From our foreign correspondent

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May 6, 2015

In her first international column Chris Ford looks at Ireland’s lack of naloxone provision

Noticing a number from abroad, I answered my phone. Before I could even say hello, a woman who I now know as Siobhan was telling me a story about her son Gary. Just 31 years old, he had died in the family home from a heroin overdose about three months previously.

On returning from work one evening, Siobhan had called up to Gary and getting no response she went upstairs to investigate. He appeared to be asleep and was snoring. She felt so angry as they had agreed to talk that evening about possible next steps, and instead she saw that he had injected. Seeing him lying on his side she decided to leave him to ‘sleep it off’. She returned to his room in the morning to find him cold and dead. With a mixture of sadness and anger, she told me how she’d screamed uncontrollably for what had seemed like hours. She described how she’d hugged and kissed him, willing him to come around, but knowing in her heart he was long dead.

Without pausing for breath, Siobhan said that she was to blame for his death: ‘If only I’d known that he was overdosing when I found him, I could have called for help and given him naloxone.’ But could she?

Gary’s history was sadly like too many other people’s. He’d had a problem with heroin for 12 years and had been in and out of treatment in Dublin for many of those years. After a short prison sentence, which he never wanted to repeat, he had decided to leave Dublin and return home to a small community close to Galway just over a year ago. He had relapsed about ten months previously and decided he couldn’t face drug treatment again. He also knew from friends that the Galway drug treatment clinic was over-subscribed and had a long waiting list, and that even if a place became available it would be almost impossible for him to get there on the compulsory daily basis.

This is not an unusual situation in rural parts of Ireland. With limited options, Gary had decided to try on his own, but this was not working; so what next steps could be possible was going to be the subject of the talk with his mum on that fateful evening.

Siobhan stopped talking for a second and realised I was listening intently to her tragic story. I was welling up myself imagining her pain of losing a son and from such a preventable condition. We talked, cried and hugged down the phone. Siobhan has learned a lot since Gary’s death and one day soon will join the campaign to stop these preventable deaths. Although not quite ready yet, she did want Gary’s story told to try and inform the debate and help other mothers to not have this happen to them.

So what is the situation in Ireland with naloxone at the moment? It is only available in hospitals and healthcare facilities under licence, for someone who has already overdosed. That is, it is not available to patients or carers.
There are moves towards changing this with training to staff, people who inject drugs and carers and a national roll-out programme, but this is not going to happen in Galway for sometime to come. As a friend who works in Ireland said, ‘Unfortunately, like most things in Ireland, strategies tend to remain in the planning phase and as we all know too well, “planning” has never reversed the effects of a single opioid overdose.’

One of the problems seems to be that no one is taking clinical responsibility for prescribing naloxone, to be given to a person injecting drugs or a family member. Patient group directives don’t exist in Ireland. Even in big centres like Dublin, naloxone isn’t on the formulary – so individual doctors working there can’t prescribe it.

Irish drug-related deaths (DRDs) are among the highest in Europe. Lack of effective, timely treatment including naloxone is undoubtedly a factor. The drug-induced mortality rate from overdose among adults (aged 15–64) was 70.5 deaths per million in 2011, more than four times the 2012 European average of 17.1 deaths per million. (http://www.emcdda.europa.eu/publications/country-overviews/ie#drd)

Increasing the availability and accessibility of naloxone would reduce these deaths overnight. We do know that the availability of naloxone is growing in several countries. Scotland implemented a national programme in 2010, and outcomes there have demonstrated its effectiveness in reducing drug overdose deaths. Canada and Estonia have pioneered programmes on take-home naloxone. In the United States, policymakers called for greater availability and accessibility of naloxone after opioid overdose deaths more than tripled between 2000 and 2010. In some states distribution has expanded, leading to a 70 per cent decrease in overdose deaths in some areas.

Last November, guidelines from the World Health Organization (WHO) recommended increased access to naloxone for people who use opioids themselves, as well as for their families and friends. Naloxone is also included on the WHO Essential Medicines List.

The role of naloxone in addressing opioid overdose was recognised for the first time in a high-level international resolution in March 2012. Members at the UN’s 55th CND unanimously endorsed a resolution promoting evidence-based strategies to address opioid overdose. Recently, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a very useful literature review of the effectiveness of take-home naloxone.

I finish this piece with deep sadness at the unnecessary loss of so many lives, all of whom are someone’s brother, friend, mother, daughter or as Gary, son. I also feel angry that there is an easy cost-effective, evidence-based medication that could be used to immediately cut these deaths and it is only bad policy and bureaucracy that is preventing it being available to all in Ireland and many other countries.

From the early results of the IDHDP survey it appears that naloxone is available in just over half the places that have completed it, but its accessibility is limited and often only available on prescription and/or to health workers. If you haven’t already, please complete our short
Global Naloxone Survey.

Let’s change this situation now! If you don’t have naloxone available in your area, ask commissioners why they are contravening WHO’s recommendations.

Dr Chris Ford is clinical director at International doctors for healthier drug policies (IDHDP), www.idhdp.com

Media savvy

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May 5, 2015

The news and views from the national media

Substance misuse policy is, of course, a subject of passionate debate at all points on the political spectrum. While policy will always remain a highly charged issue, it is facts that should guide the commissioning of substance misuse, not politicised opinion or ill-informed conjecture.

Victor Adebowale, Guardian, 2 April

If being evidence based is not your thing and the use of medically prescribed heroin is still too radical for you, it is incumbent on you to provide an alternative. Is it another attempt at methadone or an abstinence programme based on a fervent hope and prayer that this time it will work? Given their histories of unsuccessful treatment, the evidence is overwhelming that many people will relapse quickly to using illicit heroin.

Martin T Schechter, BMJ, 14 April

I see addiction as driven by supply. Almost half the US soldiers serving in the later stages of the Vietnam war tried heroin or opium; about 20 per cent became addicted. Back home in America, most of those addicts kicked the habit because they couldn’t buy grade-A heroin from their housemaids, as they could as GIs. As a young man I was an alcoholic and the only way I could stop drinking was three years’ total immersion in Alcoholics Anonymous, to whom I owe a huge debt even though I don’t buy their disease model of addiction. Later I got into cocaine but didn’t become addicted to it – because the supply dried up. If it were legal I’d probably be a cokehead or dead by now.

Damian Thompson, Spectator, 9 April

If you are a man, it has virtually become gospel that drinking more than 21 units of alcohol a week is damaging to your health. But where did the evidence to support this well-known ‘fact’ come from?… According to Richard Smith, a former editor of the British Medical Journal, the level for safe drinking was ‘plucked out of the air’. He was on a Royal College of Physicians team that helped produce the guidelines in 1987. He told the Times newspaper that the committee’s epidemiologist had conceded that there was no data about safe limits available and that ‘it’s impossible to say what’s safe and what isn’t’. Smith said the drinking limits were ‘not based on any firm evidence at all’, but were an ‘intelligent guess’. In time, the intelligent guess becomes an undisputed fact.

Malcolm Kendrick, Independent, 6 April

Joan Hollywood – obituary

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May 5, 2015

Joan Hollywood

1941 – 2015

Joan Hollywood was a mother whose adult son died in 2008 after many years of drug and alcohol use. Unable to find support for grieving a substance-related death, Joan, with her husband Paul, founded the support organisation, Bereavement Through Addiction (BTA), in Bristol.

BTA provides a helpline, support groups and an annual memorial service for people bereaved in this way, as well as training for organisations in the field.

Already an accomplished artist and crafts person, with a long-standing concern for social justice, Joan became a tireless campaigner for people bereaved by substance use. Through BTA she developed an extensive network of bereaved people and practitioners involved with substance use deaths, drug and alcohol treatment and bereavement support. She was also The Compassionate Friends’ national contact for parents bereaved in this way.

Joan was the inspiration behind a major research project to better understand and improve support for this kind of bereavement. Based at the University of Bath, in collaboration with the University of Stirling, the project is funded by the Economic and Social Research Council from September 2012 to September 2015. Joan’s passionate commitment to the research has been crucial to the project’s design; her networks were instrumental in helping us to interview 106 bereaved people and undertake focus groups with 40 practitioners (some also bereaved).

Joan also participated in a working group of 12 practitioners tasked with developing guidelines for improving how services respond to those bereaved through substance use.

Unexpectedly, Joan suffered two strokes and died a few weeks later on 10 March. The guidelines, to be launched at the project’s final event on 23 June, will be dedicated to Joan and her passionate commitment to improve support for people who have lost a loved one to drugs and alcohol.

Christine Valentine, Lorna Templeton, Tony Walter, Richard Velleman, Linda Bauld, Jennifer McKell, Allison Ford, Gordon Hay, Bereavement Through Substance Use Project.

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Joan was graced with the rare gift of being able to transform personal pain into a flame of inspiration, which she used to bring solace to those bereaved by addiction. Equally important was the power of her conviction that this issue must be taken seriously, and she worked tirelessly with the Universities of Bath and Stirling, making a most valuable, and much-needed, contribution to the research on this, hitherto, marginalised topic. Joan has left a landmark legacy, and the inspiration ignited by her dedication is certain to carry on into the future.

Esther E Harris, independent practitioner

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Joan was part of the advisory group for the Adfam and Cruse project, supporting those bereaved through drug or alcohol use to develop and deliver peer support to others bereaved in this way. Joan was one of a small number of people who had focused on this most pressing issue and laid the groundwork for national projects such as ours. In the time she was involved in the project, her passion and dedication were highly evident – she was always willing to contribute her time to providing the vital voice of families in our work. Her contribution to the family support sector will be sadly missed, and we will do anything we can to support the work of Bereaved Through Addiction over the coming years.

Oliver Standing, on behalf of Adfam, and Fiona Turnball, on behalf of Cruse Bereavement Care

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Joan Hollywood: the world has lost one of its most gentle yet influential ambassadors for the deprived and unfortunate. Joan had a huge tenacity and resilience for pioneering and driving new areas of work that can make a difference to the lives of so many. She leaves behind the legacy of her charity BTA, and the near completion of the Bath and Stirling University Research Project for those bereaved through substance use. In death, Joan continues to inspire us all to continue to develop her work and remain connected to her memory.

Darren McEvoy, senior family practitioner DHI Bristol and committee member BTA

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As mothers, Joan and I had an immediate bond because we shared a common sorrow and heartache – the loss of our sons to addiction. Since 2009, she and her husband Paul loyally attended DrugFAM’s annual Bereaved by Addiction conference to remember their son Paul. Despite her own loss, she was a kind, supportive, understanding and sympathetic lady who always had time to listen and care for others who were experiencing that devastating loss.

We spoke many times on the phone about her desire to set up Bereavement Through Addiction, which I am proud to say she and Paul achieved. Since then she has worked tirelessly in offering support and in raising awareness of the problems faced by those dealing with the death of a loved one through addiction.

I was so pleased that I attended the Bereavement Through Addiction memorial event, which took place at St. James Priory in Bristol in November last year. As always, thanks to Joan it was a welcoming and well-supported event offering all those who have lost a loved one through addiction the opportunity to come together for a wonderful, uplifting and powerful ceremony of remembrance. Her thank you email to me read, ‘Dear Elizabeth, thank you for your contribution to the BTA memorial event on Saturday – to have Simon speak as well made it extra special. I think you are right, we should team up to hold a joint memorial in 2016/17. I will have this on the agenda for our next BTA management meeting in January. We should check out Westminster Abbey and St Pauls Cathedral and have a day out together. Thank you again. Best wishes, Joan’.

It was a privilege to sit with her on the Adfam/Cruse advisory panel. She would often ring or email me with constant positive encouraging words of support for the work DrugFAM does to support the bereaved.

I have lost a soul mate who has left a dignified and long lasting legacy through the passion for her work for the bereaved in Bristol and the South West.

