Addiction Today

RECRUITMENT: NICE ALCOHOL GUIDE

ALCOHOL USE DISORDER IN ADULTS AND YOUNGPEOPLE
COMMUNITY MEMBER RECRUITMENT

Closing date 16 May 2008

NICE is extending the closing date for this community member role until 5pm 16^th May.

Community members of this group will play a key role in making sure that the views and experiences of adults and young people - about preventing and managing harmful drinking - inform the guidance's development and its recommendations to the NHS, local authorities and the wider public, private, voluntary and community sectors.

NICE would welcome an application from people (aged 16+) who have experience or knowledge of the issues that are important to adults and young people in relation to preventing and managing harmful drinking, for example as someone:

•           who has been involved in activities or groups to improve their own and/or their family’s or community’s health or well-being in relation to alcohol use 

•           who uses or has used a relevant NHS or other service to address an alcohol-related problem

•           who is a member or officer of a relevant community or voluntary organisation.

Click here for link to the website advert, further information and an application form.

Public health and other health-related professionals will be well represented on the group so we are looking for someone without this type of professional background. 

    

   

The Centre for Public Health Excellence is still also recruiting separately for public health and other health-related professional members for this Programme Development Group. Click here for informatoion.

Please note that there are different person specification criteria for the community member and professional member roles and also different application processes.

DoH POLICY & GUIDANCE DOCUMENTS

To find Department of Health policy and guidance documents, click here.

DoH ADDS TO GUIDANCE FOR REHABS:

CAPITAL DEVELOPMENT PROGRAMME FOR INPATIENT AND RESIDENTIAL REHABILITATION SUBSTANCE MISUSE (DRUG & ALCOHOL) SERVICES 2008/9.

At the end of April, Nick Lawrence, deputy director and head of alcohol, drugs and tobacco policy at the Department of Health sent out addendum guidance for addiction treatment services.

This includes guidance on the reallocation of funds, further to the capital strategic bidding process 2007/8 and 2008/9, £54.3million in capital funding was allocated to Primary Care Trusts in April 2007, to improve inpatient and residential alcohol and drug services.

The National Treatment Agency is managing this process via regional forums.

You can access the details here.

NEW PRISON AND ADDICTION POLICY UNIT

'PandA' pulls no punches.

The Centre for Policy Studies has established a specialist Prison and Addiction Unit to “challenge the government’s fundamentally flawed drug policy”.

‘Panda’ will scrutinise this rapidly expanding but largely unmonitored area of government intervention. It will advocate restricting the supply of drugs, and increasing effective treatment to help people suffering from addiction to make a full recovery. “Neither of these aims are being achieved by current government policy, despite claims to the contrary,” it asserts.

"Nothing short of a revolution in drug-abuse treatment in the UK is required. This must recognise the unparalleled harms of illegal drug use and addiction and must focus first and foremost on getting addicts off drugs,” explained Panda member Professor Neil Mckeganey, professor of drug misuse research at the University of Glasgow.

“Rehabilitation is the treatment of last, not first, resort and only then when the addict, rather than the system, is seen to have irredeemably failed – by which time the destructive impact of his or her dependency is likely to have had far-reaching and negative consequences,” stated Panda chair Kathy Gyngell.

For her full statement, click here.

RESEARCH FOCUS.

Panda will study drugs and alcohol supply, treatment policy, prevention and education in the UK. Key themes include:

• centralisation of the management of treatment and why it is wrong
• the new prisons ‘integrated drugs treatment strategy’ and its dangers
• the effective, as opposed to ineffective , treatment of addiction
• the liberalisation of the control of supply of drugs and alcohol and its damaging consequences
• the national ‘harm reduction’ drugs education programme and its implications and consequences
• what a prevention policy could look like.

