Jane drinks alcohol because it reduces her anxiety. janes drinking is being maintained by:

Home secretary ‘minded to’ explicitly exempt poppers from Psychoactive Substances Act

The home secretary, Priti Patel, has written to the ACMD seeking its advice on formally exempting alkyl nitrates – or ‘poppers’ – from the 2016 Psychoactive Substances Act. There has long been confusion about the exact legal status of the substances, and as the lawfulness of the their supply remains uncertain, the home secretary is ‘minded to remove this uncertainty by explicitly exempting’ the substances from the act, she states.

Although an initial proposed amendment to exempt alkyl nitrates from the Psychoactive Substances Bill was defeated, the ACMD later advised then drugs minister Karen Bradley that in their view the substances would still fall outside of the scope of the act as they did not have a direct effect on the central nervous system (DDN, April 2016, page 4). A 2018 Court of Appeal ruling, however, stated that substances that only have an indirect psychoactive effect could still be covered by the legislation.

The home secretary’s letter also seeks the ACMD’s advice on the drivers of increasing powder cocaine use among young people and drug sales on the ‘dark net’.

What we’re learning about better working with the LGBTQ+ community

We want everyone to know they’re welcomed and respected in our services. But for members of the LGBTQ+ community it’s not always that simple.

By Rachel King – We Are With You

We want people of all genders and sexualities to know they’re welcomed and respected in our services. At the same time, we recognise that for members of the LGBTQ+ community it’s not always that simple. Many people in this group might have had negative experiences with healthcare providers and/or experienced discrimination in their lives, both of which could make it more difficult to reach out.

So how do we better understand the needs of the LGBTQ+ community? And how do we better support them with their alcohol or drug use? Alongside existing projects, we set up an LGBTQ+ working group and we’re working with members of the LGBTQ+ community to look at how we can answer these questions. We’re still at the very beginning of what will be an ongoing and evolving project, but it’s an aspect of our work that we know is worth doing better.

Read the full article here.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content first appeared on We Are With You’s blog and can be read here.

Recovery charity offers pregnancy support

A recovery charity is delivering a free pregnancy support service for women in Greater Manchester.

Acorn Recovery Projects, a charity providing a range of recovery services across the North West, is offering confidential advice, guidance and reassurance for anyone concerned about alcohol consumption during pregnancy.

Acorn will be working with Greater Manchester Health and Social Care Partnership (GMHSCP) to support women and their families throughout Bury, Rochdale, Oldham, Tameside and Glossop. The partnership forms part of the wider Alcohol Exposed Pregnancy (AEP) programme.

The free support service is aimed at women aged 18-44 and their partners or support network. The service provides a safe, non-judgemental service for women and their families to receive mentoring, counselling and education on issues surrounding alcohol consumption and pregnancy. Support is not limited to women who are currently pregnant, but also those who are sexually active and identified as at risk of unplanned pregnancy.

Support can be accessed virtually and includes online counselling, group sessions and support from peer mentors. These services can also be delivered by phone, text and email where required. Despite misconceptions, the guidance from the UK chief medical officer advises that there is no safe level of alcohol consumption during pregnancy. Although the advice is clear, the UK currently has the fourth highest level of prenatal alcohol use in the world with 41 per cent of women drinking alcohol during pregnancy.

Recent research shows an alarming rise in alcohol consumption among drinkers since the beginning of lockdown, raising concerns around a potential increase in alcohol exposed pregnancies.

One in five (21 per cent) current and former drinkers said they were drinking more often during lockdown – Alcohol Change UK.

‘We’re excited to be working in partnership with Greater Manchester Health and Social Care Partnership to raise awareness of the issues surrounding alcohol exposed pregnancy. We’ll provide a range of person-centred services to support women and their families before, during and after pregnancy.’ 

Acorn’s pregnancy support service is available immediately and can be accessed through health visitors, maternity services, children’s centres and health centres. Alternatively, you can self-refer by calling 07583 052 031 or email

Find out more at: www.acornrecovery.org.uk/pregnancy-support

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

Charity warns of a surge of harmful illicit benzodiazepines

A surge in illicit prescription drugs has been linked to a number of overdoses in the UK, warns drug, alcohol and mental health charity We Are With You.

The drugs are made to look like benzodiazepines such as Xanax and diazepam and often come as coloured tablets in blister packs or labelled pharmacy pots.

