30 July 2007 www.drinkanddrugs.net

INSIDE: RESIDENTIAL TREATMENT DIRECTORY

DRUG STRATEGY Vernon Coaker opens the consultation PRISON SAFETY NET Preventing relapse with naltrexone CATCHING THEM YOUNG Using screening techniques in A&E HOMELESS AND ADDICTED Why do the drugs and housing sectors work in isolation? Your fortnightly magazine | jobs | news | views | research

Published by Drink and Drugs News 30 July 2007

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Editor’s letter Empowering People ‘We have moved on from a polarised debate and Chris Ford’s post-it demonstrates (page 13). single approaches to a balanced strategy focused The home secretary also calls for ‘greater on outcomes, based on evidence and delivered integration across employment, housing and Drink and Drugs News partners: through partnership’, says home Secretary Jacqui resettlement’, a need emphasised by our cover Smith, in her foreword to the new drugs story. We know only too well what happens when consultation paper, launched this week. people come out of treatment and back into a Have we? That’s surely where we need to be, but hostel of drug users. The numbers of drug users in there are many signs we’re not there yet. The need treatment might well have doubled, but we have to for evidence is constantly emphasised, underlined by make sure service users are having the best the work of the UKDPC and others. Polarisation is chance of permanent integration. rife, sometimes surfacing in robust debate, but all too Drugs minister Vernon Coaker urges DDN readers often lurking in local treatment services with the risk to participate fully in the consultation (page 8) and I of excluding those who don’t conform to an expected hope you will seize this opportunity with both hands. mould. Partnerships, when they work well can work We’re taking a break from publication in August, so I very well (as in the screening initiative on page 14), would like to thank you wholeheartedly for all your but there are too many examples of agencies in the support, contributions, and advertising – which same area whose idea of joined-up working means enables us to keep DDN independent and free of cutting out the client. Things don’t often move as charge to everyone in the field. We’ll be back on 10 straightforwardly as they should within one drug September, raring to go with your thoughts on new service, let alone between different agencies, as Dr drug strategy. Keep writing in over the summer!

Editor: Claire Brown t: 020 7463 2164 In this issue European Association for e: [email protected] the Treatment of Addiction Reporter: News Round-up treatment to give inmates a better chance David Gilliver Drug strategy consultation: government of avoiding relapse. 10 e: [email protected] pledges focus on education • A&E 2020 vision departments ignore alcohol screening Will politicians seize the chance to model a Advertising Manager: opportunities• Findings launches website fairer drug strategy? Kevin Flemen warns that Ian Ralph resource • Motivate substance misusers, say t: 020 7463 2081 the promised sea-change is more likely to e: [email protected] NICE guidelines • PM hints at 24-hour result in a darker place for human rights. 12 licensing rethink • Scots recommend Catching them young Designer: methadone audit • News in brief 4 Teams at St Helens and Knowsley have joined Jez Tucker e: [email protected] Features forces to pilot a screening process for young Cover story people entering A&E, helping them at early Subscriptions: Home and dry stages of substance misuse. 14 e: [email protected] There seems little point in spending money on Regulars treatment programmes only to house people in Letters Events: hostels rife with drug use – but that’s exactly e: [email protected] Workforce development is not a gloomy issue!; what often happens. David Gilliver looks at the in defence of the ‘Breakthrough Britain’ report; Website: need for better co-operation between housing www.drinkanddrugs.net and treatment sectors. 6 the best harm reduction is abstinence. 8 Website maintained by Post-its from Practice Minister opens strategy consultation wiredupwales.com Getting into treatment can be a long and Vernon Coaker introduces the Drug Strategy CJ Wellings Ltd, FDAP and WIRED Published by CJ Wellings Ltd, tortuous business, says Dr Chris Ford. 13 do not accept responsibility for the Consultation, launched this week, and calls accuracy of statements made by Southbank House, Black Prince on DDN readers to take part in debate. 8 Background briefing contributors or advertisers. The Road, London SE1 7SJ The third part of Prof David Clark’s look at ways contents of this magazine are the Printed on environmentally friendly Widening the safety net copyright of CJ Wellings Ltd, but do paper by the to reduce heroin overdose and death. 15 not necessarily represent its views, Caroline Cockwell explain how the Manson Group Ltd or those of FDAP, WIRED and its substance misuse team at Bristol Prison is Jobs, courses, conferences, tenders 16 partner organisations. Cover: David Lawrence using naltrexone at a far earlier stage in Centre pages: treatment directory

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 3 News | Round-up

Launch of drugs Drugs strategy: government strategy consultation: views from the field pledges focus on education

‘The fact that there is still so little The government’s next drug strategy will focus on lives together and establish themselves within society.’ money going into prevention means educating the young and protecting the vulnerable, While drugs agencies welcomed the extra cash for that many of the grass-roots projects home secretary Jacqui Smith said as she announced drugs awareness, they stressed the need for a focus on that Mentor works with, and which do what’s billed as the largest ever public consultation prevention rather than cure, rather than relying on criminal such important work within their local on the subject. Responses to Drugs: our community, justice interventions and treatment (see column, left). A communities, will struggle to survive your say will feed into the new strategy, to begin next spokesperson for Transform, meanwhile, said that the financially. The best prevention initia- April. The Advisory Council on the Misuse of Drugs announcement of a review of cannabis classification was tives out there are those that influ- (ACMD) would also begin a six-month review of cannabis ‘all about political posturing and has nothing to do with ence children’s attitudes, their skills classification in the light of concern over the availability of science. In reality the potency issue and mental health and their behaviour so that when stronger strains of the drug, she said. issues associated with cannabis are well understood and they are older they can avoid the Ministers will focus on education and treatment as have not change significantly since they were last damage that the misuse of drugs well as enforcement against drug dealers in drawing up reviewed by the ACMD in 2005’. can cause.’ the strategy, she said. Key areas will include ensuring DrugScope said it was ‘surprised’ by the Mentor UK better continuity of care after treatment, strengthening announcement. ‘We believe the decision to keep the drug support for families of drug misusers and more at Class C, as recommended by the ACMD, was right then ‘We caution that whilst there are consultation with local communities on addressing drug- and it is difficult to see why it need be changed now,’ said many questions to ask, there are rela- related crime. More than £5m would be made available for chief executive Martin Barnes. ‘The government promised tively few answers backed up by suff- the ‘Frank’ drug awareness campaign, she said. a review of the system of drugs classification in January icient evidence. Despite coming to ‘I want to sharpen our focus, target the most vulnerable 2006 and then changed its mind. That review now needs the end of a ten-year drug strategy, and educate the young,’ said the home secretary. ‘We need to happen.’ we don’t know enough about what to ensure that treatment is effective and followed through To take part in the consultation visit www.drugs.gov.co.uk. works or why, which leaves policy and I know that many users need extra help to get their Deadline for responses is 19 October 2007. makers having to operate partially blind. We need to invest now in a better, independent evaluation of policy and practice so that we can A&E departments ignore screening opportunities look forward to more effective policies based on solid evidence.’ Only two per cent of accident and in ten departments in the northern their alcohol consumption and UK Drug Policy Commission emergency departments are formally region were questioning patients about hopefully reduce this,’ he said. assessing hazardous drinking by their alcohol consumption, despite the Action on Addiction recommended ‘We hope the government’s strategy patients, according to a survey by 2004 ANARP survey identifying the A&E departments consider easy-to- will ensure that children receive Action on Addiction. region as having the largest proportion implement methods such as a single fact-based education from The charity found that just four out of harmful drinkers. alcohol screening question or the professionally trained teachers. But of 191 hospitals questioned were Health psychologist Bob Patton of Paddington Alcohol Test, which make drug education should not be about screening as a part of routine. Just 24 of the National Addiction Centre, who patients consider how much they drink. trying to scare pupils, as those the A&E departments were asking conducted the survey, said A&E ‘NHS staff in A&E departments are tactics simply serve to reduce the patients general questions about their departments’ commitment to dealing under immense pressure due to lack of credibility of the message.’ alcohol consumption. with alcohol problems was time and resources,’ said joint chief Drug Education Forum Action on Addiction compared their encouraging, but suggested going executive Lesley King-Lewis. ‘However by results to previous research that found further with a proactive approach: ‘We taking the time to formally test patients ‘The government appears committed that up to 40 per cent of people know that just asking patients a few in this way we may actually prevent re- to a drug policy that criminalises the attending A&E would benefit from help simple questions about their drinking attendance.’ poorest and most disadvantaged in with their hazardous drinking. Only one can help more people be made aware of See feature on page 14 our community, grants a multi-billion pound monopoly to organised crime and dramatically increases the harms suffered by our communities.’ Findings launches ‘what works’ web resource Transform Research on what works in substance misuse treatment is now it ‘an essential tool [that] helped us sift relevant research and What do you think should be in the freely accessible as a website resource. identify evidence from around the world that has strategy? DDN will be including Internationally respected Drug and Alcohol Findings significantly informed our change processes’. The Findings comments and inviting debate during magazine has transferred its content, previously only available partners – editor Mike Ashton, Alcohol Concern, DrugScope the consultation period. Send your as a subscription publication, to the site, http://findings.org.uk and the National Addiction Centre – hope the transition to comments to the editor, Back issues are being added to the downloadable archive, website format will give easy access to information on [email protected] as well as the popular ‘nuggets’ series, which shows research proven methods. findings in context and with implications for practice. Visitors can sign up for email updates, and there are plans Home Office minister Vernon Coaker Content of the magazine is used regularly by many for an ‘effectiveness bank’ to be set up, offering research papers introduces the consultation and practitioners in the UK and abroad to evaluate what works. and abstracts. The project has had initial funding from the invites your input: see page 8 Plymouth DAAT manager Gary Wallace says they have found J. Paul Getty Jr. Charitable Trust.

4| drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net News | Round-up

Motivate substance misusers says NICE News in brief

Combining social and psychological techniques to motivate detailed information about the risks and benefits of the Childhood challenges substance misusers to adopt a drug-free lifestyle with advice treatment first. Prescriptions of anti-depressants to on detoxification will substantially improve recovery rates, They also recommend the introduction of contingency under-16s have risen by more than a according to new guidelines issued by the National Institute for management programmes by drug services, with incentives like third in the last decade, according to Health and Clinical Excellence (NICE) and the National shopping vouchers ‘contingent on each drug-negative test’, or figures from the Department for Collaborating Centre for Mental Health. being able to take methadone doses at home rather than under Children, Schools and Families. Last The guidelines focus on positive encouragement for change supervision. These have predictably been seized on by sections year 109,535 prescriptions were and combine advice to families and carers on supporting of the press. made, compared to 78,353 ten years someone trying to become free of drugs with opportunities for ‘Some of the treatment options we are recommending in ago. Children’s charities have warned substance misusers to make their own choices in adopting a this guideline, such as offering incentives to drug users to of a generation becoming addicted to drug-free lifestyle. encourage them to stop using drugs will be seen as prescription drugs, prescribed to tackle anxiety and depression brought Among the recommendations are that two motivational controversial,’ said consulting clinical psychologist and joint on by family breakdown and exam sessions of up to 45 minutes should be offered to provide non- director of the National Collaborating Centre for Mental Health, stress. Meanwhile, a survey by the judgemental feedback whenever concerns about drug misuse Steve Pilling. ‘However, we’ve studied the results from trials Schools Health Education Unit reports are identified, and that healthcare staff should routinely involving over 5,000 participants from all over the world which that up to 10 per cent of primary provide information about self-help groups for those who show clearly that substance misusers are much more likely to school children and 19 per cent of 12 misuse drugs. succeed in treatment if they are given encouragement for the and 13-year-olds had had an alcoholic Detoxification should be an available option for those who effort they are making in coming off their drug habit.’ drink in the previous week, rising to are opioid dependant and have made a choice to stop taking The guidelines are available at www.nice.org.uk/CG51 and 40 per cent of 14 and 15-year-olds. drugs, say the guidelines, but they should always be given www.nice.org/CG52 Underage girls were more likely to be drinkers than boys.

Ratify your results MPs launch inquiry into ‘hidden’ misuse Drug action teams and equivalent partnerships, along with primary care An inquiry into the scale of the misuse this often unrecognised area of drug social and psychological harm caused, trusts and strategic health of ‘over the counter’ drugs, along with misuse. The inquiry, facilitated by said group chair Dr Brian Iddon MP. ‘We authorities, have until midnight on 6 August to ratify their provisional and the social and psychological harm DrugScope, will look particularly at the are increasingly concerned about the anonymised results for the 2006/07 caused, has been launched by the All role of the internet in supplying over the number of users buying medicines substance misuse review. They Party Parliamentary Group on Drug counter and prescription-only drugs, who online, where they face the very real risk should also submit details of any Misuse (APPGDM). should take responsibility for tackling of buying counterfeit products that may extenuating circumstances which may The cross-party group particularly their misuse, and whether enough help is be dangerous,’ he said. have affected either their wants to hear from members of the available for those experiencing problems The deadline for submission of performance or their ability to submit public who have been affected by misuse with misuse of these drugs. written evidence is 12 October, and the data. More information at of prescription-only drugs, as well as The inquiry will build a picture of findings will be published in a report www.healthcarecommision.org.uk those in the treatment and healthcare the exact scale of the problem, patterns next year. For more information visit Protocols and proformas for ratifying sectors, to build an in-depth study into and trends, and the physical, economic, www.drugscope.org.uk data and extenuating circumstances available on www.nta.nhs.uk

Infectious behaviour Brown hints at 24- Scots recommend Alcohol is being blamed for an increase in the number of sexually hour licensing rethink methadone audit transmitted infections among young people. The Health Protection Agency’s fourth annual report shows A review of 24-hour alcohol Gerontology at Brunel A national system to monitor stabilise often chaotic lives, that new diagnoses of genital herpes licensing has been ordered University, Mary Gilhooly. the prescription of methad- said community safety increased by 9 per cent between by Gordon Brown following While older people are less one across Scotland has been minister Fergus Ewing, but 2005 and 06, with diagnoses of a study at London’s St able to metabolise alcohol, recommended by the there were ‘areas of concern’ chlamydia up 4 per cent and genital Thomas’s Hospital that the generation now hitting Scottish Executive. It calls for about its use, that required warts by 3 per cent. The HPA said that found an increase in the their sixties have a national methadone audit ‘improving service delivery, the increase was also partly a result number of overnight A&E traditionally been bigger system, incorporating local improving consistency of of more people coming forward for visits since the laws were drinkers than previous data collection, as a priority. provision and, above all, testing, as awareness of these relaxed. The Home Office generations and are likely to The review was ordered improving integration of infections increased. Meanwhile, a will consult police and local remain so, she says. by the Scottish Executive methadone treatment with study by the British Beer & Pub authorities in problem areas, ‘If you take a cohort following the death of a two- the extra support needed to Association (BBPA) claims that more but the prime minister that has always drunk a lot, year-old child in East Lothian achieve the ultimate goal of than one million people a month are stressed there was no need like the baby boomers, they after drinking methadone recovery from addiction’. being turned away from pubs for being to ‘rush to judgement’. will probably drink a lot prescribed to his parents. Reducing harm and under 18 or failing to have the right Meanwhile a call for over the sensible limit Around 21,000 people in promoting recovery: a report proof of age. Police forces and trading age-based drinking when they are older,’ she Scotland are now receiving on methadone treatment for standards officers are currently mounting more than 3,000 underage guidelines to go alongside said, adding that many methadone to treat their substance misuse in Scotland: ‘test purchase’ operations in pubs those based on gender has elderly people should be heroin addiction. www.scotland. gov.uk/ and off-licences, says the association. been made by professor of advised not to drink at all. Methadone helped Publications www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 5 Cover story | Homelessness and addiction Home and Dry While common sense would dictate that there’s little point in spending money on treatment programmes only to then house people in hostels rife with drug use, that’s exactly what often happens. David Gilliver looks at the need for better co- operation between the housing and treatment sectors.

