Vol 26 | Issue 5 | september/October 2011

l Riots DruglinkReporting on drugs since 1975 l Naloxone l Housing pull-out l Mexico Behind the paradigm shift

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or email February 2012 [email protected] www.lau.org.uk/training Short courses, accredited programmes and stand alone modules We also offer courses tailor-made for your group or organisation. Contact us for details Vol 26 | Issue 5 | September/october 2011 News 2 New drugs on block show increase despite falling market 3 Doctors say naloxone hand-outs are a “no-brainer” Druglink 4 News focus: Riot special Youth guru Camila Batmanghelidjh and author Gavin Knight on the links between the August riots and the Making it real drug trade RECOVERY UNCOVERED The Recovery Movement in the UK is in its infancy and like the recovery 6 Love conquers hate journey itself, the way ahead will not necessarily be smooth. William White’s one woman’s struggle to come in seminal paper on the rhetoric of recovery sets out clearly the difficulties of from a cocaine blizzard to the shelter even untangling the lexicon of recovery, let alone seeing tangible results from of recovery. By Harry Shapiro engaging with the wider world on all the manifest issues thrown up by that ‘simple’ word. 9 Land of the free That said, there is nothing new about recovery; preparing service users for Marcus Roberts discusses recent some kind of entry into or back into society has been going on for decades, debates about ‘recovery’ in mental not forgetting those who have travelled the path without any formal service health, and asks whether too much engagement at all. But now we have recovery with a capital R and so it consensus could be at odds with the becomes freighted with more expectations and ambition. concept’s transformative potential I have in mind Bob, a hypothetical user, who is in treatment, receiving a and radical roots. methadone prescription which has brought some semblance of stability to his life. After many years of chaos and mayhem, he needs a lot of TLC, he needs 12 Founding fathers his self-esteem built up and needs to feel he is not alone. So he is very grateful the inspiration for the rising for affirmative messages on Facebook, hugs at every turn and plenty of people recovery movement in Britain has telling him he is doing well. Now he wants to move on – and in a calmer come from four Americans. Mark frame of mind, he notices lots of talk around him about recovery champions, Gilman on the influence of Simpson, recovery communities, social and individual capital and asset-based recovery. De Leon, White and McKnight. Having tried to understand the new landscape, Bob decides he doesn’t want to become a recovery activist or be a volunteer at his local drug agency. 13 4 PAGE PULL-OUT: He really does want to move on. What he wants is a decent place to live, some Housing for recovery – findings gainful employment and to see his daughter again. He is right therefore to ask from a DrugScope survey the question, ‘what does all this stuff mean for me?’ Bob might have to wait a bit for the smoke to clear, but at some point soon , the notion of recovery must 18 Asset recovery move beyond the birth pangs; the handy slogan, the inspirational conference an expanding network of current speech or the tender document with the word ‘recovery’ shoe-horned into and former problem drug users will every sentence. energise the recovery movement in the UK and create social Harry Shapiro, entrepreneurs. By Alistair Sinclair. DrugScope’s Director of Communications 20 A social contract and Information treatment offers to get the dispossessed and addicted back into mainstream society, but for many DrugScope DrugScope is the UK’s DRUGLINK STAFF Print Holbrooks Printers this offer simply lacks credibility. Prince Consort House leading independent centre Editor Max Daly Ltd, Portsmouth PO3 5HX Richard Phillips on how the recovery 109–111 Farringdon Rd of expertise on drugs and Online Jackie Buckle London EC1R 3BW the national membership Director of Communications CONTRIBUTIONS movement can offer people a organisation for those and Information Druglink welcomes letters tangible route out of addiction. Telephone working to reduce drug Harry Shapiro and other contributions. 020 7520 7550 harms. Our aim is to inform Editorial Assistant Send direct or contact Email policy development and Ruth Goldsmith Max Daly Also in this issue.... [email protected] reduce drug-related risk. Book Reviews Editor Tel: 020 7520 7562 Web We provide quality drug Blaine Stothard Email: 22 Under the shadow of the drug lords www.drugscope.org.uk information, promote [email protected] effective responses to drug ADVERTISEMENTS the vibrant Mexican city of Druglink is for all those taking, undertake research, Email Material published in Monterrey is the country’s financial with a professional or advise on policy-making, [email protected] Druglink does not necessarily hub. But as with a growing number of occupational interest in drug encourage informed debate The inclusion of an represent the views or problems and responses and speak for our members advertisement, flyer or free policies of DrugScope cities in Mexico, it is ceding control to them – policymakers working on the ground. sample in Druglink does not to the narco-traffickers. ByLeadknife and researchers, health imply any endorsement of a © DrugScope/the author(s). workers, teachers and other SUBSCRIPTIONS particular product or service All rights fully reserved. educators, social workers Subscription for the year by DrugScope or Druglink. Requests for permission Regulars and counsellors, probation (six issues): £55 to reproduce material and police officers, and drug To subscribe call Design from Druglink should be 26 reviews workers. 020 7520 7550 Helen Joubert Design addressed to the editor. helenjoubertdesign.com 28 Drugworld Diaries ISSN 0305-4349 29 Headspace

September/october 2011 Druglink | 1 NEWS

n High heels A London solicitor wore New drugs on block show hollowed-out, foot-long shoes to smuggle a mini ‘drug selling kit’ into prison for an inmate, increase despite falling Blackfriars crown court has heard. Prosecutors said Ritesh Brahmbhatt had a mobile market phone, cannabis, mephedrone and scales in his over-sized shoes, but was caught by sniffer • Mephedrone now as popular dogs. as cocaine with young users • Ketamine use doubles in four n Weed all about it years A journalist has become the • Steady decline on overall drug first professional cannabis critic in America. ‘William Breathes’ use continues tries out and reviews different strains such as Rambo and Moby Ketamine and mephedrone, two Dick for Denver’s Westword relative newcomers to the mainstream newspaper. Colorado has drug scene, have shown the biggest 100,000 people who are legally rises in use among young people in registered to use the drug for England Wales, according to the latest medicinal purposes. government figures. Results from the Home Office’s n In God we trust extensive annual British Crime Survey (BCS) revealed that the use of Parishioners at a Welsh church the hallucinogenic anaesthetic drug have unanimously voted in ketamine, has more than doubled among their new minister – despite young people since being made a Class The steady decline in overall drug the fact he was jailed for 12 C drug in 2006. Use amongst 16-24 year use was reflected in the new figures years for dealing cocaine. Brian olds has increased from 0.8 per cent in published by the NHS Information Morris, a minister at Oakdale 2006/07 to 2.1 per cent in 2010/11. Centre. Key findings from its survey, baptist church in Caerphilly, was Mephedrone, the stimulant which Smoking, drinking and drug use among released from jail after five years attained a rapid rise in popularity over young people in England in 2010, carried and trained to be a pastor. the internet in 2009, now ranks alongside out among young people aged 11 – 15 in cocaine as the second most prevalent England include: n Coca cooler drug amongst 16-24 year olds, being used • 18 per cent of pupils reported that by 4.4 per cent in the last year. they had ever taken drugs. This Peru’s new centre-left Cannabis, while still the most used represents a decline since 2001 from government has suspended drug among all age groups, continues 29 per cent; its US-funded coca eradication to fall from a peak in the early 2000s. • cannabis remains the most widely programme. Prime minister Although there was a blip in the used drug, with 8.2 per cent of pupils Salomon Lerner said he wanted statistics as far as young people were reporting having used it in the last “social exclusion and fighting concerned: 17.1 per cent of 16-24 year year compared with 13.4 per cent in poverty” to become more central olds tried cannabis in the last year 2001; to the strategy. compared to 16.1 per cent in 2009/10. • vulnerable pupils, defined as those The survey showed that almost three who had truanted or been excluded n Shipping lines million people (8.8 per cent of adults) from school, were more likely to take used illicit drugs in the past year, 2.2 drugs at least once a month than A record £300m haul of cocaine million of them using cannabis. They other pupils and were also more likely has been seized inside a also show that one million of them – or to have taken a Class A drug in the pleasure cruiser at Southampton three per cent – used Class A drugs, with last year; docks. Officials from theS erious a fall in the use of cocaine accompanied • 55 per cent of young people had never Organised Crime Agency and by a rise in the use of methadone. drunk alcohol, an increase from 39 the UK Border Agency said the The Home Office statistics, contained per cent in 2003; 1.2 tonnes of cocaine was 90 in the report, Drug Misuse Declared: • there has been a sustained decline in per cent pure, had come from Findings from the 2010/11 British Crime the number of pupils who have ever Venezuela and was bound for Survey, show that overall, drug use smoked, from 44 per cent in 2001 to Holland. continues to fall. 27 per cent in 2010.

2 | Druglink September/october 2011 NEWS

Doctors say naloxone hand-outs are a “no-brainer” “It risks drawing more and more people into a world where there’s Specialist GPs have hit out at commissioners Warning: nothing but misery because a life-saving drug that reverses the A US poster waiting for them.” effects of heroin overdoses is being kept reminding from drug users – five years after being given users Critical response by charity the green light by the government. to carry Cannabis Skunk Sense to a Despite numerous pilot trials which naloxone new range of powder-form have proven that take-home naloxone foods, including snortable saved lives, and a change in the law in 2005 asparagus made by enabling third parties to inject the drug in caterers, Bubble Foods. emergencies, it remains available only to a small number of drug users, and their friends and families. Take-home naloxone was first proposed “A cannabis plant had Judith Yates, a Birmingham GP speaking by Dr John Strang in an editorial in been planted on my on behalf of the Substance Misuse the British Medical Journal in 1996. He veranda in order to Management in General Practice (SMMGP) concluded that the distribution of naloxone network, told Druglink: “The slow progress should be seriously considered for trial and discredit me.” on naloxone is ridiculous. It is frustrating evaluation and that home-based supplies of Former Chief Beefeater at because it is now perfectly legal for people the drug would save lives. the Tower of London Major to save other’s lives with nalaxone kits, they A three year study among drug users at Gen Keith Cima claimed his are cheap, but they are being distributed in the South London and Maudsley’s Beresford dribs and drabs. Project found that more than one in 20 colleagues tried to frame “It’s a no-brainer. Naloxone script and naloxone injecting kits handed to service him with a cannabis plant. training should be given to all heroin users had reversed an overdose – saving an users along with their first methadone estimated 20 lives. A trial at 16 sites around “The drink companies script.” Yates said it was up to drug service England and overseen by the National commissioners to make naloxone widely Treatment Agency (NTA) also prevented the are on social available across the country. deaths of around 20 drug users. networking sites and there’s still a lot of direct advertising going on through sports sponsorship and so on.” Police to flush out drug packages Clive Wolfendale, chief executive of north Wales at specialist unit drug and alcohol agency Cais, after the BBC A police force has set up the country’s first into a container instead of the sewers, was revealed children as young dedicated unit to detain drug swallowers established near the hospital to allow quick as four had been treated in until substances emerge from their body. access to A&E in case packages burst while A&E for being drunk. Devon and Cornwall Police’s Drug they are being digested. Recovery Unit is being used to lock up “For some time police forces across the people who are suspected of having country have found it challenging to deal “It has the potential drugs concealed in their body. Based near with criminals who conceal illegal drugs to wipe out all the Plymouth’s main hospital, the unit provides on their person either by swallowing or cancer cells in those a safe place for arrestees to stay while secreting drugs in the body,” said Chief examples.” potentially life threatening packages pass Inspector Ivan Trethewey. “Any illegal through their body. drug carried in this way can be extremely Lead researcher Professor Following changes to the law made under dangerous, especially if a package becomes John Gordon, from the the Drugs Act 2005, police are now able to lodged or splits. This type of accident can University of Birmingham detain people suspected of having drugs result in death if not dealt with by health on how modified ecstasy in their body for 192 hours (eight days) care professionals very quickly, which is why may fight blood cancers with a senior officer’s permission.T he unit, the unit is located close to an emergency which has a special toilet which flushes department in the force area.”

September/october 2011 Druglink | 3 NEWS FOCUS New disorder The riots in London and other UK cities over a week in August stunned the country. Amid the talk of feral youths and a nation in moral decline, drug issues have been cited to become a key factor in the cause of the chaos. Below, Camila Batmanghelidjh, director of Kids Company, and author Gavin Knight give their unique insights into the links between the drug trade and the rioting that shook Britain.

