With a general election that could shape the sector for the next five years and beyond now looming, DDN looks back on another dramatic year in the drugs field 

JANUARY

The year kicks off with the government announcing that its ban on the sale of below-cost alcohol is to come into force in the spring. The legislation is instantly derided as ‘laughable’, ‘confusing’ and ‘close to impossible to implement’ by Alcohol Concern chief executive Eric Appleby, whose organisation – along with many others – still wants to see minimum pricing instead. Alcohol charity Drinkaware, meanwhile, announces ‘radical’ changes to its governance arrangements following an independent audit and criticisms over industry links.

FEBRUARY

DDN’s national service user conference chalks up a seventh successful event with Make it happen! in Birmingham – ‘emotive speakers with real passion and drive’, says PHE. As Russia prepares for the Sochi Winter Olympics, activist Anya Sarang tells DDN about the stark consequences of her country’s ongoing opposition to opioid substitution therapy, and crime prevention minister Norman Baker accepts the ACMD’s recommendation that ketamine be reclassified to class B. Worryingly, more than a third of services surveyed for DrugScope’s State of the sector report say their funding decreased in the previous year, while Nick Clegg tells the Observer that ‘if you’re anti-drugs, you should be pro-reform’ and there’s shock as actor Philip Seymour Hoffman becomes the latest high profile drug casualty.

MARCH

MPs demand action on liver disease, warning that ‘today’s complacency is tomorrow’s catastrophe’, with deaths increasing by a staggering 40 per cent in the space of a decade. Activists still have Russia in their sights as they warn that its annexation of Crimea means that the peninsula’s drug users are now at the mercy of its ‘highly repressive’ and ‘deeply punitive’ approach, while harm reduction organisations brand the joint ministerial statement issued at the UN’s Commission on Narcotic Drugs (CND) in Vienna a ‘capitulation’ to hardline states.

APRIL

A hard-hitting report from Adfam says that children are being put at risk by a lack of proper safeguards around OST prescribing, while NICE says needle exchange services need to do more to support users of performance-enhancing drugs. Meanwhile, Stanton Peele casts a critical eye at the 12-step approach in the pages of DDN. ‘Like carp infesting a lake drive out other species, AA and 12-step treatment rule out other, often more effective approaches,’ he writes, ensuring a full-to-the-brim letters page in the following issue.

MAY

Positive trends in the use of long-established drugs risk being overshadowed by the relentless increase in new synthetic substances in an ‘increasingly complex and damaging’ drug market, says a comprehensive report from EMCDDA. PHE figures showing a continuing fall in the number of opiate and crack users leave ‘no room for complacency’, agrees the agency’s Roseanna O’Connor, and home secretary Theresa May announces an overhaul of stop and search following Release’s damning report from last year.

JUNE

Turning Point’s medical director Dr Gordon Morse writes that it’s time for commissioners to start considering ‘evolution over revolution’ in DDN, while more than 100 cities worldwide see demonstrations as part of the Support. Don’t Punish campaign for more humane drug policies.

JULY

The government’s announcement of a new set of pledges as part of its controversial ‘responsibility deal’ with the drinks industry leaves health campaigners unimpressed, while new figures show rates of drug use among secondary school pupils ‘considerably lower’ than a decade ago.

AUGUST

Scottish drug-related deaths fall by 9 per cent, after two years of record high figures, with the Scottish Government pointing to the success of their take-home naloxone programme. Legislation finally comes into force allowing drug services to provide aluminium foil, and an all-party group of MPs calls for health warnings to be put on all alcohol labels. There’s also a sure sign that things are changing when a Sun editorial says it’s time for a rethink on drugs policy.

SEPTEMBER

In contrast to last month’s encouraging news from Scotland, a sharp rise in drug deaths in England sparks alarm in the field, with DrugScope expressing ‘serious concerns’. The CQC sets out its new approach to inspecting drug and alcohol services and promises the sector that it will ‘focus on the issues that matter’, while the annual UK recovery walk hits number six in Manchester.

OCTOBER

The Home Office’s study of international drug polices finds ‘no apparent correlation’ between the toughness of a country’s approach and levels of use, setting off a media frenzy, and crime prevention minister Norman Baker accuses the government of ‘suppressing’ the document, which has been ready for months. Less than a week later he resigns, stating that working with home secretary Theresa May was like ‘walking through mud’.

NOVEMBER

Fewer than half of those infected with hepatitis C know they have the virus, warns PHE, with around 90 per cent of the 13,750 hepatitis C infections diagnosed in the UK in 2013 acquired through injecting drug use, while the ACMD rejects the concept of time-limited substitution treatment. ‘There’s still an appetite in bits of government to re-ask the question about time-limited methadone, but the evidence remains the evidence,’ ex-NTA chief Paul Hayes tells DDN. Right on cue, Iain Duncan Smith pens a Sunday Telegraph piece under the headline Now fight the methadone industry that keeps addicts hooked. Finally, DDN celebrates its tenth birthday with a special anniversary issue. ‘I thought they’d taken leave of their senses,’ writes ex-FDAP chief Simon Shepherd of the time DDN’s publishers told him they’d quit their jobs to set up the magazine.

DECEMBER

As DDN looks to its 11th year, preparations are well underway for the next service user involvement conference, The challenge: getting it right for everybody, in Birmingham next February. See you there!

Many things have changed over the last decade for the DDN team – staff, premises, and even the introduction of canine office mascots. But after ten years, everything still comes together on the magazine’s press day.

 It’s half past eight in the morning on the last Thursday of the month – the lights go up, the kettle goes on, and things are kicking off for another DDN press day. 

Throughout the last month, the team has been pulling together the different strands of the magazine, all the while juggling a number of other projects – some related to DDN, and some completely distinct from it. 

Claire, Kayleigh and David have been working on the editorial features, Ian and Annie have been pinning down advertising leads, and Jez has started the designing process for the upcoming issue. 

Today is the culmination of all of this effort – but there’s still plenty of work to be done. Jez prints out the features he has already created on Quark Xpress, and David gets to work proofing them for grammar, factual errors and anything else that is out of place. 

Claire uses the morning to read and edit any editorial that has come in past the deadline, as well as summarising her thoughts on this month’s issue for her editor’s letter. There is always some zero-hour fact to be checked or author headshot to be chased in – and Kayleigh’s morning is usually spent tying up loose ends. 

Meanwhile, Annie updates the mailing list – removing addresses that no longer need the magazine, and adding new subscribers. After ten years, DDN is still a free, self-funded publication, but we do ask that organisations pass copies around and share the magazine to help us keep costs down.

When Jez isn’t creating editorial pages, he and Ian work together to set adverts, so that our advertisers can see a proof before we publish the magazine – we want to offer everyone who advertises with DDN the best customer care we can provide.

Lunchtime arrives, and we’ve still got a long afternoon ahead of us – what’s on the menu can make or break the day. Publishing pups Ziggy and Bella go for a much-needed run (they’ve had an exhausting day of supervising the office, after all) and owners Claire and Ian pick up the team lunch order from the local sandwich shop on their way back. The team dig in to well-deserved sandwiches – the only quiet part of the entire day.

The afternoon rolls on, and Jez prints out the last few pages of the magazine to be proofread by David. Kayleigh is the next in line for the proofing process, making any changes that need to be made to each article, and giving them a second read-through.

