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Phoenix Futures residential drug treatment

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Celebrating 50 years of Phoenix Futures residential drug treatment services

W: www.phoenix-futures.org.uk T: 020 7234 9740

Read the full article in DDN Routes to Rehab

Image showing icons from last 50 years covering five decades of Phoenix Futures residential drug treatment

We know from our founder’s Griffith Edwards publications that date as far back as 1968, the positive impact that Phoenix Futures residential drug treatment has been making to the lives of “otherwise lost and deprived young men,” and women over the past five decades.

Phoenix Chief Executive, Karen Biggs. Talks about Phoenix Futures residential drug treatment
Phoenix Chief Executive, Karen Biggs.

‘We are proud of our history which has seen us grow from a single pioneering residential service to a national organisation with services in community, prisons housing and residential settings. We have adapted our approach over the years to meet the changing needs of our service users, their families and society but our message remains the same; that every person who is dependent on drugs and alcohol has the potential to rebuild their lives’

This year we celebrate 50 years of life-changing work, marking this milestone offered us the opportunity to reflect on the impact that Phoenix has had on thousands of people’s lives.

See details of our services below

Scottish Residential Service

It’s been an exciting 8 months at Phoenix Futures Scotland as we’ve been settling into our  home in Glasgow. The new premises have meant that we can provide even more support for people with more complex physical health needs including those with physical disabilities.

Scottish treatment from Phoenix Futures residential drug treatment services

 

The newly refurbished 32 bed centre is fully wheelchair accessible. Detox is available, and clients can choose between a 3 or 6 month programme, delivered in a Therapeutic Community model. Interventions include life story work, peer support, role play therapy, access to gym and leisure facilities, and access to complimentary therapies and supported accommodation.

Our dedicated team facilitate a range of sports, nature and arts activities so that there is something for everyone in this inclusive community.

 

www.phoenix-futures.org.uk/scottish-residential-service

 

Sheffield Residential Service

This spacious Victorian house with large tranquil grounds is set in a leafy area of suburban Sheffield. We are a short bus ride from the city centre and within walking distance of the world-renowned Peak District National Park.

Sheffield based treatment from Phoenix Futures residential drug treatment services

Detox is available, and clients can choose between a 3 or 6 month programme. Alongside a range of interventions delivered by a highly experienced team the community has created a

therapeutic community garden growing fresh produce and creating an opportunity to learn about horticulture.

Recently rated Good with areas of Outstanding practice by CQC.

 

www.phoenix-futures.org.uk/sheffield-residential-service

National Specialist Family Service

Based in Sheffield our unique service offers support for the whole family.

Children up to the age of ten can live on-site where we have an OFSTED registered nursery rated Outstanding. Phoenix Futures residential drug treatment services family service

Parents are able to benefit from treatment to address their drug and alcohol issues and develop their parenting skills whilst remaining the primary carers for their children.

Our team creates a homely child-friendly family environment in a suburban part of Sheffield, just a short walk from local amenities and shops. Recently rated as Good by CQC.

 

 

www.phoenix-futures.org.uk/national-specialist-family-service

Grace House Residential Service

Grace House is our women-only residential rehab service in North London, where clients with multiple complex needs receive trauma-informed care in a therapeutic environment.

ScGrace House Phoenix Futures residential drug treatment service

With a maximum capacity of 10 clients, there is a high staff/client ratio, with a team of caring female staff delivering a range of specialist interventions on substance misuse, domestic and sexual abuse, eating disorders and other mental health needs.  

The programme includes a 12-week therapeutic programme, EMDR, CBT, 1:1 sessions, trauma-informed yoga sessions, Recovery through Nature sessions, gym sessions and daily structured groups of emotional management.

 

 

www.phoenix-futures.org.uk/grace-house-female-only-residential-service

Wirral Residential Service

Recently fully refurbished Wirral Residential offers a country house setting with peaceful gardens and excellent links with the local community, our excellent staff team provides holistic support and offers opportunities to access volunteering and educational opportunities. Phoenix Futures residential drug treatment services in Wirral

 

Offering detox, and a 3 or 6 month programme in a Therapeutic Community there are even kennels onsite for clients to bring their dogs with them while they stay with us.  

Recently rated Good with areas of Outstanding practice by CQC.

 

 

www.phoenix-futures.org.uk/wirral-residential-service

 

What it’s like to run a needle exchange service

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DDN
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The people I see come from all walks of life. The key is getting to know them properly without judgement

By Cilicia Wyman, Harm Minimisation Worker at Addaction Lincoln

Sitting pride of place in my home is a slightly worse for wear old teddy. Most people assume it’s a relic from my childhood, something I can’t part with. In fact, a man who used the needle exchange service I run gave it to me a few years ago.

I used to work with children who have ADHD and this man’s restlessness, trouble focusing on one thing, and tendency towards impulsive behaviour had some of the hallmarks. He was also using an amphetamine to help focus his mind.

I got him into treatment with a key worker and told them about my concerns so they referred him to a specialist. The specialist agreed with me and gave him medication to put his mind at ease. All of sudden the drugs he was using didn’t have the same hold over him. One day he popped back in, bearing the teddy. After a tough day it’s a great reminder of why I do what I do.

Read the full article on Addaction’s Blog.

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 Addaction, and first appeared on

https://medium.com/addaction-voices/

Correct methadone dosage vital for people being treated for TB

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DDN
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Methadone dose optimisation is vital when treating people on opioid substitution programmes for tuberculosis (TB) and other conditions, according to new research.

Researchers at Aston University’s School of Pharmacy, in partnership with Addaction, looked at how methadone interacts with drugs used to treat other medical conditions. Anti-TB drug rifampicin is known to increase the breakdown of methadone in the body, meaning that methadone levels need to be gradually increased and then decreased after the TB treatment ends. A wide range of medications for HIV and epilepsy, along with some antibiotics, can cause similar interactions, meaning that it’s ‘critical’ to fully understand the clinical implications, the study says.

Dr Raj K. Singh Badhan: TB medication significantly alters level of methadone in the blood.

The researchers found their ‘virtual’ clinical trial – using a mathematical computer modelling technique to analyse previous studies – to be almost 95 per cent effective in ensuring that patients avoided withdrawal symptoms or relapse while undergoing TB treatment. According to the World Health Organization (WHO), TB remains one of the top ten causes of death worldwide, with England seeing more than 5,000 cases in 2017. Of these, 13 per cent will have had at least one ‘social risk factor’, such as a history of substance use, time spent in prison, or homelessness.

‘We found that rifampicin significantly alters the level of methadone in the blood and necessitates dose adjustments, with daily doses of almost double those commonly used in clinical practice required for optimal levels of methadone in the blood,’ said lecturer in pharmacokinetics at Aston University Dr Raj K. Singh Badhan. ‘This interaction has wider implications – drugs that are routinely used for epilepsy, HIV and some antibiotics may also result in a similar phenomenon occurring and this research hopes to illustrate the clinical implications of this interaction and offer some approaches to mitigating clinical risk.’

Roz Gittins: Combining methadone with other medications can be challenging.

‘We know that when people are taking methadone for opioid dependency and rifampicin for tuberculosis at the same time, this can be challenging,’ added Roz Gittins, Addaction’s director of pharmacy. ‘We know that there has been a lack of information to advise prescribers on how to change the doses of medication in this situation. Using computer modelling, we have looked at how doses of these medicines may be changed to get the best possible patient outcomes.

‘We plan to apply this research in the “real world” and hope that in the next year we will be able to carry out similar work with other medications that are used in mental health and substance misuse services.’

Read the study at: https://www.sciencedirect.com/science/article/pii/S0376871619301450

 

DDN Conference 2024: Stronger Together

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DDN
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'What an incredible day… There were so many incredible people to catch up with & exciting projects to engage with' – @SUITeam

The DDN Conference is over for another year – huge thanks to all of this year's visitors, exhibitors and speakers for a fantastic day. Missed the conference? Attended but want a refresher? Here you will find links to reports, video footage, photos and feedback, as well as the full conference coverage in the September issue of DDN!

'Inspiring and thought-provoking discussions – new ideas aplenty to bring away, collaborate, and turn into positive change' – @lukeoneil84

Read conference reports

Session one

DDN Conference 1The first session explored how people could unite to address the ever-increasing risks from nitazenes and other potent synthetic drugs:

  • Deb Hussey and Jude Duncan, Turning Point
  • Shayla Schlossenberg, Release
  • B3 Brent
Read report on session one

'A humbling and inspiring day' – @CGLinWF

Session two

DDN 2The day’s second session heard from three different organisations who were putting lived experience at the heart of their activities:

  • Gareth Balmer and the Fife WithYou team
  • Stella Kityo, Soulgetic
  • Red Rose Recovery
Read report on session two

'As always, great conversations and inspirational speakers' – @ViaOrg_

Session three

DDN 3The afternoon saw lively, interactive discussions on three crucial topics – the ongoing fight against hep C, ensuring user involvement is genuine and at the heart of services, and getting the sector’s key issues into the in-trays of our new crop of MPs:

  • Deanne Burch, Hep C U Later, and Deborah Moores, Humankind
  • Nic Adamson, Change Grow Live
  • Mike Trace, Forward Trust
Read report on session three

'Great to be trained to use naloxone' – @DrGordonHay

Watch video footage

DDN Conf videoWatch some highlight reels here for a quick recap of the day!

Watch videos

'My favourite conference' – @judithyates1

Browse conference photos

DDN Conference picsTake a look at a selection of pics from the big day and see if you can spot yourself here!

View photos

'The event had lots of great speakers and offered an excellent opportunity to network' – @VoicesActionCh1

See our feedback

DDN Conf socials feedbackWe’ve taken to social media to share some of your fantastic conference feedback. Read some highlights here.

Read feedback

'Good motivation for peer support and lived experience… some awesome speakers' – @HarmReductionUK

DDN September 2024

DDN Conference SeptemberThe September 2024 issue of DDN magazine includes full conference coverage. Take a peek here.

Read September issue

'Had a great day… ticked something off my bucket list and met the legendary Naloxone Man' – @BenJ_LeadNurse

DDN Conference 2025

CalendarWe’ll be back in 2025!

Stay tuned for date and venue information coming soon.

We look forward to seeing you all at the DDN Conference 2025!

'Mint turn out as always' – @GBMC73

Supported by:

Five charts that show why people leaving prison need naloxone

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DDN
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People leaving prison are far more likely to die of a drug related cause. We know the overdose reversal drug naloxone saves lives, we just need to put this knowledge into practice.

Prison release drug deaths graph
Research by King’s College London found that in England and Wales male prisoners are 29 times more likely to die in the first two weeks following their release than the general public. For female prisoners this figure increases to a staggering 69 times more likely. The primary cause for both men and women is heroin overdose.
Steve Moffatt Public Policy Manager at Addaction.
Steve Moffatt Public Policy Manager at Addaction.

Last year my colleague Karen Tyrell wrote about drug related deaths in The Guardian, focusing on a “guitar playing Scot called Stuart” who she got to know as a prison drugs worker. She wrote about how she formed a strong bond with him, how he opened up to her and how he died from an overdose just two days after his release from prison.

Unfortunately this is a common story. People have been locked away for months or years and then we throw them into the deep end on release. It’s not a surprise that many people struggle and some will sink almost immediately. We need to do more to help people reset their lives in a way that supports them.

Read the full article on Addaction’s Blog.

 

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 Addaction, and first appeared on

https://medium.com/addaction-voices/

British ‘get drunk’ more regularly than other nationalities

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DDN
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British people who drink get drunk more regularly than other nationalities, according to the latest Global drug survey. Respondents in the UK reported getting drunk 51 times a year, compared to an average of 33 times.

Participants from other English speaking countries such as the US, Canada and Australia also reported getting drunk regularly – at 50, 48 and 47 times a year respectively – while those in Chile reported getting drunk 16 times per year. Almost 40 per cent of participants who drank alcohol in the previous 12 months said they wanted to drink less in future.

The survey was compiled from data from just under 124,000 people across more than 30 countries. Almost 60 per cent of respondents were male and 87 per cent were white, with a mean age of 29. Sixty per cent said they went clubbing at least four times a year.

Of the 20,000 people who completed the section on cocaine use, less than 9 per cent reported using the drug on a weekly basis, but 65 per cent said they’d used it up to ten times in the previous year. Just over 1 per cent had needed to seek emergency medical treatment following cocaine use, while more than 70 per cent of those who’d recently used it said they would support a ‘regulated fair-trade’ market, with most willing to pay more.

Use of MDMA powder, meanwhile, is now as common as ecstasy pills, although almost three quarters of people who took MDMA reported doing so on ten or fewer occasions. Use of the ‘dark net’ to buy drugs was also on the rise, with more than a quarter of people who’d bought drugs that way doing so for the first time in 2018. MDMA, LSD and cannabis were the most frequently purchased substances.

One third of female respondents reported having been taken advantage of sexually at some point while under the influence of alcohol or drugs, and 8 per cent within the last year – the rates for men were 6 per cent and 2 per cent respectively. Alcohol was involved in almost 90 per cent of overall cases.

Of the more than 52,000 respondents who completed the survey’s policing section, almost a quarter reported that they had ‘encountered police’ in relation to their drug use in the last year, including stop and search, roadside testing and use of drug dogs. People in Australia and Denmark were most likely to have had dealings with the police, and those in New Zealand the least.

Most people, however, had favourable attitudes towards the police, the document states. ‘For example 50 per cent of respondents (who are all people who use drugs) said police frequently/somewhat frequently treat people with dignity and respect. But those who have been recently policed had less favourable attitudes, and were less likely to report they would help the police if asked.’

Dr Edward Day, the government’s new recovery champion

Meanwhile, Dr Edward Day has been appointed as the government’s drug recovery champion, the Home Office has announced. Dr Day is clinical reader in addiction psychiatry at the University of Birmingham and a consultant psychiatrist, and has helped develop national clinical guidance for the substance field. He will agree an ‘annual delivery plan for drug recovery’ with ministers, support collaboration between partners such as councils, housing organisations and criminal justice, and aim to tackle issues such as stigma. ‘His work will make a real difference to the lives of those suffering the misery of drug dependency,’ said home secretary Sajid Javid.

Survey results at www.globaldrugsurvey.com

The LGBT body image problem

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DDN
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As part of our focus on mental health this week and the theme for this year – Body Image – to take a look at the LGBT community, with particular focus on the effects brought about by social media.

LGBT Person with rainbow flag

 

People in the LGBT community, through the combination of low self-esteem and stressful life experiences, are some of the most at-risk to develop mental health and eating disorders. Research by NEDA has shown that teenagers who identified as gay, lesbian or bisexual may be at higher risk of binge-eating and purging than heterosexual peers.

Body Image is the theme of this year’s Mental Health Awareness Week, and now more than ever the discussion needs to be brought up specifically around one of the more affected groups.

To read the full article on Turning point’s blog click here.

 

The full article was created by Turning Point and is available 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, and first appeared on www.turning-point.co.uk

 

Take a breath

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DDN
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As part of our focus on mental health this week, here are some tips on how to practice deep breathing and become more relaxed.

 

We often see people who have issues with their sleep. Either they lay awake for hours wrestling with their thoughts or are woken up by these in the middle of the night. They feel exhausted and life becomes overwhelming as sleep deprivation takes its toll. Such is the demand for support with sleep that our Wakefield service runs regular workshops specifically to help people improve their sleep.

To read the full article and book dates for workshops click here.

 

The full article was created by Turning Point and is available 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, and first appeared on www.turning-point.co.uk

 

International Day against Homophobia, Biphobia & Transphobia (IDAHOBIT)

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DDN
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May 17 is the International Day against Homophobia, Biphobia and Transphobia – or IDAHOBIT.

International Day against Homophobia, Biphobia & Transphobia (IDAHOBIT)

 

May 17 is the International Day against Homophobia, Biphobia and Transphobia – or IDAHOBIT. The main purpose of IDAHOBIT is to raise awareness of violence, discrimination, and the repression of LGBT+ communities world-wide.

Shaun Kennedy, National Equality Diversity and Inclusion Lead CGL
Shaun Kennedy, CGL National Equality Diversity and Inclusion Lead

In turn, it provides an opportunity for organisations and individuals to engage in dialogue with the media, policy makers, public opinion and the wider civil society.

This year’s theme for IDAHOBIT is justice and protection for all. Within the UK when it comes to being lesbian, gay, bi or trans, it is sometimes easy to take justice and protection for granted, particularly as LGBT+ rights have advanced so much over the past 20 years.  However, there are still many gaps in the law and LGBT+ people continue to experience discrimination and injustice in their daily lives. For example, according to research conducted by Stonewall:

  • One in five LGBT people in the UK have experienced a hate crime or incident because of their sexual orientation and/or gender identity in the last 12 months
  • Two in five trans people have experienced a hate crime or incident because of their gender identity in the last 12 months
  • Four in five anti-LGBT hate crimes and incidents go unreported, with younger LGBT people particularly reluctant to go to the police

In many places around the world, LGBT+ people also face injustice and live in fear and danger. The latest International LGBT Association (ILGA) global report on State-sponsored homophobia, lists 72 states that still criminalise same-sex sexual relations. In 45 of these States the law is applied to women as well as men. Many more States restrict the freedom of speech on gender and sexual diversities or put other forms of legal pressure.

This is why more legal and policy reforms are essential to ensure justice and protection for all LGBT+ people around the world.

Within Change Grow Live, I feel immensely proud to work in an organisation where I feel I can be myself and where my diversity and identity are genuinely valued. This year’s achievement in Change Grow Live becoming a Stonewall top 100 employer is a testament to the fact that we are building a positive working culture.  I fully recognise, however, that there is always be more to be done to improve our equality and inclusion practices. We will continue to focus on improving the experience of our LGBT+ staff, volunteers, service users and their allies.

