‘It’s unsurprising that staff are feeling demotivated’
A commissioner said to me this week, ‘We need to know what the evidence is, see good practice, do things like the service user conference. And we need to get the right information out there – like in your magazine – so people can say “oh that’s an interesting, exciting idea”.
I had been focusing on a crisis in the sector, as we all do when faced with the unpalatable truth of worsening DRD statistics and fewer resources. But it made me think that there’s a lot of mileage in partnership working – a phrase so well used that we’re apt to ignore it.
Our cover story (page 6) shows that the glue that holds together successful partnerships is missing in many areas. The pressure of having to do much more with much less can have a damning effect on the imagination and it’s unsurprising that staff are driven into feeling defensive and demotivated. Providers obviously play a central role in turning this around – but is this possible if they’re focused on survival? If the support networks – and the hours in the day – are not there to help them work constructively with commissioners, how is this achievable?
Caroline Cole suggests responding to the challenges by borrowing from the corporate world (page 16), while Robert Mee draws on his personal experience to share how he created his support network for the LGBT+ community on page 12.
And finally, on page 10 we share resources to put this year’s Alcohol Awareness Week campaign into action.
Claire Brown, editor
Click here to view the virtual magazine or the PDF version
I am an adult child of an alcoholic. I am also an alcoholic. I stopped drinking seven years ago. A key part of my current thinking about my alcoholism is to look at the formative role played by my dad’s drinking. To do this, I have turned to the aspects of the issue covered by the National Association for Children of Alcoholics (Nacoa) and also Adult Children of Alcoholics (ACA).
While there have been a number of reports on the impact of alcohol dependence and problem drinking on parenting, this is the first to look at lower-level consumption, with the majority of those surveyed reporting drinking levels within the recommended 14 units per week.
Release is marking its 50
The lead agency in the ‘campaign against drugs’ will now be the Philippine Drug Enforcement Agency (PDEA), Duterte stated in a memorandum, with the police, armed forces and ‘ad hoc anti-drug task forces’ instructed to leave the PDEA as the sole agency in all anti-drug operations. The move has been seen by some as an attempt to soften the country’s stance in the wake of widespread condemnation.
We have seen great strides in the development of treatment for hepatitis C in recent years. Revolutionary new drugs for this life-threatening disease, which can result in cirrhosis, liver failure or liver cancer, can save people’s lives and make a real difference. But the battle has not yet been won.
The next stage in the process is to gather information from a ‘trailblazer group’ via a brief 
Even though my husband had been in recovery for nearly three years, this was my first recovery walk. I totally underestimated just how big the recovery family is.
Our five children were so proud to tell people that we are a recovery family as we walked with the thousands of people who did not judge you for your past, and stood with you united as one big family who had been through the rough times similar to us. Our kids had so much fun and even made new friends. I now know that I will be at every walk from now on!
But we like a challenge at HMP Kirkham! Changing the culture of rehabilitation and recovery is very much a passion for the staff and community within this open establishment. Recovery is evident and palpable and our success is infectious.
We have just enjoyed our first Aquarius recovery conference, celebrating how we all approach recovery in our own unique way. The idea came about as a result of discussions with peer mentors and people using Aquarius services about how they could celebrate recovery on a local level, and we worked with partners from the Derby Substance Misuse Services and Derby University Law School to bring it to life.
When the big day arrived, the conference opened with an introductory speech about the power of recovery and the vital role it plays within communities. This was followed by an ice breaker, run by Steve Gill, and a series of mini games to make people feel relaxed. Soon the conference hall was full of laughter and people were feeling more confident about sharing their stories.
The life stories came one after the other. Kate talked about her journey from teaching at schools around the world to ending up with an alcohol problem, and how joining an art group had given her confidence and made her feel useful again.
Picture an addict, what do you see? Someone white, probably working class and straight – a stereotype straight out of Trainspotting.
Under the Equality Act 2010, the CQC is legally required to set equality objectives at least every four years. In March 2017 the regulator revealed four new objectives that will have a direct impact on services.
To combat this, the CQC has taken a series of steps, including adding a specific question to Provider Information Request forms (PIR) in relation to equality, and helping inspectors to ask the right questions and gather evidence.
