Tuesday, 25 November 2014

Guest Blog: If I had my way, the next government would…

This is a guest post by Rupert Oldham-Reid, Senior Researcher at the Centre for Social Justice, and reflects some of the ideas that he presented at this year's DrugScope Conference.

The next Government must commit itself to addressing social breakdown. In the field of drugs and alcohol misuse, as with severe debt and worklessness, policy must be ambitious for those currently reliant on the state. It is not enough to maintain people in dependence and consider our duty done. Economically this is in Britain’s long term economic interest but, more importantly, it is the right thing to do by our countrymen.

Invest in recovery 

Fundamentally, the next Government must realise it needs to invest to help people transform their lives. Although social finance initiatives hold a great deal of potential in this sphere, it will be some time before this opportunity can be fully developed. The next Government, therefore, should levy an additional charge upon the alcohol industry for the dedicated purpose of funding rehabilitation and reintegration.

The CSJ outlined one way this might be done in the form of a treatment tax. This small payment, £0.01 initially on each unit of alcohol sold off-license, would raise over £1 billion in the next Parliament.

With such investment, rehabilitation centres (including residential), supported dry accommodation, and other recovery capital-building services, could be expanded to meet the demand of those hundreds of thousands of people dependent on opiate, crack and/or alcohol. With approximately 300,000 children with a parent addicted to drugs and 700,000 with a parent dependent on alcohol, this cannot wait.

Beyond such investment, we need to appoint a Recovery Champion for England. Such an individual would ensure that resources are well spent; that localism delivers for all local people; and, to challenge the stigma around addiction and recovery.

New Psychoactive Substances (NPS – ‘Legal Highs’) 

The rising challenge posed by NPS (legal highs) requires a swift and determined response. The report by the Expert Panel is a good overview for what our response should look like. On enforcement, the CSJ is gladdened to see the Panel agree with our recommendation that the Irish Model provides a guide on how to proceed. This legislation will allow police to close down ‘head shop’ and other establishments which persist in selling NPS. We will also need to see adequate resources flowing into the National Crime Agency to allow online trade to be tackle. This approach, however, must be accompanied by effective prevention and treatment reorientation.

Transforming public services 

We must make more of every opportunity at intervention we get, be it in the criminal justice, welfare, or health services. Although effective at treating the symptoms, we have a poor record on addressing the behaviour which is putting untold pressure on public services.

In our health service, we must address the shocking rate of alcohol-related re-admissions – up 85 per cent in the last five years according to CSJ Freedom of Information requests.

In our welfare system, we must ensure the next phase of the Work Programme has a more supportive offer for those furthest from the job market. For example, we need a mixture of higher up-front payments for service providers and rewards for those who get people nearer employment, if not actually in work, for example, abstinent from drugs. At the same time, we must ensure that with the welcome drive to personal budgeting accompanying Universal Credit, we must ensure that vulnerable people get additional support, for example, through the piloting of welfare cards.

Finally, in criminal justice, action is needed to address the shocking levels of reoffending. Figures show over half (56 per cent) of offenders on community orders given a drug rehabilitation requirement (DRR) reoffended within a year of being sentenced.

Thus we need to build on the success of the Family Drug and Alcohol Court by extending the problem-solving approach to criminal justice. Similarly, we need treatment in prisons which breaks the cycle of addiction and a probation service which provides effective aftercare. To this end, we welcome the Lord Chancellor’s announcement that mental health in prison will be a priority for the next Parliament.

Social justice at the heart of Government 

Pulling all this together, the CSJ hopes that any future Government maintains the Social Justice Cabinet Committee. Chaired by a senior cabinet minister, it is essential that key departments are brought together to drive through policies which can tackle disadvantage in Britain.

Rupert Oldham-Reid is a Senior Researcher at the Centre for Social Justice and is on Twitter at @RupesOR

Tuesday, 18 November 2014

Bite-sized Briefing - Shooting Up: infections among people who inject drugs in the UK

As part of the support we offer our members DrugScope's policy team send out a monthly round-up and prĂ©cis of reports which we believe are of interest to the field.  The following is offered as an example of the content of our Bite-sized Breifing for November.

Public Health England (PHE) have updated their 2013 report setting out the current knowledge about levels of infections for people who inject drugs across the UK. As well as the report other resources include an infographic, a briefing for Directors of Public Health and a set of slides.

Key messages from the report include:
  • Two in five injecting drug users are living with hepatitis C; half of these infections are undiagnosed.
  • HIV levels remain low and the uptake of care is good. Around one in every 100 people who inject drugs is living with HIV.
  • One in four people who inject psychoactive drugs report a recent symptom of an injecting site bacterial infection. Fewer (one in six) people who inject image enhancing drugs suffer these symptoms.
  • The proportion of injecting drug users who share needles has halved in the last decade but still around one in seven continue to do so and almost one in three had injected with a used needle that they had attempted to clean.
  • There has been a recent increase in the injection of amphetamines and amphetamine-type drugs, such as mephedrone, which is associated with higher levels of infection risks.
Perhaps the most important message in the report is that the provision of effective interventions, such as needle and syringe programmes, opioid substitution treatment and other drug treatment, which act to reduce risk and prevent infections, needs to be maintained.

Download here.

If you would like to join DrugScope you can do so here.

Monday, 17 November 2014

Guest Blog: If I had my way, the next government would…

This is a guest post from Steve Broome, Director of Research at the RSA, and reflects some of the ideas that he presented at this year's DrugScope Conference.