PANDA MEMBERSHIP:
Kathy Gyngell, chair
Mary Brett, drugs education consultant, UK representative Eurad
Chris Cook, professorial research fellow, Department of Theology and Religion, Durham University, formerly professor of the psychiatry of alcohol misuse , University of Kent
Huseyin Djemil, former London Area drugs strategy coordinator, HM Prison Service, consultant – Drug Strategy, Operations and Research
Andy Horwood, former Drugs Action Team coordinator for Bedfordshire and Luton
Neil McKeganey, professor of drug misuse research, University of Glasgow
David Partington, general secretary, International Substance Abuse and Addiction Centre/ISAAC.
All members serve in a personal capacity. The views expressed in its publications and announcements are the sole responsibility of the authors. Contributions are chosen for their value in informing public debate and should not be taken as representing a corporate view of the CPS or of PandA.

The Centre for Policy Studies is at:
57 Tufton Street, London SW1P 3QL
Tel: 020 7222 4488

ANALYSIS OF FAILURE: NATIONALISATION OF ADDICTION

The 2008-2018 drug strategy.

by Kathy Gyngell.

Who could fail to disagree with the sentiments behind the government’s revised drug strategy, Drugs: Protecting Families and Communities, 2008 -2018 Strategy (Home Office, 27 February 2008)? Strengthening communities, working together, “a clear commitment to meet the needs of all our diverse communities” and “preventing harm to children, young people and families affected by drug misuse” are hardly controversial.

But does this report avoid controversy because, like its predecessors, it lacks direction, critical reflection, and a fundamental understanding of the complex problem at hand?

The new strategy is even more all-encompassing, woolly and vague. Instead of challenging the incompatibility of addicts’ wants – of their aspirations for normalcy along with continuing drug dependency, be it on licit or illicit drugs – the government continues to ask us to suspend disbelief and to muddy the waters of policy by asserting that it has met, is meeting and managing this incompatible demand.

Unsurprisingly then, the strategy document fails to look critically at the treatment system of its own creation, overburdened by bureaucracy but undermanned in terms of real skill and knowledge in relation to treatment.

RECOVERY AND/OR HARM REDUCTION?

An effective drugs strategy should be grounded on the need to move people from a culture of addiction into a culture of recovery. Helping people to get better is what the public expects and is crucial to a healthy civil society. Allied to this must be an understanding of the behavioural change involved in getting better. Yet this plays little part in current government policy. Its preferred but unachievable aim remains to reduce the harms of drugs use, mainly in terms of crime.

This approach is a misconceived ‘early retirement’ strategy to reduce crime by pasturing addicts out on prescribed substitute drugs. The necessity of abstinence, which in other european countries is recognised as the key step on the road to recovery, is absent from UK treatment policy. The revised strategy pays lip service to it – possibly in response to recent criticism of poor policy outcomes – but mentions it is only as an optional add on, not as a fundamental.

“Harm minimisation” is instead central. Again, who could disagree with this? We all want to reduce drug-related harm – social, psychological and medical – to the lowest possible level. But the harm-reduction techniques espoused to achieve this goal seem to rely almost entirely on replacing one substance (say heroin) with another (methadone).

This failure was exposed by Mark Easton, the BBC’s Home Affairs editor. “The real business of this strategy is about spending something like £4billion of public money over the next decade on drug treatment. But this strategy was written after the Treasury last year agreed its funding for all of this, based on the same targets as the old strategy. So whatever the press release says, this new plan will be very similar to that old one, based primarily on measuring how many people are signed up for treatment, and the problem with that is it doesn't tell you whether treatment is actually doing any good,” he wrote in February.

“Last October on the Today programme, we revealed figures which showed that of the 180,000-odd people who were signed up for treatment, 20,000 never actually had treatment, 80,000 didn't complete their treatment, and just 5,000, less than 3%, left the government programme free of illegal drugs. Since that report, one academic in the drugs world said it was ‘like a rocket fired into the english drug treatment structure, an emperor's new clothes moment’.”

This failure cannot be excused by the nihilistic argument that drug addiction is a ‘chronically relapsing condition’ – nihilistic because it ignores the international evidence that recovery is possible, common and more likely without rather than with government intervention.