Drug-related deaths linked to pregabalin and gabapentin have risen 2,675 per cent and 637 per cent respectively in just six years. Addaction believes the risk of addiction and overdose related to these two prescription drugs hasn’t been made clear enough, particularly where they are prescribed to people with a history of substance misuse. Death rates have risen even more rapidly than those related to new psychoactive substances (NPS), which in the same time period show an increase of 123 per cent.
‘That’s when they took off in terms of prescriptions because a chronic pain with a neuropathic element is difficult to manage with medication,’ says Addaction pharmacist, Rachel Britton. ‘They were marketed as drugs that could reduce the need for strong opiates. GPs were encouraged to use pregabalin and gabapentin in guidance about how to manage chronic pain, where we were seeing the use of long-term, high-dose opiates.
I used drink to cope. I didn’t really fit in the corporate world but I did it for fame, glory and money – all to make me look good in the eyes of other people. After coming out of detox and rehab for the second time I decided that enough was enough and that life was actually about being the person you really are and not what you thought everyone else wanted. So the acting stopped and I started a new life.
We started in a small office in a local council ‘start-up’ enterprise hub, where we co-ordinated everything. When we first advertised the groups in some locations there would be no one there for the first month or more, until people started noticing the posters and leaflets that we’d dropped off at pharmacies and doctors surgeries.
Sometimes we want to ask a question, share an experience, get help with a tricky situation or just let off some steam. For this we really need a network of like-minded people. You might be one of the lucky ones working in a stable team that never changes, or where expert advice and supervision is readily available. Unfortunately, the rest of us are left wanting.
The site has an e-learning foundation programme, with all the necessary elements for good practice, such as assessment, harm reduction, treatment and care planning. There are even role-specific modules to enhance skills for prescribers, recovery workers and volunteers. All the content is developed by experienced workers and includes knowledge progress tests, and a certificate of completion. For those wanting more there are specific workshops and webinars you can attend, all delivered with a healthy amount of networking and socialising.
The recent demise of Lifeline calls into question the continued existence of the Film Exchange on Alcohol and Drugs (FEAD). This website (
‘The work on hidden harm is so important because it safeguards children and ensures they aren’t missed out of the recovery process,’ says Chantelle Green, Hidden Harm Worker at Insight. ‘We work with parents so they can understand the effects of their drug and alcohol use, and run age-appropriate activities with children – we aren’t here to judge, but believe in everyone’s capacity to change.’
More than 2.6m people have seen Addicted Parents, the two-part BBC documentary on Phoenix Futures’ specialist family service. James Armstrong explains the background to this powerful programme.
The documentary was the subject of articles written in The Sun, Mirror, and Evening Standard and broadcast on BBC Radio 5 Live further raising awareness of drug and alcohol misuse and the challenges of rebuilding a life and a future.
Discovering that we can’t impose our own timetable on clients is a vital lesson, says our nursing columnist Ishbel Straker.
Stopping the rise of drug-related deaths needs an innovative approach – such as paying drug users to stop using, says Neil McKeganey.
The opportunities for using contingency management, however, go far beyond the use of financial inducement by existing services. For example, we could substantially expand contingency management initiatives by redirecting around half of our current drug treatment budget towards the provision of such financial incentives to drug users themselves. Any such scheme would need to be coupled with a programme of drug testing to ensure that participants were indeed ceasing their drug use.
‘Young people get a rough ride in the media with sensationalist headlines about drug or alcohol use,’ says Addaction’s chief executive Mike Dixon. ‘It’s vital we stand up and highlight that for some young people, use of drugs or alcohol is their attempt to numb or cope with trauma or emotional distress. We can better support young people if commissioned services are trauma-informed and if professionals understand why and how y
oung people use substances.’
A panel of young people offered their thoughts including:
90 per cent of cases. Hospital admissions for liver cirrhosis have doubled over the last decade, says PHE, although there are significant variations across the regions and most of the higher rates are ‘clustered’ in the more deprived areas.