A national alert has been issued by Public Health England and Public Health Scotland, with We Are With You treatment services across the UK reporting increasing numbers of overdoses linked to these illicit substances.

Testing of some seized tablets has shown they don’t contain any of the drugs they purport to be at all, instead containing more dangerous substances that are not used medicinally.

Dr Rachel Britton, Director of Pharmacy at We Are With You, said:

‘You can’t get Xanax prescribed on the NHS so if someone offers it to you it’s extremely likely to be illicitly produced. Testing has shown that these fake pills can often contain different substances in differing strengths, meaning the chances of overdose are far higher.

‘Due to the dangers, we are urging people to avoid taking these drugs. Unlike opiates, there is no readily available overdose reversal drug for these fake tablets within communities. The drug used to reverse benzodiazepines is carried by ambulance crews and in hospitals so it’s vital that anyone feeling unwell after taking these tablets seeks medical help.

‘However, if you do decide to use these drugs, take a very small amount to start with to gauge the effect. Also avoid mixing with other substances including alcohol as this increases the chance of overdose. Finally, never use these drugs alone and if anyone shows signs of overdose call emergency services immediately.’

Signs of overdose include:

• Problems with breathing
• Confusion, disorientation and feeling dizzy
• Uncontrolled eye movements
• Muscle weakness or tremor
• Lack of coordination
• Slurred speech and extreme drowsiness
• Slowed heart rate

Britton went on to urge people concerned about their drug or alcohol use to access support:

‘If you are concerned about your own drug or alcohol use, or that of someone you know, it’s really important to know support is out there. Our services are free, warm, non-judgemental spaces where we work alongside people to help them make changes. You don’t need to worry about placing extra stain on the NHS. Alternatively, you can talk anonymously to a trained advisor via our website – www.wearewithyou.org.uk.’

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by We Are With You, wearewithyou.org.uk 

Northern Ireland to consult on minimum pricing

Northern Ireland is to launch a ‘full consultation’ on minimum unit pricing (MUP) for alcohol, its health minister Robin Swann has announced. The decision follows a review of its alcohol and drug strategy carried out last year.

Northern Ireland’s new substance use strategy, Making life better – preventing harm and empowering recovery will be issued for consultation in the autumn, with the MUP consultation to follow within a year of its publication. Although the proportion of adults in Northern Ireland drinking above the recommended guidelines fell from 26 per cent to 20 per cent between 2010-11 and 2017-18, alcohol-related deaths have continued to rise while hospital admissions increased from just over 9,500 in 2008-09 to more than 11,500 in 2016-17. MUP has already been introduced in Scotland and Wales.

‘The impact of alcohol misuse is being felt by too many families and communities across Northern Ireland on a daily basis,’ said health minister Robin Swann. ‘We need to consider fully every option available to us to reduce this blight on our society. I have been closely following the Scottish Government introduction of minimum unit pricing on alcohol since 2018 and have been noting with interest the early positive evaluation reports. My department has been working in conjunction with key stakeholders on developing a new substance use strategy and this will be issued for public consultation later this year. As part of the strategy, there will be a commitment to holding a full public consultation on the introduction of minimum unit pricing for alcohol in Northern Ireland within one year.’

The announcement was a ‘positive step forward’, said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore. ‘If the measure is introduced in the north, then MUP will hugely benefit communities across the whole island of Ireland. Alcohol harm costs Northern Ireland £900m a year. By implementing MUP to raise the price of the very cheapest and strongest drinks on the market, the devastating impact of alcohol harm on families and communities across Northern Ireland can be reduced.

MUP already exists in both Scotland and Wales and legislation has passed for its introduction in the Republic of Ireland. England now risks being left behind in the race to tackle the alcohol harm crisis.’

Big strides made in elimination of hepatitis C, but still a long way to go says Lanarkshire charity

In the past five years the number of people thought to have hepatitis C in the UK has reduced dramatically.But, on World Hepatitis Day, drug, alcohol and mental health charity We Are With You in Lanarkshire says more needs to be done to meet the UK’s target of eliminating the virus by 2025.

Hepatitis C is a blood borne virus that can infect the liver, with 92% of infections through injecting drugs. Hep C is often symptomless until it reaches the chronic stage – and if left untreated, it can be fatal. 

The number of people thought to have hepatitis C in the UK has reduced from more than 182,000 in 2015 to around 143,000 in 2019. However there is still a way to go for the UK to meet its target set by the World Health Organization of eliminating the virus by 2025. 