Drug policy is headline news again. The initially delayed and much discussed Home Office report on the international experience of approaches to drug misuse and addiction has to some degree reinvigorated public debate about how we perceive and respond to it. Perhaps you take from the report and the subsequent debate the view that drug policy is working, given the downward trend in adult use of illicit drugs (although Public Health England figures show that number of adults using in the last year has not much changed since the 2010 national drugs strategy was introduced). Or perhaps you put more stock in the view that the UK’s drug laws have no effect on curbing illicit drug use. Either way, I think there are underlying possibilities that might be developed.

The shift from a focus on treatment to one on recovery (which I welcome), and this recent, more widespread questioning of the effectiveness of our drug laws, signal that we are continuing, in some ways at least, to move away from a punitive attitude towards substance misuse and progress further towards one that is recovery-orientated.  Recovery, however, cannot be ‘delivered’: the notion of active citizenship implicit in the UKDPC’s consensus statement on recovery, cannot come solely from the top down, or just the individual trying to progress their own recovery.  It requires the participation and commitment of both that individual and a wide set of stakeholders within their communities.  Consequently, it requires a more integrated approach, particularly around housing and jobs.  But there is an important social component too.  The RSA’s Whole Person Recovery model seeks to build, among other things, the social networks and attendant empathy and respect that (re)connect people with their communities and the support, information, and opportunities they can provide.

Stigma is a key barrier to enabling this.  Research by the UKDPC showed that public attitudes towards people affected by substance misuse are much more negative than, for example, public attitudes towards people with mental ill health conditions; and that service users experience significant levels of stigma from professionals.  Such attitudes have the effect of deterring those with substance misuse problems from seeking help, and contribute to worse longer-term impacts for the people concerned and for wider society.

So, taking the above, and as asked for ahead of this year’s national Drugscope conference, here is my suggestion for the next Government.  I’ve tried to draw on recent RSA work, and give a non-obvious suggestion that could be adopted now, and that does not depend, for example, on attitudes to things that divide like the decriminalisation/legalisation debate.  There is much I would change to better join up different policy domains (particularly between substance misuse, mental health and prisons), and to drive more effective co-commissioning, but these issues sit in a wider debate about public service reform.  (You can read the RSA blog platform for ideas on public service reform.)  We have to better respond to the risks presented by new psychoactive substances.  I would make far better use of restorative justice in cases where use of illicit drugs has driven acquisitive crime, particularly if this is a means for the wrongdoer to become motivated to seek treatment.  And I would also take care to protect our successes in a forthcoming parliament that may see austerity take a bigger bite yet out of public expenditure.  While there is further to go, investment in substance misuse services has improved the choice of treatment, the timeframe in which it can be accessed, and has driven innovation. 

You may think the suggestion below is too abstract and beside the point.  For me, it speaks to some of the foundations upon which recovery is made possible.

Building our collective stock of empathic capacity

To address stigma, we need a greater, and more distributed empathic capacity.  In the short term, we might, for example, mobilise along the lines of the Time to Change campaign on mental health.  In doing so, we would need to clearly understand why stigma persists in different contexts: what is it that produces discriminatory and stigmatising attitudes and behaviour in different settings?  For the medium and longer-term, we should continue to grow the focus of public policy on early/childhood years.  Within this, we should question the way we teach Personal, Social and Health Education (PSHE) in schools.  There is currently a scattergun approach to this aspect of education, with insufficient thinking about how to equip young people with the skills, attitudes, values and capabilities necessary to succeed in the modern world.  As the RSA has argued, we need ‘schools with soul’.  PSHE (or rather Social, Moral, Spiritual and Cultural (SMSC) education) should be at the heart of a school’s curriculum and purpose, and address head on questions of inclusion, citizenship and community in relation to issues such as substance misuse.

As the RSA Chief Executive, Matthew Taylor, has argued, empathy is a core competency for modern citizens.  Developmental psychologist Robert Kegan suggests that a successful society with a diversity of values, lifestyles and experiences requires us to “resist our tendencies to make … ‘wrong’ or ‘false’ that which is only strange” to us and outside our own experiences.  Such an approach would not only help to create the conditions in which recovery is better supported, but would similarly support recovery from mental health, rehabilitation from crime, and so on.  It is a key part of valuing people as assets in a shared, interdependent society.

Political scientist Richard Dagger suggests that the job of the legislator should be to design the system to foster citizenship and move people towards collaboration.  Of course, in order to become the next Government, political parties should construct and communicate a compelling vision and account of what it is to be a UK citizen in a collaborative society, and use this as the basis and decision-making framework to design policy and programmes.  This is a vision that must be coherent; that speaks to both responsibilities and the rights of citizenship.  It must live and breathe in individuals and in the public consciousness, and act as a touchstone for how we consider what progress is and how we make it.  If recovery is about hope and about the participation in the rights, roles and responsibilities of society, there should be a realistic, compelling account of what they are, and how they extend to all of us.

Steve Broome is Director of Research at the RSA, and is on Twitter at @smbroome

Tuesday, 4 November 2014

10 things about alcohol and other drugs you may have missed over the last month

These slides are a way of capturing some of the interesting information about alcohol and other drugs that I come across in my reading.

As you'll see this month includes tax revenue from alcohol across Europe, mortality rates for lung cancer, daily doses of OST in Scotland, milligrams of methadone prescribed in Scotland, reasons given for refusing 'place of safety' under the Mental Health Act, calls to the NPIS about drugs, prisoners ability to access drugs and alcohol in England, absconders from prison, re-offending drug offenders in England

It should be clear where I've sourced the information from but if not (and you'd like to know) then do get in touch.

It is also worth saying that if there are any errors in the presentation they are almost certainly mine rather than the original authors.