A FRAGILE PICTURE Commissioning in an age of cuts - GOING VIRAL - Drink and Drugs News
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Drink and Drugs News
December 2020 – January 2021
ISSN 1755-6236
A FRAGILE
PICTURE
Commissioning
in an age of cuts
GOING VIRAL
A look back at a
tumultuous year
FACING UP
ADDRESSING THE IMPACT OF ALCOHOL MISUSE ON VETERANS AND THEIR FAMILIES
UPFRONT
IN THIS ISSUE
INSIDE
6
Drink and Drugs News is
published by CJ Wellings Ltd,
Romney House, School Road, 4 NEWS HAT success; risky drinking
Ashford, Kent TN27 0LT
t: 0845 299 3429 13 LETTERS Let’s stay positive
Editor: Claire Brown 13 PARLIAMENT Tackling homelessness
e: claire@cjwellings.com
Advertising manager: Ian Ralph 14 REVIEW OF THE YEAR Looking back
e: ian@cjwellings.com over an extraordinary 12 months
Reporter: David Gilliver 15 BILL NELLES on a small ray of optimism
e: david@cjwellings.com
Designer: Jez Tucker 16 I AM A... detox manager
e: jez@cjwellings.com
17 BOOK REVIEW The Wild Remedy
Subscriptions:
e: subs@cjwellings.com 17 GYPSY COMMUNITY Support from EDP
website: 18 CHRISTMAS REHAB Phoenix’s good cheer
www.drinkanddrugsnews.com ON THE COVER: Alcohol and veterans
Website support by 19 MY WISH for meaningful support
wiredupwales.com
10
Printed on environmentally Commissioners
friendly paper by the Manson must adapt to Treating school
Group Ltd an increasingly Alcohol education children as criminals
Cover by: Eden Breitz / Alamy fragile picture for the over-50s is a recipe for disaster
8 12
CJ Wellings Ltd does not accept
responsibility for the accuracy
of statements made by
contributors or advertisers.
The contents of this magazine
are the copyright of CJ Wellings
Ltd, but do not necessarily
represent its views, or those of
its partner organisations.
PLEASE GIVE US YOUR FEEDBACK! ‘There are much-needed
‘DDN has its finger on the pulse of glimpses of hope’
drug and alcohol treatment and the Our news in this issue leads with the positive results of the heroin
wider context... keep on keeping on!’ assisted treatment pilot in Middlesbrough – a scheme whose
dramatic impact has resulted in funding to evaluate it, and which
We love reading your feedback and will hopefully encourage further roll-out. These are the moments
suggestions – please fill in our readers’ we must look for in a terribly difficult year. Our review of the last
12 months (p14) reminds us of the painful decisions and swift
survey at www.drinkanddrugsnews.
adaptations we all had to make – but it also tells the story of services
com/ddn-readers-survey-2020/ rising to the challenge and gives much-needed glimpses of hope.
There are many opportunities ahead, particularly through
DDN is a self-funded independent publication. Our bespoke partnership packages provide partnership working. Adfam and the Forces in Mind Trust have
an opportunity to work closely with the magazine. Please get in touch to find out more. been finding ways to support veterans and their families (p6),
answering a massive need that’s been flagged up for so long in
our sector. Alcohol Awareness Week has galvanised services from
all over the country to educate and inspire for the common cause
(p8). And a parent’s concern about a school’s approach to drugs is
an invitation to comment on this fundamentally important matter
(p12). We’ve also focused on the vital process of commissioning
(p10), with an invite to join the debate.
A heartfelt thank you to those of you
who have already completed our readers’
survey. If you haven’t yet, please do!
Season’s greetings and all the very best.
Claire Brown, editor
Keep in touch at
www.drinkanddrugsnews.com
and @DDNmagazine
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 3
NEWS ROUND-UP
Middlesbrough HAT pilot has
‘dramatic impact’
T
he Middlesbrough of diamorphine under supervision,
heroin assisted and have access to agencies that
treatment (HAT) pilot can help with health, housing and
launched last year financial issues. Analysis of six
(DDN, November 2019, participants who have spent at
page 5) has had a ‘dramatic impact’, least 30 weeks on the programme
according to the programme’s found a 98 per cent attendance rate
clinical team lead Daniel Ahmed. for the sessions, even throughout
Teesside University has now lockdown, while offending
been given a £60,000 grant to levels have plummeted. The six
www.gazettelive.co.uk
independently evaluate the scheme participants had committed more
and its results. than 540 detected crimes before
The HAT pilot, the UK’s first, was joining, which has since fallen to a
launched to tackle high rates of combined total of three lower-level
street drug deaths and drug litter, offences.
remove the health risks associated The scheme, which has been
with street heroin, and divert licensed by the Home Office, was
people from acquisitive crime
and offending behaviour. Since its
launched and partly funded by
Cleveland PCC Barry Coppinger
of Teesside University, Professor
Graham Towl of Durham University
‘This is not a soft
launch, 14 people for whom all using money seized under the and Dr Magdalena Harris of the option, it’s a smart
other treatment had failed and Proceeds of Crime Act, with London School of Hygiene and
were causing ‘most concern’ to further funding from Durham Tees Tropical Medicine. Of the original option.'
criminal justice and health and Valley Community Rehabilitation 14 participants, one left voluntarily
DANIEL AHMED
social care agencies have been Company. The new research will and two left after committing a
accepted on to the programme. look at the experiences of people crime, while treatment had to be
Some had been using heroin for who have ‘completed, discontinued stopped in four cases for medical
more than 20 years. or refused to engage’ with the reasons. The remaining seven are said Ahmed. ‘What we are doing is
Participants visit a clinic twice programme, and will be carried still receiving treatment. ‘This is not following an evidence base that is
a day to receive a prescribed dose out by Professor Tammi Walker a soft option, it’s a smart option,’ producing results.’