Camila Batmanghelidjh Ask yourself what kind The sight of youths smashing shop of a society have we fronts horrified the nation; sending created that children opinion-formers spinning. Sadly little of the discourse touched the truth. have come to believe Consoling itself, Britain identified that criminality and some 30,000 rioters as suffering from a ‘moral decline’. Exhibits of greed violence is the available were gleefully presented; from the law and order millionaire’s daughter, the teacher to the bandana-clad boys. For many of the children and young people in the riots, the doors of social care had slammed shut. Britain has a toxic challenge: 1.5 million children a year apprenticeship, learning violence to control drug transactions. are maltreated in the UK, with an annual cost to the economy It is, unfortunately, an organised system with ‘shotters’ who of £77.7 billion. Currently there are just under one million sell the goods, ‘shooters’ who hurt and kill people for not children not in education, employment of training. Out of the honouring debt, ‘informers’ who ride on their bikes checking 21 wealthiest countries, we score bottom for children’s well- out territories and ‘couriers’ who deliver. being, and we disguise the fact that we have some 1.1 million Vulnerable children turn to local drug dealers because children suffering from significant emotional and mental they deliver more fiscally sound solutions than the social health difficulties. care agencies who are too under-resourced to intervene The figures of children living with substance abusing parents meaningfully. Some young people seek the gang actively, are difficult to capture officially, however, it is estimated that a hoping that through criminal activities they can generate further 1.1 million children are enduring the chaos of parental resources to meet their family’s needs. Other young people addiction. Add to these vulnerabilities to the corrosive impact become reluctantly attached because their connection to the of poverty and you have a catastrophe shadowing ‘civil’ society. gang ensures their safety. Ultimately the criminal gangs have Children cannot be held responsible for the distribution of more power over vulnerable children, because paradoxically wealth and political decisions: so one wonders, whose moral they are better able to protect them than the police. The corruption we should be looking at? In dominating the public potency of the police is paralysed as witnesses are intimidated narrative, the articulate residents of reasonable Britain might into not giving evidence. miss out on the unreasonable strategies required for survival The media ridicules the children’s drive to acquire ‘respect’, on the streets. Children who endure chronic victimisation but in a dog-eat-dog world, top dog is less attacked. To be the either break down into self-harm – turning their rage onto top of a pathetic food chain the young person has to have a themselves – or they use it to fuel a solution. high credit rating. He or she has to be seen as violent and rich Amongst the rioters were children who were sent out by because the subtext is that the young people’s criminal backing drug dealers and their parents. Much was made of trainers and must be substantial to have facilitated it. It functions as a plasma TVs being stolen, but large volumes of food and nappies warning: should someone be thinking of doing harm they must disappeared. Were children given opportunity to describe the expect the revenge to be powerful. riots a more searing truth would emerge. Ask yourself what kind of a society have we created that At street-level, currently eight and nine year olds are being children have come to believe that criminality and violence is pulled into the drug trade by adults who run the drug economy the available law and order through which solutions to social much like a business. Children participate in a perverse care issues can be found.

4 | Druglink September/october 2011 Gavin Knight inside The economics are in the drug trade’s favour in these deprived inner city areas. A source in the gang community in London told me that teenage gang n Book now to avoid disappointment: members quickly realise the amount DrugScope conference 2011 of money they can make dealing crack cocaine and heroin. The amounts Rising to the challenge, our conference on Wednesday cannot compare with the low-wage 2 November, is almost fully booked. Baroness jobs on offer to them working in Browning, Minister for Crime Prevention at the Home supermarkets or doing manual labour Office, is the keynote speaker.O ther speakers include work like plastering. Tim Hollis (ACPO), Joy Barlow (STRADA), John Ashton One 21 year old girl told me she dealt drugs to show she was (Cumbria Public Health), Jeremy Swain (Thamesreach) equal to the boys, so she could dress nicely and go to auditions. and Paul Hayes (NTA), and five leading figures Another girl stole a stash off dealers to pay for her mother’s working on the recovery agenda, Stephen Bamber, medication. It sucks in the brightest and the best of a lost Mark Gilman, Anne-Marie Ward, Alistair Sinclair and generation. Often the drug dealers are the most dynamic, most Richard Phillips, will participate in a panel discussion. entrepreneurial people in these estates. Sometimes they even To download a booking form, please visit our extend help to the community – an alarming development that homepage at www.drugscope.org.uk. sees the UK drifting towards the Brazilian gang model. One of the key trends that emerged was that younger and n The Recovery Partnership: August 2011 update younger kids are becoming involved in the drugs trade. The pattern that emerged in my research was that a young child may In May 2011, the Substance Misuse Skills Consortium, first encounter addiction in the home, with his parents.T hese the Recovery Group UK and DrugScope formed the toddlers grew up opening the door to strangers who were coming Recovery Partnership to provide a new collective voice in to inject, deal and other activities. Often they witnessed for the drug sector to Ministers and Government. domestic violence in the home and, as adults, they repeated this The Partnership published a ‘Statement of Intent’ cycle. (revised in July) which sets out its aim and purpose In Glasgow some cocaine dealers would hook-in teenagers and has been undertaking work in a number of by advancing them large quantities of coke on credit. Then they key policy areas since its inception, including the would turn on them, demanding that the debt was repaid. In preparation of a paper on Housing and Recovery at one case, a 19 year old found himself in £4,000 worth of debt and the request of the Inter-Ministerial Group on Drugs held up a security guard to repay the dealer. Another tactic was (see pull out in this edition of Druglink for a briefing to force the debtor to take part in a criminal act. I heard of one based on this paper). You can read about the activities case where a young man, in this dire situation, was forced to of the Partnership in their August update, which is be the look-out on a murder. He was the only suspect who was accessible at http://tiny.cc/Rec-Par-Update-August identified and faced a lengthy sentence in prison. Another key pattern that emerged in my research was the n Debate on drug deaths influence of the ‘Olders’ on young kids. The Olders, senior gang members, usually 19 or older, with multiple convictions recruited Mike Weatherley, Conservative MP for Hove and young kids by offering them cash, new trainers and other Portslade, has responded to concerns at high rates incentives to become low-level street dealers, or ‘shotters’. They of drug-related deaths in his constituency and could earn £50 a day. One boy in London was forced to deal in the neighbouring Brighton by organising a public event stairwell of a tower block around the clock. The length of the shift entitled Are Drug-Related Deaths Avoidable?. Speakers was so long that he had no time for any other activity. The Olders include DrugScope’s Martin Barnes, Amanda Feilding will then arrange for the drug earnings or of The Beckley Foundation, Niamh Eastwood of stash of the shotter to be stolen, and then Release, John Corkery of the National Programme on force them to repay the debt by continuing Substance Abuse Deaths, Nicola Singleton of UKDPC to deal. and Danny Kushlick of Transform. This free, public Those kids who try to break out from this event is taking place at Hove Town Hall, 9.30am – intimidation face violence. I heard numerous 5.30pm on 30 September. More information can be stories of being bricked, shanked (stabbed) found online here: http://tiny.cc/DrugDeathsDebate for not dealing. An enterprising armed robber told me that shotting was drudge work and if you were smart you’d rob the dealer at the You can email: end of the day. In Manchester I heard many Martin Barnes CEO at [email protected] stories of dealers being tortured by medieval Marcus Roberts, Director of Policy and Membership means to ward them off another gang’s turf. on [email protected] To these kids, and the world they grow Ruth Goldsmith, Communications Manager at up in, a bit of stealing, violence and police Hood Rat is published [email protected] baiting isn’t anything out of the ordinary. by Picador

September/october 2011 Druglink | 5 Recovery uncovered Love conquers hate One woman’s struggle to come in from a cocaine blizzard to the shelter of recovery. By Harry Shapiro

Grace (not her real name) sits in one of violent and abusive towards my mum. being ‘out of control’, even so the reports the rooms of the Gateway Project run by So she had her problems, trying to bring acknowledged that Grace was a very Addaction in Liverpool city centre. In her up my little sister as well. I couldn’t put intelligent girl and at 17, she found her early thirties with a strong accent that all this onto my grandmother because way to college to study fashion design. betrays her deep roots in the city, she is she was an old woman. So I never felt I However, life at home was increasingly pleased to be given the chance to tell her had anybody to talk to. I couldn’t talk to difficult. Her boyfriend was never story. She is calm and relaxed, at peace my mum about certain things because I’d accepted. “One day, my mum said get with the world. It’s been a long time just get a belt. I was petrified. So I had a out of my house and that was that. I coming. lot of issues that were never dealt with.” just walked out and had to survive. That On a day to day basis, Grace was By the age of 12, Grace was drinking was when things turned, the beginning brought up by her grandmother; her and smoking cannabis with many of of the end so to speak. I did get my mother was out working and she the other kids on the estate where she qualifications from college, butI was never knew her dad as a child. But her lived; by the time she was fifteen, she like little orphan Annie floating around, experiences of growing up in a tough, had snorted her first line of coke. I“ was eventually getting faster and faster until working class Liverpudlian family were just trying to wash it all away, trying to I was bouncing off the walls of the city.” not that unusual. deal with it, but not really knowing what Grace moved into a flat with her Then around the age of seven, she it was I was trying to deal with. A lot of boyfriend, earning some money from suffered sustained sexual abuse at confusion.” She already had a boyfriend, cleaning jobs. Cocaine was gaining an the hands of neighbours that, Grace much to the disapproval of her mum, attraction. “If I got drunk, I would just is convinced, was the root of all her so that pushed her even further away pass out. But I wanted an escapism that problems. “I know that I told somebody, from her family, “but I was just looking would take me to a different level, to but it was never dealt with, swept under for somebody to love me. I came from a be able to escape what was going on in the carpet,” she says. “It was never very disciplined, old fashioned family. my own mind but still be aware.” Her spoken about and that’s how it was. I We don’t do hugs. I saw other people boyfriend, who wasn’t working, started remember that there was a change in getting hugs, but I never understood why selling cannabis, “but slowly it all started me as a person. As a little child, I became I didn’t.” to get much heavier and then he was very angry, very into myself. I felt it was Grace went to an all-girls Catholic selling cocaine. It didn’t really bother all my fault. I tried to make believe that it school, but was expelled. “I was just me at the time because we were just had never happened. really cheeky, had too much to say. I trying to survive and I had nowhere to “When I was ten, my mum had a new didn’t like the discipline. If they said go anyway. I couldn’t go home. So in a relationship. He was a heavy drinker black, I’d say white.” Yet while she was different way, I was still pretending that with a gambling addiction and was condemned in her school reports for things weren’t happening. Even then I

6 | Druglink September/october 2011 knew I was living a lie, that deep down I went through another downturn. Her boyfriend left I was asking myself, ‘what am I doing her and was involved in a serious road here?’” Liverpool like the accident with his new partner. This sent Once her boyfriend started selling Tasmanian Devil. Put Grace into even more chaotic drink and coke, Grace’s own consumption soared. drug use – a five star bender that went “It was just there. I never had to pay for more ale down my on for seven months. “Before we were it. By the time I was 19, I was a heavy throat, more vodka, just using mainly with friends. Now I coke user, two and three day binges. All just hit the party scene. I went through that pain about not feeling good about more coke, took Liverpool like the Tasmanian Devil. Put yourself was taken away. Nothing had pills, ate something, more ale down my throat, more vodka, been real for a long time. I was scared of more coke, took pills, ate something, reality, but I wasn’t scared of what was threw it up. I don’t threw it up. I don’t think I ever got a happening. I was confident, I was out think I ever got a decent night’s sleep. I had a mental there in that using world, that rat race breakdown and couldn’t remember and the people we were involved with on decent night’s sleep whole nights out. Wild beyond belief.” the dealing side went right to the very “One day I was one the phone to a top.” friend in Amsterdam and he asked me Grace put her intelligence and how I felt – and he was the first person confidence in the service of drug dealing: “I had shit loads of stuff – clothes, cars, to ask me how I was feeling. I was sitting “I used my head and would tell my money, jewellery, if I liked a pair of shoes, in this big house all by myself. And I just boyfriend what to do. I fronted it. People I’d buy a pair in every colour. On top of broke down, fell to pieces there and then. liked me more, people trusted me more, that, I never had to buy drugs, never I couldn’t stop crying. He just tripped maybe because I was a girl as well. But bought a drink in a bar. We bought a something. Up to then it was all the as we moved up the dealing scale, there house and it was chaos, just carnage. drama and the jangle of the life. I never were times when you felt in real physical Everyone knew where we lived, there came up for air. I was suffocated by danger, we got into bad situations, in was partying all the time. But in all this things and people. I looked in the mirror mad places with people we didn’t know, mayhem, I got a job as a carer. I always and I didn’t know who I was looking at. people who would go all the way for loved work. It was my own money, I just didn’t know who I was. I was so anything – nasty people. But this was because all the rest of it just wasn’t real. lost – I’d lost so much that was me – and my world. This was normal. I did what So I had my fingers in all sorts of pies.” I wanted me back.” everyone else did to belong here, but I Then after six years in the house, Grace made a decision to come off knew I was just passing through. at the age of 25, Grace’s life took yet coke. “I’d had enough. I couldn’t do it

