Letters and Comment
DDN welcomes your letters
Please email the editor, [email protected], or post them
to DDN, cJ wellings ltd, romney House, school road, Ashford, Kent tN27 0lt. letters may be edited for space or clarity.
‘...it’s best to turn a blind
eye to the “recreational”
and focus instead on the
genuinely problematic.’
unwanted
interventiOns
I very much enjoyed Mike Ashton’s look
at the chequered history of alcohol brief
interventions (DDN, March, page 22).
My gut feeling has always been that
they’re at best useless, and at worst
potentially counter-productive and –
while I realise the jury is still out – it’s
nice to get even a tiny bit of academic
back-up for that. And surely, they’re also
at odds with much of the current
direction of thought around drug use,
as espoused by more and more police
and crime commissioners – that it’s
best to turn a blind eye to the
‘recreational’ and focus instead on the
genuinely problematic.
James Burton, by email
HObsOn’s cHOice
‘Find out who your local commissioner
is, and let’s bring some new thinking in,’
advises Paul Musgrave in your
conference reports (DDN, March, page
12). Well I’ve known who my
commissioner is for quite a while. The
problem is he doesn’t know who I am,
nor does he seem to have the slightest
interest in finding out, let alone
10 | drinkanddrugsnews | April 2018
listening to anything I might have to
say. I realise my experience may not be
all that representative, but somehow I
doubt it.
‘It’s all about choice,’ he says earlier
in the article. Fine, but whose choice
exactly?
Name and address supplied
Privileged POsitiOn
Commissioning for change (DDN,
February, page 10) was a good article.
What is apparent in the current
commissioning environment is the
generalising of commissioning across
local authorities, leading to poor
analysis of need, poor engagement and,
consequently, poor decision making.
Money is being wasted on ideas rather
than need, because no one connects the
pieces anymore.
Partnership work, so fundamental to
complex health and wellbeing cases, is
best driven by a common understanding
of shared responsibility and shared
outcomes. That’s always been difficult,
made increasingly so now by fractured
thinking at the very top, which has
fragmented commissioning across three
different structures – NHS, CCG and local
authority/public health – that see
themselves in competition, even if
they’re unwilling to admit that publicly.
The one thing I would take issue with
in the article is what seems to be a focus
on the effect – the use of a substance
which needs to be resolved. What needs
to be resolved is the causation – the
background, be it peer pressure, abuse or
mental health, which leads many to self-
medicate, to misuse substances. How do
we as people face this? By seeing each
person we label pejoratively as an addict
or worse, as a human being like us,
someone who is a mother, sister, aunt,
brother.… How do we, as commissioners,
resolve this? We can’t.
Only those who experience the effect
can do that. Commissioners need to be
able to provide the tools to assist that
process. If any commissioner/authority
is brave/far-sighted enough to try,
distributed networks, together with
‘time banking’ offer some solutions for
individuals to break away. As humans
we all like to live in networks of like-
minded people – it’s easy and we’re lazy.
Those who are locked in a cycle of
substance misuse need to be offered the
opportunity to break from their
homogeneous networks to ones that are
more varied.
‘Time banking’, as envisaged by
American civil rights lawyer Edgar Cahn,
offers part of the solution: providing a
reason to integrate, an inspiration to
change. But this has to be a bold move,
energising thousands, not the few,
establishing communities that thrive
and don’t pay lip service to people’s
aspirations, because of local attitudes.
Treatment is an adjunctive, a means by
which we help people focus on their
aspirations and their innate skills to
move to where they need to be.
As providers/commissioners we
should be privileged to work with people
who have survived so much and who
currently are so let down by our system.
Clive Hallam, via
www.drinkanddrugsnews.com
Out Of cOmmissiOn
I have been out of commissioning now
for over three years. I was involved from
the mid 1980s across drugs and alcohol,
through the biggest wave of class A and
immunological challenges.
For all the flaws of the NTA a great
deal was achieved. That achievement to
my mind was to a great extent driven
by a sometimes unholy NHS, local
authority and criminal justice alliance,
but with a limited presence of user and
recovery perspectives.
Mental health and housing were
never really properly integrated. So some,
but not enough, foundations. What
happened afterwards led to the building
of even more impressive new structures
amid the shifts of resource to CCG and
local authority and public health.
That should have meant the critical
underpinning of the foundations with
housing and mental health. That should
have seen the structure develop new
understandings between treatment and
recovery. It’s not just about the money –
what we have is a house built on poor
foundations.
The loss of the criminal justice/
recovery analysis into large