Elizabeth Burton-Phillips, chief executive DrugFAM

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I remember meeting Joan for the first time over six years ago, following the death of her son Paul in 2008. What has always stayed with me was hearing her relate someone’s response to her son’s death as, ‘It must be such a relief for you’. It was this comment that brought the stigma attached to the death of a child to drugs or alcohol into such sharp relief.

The death of a child is the death of a child and the grief remains the same – regardless of the cause. Her experience with the police and coroner added to the trauma of losing her son. Joan’s need to address the stigma attached to bereavement through drug or alcohol use burned bright and led to improvements by both police and coroner’s office in how they respond to bereaved family members.

Joan and her husband Paul went on to set up a support group for others who’d also lost loved ones to drugs and alcohol, and this met regularly at Bristol Drugs Project’s (BDP) premises.

Joan’s final blow against stigma was establishing a memorial event to remember lives lost to drugs and alcohol. The first event took place in December 2010, and was both heart-breaking and uplifting in equal parts.

The names of lost loved ones were read out and then recorded permanently in a book designed by people in recovery at BDP.

Poems were shared, songs sung and a wonderful choir created space for people to remember and celebrate the lives of loved ones lost to drugs and alcohol.

In the sixth memorial event in this year we will also be able to remember and celebrate Joan’s life who, with her partner Paul, turned an experience most of us can only imagine the horror of into Bereavement Through Addiction, which supported those who were bereaved and challenged the attitude of ‘others’ to their loved ones . This is Joan’s very fine legacy.

Maggie Telfer, CEO Bristol Drugs Project

European Alcohol Conference

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May 5, 2015

Shake it up

Speakers called for a fresh look at policy and new ways to engage drinkers at the European Alcohol Conference, held at the Guildhall last month.

‘In policy terms, it’s a relatively new drug on the block,’ began Colin Drummond, consultant psychiatrist at the National Addiction Centre. He emphasised that there was a ‘policy vacuum’ where alcohol was concerned, comparing it to tobacco, which had been tackled much more successfully.

In 2012, the EU alcohol strategy had expired, and the European Commission had neither reinstated the old strategy nor brought out a new one. The House of Lords had published an EU alcohol strategy report, laying out the need for policy to be entirely independent, free from ‘vested interests’, and without influence from the industry – which ‘had no place at the table when designing policies,’ he said.

Statistics provided by the AMPHORA research project identified a huge variation of access to treatment throughout Europe, said Drummond – for instance, 23.3 per cent of problem drinkers had access in Italy, compared to 6.4 per cent in the UK – with similar variances across local authorities within the UK.

In London, for example, things were ‘beginning to get better,’ said Dr Helen Walters, head of health at the Greater London Authority (GLA). London alcohol death rates weren’t as bad as other places in the country – but alcohol-related crimes had a much higher rate.

She said that the GLA had focused on keeping alcohol on the public and government agenda. We could change how people were drinking, she said, ‘partly by changing politics, partly by changing public outlook.’

Putting alcohol policy within a cultural context, James Nicholls from Alcohol Research said that ‘there are lessons to be learned from the history of alcohol policy.’

Consumption levels had gone up and down throughout history, with the most significant recent reduction in consumption among young people – not just in the UK, but right across the board. ‘Something is happening here’ said Nicholls, ‘but we don’t know what it is.’

‘Drinking cultures aren’t static,’ he said – they have changed and changed quite quickly. Policy impacts were unpredictable, and changes occurred differently in different populations and generations.

There was a need to develop more advanced theories – policy worked within a cultural environment, and would have different effects depending on the culture around it, he said.

When thinking of new ways to engage drinkers, ‘being honest about the pleasure of drugs and alcohol is important,’ said Dr Adam Winstock, director of the Global Drugs Survey.

There were a wide variety of different relationships to alcohol across Europe, he said. The UK, for example, had the highest rate of turning up to work hungover, but also had one of the highest rates of awareness of drinking guidelines.

The countries that tended to drink more were the ones that wanted help to drink less – but were also reluctant to change their behaviour.

‘We underestimate our personal vulnerability to harm,’ said Winstock – pointing out that individuals not only enjoyed drinking, but rationalised and normalised their behaviour when it suited them, so they were more likely to accept the harms of drinking and drug taking.

The UK had the highest rate of ‘normative misconception’ in the world, with most people with alcohol dependence going undiagnosed – people didn’t know they were alcoholics.

We needed a different way to engage people, he said. The idea of stopping completely was difficult to understand, whereas simply reducing the amount consumed was more palatable. ‘We need to start a dialogue with people who drink so they just drink a little bit less,’ he said.

Treatment challenges of novel psychoactive substances

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May 5, 2015

Novel ideas

Dima Abdulrahim talks about meeting the treatment challenges of novel psychoactive substances

When it comes to managing substance misuse, there is an existing – and substantial – body of research evidence, as well as a number of clinical guidelines. Can we apply this guidance to club drugs and novel psychoactive substances (NPS)? To a large extent, we can, and should. The principles underpinning treatment are the same. Good practice is transferable.

However, it would also be wrong to ignore the particular challenges posed by club drugs and NPS, and the need to address them specifically. It is also widely acknowledged that professionals require support to improve their knowledge and confidence in the assessment and management of the acute and chronic harms resulting from the use of these substances.

With generous support from the Health Foundation, project NEPTUNE has responded to the gap in knowledge and addressed the challenges of club drugs and NPS by developing guidance based on the best available evidence and clinical consensus.

The challenges include those resulting from the drugs themselves: what are they and how do they work? There is a rapidly changing profile and ever increasing numbers of substances available for recreational use. More than 450 NPS are currently monitored in Europe, with more than half reported in the last three years alone and 101 reported for the first time in 2014. The potential harms of the NPS are still poorly understood, particularly their long-term impact. The evidence base for treatment remains limited.

NPS appear to be attracting a new group of younger users. Engaging them is a particular challenge for drug services, which are historically orientated towards opiate and/or crack users. Clinicians require improved knowledge of who is using club drugs, and how. Services generally have limited understanding of the diverse ‘cultural’ contexts of club drug use (clubbing, festivals, LGBT venues, sexual context, psychonautic use), or context of use, risk and harm. One particular challenge to drug services is the link between drug use and high-risk sexual behaviours and the use of drugs in a sexual context, particularly by gay men.

There are new challenges associated with the clinical management of club drugs and a need to improve ‘clinical’ knowledge of how to manage acute/chronic presentations. For example, the management of GBL can be complex in emergency departments, as well as in drug recovery services, as acute intoxication and withdrawal syndrome can be severe and potentially fatal. The overlap of substance misuse harms with other harms has also compelled drug treatment professionals to develop knowledge and clinical pathways in uncharted territories. For example, ketamine is associated with severe urinary system damage and management may therefore require collaboration with urology and competencies in pain management in the context of ulcerative cystitis.

NEPTUNE has responded to the fact that the management of the harms of club drugs and NPS is not only about drugs services. Guidance is therefore also aimed at emergency departments, primary care and sexual health clinics. Not only do these services manage the harmful effects of club drugs, but they also provide a good access to populations with high levels of club drug use. This makes for a strong opportunistic approach to access people who may be in need of drug treatment, but reluctant or unwilling to contact services.

Although the number of people currently in drug services for club drugs is still small, there is a growing demand for treatment. The NEPTUNE guidance and forthcoming clinical tools have been developed to support clinicians to provide effective and safe treatment and care.

Dima Abdulrahim is NEPTUNE programme manager and lead researcher

www.neptune-clinical-guidance.co.uk

Engaging dependent drinkers

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May 5, 2015

Pathway to change

Mike Ward talks about a new project that is aiming to engage dependent drinkers with treatment services

Often those of us working in the alcohol field have heard families and non-specialist workers express the heartfelt view that, ‘There was nothing we could do because they didn’t want to change their drinking.’

People believe that if a problem drinker does not want to change, nothing can be done. This is not true, but this negative attitude has hampered the response to many of the riskiest and most vulnerable drinkers.

According to Public Health England, 94 per cent of dependent drinkers are not engaged with treatment at any one time. A small group of these, so called ‘blue light’ clients, are both treatment resistant and placing a huge burden on public services.

Since 2014, we have been working on the Blue Light Project – our national initiative to develop alternative approaches and care pathways for this group. It has challenged the traditional approach by showing that there are positive strategies.

The project has developed the Blue light project manual, which contains tools for understanding why clients may not engage, risk assessment tools that are appropriate for drinkers and harm reduction techniques that workers can use.

The manual also offers advice on crucial nutritional approaches, which can reduce alcohol-related harm, questions to help non-clinicians identify potential serious health problems and deliver enhanced personalised education, and guidance on legal frameworks.

‘The response to the project has been fantastic,’ said Mark Holmes, team leader of the Nottinghamshire alcohol related long term condition team, who worked with me on the project. ‘It is filling a real gap in the health, social care and criminal justice system. For too long we have done nothing about this challenging issue.’

Mike Ward is senior consultant at Alcohol Concern

A free PDF version of the manual is available at www.alcoholconcern.org.uk

Occupational support during recovery

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May 5, 2015

All in a day’s work

Sue Bright describes how offering occupational support can bolster an individual’s recovery journey

How many activities have you already carried out today?

If you take a moment and think of perhaps some of the activities you were involved in during the first couple of hours of your morning, it gives a sense of how occupation is essential in our lives and how we are programmed to ‘do’.

Occupations are all of the things we do day-to-day, which can include domestic and personal care, socialising, hobbies, work or voluntary activities. They can include things we are expected to do, need to do and want to do.

Occupation is a natural means of restoring function and is particularly important in recovery. The World Health Organization ‘no longer looks at health in terms of impairment, disability and handicap but a person’s ability to engage in activities and thereby participate in daily life’.

As an occupational therapist (OT), my aim is to help individuals develop or maintain a satisfying routine of meaningful everyday activities that can give a sense of direction and purpose.

In my role within Unity as a recovery occupational therapist specialising in education, training and employment (ETE), I work with individuals who are ready to address their occupational functioning; in short, ready to do things – the ultimate goal being to move towards education, training and employment.

Research shows that being unemployed or not meaningfully engaged in occupation can have an impact on health. This includes reduced life satisfaction and wellbeing, increased risk of mental illness and suicide, decreased self-esteem and feelings of guilt, diminished social status, disturbed roles and routines as well as the more obvious financial impact.

Spending most of the time engaged in passive, home-based activities such as watching television, ‘doing nothing’ or sleeping is often simply a means of filling the perceived ‘endless free time’ resulting from unemployment. These activities are not often actively chosen, nor may they hold any particular significance for the individual or thought of as purposeful by them.

As Aristotle says, the quality of life is determined by its activities.

One of my daily activities is to facilitate employability clinics in our local Unity bases. Initially I will ask someone to chat about what a typical day looks like for them, from getting up in the morning to going to bed at night, as this creates a picture of their occupations, roles and routines.

For example, Robin told me he didn’t get out of bed until lunchtime unless he had appointments – ‘what’s the point? There’s only mind-numbing telly. I’ve no money to do things and need to keep away from other users. I go to bed at two in the morning as I’m not tired; I’ve not done anything in the day!’

I focus on the will, drill and skill of the individual – motivation, routines and assets.

For instance, when I met Malcolm, I discovered he was motivated to go out on a daily basis to buy his newspaper, but was not interested in cooking – living on snacks. He would regularly go out walking but always the same route. He would get frustrated and bored with the sameness of his days, acknowledging that it would often be a trigger for him to return to drinking. He lacked confidence being with people but was accomplished on the computer, having done book keeping.

Using the Model of Human Occupation to underpin my work provides a basis to then look at occupational goal-setting. Activity grading is important – breaking down an activity into stages that become increasingly more difficult. This enables an individual to become more confident with an activity before they progress to the next stage. This is also true of an occupational journey – breaking it into manageable chunks.

