Brighton and Hove has the unenviable record of having the highest rate of drug-related deaths in the country. The problem of drugs is being addressed at two events being held in the City during September. I was recently invited to speak at the first event, a ‘Round Table’ discussion organised by the MP for Brighton Pavilion, Caroline Lucas. I will also be speaking at the second event, open to the public, which is being organised by the MP for Hove, Mike Weatherley. Details of this event can be found here.
Here is the text of my contribution to the Round Table discussion:
BHT’s treatment programmes and the benefits of an abstinence based approach
BHT services support chaotic drug users, many with a history of street homelessness, through harm minimisation interventions (such as the needle exchange operating at the Phase 1 Project), and we champion abstinence through our Detox Support Project and our residential rehab, the Recovery Project.
However, nothing we do, none of the services we offer, provides the answer we are seeking today. But each is a means to an end – and that end is normal living free from drug dependency.
If clients move from chaotic use to using a needle exchange, that’s great but we have to ask “what next?” If they stabilise their drug use by going on a maintenance script. We again must ask “what next?” If they detox, at BHT we ask what next? If they go into residential rehab, we continue to ask “what next?”
I believe all interventions have a place in the recovery process. However, we must constantly ask what is best for our clients. And we must actively help clients move through to the next stage of recovery.
If any service does not move its clients through to the next stage at the earliest possible opportunity, not months and years into an intervention but within days and weeks, that service is selling its clients short.
I fear that there has been, for over two decades, a government-led lack of ambition on behalf of drug users. It has resulted in far too few clients moving from dependency into abstinence, and too many people have been left with one foot still in drug-using culture.
In Brighton andHove, the promotion of abstinence has been largely ignored. Other than CRI’s St Thomas Fund and BHT’s Addiction Services, no funded service has abstinence as its primary focus.
This has resulted, inevitably, in a year on year increase in the number of addicts, either using street drugs or those on maintenance scripts (and they are probably topping up on street drugs).
Why are we failing to get beyond harm minimisation, through abstinence and into stable housing, education, training and employment? I can think of three possible reasons:
Skills: Are our workers as skilled as they should be? Do we need to review our training so that they can become more effective in helping clients achieve abstinence?
Attitude: Too many in the drugs field find too many reasons why an abstinence approach is not right for a particular client or as they will say, the client is not ready. There used to be a programme locally called the Abstinent Programme but meaning abstinence from street drugs. There is a lack of ambition.
Policy: Medicated treatment as an outcome has been the policy of successive governments and also at a local commissioning level. We now have a perfect opportunity to change that. The Coalition Government’s strategy is for a ‘treatment revolution’ and that abstinence should be championed. I welcome this wholeheartedly, although I have doubts about the approach it is taking to payment by results.
What are the consequences of us not championing an abstinence approach in all services:
- Ever-increasing numbers of drug users
- Ongoing social dysfunction
- More and more children needing to be looked after by the local authority at huge cost
- Increased domestic violence
- An inevitable increase in drug-related deaths
- An increase in crime
- Increase demands on health services
- Damage to the reputation of the City and consequentially its economic health.
A further consequence of not changing is that in ten years time we, or our successors, will be sitting in a room like this asking what can be done about the drug problem in the City and the unacceptably high drug-related death rate.
So, we should start by acknowledging that clients want abstinence. Locally, just 9% leave drug services drug free, compared to a national average of 14%.
BHT originally adopted an abstinence approach directly in response to demands from clients. Over the years this message from clients has become stronger, and those who make it into our service offer the criticism that they were either not made aware of our service, or abstinence was never presented as an option. In fact, it is not uncommon for clients to say they were actively discouraged from seeking abstinence.
A monitoring questionnaire used to ask clients what they wanted to achieve when approaching a drug service. In year 1 the answer, in 83% of cases, was abstinence. The question was discontinued.
Unless we collectively overcome this lack of ambition for our clients, unless we seek the best outcome for them (and at the earliest opportunity), and until we stop justifying drug use as a “life style choice”, we will continue to fail our clients and our City.
Finally, a question: What would you want for your son or your daughter if they had an addiction? Ongoing maintenance or a clear move towards a drug-free life? We should also want the best for our clients.