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Andy Stonard tells delegates of a
systemic, vested interest in failure
DRUGS FIELD ‘SETTING UP PEOPLE TO FAIL’
There was a ‘massive’ income for the government from alcohol, former chief
executive of Rugby House, Andy Stonard, told delegates. The Treasury ‘had an
investment in everyone’s misery’, he said.
He had heard ‘a history of apologies’ from the government over his 25
years in the sector, he said. ‘Individuals have the capacity to change when
they’re ready, and the important thing is for services to be there when
they’ve made that decision.’ On average it took around seven years for
someone to turn their life around, which meant that motivational
interviewing was a key factor in a person’s experience of treatment, and
determining whether they came back. A US study, Project Match, had found
significantly different outcomes in treatment at the same places, he said –
‘it all depends on the staff.’
‘The drugs field does not take alcohol seriously,’ he stated, with an NTORS
study finding that, for between 30 and 40 per cent of people who had successfully
completed drug treatment, their drinking increased – the reason why it was
essential that motivational interviewing be given the right weight. ‘You’re seeing
someone who doesn’t want to give up a lifestyle – they’re confused. Motivational
interviewing is key to whether they take action, but instead in the drugs field the
first contact is about filling out a form.’ The QuADS standards stated that
assessment should be a two way process, he said. ‘It is in alcohol. I don’t think
it is any more with drugs.’
The field also needed to build the necessary partnerships and make the
links to help provide clients with practical skills, he said, which was ‘more
important than therapy.’ There was also widespread confusion that needed
to be addressed. ‘I’ve been teaching alcohol units for 25 years and I still
don’t understand them,’ he said. ‘It’s a nonsense. The models we work to
are a real blanket coverage.’
The units applied to people regardless of their age, weight and whether
they were on medication or not, rendering them effectively meaningless, he
said. ‘It’s a model that treats us all as equals, and it’s not very helpful.’ The
reality of the situation was that 80 per cent of alcohol-related ill health was
in the poorest 10 per cent of the population.
Issues like responsibility, learning and skills were central, he stressed.
People needed practical advice, but the drugs field set people up to fail, as they
were forced into treatment before they were ready. ‘They feel demeaned, they
lose confidence and it sets them back six months. How you skill your workforce
up to be worthwhile for the people that come through the door is key.’
In the drugs field there were lots of people who were well meaning but who
lacked the necessary skills, he said, and the situation was being worsened by
the increasing overlap between the drugs and criminal justice agendas. ‘What
about health? What about poverty? If we looked at it from these angles, we’d
have much more effective strategies.’
‘The other side of choice is responsibility,’
says NTA chief executive, Paul Hayes
THE OTHER SIDE OF CHOICE
‘Choice is a good thing. Responsibility is a bit scary,’ said Paul Hayes, referring
to the theme of the conference.
The responsibility of service users was to help shape services and make their
treatment successful, alongside the responsibilities to earn a living and look after
their children, he said. Service users needed to concentrate on organising
themselves to influence policy. ‘Focus on action’, he stressed. ‘It’s a message
that many people are ready to hear.’
Service user input into services was having more and more influence, he said,
and gave everyone an opportunity to make the whole process more transparent –
a ‘reality check’ that operated in two directions. ‘It means services can’t
manipulate the figures and get away with it.’ There had been a sea change that
meant service users were able to exercise much more control, but the capacity
for some to advocate on behalf of others had to remain.
In terms of income, it was important to look at the benefits system and work
together, he said. ‘Society gives people benefits because they’re not able to work
and care for their dependents. Very few people say to me “I want to be on benefits
for the rest of my life”.’ The proposed reforms of the welfare system were a ‘two-
way street’, he said – the system needed to be changed to enable people to work,
and the government was determined to build routes into work. ‘Grasp that
opportunity,’ he urged delegates. The ‘political script’ was that people did not want
to work, and that if they refused to access treatment they would be subject to the
same sanctions as everyone else, he said. However, it was not as simple as that,
with a complex world of people moving in and out of dependency and treatment.
‘It’s about meaningful engagement – enabling people to move out of treatment
into work, and to access treatment while in work’. This represented a ‘huge
opportunity,’ he said. ‘And the opportunity is real – it’s not a smokescreen.’
Drug treatment had been largely crime-driven, he acknowledged, but equal
billing was now given to the needs of children, particularly vulnerable children.
Being a parent with the additional challenges of problem drug use was
challenging, he said, but most parents rose to that challenge. ‘Drug treatment
services tend to look at people in silos – they forget that people live in families.’
Services needed to think about the people dependent on their clients, he said,
but it was also important not to fall into media stereotypes. ‘The objective we have
is parents supported and children protected, and that should be integral.’
In terms of people’s treatment, they could expect there to be a care plan,
they could expect the TOP to check on progress and they could expect checks
on their aspirations and recovery orientation. Systems and services would be
expected to focus on achieving recovery and therefore needed to work together
with self help groups and mutual aid – commissioners would be expected to
make that a more central focus. The more non-using social networks people
accessed the better, he said. ‘Nevertheless, we need to build in that there will
be lapse, relapse, success.’
Many people achieved recovery outside the treatment system, he said, relying
instead on family and friends. ‘All of this is a shared responsibility, expecting you
to take more control over treatment and goals.’ It was difficult to sustain
improvement without a job, a house, a partner or a stake in society, he said. ‘We
can give you opportunities to improve your lives, but you need to take those
responsibilities.’ There were real opportunities for service users to turn their lives
around and make them as constructive and beneficial to society as possible, he
stated. ‘But the bulk of the responsibility will always be with you.’
10 |
drinkanddrugsnews
| 23 March 2009
Voices for choices |
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