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DDN December 2024/January 2025

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At what point is intervention possible?

DDN December 2024/January 2025We’re so quick to compartmentalise – as if that makes treatment easier. Early trauma, chaotic drug use… rehab. Social scene, few too many drinks, hiding a hangover… be careful not to overdo the legally sanctioned fun.

Slightly confusing then, to look at a substance through both lenses. We’re familiar with the devastating effect cocaine can have on lives. What’s interesting is the cultural normalisation that’s contributing to the statistics (p6). If drug use starts in a safe setting and escalates, at what point is intervention relevant – or possible? Using it as a way to avoid drinking too much (aside from using it to keep going for longer) is a twist on harm reduction that we may not have contemplated, but it’s risky. The two substances combine to form toxic cocaethylene, increasing the risk of heart attack and stroke – but who’s familiar with that?

It’s complicated, but we need to look at the stats and focus on an effective response – cocaine-related deaths increased by a third last year.

As we look back on the year we’re grateful for inspirational partnerships and individuals who tackle obstacles at full tilt and don’t take ‘go slow’ for an answer. Keep going – we’re right there with you!

Enjoy the festive season!

Read the December/January issue as an online magazine (you can also download it as a PDF from the online magazine)

Claire Brown Editor of DDN Magazine

Claire Brown, editor

Number of adults in treatment up by 7 per cent

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Number of adults in treatment up by 7 per centThere were almost 311,000 adults in contact with drug and alcohol treatment in the year to March, according to the latest OHID figures – 7 per cent up on last year. It represents the biggest rise since 2008-09, and the highest number of adults in treatment since 2009-10.

People in treatment for problems with opiates were the largest group at 44 per cent, a 4 per cent drop from last year, while 30 per cent were in treatment for alcohol. The number of adults entering treatment was up from just under 138,000 to almost 159,000, with the  proportion of people starting treatment for powder cocaine reaching its highest ever level, at 19 per cent.

A fifth of people starting treatment had no home of their own, rising to almost 40 per cent of those starting treatment for opiates, while nearly three quarters of adults starting treatment reported a mental health treatment need. Nearly half of people in treatment said they were smokers, compared to just 13 per cent of men and 10 per cent of women in the general population.

Almost half of the 137,477 people who exited the system had successfully completed treatment, while the number of people who died while in contact with services stood at 1.3 per cent, a slight fall from the previous year.

There were 14,352 children and young people in drug and alcohol treatment
There were 14,352 children and young people in drug and alcohol treatment

There were 14,352 children and young people in drug and alcohol treatment during the same period, 16 per cent up on the previous year but still more than 40 per cent lower than the 2008-09 peak figure of 24,494. Almost 90 per cent were in treatment for cannabis, while just under 40 per cent had problems with alcohol, 9 per cent with ecstasy and 8 per cent with powder cocaine. Eighty per cent of children and young people said they’d started using substances before the age of 15, with 56 per cent reporting polydrug use. Almost half said they had a mental health treatment need, up from just over 30 per cent in 2018-19.

In Scotland, cocaine has now overtaken heroin for the first time as the most commonly reported main drug used by people starting treatment, according to new PHS figures – at 30 per cent to 28 per cent. Of the people who’d used opioids in the previous month, 63 per cent had a take-home naloxone kit.

opium production in Afghanistan remains more than 90 per cent down on 2022 levels
Opium production in Afghanistan remains more than 90 per cent down on 2022 levels

Meanwhile, opium production in Afghanistan remains more than 90 per cent down on 2022 levels, according to UNODC. Just over 430 tons of the drug have been produced this year, the agency estimates, which is 30 per cent up on last year but 93 per cent lower than in 2022 when the Taliban imposed its ban on poppy cultivation. Earlier this month UNODC released its opium cultivation figures, which showed that cultivation had increased by almost 20 per cent compared to last year, to 12,800 hectares – but was still far below pre-2022 levels of more than 230,000 hectares.

‘A second year of low opium cultivation and production presents opportunities and complex challenges,’ said UNODC chief executive Ghada Waly. ‘International efforts must be coordinated to ensure that this decline is not replaced with production of dangerous synthetic drugs such as methamphetamine within Afghanistan or the wider region.’

Adult substance misuse treatment statistics 2023 to 2024 available here

Children and young people’s substance misuse treatment statistics 2023 to 2024 available here

Drug and alcohol information system (DAISy): overview of initial assessments for specialist drug and alcohol treatment 2023/24 available here

UNODC report available here

Back from the brink

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Karen Biggs, chief executive of Phoenix Futures, on saving the last residential rehab for families in England.

Saving the last residential rehab for families in EnglandWe were recently forced to announce that despite significant investment in drug treatment in recent years none of this funding had reached residential treatment services. Combined with short-term and sporadic funding processes this left the National Specialist Family Service based in Sheffield, the last residential family treatment service in England, on the brink of imminent closure.

We are delighted, to say the least, to announce that the future of the service has now been secured. Closure plans have been cancelled and we are looking forward to a future we had thought was disappearing from sight.

The support of frontline drug treatment staff across the country has been invaluable, and with the convening support of OHID and the efforts of substance use commissioners across England, CGL and amazing specialist support organisations Women’s Reform and Mother2Mother, we are back from the brink!

The key challenge we faced was the spot purchasing of placements (pay-by-night per resident funding). Spot purchasing means that each family had to argue their case for an individual funding package across budgets that span adult and children, rehab and social services. It is too complicated for families in need of urgent support and already overburdened social workers and drug treatment staff. Due to such an amazing response from so many we have been able to move the service to a block funding model that will improve access for families and enable us to plan for the future.

The National Specialist Family Service provides a unique opportunity to offer parents the core benefit of treatment alongside specialist parenting and childcare support. Research suggests that substance use treatment alone is not a protective factor for families striving to stay together. There is a growing body of research to demonstrate the effectiveness of whole-family interventions for families where parents experience substance use problems.

There is so much more work to be done and with the future of the service secured, we will now move back to supporting families to stay together, evidencing what works, fighting stigma and pushing for appropriate support for parents and pregnant women.

This blog was originally published by Phoenix Futures. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Phoenix Futures

DDN’s double decade

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DDN is 20

DDN is 20How to get the drugs out of crime
Drugs minister Caroline Flint talks to DDN about drug and alcohol strategy…

‘Caroline Flint’s experience as MP for Don Valley leads her to the view that “a person addicted to class A drugs is a mini crime wave”. She argues that stealing and begging have become inextricably linked with feeding a drug habit, and points to the high positive drugs test rate among those arrested for acquisitive crime…

‘It was primarily to try to break the cycle between drugs and crime that led the Labour administration to develop the national drugs strategy, first published in 1998 and updated in 2002 – and which has fuelled a significant increase in funding for both treatment and prevention initiatives…

‘Flint points out that effective treatment for people with drug problems requires not only more and better services – the initial focus of the government’s approach to treatment – but also a more joined-up approach between agencies, a key element of the new Drug Intervention Programme (DIP) initiative (the renamed Criminal Justice Intervention Programme).’

A ‘new normal’
Natalie realised heroin addiction was ruining her life and began treatment, starting with a detox…

‘It was strange trying to re-establish a ‘normal’ life. I was so used to gouching out every night in my clothes that I had forgotten the process of going to bed. I was thinking one night, “well, what do you do? You must put your nighty on.” It’d been so long since I’d done that. I put my nighty on and I got in bed and I thought, “well, what do you do now? Right, people set their alarms don’t they?” So I did that. The feeling was so strange. It was also a strange feeling when I stopped using heroin and became aware again of simple things, like the taste of food, birds singing and springtime.’

WiredWorld of Wired
Prof David Clark explained his grassroots initiative WIRED, which pioneered merging real world activities with a high profile web based communication system…

‘I knew that WIRED has to be involved in both virtual and real world activities, fostering a strong grass roots initiative which has long-term continuity and stability. My vision was big – very naively so – but then what we are tackling is enormous. As far as I could see there are plenty of people who want to become involved in tackling substance misuse problems but don’t know how to get involved. They need something to which they can belong and contribute.’

David Clark went on to write a brilliant series of Background Briefings giving insights into all aspects of addiction – all available in our website archive.

DDN double decadeMaking the code
Simon Shepherd, chief exec of the Federation of Drug and Alcohol Professionals (FDAP) on launching a new code of practice for the sector…

‘Traditionally there has been a view that people with ongoing drug or alcohol problems should not work in this field. And many take the line that they should not do so for at least two years of having had a problem (the so-called ‘two-year rule’). While some practitioners felt that this made sense, many more felt it unfair and short-sighted, and we ultimately concluded that a more flexible approach was needed.’

DDN is 20A day in the life
Extract from a day in the life of community support worker Dave Watkins…

‘11.30. A call from my mate Larry in the cells, David was picked up again last night. Drunk and disorderly again. Out the door. In the car. Down to the cells. He’s sorry, not sure what happened, won’t happen again. Talk to Larry, another court appearance for both of us, but not today – I can take him home. The importance of networking. We’re lucky here, we all seem to sing off the same hymn sheet – agency workers, social services, probation, courts, hospitals, mental hospitals, doctors, DSS, wet houses, dry houses, local health board. If your approach is right, people generally want to help not hinder you. It’s so important to know that you’ve got back-up.’

Pace too slow on alcohol strategy
‘Alcohol campaigning has, it seems, been a little slow to get the results it needs. Tacked on to a number of major drug reports as a reference – “this could also apply to alcohol” – the needs of those who have drifted from using alcohol for regular relaxation and social confidence to desperate dependency, have been neglected. The DATs who have become DAATs may be doing their best, but it seems up to the persistent minority to remind government that targets are not set for shifting, and that a report on alcohol services due on such and such a date means that there are services looking out for a framework and a promise of commitment.’
(DDN editor’s column)

DDN 20No room at the inn
Rosie Brocklehurst was frustrated at slow progress for the many affected by alcohol problems…

‘Right now there seems to be an unspoken consensus that we must wait for more evidence-based data. We must wait until hugely increased levels of alcohol-related harm, rising trends of misuse and irresponsible behaviours, deaths, child abuse, broken families, and unquantifiable levels of individual human suffering, come spilling out of the research databases and onto analysts’ graphs…

‘I try to seek comfort by periodic night-time reading of the six pages in a 95-page strategy that talks about treatment tomorrow, maybe, and live in my own little fantasy world, dreaming that perhaps a few million quid for treatment might fall off the back of a beer lorry owned by some of those nice alcohol industry people. Meanwhile, in the committee chambers and conference halls, we talk about the criminal and the victim as if they are always separate entities, and fail to set a permanent place for the end user at the policy table for fear she might slur her words.’

Culture change needed to tackle binge-drinking
‘A cultural shift is the only way to change British drinking habits, according to Dr Jane Marshall, consultant psychiatrist at the National Addictions Centre. ‘There’s a reticence to consider a link between alcohol and violence,’ she said. Doorkeepers still keep serving people who are worse for wear… We laugh at drunk people for doing crazy things.’
(News item)

20 years DDNAbstinence or harm reduction?
Neil McKeganey, professor of drug misuse research at the University of Glasgow was involved in research – discussed here in his article – which the Scottish Drugs Forum (and many readers, through letters and articles) called ‘unhelpful and manipulative’…

‘In Scotland over 1,000 drug users were asked about the change in their drug use that they were seeking to bring about on the basis of having come forward for treatment. Almost 60 per cent of the drug users interviewed said that the only thing they were aiming for was to become abstinent from the drugs to which they had become addicted. Less than 10 per cent of those interviewed identified harm reduction as the sole change they were looking for. On the basis of these results, it is abstinence not harm reduction which reflects drug users aspirations from treatment. These findings have touched a raw nerve…

‘Rather than simply asserting that our harm reduction services are achieving both reduced harm and the recovery from addiction, we had better start to find out if this is the case in reality. I suspect that it is not, and that we have prioritised harm reduction at the expense of abstinence.’

DDN is still brought to you (entirely free of charge!) by Claire Brown, Ian Ralph, Jez Tucker, David Gilliver, and our new web editor Carly Woodhead. We’d love to hear from you, especially if you’ve been with us over the years – and even more so if DDN has made a difference to your working life and career. Maybe you found your job with us!

Picture this…

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recovery and dependency practitionerMy name is Bobby and I’m an addict. I’m 42, originally from East London, and I work as a recovery and dependency practitioner.

After a 20-year battle with cocaine addiction, which ended with my using drugs every single day against my own will, I’m pleased to say that thanks to regularly attending 12-step meetings, getting a sponsor armed with the facts, and working through and continuing to practise the 12 steps in my life every day, I have now been clean and sober for nearly five years. Moreover, I am happy.

My life used to be so dark, hostile and full of depression, anger, fear and rage. Today my life is peaceful, vibrant, content and filled with hope and gratitude.

Step 12 states, ‘Having had a spiritual awakening as a result of these steps, we tried to carry the message to the still suffering addict and to practise these principles in all of our affairs.’ I have always been a creative person, but was always too scared of what others would think to actually share my work. Now I’m using my creativity to practise my Step 12 and share my experience of hope, faith and courage with others.

My dream is for one person to see my comic, to relate to it and to seek out a 12-step meeting for themselves.

If I can recover from addiction one day at a time, then so can anybody. There is a podcast on my website – if you’re struggling then please listen to our stories, see if you can relate and if so, get yourself to a 12-step meeting in your area.

Or get in touch and I will help point you in the right direction as much as I can.

Read Bobby’s comic book story here

Government confirms compulsory levy for gambling operators

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Government confirms compulsory levy for gambling operatorsThe government has confirmed its plans to impose a statutory levy on gambling company profits. The compulsory levy will ‘generate £100m for the research, prevention and treatment of gambling harms,’ says the Department for Culture, Media and Sport (DCMS), with half of the money going into the NHS-led gambling treatment system.

The levy, which was first announced in last year’s poorly received gambling white paper, will be charged to all licensed operators and the money raised will be ringfenced, says DCMS. The government will also introduce stake limits for online slot games, set at £5 per spin for over-25s and £2 for 18-24-year-olds. Online slots are considered a higher-risk product ‘associated with large losses, long sessions and binge play’, DCMS states.

The levy – which will replace the current voluntary arrangement that sees some companies paying ‘as little as £1 a year’ – will be charged at a set rate of between 0.1 per cent and 1.1 per cent of gross gambling yield (GGY) or equivalent, for all holders of a Gambling Commission licence, says DCMS. The new levy system will be subject to formal review within five years.

gambling levy
‘Gambling harm can ruin people’s finances, relationships, and ultimately lives’

In addition to the 50 per cent of funding generated going to NHS England – alongside Scottish and Welsh bodies – for a ‘comprehensive support and treatment system’, another 30 per cent will go towards prevention activities such as training for frontline staff and public health campaigns. The remaining 20 per cent will go to UK Research and Innovation (UKRI) and the Gambling Commission for research to ‘inform future policy and regulation’.

‘Gambling harm can ruin people’s finances, relationships, and ultimately lives,’ said gambling minister Baroness Twycross. ‘We are absolutely committed to implementing strengthened measures for those at risk, as well as providing effective support for those affected. The introduction of the first legally mandated levy will be instrumental in supporting research, raising awareness and reducing the stigma around gambling-related harm. We are also helping to protect those at risk, with a particular focus on young adults, by introducing stake limits for online slots. These measures will help build an NHS fit for our future and strengthen protections whilst also allowing people to continue to gamble safely.’

Prevention-based alcohol strategy urgently needed, say health professionals

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Prevention-based alcohol strategy urgently neededThere is an urgent need for a new national alcohol strategy with a ‘strong focus on treatment and prevention’, says a new report from the Medical Council on Alcohol (MCA).

The need for a health system response to alcohol-related harms also calls for better access to community-based alcohol services, which ‘reach fewer than one in five people with alcohol dependence’, as well as more funding for alcohol care teams in acute hospitals.

Integration of care pathways also needs to be improved, the document states, to make sure people with complex needs get the right support. More than 70 per cent of adults and almost half of young people entering alcohol treatment also require mental health treatment, the report points out, while just under half of people who died by suicide while under the care of mental health services in the decade to 2020 had a history of problematic alcohol use.

Prevention-based alcohol strategy
Without action, alcohol harms will be an ever-increasing burden on health services

The last alcohol strategy was published 12 years ago. However, 2022 saw more than 10,000 deaths from alcohol specific causes registered in the UK, according to ONS figures – the highest number ever recorded. Alcohol is the leading risk factor for premature death and illness among 15-49-year-olds in England, MCA points out, and ‘disproportionately affects the most socially and economically disadvantaged, exacerbating existing health inequalities’.

Without action, alcohol harms will be an ever-increasing burden on health services, says MCA, which is an independent charity of health professionals that is ‘not primarily a campaigning organisation’. However, its members have been involved in the creation of various alcohol-related guidelines, including the NICE quality standards and the UK alcohol treatment clinical guidelines.

The report ‘reinforces what we already know – alcohol-related harm is a growing and preventable crisis,’ said lead author and professor of addiction psychiatry at the University of Southampton, Julia Sinclair. ‘While alcohol consumption is often normalised in our society, the scale of its impact on health and social inequalities cannot be ignored. Now is the time to act decisively to reverse these trends, or we risk placing an even greater burden on our health system and losing more lives unnecessarily.’

Meanwhile, the tobacco and vapes bill has passed its commons vote
The tobacco and vapes bill has passed its commons vote

Meanwhile, the tobacco and vapes bill has passed its commons vote by 415 votes to 47, meaning the legislation will likely become law. ‘Ending the harms from smoking is not a party-political issue; it is backed by voters of every political persuasion,’ said ASH chief executive Hazel Cheeseman. ‘This was clearly shown in tonight’s debate, where MPs from across the political spectrum voiced their support for phasing out the sale of tobacco to future generations.’

More than 240 people died while homeless in Scotland last year, according to the latest records from National Records of Scotland (NRS), with the number dying from drug misuse increasing from 89 to 100. Almost 80 per cent of deaths were among men. ‘Half of homeless deaths in 2023 were people aged under 45, with the most common age group for both female and male deaths being 35 to 44,’ said senior assistant statistician Beth Watson.

MCA report available here

NRS figures available here

On the brink

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Losing the last residential rehab for families in EnglandDespite significant investment in drug treatment in recent years none of this funding has reached residential treatment services. This failure, combined with short-term and sporadic funding processes, has led to England facing the loss of its last residential family treatment service. Tragically, this means that more families will suffer from a treatable condition and children will be separated from their parents, creating unnecessary intergenerational trauma.

Phoenix announced the closure of the National Specialist Family Service based in Sheffield in October. Unless sustainable funding can be secured in the next month, the service will close early in the new year. As we contemplate the loss of the last of these vital services we look back on their history and consider why parents with substance use needs are excluded from effective care.

National Specialist Family Service, SheffieldRepeated evaluations have found that residential family drug and alcohol treatment services are very successful at helping parents overcome their drug and alcohol use, supporting them to become safer and more effective parents and successfully resettling them back into their communities.  Longitudinal studies also show that the families stay together in the long term – completion rates for family services are high, at an average of 86 per cent. There is a growing body of research to demonstrate the impact of whole-family interventions for families where parents experience addiction.

There is now only one residential service in England that can provide drug and alcohol treatment to parents whilst they care for their children. That service is at risk of closure despite the evident need for the service and the high quality of provision. The key issue Phoenix faces is that spot purchasing of placements (ie pay-by-night per resident funding) is a block to both access and sustainable provision.

Spot purchasing means that each family has to argue their case for an individual funding package across budgets that span adult and children, rehab and social services. It is complicated for families in need of urgent support and already overburdened social workers. Spot purchasing also means that providers are living hand to mouth, unable to plan for any guaranteed income despite having significant fixed costs. It’s a quirk of history that means – unlike most specialist care services and community drug treatment services – the family service is funded by referrers, with their own budgetary and operational pressures, rather than funding the residential provider directly.

Phoenix Futures opened its first family residential service in 1987. Since then, thousands of parents have been able to address substance use issues in a residential setting while they take parental care of their children. Over the last 40 years Phoenix has developed specialist family residential units in London, Brighton, Bexhill and Sheffield. We established the services in response to the need for parents and pregnant women to be able to access intensive treatment without being separated from their children. This treatment option encouraged more parents to address their addiction, reducing trauma experienced by children and their families.

family servicesFamily rehab programmes recognise the integral role of family in the recovery process and provide valuable support, education, and resources for both the individual struggling with addiction and their loved ones. By addressing family dynamics and relationships, these programmes contribute to improved treatment outcomes and enhanced quality of life for everyone involved.

The National Specialist Family Service provides a unique opportunity to offer parents the core benefit of treatment alongside specialist parenting and childcare. The service supports families to achieve a range of outcomes specifically for them, such as improved communication skills to help resolve conflicts, rebuild trust, and improve relationships among family members. Addressing underlying issues within families – such as trauma, codependency or enabling behaviours – can establish and reinforce healthy boundaries within the family dynamic.

Addiction often strains relationships and causes emotional pain and conflict within the family. Family rehab programmes provide opportunities for healing, forgiveness, and reconciliation, allowing family members to address past harms, rebuild trust, and strengthen their bonds.

Evidence shows that investment in addiction services for parents delivers safe, effective treatment as well as significant value for money to the public purse. Research shows that these services break the intergenerational transfer of drug and alcohol use from parents to children. These services also create a network of family-focused resources including maternity care, specialist midwives, health visitors, perinatal mental health, GP services and more, all accessed from one residential setting.

It’s devastating that all this will be lost because of a failure to create a simple funding mechanism that works for families and their professional support.

James Armstrong is director of marketing and innovation at Phoenix Futures

Losing the last residential rehab for families in England would be nothing short of a tragedy

Further reading: Five years on and nothing has changed, by Karen Biggs, chief executive, Phoenix Futures

MPs to vote on tobacco and vapes bill today

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tobacco and vapes bill

MPs are to vote on the tobacco and vapes bill today, the government has announced, moving the UK ‘one step closer to becoming smoke-free’.

The bill was introduced to Parliament earlier this month, having been first introduced by the previous government but subsequently shelved following the announcement of a July election.

The bill includes proposals to phase out the legal sale of tobacco to anyone currently 15 or younger, along with ‘ambitious plans to protect children from vaping’, including restrictions on flavours, packaging and retail displays, as well as a ban on advertising and the sale of vapes in vending machines. The bill will be backed by an additional £70m of support for stop smoking services, the Department of Health and Social Care (DHSC) states.

‘Subject to consultation, the sale of vape flavours that overtly appeal to children – such as bubble gum, gummy bear and cotton candy – could be brought to an end, alongside restrictions on vape packaging that is designed to appeal to young people,’ says DHSC. The ban on vape advertising and sponsorship will bring regulations in line with those for tobacco, it adds.

The bill will also give the government powers to extend the existing indoor smoking ban to some outdoor spaces, including children’s playgrounds, and outside schools and hospitals, again subject to consultation.

MPs to vote on tobacco and vapes bill today
‘Without urgent intervention we’re going to have a generation of children with long-term addiction’

‘The number of children vaping is growing at an alarming rate and without urgent intervention we’re going to have a generation of children with long-term addiction,’ said health secretary Wes Streeting. ‘It is unacceptable that these harmful products are being deliberately targeted at children with brightly coloured packaging and flavours like “gummy bear” and “rainbow burst”. The tobacco and vapes bill provides the protection that children and young people need to avoid a life imprisoned by addiction. That’s why it’s so incredibly important it is voted through.’

