DDN looks back on a year that saw the drug treatment landscape transformed with the end of the NTA and the advent of Public Health England, while austerity, alcohol and new psycho­active drugs continued to dominate debate 

January

With welfare reform set to be one of the key issues of the year, TUC general secretary Frances O’Grady warns of the dangers of conducting policy ‘on the basis of prejudice and ignorance’, while outgoing UKDPC chief executive Roger Howard stresses that most people have yet to fully appreciate ‘the profound reshaping of public spending’ still to kick in. Meanwhile, the Royal College of GPs issues a statement stressing the risks of long-term prescribing for medi­cines that carry a risk of dependence. 

February

Hundreds gather at Birmingham’s National Motorcycle Museum for Be the change, DDN’s sixth annual service user conference. ‘The place was buzzing like a bee hive,’ commented Recovery Radio UK’s Jaine Mason. ‘It was absolutely brilliant to experience.’ There’s yet more evidence of shifting patterns of drug use as an EMCDDA report highlights how the internet has been a ‘game changer’ in the production and distribution of drugs, the NTA announces the number of heroin and crack users has fallen below 300,000 and the proportion of drug-related deaths involving heroin drops by nearly 10 per cent. 

March

A shocking 117 per cent increase in the number of under-30s being admitted to hospital for alcohol-related liver disease leads Alcohol Concern to demand the Department of Health outline a plan of action. Meanwhile the Hepatitis C Trust warns that local authorities are unready to deal with the challenge of the virus as they prepare to take over responsibility for public health, and the National Aids Trust calls on London councils to ensure appropriate support for people involved in high-risk drug use in parts of the city’s gay scene.

April

The treatment landscape changes forever as Public Health England comes into being, taking over the respons­ibil­ities of the NTA, while Sarah Galvani of the British Association of Social Workers urges drug workers to challenge clients who blame violence towards their partners on substance use. ‘People need to feel confident to ask the right questions in the right way,’ she says.

May 

Minimum unit pricing for alcohol fails to make the Queen’s Speech, widely perceived as the result of industry lobbying – ‘the red-faced rants from the multinational drinks corporations’, says Katherine Brown in the Guardian – and a government desperate not to seem out of touch with the concerns of ordinary people, although ministers claim the policy has not been abandoned. Kevin Flemen advises DDN readers on how to keep on top of the dizzying array of new psychoactive substances and the Organization of American States issues a landmark report looking at different options for the future of Latin American drug policy. 

June

The 23rd International Harm Reduction conference sees policy makers and service users gather in Vilnius to ‘reclaim’ harm reduction from those who seek to define it as a ‘morally suspect, clinical response’, says HRI executive director Rick Lines. The Support. Don’t Punish campaign’s international day of action on 26 June sees activists calling for more humane drug policies and a hard-hitting report from DrugScope and Ava highlights the lack of support for female drug users involved in prostitution.

July

The government’s response to its alcohol strategy consultation finally contains a firm statement that minimum pricing ‘will not be taken forward’ – and shelves plans to ban multi-buy promotions for good measure – while public health minister Anna Soubry and IDHDP clinical director Chris Ford debate whether drugs should be a health or criminal justice issue in DDN’s letters pages.

August 

Scotland records its second-highest number of drug deaths while a powerful report from Release reveals that not only are black people over six times more likely to be stopped and searched for drugs, they are more likely to be charged if any are found and receive harsher sentences than the white community. Alcohol Concern chief executive Eric Appleby, meanwhile, tells DDN that members of the Alcohol Health Alliance are more determined than ever to keep minimum pricing at the forefront of debate. ‘The government’s arguments that there’s not enough evidence are plainly just wrong, and the very obvious sense that they’ve just bowed down to the alcohol industry is only going to fire people up more,’ he says.

September

Public Health England hits back at a Centre for Social Justice document that depicts a treatment system full of ‘vested interests’, resistant to change and ‘unambitious for recovery’, while a UNAIDS report shows that many Eastern European countries are still failing to address the challenge of drug-related HIV infections. Meanwhile, recovery month is marked by bigger than ever recovery walks as well as sporting tournaments, conferences, art exhibitions and much more. 

October

Just 3 per cent of people infected with hepatitis C are treated each year, despite it being curable, according to a report from the Hepatitis C Trust. ‘Just because you’re using drugs doesn’t mean you don’t have the right to treatment,’ the trust’s chief executive Charles Gore tells DDN, while outreach worker Philippe Bonnet describes his fight to open a consumption room in Birmingham, a city where more than half of injecting drug users are infected with the virus. Meanwhile, a government reshuffle sees Norman Baker controversially replace Jeremy Browne as crime prevention minister, ‘the most eye-catching, head-scratching ministerial appointment in Westminster history’, says the Independent’s Matthew Norman. 

November

As DDN celebrates its ninth anniversary, Mat Southwell and Lana Durjava describe how services can best engage with the diverse and ill-served population of ketamine users, while Alex Boyt remains unconvinced by recovery cheerleading. ‘For many, there is something disturbing and unattractive in trying to plaster optimism over the struggles of the often disadvantaged, traumatised and neglected,’ he writes. The second Adfam/DDN families event sees a day of passionate debate in Birmingham and delegates at DrugScope’s conference discuss ways to make the most of the new treatment and commissioning landscape. 

December

As an era-defining year for the sector draws to a close, plans are already well under way for Make it happen!, the seventh DDN user involvement conference. Make sure you don’t miss it.

Social entrepreneur of the year Jacquie Johnston-Lynch talks to DDN about risk, determination and the new challenges facing the recovery movement. 

It was on a personal leadership course in Vancouver that Jacquie Johnston- Lynch got the idea for The Brink, the alcohol-free Liverpool bar and venue that’s seen her named Lloyd’s Bank social entrepreneur of the year. ‘They were asking people their ideas to take back into the world, and that was mine,’ she says.

This was in 2008, and when she came back to the UK she put the idea to her employers, Action on Addiction, who ‘weren’t that keen’, she says. ‘Treatment was what they knew. They didn’t really know about community development or social enterprise, but eventually I just wore them down. I kept saying that if you want to be the trailblazing organisation that leads this new movement then you’ll have to get behind this, and eventually they absolutely did.’

She was given the green light to look at the venues she’d already been secretly visiting, and The Brink finally opened late in 2011, ‘a dream come true’, she says.

‘Everybody loved the venue, and that’s because we’d decided it wouldn’t be what addicts are usually given – backstreet places, church halls, community centres. Why, just because people have stopped drinking and using, should they have less than anyone else, especially when they’re not going to be sick or trash the place? Why can’t they have better? So that’s what we aimed for –a really amazing venue with great quality food and drinks and a great design.’

The Brink now has 18 staff and 11 volunteers, with more than 75 per cent in recovery themselves, and customers are split 50-50 between members of the public ‘who really like the ethos of the place, and recovery folks who really want to be in there’, she says. Services are also offered in the building, ‘so we’ll have people in who are still using and drinking but their behaviour’s impeccable because they’re coming into the building to aspire to be in recovery,’ she says. ‘They want to be part of the community there, so they’re not going to jeopardise that.’

As well as live music several times a week, there’s a film night, an arts and crafts club, open mic sessions and more. ‘There’s loads of stuff,’ she says. ‘We had a chocolate-making workshop, a women-only sleepover where they had a pamper night and watched a chick flick and the staff cooked them breakfast the next morning. Chris Difford from Squeeze has played a few times because he really likes the vibe and he’s out about being in recovery himself.’

So is it doing well as a business in its own right? ‘With all social enterprises there’s a point where you can’t any longer rely on grants or philanthropy,’ she says. ‘The idea is that we move to an 80-20 position, where 80 per cent is trading, sales and contracts and 20 per cent is donation or grant-based. We’re never going to make a huge profit on food or drinks because we try to keep the prices low so that the recovery pound can afford that good quality food, so I think we’ll always need to have an 80-20 principle to our income base.’

After nearly ten years at SHARP and Action on Addiction she’s now moved on to work for two organisations, one of which is Clearmind International, organisers of the training workshop where she first had the idea for The Brink. ‘They’re based in Canada but I’m going to develop their organisation here,’ she says. ‘It just seems like it’s come full circle.’ The other, meanwhile, is something that’s been a well-guarded secret until now.

‘There’s a woman called Paula Gunn who runs abstinence-based accommodation where we’d regularly refer people from SHARP so they wouldn’t have to go back to a using and drinking hostel or anything. We were both seeing returning veterans really not doing very well at all in mainstream treatment projects, so what we’ve decided to do is set up the UK’s first ever veterans-only residential addiction treatment project.’

The project will launch in the spring as Tom Harrison House, named after Gunn’s grandfather, a navy veteran. ‘Paula herself is in recovery and when she was trying to get clean and sober one of the things she’d do was focus on doing that for him to see, so she’s set up this in his honour. It’s going to be a low-level, more sensory-focused programme, rather than cognitive or too much talking therapy that can invoke a lot of anxiety for people who’ve experienced traumatic events. It’s 16 beds, so it’s quite a small rehab but enough for us to be effective for the amount of money. We’ll have mostly beds for Merseyside but we’ll have some beds later around the UK, and people will be able to refer in.’

Leaving Action on Addiction has been difficult, however, especially as she’d set up SHARP and The Brink herself. ‘The actual projects and the people who worked in them were incredible and I found it very difficult to leave them, but I felt like my time in that kind of charity had come to an end,’ she says. 

