Change is Coming – Perhaps?

addiction-alleyLast week provided (or should provide) a ‘ground-breaking’ opportunity for improvements to those agencies tasked with supporting people impacted by drugs and addictions.

However, judging by the past results of what many see as ineffective talking-shops, can we really be that confident about all this ‘new’ (additional) talk? Will we actually the results that we need?

Many people, with lived-experience of addiction services, see many of those services as (arguably) lack-lustre and/or inadequate. Will last weeks events provide us with some significant change, this time around? Are we finally witnessing the sea-change of improvements and positive ‘productive’ actions coming down the road?

Political Conferences

Two important conferences about the Drugs Crisis in Scotland (and elsewhere in the UK) took place. Those forums dovetailed with the initial response from Prof Dame Carol Black, providing a report on phase one of her independent review of drugs (terms of reference), commissioned by the UK Government last year (see here).

Both the Scottish government and the UK government held summits in Glasgow, to discuss how they can tackle the drugs death crisis. I don’t think anybody could disagree with the fact; some ‘Bold’ action is needed to tackle drugs deaths!

Bold action is needed to tackle the drugs deaths emergency in Scotland, the leader of Glasgow City Council has told a summit.(BBC News)

Susan Aitken, an SNP councillor, called on the UK government to “support new approaches” (like safe consumption rooms), when addressing the Scottish Govt event in Glasgow. That was 24hrs before the UK government hosted their event in the same venue. She’s not wrong with her ‘bold action’ comment however; some could suggest that Aitken (and her political peers) are actually part of the overall problem?

The Public health minister for Scotland, was reported to  have been ‘extremely concerned’ at the ‘Scottish Government being repeatedly ignored by UK ministers’ when it came to organising any joint event (see here). Holding the Scottish drug summit on the day before the UK event, and in the same city, could hardly be seen as the best use of finite public money and resources. However, putting aside the clear political point-scoring in this matter, at least there appears to be some much-needed renewed focus on the issues at hand.

Both the UK and Scottish governments agree that tackling addiction and rising drug death levels should be a priority. (BBC News)

That’s all well and good however; should we merely expect similar outcomes to all those ‘results’ and outcomes that have gone before? As Faces & Voices of Recovery UK often say to the politicians… “You Keep Talking We Keep Dying!”

THE number of NHS patients referred to residential rehab to undergo treatment for drug or alcohol addiction in Scotland is at an all-time low. (The Herald)

The Dame Black Review

Like many others, I welcome Dame Carol’s findings, despite there being a lot of information that is already known (outside of politics). I say ‘welcome’ but it I can’t celebrate her findings, given the number of (arguably) preventable deaths and human misery being examined upon.

Dame Carol correctly identifies a system that isn’t working. There is no agreed understanding of best practice to engage this population in the workplace and the information flows between the different players involved are poor. (Collective Voice)

Protecting the public is our priority and we work relentlessly to tackle the whole drug supply chain. Our international networks and UK capabilities are uniquely placed to identify, disrupt, and dismantle the transnational crime networks trafficking drugs towards and within the UK. (National Crime Agency)

The findings also show that criminal justice approaches to drugs not only don’t work, but are unlikely to ever achieve their goals. While acknowledging there have been damaging cuts to policing and border agencies, Dame Black goes on to say: “Even if these organisations were sufficiently resourced, it is not clear that they would be able to bring about a sustained reduction in drug supply. (politics.co.uk)

Black’s Initial Findings

  • the illicit drugs market is a big business, worth an estimated £9.4 billion a year
  • around three million people took drugs in England and Wales last year, with around 300,000 in England taking the most harmful drugs – opiates and/or crack cocaine
  • drug deaths have reached an all-time high and the market has become much more violent – the total costs of drugs to society are estimated to be over £19 billion, which is more than twice the value of the market itself
  • most illegal drugs consumed in the UK are produced abroad – the supply of drugs has been shaped mostly by international forces, the activities of organised crime groups and advances in technology
  • the heroin and crack cocaine retail market has been overtaken by the county lines model, which is driving increased violence in the drugs market and the exploitation of young people and vulnerable drug users

As emerging evidence has confirmed, despite politicians having been previously and continually warned about the likely impacts of their strategies; it is now clear that austerity has been the root cause of so much poverty and deprivation within our society. This is covered in the latest Joseph Rowntree Foundation annual poverty report).

Social Observations

Our political strategies and polices over recent years have created significantly negative impacts for the most vulnerable in our society. Not least for those impacted by their addictions. And all this before we even start to consider any of the additional social impacts of violent and organised crime, a factor that continues to spiral out of control.

Police are very, very good at catching drug dealers, but that’s part of the problem. Police never reduce the size of the market, but they do change the shape of it. (Neil Woods, LEAP UK)

The violent crime, that is associated with the licit drugs trade, is mostly beyond any effective containment now (see here). This isn’t simply a result of the fallout from our failing Criminal Justice System (which hasn’t helped). It’s also not a direct result of the savage cuts to UK policing over recent years, although that has resulted in some significant impacts and consequences, just like the cuts to any of our our public services.

Government’s continued but tired political rhetorical – “Tough on Crime” – spiel, and the constantly self-lauded ‘success’ stories tripped out by enforcement agencies, are mostly little more than a proverbial drop in the ocean. We simply can’t arrest our way out of the issues that we face on a daily basis. These are problems that are growing significantly and exponentially. Irrespective of what the politicians, NCA and (some) police officers and their Crime Commissioners would like us to believe.