‘Every day around 350 young people start smoking, and two thirds of long-term smokers will die due to smoking,’ added ASH chief executive Hazel Cheeseman. ‘Passing this bill is a vital way the government can start to end the unprecedented harm caused by tobacco, protecting the health of the next generation by ensuring they won’t become addicted to smoking. Alongside the legislation funding is necessary to help the millions who currently smoke to quit and accelerate the creation of a smokefree country, and the announcement today is welcome.’

Meanwhile, the government is planning to confirm a compulsory levy on the gambling industry ‘as soon as this week’, according to the Guardian. The levy, which would force companies to pay a small proportion of their profits towards gambling treatment, research and prevention, would come into force next April. The proposals formed part of the government’s controversial gambling white paper, which was published in April last year.

See tobacco harm reduction feature in November’s DDN and gambling feature in the December-January issue

Five years on and nothing has changed!

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Family ServiceIn November 2019 I wrote a blog called ‘no apology for my outrage’ which announced the start of the closure process for a women’s residential treatment centre in London called Grace House, writes Karen Biggs, chief executive of Phoenix Futures.

In that blog I spoke of the systemic issues that were preventing women from accessing residential treatment in a service that had just been rated as outstanding by CQC. The service closed in early 2020.

Five years later almost to the month I started the consultation process for the National Specialist Family Service based in Sheffield. You may have seen the service featured in a 2017 documentary broadcast on BBC2. Sadly, that consultation was to close the service, the last remaining residential substance use treatment option for families.

In the intervening five years I have been highlighting what is wrong with the way we fund and access residential treatment in this country. And despite the Dame Carol Black review agreeing the system is broken and needs funding reform and despite firm commitments in the drug strategy to correct those failures, nothing has changed.

So why are we facing the closure of the last remaining drug and alcohol treatment option for families? 

There are three reasons:

  1. The unnecessarily complicated process faced by families wanting to access the service, having to navigate multiple funding streams, that design-in barriers rather than creating opportunities for engagement and assessing clinical need.
  2. The huge reduction in residential rehab funding in recent years – despite the significant investment in the wider treatment sector no additional money has come into the residential treatment sector.
  3. The challenges women face in approaching social services for support is driven by stigmatising approaches and the genuine risk of their children being taken into care.

It is not because:

  • Women don’t want to access the service – not all mums who use drugs or alcohol want to access residential provision of course, but many do.
  • The service isn’t of a high enough standard – it is rated outstanding by Ofsted for its childcare provision and achieves 85% completion rates.
  • There isn’t an evidence base for residential treatment.
  • It doesn’t deliver value for money – our most recent Social Return on Investment report shows that Phoenix’s service alone has saved £14 million for the state over the last three years.

When I had to close Grace House many people said to me afterwards – ‘I didn’t realise it was that bad if only you had come to us and asked for help.’

Family Service - PhoenixTherefore, I have been asking government commissioners and the sector for help to save this service for the last 18 months because if we don’t:

  • Women and their children will have no residential treatment option in England.
  • Pregnant women who use drugs won’t have any 24/7 treatment option to support them through to the birth of their child and beyond.

So what is the solution?
There are many alternative funding options but it will mean compromise and the current ‘gatekeepers’ of residential funding will need to change.

But the bottom line is this, as a sector we need to recognise the value of specialist treatment options for women and fund them appropriately and securely so:

  • Women can access them when they need them and aren’t shamed into the shadows.
  • More children aren’t unnecessarily removed from their families to face their childhood in the care system.
  • We don’t create more intergenerational trauma that ruins lives and has significant consequences for our health and social care system for years to come.

Can you help?
If you’re able to support us to avoid the closure of the National Specialist Family Service based in Sheffield, please do get in touch by emailing Karen.biggs@phoenix-futures.org.uk

This blog was originally published by Phoenix Futures. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Phoenix Futures

A flexible approach to work

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flexible employmentI was a heroin addict and alcoholic of the ‘hopeless’ variety, frequently stealing bottles of wine for breakfast in an attempt to stave off the anxiety of withdrawals until my dealers switched on their phones. Like many heroin addicts, I was incapable of functioning before my morning fix – unable to move from the sweat-stained sofa and unwilling to engage with life, barring the aforementioned shuffle to the off licence and payphone (obviously, I never had credit).

Paradoxically, as soon as that text came through – the one signifying chemical salvation, that simply said ‘on’ – I would leap into action, capable of crossing mountains (I was previously an addict in Snowdonia and did, literally, this).

flexible employment - Stuart

This was me during my Exchange Supplies years (DDN, September, page 14), my whole ten years of working for the company – broken, desperate and, even worse, egotistical to boot. Senior management had a background of working directly with drug addicts and worse still (for them) a social conscience. This led to a conflict of purpose – mine the endless, selfish demands of addiction, theirs a commitment to do the right thing. At times this led to farcical situations which would have been comical if we weren’t dealing with ‘life-saving’ consequences.

Myself and a couple of other employees were active addicts who, by the nature of our condition, had a very clear agenda – primarily, to stop the withdrawals. This took priority over everything. For me, it came before food, hygiene, bills, childcare, the truth, the law, self-respect – everything. They say withdrawals are objectively like the ’flu, and there’s some truth in this. But imagine a ’flu you KNOW you’re going to catch every single morning. Recollect the poorliest you’ve ever felt, and now I’m going to tell you that I could relieve that for just £10. This is the compulsion that drove me as an addict.

Different priorities
Once I was well, a different priority emerged – getting more drugs and maintaining that high. Not so desperate but still a priority, albeit one that could now be overcome with a rationale and tempered by commitments. Ever-present but not so all consuming.

I’m referring primarily to heroin addiction. Many parallels can be drawn with other addictions like alcohol or benzos, but I recognise that crack cocaine presents a different experience. For me, crack was an extra, a payday treat (alright, mostly a daily treat), but one I would forgo in favour of the necessity of heroin.

This was the emotional soundtrack of my using. The objectives of Exchange Supplies as a social enterprise included offering employment to active addicts, providing self-respect, structure and stability, and promoting both personal and societal worth. Did this help me? Yes, no and maybe – it depends what you mean by help and how it’s measured.

flexible employment policies
Stuart had his 3.5 foot long dreadlocks cut to raise money for Shelter – and to see his old habits ‘float away’

Working for Exchange Supplies coincided with the worst period of my using career, although the next decade was also pretty bad. I’ve always categorically stated that this job kept me out of gaol and free from blood-borne viruses. Obviously, I can’t know this for sure. What I do know is the income kept me from making more desperate decisions, and having my time filled countered the lack of purpose that only ever exacerbated my addiction. Having a constant supply of injecting paraphernalia without the ball-ache of visiting my local drug agency was also a bonus.

A new normal
While I’d injected a handful of times before working at Exchange Supplies, regular injecting became the norm soon after joining the team. Was it the normalisation and desensitisation of injecting practices and paraphernalia? This was definitely a factor, but we will never know if or when I would have began injecting if I hadn’t taken the job. I’m most definitely not suggesting any culpability. The truth is, I was strong willed and pig-headed, well aware of the facts (if not the consequences) when I made my drug taking choices. However, my brief for this article was honesty around working at Exchange Supplies and the impact of their accommodating employment policies – and this is my truth.

Perhaps the most significant employment issue which needs to be considered when knowingly employing addicts and attempting to flexibly cater for their needs is the risk of ‘enabling’. Did Exchange Supplies’ employment policies prolong or even facilitate my addiction and alcoholism? Among other things, they allowed for flexibility in my punctuality. Time off to score and inject. A more tolerant attitude – although not carte blanche – for me to work whilst intoxicated.

Continuing to employ me during periods of sub-standard work also gave me the finances to use more, and even working with other addicts could have been seen as helping me build up a drug using/scoring network. It’s also significant that this was mirrored in my home life – the importance given to holding down a job led to loved ones lending me money to score and looking after drugs for me – simply to ensure I got to work.

Better or worse?
There are some massive issues here – I asked Andrew, the managing director at Exchange Supplies, if they ever questioned whether they thought they were enabling me. ‘It was pretty much a daily question’, he joked in all seriousness. He then proceeded to say he tends to avoid using the word ‘enable’, and I know what he means. There’s very little that would have stopped me from using barring a drug drought, and although ‘powerless’ over my addiction I had enough agency to beg, borrow and steal (and a few other options in my arsenal – including bottles of cough syrup and dried poppies, both of which would stupefy a non-user, but barely touched the sides for me).

Poignantly, he proceeded to tell me he’d rather pose the question ‘to what extent and in what ways are we making things better or worse?’

employment I’d definitely say it was psychologically beneficial to be in work, and I was proud of both my job and my employment status. It added a semblance of structure and order to my life – no mean feat. The wage took the desperation out of my using – I’ve already mentioned avoiding gaol and disease. A good analogy I think is one of those extendable dog leads – at times they probably drew it in too short, at others they definitely allowed me to run too free. Andrew continued, ‘Sometimes there was a fine line to tread between keeping you engaged, and giving you enough time and money to make things worse… we could have “enabled” you less, the reason we didn’t was that, in my judgement, we could have lost contact with you… and without our enabling (which came linked to income, structure, support), things could’ve been even worse, and therefore more dangerous.’

These dangers were highlighted by an Observer article earlier this year which stated: ‘UK drug users are 13 times more likely to die than their European counterparts…the urge to punish drug addicts doesn’t make them go away. It just entrenches them in their misery, dependent on state provision, unable even to begin to help themselves.’

What is success?
In many ways I was part of an employment experiment – run on good intentions and that definitely made mistakes, during which I happily took the piss. Was it a success? If the intended result was to get me clean and sober as quickly as possible, it failed miserably. However, if the aim was to improve my quality of life as a using addict, or, the unquantifiable aim of being a bridge to normal living, providing some of the tools and learning which contribute to where I am today, it was an unqualified success.

I didn’t achieve sobriety during my period working for Exchange Supplies, but there were some who did. But should lifelong abstinence be our only yardstick? We know rehabs have a woefully low ‘success’ rate when measured by long-term sobriety. Should we instead be looking towards intangibles, such as seeds sown, quality of life, compassion and personal connection? Aren’t these elements of the human condition, so difficult to measure, the real markers of success? Especially if, like me, a key factor of recovery was the journey of addiction itself.

In retrospect, would I have advised Exchange Supplies to deal with me exactly as they did? No, and I doubt Andrew would either. I would, however, fully support the overarching policy of their employment model. This is essentially the same as when I was employed, just tweaked – with many of the spanners I threw removed, polished and ready to be used more appropriately. Am I glad I was treated exactly like I was, with some of its beautifully flawed judgement calls? 100 per cent.

Stuart Lloyd is several years into recovery and has become a writer

two-way street

Working for ten years in West Dorset as a community drug worker during the ‘90s as heroin arrived in our community, and setting up needle exchange and methadone prescribing with local GPs, was a fascinating place to be.

Building long-term relationships with people, and helping them with their struggles with drugs, employment, and employers deepened my conviction that there’s a huge amount of wasted talent amongst the community of people who use drugs, and that the feudal levels of power given to companies and managers under capitalism are wrong and widely abused.

It was so clear to me that the simple facets of employment – such as conduct and time-keeping – could be herculean struggles for people who use drugs, and which could be made so much easier with a bit of compassion, understanding and flexibility.

At the time, I never thought I would ever be able to do anything about it or prove that these beliefs were right, but in the early 2000s, as a harm reduction activist, I had taken on the task of sourcing citric acid sachets for people who inject and soon found myself needing help with the warehousing, packing, and distribution. I had no hesitation in knocking on the doors of former clients to ask if they wanted to come and work with me, and so began a 20 years of developing a practice of employment policies that enable us to benefit from the experience, skills, knowledge and networks of people who use drugs, and retain them in our workforce.

employer employeeI hadn’t been Stuart’s caseworker, so I didn’t know him when he replied to the ad we’d put on the notice board at the drug service – but it soon became clear he had in spades all of the issues that I’d seen make it so hard for other people who were opiate dependent to stay in employment.

I totally respected his determination not to be exploited by capitalist bosses, although we all sometimes wished he’d pull his finger out and do a bit more actual work as, over time, we began to learn to balance the need for support with the ability to provide support. We also learned how to be well enough staffed for the work to be meaningful, but not so ‘efficient’ that people being off heaped guilt on them for letting people down, and built stress and resentment amongst their colleagues.

Stuart’s degree was in linguistics, and if there was a PhD in pedantry, he’d have one. This was (kind of) great for me – if I set a boundary, he’d test it. If I was inconsistent, he’d point it out. If something wasn’t fair, he’d make sure everyone knew.

I didn’t always appreciate it at the time, but it’s no bad thing for everything to be tested to the limit. It accelerated the learning, and the after-the-fact analysis of successes and failures helped us form our compassionate collective responses to all the tricky issues that can arise – lateness, leave, absence, intoxication, and drug use on the premises – into a coherent, personalised, but consistent harm-reduction informed framework that really works.

We may not have always got it exactly right – there’s always what if’s – but we are clear that without the structure, meaning, support and something/someone to fight against over those ten years the path for Stu would likely have been much darker with, as he says, hepatitis C, overdose and prison all likely outcomes.

The value of having people who are part of the community we serve as part of the workforce can’t be overstated. The access, knowledge, commitment and connections they bring are invaluable, and the lessons we learnt with Stuart have made things a lot smoother in the years since for us. And, I’m sure, for him too.

Andrew Preston is the founder/managing director of Exchange Supplies

Adfam at 40 – Chris Lee: ‘one of the most stigmatised healthcare conditions in the country’

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Adfam at 40This year marks a special year for Adfam as we celebrate our 40th year. Throughout 2024, we have been reflecting on the past 40 years, the progress that has been made in supporting families affected by substance misuse, as well as looking to the future.

Through a series of articles over the course of the year, Adfam has spoken to a range of key individuals active in supporting and advocating for families affected by substance misuse.

For our latest ‘Adfam at 40’ article we speak with Chris Lee, director of strategy and partnerships at Change, Grow, Live, who previously also worked as a drug and alcohol commissioner in Lancashire.

Fascinated by the breadth and complexity of the topic
Chris has been working in the drug and alcohol sector since the late 1990s and his first exposure came after completing a degree in psychology, taking on the role of assistant psychologist within a local community drugs team. He remembers turning up for his interview in a suit, attracting some puzzled looks in the waiting room! Chris was bitten by the topic almost immediately and immersed himself within the sector. He quickly moved to become a frontline worker, then a team leader, before studying a masters in drug use and addiction, taking on a service manager role in a criminal justice service, then moving into commissioning in Lancashire where he stayed for many years, before taking on his current role at Change, Grow, Live.

‘It’s just rolled over the years, the longer I do it, the more fascinated I am by the whole breadth of the complexity of the topic. It’s not a single-issue thing, it touches every walk of life. I find it hard to know how you can’t be fascinated by it.’

In the early days, Chris has vivid memories of the family dynamics that would often arise when working with service users. He describes often seeing parents of substance using children at the end of their tether. Seeing it with his own eyes was an early indicator and expanded the notion for him that addiction is not an individual problem.

Chris felt somewhat ill equipped in dealing with and responding to some of these issues at the time. Where training for frontline professionals is far more rigorous now, back then it was more of a case of learning on the job. However, Chris took those experiences with him as his career progressed, determined to champion the needs of families within each of his roles. When he became a commissioner in Lancashire, responsible for thinking about the design of services and looking at things from a systems perspective, he made it a priority to include families.

Adfam CGL

Challenges getting families on the agenda
Chris suggests that the drug and alcohol treatment agenda is probably one of the most stigmatised healthcare conditions in the country. There are very few other healthcare conditions where people are so marginalised, excluded and out of the mainstream. Families are very much subjected to that stigma too, and where society stigmatises the agenda, it’s no wonder that at a policy level it doesn’t get the consideration it should. Chris hopes that, under the new government, families will get more recognition through the national drugs strategy.

This isn’t through want of trying, there have been many publications and efforts in the past arguing for greater inclusion of families, but the lack of funding available within the drug and alcohol space has often proven a stumbling block. Looking at the envelope available to fund treatment services, even with the new money in the system, there’s not enough there to offer treatment at the level it should be, and the money that should be there for families isn’t filtering out.

‘The elephant in the room is funding. Drugs strategy money has been eroded by the cost-of-living crisis and rampant inflation. It can’t deliver on what it has set out to deliver. From when it was written down, the world has changed since then. It’s not worth what it should have been.’

Chris has long argued for a national service specification which would cover a whole remit of things that should be included within a treatment system, and families ought to be a key part of that.

Services working in collaboration is another important factor in ensuring families, and other issues relating to substance use are recognised and addressed. It’s important to see how one organisation with a specialist set of skills can align with another, and Chris highlights a joint service between Adfam and CGL in Gateshead supporting families affected by substance use, as an example of this.

‘I would love for us to be in a situation where the sector collaborates rather than is deemed to be in competition all the time. People can be specialists in certain areas and work together.’

Looking ahead to the futureLooking ahead to the future
Chris goes by the notion that as professionals in the sector, we should never think that we’ve done enough, nor assume that we’ve done it well enough. We should always be looking to improve, develop and to do things better for the people we are here to support.

He describes some of the stunning work he’s seen in the sector over the years, particularly during austerity with scarce resources at play, and how inspiring it still is to see so many workers go the extra mile. There are a lot of people working in the drug and alcohol sector who genuinely care, and a lot of people who really need the help they provide.

Looking ahead to the future, for things to really change, we desperately need to tackle the stigma targeted at people affected by substance use and their families, which is still so great.

‘I’m not saying they are more or less worthy than others in society, but they are equally worthy than others in society, and that’s the point.’

There are also questions we as a sector need to constantly ask ourselves in order to improve. How can we make the lives of workers better? How can we make the offer at the front door better for service users and families? How can we reframe the population health change that we need to do?

While government has put money in, it’s still not enough to make the changes that are needed. Even with the drugs strategy money on the table, we are still only at the 2018 equivalent levels of funding, according to research undertaken by the Health Foundation, leaving us several years behind where we should have been. Those that are in the sector are going to have to continue working really hard to ensure people affected by substance use and their families get the support they need.

Chris Lee is Director of Strategy and Partnerships at Change, Grow, Live. For more information about CGL visit changegrowlive.org

This blog was originally published by Adfam. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Adfam

Community champions

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Red Rose Recovery

Over the past 12 years Red Rose Recovery has gone from strength to strength, spreading roots across the North West. We asked them to share their story.

RRRA need to nurture
Founded in 2012 to build recovery infrastructure in Lancashire, Red Rose Recovery has become nationally recognised as a pioneering organisation in developing recovery systems and creating opportunities for people affected by substance misuse, mental health and offending behaviours. RRR’s founding purpose was to provide employment opportunities to people marginalised by society, and the lived experience model is in RRR’s DNA – it now employs more than 120 people with experience of addiction, the criminal justice system, homelessness, or other complex issues. As a LERO, RRR staff’s relatable experience provides inspiration and hope to people who are struggling to find a way forward.

Core to RRR’s model is the relationship it creates with each individual – it offers inclusive, accessible, person-centred, trauma-informed and co-produced services with people at all stages of recovery and has a strong track record of collaborating with recovery community partners to enable new groups to emerge and grow. It recognises that the greater good of our communities is best served by having a broad range of groups and activities and is committed to building healthy community ecosystems across the UK – as shown by the infrastructure support provided to the emerging LERO and user forums across the North West.

Mike Wearden, managing director, Red Rose Recovery

Every voice is heard
As a true lived experience organisation, 97 per cent of Red Rose Recovery’s staff have lived experience of multiple disadvantages, with an organisational culture that believes in people and their capacity to change and grow. We help to advocate for those who are continually stigmatised and marginalised, with the aim of changing the narrative. Our community is one where every voice is heard, and those seeking treatment have a say in what their treatment looks like – a community where power is shared and learning passed on.

We have forged excellent relationships with commissioners in Lancashire and beyond, built on trust and mutual respect. Twelve years ago, Lancashire County Council public health commissioners took a leap of faith in establishing the Lancashire User Forum (LUF). Its aim was to give a voice to the voiceless and create a platform – not only for Red Rose Recovery to be born but for an independent space to thrive.

The LUF isn’t owned by anyone, it exists to serve the community and Red Rose Recovery merely lends its infrastructure to aid in its running. We have proved that the model can be replicated and is sustainable beyond the individual – and that by identifying leaders in other geographical areas, they can be nurtured and empowered to create change. Recovery is sustained when we reach back for those behind us. We have a responsibility to pass on what we have learned, to empower the community as a whole, to lend our infrastructure to those next in line, to support with training and development, and to help create seats at the tables of power.

Now we have established recovery communities in not only Lancashire, but also in Blackburn with Darwen and North Yorkshire, with other areas to follow soon. Our proven model, underpinned by belief from commissioners and involvement of the grass roots community, takes a lot of hard work, but the results are there for all to see.

Sarah O’Mara, RIO contract lead and team leader north, Red Rose Recovery

Red RoseA successful model
The Lancashire User Forum (LUF), supported and underpinned by Red Rose Recovery (RRR), has been a model we have long aspired to see replicated across the country. My focus is on identifying spaces where individuals with lived/living experience and organisations can collaborate with us to build all-inclusive communities, and where people feel empowered to develop a strong sense of identity that provides them with a stake in society.

This identity is grounded in solid systems, processes, and resources, ensuring that individuals not only receive support but also become active participants in shaping it. We foster meaningful relationships, challenge stigma, and create pathways for both personal and collective growth.

Our emphasis on the Five Ways to Wellbeing – connect, be active, take notice, keep learning, and give – ensures that we are fostering holistic health and wellbeing. We focus on the strengths and potential of individuals and communities, rather than on deficits. The LUF model, with its emphasis on collaboration and empowerment, has demonstrated significant success and our aim is to continue building supportive, inclusive systems that help people to thrive and contribute to their communities.

Peter Yarwood, director of strategic engagement and training, Red Rose Recovery

Spreading our roots
Roots Community is the Blackburn with Darwen recovery forum started up in May 2022 to support and mobilise the recovery community locally. Our co-produced aims are to connect those in recovery with others; improve engagement in activities that enhance wellbeing; empower the community through a voice in decision-making and service provision; provide opportunities through employment, training and volunteering; and inspire hope in those seeking recovery, professionals, family members and the wider community.

We do this through a calendar of ten regular weekly activities including community clean-ups, a guerilla gardening project, cooking, gym, fishing, goal-setting, music sessions and planning meetings. We also have representation at operational delivery group meetings, a place on the BwD Community Network Board and regularly involve Roots members in consultations with NHS, service providers, mystery shopping exercises and research projects that shape service delivery.

Our members are drawn from all stages of recovery/pre-recovery, with no requirement to be abstinent or subscribe to specific recovery models or activities. All we expect is mutual respect and adherence to reasonable behavioural boundaries.

Rolonde Bradshaw, team leader, Roots Community Recovery Forum

Red RoseLet’s mobilise
Project FREE is a very small LERO in Bury, Greater Manchester which for nearly two years has been supporting men coming out of prison to resettle effectively in the community. It hasn’t been directly commissioned by any organisation or authority but has grown from local recovery networks. Several small public sector grants and private donations have enabled venue hire, refreshments and volunteer expenses to run drop-ins, group sessions and activities.