In Lanarkshire, drug and alcohol workers at We Are With You are working hard to get more people tested and into treatment and support. 

Helen Hampton, who is We Are With You’s lead clinical nurse for blood borne viruses, explained: “An important part of our charity’s work is taking outreach, diagnosis and treatment for hep C into the community and away from hospitals. By continuing to do this, we can reach, test and treat more people and ultimately help WHO achieve global elimination.”

Jackie (not her real name) accessed treatment for hepatitis C. She said:

“My ex-partner died from hepatitis C. I watched him die what was quite a painful death and it got me really worried about my own health, so I approached We Are With You to get tested. 

“I thought it would be painful but it was just a pinprick; I barely felt anything. The staff were really supportive throughout. All I had to do was take a tablet every day for three months. That was it. When I came off the treatment I was concerned the virus may return but I’m now cured and feel better than ever. 

“I would urge anyone who thinks there’s a chance they may have it to get in touch with their local drug and alcohol service. It’s just one step and it will save your life.” 

Marc Simpson, who works at the We Are With You service in South Lanarkshire, said: “We launched our Positive Support service in 2011 to help people across Lanarkshire get hepatitis diagnosis, support and treatment. As 92% of hepatitis C infections are caused by injecting drugs, we have the specialist knowledge to be able to support the majority of people who have the condition.

“We work closely with NHS harm reduction teams, who put people in the community in touch with us. We take over their care at this point – which could be anything from testing them for hepatitis, free of charge, to taking them to hospital appointments and giving them emotional and practical support. We work with more than 100 people a year in Lanarkshire and it’s amazing to see them progress through treatment and go on to live full and healthy lives.

“Medicine has come so far in recent years that it’s possible to treat and cure hep C with easy-to-take tablets in 8 to 16 weeks. Everyone’s situation is different, so we work closely with hospital staff and consultants to take people on the treatment paths that are right for them.

“Anyone who’s concerned they might have hep C should give We Are With You in Lanarkshire a ring on 0800 599 9774, or you can speak to a trained advisor online via our webchat service. Just visit www.wearewithyou.org.uk.”

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

Humankind Charity supports World Hepatitis Day with new national Action Plan

The Humankind charity has launched a new national Hepatitis C Action Plan to mark World Hepatitis Day on 28 July.

The action plan aims to further increase testing for Hepatitis C across all Humankind services, ensuring specialist pathways and onsite treatment for the virus. 

‘Hepatitis C is most commonly spread through blood-to-blood contact, such as sharing needles,’ said Stacey Smith, Nursing Director at Humankind, which has drug and alcohol recovery services across the country.

‘The government have recently identified that people are not getting access to needle and syringe services as they should in this country. At Humankind, we are picking up that challenge. We really need to further embed hepatitis testing and treatment within our services so that there is no closed doors.’

She said testing was vital as there can be no noticeable symptoms in the first stages of infection, although it can cause major health problems.

Among a list of pledges set out in the plan, the organisation states it will:

• Invest in staff to increase testing rates and re-testing rates of people at risk
• invest in training for staff to ensure we have a skilled workforce
• allow time for data inputting
• ensure testing provision is across the whole treatment system
• reach out to people who are not registered with its services 
• commit to listening to what people who use its services say on how best to tackle the issue. 

Meanwhile, Humankind is joining a national campaign to raise awareness of Hepatitis C and the fact it can now be cured by a simple course of tablets. 

On World Hepatitis Day, the organisation, along with a range of other charities, NHS Trusts and the Hep C Trust are backing the Hep C U Latercampaign online and within its services.

‘Our message is that this virus can be treated and can actually be cured easily!,’ said Stacey Smith. ‘It’s not like the old treatment which lasted for months and sometimes had side effects. The success rate for this short course of tablets is much higher and it’s unlikely you’ll feel ill.’

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Humankind, and first appeared on 

www.humankindcharity.org.uk

Tayside achieves world first in effectively eliminating hep C

NHS Tayside in Scotland has become the first region in the world to effectively eliminate hepatitis C, with 90 per cent of patients diagnosed and 80 per cent of infected cases treated by the end of last year.

NHS Tayside has diagnosed almost 2,000 people since testing began, and treated more than 1,800 – more than 90 per cent of the estimated prevalence of hep C, meeting the World Health Organization’s elimination target 11 years early. The NHS Tayside project, which was developed in partnership with the University of Dundee, began in a single needle exchange and eventually led to a redesign of services with a focus on testing people who use drugs before they enter treatment.