Phil embarked on such a journey. He’d been abstinent from alcohol and had stopped smoking, making many positive changes to his life – such as regular contact with his family, decorating his flat, cycling, engaging in peer support, resolving his debts and managing his mental health. He began volunteering for several organisations, with varied occupations from re-building bicycles to answering telephones.

He had not been in employment for three years, having worked in IT, but was unsure if this was a career he wanted to re-pursue. Phil became a volunteer for us, facilitating our cyber café. As his confidence grew, he felt ready to move towards employment.

He completed a four-week employability course and attended a job club. This helped prepare him to get back into the jobs market. Phil remained unsure if he wanted to go back into an office environment, so I arranged an eight-week office work placement at a large company that maintains social housing throughout Cumbria. This allowed him to re-experience office life, regain skills and gain new ones, as well as establishing a regular work routine. Phil is now searching for IT jobs, having the belief that this is what he wants to do and is able to do.

Support is an integral part of the process. Conversations around occupation in early recovery are valuable in instilling a sense of hope and belief of a positive future as there are many fears that individuals raise – lack of confidence and self-belief, fear of relapse if they take on new occupations, concern about criminal records and not knowing what direction to take.

Jonny had mentioned several of these issues in our discussions but gradually changed his outlook.

‘Life wasn’t going anywhere anytime soon for me and I thought that I had nothing to offer or anything of value to others.

‘All that changed for me in February 2014.

‘I hesitantly started an NVQ level 2 course in adult social care – slightly overwhelming at first. All the staff and service users made me feel welcome and smoothed the transition into Heathlands Project (Learn to Care project, Carlisle).

‘The NVQ is catered for the pace of the individual and run at a relaxed pace, mixed with practical work supporting adults with learning disabilities on two days of the week.

‘I quickly realised that even a small gesture of goodwill, or an ear to offer to listen and a bit of advice, can make someone’s day better. This made me realise I had so much to offer.

‘The six-month course flew by so quickly for me and I was amazed to be offered a relief contract of two days a week working with and supporting the service users. I had a job and soon after it went to three, then four and now five days a week at Heathlands.

‘I feel a sense of worth now I’m doing a job I really enjoy. I have a different circle of friends and colleagues, and have been told I’m a trusted valued member of staff. My social life is good; I have taken up old interests and started some new.

‘I still learn everyday. I enjoy the challenges. I now intend to work my way up and become a group leader and beyond. Who knows?’

In working with individuals, I try to encourage a ‘give it a go’ attitude, focusing on positive coping strategies including a plan b. Linda had always wanted to go on a barbering course at college but was scared she would not cope with it and return to drinking. She had previously started hairdressing, but dropped out due to her addiction. We worked on activities to build her confidence and Linda was encouraged to give her dream a go, with some safety plans in place just in case. She has now almost completed her first year at college.

I work with everyone as an individual, making use of each person’s unique qualities and not taking a one size fits all approach. Occupation for those not work ready may perhaps be volunteering or structured activity as meaningful productivity.

Malcolm, whom I mentioned earlier, was dissatisfied with his routine but very gradually by using goal-setting, started to change his productivity using small steps over a period of time. He started to attend a peer support group, began walking slightly different routes and had an occasional game of golf or coffee with someone he became friends with at the group.

I encouraged him to think about volunteering, but at that time he felt this was ‘trivial’ and ‘not utilising his potential’. We discussed occupation not just as a means to succeeding but all the other positives it could bring to his life. He gradually started to warm to the idea, initially thinking about helping with dogs at an animal refuge to accompany his interest in walking.

I suggested we explored volunteering opportunities to make use of his computing and book-keeping skills. He now regularly updates a website and carries out book-keeping for a mindfulness project. He has meetings with the co-ordinators on a regular basis. Malcolm readily says, ‘It’s given me something to do which also carries quite a lot of responsibility which I needed. It also got me out of a rut.’

Little would be achievable without the Unity staff, who help stabilise and lay the foundation for ETE with individuals or the partnership agencies I work with. The Unity Asset Building Fund has helped support placements around the county as part of the wider Cumbrian commitment to recovery (Jonny has seen the real benefits of this). The Lawrie Brewis Trust in Carlisle (part of Heathlands) creates opportunities for those who may wish to find work in the care sector, to gain experience and qualifications working alongside staff and volunteers in their Learn to Care programme. Participants spend one day a week studying for an NVQ in health and social care and two days working with people with physical and learning disabilities.

Growing Well is a farm-based mental health social enterprise near Kendal. Volunteer placements there enable the recovery of people whose lives have been disrupted by mental distress. Participants spend one day a week involved in organic growing. There is an opportunity to gain a level 1 award in horticulture. Learning Fields is a community interest company near Appleby, offering educational and environmental opportunities for people of all ages and abilities. It provides a range of countryside activities in grass and woodland settings. Participants develop practical work skills to help them reconnect to their community. Connection with projects like these and others is fundamental to providing opportunities for people to develop work-based skills.

My regular attendance at an education, training and employment (ETE) North West Regional Forum, organised by Public Health England, provides information on current practice and enables networking opportunities which I find invaluable – we are able to both give and receive practical and up to the minute ideas.

I consider myself incredibly fortunate within my role as it encompasses two of my passions – people and productivity. My own meaningful occupation is the privilege of accompanying an individual on their journey of occupation.

I would be really interested in hearing from other occupational therapists working within the field of recovery from addiction, and can be contacted at sue.bright@gmw.nhs.uk

Sue Bright is a recovery occupational therapist working for Unity alcohol and drug recovery service

Make or break time?

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May 5, 2015

In a couple of days the country goes to the polls for one of the most unpredictable – and significant – elections in decades. As the outcome is likely to have a decisive impact on what the treatment sector, and wider society, might look like in a few years’ time, DDN decided to canvass opinion on what the new government’s priorities should be.

Mike Trace, chief executive, RAPt

The first thing an incoming government should do is take drug and alcohol treatment seriously. While the period of top-level political attention and increased investment is over, it is still the case that effective drug and alcohol treatment makes a significant contribution to crime reduction, public health and social inclusion of the most marginalised groups. Treatment policy has been drifting – with no clear direction, and the beginnings of disinvestment – and needs to have a renewed focus.

This does not mean going back to ring-fenced budgets, or central control, but there has to be some more strategic planning to ensure that the reduced funds available are directed towards the most effective interventions. Any treatment strategy has to maintain the ‘menu of services’ approach that was established in the 1990s, but needs to give more support to services and mutual aid groups that help people move towards recovery. This is achievable within restricted budgets – many of these activities are relatively cheap, and there is still a lot of potential in the system to reduce spending on bureaucracy and ineffective interventions.

The best lever the government possesses to ensure its treatment policy is pursued around the country is to set strong indicators of successful outcomes – the opportunity to do this through the payment by results pilots was squandered by overcomplicating the metrics. In my view, any treatment pathway or system that can demonstrate that a fair proportion of its service users are not committing crimes, not receiving benefits, and are reducing their reliance on health and social services can claim it is worthy of investment of taxpayers’ money. The next government should set these clear expectations, and ensure commissioners and providers are judged by them.

Alex Boyt, service user involvement coordinator, VoiceAbility, Camden

I sit on the drugs, alcohol and justice parliamentary group who invited all the parties to come and tell us about their stance on drugs. Pretty much nobody turned up. Politicians see drug policy as a lose/lose debate – if they have a chance of winning a seat, they go quiet.

Theresa May in her introduction to the 2010 drug strategy said, ‘people should not use drugs, and if they do, they should stop.’ The approach is infantile, pandering to Daily Mail readers who might clamour for the disembowelling of anyone who cares for a stigmatised community. What I’d like to see from a new government is a grown-up conversation about evidence-based treatment and a new legal framework.

The current fiscal approach has absolutely no sophistication or insight. It is well known that for every pound spent on treatment, around five pounds is saved on healthcare, crime and harms to the wider community. I’d like to see an incoming government join the dots and deliver care; the kind that looks after people and saves money, not the kind that squeezes the vulnerable out of the system and spends infinitely more mopping up the damage.

I’d like to see services shaped by people whose needs are not being met, as well as those who have benefitted. The recovery agenda is pulling some people forward but it is leaving too many behind. I would like to see the next government return to holding people who need it, not pushing everyone forward whether they are ready or not.

Last year drug-related deaths went up by 32 per cent, but the treatment system is more interested in tweaking successful completion rates. I would like a new government to look at drug-related deaths as if they were the deaths of people who mattered.

David Biddle, chief executive, CRI

Put simply, I want to see the progress that has been made in improving services over the past few years maintained and built upon. Time frames for working with addictions can be lengthy, therefore a reiteration of the principles of the drug strategy and a commitment to ensuring stability of funding – possibly at a lower level – is critically important.

I would also like to see public recognition of the value that third sector-organisations bring to fostering quality and innovation in the provision of services. The NHS public/private debate has the potential to damage the sector, and yet to date we have been virtually invisible in the dialogue. There needs to be a recognition that ‘not for profits’ operate from a different value base to their private counterparts, and that this ability to offer highly effective interventions that do not ‘drain’ money away from service provision can be advantageous at a time of enhanced budgetary pressures. Policymakers need to stay focused, maintain funding and keep pushing for innovation and outcomes that justify the investment.

The government’s move towards integrating health and social care is the right move on so many levels. There will inevitably be difficulties because it’s a long-term project that requires upfront investment, but nevertheless it has to be a key priority over the coming five years because of the potential it has to drive improvements in care for service users and patients. The challenge for us is to ensure our services are integrated into that system and not subsumed within it.

If I were to focus on one campaigning issue for the field, it would be tackling the stigma that has a devastating impact upon the lives of service users and long-lasting implications for their wellbeing and ability to recover. We need to be doing everything we can to tackle that by using our clout to influence key opinion makers who can help change enduing perceptions. The more people who understand recovery and what our service users can, and have, achieved, the more opportunities they will have to work and thrive. I never cease to be humbled by the commitment and resilience of people in recovery – stigma and ignorance is such an unnecessary barrier standing in the way of recovery, and it diminishes us as a society.

Graham Miller, CEO, Double Impact

From a perspective of being a relatively small, but well-established, voluntary sector provider of recovery-oriented services, we feel that a new government should consider whether the relentless cycle of re-commissioning services every three or so years really benefits the end user.

This process can place a significant strain on the resources of smaller organisations such as ours without a full-time, dedicated bid-writing team. Short contracts do not always provide partnerships with the time required to really embed a new recovery culture or delivery model to best effect for service users. If services are to make a lasting influence and contribute to the origination and growth of recovery communities, then the impact on providers of this rapid cycle of change needs to be reconsidered.

At the very least, the new government could ensure that EU procurement laws designed to make opportunities more accessible for smaller organisations – by dividing large contracts into discrete lots – are adhered to by commissioners.

It feels like a tall order for providers to fulfill PHE’s logical ambition to bring alcohol treatment alongside drug treatment, after a long history of under-investment in the alcohol sector, and at a time when the ring-fenced budget for drug treatment has been removed. We have benefited from a good relationship with commissioners throughout the transition to PHE, based on a mutual understanding and shared goals. However, there is a real risk that local authorities across the country will direct their budgets into other more ‘deserving’ areas of need.

We fully support the current government’s emphasis on being ambitious for service users to achieve a full recovery – but too many providers appear to have jumped on the bandwagon, claiming to deliver this. Double Impact has always had a clear focus on being a specialist provider of recovery interventions and not a provider of clinical interventions. Through this experience, the organisation feels well placed to understand how to deliver a genuine recovery model and would ask the new government to commit to a more defined understanding of ‘recovery’ and measure performance against this.

Viv Evans, chief executive, Adfam

Fundamentally, I would like to see the routine consideration of the needs of families affected by drugs and alcohol built into any drugs/alcohol policy adopted by the incoming government. The purpose of supporting families is twofold – firstly, they need and deserve support in their own right, and secondly, well-supported families are in a much better position to aid their loved ones through their own journeys of recovery.