It came about because Bernard, the project co-ordinator, wanted to invest his own recovery capital in helping people stuck in a pattern of substance use and offending behaviour, as he was for many years. He used his friendships and connections to mobilise support and establish a monthly steering group for strategic direction.

So far so good for Project FREE – the power of lived experience in helping people make and sustain positive change is undeniable and learning from other LEROs like Acorn Recovery and Red Rose Recovery has been invaluable. These larger groups have a responsibility to incubate ‘micro-LEROs’ and create opportunities for people like Bernard and his volunteers. Perhaps we overthink how to incorporate lived experience into the overall system and should focus on creating an environment where relationships can grow and ideas can be put into action.

Tom Woodcock, Project FREE steering group member, chair of RRR board

A unique opportunity
North Yorkshire Connected Spaces is a LERO that sits under the umbrella of Red Rose Recovery. At the heart of every recovery journey is a story – one of resilience, struggle, and eventual triumph. As a LERO we are more than a support network – we are individuals who have walked the same path.

We believe that those who have lived through addiction and recovery are uniquely positioned to offer guidance, understanding and hope to those currently struggling – sharing experience fosters a deep sense of trust and connection. Each member of our team has faced the challenges of addiction, sought recovery, and is now dedicated to helping others. We understand the fear, uncertainty, and shame that can come with addiction – and we know the incredible transformation that recovery can bring. Research shows that peer support can significantly improve outcomes, increasing engagement, reducing relapse rates, and fostering long-term sobriety.

We offer hope to those who may feel isolated or hopeless. Moreover, as advocates, we work to change the narrative around addiction, shifting the focus from punishment to recovery, from stigma to support. Together, we can transform lives and communities, one story at a time.

Emma Plant, NYCS community engager

RRR Recovery

New campaign: Addiction Awareness Week #AAW24

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DDNWeb
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Addiction Awareness Week is the cornerstone of the Taking Action on Addiction campaign.

Addiction Awareness WeekNow in its fourth year it provides a period of intense focus on addiction and recovery, its impact on people, families and society in the media, social media and public debate. By spotlighting real stories through new research, events and emotional, compelling storytelling, we are able to change misunderstanding and enable more people to speak openly about their experiences.

During the week of 30th November – 7th December, we will deliver a range of activities to drive interest and awareness of our national campaign.​ Through our emotive and thought provoking activations we want to generate more conversations on addiction in the media and social media than we have done before.​

​With your support we can continue to highlight the everyday nature of addiction – that it affects everybody. While addiction can involve tragic consequences, this year we will highlight the hope that recovery is possible.​​

By building digital communities of support we will make it acceptable to share, to speak out, to show empathy. It will help to de-stigmatise addiction and all it encompasses, one strong step at a time – helping people living in the grip of addiction to see that they are worthy of support.

Get involved – download our social media toolkit
If you’d like to support this year’s campaign on your social media channels you can use our new social media toolkit.

This blog was originally published by Taking Action on Addiction. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Taking Action on Addiction

The age of overwhelm

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DDNWeb
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Advances in technology have propelled young people – and their problems – into a different age, so how can we reach them?

Advances in technology have propelled young people – and their problems – into a different age, so how can we reach them? DDN reports from Cranstoun’s social justice conference.

‘What are your biggest challenges?’ This question brought a range of answers from young people, said Vicky Branch, Cranstoun’s head of children and young people. Mental health, loneliness, access to services, waiting lists, substance use, bullying, violence… many issues emerged and many were not being addressed early enough before becoming problematic.

So how could we think about earlier interventions? Young people’s centres were being closed and there was a lack of inclusive social spaces and activities. Simple steps made a big difference – Routes had been created as a youth hub from free space in Dudley’s Merry Hill shopping centre. With Cranstoun’s innovation fund it had become an open access, walk-in service and a safe space for help, support and guidance, which was co-produced with young people.

The age of overwhelmPhil Harris, a treatment specialist and author, had experience of developing services for the transition to adulthood. ‘We’re not only having to prepare children for adult life – but one that’s changing rapidly,’ he said. Challenges for future generations were ‘not things we grew up with’ and the challenges converged ‘in the age of overwhelm’.

One in ten children had a mental health condition – an upward trend reflected in the 100,000 children treated for mental health issues each year. ‘The modern world is having an impact and anxiety is the shift we’re seeing,’ he said. Specific technology-influenced problems and terms such as ‘doomerism’ had emerged, where ‘the doomer goes down a rabbit hole of nihilism and defeatism’.

The transition point from child to adult was a ‘particularly sensitive period’ and there were long waiting lists for support – the time delay between symptoms and treatment meant that 250,000 children were waiting. Symptoms could seem like something else – psychosis might appear to be depression – and in fact it was rare to find someone with a single presentation. Furthermore, we were seeing that ‘some disorders we thought were the same are profoundly different’.

‘We need a big shift in how we think about mental health and look at environments and brain development,’ he said. New approaches might include AI and digital therapies, including games.

Loneliness and the cost of living are some of the biggest problems facing young people
Loneliness and the cost of living are some of the biggest problems facing young people, said Connor (left) and Winter, who contributed to the discussion on challenges for the next generation

‘Violence casts a long shadow over children’s lives,’ added Caleb Jackson, head of youth at the Youth Endowment Fund. A children, violence and vulnerability study had assessed the youth sector’s role in preventing violence and found that while youth activities were popular, youth service cuts were huge and had made delivery challenging. ‘We need to reach, rather than say hard to reach,’ he said and offered approaches to reducing youth violence through the YEF toolkit.

Students Organising for Sustainability (SOS) had conducted their annual survey about students’ relationships with drugs and alcohol. Hannah Head, who ran their drug and alcohol impact training (and was also a member of Students for Sensible Drugs Policy) highlighted a zero tolerance approach and lack of knowledge in many universities. But there were barriers to universities having a harm reduction focus, she said – including misunderstanding of drugs laws – and there were obvious opportunities for interventions and initiatives that were being ignored. Greater trust between universities and their students would offer chances to communicate on health and wellbeing and be much clearer about a harm reduction approach and support. Bristol were doing this well with large posters on campus and an onsite drugs advisor, while Leeds were using Instagram stories as a more effective way of engaging than just posts. It was essential that students knew the risks and understood about drug safety, she said. A Universities UK Drug Taskforce report* had acknowledged harm reduction and – despite being ‘watered down’ by the time it was released – had said that universities should adopt a harm reduction approach.

*Enabling student health and success, available here

It’s Student Drug and Alcohol Awareness Week 2024

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DDNWeb
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Student Drug and Alcohol Awareness WeekThe Student Drug and Alcohol Awareness Week, run annually by Students Organising for Sustainability (SOS-UK), supports the move towards harm reduction in the Higher Education sector through asking institutions and organisations to share educational resources, run events and engage in meaningful conversation about student drug and alcohol use.

It encourages the move away from zero tolerance in the sector, and towards ensuring all students have access to adequate information and support around drug and alcohol use.

Following the release of UUK guidance earlier this year, and a gradual cultural shift towards harm reduction on campus, we’re hopeful that this will be the biggest Student Drug and Alcohol Awareness Week yet. We’d love to see more of the wider drug and alcohol sector taking part and we’re encouraging everyone to get involved – you could share how you support students and young people or get in touch with your local university or students’ union to discuss how you could work together.

If your organisation would like to take part in this year’s awareness week, you can still pledge to receive a free resource pack and be included in our round up of the week, no action is too small!

Find out more here

This blog was created by Fiona Murray, Project Manager – Wellbeing at Students Organising for Sustainability

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

Lady health workers smoking cessation initiative in rural Pakistan

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DDNWeb
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In Pakistan, tobacco smoking and indoor smoke from cooking fires pose significant health risks. Lady Health Workers (LHWs) play a crucial role in improving healthcare access, particularly in rural areas.

This study aimed to explore the practicality of training LHWs to deliver health education aimed at reducing household exposure to tobacco smoke and indoor biomass smoke, while also documenting baseline exposure levels and assessing the immediate impact on household awareness and intentions to reduce exposure.

The Program
Over 170 LHWs were trained and equipped with health education resources to raise awareness about the risks of tobacco and biomass smoke exposure. The training was designed to be integrated into their routine duties.

Results
Over 24 weeks, the program was delivered to 25,760 households in Gujranwala district. Approximately half of these households had at least one person who smoked, with 90% smoking indoors. Many (85%) households used indoor cooking fires. Only 24% of household head-women were aware of the health risks associated with indoor smoke exposure. Awareness of less harmful alternatives to smoking was low. Most households had someone who wanted to stop smoking and 51 women and 146 men agreed to try a tobacco harm reduction (THR) product. Primary health units’ staff appreciated the project, especially the training provided. They believed the program could be sustainable, and LHWs expressed interest in continuing it.

Conclusion
The study demonstrated the practicality of training LHWs to deliver health education on reducing tobacco and biomass smoke exposure in rural settings. The program effectively raised awareness and showed potential for sustainable integration into existing healthcare structures, highlighting the value of community-centric approaches in low-resource settings.

Lady health workers smoking cessation initiative in rural Pakistan

Enhancing public health through multi-stakeholder collaboration in Africa

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DDNWeb
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Public health policies are crucial in safeguarding the well-being of communities, particularly in low and middle-income regions like Africa, where social, political, environmental, and economic conditions create numerous health vulnerabilities.

The challenges range from infectious diseases like Ebola virus disease, yellow fever, tuberculosis, malaria, and cholera to non-communicable diseases such as cardiovascular diseases, respiratory disorders, and cancers, which are often exacerbated by high-risk behaviours like tobacco use.

Developing and implementing effective public health interventions require an understanding of these issues and collaborative efforts that go beyond traditional boundaries. While there are established frameworks for stakeholder engagement, there still remains little progress for multi-sector collaboration in most African countries. For instance, in some African countries, critical and interrelated sectors like nutrition, tobacco control, and other public health issues are regulated by separate ministries like health, trade, and treasury. This disjointed approach hinders the potential synergies that could be achieved by coordinating efforts and aligning policies around common public health goals.

This paper explores the dynamics of multi-stakeholder collaboration with the aim of understanding how diverse stakeholders in Africa can effectively work together to develop evidence-driven and contextually relevant public health interventions. It provides insights into the challenges, opportunities, and best practices surrounding collaborative efforts in African public health.

Enhancing public health through multi-stakeholder collaboration in Africa

The Interplay of Tobacco Farming and Tobacco Control: Exploring Socioeconomic and Health Dynamics in Malawi

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Tobacco farming and tobacco control are closely inter-related issues, particularly in developing countries that are heavily reliant on tobacco farming like Malawi.

This commentary explores the relationship among tobacco farming, economic sustainability, and public health, focusing on the context of Malawi as one of the major tobacco producers in Africa. Malawi’s economy is significantly dependent on tobacco farming, yet the country also struggles with smoking-related health risks, creating a dilemma between socioeconomic and public health considerations.

The commentary highlights the lack of empirical evidence regarding the socioeconomic implications of tobacco control measures on tobacco farming in the country. Moreover, despite the country’s economic dependence on tobacco farming, a majority of cigarettes consumed domestically are imported, demonstrating the complexity of Malawi’s tobacco industry. On public health implications, the article highlights the disease and death burden that is a result of tobacco smoking, underscoring the need for tobacco control measures.

The article further draws insights from tobacco end-game strategies in other countries and proposes a comprehensive approach to tobacco control. However, the article notes Malawi’s limited financial resources and healthcare infrastructure to implement traditional tobacco control measures and highlights an emphasis on tobacco harm reduction, a third pillar of the Framework Convention on Tobacco Control.

The article also advocates for an emphasis on alternative livelihood opportunities for smallholder tobacco farmers in Malawi.

The Interplay of Tobacco Farming and Tobacco Control: Exploring Socioeconomic and Health Dynamics in Malawi

Vaping set to overtake smoking for the first time in the UK as research and policy endorses tobacco harm reduction

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The latest Briefing Paper from the Global State of Tobacco Harm Reduction (GSTHR), a project from public health agency Knowledge·Action·Change (K·A·C), focuses on the remarkable shift from smoking to vaping that has taken place in the United Kingdom in recent years.

Global State of Tobacco Harm ReductionA smokefree UK? How research, policy and vapes have cut smoking rates explores some of the reasons behind the UK’s rapid and growing embrace of vaping, and provides another important case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products (SNP), following our recent Briefing Paper on the effect heated tobacco products have had in Japan.

One of a number of positive country profiles set to feature in the fourth biennial Global State of Tobacco Harm Reduction report, published later this year, this Briefing Paper shows the number of people who smoke has fallen by nearly 50% since the introduction of vapes nearly two decades ago (from 23.7% of adults in 2005 to 12.9% in 2022).

Our newest publication also includes a significant forecast, based on the latest available data from the Office for National Statistics and Action on Smoking and Health, that reveals the number of adults who smoke will continue to fall to just over 10% next year (2025). In contrast the number of adults who vape will keep rising from the 11% recorded in 2024, meaning vaping will overtake smoking for the first time in the UK. These changes provide further evidence that when consumers have access to safer nicotine products that are acceptable and readily available, they will make the decision to switch in ever-increasing numbers.

While this Briefing Paper, which will be available in 12 languages as well as English, tells a story of consumers leading the way by adopting a new technology in a bid to improve their health, it also showcases the impact that scientific research and proactive governments can have on public health policies.

Global State of Tobacco Harm Reduction Briefing PaperThe UK has played host to some significant milestones in the study of smoking and safer nicotine products. The link between smoking and cancer was first established in the UK in 1950 and these studies led to the publication of the Royal College of Physicians’ landmark report Smoking and Health. It was the first to widely publicise information about the negative effects of smoking on health, and it is considered to be a turning point in the history of public health in the UK. Moving forwards to 2015, the predecessor of the Office for Health Improvement and Disparities, Public Health England, published an independent evidence review that concluded nicotine vapes were around 95% less harmful than smoking. Now referenced around the world as the foremost example of the relative safety of vaping, this report concluded vapes had the potential to help people quit smoking.

Armed with such strong and reliable evidence supporting the role it could play in reducing smoking rates, successive UK governments have continued to endorse vaping. Not only are vapes easy to access for those aged over 18, the government and the National Health Service (NHS) have encouraged people to switch from smoking to vaping. One of the most radical ideas came in 2023 when the government announced that one million people who smoked would be encouraged to switch from cigarettes to vapes. As part of the ‘swap to stop’ campaign, a world-first national scheme, around one fifth of those who smoked would be provided with a vape starter kit, alongside behavioural support, to help them quit. For its part, the NHS provides a wealth of evidence-based advice to those who smoke about the relative safety of vapes compared to cigarettes, though it does emphasise that the full benefits of vaping are only achieved by those who manage to stop smoking cigarettes completely.

David MacKintosh, a director of K·A·C, which runs the Global State of Tobacco Harm Reduction project, commented, ‘In a similar vein to that seen in Japan, the fall in smoking rates in the United Kingdom reinforces just how rapidly situations can improve when people already consuming nicotine by smoking can access a safer alternative like vapes. When vaping overtakes smoking next year in the UK, it will not be simply the consequence of a consumer-led revolution, although this has been significant, it will also be the result of successive governments making pragmatic policy decisions based on the evidence in front of them. Maintaining a clear focus on reducing the use of combustible cigarettes provides an opportunity to achieve the ambitious 2030 ‘smokefree’ target.’

Challenging the narrative

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Assistant psychologists can play a vital role in developing stigma-free servicesAssistant psychologists can play a vital role in developing stigma-free services for people with dual diagnosis, say Edward Loveless, James Streatfield and Dr Stephen Donaldson.

Stigma surrounding mental health and the use of substances is a persistent and pervasive issue, particularly for people with a dual diagnosis. A system that’s strained and stretched by lack of funding, and disparities in available support, has sadly sustained the presence of this stigma and its impacts. This complex interplay can exacerbate the challenges faced by individuals, not only in seeking and accessing treatment, but in navigating societal perceptions.

Assistant psychologists working in mental health care play an important role in understanding, addressing, and mitigating stigma. This article explores our reflections on how we as assistant psychologists are approaching the issue of stigma and the strategies we employ to support people with a dual diagnosis.

Challenging the narrative - assistant psychologists
Stigma in the context of dual diagnosis is multifaceted and can manifest in several ways

Referrals into mental health services reflect a wide variety of presentations, difficulties and, unfortunately, the presence of stigma. Stigma in the context of dual diagnosis is multifaceted and can manifest in several ways, including public stigma, institutional stigma, and self-stigma. The stigma of blame and shame is often twofold – people can often feel stigmatised for their mental health condition and their substance use, and common consequences can include social isolation, reduced self-esteem, reluctance to seek help and feeling their needs and coping approaches are misunderstood by society.

We understand that stigma is not only a social issue but also one that can deeply impact an individual’s mental health. In our role as assistant psychologists we employ person-centred approaches, which emphasise the importance of seeing individuals holistically rather than defining people by their diagnoses. Working with the person and their language, while having knowledge of different formulation models, can help foster a non-judgemental space and collaborative understanding of someone’s experiences. By focusing on the person rather than solely on the condition, we help people feel valued and respected, which can significantly reduce the internalisation of stigma. This awareness is crucial for creating a supportive environment where people feel understood, respected and are therefore more likely to seek help and work with us on their recovery goals.

Therapeutic relationships
One of the primary tools we use as assistant psychologists to combat stigma is the therapeutic relationship. By providing clients, their families, and the community with accurate information about dual diagnosis and a safe space to talk about their experiences, we can help to dispel myths and misconceptions. This approach empowers people to better understand their conditions, reduces feelings of shame, and provides hope that there is an achievable pathway of recovery.

Addressing stigma in dual diagnosis requires a multidisciplinary and collective leadership approach. Without this, there’s a risk that treatment plans lose their holistic focus

Addressing stigma in dual diagnosis requires a multidisciplinary and collective leadership approach. Without this, there’s a risk that treatment plans lose their holistic focus. By fostering open communication and shared understanding among professionals, we help create a cohesive support system that addresses both the mental health and substance use aspects of the person’s care. Within our role we have a duty to collaborate with other services in the community who may have expertise in areas we do not.

By reaching out and inviting professionals and people who are experts from experience into service development and leadership spaces, we can increase understanding of important issues. Moreover, by having these discussions, assistant psychologists can also help influence the narrative around the impact of stigma and advocate for a more open and compassionate approach to care, reducing barriers to engagement. This allows for the sharing of strategies and resources that can be used to support clients more effectively.

A significant aspect of the work done by assistant psychologists is helping people understand coping techniques and develop new skills and strategies to manage their presenting needs. This might include psychological and mindfulness-based techniques aimed at offering alternative ways to manage their difficulties, understanding the impact of emotions, as well as relapse prevention strategies. By recognising that stigma impacts people differently, assistant psychologists tailor interventions to meet the specific needs of each individual. This personalised approach ensures that people feel valued and respected and that the support they receive is relevant and effective for the individual’s unique circumstances. 

Empowerment
Empowerment is a key theme in reducing self-stigma in dual diagnosis. A mutual therapeutic space that is collaborative and works with an individual’s strengths helps shift power dynamics within session, and empowered people can build confidence in their ability to manage their conditions and develop a sense of agency in their recovery journey.

EmpowermentAs assistant psychologists we also engage in advocacy efforts to combat institutional stigma, ensuring that people are not discriminated against in their access to care. This involves challenging stigmatising language, attitudes and behaviours within healthcare settings and advocating for policies that promote equality and inclusivity for those with a dual diagnosis. We challenge unhelpful practices by encouraging the use of non-stigmatising language, discouraging negative labelling, signposting to appropriate services and raising awareness among other healthcare professionals.

It’s vital that we advocate with the person and their needs to ensure that people accessing services with dual diagnosis do not fall through the gaps. We do this through co-production and being respectful, compassionate and responsible. We co-produce policies with service users and advocate for increased funding for dual diagnosis programmes, ensuring that we make reasonable adjustments where possible so that the people experience person-centred care that is free from stigma. 

Compassion, communication and collaboration
Through compassion, communication and collaboration, we can help support and advocate for change in perception by continuing to develop spaces where dual diagnosis can be better understood. We feel privileged in the work we do to support people with complex needs to feel connected, heard and valued, and to co-create their own journey of hope and recovery.

We can all help mitigate the impact of stigma and support individuals in their recovery by dismantling the barriers that stigma creates, and fostering a valued therapeutic relationship that empowers people to feel safe, connected and not judged for their understandable approaches to coping.

Assistant psychologistsEdward Loveless is higher assistant psychologist for the Access to Wellbeing Team York, Tees, Esk and Wear Valleys NHS Foundation Trust. James Streatfield is higher assistant psychologist for Central York Adult Community Mental Health Team, Tees, Esk and Wear Valleys NHS Foundation Trust. Dr Stephen Donaldson is dual diagnosis lead for North Yorkshire and professional lead for psychological professions York, Selby, and specialist services, Tees, Esk and Wear Valleys NHS Foundation Trust

PPN

Impact of alcohol ‘obscured by cost-driven narratives’, says WHO

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Impact of alcohol ‘obscured by cost-driven narratives’, says WHOThe true costs of alcohol are ‘often obscured by profit-driven narratives’, says a new document from the World Health Organization (WHO).

The Alcohol policy playbook is designed to help policy makers ‘navigate the ever-present debates around alcohol harms and alcohol policy’ with a view to safeguarding public health, WHO states.

Europe has the world’s highest alcohol consumption levels – at an average of 9.2 litres of pure alcohol per person per year – contributing to almost 800,000 annual deaths, including 40 per cent of cardiovascular disease cases and 15 per cent of cancer cases. Alcohol consumption is ‘draining economies in the WHO European Region, costing billions annually in health care, early deaths and lost productivity, as well as social harm,’ the agency states, and although the cost of harm in high-income countries is the equivalent of 2.6 per cent of GDP, the narrative is still often dominated by ‘powerful commercial interests focused on boosting sales’.

Despite the industry presenting itself as a major contributor to the economy the health and social costs far outweigh any financial benefits, says WHO, with the playbook designed to help ‘critically assess the evidence’ and cut through industry claims. A recent report co-authored by the Alcohol Health Alliance (AHA) also warned the UK’s new MPs to ‘wise up’ to alcohol industry lobbying tactics and make sure they avoided any conflicts of interest.

‘We will not make progress on public health if the alcohol industry’s influence on policymaking is not curtailed, as was done with the tobacco industry to great success.’ – Dr Katherine Severi

‘The price that Europeans are paying for drinking alcohol is too high,’ said WHO regional director for Europe, Dr Hans Henri P. Kluge. ‘The economic cost of deaths just from alcohol-attributable cancers in the European Union in 2018 was estimated to be almost €5bn, accounting for almost 10 per cent of the total cost of cancer deaths in the region. We know that when it comes to cancer, there is no safe amount of alcohol consumption. At the same time, less than 50 per cent of Europeans are aware of the link between alcohol and cancer. This is largely because the alcohol industry promotes misleading narratives that distract from the significant public health harms caused by alcohol.’

The document was an ‘invaluable resource that exposes the tension between industry profits and the health of nations’, said Institute of Alcohol Studies chief executive Dr Katherine Severi, equipping policy makers to ‘confront industry influence head-on’ and  ‘dispel the myths surrounding alcohol’s supposed benefits and underscore its profound health harms. We will not make progress on public health if the alcohol industry’s influence on policymaking is not curtailed, as was done with the tobacco industry to great success.’