‘I think sometimes charities that do a lot of very good quality work and a lot of due diligence don’t really understand the need to take risks, and in addiction treatment we’re encouraging people to take new healthy risks,’ she explains. ‘I think it’s bad if we stay stuck. In Liverpool we’d taken an asset-based community development approach to recovery and the charity was a little bit distant from that – we love that whole community development approach and our demographics are different to what you might see in [Wiltshire-based] Clouds House. So while I absolutely think the work of Action on Addiction is fantastic, I also think the culture might need to change in order to be more proactive around social enterprise and asset-based community development approaches to treatment.’

An eating disorder saw her enter a 12-step fellowship herself in 1997, and her first husband also had issues around gambling and alcohol. ‘I remember trying to get him into Gamblers Anonymous but he wasn’t having it, so I had some experience of 12-step from years ago but didn’t really understand it – it was when I went into treatment for an eating disorder that I got more of a 12-step message.’

Working in the field, however, she began to understand the need for choice, she says. ‘I advocated that SHARP Liverpool should change from just 12-step to more ITEP-based as well, so that people could come in and say “this is the modality I’d like to follow and if it doesn’t work I’ll swap and do something else”, and let the client have the power over that, not us telling them what works.

Another powerful motivation for entering the field, however, was the death of her brother 21 years ago, killed by a drink driver. ‘The man who killed him was a repeat offender and I just thought “what did he ever get?”’ she says. ‘He just got punishment, his licence taken off him or whatever, but he wasn’t just somebody who’d got drunk at an office party and tried to sneak home and got caught, he was doing this constantly. He had a problem and no one ever offered him any help. At Clearmind they teach about turning your pain into purpose, and I thought that all that painful grief had to be given some purpose.

‘People aren’t bad and needing punishment,’ she continues. ‘They aren’t very well and need to have a whole new realm put in front of them of “these are the possibilities of getting well”, if that’s what they want. If they don’t want it, that’s a choice too and I’m absolutely happy for people who say, “I don’t want to give up drinking and I’m happy to stay scripted”. If that’s working for them, that’s OK.’

On that note, she’s pleased that the field seems less polarised and entrenched these days – ‘people are absolutely moving towards working together and trying to join up all the dots’ – but the political and economic landscape has created new challenges, she believes.

‘I think that what we’ve got to be really careful of now is the recovery agenda being hijacked so that it becomes a decoy for just getting people off benefits and methadone. Recovery is about what kind of quality of life are people having, and we’ve got to be really careful that the government doesn’t hijack it as a means to a political end, because when that happens those people who are harm reduction advocates aren’t able to see us recovery folks in a well-meaning light.

‘They just see us as being part of the Tory agenda, and we’re absolutely not,’ she states. ‘That’s my concern.’  

Picture top right by Paul Cooper, www.cooperphotos.co.uk

Among the now-familiar talk of emerging chall­enges and stretched resources, delegates at DrugScope’s recent conference heard some positive takes on the new treatment landscape.

‘Whatever views people take of the pros and cons of the times we’re in, what everyone can agree on is we’re charting very new waters in turbulent seas,’ DrugScope’s policy director (now newly appointed chief executive) Marcus Roberts told delegates at the organisation’s Game on: drug and alcohol services and the new local players event.  

Localism presented some significant positives and opportunities alongside the challenges, he said. Although the 2010 drug strategy was still setting a direction for services, many of the decisions that affected them were now made at local level, with a loosening of central control and the national drive to focus on crime reduction gone, ‘or at least fading to grey’. The pooled treatment budget, however, had been ‘swept into a bigger public health budget with no meaningful protection, or at least none that anyone can explain or understand’, and there was now a need to convince local partners who may have previously had no engagement with the sector.

‘Obviously, it’s also a case of localism plus tight money and further cuts on the way,’ he said, against a backdrop of the rise of new psychoactive substances and, ‘absolutely critically, the role of alcohol’. But the generic ‘problem drug user’ had always been something of a cipher, he told the conference, and there was now much more meaningful work around specific groups like the LGBT community, women involved in prostitution and older people.

Financially, it was difficult to get a clear grip on what was happening, he said, although DrugScope research had found more than a third of services reporting a decrease in funding (including 10 per cent where it was the result of re-commissioning), 44 per cent reporting a decrease in frontline staff and 63 per cent an increase in the use of volunteers. More than 40 per cent also said they’d so far had no engagement with their local health and wellbeing board.

‘Overall the findings have been suggestive, but not seismic, and they do point to some positives of good adaption and resilience. But it’s worth emphasising that there are significant prima facie risks of disinvestment, and adapting to that may mean further rethinking and reconfiguration.’ The crunch points could well come next April or the April after, he said, as many contracts would have rolled over into this financial year and new structures were still bedding in.

‘I’d underestimated how long it would take for some of our systems to embed,’ echoed director of public health for Barnet and Harrow councils, Dr Andrew Howe. Although there was an austerity agenda and a now-unprotected substance misuse budget, he was ‘not hearing about any substantial disinvestment’, he told delegates. ‘But the challenge to local government is that the savings are to criminal justice and the NHS rather than them, and commissioning is fragmented.’

However, local government did fit very well with the aims of the field in that ‘if it’s about anything, it’s about improving social capital’, he said. ‘I absolutely recognise that we’re building on enormous success in the substance misuse sector, particularly around service user involvement – it’s an exemplar of success for other services – and as a commissioner I’ll be looking for outreach services from our service providers. I’m hoping that the new system will really help with integration.’

The advent of police and crime commissioners (PCCs) had also created uncertainty, said deputy PCC for the South Wales Police, Sophie Howe. PCCs needed to balance budgets and maintain services that local communities cared about, while working to develop partnerships such as the Drug Interventions Programme (DIP) – something that combined harm reduction and reducing reoffending and showed the two could complement each other. ‘But evidence of effectiveness isn’t enough in the current financial climate,’ she said.

‘The coming years are going to get more difficult,’ CEO of Blenheim CDP John Jolly told the conference. ‘I’m still mourning the death of the NTA – I think that’s a huge downside for our sector because we don’t have a body representing us at national government level.’

The NTA had done some excellent work around service user involvement, said chief executive of Build on Belief, Tim Sampey. ‘The change to Public Health England and the tightening of purse strings is a real pity, and re-tendering is awful – it’s dog eat dog and service users hate it. The buildings change, staff change – stability is really important for trust and building relationships, and without it the risk is that people drop out of treatment.’

The recovery agenda was also ‘an awful idea’, he added, and had made service users panic. ‘When I was using I hated the expression “clean”, and there’s something about recovery that seems a bit judgemental – whether it’s true or not, it’s the perception that service users have.’ Nonetheless, mutual aid could well be the future, he said. ‘I’ve seen some great stuff around mutual aid, and I don’t mean the 12-step stuff. What we need is community and family and somewhere to belong – if we can do that we can really help people.’

The ‘elephant in the room’, however, was the underfunding of, and unmet need for, alcohol services, said John Jolly. ‘There’s been a u-turn on almost everything in the alcohol strategy, and the resources that are already stretched are going to become even more stretched, with the risk that alcohol need is going to hugely reduce our capacity to deliver to other groups.’

There was also the challenge of new drugs, he said, with many users reluctant to access services and receiving no support. ‘So it’s about how we make our services relevant to specific groups such as older alcohol users and young people using new psychoactive substances – you have to give them something relevant or they won’t come. They need to like what’s on offer and like the people there.’ In the current commissioning environment, however, there was huge unmet need and ‘the risk of not being able to meet any of it’.

‘Yes, the funding has changed and there are competing priorities in local authorities for all their resources and for the public health grant, and I’m well aware that there’s widespread redesign and retendering,’ Public Health England’s director of alcohol and drugs, Rosanna O’Connor, told the conference. However, there were fewer adults in treatment than ever, she said (see news story, page 4), and the number of people starting new treatment journeys had also gone down.

‘Cannabis is the only primary-presenting drug that has any kind of increase and there are now more non-opiate clients than opiate clients,’ she stated. However, there were still increasing numbers of over-40s coming into treatment for the first time and the number of successful completions had ‘pretty much plateaued’.

‘The existing health gains and recovery ambition need to be maintained and strengthened, the sector needs to be championed and strategic partners engaged,’ she said. ‘You must ask for the investment you need. We do expect for there to be appropriate local services and for them to be properly invested in. The task in terms of making sure every service user gets a half-decent chance of successfully completing treatment is not the same across the country, and that’s not good enough.’ PHE was offering enhanced support to more than 40 local authorities that were performing less well, she stressed.

The political interest in the sector was there, she emphasised, as recovery continued to be a key measure in national outcome indicators, closely monitored by ministers and PHE. Drugs recovery would also be priority indicator of the government’s proposed ‘health premium’ if it went ahead, she said.

Particular challenges were the number of entrenched heroin users, for whom lasting recovery was often much harder to achieve, and the emergence of new psychoactive substances at an ‘unprecedented’ rate. Although the number of people seeking treatment for the latter remained small, ‘the ability of all of us to keep abreast of this is a challenge’, she said. Mephedrone presentations had almost doubled in the last year but should be seen against falling numbers of people seeking treatment for ecstasy, she added.

‘What on earth do we call these things?’ said toxicologist at St George’s Hospital medical school, John Ramsey, of the new drugs. ‘New psychoactive substances doesn’t really trip off the tongue, and legal highs doesn’t work either so I choose to call them new and emerging drugs of abuse.’ The new compounds fell outside legislation with the consequences that people were being exposed to an ‘ever-changing list’ of chemicals. ‘What do we do? If kids are having medical problems then you can’t ignore it, but when you ban them you just get a whole lot of new ones.’