omelessness and drug use People with serious drug misuse are inextricably linked. The problems tend to lead chaotic lives, agencies that deal with and homeless people entering Hthem, however, are not. treatment when no suitable Three quarters of homeless people accommodation is available clearly have a history of problematic have a far lower chance of substance misuse, rising to more successfully completing treatment. than four fifths of rough sleepers, and ‘Decent housing is critical throughout drug users are seven times more all stages of treatment, not just the likely to be homeless than the general latter stages,’ says Evans. ‘It’s critical population. But, historically, the drugs that people have somewhere stable and housing sectors have tended to when they engage in their treatment.’ work in isolation. The study found that when A new report and toolkit from treatment and housing services do Homeless Link looks at how housing work together effectively, the benefits and treatment services can work include lower rates of both repeat together to make sure treatment is as homelessness and anti-social effective as possible and reduce the behaviour, and that people are far risk of homelessness among drug more likely to stay in treatment users engaging in that treatment. programmes. It also revealed an Tackling one without the other risks urgent need for a range of housing failure, wasted resources and wasted options to be available for those at effort, says Clean Break. Putting different stages – whether that means someone through an expensive short stay accommodation to bridge treatment regime only for them to end gaps in service availability or help up in a hostel next to people actively assessment, 24-hour supported using is clearly not a recipe for accommodation for chaotic drug success. Nor is someone completing users, or general needs housing with treatment only to find themselves floating support for those who have without access to decent housing, stabilised or stopped their use. training, job opportunities or hope. The report wants to see jointly ‘We tend to talk about people as commissioned research from relevant drug users engaging in treatment or we government departments on the talk about them as homeless, when impact of different housing models on often we’ll be talking about the same treatment, and for the needs of home- individual,’ says head of policy analysis less drug users to be assessed in at Homeless Link, Alice Evans. ‘What regional housing and homelessness the housing and treatment sectors strategies. need to do is make sure the services ‘We need a national evaluation of we’re providing work together, so it’s the impact of these different forms of that oft-used word, partnership. But it housing on treatment outcomes,’ says takes a lot of time and resources to Alice Evans. ‘Is it a settled home that get those partnerships set up and someone needs, is it RSL [registered properly supported.’ social landlord] or local authority

6| drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Cover story | Homelessness and addiction

‘When treatment and housing services do work together effectively, the benefits include lower rates of both repeat homelessness and anti-social behaviour, and that people are far more likely to stay in treatment programmes.’

accommodation, or would they do just consider those already in structured rough sleepers split into separate staff, because acknowledging it as well in the private rented sector if treatment. Almost all had admission areas for those in structured treatment, means you can have policies and they had the right support? criteria banning drugs or drug use on for those beginning to address their training in place to protect your Understanding all of that, and what the premises, punishable by eviction. drug use, and for those not ready to do workers. And it’s safer for the wider would work best, is very important for While on the face of it this might so yet. ‘Projects like this have a very community, because the drug use is how you plan the services you’re seem like a common sense approach good record in attracting people who controlled in a property rather than providing. At the moment most of it’s – housing providers aiming to provide would otherwise be homeless, and of taking place on the streets.’ just based on what you can access – a safe and supportive environment getting people into treatment because So is a lack of joined-up working what’s available locally and what you’re and keep within the law – Shelter they conclude themselves that it’s a leading to precious resources being going to be able to get people into.’ found in reality it simply meant the good idea,’ says Grant Everitt. ‘If you wasted? ‘Of the areas we looked at, in This lack of appropriate housing is drug users not openly discussing their want to provide a comprehensive some places the two sectors were leading to people becoming lost in problems with the service providers. solution, and projects that are working very well together and in some the system and far higher rates of They further found, unsurprisingly, that genuinely drug free, then you need they weren’t,’ says Alice Evans. ‘They relapse than are necessary, says the while drug use can be a trigger factor somewhere for the drug users to go.’ may have been working well at a study, along with inappropriate for homelessness, homelessness was A significant barrier to this strategic level but it hadn’t filtered referrals to existing supported a far bigger trigger factor for approach however, remains the down to the practical level. There’s housing. Most worrying of all, increased drug use, with people either hangover from the Wintercomfort case, definitely a lot more integrated work however, is that it often means those starting to use or increasing their use in which charity director Ruth Wyner that could be happening, and a better desperately trying to come off drugs to cope with the situation. So those and centre manager John Brock were understanding of the pressures on living in very close proximity to people trapped in this ‘revolving door’ given lengthy prison sentences for each of the sectors – understanding actively using, or chaotic drug users situation then find their drug use supposedly allowing heroin use on the where the other person’s coming from. ending up sleeping rough. becoming more and more of an premises in a Cambridgeshire day I do think it’s improving though, ‘Because so many homeless obstacle to accessing services. centre. ‘That put a lot of homeless particularly on a national level, but people are drug users they’ll either One of the most sensible ways of organisations off working with drug there’s more for people to understand.’ stay away from hostels with a zero tackling this, says Safe as Houses is users, and it still influences today’s ‘The area that’s gravely lacking tolerance drugs policy, or else lie,’ through an increase in the number of policy,’ says Grant Everitt. ‘It’s why a lot joined up working is that those on says Grant Everitt, who runs Shelter’s projects for ongoing drug users who say they have a zero tolerance the drug treatment side tend to see street homeless project. ‘Drug use is perhaps aren’t ready to stop using yet, approach, because they think outcomes just in terms of treatment,’ rife in a lot of homeless hostels, as well as drug-free housing (DDN,8 otherwise the police will come and says Grant Everitt. ‘You’re going to despite the fact that many will have a May 2006, page 10). ‘The reality is shut them down, which is not actually have more chance of success if the ‘no drugs’ policy. They either kind of that if you have a homeless hostel you the case. person is stably housed, so it needs ignore the drug use or people tell lies are by default working with drug users, ‘The police have in fact been very far more close and co-ordinated to get in, so it’s going on illicitly. whether you say you are or not,’ says welcoming of the approach we working with the housing sector. We Obviously, one of the main ways you Grant Everitt. ‘So we need to get recommend,’ he continues, ‘because haven’t really got there with that yet.’ remain clear of drugs is to stay away through to organisations that if they if you’re a drug user in from them.’ find they have a drug user they don’t accommodation, not only have you Shelter produced its own report, have to evict them. Give them a got a better chance of reducing your Homeless Link’s Clean Break toolkit Safe as houses, just over a year ago, warning – if they’re just back on the drug use but you’re less of a threat is online at www.toolkits.home which found that demand for housing streets, that’s bad all round. The to other people – you’re not likely to less.org.uk/cleanbreak far exceeded supply among single biggest gap in provision tends to be at leave your needles in someone’s Safe as Houses can be obtained homeless people with support needs. the more chaotic end, people who garden and so forth. Housing drug through Shelter’s website. For more Even where services were provided, haven’t controlled their drug use.’ users – even ones who aren’t ready information visit however, many projects excluded drug Shelter looked at projects like New to give up – is safer for everyone. It’s http://england.shelter.org.uk/policy/p users altogether and some would only Steine Mews in Brighton, a hostel for ex- safer for the residents and safer for olicy-825.cfm/plitem/225/

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 7 Drug Strategy | Vernon Coaker

The wellbeing of our young people is of fundamental importance to the government. We all want to ensure every child, regardless of background, can make the most of the opportunities that they are presented with. A key part of that approach is ensuring that young people avoid the harm caused by illegal drugs. We have made tackling drugs a major priority. Since 2001 we have invested £9bn in cutting the harm caused by drugs through a strategy of enforcement, education, early intervention and treatment. I am proud of what we have achieved in recent years. And by we, I mean the multitude of professionals and volunteers across England and Wales who are involved in drug programmes and diversionary projects, as well as the government and police. An excellent example of this round approach is Positive Futures, which has the backing of £6m from the Home Office, and supports 121 projects around England and Wales that provide sports activities and vocational training. This helps to boost the self-esteem of young people, making them less likely to indulge in illegal drugs. Many of us can point to the fall in the harm caused by drugs, as measured by the Drug Harm Index. Drug use across all ages has fallen by 17 per cent since 1998 while young people's drug use has fallen by nearly a quarter over the same period. Enforcement – by which I mean putting dealers behind bars and disrupting drug supplies – is a vital part of our strategy. We want to harness the full force of all our law enforcement agencies, from neighbourhood police to the Serious Organised Crime Agency, to crack down on drug dealers so that they stop bringing illegal drugs into communities. We have been successfully thwarting drug dealers: last year, for example, we seized almost 75 tonnes of Class A drugs, worth £3bn. Nonetheless I have never been complacent about the formidable challenge posed by illegal drugs. We are dealing with one of the most complex social problems faced by western societies. It is for that reason that we want to have a wide open debate about how best to tackle drug use. I want to hear from professionals at the frontline about how we can further reduce the harm caused by drugs and help users re-establish themselves in the community. This focus is behind our decision to consider cannabis classification, as announced by the prime minister recently. The independent Advisory Council on the Misuse of Drugs will look at the scientific evidence for reclassification of the Class C drug to see whether we need to take into account the fact that there are stronger strains of the drug, often called skunk, on the market. I await the Advisory Council's recommendation with interest. Any decision we take will be consistent with our stated aim of reducing the harm caused by illegal drugs. Drug education has developed a great deal in recent years. Our approach has been to empower young people with the knowledge of the devastating effects of illegal drugs. Rather than simply order young people that they should not use illegal Home Office minister Vernon Coaker substances, this means telling young people about the increased risk of heart attacks associated with cocaine and the mental health effects of cannabis. introduces the Drug Strategy This has been the approach of the ‘Frank’ campaign, which has benefited from over £23m of government funds in the last four years alone, to complement drug Consultation, launched this week, education in secondary schools. The ‘Frank’ campaign plays a significant part of our support for young people. and calls on DDN readers to play a Drug use is falling among young people. The most recent schools survey, published by the Information Centre in March this year, showed that compared to the previous key part in honest and open debate. year fewer pupils aged between 11 and 15 had taken drugs in the month before the survey, fewer pupils had taken drugs in the previous year overall and that the number of pupils who said they had taken drugs once a month had fallen as well. In addition, more than half of young people now agree with the statement that cannabis is ‘very likely’ to damage health – an increase of over 10 per cent on the ‘Early intervention previous year. As drugs minister I find this heartening, but I know there is much more to do. Fewer than five per cent of pupils took Class A drugs according to the schools survey, and this is a figure that has remained stable in the last seven years. But I is the key to want to drive it down even further. We are keen to have a wide-ranging, honest and open debate about how best to tackle drugs. I hope readers of Drink and Drugs News magazine will play a constructive role in that process. tackling drug use’

