‘ I guess the difference from ’ 86 is that we could produce a paper or run a conference on anything , and there was no one to tell us we couldn ’ t . Now it ’ s so cluttered , and that ’ s the bit I won ’ t miss – it becomes quite a lot harder to achieve anything because of the slowness .’ |
it not only means those vital relationships can ’ t be built but also risks re-traumatising people , he states .
There can also be a failure to recognise why ‘ people find it difficult to trust services when their whole lives they ’ ve been failed by everyone around them ’, he says . ‘ We ’ ve thankfully moved through the punishment model , where if you miss two or three appointments you get kicked out or your methadone cut , but it ’ s the problem of people having to navigate such a complicated system .
‘ The population we ’ re trying to help have very specific needs about engagement with services that are different to the general population . We ’ ve almost set up services in the general health service model , and then failure to attend appointments means you ’ re pushed out . To me it ’ s about building that trusting therapeutic relationship over the long term , and that ’ s the bit we still haven ’ t got to , sadly .’
SHOCKING RATES Over the last decade the sector in Scotland has been dominated by the shocking rates of drug-related deaths . There was a tiny fall in 2021 , and while the provisional figures for the last quarter of 2022 showed an increase ( DDN , April , page 5 ) the prediction is that figures for the whole year will be down . Does he think we may finally be turning a corner ? ‘ My view is that we probably are ,’ he states . ‘ But I think that because the numbers have been so tragically high , a fall at some point is inevitable – that could not go on at that level . I ’ d like to think that the responses like naloxone and medication-assisted treatments are starting to have an impact , but the reality is even if it goes down it ’ s still colossal .’
At the end of 2020 when the highest-ever figures came out , SDF described it as a national tragedy and a national disgrace , and it wasn ’ t long after that Nicola Sturgeon used similar language and admitted her administration had taken its ‘ eye off the ball ’. ‘ That was the first time the government had owned the problem at that high level ,’ he says . ‘ It became a political issue that couldn ’ t be ignored .’
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The sheer scale of the deaths has perhaps also helped to change people ’ s attitudes and go some way to challenging stigma , he believes . ‘ I think it may have led to more compassion for people with drug problems overall , and we ’ ve tried to explain to the wider population that drug problems tend to be a symptom of underlying issues . We do a lot of stigma training ourselves , and you still see stigma even within the addiction services let alone other services like housing . Our view is that ’ s the place to start . It links back to those issues around being trauma-informed and building therapeutic relationships . There ’ s nothing new in any of that , but it ’ s slow to change .’
While the sector is full of dedicated and compassionate staff , some can be hamstrung by structures they work in that make change difficult to deliver , he says . ‘ Some of the challenges of service delivery are very difficult to change overnight . You have areas that have got additional monies for medication-assisted treatment , but a year or two on they still haven ’ t spent that money . The lesson is always I guess that government thinks it can kick local areas to deliver , but the accountability lines are not always there to do that .’
PEER RESEARCH So what is he most proud of during his time at SDF ? ‘ Certainly our influence in terms of the amount of resource going into the sector ,’ he says . ‘ More specifically , the peer research programme that we ’ ve been running for 25 years . When we first started that programme the notion that we could have volunteers who were still using and they could interview people who were still using was very , very controversial – that you would listen to the views of people who were still using drugs .
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That ’ s quite hard to imagine now , but it was absolutely the case . What ’ s interesting now is that peer research has become mainstream in the Scottish context , and I might argue that because of our track record we ’ re probably still doing it better than most . The other one would be the addiction worker training programme – the positive outcomes of those who completed it are 85 per cent into employment . We ’ ve probably had 300 or more folk through that programme , and obviously there ’ s opportunities to do more around that .’
POLICY INFLUENCE And then there ’ s SDF ’ s influence on policy and strategy over the years . ‘ It ’ s gone up and down . Sometimes you ’ re in the tent and sometimes you ’ re out , and the membership has often criticised us for being either too close to government or too far away . So that balance is quite tricky . But one of the things we ’ ve often done is saved government from doing something that could have made the situation worse , and that can be entirely unseen as an outcome because it ’ s behind the scenes . What we ’ ve had is that longevity and corporate memory , which is completely lacking in government because the civil servants change every three years – the number of times we ’ ve had “ new ” approaches that aren ’ t new at all . And the other thing is that we ’ ve stuck to our principles all the way through in terms of our approach . We ’ ve never wavered .’ So will he miss it ? ‘ I will , for sure , in terms of the cut and thrust of all of it . I ’ m planning on doing quite a bit of travelling – one of my granddaughters lives in Prague . Someone said to me , “ don ’ t agree to anything in the first four months of your retirement ”. I ’ ve had a couple of offers , but if they ’ re writing funding applications I think I ’ ll have to give it a miss .’ DDN
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