GOVERNMENT BUREAUCRACY COSTS LIVES.

For the past 10 years, the government has mirrored the incompatible aspirations of the addicts themselves. It has promoted the prescription of methadone as the panacea that can reduce the harms of drug use despite the reality that it is maintaining – euphemistically described as managing – drug users’ dependency, indefinitely delaying their day of reckoning.

Though dressed in the language of the need to engage families in treatment, though espousing the need to ‘safeguard’ communities, nothing in the strategy suggests a fundamental review of what constitutes treatment.

The policy of moving addicts (described as ‘service users’), from one dependency to another, in which ‘treatment managers’, ‘substance abuse’ workers and policy advisers, as well as addicts, are caught up, remains intact. Those ‘drugs workers’ who are employed by and who have ‘grown up’ under the aegis of the National Treatment Agency for Substance Misuse, know little else.

The National Treatment Agency has become the pinnacle of a monolithic treatment bureaucracy. Its commissioning edicts and care protocols must now be implemented by the 150 local area bureaucracies (Drugs Action Teams or DATs). Yet when the DATs were first formed in the mid-1990s, it was in recognition that no single agency could deal with the drug problem in its area on its own. Since the formation of the NTA in 2001, they have, however, become part of the state. Commissioners and coordinators have grown in prominence and use public funds without much accountability or transparency. The names of DAT ‘chairs’ are not even published, only those of their coordinators and commissioners.

Today, rehabilitation is the treatment of last, not first, resort and only then when the addict, rather than the system, is seen to have irredeemably failed – by which time the destructive impact of his or her dependency is likely to have had far-reaching and negative consequences.

Today ‘fast-tracking’ into prescribing treatment via the criminal-justice system is the norm. The 150 Drugs Action Teams, idealistically established on a joint services partnership basis to commission treatment, have become little more than expensive quangos.

The current treatment requirement is a demand for limited cooperation. It is not a challenge to or support for recovery. Voluntary access through the health system and through social services, where such problems can and should be picked up, has remained underdeveloped.

TRAPPED IN ADDICTION/DEPENDENCY.

In engaging in a policy of mass prescription, in believing that incompatible wants can be met, in making doctors and counsellors act to meet political goals rather than patients’ needs, the government has taken upon itself an extraordinarily interventionist, ethically questionable and contradictory role. It is guilty of worse than over-promising and underdelivering.

It is guilty of effectively legalising drug use by the back door at the tax payer’s expense; and of trapping addicts in the condition they need to escape from.

It is also responsible for a burgeoning addiction industry funded to the tune of £7billion over 10 years, replete with vested interests in its continuation. Few involved in the complex commissioning funding framework can afford to be totally honest about the problem even when they understand it. Through this treatment hegemony the government has institutionalised the pretence that addicts can have it both ways. They cannot. Neither can the government.

KATHY GYNGELL is chair of the Centre for Public Policy's Prisons and Addiction unit. The views expressed are her own.

ACMD THINKING IS FLAWED IF IT BASES ADVICE ON KEELE REPORT

IF ACMD BASES CANNABIS ADVICE ON KEELE UNIVERSITY REPORT, IT IS FLAWED

The BBC reports that the Advisory Council on the Misuse of Drugs has decided cannabis should remain a class C drug. Its home affairs correspondent Danny Shaw said the decision, in a private meeting, was based on research from Keele University which "found nothing to support a theory that rising cannabis use in the 1970s, 1980s and early 1990s led to increases in the incidence of schizophrenia later on".

There are three fundamental flaws with this argument.

The most obvious is that cannabis available 35 or so years ago was 7-12 times weaker than the product available today. It might have the same name but this study is NOT comparing like with like. 21st-century cannabis has been refined and intensified over a third of a century and causes more damage.