A week’s units for ‘Historic victory’ in Oregon
‘price of a coffee’ THE DIVISIVE US PRESIDENTIAL ELECTION
also saw Oregon become the first state
tax and savings from not processing
people through the criminal justice
to vote in favour of decriminalising system. Anyone arrested for offences
DRINKERS IN ENGLAND can consume their entire weekly possession of small amounts of all drugs related to drug dealing will still be subject
guideline amount of alcohol for the price of a coffee, for personal use. to criminal prosecution.
according to research from the Alcohol Health Alliance. The state’s electorate voted ‘yes’ to The initiative had been launched by
The alliance visited shops and supermarkets across Oregon Measure 110, which supports advocacy group the Drug Policy Alliance,
the UK and found that the cheapest drinks were all making ‘personal non-commercial which called the result a ‘historic victory’, a
in England, where no minimum unit price has been possession of a controlled substance’ ‘monumental night for drug policy reform’,
introduced. ‘It is possible to drink the low-risk weekly – including heroin, cocaine and and ‘arguably the biggest blow to the
guidelines of 14 units for just £2.68 – about the price of methamphetamine – subject to no more war on drugs to date’. The vote confirmed
a cup of coffee in many high street chains,’ the alliance than a $100 fine, as well as establishing ‘a substantial shift in public support’ in
states. Beers, wines and spirits were all on sale in London a treatment and recovery programme favour of treating drug use as a health
branches of Aldi and Lidl for between 31 and 38p per financed in part by the state’s marijuana rather than criminal issue, it said.
unit, while cider remains the cheapest product – available
for as little as 19p per unit. The minimum unit price in OREGON is the first US State to decriminalise drug possession. Measure 110 makes
Scotland and Wales is 50p. it a noncriminal violation (similar to a traffic offence) to possess:
A YouGov survey carried out in October found that 56 • Less than 1 gram of heroin • Less than 40 units of LSD
per cent of the public would support an increase in alcohol • Less than 1 gram, or less than 5 pills, • Less than 12 grams of psilocybin
taxes if the money was used to fund services impacted by of MDMA • Less than 40 units of methadone
alcohol, such as the NHS and police. While alcohol duty • Less than 2 grams of • Less than 40 pills of oxycodone
raises between £10bn and £12bn per year, PHE estimates methamphetamine • Less than 2 grams of cocaine
the annual cost of alcohol-related harm at £27bn.
4 • DRINK AND DRUGS NEWS • DECEMBER 2020 – JANUARY 2021 WWW.DRINKANDDRUGSNEWS.COM
News DDN EVERY DAY
All the news, updated daily
www.drinkanddrugsnews.com
More than half of over 50s Local News
drinking at risky levels
M
ore than 50 per of at least one parent since March.
cent of over 50s ‘We know that life changes such as
are drinking at bereavement, retirement and a lack
levels that ‘could of purpose have led to older adults
cause health drinking more in recent years while
problems now or in the future’, younger generations are drinking Higher learning
according to research commissioned less,’ said head of the Drink Wise, RCPsych’s ‘higher trainee of
by With You (We Are With You), Age Well programme at With You, the year’ award has gone to
while almost a quarter are classed Julie Breslin. ‘Nearly 80 per cent Dr Emmert Roberts at the
as ‘high risk or possibly dependent’. of over 50s we work with drink at National Addiction Centre.
The findings have been released as home alone, hidden from view. It’s ‘Addiction psychiatry is a
the charity launches a free helpline
for anyone over 50 who may be
clear from these findings that the
necessary coronavirus restrictions
'Coronavirus subspecialty on the brink
of extinction,’ he said,
worried about their drinking. Using have exacerbated these issues restrictions have and hoped the award
a validated screening tool, the whilst having a big impact on older helped RCPsych advocate
survey of 1,150 people also found adults’ mental health.’ exacerbated these ‘for funding parity for the
that more than 4m over 50s were
binge drinking at least once a week
Meanwhile, Change Grow Live
has developed a short online quiz
issues whilst millions of patients with
drug, alcohol and tobacco
during lockdown. Almost 2m stated to help people find out if they are having a big impact addiction in the UK’.
that lockdown had led to them drinking dependently and the kind List of winners at
drinking earlier in the day, while of support they are likely to need, on older adults’ www.rcpsych.ac.uk
mental health.'
more than 5m said that restrictions as well a free webchat service. ONS
had led to them drinking alone. estimates suggest that the total Light work
People aged over 55 are already number of people drinking more JULIE BRESLIN The Blue Light project has
the group most likely to drink at than the recommended guidelines now worked with more
hazardous levels, the charity points increased from 4.8m to 8.4m than 70 local authorities
out. More than 1.3m over 50s said during the first lockdown. ‘It is now and is looking to engage
the second lockdown would lead to essential that the government acts implications for public health will be with more to help develop
them drinking ‘even more’, however. to address this increase in higher disastrous’ their responses to change
As well as the effects of lockdown risk drinking,’ said Change Grow Live • Helpline at 0808 8010750. resistant drinkers.
on drinking habits and mental executive director Nic Adamson. • Alcohol quiz at www. Contact Mike.Ward@
health, the research also reveals its ‘Unless we have the capacity to changegrowlive.org/advice-info/ alcoholchange.org.uk
impact on families, with one in three reach and support over 3m more alcohol-drugs/alcohol-drinking-
people whose parents are over 50 people who are now identified as levels-quiz-self-assessment
worried about the drinking habits high-risk drinkers, the long-term • See feature page 8
Military mindset ACMD: Reclassify GHB
MORE THAN 70 PER CENT of serving and ex-service GHB, GBL AND RELATED COMPOUND 1,4-BD should
personnel with an alcohol problem have not sought be reclassified as class B substances, the ACMD has
help, according to a Forces in Mind Trust report by stated in a letter to home secretary Priti Patel. She had
the University of Liverpool and King’s College. Only written to the ACMD earlier this year requesting an Key lessons
half of those who met the criteria for alcohol misuse urgent review of GHB’s classification following high A full evaluation of
even recognised that they had a problem, it adds. profile cases in which it had been used to facilitate London’s Homeless Hotel
‘We know that military personnel are more rapes and murders (DDN, February, page 5). Drug and Alcohol Service
likely to experience alcohol problems than the However, classification and scheduling on their (HDAS) (DDN, September,
general population and this report has established own are ‘unlikely’ to be sufficient to significantly page 6) – established
that a large proportion of those with a problem do reduce the harms associated with GHB and related to provide support to
not seek any help,’ said Dr Laura Goodwin of the substances (GHBRS), the commission states, and calls people in emergency hotel
University of Liverpool. ‘One reason for this is due for improved monitoring and reporting of levels of accommodation during
to low recognition of alcohol problems, which may use. the pandemic – has been
be driven by heavy drinking being normalised in a There also needs to be better integration of drug published, including
military context. We need to do more to address treatment and sexual health service commissioning guidance for future
the stigma around alcohol problems and to support to tackle the harms associated with GHBRS use, it provision. Lessons learned at
those who require support to access it.’ Help seeking says, as well as measures to ensure that services are https://osf.io/7cdbx/
for alcohol problems at www.fim-trust.org/reports/ accessible and non-exclusive.
