The politics of drug treatment and why we keep missing the point
I’m never quite sure whether it was through planning or chance that I ended up spending most of my adult life working in the drug treatment sector – but once in it was an impossible area to leave. It began in the late 80’s early 90’s when some of the worst impacts of the Thatcher government’s approach to society were really setting in. I was working in a Bail Hostel – and in the space of only a couple of years opiate use amongst the resident group moved from being unusual to commonplace – especially in the younger ages. It was also starkly apparent at that time the criminal justice was ill-equipped to address drug ‘problems’ and that health services were largely disinterested in working with those caught up within the justice system. Prejudice and stigma was stark – and language used to describe people was shocking.
But at the same time there were exciting developments – driven largely by user activism, enlightened health professional and the voluntary sector. Fear of HIV and AIDS lead to an investment in needle exchange programmes – often hidden away, anonymous and embryonic. Whilst the investment driver was about protecting ‘us’ from infections that little was known about – these services were vibrant, caring, compassionate and ready to be active politically.
Harm reduction became the bedrock of the system.
Alongside this was an expanded workforce that recognized drug (mis)use as much broader than a medical issue.
Come the late 90’s I had joined the organization that is now Change Grow Live. We had piloted some of the initial criminal justice based ‘arrest referral schemes’. Jointly funded by police, probation and health it was a simple idea – at the point of arrest an individual is usually contemplative and open to the possibility of change. Offering hope, support and access to services that had the potential to meet their needs could be an effective way of helping them whilst reducing crime.
Diversion became a positive system development
The Labour Government took the quite bold step to publish the UK’s first National Drug Strategy – a 10 year programme that was intended to transcend the electoral cycle. This was the first major injection of cash into a system that was designed to widen access to treatment and to mainstream the provision of treatment and harm reduction. The NTA was established to oversee this strategy and it’s successors with what were really three stages of development:
- Firstly – get more people into treatment
- Keep them in treatment long enough for it to be effective
- Help people leave
Politics of course got in the way – we were going to be tough on crime and the causes of crime and lots of the new investment came in via the justice system rather than health. It was about protecting ‘us’ from ‘those drug users and their offending’. But it was also about widening the reach of treatment when historic medicalized models had long waiting times and unknown outcomes. There was significant investment within the prison estate to ensure that treatment was available where needed.
Crime reduction had become the political driver
As this period progressed the policies of ‘toughness’ popped up everywhere – the unemployed would be offered treatment or be sanctioned. Families would be ‘intensively’ worked with at the risk of losing their children. Young people would be treated at risk of school exclusion.
And then of course we entered a period where successful treatment meant abstinence which became defined as recovery.
Abstinence became the (im)moral requirement
The years since 2010 marked a whole new approach – austerity and cuts to local authorities did away with the need for Payment by Results. Contracts were slashed by anything up to 40%, those areas with the highest rates of drug related deaths seemed to bear a disproportionate brunt of these cuts. A beleaguered workforce, became overwhelmed by the scale of the challenges they faced and the lack of resources available to them.
Slashed health and treatment budgets became the reality
All within the context of reducing budgets, horrendous levels of drug related deaths and an ever rising prison population.
Dogma, distraction and loss of focus
Throughout my whole career in the sector the spectre of politics and morality hangs over people who use drugs and in different ways alcohol – that would simply not be acceptable anywhere else in health or social policy.
And throughout this time as a sector we have constantly allowed ourselves to be distracted, to focus on concocted and wholly unhelpful arguments about whether: abstinence, harm reduction or crime reduction are ‘right’ and are themselves the answer.
It is underfunding, rigid contracts and (im)moral political drivers that need to be challenged. The people in need of services should have access to all services – it’s what NICE says after all. We need drug consumption rooms AND heroin assisted treatment AND more residential rehab AND more abstinence based recovery AND more gender specific services AND much more.
So my one wish when I do hang up my boots is that the sector in its’ widest sense re-groups around the need to save lives, promote health and create opportunities. It cannot be beyond us to envisage a sector in which the NHS Provider Alliance, Collective Voice members, the CLERO recovery movement and drug user advocates / representative groups work together around this. Can it?
The politicians and moralists can have their arguments and adopt their positions – we shouldn’t be having them for them. We should be finding the solutions and serving the needs of those need us.