‘There are genuine opportunities with Public Health England,’ said outgoing DrugScope chief executive Martin Barnes, as he summed up both the event and his ten years at the organisation. ‘But despite genuine high-level commitment to drug treatment and recovery, the government has created a situation where funding is at risk. Whatever your view of the NTA, it was effective at holding DAATs and providers to account. The pendulum of localism may swing back, but at the moment what ministers think is increasingly less important.’

Further local government perspective came from cabinet member for health and wellbeing at Birmingham City Council, Steve Bedser. ‘There is a huge risk of disinvestment,’ he acknowledged. ‘“Severe” is an understatement when it comes to the pressures on local authorities, and we are, of necessity, looking at the commissioning portfolios and practices we’ve inherited. Some of the services we’ve inherited have been very poorly commissioned indeed. We have to make sense of the money and find interventions that are cost-effective. We face hard choices on the use of public money and you will have to work hard to engage politicians.

‘But if there’s a sliver of a silver lining in the whole austerity agenda, it’s that it does give us an opportunity to do integration properly. Have faith in health and wellbeing boards. They’re good things, so make sure you influence them.’ 

The speakers and workshops at Families First 2013 gave delegates an opportunity to hear personal stories, network and exchange vital expertise.

Supporting role

Kate McKenzie speaks of the seismic effect of her daughter’s addiction

Hannah’s struggle to overcome her drug addiction has been a very testing time – often heartbreaking, frequently frustrating and even at times surreal. It has had a great impact on all the family and changed us forever. My younger daughter dropped out of school, my marriage broke up, illness and money problems soon followed. Drug addiction doesn’t just affect the lives of the addict but also those close to them.

Hannah is 26 and this struggle has been going on for over half of her short life. It began at 13 with anorexia, bulimia, self-harming and alcohol; from there it was a short step into the world of drug addiction. The descent was rapid and devastating and by the time she was 18 she was addicted to heroin.

At the time, my knowledge of drugs, and heroin in particular, was extremely limited. I knew it was dangerous, and that we should teach our children to ‘just say no’ and that advocating an abstinence policy was the way forward. My assumption that those who used drugs chose their lifestyle and somehow deserved to be sitting begging on the streets or selling the Big Issue was typical of many people’s. I now know I knew nothing at all about drug addiction.

What I subsequently discovered is that many drug users are messy, damaged, chaotic individuals with very complex needs. Yet time and time again while trying to help my daughter I found the treatment available to her was piecemeal, complicated and punitive. Those who use drugs cannot be fitted into neat bureaucratic systems and there are no easy ‘one size fits all’ solutions.

After a period of almost two years of being clean, Hannah relapsed last summer. I was devastated as I could predict the vicious downward spiral of disease, degradation and crime she would inevitably be sucked into. I also knew the destructive impact this would have on her sister and me. Straightaway the trust between us was broken. We could no longer leave handbags lying around, I hid all my valuable jewellery, I changed the locks on my flat. I hated doing this, but I knew what would happen if I didn’t.

The lies started, the money ran out. Moneylenders circled and drew Hannah in. Finally when the source of funding ran dry, the crime and prostitution began, swiftly followed by illness and overdoses. It was all too depressingly familiar. The relationship between us reached an all-time low on Christmas Day when I refused to pay for another hit. I was damned if I helped her and damned if I didn’t.

Hannah’s appearance in court earlier this year was one of many, and highlighted how punishing those who use drugs is a pointless exercise. Hannah was already in debt to moneylenders to the tune of £10,000 – a further £1,000 fine for stealing goods worth £30 was not going to achieve any positive outcome. Fortunately, simply because I was there, I convinced the duty solicitor to argue her case. The judge was sympathetic and she was given a 12-month discharge. I know very well that this would not have been the case for many others in a similar situation.

I asked myself what would make a difference to Hannah’s predicament and also to the many others trapped, like her, in this all too familiar cycle of addiction and recovery. I came to two conclusions. Out of all her addictions ­– anorexia, bulimia, alcoholism to name a few – her drug addiction is the only one that is criminalised.

If Hannah had been able to be stabilised on prescribed heroin, then her need to find £20 for the next fix simply wouldn’t exist. Her benefit money would continue to be used for food, not heroin. She would still be able to pay her rent and not be made homeless. She would not have to shoplift and steal.

On a personal level, it would remove so much of the anxiety and worry that I felt as soon as she relapsed. The trust would remain between us and the arguments over money for the next fix would cease. Most importantly though, the control and provenance of her drugs would be in the hands of doctors, not dealers. All the harm caused by black market heroin would be reduced considerably.

I know that prescribing heroin is not the only solution to this problem, but used in conjunction with other holistic forms of treatment and rehabilitation it makes sense to me. To allow Hannah to be stabilised on the drug of her choice, administered in a safe environment, would enable her to have more control of her recovery.

The second conclusion I came to concerns changing the focus of the treatment onto the cause of her addiction and not the symptoms. Hannah had been diagnosed as bipolar from quite a young age, leading to bouts of mania and depression. Because she is on heroin, no NHS psychiatrist will go near her. Their response is to say that until she comes off heroin they cannot treat her, yet she uses the drug to cope with her mental illness and so is caught in a catch-22 situation.

Some years ago she had a manic episode and attacked my younger daughter with the kitchen knives. I managed to calm her down and not knowing where else to go, I took her to A&E. After many hours waiting, the young doctor appeared and apologetically explained there was nothing he could do. The duty psychiatrist refused to be called out because Hannah was on drugs, so he suggested I took her home and hid the knives.

By contrast, her current treatment within the French health system has been a revelation. In April, Hannah went to stay with my sister in France in an attempt to detox. While there, she became severely dehydrated and was taken to hospital. The next day she was transferred to a psychiatric unit and the consultant explained to me that her heroin addiction was just a symptom and not the cause of her problems. Until her bipolar illness was properly treated and controlled, she would continue to self-medicate on heroin.

This was a first! To have the focus shifted from the drugs to her bipolar totally changed how she viewed her situation. Instead of being labelled as ‘just another junkie’, she felt her illness was at last being taken seriously. Her whole demeanour changed and became more positive; she began to believe she could really get well again.

For me, it meant I no longer had to fight the system to get help – it was being offered willingly and without any conditions. I was able to leave her in France, knowing that she was getting joined-up care and support for her complex problems. 

Seven months on, Hannah is still receiving excellent outpatient treatment and psychiatric support. She has just been over for a two-week visit and the progress in her recovery is encouraging. She no longer has cravings and is a lot calmer. Her ability to deal with normal everyday issues has improved dramatically and she is starting to look ahead and plan a future.

My journey alongside Hannah in the past ten years has motivated me to try to seek better understanding and treatment for those who use drugs. I want people to know and really understand the cause of drug addiction and not be misled by the sensationalist articles pedalled by the popular press.

It breaks my heart and also makes me angry to see my daughter being treated as a criminal. When she is in the grip of her addiction she can become a monster and do things that even I find hard to accept and condone. But underneath I know there is a vulnerable damaged woman who struggles to cope with life and uses the drugs to escape from her problems.

When clean, Hannah is a kind, thoughtful and vibrant daughter who deserves to have a happy and fulfilling life. One day I hope she will finally achieve that. Until she does, I will continue to shout as loudly as I can to tell people the truth about heroin addiction. Ultimately I hope we can change misguided assumptions and get a majority to understand that people like Hannah need help, not punishment. 

Only then, when we have significant numbers of people behind us calling for a change in current drug laws and policies, will we persuade politicians to be brave enough to implement the changes needed and provide the joined-up care and treatment people like my daughter really need.

Tough lesson

 Jason Gough recalls realising the impact he was having on his family

 While I was in active addiction I didn’t understand the full impact of it on my family. Dad used to say ‘if you want to see our front room, go to cash converters – it’s all in there.’

It was only later that I realised I’d made our home an unsafe place. My family became frightened of me. I was oblivious to this; I thought at the time that I was the one who was suffering. I imagined I was protecting them in some way. When I was relapsing I didn’t say anything. I didn’t want to spoil the joy of ‘Jason’s getting better’.

In the early days it was all about escaping and nothing about my family. One day I clicked on a YouTube clip of the effect of drugs on a family and realised the impact. Hearing what someone else said had a huge effect on me. I left Sheffield that day, went to my mum, and told her I was sorry, that I loved her. I began the process of looking at my parents as individuals with their own hopes and desires, not just people there to serve Jason.

I realised how my addiction had affected them – it felt like losing a limb. I could recover from it, but life would never be the same. It was extremely difficult, realising the effect on my family. Without their support I could never have got into recovery. Without their help I never would have made it.

My father and mum dealt with me differently. My mum could cut herself off, but my father was always there and visited me in prison. He passed away while I was in rehab and never saw me get a job.

So I say to families, please share your story. Tell as many people as possible. Commissioners have to put families first.

We should be demanding naloxone

‘We need family members out there advocating naloxone,’ said drugs trainer Nigel Brunsdon, leading a workshop about this life-saving intervention. Who better to put pressure on commissioners than families, daughters, sons, mothers and fathers, he asked. ‘We should be demanding naloxone. It shows we care. We care if someone lives or dies.’ 

‘The more people that are trained, the more people can train,’ said Dr Judith Yates, a GP in Birmingham. ‘It should not be one and a half hour sessions, it should be normalised, part of life – not made an occasion.’

With an (award winning) video of his daughter demonstrating saving her teddy bear from an overdose (pictured), Brunsdon showed how administering naloxone correctly was ‘child’s play’.