The second flaw concerns the ACMD's statement that schizophrenia numbers should have increased since the 1970s if there is a causal connection and "they have not" - wrong. In 2003, Boydell and others found a continuous, significant rise in the incidence of schizophrenia between 1965-1997. It doubled in the south east of London, with the increase greatest in people under 35.

In 2004, Fischer and others from Keele University monitored 3% of England's population by looking at GP practice records - from 1993-1998, the number of people using drugs and having mental illness rose 62%, with the average age falling to 34. Between the ages of 25-34, the cases more than doubled.

And a Parliamentary Question by Rosie Winterton in 2006 revealed that the number of cannabis users admitted to hospitals with mental illness rose by 20% in the first year since down-classification of cannabis.

Last but not least, the ACMD should not ignore research showing that cannabis abusers quadruple their risk of heart attack in the first hour after smoking, that cannabis smokers have more lung health problems than tobacco smokers, that it impairs the immune system, that depression and anxiety and personality disturbances are linked with chronic marijuana use, that it hinders the ability to learn and remember information and thus school and job prospects, that it adversely affects babies of pregnant women, that it affects the reproductive systems of both men and women.

Addiction Today has been told that, of 76 research papers confirming cannabis damage, the ACMD looked at only 3; we have not confirmed this.

But this is not even taking into account the indavertently damaging messages being sent out about some drugs being "safer" or "more legal" than others. Or the arguments of the police, judiciary and medical establishment.

In 2000, before the ACMD/government downgraded the classification of cannabis, Addiction Today printed an article with the research on its harms. Read it here.

For the latest infofacts on marijuana, click here.

ADDICTION RECOVERY IN GLOBAL PERSPECTIVE

Tackling drugs, changing communities

KATHY GYNGELL reports [in March 2008 Addiction Today journal] on the Commonwealth Parliamentary Association’s “Tackling Drugs, Changing Communities” and asks if a redefinition of drug use could shift policy from controlling supply abroad to prevention and recovery at home

Is the UK’s national drugs strategy insular and blinkered? We are fortunate compared to many countries – but oblivious to our effect on them.

February’s Commonwealth Parliamentary Association week-long conference in the heart of Westminster put the UK’s recreational drug use and addiction problems into global perspective.  It demonstrated the huge pressure that the illicit drugs trade is putting on some of the poorest countries of the world. 

Attending were consumer, transit and producer countries. As well as Canada and Australia (consumers), there were delegates from Latin America, Jamaica, Trinidad, India and Mauritius, affected by all aspects of the global drugs trade. Of the new West African ‘transit’ countries, Ghana, Nigeria, Sierra Leone, the Gambia and Cameroon sent delegates, reflecting the exposure of their impoverished economies to the massive surge in cocaine trafficking through the Gulf of Guinea over the past three years.

But this first-world/third-world meeting missed an opportunity: for the UK participants – the Canadian and the Australians, too – to acknowledge the root of problem, to identify responsibilities as well as their expectations of cooperation.  It was a moment to recognise that this trade is driven by the west’s vast addiction problems, by its insatiable demand for recreational drugs, by the social and psychological malaise now symptomatic of affluent societies.

SPIN AND PR CLOUD THE SCENE.

The platform speeches were characterised by an uneasy mix of truth and spin. Unexpectedly, a sense of first-world arrogance and insensitivity pervaded some of the MP-hosted sessions on Reducing Drugs Supply and Social Impact from an International Perspective and Tackling The Links Between Drugs And Crime.

‘Feel good’ presentations from Tony McNulty MP, minister for Security, Counter Terrorism, Crime and Policing of the UK National Drugs Strategy, and from Bill Hughes, ceo of the Serious Organised Crime Agency, were marked by “euphemism, question begging and cloudy vagueness”.  More like a PR exercise, they barely touched on how to tackle the ineffectiveness of the UK drugs strategy to reduce demand at home or failure to control supply across our borders.