September/october 2011 Druglink | 7 Recovery uncovered anymore.” She had always taken lots that was the hardest part. But I knew Serendipity: “I was of foreign holidays – Spain, Holland, that none of it really meant anything in River Island and Thailand, Greece – as part of the running to me. For everything that I had, I was looking at labels away, of not dealing with the problems. never, ever happy and I had to let it all and this one said But this time, she was a more positive go. It was so lonely, but I thought if I ‘Love Conquers frame of mind when she booked a trip to can get through this loneliness, then I’ll Hate’. And that Egypt. “I missed the plane at Manchester, never be lonely again.” was so true took a taxi to East Midlands airport and Grace lasted five months without to my life.” turned up looking like a dog’s dinner. I using coke, although she was still met this woman Fiona. We just clicked drinking and smoking cannabis. In and she looked after me all the way the meantime, she gave most of her there. She was 34, a PR consultant and possessions away and asked somebody had gone through pretty much the same to post £600 through her mum’s door. as me and she was a real inspiration. She sold her house, but after paying I was in the pool at the hotel and I off her debts (the house had been re- decided I would really strip my life back. mortgaged), as she puts it, “all the rest I had this plan, bought a diary. I started went up my nose”. writing my feelings and thoughts. I None of the issues she was struggling found I could free my mind of all the with had been dealt with and she was clutter and madness. When I got home, desperately lonely. “I knew I needed help, I covered the mirrors on my wardrobes but I had no idea what to do. I thought with post-its and wrote on them on all you needed to go to the doctor, but I was the things I was going to do, like get rid too scared to do that. of all the possessions, stop using coke, “I started seeing a fella who wasn’t eat healthier, get a driving test, get back really a boyfriend, just somebody to to college. use with. We got into a very volatile relationship and he started being violent towards me. It turned out that it took nearly a year his brother’s girlfriend knew about The Lighthouse (since closed and divided up before she could I was having about the life I was living. between Addaction and CRI). And once I Because of the way I felt inside, I created start talking about was introduced to it I thought, ‘yes this is all these problems externally.” it’, I just knew. the sexual abuse It’s been three years since Grace first “Finally I had support, someone to sought help and at the time of writing, talk to, to show me the way. I knew what she has been completely off drink and “I wanted to change the way I spoke to I had done to myself, but I didn’t have all drugs for 13 months. She is about to people. I was that angry, I was horrible. the pieces of the jigsaw. I had bits, I had start the third year of an architectural I was taking all my anger out on other the corners. But I needed someone to design course, works as a part-time carer people. I wanted to do this, not just help me fill in the spaces.” and has her own flat, “my own little to prove it to myself, but other people Grace saw her key worker once a sanctuary” well away from all the people were wanting to knock me down. They week and over several months, she she used to hang with. only understood the old me. The more I began to work through all the problems She doesn’t have any more one-to- changed, the more people felt bad about she had, although it took nearly a year one sessions – “I’ve taken the armbands themselves and that’s when the claws before she could start talking about the off and stand on my own two feet” – but come out, “look at her. Who does she sexual abuse. “But then it was like, ‘oh still comes into the group sessions every think she is?” my God, finally’ – and it all became so fortnight, “really just to keep myself “I did go back to college to do 3-D much easier to talk about everything. The sharpened, to see how everybody is design. But trying to get off the coke was genie was out the bottle and I just cried getting on, share a bit. It’s always good to hell psychologically. I had to lock myself and cried. I just needed somebody to sit keep your eye on the ball. away to do it. I just went to college, went with me, to understand me, somebody “The first eighteen months in recovery to work and came home. I had to step who knew what they were talking you can be very high on life or very low out of that circle and out of that life and about, to help me with all the thoughts until you get on an even keel. I was in River Island and looking at labels and this one said ‘Love Conquers Hate’. And that was so true to my life. I had so much hate, I felt the world owed me something for robbing me of my innocence. “But I’m not angry anymore. I like the life I have, I’m not a victim, I’m a survivor. And I just appreciate all the things that most people take for granted. Like I have my Sunday roast, EastEnders, washing machine going in the background. Just those little things in life make me so happy now.”

8 | Druglink September/october 2011 Recovery uncovered Land of the free An anti-consensus consensus statement

Marcus Roberts discusses recent debates about ‘recovery’ in mental health, and asks whether too much consensus could be at odds with the concept’s transformative potential and radical roots.

“Life is fired at us point blank “What we seem to have is the My first serious encounter with the and the question is not how to get reification of the word recovery idea of ‘recovery’ was in mental health. cured but how to live.” as though it is a thing that is then From the 1980s, ‘recovery’ was a banner around which the emerging service user Rowland Urey, mental health open to disputes about ownership, movement rallied, to demand changes service user etc – as though it were like some to mental health services and to society newly discovered island about as a whole. This was an idea that was which people ask: ‘What life can initially owned and developed by service it support? Whose territory is it? users themselves. Service users have also driven the Who does it belong to?’” recent development of ‘recovery’ in drug Dr Glenn Roberts, and alcohol policy. Those who argue for a rehabilitation psychiatrist rebalanced treatment system with better access to ‘abstinence-based’ approaches

September/october 2011 Druglink | 9 point to research that suggests this is and impersonal treatment system. But was a theme in the last New Labour what a large proportion of service users critically it was about economic, social drug strategy, Drugs: Protecting families want from services. The Royal Society and political inclusion – about showing and communities (2008), with its promise of Arts’ report Whole person recovery: ‘that many people who had been written of ‘a radical new focus on services to A user centred approach to problem drug off by mental health professionals were help drug users to re-establish their use (2010) explains that service users successfully finding ways of living full, lives’. This commitment was echoed were at the centre of an RSA project to satisfying and contributing lives, despite in the Drug Strategy 2010, with a clear develop recovery-based services in two experiencing mental distress’. statement that recovery is critically locations in West Sussex (Bognor Regis about ‘enabling people to successfully and Crawley), concluding that service reintegrate into their communities’, and users want personalised interventions, A fundamental detailed discussion of policies to improve a balance between psycho-social and access to housing and employment medical interventions and ‘whole principle for the (themes that were subsequently community responses’. The 2010 Drug recovery movement taken up in the National Treatment Strategy states that ‘recovery is an Agency’s Building Recovery in Communities individual, person centred journey’ not in mental health is consultation). But the differences ‘an end state’ and that it will ‘mean that living better between mental health and substance different things to different people’. misuse are also evident – notably, much Much of the early literature on should not be less official interest to date for the latter recovery in mental health which conditional on in issues of stigma and discrimination. appeared in the 1980s and 1990s was not DrugScope has invested a fair bit of about evidence-bases, clinical practice getting better energy trying to engage the Equality or research findings.I t took the form and Human Rights Commission with of first person narratives, telling the the social (re)integration agenda set out stories of individual service users who Recovery in this sense is distinct from in the 2008 Drug Strategy, with little had found their own ways of living full, ‘recovery from illness’. A fundamental success. satisfying and contributing lives, often principle for the recovery movement The final parallel I’d note between despite a bleak prognosis from mental in mental health is that living better the history of recovery in mental health health services. This literature was as should not be conditional on getting and its more recent ascendancy in drug much about inspiration as information. better. This was a departure point policy is that the ‘consensus statement’ Transplanted to a contemporary setting, for what has arguably been one of appears to be as much a distinctive its natural habitat is the message board, the great – if unsung – liberationist genre for recovery literature as the first the social network and the blog. political struggles of the last 50 years. person narrative. In May 2007 the Care There were various strands to this Its legacies include, for example, the Services Improvement Partnership, emerging recovery narrative. First, it development of the Care Programme Royal College of Psychiatrists and Social protested that diagnostic labels like Approach, innovative Supporting Care Institute for Excellence published schizophrenia should not be regarded People schemes, multi-disciplinary A Common Purpose – Recovery in Future as ‘psychiatric death sentences’. This Community Mental Health Teams, legal Mental Health Services. In June 2008, the was partly a protest against cures that protection against discrimination on UK Drug Policy Commission’s Recovery felt worse than the illness – the sort of mental health grounds enshrined in the Consensus Group produced ‘A vision of stuff Nurse Ratched dished out in One Disability Discrimination Act 2005 and recovery’, which itself built on a similar Flew over the Cuckoo’s Nest. There are the multi-million pound Big Lottery/ exercise by the Betty Ford Institute clearly some parallels here with recent Comic Relief Funded ‘Time for Change’ Consensus Panel in the United States. controversy about the use of methadone. campaign against stigma. It is pertinent DrugScope’s own report Drug Treatment The role of mutual aid, peer support, to add that this was as much a battle at the Crossroads (2009), could also be recovery champions and service user against discrimination based on people’s viewed as a contribution to a burgeoning involvement and representation are all engagement with treatment (including ‘consensus’ literature. All this time and crucial here as well. medication) as against their mental energy put into building consensus is Two different – but related – ideas of health status as such. For example, the testimony to the combustibility and recovery were also critical for mental reasonable adjustments that employers fractiousness of the recovery concept. health: as defined by theO xford English might be expected to make under the This has most recently been evident, Dictionary, these are ‘finding something Disability Discrimination Act would for example, in the controversy that you’ve lost’ and ‘regaining something include – say – adjustments to working followed the publication in June of that has been taken away’. In simple hours to allow for the side effects of the Centre for Policy Studies’ (non- human terms what had been ‘lost’ or psychiatric medications. consensually entitled) Breaking the habit: ‘taken away’ were things like choice, The identification of recovery with why the state should stop dealing drugs and control, dignity, hope and aspiration. social (re)integration has also been a start doing rehab. Partly this was about the experience of feature of the concept’s emergence in This tendency to fractiousness disempowerment within an often remote drug policy over the last five years.I t around recovery has been every bit as

10 | Druglink September/october 2011 evident in the mental health field. Back Perhaps the All the quotations on recovery in mental in 2007, when I worked at Mind, the health are from the Mind publication mental health charity, I was responsible fundamental ‘Life and times of a supermodel: The for a roundtable seminar on recovery, stumbling block in recovery paradigm for mental health’ which was marked by disagreement and (2008), which is available online at controversy. both mental health www.mind.org.uk/assets/0000/0347/ One of the complaints from some and drug and mindthink_report_3.pdf service user participants at the Mind event was that the government focus alcohol policy has Anyone interested in the development on employment was alien to the spirit been a tendency to of the recovery paradigm in mental of recovery. It was declared that ‘many health should read this together people with direct experience of mental think of Recovery with the Sainsbury Centre for Mental distress are sick of the term recovery’, (with a capital R) as Health’s 2008 report ‘Making Recovery a because ‘we seem to have moved from Reality’ at www.centreformentalhealth. services that expect people to stay a reified thing org.uk/pdfs/Making_recovery_a_ permanently unwell to the opposite – reality_policy_paper.pdf and for many this is just as oppressive’. At service delivery level, similar issues Nor is recovery simply a descriptive were raised about the transition from term, it is a highly evocative one that traditional day services providing engages people’s passions and inspires community support (offering a cup of tea commitment. Yes, we need to build a and a place to be to often isolated service broad consensus around the sort of users) to recovery services (offering skills definition proposed by the UK Drug development, job search and pushing Policy Commission and the 10 principles people back out into the world). The of recovery set out in 2008 in the idea of the Department for Work and Sainsbury Centre for Mental Health’s Pensions assuming lead responsibility Making recovery a reality. Equally, we for recovery in the 2010 Drug Strategy need to embrace multiple voices to would certainly have raised eyebrows keep in play the various dimensions of among many mental health activists. the recovery vision – including service Others expressed shock at the user voices to challenge the tendency to ‘negativity’ of a lot of this criticism, the systematisation and codification of highlighting positive examples of recovery by statutory agencies. Perhaps local recovery practice, welcoming the one of the main benefits of ‘recovery’ Government commitment to tackling as an idea is its potential to open up economic and social exclusion, and the space for a renegotiation of power with some even arguing that identifying and control. Philosophers talk about as a ‘service user’ was ‘anti-recovery’, ‘essentially contested concepts’, which because it evinced an unwillingness to have been wonderfully defined as move on. ‘concepts the proper use of which inevitably Perhaps the fundamental stumbling involves endless disputes about their block in both mental health and drug proper uses on the part of their users’. and alcohol policy has been a tendency I’m not sure ‘recovery’ would technically to think of Recovery (with a capital R) qualify as essentially contested, but, as a reified thing, and to expend energy while it can be a troublesome and battling over its ownership and ‘the turbulent idea, we should not be too one true meaning’. Recovery is not the quick to come to a shared view and put it same as either residential rehabilitation back in its box. or employment, for example – such equivalences are not so much wrong as reflecting a misunderstanding of the root idea of recovery. It is not a specific thing or outcome or intervention, but a process (as the 2010 Drug Strategy recognises). This is as true of the recovery paradigm as a framework for policy development as for the process of negotiating individual recovery pathways in drug services.