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 5
VETERANS
The home front
Despite high levels of
problematic substance
use among ex-services
personnel, the ingrained
forces mentality can mean a
reluctance to seek help – something
that also extends to their families,
says Robert Stebbings
W
hilst the done so for many years, and
majority unsurprisingly this can translate
of serving to alcohol dependency amongst
personnel former members of the armed
successfully forces in subsequent years, whilst
transition out of the forces and issues around drug dependency
back into civilian society, sadly also exist.
it is also the case that many Such substance use problems
veterans encounter difficulties rarely exist in isolation and the
with substance use. Alcohol presence of a number of co-
consumption plays a significant occurring problems, such as mental
role in military culture, having health, violence/abuse, criminal
Force for change
We need to better serve
those who’ve served,
says Ray Lock
B
ack in the eighties, forces in the 2020s though has
I was based near changed – most are based in the
Düsseldorf as one of UK and increasingly they and their
around a hundred families are integrated into local
thousand members communities. Alcohol use has
of British Forces Germany. Friday certainly fallen, and the Ministry
night was happy hour – although of Defence has been trying for
it carried on until midnight. some years to lower consumption
Saturday night was often a formal among its people via health
dinner, and Sunday a jazz lunch. strategies. Sadly, a recent initiative
Long before it became popular to introduce an annual check has
in the UK, Warsteiner lager had been suspended due to COVID-19,
gained the nickname ‘wobbly’ for although the ministry’s intent is
Edward Dyer / Alamy
the effect it had the morning after. clear. But the steps taken so far fall
Alcohol was tax free, the only well short of those recommended
drugs taken were Brufen and life by the Commission on Alcohol
was good (if you discounted the Harm. When I ran a large base in
threat of nuclear Armageddon). Wiltshire, we had over a hundred
Life for members of the armed separately licensed bars selling
6 • DRINK AND DRUGS NEWS • DECEMBER 2020 – JANUARY 2021 WWW.DRINKANDDRUGSNEWS.COM
behaviour, and employment/ ‘There was just individuals leave the armed forces to examine how it could fit within
financial difficulties, add further and that this can cause problems their work, to provide evidence-
complexity. These problems – and nobody I could go for veterans and, therefore, their based targeted support to this
their cumulative and longstanding families. Furthermore, we were important group of families.
nature – can also have a significant to; I just had to told about stoicism amongst
and sustained impact on veterans’
families. kind of live that military personnel and how they
are expected to be strong and
This article is based on Fighting
their own battle, a new research
Over the past year we’ve been
speaking with families of veterans
life... I couldn’t infallible, and should not expose,
or ask for help with, vulnerabilities
report outlining the experiences of
families of veterans with substance
with substance use problems tell people that and problems. This mindset of not use problems (FVSUs), along
(FVSUs) across the country, and being open about problems, and with a support model designed
through their testimonies have was the life I was hence being unwilling to come specifically for FVSUs. This work was
learnt how they can be profoundly forward for help, extends to the funded by the Forces in Mind Trust
affected by their loved ones’ living.’ families too. and delivered by Adfam and the
drinking and drug problems, ‘There was just nobody I could University of York.
experiencing high levels of isolation go to; I just had to kind of live that Thank you to the many FVSUs
and loneliness, yet rarely appearing However, we now know there life... I couldn’t tell people that across the country who took the time
to access support for themselves. are a number of ways that the that was the life I was living’ (FVSU to share their experiences so openly
‘I became anxious and lost experiences of veterans’ families research participant). and honestly, particularly those on
a lot of weight as I was stressed differ to those of civilian families, Specific support for FVSUs is our project advisory group, and also
and worried. I was tearful and and certain characteristics of sparse, and of the support that is to the Forces in Mind Trust for their
frustrated all of the time and military culture play a particularly available, many aren’t aware of vital support in helping us deliver this
worried what would happen to me influential role in how this specific how or where they can access it. work and our project partners Bristol
and my children’ (FVSU research group of families are affected. Opportunities to engage FVSUs Drugs Project, HMP Parc, SSAFA and
participant). In addition to heavy and when serving personnel and Tom Harrison House.
Through our work at Adfam frequent use of alcohol, there veterans access help are also often You can find out more about this
we know all about the challenges is also the ‘fighting mentality’ missed. Based on the findings from research and download the research
families affected by substance instilled into serving personnel this research, we have developed a report in full along with the support
use face day-to-day – fear, abuse, from the start of their training. It holistic, multi-component support model on Adfam’s website.
stigma and mental health was felt that not enough is done model to address this and would Robert Stebbings is policy and
problems to name but a few. to address this mentality when encourage all support organisations communications lead at Adfam
beer at half the commercial price –
hardly what the commission wants.
Those dangerous habits of
alcohol misuse, developed during
‘Those dangerous are unlikely to form during service.
A single transgression will almost
So the relationship members service and masked to an extent by habits of alcohol always result in discharge, as
of the armed forces have with institutional encouragement and between 600 and 770 serving
alcohol remains problematical, a generally fit population, are not misuse, developed personnel find out each year,
which is why we at Forces in shed with the uniform. We know, but their treatment requires
Mind Trust funded Fighting their again from the evidence, that the during service improvement. Our research
own battle, the University of
York’s study, with Adfam, into the
proportion of serving personnel
with damaging levels of alcohol
and masked to project Fall out – the impact of a
compulsory drugs discharge with
support needed by families of ex- consumption is significantly an extent by Galahad SMS Ltd will report shortly.
service personnel with substance greater than the civilian equivalent, Evidence is clear that the
misuse. It’s useful to recognize and the same holds true for the institutional successful transition of a veteran
that the armed forces aren’t veterans population. is a successful transition for
anywhere near as homogenous as This mixture of ingrained encouragement their family too. We speak about
an observer might think. From day
one, alcohol is used to overcome
habits, an avoidance of help
seeking and an easy retreat (at and a generally ‘holistic’ transition a lot, and we
apply the same to any support
social inhibitions, provide an
acceptable environment in which
least whilst under the influence)
from daily reality, provides a fertile
fit population, are that’s offered – which is why the
joined up and wraparound family
to let off steam, and to bond. ground for a downward spiral. not shed with the force support model is so exciting.