The iCAAD team are creating a vibrant and dynamic knowledge exchange – and they want you to be involved. Read on to find out how to be featured in our new column celebrating innovative ideas and practice…
that can be applied in day-to-day practice – including workshops to support practitioners with the ever-increasing demands on small businesses.
17 was an amazing year, with events in Brussels, Paris, and Rome. In February, iCAAD Brussels featured presentations on addiction, mental health and trauma and included Dr Gribomont, a world-renowned psychiatrist based in Brussels, Christophe Sauerwein, an international expert in process addiction and co-dependency, Christophe De Pauw from Action Addiction in Brussels and David Delapalme an expert psychotherapist from Paris.
In April, speakers took the stage at the Centro Congressi, Roma Eventi-Fontana di Trevi for iCAAD Rome. Among them were experts from The United Nations, The Ministry of Health, The Italian Society of Addiction Diseases, The Community of Pope San Giovanni XXIII, and homelessness charity Project Rome. The event was filled by a diverse range of national and international delegates, including professionals in the field and representatives from treatment centres such as The Kusnacht Practice (Switzerland), San Patrignano, Narcanon and Italy’s state-funded addiction and detox programme SERT.
into one space. The venue, the Royal Garden Hotel, Kensington, London, has already been rebooked by the team for next May’s event, and the team welcomes presenter applications and abstracts as well as delegate registrations.
for another innovative and forward-thinking event that iCAAD will be hosting this November. Healing And Trauma in the LGBTQ+ Community is an event supported by Resort 12. For the first time ever, London will see Beck Gee-Cohen delivering a workshop alongside the passionate and influential Adela Campbell. These two inspirational 
people will demonstrate their deep insight and expertise on both experiential models and specialist resources in trauma therapy when working with gender-complex clients. This is an essential, not-to-be missed conversation, so make sure you register now to secure your place.
Although each specific event is unique and autonomous in the way they deal with subject matter and local issues, each will work collaboratively towards iCAAD’s global goal of communication and dialogue to share best practice and solutions. And as the therapeutic field moves towards long-term recovery goals, they will be exploring the benefits of cognitive and holistic treatment methods, from healing childhood trauma to nourishing the whole self. As we all know, behavioural, mental and emotional health issues are saturating news headlines today, the world is speaking out and loud – and iCAAD is carrying the momentum forward with each one of their unique and innovative events.
iCAAD want you to share the momentum of their expanding knowledge and ideas exchange, so we’re delighted to announce the launch of a new regular feature in DDN, supported by the iCAAD team. The iCAAD knowledge hub will showcase innovative ideas and practice each month – so if you’re involved in something new or different in your area, or a creative approach to an old or difficult issue, please get in touch and we’ll feature you in this column. Email your suggestion to the 
The drinks industry is misrepresenting the evidence about alcohol-related cancer risks, according to research by the 
The growing popularity of ketamine use is not matched by knowledge within treatment services. Sara Woods went to harm reductionists Mat Southwell and Amy Massey for some clear and informed advice.
At the end of the 1980s the threat of a crack epidemic in the UK loomed large as we scrambled to take heed of dire warnings from America. Mike Ashton and Natalie Davies delve into the Findings Effectiveness Bank to separate fact from fiction.
Yesterday (31 August) marked International Overdose Awareness Day, a global event designed to spread the message that ‘the tragedy of overdose death is preventable’, as well as help reduce stigma and acknowledge the grief of the family and friends of those who’ve died.
g and Alcohol Service. ‘The event is about letting people know that recovery is alive and being nurtured in many towns across the region and the UK.’
sees people with different addictions and health conditions come together, connect and learn new skills and most importantly have fun without the need for substances.’
Many young people do not have access to substance prevention education – and for many that do, it is ineffective or even counter-productive. Prevention needs to be different for all ages and what will be effective evolves as children grow into adolescence then adulthood. It needs to be carefully planned and adapted to maximise its relevance and usefulness.
No single approach can prevent a young person experimenting with alcohol or drugs. What we need is to build upon their capabilities and potential, rather than telling them not to misuse substances or trying to scare them. What does work is empowering young people to build upon their skills, knowledge, positive attitudes and ambition to be more resilient. It is therefore critical that we understand their perspective to improve the effectiveness and impact of our work and programmes.
