We think everyone should be talking specifically about abstinence from substances – a word conspicuous by its absence in the strategy – and making abstinence-based treatment available to all.
Although it mentions alcohol, and outlines that alcohol services should be jointly commissioned with drugs services, we are concerned that the new strategy mainly focusses on drugs, and ask for a similar strategy on reducing the harm caused by alcohol to be published or integrated into this strategy.
We welcome a focus on prevention; the promotion of more joined up services for people facing multiple issues; a strategy for reducing drug-related deaths; and a clearer approach to Novel Psychoactive Substances (NPS), formerly known as ‘legal highs’.
However, we think the government has missed one of the critical factors in considering what leads to addiction, because the strategy does not acknowledge that many people who experience addiction have also experienced childhood trauma or a traumatic event in adulthood which has led them to use substances as a coping mechanism or to self-medicate. We would like to see clear guidance and resources allocated to psychosocial interventions that identify young people at risk and address trauma at a young age, or after significant life events, in order to prevent future addiction.
Formal recognition of the links between substance abuse and: domestic abuse, both for perpetrator and victim; with homelessness; with sexual exploitation; and with veterans; is helpful. These factors can also make it more difficult to access treatment services.
We would like to see a flexible response to the most vulnerable people, including putting recovery at the front of the treatment agenda so that people can be supported to find reasons to recover, rather than trying to engage in treatment whilst the rest of their lives are unstable and the underlying issues are unaddressed. Whilst gender-specific services are not discussed in the strategy, the rise in drug related deaths amongst women is mentioned, and we believe there should be a specific treatment offer for women recognising their different needs and vulnerabilities.
We are starting to see an increase in NPS use in our homelessness services once more, after a lull where supply dipped post the Psychoactive Substances Act 2016. Harm reduction, clinical intervention and reducing supply are all much needed, however we must also look at why people are taking any illicit drugs and ensure that we help people recognise and build on their own strengths so the good things in people’s lives increase and the need to use NPS decreases.
We welcome the acknowledgement that continued re-tendering is destabilising and affects outcomes for people, and the direction to commissioners that a more flexible and co-productive approach is needed. Changing Lives is at the early stages of working in this way with one of our commissioners, and it is already much more focused on the people who use our services, rather than on a rigid commissioning/procurement relationship.
However, we do not agree that payment by results/Social Impact Bond approach is the right one to improve healthcare services for people with multifaceted psychosocial needs. We think this creates a target-driven, rather than care-focussed, culture, and takes significant resources away from frontline work. Instead, further cuts to drug and alcohol contracts should be prevented by ring fencing this in Public Health budgets. Savings could be explored by co-commissioning with mental health services and investing in multi-agency workforce development.
The strategy also fails to acknowledge that as addictions policy has moved, rightly in our view, towards health and recovery, the political drivers for austerity have been counteracting this by reducing drug and alcohol budgets, on average by 24%. Clinical interventions are essential alongside psychosocial interventions and peer support, but the clinical elements tend to be the fixed costs, so when you cut budgets, you cut the things that help people build and sustain recovery.
What is missing from the narrative around recovery are the savings and revenue increases that recovery brings. Changing Lives’ abstinence based treatment in Gateshead returns an annual saving of £139,464 to acute and criminal justice services alone, not including primary or social care costs.
Delivering truly recovery orientated services is not easy and is in its relative infancy compared to the lifespan of the harm and crime reduction agendas. As the strategy suggests, services are still not getting it entirely right, especially for opiate clients, so Changing Lives is currently piloting changes to its abstinence based treatment to support the reduction of OST in a structured therapeutic environment with facilitated access to mutual aid. It’s early days but we are seeing positive results.
The inclusion of mutual aid and peer support in the strategy is positive, although there needs to be an acknowledgement that this does not happen in a vacuum. Hearing the voice of service users and helping to build and support a strong and diverse recovery community should be central to all commissioning of drugs services.
At Changing Lives we believe people are able to challenge their dependence, achieve their goals and find meaning for themselves outside of addiction. We continue to be inspired by the people we work with and this drives us to be better at what we do. As Aaron, a graduate from our structured day programme, describes:
The biggest thing that recovery has given me is freedom from active addiction and the not needing to have to get up day in day out and have to go and score drugs. Trust is a huge thing I have been given in recovery, trust from family, trust from friends and trust from professionals too… Although I will admit that recovery is an amazing journey of self-discovery it can also be extremely difficult, however my worst day in recovery is 100 times better than my best day in addiction.
We look forward to meeting the Recovery Champion and showing them the range of our services that work in partnership with the NHS, other VCS organisations and the people who use our services to promote, build and sustain recovery. We hope that the Champion will have lived expertise of recovery a full understanding of the benefits of true co-production that will be able to help the government and services to more clearly define their ambitions for recovery from dependence.