Our research consistently shows Families are likewise affected, It needs modest additional
that when it’s time to leave, most where the barrier between uniform.’ resource, but much greater
serving people successfully make relatives and the veteran built connectivity, such as between local
the transition into civilian life. during service as a means of services and the ‘veterans gateway’.
For some though, the absence protection can remain in place greater, the alcohol misuse Becoming veteran aware would
of shared values, recognizable during tough times. Where the more severe and the chances of be a great first step forward towards
structure and comradeship, veteran has comorbid conditions, successful transition reduced. helping those who have served their
together with a less-rewarding for example mental ill health, A word on drugs. The armed country, and those they love.
professional life and diminished or there are other issues such forces operate what amounts to Ray Lock CBE has been chief
personal pride, can build a barrier as domestic violence, then the a zero-tolerance policy for illegal executive of Forces in Mind Trust
to that successful transition. barriers are higher, the stigma drug use, and habits or addictions since 2012
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 7
ALCOHOL AWARENESS
Wise Up
With awareness of the damaging effects of alcohol
still nowhere near where it should be, DDN looks
at some recent attempts to educate the public
about the risks most of us still tend to ignore
T
he third week of last per cent level, depending on which COVID-19 lockdowns on people’s A YouGov survey commissioned
month was Alcohol survey you look at, with awareness drinking habits, the need has by Turning Point found that more
Awareness Week, of the links with conditions like arguably never been greater to make than one in ten people who
which this year high blood pressure and heart sure people are armed with as much experienced loneliness were turning
took the theme of disease also remaining low. knowledge as possible. to alcohol to cope (DDN, March,
alcohol and mental None of this is helped, of course, page 5), while new research from
health (DDN, November, page by the fact that self-regulation COPING MECHANISMS With You (We Are With You) has
5). While the long-established means that inclusion of health risk And that impact seems to have revealed that more than 4m over-
week complements other annual information on alcohol labelling been significant. More than a 50s were binge drinking at least
initiatives like Dry January and is still voluntary, and the industry quarter of drinkers said they drank once a week during lockdown (see
Sober October, the public’s has in the past even been accused more during the first lockdown, news, page 5). The same survey
awareness around alcohol remains of deliberately misrepresenting with half of this group saying found that 5.2m over-50s were
stubbornly low. the evidence about alcohol-related they’d probably keep drinking drinking alone because of the
When the government launched cancer risks (DDN, October 2017, at the same levels after it lifted restrictions, with 1.9m drinking
its consultation on labelling all page 4). What’s more, there hasn’t (DDN, July/August, page 5). And earlier in the day.
alcohol products with calorie been a new UK alcohol strategy for lockdowns have significantly While it’s long been apparent
information it was revealed that almost a decade, and it’s unlikely exacerbated existing problems of that many older people increase
despite 3.4m people consuming to be near the top of the list of loneliness and isolation, both of their alcohol consumption as a
an extra day’s worth of calories government priorities anytime which can mean people increasing result of things like retirement and
each week in the form of alcohol, soon. With the added impact of the their alcohol intake. boredom, it’s clear that lockdowns
around 80 per cent
of the public were
unaware of the
calorific content
of their drinks
(DDN, October,
page 4). And while
most people
probably know that
excessive drinking
can cause liver
damage, awareness
levels of the links
between alcohol
use and cancer
tend to hover
Change, Grow, Live alcohol advice quiz at www.changegrowlive.org
around the 10-13
8 • DRINK AND DRUGS NEWS • DECEMBER 2020 – JANUARY 2021 WWW.DRINKANDDRUGSNEWS.COM
‘We did a survey...
about five years
ago of nearly
17,000 people and
identified things
like loss of sense of
purpose as factors
that led to increased
alcohol use for
people over 50...
What we’re seeing
is that those
Dmytro Zinkevych | Dreamstime.com
similar factors as a
result of lockdown
are significantly worsening these
problems, as head of With You’s
age-inclusive. So the helpline is very
much about being as accessible as
stating that unless the government
acts to address the recent increases
– loss of routine
Drink Wise, Age Well programme,
Julie Breslin, tells DDN. ‘We
we can for people who maybe want
to start having that conversation
in people drinking at risky levels the
long-term implications for public
and, very sadly for
did a survey at the start of the about changing their alcohol use.’ health would be ‘disastrous’ (see some, bereavement
programme about five years But even among those who news, page 5).
ago of nearly 17,000 people and have already accessed treatment Alcohol Awareness Week also – are going to make
identified things like loss of sense
of purpose as factors that led to
COVID-19 restrictions are having
an effect, with a peer-led survey by
saw Turning Point organise an
online forum focusing on areas
that a lot worse for
increased alcohol use for people Kaleidoscope finding that 34 per such as mental health and alcohol’s people.’
over 50,’ she says. ‘What we’re cent of dependent drinkers receiving effects on relationships and loved
seeing is that those similar factors support in Wales had relapsed ones, as well as sharing additional JULIE BRESLIN
as a result of lockdown – loss of during first lockdown. content on the Recovery News
routine and, very sadly for some, Channel with videos from Swindon
bereavement – are going to make RAISING AWARENESS & Wiltshire IMPACT and its Leicester,
that a lot worse for people.’ There is still a huge amount of work Leicestershire and Rutland ‘Dear a strategy that’s much more
to be done in terms of getting vital Albert’ services. The charity also focused on human rights and
REACHING OUT health information out there, Breslin used its Twitter account to highlight health promotion,’ says Breslin.