Empowering public health advocates to navigate alcohol policy challenges: alcohol policy playbook available here

UK has Europe’s ‘most lenient’ regulation on gambling ads

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Britain’s regulations on gambling adverts are the most lenientBritain’s regulations on gambling adverts are the most lenient ‘despite having more research on the negative effects of gambling marketing than several other European countries combined’, says a report commissioned by the GambleAware charity.

The organisation is calling for a pre-watershed ban on broadcast adverts and a ‘blanket ban across sports’, alongside mandatory health warnings and tougher restrictions on online marketing.

Gambling marketing bans are increasingly becoming the norm in countries like Italy, Spain, Germany and the Netherlands in response to concerns about gambling-related harm and ‘normalisation for young people’, says the document, which was produced by Ipsos and the University of Bristol. Gambling marketing ‘continues to bombard the public’, it states, with operators spending £1.5bn a year on advertising and marketing. More than two thirds of people think there is ‘too much’ gambling advertising, with around three quarters backing more regulation for TV and social media marketing, it adds.

Britain’s regulations on gambling adverts are the most lenient ‘despite having more research on the negative effects of gambling marketing than several other European countries combined’
Gambling marketing bans are increasingly becoming the norm in countries like Italy, Spain, Germany and the Netherlands

Regulating gambling marketing in the countries studied was a ‘political choice’, the report says, with ‘significant’ new primary legislation put in place based on a public health argument that increased consumption leads to increased harm and that gambling was being normalised for children and young people. This was despite opposition from the ‘significant’ gambling lobbies in each country, and huge amounts of revenue flowing into the sports and media sectors. ‘Arguments against regulation focused on the economic impact of lost tax revenue and employment, the risk of a black-market expansion and infringements on the commercial freedom of industry,’ it states.

The Gambling White Paper – which was finally published two and a half years after the government first announced a review of the 2005 Gambling Act – was much criticised for failing to include any meaningful measures to address advertising and marketing, despite the widespread public support.

‘In Great Britain, despite the publication of almost 500 research papers in the last decade from British universities including specialist gambling units at academic institutions such as Bristol, Bournemouth, and Glasgow – more research than Italy, Germany, the Netherlands and Belgium combined – there is no primary legislation in place to regulate gambling marketing including on TV, radio, online and in sport,’ the charity states. ‘There is strong evidence to show that gambling advertising increases participation, and therefore risk.’

UK has Europe’s ‘most lenient’ regulation on gambling ads
‘There is strong evidence to show that gambling advertising increases participation, and therefore risk.’

The result of the government consultation on a statutory levy on the gambling industry – which would compel companies to pay a percentage of their profits towards treatment, research and prevention – is expected soon. However, while GambleAware ‘looks forward’ to the introduction of the levy it still wants to see ‘urgent action’ on marketing regulation, it says.

‘Every day we are bombarded by gambling advertising, marketing and sponsorship on TV, radio and online,’ said chair of Peers for Gambling Reform, Lord Foster of Bath. ‘There is huge public support to curb it and there’s a wealth of research showing the harm it causes. But we remain woefully behind the curve in terms of the regulation needed to protect individuals from harm. Crucially, the power to regulate key aspects of this – such as gambling advertising – is already within the gift of the secretary of state as set out in the Gambling Act 2005. Our current regulations are too lenient, and fail to advance the much-needed public health approach to gambling that Peers for Gambling Reform has long called for.’

Drivers of gambling marketing restrictions – an international comparison available here

Now hear this

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Nitazenes are now part of the UK’s drug supplyNitazenes have been a topic of conversation for well over a year in the UK, as we have had multiple instances of clusters of lives lost in short periods due to contaminated drug supplies. Treatment providers have responded to fears of a nitazene-adulterated drug supply by increasing naloxone provision, providing nitazene testing strips, warning opiate users that they risk overdose even when smoking, as well as issuing alerts when nitazenes are detected locally. Despite these adaptations, many in the sector are still in denial about the real prevalence of nitazenes in our drugs market. As a result, people with dependencies on these drugs are often met with disbelief and a service offer which is woefully inadequate.

George is a Release caller who first started using nitazenes in 2022, when he was 17. After many difficult years struggling to manage co-occurring mental health disorders and an unstable home environment, George found himself experimenting with different drugs in an attempt to relieve the worst of his mental health symptoms. One of the drugs George used were pills advertised as ‘pressed oxycodone M30s’. It didn’t take long for George to develop a dependency.

Nitazenes - everyone buying pressed oxies knows they really contain syntheticsMost of the harm reduction conversations around nitazenes in the UK thus far have focused on reducing risks among people whose drugs have been contaminated with nitazenes, assuming that the user does not know about – nor desire the presence of – nitazenes. ‘The thing is,’ George explained, ‘everyone buying pressed oxies knows they really contain synthetics. “Pressed pill” is basically slang for either fentanyl or nitazenes.’ This highlights the first way in which our treatment services and harm reduction messaging are letting people down. We fail to recognise that some nitazene users are not encountering these drugs by accident – they’re seeking them out.

When George first entered treatment at his local drug service, he quickly found that there was no real understanding of nitazenes. For starters, workers were unaware that these drugs are unlikely to be detected by their drug testing equipment, and despite his daily nitazene use, George’s first urine test was negative for opiates. ‘Good news, you’re not using opiates,’ said the clinician. George was only able to begin methadone treatment at a later appointment, having learned that without smoking heroin in addition to his nitazene use he would not be prescribed.

George continued to be disbelieved as he titrated up. Different nitazenes vary in strength, but range from anywhere between ten and 2,000 times stronger than morphine. As a result, a dose of 90ml of methadone was leaving George in significant discomfort. We know from North America that people using synthetic opioids can require doses in excess of 100mg – doctors in Canada have even produced new guidance on the topic. Despite explaining this to his prescriber, and describing his withdrawal symptoms in detail, he was told that there was no way he could still be under-dosed. His prescriber’s failure to listen, and refusal to meet George’s needs, led to him managing his withdrawals by returning to nitazene use on top of his script.

We fail to recognise that some nitazene users are not encountering these drugs by accident – they’re seeking them out
We fail to recognise that some nitazene users are not encountering these drugs by accident – they’re seeking them out

Eventually George was able to be seen by a different prescriber, who agreed to a higher dose if required. Frustratingly for George, whose trust in his treatment provider was at an all-time low, even at this stage they still refused to accept that his dependence had been formed by nitazenes. His prescriber insisted on referring to the drugs he had been using as oxycodone, despite multiple tests that George conducted on his pills and on his urine using nitazene test strips. George was told that these strips were too unreliable to be considered accurate, and his trust in his treatment service was further damaged by this unwillingness to believe him. A Wedinos result would later confirm that the only active ingredient in his pills was isotonitazepyne.

Treatment providers may sometimes struggle to respond in an agile way to emerging crises. It’s understandable that drug workers, even clinicians, may not know the best way to treat a dependency on an emerging drug. However, we do know that good therapeutic relationships and patient trust are important in keeping people engaged (and alive), even when the finer details of someone’s treatment plan are a bit fuzzy.

Nitazenes have now been part of the UK drug landscape for three years, and it needs to be accepted that these drugs are sometimes used with intention, that they are increasingly prevalent, and that we must listen to people using these drugs. We must adapt our approach as a sector if we have any hope of supporting people using nitazenes in the future, as they are very likely here to stay.

Fraser Parry is drugs advocacy and support adviser at Release

This Remembrance Day, veteran urges military personnel to access life-saving support

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This Remembrance Day, veteran urges military personnel to access life-saving supportThis Remembrance Day, WithYou in Cornwall reminds veterans and other members of the armed forces community that they are not alone. The charity offers tailored support to members of the community who are experiencing challenges with drugs or alcohol.

WithYou in Cornwall supports over 100 members of the armed forces community. Graham, a veteran in Cornwall, is urging serving personnel, veterans and families to seek support with any drug, alcohol or mental health challenges they may be experiencing.

Graham, WithYou in Cornwall client, said, ‘The support that I have received from WithYou has been different to what I have received elsewhere. It’s very accessible, no matter what you need support with, it’s there. The team is always just a phone call away.

‘There’s personalised support for ex-veterans, which I haven’t experienced anywhere else – the events that are available to us, such as the ‘Walk and Talks’ and the drop-in sessions are brilliant. They’re tailored specifically for veterans, by veterans.

Having the ability to speak to like-minded individuals with similar experiences is invaluable
‘Having the ability to speak to like-minded individuals with similar experiences is invaluable’

‘Having the ability to speak to like-minded individuals with similar experiences is invaluable. A lot of the veterans that I’ve met have been a similar age to myself with a variety of different experiences in the forces, and with their own unique challenges: from suffering with PTSD to having their battles with alcohol.’

WithYou in Cornwall creates a welcoming space where service members and their families can connect through peer support groups and engaging activities. The charity also helps individuals who need support with their mental and physical health or are facing challenges with finding suitable accommodation.

Commenting on the importance of supporting members of the armed forces community, Andy Craze, National Armed Forces Programme Lead at WithYou, said, ‘Remembrance Day is a poignant day for the armed forces community. It is an opportunity to remember past and present members of our community who have served their country.

‘For ex-forces members, the transition back to civilian life can sometimes feel isolating and overwhelming. Here at WithYou, we want our military personnel to know that there is a safe and welcoming space for them here.

‘We’ve developed a dedicated programme at WithYou which provides specialist support for veterans and their families.

‘By acknowledging their unique experiences, specific needs and military identity, WithYou is able to better enhance their drug and alcohol recovery.

‘Veterans have given their lives to their country, and we are proud to play a small part in improving access to the support that they, and their families, deserve.’

This blog was originally published by WithYou. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by WithYou

Building bridges to recovery: Success of The Bridge Programme at HMP Rye Hill

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Building bridges to recovery: Success of The Bridge Programme at HMP Rye HillWith the project having launched earlier this year, staff at HMP Rye Hill have been delivering a new specialist drug and alcohol support service for people currently in prison with addiction issues. Drug and Alcohol Recovery Team (DART) Service Manager, Joanne Steele, reflects on the successes of the programme to date.

The Bridge Programme was first introduced at HMP Rye Hill in January 2024. The aim of facilitating this programme was to help clients of The Forward Trust who are currently in prison to address medium to high-risk substance dependency use.

The Bridge Programme works around the 12-step treatment approach with continuous themes of coping skills, addressing behavioural changes, and ongoing recovery planning, some of which were new ideas to the clients engaging with the service.

To date, we have had a total of 27 graduates in our first year of delivery, which is a huge success for the DART service. Change can often result in a difficult journey of acceptance, especially within in a prison environment, but strong leadership, motivated facilitators, and a cohort of service users who are keen to make positive and lasting changes to their lives have resulted in great achievement.

The Bridge graduates, participants, and facilitators have all spoken positively about the impact the groups have had and the personal reflection that has followed.

Success of The Bridge Programme at HMP Rye HillThe Forward staff at HMP Rye Hill, particularly those who have facilitated programmes so far, have had to adapt to new elements of treatment and recovery that they were not familiar with.

As their Service Manager, I am beyond proud of the team and how they have taken this programme on and adapted it for our clients, which can be a complex ask at times. Each member of the team has brought their own experience of group delivery and supporting those in recovery to their delivery style.

This project was also started during a period of change at HMP Rye Hill, currently under construction due to an expansion of the prison, which will see an additional 458 spaces being created (arriving in December 2024) so we are planning for a busy few months of supporting these individuals as they enter the prison.

We hope to continue with The Bridge in the future and plan to hold catch-up sessions with our former graduates over the coming months to reflect on their learning and what they will take forward on their individual recovery journeys.

Testimonials – Graduates of The Bridge course

‘The Bridge course has taught me some valuable tools that I did not think I needed before I signed up to it. The facilitators were open, kind, and willing to get to know us on a personal level. I will miss the group as it has been a great support network for the past 6 weeks.’ – Bridge Programme Graduate

‘I have found The Bridge programme to be a very meaningful and worthwhile experience. It has enabled me to look back over my life through my addiction and begin to not just remember, but to start to deal with some of the feelings and look forward to a life beyond my addiction.’ – Bridge Programme Graduate

‘When I first started, I was reluctant to open up due to my past experiences with recovery programmes. However, I feel that I am now more aware of what life holds for me outside, which will keep me clean and out of prison. I have more confidence that things will be okay and I am looking forward to the future.’ – Bridge Programme Graduate

This blog was originally published by Forward Trust. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

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Cranstoun joins charities in signing letter to the Chancellor

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Cranstoun joins charities in signing letter to the ChancellorCranstoun’s CEO Charlie Mack has joined charities, through the National Council for Voluntary Organisations (NCVO) and Association of Chief Executives of Voluntary Organisations (ACEVO), by signing a letter to the Chancellor of the Exchequer following the budget delivered last week. The letter raises concerns about the impact of National Insurance Contribution changes and the impact it will have on the sector.

You can read the full letter below:

Dear Chancellor,

Congratulations on your first budget as Chancellor. Your plan to increase investment in local government, SEND provision, and housing are all welcome. They will support many of the communities we serve and reduce the need for us to step in and provide essential, sometimes crisis, services to those in need. However, the impact of these investments won’t be immediate, and our sector will have to continue plugging the gaps until then.

Ahead of the budget, we have been clear that charities are in a dire situation as they try and meet the demands of rising need in communities while their own costs escalate and funding declines. The decision to increase employer National Insurance Contributions (NICs) – and not to carve out an exemption for them – will place another major strain on charities at a time when we are already struggling.

Charities employ almost 1 million people, meaning charities of all sizes will severely feel the impact of the employer NICs increase. NCVO’s initial estimates have found the increases will create an annual additional bill of £1.4bn.

Our sector will have less flexibility than ever before to absorb these increasing costs. Many of us will have to make difficult choices in the coming months as a result. The harsh reality is that many organisations may be forced to reduce staff, cut salaries, and most importantly, scale back services for the very people they strive to support.

Many of us already subsidise the shortfall in our government contracts using fundraising or cash reserves. Research from NCVO found that almost 3 out of 4 charities are withdrawing from public service delivery or considering doing so, and most are reducing their services in order to reduce costs. This is unsustainable for our communities. Not only do charities deliver almost £17bn worth of public services every year, but many of us also provide support when public services fall short, without receiving any public funding at all.

The Prime Minister spoke eloquently two weeks ago at the launch of the engagement on a Civil Society Covenant about our sector’s essential role in working alongside government to deliver a decade of national renewal. You have recognised the challenging impact of raising employer NICs in your decision to reimburse the cost to public sector organisations. As essential partners of the state – both through direct public service delivery, and through providing preventative services where austerity has left a void – the voluntary sector requires the same support. We urge you to commit to reimbursing voluntary organisations’ increased employer NICs, the same as you will do for the public sector.

We are wholly committed to fostering a stronger partnership with the government to ensure that future budgets fully consider the vital role of charities in delivering essential services. Our work with the Prime Minister and the Secretary of State for Culture, Media and Sport on the Covenant – as a new agreement to reset the relationship between the voluntary sector and all levels of government – is key to this. We look forward to working with you to support the voluntary sector to play its role in building stronger, more resilient and connected communities.

This blog was originally published by Cranstoun. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Cranstoun

Mental health-based prevention scheme for young people pilots in UK

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Illicit ProjectAn Australian drug prevention scheme with a focus on young people’s broader mental health and attitudes is to be piloted in 20 UK schools. The Illicit Project, which is led by Liverpool John Moores University (LJMU) and funded by the National Institute for Health and Care Research (NIHR), will pilot in 20 schools across Merseyside, Falkirk and Stirlingshire.

The low-cost programme is one of four to share £1.8m from NIHR’s Innovation Fund to Reduce Demand for Illicit Substances. Focusing on the relationship between drug use and mental health, it ‘seeks to promote mental wellbeing, self-efficacy for help-seeking, drug reduction skills, and the development of drug/health literacy’, LJMU states.

Originally designed by neuroscientists and mental health professionals at the University of Sydney, the programme consists of interactive workshops delivered by trained facilitators over the course of a month, and ‘significantly reduced’ use of ecstasy, cocaine, alcohol and nicotine among 15-19-year-olds when implemented in Sydney schools, says LJMU.

The three other research projects sharing the funding are evaluations of a theatre in education programme for 12-14-year-olds being used by East Sussex County Council, a drug education programme created by the Daniel Spargo-Mabbs Foundation aimed at 13-15-year-olds, and educational materials, therapy and a public health campaign aimed at 11-16-year-olds.

Illicit Project - mental health-based prevention scheme for young people
13 per cent of 11-15-year-olds in England have taken a drug, while 37 per cent reported having drunk alcohol

According to the latest figures from NHS Digital, 13 per cent of 11-15-year-olds in England have taken a drug, down from 18 per cent two years ago, while 37 per cent reported having drunk alcohol.

Focusing on mental health and safety was far more likely to have a positive impact than ‘out of date and ineffective approaches that only focus on stressing the dangers of substance use’, said Professor Harry Sumnall of LJMU’s School of Psychology, who will lead the pilot project.

‘Although alcohol and other drug education is part of the curriculum, teachers often struggle to find the right resources and we don’t know what is delivered in schools actually leads to reductions in substance use,’ he said. ‘The Illicit Project holds great promise. It is one of the few substance use prevention programmes that is backed up by high quality evidence. We are going to work with young people to update the programme contents to make sure it is relevant to them, and with school staff and other professionals to ensure that it can be easily delivered in classrooms.’

theillicitproject.com

County lines ‘becoming more localised’, say police

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county linesCounty lines operations are shifting from their traditional business model to become more localised, according to a report from the National Police Chiefs’ Council (NPCC) and the National County Lines Coordination Centre (NCLCC).

‘External’ lines – that cross a police force boundary – are down by 12 per cent, while lines that begin and end within a single force boundary are up by more than 230 per cent, the document states. ‘The county lines threat has become more localised, with fewer lines running outside force boundaries and fewer children recorded by the police as involved in any capacity,’ it says.

There are almost 1,500 organised crime groups linked to county lines activity, with three out of four county lines offenders having previous convictions for violence and/or possession of weapons. The county lines market continues to be dominated by on-street or ‘burner’ phone sales of heroin and crack cocaine, the report says – substances that are rarely available on social media accounts advertising drugs.

‘The county lines threat remains stable, following intensive policing activity, focussed on tackling county lines from the four exporter cities of London, Liverpool, Birmingham and Manchester and on the rail network, alongside education and multi-agency intervention work with those at risk of, or being, exploited,’ says the document. ‘This is despite the overall threat from drugs increasing, as cocaine production remains high, pricing consistent with high profit margins, and nitazenes increasing the risk to users. Law enforcement activity has made the enterprise riskier for criminals.’

The county lines market continues to be dominated by on-street or ‘burner’ phone sales of heroin and crack cocaine
The county lines market continues to be dominated by on-street or ‘burner’ phone sales of heroin and crack cocaine

Despite fewer children and more adults being recorded as having county lines involvement between April last year and March this year, the business model ‘continues to involve child criminal exploitation, as well as child sexual exploitation’, the report points out. ‘Children going missing is a fundamental feature, where they are trafficked to work on drug lines at the sharp end, as drug runners transporting and selling drugs directly to users. This puts them in the most dangerous role within the supply chain, possessing valuable cash and commodity that other criminals may seek to steal, and with potential for violent conflict linked to the drugs operations, particularly over territory.’

A 2021 report from the University of Nottingham said that county lines activity was becoming characterised by rising levels of ‘extreme’ violence and sexual exploitation, with young people coerced into the gangs via online grooming and controlled through the harbouring of sexually explicit images, along with sexual abuse of both males and females.

‘One of our priorities has been to enable police officers to recognise the signs of exploitation when encountering young people involved in county lines so that they are able to safeguard those being exploited via these violent criminal gangs,’ said NPCC lead for county lines, Commander Paul Brogden. ‘Identifying potential indicators of vulnerability at an early stage gives policing the opportunity for early intervention, which could mean a referral to statutory and/or specialist support provision. We know the county lines drugs supply business model continues to exploit children and vulnerable adults, so we must continue working across the country to effectively tackle this cross-border crime.’

County lines strategic threat risk assessment available here

Afghan opium cultivation up almost 20 per cent

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opium cultivationOpium cultivation in Afghanistan has increased by an estimated 19 per cent this year, according to the latest survey by UNODC.

Cultivation now stands at 12,800 hectares, says the report, after a 95 per cent decrease in last year’s crop season following the Taliban’s April 2022 ban on poppy cultivation. However, cultivation levels remain ‘far below’ 2022 levels, when more than 230,000 hectares were cultivated.

Dry opium prices have now stabilised to around US $730 per kg, compared to a pre-ban average of just US $100 per kg. ‘The high prices and dwindling opium stocks may encourage farmers to flout the ban, particularly in areas outside of traditional cultivation centres, including neighbouring countries,’ UNODC points out.

opium poppies
The geographic centre of cultivation has shifted to the north eastern provinces

The geographic centre of cultivation has now shifted from the country’s south west provinces – ‘long the heart of Afghanistan’s opium cultivation’ – to the north eastern provinces, which have seen an increase of almost 400 per cent. Late last year Myanmar overtook Afghanistan as the world’s largest source of opium, following a 20 per cent increase in cultivation.

Although traffickers are thought to have stockpiled opium before and since the 2022 cultivation ban, drugs agencies around the world have long expressed fears that a ‘heroin drought’ as a result of the ban would lead to markets seeing ever-larger supplies of powerful synthetic opioids to fill the gap – dramatically increasing overdose risks. ‘Now entering its second year of enforcement, the ban continues to hold,’ the UNODC report states. ‘The rapid and currently sustained decline in poppy cultivation and opium production has important and wide-ranging implications for the country and opiate markets long supplied by product from Afghanistan.’

‘With opium cultivation remaining at a low level in Afghanistan, we have the opportunity and responsibility to support Afghan farmers to develop sustainable sources of income free from illicit markets,’ said UNODC executive director of Ghada Waly. ‘The women and men of Afghanistan continue to face dire financial and humanitarian challenges, and alternative livelihoods are urgently needed.’

Opium poppy cultivation 2024 available here

Tobacco and vapes bill introduced to Parliament

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Tobacco and vapes bill introduced to ParliamentThe tobacco and vapes bill will be introduced to Parliament today, the government has confirmed.

The bill will contain measures to ‘create a smokefree generation’, including phasing out the legal sale of tobacco to anyone currently aged 15 or younger, as well as a ban on vape advertising and sponsorship and tightening the regulations on vape flavours, display and packaging. Separate legislation will also see disposable vapes banned from June next year.

The indoor smoking ban will also be extended to ‘certain outdoor settings’, the government states. These could include playgrounds and the areas outside schools and hospitals, subject to consultation. However the government appears to have abandoned plans to include outside pubs and restaurants, beer gardens, and nightclub smoking spaces in the legislation, following concerns about the potential impact on the hospitality industry.

The government is also considering ‘tougher action’ to address youth vaping, it says, with the latest ONS figures showing that a quarter of 11-15-year-olds had tried a vape, with 9 per cent vaping regularly. The number of 11-15-year-olds who had ever smoked tobacco, however, has fallen to its lowest ever level, at 11 per cent. Plans to make smoke-free spaces vape-free spaces as well are also being considered, again subject to consultation.

The government is also considering ‘tougher action’ to address youth vaping
The government is also considering ‘tougher action’ to address youth vaping

The tobacco and vapes bill was originally introduced by the last government but was shelved following the announcement of a general election.