To view and respond to the drug strategy consultation document, ‘Drugs: Our Community, Your Say’, go to http://drugs.homeoffice.gov.uk/

8| drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Letters | Comment

Distorting the truth Abstinence as starting point

‘In the last issue of DDN, workforce Suggestions that the proposals in the I am finding myself reading DDN in a Breakthrough Britain report are intended complete outrage today – it just strikes development seemed rather gloomy. to close down needle exchanges and end me that we have got things drastically I personally don’t share this view... methadone describing, are exaggerated if wrong. I volunteer with a number of not deliberately distorted (DDN, 16 July, drugs projects, but I feel Release and at Blenheim CDP we take workforce page 4). What is clear is that all services the editor have missed the point. will be subject to independent clinical During my reading around the development seriously. A commitment evaluation and those found to be subject of addiction I came across substandard will be closed. some writing by Leah Betts’ parents, to staff development is written into the It is not difficult to understand how a which I happen to empathise with. I organisation’s core principles and the disturbed mind, or the mind of someone struggle with harm reduction; I want to who lacks comprehension abilities, could see people recover to live healthy and NTA workforce targets form part of the distort, or misinterpret proposals to productive lives, not be encouraged to bring about desperately needed stay on gear safely (if staying on heroin organisation’s strategic business plan.’ improvements to the current poorly can ever be made to be safe). managed methods of methadone I do not want users to get injuries dispensing. But it is baffling how through injecting with dirty needles (does Developing workforce Blenheim CDP is renowned for the balanced, well-read people could have anyone?), but is a needle exchange really extent and quality of its work to involve come to such a conclusion. a long-term solution to the client’s In the last issue of DDN, workforce volunteers in all aspects of service The Breakthrough Britain report is a problem? Are users going to delay their development seemed a rather gloomy provision. Annually we recruit, train and skilfully balanced mix of empirical shot for ten minutes while they get to a issue (DDN, 16 July, page 8). I support more than 40 volunteers. evidence from around the world, together safe location? My experience tells me personally don’t share this view, so Volunteers are provided with a detailed with an objective review of the outcome of they are focused on scoring; everything would like to share some examples of programme of induction training, differing treatment modalities provided by else is unimportant. how Blenheim CDP is taking this agenda supervision and support in their work, NTORS – and last but by no means least, The crux of my argument is this: the forward. and the opportunity of gaining the anecdotal evidence of DAT teams and best form of harm reduction is abstin- At Blenheim CDP we take workforce accreditation of their knowledge and skill users with their vital, but frequently ence. If someone is abstinent then we development seriously. A commitment to through our unique LOCN accredited disregarded, first-hand knowledge and have to reduce the harm on their body to staff development is written into the course, A Pathway to Drugs Work. By experience of the shortcomings of the zero. Perhaps using this as a starting organisation’s core principles and the combining structured learning with a present strategy. point would enable projects to work with NTA workforce targets form part of the ‘hands-on’ experience, volunteers It is this carefully researched and other client issues, eg prostitution, family organisation’s strategic business plan. develop all the relevant skills, knowledge unprecedented collection of all of the care and parental skills, with an increas- On a practical level, Blenheim CDP and and experience necessary to pursue a foregoing evidence in one document, ing sense of perspective and focus. Harm Quay Assessment have come together to career in the drugs field. which clearly shows that an eclectic and reduction merely plasters over the scars design and deliver ‘SMASH’ which stands All staff at Blenheim CDP are trained balanced mix of valid harm reduction of a user, whereas long-term abstinence for Substance Misuse Award in Social in the use of ITEP (International methods and abstinence focused forms the basis of a holistic solution. Health. The qualification gained is the Treatment Effectiveness Project). The treatment are capable of providing What prevents the abstinence taking NVQ Level 3 course in Health and Social training relates to node-link mapping effective and satisfactory outcomes. Far off? I go back to the point made by Leah Care; however the course is tailor-made (referred to as mapping), and a brief from making a clean break from harm Betts’ parents. The abstinence model for workers in the substance misuse field intervention aimed at changing thinking reduction programmes, the reference to requires abstinent practitioners (let’s face and directly supports Blenheim CDP and patterns. Mapping provides a visual Kaleidoscope in the report makes it it, practitioners would be a bunch of other organisations to meet the NTA communication tool for clarifying clear that Iain Duncan Smith is ready to hypocrites if they weren’t). Imagine the workforce targets. information shared between client and embrace valid programmes which do not scene, providing alcohol advice to a client During 2007-8 more than 100 staff key-worker. Its regular use during key- keep users locked into addiction – all day towards the goal of abstinence, from London based substance misuse working sessions provides a model for unlike the proposed extended then the practitioner goes to the pub for a organisations will complete the systematic and ‘cause-effect’ thinking prescribing of heroin, which has as few scoops after work and on the way to qualification. The course offers a unique and problem-solving, which clients begin much to do with harm reduction as the kebab house bumps into a client mix of training in the core DANOS (Drug & to adopt. Other initiatives include a core encouraging someone suffering from struggling to stay sober. I don’t think the Alcohol National Occupational Standards) training programme and a range of emphysema, to continue smoking. client would be stopping to think about units as well as assessment of learning external training for other organisations. It is also puzzling and indeed the situation being normalised. The and practice that will ultimately lead to the Future planned initiatives include the seemingly self contradictory, to note that abstinence model requires sacrifice – are award of the NVQ Level 3. development of a range of accredited the report has been met with undisguised you reader, practitioner, prepared to make Additionally, all Blenheim CDP staff continual professional development hostility and concerted attempts to that sacrifice to help your clients? will by the end of 2007 be members of (CPD) awards with people completing discredit it by various members of The We had fantastic news recently that the FDAP professional certification clusters of units relevant to their role to Alliance, who among other professed Gordon Brown has pulled the plug on scheme, which is recognised as meeting ensure continuous professional objectives, are intent on improving the this super casino in my home city of the NTA target of working towards an development and assessment of welfare of users. Less than two months Manchester. He seems to think that not NVQ Level 3 or equivalent. All Blenheim competence. ago, one member publicly called on the having the super casino is the best way CDP workers will be expected to meet This work is supported by a current administration to get addicts off of to prevent the social problem of the standard for registration and to work dedicated learning and development drugs – but presented with proposals that problematic gambling. I was delighted to towards the required accreditation. team who increasingly work to support aspire to do just that, he accuses the hear this – it made my day. Perhaps the Managers within the organisation are managers to identify ongoing training Conservatives of ‘failing to grasp the new government line is going to be truly supported to begin a Level 4 or higher needs of individuals and teams. nettle’. How strange! revolutionary! management qualification. John Jolly, CEO, Blenheim CDP Peter O’Loughlin, Eden Lodge Practice. Tim Wightman, Huddersfield

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 9 Prisons | Relapse prevention

Widening the safety net Substance misuse manager Caroline Cockwell explains how her team at Bristol Prison is using naltrexone at a far earlier stage in treatment to give prisoners a better chance of avoiding relapse.