Personal [informed] Observations

I’m based and work (mostly) in England and yes, my primary experience and knowledge, about addiction treatment and recovery support services, does relate to England. However, my work also has a UK wide remit with an international element, all of which provides me with a comprehensive oversight, of many of the fundamental issues we are facing.

It continually saddens me that I and others still need to point out; drugs, addictions and the trade which simply matches consumer demand, all present significant and profoundly negative impacts for the whole of our society.

Controlled drugs, be they street or prescription sourced, are not the consequence of many problems, not the cause. They provide connections for the disconnected, a comfort blanket for many people who see themselves as out in the cold and fearful extremities of our society. Drugs provide people with an often much-needed crutch of support whilst traversing the detritus of social poverty and deprivation. And yes, drugs block out issues with increasingly shorter periods of pleasurable escape from the trials and tribulations of life that people face.

Contrary to common belief, this is not simply about some more of those ‘other’ people dying, due to their individual hedonism desires or stupidity, it’s about impacts on humanity and our society!

Working across the UK, with a diverse range of addiction treatment providers (from the public, third and private sectors), there are undoubtedly examples of great, good, indifferent and poor service provision. That said and in the main, I see fare more good than what some would refer to as ‘bad’ …which is often a relative and subjective descriptive in any case.

But, one thing that does continually frustrates me, and really shouldn’t be the case is; too many skilled, professional and empathetic people are constantly impeded by failures of the ‘systems’ they are working within. One example of this is that too often; the commissioning and measurement of efficacy factors appear to be the end-game where services appear to loose sight of the delivery and outcome goals – i.e. the patients / clients / service-users.

In some services, people are still seen as widgets by those organisations who are tasked with treating and supporting them. They are looked upon as cohorts of demographic statistical data, rather than individual human beings… with specifically individual issues and needs.

In general, it’s the systems and not the workers that are failing those people who are looking for help during their recovery journeys. And often, to the detriment of the people struggling to provide care, with limited resources and funding, on the front-line of any particular workforce.

The big question that gets raised Ad infinitum and with monotonous regularity is; what can we do about our drug crisis (not only in Scotland) across the UK?

As ever, especially when politics, money and organisational or individual aspirations and priorities are involved; the issues we face require a great deal of joined-up holistic thinking and action… which sadly still isn’t happening and in way too many cases. It would good if we could start doing something to end the ‘postcode lottery’ of addictions treatment.

The lives of people battling with addiction issues are still being put at risk because they are being told they will have to wait for weeks or even months to get medication and therapy, and being refused options such as rehab because they live in the “wrong postcode”, it has been claimed (The National)

There is strong and growing activism, mostly from those with lived-experience of addiction service provision, that suggests; reduced (austerity driven) funding has resulted in the loss of too many residential rehab beds, particularly but not exclusively in Scotland. The voice of activism also tends to laud residential rehab as a panacea for addiction recovery, almost to the exclusion of other resources sometimes.

But, in a landscape of finite resources, where organisations are (correctly) required to quantify all their expenditure, I remain unconvinced the residential rehab is always the best use of limited public funds.  Rehab rarely presents positive outcomes in high percentages, at least not in sufficiently large numbers, that could realistically be justified as Value For Money.

What is most and least useful in residential rehabilitation? Arrangements for care need to be considered before admission, not just before discharge… Residential rehabilitation has evolved from a service provided mainly for older people with alcohol problems, to those with heroin addiction and now those with dual or multiple addictions, notably involving crack cocaine. It may be that different types of ‘therapeutic community’ are needed for different problems. (Wilkinson et al 2009)

Residential rehab is not the panacea that many see it to be. There is no guarantee of realising successful outcomes. The overall efficacy of the process is (sadly) patchy and sustained recovery results, for many who undergo rehab, are not as good as they could/should be… due to a diverse range of reasons.

Programme factors that influence completion of residential treatment: Programmes with more drug than alcohol users had lower completion rates, but the proportion of dual diagnosis or criminal justice referred clients did not appear to affect retention. Completion rates varied as a function of a number of service factors that are amenable to manipulation. (Meier, Best 2009)

Simple [problematic] Solutions

Aims & Goals: Our systems are failing simply because (too often) we are missing the aims in our required public service provision, I.E. to save lives, whilst reducing (or at least mitigating against) all the negative personal and social impacts of drug use.

Strategy: Strategies, policies and procedures must be put in place that are totally devoid of silo-thinking and promote ‘effective’ partnership working… providing a person centred individual approach to treatment, care and support.

Solutions: OK, many will consider it a little trite to suggest ‘simple solutions’ for what is undoubtedly a complicated issue however; if the organisations in our systems tried to focus more on the aims, rather than the process, with all the political point-scoring and necessary financial considerations, that would be a good start.

Time for a bold debate on the modernisation of the drug control normative framework. (Global Commission on Drugs Policy)

The Required Goal(s)

My simplistic Top Five bullet-point Plan, based upon the KISS principleSave LifeReduce HarmImprove Society – would include;

  1. Systems: We need Systems Thinking to improve effective and successful treatment services and after-care support
  2. Science: Stop the politics – ignore tired rhetoric – end stigma inducing virtue-signalling – challenge the media – decriminalise / regulate and Follow the science!
  3. Care: improve person-centred approach to care – focus on individuals – change the (still prevalent) one-size-fits-all methods that are aimed at cohorts of demographics
  4. Investment: invest in goals to improve long-term change, rather than continually chasing short-term quick fix outcomes
  5. Service: Addiction treatment and recovery support is social issue. Provision is a public service, one that can and should always aim to improve the lives of individuals who reside in our communities. We need to continually call out all those individuals and organisations involved in that process for any silo-thinking, self-interest and their personal aspirations.

As ever… the problems are in the details!

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