I have a dream…. that one day all student nurses will be made to feel welcome while on their placements… that student nurses will be nurtured and valued through their journey on hospital wards and community settings. They will arrive with a mentor already named and a timetable set, which will maximise their learning outcomes. They will be encouraged to ask questions and feel comfortable to highlight areas for improvement within services.
Scotland has once again recorded its highest ever number of drug-related deaths, at 867. The 2016 figure is 23 per cent higher than the previous year and more than double the number from a decade ago. Scotland’s drug death rate is now higher than anywhere in the EU, and roughly two and a half times higher than the UK as a whole.
The US president, Donald Trump, has instructed his administration to use ‘all appropriate emergency and other authorities’ to respond to the country’s opioid crisis. He later told reporters that the situation was a ‘national emergency’.
The situation has become particularly critical during August but limitations on supply are likely to continue until early 2018. To preserve stock for those at highest immediate risk and to maintain supply during the period of shortage, more restrictive vaccine ordering limits have been instituted by manufacturers.
I’m a 48-year-old single white British male and not only do I have HIV, but also ongoing mobility issues due to post-thrombotic damage in both my legs. I have multiple mental health issues: as well receiving help for a history of addiction I also suffer from a persecution complex, anxiety, depression and paranoia, all of which have worsened as I try to navigate through welfare reform.
Last year saw 3,744 drug poisoning deaths in England and Wales, according to the latest ONS figures – 2 per cent higher than the previous year (DDN, October 2016, page 4) and the highest number since comparable statistics began in 1993. While the figure relates to both legal and illegal drugs, almost 70 per cent were classed as drug misuse deaths.
Take-home naloxone has been made available by 90 per cent of English local authorities, according to a report from the Local Government Association (LGA). Of those, 90 per cent provide it through drug treatment services, 25 per cent via hostels and 25 per cent through outreach workers, says Naloxone survey 2017.
hat 75 per cent of users of drug services and 85 per cent of users of alcohol services were experiencing mental health problems, and 44 per cent of mental health service users either reported drug use or had used alcohol at hazardous or harmful levels in the past year (Weaver et al, 2002).
e ‘has grown to become one of the most common causes of premature death in the UK and its burden continues to escalate’, says the report, which also looks at the impact of viral hepatitis and obesity alongside alcohol misuse.
Responses to the new drug strategy
A new drug strategy was released by the Home Office on 14 July – here are some responses and we will add more as they come in. To add yours, please email the editor.
Concerned at lack of focus on harm reduction
The English Harm Reduction Group are a coalition of organisations including the National AIDS Trust, Release, Blenheim, DrugScience, International Drug Policy Consortium, SMMGP, Harm Reduction International and IDHDP.
We express great concern at the lack of focus on harm reduction in the new drug strategy. Harm reduction is an evidence-based response that protects people and ultimately saves lives – at a time when drug-related deaths are the highest on record.
People who use drugs are often vulnerable and marginalised. This new drug strategy simply does not begin to support them and reduce drug-related deaths. We call on the government to implement the recommendations of the Advisory Council on the Misuse of Drugs to tackle opiate related deaths. These include: optimal OST prescribing; easier access to naloxone; a national HAT programme; and that drug consumption rooms are implemented where there is need.
The government must also ensure a minimum level of care by requiring local authorities to provide drug treatment and harm reduction services by law.
An excellent way forward
The NHS Substance Misuse Provider Alliance welcomes the publication of the drug strategy. From our perspective this provides a balanced roadmap for the future, which can either be embraced in spirit of co-production or alternatively critiqued to the extent where a desire for the perfect gets in the way of the good.
Our approach will be to make a success of the strategy, embrace the elements we deem positive and constructively work to address the areas where further development is required.
We welcome the strong focus on the importance of partnership working that is present throughout the document. This is particularly the case where the strategy stresses the importance of working with colleagues in mental health, employment, the criminal justice system and housing. These are not necessarily new ambitions and relationships do already exist in many areas, but from our perspective they often do not function operationally or have become ineffective. As NHS providers we are used to working in partnership and look forward to reinforcing these relationships.