Amendments to adverts are made – occasionally we get a last minute booking that we weren’t expecting, which is always a good problem to have. Ian creates an ad list for every issue, so that he knows what advert will go on what page. He works with Claire to decide what size each issue will be, depending on how much advertising we get and how much editorial there is, and finally Claire creates a flatplan for each person to work from.  

We’ve always been a small team, so press days usually entail a fair bit of multi-tasking for everyone. No hands are left idle, and it’s important that we keep our channels of communication open so that, even with several plates spinning at the same time, no mistakes are made. 

When all the editorial pages have been proofed and corrected, Claire has her final check through them before she signs off the editorial – Jez can then prepare them to be sent to our printers.

The day draws to a close, and the DDN team breathe a sigh of relief… until the next morning anyway, when the advert pages of the magazine are also finalised and prepared to be printed. Ian will take adverts right up until the end of the day – we depend on advertising to fund every issue, so every advert counts. Our accounts whizz Chrissie will then create invoices for all of our advertising clients, and get them out of the door with a hard copy of the magazine. 

In the afternoon, Annie makes recruitment and tender adverts live on the website – being featured online is part of the package when someone buys a print advert. Kayleigh prepares the editorial features to go up on the DDN website after the weekend – along with the virtual magazine – just in time for when the printed magazine will start landing on the desks of our faithful readers.

And just as you’re opening up your latest issue, we start thinking about the next.  

Let us know what you want from your magazine! 

Visit www.drinkanddrugsnews.com to complete our readers’ survey – and for your chance to win a £50 Amazon voucher.

Three sector stalwarts, who were there at the start, look back at the birth of DDN 

When they threw everything into DDN I thought they’d taken leave of their senses, says Simon Shepherd

Back in the early summer of 2004, as director of FDAP, I’d agreed to meet two people from a public health magazine to discuss the idea of a special issue on substance misuse. We were due to meet in a hotel in Brighton, where I was based and they were covering a conference, but I couldn’t find them (it turns out they’d been just around the corner!). It was a lovely day and on the way back to the office I stopped for lunch by the beach. While I waited, they called and asked if they could join me there. I agreed but it soon became clear their company wanted money for their special issue, and that was never going to happen! 

As I got up to leave, they asked if I thought that there was a case for a regular magazine specifically about substance misuse and distributed free across the field. I sat down again. A couple of hours later we’d sketched out the bones of what it might look like, we’d even thought of a name, Drink and Drugs News, but in truth I couldn’t see how they’d make it work and didn’t really expect to hear from them again. 

When Claire and Ian called to say they’d decided to quit their jobs and throw everything into DDN I thought they had taken leave of their senses – but they were convinced they could make it work, and I agreed to help. 

Although we held regular meetings over the summer, I was astonished, when the first issue came out, by the magazine’s overall quality and the range of issues it covered. It’s amazing to think that all that was ten years ago now and, given the challenges they faced, that the magazine has not only survived but thrived in that time.

It’s hard to over-state the impact that DDN has had. While the Labour government set up the NTA in 2001 and committed significant funding to treatment, there really wasn’t much of a field back then. The sector was riven between two seemingly intractable camps, those committed to harm minimisation on one side, and the abstinence-based camp on the other, and there was little sense of substance misuse work as a profession. 

While I am not pretending that all is now rosy in the garden, there is a clear sense of the sector as a profession, and a shared identity which extends across the field as a whole. They obviously didn’t do it alone – I’d like to think, for instance, that FDAP played at least a small part itself – but DDN’s very existence, its comprehensive coverage of all aspects of substance misuse treatment, its commitment to editorial neutrality and the evidence base, and the outstanding quality of its writing, have all played a huge role. 

The success of DDN is of course all down to Claire and Ian, but I am glad we did eventually meet that day, or perhaps it would never have happened… 

Simon Shepherd, former chief executive of FDAP (now chief executive of The Butler Trust)

DDN started at a time of change, remembers Dr Chris Ford 

I can’t believe that DDN has been around for a decade – and haven’t they done a good job! I first met Claire at a conference just before publication of the first edition of DDN. We got talking and I instantly liked her. I was amazed that she hadn’t worked in this area before but she seemed to get it and there was born a great ongoing relationship, both with Claire and then the rest of the team. 

DDN started at a time of change and the magazine always kept us abreast of the changes. They always tried to present all sides of the argument, even at times when I wished they would be more biased! It was really exciting times for treatment in general practice (with the number of GPs involved in care of people who use drugs rising from below 1 per cent in 1994 to over 32 per cent of practices in 2012. This change was helped by the birth of SMMGP in 1995 (a network to specifically support primary care practitioners when there was nothing), our annual conference now in its 20th year, and RCGP training courses.

Claire and the team have always been a ‘can do’ lot – as a 90-year-old once told me ‘no such thing as can’t, you just take the ‘t’ off!’ So when I suggested a column about treating people in general practice called ‘Post-its from practice’, they were up for it. Then when the Alliance wanted to get to more people, the joint service user involvement conference was born, and is now in its eighth year. 

Although often uphill, everything seemed to be advancing until a government change, bringing with it a philosophy change. Recovery, as with any positive change and self-defined journey, is wonderful and we have always promoted that. But contracting services that provide ‘one size fits all’ and dramatically cutting budgets is not congenial to person-centred care, which for me is the only way possible. Set that in a climate of destroying the NHS and general practice, increasing privatisation of all treatments and the madness of constant re-tendering, and it feels a difficult time at the moment.

But I’m an optimist and there are so many amazing people both using and working in the sector I feel confident that things will again improve.

Thank you DDN for being there!

Dr Chris Ford, retired GP and clinical director of IDHDP

A letter from Prof David Clark, author of our hugely popular series of Background Briefings

Dear Claire and Ian,

Firstly, a huge congratulations for DDN’s tenth birthday! Can you fly me back for cake and champers?

Do you remember approaching Simon Shepherd (FDAP) and me (WIRED) all those years ago and asking whether we thought the DDN concept would work? Our answer was brief – ‘Yes!’ – and our enthusiasm obvious. Not that you needed much encouragement. You saw a niche and have taken DDN to where it is today.  

 I’d started WIRED (later Wired In) as a way of empowering people to overcome substance use problems at the end of the millennium. I left a successful 25-year neuroscience career and started working with real people. 

I knew that quality information and education was key to helping people recover and to improving addiction treatment. I knew that we needed to create hope and connect people.

 My colleagues and I started the news portal Daily Dose in 2001 and over the years a variety of other Wired In community based initiatives – personal stories, research, an online recovery community (Wired In To Recovery). Sadly, we always struggled for funding, so were limited in what we could achieve. Mind you, I’m very proud of what the Wired In team (Lucie, Kev, Sarah and Ash) achieved. 

One of my favourite activities was writing an educational column, Background Briefings, for DDN. It was fun and stimulating. I still remember Claire’s calls saying the deadline was an hour away! I was touched by the amount of positive feedback I received and still have each briefing in my study drawer.

Gosh, we had some good times then, didn’t we Claire and Ian? You were a very stimulating duet to work with… but I sometimes had to watch my health in the evening!

When I look back, the real highlight for me during this time was seeing people recover from their addiction. Their joy and gratitude was beautiful! So many of these people overcame great adversity… and then went on to help other people. Amazing!