September/october 2011 Druglink | 11 Recovery uncovered

Founding fathers

When harm reduction was the The inspiration for the rising recovery organising principle we often looked to Europe and Holland for inspiration and movement in Britain has come from four ideas. With recovery, we have looked to the US – and draw inspiration and Americans. Mark Gilman on the influence ideas from four of their most influential recovery thinkers and writers. These of Simpson, De Leon, White and McKnight. are Dwayne Simpson, George De Leon, William L. White and John McKnight. As the organising principle for drug discussed the role of abstinence-based Together they also represent a range treatment, harm reduction was not treatment and how to move from a focus of interventions that move from rocket science. Provide needles and on quantity to an emphasis on quality. the individual to the collective. The syringes to make contact with injection This group gave birth to the North treatment of addiction and ‘addiction drug users and reduce the transmission West Recovery Forum, which has been science’ has focused primarily on the of blood borne viruses. Provide exploring the ways that treatment can be individual. ‘Recovery’ on the other hand maintenance medication to maintain organised to support recovery ever since. is focused on fellowship, mutual aid, that contact and cut crime. We did this Recovery is now the organising community and the collective. and it worked. However by 2005 there principle of everything we do in the Dwayne Simpson first came to the was growing concern, within the sector commissioning and provision of NTA’s attention in 2005 as a result of the and articulated in the NTA’s treatment substance use disorder treatment. NTA partnership with the Institute of effectiveness strategy, that this was not Building recovery in communities is Behavioural Research at Texas Christian enough. Questions began to be asked one of the three pillars of the coalition University. At that time the NTA was about whether recovery should be the government’s drug strategy, with its keen to look at ways of reducing the organising principle for treatment. commitment to create a recovery system numbers of individuals who dropped out In that year, a group of almost 20 that focuses not just on getting people of treatment very early. Dwayne Simpson commissioners, providers and ex-users into treatment but getting them into is internationally recognised for his work met in Manchester to face this challenge full recovery and off drugs and alcohol on maximising treatment engagement from a local perspective. The north west for good. There are a growing number of and retention. But it was Dwayne’s was where the UK heroin epidemic people who support and champion this emphasis on treatment as a journey that started and we had a disproportionately movement in the UK, but where did their grabbed the attention of the North West high drug-misusing population. We inspiration come from? Recovery Forum.

12 | Druglink September/october 2011 housing survey HOUSING FOR RECOVERY

Findings from a survey on access to housing The Recovery Partnership was founded by the Substance Misuse on behalf of the Recovery Partnership Skills Consortium, the Recovery Group UK and DrugScope in May 2011 to provide a new collective n Marcus Roberts voice on recovery for the drug sector Director of Policy and to ministers and government. Membership, DrugScope August 2011

Nobody seriously questions the FINDINGS importance of housing for successful KEY FINDINGS engagment with drug and alcohol The impact of changes to FROM OUR SURVEY treatment and for recovery. The Drug Supporting People funding Strategy 2010 explains that housing, with appropriate support, contributes to Over half of respondents expected 70% said housing services were engagement and retention in treatment, Supporting People funding to decrease ‘difficult’ or ‘very difficult’ to access improved health and social well-being, with the removal of the ring fence, in their local area improved employment outcomes and with only one respondent expecting an reduced re-offending. But how far is increase in funding. Of 33 respondents the recognition of housing’s role at who felt able to express a view, 17 64% said housing services policy level shaping the development of estimated that they would see changes would become ‘less accessible’ in recovery-orientated practice? What is to funding of between 25% and 50% and the next 12 months the impact of changes to housing-related 4 said more than 50%. policy for drug and alcohol services, including the removal of the ring-fence What, if any, has been the impact in 89% said ‘safe, secure and from ‘Supporting People’ and housing your local area and for your clients of appropriate accommodation’ was benefit reforms? the removal of the Supporting People ‘difficult’ or ‘very difficult’ to access Over a two week period in June-July 2011, ‘ring fence’? in their local area DrugScope conducted an on-line survey Decrease in Supporting People 53% on behalf of the Recovery Partnership funding (DrugScope, Recovery Group UK and the 62% said appropriate Substance Misuse Skills Consortium). We No significant change in 22% accommodation would become ‘less reported on the findings directly to the Supporting People funding accessible’ in the next 12 months Inter-Ministerial Group on Drug Policy, Increase in Supporting People 1% which brings together key ministers in funding Government with a role in drug policy. 53% reported reductions in We received 91 responses to the survey Don’t know 23% Supported People funding for their from services across the country, with clients. representation of the private, statutory and voluntary and community sectors One respondent commented on the and covering a range of treatment impact of local funding reductions modalities (and homelessness services). of 40% to local Supporting People

September/october 2011 Druglink | 13 funding saying that housing stock was Access to housing How would you describe the ‘increasingly insufficient’ and ‘services accessibility of safe, secure and that work to support clients in the We asked about the accessibility of (i) appropriate accommodation in your community to maintain tenancies housing support (for example, through locality for clients of drug and alcohol and to support them in their recovery Local Authority Housing Departments) services? (such as floating support) are more or and (ii) safe, secure and appropriate Easy to access 0% less extinct’. Another said ‘we set up a accommodation for clients. Most therapeutic sober living house with a respondents said that both housing Reasonable to access 10% plan to include funds from Supporting services (70%) and appropriate Difficult to access 47% People. This will not happen now and accommodation (89%) were ‘difficult’ we will be challenged to find alternative or ‘very difficult’ to access in their Very difficult to access 42% funding’. local area. Two thirds expected them to Don’t know 1% become less accessible in the next 12 If Supporting People funding is either months. decreasing or increasing are you able One respondent commented that ‘I seem to provide an estimate for the scale of How would you describe the to have more and more clients and there this change?* accessibility of housing services in seem to be less and less hostel places, your locality for clients of drug and longer waiting lists and less money for Less that 10 per cent 2% alcohol services? accommodation’. Another said ‘‘I have Between 10 and 25 per cent 17% been in contact with many DAATs in Easy to access 3% the South East and, with the exception Between 25 and 50 per cent 27% Reasonable to access 27% of one or two DAAT areas, access to More than 50 per cent 6% housing for clients in drug and alcohol Difficult to access 32% treatment is very difficult’.O thers Don’t know 48% Very difficult to access 38% highlighted the problems of particular client groups. For example, explaining * Only one respondent expected Supporting Don’t know 0% that ‘young people aged 16-25 are placed People funding to increase, compared to in wholly unsuitable accommodation 48 who expected a decrease, so we have with little support which … contributes assumed these figures are for anticipated What do you expect to happen to to their increasing drug use’. decreases in funding your clients’ ability to access housing services over the next 12 months? What do you expect to happen to Concern was expressed that a reduction More accessible 11% your clients’ ability to access housing services over the next 12 months? in Supporting People funding – and As accessible 20% greater reliance on the private sector More accessible 10% – was leading private landlords to Less accessible 64% As accessible 24% “cherry pick” tenants. In particular, it Don’t know 5% was suggested that while housing might Less accessible 62% be more accessible for people who had achieved abstinence, little or no housing Don’t know 4% was available at the earlier stages of treatment. Issues identified included housing benefit changes, lack of social housing, lack of investment by local authorities, Supporting People: increasing competition for private rented An example of the impact accommodation, finding deposits, past problems with tenancies and the quality ‘Since the removal of the Supporting People (SP) ring fence and the recent of some housing provision. pressure on public funding we are seeing a leakage of funding from this vital 1 Quality of accommodation. Several component of the recovery journey through SP cuts’. respondents had concerns about the quality of some housing. It ‘An example: Portland House service was an innovative rehabilitation service was commented that ‘service that was delivered in partnership with Phoenix Futures and Framework Housing users tend to be ghettoised in low Association in Nottingham. This service delivered an intensive rehabilitation service quality – and sometimes unliveable for women experiencing problematic substance misuse. Phoenix Futures provided – accommodation. This provides the therapeutic interventions for the women’s addiction issues and Framework Housing antithesis of a “recovery community”. Association provided the life skills support. The service was well regarded by Another was concerned about ‘a commissioners across the country and had very good occupancy of over 95 per number of private landlords who cent for many years and achieved excellent outcomes. The service closed in March extort, manipulate and abuse service because Framework Housing Association lost their SP funding. This was an across users, and fail to maintain their the board cut in SP funding by the local authority. This is a funding decision taken properties’. outside of the recovery sector that has impacted directly on recovery provision.’ 2 Hostel accommodation. The suitability of multi-occupancy and

14 | Druglink September/october 2011 hostel-style accommodation was a There is a lack concern in the light of plans to extend Some comments on to claimants under 35 years rules of suitable accommodation and prisoner preventing them receiving housing accommodation resettlement benefit for self-contained housing that currently apply to under 25s. for people in the Lack of housing for prisoners on It was suggested that it would be early stages of release was a recurring theme, with helpful for hostel staff to receive comments including: training on recovery and for better treatment enforcement of housing standards ‘Clients being sentenced to shorter in hostels. A clinician commented ‘a sentences who have properties problem I regularly face is trying to 5 Different groups. Issues were raised removed should … have a guarantee help a patient who is motivated for about the availability of supported of suitable accommodation on release treatment but lives in accommodation accommodation for young people, … custodial services must inform where drugs and/or alcohol use are women, families and people housing providers that a person is widespread’. A question was raised experiencing domestic violence. in custody … to negate the numbers of whether women could be required One respondent explained that ‘if being charged rent while in prison to share multi-occupancy housing you are male and single you are less and being released to huge debts’. with men or would be entitled likely to have housing options, as to access appropriate single sex you are not deemed as a priority’. ‘I would like to be able to complete accommodation. Concern was expressed about the a housing needs referral on behalf of impact of lowering of housing benefit my client prior to their release from 3 Treatment and behaviour. Some allowances for single people. short-term custodial sentences so hostels advertise that they support that upon release they have a better people with drug and alcohol 6 Residential rehabilitation. Concerns chance of accessing appropriate problems but ‘deny access if they were raised about support for people accommodation sooner’. return under the influence and leaving residential rehabilitation. evict if they use drugs or drink on Community Care Grants have the premises’. This was identified provided financial assistance to as a broader issue, particularly with help with the costs of setting up respect to young people under 25, a home. The Welfare Reform Bill Partnership Working who, if they declared issues around 2011 includes provision to abolish drug use could find themselves Community Care Grants, replacing labelled as a ‘management problem’ them with locally administered How would you describe the – ‘once labelled in this way support assistance at the discretion of Local engagement of local housing for a person fades, behaviour is Authorities. Other respondents stakeholders in the recovery agenda? “logged” as incidents and the tenancy reported positive experiences of A sufficient level of engagement 9% eventually fails’. Clients who had rent accessing housing – for example, arrears may be excluded from housing in one area clients who were hard Some engagement 33% until the debt is repaid. People who to re-house on leaving residential An insufficient level of 43% have criminal records or have been rehabilitation had been referred to engagement evicted from previous tenancies can the Supporting People ‘High Priority find themselves excluded for as much Panel’ and placed successfully. Some No engagement 8% as two years after the conviction. expressed concerns that service Don’t know 7% users not yet in abstinence-based 4 Stages of recovery. There is a lack of treatment were excluded from suitable accommodation for people housing. One housing provider sought in the early stages of treatment. It Over half of respondents to our to justify this, commenting on the was suggested, for example, that survey said engagement of housing ‘pro-citizenship outlook’ of ‘post ‘supported housing in the early stages stakeholders in the recovery agenda residential rehabilitation clients’, and would be most appropriate and once was either insufficient (43%) or there claiming ‘the sheer level of support stable the client could be moved to was none (8%). On a positive note, the they enjoy … means that we can say a time limited leasehold property – majority said that there was progress with a huge degree of certainty that as ideally they will have reached a towards more effective joint working, they are completely drug, and often point where they are self-sufficient and more than one in six reported ‘good alcohol free, which means in terms and could move on’.1 Another issue progress’. of being “suitable tenants” they are a is people who need a ‘fresh start in a safe bet. We cannot say the same for A couple of respondents talked about different area’. people accessing our services from the local development of Joint Protocols. the non-recovery population’. Others expressed frustrations at difficulties in securing housing provider 1 Interestingly, one respondent questioned participation in strategy groups (for whether clients should always be stratified into strict ‘needs groups’ for the purposes example, a Reducing Reoffending of housing support, explaining that it could Strategy Group). Predictably, barriers be beneficial if ‘small groups of clients who to information sharing emerged as an have formed relationships at each stage are issue, and concern was expressed about able to continue together’