‘Previous thinking had been that a community of people who inject drugs and their lives are too chaotic to allow for the sort of sustained treatment that hepatitis C needs to achieve a cure,’ said consultant hepatologist Professor John Dillon. ‘However, our view was that with the right approach, supported with appropriate resources, we could tackle what is a very significant problem and reduce the rates of hepatitis C infection. If you can offer treatment at a very early stage, while people who are infected are still actively injecting –when they have contact with other people who inject and share equipment with other people – their chances of transmission disappear because they’re not infected any more. It’s the idea of treatment as prevention.’

‘Getting such a high proportion of people treated is a huge achievement by NHS Tayside,’ said Hepatitis C Trust chief executive Rachel Halford. ‘People who inject drugs often struggle to access treatment due to barriers like stigma around the virus and drug use. NHS Tayside has shown that it doesn’t have to be this way and that everyone can be treated for this virus. No one is ‘untreatable’. If services adapt to patients, everyone can clear the virus and we can make sure we leave no one behind.’

More information at www.behepcfree.org 

Government to consult on calorie labelling for alcohol

The government will launch a consultation on plans to provide calorie labelling for alcohol, it has announced. The consultation, which will be launched before the end of the year, forms part of the government’s new obesity strategy designed to ‘beat coronavirus and protect the NHS’.

Other measures in the strategy include a ban on TV adverts for unhealthy foods before 9pm and a requirement to display calories on menus, which could also include ‘hidden liquid calories’ for alcohol drinks. The strategy has been launched alongside a new Better health campaign from Public Health England which is calling on people to ‘embrace a healthier lifestyle’.

Around 80 per cent of people are unaware of the calorie content of alcoholic drinks, the government says, with alcohol consumption estimated to account for almost 10 per cent of calorie intake for those who drink. Around 3.4m people are consuming an additional day’s worth of calories per week, it adds.  

‘The government’s plans to consult on ending the current exemption for alcohol products from calorie labelling requirements are very welcome,’ said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore. ‘When the calorie equivalent of a large glass of white wine is the same as a slice of pizza or a cocktail is the equivalent of a cheeseburger, it is clear why alcohol products should be included in the government’s plans to tackle the obesity crisis.

‘Alcohol is a factor in more than 200 health conditions and is the leading risk factor of death among 15-49 year olds in England,’ he added. ‘Labelling on all alcohol products with prominent health warnings, low risk drinking guidelines and information on ingredients, nutrition and calories would help equip the public with the knowledge they need to make healthier decisions about what and how much they drink. If we want to build a healthier, more resilient society we need to wake up to the harm alcohol does to people’s health.’

A million have quit smoking since lockdown

More than a million people in the UK have stopped smoking since the start of the COVID-19 pandemic, according to research by ASH and UCL.

Another 400,000 have attempted to stop during the same period, the organisations say. The figures are based on a survey of more than 10,000 people. 

A new stop-smoking campaign funded by the Department of Health and Social Care (DHSC) is also being launched, with a particular focus on older people as they are at risk of worse outcomes from COVID-19 through smoking-related conditions such as COPD. It will also the target local authority areas with the highest rates of smoking.

‘Over a million smokers may have succeeded in stopping smoking since COVID-19 hit Britain, but millions more have carried on smoking,’ said ASH chief executive Deborah Arnott. ‘This campaign is designed to encourage those who’ve not yet succeeded to wake up and decide today is the day to stop smoking.’ 

Doorstep Challenge

Strong partnerships could overturn nimbyism and make supervised injecting facilities a reality, DDN reports.

Read the full article in DDN Magazine

A supervised injecting facility (SIF, also referred to as a drug consumption room or DCR) is not the only answer to reducing drug-related deaths, but could fit into ‘a multi-component strategy’ to reduce vulnerability, overdose risk and fatal outcomes from overdose. Introducing an online session, Professor Alex Stevens of the University of Kent wanted to discuss the evidence, the obstacles and a way forward for making SIFs a reality.

‘Not only do they save lives, they help people to improve their injecting technique, access treatment and harm reduction services, and address other vulnerabilities in their lives,’ he said.

looked at whether a SIF could be legal. With the government ignoring the ACMD’s recommendations and continuing to oppose such a facility, three offences relevant to a DCR/SIF stood out in particular – possession, encouraging or assisting a person to commit an offence, and contravening the Anti-Social Behaviour Act.