McNulty asserted the success of the UK’s drug strategy. But he avoided the key issue of the UK’s sharply rising use of and demand for cocaine. Hughes also blurred the line between words and actions. His picture of strategic intelligence and international cooperation gave no measure of what has been achieved or not, of the scale of the trade, nor of Soca’s effectiveness.

NEGATIVE INDICES ON THE RISE.

“In relation to drug use, we are just beginning to realise the enormous impact on society of not a huge but a tiny problem,” commented Professor Neil McKeganey of Scotland. He brought an end to the conference’s good news, painting a bleak picture of the huge amount of damage caused by relatively low levels of drug use.

It made Tomas Halberg’s call for all to adopt Sweden’s abstinence-led drugs policy more, rather than less, relevant. [AT editor’s note: Sweden’s high-quality outcomes have been praised by the UN, and more rigorously examined than any other country by sceptics unwilling to admit that an abstinence-led policy works better than others – Sweden also adopts harm reduction, but not at the expense of the goal of drug-free lives.]

Statistics amassed by McKeganey’s research unit at Glasgow University showed every negative index to be on the rise – from blood-borne viruses, recorded drug offences, problem drug use and community safety to the damage caused to children. Scotland, he told us, is experiencing the equivalent of a jumbo jet full of young people dying from drugs each year.

Raised to any higher levels, drug use would, he argued, destabilise and corrupt the politics and economies of western democracies. Describing it as a threat on a par with global warming and terrorism, he asked the pertinent question for every country represented: “How much illegal drug use can society afford?”.

These contrasting critical assessments of UK policy must have left the Commonwealth delegates bemused. Is the UK’s problem big or small?  Are we in control or not?  Who is telling the truth?

GHANA  HIT BY EUROPEAN DRUG USE.

Both McNulty and Hughes left after their own sessions. They did not wait to listen to Kwamena Bartels MP,  Ghana’s minister of the Interior, who spoke later in the programme. “Ghana in the past three years has had significant increases in drugs trafficking, reflecting an increase through the whole continent and West Africa in particular which traffickers are increasingly using to smuggle cocaine from Latin America into Europe,”  he despaired.

Bartels spoke of the tons of cocaine offloaded onto the beaches of the Gulf of Guinea, of his country’s determined attempts to cooperate with the United Nation’s global container project, of the impossible task of patrolling 600 kilometres of coastline with only one vessel too old to pursue the containers shipments – whether or not alerted by Soca’s advanced intelligence network.

Not only are fishing villages targeted in the transit trade from Latin America to Europe, but there is a spill-over of drug dependency into local communities and recruitment of aspirant migrants to the UK as drugs mules. The traffickers easily exploit their impoverished economies and weak maritime capabilities.

Only David Partington and Rabbi Sufrin among the week’s platform speakers identified the west’s drug use as a moral issue in that much of the crisis which the UN and UK were enjoining their impoverished countries to help contain  originated from their own citizens.

ONE PSYCHIATRIST FOR A COUNTRY.

At least Ghana managed to put 1,475 people into drugs treatment last year. Perhaps more shocking was the revelation that Sierra Leone has only one addiction psychiatrist to rehabilitate thousands of exploited children. “In our country, there is only one addiction psychiatrist to attend to the all the needs of the thousands of former child soldiers manipulated by drugs into killing,” confirmed Ibrahim Bundu MP,  from Sierra Leone.

REDUCE DEMAND BEFORE SUPPLY.

Bravely, the conference did put up for debate the UN and UK’s favoured and expensive solution to the global drugs problem: namely, reducing supply in countries of production. 

Philippa Rodgers of the Afghan Drugs Inter-departmental Unit of the Foreign and Common-wealth Office was admirable in pulling no punches regarding the failure of counter-narcotics and development strategy, of the increase, not decrease, in opium production in Afghanistan.

Independent consultant David Mansfield set out with clarity the almost impossible difficulties of eradication policies in Afghanistan. A similar line was taken by Ricardo Soberon, consultant on Drugs and Security, in relation to Peru.