So I’d like to see family support right up there, both as part of an ambitious treatment system and a vibrant and innovative community sector. And to back up this I’d also like to see, of course, some spending commitment that is much broader than ‘troubled families’ – effective and sensitive support for any family member in the country, no matter where they live. We are currently quite a way from this.

Drug and alcohol use has of course a strong correlation with the wider picture of social inequality, so I’d like to see a more just society. I think the wider policy area for us is really around the carers’ agenda – we’ve witnessed some good progress with the Care Act last year – so we’d like to see more recognition of those caring for people with drug or alcohol problems within the wider pool of carers. We are also concerned that a new government addresses the needs of the children of drug/alcohol users. Treatment for parents can improve outcomes for children, and parents who are able to care effectively for their children save government money by keeping them out of the care system.

The field needs to stop obsessing over the minutiae of recovery. Let’s all come together to try and promote a coherent voice to the ‘outside’. Sometimes convincing people of the need for support, investment and compassion towards anyone affected by drugs and alcohol can be difficult on account of the ‘well it’s their own fault, isn’t it?’ argument. We need to keep making the case for support for drug users and their families, both in terms of economics – it makes sense if you do the sums – and compassion.

Niamh Eastwood, executive director, Release

With a growing number of jurisdictions implementing drug policy reform, including the ending of criminal sanctions for possession offences and regulated markets for cannabis, it will be hard for the next government to ignore the issue. The recent Home Office report that concluded that there was no obvious relationship between the toughness of a country’s enforcement against drug possession and levels of drug use clearly demonstrates that any government pursuing the current criminal justice approach is needlessly criminalising tens of thousands of people every year.

In terms of the treatment sector, Release would like to see the next government promote interventions based on the evidence rather than ideology, recognising the importance of harm reduction. That’s not to say that the availability of abstinence-based options is not important, but rather that we need a treatment system that responds to the needs and wishes of the individual, instead of one based on a political doctrine.

Something we talk about a lot at Release is how in many ways the problems our clients face are not strictly about drugs. As such we would like to see the next government revoke some of the worst aspects of welfare reform, including the bedroom tax, the restriction on social fund payments and the housing allowance cap, all of which have significantly and negatively impacted on many of those we represent. We would also challenge any government that brings in treatment conditionality for benefit claimants.

On the issue of policing, we would like to see the next government tackle the issue of our drugs stop and search laws and explore ways in which these could be reformed. These laws are having a detrimental impact on community-police relations and criminalising vast numbers of youth.

With the UK government spending £1.5bn on law enforcement but only £600m on drug treatment, we would like to see the field unite around the need to shift our drug policy from one based on a criminal justice response to one based on health, human rights and harm reduction. At the end of the day we should be advocating for the rights of those we represent, which should include that they are no longer treated as criminals.

Victor Adebowale, chief executive, Turning Point

Whoever forms the next government, and however it is formed, they will need to recognise that drug and alcohol treatment is changing. Services today must innovate in order to get better results from lesser resources and to cope with emerging challenges, such as legal highs and restrictions on other social care provision. This makes it imperative that services are able to cater for other health needs that are often co-morbidities with substance misuse issues, such as sexual health and smoking cessation. We must also reach groups such as the over-55s and those who misuse prescription medications. Policymakers must not fall into the trap of considering substance misuse services as somehow separate from the wider public health agenda.

With nearly three-quarters of substance misuse service users also experiencing a mental health condition, recent interest in mental health has been welcome, but mental health is only one of the many issues that can affect those with complex needs. Commissioners must make sure that contracts and funding encourage service providers to provide individuals with whole-person care.

In addition to integration within services, it is essential that health and social care organisations in a given community have the flexibility and freedom to work together. This is especially relevant to children and young adults, who may have seen substance misuse within the family. It’s vital that young people’s services are given adequate priority within organisational design and commissioning specifications, both to safeguard vulnerable individuals in the short term, and to prevent inter-generational dependency in the longer term.

Hannah Shead, chief executive, Trevi House

In considering what I hope to see from the next government, my first response will always be about funding; specifically a greater commitment to interventions that work with the wider family. When we approach recovery as a single issue, we miss a trick. For every person receiving help, there are countless loved ones also in need of services.

The provision of effective support for family members and friends can prove a sound investment; they often provide the longer term love and care for people in recovery and can boost the fabulous work being carried out within mainstream services. It is sad to see the future of so many people determined by cost, as opposed to need. At Trevi House, the majority of our residents state that they would never have even considered entering residential treatment if it had meant separation from their children, yet cost invariably seems to be a barrier for so many others I speak to.

Funding is not all I would like to see. Politians, alongside the media, create a narrative around substance misuse, and have a key role in helping services to challenge the prejudice and stigma of dependency. I frequently hear people discussing addiction in moralistic tones; this is especially the case when we talk about mothers who are drug or alcohol users. I would invite the new government to come into our services – not with the press officer or the media advisor, but to come in and try to understand the work we do. I would ask them to be brave enough to declare their own previous drug use, or their personal battles with alcohol; to stop treating substance misusers as ‘them’ and not ‘us’.

I would ask the government to come and talk to women who have battled to recover from drug use, who have managed to break free from domestic abuse, who have managed to raise their children with little support and much judgment. I would invite the government to come and hear the real stories of people out there in recovery.

And you just never know, once they have done all that, the dream of more, better funding, might become a reality.

Yasmin Batliwala, chair, WDP

The government’s priority should be to ensure that adequate funding is available for both drug and alcohol services, and such funds should be supervised to guarantee that they will reach these important services. The government must also focus on prevention regimes that work. Solutions can be sought without reinventing the wheel on one hand or repeating past mistakes on the other.

In addition, it is essential to build confidence in commissioners. The quality of commissioners’ decision making directly affects the quality of service provision, so it is vital that the former is addressed in order to safeguard the latter. This requires accountability, which can only be promoted by making commissioners’ decision-making processes more transparent.

As a field, we should be campaigning for the destigmatisation of drug use. This is at the core of all the work we do, and could mean the difference between someone in trouble seeking help or struggling in silence.

Brian Dudley, chief executive, Broadway Lodge

Where is treatment going wrong? I believe the fault lies in common sense being ignored and not looking at the whole picture. Overall, community treatment in the UK is good – mainly from a few big national providers. The issue for me lies with the more complex clients and those who have repeatedly failed in the community.

Residential rehab is on the whole an ‘out of area’ placement, so common sense would be commissioning nationally rather than locally. Why would a local commissioner want to spend their budget sending someone to a completely different area from which they might never return?

Also community treatment is purchased in three- to five-year blocks, whereas residential treatment on the whole is spot purchased. How can a rehab plan and improve with no guarantee of income?

But by far the biggest waste of taxpayers’ money is local authorities using NHS services for services, especially inpatient detox. The outcomes for people being put in mental health wards at up to £500 a day are at best poor, and at worst putting people’s lives at risk. Specific units run by third sector organisations are shown to produce significantly better results for less than 50 per cent of the price, and are registered with CQC to ensure quality is not compromised.

When is an incoming government going to listen to those in the field with the actual knowledge and experience, rather than the big organisations looking out for themselves without the best interests of the clients at the forefront?

Sarah Vaile, founder and director, Recovery Cymru

If I had one message to the incoming government regarding how we give people the best chance of achieving and sustaining recovery, it would be to plan ahead and invest in aftercare and the recovery community. These are so often the missing links in a successful, recovery-oriented system of care that achieve the best outcomes for individuals and their families – as well as a return on investment.

Aftercare and community support have traditionally been an afterthought. This doesn’t make sense as a coordinated and planned approach to people leaving treatment, building lasting recovery capital and integrating fully with communities are primers for sustaining change and not returning to treatment.

Ultimately, investing in aftercare and the recovery community will ensure the efficacy and value for money of treatment services, stopping the revolving door and reducing dependency on treatment services.

At Recovery Cymru our ‘recovery centre hubs’ are 365 days a year. It’s about living life – a community not a service. Our members include families and recovery advocates, as well as people ‘in’ or seeking recovery. But we are also a valued part of the treatment system in South Wales, offering support to people on all stages of their recovery and treatment journey, and working well with practitioners. This is exemplified by our recent collaboration with a treatment (Solas) and training (Newlink Wales) provider to deliver integrated aftercare, volunteering and recovery community support to people in Cardiff and the Vale of Glamorgan. We have been commissioned to do this, recognising the value and impact on efficacy of treatment services this will have.

The incoming government needs to promote this model, understanding the importance of a coordinated approach to collaborative aftercare and the recovery community. Developing the culture of recovery nationally would help to avoid black and white thinking and be a true investment in the workforce.

Martin Powell, head of campaigns and communications, Transform

The incoming government will find a situation changed beyond recognition compared with 2010, nationally and internationally. In the UK, polling shows a majority of the public in favour of decriminalisation of possession, or legal regulation, of cannabis, and over two-thirds in favour of a comprehensive review of our approach to drugs. Support runs across party political affiliations, and most media outlets – including the Sun – now back reform.

Internationally, taking an actively prohibitionist line is becoming increasingly difficult for the UK. Latin American trade partners, including Mexico and Colombia, are criticising the drug war and calling for alternatives to be explored. Multiple US states have legally regulated cannabis, and if California legally regulates it in 2016 then cannabis prohibition in the US will be over. A swathe of countries across the Americas and Caribbean will follow suit – as Uruguay and Jamaica already have – and European states will join the anti-prohibition wave.

So the door is open for the incoming government to make a commitment – real this time, not rhetorical – to deliver evidence-based policy nationally and internationally. To that end, we would like to see them build on the Home Office’s international comparators report that showed harsh drug laws do not reduce use (DDN, December 2014, page 5), by initiating a comprehensive independent review of UK drug policy, comparing our current approach with alternatives like Portuguese decriminalisation and models of legal regulation. This would lay out the evidence for reform and provide political space to develop cross-party support to implement it.

So what should we be campaigning for? A number of groups in the field, including service providers like Blenheim CDP, Westminster Drugs Project and Kaleidoscope have already signed up to our Count the Costs campaign for a review (www.countthecosts.org). But whether through that coalition, or other routes, we would like to see all groups in the field pressing the incoming government and all UK political parties to support a review.

The resulting report will make it much harder for politicians and media to blame drug users for the failings of their prohibitionist approach, or conflate drug use harms with those caused by our punitive drug policy. As a result, we will genuinely be able to manage drug use and misuse in a way that is just, effective and humane, and campaign more effectively for the true root causes of the ‘drug problem’ to be addressed.

Alistair Sinclair, director, UK Recovery Federation (UKRF)

The UKRF held its first event in May 2010 one day after an election that brought the Coalition to power, bringing with it five years of ‘austerity’. Ten days away from our next election the Guardian reports that ‘Britain’s billionaires have seen their net worth more than double since the recession, with the richest families now controlling a total of £547bn’, an increase of more than 112 per cent. The Equality Trust says that ‘the richest 1,000 families have more money than the poorest 40 per cent of British households combined’ with their wealth increasing last year by £28bn, the equivalent of £77m a day. Meanwhile the public sector has seen massive restructuring and rebranding, creeping privatisation and huge cuts.

The most vulnerable victims of a neo-liberal agenda that has put profit before people for decades, have found themselves disregarded, sanctioned and vilified as responsible for their woes. While those that work within our economic ‘recovery’ find themselves increasingly trapped in insecure jobs and zero hour contracts, the unemployed (the antithesis of ‘hard-working families’) are categorised within a new deserving and undeserving poor narrative. Nowhere is this more evident than in the DWP and the words and deeds of Iain Duncan Smith, the principal proponent of a politicised ‘recovery’ that puts abstinence before social justice and economics before equality.