Read the full article at www.changegrowlive.org

 

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 CGL, and first appeared on www.changegrowlive.org

 

I carried all the suffering alone

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DDN
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From a young age, Carol took it upon herself to make sure her loved ones were OK – at her own expense. She recalls the events that drove her to depression, and how 40 years later she found herself in a now-or-never situation.

Glass being filled with water to illustrate anxiety
But then, with anything else major happening to us or me, my issues became more apparent. I compare it to liquid in a glass: when it’s low down, if you get anything else poured in, it doesn’t come out of the top. But when you are continually functioning like a glass full, and something else happens, it spills over the side.

I didn’t realise over time, it only came about during therapy really, that I probably have been suffering from depression in one degree or another, for about 40 years. For all that time I didn’t know the extent of it, I didn’t do anything to try to combat it.

But I know the initial start of it, the trigger.

I lost my father in a mining accident when I was 17, which was way back in 1976. My mother took it really badly. My sister and brother were younger than I. It was at a critical age really, I was in the middle of my A-Levels; my sister was in the middle of her O-Levels; my brother was 11, an age where he was just starting to form a bond with my dad. As a result of the accident, he went off the rails a little bit. It was horrendous for a bit in the house afterwards.

In those days, depression wasn’t talked about, or dealt with. It was dismissed. I thought it was my job to look after everybody else in the family and to be there for them, and it just all got brushed under the carpet. At the time, I also went through a lot – incidents, events, circumstances – that added to my depression and put a lot more lead on it. Being there for everybody, over the years, just worsened it. I had a lot of personal things that happened to me straight after that, and generally had quite a few traumatic circumstances on and off through my life.

 

The full article was created by Turning Point and is available here.

 

 

DDN is an independent publication funded by advertising. We are proud to work in partnership with some of the leading charities and treatment providers in the sector.

Find out more here.

Time for a compulsory tax on the gambling industry, say academics

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DDN
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A new compulsory levy should be placed on the gambling industry to support people with gambling problems, according to a report published in the BMJ.

The paper also wants to see the 2005 Gambling Act revised and responsibility for gambling moved from the Department for Digital, Culture, Media and Sport (DCMS) to the Department of Health and Social Care (DHSC).  

A three-year strategy was recently launched by industry regulator the Gambling Commission to address gambling harms (DDN, May, page 4). However, less than £1.5m was spent in 2017-18 on ‘prevention activity’ in Britain, the paper says, compared to more than £9m in New Zealand, which has a population of 4.7m compared to the UK’s 66m. There is no ‘government-owned strategy’ to prevent gambling harm, and a ‘critical need’ to increase funding, it argues.

The extent and cost of UK gambling has been significantly underestimated, say the academics, and major investment is now needed to ‘alleviate the growing burden’ on society. There are currently 33m active online gambling accounts in Britain, with almost 60 per cent of the population having gambled on activities such as the National Lottery, slot machines, casino games or online gambling within the last year.

Around 340,000 people in Britain are estimated to be ‘problem gamblers’, with a further 550,000 at ‘moderate risk’. The harms associated with gambling can include serious financial problems, relationship breakdown, abuse or neglect of partners and children, and suicide, says the report. Estimates of the social costs of between £200m and £1.2bn are likely to be ‘considerable underestimates’, it adds, while prevention and treatment provision is ‘woefully under-resourced’.

‘Public health approaches to reduce harms related to gambling should encompass a range of population-based approaches supported by regulation, legislation and funding,’ the report states. ‘Simply stating that gambling is a public health concern is not enough. It must also be treated as one.’  While the statutory power to impose a compulsory levy exists, successive governments have been ‘unwilling’ to enact it.

Gambling Report co-author Professor Gerda Reith of the University of Glasgow.
Report co-author Professor Gerda Reith of the University of Glasgow.

‘As a society we need to face up to the broad environment that gambling harm is produced in – the role of the industry, as well as the policy climate that they operate in,’ said co-author Professor Gerda Reith of the University of Glasgow. ‘Gambling doesn’t just affect an individual. The impacts ripple out beyond them to their family, friends, communities and society. Not only does this have major implications for our health services, it is also a social justice issue. Gambling harms disproportionately affect poorer or more vulnerable groups in ways that can exacerbate existing inequalities. We urgently need a marked change in approach, and one that is long overdue.’

Gambling and public health: we need policy action to prevent harm at www.bmj.com

 

 

County Concerns

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DDN
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The Home Office has produced a series of posters to help staff working in social housing identify potential victims of county lines activity and report their concerns.

 

The number of potential modern slavery victims reported to the authorities has risen by more than 80 per cent in the last two years to just under 7,000, according to the National Crime Agency (NCA) (DDN, April, page 4). The numbers of British citizens and minors referred doubled between 2018 and 2019, both partly the result of exploitation of young people by county lines gangs.

 

More information and poster downloads at www.gov.uk

Residential Drug Treatment – Family Ties

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Family ties

Close-knit support involving loved ones can be invaluable to sustained recovery

Families and friends of those affected by addiction can suffer a great deal of stress, often worrying that they are responsible for the problem and not feeling equipped to react to the situation.

Many residential treatment settings offer a range of support services, including support groups, wellbeing days, and specific support programmes for relatives and friends. Trevi House in Plymouth has pioneered programmes that create space for women to keep their children with them as they attend treatment.

Research has shown that supporting families can increase the chance of successful outcomes for the addicted person, while counselling and support programmes can greatly improve the dynamics of family relationships.

Hannah Shead of Trevi House Rehab
Hannah Shead is chief executive of Trevi House.

 

‘For the past 25 years Trevi House has worked with hundreds of women and their children – at a residential rehab and more recently through outreach at our Sunflower Women’s Centre – getting mum off drugs or alcohol for good and giving her the skills to be the best parent she possibly can.’

John Taylor, family and carers lead, DAWS talks about families roles in drug and alcohol treatment
John Taylor, family and carers lead, DAWS

 

 

 

‘Groups can work so well for “affected others” just as they can support people tackling their own addiction. You can be with people who are just like you, get identification and lose the feelings of judgement and shame. It takes away the isolation that can come with addiction and make people unwell.’

 

 

View all editorials from the guide here

Alternatively read the guide as a mobile magazine

Residential Drug Treatment – Ongoing support

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Building networks

Rehabilitation is as much about creating support networks to feel sustained within in the community as about facing the past

There are many different options for seeking help with addiction in the community, and various levels of support. Help is available from treatment agencies, projects and community drug services all over the country.

Options include structured day programmes, counselling, organisations offering advice and information, and support groups.

Danny Hames, NHSSMPA talks about ongoing support after drug and alcohol treatment
Danny Hames, NHSSMPA

‘To be treated at CNWL’s national problem gambling clinic, people can self-refer or be referred. If accepted for treatment, a proven and effective help is cognitive behavioural therapy (CBT), which is provided on an individual and group basis. Psychodynamic psychotherapy is another option and may be used with those who have failed to maintain abstinence using CBT methods, or for those who are clear that there are emotional reasons for their lapses. With the emphasis also on the family, the clinic offers behavioural couples therapy, while another option is medication, specifically naltrexone to suppress cravings.’

Jody Lombardini, CNWL and Danny Hames, NHSSMPA

 

 

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Online options

The internet has opened up a whole new world of support through website advice, forums and online chat, which can work well to continue the support beyond rehab.

Drink Coach online support for alcohol issues
Drink Coach online support for individuals worried about their drinking.

You can find information and advice from many sources, including the websites of treatment agencies and government sites such as www.talktofrank.com

If you are experiencing problems with addiction yourself, there are structured interventions on offer, such as online chat rooms, which provide online meetings, scheduled in advance, with topics introduced by a chairperson. Using a microphone and speakers, you can take part in the live chat, or share in the discussion by typing your message onto the screen.

If you need support during your addiction or recovery, sites such as www.smartrecovery.org.uk run an online community, with 24/7 live chat, online meetings social networking.

Many of the mutual aid groups, such as Alcoholics Anonymous (AA) and Narcotics anonymous (NA) hold online open meetings for those needing support to maintain recovery based on the 12 steps.

There are many specialist support sites to help you with all kinds of addictions, even if you are just looking for reassurance that you are not alone.

A Safe Space

‘I believe the group helps with coping strategies, helps women feel more empowered and gives them a sense of community – a place to relate their personal experiences and one that provides understanding. Women open up on issues that would otherwise be taboo in mixed meetings. The “closed” group means only members can see posts, and it is open to women already in recovery looking for continued support, as well as those looking for a way out… I believe we need other women in our lives to heal and stay sober.’

Annalice Sibley, founder of ‘Women Only Recovery’ Facebook group

Support with drinking

A free online tool has been developed to support people who are concerned about their alcohol use. It can be a hard thing to admit if you’re getting worried about your drinking, but DrinkCoach provides a ‘one-stop-shop’ for expert alcohol help from health and social care specialists Humankind. Available at www.drinkcoach.org.uk, it is the only UK tool to offer online screening, advice and access to an alcohol specialist all in the same place.

Seeking help can feel intimidating, but DrinkCoach’s online sessions allow people to talk to a professional in the comfort of their own home at a time that suits them – including evenings and weekends. The 40-minute sessions are conducted via Skype, which means no waiting lists and no off-putting clinical settings.

‘We developed DrinkCoach to support people who are concerned about their drinking,’ says Mark Holmes, assistant director at Humankind. ‘Evidence shows us that the earlier we can intervene the better their outcomes. Our range of tools and services are designed to support individuals to meet their drinking goals, whether to reduce or quit, in their own time and in their own space.’

 

Click here to read the next article in the series: Routes to Funding

Alternatively read the guide as a mobile magazine

Residential Drug Treatment – Home or away?

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Home or away?

There are several important factors to take into account when choosing location

Many people seeking help for their addiction look abroad to find treatment. There are hundreds of treatment providers based all over the world, many of them in exotic locations, and the current exchange rates mean that prices of overseas residential treatment can be very cost-effective. Travelling abroad also gives individuals space to recover in a new environment, away from chaotic lifestyles, and give an added boost to wellbeing. 

Before deciding on what centre is right for you, it’s important to take into consideration the regulations and culture of the country where you are looking before undergoing treatment.


In the UK, rehabs are monitored and inspected by the Care Quality Commission,  and issues with members of staff can often be resolved by the Federation of Drug and Alcohol Professionals.

Each individual country will have their own system of inspection and regulation, and it is important that you ask about this when booking anywhere. Ensure you speak directly to individual rehabs, rather than through a third party, and ask them about how they are regulated.

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Articles and opinion pieces in DDN have considered one treatment environment over another – with the only fair conclusion being that any successful treatment has to be tailored to the individual and their circumstances. For some, the best option is to be given respite from their normal routine by ‘getting away from it all’ to concentrate on an intensive treatment programme; for others it is essential to keep the links with home life, so attending a local service is more practical.

Mark Gilman form Public Health England Lead talks about residential drug and alcohol treatemnt
Mark Gilman, Discovering Health

 

‘I certainly think that if people do need residential detoxification and residential rehabilitation they should stay as near to home as they can. We do recover and we can get well where we got sick. When we are “recovered” or “in recovery” and walk through our local shopping centres, people who know us, who drank and used with us but are stuck in the madness see us, they can connect to hope.’

 

Owen Baily talks about residential treatment for gambling addiction
Owen Baily, gambling expert by experience

 

‘As with thousands of other people facing the challenges of overcoming addiction, I had a serious relapse – time for rehab. I began the search in October and come March, I was walking up the drive to the therapeutic community where I stayed for 20 months. It was a therapeutically difficult and painful experience, but one which I am so grateful for.’

 

Danielle Robinson of Acquiesce talks about residential drug treatment
Danielle Robinson, service manager, Acquiesce

 

‘The urban recovery model allows for individuals to recover in real life situations, while being in a secure and supported environment… Building your recovery capital locally can make leaving treatment a much less scary prospect, as you are leaving with a plan of support that you have already begun engaging with.’

 

 

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Residential Drug Treatment – A place called home

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A place called home

Safe and stable living conditions are essential to ongoing recovery

Supported housing is an option for people who have already accessed treatment, to give them a more stable lifestyle and a better environment in which to recover.

Offered by many treatment providers, the housing provides a safe place for people trying to recover from drug or alcohol addiction, allowing them to be around drug workers and others going through the same experience to aid their recovery journey.

Ron Dougan Trent Housing talks about the rle of housing in residential drug treatment
Ron Dougan, chief executive, Trent and Dove Housing

 

‘People need three basic things: a decent home in the right area, continued support including a network of family and friends, and something decent and permanent to do.’

 

 

Therapeutic communities

A therapeutic community is designed as a mini society to get inhabitants used to living without drug or alcohol dependency. Sometimes they are integrated with a residential treatment programme and have the aim of ‘unlearning’ addictive behaviour, helping people to develop practical skills to live an independent life.

There are many successful therapeutic communities worldwide, many of whom use supported housing to bridge the gap to truly independent living.

Where recovery can begin

Phoenix Futures Scottish Residential Drug Service

Phoenix Futures’ Scottish residential service houses a therapeutic community that operates on a peer-led model. Members take ownership of the whole community’s recovery plans and all aspects of day-to-day life, including cooking, cleaning and tending the garden. Residents have also been involved in designing the house, right down to choosing the wallpaper and colour schemes.

 

Karen Biggs phoenix Futures talks about residential drug and alcohol treatment
‘For thousands of people, this is where their recovery began,’ says chief executive Karen Biggs.

 

When residents arrive they will enter the first stage, establishing a commitment to the programme and a desire for recovery, before moving into the main house for the core part, learning to talk about experiences that have had a direct impact on their lives. Then when they are ready, they will move on to the senior stage, which gradually introduces them to life in the wider community and opens doors to training and volunteering.

 

Click here to read the next article in the series: Home or away

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Residential Drug Treatment – What happens in drug and alcohol rehab?

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What happens in residential drug and alcohol rehab?

Counselling and intensive support from a qualified team of professionals is an extremely important part of the rehabilitation process, from the minute you step through the door. They may have a particular ethos or be able to offer different options for treatment, but a period of stabilisation will be essential.

Drug and Alcohol treatment counsellor

Detox

Detoxification from drugs or alcohol is usually the first step, with a focus on healing the body after long-term drug or alcohol use.

Individuals go through a process of stabilisation and detoxification, to help the body rid itself of the unwanted substance, and are then supported through the subsequent withdrawal symptoms.

People who go through detox will then move on to a longer-term programme to continue their recovery.

12-Step

The 12-step programme is frequently offered and has introduced lifelong support to many people. It originates from the 1930s, where the first Alcoholics Anonymous 12-step fellowship was founded by ‘Bill W’ and ‘Dr Bob’ and encouraged participants to turn to a ‘power greater than ourselves’ (often, but not necessarily, interpreted as God) for support. Since then, the programme has been adapted to address substance misuse and other addictions.

As the name suggests, the approach uses 12 ‘steps’ to aid recovery. These include admitting that you have a problem, looking at mistakes you have made in the past and making amends for them, as well as learning to live by a new code of behaviour and supporting others with similar problems.

Individuals in 12-step programmes attend meetings where they are able to identify and work through their addiction problems, supported by other people who are experiencing the same issues in a safe, non-judgmental environment.

Cognitive Behavioural Therapy (CBT)

CBT is a psychotherapy treatment that uses a practical, goal-setting approach to overcoming addiction.

A counsellor will work with an individual to look at the reasons behind their actions and behaviours, and at the relationships between the way a person thinks and their problems with addiction.

The therapy is aimed at changing the patterns that cause individuals to act the way they do, so that they can respond to challenges in a more effective, healthier way.

Tony Adams footballer - taking about drug and alcohol treatment
Tony Adams, former Arsenal and England footballer

 

‘I had my moment of clarity, my surrender moment at 29 years of age. I started to cry. “I don’t want to drink. I’m still getting drunk. All this behaviour I’m doing, I don’t want to do.” My life was a complete and utter mess. But as soon as I surrendered, as soon as I gave in, it was a release. Somewhere inside of me I had a moment of clarity, something shifted within me that let a shaft of light in and the therapy got me well.

If one programme doesn’t work for you, try everything. And as professionals, put everything in front of people and they might pick up one of the tools.’

 

 

Click here to read the next article in the series: A place called home.

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Residential Drug Treatment – Routes to funding

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UK residents can apply through the NHS for community-based and private rehab.

Your first port of call should be your GP, who will recommend the best treatment for you, and can refer you on to your local drug or alcohol service.

After you’ve been assessed, you’ll be introduced to your key worker, who will then work with you to find the right treatment for you.

You can also sometimes self-refer yourself to treatment services if you contact them directly for help, and there are many voluntary sector organisations who offer treatment and support services.

Alternatively, if you have the funds available or have private health insurance, you can access treatment privately. This process is usually quicker, but treatment through the NHS is free of charge.

Dr Yule Action on Addiction Drug Treatment service
Dr Simone Yule, clinical lead, Action on Addiction

 

‘I fully believe in the holistic approach to pain management. The drugs are a quick fix and should only be used in the immediate aftermath of an accident or illness. I think true rehab, where you are looking at the psychological aspects and physical rehabilitation to manage and help alleviate the pain, is not nearly accessible enough.’

 

 

 

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Dayhab drug Treatment from Help Me Stop

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A new Dayhab treatment centre sets out to make recovery available to everyone who needs it.

W:www.helpmestop.org.uk T: 020 8191 8920

Read the full article in DDN Routes to Rehab

Vernon Hartshorne, head of treatment at Help Me Stop’s new ‘dayhab’ service explains why he believes recovery should be part of everyday life, and how Help Me Stop’s new ‘dayhab’ treatment service can offer recovery to more people.