They were exciting times and I feel really proud being part of that early recovery advocacy movement in the UK. Mind you, they were tough times as well, because there was shit flying around. The addiction care system is very resistant to change, in part because of vested interests. Ironic really, when people working in and overseeing the system were being paid to help people with addiction problems change their behaviour!   

For those of you wondering what I am doing now, I took early retirement from Swansea University in 2006 and moved to Perth, Australia in 2008. Last year, I started Recovery Stories (www.recoverystories.info) and Sharing Culture (www.sharingculture.info). The latter is focused on helping indigenous people in Australia (and further afield) overcome historical trauma and its consequences.

I am very excited by this latter project. It will be my toughest challenge, but I know that my close colleague, filmmaker Michael Liu, and I can make something happen if we can attract funding. I am appalled at the way that indigenous people in Australia are treated – and what they still go through – and I am very determined to help make a difference. They are beautiful people and their culture special. 

Maybe I can do another DDN Background Briefing one day?

Professor David Clark’s Background Briefings are available in our back issues in the magazine archive.

One of the key figures in the story of drug treatment in England, ex-NTA head Paul Hayes talks to David Gilliver for DDN’s tenth anniversary issue. 

Paul Hayes was chief executive of the NTA from its inception in 2001 until the agency’s functions were taken over by Public Health England last year. He now works with a range of voluntary sector organisations including DISC, the Cyrenians and Family Action and is an honorary professor at the London School of Hygiene and Tropical Medicine. 

Prior to the NTA he’d worked in the probation sector for almost 30 years, and was chief executive of the South East London Probation Service when he was asked to put himself forward to be chief executive of the new organisation. 

What attracted you to the NTA job?

‘There are two aspects. I’d led on drug and alcohol policy for the Association of Chief Officers of Probation for a number of years and I was working in Southwark when the first heroin epidemic hit, so I was acutely aware of the change in the environment – it was an issue that I was confronted with on a daily basis.

I was given a job developing drug policy for the probation service in London, and then when I became a chief I was given the national brief, so I’d worked in drug policy for many years before the NTA was created, and it was put to me that this might be a good thing for me to do. On a less positive note, the probation service was being restructured at the time and my job was being abolished, so in personal terms it wasn’t much of an ask – it was either the NTA or the dole.’ 

The NTA improved access, cut waiting times, oversaw reductions in drug-related deaths. How big was the difference it made to treatment in this country? 

‘Immense, absolutely immense – I firmly believe that. If you go back to the Audit Commission’s 2002 report, Changing habits, it describes the treatment system before the NTA was created. People waiting months, very early drop out, and what you got was what that particular service believed in – one of the things that report talks about is inconsistency in treatment and how it’s belief-driven rather than evidence-driven. But the most important thing really wasn’t the NTA, it was the money. 

The Blair government chose to invest an awful lot of money in drug treatment. Central government spend went up from £50m a year to about £400m – that was the direct spend, the criminal justice money was on top of that – and the real reason for the creation of the NTA was that Jack Straw, who was home secretary, basically didn’t trust Alan Milburn, who was health secretary, to spend the money on drugs if it was just given to DH. They wanted a new outfit to ride shotgun on it, so they created a quango jointly owned by DH and the Home Office primarily to oversee the money. 

We then decided to take on a best practice, performance management, commissioning oversight role to achieve that, but that wasn’t set in stone and it was actually very difficult to achieve, because we cut across a lot of the pre-existing assumptions about how things should operate, within both health and the criminal justice system. We had to fight quite a lot of Whitehall battles, battles with the health bureaucracy and the criminal justice system and local authorities, in order to create that space. But a lot of that comes back to the money. If you’re dangling cash around you’re given an awful lot more licence than if you’re not – “we want you to do all this new stuff, by the way here’s 400m quid to do it”. That makes life a lot easier.

So the performance management stuff was important, the leadership stuff was important, identifying best practice was important. But without the money, and the government’s commitment to spend the money – Gordon Brown’s money, Tony Blair’s leadership – we wouldn’t have got anywhere.’ 

Do you think Tony Blair’s contribution is something that’s acknowledged?  

‘Everybody hates Blair, but I think there may be different views in a different generation. From my point of view, leaving foreign policy aside and just focusing on drugs, the drug treatment sector does owe Blair a great debt – the central direction we got, particularly as a cross-cutting issue. Drugs wasn’t important enough to any one of the government silos to actually deliver it. It wasn’t important to DH, which is why Norman Baker’s call for drug policy to go to health would be a mistake, in my view – it doesn’t kill enough people and it doesn’t make enough people sick. As far as they’re concerned, drugs is very small beer, and it’s smaller now because it’s largely been capped off. It’s nowhere near as significant as tobacco, obesity, alcohol, cancer, dementia – if you’re running the NHS, how much attention are you going to pay to drugs? 

If you’re running the Home Office you’re rather more interested because of the drugs/crime link, but it’s still not top of your list of priorities – it’s one thing among many. If you’re interested in welfare dependency then it plays a role, but unless you’re Iain Duncan Smith it isn’t going to be near the top of your list of priorities either. So it matters at about the 5 per cent level to about half a dozen different departments, but not enough to any of them to really give it some oomph. The only point in our system where cross-cutting issues really come to matter is at the centre of government – at No.10 – because that’s the only place where they have to own all these different 5 and 10 per cents that stack up to being a real issue. 

So you needed not only the money, but a government that was structured to drive things from No.10, and that was how Blair did stuff. Obviously all of that – targets, performance management – became deeply unfashionable, and I think it’s very interesting that Nick Clegg is now saying he’s taking mental health seriously because he’s imposing targets on the system. The Lib Dems and the Tories spent years castigating the previous Labour government for too much focus on targets and bureaucracy, so I think it’s very interesting that they’re now learning – as most governments do – that localism and absence of central direction is a great theoretical prospect in opposition but it’s no way to run a government.’ 

Overall, what do you think the NTA’s main legacy will be? You’ve mentioned before that it might well be the National Drug Treatment Monitoring System (NDTMS).

‘I think it is, and I think it’s important that that’s been retained in Public Health England, because you need to know what you’re doing, to account for what you’re spending your money on, how many people you’re treating – heroin users or ketamine users. The world changes and you need to keep abreast of that – are you doing as well with men as with women, are black people getting a fair shake, is the North East performing as well as London? If you’re not asking yourself those questions then you’re not really able to address what’s going on and improve it, and you’re letting service users down. And unfortunately, in order to do that, you’ve got to do boring stuff like keying in information, and it has to be collected in a consistent way.

James Brokenshire, when he was on the front bench in opposition, read out the NDTMS definition for waiting times, I think it was, basically to take the piss out of it, and all the Tory backbenchers were laughing their heads off. Well, five years in they’re still using it.’ 

On that note, how much of a change did you see when the coalition government came in? 

‘Much less than anyone expected. There was a change in attitude – the NTA immediately became the enemy within, because we weren’t ‘their’ NTA. The important thing from our point of view was to hold on until PHE came in, because it was ‘their’ Public Health England. So PHE, even though it continued the same policy, was a good thing, whereas the NTA was a bad thing.

But this happens to all governments – all of sudden you’re in charge of stuff. You’ve got a set of ideas you picked up from think tanks, you come into government and instead of being able to make broad statements about you’ll do this and do that, all of a sudden what you think and what you say actually matters and you’ve got civil servants saying, “here’s the reasons why the other lot did these things that you spent the last five years saying were stupid.” You start looking at them and you go, “maybe it wasn’t so stupid after all – maybe there’s a reason for that. We still think bits of it are bonkers or ideological, but other bits of it maybe make more sense.” 