The emphasis and focus on a number of vulnerable groups is important. However we particularly welcome the emphasis on the increasing relevance of physical and mental health issues and how these factors can compound an already complex picture with regard to the vulnerabilities of the ageing, traditional service user population.
As service users get older, drug and alcohol treatment services need to ensure they have an appropriate, knowledgeable workforce that is able to intervene appropriately and navigate the range of services someone encountering long term conditions will encounter. Drug and alcohol treatment should not be seen as a ‘niche’. Increasingly it is important that the sector steps up as a full and engaged partner in health and social care that understands its responsibility – not only to the individual, but in positively influencing the population’s health.
We are pleased to see the strategy acknowledging the changing profile of substance use in the country and the broad spread of issues now encountered, for example addiction to medicines, CSE, Chem sex, IPEds, the place of the internet and the global nature of both the issues and solutions associated with substance use. Of particularly note is the focus on substances such as synthetic cannabinoids and the renewed commitment to address these issues. The Alliance will continue to make its contribution to this and many of the debates included in the strategy.
We are aware that this is a drug strategy, but also note the inclusion of alcohol in many places and would welcome the merging of the two in future years, particularly as that is the expectation at a commissioning, prevention and treatment level.
We note that the strategy emphasises successfully addressing substances with the goal of complete abstinence. While an ambition of supporting individuals to become free from dependence must unify all treatment providers, it is important to guard against a simplistic or narrow interpretation of this – the most fatal interpretation being a lack of acknowledgment and value placed on the reduction of substance related harm. This is particularly pertinent when considering the very troubling rise in drug-related deaths. We wholeheartedly support a sophisticated, ongoing and energetic effort to reverse this trend.
We note that the strategy talks about extended and diversified information collection and analysis. While we value the availability of high quality information and deem this essential – particularly in measuring joint outcomes with partners in employment, mental health, housing and the criminal justice system – we would caution against any increased administrative and reporting burdens.
This is particularly important when we see drug and alcohol treatment budgets consistently reducing across the country. Providers are doing their utmost to innovate, target their resources and mitigate the impact on the person who receives treatment. The success of this varies and is heavily influenced by how budget cuts are applied. It is important that we are mindful of this scenario with regards to any development or initiative, and the potential impact on frontline resources.
The strategy does not particularly discuss the role of commissioners in local areas and the central function and accountability they should have for ensuring the successful commissioning and management of treatment systems. We would welcome a stronger overview of commissioning functions, processes and decisions along with more support and resources to support them in this function.
A move towards stronger governance, as described in the strategy, with the establishment of the Drug Strategy Board and the appointment of a national recovery champion is broadly welcomed by the Alliance. Senior ministerial control is a powerful statement that will aid the provision of stability and direction for the sector.
As a representative forum of service providers, we would assert that this board needs to include the voice of providers from both the NHS and voluntary sector to support its effectiveness and relevance. This will ultimately benefit our service users but we also would hope provide stronger assurance into local decision-making. We note that this function remains within the Home Office, but are encouraged at the commitment to a cross- cutting strategic view recognising the multi-faceted nature of these issues. We are particularly encouraged by the emphasis on moving mental health and substance misuse closer together.
Broadly, we feel the new strategy, along with the newly published updated clinical guidelines, provides an excellent road map for the development of the sector over the coming years. As with any roadmap there are some paths that will need to be trodden more, and ones that have not even been mapped yet.
The test of the success of this strategy is not now though, but when we reflect on it and ask ourselves: did we as government departments, local commissioners, elected members and service providers step up for those we ultimately serve, and for the reason that this sector exists – the individuals, families and communities blighted by drugs? I hope the honest answer will be ‘yes’.
Aspirational… but leadership and detail are missing
It has been a week since the new drug strategy has been published. Rather than rush to respond we have taken the time to read, consult and agree our views before outlining our considered response to the strategy.
The emphasis placed on prevention is also to be welcomed. It is far better that we aim to prevent drug use rather than wait for it to develop and then attempt to tackle it. What is worrying is the lack of detail on how this will be achieved and what extra resources will be available to undertake this. The same could be said for the emphasis on dealing with young people, unfortunately as budgets are cut young people’s services are increasingly being commissioned as part of the wider adult services. A clear statement from the government that young people’s service should be separate and distinct and incorporate a high degree of prevention work would have been reassuring.
