people where they are.’ A mantra, and an important guiding principle when working with people who use drugs. UK drug treatment services aim to empower people on their recovery journey – but for people who work, especially in regulated professions, the system often feels punishing, inflexible, and even career-ending. Despite the emphasis in the‘ Orange Book’ on recovery and patient-centred care, services routinely operate in ways that make it incredibly difficult for employed individuals to access meaningful support.

‘ Meaningful employment’ is referenced a number of times throughout the 2017‘ Orange Guidelines’, framed as an important aspect of someone’ s treatment and recovery. Many services provide, or have links to, employment support and vocational training, but seem to find it difficult to work around the schedules of individuals accessing the service who are working, especially those with a full-time job. At Release, we’ ve spoken to numerous individuals who’ ve been penalised for missing appointments, despite notifying their services of their work schedules. In recent years, some services have changed their operating hours to better accommodate service users who are in work, but this isn’ t always enough as clients can find it

difficult to get an appointment during late opening hours due to the demand.

In addition to these practical barriers, for those working in regulated professions – which usually require a licence to practise and are overseen by regulatory boards – engaging in treatment carries serious risks to their career. In the below example, we’ ve combined aspects of two individuals’ experiences with treatment services, and how accessing support ultimately cost them.

M, who worked in a regulated profession, signed themselves off sick when they felt that their drug use could potentially have an effect on their work. They were using stimulants socially once a week, but were experiencing cravings that they were concerned about. During the period in which they were signed off, their drug use increased significantly.

M contacted Release two weeks into their sick note and told us that they had decided to access their local drug service. They said how difficult this decision had been, and how worried they were about their job. The‘ Orange Guidelines’ state that clinicians‘ continue to have a duty not to break confidentiality unless established exceptional grounds for doing so are met’, which at the time had reassured M that they would be able to access the service without their

workplace being told. M had resolved to be completely honest with their drug service, and told us at Release that the love of their profession was a big part of the reason they decided to access support. Unfortunately, the drug service reported their drug use to the relevant regulatory board – which M discovered after being contacted by the regulators; not their drug service.

At no point had M’ s drug service expressed any concerns directly to them, nor had they discussed the potential need to make this referral. M was still signed off sick at this stage and had said they wouldn’ t return to work if there was any chance that their drug use could pose any risk to the individuals they supported. M underwent a rigorous and traumatic investigation, which resulted in many of their colleagues discovering their drug use, as well as losing their job. M is still awaiting the final outcome of the investigation, which will state whether they will lose their licence to work in that field.

This, understandably, has left M feeling that they were wrong to seek support. The guidelines warn that referrals should be made only when there is a clear safeguarding concern, not as a default response to disclosure. The actions resulting from safeguarding processes

We’ ve spoken to numerous individuals who’ ve been penalised for missing appointments, despite notifying their services of their work schedules.

often have a significant, and sometimes catastrophic, impact on a person’ s life. So having their input, or at least making them aware of the possible outcomes, is the least we can do.

Though services work with the conviction that they should support people into accessing‘ meaningful recovery’, they often struggle to support them when they are working. Employment shouldn’ t be a barrier to recovery, it should be part of the foundation for it. For those working, particularly in regulated professions, it can feel like they are facing a stark choice: compromise their job, or compromise their recovery.

Riley Johnson is drugs support advisor and NSP specialist at Release

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