The bill forms part of the government’s ‘reform agenda to shift the focus of healthcare from sickness to prevention, and will address one of the biggest risk factors driving poor health’, the Department of Health and Social Care (DHSC) states.

‘A smokefree country would prevent disease, disability and premature deaths for children born today and for people long into the future,’ said chief medical officer Professor Chris Whitty. ‘Smoking causes harm across the life course from stillbirths, asthma in children, cancers, strokes and heart attacks to premature dementia. Most smokers wish they had never started, but are trapped by addiction.’

The rising numbers of children vaping was a ‘major concern’, he said, and the bill would ‘help prevent marketing vapes to children, which is utterly unacceptable. This is a major piece of legislation which if passed will have a positive and lasting impact on the health of the nation.’

See tobacco harm reduction feature in the new issue of DDN here

Scottish Parliament consults on right to recovery bill

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Right to Addiction Recovery (Scotland) BillThe Scottish Parliament is seeking views on the right to addiction recovery (Scotland) bill, which was introduced earlier this year. The parliament wants to hear from individuals, charities and support groups, as well as people working in the health, academic and legal sectors and local and national government, it says.

The bill would ensure that anyone diagnosed by a health professional as ‘addicted to alcohol or drugs or both’ is provided with treatment within three weeks, and that they have a say in the type of treatment provided. If the health professional decided that the treatment chosen was inappropriate – or that no treatment was necessary – they would have to inform the person in writing why this was the case. People would also be able to seek a second opinion if they did not agree with the original decision.

‘We’re keen to hear views on whether people agree with the purpose and extent of the bill and whether it will help those facing drug and alcohol addiction,’ said Clare Haughey MSP. ‘We want to know what the key advantages and/or disadvantages are of placing this right to receive treatment, for people with drug and alcohol addiction, in law. We also want to hear views on the proposed procedure for determining treatment, and timescales for providing treatment.’

Downing Street - budget
Collective Voice has expressed concern about the potential impact of the recent budget on the drug and alcohol field

Meanwhile, Collective Voice has expressed concern about the potential impact of the recent budget on the drug and alcohol field. While broadly welcoming the budget as ‘a realistic response to what has been a serious assessment of the situation facing the country’, executive director Will Haydock said he was worried that charities risked being overlooked when it came to allocation of resources.

‘Most of the funding in England for community treatment for issues with alcohol or other drugs comes through local authorities’ public health grant and the Supplementary Substance Misuse Treatment & Recovery grant – both of which are provided through the Department of Health and Social Care (DHSC),’ he said. While the budget’s funding increase for DHSC meant he was hopeful that money would ‘filter down to individual programmes’ and mean funding for local providers would be ‘at least maintained at current levels’, the risk was that charities would not necessarily be considered under the health umbrella – ‘which is often simply thought of as “the NHS”,’ he stated. There was also a risk that charities could be excluded from the health sector exemptions to increased employee national insurance contributions, he warned.

While the budget included £233m of additional homelessness spending in 2025-26, the most recent figures from the Combined Homelessness and Information Network (CHAIN) revealed an 18 per cent increase in the number of people sleeping rough in London between July and September this year on the same period last year. A total of 4,780 people were recorded as rough sleeping, 2,343 of whom were rough sleeping for the first time. More than 680 people were also deemed to be ‘living on the streets’, more than 40 per cent more than last year.

‘It is heart breaking to see the latest reality of the homelessness crisis brought home by these figures – almost 5,000 people sleeping on the streets of London in just three months is a number that should incense us all,’ said St Mungo’s chief executive Emma Haddad. ‘With a massive increase in the number of people sleeping rough for the first time, alongside a massive increase in the number of people actually living on the streets, we need to treat this as an emergency. Our outreach teams are on the frontline of this crisis right now. They supported 9,000 people rough sleeping in the UK last year. They are also responding to increased levels of need, with mental health needs particularly pronounced.’

While the £233m allocation in the budget was welcome, funding needed to be ‘sustainable, long term and part of a much broader solution that prevents people becoming homeless in the first place’ to have a real impact, she stressed.

Right to addiction recovery (Scotland) bill – call for written evidence available here until 20 December

An open goal

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DDNWeb
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Tobacco harm reduction

When vapes first came onto the UK market around 20 years ago, almost a quarter of adults were smokers. According to the latest ONS figures, that’s now fallen to less than 12 per cent (DDN, October, page 5).

A new briefing paper from the Global State of Tobacco Harm Reduction (GSTHR) points out that not only will the proportion of adults who smoke likely have fallen to just over ten per cent next year, but the proportion of vapers will have overtaken it. It will be a landmark moment, especially considering that when ONS first started compiling smoking statistics 50 years ago, more than half of men smoked, along with 41 per cent of women.

The document highlights that the large-scale shift to vaping, while clearly consumer-driven, has also been helped by successive UK governments making ‘pragmatic policy decisions based on the evidence’, publishing the science on the safety of vapes compared to smoking, and endorsing and promoting their use as a smoking cessation tool.

Controversy and confusion
But vaping remains controversial. While PHE stated in 2018 that it was 95 per cent less harmful than smoking tobacco, and anti-smoking charity ASH has long backed vapes as an effective quitting tool (while also expressing concerns about levels of youth vaping), the WHO’s position is that ‘strong decisive action is needed to prevent the uptake of e-cigarettes’.

smoking vaping
‘If you smoke, vaping is much safer; if you don’t smoke, don’t vape.’

Add in the extensive media coverage and it’s not surprising there’s a great deal of confusion around. Last year, a YouGov survey of more than 12,000 people found that just under 40 per cent of smokers thought vaping was ‘as or more risky’ than smoking, which prompted ASH to issue a ‘myth buster’ to challenge ‘common misrepresentations of the evidence’. The document summed up the argument by quoting chief medical officer Chris Whitty: ‘If you smoke, vaping is much safer; if you don’t smoke, don’t vape.’

‘A lot of the rhetoric around vaping, and the quite legitimate concerns about young people vaping, ends up creating a slightly toxic environment,’ David MacKintosh, a director at Knowledge Action Change (KAC) which runs the GSTHR project, tells DDN. ‘But one of the reasons the UK is in a better position than some other places is that we’ve had people in PHE who were prepared to say this is a good thing, and a cadre of academics who’ve done the research and have the evidence – the work coming out of UCL is always very balanced, for example.’

While some people argue that vapes haven’t been around long enough to fully understand the potential health effects, we’re now ‘starting to get to the point where we’ve actually got a pretty long exposure window’, says MacKintosh. ‘Inevitably there will be some issues – it’s not a healthy thing to do – but I’m sure we’ll be able to shoot some of the wilder foxes in terms of health effects.’

Negative coverage
In the meantime, however, the negative coverage does have an impact. One example is the ambitious ‘swap to stop’ campaign, which aims to provide nearly one in five smokers with a vape starter kit alongside other support to help them quit. ‘The smoking cessation people and people working with homeless populations and in drug services, I think they get it,’ MacKintosh states. ‘But when you’re trying to get local buy-in from the cabinet member for health, or whoever, that headline about “are they really safer, do we really know?” can have a chilling effect. I’ve seen it time and again with the drugs stuff, because those people aren’t necessarily experts and they are influenced by what’s in the paper or on the news. So the scheme has probably got a little bit lost, which is a shame because the potential was incredible. I can’t think of an equivalent public health campaign with that sort of ambition, that was realisable in a short, measurable timeframe.’

harm reductionOne problem is undoubtedly that people tend to see the hand of big tobacco in all this. But while the industry has certainly ‘played catch-up’, most of the safer nicotine products didn’t originate with them, he points out. ‘But it is a fundamental problem that none of these products have come from a public health laboratory – or even from a pharma company. That’s a genuine challenge, and it has fuelled a lot of the “it’s all a plot” thinking. Tobacco companies were – quite rightly – seen as big, bad, evil and wrong, and have been exposed in court and so on. But even though the companies in China that make the vast majority of the world’s vapes have no connection to them, ultimately it’s still industry. And there have been some huge missteps in the marketing, no doubt.’

One example is the marketing of fruit flavours, something the forthcoming tobacco and vapes bill intends to regulate. However, an evidence review commissioned by OHID found not only that vaping products were associated with the highest rates of success in helping people to quit smoking, but that fruit flavours were the favourite option for most current vapers. ‘There’s certainly scope for better regulation, but the risk is that you end up banning all flavours apart from tobacco, and then you’re really setting people up to fail,’ he says. ‘Fruit flavours start breaking the association with cigarettes. Why you would want to maintain that association, I have no idea.’

Having a wide range of products is important, he stresses. ‘Lots of people use different products at different times, and as long as it’s adults I really don’t think we should care. And we do need to be careful, because if we impose so many barriers that a legitimate, regulated market is undermined then a lot of this stuff isn’t that difficult to manufacture.’

Shifting attitudes
In terms of media reporting, however, things might finally be beginning to shift, he believes.

‘When the new government figures came out the BBC TV news report was actually quite a balanced piece, which is kind of not what I’m used to seeing. They had a pulmonary specialist consultant and he was very clear that vapes aren’t good for you – your lungs are designed for clean air – but compared to smoking they’re much better, and we mustn’t lose that message that smokers would be better off vaping. There are echoes of that across a lot of the other media at the moment, so I think we’re perhaps getting to a more mature media position.’

vaping fruit flavours
‘Fruit flavours start breaking the association with cigarettes. Why you would want to maintain that association, I have no idea.’

Ultimately, the prize is the smokefree 2030 target, which aims to get the smoking rate down to 5 per cent or less. Is it something we’re likely to achieve? ‘If we can show the same kind of ambition we put behind the swap to stop stuff, put in targeted supported for people, and don’t balls up access to products, I think we definitely can,’ he states. ‘Look at what we’ve already achieved, and the pace of change in other countries. But we need to get the messaging right and targeted at the smoking population.’

This means looking at groups where smoking rates remain extremely high. ‘We still have populations where smoking is the norm, so we need a good focus on that. If you can knock it down from say 60 per cent to 40 per cent in some of those populations, you’ll see quite rapid change.’

Some of this could be achieved through peer-to-peer engagement, but it also means getting professionals fully engaged. ‘Most health professionals have very limited understanding of the lives of a lot of the people where smoking is concentrated, so we need targeted support for those areas, making sure the GPs have all the information. And there’s still much more we can do in drug and alcohol services. Staff could – while emphasising the primary importance of giving up smoking – be encouraging service users to try vapes. It does wonders for people’s self-confidence, so these are quick wins.’

Crucially, it’s also something that costs almost nothing, he stresses. ‘Most smokers could easily experiment with vapes themselves at no cost to the public purse. We don’t have many public health outcomes with such a significant gain that require so little investment, so we really need to focus on the gains to individuals and communities. Fifty per cent of people who smoke regularly will die prematurely as a result, and we can significantly turn that around – even for people who won’t give up nicotine – by supporting them to get on a safer product.

‘So we’ve made a lot of progress and if we embrace the potential of tobacco harm reduction we can reach the 2030 target. It really is one of the great public health wins, and one that’s within our grasp.’

A smokefree UK? How research, policy and vapes have cut smoking rates available here

Swap to stop - tobacco harm reduction

DDN November 2024

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How much has changed over two decades?

DDN November 2024Twenty years ago I was sitting in our little office in London, typing my first editorial (p20). ‘This issue we catch up with Caroline Flint at the Home Office, who shares some interesting thoughts on drugs and crime…’ Remarkable that back then you could speak with the drugs minister directly! We were the new kids on the block. Now we’ve been round the block a few times… but some things have changed very little. We still need a robust (and honest) alcohol strategy. We still talk about harm reduction as if it’s optional. We still rediscover a link between substance use and mental health. We’re still finding that releasing people from prison without all-round life support is leaving them to sink. And did we actually leave the old harm reduction v abstinence debate behind – or just go via recovery to change the language?

Other things changed a lot. Vaping was emerging as a novelty but the idea that it could overtake smoking (p6) was outlandish. Feedback often came by letter and we eagerly anticipated the mail every day (I still miss that!). The frequent in-person events were regular opportunities to connect. Technology made it easier to do our jobs – and harder to disappear. It would be nice to think we could take the best of both worlds.

Read the November issue as an online magazine (you can also download it as a PDF from the online magazine)

Claire Brown Editor of DDN Magazine

Claire Brown, editor

Different class

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class drug useSociety has always taken a different view of middle class and working class drug use, says Mark Gilman – and the results are plain to see.

In the 1990s I wrote a lot about drugs, class and culture. The basic premise of most of my writing back then was that it was OK for middle class people to use drugs, but the use of mind-altering chemicals by the working class was a major cause of societal concern.

If a middle class person were to develop some concerning issues with their consumption they had a ‘drug problem’, but when a working class person developed a similar issue they became a ‘drug problem’. Middle class drug problems were to be medically treated in expensive private clinics. Working class drug problems were to be policed and controlled, as they were perceived as a threat to public health and safety. The goal of middle class drug treatment was detoxification and abstinence. The goal of working class treatment was social control.

The rationale of government investment in the expansion of drug treatment since the 1980s has always been clear – reduce drug-related crime and prevent the spread of infectious diseases from the working class to wider society. Since the advent of public health in terms of drug treatment investment, a further goal has been added – the reduction of drug-related premature death. This latter goal has seen a more empathetic response to working class drug treatment.

The message to working class drug users is now threefold – don’t commit crime, don’t spread diseases and don’t die too early. The method of controlling working class drug use by way of drug treatment had three elements – get them in, keep them in, get them out. Providers of drug treatment were monitored and rewarded or penalised by their ability to juggle these three elements. Some third sector providers grew to dominate the drug treatment sector by their adeptness at juggling these balls. The NHS, as a slow and lumbering bureaucracy, wasn’t that good at juggling and lost many of its historic contracts.

If you’d been in a coma since 1985 and woke up in 2024, would you see substantive change for the better?
If you’d been in a coma since 1985 and woke up in 2024, would you see substantive change for the better?

There is now in the UK a drug treatment industrial complex. Have things changed for the better? Have we managed to control working class drug use to the satisfaction of government and middle England? Are the prospects for a working class person with a drug problem better now that they were in 1985? If you’d been in a coma since 1985 and woke up in 2024, would you see substantive change for the better?

There have been improvements as a result of continued government investment. People with an opioid use disorder now have more choice in medication. Methadone is still available and various preparations of buprenorphine are around. Heroin-assisted treatment has been made available to some.

Working class people now have greater access to detoxification and residential rehabilitation, often in the form of ‘recovery housing’ provided by people with ‘lived experience’. There is much greater access to various forms of ‘mutual aid’. There are ‘LEROs’ – lived experience recovery organisations. However, if you came out of your coma in Piccadilly Gardens in Manchester (a place I’ve been familiar with for over sixty years) you might be forgiven for failing to appreciate these improvements. You might feel that you’d emerged into a dystopian other world. Drug ‘addicts’ in wheelchairs with limbs missing (as result of infected femoral vein injection sites) slumber in public under the influence of Lady Morphia or wheel around in crack cocaine induced confusion. Homeless people lie in shop doorways or on the pavement.

The inner city of Manchester today makes the Piccadilly Gardens of 1985 look like the lawns of Downton Abbey. How has this happened, and what role has drug treatment had in such a spectacular and depressing downturn? Are the actors in the Piccadilly Gardens dance of despair in drug treatment? If not, why not? If yes, why are they in such a sad state of disrepair? Can we not get them into, or keep them in, treatment? What part of our offer is not sufficient to improve their lives?

Every town and city in the UK has its own version of Piccadilly Gardens, and some places are worse. There are some explanations for this decline. In 1985, few heroin users were also dependent drinkers. Crack cocaine wasn’t widely available. ‘Spice’ still meant chilli powder. Illicit benzodiazepines weren’t available at pocket money prices. Heroin wasn’t available 24/7, 365 days of the year. Dealers didn’t make their daily heroin and crack offers available via mobile phone.

middle class and working class drug useI’m all too aware that all this can sound like your grandad saying ‘In my day… blah, blah, blah’. For the record, I happen to be a person with ‘lived experience’. For many years, I was a staunch advocate for ‘recovery’ in general and 12-step mutual aid in particular. To an extent I still am, but as a result of my lived experience I have many critiques and criticisms of all that. I’ve made many bad decisions in my life but the worst mistakes I’ve made have been while ‘clean and sober’ and engaged in 12-step mutual aid. As a direct result of those mistakes I now find myself, at the tender age of 68, living near Blackpool with regular visits to Manchester and Bradford. When I came into the drug treatment world I was a fundamental ‘harm reductionist’, and I’m back there again.

It seems to me that the primary response to the challenges that face us today is good old fashioned harm reduction. At the time of writing the working class are once again being demonised by polite middle class society. Who would have thought that John Major’s ‘condemn more, understand less’ would be repeated by progressive middle class liberals? It’s a funny old world.

Mark Gilman is a freelance consultant in substance use and is expressing his personal opinion in this article

Scottish Government ‘slow to progress’ key alcohol and drug strategies

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The Scottish Government has made headway in implementing treatment standards and increasing residential capacity, but has been ‘slow to progress key national strategies’, says a new report from Audit Scotland. 

Scottish parliament
Ministers needed to ‘understand which alcohol and drug services are most cost-effective’

These include a workforce plan and reform of alcohol marketing, it states, with the increased focus on drug harm also ‘shifting attention away from tackling alcohol issues’.

While spending on drug and alcohol treatment has increased from just over £70m a decade ago to more than £160m, Scotland still recorded 1,277 alcohol specific deaths last year – the highest figure since 2008 – along with 1,172 drug misuse deaths. ‘Scotland’s drug and alcohol deaths remain among Europe’s highest – despite an increase in spending and better national leadership,’ says Audit Scotland, which is tasked with checking that public money is spent ‘efficiently and effectively’. 

Treatment services are coordinated by alcohol and drug partnerships locally but these have ‘limited powers to influence change and direct funding’, the agency states. ‘Most alcohol and drug funding goes to NHS specialist services to treat people at crisis point – this means there is limited money to put into preventing people getting so ill in the first place,’ it says. 

As the partnerships are not statutory bodies they are ‘not needed by law’ the report points out, meaning that it ‘needs to be clearer who is responsible for each service’. Funding that happens ‘for a few months or a year makes it difficult for services to plan for what will happen in the future or put money into prevention’, it adds. 

A 2022 Audit Scotland report found delivery of services to be ‘complicated’, with lines of accountability ‘not always clear’ – making it difficult to track where the spending was going or what it was achieving (https://www.drinkanddrugsnews.com/clear-plan-needed-to-improve-complex-scottish-services/). The report also called for a ‘clear plan’ to improve service provision. 

‘Alcohol and drug services are complex and delivered by a wide range of partners,’ said Accounts Commission member Christine Lester. ‘But there needs to be more collective accountability across the system for how each body is helping people whose lives have been blighted by alcohol and drugs.

Better information is needed to inform service planning and where funding should be prioritised. There is also more to do to tailor services to individual needs, using the experience of service users. Right now, not everyone can access the services they need, and that experience is worse for people facing disadvantage.’

auditor general Stephen Boyle
Auditor general Stephen Boyle

In 2023-24, £63m of funding came from the government’s national mission to reduce drug-related deaths, and ministers needed to ‘understand which alcohol and drug services are most cost-effective’ and plan how they would be funded when the mission ended in 2026, said auditor general Stephen Boyle.

‘That’s especially important at a time of increasing strain on the public finances. With many alcohol and drug workers reporting feeling under-valued and at risk of burn-out, there is also an urgent need to put a timeline against plans to address the sector’s staffing challenges.’

Alcohol and drug services at https://audit.scot/publications/alcohol-and-drug-services

Get it together

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Better Together West Midlands LEROBetter Together – Solihull Recovery Community is the lived experience recovery organisation (LERO) operating out of SIAS (Solihull Integrated Addiction Services), a community-based commissioned service in the West Midlands. SIAS is a partnership of organisations consisting of Birmingham and Solihull Mental Health NHS Foundation Trust, Aquarius, Welcome Charity and Better Together-Solihull Recovery Community. We have evolved from what was Changes UK, a supported living housing provider in Birmingham. Changes UK entered administration in December 2023, but with the support of the other providers in the SIAS partnership and our local commissioners, Better Together-Solihull recovery community was formed.

We are a LERO that has become a vital lifeline for individuals in the Solihull area. Dedicated to helping people recover from addiction and mental health challenges, we are a community-driven initiative with an innovative approach that includes offering an extended out-of-hours service through a diverse range of activities and mutual aid programmes.

support LEROOur foundation is in lived experience. We are led by people who have walked the path of recovery themselves, making it a place where our members can find empathy, understanding and genuine support. This peer-led model fosters a sense of belonging and community that is often lacking in more traditional recovery services. By providing a platform for people who have successfully navigated recovery, we not only help individuals on their own journeys, but also empower them to give back to others who are at different stages of the process.

Recognising that recovery doesn’t follow a nine-to-five schedule, we have taken the step of offering extended out-of-hours services. By being available at times when people might feel most vulnerable, we fill a critical gap in the recovery landscape.

This extended support is provided through a wide array of activities designed to engage and empower individuals. From creative workshops and social events to mindfulness sessions and physical activities such as hiking, walks, camping trips, bowling, cinema, theatre and museums, we offer something for everyone. These activities are not just distractions – they offer individuals opportunities to rebuild their confidence, discover new passions, and foster healthy relationships.

At the heart of our approach is connection. Mutual aid groups bring together people who are going through similar experiences, allowing them to support each other through shared understanding and encouragement. These groups often operate outside of traditional medical models, focusing instead on personal connection and community-based support.

recovery - West Midlands LERO
‘Our aim is not to be just about individual recovery – it’s about building a recovery-focused community’

We hold local mutual aid meetings which offer a safe space for individuals to share their stories, celebrate successes, and work through challenges. The peer-to-peer format empowers participants to take control of their recovery and helps them build lasting relationships that can be pivotal in maintaining long-term sobriety.

Our aim is not to be just about individual recovery – it’s about building a recovery-focused community. We’re trying to create a positive, inclusive environment where everyone is welcome, regardless of their background or the challenges they face. This sense of community helps to reduce the stigma often associated with addiction and mental health issues, creating a space where people feel seen, heard, and valued.

Through our combination of lived experience, extended out-of-hours support, and mutual aid, we’re hoping to make a profound impact on the lives of those we serve. We’re aiming to become a beacon of hope for individuals seeking recovery and a powerful example of how peer-led, community-based initiatives can create lasting change.

As we continue to grow, we’re committed to expanding our services and reaching even more people in need. By offering extended support, fostering mutual aid, and championing the power of lived experience.

Nicky Dwyer is service manager at Better Together

West Midlands LERO

Campaigners welcome increase in alcohol duty rates

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DDN
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Alcohol duty rates on non-draught products will increase in line with RPI (the retail price index) from February next year, the chancellor announced in her autumn budget, a move that has been welcomed by alcohol health campaigners. 

Dr Richard Piper, CEO of Alcohol Change UK.
Dr Richard Piper, CEO of Alcohol Change UK.

‘After years of real terms cuts, today’s announcement that alcohol duty will keep pace with inflation is a step in the right direction,’ said Alcohol Change UK CEO Dr Richard Piper. ‘This will see the country’s total alcohol duty receipts reach £15.9bn per year by 2029/2030. Yet this is still less than half of the cost of alcohol-related harm in the UK, currently estimated to be at least £33bn each year. This gap needs closing.’ 

