couple of years ago, addressing an audience at The King’s Fund, Lord Victor Adebowale
commented, ‘There should be no wrong door and every service should reverse the Inverse Care
Law, which simply states those people in need of health and social care the most get them the
least.’ Since then, this conversation has grown louder. As the threat of disinvestment has
become reality and more of the smaller treatment agencies are forced to close their doors, we
find ourselves looking at escalating mortality figures relating to drugs and alcohol and
wondering why this is allowed to happen.
If, as Lord Victor suggests, we are drifting towards the opposite of community-based care, what
should we do about it? Can we overturn the mentality of ‘survivalism’ we’ve been forced to adapt to
and harness an appetite for revolution? Are our systems and processes wrong – and what
specifically isn’t working?
According to Annette Dale-Perera, an international consultant who has spent many years
working in UK drug policy, we have lost much of the perspective that comes with being a
comparatively rich country. ‘We are seen as a high investor, but our systems aren’t
comparable to some other countries,’ she says. ‘We get criticism around the world for
focusing on getting people out of treatment.’
We need a switch in focus to ‘really work together, providers and commissioners’
and reach a consensus to ‘not go below the line, or treatment will suffer’, she says.
By going ‘below the line’, she means cut-price tendering – and the frequent
recommissioning (‘bloody waste of money’), ‘political yo-yo-ing’ and ‘bean
counting’ that has helped to deprioritise investment in addiction services.
What we’re left with is a state of growing inequality and what she
describes as the ‘really shit life’ syndrome. ‘We've got to ask ourselves why
we've got people living in worse situations than in war zones,’ she says.
‘Maybe it’s our systems and processes that are wrong. Have we built
processes that don’t work? There are structural inequalities and our
benefits system is shocking.’
Furthermore, she believes we are missing the public health
and human rights approach to drug use, which UNGASS (the
United Nations General Assembly Special Session on Drugs)
brought to global policy in 2016. At this latest session, 193
member states agreed the need to move from a criminal
justice to a public health approach, and supported the
concept that people can recover through evidence-based
treatment and social support.
‘There have been calls for solutions that dovetail with
the mainstream – long-term recovery and support,’ says
Dale-Perera, and these should include strong elements of
harm reduction – community OST, more needle
exchanges, and better coverage with naloxone.
Mike Dixon, chief executive of Addaction, believes
we need to ‘change the feel of services’ – a strong
message from one of the larger treatment agencies.
‘Many services operate from a room that local
authorities don’t want to use for other stuff,’ he says.
Changing the welcome to clients is part of changing
something much bigger, he adds. ‘We need to reach out
to a lot more people, particularly for alcohol and non-
opiates. We divide people by substances [to treat them]
10 | drinkanddrugsnews | October 2018