t has been estimated that there are around one and 12 months. 40,000 people who misuse substances in G They can demonstrate motivation, by Iprison in England and Wales at any one engaging with CARATs for example. time – almost half of the total prison G They are in good health and opiate free. population. A UK survey also revealed that 21 G They have a prescriber on release. per cent had used illicit substances during their sentence. Needless to say this presents The rationale for this innovative approach is major challenges for staff working in this that the Integrated Drug Treatment System environment – none more so than for our (IDTS) recommends that a variety of substance misuse team at Bristol Prison. treatment options – not solely methadone HMP Bristol is a busy category B prison, maintenance – should be made available. On which takes prisoners from all local courts a practical level, prison presents a window of and holds in the region of 600 male prisoners. opportunity for many prisoners to make These range from remand to sentenced significant changes in their drug-taking prisoners, as well as a small number of young careers. Many are able to cease or reduce their offenders. Our team will offer a range of treat- consumption of drugs while they are inside ments for anyone declaring a drug or alcohol but the gap between detoxification and problem as they arrive at HMP Bristol, which release leaves them vulnerable to relapse. usually means around 35 new problematic In a community setting, naltrexone would opiate users per week. These treatment be offered immediately following the options range from support and advice via the withdrawal period, and so it is logical to offer Counselling, Assessment, Referral, Advice and a similar service in prisons. Throughcare services (CARATs) to a variety of Naltrexone provides prisoners with a pharmacological interventions for detoxi- ‘safety net’, which helps them to resist press- fication, maintenance and relapse treatment ures and temptations as well as providing an and prevention. opportunity to demonstrate to family and the Team support: Caroline Cockwell (right) joined forces with nursing A recent innovation in the prison is the criminal justice system their commitment to colleague Carole Preston to offer more active relapse prevention. formation of the relapse prevention and remaining opiate-free. treatment clinic, which not only provides the We find that starting the client on option of treatment with the opiate blocker naltrexone early gives them the opportunity Why do prisoners relapse? naltrexone, but also encourages prisoners to to discuss any issues or concerns about their link in with the CARATs team who will provide medication, which will enable them to feel Prisoners can relapse if they have had some bad news, are appropriate psychosocial support. Together confident about their treatment and so experiencing pressure from other prisoners, or they have with Carole Preston, another member of the improve their compliance. succumbed to temptation on their wing. Or it might happen if nursing team, I have successfully completed Also, because Bristol is a local prison, they are celebrating some good news, they might be joining in the nurse prescriber course, which has clients are often transferred to other with other prisoners, or they may be responding to boredom. enabled the whole of the relapse, treatment establishments soon after sentence – an and prevention service to be nurse-led. We are unsettling and stressful event that can trigger What does naltrexone do? able to prescribe naltrexone as well as other a relapse. In this situation, naltrexone can symptomatic and non-opiate detoxification provide the prisoner with some protection Naltrexone is an opioid antagonist (usually known as Opizone treatments such as lofexidine. before they enter another establishment. or Nalorex), which is licensed for use as an additional therapy Naltrexone is increasingly being offered In setting up this enhanced and innovative within a comprehensive treatment programme for detoxified throughout the prison system to prisoners treatment service, our substance misuse patients who have been opioid-dependent. It binds who are about to be released back into the team has been grateful for the support and competitively to the opiate receptors in the brain and blocks community, as a way of helping to reduce encouragement we have received from coll- the euphoric effects of opiates, which means that they have relapse and the risk of drug overdose at this eagues within the prison, the PCT and Bristol no effect. Blocking the effects of opiates can help to eliminate extremely vulnerable time. We decided to Specialist Drug Service and we are now their ‘rewarding’ effects, which play a significant part in offer clients in Bristol Prison the opportunity optimistic that this type of provision will craving and subsequent relapse. However, it is important to be of beginning naltrexone treatment at a far expand across the region. aware that any treatment that results in a loss of tolerance to earlier stage of their sentence providing they opiates, should be supported by training and advice on meet the following criteria: Caroline Cockwell is the substance misuse preventing overdose should the client return to opiate use. G They are serving a sentence of between manager at Bristol Prison.

10 | drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Q&A | Support after relapse

A drug and alcohol worker in my team has come to me wanting support because she has just relapsed after several years. She is a valued member of staff and we want to help her over this episode and keep her in her post. Can anyone suggest practical support we can give her? QA Lizzie, by email Supervision sessions waiting list for statutory referral. I to rethink her life so that she doesn’t re- performance management/disciplinary returned to work two months later and lapse again after she hopefully gets clean. procedures should be invoked. Dear Lizzie have been (I believe) a valued employee Ian, Harrogate. While the above is based on good Might I suggest a few things. You have for the last three years, repaying the faith practice guidelines, for a variety of reasons, already started the process of keeping a of my employer. Friends and colleagues some organisations may agree that an valuable member of your staff who I am that I know have not been so lucky. Policy, policy, policy employee’s drug and alcohol misuse is a sure has contributed to alleviating Their employers have either not been matter for dismissal. Consequently, organ- suffering for addicts in her care. so sympathetic or simply have not been Dear Lizzie isational requirements should be clearly I am sure you have made her aware of as well connected as mine and as able to Although I’m unable to provide sugges- stated within the rules of the organisation this – it sounds like a case of burnout to arrange treatment so easily. Often these tions for individual support, your question and disciplinary/performance management me. I am sure you have done a thorough people have ended up resigning from their raises the wider issue of alcohol and drug procedures followed when necessary. The exploration to cater for your worker’s needs. jobs and disappearing from the system misuse in the workplace and how organ- issue of drug and alcohol workers relapsing I would suggest that you need to be with the result that they have not received isations are equipped to deal with this. can be complex and sensitive; the above is aware of the need for all employees to proper treatment till a lot later than they I believe the following process, within a way to ensure employers treat employees have regular supervision sessions, should have – and in one case too late. an effective HR policy and procedure fairly and supportively while meeting the especially when the workload is getting The only practical advice I can offer from framework, shows how organisations can needs of their organisation. people down and there is a noticeable my experience is to try everything you address employee drug and alcohol Coreen Nugent, Organisations Policies change in the working climate. can, get in touch with all your contacts misuse supportively, fairly and minimise Training (OPT), Those of us who have had a negative and try and arrange confidential treatment the impact on service delivery: [email protected] experience of addiction and turned it for your colleague as soon as possible. G Wherever possible an employee’s around to help others are invaluable to You owe it to her as an employee and drug and alcohol misuse should be the workplace, as we have such an in- more importantly, as a human being. treated as a health problem. Play the game depth understanding of our clients. Ali, by email G A drugs and alcohol in the workplace Unfortunately, maintenance of our policy and procedure can provide a frame- Dear Lizzie successful recovery to keep us working work for the employer and employee to iden- It is stating the obvious that solid recovery on par loses its priority. Root of the problem tify the most appropriate areas for support. is based on honesty, but like pregnancy it You and your team have a very G Such a policy and procedure can does not come in half measures. How realistic insight. I wish you all well. Dear Lizzie provide an outline of the level and type of disappointing it is to have a management Chris Donnelly, Newcastle Ok, good points first. Your colleague has support an organisation is able to offer its system, which in spite of its fine words in come to you for help rather than trying to employees, eg referral to another agency, terms of supporting staff, rarely delivers. hide things and the fact that she got counselling, GP. I have experience of a service where a Good connections clean to begin with suggests that there is G Time off while rehabilitating and the senior manager was allowed to go without hope she might be able to do it again. individual’s return to work can be covered sanction when s/he was convicted of drink Dear Lizzie However, I don’t see how she can do by an organisation’s sickness absence driving, yet a more junior staff member was I can only speak from my own personal her job effectively whilst she is using. She procedure. dismissed for a conviction for cannabis experience and the experiences of some of needs time off and some sort of plan in G A drugs and alcohol in the workplace possession. Worse still, service users are my friends and colleagues within the field. I place to get her clean. In your line of policy and procedure can assure the aware of this and that most hard earned had been four years clean and was working work, you should have some good clinical employee that related information will commodity, credibility, has been lost. for a private treatment provider when I contacts and might be able to find a remain confidential and only shared within To the question in hand I suggest she relapsed (through personal reasons, not suitable place for her to go on some sort the organisation on a need-to-know basis. is economical with the facts – every other work related issues) and as I now know, of detox programme. G In instances of relapse during so and so is – and play the stress card was very, very lucky. My employer treated Try also to identify what has made her treatment each case can be considered on while she sorts herself out. me with the same care and respect with relapse – has she started seeing old its merits to determine whether a further Best of luck, which they treat all their clients. They friends who are known users? She needs opportunity should be offered and whether Joe, by email accepted my condition as an illness as they would with a client who came to them with similar problems, and arranged residential Reader’s question treatment away from my home and I enjoy my role as a drugs worker and feel that I am working well with my clients, but recently I have been feeling workplace. very over-supervised. My manager has started to sit in on my client meetings and interrupts to the point where I’m Through links they had with a different feeling thoroughly undermined. I feel I’m being picked on. How can I tackle this calmly and constructively? provider, they were able to arrange immediate treatment for me that would Rob, by email have been way beyond my means and meant I avoided the (at the time) long Email your suggested answers to the editor by Tuesday 4 September for inclusion in the 10 September issue.

