DRUG STRATEGY 2008-2018: treatment details

The following are the promises made in the strategy regarding treatment for drug-and alcohol problems, as well as the proposed action plans - available in full at Drugs: protecting families and communities – 2008-2018 strategy (1Mb pdf file) and at Drugs: protecting families and communities - Action plan 2008-2018 (1Mb pdf file)

“THE GOVERNMENT WILL...

...Clearly prioritise those who are causing the most harm to communities and families – getting offenders, and parents whose drug use may put their children at risk, into effective treatment quickly.

...Pilot the use of individual budgets to help those successfully completing treatment to access housing, employment, education and training, to support them in re-establishing their lives, free from dependency.

...Use all emerging and available evidence to make sure we are supporting the treatment that is most effective, targeted on the right users – with abstinence-based treatment for some, drug-replacement over time for others, and innovative treatments including injectable heroin and methadone where they have been proved to work and reduce crime.

...Involve families and carers in the planning and process of treatment, for young people and for adults.

...Ensure that the benefits system supports our new focus on re-integration and personalisation. To ensure that it creates incentives for people with drug problems to move towards treatment, training and employment, we will at a minimum:

– require drug misusers on out-of-work benefits to attend a discussion with an appropriate specialist treatment provider or partner organisation as part of the Jobseeker Direction or Work Focused Interview requirements; and

– encourage closer links between relevant agencies so that drug misusers who are claiming benefits can be referred to specialist services."

These changes are a first step in helping clients to overcome barriers to work and ensuring Jobcentre Plus engages more closely with local drug partnerships and treatment providers. It is not right for the taxpayer to help sustain drug habits when individuals could be getting treatment and overcoming barriers to employment. So it is proposed to introduce a regime with more tailored and personalised support . In return for benefit payments, claimants will have a responsibility to move successfully through treatment and into employment. “ Further proposals will be announced regarding these measures."

PREVENTION

The strategy will expand its approach so that it increasingly focuses on young children and families before problems have arisen.

It will take a wider preventative view that is not focused just on illegal drugs, but on all substances and the risk factors that we know can lead to drug use, alcohol misuse and volatile substance abuse (gases, glues and solvents) as well as other problems later in life.

Ant it will look at the whole family, ensuring prompt access to treatment for drug-misusing parents with treatment needs and particularly those whose children are at risk, with assessments taking account of family needs, and providing intensive parenting support alongside drug treatment.

KEY STRATEGY ACTIONS

Develop pilots to test new approaches which can provide better end-to-end management through the system, including a more effective use of pooled funding and individual budgets, and with a sharper focus on outcomes.

Develop a package of support to help drug users, particularly those causing the most harm, to access and complete treatment and to re-integrate into society.

Use opportunities presented by the benefits system to provide support and create incentives to move towards treatment, training and employment.

Ensure treatment is personalised and outcome –focused, making full use of new treatment approaches which are shown to be effective.

Draw on significant new funding to support research into developing better forms of treatment.

NEW APPROACH IN DETAIL

“The goal of all treatment is for drug users to achieve abstinence from their drug – or drugs – of dependency," states the strategy.

"For some, this can be achieved immediately, but many others will first need a period of drug-assisted treatment with prescribed medication. Drug users receiving drug-assisted treatment should experience a rapid improvement in their overall health and their ability to work, participate in training or support their families. They will then be supported in trying to achieve abstinence as soon as they can."

While large numbers are entering drug treatment, with most deriving significant benefit from it, too many drug users relapse, do not complete treatment programmes, or stay in treatment for too long before re‑establishing their lives. The challenge is to maximise the impact of treatment for those who receive it. There sould be more personalised approaches to treatment services, which have the flexibility to respond to individual circumstances. The government will examine how to best support those leaving and planning to leave treatment with packages of support to access housing, education, training and employment. "We will deliver better outcomes, with more people becoming re-integrated into society, through a focus on four key objectives."

TARGETING THOSE MOST AT RISK

The Department of Health has lead responsibility for delivering effective drug treatment and will continue to prioritise heroin and crack use, while improving access for under-represented groups and those with complex needs by:

• addressing unmet treatment needs and barriers to treatment, which may include the needs of young people, women, crack or poly-drug users, particular black and ethnic or other minority communities, sex workers or parents with dependent children;

• removing barriers to accessing services for users with children, and acting promptly to protect children where they are found to be at risk;

• targeting services for those with complex needs, such as drug users with mental health problems; and

• prioritising access to treatment for those drug-misusing offenders who enter through DIP and those leaving prison or completing the DRR of a community sentence or a period on licence.