Five years on, we live in a more unequal society and the gap is growing. As Professor Hanlon of Glasgow University put it, ‘modern society: unequal, inequitable and unsustainable’. So in an ‘age of dislocation’, as our communities fragment and fray and people reach for comfort in all sorts of unhealthy ways, I think the government’s priority should be honesty as to the roots of the problems we all face, and the wider community recovery we all need. Perhaps then we’ll begin to find real solutions?

Organisations working with offenders at increasing financial risk

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May 5, 2015

Voluntary sector organisations working with offenders continue to be dogged by financial uncertainty, according to the latest State of the sector report from Clinks. A survey of organisations ranging from small volunteer-led community groups to those employing upwards of 2,000 staff found that many were now relying on their reserves, putting them ‘at risk of closure’, and that the majority rarely recover their costs on the contracts they deliver.

While the needs of service users are becoming increasingly complex, organisations are having to rely more and more on volunteers, says the document, with an average of nearly two volunteers for every member of paid staff. Policy changes such as welfare reforms, meanwhile, had also had a negative impact on service users’ mental health, financial stability and ability to find appropriate accommodation.

‘The tension between increasing demand for services and decreasing access to funding continues to erode the sector’s ability to provide quality at the required scale,’ said Clinks director Clive Martin. The reality of this situation needs to be acknowledged; otherwise it will become too burdensome for staff and the communities they work in.’

Commissioners could help address the situation by making sure that procurement processes were accessible and efficient, he added, while initiatives like payment by results (PbR) – although still relatively limited – took up a ‘large amount of policy rhetoric and staff time’ and created ‘unwelcome uncertainty’.

State of the sector 2015 at www.clinks.org

Charities welcome home HIV self-testing

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May 5, 2015

The first legally approved home HIV self-testing kits have gone on sale in the UK. The kits are able to detect antibodies in small drops of blood and can provide a result in 15 minutes, although positive results must then be re-confirmed at a clinic.

Manufacturers BioSURE claim their self-test kit is more than 99 per cent accurate from three months after suspected exposure, although it cannot detect infections that have occurred within the last three months. The single-use, disposable device ‘has gone through extensive scrutiny’, says BioSURE, and is the only one so far approved for sale in the UK.

The ability to test outside of a clinical setting has been welcomed by HIV organisations, although they stress the importance of fast access to support after a positive result. ‘We campaigned for a long time to secure the legalisation of HIV self-test kits which happened in April 2014, so it is great to see the first self-test kits being approved,’ said Terrence Higgins Trust chief executive Dr Rosemary Gillespie. ‘We know that if people are diagnosed with HIV and start treatment early then they can avoid serious complications and lead long and healthy lives. Unfortunately 24 per cent of people living with HIV in the UK remain undiagnosed, so we have to do much more to encourage people to test.’

‘We currently have a long way to go when it comes to diagnosing people with HIV on time,’ added National Aids Trust chief executive Deborah Gold. ‘Over 40 per cent of people living with HIV are diagnosed late, meaning they have been living with HIV for at least four years. People diagnosed late are eleven times more likely to die in the first year after diagnosis. To address this public health challenge we need to look at new ways for people to test, and self-testing is an important and welcome additional option.’

Meanwhile, the Terrence Higgins Trust has called on the incoming government to commit to four key changes in HIV policy, including training to help end stigma in health and social care settings, making HIV prevention a national public health priority and ensuring appropriate financial support for people affected by HIV-related illness.

A third of Scottish drug related deaths are parents

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May 5, 2015

More than a third of Scottish drug-related deaths in 2013 were parents or parental figures, according to figures from ISD Scotland – affecting more than 270 children. The proportion of deaths in over-35s, meanwhile, increased from half in 2009 to two thirds in 2013. The figures represent a further analysis of the drug-death statistics published last year (DDN, September 2014, page 4).

As with previous years, three quarters of those who died were men and half were living in Scotland’s most deprived areas. More than half had been in contact with drug treatment services, while just over a quarter had been admitted to hospital for an acute or psychiatric stay in the previous six months.

The percentage of Scottish drug related deaths where heroin was present was unchanged from the last two years, although the percentage with methadone present fell from 56 per cent to 47 per cent between 2011 and 2103. There were more than 200 cases where new psychoactive substances (NPS) were present in the four years to 2013, more than half of which were in 2013 alone.

‘By providing further context around these deaths, and by studying the contributing factors, we can ensure that more families in Scotland can avoid the painful loss of a loved one to drug use,’ said community safety minister Paul Wheelhouse. ‘These figures also show that Scotland is dealing with an ageing cohort of drug users. We are continuing to work alongside our sponsored organisations to investigate the health and social care needs of this vulnerable group and look at how we can improve the quality and range of treatment and support available to them throughout the country.’

It was also becoming ‘increasingly clear’ that NPS represented a significant challenge for health, justice and third sector organisations, he stated. “The Scottish Government are in early discussions with the Home Office on how we will work together to create new legislation to control the sale and supply of NPS, both here in Scotland and also around the rest of the rest of the UK.’

National drug related deaths database (Scotland) report 2013 at www.isdscotland.org

New government must help those with multiple needs

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May 5, 2015

The incoming government should launch a national programme of improved and coordinated support for those with multiple and complex needs, according to charity the Revolving Doors Agency. Any new government would be unable to afford to continue a situation where ‘shrinking public funds are tied up paying for the consequences of repeated failed interventions’, it says, with the organisation estimating the cost of ‘severe and multiple disadvantage’ at more than £10bn per year.

There are ‘a minimum’ of 58,000 people in England alone experiencing a simultaneous combination of substance problems, homelessness and offending, frequently linked with mental health issues, the charity says, with health and welfare systems designed to tackle single issues struggling to respond.

The agency is calling on the government to prioritise support for long-term recovery – including ‘the journey towards employment’ – which should include an immediate review of the impact of welfare sanctions on vulnerable groups. It also wants to see improved opportunities and provision for service user involvement, as well as effective community-based rehabilitation for offenders with multiple needs, including specific services for groups such as under-24s and women.

‘In a period of falling spending and rising demand on our public services, tackling the complex problems faced by individuals caught in this negative “revolving door” cycle must be a priority for whoever forms the next government,’ said chief executive Christina Marriott. ‘We cannot continue in a situation where public money is tied up paying for the consequences of repeated failed interventions – the financial, social and, above all, human cost of this failure is too great.

‘We want to see a system where people facing multiple and complex needs are supported by effective, coordinated services in every area, and are able to tackle their problems, reach their potential and contribute to their communities,’ she continued. ‘The evidence shows this could save public money while improving outcomes for some of the most excluded people in our society. We know what works. Now is the time for action.’

The Revolving Doors Agency manifesto 2015: Five priorities for an incoming government at www.revolving-doors.org.uk

News in brief – May 2015

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May 5, 2015

Who’s responsible?

Responsible drinking messages in advertising are being used by the alcohol industry to promote their brands rather than help consumers ‘make sensible choices about their drinking’, according to a report from Alcohol Concern. The charity wants to see ‘ambiguous’ messages replaced with factual health warnings, after its research found that responsible drinking messages had ‘frequently been expanded to include the brand name or drink type, or some other extra wording added to fit the wider theme of the advertising campaign’.

Drink responsibly (but please keep drinking) at www.alcoholconcern.org.uk

More NPS banned

Five more ‘legal highs’ have been banned under temporary powers by the government. Compounds related to methylphenidate – including ethylphenidate, which is sold as Gogaine or Burst – are now subject to a temporary class drug order (TCDO) for up to 12 months while the ACMD decides whether they should be permanently controlled. ‘Users have been known to inject the drug, putting themselves at risk of blood-borne disease and infection,’ said the Home Office.

Hep awareness

A new film about hepatitis C designed to raise awareness and improve confidence in diagnosis among GPs and other primary care staff has been launched by the Royal College of GPs, HCV Action and the Hepatitis C Trust. ‘Despite the fact that hepatitis C affects so many hundreds of thousands of people in the UK, we frequently hear of low awareness and knowledge of the virus among GPs,’ said Hepatitis C Trust chief executive Charles Gore. ‘GPs will be increasingly relied upon in the future to manage and detect the virus, so this really is a must-see film.’

Detecting & managing hepatitis C in primary care available to view at hcvaction.org.uk

Cannabis care

Provision of effective cannabis treatment is likely to become more vital in European drug policy, according to a new report from EMCDDA. The document analyses the interventions most likely to be successful, based on evidence from a range of treatment programmes across Europe. ‘With large numbers entering cannabis programmes every year in Europe, largely paid for by public funds, treatment effectiveness is a key consideration for policy,’ said EMCDDA director Wolfgang Götz. ‘With this report we hope to offer experts and policymakers a firm basis for their decision-making.’ Treatment of cannabis-related disorders in Europe at www.emcdda.europa.eu

Drink violence down

The number of violence-related A&E attendances in England and Wales last year was down by more than 100,000 compared to 2010, according to figures released by Cardiff University’s violence research group, with a fall in binge drinking rates among young people thought to be partly responsible. ‘Reductions in alcohol consumption (litres per capita) and in high episodic drinking (more than eight units per session for males and six units per session for females)’ among 16 to 24-year-olds were a likely contributory factor to the reduction in violence – ‘much of which takes place in urban centre streets at night’, says the document.

Violence in England and Wales in 2014: an accident and emergency perspective at www.cardiff.ac.uk

Codeine codes

Codeine should not be used to treat coughs and colds in the under-12s, the European Medicines Agency has stated. Codeine’s conversion into morphine in the body can cause side effects including breathing difficulties in some children. The ruling, which follows a previous review of the use of codeine for pain relief in children, has been endorsed by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA).

May 2015

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DDN

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May 5, 2015

In this month’s issue of DDN…

‘Take drug and alcohol treatment seriously.’

In this month’s issue: DDN canvasses opinion from the drug and alcohol sector on what the new government’s priorities should be.

Click on the links below to read more, and don’t forget to join the discussion by commenting, tweeting and liking our Facebook page.

PDF Version / Mobile Version

Local news – May 2015

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May 4, 2015

Veterans’ service advances to South West

A new treatment service for military veterans with drug and alcohol problems is being expanded into the south west of England.

Right Turn, launched by Addaction and funded by the Forces in Mind Trust, is already available to veterans throughout Scotland and the north of England. It aims to offer ex-service men and women support during their transition back to civilian life.

The programme also hopes to influence policy makers and improve services by providing a detailed evaluation both of the project and the scale of the problem.

Meanwhile, initiatives to help ex-service personnel continue at Liverpool’s Tom Harrison House (DDN, December 2014, page 6) where a new national conference learned from US colleagues about developing veteran-specific addiction treatment.

‘We have a lot to learn about how we support our veterans who are experiencing active addiction or alcoholism,’ said head of service, Jacquie Johnston-Lynch.

BDP and students embrace technology challenge

A team of students from the University of Bristol, working with the addiction charity Bristol Drugs Project (BDP), have won the 2015 Tata Consulting Services (TCS) Tech Challenge.

In its second year, the TCS Tech Challenge is designed to inspire young people to get creative with technology.

The team from Bristol University collaborated with BDP to create an IT solution that targeted and engaged recreational drug users. Researching the project by working with the university’s student counselling service and attending BDP group sessions with service users, the team developed a prototype app that combined a questionnaire, examples of users’ stories and personal diaries.

Each member of the winning team has been awarded a paid one-month internship at TCS, while BDP has received a £1,000 donation.

Restoration enterprise heads for new heights

A social enterprise in London has celebrated more than a year of successful business with an event to thank its supporters and recognise the conclusion of a successful pilot phase.

Restoration Station, a project of the Spitalfields Crypt Trust (SCT), is now providing work experience restoring vintage furniture for six people in recovery, as well as making original pieces from reclaimed and recycled materials.