The move was an ‘important moment for public health,’ added Alcohol Health Alliance chair Professor Sir Ian Gilmore. ‘The bulk of alcohol-related harm comes from cheap supermarket drink – this decision will help to reduce harmful off-trade consumption, reduce pressure on the NHS and boost the economy, while supporting the hospitality sector. Raising alcohol duty is a proven step toward reducing the significant harm alcohol causes in our society.

Alcohol Health Alliance chair Professor Sir Ian Gilmore.
Alcohol Health Alliance chair Professor Sir Ian Gilmore.

After years of government inaction and repeated freezes or cuts to alcohol duty, this increase is not only a necessary measure in light of rising alcohol-related deaths, but also signals a shift toward prioritising health over industry interests, protecting the most vulnerable, and mitigating preventable harm.’ The money raised should be put towards frontline NHS and alcohol treatment services which remain unequipped to deal with the number of people in need, he added. 

Draught duty will decrease by 1.7 per cent, however – the equivalent of a penny reduction in the price of a pint served in the pub. The budget also included a flat-rate tax of £2.20 per 10ml bottle of vape liquid, to be introduced in two years’ time along with a one-off increase in tobacco tax to retain the price differential with vaping and incentivise people to switch. 

‘Continued tobacco tax rises are necessary to encourage smokers to quit and reduce the burden of smoking on public finances and the economy in the future,’ said ASH chief executive Hazel Cheeseman.

ASH chief executive, Hazel Cheeseman.
ASH chief executive, Hazel Cheeseman.

‘The vape tax aligns with recommendations we made to government regarding the importance of an excise tax and the necessity of it being a flat rate. An excise tax on vapes will reduce access to cheap products for children by both reducing affordability and creating more powers to tackle illegal imports. The one-off additional rise in tobacco tax alongside the new vape tax is vital to maintain the price difference and the incentive for smokers to switch to the less harmful products.’

The charity is also calling for a levy on tobacco companies, as the impact of these tax rises will be felt by consumers rather than the tobacco industry. ‘The chancellor could have raised an additional £700m through a levy structured to reduce their profitability and cap their prices,’ she stated.

Still kicking

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deadly nitazenesDrugs were changing rapidly and overdoses were risingDrugs were changing rapidly and overdoses were rising – there was no time to lose. The ‘Stayin’ Alive’ plan came about from the passion and frustration of a group of individuals, transcended treatment services and ‘came from a genuine place of care and concern’ (DDN, November 2023, page 6).

At a breakout session at Cranstoun’s conference, three of the group – Maddie O’Hare from HIT, Chris Rintoul from Cranstoun and Deb Hussey from Turning Point gave their perspectives on progress.

‘After recovery had been prioritised in services, it was more difficult to talk about harm reduction,’ said O’Hare. ‘So it was important to have a united front. The campaign had to happen because of nitazenes but we knew we couldn’t change anything without a bit of tension.’

‘The conversations on Twitter were about ways of mitigating risks,’ said Rintoul. ‘It became a conversation – what messages would work? Lynn Jeffries of EuroNPud came up with simple messages, and we elaborated on these. We knew that a proportion of people die alone at home. But we can’t say with any certainty where people are going to be when an overdose occurs.

‘So the group focused on the need for making a plan, which has to stay with you – and this was the basic concept of ‘Stayin’ Alive’. It was developed with people who use drugs, particularly those using alone. What can you do? What can you put into practice? The ideas were theirs but could apply to anyone.’

‘This was happening, people were dying – so we gravitated towards people who understood what was going on,’ said Hussey. Another important result from the campaign was the added intelligence available to participants’ own services to enable them to focus on supportive action – ‘as my organisation has seen stuff come together, there’s been a shift towards harm reduction,’ she said.

Still kicking - deadly nitazenesThe group fully endorsed the value of working as a self-selecting group, ‘especially with people you trust and like’. The common purpose was much more likely to succeed, they agreed, and it felt like a hub of creative individuals coming up with ideas.

There was plenty to do – feeding back on the overdose campaign, more work on nitazenes, and a piece of work on ketamine.

‘People think they can’t make a difference,’ said Hussey. ‘For us in services, we need to inspire our colleagues – we have a responsibility to make our services responsive. We need to lead by example and make a lot of noise.’

On moving forward…
‘The Welsh Government has given approval to nitazene checking machines. Don’t forget Wales; we can each do things the others can’t. Martin Blakebrough, Kaleidoscope

‘If we’re going to do something meaningful, we need to push the envelope.’ Peter Krykant

‘It’s too medicalised – in Scotland the consumption rooms are NHS led and cost a lot. But every needle exchange should be able to offer a room – it’s about moving away from risk.’ Martin Blakebrough, Kaleidoscope

On inconsistency…
‘In London, you can get same day prescribing in one borough but wait four weeks in the next. And how can we support each other to call out clinicians who are putting people on subliminal doses? We have a crisis on our doorstep. What can we fix now?’ Niamh Eastwood, Release

‘Working in hostels we struggle to get a roof over people’s heads. We need more opportunity for collaboration and shared delivery.’ Delegate

naloxoneOn naloxone…
‘The message is getting skewed – we’re getting them breathing, not bringing them back to consciousness.’ Deb Hussey

‘Has there been any conversation about providing oxygen?’ Lynn Matthews

‘Naloxone works but it’s not something everyone wants – it can lead to miserable withdrawal. Oxygen is under used, under explored and over regulated.’ Chris Rintoul

On harm reduction…
‘Harm reduction can be seen as just naloxone and a few pins. But it should span all areas.’ Chris Rintoul

‘It’s difficult to give harm reduction information to children and young people in case you’re seen as encouraging them.’ Delegate

‘Schools are not the only way to deliver harm reduction. Social media offers a plethora of ways to get messages around.’ Maddie O’Hare

‘How does harm reduction keep up?’ (Question sent from Anna Millington)

‘By holding people to account; by being a thorn in their side.’ Maddie O’Hare

WithYou appoints James Angus Pow as new Chair of Trustees

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DDN
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WithYou is delighted to announce the appointment of its new Chair of Trustees, James Angus Pow.

James Angus Pow
‘James is an experienced Chief Executive, bringing significant business and people-centred experience to the role.’

James is an experienced Chief Executive, bringing significant business and people-centred experience to the role. He is a specialist in branded retail, wholesale and consumer sectors internationally, and his experience spans more than four decades within manufacturing, supply chain, sales and marketing and brand.

James is also the Chair of Victim Support Scotland and Vice-Chair of Blue Triangle (Glasgow) Housing Association, a charity dedicated to help young people and adults struggling with homelessness and trauma in their lives.

James succeeds in this role Anne Chapman, the longest-standing Trustee at WithYou.

James says: ‘I am delighted to join WithYou as the Chair of the Board of Trustees. WithYou’s approach where anyone seeking help with drugs, alcohol or mental health issues feels welcomed, not judged, is a powerful ethos that I stand behind. I feel privileged to be able to work so closely with people in our society who need the most expert help and support, at such an important time for these vital people-centred support services.’

Simon Phillips, CEO of WithYou, says: ‘I am delighted that James has made the decision to take on the role of Chair of Trustees for our charity. James brings a diverse wealth of experience both as a Non-Executive Director and as an expert in complex strategic and operational environments. His significant expertise and clear passion for the sector will support WithYou in the ongoing development of our strategy and the absolute focus on supporting our clients where and when they need it the most.

‘I’d also like to take this opportunity to thank Anne Chapman, WithYou’s departing Chair, for her passion and dedication to the charity over her 10 year tenure as Trustee, two of which as WithYou’s Chair.’

This blog was originally published by WithYou. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by WithYou

Number of countries supporting harm reduction at highest ever level

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DDN
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The number of countries supporting harm reduction in their national policies is higher than ever, according to the latest Global state of harm reduction survey from Harm Reduction International (HRI).

Global state of harm reduction 2024There are now 108 countries that include references to it in their policies, says the report, which tracks the availability of services like opioid agonist therapy, needle and syringe programmes and consumption rooms. Ninety-three countries now offer at least one needle and syringe programme, with 94 offering opioid agonist therapy like methadone or buprenorphine – up from 88 in 2022. There are also consumption rooms established in 18 countries, most recently Colombia and Sierra Leone, while take-home naloxone programmes are available in 34 countries.

However Iran, which mentions harm reduction in its national HIV policy, executed nearly 160 people for drug-related offences last year, the document points out. There are also reports of police arresting people for possession of injecting equipment in Mozambique, which also includes harm reduction in its HIV plan. 

Long-term sustainability for services could also be at risk, the report warns, with the Open Society Foundations (OSF) – once the third largest international funder – halving its support in the last five years. ‘The number of international harm reduction donors remains small, leaving harm reduction vulnerable to their shifting priorities,’ it says, with harm reduction remaining seriously underfunded in most regions and domestic funding ‘even more fragile’.

The 2024 report has a particular focus on young people and indigenous people, and finds that both are being neglected in overdose and HIV responses. ‘Because harm reduction services have been designed for adults, they neglect the needs of young people who use drugs,’ it says. Despite being among the largest demographics of people who use drugs, fear of academic or legal consequences that could affect their future prospects often means young people are reluctant to access services, the document adds. 

Meanwhile, indigenous people in the US, Canada, Australia and New Zealand face structural racism when trying to access services, it continues, including lack of funding, over-policing and over-prescription of opioids. Access to harm reduction for people in prison also remains inadequate, despite an ‘estimated one-third to half’ of people in prison having a history of drug use.

HRI deputy director Colleen Daniels
HRI deputy director Colleen Daniels

‘Policymakers know that a health approach to drugs works,’ said HRI deputy director Colleen Daniels. ‘That’s why so many countries now include harm reduction in their policies. Now it’s time they walk the talk and stop pouring money into failed approaches.’

The global state of harm reduction 2024 available at https://hri.global/flagship-research/the-global-state-of-harm-reduction/the-global-state-of-harm-reduction-2024/

Building trust

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homelessness - building trust

Homelessness is what happens when all else fails, so how can we reverse the trend? asked Cranstoun’s Social Justice Conference. DDN reports.

‘We don’t have rough sleeping in Finland, and a key factor has been the implementation of Housing First policies,’ said Riikka Perälä from the Y-Foundation. Temporary accommodation had been made available to people who were homeless, comprising individual units with a shared kitchen and bathroom.

The Finnish government had been actively involved in national homelessness programmes with a goal to end rough sleeping, and prevention had then been adopted as part of the model. The focus had been both national and local. ‘There’s been cooperation at different levels, including service providers and politicians, for things to work,’ she said. A ‘wide partnership’ coupled with ‘concrete quantitative goals’ had brought this about.

homelessness Cranstoun Conf
Pictured, l-r: Riikka Perälä, Rick Henderson and Rebecca Sycamore

The Housing First model in Finland highlighted housing as a human right, focused on permanent housing, and looked at the related support. ‘It’s important for people to feel that their housing is permanent,’ she said. Through the original model, the country had been investing in a stock of affordable housing – although she was concerned that the government elected 18 months ago was cutting down on these policies.

‘Instead of highlighting an emergency response, we highlight prevention,’ she said. ‘And we highlight support to remain in housing.’ Affordable social housing was a critical element of ending homelessness, alongside adequate housing benefit. ‘It’s not just about one policy, it’s about being collaborative.’

‘A housing crisis and home­lessness are not the same crisis,’ said Rick Henderson of Homeless Link, who acknowledged the ‘many intertwined’ crises in the UK. ‘All the numbers have been going in the wrong direction for a long time,’ he said. ‘Homelessness is what happens when everything else fails. For the last five years the government followed a strat­egy to end rough sleeping. It failed.’ For every person taken off the streets, two were arriving – because the government was doing nothing to keep people off the streets. ‘We can wax lyrical about what contributed to the rise in homelessness, but the new government is a chance for change,’ he said.

There was talk of ending homelessness through housebuilding – ‘but this takes ages. What happens between now and then?’ The new government had said it would set up an interministerial cross-departmental task force, but it hadn’t happened yet. ‘It would be nice to work in partnership with government and give it a chance after an adversorial relationship,’ he said.

In any case we couldn’t ‘put all our eggs in a housebuilding basket’ – we needed to look at why people were coming into this situation in the first place and realise that there was much more we could do on a prevention-focused approach.

housing homelessness‘Their needs are as important as a roof,’ he said. ‘Politicians are not convinced by this – they don’t get it or realise the huge amount of work we need to do. You can’t have housing without support.’ Talk of a taskforce chaired by Angela Rayner gave him hope that there was ‘a lot to play for’. But we needed to ditch the ‘heavy handed, patronising approach to responsibility’ – the view that ‘you need to pay your rent before you do anything else.’

Rebecca Sycamore had worked for 25 years in the homelessness sector and was now CEO of Toynbee Hall. In 1898 the charity had set up one of the first services to give free legal advice to tenants so they could challenge their landlords. By the 1920s they provided hostels for people with many different backgrounds.

Rent arrears were the most common debt type contributing to the housing crisis, and there was a ‘ticking time bomb’ of people with massive debts. ‘We have to do more than emergency support – we need more powerful pieces of work bringing people together,’ she said.

When Toynbee Hall was founded, many people didn’t have the vote and there weren’t any trade unions. But where housing was concerned, progress had been slow and things hadn’t changed fast enough, right down to having somewhere basic to live. ‘Promises are not houses,’ she said.

Participants agreed that the situation would only improve with a mindset of collaboration between services that were willing to listen, be flexible and compromise.

Gambling harms ‘more substantial than previously understood’

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DDN
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The harms to health and wellbeing from gambling are ‘more substantial than previously understood’ says the Lancet Public Health’s commission on gambling, extending beyond gambling disorder to include a wide range of other harms and affecting ‘many people’ in addition to those who gamble themselves.

The industry’s growth is fuelled by highly accessible online gambling

Evolution of the rapidly growing gambling industry is at a ‘crucial juncture’, the document states, as it becomes increasingly digital in nature. Governments worldwide have so far paid too little attention to gambling harms and done too little to prevent them, it adds. ‘Decisive action now can prevent or mitigate widespread harm to population health and wellbeing in the future’. The commission is calling for stronger and internationally coordinated harm-prevention policies and regulation controls, ‘independent of industry or other competing influences’.

‘The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly US $700bn by 2028,’ the document states. ‘Industry growth is fuelled by the rise of online gambling, widespread accessibility of gambling opportunities through mobile phones, increased legalisation, and the introduction of commercial gambling to new areas. Recent expansion is most notable in low-income and middle-income countries, where regulatory infrastructure is often weak. Online gambling, given its borderless accessibility, is available everywhere via the internet.’

The consequences of this shift to digitalisation have not been fully recognised, it adds, while sophisticated digital marketing via social media and user data, along with sports and media sponsorship, are all helping to drive the expansion of the industry. ‘The boundaries between digital gaming and gambling are also becoming blurred,’ it adds, and urges governments to prioritise protecting health and wellbeing over ‘competing economic motivations’.

‘Gambling is not a simple leisure activity; it is a health-harming addictive behaviour,’ says Lancet Public Health. ‘The commercial gambling sector promotes its products and protects its interests by adopting corporate practices designed not only to influence consumer behaviour, but also the narrative and political processes around regulation – with a tendency to focus on individual responsibility rather than broader policy changes. Such practices are not new and have been used by other harmful industries, but in today’s digitalised, interconnected, and borderless world they pose increasing threats to public health.’

Dr Heather Wardle: Anyone with a mobile phone has access to ‘a casino in their pocket’.

‘Most people think of a traditional Las Vegas casino or buying a lottery ticket when they think of gambling,’ said the commission’s co-chair, Professor Heather Wardle of the University of Glasgow. ‘They don’t think of large technology companies deploying a variety of techniques to get more people to engage more frequently with a commodity that can pose substantial risks to health, but this is the reality of gambling today. Anyone with a mobile phone now has access to what is essentially a casino in their pocket, 24 hours a day. Highly sophisticated marketing and technology make it easier to start, and harder to stop gambling, and many products now use design mechanics to encourage repeated and longer engagement. The global growth trajectory of this industry is phenomenal; collectively we need to wake up and take action. If we delay, gambling and gambling harms will become even more widely embedded as a global phenomenon and much harder to tackle.’

Commission report available here

Drug-related deaths up more than 10 per cent

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There were 5,448 drug poisoning deaths registered in England and Wales last year, according to the latest figures from the Office for National Statistics (ONS) – up 11 per cent on 2022’s figure of 4,907.

drug poisoning deathsMore than 3,600 of the deaths were registered as drug misuse, with the highest death rate – as in the last 11 years – found in the North East, at three times higher than London’s rate.

Just under half of all deaths involved an opiate, while there was also a huge rise in deaths involving cocaine – more than 30 per cent up on the previous year, at 1,118. The number of cocaine-related deaths has now risen for 12 consecutive years, ONS states.

Among males, 3,645 drug poisoning deaths were registered in 2023, compared to just over 1,800 deaths among females. The overall death rate represents 93 per million, which is now double the rate in 2012. Delays in registration, however, mean that two thirds of 2023’s deaths actually occurred in previous years, ONS points out. Almost 380 deaths were registered in Wales last year, up from 318 the previous year.

The average age for drug misuse deaths was 44 for men and 47 for women. ‘People born in the 1970s continue to have the highest rates of drug misuse deaths,’ ONS states. ‘They are part of the cohort often referred to as “Generation X”, born between the late 1960s and early 1980s, who have consistently had the highest rates of drug misuse deaths for the past 25 years.’

drug deaths
Among males, 3,645 drug poisoning deaths were registered in 2023, compared to just over 1,800 deaths among females

ONS also points out that as it does not have access to post-mortem reports or toxicology results and depends instead on information provided by coroners, the figures for drug misuse and for specific substances will be underestimates. While opiates continue to be the most frequently mentioned drug type, more than half of all drug-poisoning deaths involve more than one drug, the agency adds, meaning that it is also not possible to ‘tell which substance was primarily responsible for the death’.

‘This devastating loss of life is deeply saddening, unnecessary and unacceptable,’ said Change Grow Live’s deputy chief executive Nic Adamson. ‘Without the hard work of frontline staff and volunteers in our own and other services, deaths would undoubtedly be even higher, and the strain on the NHS much worse. As mental health issues, financial struggles, inequalities, and dangerous synthetic drugs continue to fuel the crisis, we must do everything possible to make sure harm reduction services reach those most at risk. We are at a critical moment, and strongly urge the government to respond to the calls from the Association of Directors of Public Health and Collective Voice to continue its investment in the ten-year national drug strategy and increase public health grant funding in the autumn budget.’

‘A growing number of adulterants within the drug supply have meant that drug supplies are more unpredictable than ever’

The public health crisis of drug-related deaths was now ‘turning into a health catastrophe,’ stated Release executive director Niamh Eastwood, with the delays in registration and ever-increasing availability of powerful synthetic drugs meaning that the figures did not even ‘capture the catastrophic impacts’ of synthetic opiates. ‘Across England and Wales, those using drugs have been intentionally abandoned by the state,’ she said. ‘A growing number of adulterants within the drug supply have meant that drug supplies are more unpredictable than ever; more and more people are unknowingly exposed to a toxic drug supply, whether it be synthetic opiates or cocaine of unprecedented purity levels, with limited access to resources to stay safe. We must act now to prevent more deaths, suffering, and health harms.’ The government needed to scale up harm reduction interventions, including drug consumption rooms and drug checking services, she urged. ‘This is why we are calling on Wes Streeting and Yvette Cooper to implement reforms immediately.’

While the reasons behind the public health crisis were ‘deep-rooted and complex’, the new government needed to be ‘brave and bold’ added WithYou chief executive Simon Phillips. ‘To take this tragedy seriously we want to see guaranteed funding for high-quality evidence-based drug treatment and recovery services in the autumn budget, and a long-term commitment in the spring spending review. Steps to increase the supply and accessibility of naloxone must be implemented as soon as possible, and we want the government to go even further, and ensure it is available to all opiate users and their friends and family members too.’ Alongside provision of widespread drug-checking services and consumption rooms, the root causes of the crisis also need to be tackled, he said. ‘We cannot stop drug-related deaths if people don’t have safe places to live, access to health and mental health services, and a safety net for when they need it.’

Deaths related to drug poisoning in England and Wales: 2023 registrations available here

Recovery Month reflections: Forward’s in-person recovery event for London-based staff

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On Wednesday 25th September 2024, The Forward Trust’s Dependency and Recovery Team brought together employees from Forward and partner agencies for a day of education, networking, and shared experiences.

Recovery Month reflectionsThe event, which was held at Roots and Shoots in London, was well-attended and fostered an engaging atmosphere.

The day kicked off with a warm welcome from Annie Gaisie, Service Manager for London Dependency and Recovery in the South East, who outlined the day for those who attended. She was joined by Mark Ash, our Lived Experience Coordinator, and Nathan Naine, a Peer Mentor.

Several partner agencies delivered informative sessions, including naloxone training from Turning Point and presentations from The Bridges, Forward Connect, and Catch 22. These talks were aimed at enhancing understanding and collaboration among participants.

The event also featured impactful testimonials from service managers, team leaders, and both current and ex-service users shared their personal journeys of recovery.

Participants had the chance to explore various informational stalls throughout the day, including ones on:

  • Wellbeing: This stall provided resources on sleep hygiene, mindfulness, and daily activity tracking, along with stress balls, lavender bags, and motivational books.
  • Substance Misuse Awareness: Offered a drugs awareness box featuring synthetic drugs, alcohol unit measuring cups, and beer goggles for educational purposes.
  • Forward Trust Services: Shared vital information on dependency, recovery processes, local treatment providers, and harm reduction.

There were also lots of fun activities, such as live music and line dancing, a substance misuse awareness quiz, and an award ceremony to celebrate the work of Forward employees and volunteers in and around the area of recovery.

Recovery Month reflectionsShareen Hemmuth, Senior Operations Manager of our Rehabilitative Services, had this to say about the event: ‘We were delighted to have been able to bring together members from across the recovery community for this important networking and partnership event. It was amazing to hear speeches throughout the day from those with lived experience of addiction and to see the impact that recovery services have had on their lives. Listening to stories on how many now work as peer mentors was something really special and we are proud to work with those who have a real understanding of how important our services are.

‘This event showed just how much we have delivered over the last 12 months and highlighted our ambitions for the year ahead. Most importantly, it demonstrated the role that staff across these services have in helping individuals transform their lives by encouraging them to move on from addiction and the cycles of crime.

‘The Forward Trust remains at the forefront of frontline drug and alcohol harm reduction services, both in the community and within criminal justice settings. This event allowed us to celebrate and recognise the contributions of staff working in Forward’s Dependency and Recovery services.’

The Recovery Event was a great way to wrap up Recovery Month at The Forward Trust, fostering education, connection, and community among those involved in recovery services.

This blog was originally published by Forward Trust. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Forward Trust

Greater than the sum

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mental health and substance use

In early 2021, we conducted an audit across Turning Point’s Leicester, Leicestershire and Rutland services, and our results found that 55 per cent of the population in structured treatment had disclosed a mental health need. The actual figure was likely to be higher if we considered the population with non-disclosed mental health difficulties.

The figures are unsurprising as data from the Office for Health Improvement and Disparities revealed that nearly two-thirds of adults (63 per cent) starting treatment for substance use from 2020 to 2021 disclosed having a mental health treatment need.

From our experience, people with coexisting substance use and mental health difficulties have reported a range of issues when accessing services to get the support they need. Organisations tend to focus on one problem rather than the combination of challenges that people with coexisting substance use and mental health difficulties experience.