In response, With You has launched stresses. ‘That level of awareness different aspects of its available ‘When you look at the Scottish
a free, national and confidential around wider health conditions support throughout the week. strategy compared to the UK’s it’s
over-50s alcohol-specific helpline, really needs to be increased. People ‘It is estimated that 82 per really focused on recovery, rights
available seven days a week. The very much think of alcohol in cent of dependent drinkers are and respect. I think we need to
idea was partly to try to reach out relation to liver disease, they don’t not in treatment and that hospital have much more of a focus on the
to people who would normally think of the other factors – cancer, admissions due to alcohol have risen issues that people are actually
be unlikely to consider accessing heart disease, dementia, cognitive almost a fifth in the last decade,’ experiencing, whereas up until
treatment services, she says. ‘We impairment. People need to said Nat Travis, Turning Point’s the now the strategy has very
already know that only about one understand the wider implications.’ national head of public health and much been around the criminal
in five people who are alcohol- Change Grow Live has now substance misuse. ‘There is still a justice side of things. Obviously,
dependent are in treatment anyway, launched a short online alcohol long way to go, but occasions like regulation is crucial – things like
and we feel that would be even less advice quiz to provide people Alcohol Awareness Week are a great MUP – but what I would like to see
as people get older. There are more with fast and accurate evaluation opportunity to open up the dialogue is a much more compassionate
and more barriers to treatment of their drinking and the kind of and start making changes.’ strategy.’ DDN
as we age, which is down to lots support they might need (www.
of things – individual stigma, changegrowlive.org/advice-info/ RECOVERY, RIGHTS AND RESPECT Next issue: Mike Ashton looks at
system-level stigma, and ageism. alcohol-drugs/alcohol-drinking- So when an alcohol strategy does ‘controlled drinking’ and some of
We really need to look at the design levels-quiz-self-assessment), with finally come along, what should the most controversial studies seen
of our services and whether they’re executive director Nic Adamson be in it? ‘What I’d like to see is in alcohol treatment
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 9
COMMISSIONING
‘T
here are many
of us working
A FRAGILE
in isolation
with growing
portfolios
beyond drugs
and alcohol.’ Niamh Cullen is giving
her perspective of the challenges
PICTURE
faced by commissioners. As a public
health manager in Halifax, she is
balancing the increased workload
with ever-dwindling resources. ‘It’s
not the time to be fixed to service
specs,’ she says. ‘We need to work in
an agile way to adapt to continuous
change.’
Cullen and her fellow
commissioners in England are no
strangers to the need to adapt.
In 2013, the NTA was merged
into Public Health England and
drug and alcohol budgets were
transferred to local authorities,
controlled by directors of public
health. Since then, the landscape
has shifted beyond recognition as
services fight for survival and vie
for priority. Commissioning with a
‘client centric’ approach has meant
thinking creatively about ways
to stay ahead of the countless
challenges.
Many of the trusted partnerships
have been dismantled through
this period of change, she points
out. Furthermore, a great deal of
back office resources have had to
be sacrificed to prevent further
cuts in services. Cullen has joined a
growing network of commissioners
from different parts of the country
who are trying to energise the
commissioning process and harness
mutual support.
Chris Lee, a public health
specialist in Lancashire, is one
of the enthusiasts behind this
initiative and a founding member
of The English Substance Use
Commissioners Group (ESUCG),
formed earlier this year as a forum
for commissioners (DDN, June,
page 11). While the coronavirus
pandemic has dominated most of
the year, the idea behind the group
Commissioning is struggling under will drive it beyond the immediate
crisis. It’s a ‘safe space’, he says, ‘to
relentless rounds of cuts. DDN learn together and develop best
Photomontage: JellyPics
hears about the need to collaborate
practice for the years ahead, taking
into account all that the sector and
to keep clients moving forward
local government has been through
in the last seven years or so.’
The lack of formal mandated
structures has left commissioning
fragile in some parts of the country,
10 • DRINK AND DRUGS NEWS • DECEMBER 2020 – JANUARY 2021 WWW.DRINKANDDRUGSNEWS.COMand it’s a picture the group wider approach across the health,
wants to change. ‘Partnership social care, housing and education
involvement and relationships can sectors to meeting the needs of
be hit and miss between different people using substance misuse
areas, which doesn’t seem fair on services. ‘We aim to design services
people who need support,’ says Will around people,’ she says, and this
Haydock, senior health programme involves ‘trying to improve the
advisor at Public Health Dorset. The pathway for people using services
group is devising a workplan, but is through joint commissioning for
‘Trust is key, ‘When I joined
waiting for the recommendations outcomes and exploring looking
of Dame Carol Black’s review (DDN, at how best to align provision
July/Aug, page 5) to avoid any
duplication or inconsistency.
alongside mutual throughout the system.
‘As commissioners we are
Southwark, when
They are, however, certain that respect and always trying to balance the the PCT still
their plan will focus on developing challenge of providing effective,
best practice and workforce skills in equality, and it’s high-quality, evidence-based, existed, there were
all different areas – including tier joined-up treatment and support,
4 (both detox and rehab), criminal important to with the longer-term vision of 11 people between
justice commissioning, and
complex needs. Reducing drug- and
include everyone, prevention,’ she says. ‘We take a
public health approach but there’s
the DAAT and the
alcohol-related deaths will be at
the top of the agenda.
the sub-contracted always more we can do… it would
be really useful to discuss these
PCT, doing the
smaller providers challenges with commissioners functions that two
BEST PRACTICE from other areas of the UK to learn
One aspect of commissioning that too.’ from each other.’ of us now do.’
comes through very strongly in
the ‘best practice’ conversation
NIAMH CULLEN DAAT RETENTION IAIN GRAY
is the need for it to be a natural The London borough of Southwark
part of the public health agenda. has retained a drug and alcohol
The ESUCG talk about how drugs further improve outcomes.’ team (DAAT) structure, which Wirral easier than getting them on
and alcohol issues should be Commissioning of substance gives the team a clear remit to a bus up to City Roads? No, it’s not.
everybody’s business, permeating misuse services in Wales is the commission treatment and support It’s so obvious.’