‘As long as it is injected into the thigh muscle it’s fine – you cannot overdose from naloxone,’ he reassured participants concerned about lack of knowledge. It was important to get naloxone into families with drug-using children or parents, he stressed.

For more advice and the naloxone film, visit www.injectingadvice.com

Drinking affects every family differently

‘Alcohol often gets left behind when people talk about substance misuse,’ said Alcohol Concern’s workshop programme manager, Lauren Booker, in a session about alcohol and families.

While alcohol had always received less money for services, people who gave up class A drugs often turned to alcohol, using it as a replacement, Lauren Booker explained. Roughly 1m children lived in a household with one or more dependent drinkers and almost a fifth of the population were affected by the alcohol use of family members.

The most common question asked by relations and friends of people with alcohol problems was ‘What can I do to help?’ While the World Health Organization defined dependence as ‘when alcohol affects physical, emotional and social functions’, it also applied to the functions of those around someone who struggled with alcohol issues.

During the workshop, case studies were given to groups describing a family of five with two parents who drank the same amount of alcohol per week (over the recommended number of units) but in different social and economic situations. Groups were asked to give examples of the effect of alcohol on the families – depression, break-up of the family, abuse, bad influences on the children leading to trouble at school or with the police, problems with household budget and negative impact on careers.

It was agreed that drinking affected every family differently and that there was no ‘standard’ pattern of what would happen. The environment surrounding the family and alcohol users had a big impact – it was never cut and dried. Alcohol was a short-term coping method, but caused more problems in the long term. Participants discussed what could be done to help families who were experiencing alcohol misuse. The ideal was to catch it early before problems became serious. Failing that, what was necessary was early identification, assessment and referral pathways, coupled with better multi-agency working.

Effective approaches to helping family members included online forums, recovery communities, and workplace counselling and referrals. It was essential to know what different services were available and to recognise that treatment did not necessarily mean abstinence.

Alcohol was all around us, in our society, community and families, said Lauren Booker, and there was a lot we could do about alcohol-related harm. However, it would be a slow process, in the same way that society eventually began to realise that tobacco was harmful and the culture around it changed. ‘

We are at the start of a long-term mission to change the way the nation drinks,’ she said.

Step by step

DDN reports from the second Adfam/DDN national conference for families and carers, which highlighted that, despite the progress in bringing family support to the fore, there’s still a long way to go to convince commissioners.

‘We might be fed up of banging on about the same old thing – but many families haven’t heard it and it’s important that they do,’ Adfam’s chief executive Vivienne Evans told delegates at the second Adfam/DDN Families First conference. ‘We have to aim that people can speak out.’ Much of Adfam’s work was centred on promoting family support in its own right, tackling stigma, and developing forums and regional networks, she said.

Mark Gilman, national recovery strategy lead at Public Health England (PHE) believed in the essential value of support networks. ‘Social relationships are a matter of life and death,’ he said, adding that social isolation could be ‘a death sentence alongside the chemicals.’ This applied equally to families of loved ones, whose involvement with organisations such as Al-Anon showed better outcomes and support throughout the recovery process.

Nick Barton, chief executive of Action on Addiction tackled the difficult concept of ‘tough love’, commonly seen to mean not tolerating certain behaviours and often driven by helplessness.

‘When someone comes up with a simple formula like tough love seems to be, there’ll be plenty of takers,’ he said. ‘But the core question is, can you get someone to stop their addiction by the way you relate to them? My answer would be no. And can you improve your life by the way you relate to someone with addiction? The answer is yes.’

Setting boundaries was no bad thing between adults, but it had to be done for the right motives. Families needed to realise that it might have an effect, or it might not, he said.

‘Addicted people often offer invitations to treat them badly,’ he stated. ‘We don’t have to accept these – in fact they should be resisted. Don’t take the addicted behaviour personally – it’s not directed at you. It’s about their difficulty in being themselves. 

A nurturing attitude to helping was usually better than confrontation, he suggested. ‘There’s no evidence for tough love. It can be counterproductive and make problems worse.’ Participants in a ‘carers’ rights’ workshop were glad to hear this advice.

‘It was so reassuring to hear Nick Barton’s talk on tough love and that it doesn’t necessarily work,’ said a couple from Southampton. ‘We had been living with guilt as we couldn’t do it.’ The couple’s son had been ‘cast adrift’ from a young people’s support service as soon as he’d reached 18, leaving them struggling, with nothing but the number of a local support group that had turned out to be a lifeline.

The couple explained that they had been to their family doctor who gave no more help than to say ‘I don’t know how you cope,’ leading to a discussion within the workshop about the need for GPs to be actively involved.

‘The biggest theme to come out of this is that GPs should signpost information and support,’ said Su Bartlett, drug and alcohol development worker at Carers in Hertfordshire, who led the workshop.

‘Caring is tough whatever the rules,’ she said. ‘It’s hard work and often a battle. The impact is on your physical and mental health – it’s a huge, huge issue.’ It was even difficult to get people to identify with the label of carer. ‘Some drug and alcohol carers feel that they shouldn’t be accessing services,’ she said.

A UK Drug Policy Commission (UKDPC) study suggested that around 1.5m adults in the UK were affected by a relative’s drug use, but other studies put this number closer to 8m, she said. Whatever the figure, there was no doubt of the significant negative impact on physical and mental health, emotional wellbeing, family relationships and finances, and the health and wellbeing of any children involved.

The workshop group brought family members and carers into discussion with practitioners, and the conversation frequently became impassioned as carers brought their day-to-day tensions to the group.

‘I don’t hate my son, but I hate what he does,’ said a mother. ‘It helps me to go to the support group. I hadn’t really thought of myself as a carer till today – I’m his mum. My group takes us away on days, such as spa days, and I think “why am I here? Because my son’s a drug addict.”’

‘My son was on drugs for nine years before I knew about support,’ said another mother, highlighting how far family support still needed to go.

‘So how can we encourage people to access support for themselves?’ asked Su Bartlett. The Adfam stigma campaign would help to show that carers had a right to get angry and give them the way forward to deal with a lot of internal processes, said Esther Harris, an independent practitioner.

‘A lot of parents believe it’s their fault, and this erodes the belief that they deserve something for themselves.’

Adfam’s Kate Peake addressed the issue of stigma at a plenary session later in the day and explained the charity’s ‘Speak Out’ campaign.

‘It’s about telling the world this can happen to anyone,’ she said. This isn’t an additional extra, it’s intrinsically related to the main agenda. It’s about regaininghumanity for family members.’ 

Family members were not comfortable talking about their issues, but could be encouraged to share, she said. Illustrating her point with an account of organising a flash mob with a carers’ network in Tyne and Wear, she said the important message to convey was that ‘things can and do get better’. This local initiative had enabled the participants to give out the message that ‘family members need support and here’s where you can get it’.

‘There’s still stigma, but there are huge changes and we need to learn from that,’ she said. ‘We have to take small steps.’

Julia Dixon-Large tells DDN about BADSUF’s innovative, volunteer-led charity shop

This is a difficult financial climate to come off benefits and find employment, when individuals may have neither employment history nor qualifications. BADSUF identified that some people wanted to obtain volunteer placements, and we proposed to open up a charity shop so that these individuals could build on their employment experience in a safe and contained environment.

The proposal was put forward to the local DAAT, and it was agreed that it would be pump-primed by the DAAT and BADSUF with the aim of it becoming self-funding over time. We looked at areas and decided on Boscombe for a variety of reasons, and the Boscombe Regeneration Partnership identified a number of key priorities to focus on – housing, employment and enterprise, environment, crime, health, education and attainment. We felt that we could help to meet some of these priorities by having the shop in this location.

The shop was sourced (which took a lot of hard work behind the scenes), refurbished and launched in February 2012 by the mayor of Bournemouth. We held open days and a volunteer day, as well as joining the Charity Retail Association and the Bournemouth Chamber of Commerce so that we could ‘mingle’ not just in retail arenas, but also with local business.

We made links with local businesses and schools, and received donations from a lovely group of schoolchildren. We also set up an eBay account and Facebook page to promote the shop.

As part of the BADSUF team we have Margo Benjafield, Nigel Seal and Jackie Twine, all doing different roles but primarily promoting the shop and volunteering opportunities.

 We’re lucky to have Caz Anderson as our charity shop/volunteer coordinator as she has vast experience in retail, treatment settings and managing and developing volunteers. Caz started with BADSUF in May and has worked very hard, and because of her enthusiasm and passion we now have 15 amazing, dedicated and hard-working volunteers from all walks of life and whose ages range from 21 to 72. This has created a diverse and eclectic bunch of people who offer a variety of fantastic skills. 

Claire, a BADSUF volunteer, said of the shop, ‘I have worked in charity shops before, but none so dedicated to their cause as this one. It does exactly as is said on the tin! The shop is the first point of call for many in the dark about the right channels to go down to better their lives, and it is truly a privilege to work here. The atmosphere is relaxed and happy – we love what we do.’

Another volunteer, Kaye, added, ‘Having had a really chaotic lifestyle due to my addiction, and having been through the treatment “cycle” many times, I really found it difficult to fit in anywhere. I struggled to find a purpose in my life. Now I have a reason to get up every morning. I feel I have regained my confidence and self-esteem. I feel I am part of a team, a little community working with like-minded people.’

A typical day at the shop includes sorting out stock donations into relevant piles, steaming and hanging clothes, and then putting the stock out on the shop floor in order and in themes. Creating interesting and eye-catching window displays is also important, as we have a double-fronted shop.