So what you can do is say to them, “you want more people to recover – here’s the sensible way to do that. You want that to happen at the same time as drug-related deaths not going up, as keeping a lid on crime, here’s the bits of what the other lot were doing that it makes sense to keep, and here’s the bits you could sensibly change.”

We were able, with an awful lot of help from some very, very smart civil servants in the Home Office and DH to get the key ministers to see that it was actually in their departmental interest, and in the interest of the country as a whole and of service users, to keep much more of the existing package than anyone would have dreamt they were going to keep from the simplistic IDS/Centre for Social Justice pre-election line. The other thing that helped was that IDS didn’t play his cards very well within government and wasn’t able to persuade Andrew Lansley and Theresa May to go down his route.’  

How many of those achievements of the NTA under threat now, do you think? 

‘To an extent, everything’s under threat. NDTMS isn’t under threat instantly –the solidity of it was exemplified I think when Oliver Letwin agreed that it would be used as the basis for the payment by results pilot, so instead of being vilified it was co-opted. How long PHE continue to invest in it, and exactly where it goes, is another matter. 

But there are significant signs of disinvestment from local authorities. Some of that might be legitimate – seeking better value – because investment in the sector went up so rapidly that it’s impossible to say that it’s all been as well spent as it should, but there are limits to how far you can actually cut back. People will want to readjust between drugs and alcohol, people will want to spend on what I’ve previously called “narrow public health” – most of the benefits around drugs accrue in terms of crime, welfare dependency etcetera, which historically have never been very important to public health. Locating public health in local authorities should make it easier to make that argument, but there is a sense in which that success that you’ve acknowledged is largely invisible in the media and political circles.’ 

I was just about to come on to that.

‘So you’ve got Nick Clegg and his “failure in drug policy on an industrial scale” stuff, and while that’s the default position – while the left think we’ve got a failed war on drugs that will be solved by decriminalisation or legalisation, and the right think we’ve got a wrong-headed harm reduction-led policy when we ought to have abstinence – the only thing they can agree on is that we’re going to hell in a handcart. Which is the opposite of the reality.

I gave a lecture to a group of criminology students recently and the only thing they were interested in were the numbers I started off with, about the improvements in the system, the decline in use and the crime reduction. They were gobsmacked, they had no idea. They were saying, “What are your references for this?” and I said, “It’s the ONS – this is what the official figures say.” People just don’t know. It’s so locked into the media assumptions that it’s failed, and in a sense it becomes a sort of proxy space for left and right to have an argument. I think it’s even the case that because it’s working, because we’re not at the state of crisis we were at in the ’80s with HIV or the ’90s with escalating crime, to an extent that enables people to go back to their ideological corners and throw hand grenades at each other. If there was a real problem they’d roll their sleeves up and get it sorted.’ 

Do you think all that polarisation is starting to ease off at all? 

‘I think the polarisation in the sector – the harm reduction/abstinence wars – has calmed down. There’s still an appetite in bits of government to re-ask the question about time-limited methadone, for example, which in my time they asked four times and always got the same answer. They keep hoping they’ll finally find someone to tell them what they want to hear, but the evidence remains the evidence. 

What hasn’t calmed down is the ideological stuff about the legal status. But what I think will change things dramatically is what’s happening in Colorado, funnily enough. I think that will actually harden opinion against changing the law, because now we’re starting to ask detailed questions about how does a market work and how regulated can a market be. So rather than being theoretical these issues become real. I think people are very dubious about where Colorado’s going to lead.’

With the involvement of big business and so on?

‘Absolutely. I don’t think there’s a space in between prohibition and marketisation – that’s my gut instinct. You might be able to get there in Uruguay, when you’ve got government control of supply – a political impossibility here – but not in a European-wide free market. What is the space that enables you to have something that’s marketed but exerts real pressure on the producers not to maximise their market? We try to do it with tobacco, with alcohol but, particularly now with social media, I don’t know how you’d prevent viral marketing and so on. How do you stop bigger and bigger entities operating in the market and trying to get the number of people using their product up, when at the moment it’s falling? 

To come back to Clegg and his “failure on an industrial scale”, you only need to adopt a radical policy like decriminalisation if you think the thing’s not working. If you think it is working then you need to look at the harms that come from prohibition and address them directly, rather than running the risk of doing more dramatic things.

We lock up only small numbers of people for cannabis possession – 500 a year, according to official figures – and they only go for two or three weeks, but it does seem crazy that we’re locking people up at all for simple possession. But if the consequence of getting rid of that is cannabis being marketed, then when use goes up, harmful use goes up, as night follows day. The debate is really about what are the negative consequences of prohibition, and how we can minimise them. You can keep things illegal and not lock people up. You can keep things illegal and stop the police using it as an excuse to give a hard time to young black men. You can stop a conviction for cannabis blighting someone’s employment opportunities by changing the Rehabilitation of Offenders Act. You can actually address the harms that flow from prohibition without legalising. 

But as you soon as you begin to legalise I think you’re running a real risk of slipping away from something that’s a very inefficient market – that doesn’t maximise its clientele – towards a market that’s seeking fresh users all the time. And it won’t be the Richard Bransons and the Russell Brands who’ll be using, it will be people who are in and out of our prisons and our psychiatric hospitals, it will the most vulnerable people who are most likely to succumb. I also fear the market may escalate very quickly, like we’re seeing with gambling.’ 

As it’s the tenth anniversary issue of DDN, what do you think have been the most significant changes in the sector over the last ten years?

‘In 2004 the treatment system’s expansion was well in train, but I think the biggest thing has been the re-focus away from expansion and getting people in, to trying to improve the offer for people when they are in, and trying to strike that delicate balance between holding on to people for as long as you need to and working with them in order to maximise their opportunities to recover. Improving practice to do that is a really big ask. 

Eventually we were successful in getting the clinicians to recognise that they weren’t being ambitious enough on behalf of many of their patients. That’s now accepted, and the stuff that John Strang led on was very helpful in that – finding a clinically appropriate space where we can actually protect people and give them a platform for them to recover. The big question for me, and this is something the ACMD have been looking at, is that we need some benchmark for what good looks like. How many people can you actually expect to recover? There are no really solid international comparators. 

If you talk to the Americans, for example, they say, “well, no one’s really got to the stage you’re at in England” – a system where the vast majority of people who need to be in treatment are in treatment, a system that can get people in quickly and hold on to them – so nobody else knows. Without some sense of what good looks like, we’ll always be vulnerable to being told that it’s not working.

As a slight corrective to that, what I’m not sure of is the extent to which we focus too much on the drug and not enough on the person. There’s a group of people in society who’ve been dealt a not very good hand – they’ve been born into families with difficulties, born into cities and regions with very poor employment prospects, they’ve been let down by the education system, they’ve got mental health problems. If they’re the majority – which the evidence suggests they are – of the population addicted to heroin and crack, then maybe the issue we should be looking at isn’t how many people we can cure, as such, but how do we actually manage a population that will continue to struggle with life, only one of whose problems is actually focused on their drug and alcohol use? 