IMPROVING QUALITY AND EFFECTIVENESS OF TREATMENT

Better outcomes for people entering treatment should be achieved by:

• improving retention of clients in treatment, with more clients overcoming drug dependence and successfully completing treatment programmes and re-integrating into communities;

• driving up standards across all treatment providers through new local clinical governance arrangements and by monitoring a range of treatment outcomes, including re-offending, employment and health;

• improving, where appropriate, the sharing of information between agencies to facilitate the management of clients;

• continuing to promote harm minimisation measures including needle exchange and drug-assisted treatments that encourage drug users to enter treatment, to reduce the risk of overdose for drug users and the risk of infection for the wider community; and

• improving commissioning skills and continuing to engage service users in the planning and delivery of services at a local level, to ensure that services are responsive to local needs.

NEW TREATMENT APPROACHES

The government says it  will build on new evidence of what works and maximise the range of approaches used, including by:

• using contingency management pilots, in which positive reinforcement techniques are used to encourage clients to maintain a course of treatment, to identify and reinforce good practice and address concerns about the inappropriate use of rewards in treatment;

• encouraging clients and family members to make wider use of mutual aid support networks, such as abstinence programmes and local support groups, to improve treatment outcomes;

• developing and delivering a significant new initiative to support research that will boost understanding of addiction and identify opportunities for new forms of treatment or prevention. Building on the major expansion of health research funding from the last Spending Review, the Medical Research Council and the National Institute for Health Research agreed that addiction should be one of the joint priority areas for health research funding, led by the Medical Research Council;

• applying learning about what works gathered through the routine monitoring of treatment outcomes through, for example, the National Drug Treatment Monitoring System; and

• rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment, subject to the findings, due in 2009, of pilots exploring the use of this type of treatment.

“RADICAL NEW FOCUS" TO RE-ESTABLISH LIVES

The ambition of this strategy is to achieve sustainable reductions in the harms caused by drugs. Drug problems do not occur in isolation, and may be both the cause and the consequence of wider social and personal problems. The government’s programmes to tackle social exclusion among adults and at risk families recognise that people or places can become trapped in a cycle of related problems, such as unemployment, poor skills, low incomes, poverty, poor housing, high crime, bad health and family breakdown – all factors which can be related to higher levels of drug use.

To address the wider problems faced by those affected by drugs, this strategy is linked with the framework set out in Reaching Out: An Action Plan on Social Exclusion and the Families at Risk Review and will draw on the Adults Facing Chronic Exclusion Programme as part of a package of action, social care and support to help individuals and families to re-integrate themselves in the community.

It will also make full use of the Working Neighbourhoods Fund, a £1.5billion contribution to the Area Based Grant launched in November 2007 to help local authoritiy areas facing challenges of worklessness and low levels of skills and enterprise. The Working Neighbourhoods Fund has been allocated to 87 local authority areas for 2008-2011.

For drug misusers, the Department of Health, the Department for Work and Pensions and the Department for Communities and Local Government will take the lead on work to support drug misusers’ re-integration into society by:

• encouraging joint working between treatment agencies, Jobcentres and sources of housing advocacy and advice, to plan and manage clients’ journeys through treatment and into work, helping them access the wider support they need to re-establish their lives;

• encouraging local authorities to work with partners to meet locally-identified need for housing and support for those affected by drug misuse;

• allowing the Pooled Treatment Budget to be used alongside other funding streams to provide advice on re-integration support and case management;

• ensuring that all local partners are aware of the need to assess the wider needs of drug misusers and those in treatment;

* exploring the potential, initially through pilot projects, of the use of pooled budgets, end-to-end case management and individual budgets linking treatment benefits, training and employment support, with a focus on achieving positive outcomes for clients.

MEETING TARGETS

Delivery will be measured against the 1008-11 Public Service Agreement targets relating to the number of drug users in effective treatment (PSA25).

National indicators relating to this section include:

NI40 – drug users in effective treatment

NI120 – all-age all-cause mortality rate

NI141 – number of vulnerable people achieving independent living

NI143, 145, 147,149 – socially excluded adults living in settled and suitable accommodation

NI144,146,148, 150 – socially excluded adults in employment, education or training

NI152 – working-age people on out-of-work benefits.

FAMILIES

The Department for Children, Schools and Families (DCSF) leads on work to prevent substance misuse among young people and on family-based interventions. Within this work, families will be supported and strengthened, so that they can build young people’s resilience and reduce the harms caused by substance misuse by:

• providing better information to parents and other carers to strengthen their role in preventing young people’s substance misuse;

• where appropriate, involving families in the treatment of young people and other family members; and

• developing additional support for families at risk, drawing on learning from a range of pilot programmes.