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 11 Drug strategy | Human rights vi Will2 politicians seize the chance to model a fairer2 drug strategy? The signs aren’t good, says Kevin Flemen, who warns that we could be looking forwards to a much darker place for human rights. he steady stream of critical, evidence-based reports must surely be hitting the market. Following from long acting Naltrexone implants, how about a chipping away at the edifice of drug prohibition policy. Mustn’t it? Each combination blocker that includes not just an opiate antagonist, but a cannabis, new report is heralded by a chorus signalling that it represents another alcohol and cocaine antagonist? As a deep implant lasting up to 12 months it T nail in the coffin of a discredited strategy. But there’s precious little would form the lynchpin of mandatory drug treatment. And by building a RFID evidence that the reports are going to result in a sea-change in drugs strategy. (Radio Frequency Identification) chip into each implant they should be easy to Much energy has been expended on lobbying and consulting in the run-up to monitor for tampering. the launch of the new ten-year drug strategy. But early signs and comments do not suggest that there will be a radical change in direction. More laws, stronger laws Some commentators, DrugScope included, had held out hope that the Conserva- tives, under David Cameron, would have the courage to break with past dogma and Of course, having new treatments is no use unless backed up by a robust pursue a balanced, evidence-based drug strategy. The Conservative strategy legislative framework. Having moved further and further in the past decade document Breakthrough Britain should thoroughly disabuse anyone of this notion. towards coerced treatment models, a logical endpoint is the introduction of legal In fact, despite the wishful optimism of many key commentators, the future powers to enforce treatment – such as implants – on users. may instead be a far darker place. There is huge scope for other legislative developments: the government wants to extend closure powers to all premises, not just those involving class A drugs. Testing times There have been proposals that would require statutory or voluntary sector workers to inform police of all people they thought could have the potential to be Drug testing technology, already becoming more widespread in pub and club violent – including those with alcohol or drug problems. And as testing technology settings, seems likely to spread further. It’s already been piloted in some becomes more widespread and reliable, it seems more likely than not that new schools, apparently with the blessing of the Association of Chief Police Officers offences – such as past drug use, as evidenced by a drug test – will be created. (ACPO). Some police forces have used it at roadside traps, stopping cars and swabbing drivers. And at least two police forces have tried to persuade hostels ID cards and the cashless society to allow the police to test residents for contact with drugs. As technology such as the Itemiser Ion Track equipment becomes more The biggest ‘power’ to control drugs and drug use probably won’t come from drugs portable and affordable, the testing check points in other public arenas – railway legislation at all, but from the introduction of identity cards and the end of cash. stations and job centres for example – are likely to become more widespread. Unless there are some substantial changes, it will be mandatory to possess Ultimately, we can expect to see the technology integrated with other systems – an ID card in the not-too-distant future. While the requirement to carry the card a rapid thumb detection system as you gain entry to your workplace for example, at all times may be far off, an increase in police powers to stop people and seek or the transport system. to ascertain their identity and movements, as discussed at the ACPO At present anyone is at liberty to refuse to be scanned, but such a refusal conference, is already being considered. could be grounds for a search. As the Police and Criminal Evidence Act (PACE) Within a short time, ID would be required in a wide-range of situations – hasn’t been revised to cover ‘new’ approaches, such as Itemisers use or sniffer swipeable ID cards which could provide access to buildings, to transport dogs in public settings, there is no clarity as to the legal status of such search networks, before collecting methadone, and when receiving benefits. techniques. ID cards will mesh neatly with another foreseeable development: the last days of cash and the rise of debit and cash-free payments. The techno-cure The use of debit or credit cards for a growing number of purchases is already widely established. New trials in London are looking at the use of Oyster cards – We’ve already seen advances in the development of drug treatment: media already used as a pre-payment system on public transport, as a way of making small including The New Scientist have reported the development of promising cocaine payments without cash. Items under ten pounds could be paid by Oyster; more than ‘vaccines’, potential cannabis antagonists, and the introduction of combined that, on a debit card – all backed up by the verification of an ID card as required. naltrexone and buprenorphine treatments like Suboxone are touted as the next Street level drug use is heavily predicated around cash – the sale of goods or steps in the pharmacopoeia of drug treatment. services for cash, which can, in turn, be used to buy drugs, But how does one Further down the line, we can expect to see more combined treatments beg, sell sex, or fence stolen goods in a cashless society?

12 | drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Drug strategy | Human rights

Post-its from Practice Lost in paperwork Getting into treatment can be a long and tortuous business in some cases, says Dr Chris Ford.

Stuart is the partner of one of my patients and came to see me the other day with a story that was difficult to believe. However the service in question has confirmed the facts of the matter. Stuart took a day off work to attend our local drug service for an initial assessment. At his next appointment the drug worker ision made a partial assessment and so asked him to return for another one hour appointment. At this next appointment he learnt that his written assessment had been Information is king lost (the service does not yet use computers) and that all 15 pages of the local Thanks to the rapidly burgeoning database industry, the ability to closely assessment form had to be completed again before he was put on the two- monitor drug users should increase dramatically in the coming decade. Using week waiting list to see the doctor for assessment. the national ID card database, and by cross-referencing that with the NOMS Surprisingly, he still attended, was assessed by the doctor, and chose database, relevant NHS databases and the police national computer, it should methadone substitution. He was told at this point that prescribing would be be very feasible to identify, trace and monitor the majority of people who use dependent on attending three consecutive days of titration and also drugs problematically in the UK. dependent on his withdrawal symptoms, which would be measured But of great importance will be the proposals to identify and flag young objectively. However when he attended, he was deemed not to be in ‘enough’ people who use drugs early on, and ensure that they too are added to a withdrawal, although he felt and looked awful. Stuart heroically returned the database of young people ‘at risk’. The foundation for this will be ContactPoint, next day and although his heroin use was more than 1 g a day, was given only the DfES-managed database that will go live from 2008. This will include basic 20mls substitution of methadone mixture by supervised consumption. information on all children in England under 18 years of age. There is scope for This was the final straw. Stuart had told them that he needed to leave for this to record that a child is accessing drug-related services, and this work at 7am the next day, and so supervised consumption would be difficult information to be shared with other professionals without the child’s consent. as there wasn’t a late opening chemist close to where he lived or worked. By ensuring close dovetailing between these, NHS, ID and offender Stuart presented to us in withdrawal. He had an excellent assessment in databases, it should be relatively easy to achieve early identification and close 20 minutes by our specialist drugs counsellor, who gained the necessary vital monitoring of drug users from early years to adulthood and beyond. information and undertook a urine drug test, which confirmed the use of heroin. This was followed by a ten-minute review of the assessment and a The absence of checks and balances physical examination from me, which confirmed Stuart had normal blood pressure, a clear chest, old and fresh track-marks up both arms and enormous Many of the ideas or concepts described above are at various stages of pupils. He left the surgery that day with a prescription for 40mg of development or implementation. And in this brave new phase of the ‘war on methadone mixture and another dated the next day for 40mg, with an drugs’, few are asking ‘should we be doing it?’ Defending the idea that human appointment to return the following afternoon. rights should be extended to drug users is becoming less and less fashionable. Four weeks into treatment Stuart is doing very well, having settled on Ten years ago, the idea that a person, convicted of no offence, could be 90mls of methadone mixture. He still has his job and is now using his wages locked out of the home that they legally owned, without there being any proof of to pay back borrowed money to his partner; they are even planning a holiday. any wrong-doing would have been inconceivable. Back then, the principle of Stuart’s story raises several concerns: why was he not told properly about defending the right to housing, and security of tenure would have been a cause the assessment process so that he could give fully informed consent to the celebre. But because the houses involved were labelled ‘crack dens’ and the treatment? Why is the service so unconcerned with their blunders, their lack people involved were the nation’s new folk devils, such legislation was passed of encouragement and timely care? If Stuart had been a young mother with unchallenged. children or had been more problematic, I don’t think such a person would So given this lack of effective and coordinated challenges to the erosions of have managed to make the third, let alone the fifth appointment when the civil liberties that is becoming commonplace in the ‘war on drugs’, we can first methadone was dispensed. Finally, if staff apply guidelines as tramlines expect to see more such encroachments. or are completely risk averse, whether due to inexperience or to lack of If, just if, the new developments described above were effective in identifying clinical expertise or resources, then the final service will likely be a poor and controlling drug use, would the loss of privacy and liberty involved be a production line process. price worth paying? Stuart won’t be complaining about his experience at the local service, so they continue to be unaware that they are failing to provide a patient centred This article was originally delivered as a presentation for the Genesis Hope service – but I’ll use his promised postcard as a positive marker of ours. Project conference in Stoke on Trent in 2007. Dr Chris Ford is a GP at Lonsdale Medical Centre and clinical lead for SMMGP Kevin Flemen runs the drugs consultancy KFx. Details at www.ixion.demon.co.uk

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 13 Young people | Screening in A&E

Catching them young A simple screening process can catch young people at the early stages of drink and drug misuse and point them away from lasting harm. St Helens Council Young People’s Drug/Alcohol Team and Knowsley Substance Misuse Nursing Service (Health and Social Care) share promising results of a pilot scheme demonstrating positive partnership working alongside Whiston Hospital Trust and St Helens PCT.