Where the strategy is strong is that it attempts to raise the profile of other drugs and also other marginalised groups affected by drug use. The sections on families, domestic abuse, sex workers, homeless, veterans, old users, the spread of NPS, chemsex, image and performance enhancing drugs and prescribed medication shows that the strategy is attempting to cover a wider remit and scope.
While the sections on dealing with drug users in the criminal justice system do outline a range of interventions from diversion through to sentence the greatest concern would be how much of this is achievable. Given the current state of the prison service and the problems with the CRCs is it realistic to expect any meaningful treatment to take place for those that involved in the criminal justice system and perhaps the ideas outlined are more aspirational than achievable.
It is good that the ring fence for funding for treatment services will remain till 2019 but disappointing that this isn’t for longer. It is good that the strategy highlights the risks associated with the tendering culture and reminds commissioners that there are other ways to enhance performance, quality and outcome that are more collaborative and do not require a re-tender.
I am pleased that the focus on recovery remains as I do believe that we should be encouraging, motivating, challenging and supporting people to change. A broader definition of recovery would have been useful so that stable clients on maintenance scripts aren’t excluded and measures to show reductions in medication were included. Both would have given a more nuanced overview of how treatment is working.
However the rise in drug related deaths is a major problem and the lack of detail or focus on harm reduction measures within the strategy is a worry. Harm reduction is the core of a quality drug treatment system and I would have welcomed a dedicated section outlining clear expectations on what harm reduction measures should be in place, rather than these being lost in other sections within the document.
I welcome the use of outcome data to show success and I welcome the focus on ensuring quality, it is good that the importance of high quality staff is recognised and that concerns about the residential sector have been highlighted. More detail in all these areas would have been good but it is helpful they form part of the strategy.
Overall the strategy attempts to cover a lot of ground. In doing so it doesn’t provide detail and some of the aims can be seen as unrealistic in a time of shrinking budgets and wider issues within the criminal justice system. However the establishment of a new Drug Strategy Board is welcomed in that we hope this brings a positive influence to bear on local government in protecting drug and alcohol budgets. Providers need to play a significant role on this with service users to ensure that the reality of the pressures on local authorities and providers in not diluted. Hopefully the new recovery champion appointed to the Drug Strategy Board will help with this process.
As a provider I don’t think it comprehensively addresses the core challenges of increasing treatment outcomes and reducing drug related deaths. It attempts to widen the focus of the drug policy but fails to provide the detail and leadership on how this can be achieved and therefore feels like a good, well intentioned effort but slightly disappointing.
Where’s harm reduction?
SMMGP welcomes many of the strategy’s ambitions including:
However, it is difficult to remain positive about achieving many of the strategy’s good intentions working within the reality of the sustained and ongoing cuts to the drug and alcohol sector and the public and voluntary services in general.
One of the most concerning issues for those who work in the field in recent years is the rise in drug-related deaths in the UK. While this matter is raised in the new drug strategy, there appears to be an absence of support for evidence-based approaches to address this (for example drug consumption rooms, or consideration of decriminalisation of possession or use of drugs, or how to reach people who are not in treatment through for example harm reduction initiatives).
There is also an ongoing focus on the pursuit of abstinence without mention of the essential role that harm reduction fulfils in reducing drug-related deaths. So SMMGP believes that while the Drug Strategy’s ambitions are good, it frustratingly does not provide a realistic direction for how they will be delivered.
Resources are a must
We welcome the long-awaited drug strategy, for which we have been pressing this last year. We trust that the required resources will also be forthcoming, to make the objectives outlined in the strategy a reality.
A welcome emphasis on complex needs
Turning Point welcomes the release of the new drug strategy, especially as we face changing trends in people’s drug and alcohol use. People continue to use new psychoactive substances despite criminalisation last year; there is an increasing number of people using image- and performance-enhancing drugs; and an ageing population of heroin and crack users has resulted in a dramatic increase in the number of deaths as a result of drug misuse since 2012.