So it might actually be that the number of people you can expect to recover isn’t a product of the drug they’re using, but of the society they’re living in and the economic and social disadvantages that they suffer within that society.’ 

Which is a much bigger issue to try to tackle.

‘And for the current government, particularly, a much more challenging prospect than to say drug use is a cause of poverty. If you think drug use is a cause of poverty then you don’t have to think in terms of redistributing wealth, and for a party of the right that’s a nice comfortable place to be. But if you believe that poverty causes drug use, then that does suggest that you need to do something about redistributing wealth and maintaining investment in public services.’  

So finally, what do you think the sector might look like ten years from now?  

‘This might sound peculiar, but I think the optimistic scenario would be that the sector is still dominated by a diminishing cohort of heroin users who haven’t yet recovered, and they haven’t been topped up by new cohorts either of heroin users or users of some substance as yet unknown that’s arriving from some lab in India or China that wreaks new havoc. If we’ve got a diminishing number of heroin users left over from the epidemic of the ’80s and ’90s and a system that’s flexible enough to continue to provide services to that cohort and respond to the probably smaller numbers of people succumbing to dependency on other drugs as they emerge, and that frees up money to provide better services for alcohol users, that would be the golden scenario. 

I see not reason at all, structurally, why we shouldn’t be able to do that. But the big proviso, of course, is money. If there’s not enough money retained in the system to do that then we come back to competing priorities in the NHS and local government. Which, at the risk of sounding like a stuck record, is why you need the broader perspective. If you’re not thinking crime, worklessness, child protection – if you’re just thinking narrow health – then you’re not going to want to make the investment. 

But I was very disappointed and shocked to see the recent big increase in drug-related deaths, and we need to watch that like a hawk. It might be a blip, it might be something about the recording, it might be a consequence of the end of the heroin drought, but we need to be looking at that. And if that’s followed by an increase in use, when those numbers come out, then I think all bets are off.’ DDN

What has the past decade meant to you and your role? What have been the most significant changes to the sector? And what will happen next? You gave it to us straight. 

‘We’ve been riding a chemical carousel’

It’s only when you step back from the day-to-day hubbub that you realise what a chemical carousel we’ve been riding for the past decade in this world of drugs.

In 2004, cannabis was regraded from class B to C after three years of wrangling from the first announcement. In 2005 the then Tory leader Michael Howard vowed that if his party won the next election, they would put it back to B and accused Labour of being soft on drugs. They didn’t win, but Labour in turn asked the ACMD to reconsider the classification once again. The ACMD resisted the political and media clamour for another change, but couldn’t in 2007 when Gordon Brown, the in-coming PM, declared his intention to reclassify whatever the evidence. At the same time, the police were uncovering previously unsuspected numbers of cannabis farms across the country; from a position in 2002 where the imported/home grown ratio was about 75:25, by the late noughties the situation was reversed. Yet all the evidence showed that cannabis use was falling. Who was/is consuming all this cannabis? We still don’t really know.

Other drugs were showing a similar trend; we began to experience an ageing heroin population, and the use of other drugs such as MDMA, amphetamine and cocaine were not at the levels of the 1990s. Other drugs were apparently tailing off in popularity, but were causing real problems for those who carried on using – ketamine being the prime example.

But overall the stats were going in the right direction. It was the quiet before the storm. In 2009, say hello to mephedrone, synthetic cannabinoids and the whole dust storm caused by the advent of new psy­choactive drugs, which still swirls on. The internet has been the game changer in this dynamic flux. And not just for buying drugs whose actions mimic club and other recreational drugs. We now have an array of per­form­ance and prescription drugs available at the click of a mouse – all driven by a well-embedded world­wide connected industry of retailers, wholesalers and chemists.

Down at the sharp end, the drug treatment field has undergone some seismic shifts – moving from a political focus on harm reduction and crime prevention to recovery, accompanied by a removal of ring-fenced funding, ferocious contract-culture and a cliff drop in public spending. The UK drug treatment system has been hailed as world class in its comprehensive coverage, its adherence to the evidence base and its basic humanity and pragmatism. No doubt new drugs will come and go and the arguments for and against law reform will rage on. But our real concerns must be for the future of services caring for our most vulnerable citizens. One can only hope that in ten years time we are not looking back and mourning what we have lost.

Harry Shapiro, director of communications and information, DrugScope

‘Lack of funding will have a massive impact’ 

People’s needs are becoming much more complex, with increased mental health issues, general health concerns, and higher levels of medication. We’ve seen the use of new drugs such as legal highs, an increase in ketamine use, and in the last ten years an explosion of alcohol problems. There’s also a time-bomb with gambling and gaming.

With many rehabs closing, there is a move towards recovery, but it involves a less skilled workforce as community providers especially look to volunteers and support workers. There’s been more domination by big national community providers as contracts tendered are for the whole service and not the separate parts. We’re going the way of the few big supermarkets. By 2024 we’re likely to have one or two dominant market players and just a handful of specialist providers. 

The lack of funding coming will have a massive impact and set the whole field back decades, with rises in crime and deaths due to addiction. I’m sorry to paint a bit of a bleak picture, but this, unfortunately, is how I see it.

Brian Dudley, chief executive, Broadway Lodge

‘Patterns of use are changing’

Addaction has grown as a result of market changes in the last ten years. We’ve quadrupled staff numbers since 2004 and expanded our remit into more clinical work. Our staff now includes pharmacists, 100 former NHS nurses and 20 doctors as a result of the contracts we’ve won. 

The staff profile has also changed. The numbers of former service users volunteering as recovery champions have grown and service users influence the entire organisation, including senior leadership.

During this time the sector has moved from an exclusively harm reduction model to a greater emphasis on recovery. The approach in 2004 was about getting people into treatment, whereas now it’s about getting people into recovery. There is more regulation in the sector now, most notably the Care Quality Commission, which we welcome. There’s also been a move from NHS to local authority commissioning.  

The landscape of substance use is changing. We have a legacy of opiate users stuck in treatment, although opiate use itself is reducing. There is an ageing population of people used to using a variety of substances but for the young, the pattern of substance use is changing with the prevalence of stronger cannabis, and new psychoactive substances creating new challenges for treatment providers. 

However it isn’t just drug use among the young that is changing. More people drink at home and the context is no longer social; it has more to do with isolation and loneliness. So the way we live our lives is also having an impact on the way we use substances and the damage they can cause.

There is also a growing acceptance of substance misuse – three or four generations of people have grown up in a world that uses drugs, and so the decriminalisation/ legalisation debate will rumble on. In addition to illegal drugs, we will probably be facing up to the legacy of inappropriate prescribing in primary care.

Services will integrate professional staff with recovery services staffed by volunteers. The commissioning landscape is changing, with increased emphasis on social value and community-led recovery. Following the pattern of our broadening remit, I predict we will increasingly be engaging with other services like housing and mental health.

Gervase McGrath, director of UK operations, Addaction

‘We’ve changed focus in Scotland’

Over the past ten years, SDF has seen changes in its focus. There has been a great concentration on improving the quality of service response; reducing the numbers of drug deaths, including pushing for the national naloxone programme and supporting implementation; ensuring an effective user voice; and innovating means of helping people with a history of drug or alcohol problems into employment.