“I believe there’s only one thing that matters about addiction treatment; that it works. And once you’ve worked out what works, you make it available to as many people in need of help as you possibly can. Like most people in recovery, I’ve always believed in helping the many not just the few.” Vernon Hartshorne

Vernon Hartshorne, head of treatment at Help Me Stop dayhab drug treatment service
Vernon Hartshorne is head of treatment at Help Me Stop.

For Vernon Hartshorne, that dream was the starting point for Help Me Stop ‘dayhab’ treatment service and began with a series of ‘what ifs’; What if there were a model that allowed people to recover at their own pace at an affordable cost? What if they could continue to live at home, work and look after their children while in treatment? What if centres were located in modern, well-equipped premises on the high street, as easy to walk into as a corner shop? What if we combined the interventions we know contribute to successful treatment as recognised by the World Health Organisation: CBT, mindfulness, art therapy, one-to-one counselling underpinned by a 12-Step approach?

Help Me Stop is a flexible Dayhab programme that enables people to recover in the real world, instead of taking them away from their homes, families and jobs. And at £2,500 for a five-week, 160-hour programme, it’s a fraction of the cost of most residential rehabs. Similar models have become the norm in many parts of the U.S, and have success rates that are as high, if not higher, than residential rehab.

Hartshorne says Help Me Stop’s approach is “built on solid foundations of experience and expertise in addiction, commenting that, “At Help Me Stop we know what works because all our therapists have had personal experience of addiction and recovery. We understand what saves lives. We know how to flip anger and resentment into love and compassion for self and others, to bring about a sense of purpose and inner contentment. By taking the best treatment approaches and leaving the rest, we deliver effective, high-quality treatment.”

Help Me Stop’s founders knew from their own experiences in addiction therapy that what works has, until now, been only available to the very few. And they felt that wasn’t good enough. Hartshorne said: “Thousands of addicts die every year never knowing recovery is available. If your problem is addiction we have the solution.”

The first Help Me Stop centre opens May 2019 in West London. Located in a former bank, the airy, light-filled premises are comfortable and welcoming. Having worked in high-end treatment centres all over the world, Hartshorne says he’s “Immensely proud that we’re bringing rehab to the high street. Addiction is a common problem affecting people from all walks of life – it’s about time recovery became commonplace too.”

Although more interested in people than stats, Hartshorne knows his facts and figures commenting that; “According to Eric Bowman, a lecturer in psychology and neuroscience, 22% of people who drink alcohol will become dependent. Almost everyone will know someone, or know of someone with a drink or drug problem, but do they know how and where they can get help?”

Hartshorne points out, “Alcohol and drug problems wreak devastation and destruction. They are not a problem waiting to happen. They’re here with us, right now, tearing lives and families apart.” But, he says, “Help Me Stop has a solution that works. Our Dayhab programme is recovery in the real world.”

Help Me Stop dayhab drug treatment services

Designed to fit around daily life, clients can take their 160 hours of treatment at times that fit their schedule. So, for example, clients who work or study can create a schedule where they attend during the day, early mornings, evenings or weekends. Or a parent with young children could come in during school hours, or whenever they have childcare available. It’s flexible enough the make sure everyone can find a way to make treatment part of their lives.

If you have a problem with alcohol or drugs, or you know someone who does, Help Me Stop could be just the solution to help you stop the cycle of addiction and start to live life to the full again.

The first Help Me Stop centre opens in West London in summer 2019.

Help Me Stop plans to open five centres in London and the south east of England over the next year.

020 8191 8920 • lucyc@helpmestop.org.uk • www.helpmestop.org.uk

Residential Drug Treatment from Promis

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PROMIS residential drug treatment offers intensive, expert and personally tailored therapy in unbeatable urban and rural settings.

 W:www.promis.co.uk T: 020 7581 8222

Read the full article in DDN Routes to Rehab

Promis residential drug treatment service in KentAt PROMIS residential drug treatment , the client is at the centre of everything. They receive a bespoke treatment plan that has been specifically designed to meet their needs and, whatever they’re looking for, the settings are second-to-none.

Clients can choose between the tranquility of Hay Farm, a 12-bed facility set in 12 acres of land on Kent’s breathtaking North Downs, or PROMIS London, an exclusive six-bed facility across three beautiful Kensington mews houses. Hay Farm is a haven of peace, surrounded by nature reserves and woodlands, while PROMIS London offers a quiet, elegant setting that’s still only minutes away from world-class business and leisure facilities. This makes it ideal for those clients who need treatment options that allow them to stay on top of their professional commitments.

Clients at Promis residential drug treatment in London and KentBoth of these settings create a warm, safe and serene atmosphere that’s the perfect environment for recovery and self-care. Each offers clients the ability to get away from the distractions and triggers of everyday life, and focus completely on their physical and emotional recovery. Both also provide nutritious gourmet menus that cater for any dietary requirements and are expertly made from fresh, locally sourced produce.

Unlike many facilities, one-on-one therapy is available every day, and clients also have weekly sessions with a psychiatrist throughout the length of their stay. While the residential settings are abstinence-based for substance misuse clients, there is no rigid or dogmatic approach. Staff are equally comfortable delivering SMART, 12-step or ACT-based programmes, or anything else that the client feels will benefit them from the full range of evidence-based treatments.

There’s also a relaxed, comfortable and individualised detox programme that incorporates a full medical assessment combined with proper nutrition, rest and 24-hour nursing care. Clients can be collected from anywhere in the country, and an extensive family programme is also available.

In addition to substance misuse, PROMIS residential drug treatment offers a range of proven, effective treatments for issues such as depression, anxiety, stress, burnout, eating disorders, problem gambling, pain management, relationship difficulties, OCD and other compulsive or addictive behaviours. Expert medical and psychiatric care is combined with evidence-based psychotherapeutic treatments in individual and group sessions, designed to create a fully integrated treatment programme to facilitate maximum personal growth and development. In every case, the structure, intensity and pace of treatment is tailored to the specific needs of each individual client.A room at Promis residential drug treatment Kent

The range of therapies on offer in each setting is characterised by choice and flexibility, and staff to client ratios are almost one-to-one, allowing for unparalleled levels of care and attention. In addition to trauma therapies such as EMDR and somatic work, clients can choose from CBT, dialectical behaviour therapy (DBT) and experience-based approaches such as equine-assisted psychotherapy, which allows people to interact with horses in their natural environment as a vital tool for emotional growth and development.

Treatment at PROMIS is also defined by an absence of rigid programmes that clients are expected to adhere to. The philosophy is all about working around the client’s needs, which means that people can choose to split their treatment into a series of shorter visits instead of one prolonged stay if they prefer.

Hay Farm Promis residential drug treatment service in KentThe highly experienced, multi-disciplinary staff team at PROMIS includes doctors, clinical psychiatrists, therapists, nurses and healthcare assistants. The team are specialists in dual diagnosis, allowing them to provide expert care to people struggling with both substance misuse and mental health issues, and PROMIS prides itself on a compassionate and supportive approach that is genuinely non-judgemental. As with anything, this level of quality comes at a price, and around 90 per cent of PROMIS clients will pay for their own care.

PROMIS is a family-owned business that has been operating for more than 25 years, and most admissions are the result of recommendations from previous clients or other treatment professionals.

To find out more visit promis.co.uk, email enquiries@promisclinics.com, or call 0207 582 8222 (London) or 01304 842 700 (Kent) in complete confidence, 24 hours a day.

Residential Drug Treatment from Sefton Park

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Sefton Park bases its personalised treatment on the belief that no two clients’ treatment needs are the same

W: www.seftonparkrehab.co.uk T: 01934 626371

Read the full article in DDN Routes to Rehab

Sefton Park is a residential addictions treatment centre located by the beach in the seaside town of Weston-super-Mare. This year the service is celebrating 25 years of helping people become free from addiction.

Our shared belief is that every individual has the right to care, respect, autonomy and choice, and that every individual should also have the opportunity to change the way they live. We provide that opportunity by helping the client to understand the causes of their addiction and gain more control over their lives.

Planes fly by Sefton park residential Drug treatment

Our treatment approach

As an alternative to 12-step, the treatment we provide takes a self-empowerment approach, helping the client to gain a better understanding of their underlying issues, attitudes and behaviours.

The qualified and experienced team deploy a wide range of cognitive and person-centred interventions within the caring and supportive environment of the therapeutic community. In this way, we help our clients to better understand their underlying feelings and anxieties within a person-centred ethos.

The detox facility is now in its second year and has had an excellent response and very good outcomes. We also partner with other units in the South West to provide full medically assisted detoxes.

Working with the family and significant others

We recognise that addiction is something that affects the whole family. If requested by the client we will facilitate family conferences in the interest of establishing dialogue and mutual understanding around the impact that substance misuse has on the family. This can also prove to be a good opportunity for the client and their family to consider the choices open to them for the near and more distant future. Staff encourage family visits at weekends as we understand the importance of the family unit and the support that can be provided through social visits.

Healthy living and mindfulness

We support the client in building confidence by helping them develop their potential.

We provide a ‘Discovery Day’ in a rural environment that promotes new experiences through risk taking and team building. These are outdoors activities such as falconry, rope climbing, orienteering, bushcraft and woodland cooking – lots of team-based exercises and having fun in the outdoors.

Fortnightly, our staff organise a ‘Mindfulness Day’, with the opportunity to experience a whole raft of mindfulness activities – acupuncture, meditation, poetry, music and artwork, depending on what’s available on that particular day. The client selects their own choice from the activities. It’s about relaxing, learning, experiencing new things and self-expression through art and poetry – doing things that allow people to reconnect with themselves. It’s about re-finding your inner self.

Food is a large part of recovery.

We focus on a healthy lifestyle and our kitchen team ensure that all dietary requirements and preferences are catered for. We bake our own bread each day and our clients enjoy a varied diet and healthy range of meals. We have considerable experience of supporting clients with food issues and a well-developed understanding of the support required.

Exercise is also encouraged – there are opportunities to access a local gym and the two miles of sandy beach on our doorstep create the opportunity for walks, running and bike rides. Bikes are provided!

Access to structured aftercare and supported housing

Having access to aftercare support is a very important element of the treatment journey, so aftercare services are available to all Sefton Park clients. If you’re in recovery and you’ve completed Sefton Park then our aftercare support is available for as long as it’s needed. We also offer aftercare support via Skype.

We offer support with housing via our experienced aftercare and resettlement worker and enjoy strong connections with a range of supported housing providers in the local area and across the country. Each client who completes treatment at Sefton Park will normally have access to supported housing locally.

images of sefton park residential drug treatment

A whole team approach to client care

The whole team at Sefton Park take pride in supporting each individual client in achieving a successful treatment outcome, with the client’s needs at the core of what they do. The work is intensive, and it’s very much client-centred which means it’s personalised to the needs of each client.

You can put any four clients in a room together and it will soon be obvious that they are not the same.

Each client is different and has different issues to address. Each client is on a different journey.

So, each client needs an individualised approach that recognises their differences.

www.seftonparkrehab.co.uk

Residential Drug Treatment from Equinox Care

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Equinox’s residential alcohol treatment service staff at Aspinden Wood are on a mission to make sure every resident becomes stronger, happier and healthier.

W: www.equinoxcare.org.uk T: 020 3668 9270

Read the full article in the DDN residential rehab Guide

Equinox Residential Drug Treatment Client
We empower people to determine their own recovery.

Aspinden Wood Centre (AWC) is a residential drug treatment home supporting service users with alcohol misuse. With a staff team that is committed to a harm minimisation model AWC is moving forward by recognising people’s choice to drink, while providing a safe and secure home.

Based in Bermondsey, south east London, we are a unique service in a vibrant part of London and are working hard to make our mark by delivering the best quality of care that we can. At AWC we support up to 26 men and women who are alcohol dependent and living with a range of personal care and support needs.

So what exactly is harm minimisation at AWC, and how do we get our service users to see that reducing the harm of alcohol on their life is a good thing?

We believe that there is not just one method of harm minimisation but that the success of the model here is based on a holistic approach of recovery that creates an intrinsic desire within our service users to accept help, know that things can change, and learn new associations with alcohol. Many of our service users have been through the cycle of detox and rehab several times and are disillusioned with services.

As with any workplace, Equinox residential alcohol treatment staff team experience highs and lows. Everyday working life at AWC consists of alcohol misuse support, mental health support, personal care, meal support, agony aunts, joke tellers and just about anything else that works towards enriching the lives of our service users. The friendly conversations and recovery milestones are sometimes paired with challenging behaviours and emotional distress. Although there are many positives throughout the day, alcohol is still a part of everyday life at AWC that this can make things unpredictable.

A man and a dog bonding during Equinox residential drug treatment.
Pet therapy helps clients deal with stress.

Our aim is to work with service users using an approach of person-centred care and investing in a psychologically informed environment (PIE).

PIE frameworks and methods allow us to reach our service users on a deeper level by considering their psychological backgrounds and trauma, which can shape and mould their choices today. Introducing PIE to service users definitely brought about a few sceptical laughs and puzzled looks to begin with, but eventually service users came on board.

Our newly adopted PIE scheme seeped into all areas of the service – physical changes to buildings have taken place to create open and neutral spaces, while the language during keyworking sessions has evolved to be more understanding of strong reactions to certain topics of discussion. For service users, the use of PIE has been a positive change that has been reflected in a calmer atmosphere around the service.

There are many work ethics that make the cogs turn at AWC. Patience, problem solving, team working and compromise are all day to day features on the ground here, but none can be more important than promoting motivation. Our service user group can struggle with motivation after many years street homeless or just stumbling through life, and suddenly finding the motivation for daily activities can be very difficult. This can be frustrating for a hard working team that sees so much potential in each one of the individuals that live here, but somehow a combination of commitment, passion, excellent training and ultimately a team of good people led by a focused and hardworking manager has come together to create a motivation machine.

At every hurdle there is a team here that won’t give up, and 2019 for all at AWC has been coined as The Year of Empowerment. This movement embodies the drive that staff have to see every single service user thrive and become stronger, more independent, happier and healthier than they were when they first arrived.

When we work with service users it is important to us that they feel respected in what recovery means to them. At AWC all achievements are celebrated, whether they are as big as mending broken relationships with family members to a service user taking leadership on their breakfast for the day. Working with such a marginalised group as we do at AWC means that we do not take any of the small things for granted.

Equinox Care Logo
Equinox is part of The Social Interest Group.

AWC is part of a wider group of services and teams dedicated to care and support known as The Social Interest Group. The advantages for AWC service users and staff of existing within the group is a wealth of knowledge, experience and support across the companies.

Our closest neighbours, Brook Drives in Elephant and Castle and Southampton Way in Camberwell, are a short hop away and always at the end of the phone for support and advice.

To find out more about Equinox residential drug treatment services visit our site or contact service manager Judy Howells at judy.howells@equinoxcare.org.uk

Brynawel residential drug and alcohol treatment service

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Having chosen recovery over dependency, how do you go about choosing the right rehabilitation centre? David Richards takes you through the wide range of options at Brynawel residential drug and alcohol treatment service.

W: www.brynawel.org T: 01443 226 864

Dave Richards CEO of Brynawel Drug Rehab
Dave Richards CEO of Brynawel Rehab

You might be the person making the decision or you might be a professional, a family member or friend, supporting them. Having made the vital decision to change, you are faced with a range of options, claims and counter claims as to which programme, philosophy or approach will be the most effective. So how do you choose? It’s extremely important that all options are considered before making the final decision – an individual’s choice will play a major part in determining the success of their treatment outcomes.

Some people benefit from a 12-step programme, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). While these types of programmes can be helpful to some, and have helped many, they are not for everyone – so what’s the alternative?

A secular, evidence-based, holistic approach tailored to the individual is such an alternative. At Brynawel residential drug and alcohol treatment service we believe everyone can recover given the right support. We focus on overcoming alcohol or drug dependence through the use of a wide range of therapies, including cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT), improving self-esteem and overall physical and mental health supported by daily structure, healthy diet and exercise.

Our programmes meet the needs of the individual instead of being set up as ‘one size fits all’ solutions. We emphasise personal responsibility.

Brynawel Drug and Alcohol rehab

We offer:

Detox: A medically supported withdrawal may be needed. We can help by assessing whether it can be a residential detox here, or if an inpatient detox is required. It could be necessary to substitute a weaker, less addictive substance – such as buprenorphine (Subutex) – during a transition period. We accept clients on Subutex scripts.

Psychological therapies: One-to-one and group therapy sessions can determine what led to dependency, teach new behaviours and coping strategies and can help to prevent relapse. Therapies include CBT and DBT, motivational interviewing, and for those who request it, family therapy.

Because we use only evidenced-based approaches, clients will only experience therapy with a professional who is highly experienced, qualified and registered (BACP) to help them overcome dependency effectively.

Horses at Brynawel Drug and Alcohol rehab

Dual diagnosis support: At Brynawel Rehab we understand the need to integrate mental health treatment and psychological treatment into our programmes – treating underlying mental health issues is key to achieving abstinence. Dual diagnosis is a condition that includes two co-occurring problems that may be interrelated and requires treatment for each problem – for example anxiety, depression, bipolar disorder or personality disorders, together with dependency on alcohol or drugs. DBT is a type of talking treatment based on CBT and has been adapted to help people who experience emotions very intensely. It’s mainly used to treat problems associated with borderline personality disorder (BPD), but it has also been proven effective for people who have experienced trauma.

An individualised plan: Based on assessment of a client’s recovery capital, an individualised plan can help overcome their alcohol or drug use while also addressing a range of specific needs.

Physical therapy and nutrition: People dependent on alcohol and drugs tend not to take care of themselves or eat well. The recovery process includes exercise, eating balanced meals, and learning better habits.

Alternative therapies: Mindfulness, acupuncture, tai chi, yoga, and equine therapy are all offered and can really help as relaxation techniques.