Turning Point initially published the dual-diagnosis toolkit with Rethink to address these difficulties in 2004. In 2021, we published a revised Substance use mental health resource pack (available at turning-point.co.uk) to provide guidance on how services can better support people with coexisting substance use and mental health difficulties.

In September 2021, we established a substance use and mental health team across Leicester and Leicestershire. Our team aims to facilitate the integration of substance use and mental health treatment with local services and address the issue of service users falling between the gaps between the two services. 

Team work - mental health and substance use
We work together to provide consultation support and facilitate the development of a treatment plan that considers support available internally alongside local mental health services

Team working
The substance use and mental health (SUMH) team comprises psychological support, advanced practitioners, input from the service psychiatrist, and the adult safeguarding lead. We work together to provide consultation support and facilitate the development of a treatment plan that considers support available internally alongside local mental health services.

In line with national guidelines, we recognise that mental health is a shared responsibility and everyone’s job. We are, therefore, focused on developing skills within the workforce to understand mental health and are developing trauma-informed practices through training, consultation, and collaboration with service users.

During staff induction, we have introduced training on developing therapeutic relationships with service users. We also offer crisis survival skills training for staff, which has been developed and is facilitated by the psychology team. This enables staff across the service to work with individuals to develop safety plans and discuss skills to manage crisis periods. 

Towards integrated care
Following service users’ identification of a mental health treatment need, we offer an initial consultation meeting with the SUMH team to identify relevant local mental health services that can support the individual and explore appropriate interventions within the service to meet their needs.

mental health - dual diagnosisWe aim to deliver care for individuals with complex needs collaboratively by partnering with local mental health services and conducting joint professional meetings to coordinate care.

Plans are underway to establish local pathways for individuals with co-occurring substance use and mental health difficulties by holding meetings with local mental health agencies, such as joint meetings with CMHTs, crisis cafés, and the mental health central access point (the local helpline and triage service for anyone needing mental health support).

If an individual is under the care of a local mental health team, we will try to establish shared care plans to achieve the best outcome for them. Our advanced practitioners are also aligned with the local community mental health teams. We have relationships with the local inpatient unit and multidisciplinary meetings with local agencies to ensure that plans around discharge are coordinated.

Besides working with local agencies, we also offer a range of group and one-to-one interventions within the service that aim to ensure the person’s safety and support the development of mental health coping strategies. We offer interventions for managing low mood, stress and anxiety and a safety toolkit on how to cope with trauma symptoms. Where people present with a range of difficulties that may impact progress across services, we also offer bespoke psychological assessment, formulation, and interventions.

Outcomes of the service
» The team has made significant progress in partnership and are attending meetings with local community mental health teams, the inpatient mental health service, crisis services, and a range of other local agencies.

»  For 2023-24, the team received 863 referrals across the city and county. We also saw an increase in the number of people under 25 supported by the team following the introduction of a senior assistant psychologist who works solely with under-25s, allowing for a more focused approach to the service’s offer for young people and young adults.

» Service users engaging with the SUMH team have reported significant improvement in their self-rated mental health, physical health, and quality of life between 2022 and 2024.

» While these clients initially presented with scores in the clinical range of severe psychological distress, they presented scores in the moderate range of psychological distress following SUMH interventions.

» Service users receiving this support also report high levels of distress tolerance, showing improvements in their ability to manage an emotional incident without feeling overwhelmed.

» Service users also report improvements in self-care and self-compassion following attendance at some of the SUMH groups.

Dr Hauwa Onifade is senior practitioner psychologist at Turning Point

CASE STUDY – Jamie

Jamie was struggling with her mental health and alcohol use when she started receiving additional support from Louisa, an advanced recovery practitioner within the substance use and mental health (SUMH) team. The team were able to support Jamie in exploring her mental health history and social circumstances. Following this, they completed psychoeducation exploring how alcohol and mental health can negatively impact one another. She engaged in interventions around managing low mood and anxiety and completed a safety plan to manage difficult periods.

The advanced recovery practitioner also established a relationship with the local community mental health team (CMHT) and facilitated communication with her community psychiatric nurse (CPN) and psychiatrist. Her case was discussed at a multidisciplinary team meeting to ensure appropriate support from all involved, particularly in relation to her continued engagement with the CMHT.

In addition, Jamie was offered employment advice and was signposted to local employment advisory services.

Greater than the sum - dual diagnosisJamie has successfully met her goals related to reducing alcohol and maintained her progress throughout the programme. She remains under the care of the CMHT, where she will be receiving cognitive behavioural therapy, and we liaised with the necessary services to initiate a referral for an ADHD assessment.

Jamie is now actively engaged in mutual aid support and aftercare services, ensuring she remains connected to a supportive network as she moves forward. She has been referred for peer mentor training within Turning Point, allowing her to share her experiences and support others in similar situations.

‘I’m now coming close to finishing my digital marketing course and looking to start a payroll and HR course,’ she said. ‘I’m hoping to do level 2 now and start the level 3 CIPD people’s practice course in September.’

‘I studied law before, and I was pretty good at it – my mental health ruined that. Thanks to Turning Point, I’ve managed to find confidence within myself and received the support I needed to continue with life. There have been so many times where I wanted to give up. But thanks to Louisa and her conversations – she has always listened and made time for me to confide in her.’

Life portrait

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Portraits of RecoveryMark Prest founded visual arts charity Portraits of Recovery as part of his own recovery. He provides an update as its second annual Recoverist Month draws to a close.

From Instagram reels exploring sober curiosity to a gallery takeover themed around chemsex and a museum panel discussion on barriers to recovery among South Asian women, it’s been a hectic few weeks.

Greater Manchester-based Recoverist Month (DDN, October 2023, page 10) is the UK’s only arts-based awareness event that places people in recovery from substance use centre stage. And ever since I started my own recovery journey in 2008, it’s been a burning ambition to make it a reality. 

Recoverist Manifesto
In part, it was inspired by the radical outlook and language of the ‘Recoverist Manifesto’, a powerful collective statement that unites the voices of individuals in recovery. The manifesto was born out of a project led by Portraits of Recovery and curated by Dr Clive Parkinson, former director of arts for health at the Manchester School of Art. It is now also available on our website in Italian, Dutch, Lithuanian and Gaelic.

At its core, the Recoverist Manifesto champions the direct voices of those in recovery, advocating for the transformative redefinition of recovery identities. It doesn’t view people as mere passive participants in recovery but instead empowers them as ‘recoverists’. In case you haven’t already worked it out, ‘recoverist’ is a portmanteau word, blending recovery and activism.

The spirit of the manifesto runs right through Recoverist Month, which coincides with International Recovery Month each September. Now in our second year, our aim is to embed the event within the region’s annual cultural calendar, a bedfellow to the more established Pride and Black History Month. 

Life portraitQueer Takeover
One of this year’s finale events was a queer takeover of Manchester Art Gallery curated by the project’s lead artist Harold Offeh and five other queer international artists. Called Let’s Talk About Chemsex Presents…, it explored themes around sex on chems, intimacy, desire, respect and consent within the LGBT+ community – outside of London, Manchester has the largest chemsex scene in Europe.

Chemsex could be seen as a response to internalised forms of homophobia, and art lends itself to exploring issues around sex on chems by opening up liminal space for the building of mutually trustful, sharing relationships. At the event Offeh debuted a double A-side EP called Anticipation <—> Anxiety and A Warm Hug, which he co-created with a group of people with lived experience of chemsex.

Beyond the Surface at The Turnpike Gallery is an exhibition profiling ten years of Fallen Angels Dance Theatre’s work in the Greater Manchester borough of Wigan. Running until 23 November, its focal point is a newly commissioned work called Samadhi. An immersive digital dance, light and sound installation, the work aims to bring audiences to the heart of healing journeys experienced by people in recovery. Chester-based Fallen Angels exists to support people in recovery from addiction and those living with a mental health condition to transform their lives through dance, performance and creativity.

Portraits of Recovery Recoverist MonthSober Curiosity
A digital element to this year’s Recoverist Month was Sober Curiosity, a series of street-based interviews, disseminated as Instagram reels, by established content creator Scott James (@projectcerti). A photographer and filmmaker, he has amassed a large social following for his laid-back interviews with passersby, which engage with mental health and promote self-acceptance and wellbeing.

For Recoverist Month, @projectcerti turned its attention to the theme of Sober Curiosity and Portraits of Recovery commissioned the creator to film individual conversations with people from five locations across Greater Manchester. Subjects were asked if they had heard of sober curiosity and how it impacted on their lives. The clips garnered thousands of views and generated positive online conversations around actively choosing not to drink or to lessen alcohol consumption.

Ed Edwards’ award-winning play The Political History of Smack and Crack, which chronicles the Thatcher-era heroin epidemic, was safe in the hands of Eve Steele and William Fox. The actors, who have been performing together as lovers and heroin users Mandy and Neil since 2020, gave a rehearsed reading at Oldham Library’s performance space.

Will Belshah is a neuro­divergent queer artist, working predominantly in painting. Spaces Between kicked off a 12-month project, in collaboration with Portraits of Recovery, Venture Arts and HOME arts centre, on the intersectionality between neurodiversity, substance use and artistic practice, with the audience invited to take part in a shared creative response. Specialist speakers included Amanda Sutton, director of Venture Arts, Lisa Williams, lecturer in criminology, University of Manchester, Michele Hacking, NHS clinical psychologist and Dominic Pillai, curator of social engagement at Portraits of Recovery.

Also at HOME, we screened Fallen Angels’ Transfiguration, a trio of short dance films. I Fall, I Need and We Rise focus on a series of defining moments in the journey from active addiction to recovery. Paul Bayes Kitcher, co-founder/artistic director of Fallen Angels took part in a post-screening Q&A alongside director Dan Thorburn and playwright/actor Eve Steele, compered by Leon Clowes.

Portraits of Recovery IZZATManchester Museum
IZZAT: South Asian Women and Substance Use was a panel discussion exploring the unique barriers South Asian women face in accessing support for substance use. Speaking at Manchester Museum were Dr Sarah Fox from the substance use and associated behaviours research group (SUAB) at Manchester Metropolitan University, recovery advocate Aunee Bhogaita AKA Brown Girl in a Bottle, who has lived experience of sexual violence and substance use and Kim Kaur and Poonum Chauhan of SAFIR* (South Asian Females in Recovery). The discussion served as a launch pad for a creative project with South Asian women in recovery, which will take place throughout 2025.

A second collaborative event with Manchester Museum saw Dr Njabulo Chipangura, curator of living cultures at Manchester Museum, offered the rare opportunity to engage with and handle cultural heritage objects used for spiritual or ancestor worship purposes. African Objects: Psychoactives and Spirituality saw several exhibits ordinarily confined to the museum basement brought above stairs to begin conversations on the use of psychoactives for enhanced notions of spirituality and for the treatment of substance use issues.

Portraits of Recovery - Mark PrestPortraits
Finally, a reflective event, Recoverist Curators: Cabinet of Curiosities showcased a back catalogue of Portraits of Recovery work since 2011. Displayed at Whitworth Art Gallery, content was selected by the recoverist curators, a group of people in recovery from substance use. Delving into the Whitworth’s own collections, the group will, over the next few months, select and re-interpret artworks through a recoverist lens, helping to challenge societal stigma by rewriting the narrative. A resulting exhibition will open in spring 2025.

Portraits of Recovery’s work, including Recoverist Month, is about increasing access and opportunity to the transformational power of the arts and culture. We only need to look at how the queer, disabled and neurodivergent, global majority and women’s movements have taken back control through their cultural production. We strongly advocate this approach for the recovery community.

Mark Prest is the founder and director of Portraits of Recovery.

portraitsofrecovery.org.uk

Cranstoun micro-eliminates hepatitis C across Sandwell

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Cranstoun micro-eliminates Hepatitis C across SandwellSandwell’s drug and alcohol provider has announced that it has achieved the remarkable milestone of micro-elimination in its efforts to combat hepatitis C.

Led by Cranstoun, the drug and alcohol service provider in the borough, this achievement highlights the commitment and dedication to improving the health and wellbeing of people affected by substance use and marks a significant victory in the national effort to eliminate hepatitis C as a public health concern.

Hepatitis C is an infection of the liver which continues to attack the organ over time and, if left untreated can lead to life-threatening damage including liver cancer or failure. Symptoms often don’t show until it’s too late.

It was estimated in 2019 that around 118,000 people in the UK had chronic hepatitis C. It can be spread by coming into contact with the blood of someone who is infected.

Cranstoun support over 2,000 people across the Sandwell borough each year with managing their substance use.

Micro-elimination is a targeted strategy focused on reducing hepatitis C prevalence within specific groups. Success in these areas, as recognised by the NHS, has meant that the virus has been ‘micro-eliminated’ in the borough.

Hepatitis C Sandwell
The results of a rigorous regime of testing of people coming into the service has allowed the charity to treat and eliminate hepatitis C

The results of a rigorous regime of testing of people coming into the service has allowed the charity to treat and eliminate hepatitis C to reach this high standard.

Achieving these targets demonstrates Cranstoun’s commitment to delivering exceptional care and its proactive approach to addressing the needs of those at risk of blood-borne viruses, particularly hepatitis C, among people who inject drugs.

Lin O’Brien, Non-Medical Prescriber at Cranstoun Sandwell, said: ‘This is an enormous achievement not only for Sandwell and Cranstoun, but for the people who use our services. In the past two years we have supported 80 people by identifying their positive Heptatitis C virus and treating it before it became liver cancer – not to mention the others that it could have been transmitted to and the emotional pain and hurt that has been averted. Testing is now woven into the fabric of the day to day work.

‘This achievement is testament to the respect and commitment of all the staff at Cranstoun Sandwell, who have been dedicated to achieving micro-elimination for the health of the people who use our services, to enable them to live healthier, longer, safer lives.’

Liann Brookes-Smith, Director of Public Health for Sandwell said: ‘Achieving hepatitis C micro-elimination among people who use drugs in Sandwell is a major public health victory for our community. This reflects our tailored, local approach – ensuring those most affected have access to vital testing, harm reduction services, and life-saving treatments right here in Sandwell.

‘By working closely with local partners, addressing stigma, and making care accessible, we’ve not only transformed individual lives but taken a huge step towards eliminating hepatitis C across the borough.’

Hepatitis C Sandwell - Cranstoun
‘This success is about more than just numbers – it’s about saving lives, reducing harm, and making sure those most at risk get the support they need’

Councillor Jackie Taylor, Cabinet Member for Adult Services, Health and Wellbeing said: ‘This success is about more than just numbers – it’s about saving lives, reducing harm, and making sure those most at risk get the support they need. Sandwell is leading the way in public health for those with drug or alcohol support needs, and this milestone proves that with the right focus, we can make a real difference.’

The charity has worked closely with Sandwell Council, the Office for Health Improvement and Disparities (OHID) and local hospitals to treat and track the progress towards the goal of micro-elimination.

Cranstoun’s achievement sets a benchmark for other service providers and underscores the effectiveness of targeted intervention strategies. Through collaborative partnerships, community engagement, and an unwavering commitment to health equity.

The work will continue across the borough to eradicate hepatitis C entirely by 2030, to meet the UK Government’s and World Health Organization’s targets.

This blog was originally published by Cranstoun. You can read the original post here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Cranstoun

Potential cocaine production in Colombia up by more than 50 per cent, says UNODC

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cocaine production in ColumbiaPotential cocaine production in Colombia reached more than 2,600 metric tons last year, according to the latest survey from the UN Office on Drugs and Crime (UNODC). This represents a potential 53 per cent increase in production over 2022 and marks the tenth consecutive annual increase, the agency states.

The estimate is based on a 10 per cent increase in coca bush cultivation in the country between 2022 and 2023, to more than 250,000 hectares. While previous increases have been heavily concentrated in a single region – the Putomayo administrative region, or ‘department’ – last year saw increases in cultivation in 16 of the country’s 19 coca-producing departments.

The increases in cultivation are coinciding with an ‘increase in violence against social leaders, a deterioration of security conditions and additional pressure against indigenous and Afro-Colombian groups’, the agency states. While most coca ‘remains far from market centres in territories with high vulnerabilities and limited accessibility’ the latest survey found that the number of hectares planted with coca within 12 km of a population centre has increased from 37,000 a decade ago to almost 210,000. This closer proximity could cause ‘legal economies to become increasingly dependent on resources generated by illegal activities’, it says. ‘Armed groups in Colombia remain heavily involved in the cocaine market, intensifying violent conflicts in areas affected by drug trafficking, illegal mining and human trafficking.’

Potential cocaine production in Columbia up by more than 50 per cent, says UNODC
Cocaine availability in Europe also quickly surpassed pre-pandemic levels

A separate UNODC report from last year found that worldwide production of cocaine had ‘jumped dramatically’ following its COVID-related slowdown, driven not just by the expansion of coca bush cultivation but also improvements in the process of converting coca into cocaine hydrochloride. Cocaine availability in Europe also quickly surpassed pre-pandemic levels, according to EMCDDA, with vast quantities of the drug entering via ports such as Antwerp and Rotterdam and record levels of seizures.

Latin American and European crime networks are also collaborating to produce more cocaine in large-scale laboratories in Europe itself, EMCDDA reports, and the last few years have seen ‘unprecedented levels’ of drug-related violence, including kidnappings, killings and torture.

According to OHID figures, the number of people in England entering treatment for powder cocaine increased by 10 per cent in 2022-23 to more than 23,500, alongside a rise in people entering treatment for crack. In Ireland, cocaine overtook heroin three years ago as the main problem drug for people seeking treatment for the first time, according to the country’s Health Research Board.

UNODC: Cultivos de coca 2023 available here

Market forces

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Market focus - cannabis reform

Successful cannabis reforms are accelerating across the globe, benefitting millions of people, with good reason. The UK’s illegal cannabis trade alone is worth £2bn a year, profiting organised crime, and fuelling street crime, child exploitation and violence. The criminalisation of people who use cannabis – and, indeed, all drugs – is harmful, ineffective and costly.

Marginalised communities are carrying the greatest burden of these harms, as those who work in treatment, housing and other services know. For example, vulnerable people are evicted because smoking cannabis is specifically named in the (wildly out of date) 1971 Misuse of Drugs Act as something landlords must prevent. Possession offences can be part of an accumulation of convictions and unpaid fines leading to prison. Most police stop searches – disproportionately impacting Black people – are for cannabis, and young people carrying cannabis for older suppliers is an entry point to being drawn into county lines supply. Cannabis use can also be a barrier to accessing mental health services, in part because of its illegality.

Yet five years after legalisation in Canada, a substantial proportion of the cannabis market is now legally regulated. In the US, over half of the adult population can access legal cannabis, while in Europe, Germany is introducing a new non-profit model – based on one Transform helped Malta develop. The momentum is unstoppable.

cannabis reform strategy
We need a regulatory model that benefits individuals, communities and society by putting social justice and public health at the heart of our new approach

The question is, what will the UK’s approach be? We need all concerned stakeholders – including readers of DDN – to help us develop a roadmap to reform. We need a regulatory model that benefits individuals, communities and society by putting social justice and public health at the heart of our new approach. If frontline expertise in the drugs field is not engaged in this debate at this critical early stage, we risk repeating mistakes made with over-commercialised, under-regulated alcohol and tobacco markets.

In the last 20 years, Transform has largely operated internationally on this issue, advising governments and working with civil society in almost every country that has legalised recreational cannabis (Canadian civil servants described our How to Regulate Cannabis guide as the ‘regulation bible’). We’ve also worked in the UK (for example, helping the Green Party and Liberal Democrats develop their cannabis legalisation policies) but now want to turn our full focus on our cannabis laws.

To make this possible we need help. That’s why we’ve launched a crowdfunder which has just reached £10,000 of our £50,000 target. This money will fund everything from an authoritative report on economic impacts to workshops engaging those with the greatest stakes in how cannabis is regulated – including drug services. Because it’s time to legalise and responsibly regulate the UK’s most widely used illegal drug.

cannabis reforms - cannabis regulation

Martin PowellMartin Powell is head of partnerships at Transform Drug Policy Foundation

Number of young smokers at lowest recorded level

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young smokersJust 11 per cent of 11-15-year-olds have smoked at least once, according to the latest figures from NHS England – the lowest level ever recorded. Three per cent classed themselves as ‘current smokers’, with just 1 per cent saying they were regular smokers.

However, a quarter had tried a vape, and 9 per cent vape regularly – up from 6 per cent in 2018 – according to the Smoking, drinking and drug use among young people in England report for 2023.

The latest ONS statistics, released earlier this month, also revealed that less than 12 per cent of the adult population – around 6m people – were current smokers, again the lowest proportion since records began. The biggest drop in smoking prevalence – from more than 25 per cent in 2011 to less than 10 per cent – was among 18 to 24-year-olds.

According to the new NHS figures, the proportion of 11-15-year-olds who have ever taken a drug has fallen to 13 per cent from 18 per cent two years ago, with cannabis the drug most likely to have been used. However, 37 per cent said they’d had an alcoholic drink, a proportion unchanged since 2021. Fifteen per cent of 11-year-olds reported having drunk alcohol, rising to more than 60 per cent of 15-year-olds. Eleven per cent of 15-year-olds said they usually drank at least once a week.

The results are from an Ipsos UK survey of almost 14,000 secondary school pupils across 185 schools in England. Ten per cent of the children surveyed also reported feeling lonely ‘often or always’, with 18 per cent saying they felt they ‘often had no one to talk to’.

Number of young smokers at lowest recorded level
‘It’s very worrying to see a quarter of pupils tried vaping last year’

‘It’s very worrying to see a quarter of pupils tried vaping last year,’ said public health minister Andrew Gwynne. ‘The health advice is clear that children and adult non-smokers should never vape, so it is unacceptable to see unscrupulous retailers marketing them at children. Through the tobacco and vapes bill, we will stop vapes from being deliberately branded to target children, protecting future generations from becoming hooked on nicotine and ensuring the next generation grows up smoke and vape free.’

Meanwhile, the Department of Health and Social Care has announced that 11 projects exploring the potential to use AI, wearable technology and virtual reality to support people with substance issues could be rolled out if they prove to be successful.

The projects include a chest-worn sensor that monitors breathing and sends an alert to emergency services and naloxone carriers if an overdose is detected, and the use of virtual reality to help people overcome triggers for cocaine use. Around £12m in funding has been provided through the Addiction Healthcare Goals Programme, which is run by the Office for Life Sciences.

‘From wearable technology to AI-powered tools, these innovative projects highlight the power of collaboration in delivering life-saving treatments,’ said science minister Lord Vallance. ‘By investing in these partnerships, we are tackling addiction head-on and ensuring that cutting-edge science reaches those who need it most, improving public health across the UK.’

Smoking, drinking and drug use among young people in England report for 2023 available here

No time to lose

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alcohol strategyThe latest meeting of the APPG on Drugs, Alcohol and Justice was dedicated to looking at alcohol harm and treatment. Guest speakers were from VIA, introduced by the charity’s chair Yasmin Batliwala, who shared statistics to demonstrate the cost – both to individuals’ health and to services. The team would give thoughts on clinical harm, impact and innovative approaches.

There were around 600,000 people dependent on alcohol in the UK, and around 70 per cent of those had codependent mental health issues, she said – a link that was well-established by Dame Carol Black’s report. ‘Too many people are denied access to alcohol services because of their mental health,’ she said.