Cleaning, tidying and customer service are a part of the daily routine, as well as giving out relevant information and leaflets and just enjoying being part of our little community – and taking turns to make a nice cup of tea to keep us all going. We have a real giggle at times too.

We have lots of returning local customers as the shop has a lovely atmosphere and is spacious, having been decorated stylishly by a local painter and decorator, John Gater. Customers have said it has a ‘beautiful aura’, and we all agree.

We would like thank Bournemouth DAAT, as well as countless others, for supporting us, and Action on Addiction SHARP Bournemouth Working Recovery for making and designing our sign. We welcome anyone who is interested to come along – just get in touch via the BADSUF website, or contact Caz, Julia or Jackie. There are lots of innovative ideas still being worked on behind the scenes so watch this space!

Julia Dixon-Large is the charity manager of BADSUF, www.badsuf.com

September saw recovery activities taking place across the UK and Ireland. Richard Cunningham, Alistair Sinclair and Stuart Green look back on a vibrant recovery month.

Protective shield

Recovery is at the heart of a popular annual tournament in Gateshead, as Richard Cunningham explains

This September Gateshead International Football Stadium played host to a football event with a difference. The majority of the players involved in the tournament were recovered, or in recovery, from drug or alcohol dependency.

The recovery shield is an annual tournament organised by Turning Point. It has been going from strength to strength and is now in its third year, with each year seeing more players and teams competing. What started off as a local tournament has become a national event, with healthy regional patriotism adding to the tournament’s competitive edge. This year we had a record 20 teams and more than 200 people took part. 

It is my hope and one of the main aims of the recovery shield that the growing profile of the tournament will help to break down the stigma often associated with alcohol and drug dependency in wider society. Without concerted efforts to bridge the gap into the community, there is a chance that people in the early stage of recovery can be left feeling more and more isolated, making sustained recovery much more difficult to achieve.

Working in the substance misuse field we know that dependency on alcohol and drugs does not discriminate. It is not restricted to certain segments of society, nor is it a question of age or gender. When an individual is dependent it can often be hugely difficult to see a way of escaping the problem, and that is why it is so important that events like the recovery shield exist to not only support people in their recovery but to give a wider reason to recover and reassurance that it is possible. 

As Tommy Armstrong, one of the players from this year’s winning team Norcare, said: ‘Everyone participating took it as an opportunity to make friends and show the outside world that we are not all the same and people can make a difference to their lives with support and social interaction.’

The event provides a meeting place and an activity that enables those in recovery to come together in an environment without  judgement – a place to meet new people and share experiences. This can assist with recovery and, more importantly, provide a situation where the players can feel comfortable and be themselves. 

I am not claiming that events like this are the magic cure for those in recovery but they can go a long way towards helping people reintegrate back into their community, to show that there is life after dependency.

The game itself is also shown to have a positive effect on people’s mental health. Players feel part of a team, which is very important to those who can often feel outside of, or removed from, society. In the tournament these players become part of a collective that must work together to progress through the rounds. Those who have played in football games, or any team sport for that matter, will know that you need to place an element of trust in your team mates and the importance of this simple human connection cannot be overplayed. 

The recovery shield is all about partnership working. Scott Duncan from HMP Northumberland, a key partner in the event, spoke about his involvement:

‘I was delighted to be involved in the 2013 recovery shield and feel the whole event was a huge success. The players who participated were a credit to their various organisations and testimony to this is the fact that we had a total of 52 matches and at no time was a player ‘sin-binned’ for inappropriate behaviour. Bringing together teams from various areas encourages integration and sportsmanship, this was evident in abundance.

‘My personal role as HMP Northumberland’s representative in the community is to assist ex-offenders on their recovery journey to minimise the likelihood of reoffending. Sport is a hugely important part of recovery and clients who attend the gym on a regular basis whilst in custody are given excellent tuition on health and training by the PE department at HMP Northumberland. This support is carried on to when they are released through the SAS (Sport After Sentence) project when they are given advice and guidance on local sport and gym opportunities.’

David McCormack, who played for North East Athletic at the tournament added:

‘The recovery shield is strongly becoming one of the most celebrated events in the recovery community both in the North East and further afield. It celebrates the changes in people’s lives and also gives renewed hope to those around, by allowing them to understand there is something else out there other than addiction. 

The tournament has been a fantastic success and I would like to take this opportunity to congratulate the winning team Norcare. The awards and recognition are great of course but the recovery shield is all about coming together, as individuals in recovery, partner agencies, friends and family and all those who work in the substance misuse field to celebrate and promote recovery. This is at the heart of everything we do.

If you are interested in being involved in the 2014 recovery shield please get in touch! 

Richard Cunningham is peer mentor coordinator for substance misuse at Turning Point, richard.cunningham@turning-point.co.uk

We made the path

With its ambitious walks and varied activities across the country, the vision of a recovery month became a reality, says Alistair Sinclair

As I write this, on the last day of September, I’m on my way to the Wirral to attend the ARCH 20th anniversary recovery event and mark the end of the first UK recovery month. This seems particularly apt as a few days ago I attended the official launch of Hope Springs, a new recovery centre in Chesterfield, Derbyshire, where Mark Gilman, recovery lead at Public Health England, talked about the heroin explosion on the Wirral in the mid-80s. Mark said that nearly 30 years later, people on the Wirral were ‘finding recovery’ with the same people who had introduced them to heroin, and he went on to talk about the vital importance of authenticity, healthy social networks and visible recovery in communities.

Recovery was very visible at the fifth UK recovery walk in Birmingham on 22 September. Around 5,000 people from all over the UK walked through the city centre, celebrating community strengths, solidarity and the importance of building friendships and connections. Organised and delivered by the Birmingham Recovery Community (you can find them on Facebook) the UK recovery walk was the big celebration in a recovery month that saw events in many places across the UK. The UKRF had promoted the ‘idea’ of a recovery month through its networks, and we were pleased – if not a little relieved – to see 49 recovery events (that we’re aware of) take place throughout September. This year was a bit of a rehearsal for future years, but it saw thousands of people engaged in making recovery visible and making new connections in many places across communities.

On 1 September more than 100 people from Birmingham, Chester, Coventry, Leicester, Lancashire, Bradford and North Wales, climbed 3,600 feet to mark the beginning of recovery month, raising a purple flag of recovery on Snowdon’s summit. Gloucestershire and Cumbria held their first recovery walks and Weston held its second. In Lancashire, 55 very determined people endured appalling rain to climb to the top of Pendle Hill. There were other walks – some in fancy dress and sponsored – in Cleethorpes, Scunthorpe and Leicester and a bike ride in Morecambe. Dublin held its second Irish recovery walk and there were recovery celebrations in Ayr, Durham, Doncaster, Cardiff and Liverpool. There were film nights in Wigan and Blackpool, football tournaments in York, Burnley and Lancaster; an art exhibition in Liverpool; a festival in Oxford; a recovery awareness day in Kingston and the opening of Café Hub in Blackburn. 

The UKRF ran six workshops in recovery month exploring community values and strengths in Derbyshire, Rochdale, Norwich and Birkenhead. Working in partnership with the Derbyshire NHS Trust, we brought people from the worlds of mental health and drug recovery together at a national conference in Chesterfield to explore shared values and begin work on a recovery model for the whole community. 

Ruth Passman from NHS England spoke at our conference and invited recovery community members to an NHS values summit in Manchester. The summit was opened by the head of NHS England, Sir David Nicholson, who described it as taking place in ‘national recovery month’. This idea – a month that brings people together to champion recovery in its widest sense, celebrating and promoting wellbeing for all within communities – became a reality in September. 

For recovery activists involved in September’s activities, 2013 will be a significant year. The British recovery movement, a movement that places individual and community wellbeing above drug or alcohol or mental health status, is finally on the move. Watch out for recovery month 2014.

Birmingham Recovery Community, https://www.facebook.com/BirminghamRecoveryCommunity?fref=ts

Friends of the UK Recovery Federation, https://www.facebook.com/groups/UKRecoveryFederation/

Alistair Sinclair is UKRF director

In it to win

Giving something back to the community gave a winning formula to Doncaster’s recovery games, says Stuart Green

Every year at New Beginnings, part of Rotherham Doncaster and South Humber NHS Foundation Trust, we look to raise sponsorship for Aurora, a local cancer respite charity. This year, one of the staff at New Beginnings, Neil Firbank, came up with the brainwave of the recovery games. The idea came from discussing with a colleague and group members what had inspired them over the past year and the Olympics and Para-Olympics kept coming up – actually seeing and believing in others who had achieved something to be proud of appeared to be the main reasons. So we decided to go ahead with the recovery games. 

The original idea was to have local teams competing against each other, while raising money for charity. This would give them the opportunity to give something back to their local community, learn to work together in a team with staff and each other as well as reducing stigma within our community. We were looking to attract between four and eight teams of up to ten members.  Once we got the message out with the venue – a local activity centre with its own marina, part of Doncaster Cultural Leisure Trust (DCLT) – it became apparent that this was going to go viral. We closed registration with 22 teams and had to turn away four further teams of ten. 

The day began with a zumba demonstration as a warm-up, with people competing against each other in eight rounds of events. These included a gladiator duel climb, low rope challenge, kata-canoe race, eliminator run, team archery, the boom blaster, giant buzz wire and a demolition wrecking ball.

The event was pitched in the summer holidays to attract a family atmosphere and there was plenty for spectators to do, including a bouncy castle, face painter and a circus entertainer mingling with the crowd. The children competed in a space hopper grand national, with the fastest time over three age groups being awarded recovery games gold medals. 