Where parental substance misuse exists, intergenerational harm should be prevented and access to treatment supported by:

• ensuring that drug-misusing parents have prompt access to treatment, where it is required, and that parents who are problematic drug users and whose children are at risk have rapid access to treatment, with assessments taking account of family needs;

• encouraging the provision of more ‘family-friendly’ drug treatment services, reducing barriers for those unable to engage in treatment due to caring responsibilities;

• delivering a package of interventions and providing intensive and integrated support for families at risk, to improve parenting skills, reduce risk factors for children, support families to stay together and break the cycle of problems being transferred between generations, drawing on learning from innovative programmes, (including Family Intervention Projects, Family Drug and Alcohol Courts and Family Pathfinders);

• supporting kin carers, such as grandparents, who take on care responsibilities for the children of substance-misusing parents, with improved information and support;

• prioritising the protection of children of substance-misusing parents through early identification and improved information-sharing between children’s and adult services;

• improving access to additional support services, including help and advice with accommodation, employment and education, for parents who are undergoing treatment; and

• addressing pre-natal harms through improved links between maternity and treatment services.

DRUG-MISUSING OFFENDERS

To ensure that those who cause the most harm are identified, properly managed and receive appropriate and timely interventions, the Home Office, Ministry of Justice, prosecutors, police and partners will:

• present drug-misusing offenders with tough choices to change their behaviour or face the consequences;

• ensure that DIP-based powers, such as drug testing, required assessment and restriction on bail, are effectively applied at a local level; and

• keep those powers under review, for example by considering the range of substances for which an offender is tested, where emerging new drugs pose a threat to continued reductions in offending.

The number and range of offenders brought within these arrangements will be increased by:

• promoting an integrated approach to managing offenders, sharing information and risk assessments across different agencies to better identify priority offenders and the interventions needed to address their offending;

• supporting new areas and partnerships to expand the range of DIP interventions available locally, including, for example, through self-funding of drug testing regimes;

• increasing the number of offenders whose drug-related offending is addressed through the use of DIP conditional cautions; and

• managing offenders better at crucial times, such as on discharge into the community from prison, when the risks of relapse and re-offending are high by improving the continuity of case management of drug-misusing offenders and reviewing and strengthening links between prisons, local Criminal Justice Integrated Teams and probation services.

The Ministry of Justice will lead on maximising the impact of prison and community sentences to reduce drug misuse and its related harms. In conjunction with the Department of Health and other partners, this will be achieved by:

• maximising the use of community sentences with DRRs;

• ensuring that all prisoners have access to a minimum standard of clinical drug treatment;

• exploring the scope for streamlining funding and commissioning arrangements for the National Offender Management Service, Primary Care Trusts and Joint Commissioning Groups through commissioning and delivery pilots;

• extending the use of successful interventions throughout the criminal justice system, including further rolling out of the IDTS;

• piloting the introduction of the National Drug Treatment Monitoring System into prisons and ensuring that community-based treatment services are notified when a drug user is released from prison, to provide a better link between prison and community-based services;

• raising the quality of interventions in the prison estate and developing the skills of the workforce in prisons and probation services, so that they can deliver quality drugs services;

• examining the potential of offering sentencers additional community-based options for substance misusers within the intensive alternative to custody programme;

• extending the successful Dedicated Drug Court pilots, in which courts look to address drug misuse as a cause of offending, to up to four further areas, subject to evaluation of the Leeds and West London pilots; and

• improving measures to control the supply of drugs into prisons, including extending the use of drug-free wings.

Comments

[Harry Walker, Turning Point]

“We at Turning Point understand the motivation behind the idea of keeping people in treatment through benefit sanctions. But as a service provider we are aware that in real life such a policy could have unforeseen problems, including a higher bill for the taxpayer through health and crime costs. We would want to see clear evidence from pilot programmes that such a policy would keep people in treatment and would not lead to problems becoming more intractable.

“Such headline-grabbing announcements are also a distraction from the most welcome aspect of this strategy – a focus on finishing the job of treatment by providing support for people to get a job and a place to live to help them to stay off drugs and become active citizens in our society. The pledge to increase the use of community sentences for drug-using offenders, is also to be welcomed.

"We are concerned that the strategy fails to tackle the problem of alcohol misuse: if the government truly wishes to address all the needs of substance misusers so that they can live productive lives in their communities, it must address all the drugs being used by the people this strategy is aimed at. The welcome focus on drug users’ wider problems should include a recognition of alcohol so that policy in this area is more joined up, to make sure that treatment works.”