Continued support: Rehab isn’t the end of the road to recovery, just the start of it. We offer continued therapeutic support eg weekly therapy one-to-ones following completion of the Kick Start Programme, and training in SMART Recovery facilitation (Self-Management and Recovery Training, which uses evidence-based behavioural therapies).

Yoga at Brynawel Drug and Alcohol rehab

A welcoming environment: Our accommodation is single room only, with ensuite facilities including TV, and is computer and mobile phone friendly in a semi-rural setting. Our experienced staff work to design treatments to suit individual preferences and needs, as our clients deserve nothing less.

Private rooms and a small client base allow our clients to focus on their recovery.

Clear and straightforward pricing: We believe in transparency with our clients, from the very moment you consider Brynawel Rehab for treatment.

Booking an assessment is completely free of charge, helping the client’s decision-making and deepening our understanding of their needs. This is easily arranged by calling 01443 226864 or going onto our website – www.brynawel.org to take a virtual tour and contact us using contact@brynawel.org

CZAR GAZING – Finding the right balance

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As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the fifth of his series of articles he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces... Read it in DDN Magazine.

Mike Trace is CEO of Forward Trust

In last month’s article, I looked at what the sector needs to do to achieve better results with fewer resources – focusing on reducing bureaucracy and redirecting activity towards the most effective interventions. I also said that we need to do less of some things and, controversial as it may be, one of the things we need to reduce expenditure on is the clinical component of drug treatment – the cost of prescribing, purchasing and dispensing medicines.

This is not a simplistic call to prioritise abstinence and recovery. Amazingly, after 40 years of debating it, too many people in the sector still see the abstinence/harm reduction issue in binary terms – choose your side and criticise the other side. An effective system has to have a full menu of services.

Good healthcare provision for drug users is important, and the delivery of harm reduction interventions to people at risk should be at the core of any local treatment service. Substitution treatment in particular is proven effective in attracting opiate users to services, helping them to stabilise their lifestyles and reducing overdose and infection risk.

But, looked at from the perspective of changing needs and tightening finances, our focus of resources on the healthcare aspect of treatment presents two problems. The first is a mismatch between presenting needs and allocation of resources. Our treatment system has been built around the needs of daily heroin and/or cocaine users. As this cohort has aged, there are new generations presenting to services with similar patterns of use, but many more whose problems are with cannabis, novel psychoactive substances (NPS) like spice, prescription drugs, or alcohol.

In recent years, only a small proportion of people presenting to treatment are primary heroin/opiate users (in 2017/18, around 30 per cent), but substitute prescribing is the service most commonly provided (to around 50 per cent of all clients recorded on the National Drug Treatment Monitoring System that year). Of course, substitution treatment is also relevant to those using opiates as a secondary drug, but there will also be hundreds of thousands of people struggling with the use of non-opiate drugs who do not present to treatment services because they do not find what is on offer attractive.

The second problem is that of spiralling costs. The days when substitute prescribing was seen as the cheap option seem long gone. The rise in supervised consumption, the costs of the drugs themselves, the shortage of suitably qualified doctors and nurses (allied with exorbitant agency fees), and the raising of standards on governance and dispensing by the Care Quality Commission (CQC) and the National Institute for Health and Care Excellence (NICE) have led to a multi-headed inflation of costs that stretches provider resources and commissioner budgets. In some of the Forward Trust contracts (prison and community based), the cost of delivering medicines safely to clients takes up over 40 per cent of the entire service budget. I am prepared to consider that other providers are more efficient than us but, looking at the financial profiles of contracts run by others, the general picture is the same.

So, while it is important to maintain good clinical components of any local treatment system, we do have the problem that too high a proportion of the available budget is spent on them, and we have to remember that these services are not relevant to an increasing proportion of potential clients. Meanwhile, this concentration of resources pushes out any possibility of investment in other areas of provision – including other harm reduction measures – or quality improvement.

It’s not clear what we do about this, as any reduction in coverage or quality of clinical services is quickly met with challenges from CQC or commissioners, which can lead to loss of contracts. However, the sector needs to find a way out of this dilemma. We know that good quality healthcare provision attracts people into services, and can provide a good foundation for behaviour and lifestyle change, but it is not enough on its own.

All the research on substitution treatment emphasises the need for it to be allied with psychosocial/therapeutic work to be effective, and the recovery programmes and pathways that move people towards independence and reduce the burden on clinical services are still not sufficiently widespread or well funded in our system. We need to have a mutually reinforcing balance between healthcare provision and recovery pathways, but the sector does not have that balance at the moment. This inhibits our impact.

There are indeed many challenges facing the sector, but not without possible solutions. In my next piece I will try to lay out my vision of how we can create a new period of positive achievement.

Mike Trace is CEO of Forward Trust

Residential Drug Treatment from Turning Point

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How a unique partnership between Turning Point residential drug treatment services and Community Rail Cumbria is transforming the lives of service users…

Read the full article in DDN Routes to Recovery

On a cold February day a few years ago, a group of residents from Turning Point’s Stanfield House residential drug treatment service were painting an old and neglected fence at Harrington railway station in West Cumbria. A neighbour came out of her house with a tray of tea and biscuits. She asked what the group were up to and two of the residents shared that they were undergoing rehab. Painting a fence made them feel better – it gave them a sense of achievement and was their way of giving back. This was the beginning of the Railway Journey to Recovery, a partnership between Turning Point and Community Rail Cumbria.

Turning Point residential drug treatment and Cumbria Rail - Showing a train by the coastOne part of the Railway Journey to Recovery programme is the Green Road project. Running since 2017, it involves weekly visits to Green Road railway station where residents tend to the hedgerows and flowerbeds, feed the birds and maintain the station buildings. Involvement in the project has seen a profound change in the confidence and self-esteem of residents.

Alcohol and substance misuse can so often lead to isolation. As an addiction grows, people are increasingly likely to develop a lack of self-worth, retreat from society and lose ties with their families, their friends and their communities. Turning Point’s detox and rehab services recognise that a major part of recovery is breaking down the stigma of substance misuse and helping people feel good about being in the community again. Many have forged such a connection with the local landscape and community as part of their recovery that they have relocated to Cumbria after completing their treatment programme.

Weekly visits to Green Road were pivotal to Harriet’s recovery while at Stanfield House: ‘When I first entered rehab I was in a very dark and isolated place. I was very scared, and I really struggled. I was in a very controlling relationship for ten years and through my drug addiction I lost my home, I lost my job and I lost the custody of my daughter. I’d given up. I eventually asked for help through Turning Point and I’m so grateful. The actual journey to Green Road gives you time to reflect on how far you’ve come. And arriving at Green Road and seeing the work that’s put in and the dedication from everyone else is amazing. My heart belongs to Stanfield House. It always will. The journey has changed my life.’

As much as the railway connects people to the landscapes, the views, and nature, it also connects them to the community and each other. Buying a ticket, learning to understand a rail timetable, a chat with the guard or a wave from the driver, walks from one station to the next, appreciating the environment and local wildlife, alleviating anxiety in crowded places, learning new skills and reviving old ones – these all play a fundamental role in the rehabilitation process at Turning Point residential drug treatment service Stanfield House.

Turning Point residential drug treatment Stanfield HouseResidents past and present have used the train window not simply to view the passing landscapes but also as a metaphor – to frame the problems of the past, put into perspective the challenges and reality of the present, or to visualise and make real their hopes for a future free from alcohol or drugs.

At 52, Margaret entered rehab following a long history of severe domestic violence. At Stanfield House, she discovered new skills and developed a deep love of gardening, transforming an unkempt area in the gardens into a productive flower and vegetable patch, and introducing her home grown produce into weekly picnics at Green Road. Margaret is now back in her home town, alcohol free and thriving in recovery.

We welcome referrals from community drug and alcohol services and private referrals: Find out more here.
email: ResidentialDetox&Rehab@turning-point.co.uk

New strategy to tackle ‘gambling harms’

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A NEW THREE-YEAR STRATEGY TO REDUCE GAMBLING HARMS has been launched by the Gambling Commission, the government has announced. The strategy will bring together businesses, regulators, charities and health bodies to ‘work to bring a lasting impact’.

MIMs DavIes, Minister for Sport and Civil Society
‘The whole sector must come together to reduce problem gambling and the harm it does to people and their families’ MIMs DavIes

The strategy will focus on prevention, education and support – delivering ‘truly national’ treatment that ‘meets the needs of users’ – while the commission has also pledged to take a ‘firm’ regulatory enforcement approach.

Gambling advertising has long been a controversial issue, with new standards to protect children from ‘irresponsible’ adverts published by the Committee of Advertising Practice (CAP) earlier this year (DDN, March, page 4). Finding help for problem gambling, meanwhile, is still seen largely as a postcode lottery – ‘if you use substances you’re far better off in terms of access to treatment’, gambling harm consultant Owen Baily told this year’s DDN conference (DDN, March, page 16). ‘With gambling it very much depends on where you live.’

‘The Gambling Commission’s strategy reflects our clear expectation that the whole sector must come together to reduce problem gambling and the harm it does to people and their families,’ said sport and civil society minister Mims Davies. ‘Through increased research, education and treatment I want to see faster progress made in tackling this issue.’

Public Health England will also conduct a review of evidence on the public health aspects of gambling to be published next spring, looking at the ‘range and scale’ of gambling harms and the impact on health and wellbeing. ‘PHE welcomes the strategy’s commitment to taking a public health approach to gambling related harms,’ said the agency’s director of alcohol, drugs and tobacco, Rosanna O’Connor.

Strategy at www.reducinggamblingharms.org

System Failure

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Huge numbers of people accessing drug or alcohol treatment have experienced childhood sexual abuse, yet most services remain ill equipped to offer them the support they need. DDN reports.

Person holding Me Too sign
Read the full article in May 2019 DDN Magazine

‘I credit alcohol as the coping mechanism that saved my life,’ says Claire, one of the people quoted in the One in Four charity’s stark new report Numbing the pain: survivors’ voices of childhood sexual abuse and addiction (DDN, April, page 5). ‘The feelings of shame, self-disgust, dirtiness, worthlessness lead to a deep pain that only medication with alcohol can pacify,’ says Elizabeth.

Although disturbingly common, the link between childhood sexual abuse as an underlying trauma and adult substance misuse remains poorly understood, says the report. The ongoing adverse childhood experiences (ACE) study, which began 20 years ago, has identified that people who experienced four or more types of ACE – which includes sexual abuse as well as emotional and physical neglect and exposure to domestic violence – are ten times more likely to be involved in injecting drug use, seven times more likely to be alcohol-dependent and 12 times more likely to have attempted suicide. Anecdotal estimates by One in Four put the proportion of people in substance treatment who have experienced childhood sexual abuse at anything up to 70 per cent.

One significant problem, however, is that this data is not routinely collected in the UK, and the document calls for all treatment services to record anonymous adult disclosure of abuse, which could then be collated via the National Drug Treatment Monitoring System (NDTMS). Services also need to make sure that workers are trained to respond to disclosure, and that appropriate processes to support survivors are in place.

While some organisations have taken measures to equip their staff with the necessary skills to respond appropriately (DDN, 19 October 2009, page 6), they remain far from the norm. But what services really need to do be doing, the report stresses, is properly ‘making the link’ between the underlying trauma of childhood sexual abuse and adult substance issues.

The report is not the first to highlight the need for better understanding and cooperation – just over two years ago, a PHE-commissioned report on young people’s specialist substance misuse services by the Children’s Society called for better joined up working with child sexual exploitation and abuse support services, with PHE’s director of alcohol, drugs and tobacco, Rosanna O’Connor, stating that it was important to remember that young people did not ‘develop substance problems in isolation’ (DDN, February 2017, page 4).

Many survivors of childhood sexual abuse self-medicate with drugs and alcohol to ‘numb the emotional pain of this trauma’, says project consultant for the One in Four report and senior lecturer at the University of Roehampton, Christiane Sanderson. ‘We are encouraging addiction services to make the link between addiction and the underlying childhood trauma and signpost clients to specialist support, following recovery, so they can achieve post-traumatic growth in their lives.’

The document comprises 14 powerful and harrowing first-person testimonies from people who have experienced childhood sexual abuse. Their ages range from 20s to 60s, and common to them all is the use of substances. This can be to ‘feel euphoria or fill the void’, says the charity, with drugs or alcohol often providing ‘a mask to bury the secret’ of abuse, the ‘corrosive feelings of shame and self-hate associated with it, and to keep negative mental health and suicidal thoughts at bay’. The testimonies describe journeys through addiction and recovery – often after hitting ‘rock bottom’ – as well as PTSD, anxiety, depression, self-harm and repeated failures by professionals to offer appropriate help.

Many of the survivors also painfully detail the impact on their emotional lives and ability to relate to others, with fear and mistrust of intimacy leading to loneliness and isolation, and substances often becoming a substitute for relationships. Drugs and alcohol can be ‘life saving’, says the report, as for some, emotions can be so ‘unbearable and overwhelming that they are unable to manage them, or they shut down to the extent that they don’t feel anything at all’.

One in Four has developed a National Lottery-funded film for treatment services to promote awareness of the links between childhood trauma and addiction, which urges services to build links to specialist support so that when clients are ‘stable following recovery, their underlying trauma can be addressed’. A guidebook for drug and alcohol workers, GPs and others, Numbing the pain: a pocket guide for professionals supporting survivors of childhood sexual abuse and addiction will also be launched in the summer.

While the organisation acknowledges that funding remains a challenge for many services, they still need to move beyond the ‘medical model of dealing with addiction and begin to provide support for survivors holistically’ as in far too many cases they are still treating the ‘symptoms rather than the cause’, it states. Without identifying the trauma of childhood sexual abuse, it is not possible to ‘begin the process of managing the trauma symptoms’.

Childhood sexual abuse is still ‘dealt with poorly across addiction services’, says addiction consultant to the study, Chip Somers, with services under-resourced and residential rehabs ‘out of the reach’ of most people.

‘We all know the numbers are immense, yet this is an issue which still gets side-lined,’ he said at the report’s launch. ‘I don’t blame the workers – I blame the system. The workers don’t have the opportunity to engage in proper sit-down time and talk with service users. The work is not being done because people don’t have the time. And I can see those resources disappearing year-on-year.’

At the start of his 30 years in the substance field there was a ‘general attitude that you should never go near trauma and child sexual abuse in any way,’ he stated. ‘What we are saying today is the opposite – if you don’t do that work a lot of the other recovery work we are doing can easily be wasted, because we are not getting people to a place of good stability and they are much more likely to fall back into bad ways.’

It was vital to make sure that people felt safe and properly supported, he said, and it was ‘really so easy’ to make a referral. ‘If you work in a service that deals with drug and alcohol addiction, then it is your responsibility to find what’s available in your local area.’

SURVIVORS’ VOICES

Picture of One in Four Report on Sexual abuse
Report at www.oneinfour.org.uk

‘My story is difficult to hear. I don’t want to hear it myself. I don’t want it to be about me. I don’t want it to be true. Better to have no story at all than to have mine. It has taken me over 60 years to find the courage to face the truth about my childhood. Sixty years during which I have defended against the pain of that knowledge in the only way I knew how, by dissociating so completely I wasn’t really there.’ Thomas

‘I was drinking to numb myself and block it all out. The blackouts became frequent, landing me in some dangerous situations. It’s as if I had no care for myself left anymore. I felt like I died during the abuse and had nothing left to live for. I went past the point of controlling my drink and I could no longer predict where I would end up if I picked up the bottle. It was like a game of Russian roulette.’ Claire

‘When I went to drug counselling we talked about triggers, cutting down, substituting, creating healthy habits. By that time, the reason why I used had pretty much been forgotten. I used because I used. That was just my thing, my problem. I tried to talk about the sexual abuse a few times. But I could not face it. I would go to a session and yammer about my dad, anything to change the subject from how I was, the deep fear and hurt that I carried.’ Eve

‘Even in my early 20s when I went to my GP with depression and told him about the CSA [child sexual abuse] he only prescribed anti-depressants, which I used in a suicide attempt. Even then in A&E they didn’t ask why I had attempted suicide and didn’t offer me help. I asked to be hospitalised, and although they didn’t want to section me, I was not referred for help.’ Elizabeth

‘To others with the same sexual abuse history, I want to say you are not alone. Seek some help. Be kind to yourself. There is a future. You are worth fighting for. Let go and live.’ Aishya

Report at www.oneinfour.org.uk

A question of why

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Existentialism can give us a fresh angle on addressing the debilitating void that follows addiction, suggests Lana Durjava.

Read the full article in May 2019 DDN magazine

Lana Durjava picture. Who has a background in forensic psychology and works in the probation service
Lana Durjava has a background in forensic psychology and works in the probation service

Through years of interactions with compulsive drug users in a variety of different settings, I have noticed the recurring pattern of lack of direction and meaning. This has appeared to be a significant factor in both predisposing and perpetuating addictive behaviour, and is something that is not automatically eliminated when a person stops using drugs.

Purpose deficit, so to speak, frequently persists through time, and it sometimes becomes even more pronounced once drug-free life is achieved. To help people attain long-term and personally fulfilling recovery, it is advisable for practitioners to be mindful of this shortfall, to understand how it relates to excessive drug use and to possess enough practical knowledge to be able to confidently deliver effective interventions. In order to do that, useful insights can be drawn from a field that is not necessarily the first go-to within substance use treatment – that of existential philosophy.

Existentialism is a philosophy that is concerned with finding self and the meaning of life through free will, choice, and personal accountability. Its basic premise is that there is no inherent purpose in life and that each individual is responsible for finding their own meaning, making autonomous choices and aspiring towards freedom and authenticity. The topics that it focuses on are directly relevant to the symptomatology of addiction, and because of its emphasis on understanding people as free agents who are fully accountable for their lives, it can offer a fresh angle that complements biopsychosocial theories and treatment of substance use.