At New Beginnings it was a frantic week leading up to it – the arts and crafts room was abuzz making banners, costumes and the podium for the winners. We gained a lot of support from people we work in partnership with, who kindly donated time or money to the event. This resulted in every participant getting a medal presented by the mayor of Doncaster and our assistant director, Ian Joustra, with the winners receiving gold medals and a commemorative shield. During the lunch break we had live jazz and a raffle for locally sourced produce from the place where our service users volunteer. As well as entertaining the crowds, a strong message of health and wellbeing was promoted throughout the whole day, with a number of stalls from the community fire safety team, local carers groups, complementary therapy taster sessions and free physical health checks.   

On the morning, it was pouring down with rain and we really didn’t know what to expect. But suddenly coaches, cars and people started turning up in their masses. We had more than 300 people attend. There was a clear buzz in the air and a competitive but respectful edge for each other among the teams. The local campers thought the Martians had landed and could not work out what was happening to their tranquil camping site next door. As the weather improved, more people arrived and the catering facilities did not stop all day.  

The culmination of the day was a united feeling that recovery could be fun, competitive and a genuinely viable option. We had teams from Scunthorpe, Grimsby, Doncaster, Chesterfield, York, Rotherham and Sheffield, to name just a few, and more than £400 was raised for charity. Feedback is still pouring in as to how much people enjoyed the day itself, from local community members, staff and of course those in recovery. This looks like it’s going to become an annual event, with York expressing an interest to take it forward next year.

Oh, and finally, there was no fix but New Beginnings won – all that training paid off!

Stuart Green is service manager at New Beginnings, www.drughub.co.uk

Philippe Bonnet, founder of the Independent Consortium on Drug Consumption Rooms, says he won’t rest until there’s a room established for Birmingham’s 10,000 problem drug users. He talks to DDN.

When the Independent Drugs Commission for Brighton and Hove reported earlier this year it made more than 20 recommendations, but the one seized on by the media – both liberal and conservative – was a feasibility study into the setting up of a drug consumption room (DCR) in the city.

Despite the existence of DCRs across the world – in Switzerland, the Netherlands, Germany, Spain, Australia, Canada and elsewhere – and a body of evidence on their effectiveness in promoting access to services and reducing both risk and public drug use, they remain a divisive issue. 

Now an Independent Consortium on Drug Consumption Rooms (ICDR) has been established in Birmingham, with the aim of setting up a DCR in the city. Founded two months ago by outreach drug worker and trainer Philippe Bonnet – who is also deputy chair of the National Needle Exchange Forum (NNEF), chair of the Birmingham naloxone steering group and a trustee of homeless charity Birmingham Christmas Shelter – the consortium has already attracted some well-known names from the sector, including NNEF chair Jamie Bridge, Nigel Brunsdon of Injecting Advice, researcherNeil Hunt and Dr Judith Yates, who has more than 30 years’ experience working with Birmingham’s drug users. 

 ‘Perfect sense’

Given the controversy around DCRs, what’s been the response from officialdom so far? ‘We’ve arranged meetings with Birmingham City Council, Public Health England, the health and wellbeing board and the police and crime commissioner, but unfortunately the council and Public Health England have said they won’t endorse the plan “for the foreseeable future”,’ he says. While police officers have told him off the record that ‘as a citizen it makes perfect sense, but as a police officer I can’t be seen to endorse it’, he points out that ‘police reports and attitudes from the DCRs operating worldwide are 100 per cent positive and officers are even pointing street users towards their local DCR’.

The next step is to find the local councillors most likely to adopt a sympathetic and pragmatic approach, he explains. ‘Dr Yates and I met with a councillor who said DCRs made perfect sense to him and that he’d speak to other councillors to try to gauge who would eventually support us – he’s aware DCRs aren’t a vote winner,’ But a growing number of organisations are already backing the campaign, including Release, the National Aids Trust (NAT), the Hepatitis C Trust, HIT, Swanswell and Inclusion Drug Alcohol Services in Birmingham. 

Media storm

Considering the reaction to the Brighton report, however, just how big an obstacle does he anticipate the media will be? ‘It could be massive, but my argument when I’m told that consumption rooms aren’t flavour of the month is that they never have been and never will be. I run clinics in the two busiest needle exchanges in Birmingham city centre and I see the damage of street injecting on a daily basis. Every single DCR caused controversy at first, but they’re all well embedded now and it’s not a big deal anymore – residents and the police are actually glad they exist. We need to take the sensationalist factor out of DCRs – you could even argue that pubs are kind of consumption rooms for alcohol.’

On the subject of sensationalism, getting a fair hearing is vital, he stresses, although not always easy. ‘When the Brighton thing kicked off in the press I was interviewed by the local BBC radio in Sussex and then I got a call from BBC West Midlands asking if I’d be prepared to do an interview. I said that what I would like is to have a televised debate that is actually a real, rational debate – us stating our case and people who are against stating their case – so that we can properly put counter-arguments and they’re not lost in the editing. We haven’t heard anything back as yet.’ 

Given the controversy and the reluctance from the authorities, how confident is he that he can actually pull this off? ‘Put it this way, I won’t rest until it’s in place,’ he states. ‘Commissioners and councillors come and go – they aren’t in post forever – and I’ll carry on until it opens. One of my mottos is that although I don’t necessarily condone drug use, I’ll fight until my death for the rights of people who use drugs to be able to do so as safely as possible.’ 

As an ex service user he’s speaking from personal experience, having spent about 12 years with a ‘heroin, crack and other pharmaceuticals’ problem followed by ten years in recovery. ‘I was an injector but I was lucky to have friends in the medical profession, which is why I was so good at injecting and why my skills now are around teaching safer injecting and other harm reduction interventions.’ 

 Growing demand

Although French, he’s been in the UK for 25 years, but is in regular touch with key figures in the drugs sector in France, which will see its own first consumption room open near the Gare du Nord in Paris next month. ‘Bernard Bertrand is the French expert on consumption rooms and he created the Global Platform for Drug Consumption Rooms – I’m in contact with him regularly and we talk about what’s happening here and in France,’ he says. ‘It took ten years to get where they are now, and especially the last four years have been horrendous.’

Presumably that was because of the political climate under Sarkozy? ‘Yes, but now Marisol Touraine, the health minister [under current president François Hollande] has said “OK, I’ve heard a lot about the effectiveness of DCRs in other countries, I have enough evidence and I want to implement it as soon as possible”. But also the local mayors were very influential. The mayor for the 10th arrondissement, where the consumption room will be located, was all for it and other local mayors said they wanted it too, but because this was under the Sarkozy government they were told no. They said, “we’re the local councillors – we know DCRs are effective and we want them” but the ruling party said no.’

There’s now growing demand from other French cities with problems around street injecting, he says – particularly Marseille, Strasbourg and Bordeaux – and, perhaps surprisingly, once the new government was in place the plan for the Paris consumption room was agreed without significant opposition. 

‘A Facebook page was created by people who were against it, but they only got about 200 members, and there were a couple of protests in the streets. The thing is that this is evidence-based – it’s not just some people saying it’s a good thing. There’s a mountain of evidence about the effectiveness of consumption rooms in reducing overdose deaths, injecting complications, needle litter and so on.’ 

Uphill struggle

Nonetheless, he’s fully aware that it’s going to be very much an uphill struggle in Birmingham. ‘The main barriers are going to be local politicians,’ he states. ‘Who will be willing to take the plunge and endorse DCRs? Who will be ready to perhaps risk losing a few votes but ultimately save a few lives and a vast amount of PHE money? Because we know DCRs are cost-effective as well.’ 

When it comes to funding, the consortium’s intention is not necessarily to approach PHE, he explains. ‘According to government figures, between 2007 and 2010 more than £90m was recovered from drug traffickers through confiscation orders. That could fund DCRs very nicely.’ 

And DCRs do fit with official policy, he stresses. ‘The drug strategy clearly states that the government is committed to reviewing evidence of what works from other countries and what can be learned from it, and that’s music to my ears. And let’s not forget as well that Public Health England has been mandated to look after the most vulnerable in our society. I don’t think in this day and age in England we should be allowing people to inject in the circumstances that they’re forced to – I think that’s pretty appalling and sad. We need to be more pragmatic and health orientated.’

Consumption rooms have also had some high profile support, he points out, with David Cameron a member of the 2002 home affairs select committee that recommended they be piloted in the UK. ‘Now, 11 years later, there’s even more evidence. I’ve written to him asking if he still stands by his statement, and I’m waiting for a reply.’

www.facebook.com/IndependentConsortiumOnDrugConsumptionRoomsIcdcr

A survey of needle exchange clients revealed the need for staff to keep up with the times, as James Langton explains. 

As a supplier of injecting equipment to needle and syringe programmes (NSPs), Daniels Healthcare wanted to discover more about what appeared to be a significantly changing profile of the injecting drug users who are our end-user clients. For a long time, anecdotally, we had been aware that steroid injectors were accessing needle exchanges for their equipment in ever-greater numbers. So over the course of last year we began to think it would be valuable to learn more about how our provision to this client group could be improved and also see if we could provide further information for commissioners and drugs services to help them understand the needs of a client group that frontline drugs workers often find very hard to engage with, beyond a quick exchange.

We approached Kevin Flemen at KFx to undertake research to use alongside experience gained at his workshops and training sessions, and a simple questionnaire was created and distributed by needle exchange workers to people attending exchanges and who used steroids. Fifty-four completed responses provided some interesting, and at some points surprising, results.

