As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the second of his series of articles, he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces. Read the full article in DDN Magazine Mike Trace is CEO of Forward Trust In my previous article, I described the policy and financial strategy that the last Labour government used to build the national drug and alcohol treatment system we all now work within. This time, I want to take an unvarnished look at the results achieved over the last 15 years with the billions of pounds of taxpayers’ money that has been expended. Most readers will know that the picture has been mixed. My personal view is that we have not achieved everything we set out to do because, despite political support and big investment, the system we have created is too often process driven and bureaucratic, and insufficiently human and welcoming. The evidence is stacking up that the key precondition for engagement and behaviour change is human connection (Johann Hari sums it up well), and the services that have most impact are the ones that get this right. For too many marginalised people, their experience of services is too much form-filling and onward referral, and not enough inspiration and consistent personal support. If we want people to change and grow, we have to give them more reasons to believe that a different life is possible. So how do we get better at facilitating real change, when the sector is under the pressure of cuts, and our clients’ lives are getting harsher? That is now the challenge we face, which I will address in my next article. Reasons to be cheerful We have one of the most comprehensive publicly funded treatment systems in the world, with a high rate of ‘penetration’ (proportion of the population in need who are in touch with services). This major investment in care and support for some of the most vulnerable people in society is both humane and cost effective. We have been successful in reducing drug-related crime, with Home Office research concluding that our treatment system was a key contributor to the reduction of overall crime rates between 2000 and 2010 (although recent trends seem to indicate that this effect is waning). We have been successful in keeping drug-related HIV infections low. The UK was an early adopter of harm reduction practices such as needle exchanges in the 1980s. As a direct result, HIV transmission rates from injecting drug use have remained among the lowest in the world. (Once again, the scope and quality of harm reduction services has recently been under pressure, which may lead to an upturn in infections). Reasons for concern We have not been able to reduce the scandalous level of drug-related overdose deaths, that remain way above European averages. There has been much discussion around the reasons for this, but the fact remains that one of the key objectives of having a well-funded treatment system was to significantly reduce the misery caused by these premature deaths, and we have not yet succeeded. We have not been good at moving people through the treatment system into positions of independence and wellbeing. Apart from the missed potential for individuals, this has created a ‘system’ problem where capacity demands on services constantly increase as new clients outnumber those who move into recovery. We have not sufficiently overcome the funding and delivery ‘silos’. We all know that drug/alcohol treatment clients have multiple needs, but there are not enough examples of truly integrated planning or care and, conversely, sometimes duplication of services. In particular, substance misuse and mental health services still work to separate methods and objectives, and support for children and family members is still an underfunded afterthought.