The project is popular with both shoppers and other local businesses looking for bespoke creations, and gives individuals in recovery the opportunity to build their confidence and develop new skills.

‘It’s a fantastic project,’ said Della Tinsley of the East London Design Show. ‘I think that the power to have a skill and make something is incredibly restorative… something that really has an ability to change lives.’

Free training for family members

Adfam is offering free training to friends, family members and carers of individuals with substance misuse problems.

After a pilot in the London Borough of Greenwich, Adfam has now extended the training to services in Kent that support people affected by others’ substance use.

The one-day training programme aims to empower individuals to become Family Recovery Champions, who would in turn be able to offer support and advice to others using the service.

For more information or to book training contact Bex Peters, r.peters@adfam.org.uk

Sponsored bike ride honours Barry’s memory

Staff from Addaction Cornwall have taken part in a sponsored bike ride to raise money in memory of a volunteer at the service.

Barry Marsh died in November last year of cancer after dedicating many hours of his time to offering other people support and sharing his own story.

The team of staff organised and completed an 11-mile cycle route, and the money raised has been donated to Cornwall Hospice Care, which supported Barry towards the end of his life.

Service user champion wins management award

Sunny Dhadley, service user involvement officer at the Wolverhampton Service User Involvement Team (SUIT), has been awarded an Award for Excellence from the Chartered Management Institute (CMI).

The award recognises his management and leadership skills, and was presented to SUIT at the recent CMI Midlands annual conference and awards event at Birmingham’s ICC.

‘I’m delighted to have been given this award by CMI in recognition of my management and leadership abilities,’ said Dhadley. ‘At one point in my life I didn’t think that anything was achievable. This award has shown me – and others – that everything is.’

iCan Speak Bootcamp

Uncategorized

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DDN

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April 17, 2015

Confidence is a skill you can master – let Richard McCann show you how!

Birmingham, 23 June 2015

£145 + VAT professionals, £95 + VAT service users

BOOK HERE NOW

He wowed the DDN conference this year, could you be the star of the show next year?

Does the thought of standing on a stage of a group fill you with fear?

Do you want to improve your communication skills?

Does a lack of confidence stop you getting your point across?

Do you struggle in official situations?

Do you find it hard to have your voice heard?

If you answered ‘yes’ to any of these questions, the iCan Speak Bootcamp is for you.

By the end of this highly interactive course you will know how to successfully engage with people, how to present yourself, how to deal with nerves, and you will feel your confidence soaring!

The skills learned on this one-day course will provide confidence that will help everyone in everyday situations, as well as those looking to improve their public speaking.

Just 10 years ago Richard McCann had an unhealthy fear of meeting people and speaking in public. He made it his mission to overcome that fear in order to share his story and message with others, and has done so with incredible success. Having been there and done it, Richard is keen to share his personal journey of how he overcame his speaking fears with others seeking to become more engaging speakers.

What will you learn at the iCan speak bootcamp?

Richard will share his tried and tested techniques which helped him become one of the most booked professional speakers in the UK and beyond.

Stand and deliver:
How to look the part on stage. Concentrating on your non-verbal communication.

Start with impact:
How to grab the attention of your audience from the very start.

Vocal variety:
Learn techniques that will give you the edge.

Spice it up:
Learn language techniques that will enhance your delivery.

Involve your audience:
Be a stand-out speaker by engaging with your audience.

Own that stage:
The stage is your home and your audience – learn how to own it!

Silence the cynic:
How to silence even the most cynical of audience members.

BOOK HERE NOW

Care at Windmill House

Features

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DDN

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April 15, 2015

The Surrey and Borders Partnership NHS Foundation Trust talk about the specialised, individualised support they offer

Windmill House is a specialist unit in Chertsey, Surrey, which provides 24-hour residential treatment and support to adults over 18 who want to become abstinent from drugs or alcohol.

As well as standard detoxification from single or multiple substances, we are expert in managing individuals with complex needs such as mental ill-health, eating disorders or self-harm, pregnancy and physical health problems, as well as learning disabilities and limited mobility.

The service is run by Surrey and Borders Partnership NHS Foundation Trust, the leading provider of health and social care services for people with mental ill-health and drug and alcohol problems in South East England.

Windmill House at a glance

On an acute hospital site in a semi-rural location, adjacent to a district general hospital with A&E, the unit offers its clients a dedicated and experienced staff, with fully accessible facilities, suitable for people with limited mobility. Detoxification and therapeutic programmes are available, as well as 24-hour medical and nursing care.

Recovery planning is incorporated throughout each individual’s stay, including a full discharge plan agreed with the person and their community key worker, and access and links to statutory and non-statutory agencies are a part of the care provided.

Detoxification

Everyone who comes to Windmill House receives a full medical and physical examination upon admission. This takes into account their personal, medical and psychiatric history, as well as their history of substance misuse. It includes:

Routine blood tests and any other investigations required
An ECG
A chest x-ray
A mental health assessment
Testing and vaccination for blood-borne viruses where appropriate
Direct contact with the person’s GP to verify their prescribed medication and medical history

Based on these results, our medical team devises a detoxification plan with the person, which starts as soon as possible and is individualised according to their specific needs.

Detoxification can last between seven and 28 days. Our medical staff review the individual’s plan on a daily basis, making regular observations and monitoring their vital signs throughout.

During detoxification, we encourage people to attend our preparatory groups. These help enhance people’s motivation to remain abstinent and help them acknowledge that they need to work on their recovery on a daily basis, either at Windmill House or in the community.

Our therapeutic programme groups are designed to give people intense support, refresh their life skills and provide opportunities to meet others and share their experiences.

Here we focus on developing coping skills and improving self-esteem. We provide recovery groups to encourage people to look forward and put plans in place to achieve their goals, and art therapy to allow them to communicate and understand difficult feelings in a safe environment.

Members of local Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) fellowships also visit, providing invaluable links to ongoing support in the community.

Our approach

Each person’s admission plays an important part in their journey towards recovery. While staying with us, our unique care planning helps people look at all aspects of their life – from basic essentials such as finances and accommodation to health needs, emotions and communication – and identifies key areas that they need to address as a priority. Regardless of how far people get with that process, we see the positives in their admission and offer as much help and support as we can.

www.sabp.nhs.uk/windmill-house

Media savvy

Features

By

DDN

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April 14, 2015

The news and views from the national media

Isn’t it time for a wider discussion on the potential effects of safe, regulated cannabis consumption on society?… In an age when every penny of government spending is fought for, the demonstrated potential savings and revenues at very least deserve serious investigation. Revenue raised from a regulated cannabis trade could be directed towards education on safe use of cannabis. That’s why the next government – regardless of who it is led by – should set up a Royal Commission into drug legislation.

Paul Birch, Telegraph, 4 March

It is important to remember that we do not consider the law against murder a failure simply because, year after year, there continue to be murders and that therefore the ‘war’ against murder has been lost. No law achieves exactly and only its ostensible purpose. We should be wary of applying the experience of other countries too directly to our own, however. For example, relaxation of the drug laws in Portugal had been followed by only a relatively minor increase in consumption. But in Britain, the relaxation of the licensing laws led to a vast increase in public drunkenness and alcohol-related problems. Genies are often difficult to put back into bottles.

Theodore Dalyrmple, Telegraph, 9 March

I found out a few months ago that Nick Clegg is astonishingly ignorant about the drug laws in this country. He really believes that the police cruelly persecute drug users (if only they did). Ignorance of this kind is wilful. The truth is readily available. He remains ignorant because he does not want to know.

Peter Hitchens, Mail on Sunday, 8 March

Cannabis, officer? No, it’s lucky heather. Gypsies given £1.3m of taxpayers’ money by the Welsh Government to improve their caravan site showed their gratitude by turning it into a giant cannabis factory… It is believed suspicions were aroused because no one could ever remember travellers actually buying garden equipment before.

Richard Littlejohn, Mail, 3 March

The problem isn’t just that the money we spend on welfare is out of hand. It’s the effect of that spending. Welfare has become, for many, not a helping hand in times of need – the help in need that almost everyone agrees we should offer to the vulnerable and those in temporary difficulties – but an alternative way of life… And that is not just financially reckless; it is morally reckless, promoting an entirely new and warped model for society itself.

Stephen Pollard, Express, 27 March

No hiding place

Features

By

DDN

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April 14, 2015

Efforts to stop drugs from being smuggled into prisons are failing – so why aren’t we tackling prisoners’ drug use through universal testing, argues Neil McKeganey

Successive UK governments have acknowledged that it is all but impossible to stop drugs getting into prisons. For many people, that acknowledgement will seem utterly inexplicable. Prisons represent the single most controlled environment on the planet, and if you can’t stop drugs getting into prison what possible hope is there of stopping their proliferation anywhere else?

An estimated 38 per cent of prisoners in Scotland have used illegal drugs in prison, and a quarter of prisoners in England say that drugs are easy to get. The arrival of legal high drugs, which are harder to recognise and easier to conceal, only makes the challenge of stemming the flow of drugs into prison that much harder.

If we are unable to stop drugs getting into prisons, then perhaps what we should be doing is switching our focus to stopping drug use. Drug testing is our best means of identifying what substances an individual has used, and whether that use is recent or in the distant past. We can identify the use of cannabis, cocaine, heroin and a host of other drugs. At the moment though, drug testing programmes are used within prisons on a limited basis, with relatively small samples of prisoners selected for random, though infrequent, testing.

If prisons were instead to mount a massive programme of regular and exhaustive drug testing of all prisoners, the entire environment of prison-based drug use would change. Out would go the statistically small risk of having your drug use identified, and in would come the certainty that staff would identify which prisoners were using which drugs, and with what frequency.

Recent research evaluating the effectiveness of drug treatment in the community has found that when treatment is aligned with regular drug testing, coupled with proportionate, certain, and swift sanctions for those testing positive, the treatment itself becomes much more effective.

There will be those who will object to any suggestion of using drug testing to try to stem the demand for drugs within prisons. Yes it will be expensive, but so too is the current investment in a security system of drug searches and drugs surveillance that is failing to stop drugs getting into prison. There is an analogy here with our capacity to tackle drink driving. We could provide all the education and all the counselling in the world, discouraging drivers from drinking alcohol, but the game changer in tackling drunk driving was the breathalyser – the capacity to ask a driver to blow into a tube and get an immediate read-out of his or her alcohol consumption. It was the certainty of that measure and the knowledge of the punishment that would follow that enabled us to tackle the problem of drunk drivers.

Effective prison-based drug treatment and rehabilitation could become the norm rather than the exception, and we would have made a major advance in tackling our drug problems within wider society. The alternative? Continuing costly investment in a system that fails to stop drugs getting into prison, and continuing costly provision of prison-based drug treatment that is undermined as a result.

Professor Neil McKeganey is director of the Centre for Drug Misuse Research, Glasgow. A sociologist who has carried out research on tackling drug problems in Scotland over the last 25 years, he is currently carrying out research evaluating the effectiveness of drug treatment within UK prisons.

Recovery in action

Features

By

DDN

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April 14, 2015

Dear Albert’s Jon Roberts talks to DDN about film screenings, mutual aid facilitation, and their new, innovative recovery programme

DDN: Dear Albert – it’s a great name, where did you get it?

DA: It’s part of the story – if you want to know more, then you best see the movie!

DDN: Can you tell us anything about the film?

DA: Well, after the world premiere at the Calgary International Film Festival, it’s now available for UK screenings. Nick Hamer from Intrepid Media began the project over four years ago with backing from Sarah Hancock-Smith from LIFt (formerly Leicestershire and Rutland Probation Trust).

Whether launching an initiative, making recovery more visible in local areas, or bringing associated sectors together, the shared experience of such an emotional and homegrown recovery film really illustrates what’s achievable, while capturing the fragility of the journey. We want the Dear Albert film to bring different approaches within the field together.