KFx and Daniels were both aware of worryingly wide variations in knowledge among people who use steroids, from the highly knowledge­able and experienced to those with only very basic understanding, so we decided to develop a series of information leaflets. We really liked KFx’s idea of dividing the information into specific knowledge areas and creating resources which could be distributed either with their pharmacy packs, or individually by frontline workers, and eventually free of charge from our websites. 

Starting with those who may not have extensive knowledge, it was decided that the following subjects would be the most helpful in offering straightforward harm reduction advice for naive injectors, as well as those who might be interested in exploring potential alternatives to steroid use.

The five leaflets focused on:

• When to start? A leaflet for younger people who either hadn’t started using, or were just thinking about starting to use, performance-enhancing drugs. 

• IM injections: a basic leaflet covering intramuscular technique, to be given out with packs for IM injection.

• SC injections: for people using any compounds subcutaneously, describing SC technique and to be given out to people taking packs for subcutaneous injection.

• Melanotan: a specific leaflet for people injecting tanning agents, identified as a group for whom there was little literature about administration.

• Polydrug users: a leaflet for people using steroids in a non-structured way alongside other substances such as alcohol and ecstasy. This group of young polydrug users was considered especially high risk and lacked any targeted literature.

By acknowledging the growing numbers of steroid injectors who were accessing drugs services, we hoped to demonstrate to this group that an exchange could also be part of a tailored intervention.

We wanted to be part of a conversation that acknowledged that NSPs were as much for people who used steroids as any other substance. As part of the same process, we concluded that if sharps boxes were going to carry any messages at all, some of these should also be steroid-specific, so we developed a series of educational messages specific to steroid users, delivered in an engaging way.

The relatively high response rate to the survey allowed us to see some clear trends emerging. However, as the sample group were self-selecting (ie the surveys were conducted in needle exchanges) it provided a poor impression of what went on for people who didn’t use a needle exchange.

We used a simple nomination question to find out if service users felt that most of the people they knew already used needle exchanges. The results indicated that the majority of people attending services felt that most of their peers were also using exchanges, but there was also a significant population that didn’t.

We asked people what aspects of service were important to them, and the results confounded expectations. Despite our preconceptions, a steroid-specific service was the least important aspect and less than a third considered evening or weekend sessions necessary to them. The crucial aspects were friendly, knowledgeable staff delivering the right equipment in a confidential setting.

While the result was biased – completed as it was by people already using needle exchange – the findings were still striking. They highlighted the need for effective staff training rather than a concentration on extended opening or steroid-only sessions. 

We found the exercise of focusing on the needs of steroid users informative and enlightening and will use the results to inform how we develop our distribution of equipment to this client group.

James Langton is harm reduction planning officer at Daniels Healthcare, www.daniels.co.uk

To receive a copy of the research, contact Kevin Flemen at www.kfx.org.uk

DDN reports from the 2013 NNEF annual meeting in Bournemouth, which has become a keenly anticipated fixture for information and ideas. 

Keeping harm reduction at the heart of drug strategy was a key concern of the National Needle Exchange Forum (NNEF)’s annual meeting. This year it was held in Bournemouth and drew enthusiastic attendance from needle exchange workers from all over the country.

The forum’s chair Jamie Bridge reiterated the NNEF’s aim of promoting, supporting and protecting good quality needle exchange in England, and invited Steve Taylor from Public Health England to give an update on how PHE related to this agenda. 

‘Harm reduction and public health interests align in a way that they didn’t when the NTA had to be seen to be aligning with the government’s recovery strategy,’ said Taylor, outlining work on newer psychoactive substances, men who have sex with men (MSM), improving access to hep C treatment, adding to recovery resources and collecting evidence on the effect of recent legislation relating to the use of foil.

His colleague Vivian Hope, previously of the Health Protection Agency, gave an update on injecting drug use and infections from PHE’s injecting drug use team. Patterns of injecting were changing, he said, with an increase in psychoactive and club drugs as well as performance drugs – primarily anabolic steroids.

Hepatitis B and C had declined markedly over time, thanks to ‘harm reduction approaches supported by good drug treatment’. Levels of HIV infection were stable, although four times higher in London than elsewhere in England and Wales, and there had been spikes in transmission of HIV, probably related to crack cocaine and increased risk behaviour. Needle and syringe sharing had declined overall, but the changing patterns could increase risk among different populations, so it was important to respond quickly to any changing

‘Changes will be positive’

Blenheim’s chief executive, John Jolly, was asked to give an update on commissioning and policy in England, and could not find much to be optimistic about in the new localism agenda, with the impact likely to be that ‘the needs of the many outweigh the needs of the few’. Despite politicians telling us ‘changes will be positive’, the drug and alcohol sector needed to realise that ‘we are no longer the priority’, he said. ‘The priorities for public health are at local level.’

Ring-fenced drug money had gone into ring-fenced public health money, ‘but it gets worse,’ he said. ‘The ring-fence comes off in 2015 and we’ll have to compete with everything else. In London it feels a bit like the Wild West – the last man standing.’

Niamh Eastwood, chief executive of Release, underlined the need to be ready with legal challenges in this changing climate, and offered Release’s practical help.

‘If any of your clients are being harassed by police, let us know,’ she said. Release was challenging such ‘incredibly humiliating’ experiences as strip search before arrest and the practice of forcing clients to reduce their methadone script, where it was linked to an organisation’s policy decisions. They were also keen to challenge services that attempted to discharge clients on the grounds of bad behaviour, reminding them of their duty to provide alternative support. 

Frontline action

Next the spotlight fell on local services for a look at experiences on the front line.  Tim White from DHUFT (the local NHS foundation trust) credited a multi-agency approach with bringing drug deaths down.

‘We’re doing what we can to bring services to the community,’ he said, with the help of a thriving working relationship with the Big Issue and great support from Bournemouth DAT. 

Simon Chilcott of the Big Issue Foundation said that about half of the 81 Big Issue vendors in Bournemouth had substance issues and that the needle exchange was successful in attracting repeat visitors, including steroid users.

‘We see street users, people who are falling through services – it would be nice to catch them before they go down that far,’ he added.

Richard James, a blood-borne virus specialist said the BBV project had become successful through working with other agencies, using dry blood spot testing instead of needles, and training more workers to do the testing. With the percentage of people needing hep C testing higher than normal in this client group, it was a good idea to partner with a BBV project, he said. Needle exchanges represented a good opportunity to make contact with clients that didn’t present to other agencies.

The meeting brought in expertise from frontline workers in other areas of the country. Philippe Bonnet, an outreach drug worker in Birmingham talked about his work with chaotic clients – people who had become regarded as ‘problem people’ rather than ‘people with problems’.

Working in pharmacies in the centre of Birmingham had convinced him of the need for drug consumption rooms (DCRs) in the city, he said. Injecting in cold dark conditions often led to hurried injecting into cold veins, resulting in a high incidence of venous ulcers and abscesses.

Drug consumption rooms reduced deaths, as well as saving money for the NHS and reducing needle litter – apart from which, he pointed out, human beings should not be injecting in such circumstances. There were now 90 DCRs around the world, with the 91st opening in Paris next month. ‘The drug strategy says we are committed to learning from what works in other countries and an evidence-based approach,’ he said. ‘So how much evidence do you need?’

Practical knowledge sharing

Next up to talk about frontline action, Nigel Brunsdon of HIT and the NNEF explored the potential of harm reduction cafes in sharing ideas. 

‘It’s a return to the grassroots idea of small stuff that led to bigger action,’ he said. The internet offered a way to share resources and ideas: ‘Use the tools and adapt them, even if you’re in the recovery movement.’ Get active, piggyback events, choose the right venue and time (late afternoon or early evening) and think about involving speakers – ‘but above all, don’t wait for others to do it,’ he said. 

Moving on to the key developments for needle exchange, trainer and consultant Stephen Molloy wanted to know why all commissioners were not fully aware of the benefits of supplying naloxone.

‘How can we prevent people from standing beside the graves of their loved ones who have died needlessly?’ he asked, before giving a detailed reminder of the world’s first licensed kit. Although recommended by the ACMD’s naloxone report, it was still batted away by many politicians who said the decision lay with local areas. 

‘We know kits are used and we know lives are saved – so why wait?’ asked Molloy. ‘There are more than 1,700 deaths every year in the UK from accidental overdose. Why is this allowed to happen when naloxone works?’

Changing behaviour would mean having to talk to people about the potential of death – not a comfortable subject, he said. ‘But we need to change attitudes – an opiate-related overdose death doesn’t have to happen.’

The practical knowledge-sharing continued with Andrew Preston of Exchange Supplies explaining latest developments with low ‘dead space’ syringes – a design shown to have a much lower viral burden of HIV.  Exchange were now working with Bath University to see if they could further improve the dead space measurement without compromising the fit of the needle. 

The meeting then moved on to review changing trends, starting with trainer Danny Morris’s look at mephedrone (MCAT) and methamphetamine (crystal meth). ‘There have been changing trends in drug use that suggest progress in the work we do,’ he said, but the rise in MCAT and crystal meth use among some groups – primarily MSM – bucked this trend. With the former drug massively cheaper than the latter, ‘if gay men can’t get hold of meth, MCAT will do,’ he said. 

The resulting extreme behaviour, which could include sex sessions of up to four days with different partners, meant the need for greater knowledge and understanding among drug workers, as well as expertise relating to possible complications including mental health problems. 