Recovery as a key concept and discourse has been an important change during this time. Initially in Scotland there was an over-emphasis on abstinence, taking us back to an era when the focus was on people who were ‘motivated to change’; a narrow focus on the individual and not wider societal inequalities and poverty. Thankfully, we’ve returned to a balanced approach – recovery and harm reduction are dovetailed and not separate. Competing approaches, eg naloxone, are recognised as a step towards recovery.

In England there seems to be a more fractious relationship between the evidence base and what government would like. Sticking to evidenced-based approaches and not ones driven by moralistic views is a challenge – such as UK government requests to explore time-limiting methadone. 

Going forward, we’ll see challenges dealing with an ageing group of users, with services working closely with wider care services designed for older people.

In terms of trends of drug use, how will problems manifest themselves? We see significant problems with new psychoactive substances, but this covers a range of compounds with differing effects and issues. We know that if the needs of vulnerable young people aren’t adequately addressed today they will become, sadly, the service users of tomorrow.

David Liddell, director, Scottish Drugs Forum (SDF)

‘I hope that quality will win the day’

I have been privileged to be involved in the regulation of the treatment sector over the past ten years. It all began in Weston Super Mare where, as head of inspection, I had to make sense of the concentration of treatment services in the area. 

I was constantly bombarded by services who told me in no uncertain terms that they were not ‘care homes’, but something entirely different. The legislation in the Health and Social Care Act 2008 created a new regulation, which described services as ‘accommodation for persons who require treatment for substance misuse’. Unfortunately CQC chose not employ someone to coordinate the implementation of this regulation and, as this had become my passion, I took early retirement and sought to assist services as an independent consultant. Sadly, in my view, CQC implemented this inconsistently for the first five years. However they have now decided that a policy manager for substance misuse is needed and a separate nationally recognised inspection methodology is being developed.

The last decade has seen the passing of some long-standing residential rehabs to be replaced by newer ones. Regulation has also been extended to many community-based services, many of which are doing an excellent job. My passion is that services are run respectfully and with a central focus on the needs of people using the services, with recovery as chief aim. My hope for the future is that quality will win the day and the new rating system introduced by CQC will highlight where there is good, and even outstanding, practice among treatment providers. 

David Finney, independent social care consultant

‘Wales now has the best route out of addiction’ 

Kaleidoscope began its own rehabilitation by establishing itself in Wales ten years ago. What we saw when coming to Newport were huge waiting lists for treatment and a lack of support for people with drug and alcohol use in many parts of the country.

Today we see Welsh-based organisations forgetting past rivalries and coming together and sharing best practice. This has best been shown by the establishment of Drug and Alcohol Charities Wales (DACW), which ensures there are Welsh solutions to the problems of substance use. Innovation has flourished, be it through Peer Mentoring (an ESF Funded Scheme) which saw hundreds of people with drug and alcohol issues obtain work; Change Step, which is a unique project supporting veterans; the development of computerised dispensing systems in our major cities; and the establishment of social enterprises for service users. Wales is fast becoming the best country in the UK to be in when looking for a route out of addiction, when it used to be the worst.

I am worried that the uniqueness of treatment in Wales will be replaced by the huge English or international companies in ten years’ time, peddling average drug services at cut-price costs. In Wales, service users have grown in confidence. In Gwent, The Voice service users group works closely with the local providers and is actively involved in how treatment works. Its voice is heard because management is close enough to hear, and is near enough to meet with. As DACW has shown, with drug services in a small country, networks with trust can be formed which simply would not happen with large faceless organisations.

Positively, I do see a change in legislation and the re-emergence of harm reduction. The Welsh Government policy of a drug and alcohol strategy is an example where all mind-altering substances are looked at rationally and not, as in the case with the UK government, on ill-informed legislation governed more by the Daily Mail than by the experts on the subject. 

Martin Blakebrough, chief executive, Kaleidoscope Project

‘Mistaken paradigm still dominates research’

A striking aspect of treatment research from the past ten years is the realisation forced on Project MATCH researchers: that after the most sophisticated research of the most highly technically specified therapies ever seen in alcohol treatment, their therapists were in essence doing nothing different from the faith healers and witch doctors of ‘primitive’ societies – providing a culturally accepted route to recovery which gave clients permission to activate their pre-existing resolve and resources. What was critical was cultural fit, and the status it gave to the intervention and to the therapist. It was an example of the creation of new understandings from the rubble of a massively expensive and unexpected failure – in this case, to match different psychosocial therapies to different kinds of patients.1

Underlying most research is a very different preferred message – that we have found treatments that work because they embody the right psychological technology to treat a techno-medical disorder of the body and mind. The car is not working; as long as the technician uses the right spanner on the right nut and turns it in the direction and by the amount specified in the manual, then it will be restored. Despite what (in The No. 1 Ladies’ Detective Agency novels) Mma Ramotswe’s mechanic husband likes to believe, it matters not at all how the technician talks to the car, whether he loves or loathes it, shows respect or disdain, and the car itself plays no part in the process.

For substance use, this profoundly mistaken paradigm should have been shattered by the ‘failure’ of Project MATCH, but it still dominates research. In psychotherapy generally, things have decisively moved on with the American Psychological Association’s recognition that evidence-based relationships must take their place alongside evidence-based treatments:2 ‘It reflects an inexorable, evidence-based recognition that the relationship is a common denominator that brings diverse clinicians together.’

Mike Ashton, editor, Drug and Alcohol Findings

‘A landscape with conflicting priorities’

The National Treatment Agency had strong political support during the past decade for its very clear mission to improve the quality and quantity of drug treatment. We actively supported local areas, set targets, asked challenging questions and introduced a recovery ambition.

As Public Health England, we have a much broader interest in alcohol and drugs, in prevention, treatment and recovery and in health inequalities. Local government is now in the lead; we support them through reflecting their performance back to them, promoting the evidence and providing bespoke support to them and providers to deliver safe and cost-effective services. Some things remain constant, but the landscape is now more complex, with conflicting priorities and an un-ring-fenced treatment funding pot.

Substantial investment expanded the sector massively; many more people started treatment quickly and stayed long enough to see real health benefits. The introduction of ambitious evidenced-based prison treatment helped close the gap between prison and community drug treatment.

The centrality of links between effective treatment and crime reduction was a key driver and the emphasis on recovery introduced greater ambition, ensuring a positive shift towards more active and personalised treatment, often harnessing and enhancing mutual aid and peer-led initiatives. During this time we developed a world class data system and accumulated evidence of what works, so our guidance and support is now well developed and highly regarded, with the system delivering much improved outcomes. 

Of late, the most significant development has been the transfer of commissioning to local authorities, with the loss of partnership commissioning and protected funding. 

Who knows what the sector might look like by 2024, but hopefully it will be responsive to new populations of users, valued by local authorities, health and criminal justice partners and the public. It should certainly be more aligned with broader services – training and employment, housing, families, mental and sexual health – better integrated with local initiatives, and most importantly, seen to be delivering first class outcomes for the whole community.

Rosanna O’Connor, director of alcohol and drugs, Public Health England (PHE)

‘Ten years ago it was about getting everyone on a script’

I have worked in the drug and alcohol field for the past ten years and have seen a dramatic change in not only our way of working but also in the types of drugs used. When I started, it was a case of getting everyone on a script and keeping them there. It felt as though the government believed that if drug users were on a script then crime would disappear (of course it never did). The only therapy was one-to-one key working, which on its own proved not to work for many.