David Best kindly invited us to play the film to support the launch of the Sheffield Addiction Research Recovery Group, and it was fantastic to witness the great work going on there. The film went down a storm when hosted by Coventry Recovery Community recently, and there is a promotional screening at UKESAD this May.

Greg Williams, who made The Anonymous People, said that the film ‘humanised the essence of recovery in such a deep way’ and it was wonderful to read that.

If you go to www.dearalbert.co.uk, you can have a look around our website – and book a screening from there.

DDN: We hear Dear Albert is also involved in creating its own recovery programme.

DA: Well, that’s really what I want to talk about and why we decided to be involved in one of DDN’s promotional features. The organisation Dear Albert is a social enterprise, governed with the support of a voluntary board made up of people living in long-term recovery themselves.

Our new peer-led programme is called You do the MAFs (mutual aid facilitation sessions) and we want as many people to start looking at this as possible. It’s a successful approach, with completers having experienced mutual aid for themselves, leaving the programme with a clear understanding of how different mutual aid approaches can help.

You do the MAFs facilitates meaningful engagement and empowers participants to make the right decisions.

DDN: How does it work?

DA: After several years’ hard work, the programme has brought a number of different facets together. Sitting

alternative philosophies side by side in

a therapeutic setting invites exploration, with participants facilitated into deciding for themselves how best they can resolve their substance misuse problem.

The six-week programme is completely peer-led, has a great incentive package and introduces participants to existing recovery communities and other positive social networks.

Obviously, it helps that the sessions are run and managed by those living a life of abstinence-based recovery themselves. The achieved objective is to promote abstinence-based approaches, making recovery the viable option from the very beginning of treatment and instilling a sense of personal responsibility for getting well.

A six month evaluation by Phoenix Futures’ research department has recently been completed and is undergoing peer review to be published in a top academic journal, co-written by King’s College London. How cool is that? The findings of this comprehensive review highlight how the programme really works, with impressive figures to match. The support of Phoenix Futures has been really valuable in getting this initiative up and running, and we now want others to take advantage of this great programme.

To see the Impact Report, and for more information, visit www.dearalbert.co.uk

www.facebook.com/DearAlbertRecovery

Off the record

Features

By

DDN

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April 14, 2015

A frontline drug worker, once a service user himself, warns against being taken in by the politicians’ promises

I grew up in a northern town and got into drugs the same way most people do, and by 25 found my heroin addiction too much. After six home detoxifications and one hospital admission the penny dropped that I was very ill and needed to stop using, which I did. Naltrexone played a part in this and a good structured daycare service allowed me to understand my addiction and reassess what I wanted out of life.

I started volunteering at my service doing art sessions then facilitating relapse prevention sessions. The service liked my work and after a lot of hard work found funding for a one-year part-time trainee drugs worker post, which I completed. Eventually I ended up running the structured daycare programme full time and did this for many years, after which I temped all over – inpatient detoxification unit, prescribing/dual diagnosis service, DRR service, prescribing and more.

My current post is working in a dual diagnosis/prescribing service in a rundown northern city where heroin is still the drug of choice, despite national trends, and I want to share my thoughts on the things I see and hear as a frontline drug worker. IDS and the DWP do not care about drug users. They do not care about ‘the methadone industry keeping people addicted’. What they care about is money, full stop, and this war on the methadone industry will give no alternative other than dealer supply. But at least the dealers can cover the phones 24/7 when services are usually stuck with 9 to 5.

In my opinion the only way to move forward is to keep working with people on all fronts of addiction. NA, structured daycare that moves to volunteering and education, and even prescribing services all have their place in helping people move forward.

If we are not careful to appreciate our services IDS will say they are not fit for purpose and we will be back to the mid ’90s – from what I hear prisons are already at mid ’90s standards. Yes drugs are continuing to change, but drug use is increasing while service provision is reducing, so please don’t buy into politicians telling you that you deserve better while taking away the little you have.

Something to get off your chest? Share it ‘off the record’ by emailing the editor, claire@cjwellings.com

New approaches to alcohol

Features

By

DDN

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April 14, 2015

The management of alcohol as a consumer product, a health risk, and as part of our economy raises different challenges, to be tackled by a European conference. Andy Stonard explains

The European Alcohol Conference, to be held in London later this month, offers an opportunity to both think and learn, exploring different attitudes and practice in dealing with alcohol. It’s a timely event, given the current developments around alcohol policy, with local areas exploring their ability to influence the situation.

As senior policy manager at the London Drug and Alcohol Policy Forum (LDAPF), who are hosting the event, David Mackintosh is familiar with the challenges involved in addressing alcohol-related harm. ‘With a few honourable exceptions it has remained in a narrow policy silo for this whole period, despite alcohol harm being a significant factor across many priority policy areas,’ he says. ‘There are now some glimmers of a more holistic approach and a realisation that it’s not a peripheral issue that only relates to a small minority.’

There is a growing body of research and experience that can help to inform our responses to alcohol, but we need to work to bring these together and provide a coherent approach that is understood and supports our communities. Too often responses are characterised by one-off initiatives or approaches that are known to be ineffective.

Through this conference, we hope to combine the latest research and thinking alongside practical delivery from differing settings. We want to consider the political, cultural and environmental factors that have a significant bearing on how we manage alcohol, and provide support and inspiration for those working to reduce drink-related harms.

Andy Stonard is author of A Glass Half Full: Drinking – reducing the harm

European Alcohol Conference: Comparing and contrasting practice across Europe, 24 April. London. For details and booking, visit this link.

Local news from the substance misuse field

Features

By

DDN

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April 13, 2015

DDN takes a look at local news from the substance misuse field across the country

Drugs worker to run London marathon

A drugs worker based in Somerset will be running the London marathon to raise money for Addaction.

Ex service user Joe James, who has been in recovery for five years, has been working as a substance misuse practitioner for 18 months and runs regularly as part of her recovery. She aims to raise money to support the services that helped her during her treatment.

‘A drugs service kept me alive and offered me hope when I didn’t think I had any,’ said James. ‘I’m so passionate about raising as much money as I can for this cause. It’s a personal mission.’

To sponsor Joe visit www.justgiving.com/Joey-James

Southwest project raises legal high awareness

A new project has been launched by Addaction in Cornwall to offer advice on the risks associated with new psychoactive substances.

To raise awareness, the project will put up posters about the side effects of legal highs, and a series of drop-in sessions and workshops will be held to offer factual information and advice on preventing harm, and answer the questions of anyone seeking help.

Addaction Cornwall has also created a Facebook group to provide online support.

‘There are so many myths about these new substances,’ said operations manager Darren Jones. ‘This project will bring the facts to people’s attention so they know all about the dangers and risks involved and hopefully make safer choices.’

Humbercare Changes work recognised

Humbercare Changes staff were recently recognised for their work at an event held at the House of Commons.

Parliamentary under secretary of state for public health Jane Ellison thanked Changes staff members David Reade and Adele Birbeck for their work in supporting public health.

Birbeck was also recognised for her efforts in working with and supporting families.

Mental health charity organises election hustings

London Cyrenians will be organising a series of mental health hustings in London in the run-up to the general election.

Working with Westminster Mind, K&C Mind, and Hammersmith and Fulham St Mungo’s Broadway, Cyrenians have created the ‘I’m In!’ events with the aim of raising awareness and increasing political empowerment for those in mental health treatment across London.

Representatives from the Conservative, Green, Labour and Liberal Democrat parties will be present at each event.

For more information, contact camstreet@cyrenians.london

New Brighton service opens

A new drug and alcohol service opened in Brighton this month, offering a drop-in service and 24-hour helpline to support local service users.

Launched on 1 April, the Pavilions Partnership, led by Cranstoun, worked closely with Surrey and Borders NHS Partnership Foundation Trust, Equinox, the Brighton Oasis Project, YMCA Downslink and Cascade Creative Recovery to develop a service that would respond to the needs of service users in Brighton.

Pavilions will offer street outreach and hostel in-reach teams, and specialist and dedicated support for families, carers, and women with specific needs.

Drugs manager retires after 26 years of service

Steph Noble, registered manager at Broadway Lodge, retired this month after 26 years of commitment and dedicated care to the charity’s clients. Over her career she has supported more than 13,000 individuals during their journey towards abstinence.

Broadway Lodge CEO Brian Dudley presented Noble with a present and plaque in appreciation of her years of work.

Local residents to influence public services

Southampton residents are being invited by the council to take part in local decision making by joining Southampton’s People’s Panel.

The aim of the panel is to influence how public services are delivered, as well as highlighting issues that need to be addressed, and will help Southampton City Council and Southampton City Clinical Commissioning Group (CCG) to meet the needs of local residents.

Anyone over the age of 18 is invited to join the panel.

For more information, visit http://www.southampton.gov.uk/council-democracy/have-your-say/peoples-panel-questions.aspx

‘Worsening financial situation’ leads to closure of DrugScope

News

By

DDN

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April 13, 2015

DrugScope trustees have taken the decision to close the organisation, based on its ‘worsening financial situation’. Founded 15 years ago from a merger between the Institute for the Study of Drug Dependence (ISDD) and the Standing Conference on Drug Abuse (SCODA), the charity has long campaigned for evidence-based treatment and against stigma and discrimination.

‘It is with a heavy heart that the board has taken this extremely difficult decision,’ said chair Edwin Richards. ‘I am saddened for DrugScope members whose support for the organisation has been at the heart of its work and governance. The focus going forward is on ensuring that the mission is carried on by other means.’

The charity provided ‘an important voice for those working in the drug and alcohol sectors’ and proved ‘an authoritative and influential contributor in Whitehall and Westminster’, said the Guardian, which went on to praise its ‘topical, non-judgmental and evidence-based approach’, while Turning Point chief executive Victor Adebowale wrote that the closure risked creating a vacuum that would be ‘a blow for all of civil society, not just for social care’.

The decision to close DrugScope would not affect the Federation of Drug and Alcohol Professionals (FDAP), stated chief executive Marcus Roberts.

‘I would like to take this opportunity to thank staff – past and present – for all their exceptional hard work and loyalty which has ensured DrugScope’s high reputation within the sector and beyond,’ he said. ‘It has been an immense privilege to lead such a skilled and dedicated staff team. I’d also like to thank all those who have worked as DrugScope trustees – now and over the years – for their support for the organisation and its mission.

‘DrugScope has had the opportunity to represent the exceptional individuals and organisations who support individuals and communities affected by serious drug and alcohol problems,’ he continued. ‘This is one of the most marginalised groups in our society and the work of the drug and alcohol sector saves and transforms lives and plays a critical part in creating safe and healthy communities.’

‘More than 50’ cocaine cutting agents identified

News

By

DDN

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April 13, 2015

More than 50 cutting agents have been identified in cocaine, including some that can cause ‘serious medical harm’, according to a report from the Advisory Council on the Misuse of Drugs (ACMD). Although cocaine powder remains the second most commonly used illegal drug, use levels have been on a ‘general downward’ trend since 2009, says Cocaine powder: review of the evidence of prevalence and patterns of use, harms and implications.

The council initiated the review partly because of concerns over perceptions ‘that the drug is “safe”,’ it says, with even infrequent use carrying the risk of ‘acute health problems such as cardiovascular issues, temporary psychotic symptoms and convulsions’. The review’s conclusions are similar to previous reports in finding evidence of a two-tier market, with most of the cocaine powder available ‘of very low purity’.

Among the document’s recommendations are that commissioners ensure that cocaine treatment services are accessible and sufficient to meet local needs, and that more is done to develop assessment and brief intervention models for use in generic settings.

‘Once characterised as the preserve of wealthy bankers and celebrities, the research highlighted in this report shows a cheaper, low-purity version of the drug has permeated society far more widely,’ said ACMD chair Professor Les Iversen. ‘Given the clear health risks associated with even infrequent cocaine use, and associated issues such as dependency and crime, this development has posed a huge challenge to health professionals, law enforcement, educators and academics.’

