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November 2014 |
drinkanddrugsnews
| 13
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‘PATTERNS OF USE
ARE CHANGING’
ADDACTION HAS GROWN
as a result of market
changes in the last ten years. We’ve quadrupled
staff numbers since 2004 and expanded our remit
into more clinical work. Our staff now includes
pharmacists, 100 former NHS nurses and 20
doctors as a result of the contracts we’ve won.
The staff profile has also changed. The numbers
of former service users volunteering as recovery
champions have grown and service users influence
the entire organisation, including senior leadership.
During this time the sector has moved from an
exclusively harm reduction model to a greater
emphasis on recovery. The approach in 2004 was
about getting people into treatment, whereas now
it’s about getting people into recovery. There is
more regulation in the sector now, most notably
the Care Quality Commission, which we welcome.
There’s also been a move from NHS to local
authority commissioning.
The landscape of substance use is changing. We
have a legacy of opiate users stuck in treatment,
although opiate use itself is reducing. There is an
ageing population of people used to using a variety
of substances but for the young, the pattern of
substance use is changing with the prevalence of
stronger cannabis, and new psychoactive substances
creating new challenges for treatment providers.
However it isn’t just drug use among the young
that is changing. More people drink at home and
the context is no longer social; it has more to do
with isolation and loneliness. So the way we live
our lives is also having an impact on the way we
use substances and the damage they can cause.
There is also a growing acceptance of substance
misuse – three or four generations of people have
grown up in a world that uses drugs, and so the
decriminalisation/ legalisation debate will rumble
on. In addition to illegal drugs, we will probably be
facing up to the legacy of inappropriate prescribing
in primary care.
Services will integrate professional staff with
recovery services staffed by volunteers. The
commissioning landscape is changing, with
increased emphasis on social value and community-
led recovery. Following the pattern of our broadening
remit, I predict we will increasingly be engaging with
other services like housing and mental health.
Gervase McGrath, director of
UK operations, Addaction
‘WE’VE CHANGED FOCUS
IN SCOTLAND’
OVER THE PAST TEN YEARS
, SDF has seen changes
in its focus. There has been a great concentration on
improving the quality of service response; reducing
the numbers of drug deaths, including pushing for
the national naloxone programme and supporting
implementation; ensuring an effective user voice; and
innovating means of helping people with a history of
drug or alcohol problems into employment.
Recovery as a key concept and discourse has
been an important change during this time. Initially
in Scotland there was an over-emphasis on
abstinence, taking us back to an era when the focus
was on people who were ‘motivated to change’; a
narrow focus on the individual and not wider
societal inequalities and poverty. Thankfully, we’ve
returned to a balanced approach – recovery and
harm reduction are dovetailed and not separate.
Competing approaches, eg naloxone, are recognised
as a step towards recovery.
In England there seems to be a more fractious
relationship between the evidence base and what
government would like. Sticking to evidenced-based
approaches and not ones driven by moralistic views
is a challenge – such as UK government requests to
explore time-limiting methadone.
Going forward, we’ll see challenges dealing with an
ageing group of users, with services working closely
with wider care services designed for older people.
In terms of trends of drug use, how will
problems manifest themselves? We see significant
problems with new psychoactive substances, but
this covers a range of compounds with differing
effects and issues. We know that if the needs of
vulnerable young people aren’t adequately
addressed today they will become, sadly, the service
users of tomorrow.
David Liddell, director, Scottish Drugs Forum (SDF)
‘I HOPE THAT QUALITY
WILL WIN THE DAY’
I HAVE BEEN PRIVILEGED
to be involved in the
regulation of the treatment sector over the past ten
years. It all began in Weston Super Mare where, as
head of inspection, I had to make sense of the
concentration of treatment services in the area.
I was constantly bombarded by services who
told me in no uncertain terms that they were not
‘care homes’, but something entirely different. The
legislation in the Health and Social Care Act 2008
created a new regulation, which described services
‘The internet has been
the game changer in this
dynamic flux.’
HARRY SHAPIRO
‘There’s... a time-bomb
with gambling and
gaming.’
BRIAN DUDLEY
‘It isn’t just drug use
among the young
that is changing.’
GERVASE MCGRATH