September/october 2011 Druglink | 15 short-term commissioning cycles and Some practical recommendations l consideration of the role of amnesties compartmentalised funding. Several for rent arrears; respondents commented on the need l local Authority bond schemes to for ‘hands on’ involvement (for example, We asked contributors what specific enable clients to pay deposits to a scheme where drug workers ran changes to policy and practice they private landlords and cover rent surgeries in homeless hostels in Bristol2). would like to see. Suggestions payments in the early period of a One Local Authority had funded and included: tenancy; appointed a post for a homelessness worker specialising in people with drug l service user involvement in l national monitoring and oversight of and alcohol problems and providing developing accommodation services; the impact of reduced public spending a bridge between housing and drug on the availability of housing; l providing clarity about the legal services. responsibilities of housing providers l ring-fencing – or other protection – of (especially around section 8 of the How would you describe progress local housing investment; towards more effective joint working Misuse of Drugs Act 1971 – and review l between the housing or homelessness a nominated team or individual of this provision); in Local Authorities with a specific sector and drug and alcohol treatment l Housing benefit or other incentives responsibility for housing and in your local area? for engagement with recovery (for recovery; Good progress on more 16% example, access to more independent l effective joint working Joint commissioning and shared and supported housing for clients outcome frameworks for drug and who have not been involved in the Some progress 49% alcohol and housing services to criminal justice system for a given Little progress 29% incentivise partnership work in time period, have engaged with support of recovery; treatment and/or contributed to the No progress 6% community); l incentives for landlords to develop and make available empty properties; l reviewing the impact of local Another issue was the need for training residence tests, which can tie people and workforce development around the l pre-tenancy qualification schemes to an area where their networks are recovery agenda. Sixteen per cent of for vulnerable clients to give housing based around previous drug or alcohol respondents said people working in drug providers confidence in their ability to misuse; and alcohol treatment had ‘high training manage a tenancy, with involvement needs’ on housing, and 80% felt there of private landlords; l improving access to Tier 4 recovery was ‘some training need’. Forty two per services, including residential l support for clients to address rent cent said people in housing services had treatment option for street arrears and specialist accommodation ‘high training needs’ on drug and alcohol homelessness clients. schemes designed for people who issues, and 55% identified some training have had problems with other need. tenancies; l on-going support from housing teams once someone is in accommodation, (for example with financial management of rent and bills);

Some comments on partnership work Over half of respondents ‘Despite being invited to meetings to discuss the recovery agenda some housing providers fail to attend. A recovery action plan has been launched … but gaining the buy to our survey in from housing stakeholders is proving difficult’. said engagement

‘The recent opening of a harm reduction suite as a joint venture between the DAAT of housing and Action Homelessness has led to some fantastic inroads. The suites are being stakeholders replicated across five sites. Training has been sourced by the DAAT for frontline workers, including both housing options staff and hostel staff, and a programme of in the recovery training will run over the next 12 months.’ agenda was either

‘Brighton and Hove have done some effective work in the last five years integrating insufficient (43%) or both treatment and accommodation pathways. We have now employed a nurse to work there was none (8%) specifically with dependent drinkers in hostels, facilitating slow alcohol reduction using a recovery model.’

2 Although it was reported that funding for this sort of work was being withdrawn.

16 | Druglink September/october 2011 People on journeys need maps in the same communities where they is ‘medication assisted recovery’ and the International Treatment had been living wrong? When De Leon and ‘recovery-oriented methadone Effectiveness Project is perhaps most came to Liverpool in March 2011 this maintenance’. This work reminds us associated with mapping. This was question had been answered with a that there are many paths to recovery. revolutionary to our client group. resounding yes. Liverpool now has a very All are a cause for celebration and that At a meeting of the North West large and growing network of Narcotics includes people on methadone and service user group in 2005 the idea of Anonymous groups. Cocaine Anonymous buprenorphine. The best treatment will treatment as a journey was met with and Alcoholics Anonymous have seen prepare you for ongoing support in a a mixture of quizzical and concerned similar growth. community. Commissioned treatment responses. “What do you mean systems can support, but not provide, treatment journey? I didn’t know I was long term recovery. Long term recovery is going anywhere? I thought I had arrived. When harm reduction sustained and maintained in fellowship I am settled on methadone maintenance. was the organising and mutual aid in recovery communities. I thought this was it!” Simpson replied: By 2009, it was becoming clear that “You’re on a train that has MMT principle we often there was a piece of our recovery jigsaw (Methadone Maintenance Treatment) on looked to Europe missing. What happens to people in the side and unless you get off then the long term recovery? Do they just stay evidence based destination is the grave”. and Holland for in recovery meetings? Where else do The same year, one of Simpson’s inspiration and ideas. they go and what do they do? We had colleagues was visiting the UK and come to believe that people in long term visited a classic Tier 3 community With recovery, we recovery were “better than well”. This is prescribing centre. He came back to have looked to the US where the work of John McKnight and the NTA and said how impressed he his colleagues fits into theUK recovery was with the “dosing clinic” and looked picture. ‘Asset-based community forward to seeing treatment. He and Inspired by De Leon’s work, we have development’ has emerged as a way Simpson were a little shocked when embraced the mutual aid mantras of “I of responding to the challenges posed they were told “that is the treatment”. can’t but we can” and “you alone can do by both health and social inequalities. So, Simpson gave us the whole notion it but you can’t do it alone”. Most people The most difficult and complex cases of of recovery being about movement, start using substances as a communal addiction, presenting to public services journeys and maps. He also prompted us thing. There was a time when substance for treatment, tend to be emerge to question whether medication dosing use was a fun thing to do with friends from, and are located in, the most alone should be classed as ‘treatment’. and peers. In the grips of active addiction impoverished communities. Treatment George De Leon is perhaps best social isolation takes hold, self will runs alone cannot provide a long term known for his 2000 paper The therapeutic riot and the addict’s identity as a victim answer to addiction that has its roots in community: Theory, model and method takes hold: “Poor me, poor me, pour me intergenerational health inequalities. and his work on the stages of recovery. a drink”. Long term sustainable recovery As the treatment system prepares It was within his work that we first for De Leon requires a complete identity for the transition to a new public health came across the notion of ‘recovery- change. With this identity change people system, under the auspices of a new oriented integrated systems’ (ROIS). We become pro-social, conventional adult body to be called Public Health England, set ourselves the challenge of trying to citizens. If their recovery is visible and the NTA is already encouraging local articulate or better still, establish a ROIS attractive it becomes contagious. They areas to adopt asset-based interventions. in a geographically defined community. become role models for recovery. They Its action plan for 2011-12 makes clear De Leon’s work on community as show that recovery is a reality. They this approach will enable partnerships method was crucial in our thinking. His model recovery in their communities to assess the recovery networks of their proposition is that by coming together as and living in those communities own communities as part of the local part of a therapeutic community people becomes a method of recovery. strategic planning process. Treatment can learn how to live ‘right’. This is where the work of William L that is recovery-oriented and recovery “Right living” is another of De Leon’s White became crucial. White is one of that is asset-based can ensure that our contributions to the UK recovery the most important thinkers and writers sector plays a major role in our new movement. In the past, places like on recovery and recovery communities. public health system. People recovering Liverpool had sent significant numbers At a seminar in London in March 2009, from addiction in the same postcodes of people to residential rehabilitation White employed the metaphor of a dying that they were sick are real community centres far away. Northern regional tree. You can take a tree that is dying assets. They show that new and healthier accents could be heard in residential and dig it up and replant it in rich soil. If identities can be forged by coming rehabilitation centres all over the you nurture the tree it can flourish. But, together and creating communities that south of England. If they did well they if you dig it up again and replant it in foster recovery in the widest sense of the stayed away from their home towns the old soil it will start to die again. The word. and cities. If they didn’t do so well, they question then becomes, can we enrich relapsed and came home. So, north the soil so that the tree can survive and n Mark Gilman is National Strategic west commissioners of residential thrive without having to be dug up and Recovery Lead for the NTA rehabilitation were exporting ‘success’ replanted elsewhere. In recovery terms, and importing ‘failure’. Inspired by the can you get well where you got sick? For more information go to: work of De Leon we wanted to see if The answer from Liverpool, is yes you www.ibr.tcu.edu/persons/simpson.html we could establish a ROIS in Liverpool. can, or more precisely yes ‘we’ can. The www.williamwhitepapers.com Can people get well where they got recovery community becomes a method www.abcdinstitute.org/profile/ sick? Can people learn how to live right of recovery. White’s latest contribution ?ProfileID=47&/JohnMcKnight/

September/october 2011 Druglink | 17 Recovery uncovered Word of mouth An expanding network of current and former problem drug users will energise the recovery movement in the UK and create social entrepreneurs. By Alistair Sinclair.

Recently, in Drink and Drug News, I voices who don’t end up on conference who are healthy you are more likely to questioned whether we’d reached the rostrums, write articles for journals and become and remain healthy. point where we could reasonably claim blogs nor have reputations as leading William White has written extensively there was a recovery movement in the lights of recovery. Rather, they work of the importance of generating UK. I said we needed to hear from new within services and communities, often pathways from cultures of addiction to voices if we were to see a healthy and unpaid and with very little recognition, cultures of recovery. All good stuff. But dynamic movement form, and that to support and empower those who have how do you do it? The UKRF believes these voices could be found within the very little power, through established that we can make a start through the community. I wrote that there was a mutual aid groups and the generation generation of recovery networks that need for new community-led ‘recovery are open, inclusive and founded on a networks’ and touched on what the UK number of very simple basic values; we Recovery Federation (UKRF) has been We believe recovery are more alike as human beings than doing to support emerging networks in is bigger than an different, all human beings have the the UK. same basic needs, and every human Here I want to outline the UKRF individual’s drug being is of equal value. A strong recovery vision for these recovery networks. status. It’s a process network will be made up of people in It’s a vision borne out of two UKRF long-term recovery, people in early conferences involving nearly 600 of transformation, recovery, people who are recovering and people (the majority of whom were in of empowerment, recovery allies. How people chose to recovery), a consultation on what our define themselves will be up to them. principles should be and lots of events a journey toward The Service User Recovery Forum and meetings in many different parts of renewed meaning and (SURF) on the Wirral puts it rather the country. We have been influenced by nicely: “You’re in recovery if you say you the work of Faces and Voices of Recovery value for individuals are”. Whilst this view had generated (FAVOR) in the US, William White in the and communities consternation in some, who prefer substance use field,L arry Davidson in definitions of recovery that place mental health and John McKnight in abstinence at the centre, it has enabled community development. Writers and SURF to begin to generate a network thinkers like Saul Alinsky, Paulo Freire of new forms of mutual aid rooted in that is open to a wide range of people and Myles Horton have also had an political advocacy and diverse forms of from very different backgrounds. The influence, as haveA ntonio Gramsci’s social networking. Merseyside Recovery Network (in which writings on education and John Bowlby, Recent work undertaken by the RSA in SURF members play an active part) DW Winnicott and Bruno Bettleheim’s their Whole Person Recovery and Connected brings together people from abstinence work on attachment and dependency. Communities projects has highlighted and harm reduction-focused arenas, as At its core, our vision for community- the importance of access to wide does the newly emerging South-East led recovery networks reflects the social networking opportunities in the Recovery Network and others around experiences of our members, and this development and sustaining of ‘recovery the UK. We hope the networks will grow, includes people who work in services, capital’. It’s not just what you know, but through the establishing of diverse who have engaged with the UKRF, who you know. ‘Contagious recovery’, relationships, to encompass all those supported it and helped shape its values a concept that’s been promoted by who want to support recovery within and methodology. At this point they are David Best amongst others, rests on the the community at individual, cultural the unsung heroes of the UKRF, the silent premise that if you hang out with people and structural levels. And that they

18 | Druglink September/october 2011 will seek to address the medical, social, Merseyside Recovery Network we have of us live. Recovery networks offer hope psychological, spiritual, economic and focused on the development of shared and optimism. They place a great deal political recovery issues within their values and the ‘mapping’ of the many of faith in the abilities and passions communities. talents, skills and abilities that members of people who are often perceived and The UKRF has consciously avoided a have. This process has helped the group portrayed as the afflicted.T hey offer the definition of recovery because we believe form, to learn about each other and to possibility of change. recovery lies within individuals and begin to plan the things they want to do. The UKRF believes that we will see communities. They must define what The UKRF believes that recovery recovery networks in every region of recovery means to them. However we networks have the potential to the UK, every locality, city and town. believe there is a need for a set of core generate a huge number of new social These networks will be connected with values and principles around which entrepreneurs. By identifying strengths each other, sharing resources, skills, diverse individuals and groups can locate within communities, with a focus on abilities and passion. They will be open themselves. We have developed a set of the development of diverse and open to everyone who wants to recover, who UKRF recovery principles, building on the wants to transform the way that they work of the Centre for Substance Abuse live and wants to support others in Treatment (CSAT) in the US. their transformation. The networks will A central UKRF principle is that explore new ways of using their ‘assets’, “recovery transcends, whilst new ways of communicating and embracing, harm reduction and new ways of organising, working abstinence based approaches and living. and does not seek to be I haven’t been specific prescriptive”. We believe about what these networks recovery is bigger than will do. This is important. an individual’s drug It’s not for me or others status. It’s a process to say what function of transformation, the networks will have. of empowerment, They will do what they a journey toward want to do, what they renewed meaning and are able to do – based value for individuals on the strengths, and communities. experience, abilities, There is a need for passions of their individual change members and the new but, perhaps more relationships they form importantly, there is in their communities. a need for change on They will have builders, cultural and structural carpenters, writers, levels. Power inequalities gardeners, administrators, lie at the heart of philosophers, managers, discrimination and stigma artists, musicians, performers, and recovery must challenge accountants and story-tellers. these. Recovery networks will do They will have many skills and this through the nurturing of new will be built on the strengths of open and honest relationships founded community members. They will have on the strengths, abilities, experience abundance. and passions of network members. Recovery networks require What will recovery networks do? relationships, we believe recovery mobilisation, organisation and resources. We believe that if they adopt the values networks can generate wide ranging There are many people in recovery with and recovery principles promoted opportunities for network members the skills to support the networks but by the UKRF they will do all kinds of and the wider community. They can they also need support. The UKRF has amazing things. William White has play a crucial role in the development identified over 50 people from all over written extensively on the strengths and of recovery-oriented services, by the UK who have indicated an interest in abilities everybody has within ‘cultures supporting them in the establishment training to become recovery community of addiction’ and the importance of first of core recovery standards and by aiding organisers (RCOs). We will begin to developing a cultural understanding and communities – through the promotion of explore how we can support them at then supporting people in applying their a DIY culture that places social cohesion, our national conference in Cardiff on strengths within cultures of recovery. connectedness and renewed meaning at 9 September and will be holding UKRF These cultures need to be defined, its heart. recovery seminars in every region of the developed and nurtured within the Many people in recovery , and I use UK, beginning in Lanarkshire in Scotland community, hence the importance of the term in its widest sense, have found on 28 September. It’s a long path – and open and inclusive recovery networks new forms of meaning and value outside we make it by walking it. embedded within communities and of, and far beyond, the pervasive cultures community-led. In the emerging of unhealthy dependency in which many n Alistair Sinclair is a Director of UKRF