Bus stop with the message: You are nothing else but what you make yourself

Clients with substance use problems often present under the illusion that they are working against their will when they are using drugs. The existential perspective suggests otherwise. It argues that drug use is not random but serves a specific purpose; underlying drug use is a particular need and people are acting in accordance with their will, which aims for this need to be met. As a part of effective addiction treatment, this need has to be identified, fully explored and addressed in an alternative way.

However, that is not enough. We shouldn’t just focus on why the drugs, we must also inquire into why anything else. What motivates a person at a specific time to change their behaviour? What could carry more significance than drugs? What can provide solid ground and a sense of direction? What has the potential to offer some value to life?

Drug use is essentially a needs-driven behaviour, and underlying every addiction there is a certain lack, an emptiness, a gap that needs to be filled. This gap might have been, to varying degrees of success, replete when the person was using drugs. However, when drug use stops and once the initial post-detox honeymoon phase comes to an end, the person is faced with the original void that played a material role in setting off compulsive drug use in the first place.

Jean Cocteau once wrote down reflections on his opium using days and treatment, and I have encountered the same message, expressed with different words, on multiple occasions during my work with people with substance use problems: ‘After the cure. The worst moment, the worst danger. Health with this void and immense sadness. The doctors honestly hand you over to suicide.’

Every person is unique, and people use drugs for a variety of different reasons, but among those who progress from recreational to dependent drug use, certain patterns keep emerging. There is a recurring motif of disconnection from the world; an acute sense of feeling out of place. Reality is experienced as unsafe and unreliable to lean on, relationships are perceived as overwhelming and bewildering, and self is interpreted as overly sensitive and ill-equipped to navigate through life on its own resources.

Among other things, drugs bring relief, freedom, joy, relaxation, company, safety, focus, comfort and solace. Because they serve to compensate for the deficits in other areas in life, the relationship with them develops the structure and dynamic of a volatile love story, and practitioners need to be aware of the meaning clients attribute to drugs and the amount of hope they invest into this relationship. Meaning and hope, in combination with extreme attachment to the drug, is what makes the transition away from compulsive drug use a complicated process.

Change can, of course, be initiated by applying pressure or removing an obstacle, and recovery often begins in the context of a crisis of sufficient magnitude that it temporarily overwhelms the person’s deep-rooted aversion to stopping using drugs. However, what triggers the commencement of recovery is not necessarily sufficient for its maintenance. To keep drugs out of the equation on a consistent and long-term basis, something else will need to start to matter more than them because a satisfying life can simply not be built around emptiness.

But just as there is no one-size-fits-all in addiction treatment, the new meaning is not universal. Every person needs to find what gives their life a direction, fulfilment and purpose, and the practitioner’s role is to support this journey of discovery, not endorse a particular model of living. Clients primarily need to be encouraged to consider their life experience in light of their implications, purpose and consequences, and leading the way in the process of reflection and change must be the client’s own narrative, not the practitioner’s theoretical model or personal biases.

Addiction tends to be accompanied by a dissatisfied world view and thrives in an atmosphere of unhappiness, mistrust and isolation. It is also closely associated with a general feeling of disorientation and discomfort with existing in the world. However, while it is overall a rather unsatisfying condition, it does come hand in hand with the longing for something more, with an itch to live a different life – a life that matters.

This is a natural human condition that addiction doesn’t eradicate. It might temporarily mask it, but it doesn’t put an end to it because people have an intrinsic orientation towards a personally meaningful life. After all, human beings are just meaning-making animals. This inclination towards purpose is important to be acknowledged and utilised as a solid foundation for the process of change, self-discovery and development of a value-driven life.

Friedrich Nietzsche picture with the quote: ‘If we have our own why in life, we shall get along with almost any how.’
Friedrich Nietzsche: ‘If we have our own why in life, we shall get along with almost any how.’

Once people feel safe within their own psychological resources, once they have a better understanding of their authentic self, and once they discover things that are of personal significance to them, they will find it substantially easier to move on from drugs and invest their time and energy in activities and relationships that are purposeful, fulfilling and sustainable on a long-term basis. And while an important part of recovery consists of learning new skills and adopting alternative patterns of thinking, feeling and relating to the world, people also need a rationale for making these changes, direction as to where they want to go, and the belief that a drug-free life is worth the effort.

Essentially, when the going gets tough, people need a reason not to give up. Or to put it in words of Friedrich Nietzsche, a philosopher whose work has been fundamental to the existentialist movement: ‘If we have our own why in life, we shall get along with almost any how.’

 

DDN May 2019

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‘There is no one-size-fits all in addiction treatment… every person needs to find what gives their life a direction, fulfilment and purpose, and the practitioner’s role is to support this journey of discovery, not endorse a particular model of living.’

Many of us would agree with Lana Durjava’s words in this month’s cover story (page 6); yet according to Mike Trace (page 8), ‘too many people in the sector still see the abstinence/harm reduction issue in binary terms’. We have failed to achieve a balance between healthcare provision and recovery pathways, he argues. Is this your experience?

One certainty is the need to find effective ways to tackle chronic pain without always resorting to opiate medications (page 9). For many people these should not be the default option, yet so often they are. Sharing experiences from a recent pilot scheme, Robert Ralph suggests that with the right system in place and a fully engaged partnership model, the results can be dramatic – not just in achieving the vital pain reduction, but also in improving quality of life.

Recently we’ve been exploring the links between childhood trauma and substance misuse and this month we take a look at the distressingly common – yet poorly understood – exposure to childhood sexual abuse among people in treatment services. One thing we do know is that staff must be trained to respond to disclosure and be able to support survivors in an appropriate way. We hope you find the article helpful, and if you can add to our understanding of this vital work, please get in touch.

Read the virtual magazine or download the PDF

Claire Brown, editor

 

Celebrating 50 years of Residential Services

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This year we celebrate 50 years of life-changing work, marking this milestone offered us the opportunity to reflect on the impact that Phoenix has had on thousands of people’s lives.

We know from our founder’s Griffith Edwards publications that date as far back as 1968, the positive impact that Phoenix has been making to the lives of “otherwise lost and deprived young men,” and women over the past five decades.

Phoenix Chief Executive, Karen Biggs.
Phoenix Chief Executive, Karen Biggs.

‘We are proud of our history which has seen us grow from a single pioneering residential service to a national organisation with services in community, prisons housing and residential settings. We have adapted our approach over the years to meet the changing needs of our service users, their families and society but our message remains the same; that every person who is dependent on drugs and alcohol has the potential to rebuild their lives’

Read the report and more updates at:

www.phoenix-futures.org.uk

Residential Drug and Alcohol Treatment from Choices

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Residential Drug and Alcohol Treatment from Choices

When making the right choice matters, consider Choices Rehabs. Hannah Shead, CEO of Trevi House and Chair of Choices Rehabs, talks about how to get help when sourcing residential drug and alcohol treatment…

If you are living with the pain and chaos of addiction, either your own or that of a loved one, it can sometimes feel overwhelming.

Family members often describe the enormous feat of trying to seek help will make them feel like they are being bounced from pillar to post. Many people just don’t know where to start to find help to be drug and alcohol free. At a time when one most needs guidance and certainty, it can seem like you are wading through treacle in the dark with a blindfold on!

However, I do not want to paint a picture of doom and gloom! I frequently witness first-hand the transformational power of getting the right help at the right time. There are many amazing services out there, staffed by wonderful people. Every day all across the country clients are leaving residential care feeling positive about their future. At this very moment, as you read this, there will be a graduation ceremony taking place in a residential drug and alcohol treatment centre somewhere in the UK, celebrating the achievement of another person leaving treatment drug and alcohol free.

4 doors providing a metaphor for choices of residential drug and alcohol treatmentSo, the perhaps the question is not “is there help out there?” but instead “how do I get the help I need?”.

It is in response to this challenge, that Choices Rehabs was formed. Choices Rehabs is a collective of 15 independent rehabs who share the belief that treatment should be ethical, affordable and effective. Spanning the UK, with nearly 500 years’ experience between us, we came together over five years ago to see if we could find a way to make the process of sourcing residential treatment that little bit easier.
Over the years, we have worked on a number of projects together.

The first one of these was a website, a powerful portal to all the Choices Rehabs services. The Choices Rehabs powerful online portal is transparent, trustworthy and free and gives:

  • Detailed suggestions on how to choose a rehab
  • Comparison tables of all the services of each Choices Rehab
  • Advice for relatives (not there yet)
  • Direct access to the Choices Rehabs you want to talk to further.

Whether you are a worried family member or looking for help yourself, www.addictionrehabuk.org is the perfect place to begin your search for help. Not only will you find details about a range of different rehabs, you will find other useful information to help you navigate through this journey.

We are passionate about achieving the best possible outcomes for the individuals we support. We meet regularly to drive up best practice by sharing information and experience across our members. One of the initiatives that has emerged from this sharing of ideas and practice, is a Treatment Loop, whereby we work together to retain people in treatment. Since the loop began, we have had a number of individuals complete treatment who might otherwise have been discharged early.

We also offer our wealth of knowledge and experience to advise others on treatment issues. We are, after all, a body with a collective respected voice that can be consulted to support or give feedback to policy makers, politicians or others working in this field.

So, whether you are struggling with addiction, a family member, a commissioner, a frontline practitioner…or anyone with an interest in this sector, we believe that Choices Rehabs has something to offer.

We would encourage you to check out our website and follow us on Social Media.

https://www.addictionrehabuk.org/

Matt Wigley – Outreach Worker

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An interview with Matt Wigley – Outreach Worker at West Yorkshire Street Outreach Service

Tell us about your background

When I was younger a friend of mine was made homeless through circumstances out of his control. I think that was the first time I became aware of the societal and individual social factors that affect someone’s life and can create challenges that impact their future prospects.

I did some volunteering at a homeless shelter, then went on to study Sociology and Psychology at University. I wrote my Master’s dissertation on homelessness in Leeds, while also doing some part-time jobs working with entrenched rough sleepers. After that I was fortunate to be able to put my learning and experience to good use, joining the Leeds Street Outreach service as an outreach worker. I’ve been working at the service for 18 months now.

Read the full interview at www.changegrowlive.org

 

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DDN Diary Dates – add a listing

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Please use the form below to add details of your event, webinar, podcast or training.

DDN is a free publication self-funded though advertising and sponsorship. Full listings are for free services or promoted paid for resources. If you are listing a commercial event and would like a full description and link our promotion starts from just £99.

Please get in touch with the team who will be happy to provide you with all the options.

 

Don’t struggle alone

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There is support available to help young people cope with their emotional health in the Wakefield area.

As we head towards the Easter holidays, we think about the state of mental health amongst our young people who are deep in the midst of revision time in preparation for their exams next term. According to a new study from King’s College London, one in 13 young people in the UK have a diagnosis of post-traumatic stress disorder (PTSD) by the time they reach the age 18. 31% who had experienced trauma during their childhood were twice as likely as their peers to have a mental health issue.

graphic showing young people with PTS

Shockingly only one in three young people with PTSD had spoken to their GP in the last year about their mental health, and just one in five had seen a mental health professional. One in four were not in training, education or employment at age 18 and half experienced social isolation or loneliness. Three in four of the young people with PTSD have another mental health condition at the age of 18, half has self-harmed and one in five had attempted suicide since age 12.

 

The original article was created by Turning Point and is available here.

DDN is an independent publication funded by advertising. We are proud to work in partnership with some of the leading charities and treatment providers in the sector.

Find out more here.

Residential Drug Treatment beginning the journey

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The many options on rehab mean you can find somewhere that will suit your needs and preferences

There are many varied options for residential rehabilitation treatment (‘rehab’), throughout the UK and abroad. Some are registered charities and provide treatment, counselling and support. Others provide a complete journey from onsite detox to an aftercare stage in supported housing.

Addictions treated in these settings include drugs, alcohol, gambling, eating disorders and self-harm.

The abstinence-based programmes might follow the 12 steps of Alcoholics Anonymous, or one-to-one therapies such as cognitive behavioural therapy (CBT). Many increasingly offer options such as equine assisted psychotherapy (EAP) or creative therapies.

A placement in residential rehab can vary in length from four to 12 weeks of intensive support. Some patients receive funding through the NHS or local authorities; others fund themselves privately or through medical insurance.

————–

Personal Story

Fresh out of detox, Wayne was given three options by the drug and alcohol team who sorted out his funding. His struggle was with alcohol and he had ‘died from it twice’.

‘They gave me five days to live, it was my last chance,’ he says. ‘I tried to do it my way and couldn’t.’ He chose Kenward, as it was ‘right in the middle of nowhere, with a long walk to the shops… You’ve got a long time to think what you’re doing. When I arrived, I wanted to get back out drinking again, but I forced myself to stay there – and I’m glad I did.’

Man having been through drug and alcohol residential treatment

 

 

Read Wayne’s story ‘The Space to Grow’

 

 

 

 

Click here to read the next article in the series: Routes to Funding

Alternatively read the guide as a mobile magazine

DDN Conference 2026 Programme

By
DDN
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The DDN Conference 2026
Programme

Me, Myself... Us

Conference Timings

REGISTRATION
9.00 – 10.00

SESSION ONE
10.00 – 11.20

REFRESHMENTS
11.20 – 11.40

SESSION TWO
11.40 – 13.00

LUNCH
13.00 – 14.00

SESSION THREE
14.00 – 15.30

CLOSE
15.30

Featured Speakers Include

Return to main conference page

A space to grow

By
DDN
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We are failing to reach women, connect with them and provide a safe environment in treatment, hears DDN.

Read the full article in DDN here

Drug-related deaths among women are the highest since records began. In the decade since 2006 there was a 95 per cent increase in women dying as a result of drug misuse, meaning that 697 women lost their lives in 2016.

So what’s going wrong and where are we failing? And how can we turn this situation around? At a meeting of the Drugs, Alcohol and Justice Cross-Party Parliamentary Group, speakers were asked to give their thoughts on how we can break down barriers to improve women’s access to treatment.

‘Abuse and violence are underpinning problems,’ said Jessica Southgate, policy manager at Agenda – the Alliance for Women and Girls at Risk. In many cases women’s substance misuse was likely to be intertwined with violence, criminal justice and mental health issues and linked to hidden violence and trauma.

‘Drugs are often used as a way to numb the pain of trauma,’ she said. ‘Women often end up in abusive relationships and remain in them because of their dependencies.’

Among the population of women prisoners, it was found that 66 per cent had committed offences to buy drugs and 48 per cent had offended to support the drug use of someone else (compared to 22 per cent of men). As well as abuse and trauma, recurring themes in the lives of women facing addiction were poor socio-economic circumstances and strong feelings of stigma and shame, which could include specific cultural disapproval among BAME communities.

The many complicated reasons that women turned to substance misuse meant that getting them appropriate help could be extremely difficult.

‘Women substance misusers typically have complex needs and are often overlooked in service provision and policymaking,’ said Southgate. As well as being overlooked in mainstream services they could also find themselves in ‘intimidating spaces’, particularly if they had experienced violence in their relationships with men.

‘Service design is one of the key pieces from evidence… so often policy is made in silos.’ Jessica Southgate

Her organisation, Agenda, had partnered with AVA (Against Violence and Abuse) to produce Mapping the Maze – a project looking at the provision of services for women across the sectors of substance misuse, mental health, homelessness, offending and complex needs in England and Wales. They found that only 19 areas out of 173 in England and Wales had services that addressed all of these issues, and that most services only tackled a single issue. Many services were focused entirely on pregnant women or those with young babies, while provision for BAME women was extremely rare. There was nothing at all specifically for LGBTQI, those with disabilities, or refugees and asylum seekers.

While funding cuts and contract requirements were found to be serious obstacles to delivering good and effective services, the Mapping the Maze model was being suggested as a framework for developing effective interventions.

‘Service design is one of the key pieces from evidence,’ said Southgate, and this included making sure staff were trained to look for, recognise and understand issues relating to multiple disadvantage and the impact of trauma, particularly in terms of violence and victimisation.

Talking to women who were affected had revealed that getting the right help could be extremely difficult and could take a long time where services did not link up. Drugs were often used to numb the pain of trauma, she said, and it was important that all the appropriate support services were primed to help.

A collaborative approach with women worked best in understanding the links with substance misuse, asking their opinions and valuing the ‘lived experience’ of peer support. At the moment, women were being ‘systematically excluded’ as ‘so often policy is made in silos’, she said, when we needed to ‘put women’s voices at the heart of it’.

Having been in the sector for 20 years, Addaction’s executive director of external affairs Karen Tyrell wanted to talk about some ‘long-standing issues’.

‘I’m fed up with women’s provision just being through the lens of childbirth and childcare.’ Karen Tyrell

‘Drug and alcohol services have failed to meet the needs of women,’ she said. ‘We inadvertently create barriers.’ There was a perception that women didn’t need services as much as men, but they actually had more complex needs. ‘They are often deeply concerned about social services getting involved and taking their children away,’ she said, and ‘they often don’t have positive experience of authority figures’.

Women in Addaction’s services had nearly always experienced some kind of trauma, she explained, and it wasn’t ‘a simple relationship between childhood experiences and drug use’. Many had been abused by a partner.

Services needed to enquire carefully about individual experiences and look for trauma symptoms. ‘Our job is about taking a strength and resilience-based approach – changing it from “what’s gone wrong?” to “what’s happened to you?”,’ she said.

First impressions of treatment were important, and the experience could be negative if the first person they saw was male. Making progress also depended on understanding the level of stigma many had experienced – ‘what kind of a mother are you?’ – which tended to be very different from the attitude towards a dad who used drugs and alcohol.