A BBC documentary at the end of last year claimed The HAS review calls for healthcare questionnaire, but the fact that the hospital staff that there has been a 20 per cent increase in the professionals to research the effectiveness of are able to offer this input across boroughs and number of 14 to 15-year-olds presenting at accident screening, assessment and brief interventions, and have built up working relationships and contacts and emergency wards for drink-related incidents. suggests these initiatives could make a significant with the young people’s substance misuse teams These statistics may be the harsh reality of today’s impact on public health. within each of its main servicing areas – in our youth culture; but to professionals working within the We decided that given the busy nature of hospitals, case, St Helens and Knowsley. substance misuse field, they provide more evidence of particularly A&E, screening had to be as short, Through screening we can establish recent the need for agencies to work together in addressing straightforward and quick to administer as possible. consumption and identify immediate health risks in both the social and individual aspects of alcohol and Our screening tool is currently a one sided, predom- relation to recent heavy drug or alcohol use. These drug related harm. inantly 'tick box' carbonated document, separated as can be considered in relation to potential hospital The Health Advisory Service (HAS) The Sub- follows: Part a – copy for hospital records; part b – treatment or medication, so that modifications can stance of Young Needs Review 2001, recommends copy for the school nurse; part c –copy for the relevant take place. For example, the impact of recent introducing drug and alcohol screening for young young persons substance misuse team. amphetamine use needs to be considered if a people in health services. Introducing screening is not intended to replace general anaesthetic is prescribed. In the spirit of partnership working, two substance any existing protocols, but it allows the young person A recent evaluation of the screening tool misuse teams from neighbouring boroughs within to make informed choices in relation to further revealed that health professionals had, at times, Merseyside have introduced clear care pathways from support for their drug and/or alcohol use. It also lets been reluctant to deal with drug or alcohol issues a local general hospital into young people’s substance us consider the wider agenda, such as whether child among young people. In some cases this was seen misuse community services. The aim is to provide protection procedures might be needed. as relating to a lack of understanding and direct follow-up for young people who arrive intoxicated The screening tool emphasised our need to knowledge about the needs of young people in at A&E, but we hope it could also have an impact on formalise links between school nurses and the young relation to drugs and alcohol and how to deal with revolving door syndrome, as well as enhancing current people’s substance misuse services through a struct- such issues. The screening process, combined with good practice and consistency of care. ured care pathway. Ongoing use of screening has not supported training around drug and alcohol The pilot screening tool encourages hospital only had a positive impact on appropriate referral; it awareness, provides hospital staff with a quick and staff to screen – with consent – any young person has also improved lines of communication, enabled straightforward means of broaching the subject with aged 11 or over for drugs and alcohol, regardless of information-sharing, and made multi-disciplinary work- young people, understanding related needs and their reason for attending the hospital. ing more effective. School nurses are able to follow up providing an opportunity for appropriate referral. Following the screening, if necessary, they are then and monitor those young people who refused an initial While the rationale and aims of the screening tool given information about substances and relevant local referral to the Tier 3 service, and help to raise aware- are clear, we now need further investment in its support services, or (with consent) they are referred to ness of those young people whose substance use may delivery and use on a number of levels. During its an appropriate substance misuse service in their area currently be within the experimentation stages, so that pilot phase the screening work relied on good will and for a comprehensive assessment. information can be targeted appropriately. the excellent working relationships between frontline The focus of the screening tool is to identify sub- Through the ‘paediatric liaison’ route, young workers. For the tool to be used consistently and stance related issues and facilitate referrals to comm- people up to the age of 16 years would normally be effectively, it needed to be recognised at a strategic unity services – principally young people’s drug and identified as needing advice and support around level and embedded within other ‘day-to-day’ hospital alcohol teams and specialist nursing services. Its aims drugs or alcohol. Before the screening tool was procedures. This has now been achieved, and the were identified by looking at national and local strategy, introduced there were concerns that those aged 16- young persons substance use screening tool is to and by consultation with service providers in the two 18 would not being identified as at risk or needing become part of standard practice. boroughs. In developing the screening tool, young help, as they were recognised as adults within the people were asked if they felt that questions about hospital admissions process. The screening Madeline Jones (St Helens Young Peoples Drug and drug and alcohol use were relevant and appropriate to process would prevent these young people from Alcohol Team) & Debbie Olyott (Knowsley Substance ask within the hospital environment. They all felt that being excluded from support. Misuse Service) are available on email for further they were, and that having it taking place in a hospital The main strength of such a screening tool is information regarding the screening process: madeline would lead to appropriate treatment. not only its simplicity in being a one-sided [email protected]/[email protected]

14 | drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Background briefing | Professor David Clark

Heroin overdose (part 3) Professor David Clark continues to look at various ways that can be used to reduce the number of heroin overdoses and overdose deaths, and at the responsibility that we all share in trying to do this.

In my last Briefing, I emphasised that a wide range Policymakers and commissioners need to take of people are potentially able to help reduce the up the suggestions of John Strang and colleagues number of heroin overdoses. These include heroin (British Medical Journal, 21 June 2007) to increase users themselves, specialist and generalist workers the availability of naloxone and provide relevant in the field, family members and friends, training to non-healthcare staff, and to users, their commissioners and policy makers, and even families and carers. members of the general public. In this Briefing, I Three groups are considered to have a relatively continue to look at ways in which these various higher incidence of heroin overdose: former users groups of people can contribute. who are just leaving prison, former users who have Heroin users most commonly overdose when in been on an abstinence-based treatment company, and death from overdose is rarely programme, and clients in the early stages of a instantaneous, creating opportunities for those methadone substitution programme. present – most commonly other heroin users – to The dangers of overdose to people in these reduce potential morbidity and mortality by situations needs to appreciated, not just by the intervening in some way. individuals themselves, but also by their families However, research has consistently shown that and carers, as well as by practitioners and only a small proportion of overdose witnesses use commissioners. The reality is that most members first aid measures, such as cardiopulmonary of the latter groups are not well-trained or well- resuscitation (CPR) and placing the overdose victim informed about heroin overdose. in the coma position. Moreover, studies reveal that One of the fears expressed by parents is the an ambulance is called in only about 50 per cent of ‘knock on the door’ – by a policeman ready to cases. inform them that their son or daughter had been Many heroin users who do not call emergency found dead, of a suspected heroin overdose. Given services fail to do because they are concerned their concerns, and lack of knowledge about about being arrested by the police, for possible ‘Police should not attend overdose, it is important that family members and manslaughter or for possession of drugs. Despite a non-fatal overdose carers receive credible, objective and understanding the fact that there is no reason for the police to communications from those people they turn to for turn up at an overdose incident unless a fatality unless essential’ advice and support, such as their GP. has occurred, they generally do so in the UK. This is One mother who participated in a WIRED not the case in Australia. research project was told by her GP: ‘I think you’ve There are a variety of ways in which we can got to face the fact that… your son is gonna die… reduce overdose deaths by a greater ‘engagement’ it’s either gonna be accidental or deliberate… he’s of overdose witnesses. by members of emergency services and, in particular, not getting better. He’s as bad as he can be, he’s Treatment agencies should offer regular by the police: taking anything and everything; he’s so desperate.’ education courses on drug overdose, with topics ‘…They just treated me like a dirty junkie which I She received no support or advice. Although this ranging from prevention measures through to first suppose I was… but if it wasn’t for me he would be is an isolated example, it emphasises the need for aid classes. These courses should involve discussion dead, you know.’ (Unpublished WIRED research in better training and education, and understanding between service users and staff as to how to Swansea.) about heroin overdose among generalist workers. increase the flow of credible messages about Heroin users must accept that they have to As a final comment, it must be recognised that overdose among a networks of users. provide information for the coroner’s court if they we live in a society that is highly prejudiced against Police should not attend a non-fatal overdose are witness to an overdose death. Treatment heroin users. As a result, some heroin users are less unless essential. Ambulance crew should agencies should provide them with information likely to access treatment services, and some ex- acknowledge the help of witnesses when merited. about, and support concerning, the giving of users are less likely to be accepted by, and be If a heroin user has done something right they information and attending a coroner’s court. integrated back into, ‘normal’ society (a critical should be told, since they will be more likely to do Naloxone, an opiate receptor antagonist, is used element of recovery). They are therefore likely to it again. to reverse the life-threatening suppression of continue using, or start using again, thereby being Research has found that rather than being respiration caused by heroin. Whilst naloxone is at risk of overdose. thanked for their positive and sometimes life- often used by ambulance services to ‘revive’ people Reducing prejudice, stigmatisation and saving actions – which can enhance their self- who have overdosed on heroin, the drug is not freely stereotyping of heroin users will reduce heroin esteem – heroin users are often looked down upon available for use by heroin users. overdoses and deaths.