September/october 2011 Druglink | 19 Recovery uncovered A social contract Treatment offers to get the dispossessed and addicted back into mainstream society, but for many this offer simply lacks credibility. Richard Phillips on how the recovery movement can offer people a tangible route out of addiction.

Last year, I watched an intriguing To the economist, white middle class mutual-aid and recovery communities television programme about a radical achievement in school is powerfully are helping treatment services bring educational experiment in a deprived incentivised by a credible promise forward the benefits of recovery and neighbourhood of New York. A black of future reward. To the kids in the create more realistic pathways to social professor of economics explained deprived inner city schools, the promise re-integration. his own journey from “the ghetto” to of future reward, even if loudly made or So what does treatment ‘offer’? When academic success at Harvard and also repeated often, is simply not believable. we invite people into treatment we put his radical experiment in educational The financial incentives he put in place an offer on the table that makes the rescue. simply brought the rewards of education case as to why they would be better off For the schools he was working forward in time, into the lived experience in treatment than not. In the simplest with, the statistics were as depressing of the students. This helped them value terms, treatment offers to ease or relieve as they were familiar, with only a education and hopefully benefit from it suffering, make the life in treatment, small proportion of students actually in the long term. better or more bearable than life completing school and boys landing in without. Given the readiness of service the morgue more often than college. His users to stick with treatment, I think remedy was simple: provide monetary To the kids in the it reasonable to accept that treatment payments to pupils based on attendance, deprived inner city does a pretty good job of achieving good behaviour and course completion. this basic goal. From research, we can The sums of money were significant and schools, the promise also be confident that treatment is diligence could result in many hundreds of future reward, helping keep people alive, healthier and of dollars at the end of term. The communities safer. This is an impressive evidence he was presenting suggested even if loudly made set of achievements and has for 20 years impressive results. or repeated often, is justified a remarkable level of public This was interesting enough, with investment in these services. obvious similarities to contingency simply not believable Treatment often helps people re- management for addictions, but what I integrate back into society. We should found intriguing was his explanation as not forget, for example, that many to why this approach worked and was You are probably wondering what an people build on the stability offered by morally justified. earth this has to do with recovery from substitute prescribing to get jobs and He pointed out that white, affluent problems of addiction. rebuild families. Others benefit from students in the leafy suburbs of the The parallel is the idea that treatment residential rehab and effective packages same city had a very clear understanding offers to get the dispossessed and of aftercare. The system, overall, has not of what the trade-off was for the hard addicted back into the blossom of lived up to the hopes and aspirations of work of school. If you work hard at society, but for many this offer simply service users. Too many remain bleakly school there will be ample reward for lacks credibility, just as the value isolated and on the fringes of society. you later. You can expect a good job, your proposition of those deprived schools Too few are enabled to step out from the own house, a car and indeed the rest of was not believed by their students. isolation of addiction and build a self- the American dream. I want to explore whether self-help, image and lifestyle as a fully involved

20 | Druglink September/october 2011 and valued member of the community. Through self-help, peer support, user The best approach is partnership. Of course these are generalisations forums, mutual aid and similar groups, Providers can do much to support, assist and some services do a great deal people recovering from addictions are or strengthen recovery communities to aid social re-integration – but a regaining the foothold in society that the and encourage their service users to mismatch remains between what treatment system alone has not been get involved early in treatment. Many treatment services have been able to in a position to provide. This should not providers now offer practical help where deliver and what people in treatment be directed or taken as a criticism of help is needed but step back when more feel they were offered. Linking back treatment, but a little humility may be independence is requested. With these to our example of education in the needed to acknowledge that for all the approaches, providers will help bring deprived neighbourhoods of New York, time and effort trying to create wrap forward some of the benefits of recovery the treatment system offers social around provision, through-care and and show to their service users that their reintegration just as those schools seem after-care, there has been something hopes of social integration really are to promise economic success – but the missing that only people in recovery possible to fulfil. promise does not seem credible. could provide for themselves. Finding the best relationship between So where is the evidence for this treatment and recovery communities mismatch of expectations, this pent up will take time. This is new terrain and need – and if this is so important, what A simplistic but I we should live with the fact that some should be the response? think helpful view things will work and others not. The answer to both questions is There should be nothing emerging up and down the country of recovery is simply unfamiliar about social contingencies, in the remarkable growth of recovery to build the inverse responsibilities and relationships communities, a phenomenon I believe supporting or mediating recovery from to be the single most important path, to bring forward addictive behaviour, though personally I development in this field since harm the benefits of social subscribe to the description of addiction reduction. put forward by William Burroughs: “You In my work promoting SMART re-integration so become a narcotics addict because you Recovery I have been invited to speak at that the option of do not have strong motivations in the service user forums, peer involvement other direction. Junk wins by default.” conferences, recovery community continued or resumed A simplistic, but I think helpful view events and meetings named from addictive behaviour of recovery, is to build the inverse every permutation of the words path, to bring forward the benefits of recovery, involvement, forum, peer and simply loses its appeal social re-integration so that the option communities. What I have seen is a of continued or resumed addictive remarkable, broad-based and grass roots behaviour loses its appeal. movement of people in recovery working Recovery communities offer new and together to build up their stake in A few organisations seem to take the pro-social identities to people who have society. It is an emergent movement, all position that ‘we don’t do recovery’. This much to leave behind, reinforcement of the stronger for the absence of a singular is a failure to understand a transition of healthy moral codes, the encouragement ideology or national leadership. It is real importance to service users, though of those who have walked the same driven by both broad based involvement I predict such services will quickly path and pride in helping others. The and also dozens of remarkable people change their minds or face extinction at growth of recovery communities will taking on leadership roles within the hands of frustrated commissioners! probably improve treatment outcomes, individual projects and groups, whether A few others claim to do recovery ‘all by building up the long-term social as SMART recovery facilitators, spreading in-house’. There are important things contingencies that reinforce recovery, fellowship meetings or within any of the that can be done within services, but but we should not wait for such evidence two dozen or more other peer support failure to build links to organic, user-led to accrue before deciding whether such structures already established or being or other independent groups suggests communities should be supported or tried across the country. that the point has been missed. We encouraged. The reason for building The main thing that makes this a should be wary of ‘Potemkin’ recovery bridges between treatment and recovery common community is perhaps the communities, smoke and mirror communities is foremost a moral guiding adage that “We alone can do it, creations put together for tenders rather one, that the desire for self-respect, but we cannot do it alone”. than to meet the aspirations and needs community and the bonds of friendship This recovery movement is not driven of clients. are such basic human needs that the by ideology and is beyond a belief in Yet other services see this recovery default position should be to support self-reliance, mutual aid and social agenda as important, but correctly this wherever possible. reintegration. For most, it is not even handled entirely by service users or Get this right, however, and just specifically about abstinence.A lthough people in recovery. They don’t want to perhaps we will achieve a treatment a political debate about abstinence has get involved because they don’t want to system where the promise of a stake in run alongside these developments, many interfere with what should be peer–led. society is credible and at last recovery groups are proving able to include and This is more benign and shows greater will win by default. embrace the methadone maintained, understanding of the nature of the fellowship attendees and people at recovery movement, but still sells their n Richard Phillips is director of SMART almost every stage of recovery. service users short. Recovery

September/october 2011 Druglink | 21 INTERNATIONAL

Under the shadow of the drug lords

The vibrant Mexican city of Monterrey is the country’s financial hub. But as with a growing number of cities in Mexico, it is ceding control to the narco-traffickers. Reporting from the city, one eyewitness describes the suffocating effect that crime linked to the drug trade is having on everyday life in the city.

22 | Druglink September/october 2011 Monterrey: From one of the safest to one of the deadliest cities in Mexico in six years.

Perched at the eastern edge of the Sierra while many of (gunfight) mentioned.T hey can occur Madre mountain range that cuts vertically daily around the city, anytime, anywhere. through Mexico, Monterrey is a three her friends have The volume of fire in these encounters hour drive south of the Texan border. stopped going out has been likened to open warfare. From It is Mexico’s third biggest conurbation January to April of this year, in Monterrey with a metropolitan population of four at night, Patricia alone, 12 bystanders, including young million: it is also the nation’s financial continues to children, have been killed by stray bullets and industrial capital. Framed by the high during shootouts. peaks of the Sierra, it is a spectacular regularly meet the Fear among the general public is looking metropolis. From all vantage few who are still palpable. Security forces in balaclavas points, with few tall buildings, it sprawls drive armoured transport in convoys as far as the eye can see. prepared to step around the city. Soldiers, mounted in In 2005, Monterrey was ranked as Latin out after dusk the open backs of each of these vehicles, America’s safest city. It is now one of clutch firearms across their chests. Such Mexico’s deadliest. spectacles do not inspire confidence; There are commentators who say I have connections with Monterrey. They they leave only a sense of foreboding and that Mexico is close to becoming a failed go back to 2001 when I worked there for apprehension. state and is facing a crisis equal to its three months. I met my future wife in Monterrey is home to many long, bloody civil war sparked by the Monterrey and over the last decade the international corporations. It is certain Madero revolution of 1910. Others claim city has become my second home – my that these organisations will become that the country is now a Colombian- family spend a month there every year. less able to function in such a hostile style narco-state, with law enforcement The turf battles taking place around environment and the possibility of their effectively powerless. Declarations of this the district are now so frequent and relocation is a real one. The economy type are gaining in pace and credibility. severe that the population is struggling of the entire district may become The growing sense of crisis is a product of to go about its daily business. The fractured as a result. Monterrey also drugs trafficking and the crime that goes upsurge in violence has been attributed hosts Mexico’s most elite university – the with it. to the two major cartels that vie for Universidad Tecnologico de Monterrey. In the last decade, there have been control of the city’s drug trade – Los This university was once a first choice tens of thousands killed as a result of Zetas and the Gulf Cartel. Los Zetas, in for affluent students throughout the fighting between the drugs cartels and particular, have a fearsome reputation. country. According to local news reports, security forces. Over the last two years, Their preferred tactic of terror is many students are now choosing to the ferocity of violence has intensified, decapitation. The heads of the butchered further their studies in Mexico City and reaching endemic proportions. The are regularly placed in plazas and Guadalajara. Opting for Mexico City over ‘warfare’ was once confined to the other public places. This method of Monterrey on account of security factors north-west of the country but now exists intimidation is now commonplace. would have been inconceivable just a throughout the entire northern half of the It is difficult to go more than an few years ago. nation. hour without hearing the word balacera Crime in Monterrey is a rapidly