Fedotov calls for ‘evidence-based’ practices

News

By

DDN

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April 13, 2015

Evidence-based practices are the best means of preventing and treating drug misuse, said UNODC chief executive Yury Fedotov in his closing message to the 58^th Session of the Commission on Narcotic Drugs (CND) in Vienna. It was vital to ‘remove the damaging influence of ideology’ and instead provide help ‘solely on the basis of science and research’, he said.

The nine-day event saw 11 resolutions passed on issues including protecting young people from online sales of NPS and blocking ‘financial flows’ linked to drug trafficking. Harm Reduction International (HRI), meanwhile, used the CND to launch its ‘10 by 20’ campaign, which wants to see governments redirect 10 per cent of the money they spend on the ‘war on drugs’ to harm reduction by 2020.

‘Harm reduction interventions are low cost but have remarkably high impact, keeping HIV infection rates low among people who inject drugs and saving lives and healthcare costs,’ stated the organisation. ‘Yet many countries still do not provide harm reduction and global funding, for it amounts to just $160m – only 7 per cent of what is needed. By contrast, each year governments spend over $100bn waging an ineffective war on drugs.’

A call to redirect resources from the war on drugs to harm reduction at www.ihra.net

‘No let up’ on legal highs, says government

News

By

DDN

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April 13, 2015

The government has initiated a range of measures as part of its stated aim to tackle new psychoactive substances (NPS). Along with the banning of synthetic opiod MT-45 and stimulant compound 4,4’-DMAR as class A drugs, the Home Office has published new guidance for police and local authorities detailing the action they can take against ‘head shops’ and has also written to music festival organisers about NPS ahead of this summer’s festival season.

The banning of the two substances is ‘part of a concerted range of action’ to respond to the challenges posed by NPS, said the Home Office. The government would also be establishing a clinical network to help share intelligence, it said, and was ‘developing proposals’ for a general ban on the supply of NPS across the country.

The country-wide ban would ‘give law enforcement greater powers to tackle the NPS trade as a whole, instead of a substance-by-substance approach’, said crime prevention minister Lynne Featherstone. ‘I will be working right up until the dissolution of Parliament to ensure we have done as much as we possibly can to pave the way for a general ban.’

Meanwhile, two new NPS a week were detected in the EU last year, according to the latest update from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). More than 100 new substances were reported to the EU Early Warning System (EWS) in 2014, up from 81 the previous year. Most were either synthetic cathinones or synthetic cannabinoids.

More than 450 substances are now being monitored by EMCDDA, more than half of which were identified in the last three years. ‘New psychoactive substances can move quickly from obscurity to infamy and cause serious harm,’ said EMCDDA director Wolfgang Götz.

Head shop guidance and letter to festival organisers at www.gov.uk

New psychoactive substances in Europe at www.emcdda.europa.eu

News in brief

News

By

DDN

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April 13, 2015

Cocaine cutting agents

More than 50 different cutting agents have been identified in cocaine, including some that can cause ‘serious medical harm’, according to an ACMD evidence review. ACMD initiated the review because of concerns over ‘increased consumption and a perception that the drug is “safe”,’ it says.

Evidence is best

Evidence-based practices are the best means of preventing and treating drug misuse, said UNODC chief executive Yury Fedotov in his closing message to the 58^th Session of the Commission on Narcotic Drugs (CND) in Vienna. Harm Reduction International (HRI) used the event to launch its ’10 by 20’ campaign, which wants to see governments redirect 10 per cent of the money they spend on the ‘war on drugs’ to harm reduction by 2020.

Government looks to ‘general ban’ on NPS

The government is ‘developing plans’ for a general ban on the supply of new psychoactive substances across the country, according to crime prevention minister Lynne Featherstone. The announcement was made as the Home Office outlawed two more substances – synthetic opiod MT-45 and stimulant compound 4,4’-DMAR – as class A drugs.

Social worker guide

The first national guide for social workers on working with people experiencing drug and alcohol problems has been launched by Manchester Metropolitan University, the British Association of Social Workers and the College of Social Work. ‘Social workers specialising in adult and children’s social work practice are working regularly with people with substance problems, be it alcohol, other drugs or a combination of both,’ said the guide’s author Sarah Galvani. ‘As a profession we’ve not equipped them adequately for this work. They need clarity about what their role and remit is and how their supervisors and managers can support them.’ Alcohol and other drug use: the roles and capabilities of social workers available at www.mmu.ac.uk

Funding fears

The areas with the highest levels of alcohol-related harm – often those with high levels of social deprivation – are also the most likely to be reducing funding for alcohol treatment, according to Alcohol Concern. Its Measures of change report looks at how the transfer of public health responsibility to local authorities has affected alcohol services. ‘Only 6.5 per cent of dependent drinkers access treatment in the UK which means that both treatment and prevention services need to be given clear prioritisation and investment, by all responsible agencies including clinical commissioning groups,’ said head of policy Tom Smith. Report at www.alcoholconcern.org.uk

Bereavement training

The pilot round of training for Adfam and Cruse’s drug and alcohol-related bereavement project is now open, the organisations have announced. Anyone who has been bereaved as a result of drugs or alcohol and would like to offer peer support to others going through the same thing is invited to get in touch, with initial training taking just two days. Details at www.adfam.org.uk

Online help

CRI has joined forces with digital healthcare provider Breaking Free for Breaking Free Online, an evidence-based internet treatment and recovery programme which covers nearly 40 substances. CRI can now ‘offer all its service users 24/7 access to confidential treatment and recovery support via the internet every day of the year’, says the organisation. ‘I’m very excited to see CRI embracing technology-enhanced recovery,’ said new technologies lead Michael Lawrence. ‘It is a comprehensive and adaptable tool that includes a range of evidence-based psychosocial interventions.’ www.cri.org.uk

Three drink risk

There is ‘strong evidence’ that just three or more alcoholic drinks a day can cause liver cancer, according to a report from the World Cancer Research Fund, which analysed 34 previous studies covering more than 8m people. ‘Until now we were uncertain about the amount of alcohol likely to lead to liver cancer,’ said fund director Amanda McLean. ‘But the research reviewed in this report is strong enough, for the first time, to be more specific about this.’ Diet, nutrition, physical activity and liver cancer at www.wcrf-uk.org

Prison problems

High levels of violence in a prison deemed ‘in crisis’ by inspectors are being driven by ‘the supply of drugs, particularly synthetic cannabinoids such as “Spice’’,’ according to a report on HMP Guys Marsh in Dorset. ‘I was told by prisoners and staff that they suspected gangs were threatening some prisoners to request a move to a different part of the prison so that they could then be forced to act as distribution points for drugs,’ said chief inspector of prisons Nick Hardwick. Use of new psychoactive substances is now seen as one the biggest problems facing the prison estate (DDN, February, page 6).

Stop strips

Release and stop and search campaigners StopWatch are urging the Home Office to make sure strip searches are only allowed as part of a stop and search when the ‘threshold of arrest’ has been met. ‘The use of strip search as part of a stop and search is an extremely intrusive power, often linked to the search for simple possession of drugs,’ said Release executive director Niamh Eastwood. Last month saw the launch of a comprehensive Her Majesty’s Inspectorate of Constabulary (HMIC) review into the use of stop and search.

Naloxone knowledge

A new information resource for naloxone campaigners, policy makers and service providers has been launched by the Naloxone Action Group (NAG). A range of useful documents on extending the use of naloxone in the community can now be found at nagengland.wordpress.com/key-documents

Stronger together

Substance misuse support organisation Aquarius has entered a formal partnership with the Richmond Fellowship mental health charity to strengthen services for people with mental health and substance problems, the organisations have announced. ‘Collectively we’re all passionate about being socially inclusive, person-centred and recovery focused,’ said Richmond Fellowship chief executive Derek Caren. Meanwhile, Action on Addiction has merged with COAP (Children of Addicted Parents and People). ‘We are delighted to welcome COAP to the Action on Addiction fold,’ said chief executive Nick Barton.

Comment from the drug and alcohol field

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April 13, 2015

The DDN letters and comments page, where you can have your say about the drug and alcohol sector.

To be included in the next magazine, send your letters and comments to claire@cjwellings.com or to 57 High Street, Ashford, Kent TN24 8SG. Letters may be edited for space or clarity – please limit submissions to 350 words.

Challenging times

My biggest challenge, as an addict who has been off drugs for over seven years now, is coping with the entourage – or let’s call them friends or drug friends. Some are still in active addiction, some are still seeking help, others (sadly) are still in denial. I’m struggling with my unconscious need to want to help however I can, and I forget that this kind of change has to come from within.

I find myself preaching abstinence when I know how that makes me look and sound, as I remember people and family and drug workers looked like fake priests to me, who didn’t even believe what they were preaching. Not to mention that my own journey, and my responsibility towards myself, should dictate staying away till someone wants, from the bottom of their soul, my hand for that first step in admitting that help is what they sincerely want and need.

Hence I’m off preaching and I try to lead by example. Maybe that’s the best help I can provide – showing them that I’ve done it, and that what one individual can do, another individual can do too, with the right environment, the right help and above all, the willpower to take a life-changing decision.

Aboudi Naboulsi

Russell Brand: help or hindrance?

I wonder how many DDN readers watched the documentary of Russell Brand commenting on the drug war (End the Drugs War, BBC 3). Word on the street is that outspoken ‘recovering (or not) folk’ were not happy about the content, and others were just grateful that said issues are getting any airtime at all. One articulate morphine-scripted friend said, ‘the problem is that the message he gives makes it OK for treatment providers to radically reduce harm reduction services’, and that should worry us all at a time where overdose deaths have doubled in the UK and the government is planning to build more private prisons.

To give credit where it is due, Brand is an ardent advocate for ending the war on drugs and in his book Revolution he gives a whole page to recommendations that demand nobody ever be charged or arrested for mere possession of (currently illegal) drugs. For that I, for once, am grateful. On the other hand, he doesn’t seem to get the critical importance of services which provide active users with drugs and even safe, clean places to take them. His comment about the Zurich drug consumption room initially infuriated me – that it was the ‘beginnings of quarantining’ – but then I wondered whether he was simply expressing profound fear; after all, he is off drugs, but oddly exposed himself in the Zurich DCR to heroin, even smelling a fellow ‘addict’s’ silver foil.

His drug policy activist self is a few years old: he is in early adolescence, as it were. So I can understand why hardcore harm reducers have trepidation about him being our current spokesperson. I say we give him time.

Just a thought.

Andria Efthimiou-Mordaunt

Twelve-step success

We should all be indebted to Rowdy Yates for his excellent letter in your February edition.

As Rowdy indicated, in the UK we constantly find that the biggest barrier to public, press and political support for successful training is the false idea sold by the psycho-pharm commercial interests to politicians, when 60 years ago they were told ‘we recommend opioid substitution therapy in the form of prescribed daily methadone doses, to be supplied free to addicts and paid for by taxpayers, because addiction is basically incurable.’

That ‘sales talk’ was swallowed hook, line and sinker by press and politicians everywhere, who have since so often repeated it that they have no wish to now lose face by contradicting themselves.

This false ‘incurable’ impression is unfortunately reinforced by the one to three years it takes well-meaning 12-step practitioners to achieve a 20 to 30 per cent lasting abstinence result – especially as, on a residential basis, it seldom if ever meets the 12 months free of addiction requirements of payment by results.

However, those low percentage, long-winded 12-step results should not, for two reasons, be sneered at because they don’t deliver on a PbR basis. One, because not-for-profit fellowship does not need payment by results to survive, and two, because we know that ARTS’ initial drug-free ‘withdrawal procedures’ can both shorten 12-steps’ duration and improve the number of successes.

Ken Eckersley, CEO Addiction Recovery Training Services (ARTS)

Drug use in prisons

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April 13, 2015

No hiding place