The emergence of recovery started a few years ago and appears to have blossomed. Sadly not enough staff were trained in it and still few are – it’s always been a case of just running with it. Group work and peer support have gone from strength to strength. The ever-changing legal highs are now a real problem and I believe that we will need to change our way of working with clients who use them.

The one thing I hope not to see widespread in the drug and alcohol field is payment by results, which I was unfortunate enough to work with for a short period of time. This was appalling and put price tags on people’s lives.

Sue Andrews, drug worker

‘Integration with public health will be the norm’ 

Turning Point has been delivering services for 50 years this year. In 1964, founder Barry Richards launched a small non-profit organisation called Helping Hands – the UK’s first attempt to help those with alcohol problems, by using a community based, residential programme. 

Barry Richards was breaking new ground and that’s what we are still trying to do. It’s enabled us to grow from what was effectively a small single-issue charity to a leading social enterprise now employing more than 3,000 people and operating over 200 services in the areas of substance misuse, learning disability, mental health, primary care, employment, criminal justice and community commissioning. 

Over the past ten years we have kept growing and developing, increasing our expertise around complex needs and dual diagnosis. A very welcome change over the past decade has been the move to more integrated services, which bring together drugs, alcohol, criminal justice, and young people’s support. 

The recent move of substance misuse back into local authorities, as part of public health, is also positive, although it presents challenges for providers to ensure we’re demonstrating clearly the community benefits of investment in us. The benefit of this move is starting to come to fruition through the broadening of traditional substance misuse services to include public health priorities, such as the launch of smoking cessation pilots in six of our substance misuse services.

Integration will be the norm by 2024, so we’ll no longer be talking about drink and drugs and mental health but more readily talking about ‘public health’, with commissioning reflecting comorbidities. Health and social care are intrinsic elements of an equal society and in order to fix them we need to foster collaborative thought and practice.

The bulk of investment should be in prevention and the importance of education and early inter­vention in the substance misuse sector should not be underestimated. I hope that by 2024 we’re investing in services that reach at-risk individuals earlier so that intergenerational problems cease to exist.

Additionally I’d hope that the stigma associated with alcohol and drug dependency and dual diagnosis, which often prevents people from seeking help, would be vastly reduced, so that more people know and accept that sustained recovery is possible for anyone.

Lord Victor Adebowale, chief executive, Turning Point

‘Family support services are forced to compete’

Ten years ago Adfam was an organisation which focused its work on direct support for families affected by substance misuse in the criminal justice system – we had services in several prisons in London and we also had a national helpline.

With funding changes, taking account of new political and economic structures and constraints, we became an umbrella organisation in 2008 and now provide indirect support to families and the prac­ti­tion­ers who work with them, via our website, regional support team and policy and campaigning activities.

The word ‘family’ appeared twice in the 2002 government drugs strategy; it was included in the title of the 2008 strategy. The need for family support will probably never go away, but the current economic climate means that support services are increasingly being squeezed and forced to compete with large providers for funding.

By 2024 the drug sector may be comprised of a few, large treatment providers with family support included or just tagged on. This ignores the need for support for families whose loved ones are not in treatment. There will be a much larger recognition of the needs of families, achieved through a community led movement, not dissimilar in character and influence to the user recovery movement.

Vivienne Evans, chief executive, Adfam

‘Things can only get better!’

Like many organisations in this field, WDP has grown significantly over the past ten years. We now provide more services to a larger number of users over a wider geographical area. Quality remains a key component of our service, reflecting our staff team who are always prepared to go that extra mile.

There have been a number of significant changes in our sector over the past ten years. The nature and type of drug use is changing, with legal highs becoming increasingly common and a reduction in individuals using heroin and cocaine. There are greater numbers of ageing users presenting with more complex health problems than perhaps ever before. 

On the positive side, the public perception of illicit drug misuse is starting to shift. It is slowly being seen as a healthcare issue, rather than as a criminal one. The politics of alcohol has also come into play, with government ministers willing to talk, albeit cautiously, about the links between the price of alcohol and its abuse.

There will be important changes ahead that will impact on the planning, commissioning and delivery of services resulting in a very different landscape of service provision. The reality is that it is likely there will be fewer specialist treatment services available – ‘choice’ of service by the user, which has been systematically eroded, will become even more so.

The resident government, regardless of political persuasion, is likely to be amenable to discussion on UK drugs policy – not because it wants to, but because it has to in order to keep up with current thinking. This may lead to the state regulation of illicit drugs becoming a possibility.  

The substances misused will continue to change and the dynamics of treatment versus prevention will be played out in the public arena. The short-term future appears somewhat bleak, but strangely this gives cause for optimism: things can only get better!

Yasmin Batliwala, chair, WDP 

‘We’ll build on successes’

This year DISC is celebrating 30 years of being at the forefront of service delivery to those facing the most challenging circumstances.

We’ve expanded from a charity focused on training to the development of our current organisation – one of the north’s most successful charities, with over 400 staff, 100 volunteers and peer mentors, and an annual turnover of £16m.  We’re committed to supporting people and communities to achieve their goals and helping people reach their potential.

Our anniversary has caused us to reflect on what we’ve achieved. We can look back on some amazing successes; contracts won, jobs created and partnerships improved. But what we really care passionately about is the number of people, year on year, whose lives we’ve helped to improve. Through initiatives developed by DISC, we have supported more than 100,000 people in the last ten years alone.

We’re an innovative organisation and we are constantly developing diverse ways to meet the needs of current and future service users. By investing in new programmes, developing new partnerships and leading with innovation, we will continue to support healthy communities to bring about change and provide inventive services to help those with problems of alcohol and drug addiction overcome challenges in their lives.

Mark Weeding, CEO, DISC

‘We’re in a social inequality war’

The past ten years have seen remarkable changes: the years of expansion in drug treatment, the stall, then a chill wind of austerity biting in many areas. 

The massive influx of cash driven by the Blair government’s wish to reduce drug-related crime came hand-in-hand with what the Scots call the ‘English disease’ of targets, data collection (forms, damn forms!) and increasing performance management by commissioners. The NTA quango, with its `delivery assurance’ role and armed with `toolkits and guidance’ pushed the sector hard and fast with a mantle of assumed power (all ‘fur coats and no knickers’!). 

The bubble was burst by a groundswell of people in recovery (rightly) wanting more, and a new coalition government wanting something different. The vibrant recovery movement is a fabulous legacy of this decade, but growing stigma against those who cannot reach abstinence is a deeply worrying sign of a society that increasingly disapproves of all state dependence.

By 2024 there will be a lot more old people: one in three over 65 by 2015 and increasing at 4 per cent a year. There will be less money – with a per capita spend on health and welfare less than the USA by 2018. My cynical self thinks this will drive funding to ‘mandated groups’ only (eg the elderly and children) OR those doing the most harm to others – where interventions are cost-effective. Our ‘lifestyle diseases’ may be left to ‘mutual aid’, web-based health intervention, volunteers and  a postcode lottery of services. 

I sincerely hope we don’t have another heroin epidemic or a new methamphetamine epidemic. I hope synthetic drugs become even less moreish and cannabis CBD levels rise. Who knows, maybe we will follow the USA on cannabis, as we have in obesity.  

In 2024, I aim to still be around, championing the cause. We are not in a drugs war, we are in a social inequality war – and we need more troops. 