‘The fear of having children taken away can’t be underestimated,’ she said, and there was much to be done in becoming trauma and gender aware. Safe spaces for women were not just ‘nice to have’ services that could be cut first – they were vital and must be protected.

‘I’m fed up with women’s provision just being through the lens of childbirth and childcare – we have got to change,’ said Tyrell. ‘We need to demand more from each other as treatment providers. There must be ways we can work together differently.’

Kim Morris, Addaction’s North Somerset Women’s Group coordinator felt that women represented ‘a section of society that we’re not reaching effectively’. She recently started a group to let women explore relationships and improve self-esteem and self-awareness, looking at trauma through the context of adverse childhood experiences (ACE). Substance misuse was ‘the red herring’ – not the root cause of problems, but an effect.

Providing a safe environment for discussion gave the opportunity to talk about all kinds of issues that could be barriers to treatment, such as fear of being judged, socially ingrained sexism, lack of faith that life could be different, and being dubious of the support that services could give them. The idea that services were ‘the enemy’ could be intensified by previous experiences with social services, particularly if children had been taken away from them.

Morris described how the group was helping women to grow in confidence and develop ‘a greater sense of honesty and behaviours’. Trainee social workers were encouraged to sit in on the group and this further contributed to helping relationships. ‘I have learned to stop blaming myself and apologising for everything,’ one group participant had commented.

There was a lot to do, said Morris – the ‘Orange Guidelines’ only mentioned women in relation to pregnancy. But there was a growing interest around the group, and although it had started small it was going well and now needed commissioners on board.

‘All services need to commit to being gender informed,’ she stated. ‘We need to ask about barriers and be open to listening about what would make a difference.’

Does your service run specific support for women? Do you have ideas on what would make a difference? Please email the editor or comment below.

Include me in

By
DDN
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The inclusive cities model is a forward thinking-approach to boosting people’s recovery in the communities where they live, say Professor David Best, Professor Charlotte Colman and Stuart Green.

Read the full article in DDN here

How does recovery happen? Research shows that people overcome addictions and recover through a combination of three factors. The first is personal factors such as maturation and personal motivation, the second is social factors like support from family and friends, and the third is community factors such as effective reintegration. This shows that recovery is not just an issue of personal motivation, but is also about acceptance – by family, friends and a range of organisations and professionals across the community.

(left to right): Stuart Green, service manager, Aspire Drug and Alcohol Service; Professor David Best, Sheffield Hallam University; Linda Nilsson, City of Gothenburg development manager; and Mulka Nisic, Recovered Users Network (RUN).

In the beginning, research and practice mainly focused on understanding personal and social factors in recovery. But today we know that what is equally, or even more, important is one’s relationship with the community – recovery doesn’t happen in a vacuum. Therefore to support pathways to recovery, structural and contextual efforts are needed to supplement individually oriented interventions and programmes.

(Re)building one’s relationship with the community is, however, a difficult journey. While the community could be central to recovery by building and strengthening bridges between members, it could also act as a barrier. People who struggle with addiction – even those in recovery – experience exclusion, stigma and discrimination, such as employers not offering them a job, landlords who discriminate against them, or neighbours who ignore them. Such a community has negative consequences for sustaining the recovery of its citizens.

It’s against this backdrop of exclusion, stigma and discrimination at a community level that the drive for ‘inclusive cities’ arises. An inclusive city promotes participation, inclusion, and full and equal citizenship to all its citizens, including those in recovery. The first purpose is to build and promote inclusive cities for people who are in recovery from illicit drug and alcohol use, while the larger aim is to challenge exclusion and stigma through a championed model of reintegration for other excluded and vulnerable populations. This can be done by channelling peer successes, and building on innovation and existing connections.

The central idea of an inclusive city is that no one should walk the recovery path alone. In an inclusive city, the city council, private and public organisations, housing providers, welfare and health centres, employers, and neighbours commit to working together with people in recovery to support them in their recovery process. By focusing on social connection, an inclusive city aims to challenge exclusion, and by doing so reduce stigmatisation.

A strong example of social cohesion is the Northern Recovery College, where collective learnt, lived and worked experience based on ‘everyone has something to give’ comes together to share experiences of individual strength-based or community assets. There are countless examples of initiatives that fit within the idea of inclusive cities – they could be small steps involving limited budgets, or more structural steps such as establishing a social enterprise model.

One of the aims of an inclusive city is to celebrate recovery and to create a safe environment supportive to recovery. After all, celebrations involve rituals, fostering social bonding and strengthening solidarity and social cohesion by bringing people together. But although we celebrate a lot of events in our lives, we don’t tend to celebrate successful recovery journeys.

One of the first steps to celebrate recovery, therefore, is to make recovery visible. Activities such as recovery marches, recovery games, recovery bike rides and recovery cafes have been an attempt to create a visibility around recovery, as well as to create a common bond and to challenge exclusion and stigmatisation. Equally important are visible and strong representations in local and mainstream media, to create a balanced view of recovery and wellbeing and demonstrate visible community benefits.

One example is high-profile clean-ups of injecting drug use litter near pharmacies, showing the value people in recovery place on where they live and helping to change public perceptions. We will attempt to collect success stories and promote innovations and exciting new initiatives through our website at http://inclusivecities.info

Another aim is to focus on peer and community support and cohesion. Setting up a recovery café – such as the Serenity Café in Edinburgh, or Nottingham’s Café Sobar – could be a way to foster this. A recovery café is a social place where people can support each other in their recovery journey. Because the café aims to promote social integration and broaden social networks, it is open to everyone – people in recovery, volunteers and the general public. Activities such as social and hobby groups, recovery-support groups and training programmes to become recovery coaches are also regularly organised.

An inclusive city also has a focus on meaningful life and social roles, such as access to meaningful jobs. A city could therefore work together with employers to foster certain skills, promote apprenticeships and create access to worthwhile employment, and inspiration for setting up such an initiative can be found in Blackpool’s Jobs, Friends and Houses project.

So, how do you become an inclusive city? It’s a process that takes time, and even small steps – mostly focusing on making recovery visible in the community by raising public awareness – are steps in the right direction.

The role of the community could include the provision of mutual aid, peer support and educational campaigns, establishing inter-sectoral partnerships to promote social inclusion, carrying out activities and setting up structures to change attitudes and reduce stigma, providing incentives for employers to employ people in recovery, and implementing anti-discrimination policy. Our initiative is an indication that there is a growing momentum that we are tapping into and bringing together from its disparate roots.

Of course, no plan for inclusive cities can have any chance of acceptance and implementation without a positive mind-set and the buy-in of key stakeholders involved in local government and local community connectors – the ‘go-to people’ who live there. So the first step is bringing together key people from organisations responsible for employment, housing and social welfare in each city to make an overview of existing practices (community asset mapping), as well as to identify current gaps.

They will also define the city’s mission, vision statement and related – short-term as well as long-term – goals and actions to support recovery, in line with the available resources and the people’s needs. People in recovery, as well as their families, will be included in defining these actions, leading to services being tailored to their needs. The second step is implementing the identified actions, while monitoring and evaluating the process.

Beginning the process of recruiting community connectors at the Recovery Cities event in Gothenburg, Sweden.

A recent recovery cities event in Sweden hosted by the City of Gothenburg began a process of recruiting community connectors, key citizens and early adopters to support this process in the local delivery of well-connected recovery communities. Inclusive cities was also presented at a ‘recovery cities’ side event at the recent Commission on Narcotics Drugs (CND) in Austria. The event highlighted the advantages of joint cooperation and partnerships, with the CND seeing more than 2,400 participants from 140 countries.

By building a learning set of cities across Europe, the idea of inclusive cities can be implemented and tested in practice. When several cities engage with the idea of inclusive cities, ingredients and – hopefully – good practices to improve social justice and community engagement can be shared.

The full published paper is available at: https://www.tandfonline.com/doi/full/10.1080/16066359.2018.1520223

Ted Talk at https://www.youtube.com/watch?v=GKTbAZCF4e0

David Best is professor of criminology at Sheffield Hallam University.
Charlotte Colman is professor in drug policy and criminal policy at Ghent University.
Stuart Green is service manager at Doncaster Aspire

 

CZAR GAZING – How do we get more for less?

By
DDN
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As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the fourth of his series of articles he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces... Read it in DDN Magazine.

Mike Trace is CEO of Forward Trust

In my last article, I offered to make some suggestions on how the drug and alcohol treatment sector can respond to the current ‘perfect storm’ of increasing demand and reducing resources. In a situation where there is insufficient political support, at central or local government, for a big increase in resources for treatment, we have to find ways of achieving better outcomes for less funding.

The first thing we need to do is get much better at focusing the available resources on delivering the outcomes that matter. This is a challenge to the commissioning and procurement system. Start by defining the desired outcomes much more clearly – the ones that matter to our clients and the community (and therefore politicians) are reductions in drug- related deaths, infections and offending; and increases in purposeful activity, secure accommodation – and family stability.

Each of these are definable and measurable but, 20 years after we established our national treatment system, these outcomes are not routinely reported on in national data systems, few commissioning decisions are based on evidence of their achievement, and few providers bother to conduct research on their achievements against them. I thought we would by now have developed a clear bank of evidence on the extent to which local treatment systems achieved these outcomes and the extent to which individual providers or models of service deliver the desired results.

Instead we have a very thin outcome evidence base, which is a real failing after billions of pounds of investment. This leads to two major problems – it undermines our ability to demonstrate value for money to politicians and taxpayers, and it leaves procurement decisions to be made more on a bidder’s ability to write good bids or manage good processes, rather than on their ability to deliver outcomes.

Secondly, we need to be much better at stimulating behaviour change among our clients, rather than just managing the impacts of continuing high-risk patterns of consumption. Of course, the first behaviour change is towards safer using and engagement with services, but we need to move quickly towards motivating clients to believe they can make changes in their drug use and wider lifestyle, then offering them support and practical help to make those changes.

When people with a history of drug/alcohol dependence are able to make these changes (what we all refer to as ‘recovery’), there are massive benefits for them, their families, and the community. There is also the benefit that pressure is relieved on the overstretched system – people in good recovery make less use of drug/alcohol services, wider health services and social services. They also cease to be a burden on the criminal justice and benefit systems.

Next, we have to be brave enough to do less of something. The demand has increased – from the diversification of drug problems (no longer just daily heroin/cocaine use) and the (perfectly sensible) addition of primary alcohol users to the system. And the resources are reducing – around 20 per cent in the last four years, with most informed opinion predicting that this trend will continue in the next few years.

So, what can we do less of? My focus would be on reducing the paperwork and bureaucracy involved in substance misuse case management – these systems have been built up over many years, and have good reasons for existing, but it cannot be right that scarce face-to-face client time is largely taken up with filling in forms and populating databases. We need to make the client/worker interaction more human again.

Linked to this, we must lose the obsession with doing a little bit with everyone and get better at focusing resources on where we can make a difference. Most services are commissioned on the basis of engaging with the maximum number of clients at minimum cost. This inevitably leads to low intensity provision for most people, when we know that most of them will need deeper help to tackle the social and psychological challenges that have brought them into services. We need to be brave enough to put less effort into those not willing to engage and more into those who are open to changing their behaviour.

Finally, we need to reposition the treatment sector in the machinery of government – with greater health and social focus, but getting back to the original aim of convincing politicians that our sector delivers true cross-sectoral benefits. More about that next month.

Mike Trace is CEO of Forward Trust

Hep C deaths down 16 per cent

By
DDN
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Deaths from hepatitis C related liver disease fell by 16 per cent between 2015 and 2017, from 380 to 319, according to the latest figures from Public Health England (PHE). While this puts England ahead of the World Health Organization’s (WHO) target of reducing deaths by 10 per cent by 2020, challenges still remain, says PHE. Around 113,000 people in England are estimated to be living with chronic hep C, with up to 79,000 of them undiagnosed.

Improved access to new treatments has also led to a fall in the number of people needing liver transplants, with a 53 per cent drop to a ten-year low of just 63. The new treatments have a cure rate of around 95 per cent, stresses PHE.

The agency used the announcement to repeat its call for anyone who has ever injected drugs – even if ‘only once’ – to get tested. Injecting drug use continues to be the most important risk factor for infection, being ‘cited as the risk in around 90 per cent of all laboratory reports where risk factors have been disclosed’. However, transmission rates among ‘recent initiates’ to injecting drug use remain relatively stable, says PHE, with infection prevalence standing at 23 per cent in 2017 compared to 20 per cent in 2011.

Dr Helen Harris: ‘A huge and very welcome step forward.’

‘The fact that more people are accessing treatment and fewer people are dying from the disease is a huge and very welcome step forward,’ said PHE senior scientist Dr Helen Harris. ‘Yet more needs to be done if we are to eliminate this disease as a major public health threat in England. Over a hundred thousand people in this country are thought to be living with this serious infection, and we know that significant numbers of them are unaware they are infected.’

It was ‘essential’ to work to find the estimated 40 to 50 per cent of people who remained undiagnosed and support them to access treatment, added Hepatitis C Trust chief executive Rachel Halford. This would ‘stop unnecessary deaths and ensure we reach elimination of hepatitis C by 2030 at the latest. Anyone who thinks they may have been at risk of transmission should get tested – The Hepatitis C Trust website hosts a simple quiz which can tell you whether you may have been at risk.’

Hepatitis C in England 2019: working to eliminate hepatitis C as a major public health threat available here

Could you have hepatitis C? at www.hepctrust.org.uk/quiz

DDN April issue

By
DDN
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DDN April 2019

‘Recovery is not just an issue of personal motivation, but is also about acceptance.’ Our cover story (page 6) examines the thought that recovery doesn’t happen in a vacuum but can thrive with community support.

How often do we focus solely on the individual – their medication, their state of mind, their ‘readiness’ to take the step to sobriety? The inclusive cities model looks at the great potential of harnessing the power of communities. It also examines the difficulties of negative community influence – the barriers created by exclusion and stigma.

The divide between those inside and outside recovery becomes even more stark when we look at our success rate with treatment for women. Drug-related death rates among women are the highest since records began, and what are we doing about it? Do we know why women aren’t accessing treatment? Do we understand the barriers that are preventing many women from seeking help? Do we take account of the fear that drives women to try to hide their personal crisis from anyone in ‘authority’?

Read our article on page 8 and consider whether service provision in your area is reaching out to women’s needs – and let us know if you have ideas to share. As the parliamentary group speakers stated very clearly, we need to do a lot more – starting with demanding more from each other as treatment providers.

  • Also with this month’s issue, you’ll find Routes to Recovery, our latest residential rehab guide. We hope you’ll find it useful when looking for the absolutely right option for your clients.

Claire Brown, editor

Read the latest issue as a mobile magazine or download the PDF

Keep in touch on our DDN Magazine Facebook page and on Twitter @DDNmagazine

Anything you’d like to say?

By
DDN
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DDN welcomes your letters!

To contribute to our letters page, please email the editor, claire@cjwellings.com

Our next deadline is Wednesday evening, 3 April.

Your comments and opinions are welcome on any aspect of DDN magazine and conference, your job, the state of the sector… anything you want to share with other readers!

You can also leave comments at the foot of articles on this website, write on DDN Magazine Facebook page, or tweet us @DDNMagazine

Aggressive marketing and changing attitudes driving increased crack use

By
DDN
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Aggressive marketing by dealers and a change in attitudes towards the drug were among the reasons for increasing levels of crack cocaine use in England, according to a new investigative report from Public Health England (PHE) and the Home Office.

Crack has become increasingly available and affordable in recent years, following a surge in cocaine production since 2013. Dealers were also selling the drug in smaller quantities, says the document, as well as offering free samples with their heroin or ‘three-for-two’-type deals, something particularly common with dealers aiming to infiltrate new markets and build a customer base.

Attitudes to crack were also changing, however. Many service users, treatment professionals and police officers interviewed for the report thought that ‘the stigma of using crack had declined in recent years’. Last year Kevin Flemen warned in a DDN cover story (right) that ‘the stigma-driven barriers between powder cocaine and crack may be breaking down’ (DDN, June 2018, page 6).

The report, which focuses on six areas in England, found that while the majority of people using crack were ‘observed to be existing heroin users’, some dealers were also ‘opening up new markets’ of younger, first-time users who were not using heroin or engaged with treatment services. There was ‘clear evidence’ of county lines activity, although this varied from area to area, with county lines groups much more likely to engage in serious violence and ‘exploit vulnerable young people and drug users’. A ‘reduced focus’ on drug dealing by the police – and fewer police on the streets – were also thought to be contributory factors, with less capacity to target dealers or people carrying drugs.

The document is published at the same time as a report from Liverpool John Moores University which found that the estimated number of people in England using opiates and/or crack had increased by 4.4 per cent between 2014-15 and 2016-17, an increase that was ‘statistically significant’. Most crack users in treatment, however, were there ‘because they’re using heroin as well, and it’s the heroin problem that brought them in’, says PHE, which meant that local treatment systems had to respond to increasing levels of unmet need.

Rosanna O’Connor: ‘local areas need to invest’. (Pic by Nigel Brunsdon)

‘This report will come as no surprise to those working on the frontline, who will have seen first-hand this surge in crack use in their communities,’ said PHE’s director for drugs, alcohol, tobacco and justice, Rosanna O’Connor. ‘Local areas, more than ever, need to continue to invest in effective drug services if we are to stop the creep of this highly addictive drug into the wider community and people’s lives being torn apart. Services need to reach out to crack users and offer more attractive and tailored support to meet their specific needs. And more needs to be done to improve the links from the criminal justice system into treatment services, for example through greater availability of arrest referral schemes and improved monitoring of drug rehabilitation requirements.’