As well as ‘getting kit out there’ it was important to engage and work in partnership with services including sexual health clinics, who were ‘ill-equipped to give any advice’, said Morris. He also advised the drug and alcohol field to ‘de-emphasise recovery’ in this context. ‘If you have a recovery service, the door’s not going to be open to them,’ he said. 

Unknown population

Josie Smith of the Welsh Needle Exchange Forum, added her knowledge from the 2013 Steroids and image enhancing drugs survey (SIEDs) – an online survey from harm reduction databases in Wales.

It was found that many needle exchange workers felt ill-equipped to deal with the problem of steroids, which were distributed by coaches and increasingly used in bodybuilding. The majority of steroid injectors were between 18 and 22 years old – ‘an age where you shouldn’t be injecting these, as they interfere with natural hormones. A lot of younger users think you don’t have to train or eat properly – you just bang the steroids in,’ she added.

Needle sharing had increased as this population did not see itself as at risk, so they needed to be offered hepatitis B vaccinations and warned about the dangers. There were many risks and complications from a public health point of view, ‘because we know so little about this population,’ she said. 

An online survey (at www.siedsinfo.co.uk) would help workers and pharmacists to learn more about this population, she added. Another initiative in Wales was to go out to gyms – ‘the ones who are providing the gear’ – but it was a constant battle to distribute information and posters, as gyms did not want to be associated with it.

With so much information-sharing taking place throughout the day, it was up to Mat Southwell of Coact to comment on the value of needle exchange in the past, present and future. Telling the story of one of the early drug user activists from the Italian drug using community in London, he highlighted the need to protect harm reduction, while emphasising how far we had come from the early dark days of the HIV response. ‘This field has to be commended for its positive progress and culture of collaboration,’ he said. 

Figures obtained by the BBC reveal the extent to which young children are ending up in hospital because of alcohol, reports DDN. 

While recent reports have indicated that the numbers of young people drinking are on a downward trend, it seems that those who are drinking may well be drinking more. 

Over the last five years, there have been nearly 48,000 incidents where alcohol or drugs have led to hospital admissions for people aged 17 or younger, according to according to figures obtained – via freedom of information (FOI) requests – by BBC Radio 5 Live’s Victoria Derbyshire programme. 

The true number is likely to be higher as only 125 of 189 trusts responded to the FOI request, the BBC points out. Perhaps most disturbingly, 293 children aged 11 or below went to an A&E department last year because of alcohol – including for falls and poisoning – a tenth of whom had to stay in hospital overnight. In addition, more than 1,300 12 to 14-year-olds attended for alcohol and over 4,600 15 to 17-year-olds, although, as the programme points out, the figures are down on 2009’s totals. 

‘Probably about 11 or 12’ says one of the programme’s young interviewees, when asked how old he was when he started drinking – alcopops, lager, cider ‘or whatever was lying around’. Many obtained their drink through siblings or asking strangers to buy it for them, and others discussed moving on to spirits as it got them drunk more quickly. Most cited boredom, peer pressure or the normalising effect of their parents’ heavy drinking as reasons why they drank. 

Alcohol charity Drinkaware called the figures ‘shocking’ and a ‘stark reminder about the dangerous consequences of alcohol misuse’, and urged parents to talk to their children about alcohol. ‘As important role models for children when it comes to alcohol use, we encourage parents to have open and honest discussions about the risks of underage drinking,’ said chief executive Elaine Hindal. ‘We believe that the “alcohol chat” is better in the living room than in A&E.’

‘I think it’s more about what parents say to each other,’ Alcohol Concern chief executive Eric Appleby tells DDN, however. ‘It’s very often a case of “do as I say but not as I do”. We shouldn’t be that surprised that kids get into trouble with alcohol, given the environment in which they grow up. It’s no good saying to kids at the age of 14 or 15, “be careful with drink, don’t drink too much” if they’ve spent the previous 14, 15 years hearing their parents and everyone else talking in very approving terms about drink – “it’s Friday, let’s have a drink!” and so on. By the time they’re old enough to get their hands on it, they’ve been pretty much, you could almost say, brainwashed into thinking it’s a good thing, an important thing, an adult thing.’

Although his organisation isn’t ‘entirely surprised’ by these latest figures, they are nonetheless ‘pretty frightening’, he says. Alcohol Concern and others have consistently campaigned for tighter marketing restrictions – how much of a role does advertising play for this age group? ‘It’s one important factor – they see it all around them – and the research we did in Wales showed that kids know the alcohol brands more than they do the sweets or cakes brands (DDN, July, page 5)’ he says. ‘We know the advertising gets inside their heads and they retain that.’

And, inevitably, kids tend to buy alcohol that’s cheap. So are these figures another argument in favour of minimum pricing? ‘Absolutely. A couple of the kids interviewed on the Victoria Derbyshire programme actually said “we buy it from our pocket money” – we’ve been using the phrase “pocket money prices” for the last year or so, and it’s just a perfect illustration.’

Minimum pricing is far from a silver bullet on its own, however, he acknowledges. ‘It’s one obvious response, but one thing we mustn’t do is just blame the victims all the time. Yes, it’s a strategy we need to take, but just saying “we should be tougher on pricing, tougher on underage sales” is only really scratching at the surface. Those are the things we can do straight away, but in the longer term it’s about the environment that we subject young people to.”

When it comes to getting treatment for those affected, are commissioners sufficiently aware of the specific needs of young people with alcohol issues? ‘It would appear not,’ he states. ‘It feels as though people are still surprised when kids turn up in A&E and hospital wards with alcohol problems. They know all about the dangers of drugs but it somehow still seems to have passed them by that the numbers coming in through alcohol are much greater. And we clearly need to do more to tackle it.’ 

 Launching our DDN good practice exchange, Natasha Bray of the Wallich Community House Team shares how she delivered a successful naloxone training initiative.

The Wallich Community House is a unique homelessness project specifically for people with co-presenting mental health and substance use issues. We provide semi- independent supported accommodation for 33 service users across eight properties, and place an emphasis on harm reduction.

A key aspect of the Working together to reduce harm strategy 2012 is the development of ‘take-home’ naloxone. After working with service users with dual diagnosis, I noticed there was very little motivation to attend the training despite initial interest. Very few service users had taken up the training in the 18 months I had worked at the project.

An initial survey revealed that one in four service users could not accurately describe what naloxone was. According to the non-fatal overdose questionnaire, 58 per cent of service users had experienced non-fatal overdose involving an opiate, with over 85 per cent of these accidental. Despite this, there were only three kits among current IV users in our eight project houses.

I developed a new initiative for engaging and training people with dual diagnosis in overdose awareness and naloxone. The purpose of this pilot was to make naloxone training more accessible in an attempt to increase safety in the project houses. It was also important to empower service users to be more responsible for reducing harms associated with substance use by increasing their knowledge and confidence in dealing with overdose. The aim was to have a minimum of one trained person and kit available in each house.

I started the initiative by using the Welsh Assembly Government naloxone poster campaign to raise awareness in the houses in the weeks before training started. However planning too far in advance or putting signs up with dates and times of training did not have as much success as talking to clients face to face and making arrangements to do training within the next couple of days. Groups consisted of between one and four service users, and training was offered in their own homes with refreshments provided.

The training was approximately 45 minutes to an hour, depending on group size, and consisted of a presentation adapted from the original training to make it more service user friendly. Emphasis was placed on overdose information, myths and risk factors, before discussing naloxone, practising injecting on an orange, a naloxone DVD, and a question and answer session on the important points to remember. The sessions concluded with further discussion of first aid, CARA and practising the recovery position.

I worked in partnership with Jo Simmons of the CAU to facilitate prescription of naloxone, so that each prescribed service user received two kits, one of which is kept in a communal area

known to all other residents. I also used the naloxone training as an

opportunity to promote the Wallich in-project needle exchange and harm reduction advice. I took a portable ‘needle exchange’ selection with me and provided paraphernalia to those who needed it. This provided opportunities to intervene in any poor injecting practices, and promote foil and sterile water. It also created an opportunity to provide people living in the same accommodation with different colour ‘nevershares’ to reduce likelihood of accidental sharing among residents. The uptake of our needle exchange was previously quite low and has now increased significantly.

Forty per cent of clients took up the first train- ing session offered in their shared accommoda- tion and the feedback was good. Residents liked the fact the training was brought into their own homes and was more relaxed. Twelve service users were eligible for naloxone prescription, bringing the total to 15 trained service users with naloxone kits among the eight project houses, with a minimum of one trained person with a kit in each house (compared to only three kits in the eight houses previously). Three new staff members were also trained.

This form of intervention needs intense staff preparation, implementation and time. I would like to get all staff trained and involved in delivering the training in line with service user support plans, and make it part of the role of project workers within our team. I would also like to get service users involved in the delivery of training.

I conducted a questionnaire before and after to gauge knowledge and confidence in dealing with overdose, and it identified that all clients felt they had learnt something new. Knowledge in regard to recognising overdose and about naloxone had increased from 76 per cent to 90 per cent, and confidence in dealing with an overdose situation increased from 79 per cent to 93 per cent.

I think the approach is working for a number of reasons – I took an assertive approach and made the training more accessible and less formal by conducting it in clients’ homes. I also made the training flexible and responsive to the needs to service users.

In the future, I would recommend regular weekly training sessions, especially if there is a high turnover of clients. Naloxone training should be discussed with service users during induction, as this pilot helped identify people at high risk of overdose and allowed for more intensive interventions.

Natasha Bray is a project worker at the Wallich Community House

If you have a bright idea or a successful initiative to share with other readers we’d love to hear from you. Please email DDNexchange@cjwellings.com