Local authority spending to treat these conditions was around £637m in 2021-22 which represented a real term spending cut of 27 per cent since 2014. There had been an 89 per cent increase in alcohol-related deaths over the last 20 years.

‘Are we doing enough to tackle the clinical impact of excessive alcohol consumption?’ asked Dr Yasir Abbasi, consultant psychiatrist and executive medical director at VIA. Clearly not, as he shared that more than 80 per cent of alcohol dependent people were not in treatment and there had been a 20 per cent increase in alcohol-related deaths since 2020. ‘People who are drinking in a dependent fashion are most likely to need a clinical intervention to come off,’ he said. He also highlighted the links to violent crime and cancer.

APPG alcohol strategy
‘Stigma often prevented people accessing alcohol treatment and many were reluctant to acknowledge that they had a problem’

Lack of a new alcohol strategy since 2012 and the reduction in funding were driving the statistics, he said. We needed a new strategy to focus on tackling inequalities, provide treatment pathways for people suffering alcohol-related brain damage (ARBD), and take an evidence-based approach that included a meaningful discussion around minimum unit pricing. We also needed to focus on early life interventions and disrupting intergenerational transmission.

Providing clear pathways to treatment was a challenge said David Targett, area manager at VIA. NDTMS data showed 100,000 people in treatment with alcohol as a primary issue – preventing even 1 per cent of them needing treatment would have a strong impact. ‘For those suffering the most harm treatment is an established pathway, but those earlier on in their journey don’t want to come to a drug and alcohol service,’ he said.

Stigma often prevented people accessing alcohol treatment and many were reluctant to acknowledge that they had a problem. To address this, VIA had been trialling a service in the North West that reduced barriers by offering treatment as ‘lifestyle guidance’ rather than a drug and alcohol service. The New Beginnings service took referrals from both professionals and individuals and offered evening appointments, online groups, and telephone or video sessions that fitted around work and other commitments. The service looked at ways people could reduce their drinking while providing support for health and wellbeing. ‘We need a new alcohol strategy but also a healthy living strategy,’ said Targett.

Stigma not only created a barrier to people accessing services, but also led to under-reporting of alcohol consumption, said Gayleen Winn, head of VIA’s young people’s service. This was particularly prevalent around family support, with young people often complicit in hiding parental alcohol consumption through fear of social services and the prospect of being placed in care – 2.6m children lived with parents who were drinking at hazardous levels and alcohol-related problems were under the radar.

alcohol strategy
‘We need to work with schools to help teachers look for signs that young people may need support’

Early intervention could offer strategies to help them manage and cope. ‘We need to work with schools to help teachers look for signs that young people may need support and clearer pathways that encourage parents to seek help,’ said Winn. ‘We must intervene earlier, and we need more funding to break the cycle of intergenerational drinking. Let’s talk about issues openly and courageously so we can protect our children.’

Sharon Read, a peer mentor at VIA, explained how she had developed a problem with alcohol following early retirement and said that accessing services at VIA had changed her life. From being a ‘binge drinker’ who ‘saw alcohol as the only way I could face things’, she was now volunteering as a peer mentor and taking qualifications to provide support for other people accessing treatment. ‘VIA gave me my life back, so I’m now giving back’, she said.

APPG chair Graham Morris MP opened questions and encouraged the group to campaign for action. Among the key issues was the need for independent family support that was not necessarily linked to treatment services. A vital piece of this jigsaw was represented by family services – Adfam CEO Viv Evans highlighted research that showed 5m people were adversely affected by a family member’s substance use, and in many cases this substance was alcohol.

Read previous Drugs, Alcohol & Justice APPG reports here

Taking Action on Addiction parliamentary reception

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Parliamentary reception
‘This gives us a great opportunity to enlist new supporters to help get addiction and recovery further up the political agenda’

On Wednesday 23rd October, the Taking Action on Addiction campaign is hosting a breakfast reception for MPs at 9am in the Terrace Pavillion, House of Commons.

With a new government and over half the number of MPs elected for the first time, this gives us a great opportunity to enlist new supporters to help get addiction and recovery further up the political agenda.

The stakes are high – it is true that thousands of people overcome addiction and related mental health problems every year but it is also true that thousands of others die every year from drug and alcohol related causes – this tragic trend is increasing and requires urgent action from the new government.

Please join us in fighting for greater understanding, and better treatment, for the people, families and communities that are struggling with addiction.

Due to strict security in the House of Commons, this is an invitation only event. If you are able to attend, please contact Fiona.mcdonald@forwardtrust.org.uk

You may have had a new MP since the election, you can find your local MP and their email address here.

Parliamentary reception emailPlease find a template email below to send to your MP:

Parliamentary reception Taking Action on Addiction 23rd October 2024, 9am Terrace Pavillion

Dear

I am writing to you with an invitation to a parliamentary reception on 23rd October at 9am in the Terrace Pavillion.

The issue of addiction is important to me because…. (please use this opportunity to tell them about your experience/why you think it is important that they attend etc.)

I hope that you can attend the reception and support the Taking Action on Addiction campaign in parliament.

Name
Address (it’s important that you add your address as the MP will not respond)

This blog was provided by Forward Trust.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Forward Trust

Scottish Parliament seeks advice from public on drug harms

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Scottish drug harmsThe Scottish Parliament has set up a ‘people’s panel’ to look at ways of tackling drug-related harms, it has announced.

Last month the parliament sent 5,000 letters to residential addresses across the country selected at random from the Royal Mail’s database, with 25 people then chosen to form the panel. Panel members – who are ‘broadly representative of the Scottish population’, the parliament says – will consider what the country needs to ‘do differently’ to reduce drug-related harms.

The panel will meet over one weekend this month and one next month to hear from people with lived experience, as well as people working in the sector, academics, researchers, and representatives from the Scottish Drugs Forum, Scottish Families Affected by Alcohol and Drugs and Community Justice Scotland. A final report will then be produced identifying what the panel sees as the key issues, with recommendations for further action.

Scottish Parliament drug harms
‘The number of drug-related deaths and the impact of drug-related harms has been a cause for concern for many years’

Scotland recorded more than 1,170 drug-related deaths last year, 80 per cent of which involved opiates or opioids. People in Scotland’s most deprived areas are 15 times more likely to die from drug misuse compared to those in the least deprived, says National Records of Scotland.

‘The number of drug-related deaths and the impact of drug-related harms has been a cause for concern for many years,’ said convenor of the parliament’s Health, Social Care and Sport Committee, Clare Haughey. ‘It is an issue which deserves national attention and that’s why it’s so important a range of views from across Scotland are heard. Holding a people’s panel on this topic is an opportunity for a broad section of Scotland’s society to shape political discourse, to consider this matter in detail and to make recommendations which can help tackle this issue.’

A welcome diversion

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A welcome diversion - diversion schemes

Our prisons are in crisis and we need to take a whole system approach to managing it, said Darren Nicholas, assistant director of services at Cranstoun. The options of diversion and deflection provided value for money, but they also offered ‘better and more effective ways to bring down offending rates’.

Diversion schemes were about making sure people did not enter the criminal justice system but got the treatment and support they needed, ‘with excellent harm reduction and support’ along the way. They also saved many hours of police time. ‘We need to make it as easy as possible for officers to use diversion,’ said Nicholas. ‘It can be done at different – and all – points.’

Pre-arrest referrals or out of court resolutions (OoCRs) came in different shapes and sizes – and with 75 per cent of court cases resulting in a fine of £200 or less, they offered a range of more viable alternatives. These included deferral – where someone apprehended for a ‘low-level’ offence such as drug possession was given the option of entering a treatment or education programme rather than entering the criminal justice system via arrest and court proceedings – and deflection, where a police officer could use their interaction with an individual to suggest potential resources and positive actions in a situation where no official action was taken.

OoCRs offered huge benefits for both the individual and the wider population, said Nicholas. They provided an opportunity to engage with education and services and could help to avoid a criminal record and potentially a prison sentence with all its negative impacts.

There was also a significant opportunity for expanding workplace diversion schemes, he added. Companies in several sectors regularly drug tested employees without having a clear plan on how to deal with the results of a positive test. Offering access to treatment and education as an alternative to dismissal would benefit everyone involved.

police-led drug diversion schemesOpportunity knocks
Diversion also had an important role for people currently in the criminal justice system, explained Emma Rimell, psychosocial service manager at HMP Birmingham. Prison should go beyond punishment and was a real opportunity to help people engage with education, treatment and social services. Instead of people becoming institutionalised, it was ‘an opportunity with a captive audience for meaningful interventions’.

Overcrowded jails, the lack of specialist wings and the condition of many prisons made this difficult, especially when working with prisoners on remand – ‘a forgotten cohort’. ‘It can be disruptive for them and there’s less opportunity for meaningful intervention with limited time in custody,’ she said. With the high risk of overdose and reoffending immediately after release, continuity of care – with integrated pathways – was crucial.

She acknowledged the many challenges but, given the high incidence of overdose after release and levels of reoffending, stressed the importance of trying to engage prisoners with treatment services and mutual aid. ‘It’s important that a rehab culture is taken on board by everyone in the prison setting,’ she said. A positive environment should reflect ‘fair and just decision-making’ but also extend to wellbeing initiatives and social support networks with friends and family.

There were other factors to consider: being in a prison not close to home made follow-up difficult and women’s needs were also different. Living conditions in some prisons were inhumane. ‘So do we invest in prisons, or divert?’ she asked.

criminal justiceConsider the evidence
‘Diversion is evidence based,’ said former deputy chief constable for Lincolnshire, Jason Harwin. ‘It’s not just about saving money, it’s about a better outcome for the individual. We should be doing more of it, not less – it’s just about how we do it.’

There was currently a ‘postcode lottery’, he said, with some areas working more proactively than others to deliver OoCRs. This could result in differing outcomes for the same offence.

There were additional challenges with the culture surrounding diversion – ‘media reports that this is rubbish, that we’re letting people off’. ‘The scheme may not be perfect but what is right are the interventions and support,’ he said. A report due to be published by next March would help to shape diversion. Collaboration and innovation were key to making sure initiatives were not just police led, and this required ‘a whole system, evidence-informed approach’.

In a later session, Dr Matthew Bacon of Sheffield University, who had been evaluating the effectiveness and cost-effectiveness of police-led drug diversion (PDD) schemes for drug-involved suspects, highlighted that there needed to be a whole system, evidence-based approach beyond merely counting the number of officers. One of the main challenges was convincing the public of the benefits of a scheme that was too often described as being ‘soft on crime’.

diversion schemesA new way?
The premise of deflection was looking at what happened when you don’t do it, said Jac Charlier, of TASC’s Center for Health and Justice in the US. With likelihood of overdose, death, a crisis, an arrest, deflection gave an opportunity of ‘flipping the script’.

Deflection was increasingly used in the USA in situations where arrest was possible but not mandatory – 60-80 per cent of police interactions in the USA resulted in no action. Having a positive intervention at this stage created an ‘upstream approach’, said Charlier, and focusing on prevention instead of crisis management was better, faster and cheaper, benefiting everyone concerned. The approach was community led, providing a gateway to services.

Charlier stressed that the approach was made up of ‘one tenth police, nine tenths you’, but the link between drugs and criminal behaviour meant that the police were often the first contact. ‘This is a data-based reality – police will be involved, neighbours will call the cops,’ he said. ‘History is that they arrest you, but this offers a new way. We are not saying that we should make police public health workers.’

Comments from the conference audience reflected some strong concern about the police role. ‘The UK has a problem in that stop and search for drugs went up to the highest rate since 2012,’ said Niamh Eastwood of Release. ‘So there’s a problem with suggesting police move further into the community. Extending the role of police beyond diversion is deeply concerning.’

‘The police aren’t culturally humble – they don’t understand the issues,’ said Aaron Anthony, a youth justice worker in London. ‘When kids fight in school the police are involved. We don’t feel like police want us to be safe, and we need to address this first.’

diversion and deflectionChanging attitudes
This culture was examined in a later session by Josh Torrance, research associate at the University of Bristol. While improved efficiency was one of the key drivers for diversion, there had also been a change in attitude among police that reflected wider society, he said. His research showed that newer, younger police officers had a different outlook – a move away from paternalism to a more progressive approach. This suggested a change in perceived role, from crime fighting to protecting vulnerable individuals.

He had encountered several officers who had personal experience of a family member with drug issues, or who had witnessed overdoses and problems faced by people using drugs. Talking about the overdose of a local man, one officer said he regretted just giving him a caution and wished he could have done something to help. Another said he had not confiscated drugs from someone he saw injecting as ‘he will just go and commit another crime to buy more.’

The schemes were not a ‘silver bullet’ and the opportunity for interaction and building relationships should not be overplayed, said Torrance. Most individuals just wanted to accept the OoCR and go. Dealing with the police was still a stressful situation whether you were being arrested or not, and people did not want to hang around for a chat.

But he believed that a key factor in the scheme’s success was to ‘make the process simpler and easier than what was done previously’. To this end, Cranstoun had been partnering with the technology social enterprise Make Time Count to help officers make a referral in minutes, rather than the hours taken up by processing a traditional arrest. Working with five police forces, they had co-designed a platform that made it quick and easy for an officer to refer someone to a service on the spot, and also supported the individual by providing updates and reminders for appointments and key dates.

‘We need to do away with sending letters and use the technology that people have in their pocket,’ said CEO and founder Jonathan Ley. ‘If the dentist and pizza delivery service can send you text reminders there’s no reason that the criminal justice system can’t do this too.’

Services still not properly equipped to deal with dual diagnosis, say researchers

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Services across the UK ‘remain ill-equipped’ to meet the needs of people with co-existing substance use and mental health issues, says a report led by Glasgow Caledonian University.

dual diagnosis
Around 30-50 per cent of people experiencing serious mental ill health have co-existing drug or alcohol conditions

Expert clinicians should be introduced across all health services to better coordinate treatment for this client group, says the study, which is funded by the National Institute for Health and Care Research (NIHR) and published in Health Technology Assessment.

Around 30-50 per cent of people experiencing serious mental ill health have co-existing drug or alcohol conditions, with those in areas of deprivation ‘worst hit’, the researchers state. Addressing the problem requires both joined-up government policy and local integration of health and social care services, with clinical leads ‘supporting the workforce to come together’.

The study involved experts from across both sectors, as well as King’s College London, Liverpool John Moores University, Leeds and Northumbria universities, and NHS trusts. Researchers interviewed staff and service users – including ex-prisoners and homeless people – to find out how local services can best work together.

Mental Health dual diagnosis
‘There will be people who slip through the net and spiral out of control because they feel there’s nowhere for them to go’

‘It’s hard to believe that we are in 2024 and people with combined serious mental health illness and alcohol or drug use are being left behind in the system because of the lack of a co-ordinated approach in treatment and services across the whole of the UK,’ said lead author Elizabeth Hughes, professor of substance use research at Glasgow Caledonian University. ‘There will be people who slip through the net and spiral out of control, or even take their own lives, because they feel there’s nowhere for them to go and they keep getting passed from pillar to post.’

Things worked well when there was a dedicated clinical leader to co-ordinate services, be a role model to other staff, and arrange in-house training, she said, as well as ‘broker that relationship between substance use and mental health, which is really divided right now. Nothing really happens without somebody on the ground doing those things, because we found in one of our case studies locations that they had a consultant nurse doing that role who retired and hadn’t been replaced – and nothing worked after that as there was nobody joining the dots. We will use all that we have learned from this study to help people who fund and provide health services to improve these services. We will also make sure our findings are shared with people in the Department of Health who develop policies and guidance that will be used in the future when new services are developed.’

Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation available here

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DDN launched in 2004 and has a 10,000 print circulation and a readership of more than 25,000 as copies are passed around teams. We have over 25,000 online readers a month, 6,500 email subscribers, and an active social media presence on Facebook and with our 10,000 Twitter followers.

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Delayed opening for Glasgow consumption room

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The opening of the UK’s first consumption room in Glasgow has been delayed while checks are made to the building. The facility had previously been set to open on 21 October.

Glasgow consumption roomA spokesperson for Glasgow City Council told the BBC that ‘like any project of this scale, there are complexities which need to be worked out. Whilst we haven’t been able to meet our estimated opening date, all partners continue to work at pace to ensure we get this service open as soon as possible. This will happen once the building passes the stringent NHS Assure process which has been put in place to ensure public safety.’

The consumption room, which is located on Hunter Street in the east end of the city, will include injecting booths and medical rooms and operate for 12 hours a day, seven days a week.

This summer Glasgow City Health and Social Care Partnership announced that feedback from engagement sessions with people with lived experience had led to some late changes to the layout of the service, including the addition of a shower room and a secure outside area. The recruitment campaign for the facility had been a success, said service manager Lynn MacDonald, with more than 700 applications and staff due to come into post in August.

The consumption room was finally given the go-ahead by Glasgow’s Integration Joint Board last September, after Scotland’s lord advocate said it would not be in the public interest to prosecute people using the facility for simple possession offences.

Homelessness services facing financial ‘cliff edge’, charities warn

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Homelessness services facing financial ‘cliff edge’, charities warnAn open letter to the chancellor signed by almost 80 homelessness and housing organisations warns that services across the country are facing a ‘perilous funding cliff-edge’.

The organisations are calling for a rollover of existing homelessness funding into 2025-26 in this month’s budget to give the sector ‘certainty’. Otherwise almost £1bn is set to leave the sector next April, states the letter, which was coordinated by Homeless Link.

The 2021 spending review period, through which the government has provided grant funds to deliver homelessness and rough sleeping services, is about to come to an end, with the ‘vast majority’ of funding commitments set to expire by next April. These include £548m in rough sleeping initiative funding, £435m in rough sleeping accommodation programme funding, £13m in night shelter transformation fund money, £7m in voluntary and community frontline sector funding, and more. ‘It equates to almost £1bn due to leave the homelessness sector by the end of the financial year,’ the letter warns. ‘Without an extension, this would represent the most significant setback in progress towards ending homelessness and rough sleeping in recent history.’

Alongside increases in all forms of homelessness, the risks included large-scale loss of skilled staff, trusted providers leaving the market and the end of well-established local partnerships, says the letter. The signatories are also calling for a systematic, cross-departmental review of all homelessness-related spending in order to develop a ‘consolidated, ring-fenced’ funding system from 2026-27 onwards.

homelessness services
‘It equates to almost £1bn due to leave the homelessness sector by the end of the financial year’

The number of people estimated to be sleeping rough in England on a single night in autumn last year was already up by more than a quarter on the previous year, according to official figures from the Department for Levelling Up, Housing & Communities. According to ONS statistics from 2022, almost two in five deaths of homeless people are drug-related.

‘Everyone needs a safe, secure place to live,’ the letter states. ‘But rough sleeping rose by 27 per cent in 2023 and 60 per cent since 2021. If it keeps rising at the current rate, numbers in 2024 will be similar to the 2017 peak.’

‘The sheer number of organisations who’ve signed this letter shows how much anxiety the funding cliff-edge is causing homelessness services across the country,’ said Homeless Link CEO Rick Henderson. ‘Organisations are already considering redundancies and scaling back services. The autumn budget is the government’s final opportunity to give the sector some certainty and prevent the inevitable surge in homelessness that will come if services are forced to close their doors from March.’

Beyond the next financial year there were also ‘deep flaws’ in the current system of funding, he added. It was ‘inefficient and complex, comprising a patchwork of different pots which focus on short-term crisis interventions at the expense of preventing people from experiencing homeless in the first place.’ A ring-fenced funding system would give the sector the stability to ‘effectively prevent and end people’s homelessness, saving lives and reducing strain on health and emergency services in the process’, he stated.

A Ministry of Housing, Communities and Local Government spokesperson told the Guardian that the government had ‘inherited homelessness levels which are far too high’ and that it was ‘taking action by setting up a dedicated inter-ministerial group chaired by the deputy prime minister that brings together ministers from across government to develop a long-term strategy to get us back on track to end homelessness. Local authorities and their partners deliver vital work to tackle rough sleeping, and funding allocations will be set out following the budget.’

Open letter available here

Community is key

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Community is key - Kaleidoscope

My career at Kaleidoscope spans three decades and as I look to step down from my leadership role I’ve reflected on what has happened in the field over that period. Kaleidoscope is a pioneering organisation – in its 55 years it has been at the forefront of advocating harm reduction, community support and systemic reform in drug policy. At the heart of the work is a deep commitment to empowering the most marginalised people in society and fostering positive change through innovative programmes.

Kaleidoscope was founded by my father in 1968 as a mission-based project, starting with a club on Friday nights supporting those in need. Growing up in this environment, I witnessed the challenges faced by people with mental health and substance issues firsthand. In 1993, following a stint as a pastor, I returned to Kaleidoscope, ready to lead the organisation alongside my sister.

In 1998 I took on the role of director, transforming Kaleidoscope into an indepen­dent charity. This enabled us to move from Kingston and locate where we could be the most effective in driving change. I was fortunate that Newport City Council, supported by the Welsh Government, invited us to provide a small service in the city and the wider Gwent area. Devolution in Wales led to ambitious plans for lasting social change, and I hoped to play a small part in this. The decision to relocate to Wales has meant that today Kaleidoscope is the largest provider of drug services in the country.

Community - KaleidoscopeWales is a country that sees substance use as something best addressed as a health issue, rather than one of criminal justice. The frustration is that Wales is still subject to the 1971 Misuse of Drugs Act, which means setting up enhanced harm reduction facilities and other health related support services remains difficult.

In the UK the support for people with drug and mental health issues has not noticeably improved. There is a growing number of people with complex issues who are either street homeless or in prison. I believe the UK sets individuals up to fail, especially those with complex needs. It’s not uncommon for people who have mental health issues to self-medicate through illicit drug use, as they cannot access support – and once they do medicate themselves, mental health services will not work with them.

‘I believe the UK sets individuals up to fail, especially those with complex needs’

In this chaos, the government benefits system expects people to self-manage their benefits and pay their rent. The immediate needs of addiction and finding inner peace are so acute that budgeting becomes impossible and people lose their accommodation. The failures of the current approach mean record deaths, which will continue to rise without real change. There are, however, reasons to feel some optimism.

The movement toward co-production – where services are designed and led by those using them – could drive through real change. Maybe we can move away from an over-reliance on commissioners towards a new system – either an alliance model as championed in Cardiff, where services come together to deliver, or one of multiple approved providers, allowing the service user to choose what’s best suited to their needs. With the rise of service user advocates fostering a peer-led approach that includes initiatives like naloxone peer-to-peer distribution, I feel there is real change in the air. I also believe there will shortly be safe injection facilities to reduce drug-related harm.

Kaleidoscope has always believed that what we must try to do is create community. I’m proud to see the drive for community hubs, service user-led cafes and an awareness of the value of sport, be it park runs or football. Social connection is critical, but particularly for people who can be isolated through an addiction issue or poor mental health. Creating community opportunities is key, and many services are now tapping into this.

Community is key
‘I hope service providers now focus on the people we are there to help rather than being in competition with each other’

I hope service providers now focus on the people we are there to help rather than being in competition with each other. In Wales there is a spirit of working together and in England I think partnerships fostered through Collective Voice give reasons to be more optimistic.

As for my future, I’ll always have Kaleidoscope in my heart and people who use drugs and alcohol in my soul. I have experienced so much love from the community of drug and alcohol users that the tie can never be broken.

Martin Blakebrough is chief executive of Kaleidoscope

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