Annette Dale-Perera, strategic director:addictions and offender care, CNWL

‘Steep challenges for the gay drug-using community’

Ten years is a long time in drug treatment. In Antidote – London Friend’s specialist service for lesbian, gay, bisexual & transgender people (LGBT) – some changes have been quite astonishing. 

Our data from a decade ago shows most clients experienced problems using alcohol and cocaine, with a handful having partied too hard on ecstasy. Generally though, most people managed their party drugs reasonably safely. 

We had already heard rumblings from other major cities that crystal meth was a-coming. The mainstream media sprang into a panic predicting the next pandemic, but for the most part it never came. Quietly though, away from view in private houses, crystal was making itself known among a small group of gay and bisexual men.

Fast forward a decade and it’s become one of three main problems we deal with – the others, GHB/GBL and mephedrone, having similarly appeared as if from nowhere. A typical user tells us how they ‘slam’ (the colloquialism for injecting, perhaps coined to avoid associations with IV drug use) and attend weekend-long sex parties with several other men.

Of course, gay men, sex and drugs are hardly strange bedfellows, but a decade ago you partied and maybe then fell into bed if you’d got lucky on the dancefloor; now the norm is to get app-y on smartphones where ‘chemsex’ is readily found on ‘dating’ sites without even needing to leave the house. 

The fallout is harsh: we’re seeing significant mental health concerns, psychosis, and a group of previously stable men whose lives, relationships, jobs and housing are falling apart around them. Men whose self-esteem has plummeted. Men who are contracting HIV as heterosexual infections are falling.

It’s been a challenge for us to adapt to new drugs and trends, such as slamming, that were never common within our communities. As these patterns make their way into mainstream services it’s important for them to consider how to meet this challenge too. Our recent report Out of your mind has some resources to support this. 

Monty Moncrieff, chief executive, London Friend

‘Hang on to user-led initiatives’

Ten years ago, KFx was in its terrible twos. Using the waybackmachine I can see how, in some respects, things haven’t changed. Cannabis had been reclassified and the ACPO guidance was the source of much discussion. As housing providers were still concerned about the fall-out from the Wintercomfort Trial, I was busy with housing and drugs policy work, which still remains an issue today. The legal issues still haven’t been addressed.

GHB had earlier been made a controlled drug, but since then GBL emerged as a successor and ten years on we’re dealing with a slew of newer psychoactive compounds.

Ten years ago, the paraphernalia laws were slowly being amended, allowing distribution of acids and other paraphernalia. It’s taken a further decade for the law on foil to be amended. The farcical nature of the paraphernalia laws forms part of my safer injecting training. Sadly over the past couple of years, there has been a sharp decline in requests for this course. I hope that in ten years time we aren’t paying a huge price in injuries and infections from not ensuring staff delivering injecting interventions are adequately trained.

More than 1,000 workshops and 16,000 participants later, I think my passion for and interest in the subject hasn’t dimmed. Sadly, not all the organisations that I worked with ten years ago still exist, and have perished in the new world of competitive tenders. A huge change therefore has been a reduction in the number of small, local service providers and a growth in larger national ones. In sharp contrast to the increasingly corporate nature of provision, the grass-roots emergence of user-led initiatives has been amazing and inspirational to behold. Ensuring that this does not in turn become incorporated, co-opted and neutered will be one of the key challenges in the next ten years.

Kevin Flemen, KFx

‘Society doesn’t take addiction seriously’ 

Good things happen, progress is made, people do get good help and lives are transformed. Whatever the turn of the political and funding wheels and the system they drive have taken, over the last ten years that has undoubtedly been the case. Whether the good has happened because of the system or in spite of it, I am not so sure. 

The bad also happens both because of systemic flaws and in spite of them. Progress is thwarted and undermined as too often we take two steps forward and then a couple or more back. Just as we seem to be getting somewhere the operating environment changes, the seeds of progress are ploughed up and obstacles strewn in our path.  That’s when we’re not getting in our own way and tripping ourselves up for one reason or another. 

I could explore changes to funding and political structures, degrees of workforce competence, the adequacy of investment in research and whether sufficient priority is given to families. I could discuss recovery and treatment modalities and the tensions between them and examine the commissioning and providing relationship and more.

But I think the fundamental problem is that unlike other life-threatening conditions we simply do not yet as a society really take addiction seriously in its own right. We only address it because of its costly nuisance effect. Empathy for addicted people remains in pretty short supply.

It’s not treated like every other major life-threatening ailment; cancer, diabetes, heart disease, for instance. Why? The answer is stigma. Society looks at our client group through the lens of the consequences of addiction and projects conveniently onto it. It loses sight of the people; the human beings.

Until, as a society, we adjust our way of looking at addiction and thereby remove the stigma, we will never properly understand it or be able to respond in a fully rational way that moves beyond the kind of uncoordinated tinkering that characterises much of what we do now.

Once we have done that we can begin to look bravely at the question as to why addiction flourishes in our society in the first place. Maybe in another ten years we will have got there. 

Nick Barton, chief executive, Action on Addiction

‘The heart of the matter’

With the help of supportive commissioners, Nottingham’s service users have made sure they’re now at the heart of decision-making.

May’s meeting of Nottingham’s Recovery Forum celebrated ten years of meaningful service user involvement. Over the years the forum has had numerous names, but the function has always been the same – not only for service users to feed into the commissioning process, but also development of services, as well as being a catalyst for many members to go on to paid employment, and not just in substance misuse and mental health.  

As was recognised quite early on, clients in recovery, be it on medication, in aftercare or not even engaging, have many complex needs and it was decided other groups would be set up with active user involvement at their heart. 

Through the Recovery Forum (and its various names) other forums have become established, such as the Dual Diagnosis Forum (DDF), Alcohol Service Users’ Forum (ASUF) and Substance Campaigns User Friendly – formerly Shared Care User Forum – (SCUF). These forums were set up not only to give shape and input into needs assessments, service provision and delivery, but also to give participants a time to check in with their peers for things such as self help and support, as well harm reduction and awareness education and access to training.

The forum and its members have always been integral to anything that has happened within substance misuse in Nottingham City and several members sit on various steering group and strategy meetings and working groups.

One thing that has been key to the Recovery Forum’s success is its desire to do partnership work with all the agencies and support services within the city to ensure not only cost effective, but also successful, services that are fit for purpose. 

Members of the group have been involved with various agencies producing DVDs around needlestick injuries, safe returns and overdose response, and have produced consistent award-winning work around stigma.

Members of the forum were involved when it came to relocating and rebuilding our current detox unit to become a state-of-the-art unit called The Woodlands, whose statistics speak for themselves. The building and fittings are still as new three years on as when it was built – all down to service users and staff respecting the environment.

The Recovery Forum continues to be at the forefront of what is done in Nottingham’s treatment system, and in November last year two organisations came together for ‘Recovery Rocks’ (DDN, January, page 10) where more than £400 was raised to provide food parcels at the homeless drop-in.

Although it took four years and many meetings  – as is often the case with strategic stuff – it was because of the service user relationship and power that naloxone is now being distributed, with 64 kits being issued since it was launched in December last year.

Among many many other things besides The Woodlands and the provision of naloxone, service users are where they should be – at the heart of what’s happening, thanks to a forward-thinking commissioning team, a dedicated involvement worker and a committed group of service users refusing to be pushed aside and ignored.

Lee Collingham, service user activist, Nottingham