into all areas of social care, responsibility of area planning services related to this client group. Despite the many challenges,
education and all aspects of life. boards, and these are made up The enormous challenge related to connections with local treatment
Networking right across the of members of the ‘responsible this is that their budget has been services are still strong and
sector is key to this, says Niamh authorities’ which form the severely reduced. essential to putting service
Cullen, and making sure that community safety partnerships in ‘When I joined Southwark, users first. ‘We collaborate and
substance misuse services are linked Wales. The area planning boards when the PCT still existed, there consult heavily in the design
into primary care networks and local also have responsibility for providing were 11 people between the DAAT of services,’ says Gray, which
developments and are on the ‘front strategic leadership to deliver the and the PCT, doing the functions influenced them to invest in a
foot’ of what’s happening locally. Welsh Government’s substance that two of us now do,’ says Iain dynamic purchasing system for
‘Trust is key, alongside mutual misuse strategy across their regions, Gray, a commissioner with 15 commissioning residential rehab
respect and equality,’ she says, ‘and and so commissioning decisions years’ experience. Partnership and residential detox services– a
it’s important to include everyone, are made taking into account both working was easier with a larger flexible framework that’s working
the sub-contracted smaller the long-term vision of prevention, team, but with only two people, well to match clients to services
providers too. We need to share risks and the current needs of a region’s partnership working is an area that around the country. ‘We took on
– sometimes big ones, particularly population. has suffered. board what our local services said
working in an environment of ‘With the cuts, you look at it on and their experiences previously
contract extensions.’ PARTNERSHIP paper and try to make sense of it. with dynamic purchasing systems
A strong relationship between Partnership decision-making is We have cut X, Y and Z as they’ve to make sure we didn’t make the
commissioners and providers at the core of the commissioning asked us to, but they still come same mistakes,’ he says.
increases capacity for strategic process, and there are close back for more,’ he says, knowing As with colleagues all over the
work, says Cullen. The other relationships with Welsh that it will keep getting worse. country there’s a weary acceptance
essential partners are of course the Government, explains Eleri Probert, He worries particularly about the of a difficult climate but a strong
service users, and the group is keen a commissioning programme vulnerable clients who are bearing will to push through to get the
to talk about co-production rather manager. The benefits of this have the brunt of local services being right result for those who will
than service user involvement to been seen during the COVID-19 sliced away. ‘When I started there most feel the impact. As Gray says,
make sure it is never tokenistic. pandemic: the Welsh Government were seven or eight detox units in ‘Everything in the garden isn’t
‘The task is ensuring that co- responded promptly to local London – there is now one, for the rosy, but we are determined to get
production is common practice, clinicians seeking to expand a pilot whole of London,’ he says. ‘That clients’ needs met.’ DDN
and we should focus on how that of long-acting buprenorphine by doesn’t mean that we don’t use
is embedded rather than on service investing in a rapid national roll- other detoxes outside of London, This article has been produced with
user involvement,’ she says. ‘We out, with positive results. but for complex clients who have support from an educational grant
hope to move to a dynamic and The Welsh Government’s public poor mobility, poor motivation, is provided by Camurus, which has not
co-produced service specification to health perspective requires a much sending them on a train up to The influenced the content in any way.
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 11EDUCATION
LEAVE THEM KIDS ALONE
Treating school children like criminals is not Our kids deserve care and
understanding if and when they
a sensible or constructive approach to drugs begin to explore things that can
be dangerous – not sniffer dogs or
education, says Andria Efthimiou-Mourdant searches. Whenever I was leaving
the US from drug policy reform
‘G
conferences, fellow reformers
ive our kids accurate police station is not acceptable. would say to me, ‘Andria, tell your
information about They have been through enough people not to look west for drug
drugs, both pros this year. But what can we actually ‘With the Golden policy or education.’ How ashamed
and cons, and let do, when the legislation allows do I now feel, watching the UK
them make up their schools to carry on like this? Age of Harm slowly become the close cousin in
own minds about drugs.’ That was Here’s something to consider the drug war. Indeed, some parts
the mantra re drugs education for – the children concerned are Reduction of the US are a lorryload more
young people in the 1990s, right?
Here we are in 2020,
already becoming defiant, angry
and rebellious. ‘They should be at
behind us and progressive than we are now
All I – and I think, all – child
undergoing the most stressful that age,’ I hear you say. Rebellious a conservative carers want is for our kids to be
time the UK has seen with a right and adventurous, yes. Furious and safe, happy and well.
wing and apparently incompetent defiant has the danger of wrecking version of it My poor mum didn’t have a
embedded in our
government, and the legislation is their time in school and, ultimately, clue what to do. She certainly did
such that our children can now be their mental health. Indeed, one not know drugs, though she did
temporarily excluded for the mere
possession of tobacco, never mind
of the girls is complaining of
‘causeless’ anxiety.
corporate drug love me, and one day asked, ‘If I
give you 50p, will you get me one
anything illegal. I dared to mention some services, kids are of those LSDs?’ Her way of saying
What on earth has happened in of this in a meeting where a I accept you, no matter what. And
these 27 years? With the Golden Age school governor was present and regularly being I truly believe that is why I am still
searched at school.’
of Harm Reduction behind us and a complained that the only thing the alive today, having survived heroin
conservative version of it embedded teachers seem to care about is high addiction and two viral strains
in our corporate drug services, kids grades and results. Even the kids of hep. Ultimately, I knew I was
are regularly being searched at are dangerously aware of that, so and ask them if they have thought cared for.
school. In one London school – and their self-worth is diminished. about the impact of treating our The schools will say, ‘We need
the legislation allows it – three If you’re still reading this, I’m children like mini criminals before to stamp it out before it spreads.’