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 15 Classified | training and services

16 | drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Classified | recruitment

The Space KC provides a range of holistic support services for young people in London including a harm reduction service, drugs and sexual health advice, training, counselling, a drug free programme, complementary therapies, specialist clinics and an LGB group. The project uses the Criminal Records Bureau disclosure service. An enhanced disclosure is required for this post. Registered Charity Number: 1003657

Full Time Practitioner (Drug Free Programme) Salary range: NJC Points 26-31 (£23,994 - £27,807) Required to deliver the drug-free programme: a structured substance misuse programme for young people from our two sites – Earl’s Court and Golborne Road. Must have: G At least 1 year’s experience of working in the substance misuse field G At least 1 year’s experience of working with young people G Ability to develop relevant programme activity The Space KC encourages applications from men as they are under- represented in the organisation. For an application pack call Elizabeth Oakley on 020 7373 2335 or email [email protected] Closing Date: 16 August 2007

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 17 Classified | recruitment, tenders and training

‘From dependence Kaleidoscope Project is an innovative treatment provider to independence.’ seeking to provide good accessible treatment services to those experiencing illicit drug misuse problems. WELLINGTON LODGE Hospitality is key to all our services. Project Workers (F/T) £17,000-£21,000 pa You will be part of a multi-disciplinary team providing care planning and support of illicit Addiction counsellors and bank staff required substance users. The role includes supporting the methadone administration programme, Candidates must be qualified counsellors and have liaison with partner agencies and some administrative work. A proven record in the social experience in group and individual therapy within the care field would be an advantage. drug and alcohol field. FDAP accreditation or proof of Closing date: 31 August 2007 working towards this is essential. The candidate must be flexible to meet the needs of the client group. Salary For an informal discussion please contact Sian Chicken, Drugs Services Manager on 0208 549 2681. depends upon experience. For an application form and job description please call All posts subject to Enhanced CRB and POVA checks. Veronica Snowball on 01633 245012

Applicants that require an application form or further Kaleidoscope is committed to equal opportunities and welcomes applicants from diverse communities. information please contact [email protected] or telephone 020 8421 2266 DDN – FDAP workshops

The essential drug and Supervision, appraisal Performance alcohol worker and DANOS management 17-21 September, London 8 October, London 15 October, London

This five-day course pro- This one day workshop for This one day workshop for vides a full introduction to line managers and HR line managers and HR direct- the elements of effective directors covers supervision, ors builds on the ‘Supervision, drugs and alcohol work. This appraisal and development appraisal and DANOS’ workshop is delivered in of front line staff against workshop, and focuses on association with DDN and DANOS and other national managing and developing DrugScope. occupational standards. practitioners' performances.

All one day workshops cost: £110 + VAT per head Five day workshop cost: £635 + VAT per head (15% reduction for FDAP members/affiliates – rates for groups on application)

Contact Tracy Aphra e: [email protected] t: 020 7463 2085

The DDN nutrition toolkit an essential aid for everyone working with substance misuse

• Written by nutrition expert Helen Sandwell • Specific nutrition advice for substance users • Practical information • Complete with leaflets and handouts Healthy eating is a vital step towards recovery, this toolkit shows you how. Available on CD Rom. Introductory price £19.95 + P&P

To order your copy contact Tracy Aphra: e: [email protected] t: 020 7463 2085

18 | drinkanddrugsnews | 30 July 2007 www.drinkanddrugs.net Classified | recruitment

Bridgegate Drug Services is an independent company with charity status and funding that provides services for people with substance misuse problems, their families and concerned others, across Peterborough and Cambridgeshire.

Engagement Lead (Adult Services) Salary £23,952-£26,928p.a. (NJC pay scale 30-34) 37 hours per week, located in Peterborough

We are seeking a dynamic self-starter who is able to lead our Engagement and Harm Reduction services. The successful applicant will be responsible for the co-ordination of the Peterborough office’s Open Access services. This includes Needle Exchange services, telephone helpline and assistance to face to face enquiries. You will be working to defined targets and will be expected to demonstrate your ability to translate our strategic goals into clear performance outcomes. This role offers an opportunity to develop innovative outreach and community initiatives. You will need a relevant qualification and a proven track record. For an application pack please call Marion Denny on 01733 314551, or email [email protected] Applications close 13 August 07. Interviews to start 28 Aug.

We are an equal opportunities employer and committed to supporting the development of our staff. All posts are subject to a Criminal Records Bureau check.

FDAP/Alcohol Concern Assessors and Verifiers

The Open University VQ Assessment Centre is looking for qualified assessors and verifiers to help them, on a consultancy basis, to deliver a suite of vocational awards based on the DANOS units. These awards, ranging from three to ten units, have been developed in conjunction with the Federation of Drug and Alcohol Professionals and Alcohol Concern. The awards are designed to recognise and demonstrate the competences of managers and practitioners in the drugs and alcohol field - in line with the DANOS-based competence framework. All assessment relating to these awards is desk based so there will be little requirement for you to travel. As a consultant assessor, you will be required to assess a case-load of candidates, enabling them to achieve their qualification. It is essential that you already have the D32/D33 or A1 assessor, or the D34 or V1 internal verification qualification. You must also have at least two years of occupational experience within this sector and have evidence of assessment activity within the last 12 months. The amount of work you will be offered will be dependant on the

frequency from Monday 10 September. Advert 10 September. Monday from frequency deadline 6 September. number of candidate registrations that the centre receives at each of DDN is now taking a Summer break, we will be back to our fortnightly will be back to our fortnightly we DDN is now taking a Summer break, its quarterly registration periods. If you are interested in working with us, please email [email protected] attaching your most recent CV, an outline of your sector and assessment experience and an indication of the number of candidates you feel you will be able to support.

www.drinkanddrugs.net 30 July 2007 | drinkanddrugsnews | 19 STILL NUMBER 1 FOR RECRUITMENT AND CONSULTANCY SOLUTIONS 020 8987 6061

Important to us: INTEGRITY... we are built on it DELIVERY... we achieve it Important to you: VALUE... we provide it

Call today to discuss your consultancy and recruitment needs, or register on-line at www.SamRecruitment.org.uk

Due to our unprecedented growth TTP Counselling is looking to recruit the following members to its team:

2 BUSINESS DEVELOPMENT MANAGERS MANAGER, COUNSELLING SERVICES Luton and North West (Wigan) North West (Wigan) Salary £24k basic OTE £36K Salary £30k to £35k Developing business relationships with both statutory and GP referrers. 2 years + working within Experienced Service Manager required for our new 80 bed centre in the North West (opens the substance misuse field and familiar with DAT/DIP referral pathways and purchasing of Tier 4 January 2008). Must have direct personal experience of the 12 step programme of services. Knowledge of the 12 step programme of recovery is preferred but not essential. recovery and managing a team of counsellors. You must be trained to a minimum of diploma level and have 3 year managerial experience. MANAGER, DETOX FACILITY Surrey 10 COUNSELLORS Salary £30k to £35k Luton and North West (Wigan) Responsible for running the TTP detox facility in Surrey. You will lead the nursing team and Salary £14k to £24k ensure that residents receive a high quality service in a safe environment. The following If you are qualified, in training or wish to train, to a minimum of diploma level and competencies are required: have personal/professional experience of the 12 step recovery programme, G Leadership and Management we want to hear from you. G Financial management G Appropriate level nursing qualifications G Professional nursing expertise working with substance misuse clients G Able to communicate to various audiences, written and oral G Facilities management Please email your CV, with covering letter, to [email protected]