‘ Why treat people and send them back to the conditions that made them sick ?’
SIR MICHAEL MARMOT
THE HEART OF THE PROBLEM
Working with a public health approach can reach beyond treatment , hears DDN
‘ A
healthy person isn ’ t somebody who ’ s just free from disease but somebody who has the opportunity for meaningful work , secure housing , stable relationships , high esteem and healthy habits ,’ Alice Wiseman told the Drugs , Alcohol and Justice APPG .
As director of public health in Gateshead and addiction lead at the Association of Directors of Public Health , she had been invited to share her perspective of a public health approach to addiction . Quoting Sir Michael Marmot ( above ) she said sustainable interventions involved looking behind a problem or illness to understand what was driving it .
TRAUMA ‘ For many people addiction is a response to trauma that has not been dealt with ,’ she said . ‘ Trauma comes in many shapes and sizes and people respond and react differently . The substances give people an opportunity to block out negative experiences they ’ ve had .’ Data showed that addiction was significantly more common in communities that were experiencing other hardships , such as poverty , lower educational attainment and vulnerable employment – conditions that often resulted in psychological distress and led to using substances . The patterns of illness showed that ‘ addiction is considerably more complex than individual behaviour choices ’, she said .
CHILDHOOD EXPERIENCES Research on adverse childhood experiences ( ACEs ) showed how they disrupted a child ’ s nervous , hormonal and immune development and led to social , emotional and learning problems – contexts in which addiction could thrive . But there were prevention opportunities throughout this pathway and ‘ nothing is set in stone ’, said Wiseman . She used research from Bellis et al in 2014 to show the impact we could have on the poor outcomes we wanted to tackle : ‘ If we focused our attention in a really robust way on reducing ACEs we could reduce heroin and crack use by 66 per cent , incarceration by 65 per cent , perpetration of violent crime by 60 per cent and high-risk drinking by 35 per cent .’
She demonstrated the human cost by sharing the case of a local man who had died in his late 20s . His was one of the many cases reviewed by a multi-agency panel in her area which was working closely with the coroner to look at the six months prior to each person ’ s death and see if there was any learning that could help services reduce the risk of drug-related death .
‘ The panel were able to see that the man had been known to services as a child due to trauma and neglect ,’ she said . ‘ He ’ d been in the care system and moved into the criminal justice system as a young person and had become an adult while in custody . When reviewing his past in this way , it was no surprise that as an adult he presented as someone who had little or no trust in the services we provided .’ Services that had had contact with the man had found him to be aggressive , hostile and hard to build a rapport with . He had recently been released from prison , ‘ which we know puts people at a higher risk of drug-related death ’ and had been released to premises in another local authority before returning to his local area . This had meant re-registering at the GP and changing treatment providers , ‘ and as a result we needed to restart engagement , support and try to build a trusting relationship all over again ’.
While decisions had been made to try to protect this man , there was also acknowledgement that processes to remove one type of risk could result in the exacerbation of other risks . ‘ There was also an acceptance that to prevent a drugrelated death we absolutely need to focus our attention on those underlying causes of addiction and ensure that people are not let down repeatedly in their earlier life ,’ she said . Acknowledging the ‘ significant ’ pressure on child social care , she said we needed to provide ‘ robust support for families very early on , as soon as those problems start to manifest ’, as well as offering interventions for children who had been affected . ‘ We label their behaviour as bad . We punish and criminalise them rather than understanding the causes of this behaviour and showing compassion . But we must invest in them in a robust and sustainable way ,’ she said .
MENTAL HEALTH Treating criminal behaviour separately to mental illness amounted to ‘ fail [ ing ] to recognise what we ’ re asking them to do ,’ she said . ‘ By asking them to give up drugs we ’ re asking them to give jeremy sutton-hibbert / Alamy
18 • DRINK AND DRUGS NEWS • MARCH 2022 WWW . DRINKANDDRUGSNEWS . COM