We welcome the emphasis on equity of access for a range of people with differing needs and recognition of those with the most complex needs, people with a dual diagnosis – defined as someone with two or more co-existing needs – as well as wider population based interventions. We also welcome the emphasis on supporting people through peer support or recognising the centrality of housing and employment to a sustained recovery.
Mental health is a key theme throughout the strategy, recognising that mental health and substance misuse are strongly interlinked. Partnership working with other agencies is important in order to develop resilience among young people, families, homeless people, serving military personnel and veterans.
The establishment of a drug strategy board overseen by the home secretary should bring a much needed focus on drug treatment and help support local areas to ensure they are delivering safe and effective services. The focus on transparency of commissioning is also welcome and recognises the vulnerability of drugs treatment to local funding arrangements. It is essential that if basic standards of good treatment are to be maintained that there is monitoring of local spending on drug treatment.
We hope the emphasis on data collection and evidence-based support will highlight that investment in drugs services helps not only to save lives, but also to reduce the financial impact on the NHS, local authorities and the criminal justice system.
Clear call for decent housing
In the new drug strategy the government have announced their intention to appoint a national recovery champion who will report into a new drug strategy board, chaired by the home secretary and including representatives from the wider government departments. One of the important roles of the recovery champion will be to ‘seek to address stigma faced by people with drug or alcohol dependency issues’.
At Phoenix we are committed to giving people in treatment and recovery a voice. One area where people face significant stigma is in accessing decent appropriate housing that will support their recovery process. At Phoenix we know the difference housing can make to helping people keep well during and after treatment.
We are very pleased to see a clear recognition from the government in this strategy of the need for decent housing for people in recovery. The strategy says: ‘We will work with treatment providers, the homelessness sector and housing support services to identify and share best practice to support local authorities in identifying routes into appropriate accommodation for those recovering from a drug dependency.’
The new strategy sets out some important priorities for all concerned with the impact of drugs on our society. The government has made it clear that the ambitions of the strategy can only be achieved through effective partnership working. At Phoenix we are in no doubt our work helps people and their families recover from the devastating impact of substance misuse. We are glad to see the government committing to a number of critical measures that we hope will ensure everyone can get the vital help they need, when they need it, wherever they are in the country.
No mention of LGBT people
LGBT Foundation are glad to see chemsex recognised within the strategy.
For several years, we have been providing advice and support for people involved in chemsex and we have seen the importance of targeted harm reduction advice and a holistic approach to addressing drug use, sexual health and other underlying issues, such as mental ill health and internalised homophobia.
We welcome PHE taking a lead in building consensus and awareness of good practice and ensuring needs are met in all areas.
However, it is important to recognise that LGBT people overall are much more likely to use drugs, as shown by evidence in our research Part of the Picture and the Trans Mental Health Study.
Even within MSM in Greater Manchester, we have found there to be huge diversity in drug use, including higher rates of using opiates and crack (www.lgbt.foundation/news).
Therefore, it is disappointing for there to be no mentions of LGBT people in the strategy as it is vital drugs and alcohol services are proactively engaging LGBT people, and staff are equipped to provide effective and appropriate support for LGBT people.
Continued investment is vital
We welcome the new drug strategy. Since the 1990s the investment into, and delivery of treatment has increased significantly and we hope this will continue. This investment has contributed to many thousands of people receiving high quality treatment and recovering from their addictions. We have also seen huge reductions in drug related crimes and other harms.
We welcome the fact that the home secretary is to have direct involvement in overseeing the roll-out of the new strategy and will directly chair an inter-ministerial group ensuring that the aims and benefits of treatment are understood and owned across government.
We have a treatment system in the UK that is often considered to be world leading and we welcome the consistency in approach that the new strategy brings, its focus upon a system that balances the reduction in harm with long term abstinence, that focuses investment on those most at risk, that is rooted in clinical evidence of effectiveness and which also promotes those measures that we know have transformative impacts upon our service users: employment, skills and housing.
If substance misuse is going to be tackled, there needs to be cooperation between a number of government ministries and local government departments including health, justice, employment and children’s services. Drug treatment is a complex issue that requires the correct level of attention and emphasis on both recovery and harm reduction.