September/october 2011 Druglink | 23 “We are thinking of changing the car for something smaller and older. I feel so vulnerable alone with the boys in the vehicle – we would be such an easy target for someone wanting to steal the car. I now thank God at the end of every day that we arrive home without incident.” Lorna is a resident of the colonia of Villa Mitras. She was at pains to explain to me that the inhabitants of Monterrey are becoming more and more exposed to la delincuencia (delinquency). This is especially true for those with presumed links to cartel members. In January of this year, her mother’s house was destroyed in an act of arson. Her mother, a retired cleaner, had been out for the day with Lorna and her newborn son. They returned late in the evening to discover that the house was a blackened ruin. Lorna says: “This was an attempt on my mother’s life. Both of my brothers have been accused of drug related activity. They have been to prison before, but are both now trying to rebuild their lives. This problem never goes away expanding business. It is impossible the local population and these ‘narcos’ will seek to murder, to say how much of this is directly kidnap and attack their rivals and their related to cartel activity but incidents of contracted a families.” carjacking and robbery have increased group of Colombian Patricia, a sales consultant, is 48 and at an alarming rate over the past couple likes to socialise. She looks forward to of years. mercenaries to her nights out after work with colleagues According to a security report on protect them and and friends. Patricia told me that, while Monterrey, written in February 2011 by many of her friends have stopped going the US Department of State – Bureau of their businesses. This out at night, she continues to regularly Diplomatic Security, vehicle thefts and is why you see the meet the few who are still prepared to carjacking jumped by over 1000 per cent step out after dusk. ‘‘It’s awful what is in the city in early 2010 and continued place so busy here happening to the city,” she says. “The an upwards climb until the middle of the nightlife is unrecognisable from how it year. It is presumed that many of these was just a couple of years ago. However, I are being used to replace cartel losses at night and many were talking about am not going to stop going out, although during confrontations. The same report the dangers of going out during the I am now taking more precautions. I goes on to say that throughout 2010, hours of darkness. This year, many of the no longer stay out late at night and abduction rates soared to between 200 businesses in Barrio Antiguo are closing I’m trying not to drive anywhere after and 300 per month. However, these go down. midnight.” widely unreported due to civilian fears The bulk of the urban population now She went on to tell me about the most of police collusion with kidnappers. take precautions as a matter of routine. wealthy and exclusive area of the city, Crime, and the drugs trade in particular, For many, leaving home to undertake Valle, in the municipality of San Pedro is transforming the culture of Monterrey everyday tasks requires a level of Garza Garcia. Here, where a meal and and degrading it. vigilance around personal security. The a few drinks will cost the equivalent of The sense of insecurity impacts following personal accounts from people a week’s wages for many of the city’s on community life in many ways. A we know in Monterrey illustrate the workers, Patricia claimed that the bars very obvious example of this is in the difficulties of life in the city. and restaurants were still busy. In view way things have changed in the city’s Ivonne is a mother of two boys under of the dwindling nightlife throughout the nightlife. During our visit in 2010, we seven. Her daily routine of taking the city, this seemed an anomaly. I imagined noticed that Barrio Antiguo, Monterrey’s children to school and picking them up that the residents of this part of the fashionable district of trendy bars at the end of the day has now taken on city, among the wealthiest in Monterrey, and expensive restaurants, was less new dimensions. ‘‘I never used to give would have most reason to stay at home populated than it had been in previous it a moment’s thought. Yes, the traffic with their private security and cocooned years. Instead of having to squeeze in Monterrey is terrible and the drive behind high-walled barricades. It would through crowds to find some standing to school has never been a relaxing appear, however, that it is exactly these room, tables were now easily available. one, but I am now more conscious than residents who are keeping the night- People were beginning to stay indoors ever of my surroundings,” she tells me. time economy alive.

24 | Druglink September/october 2011 The following Saturday night, I ventured into Valle to meet a friend. Rene is a teacher of languages and a resident of the municipality of San Nicolas, a 30-minute drive from Valle. He is prepared to drive across the city for his entertainment. Rene told me that he had heard that the local population of Valle had contracted a group of Colombian mercenaries to protect them and their businesses. “This is why you see the place so busy here,” he says. “Look at the people. They don’t appear too afraid, do they? I feel safer here. Sure, you never know when a balacera can start and one could still happen around here, but I feel happier to be out in Valle and would rather drive across the city to socialise in these bars.’’ The current Mayor of San Pedro is Mauricio Fernandez. According to a recent article in the Washington Post, the mayor has installed 2,000 security cameras, quadrupled the police force, established neighbourhood watches with 1,000 residents and built his own intelligence service in a $65 million bid to “armour plate” the district. “I pay for Purges of the police occur periodically, Undaunted: Kindergarten teacher Martha information, just like the FBI or Scotland but these have failed to eradicate the Rivera Alanis was presented with an award Yard,” he told the Post. The article goes problem and it is difficult to see how this for outstanding civic courage after she kept on to say the mayor keeps informants can change, given the blend of coercion her pupils safe when gunfire erupted yards on every block. He has supplied them and low police wages. from her school in Monterrey in May. When with walkie-talkies to communicate Drug trade terror is a threat and the shootout began, Rivera Lalanis became directly with his “bunker”—a high-tech, a reality that poses dangers not only scared the classroom could be hit in the multimillion-dollar command centre. to public security but to the fabric of crossfire. She protected pupils at Jardin de Passing through Valle on the drive society itself. In the main, the drugs Ninos Alfonso Reyes school by persuading home, I noted that queues still formed trade in Mexico flows north to the USA, them to lie on the floor – by singing them a outside some bars and restaurants Consequently, America has a direct song about the sky raining chocolate, telling and that, on the face of it, all appeared interest in this issue. Mexico does not them the need to catch the candy in their normal. However, as consolations go, this appear to have the means to win this mouths. “I’m going to carry on, of course it is was a small one given the extinction of battle and there has been recent talk in possible,” said the mother of two. “If my five nightlife in other parts of the city. the press that the government is now and six year olds can do it, it is up to the rest There are no discernable signs that considering the legalisation of drugs. of us to carry on.” the authorities are able to combat the Although this may lessen some of the situation in which the country finds problems, it would only succeed in itself. The drug cartels are rich, powerful removing a part of the cartels’ income. and well organised. They use violence The dramatic rise of kidnap, extortion and intimidation as instruments of and robbery would suggest that they used by the cartels originate in America. control. Cartel propaganda banners, have developed other sources of income But, given America’s anti-control lobbies, ‘narco-mantas’, have begun to appear and power which drug legalisation would and the lack of public opinion to enforce around Monterrey. In addition, several leave untouched. gun control, it seems that the supply to anonymous emails and rumours of However, the American the cartels is not likely to be restricted impending violence went viral through administration continues to put pressure any time soon. the community. These have had a on the Mexican government to maintain Certainly, the drug epidemic will destabilising effect on the population the fight against the cartels.P resident continue to tear the country apart. The and negative impact on the local Felipe Calderon recently repeated his 19th century Mexican President, Porfirio economy. In the past, public critics vow to win the drugs war. In return, Diaz, said: “Poor Mexico! So far from of the cartels, mainly journalists and Calderon has demanded that the God and so close to America”. What politicians, have been routinely executed. Americans review their regulations additional lamentations would he have Today, newspaper articles that denounce on the sale of arms – the Mexican now? the cartels rarely bear the name of the government says cartels are equipped author. through guns purchased in the USA. The author of this article wants to Police corruption is rife and this The US Senate itself confirms this and remain anonymous under the name contributes to the power of the cartels. estimates that 87 per cent of all weapons Leadknife

September/october 2011 Druglink | 25 Mind the gap

David J Linden is an academic with an international reputation in the field of neurobiology. He is also a talented writer with a gift for explaining complex things in terms that can be understood by the intelligent lay reader, and to that extent is an important populariser of science.

This, his second book, again mixes humour, to the “pleasure centre”. It is notable that not all interesting anecdotes and serious brain science into neurobiologists take the same view. Thus Dr Don C a blend which is very readable. The basic message Kalant, in a 2009 paper entitled What neurobiology of the book is that despite cultural influences, cannot tell us about addiction, gives an account of the hedonistic behaviours are best understood in terms different processes that take place in the so-called of neurology and biology. The message is underlaid ‘reward system’ (another name for the ‘pleasure Reviews by an unswerving commitment to materialist and centres’) which include alerting the organism mechanist-deterministic philosophies of science to new stimuli, decreased dopamine output in n John Davies and it is suggested that such an understanding is some situations, and the fact that sometimes Professor of “more fundamental” than alternative explanations. aversive stimuli are associated with dopamine Psychology, Professor Linden illustrates his message with release. Dr Kalant says: “The whole concept of University of examples taken from brain stimulation studies, the dopaminergic mesolimbic and mesocortical Strathclyde in animal studies, careful descriptions of the neuro- pathways as a ‘reward system’ must be regarded Glasgow chemical processes involved in drug use and the as a convenient label rather than a literal fact. It nature of addiction. He concludes with an amazing is inherently impossible to explain addiction by chapter on the future, including the possible use pursuing only the analytic study of drug interactions of injectable nano-robots who are tasked to cheer within the nervous system at ever-finer levels of us up, as and when necessary. There is a lot to be molecular structure and function.” impressed with. Why then do I react so negatively to this book? It’s because the book presents a point of He concludes with an view, but reads as if it were the ultimate truth. amazing chapter on Evidence is marshalled in support of that point of view to the exclusion of other points of view, the future, including and without reference to contradictory evidence. injectable nano-robots This raises a problem because Professor Linden’s book may seduce some readers into believing that who are tasked to cheer it reveals the truth about why people do things, us up, as and when simply because it has all the trappings of science and technology. But science is a philosophy of necessary knowledge and how it is acquired, not a check list of laboratory equipment and a lexicon of rarely-used words. Dr Kalant points out that ‘addicted’ behaviour The first objection is philosophical and the does not take place in a pharmacological vacuum, issue here is the mind-body problem, and the book but involves psychological, social, economic and blunders through this minefield as though it didn’t situational factors, absent from experimental and exist. The brain consists of some neurones and animal studies, but which have major impacts on some chemicals (neurotransmitters) and neither behaviours in the real world. He notes the failure neurones nor chemicals feel happy or sad, or have of the neurobiological approach to explain “why desires or wants, or worry about where to go on some drug users become addicted while the great holiday next year. But people do. In other words, the majority of users, in whom the drugs also stimulate mind has properties that ‘brain stuff’ does not. dopamine release in the nucleus accumbens, never Descartes bridged the gap between mind stuff pass from use to compulsive use”. and body stuff by invoking God – not a solution that Which raises another issue. Spontaneous suits everybody, but it does at least acknowledge remission from problem behaviours is common. that there is a gap to fill.T o see neurobiology as In the UK, Italy, the Netherlands and elsewhere, the ultimate fount of human action is to assume the number of ex-smokers approaches or even that properties of mind (such as wants, desires and exceeds the numbers still smoking. A 2010 paper beliefs) can be elucidated by studying an area where by Chapman and McKenzie, The Global Research these things do not exist, at higher and higher levels Neglect of Unassisted Smoking Cessation: Causes and of magnification. Consequences, cites data from the American Cancer A second issue concerns the repeated reference Society showing that in 1986, of 37m people who

26 | Druglink September/october 2011 had quit smoking, some 33m did so without any principle, the message is clear but empirically wrong form of therapy or chemical (nicotine replacement) – because people quit all sorts of established habits intervention. in some numbers. On the other hand, if addiction Self quitting is common, is the normal way out of means that quitting is difficult but possible, that this habit and appears to be largely independent of is empirically defensible. But since in any group of severity of cravings or amount smoked, concluded people whose brains are all affected, for example, by Russell and Davies in their 2009 paper, Empirical, drugs, there will be those who quit and those who Logical and Philosophical Arguments against Cigarette continue to use. It is difficult to see what exactly is Smoking as a Pharmacologically Compelled Act. The being explained by brain studies. problem is that all smokers undergo the same I hate this philosophically and empirically blind process of nicotine-binding at receptor sites in the brand of determinism. People encounter problems ‘pleasure centre’, yet huge numbers of them quit by with various kinds of unwise behaviours, and simply deciding to do so. This is also true, to varying there is a pharmacology and biology behind all degrees, for other drugs. So in the world outside the these behaviours. Indeed, there is a genetic and laboratory, the fact that the binding of some drug to neurobiological basis at some level for everything a sub-set of neurones-with-appropriate-receptor- we do. But despite these underpinnings, we do not sites predicts either continuing use or quitting, is cross the street simply because our brains make our not particularly helpful. legs walk. We do so because Marks and Spencer’s is on the other side, and to the best of my knowledge neurones and chemicals don’t have a strong desire the implication that the to shop there, and don’t even go there unless ‘real’ causes of human accompanied by an entire human being. Let me be clear. This is an interesting book, action lie at the level of carefully put together for the most part; though Pleasure the paragraph on page 66 on how the talking body (the brain) rather David J Linden therapies work to “reverse or otherwise counteract Oneworld Publications, than mind is unwarranted the rewiring produced by addiction” represents June 2011 speculation on the grand scale. Mostly, it sheds light Paperback, 230 pages, on a number of brain mechanisms associated with £10.99 Interestingly, Linden puts a spanner in his own certain kinds of behaviours and I have no problem ISBN 978-1-85168-824-1 works, as Leshner, in his 2001 paper, Addiction is with that. But the conclusions are empirically, a Brain Disease has done previously, in asserting philosophically and that although addiction is a disease, people are to logically flawed, where be held responsible for their addicted behaviour these mechanisms and their recovery. Linden makes the analogy with are assumed to be heart disease patients, who remain responsible for the primary reasons changing their diet and lifestyle in the interests why people do things. of recovery. Fair enough. But the analogy is deeply Consequently, the flawed.T he whole point of ‘addiction’ is that implication that the supposedly it removes the capacity for decision ‘real’ causes of human making. But Linden’s argument holds the person action lie at the level responsible for failing to make those decisions of body (the brain) which, according to the ‘disease’ diagnosis, rather than mind is represent the exact capacity which has been eroded unwarranted; note and is the primary ‘disease symptom’. that the terms ‘brain’ However, the supreme irony lies in postulating and ‘mind’ are not that responsible action is required within a interchangeable. paradigm that explains behaviour in terms of the My view is that neural and biochemical mechanism. There cannot despite its many be responsibility in Professor Linden’s world! virtues, the book is That brings me to the final point, which has in essence a claim bedevilled this debate for decades. One cannot claim to a single Universal that an addiction is, on the one hand, a compulsive Truth about human form of behaviour from which the person cannot behaviour which desist, but also a behaviour which is difficult to is bankrupt when control and quit. Impossibility and difficulty are not applied to areas complementary but irreconcilable. Flying by flapping literally awash with your arms is impossible but playing the violin is reasons and causes difficult. at the individual, Thus, if the message behind this book is that societal, cultural and some things are compulsive and uncontrollable in socio-economic levels.