Read Increase in crack cocaine use enquiry: summary of findings from www.gov.uk here

Read Estimates of the prevalence of opiate use and/or crack cocaine use, 2016/17: Sweep 13 report from www.ljmu.ac.uk here

DDN Magazine Partners

By
DDN
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DDN is a free independent publication that works in partnership with some of the major charities and treatment providers in the sector.

 

Our partners provide expert input into the publication to help provide the best possible up-to-date news and features from the substance misuse field.

If you are looking for a treatment service please see a list of our partner treatment organisations. Other charities and partners providing information and resources can be viewed on our useful links page.

Partner treatment providers

Please see an alphabetical list of the treatment providers who work in partnership with DDN Magazine.

 

Acorn DelphiAs part of the Syncora Group Acorn/Delphi focus on providing treatment provision as part of a recovery pathway which supports and facilitates patients to engage in genuine recovery.

 

www.delphimedical.co.uk

 

Change grow live logo

Change, Grow, Live is a national charity providing substance misuse and criminal justice intervention projects in England and Wales.

www.changegrowlive.org

The Forward Trust (formerly RAPt and Blue Sky), are a social business with charitable status that empowers people to break the cycles of crime and addiction.

www.forwardtrust.org.uk

Humankind LogoHumankind provides services and support to meet people’s complex health and social needs, helping them to build healthier lives that have meaning and value for themselves and their families. 

 

www.humankindcharity.org.uk

Phoenix Futures drug and alcohol treatmentPhoenix Futures are a charity and housing association which has been helping people overcome drug and alcohol problems for 50 years. They provide residential, prison, community and specialist services.

 

www.phoenix-futures.org.uk

Social Interest GroupThe Social Interest Group comprises Equinox Care and Penrose Options to provide services for vulnerable people to help them to thrive and grow.

 

www.socialinterestgroup.org.uk

Turning Point addiction treatmentTurning Point is a health and social care organisation that works across mental health, learning disability, substance misuse, primary care, the criminal justice system and employment.

 

www.turning-point.co.uk

We are with youWe Are With You (Formerly Addaction) is a British charity founded in 1967 that supports people to make positive behavioural changes, most notably with alcohol and drug misuse, and mental health.

www.wearewithyou.org.uk

WDP drug treatmentWDP is a drug and alcohol charity committed to helping those who are affected by substance misuse. WDP believes with the right support people can make long-lasting transformations in their lives to improve health, wellbeing and social integration.

www.wdp.org.uk

Lack of harm reduction services impeding HIV progress, warns UNAIDS

By
DDN
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Around 99 per cent of people who inject drugs live in countries that are failing to provide adequate harm reduction services, says a new report from UNAIDS.

Despite overall new HIV infections declining globally, infection rates among people who use drugs remain unchanged, says Health, rights and drugs: harm reduction, decriminalisation and zero discrimination for people who use drugs.

One in eight of the 10.6m people who inject drugs are living with HIV.

Although ensuring comprehensive harm reduction service coverage such as NSP programmes, substitute prescribing and HIV testing would ‘kick start progress’ on stopping new infections, few UN member states were living up to the 2016 agreement that came out of the UN General Assembly Special Session (UNGASS) on the World Drug Problem to establish an effective public health response (DDN, May 2016, page 4). Investment in harm reduction measures is falling ‘far short’ of what is needed for an effective HIV response, says the document – in a third of low and middle-income countries, more than 70 per cent of spending on HIV services for people who use drugs came from external donors.

More than half of the 10.6m people who inject drugs were living with hepatitis C, and one in eight were living with HIV, says the report. UNAIDS is calling for the full implementation of comprehensive harm reduction services, as well as ensuring that people who use drugs have access to prevention, testing and HIV and hepatitis medication. It also wants to see the decriminalisation of drug possession for personal use, and action to tackle drug and HIV-related stigma.

Criminalisation and ‘severe punishments’ remain commonplace despite the evidence showing that decriminalisation of personal use and possession can increase the uptake of health and treatment services, says UNAIDS. Around one in five prisoners worldwide is incarcerated for drug-related offences, of which around 80 per cent are for personal use only. Meanwhile, the death penalty for drug-related offences remains on the statute books of 35 nations.

‘UNAIDS is greatly concerned about the lack of progress for people who inject drugs, which is due to the failure of many countries to implement evidence-informed, human rights-based approaches to drug use,’ said UNAIDS executive director Michel Sidibé. ‘By putting people at the centre and ensuring that they have access to health and social services with dignity and without discrimination or criminalisation, lives can be saved and new HIV infections drastically reduced.’

Report at www.unaids.org

 

DDN Conference 2019

By
DDN
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DDN Conference Magazine Cover

Speakers at the DDN conference embraced the theme ‘Keep on Moving’. What came out very strongly was that we need to take others along with us as we move – not just peers and colleagues, but people who are not in treatment or connected to services.

Read the full reports, and view videos and presentations

Read reports and watch highlights of the opening session – Moving Forward.

Read reports and watch highlights of session two – The big Conversation.

Read reports and watch highlights of the afternoon session – Insightful stories.

 

DDN would like to say a big thank you to all the speakers, sponsors, exhibitors, and magazine partners, the volunteers from Changes UK and CGL Coventry, Nigel Brunsdon, Paolo Sedazzari, Lee Collingham, Marcus Wolf, and all the delegates and groups who made it such a fantastic event.

If you have any feedback on this year’s conference or would like to be involved in the planning consultation for next year please click here.

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End of life care for people with problematic substance use and their families

By
DDN
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A special supplement on end of life care for people with problematic substance use and their families.

End of Life Care Guide for people with problematic substance use issuesPeople with problematic substance use, and their families, deserve the same respect and dignity at the end of their lives as people without Alcohol and other drug (AOD) problems.

They deserve care that is based on their needs, care that is delivered without judgement, and care that offers them the best possible choices in the final months, weeks and days of their lives.

Unique research project at Manchester Metropolitan University explored whether or not this was the case. It sought the views of a range of people including people with experience of AOD use and end of life care needs, their families, friends and carers, and the professionals and experts who supported them.

Read this special supplement written by the expert team at Manchester Metropolitan University as a mobile publication or download the PDF

 

CZAR GAZING – What is substance misuse treatment for?

By
DDN
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As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the third of his series of articles, he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces.. Read it in DDN Magazine.

Mike Trace is CEO of Forward Trust

What is substance misuse treatment for?

In my last article, I summarised what I think have been the achievements, and failures, of the substance misuse sector over the last 20 years. One of the disappointments is that the sector has not facilitated a higher rate of recovery – helping more people to make transformational changes to the circumstances and behaviours that led them into drug and alcohol problems. The sector argues endlessly about definitions of recovery, and how best to enable people to find it, but I think we can all agree that we should be helping people to move from chaos and dependence to self-control, self-respect and independence.

The reason I started work in this sector 30 years ago was to help people who had been dealt a poor hand in life to confront the emotional and economic hardships they had endured, resolve to overcome them, and build a new life. That remains my reason for going to work. And observing the courage and determination of people going through that journey, and their joy in finding recovery, is my main job satisfaction.

So it amazes me that the sector does not focus more on this function – of inspiring and supporting transformational change. All drug and alcohol services are called recovery now – but my experience is that too much of what they do is neither inspirational nor ambitious for clients. Funding and performance management systems too often seem to encourage this focus on delivering basic care and case management processes, with not enough focus on the human factors that inspire change – organisations can win contracts to provide millions of pounds worth of services without demonstrating (or even describing) how they will help people to become independent.

The National Treatment Agency (NTA) blew its last chance to create the right incentives for a more recovery-oriented system. It created the national Key Performance Indicator around the number of people leaving treatment and not returning within a specified time. I said at the time that this is just another measure of our own processes, not of an individual’s real personal development. The aggregation of these sort of proxy indicators tells us little about a service’s real effectiveness, just the nature of its record keeping. But it is currently the main measure that is used to judge a service’s recovery credentials.

So real recovery – changes in attitudes and lifestyle – is not systematically embedded into, and incentivised within, our system. It is left to the initiative of good projects and good people (those projects that welcome, inspire, support and affirm – and fill their environment with positive, ambitious messages for clients, and role models and mentors to show what is possible). A great development in recent years has been the growth of peer-led recovery networks and communities. These are essential elements of a local treatment system, but it is shameful to see how little of the available funding goes to them, and most I speak to these days are struggling to grow.

Where this lack of vision and ambition exists, it not only misses opportunities for clients to show their potential, it creates a ‘system’ problem – if we have 270,000 people in treatment, hundreds of thousands more who should be in treatment, and around 120,000 new entrants per year, we need to have many more than the current 50,000 leaving the system per year (meaningfully leaving, not just ducking in and out) to make the numbers sustainable. In the absence of more effective move on/recovery, the treatment sector ‘bucket’ overflows and quality suffers in an overextended system.

In a context of an overall reduction in resources, this problem is acute – I will use my next article to suggest some ways out of this downward spiral.

DDN March 2019

By
DDN
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Speakers at the DDN conference embraced the theme ‘Keep on Moving’. What came out very strongly was that we need to take others along with us as we move – not just peers and colleagues, but people who are not in treatment or connected to services.

We know that many drug-related deaths are outside of treatment, and Rosanna O’Connor of PHE was among those urging us to reach out. Lord Victor Adebowale said we ‘have to work together like never before’ to reach those at the sharp end of the inverse care law (where those in need of health and social care the most tend to get it the least).

Mat Southwell made the strong point of calling on the treatment community to look beyond its doors to the active drug user networks, because ‘when you engage with us you can interact with all those people who don’t use treatment’.

Our debate session on forming a service user network acknowledged that good communication is vital if we are to get anywhere. As Radha Allen from B3 pointed out, ‘chaotic drug users aren’t represented in a lot of service user groups’. Throughout the conference we heard inspirational words and saw the best networking in action. We heard new ideas and real enthusiasm for joining up with others to form an active, diverse and representative network that ‘agrees to disagree’, in the words of Tim Sampey, and gets everybody on board.

Can we do this? We hope so at DDN, and are ready to support communications within a service user initiative. As Jacquie Johnston said, ‘everyone is hardwired for connection’ and this whole diverse community could be its own strongest asset.

Claire Brown, editor

Read the latest issue as a mobile magazine or download the PDF

This issue also contains a supplement on end of life care, produced for Manchester Metropolitan University. 

 

 

Local authorities failing to provide sufficient naloxone

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DDN
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The amounts of naloxone being provided by local councils and prisons are ‘extremely limited’, warns a new report from Release. While all but three of the 152 local authorities who responded to Freedom of Information requests now supply the overdose-reversing medication – up from 90 per cent a year ago (DDN, February 2018, page 4) – the amount being dispensed is still ‘drastically insufficient’, says Release.

Zoe Carre from Release: ‘This life-saving medication is not reaching those who most need it.’ (pic: Nigel Brunsdon)

Just 16 take-home kits were provided for every 100 people using opiates in 2017-18, equating to 16 per cent coverage, with many areas also failing to provide kits to ‘key populations most likely to experience or witness’ an overdose. Almost 60 per cent failed to provide kits to clients accessing opioid-related treatment or services at community pharmacies, a quarter did not provide them to people in contact with outreach services for homeless populations, and more than 10 per cent failed to supply them to families and friends of people who use opioids.

While Darlington was the only local authority in England that did not report either having a take-home programme or plans to introduce one, low levels of coverage elsewhere were ‘particularly shameful’ given record rates of opioid-related deaths and the fact that naloxone is ‘cheap to acquire and has no potential for misuse’, says Release.

Many prisons were also failing to provide naloxone despite the acknowledged high risk of overdose in the first two weeks after people are released, the report says. Just over half of the 109 prisons that reported on take-home naloxone had a programme in place, and only one in five young offenders institutions. Failing to provide kits to people upon release meant that prisons were not fulfilling their duty of care, the charity states.

Release is calling for each authority to provide at least one kit to every person in the community using opiates, as well as making kits available to anyone else who requests them. People not in contact with treatment should be able to easily access naloxone through distribution points like community pharmacies, GP surgeries, ambulance services and peer networks, it adds, while every adult prison should also offer kits and training to everyone prior to release on an ‘opt-out’ basis.

‘There is a crisis of drug-related deaths in this country and many local authorities are failing to protect people from fatally overdosing on opioids,’ said policy researcher at Release, Zoe Carre. ‘The amount of take-home naloxone given out nationally has been abysmally low. This life-saving medication is not reaching those who most need it. People who use drugs are an extremely stigmatised group in society, facing significant health risks which are exacerbated by the government’s ideological abstinence-focused approach to drug use. If any other group of people were needlessly facing barriers to accessing a cheap and effective life-saving medication, there would be widespread public outrage.’

Meanwhile, the number of men dying from drug-related causes in Northern Ireland has doubled in a decade, according to figures from the Northern Ireland Statistics and Research Agency (NISRA). More than 100 of the 136 drug-related deaths registered in 2017 were males, compared to 51 in 2007. Female drug-related death rates have remained unchanged.

Finding a needle in a haystack: take-home naloxone in England 2017/18 at www.release.org.uk

Drug-related deaths and deaths due to drug misuse in Northern Ireland 2007-2017 at www.nisra.gov.uk

 

CGL and Sova announce full merger

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DDN
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Change Grow Live (CGL) and its subsidiary Sova are to fully merge, the charities have announced. The merger will mean integration of the infrastructure, expertise and service delivery of both organisations to allow service users to ‘benefit from a wider range of support, seamlessly delivered under one name’.

CGL chief exec Mark Moody: ‘Fully merging will create greater stability.’

Sova supports people with multiple and complex needs, and last year reported income of almost £4m, delivering more than 40 services across England and Wales. These included mentoring for young people, families and young and adult offenders, as well as mental health services, befriending, training and employment support. From this month all services will continue to be provided under the ‘Change Grow Live’ moniker, with the intention to make the change as seamless as possible – all service users have been informed of the new arrangement.

CGL’s work includes areas such as family services, domestic violence and homelessness alongside substance misuse, with the organisation changing its name from Crime Reduction Initiatives (CRI) three years ago to more accurately reflect its wider remit (DDN, February 2017, page 11).

‘We’ve achieved a great deal under the Sova brand over the years, however this seems like the right time to work more closely with Change Grow Live,’ said Sova’s head of operational delivery, John Leach. ‘We are making this change from a position of financial strength and this is a move that makes sense for us as an organisation as part of a strategy to have a bigger impact for the people we help.’

‘Everyone should feel proud of what Sova has achieved over the last six years as an independent entity within Change Grow Live,’ added CGL chief executive Mark Moody. ‘The two organisations already work closely together and share a lot of systems and processes and, as the number of people we support increases, this feels like the right time to bring all the services together. Fully merging the two organisations will create greater stability, allow us to deliver more impact and will ultimately benefit the people who we help. It will allow us to provide a more holistic approach to our services, benefitting the people who use them, and will also mean that we can run our services as efficiently as possible and plan effectively for the future.’

Home Office gives go-ahead for pilot drug-testing scheme

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DDN
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The University of Hertfordshire working with Addaction in Weston-super-Mare

The Home Office has granted the UK’s first official licence for a drug checking service. Anyone over the age of 18 can now take a sample of their drugs to Addaction’s service in Weston-super-Mare for the contents to be tested. The service is completely anonymous, with staff available to discuss support options and offer harm reduction advice.

The pilot project will operate in partnership with the University of Hertfordshire, with additional support from drug testing service The Loop. The testing process takes around ten minutes, during which people will fill in a short questionnaire to ‘allow harm reduction advice to be tailored to their needs’.

Fiona Meesham welcomes ‘an exciting development’

Along with identifying the content of drug samples, the service will help to gain an understanding of new drug trends, identify potential sources of harm and raise alerts. The drug samples will not be returned to their owners.

‘This is an exciting development for Addaction, the Loop and for UK harm reduction generally, resulting from several years of hard work,’ said director of The Loop, Fiona Measham. ‘Three summers piloting festival testing and a year piloting city centre testing has shown that drug safety testing can identify substances of concern, productively engage with service users and reduce drug-related harm.’

Roz Gittins
Roz Gittins: ‘It’s our job to help people make informed choices about the risks.’

‘This is about saving lives,’ said Addaction’s director of pharmacy, and project lead, Roz Gittins. ‘We know people take drugs. We don’t have to condone it but nor should we judge people or bury our heads in the sand. It’s our job to do whatever we can to help people make informed choices about the risks they’re taking. Checking the content of drugs is a sensible and progressive way to do that. If people know what’s in something, they can be better informed about the potential harm of taking it.’

Welsh Government to press ahead with 50p minimum price

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DDN
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The Welsh Government has committed to introducing a 50p minimum unit price for alcohol, following the results of a public consultation. ‘Ministers remain of the view that a 50p minimum unit price is a proportionate response to tackling the health risks of excessive alcohol consumption,’ the government announced.

Vaughan Gething: minimum pricing is part of a wider strategy in Wales

The government will now ‘lay regulations’ to the National Assembly for Wales for consideration later this year, it states – the assembly has already supporting minimum pricing when the Public Health (Minimum Price for Alcohol) (Wales) Bill was passed last year (DDN, July/August 2018, page 4).

There were almost 55,000 alcohol-related hospital admissions in Wales in 2017, as well as 540 deaths.

Minimum pricing came into force in Scotland last May following years of legal battles, while more than 100 MPs, health bodies and charities signed an open letter to the Sunday Times last year calling for it to be introduced in England ‘immediately’ (DDN, February 2018, page 5).

‘The Welsh Government has always said that minimum pricing forms part of a wider strategy and approach to reducing substance misuse,’ said health minister, Vaughan Gething. ‘Following a public consultation, I’m pleased to confirm we will now ask the National Assembly for Wales to approve a 50p minimum unit price. We believe a 50p minimum unit price strikes a reasonable balance between the anticipated public health and social benefits and intervention in the market. We will continue to use all available levers to reduce the harms caused by the excessive consumption of alcohol, as we develop and take forward a new delivery plan for substance misuse.’