The renewed focus on drug-related deaths is encouraging. We have been working on a number of prevention techniques to reduce the number of drug related deaths, including identifying and predicting those people who are most at risk of overdose, and it is vital this continues.
A renewed focus upon tackling the specific problems facing our prison system and the prisoner population as a result of new patterns of drug use and supply is also to be welcomed.
Drug use affects families and communities across the country and we will be working tirelessly to promote the benefits of treatment, to reduce the unfair stigma often faced by our service users and are committed to ensuring that all agencies pool their resources and expertise to generate long term benefits.
Whilst we welcome the focus on alcohol abuse, it is disappointing to see it treated as a subset of this long-awaited drug strategy. There is a lack of concrete strategy on mental health, dual diagnosis or joining up systems to treat those who need it, as the responsibility instead falls to local authorities to agree this approach. These are all factors which can play a part in substance misuse, and how it is treated, and we would look for clear national direction to effectively tackle these issues as a whole.
Although this strategy is encouraging, it is essential that all of these proposals are supported with relevant funding and investment. Everyone should have the best chance in life, but we are only able to continue our work to support these people with adequate support and investment.
A welcome commitment to evidence
We commend the government’s commitment to evidence-based drug treatment, as well as the introduction of a national recovery champion to drive improvements in rates of recovery from drug and alcohol dependence. Our experience at the frontline of drug services in both prison and the community shows that for successful recovery to truly happen, we need more evidence-based drug treatment programmes – such as our accredited prison substance misuse programmes.
The Forward Trust (formerly RAPt) have been supporting people to build and maintain a life without drugs and alcohol for more than ten years through our Recovery Support Service. This continued care can help build the resilience and strength needed to maintain recovery from addiction and live a positive and productive life with a job, family and community. Our dedicated employment services help people to break the cycle of reoffending and addiction through training and employment activities that are grounded in the real world of work. We believe that anyone is capable of transformational change, no matter how entrenched their addiction or prolific their crimes, and we hope that this new strategy will give more people the support they need to move forward with their lives.
Focus on families
Adfam welcomes the strategy and draws attention to the following points.
Commitment to evidence: Adfam is driven by what works and therefore endorses the strategy’s commitment to evidence-based interventions, in terms of both treatment options and support for families.
Inter-relatedness of problems: For most of the families we work with the substance use of their loved one is not the only issue they face. The challenges of mental ill health, domestic abuse, offending and bereavement sadly often go hand-in-hand with problematic relationships with drugs or alcohol. We therefore welcome the strategy’s acknowledgement that ‘there are families where substance misuse is just one of a number of other complex problems’ and the driving force social inequalities play in the development of all these issues.
Support for and work with families: We welcome the strategy’s recognition of the key role families and parents can play in prevention, the inclusion of the need to support families in their own right, with the suggestion that ‘evidence-based psychological interventions which involve family members should be available locally and local areas should ensure that the support needs of families and carers affected by drug misuse are appropriately met’. The strategy’s highlighting of the efficacy of peer support in the recovery journey of both drug and alcohol users and their families resonates with the experiences of the families and practitioners we work with, and is therefore welcome.
From our experience, much of the support families value can include broader work encompassing one-to-one practitioner support based on listening, signposting and the provision of information – the structured therapeutic approaches mentioned can be expensive or impractical for voluntary and community groups to deliver.
Harms experienced by adult family members: The main focus of the strategy’s coverage of families is driven by the desire to protect the children of those parents who use drugs or alcohol problematically. This desire is laudable. However the realities of the harms experienced by the families of substance users are significantly wider: many of the people Adfam supports are adults profoundly harmed by the substance use of partners, friends and children, both under and over 18. The focus on children within policy discourse means that sometimes the needs of adult family members are overlooked; we would therefore have liked to see a wider focus in the strategy.
Resourcing: The acknowledgement in the strategy of the important role played by the voluntary sector is good to see, as are the commitments to supporting those with substance use issues and their families. Adfam joins others in the sector in noting that the long-term challenge will be ensuring there is sufficient resourcing and political will to meet those commitments.
Read the drug strategy in full here.
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