support.
First of all we noticed a gap in our knowledge and recruited specialists in chems. Not only did this help to upskill the team but we tried offering specialist sessions for online one-to-ones with Ben, a frontline recovery worker and member of the community. This enabled people to access specialist support from wherever they were comfortable.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by With You
Cannabis four times stronger than 25 years ago
Cannabis potency has increased by as much as four times since 1995, according to UNODC’s World drug report 2021, a period that has also seen the number of adolescents who perceive it as harmful falling by 40 per cent.
This is despite ‘evidence that cannabis use is associated with a variety of health and other harms, especially among regular long-term users’.
The percentage of THC, cannabis’s main psychoactive component, has almost doubled – from 6 per cent to more than 11 per cent – in Europe since 2002, and quadrupled from 4 per cent to 16 per cent in the US since 1995, the document states. The agency is calling for increased investment in research into both cannabis harm and the drug’s potential medical uses, along with a worldwide ban on cannabis advertising to ‘prioritise public health over private business’. In a survey of health professionals from almost 80 countries, 42 per cent said they perceived cannabis use was on the increase.
Around 275m people worldwide used drugs last year, 36m of whom have a ‘drug use disorder’, the agency states. The number of people using drugs has increased by 22 per cent in the last decade as a result of population growth, with demographic changes likely to mean an 11 per cent increase worldwide in people using drugs by 2030 and a 40 per cent increase in Africa. An ‘integrated, people-centred and human-rights based approach’ will be needed to empower African societies to ‘develop sustainable solutions to drug use’, the document says.
More than 11m people worldwide are now estimated to inject drugs, around half of whom are living with hepatitis C. The number of daily doses of methadone and buprenorphine has risen from 557m in 1999 to 3,317m, a six-fold increase.
In common with recent reports from EMCDDA and others , the document states that drug markets ‘swiftly resumed operations’ after the initial disruption caused by COVID-19, demonstrating traffickers’ ‘ability to adapt quickly to changed environments and circumstances’. Diversified cocaine supply chains into Europe were ‘pushing prices down and quality up’, it added, while major online ‘dark web’ drug markets were now worth upwards of $315m in annual sales.
UNODC’s executive director Ghada Waly, who took office earlier this year, stressed the importance of strengthening the evidence base and raising public awareness. ‘Lower perception of drug use risks has been linked to higher rates of drug use, and the findings of UNODC’s 2021 World drug report highlight the need to close the gap between perception and reality to educate young people and safeguard public health,’ she said.
Document at www.unodc.org
How the employability sector is creating thousands of new jobs
The employability and skills sector is at the heart of the government’s Plan for Jobs strategy. New programmes such as DWP Restart and Kickstart, as well as the growth of traineeships, aren’t just supporting people into careers: they’re also creating exciting new job opportunities, says Forward’s Asi Panditharatna.
As reported in Personnel Today: ‘On top of the 27,000 work coaches [the government] plans to recruit for Jobcentre Plus branches, employability providers will need to recruit about 20,000 additional roles to support Restart and other employability programmes.’
This reflects our experience at Forward, where we have been busy recruiting new employability advisors, skills trainers and managers for our new DWP Restart service. This includes people who are new to the sector, whose lived experience gives them qualities such as resilience, determination, courage and hard work. They will be great role models to our clients and learners.
In previous blogs I have written about skills adjacency, where people who are un- or underemployed use ‘step into’ roles like these to develop adjacent or similar skills and knowledge required for a new career. We need to see more of this in the employability sector to recruit the work force we will need.
Becoming a Level 4 Employability Practitioner Apprenticeship provider
Training and development will be important for existing staff as well as those who are joining the sector this year. And as both an employability provider and employer, we are well placed to offer an apprenticeship journey based on our experience of working in the employability sector.
It is why we have become an approved apprenticeships training provider and deliver the Level 4 Employability Practitioner Standard. We knew we had the insight, experience, knowledge and know-how from delivering careers advice, vocational training, and employability and enterprise services. Many of our team have been working in this industry for a long time, and are keen to share experiences with colleagues who are newer to the sector.
It is also why we have joined the Institute of Employability Professionals (IEP). It enables us to offer membership to our staff, as well as opportunities to do the IEP Accredited Sector Induction Level 2 programme. This will help our staff enhance their knowledge and fine-tune their skills to deliver the best service to our clients or learners.
Read the full blog post here.
DDN magazine is a free publication self-funded through advertising.
We are proud to work in partnership with many of the leading charities and treatment providers in the sector.
This content was created by The Forward Trust