The late Paul Flynn MP – an early advocate of drug law reform

Meanwhile, veteran Welsh MP Paul Flynn has died, aged 84. The Newport West MP was an early and vocal advocate of drug law reform – including around medicinal cannabis – and as chair of the All Party Parliamentary Group (APPG) for Prescribed Drug Dependence led the call for Public Health England to establish a helpline for people struggling with issues around prescription drugs (DDN, April 2017, page 4).

An early day motion he tabled on the Psychoactive Substances Bill stated that, ‘This House regrets the depth of scientific illiteracy’ in the document (DDN, February 2016, page 4) while he told DDN that the 2010 Drug Strategy was ‘exactly the same as every other drug strategy – self-admiring, futile and the product of the cowardice and stupidity of politicians,’ (DDN, June 2011, page 21). ‘The adjective that has been used about me over the years is “controversial”, which means that everyone agrees with every word you say years after you say it,’ he added. ‘It’s just a question of being patient.’

Tougher rules to protect children from gambling ads

By
DDN
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New standards to protect children from ‘irresponsible’ gambling adverts have been published by the Committee of Advertising Practice (CAP). The new guidelines prohibit online adverts for gambling products being targeted at people ‘likely to be under 18’, along with the use of celebrities, sportspeople or others who are – or appear to be – under 25.

A 2016 report from the Gambling Commission estimated that around 9,000 children in England and Wales were ‘problem gamblers’, with 450,000 gambling every week via fruit machines, scratch cards or other means. Twice as many 11-15 year olds had gambled in the last week than had drunk alcohol, the review found, with three quarters reporting seeing gambling ads on TV.

The new standards, which come into force in April, include a list of unacceptable content that includes licensed characters from films or TV, certain types of animated characters such as cartoon animals, references to youth culture, and use of sportspeople and celebrities ‘likely to be of particular appeal to children’.

‘More freedom for gambling operators to market their products has gone hand-in-hand with huge growth of digital gambling platforms,’ says the report. ‘Online gambling is now readily accessible through smartphones and other internet-connected devices. Developments in social media have given rise to new marketing channels through which operators seek to engage more directly with consumers.’

Games that feature elements of simulated gambling are also not to be used to promote ‘real money’ gambling products, and gambling companies also need to avoid placing their adverts on web pages likely to appeal to under-18s, such as the parts of football club websites aimed at younger supporters. They must also ‘use all the tools available to them’ to prevent targeting young people on social network platforms, including information around browsing behaviour and users’ interests.

‘Playing at the margins of regulatory compliance is a gamble at the best of times, but for gambling advertisers it’s particularly ill-advised, especially when the welfare of children is at stake,’ said CAP director Shahriar Coupal. ‘Our new standards respond to the latest evidence and lessons from ASA rulings, and require that greater care is taken in the placement and content of gambling ads to ensure they are not inadvertently targeted at under 18s.’

Protecting children and young people – gambling guidance here and at www.asa.org.uk

This year’s DDN conference includes a dedicated session on gambling addiction and treatment. Book here

Government announces drugs and violence review

By
DDN
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The government has appointed Professor Dame Carol Black to lead a wide-ranging review into ‘the ways in which drugs are fuelling serious violence’. Professor Black previously led the government’s review looking at whether people with drug or alcohol problems should be made to undergo treatment in order to claim benefits (DDN, September 2015, page 4).

Professor Dame Carol Black: bringing ‘a wealth of experience’ to the role

The ‘changing drugs market’ has been identified by the government’s serious violence strategy as a key driver of the recent increase in violent crime, and the new review will look at ‘who drug users are, what they are taking and how often’ to build a comprehensive picture of the issue, the Home Office states. The initial findings will be reported in the summer, followed by a second phase of the review.

‘We know the sale and use of drugs is driving serious violence,’ said the home secretary, Sajid Javid. ‘This review will give us a greater understanding of the drugs market so we can make our action even more targeted. Dame Carol has a wealth of experience and I am confident that she will bring independence, integrity and a strong focus to the review.’

In a radio interview with Professor Black she stated that the Home Office had placed issues of decriminalisation and legalisation outside the scope of the review, however, an approach that Transform chief executive James Nicholls called ‘untenable’.

CZAR GAZING – So how are we doing?

By
DDN
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As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the second of his series of articles he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces... Read it in DDN Magazine.

Mike Trace is CEO of Forward Trust

In my previous article, I described the policy and financial strategy that the last Labour government used to build the national drug and alcohol treatment system we all now work within. This time, I want to take an unvarnished look at the results achieved over the last 15 years with the billions of pounds of taxpayers’ money that has been expended. Most readers will know that the picture has been mixed.

My personal view is that we have not achieved everything we set out to do because, despite political support and big investment, the system we have created is too often process driven and bureaucratic, and insufficiently human and welcoming. The evidence is stacking up that the key precondition for engagement and behaviour change is human connection (Johann Hari sums it up well), and the services that have most impact are the ones that get this right.

For too many marginalised people, their experience of services is too much form-filling and onward referral, and not enough inspiration and consistent personal support. If we want people to change and grow, we have to give them more reasons to believe that a different life is possible.

So how do we get better at facilitating real change, when the sector is under the pressure of cuts, and our clients’ lives are getting harsher? That is now the challenge we face, which I will address in my next article.

REASONS TO BE CHEERFUL

  • We have one of the most comprehensive publicly funded treatment systems in the world, with a high rate of ‘penetration’ (proportion of the population in need who are in touch with services). This major investment in care and support for some of the most vulnerable people in society is both humane and cost effective.
  • We have been successful in reducing drug-related crime, with Home Office research concluding that our treatment system was a key contributor to the reduction of overall crime rates between 2000 and 2010 (although recent trends seem to indicate that this effect is waning).
  • We have been successful in keeping drug-related HIV infections low. The UK was an early adopter of harm reduction practices such as needle exchanges in the 1980s. As a direct result, HIV transmission rates from injecting drug use have remained among the lowest in the world. (Once again, the scope and quality of harm reduction services has recently been under pressure, which may lead to an upturn in infections).

REASONS FOR CONCERN

  • We have not been able to reduce the scandalous level of drug-related overdose deaths, that remain way above European averages. There has been much discussion around the reasons for this, but the fact remains that one of the key objectives of having a well-funded treatment system was to significantly reduce the misery caused by these premature deaths, and we have not yet succeeded.
  • We have not been good at moving people through the treatment system into positions of independence and wellbeing. Apart from the missed potential for individuals, this has created a ‘system’ problem where capacity demands on services constantly increase as new clients outnumber those who move into recovery.
  • We have not sufficiently overcome the funding and delivery ‘silos’. We all know that drug/alcohol treatment clients have multiple needs, but there are not enough examples of truly integrated planning or care and, conversely, sometimes duplication of services. In particular, substance misuse and mental health services still work to separate methods and objectives, and support for children and family members is still an underfunded afterthought.

Mike Trace is CEO of Forward Trust

Alcohol-related hospital admissions up 15 per cent in ten years

By
DDN
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There were 338,000 hospital admissions in 2017-18 where the ‘main cause’ was a result of drinking alcohol, according to the latest figures from NHS Digital, a 15 per cent increase on a decade ago. People over 45 accounted for almost 70 per cent of the admissions, with more than 20 per cent of adults drinking over the government’s recommended 14 units per week.

The figures are based on a measure where alcohol-related diseases, conditions or injuries were the primary reason for admission – using the broader measure of looking at ‘a range of other conditions that could be caused by alcohol’, the numbers rise to 1.2m.

There were 5,800 ‘alcohol-specific’ deaths in 2017, up 6 per cent on the previous year and 16 per cent higher than a decade ago, with alcoholic liver disease accounting for 80 per cent of the deaths.

While those in the higher income brackets were more likely to drink above government guidelines, alcohol-specific death rates were once again highest in the most deprived areas, and – despite the rising rates of hospital admissions and deaths – the number of people in treatment for problematic drinking fell from by 6 per cent between 2016-17 and 2017-18.

‘Once again these figures demonstrate that it is the most vulnerable in our communities who are suffering because cheap alcohol is far too available,’ said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore. ‘In fact, studies suggest that there tend to be more outlets selling alcohol in poorer areas than in more affluent communities. These figures send a strong message to the government that an evidence-based approach to tackling alcohol harm is long overdue if they are truly committed to tackling health inequalities.’

The government’s forthcoming alcohol strategy ‘must’ include measures to tackle affordability, availability and promotion, he said, and should ‘start by following Scotland’s example’ of introducing a minimum unit price. ‘The measure would save lives amongst poorer groups and at the same time reduce the pressure on our over-stretched public services,’ he said.

Huge increase in ‘county lines’ activity, says NCA

By
DDN
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‘County lines’ drug dealing networks are continuing to expand with increasing exploitation of children and vulnerable adults, says a report from the National Crime Agency (NCA). The county lines model involves gangs and criminal networks moving drugs – primarily heroin and crack – into new supply areas such as smaller towns and rural areas, and using dedicated mobile phone lines to take orders.

There are now around 2,000 operative mobile lines compared to 720 in 2017-18, says NCA’s latest County lines drug supply, vulnerability and harm document, with the gangs remaining ‘highly adaptable in their operating methods and practices’. Gangs will offer free drugs in exchange for contact details of potential customers to expand their supply base, says the report, using ‘mass marketing text messages’ to advertise their product.

Children aged 15-17 – both male and female – make up the bulk of vulnerable people involved, recruited via grooming techniques ‘similar to what has been seen in child sexual exploitation and abuse’. Rather than seeing themselves as victims, the young people are often ‘flattered by the attention and gifts they receive’, making them less likely to engage with the police. However, the exploitation methods used include sexual abuse, modern slavery, and the ‘threat of violence and injury to ensure compliance’.

County lines gangs will also ‘capitalise on drug users who allow the use of their property, as well as those who introduce new customers to suppliers in exchange for drugs’, says the document. ‘These drug users may believe the arrangement to be mutually beneficial, but in many cases will be building up a debt to the offending network, which they are expected to pay back through engagement in county lines offending.’

Government, law enforcement, charities and other organisations need to work together to ‘safeguard the vulnerable’, the report stresses, with county lines activity driving a two-thirds increase in the number of minors referred as potential victims of modern slavery between 2016 and 2017 (DDN, April 2018, page 4). One week of coordinated police activity between 21 and 27 January this year saw 600 arrests, says NCA, along with more than 400 vulnerable adults and 600 children ‘engaged for safeguarding purposes’ and seizures of more than 140 weapons including guns, machetes and swords.

Nikki Holland: ‘We need to ensure that those exploited are safeguarded.’

‘We know that criminal networks use high levels of violence, exploitation and abuse to ensure compliance from the vulnerable people they employ to do the day-to-day drug supply activity,’ said NCA’s director of investigations, Nikki Holland. ‘Every organised crime group trafficking drugs is a business which relies on cash flow. County lines is no different. What we will continue to do with our law enforcement partners is disrupt their activity and take away their assets. We also need to ensure that those exploited are safeguarded and understand the consequences of their involvement. This is not something law enforcement can tackle alone – the need to work together to disrupt this activity and safeguard vulnerable victims must be the priority for everyone.’

Report at www.nationalcrimeagency.gov.uk – read the report here

Countdown to hep C eradication

By
DDN
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NHS England’s target date to eliminate hepatitis C is now just six years away. DDN hears what progress has been made, and what’s left to achieve, at the LJWG on Substance Use and Hepatitis C annual conference.

Read the full article in DDN Magazine

‘The strategy from NHS England has always been to eradicate hepatitis C,’ NHS clinical lead for hepatitis C, Dr Graham Foster, told December’s Seven years to elimination: the road to 2025 event. ‘We’ve never pulled punches – we just want to get rid of the damn thing for once and for all.’

Reductions in drug prices meant this was now achievable, he said, and the strategy had been to split the country into networks and allocate treatment numbers accordingly. ‘From the get-go we insisted on outreach treatment, and we insisted on using the cheapest drugs. The strategy is to get out there and find and treat, and we’ve been pretty successful. We’re still not testing enough, but the figures are moving up. We are working, we are curing people, the strategy is being successful.’

Testing rates in good drug services stood at around 95 per cent, while in some it was as low as 5 per cent. ‘So the challenge is to move that bottom segment into the top segment’. Treatment in prisons remained poor, meanwhile, and too many needle exchanges still weren’t offering testing. However, death rates were falling, as were waiting lists for liver transplants.

But the main challenge was that ‘too many people with a history of drug use still aren’t getting tested’, he said. ‘We need to look at the good services and follow their lead.’

‘For me it’s about supporting services to be doing this treatment themselves,’ said nurse consultant at King’s College, Janet Catt, adding that peers were fundamental to reaching marginalised populations. ‘A lot of people know they’re positive, but hep C treatment can also help them engage more with drug treatment and build goals for themselves,’ added peer support worker Chris Laker. ‘Word of mouth builds that treatment is accessible and successful. Clients really want this.’

People who inject drugs accounted for 95 per cent of all new diagnoses, consultant hepatologist at Chelsea and Westminster, Dr Suman Verma, told the conference. They were a group that tended to ‘dip in and out’ of treatment, she said, and were often of no fixed abode, with no GP and no NHS number. ‘But they do engage with needle exchanges.’

This is where a recent pilot project offering testing in pharmacies with needle exchange facilities had proved so successful (DDN, June 2018, page 5). The aim had been to develop sustainable, effective point-of-care testing and pathways into treatment, she said, adding that it was important that participating pharmacies had adequate facilities for confidential discussion and were able to refer patients with positive tests to the appropriate pathway.

‘But what do you do if you have no fixed abode?’ The answer was the pharmacies themselves acting as mailing addresses for clients so they wouldn’t miss appointment notifications, she said. In the pilot more than 50 per cent of service users were found to be antibody-positive, and 57 per cent of those tested were unaware that treatment was now interferon-free. ‘Opportunistic HCV testing in NSP community pharmacies can be really effective,’ she stated.

‘We all know that hepatitis C is a huge health inequality issue that affects some of the most marginalised,’ said London Assembly member Susan Hall. ‘So it’s a travesty that it wasn’t part of the mayor’s recent report into health inequalities. It shows what a battle we have on our hands to get people to take notice.’ There was growing momentum from more and more organisations to take action, however, but this would need a ‘huge amount’ of joined-up working across often complex networks.

In terms of the practicalities of operational delivery networks (ODNs) meeting their HCV targets, Dr Katherine Morley of the National Addiction Centre at King’s College shared the results of an evaluation project on identifying obstacles. Among the main themes that emerged were degrees of confusion over who should be meeting Public Health England (PHE) reporting requirements, as well as issues around referrals to secondary care as a result of service user drop out, often related to time lag. Missing data was also a problem, the result of providers having different electronic patient record systems – ‘an endemic problem across the NHS’.

Chair of the British Viral Hepatitis Group, Dr Andy Ustianowski, described the methods used in Greater Manchester’s HCV elimination programme, and the lessons learned. The first step was to ‘get an idea of what you’re dealing with – the numbers’, he said, and also to ‘get rid of preconceptions’. The next step was always to ‘contemplate the simplest model’ and work out how to get people to engage for minimal cost.

‘Work out what needs to be done – what’s absolutely necessary and what’s “nice”,’ he told delegates. ‘The “nice” might need to be sacrificed.’ The programme was treating around 930 people a year, he said, using community pharmacies and reaching out to treat people’s networks. ‘Before we treat them we incentivise them to bring their network up for testing.’

Also useful were interrogation of records, rapid prison diagnosis and treatment, and – just as importantly – knowing when an initiative had reached its logical conclusion and should be stopped. The programme was currently also scoping the possibility of testing in primary care and A&E settings, he added. ‘Anyone who’s got a good idea, I’m happy to shamelessly nick it.’

‘One of the things I feel in retrospect is why is it so difficult?’ said former Hepatitis C Trust chief executive Charles Gore. ‘We have these drugs, they cure people – so why does it seem such a struggle?’ In the 1990s, after his hepatitis C diagnosis, he had only been able to find one support group, he said. ‘Everybody was using heroin, and half of them were nodding out – it didn’t feel very supportive.’ He had set up the Hepatitis C Trust despite having ‘no useful experience’, as there was not a single charity for the condition. ‘It was very much on-the-job learning. But I cared about people with hepatitis C, particularly those who don’t have a voice.’

Although the charity had had to abandon its aim of only employing people with a hep C diagnosis after it proved ‘way too restrictive’, it was still driven by the belief that ‘people with lived experience are incredibly useful’, he said, with the role of peers now central to the hepatitis C response in the UK.

Awareness remained a critical issue, and not just in this country, he stated. ‘The big problem is that not enough people are diagnosed, and I’ve become a big convert to the idea of screening. There’s now screening in drug services and prisons, but we need to do more of it. And with the cost of the drugs coming down, it means you can spend more money on screening and it will still be cost effective.’

There were now discussions about long-acting injectables for the condition, he told delegates – ‘one shot and that’s all. It looks like that might be possible’, while in the past NHS England’s rationing of drugs had been ‘appalling’ (DDN, April 2017, page 20). ‘In my view that was simply because of the assumption that people with hepatitis C were a disadvantaged group, and wouldn’t complain too much.

‘I truly think this is doable, and we’re beginning to see more and more countries saying, “yes, we want to do elimination”,’ he continued. ‘We have a cure for a disease that kills people, and we don’t do it? That’s just insane.’

‘There are lots of things yet to do, there are still some challenges,’ Dr Suman Verma told the conference. ‘But we just have to keep on pushing harder.’

Read DDN’s guide, Hepatitis C and Health 

Speaker pictures by Jon Derricott. To view video footage of the event visit Jon Derricott’s YouTube channel.

 

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