But if anyone thought that these critiques were a recipe for legalisation of the drugs trade, Mansfield brought them up short. He was not, he said, a believer in legalisation as Afghanistan does not and will never have a comparative advantage in poppy cultivation in a legal regime compared with countries like Australia which would then enter the frame. “Producing poppy legally will end up increasing rather than reducing dependency on an increasingly subsidised, uncompetitive poppy crop.”

This brought the debate full circle. Where were the solutions?

POLITICIANS MUST CONQUER DENIAL.

What the conference showed was that, while the UK can pontificate to and experiment with the rest of the world, it is still blinkered about the root of the problem in its own backyard.

Caught up in liberal shibboleths about the normalcy of drug use, few politicians condemn domestic use as wrong. It is convenient to identify and attack the drugs problem as deriving from trafficking and production – particularly from elsewhere. What choice is there for them but remain in denial about home-grown dependency and addiction problems, which are psychologically rooted and require more than substitute prescribing to resolve them or the crime which stems from them? Or, when faced with evidence to the contrary, to argue that proven treatment is too expensive?

This conference exposed the ‘displacement’ at the heart of UK drugs policy and expenditure.

KATHY GYNGELL is a research fellow at the Centre for Policy Studies. This article is a personal view.

Some time ago, NICK BARTON wrote an article in Addiction Today titled Mind The Gap which looked at the disconnection, even antagonism, between harm-reduction and abstinence-based treatments aimed at recovery. He gave an update at the Commonwealth Parliamentary Association conference.

“I am dismayed that the gap is as wide as it has ever been, made by so much over-investment in one area,” he said. “It is time for a fresh vision which sees harm reduction not only as limiting damage but also as an opportunity to engage motivation to change and to set out on a path of recovery.

“Harm reduction is about a person achieving less of something important – recovery is about them achieving more, and more of themselves.

“Our job is to help people end their consuming relationship with substances. We should help them deal proactively with whatever sustains it, be that internal states or social circumstances.

“As a means to that, each person should be helped to identify recovery capital at their disposal. What resources do they lack in terms of recovery, and what do they have in the bank or could they acquire with the right help?

“As we await a new UK drugs strategy, I fear policy-makers will respond like the man asked if he had learned from his mistakes who replies ‘Yes, I have learned my mistakes – in fact, I can repeat them exactly’.

“Let’s hold in mind that recovery is possible. Nobody has the right to tell or infer to anyone that it is not.”

NICK BARTON is joint chief executive of Action on Addiction.

_________________________________________

ORGANISATIONS TREATING ALCOHOL DEPENDENCE ARE NOT ON STAKEHOLDER LIST FOR Nice GUIDELINE ON ALCOHOL DEPENDENCE

“I was alarmed not to see the many treatment centres specialising in recovery from alcohol dependence NOT represented on the list of stakeholders informing/steering the Management of Alcohol Dependence  guidelines from the National Institute for Health & Clinical Excellence,” reports Addiction Today editor Deirdre Boyd.

The Addiction Recovery Foundation charity has re-registered as a stakeholder, offering a clinical, research and experiential knowledge base built since 1989.

In October last year, the Department of Health formally requested Nice to “prepare a clinical guideline on the Management of alcohol dependence, including the management of alcohol-related brain damage”. To ensure best practice for patients who desperately need care, addiction-treatment organisations can read details here. 

To download a Stakeholder registration form, click here.

RELATED GUIDELINES IN PROGRESS

The DoH also tasked Nice to produce “combined health and clinical guidance on Management of alcohol use disorders in adults and adolescents”. Click here for details.

Of related interest, given its large overlap with ‘medicating’ through addictive use of substances and its role in relapse, are guidelines on Depression.  Click here for details.

For similar reasons, also of interest are the Nice guidelines on Personality disorders – borderline, due in December this year. The consultation on the draft guideline with stakeholders will start in June 2008. Read more here.

Register as a stakeholder

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 ca