September/october 2011 Druglink | 27 drugworld Diaries

She’s frighteningly high risk, but is the door, but she doesn’t strike me as she mentally ill? Her behaviours have someone who is mentally ill. If anything developed over time, and when you get her behaviour is logical. Most people to know her and her story you can trace would be wary about going out after an it all back. attack, drinking lots of alcohol helps Wednesday, and I’m on duty in the to temporarily forget and self harming office. Jimi, who I’m working with on because of being violated all make sense his heavy cannabis use, calls in to see to me. me and Denise covers the office while Between home visits, I collect 10-year- I talk to him. Earlier in the summer old Billy and drop him off at the office. I encouraged him to start college on As part of the family work we do, he’s Tony Willis an access course to promote self- having some play therapy with Debs our confidence, raise aspirations and complementary therapist. His mum has Young person’s substance create a structure in his daily life. been the victim of domestic violence and misuse worker Unfortunately at the interview stage has used excessive amounts of alcohol Project 360, Bolton he walked out of a group meeting and for years to see her through. Although didn’t get a place. I had introduced Billy has witnessed this, he rarely talks Jimi to Gary, our Emotional Health about the past, his mother’s drinking Practitioner a while back. Gary’s or what it’s like for him at home. If we The notion of an Amy Winehouse Rehab assessment was that he displays don’t help him deal with it all, he’s at Centre was being discussed on the news the trait of social anxiety and uses very serious risk of developing his own following her tragic death. An addictions cannabis as a coping mechanism, substance problems as he gets older. specialist was talking about the value of which has only served to maintain an In the morning, I visit Jackie, a young people’s services, but ended by underlying emotional problem. Gary is 14-year-old year old going heavy on saying that addiction is a mental illness. using CBT to address the social anxiety, cannabis and alcohol – there is a family This got me thinking about work and I and I’m working on the cannabis use. history of substance misuse. Jackie is not hadn’t even set off from home yet. The idea is to enable Jimi to reach a in, but her mum, recently released from Monday morning is set aside for point where he no longer feels the need prison, opens up about her own street a team meeting. The big thing on to self medicate and then we can start methadone and benzo use. I start talking everyone’s mind has been the spending working on stopping altogether. about a way forward for her and how to cuts and whether their job is safe. The access support through adult services. service has been under review and last It’s easy to see how Jackie is learning week we finally heard the proposals. In the morning, I visit to copy her mum’s use of drugs to cope Although there are losses, it’s not as Jackie, a 14-year-old with life’s troubles. Inter generational bad as most of us feared and relatively transmission of problems may be a cycle speaking the service has done well. year old going heavy on but it’s not a mental illness. Maybe more Despite massive cuts in our grants, the cannabis and alcohol – family-orientated services would make local council has shown its commitment this clearer. by putting more money in to soften the there is a family history The week ends on a positive, with blow. It’s been hanging over our heads, of substance misuse Carly calling into see us. She’s been so it’s a relief to know what will happen, hospitalised in the past because of her even though not everyone is happy. Jimi certainly has issues, but to label alcohol and stimulant use – she was Tuesday and the doctor is here for his them a mental illness seems a bit hallucinating and hearing voices – and clinic. Lily, a 17-year-old amphetamine harsh, certainly to him. He’d never go to the talk was of mephedrone induced injector, comes in to see him about her the hospital for a CAMHS appointment psychosis. She’s doing well now though, use and injecting practice. We’re really because he doesn’t like the idea of drug free, engaging well and working worried about her and there is a much accessing a ‘mental health’ service, and hard on relapse prevention. She’s older boyfriend on the scene who got anyway, it’s two bus rides away. pregnant, which some may see as a her into injecting – all too common. On Talk in the office today is about negative, but she’s looking healthier all the way here she said she had difficulty Janice, one of Nicola’s clients. She’s the time and may just be at the point walking and was experiencing pain in been hospitalised a few times lately for where she’s starting to turn it all around, her leg. The doctor suspected cellulitis overdosing and self harm. Janice has fingers crossed. and called an ambulance. After a few been the victim of rape and is drinking Driving home at the end of the week days in hospital she was discharged with to deal with her feelings after the I don’t want to listen to the news on a course of antibiotics. Unfortunately, her trauma. Unfortunately this seems to be the radio. I have a Jolly Boy’s version of commitment to stop using evaporated exacerbating all her anger and anxiety. Amy’s Rehab in the car and listen to all too quickly. She was feeling better She’s enraged for obvious reasons and it repeatedly as a personal tribute to a and injecting again within the hour. is anxious about setting foot out of fantastic talent. I bet she won’t finish her antibiotics.

28 | Druglink September/october 2011 Headspace ...drugs from the left field Camden crawl

Camden in north London, where I live, place becomes available it is irrelevant or has for a long time been synonymous too late.” with alternative fashion and music. People aged under 24 are far more Alongside its famous clothes market, likely to attend treatment for cannabis, the area is one of London’s seminal rock ecstasy, khat and powder cocaine destinations, with wall to wall dives and use, while older users are treated for pubs playing host to indie, punk and the opiates and crack cocaine. These users rest. But Camden is also notorious for its often suffer from HIV, HCV, COPD and very open street drug market, and is an a number of other problematic health area with a higher than average number issues that affect elder users across the of crack houses and a significant drug country. Drug related deaths also present dependent street homeless population. a major problem in Camden. In 2009, 23 The area was also a favourite haunt drug related deaths were recorded, a 50 of singer Amy Winehouse, who died per cent increase on 2008 and one in ten tragically aged 27 at her home in an drug related deaths in London. affluent, tree-filled square just off For the average For the average problem drug user, Camden’s main drag in July. Yards problem drug user, the the environment at some of Camden’s away from her home existed the lively services are little more earthy than heroin and crack markets of Agar environment at some of might be found at the Priory. One drugs Grove, Cantelowes Park and Rochester Camden’s services are worker described a drop-in centre where Place, to name but a few. Her previous he worked in the borough as so chaotic Camden home on Prowse Place was little more earthy than it was like “a human zoo.” A dry hostel within spitting distance of a stretch of might be found at the for alcoholics has a particularly bad road – between Sainsbury’s and Camden reputation, with persistent drinking School for Girls – which was an open Priory sessions, while recently two drug dealers drugs market from 8pm to 3am. There attacked a client with baseball bats. were rumours that local dealers actively near 2000 people in treatment. There When I went round to Camden approached her house with guarantees are two detox-rehabs within the local Square to seek the opinions of some of of large sales. health authority, one of which caters for those mourning Amy’s death I asked if it With boundaries encompassing drug users in some form of crisis such as had changed their attitude to the average some of the capital’s richest and most domestic violence, serious health needs, drug user who dies in Camden. The most cosmopolitan areas, from Hampstead homelessness and bereavement . The common answer was “no, she had talent in the north, to Kings Cross and Covent other primarily deals with dependent and something to give to the world”. The Garden in the West End, the borough drinkers. only person that said yes was a tourist has nearly twice the national average Experiences of these services have from Germany who had volunteered in per head of people seeking treatment been good and bad. Waiting times to a safer injecting room back home, he for drug problems. Amy was one of get a place in a rehab or detox can take understood that every drug user has around 3,000 problem drug users in the anything from three weeks to several their own story. On 21st July this year London Borough of Camden who have months. Camden service users told an it was Drug User Remembrance Day. sought help for their addiction, of which internal report into waiting times that We should remember those who have 1,197 are currently in treatment. But it was “very difficult to get in”; “not fast died from drug use, who had their own while Amy was able to afford the best enough. Everyone knows that addicts stories too, and are just as entitled to our treatment money can buy, most problem are impulsive and that needs to be taken sympathy as Amy was. drug users in Camden use the area’s advantage of”; “when you present at a statutory services. drugs agency you are in crisis and need n Peter Simonson is a service user who Camden has 17 drug services for the help there and then, often by the time a lives in Camden

September/october 2011 Druglink | 29 Essential substance pregnancy cov AW:1 19/04/2011 16:43 Page 1

“This very comprehensive, up-to-date and practical ESSENTIAL THE text provides an excellent framework for good clinical The Essential Guide to Problempractice and the development of guidelines and pathways for care. Hugely important, it’s a must-read for everyone concerned with both the care of women with substance misuse problems, their children and THE Pregnancy During Use Substance Problem to Guide ESSENTIAL the well-being of future generations.” SERIES Faye Macrory MBE, Consultant Midwife, Manchester Substance Use During PregnancySpecialist Midwifery Service “Substance misuse in pregnancy is an issue likely to cause moral panic and is therefore an area where information, advice and support are vital. This book is required reading – its range is comprehensive and THE “An excellent framework for good “Required reading.its depthIt andis attention the to detail are of paramount importance. The title describes it accurately – it is ESSENTIAL the ‘essential guide’.” clinical practice. A must-read.” ‘essential guide.’” Joy Barlow MBE, Head of STRADA (Scottish Training on SERIES Drugs and Alcohol) Fay Macrory MBE, Consultant Midwife, Joy Barlow MBEMany, differentHead service providers of andS professionalsTRADA are involved in the care of women who use drugs and/or alcohol during the course of their reproductive life. Health and social issues linked to problem substance use often present significant challenges for practitioners who provide care to these women, and coordination Manchester Specialist Midwifery Service and understanding between services is vital to ensure the wellbeing of mother, baby and family.

The Essential Guide to Problem Substance Use During Pregnancy aims to establish a ‘framework for care’ so that all women who use drugs and/or alcohol can be offered appropriate support before, during and after the birth of their baby. Information and intervention strategies are provided on topics such as antenatal THE ESSENTIAL care, the management of substance use during pregnancy, Neonatal Abstinence Syndrome (NAS), breastfeeding, postnatal care and the management of risk and The latest in DrugScope’s series of appropriate supportchild welfare concerns before during pregnancy. and Midwives, neonatalduring nurses, health visitors, GPs, social workers, drug and alcohol workers and students from all these Guide to Problem professional resource books, The Essential pregnancy, as welldisciplines willas find the after guide invaluable. the birth of Anne Whittaker works for NHS Lothian as a Nurse Facilitator, specialising in drugs, alcohol and blood borne viruses and wrote the original resource book on Substance Use which this guide is based for NHS Lothian in 2003. Anne has fully updated, Guide to Problem Substance Use During their baby. Informationrevised and improved this and version, ensuring intervention it follows the very latest good Pregnancy is the go-to reference guide strategies are providedpractice guidance. on topics such During Pregnancy for all practitioners who provide care to as antenatal care, the management of DrugScope A resource book for professionals Anne Whittaker women who use drugs or alcohol before or substance use during pregnancy, Neonatal during their pregnancy. Abstinence Syndrome, breastfeeding, postnatal care and the management of This unique text was written by Anne risk and child welfare concerns during Whittaker, a Nurse Facilitator working pregnancy. The book also features 11 for NHS Lothian who specialises in downloadable leaflets and factsheets for £15.25 for members drugs, alcohol and blood borne viruses. use by professionals and service users. £16.95 for non members It establishes a ‘framework for care,’ Drug and alcohol workers, midwives, synthesising the latest good practice neonatal nurses, health visitors, GPs, Order your copy from HIT at advice, official guidelines and research social workers, and students from all www.hit.org.uk, by email at knowledge, so that all women who use these disciplines will find this guide [email protected] or by phone on drugs and/or alcohol can be offered invaluable. 0844 412 0972. DrugScope Conference 2011 Wednesday 2nd November 2011

NCVO HQ Regent’s Wharf 8 All Saints Street LONDON N1 9RL Keynote speaker: Drugs minister Baroness Browning