SO , HOW ARE WE DOING?
As deputy drug czar for the Blair government, Mike Trace oversaw the
expansion of today’s drug and alcohol treatment system. In the second of his
series of articles, he gives his personal view of the successes and failures of
the past 20 years, and the challenges the sector now faces.
IN MY PREVIOUS ARTICLE, I described the policy and
financial strategy that the last Labour government
used to build the national drug and alcohol treatment
system we all now work within. This time, I want to
take an unvarnished look at the results achieved over
the last 15 years with the billions of pounds of
taxpayers’ money that has been expended. Most
readers will know that the picture has been mixed.
My personal view is that we have not achieved
everything we set out to do because, despite political
support and big investment, the system we have
created is too often process driven and bureaucratic,
and insufficiently human and welcoming. The
evidence is stacking up that the key precondition for
engagement and behaviour change is human
connection (Johann Hari sums it up well), and the
services that have most impact are the ones that get
For too many marginalised people, their experience
of services is too much form-filling and onward
referral, and not enough inspiration and consistent
personal support. If we want people to change and
grow, we have to give them more reasons to believe
that a different life is possible.
So how do we get better at facilitating real change,
when the sector is under the pressure of cuts, and our
clients’ lives are getting harsher? That is now the
challenge we face, which I will address in my next
Mike Trace is CEO of Forward Trust
REASONS TO BE CHEERFUL REASONS FOR CONCERN
We have one of the most comprehensive publicly funded treatment
systems in the world, with a high rate of ‘penetration’ (proportion of the
population in need who are in touch with services). This major investment
in care and support for some of the most vulnerable people in society is
both humane and cost effective. We have not been able to reduce the scandalous level of drug-related
overdose deaths, that remain way above European averages. There has been
much discussion around the reasons for this, but the fact remains that one of
the key objectives of having a well-funded treatment system was to
significantly reduce the misery caused by these premature deaths, and we
have not yet succeeded.
We have been successful in reducing drug-related crime, with Home
Office research concluding that our treatment system was a key
contributor to the reduction of overall crime rates between 2000 and 2010
(although recent trends seem to indicate that this effect is waning).
We have been successful in keeping drug-related HIV infections low.
The UK was an early adopter of harm reduction practices such as needle
exchanges in the 1980s. As a direct result, HIV transmission rates from
injecting drug use have remained among the lowest in the world. (Once
again, the scope and quality of harm reduction services has recently been
under pressure, which may lead to an upturn in infections).
We have not been good at moving people through the treatment
system into positions of independence and wellbeing. Apart from the
missed potential for individuals, this has created a ‘system’ problem where
capacity demands on services constantly increase as new clients
outnumber those who move into recovery.
We have not sufficiently overcome the funding and delivery ‘silos’. We all
know that drug/alcohol treatment clients have multiple needs, but there are
not enough examples of truly integrated planning or care and, conversely,
sometimes duplication of services. In particular, substance misuse and mental
health services still work to separate methods and objectives, and support for
children and family members is still an underfunded afterthought.
February 2019 | drinkanddrugsnews | 15