13-year-olds had their bags searched guessing you’re the parent, carer they even have a chance to learn. Unlike COVID-19, drug use is not
recently. Indeed, they were taken or guardian of adolescents in the Thousands of young people explore transmissible, but it does thrive in
Photomontage: JellyPics
out of their classes and marched UK, so let’s do something about some drugs and thankfully, the vast punishing environments. If you are
to the deputy head who searched this. There must be something majority do not end up with drug a guardian, parent, and wish to get
their property in front of them. They we can do to stop the relentless, problems. But if you are a vulnerable talking about how we educate and
happen to be kids I know: smart soul-destroying drug war from child in these circumstances you care for our kids, please email me at
lovable and cheeky ones destroying our own children. will turn increasingly to drugs as andriae4@gmail.com
Treating our children like you Hundreds of us could write to our you lose faith in the ‘trusted adults’ Andria Efthimiou-Mourdant is a
would a suspected criminal at a MPs and local education authorities around you. health campaigner and activist
12 • DRINK AND DRUGS NEWS • DECEMBER 2020 – JANUARY 2021 WWW.DRINKANDDRUGSNEWS.COMLETTERS AND COMMENT HAVE YOUR SAY
Write to the editor and get it off your chest
claire@cjwellings.com
‘If COVID-19 has shown
us one thing, it is that low
threshold, evidence-based
harm reduction interventions
remain something we can
still provide with a level of
specialism’
OPPORTUNITY KNOCKS LET’S LOOK AHEAD
It was heart-warming to read the positive
Reactions to the pandemic have opened statements from the leadership across our sector
in response to the appalling latest ONS drug-
doors for action on homelessness, heard the related death statistics as this year draws to a
parliamentary group close (DDN, November, p18). What struck me about
the individual responses was the same message
G
entrenched throughout: the need for us to continue
iven the situation with enabled them to work on other issues and to follow the evidence in doing as much as we
COVID-19 it could be easy gradually build recovery capital. can, and continuing to provide easily accessible
to forget the underlying With more than 100 services in the and low-threshold, evidence-based interventions
picture of homelessness in UK based on Housing First principles and to a wide range of people – often with multiple
the UK, Matt Downie, Crisis’s around 2,000 individuals accessing them, and unresolved traumas or social and economic
director of policy and external affairs, told the initiative was central to achieving the disadvantages that more often than not carry
the December Zoom meeting of the Drugs, government’s commitment to end rough incredible risk in how people are forced to live.
Alcohol & Justice Cross-Party Parliamentary sleeping by 2024. Its success required a For a moment I could almost envision the
Group. multi-agency approach to provide the full headlines of the next UK strategy leading with:
Since 2010 there had been a steady range of support and this was emphasised Follow the evidence, change or abolish antiquated
increase in people facing all types of by Tom Sackville and Craig Middleton from laws, level up and invest in treatment, while
housing issues in England, with 300,000 WDP. A safe, secure place to live was a basic making sure we offer service users the equality of
homelessness applications representing an tenet of the hierarchy of needs, without opportunities we would expect for ourselves and
unprecedented demand on local authorities. which it was difficult to engage with drug our families.
Street homelessness had benefited from treatment services. They called for increased If COVID-19 has shown us one thing, it is that
being the focus of several initiatives which, outreach services that offered a full range low threshold, evidence-based harm reduction
while they were very welcome, often hid of harm reduction provision, a change to interventions remain something we can still provide
the problem through people moving into prison release practices and a drive to tackle with a level of specialism, unlike any other health or
hostels and resorting to ‘sofa surfing’. the stigma faced by homeless people. social care provider – while still improving upon the
There had been a number of temporary Alongside drug treatment, Humankind delivery as a collective with a mutual passion and
measures during the pandemic including provided supported housing through several insight. This has been demonstrated this year in the
a ban on evictions and the ‘Everybody In’ schemes including Red Bank in Manchester sector’s solidarity, flexibility and attitude.
initiative, as well as small uplifts in funding and the Greens in Sheffield – abstinence- With services maintaining open access in the
to local authority housing allowance and based environments where residents could majority of instances and new low-threshold
universal credit. While helpful in England access services including one-to-one life skills, innovations such as NSP direct, it’s obvious that
in the short-term, a joined-up solution was support, and group recovery sessions. Steve together we can do much more of the same in the
needed to tackle the problem. New policies James of Humankind explained how they challenging year ahead with a refocus on harm
in Scotland had almost eradicated rough encouraged residents to begin volunteering reduction approaches that have stood the test of
sleeping and led to permanent closure of and move into peer mentoring positions; both time.
night shelters in favour of a ‘housing-led’ schemes had around a 75 per cent success Peter Furlong, Change Grow Live NW harm
approach. Scotland and Wales had seen the rate in moving clients out of homelessness reduction lead and development manager
pandemic as an opportunity to change policy and addiction. Despite this, they faced
and tackle the problem head on, said Downie. challenges through fluctuating levels of
Jennie Corbett, policy manager at funding – directly from local authority grants, DDN welcomes all your comments. Please email
Homeless Link, explained the principles and through housing benefit payments which the editor, claire@cjwellings.com, join any of
behind Housing First. The holistic approach were linked to occupancy. the conversations on our Facebook page, or send
supported people with complex needs, Mike Trace, chief executive of The letters to DDN, CJ Wellings Ltd, Romney House,
usually involving issues around mental Forward Trust welcomed the government’s School Road, Ashford, Kent TN27 0LT.
health and substance misuse and offered commitment to spending in this area but Longer comments and letters may be edited for
accommodation, intensive support, and questioned where all the money was going
space or clarity.
harm reduction interventions – without and who was overseeing the spend. ‘If it is
imposing conditions. Giving clients long- spent unstrategically, results will be poor /ddnmagazine @ddnmagazine
term safe and stable accommodation and the opportunity lost,’ he said. DDN www.drinkanddrugsnews.com
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 13REVIEW OF THE YEAR
Going viral
2020 will forever be remembered as the year COVID-19 transformed our
lives. But one note of optimism was the way services immediately rose to the
challenge of looking after their clients in extraordinarily difficult circumstances
JANUARY APRIL the harms it exists to reduce, or the and an ageing population – to
Research by St Mungo’s finds that With the sector, and the country, means it might use to achieve that,’ reach a critical tipping point, warns
at least 12,000 homeless people reeling from the impact of the states committee chair Meg Hillier. Change Grow Live chief executive
went without much-needed drug pandemic, services scramble to Mark Moody.
and alcohol treatment, but rough keep up with the relentless pace JULY
sleepers would be facing more stark of developments. ‘We had a full NHS Tayside provides a rare
challenges as the months went on. business continuity plan set up on glimpse of good news when it
the afternoon the prime minister becomes the world’s first region to
FEBRUARY did his first big announcement,’ effectively eliminate hep C, while
The long-awaited first part of Humankind’s executive operations Northern Ireland announces a ‘full
Professor Dame Carol Black’s drugs director Anna Headley tells DDN. consultation’ on whether it will
review states that a prolonged ‘It was out of date within an hour.’ follow in the footsteps of Scotland
shortage of treatment funding Alcohol Change UK finds that the and Wales by introducing MUP.
has led to a loss of skills, expertise stress of lockdown means a fifth of
and capacity, while a ‘much more daily drinkers are now consuming AUGUST
violent’ illegal drugs market has even more. PHE becomes a COVID fall guy,
‘never caused greater harm’. with the government announcing
MAY its abolition to make way for the
MARCH With around 90 per cent of rough new National Institute for Health
As COVID-19 hits hard, the sleepers housed in temporary Protection – but no detail on what
government includes drug and accommodation, the Housing, will happen to its drugs and alcohol
alcohol staff in its definition of Communities and Local Government remit. More than 80 organisations NOVEMBER
key workers, while services move Committee urges the government immediately issue a statement The spectacularly divisive US
to online models of delivery where not to miss the chance to end rough expressing their concern in the presidential election also sees a
they can and DDN takes the sleeping for good. Meanwhile, BMJ. ‘Organisational change is ‘monumental victory’ for drug
inevitable but painful decision Collective Voice’s Peter Keeling writes difficult and can be damaging at policy reform as Oregon votes in
to postpone its annual service in DDN that while the sector’s swift the best of times,’ it says. ‘These favour of decriminalising personal
user conference. adaptation to the COVID landscape are not the best of times.’ possession of all drugs, including
has been hugely impressive it’s heroin and cocaine. A year on from
vital that developments like remote SEPTEMBER the launch of Middlesbrough’s
and digital delivery are seen as The Royal College of Psychiatrists heroin-assisted treatment pilot,
a ‘welcome addition’ – not a warns that services are not clinical team lead Daniel Ahmed
replacement. equipped to deal with the ‘soaring hails its ‘dramatic impact’, with
numbers’ of people drinking at high 98 per cent attendance rates
JUNE risk levels during the pandemic, among long-term participants and
Two parliamentary reports within and calls for an urgent multi- offending levels slashed.
a fortnight call for an overhaul million pound funding boost.
of gambling regulation, with DECEMBER
James Boardman / Alamy
the House of Commons Public OCTOBER As the year comes to an end,
Accounts Committee slamming the In what has become a grim annual and optimism about a vaccine is
‘weak and complacent’ oversight milestone, England and Wales once tempered by the reimposition of
of the industry. ‘What has emerged again record their highest level of tough restrictions on much of the
in evidence is a picture of a torpid, drug deaths at, 4,393. The pandemic UK, the sector – and the country –
toothless regulator that doesn’t had now worsened a ‘perfect storm’ hopes that the worst might finally
seem terribly interested in either of factors – including disinvestment be over. DDN
14 • DRINK AND DRUGS NEWS • DECEMBER 2020 – JANUARY 2021 WWW.DRINKANDDRUGSNEWS.COMDRUG POLICY
Ray of light
Bill Nelles finds some cause for
Mimomy / iStock
optimism at the end of a bleak year
I’
m writing at the end of the disconcerting. Voter suppression crucially past the winning 270 votes
most horrible year in our in some Republican-controlled in the Electoral College. Meanwhile,
lives. It’s not just COVID states meant mail-in ballots could ‘The one really Ms Emily Murphy, administrator of
that’s made it so bad but not be counted when they came the General Services Administration,
the pathetic role of Trump in, but only on and after the day wonderful refuses to ‘ascertain’ the result and
who has completely failed to give
any lead and put partisan politics
of the election. So the early results
favoured Trump. He’d told his base election result release funds for the transition to
President-elect Biden.
before the nation’s health.
2020 has been a year in which
not to trust voting by mail, because
he had also nobbled that.
came from the However, the one really
wonderful election result came
one of the few bright lights was the I went to bed about midnight State of Oregon... from the State of Oregon. States
possibility of removing Trump from feeling dejected and appalled that often have propositions (mini
his post and repairing the criminal so many Americans could still vote electors voted yes referendums) on their ballot to
damage he has wrought to the
political process.
Trump. But by the next morning,
the big city and mail-in votes for on Measure 110 to enable people to vote to determine
controversial issues. This is how
I am a deeply blue Democrat. In
1972, supporting George McGovern
Democrats had gradually crept
up, eventually taking Biden to
decriminalise the marijuana legalisation was achieved
in most US states. This year, Oregon
against Nixon, I watched Watergate the winner’s post with the same possession of all electors voted yes on Measure 110
unfold and never forgot its lessons. number of electoral votes as Trump to decriminalise the possession
However, Nixon was almost had gained in 2016. More than two drugs within their of all drugs within their state (see
honourable compared to Trump.
The framers of the Constitution
weeks have now passed but Trump
still won’t concede, telling his base
state.’ news, page 4). The vote was 52 per
cent to 48 per cent, (I know I’ve
assumed a certain level of to reject the verdict as fraudulent heard that margin somewhere
honourable conduct, not rampant and corrupt. allow the legislature in each state before!). This is a shining example
narcissistic sociopathy. And then What is now being called the to ‘determine’ the electoral college of the positive side of US politics.
Senate republicans did their work ‘clown coup’ is moving forward voters instead of the people’s voice. But there is some push back, and
and forced his resignation rather as Trump and his surrogates have Not a scintilla of evidence exists, I’ll write more in my next column.
than impeachment. Not so in 2019. abandoned using lower courts of course, that any fraud took place. In the meantime, have a safe and
As results started to come in, it and instead try to use Republican All votes are counted and scrutinised careful holiday.
was 4 am in the UK. Trump’s advice legislatures in key states to change by both parties and Biden is millions Bill Nelles is an advocate and
to his supporters to vote in person the election results by casting of votes ahead in the popular vote activist, now in Canada. He founded
was as impressive to see as it was enough doubt on the votes to (which means little in the US) but The (Methadone) Alliance in the UK
WWW.DRINKANDDRUGSNEWS.COM DECEMBER 2020 – JANUARY 2021 • DRINK AND DRUGS NEWS • 15You can also read