With legislation unlikely to change anytime soon, she suggested that a way forward would be through multi-agency agreements between the police, local authorities, PHE, health providers and prosecution services. ‘Letters of comfort’ could be provided by police to allow local services to provide harm reduction equipment such as citric acid and foil. ‘The impetus comes from local activity,’ she said.

DCI Jason Kew gave thoughts on working with the police to open a SIF. His strong view was that it was a health matter – ‘a medical facility, a harm reduction facility’ – and it wasn’t the police’s place to lead on this work. The data on drug misuse deaths showed ‘a clear picture of where we need to act sooner,’ he said. With 78 legalised DCRs operating in Europe without a single drug-related death, we needed to ‘humanise the statistics’. ‘Is there really the public interest in prosecuting a healthcare professional trying to safe somebody’s life? Absolutely not,’ he added.

‘DCRs attract a great deal of emotion for or against them,’ said Rudi Fortson QC. A local memorandum of understanding was the best way forward, he suggested. ‘One has to look at the reality of the situation, which is that despite 14 years of campaigning to even pilot a DCR within the United Kingdom, we haven’t got one. Why not? It comes back to those fundamental issues of public acceptability of a DCR on their doorstep.’

Saket Priyadarshi, medical lead at Glasgow Alcohol and Drug Recovery Service, had been closely involved in making the case for a DCR in the city – a move provoked by an outbreak of HIV in people who injected drugs. A formal health needs assessment by public health colleagues had resulted in recommendations for a heroin-assisted treatment service (HAT) and a SIF. Glasgow’s health and social care partnership – which included police and people with lived experience of using drugs in public places – had accepted the recommendations and asked for a business plan for a SIF in the city.

The model they proposed was co-located with HAT and a very low threshold service ‘to capture as many of our target population as possible’, including pregnant drug users. The large fixed-site model ‘would manage the clinical governance concerns being expressed’ and it included an aftercare area.

The project is currently snagged by ‘a constitutional stand-off between Edinburgh and Westminster’ but they have made plans around public engagement to manage local concerns and ‘have an evaluation and research agenda in place’. A HAT service has already been implemented in the interim, and they anticipate that the SIF will be a ‘scaled-up version’.

The West Midlands had also been developing a model, as Megan Jones, head of policy for the Office of the West Midlands Police and Crime Commissioner, explained. The office had begun by looking at the scale of the drug problem in the region, with the cost of heroin and crack cocaine users calculated as £1.4bn and the cost of crime committed by the average heroin or crack user as £26,000.

A drug policy summit had involved the public in looking at a new approach, with the drivers of reducing harm, reducing crime, and reducing cost. The eight recommendations had included DCRs, and an independent report – Out of Harm’s Way, written by Ernie Hendricks in March 2020 – covered evidence from the UK and across the world. Its two main recommendations were to develop a business case through a multi-agency steering group, and to work with government and the steering group to support a DCR pilot site in the West Midlands.

We had to be led by the evidence, take the public with us and have an ‘open mature conversation about drug policy and its failings,’ she said. It needed to be done with existing treatment providers and people with lived experience, be linked to the homelessness agenda, and be done through a partnership approach.

Martin Blakebrough had been asked to talk about developing a model for Wales, and as CEO of Kaleidoscope he had experience of an early SIF model. In the ’70s and ’80s Kaleidoscope ran a club that also had a needle and syringe exchange in it, with a methadone dispensing system and doctors and nurses: ‘In many ways it was a drug consumption room, but it wasn’t actually publicised as that.’

Looking at other places, such as Cardiff, ‘we know there are unofficial consumption rooms there, in hostels,’ he said. ‘So it’s not quite right to say we don’t have consumption rooms – but we don’t have DCRs that can call themselves that, or that are recognised in law.’

The idea that the facility had to be an expensive option was ‘ridiculous’, he added. ‘In Wales we’re saying “it’s just a room”. The idea that we need to create ridiculously safe spaces that are sterile is also difficult – would you want to be drinking beer in a sterile environment? We have to create services that are hugely attractive to the people we want to serve. And they need to be involved in the design and development of that service.’

Peer mentors were the best people to advise someone on how to inject drugs, and the idea should be around creating a space for service users to help each other – ‘and if it’s part of a drug service or adjacent to it, I don’t really see the public outcry,’ he said. ‘Let’s make this happen by using the skills and passion of our drug using community and champions’, giving them the money to run the services, the legal cover, and the clinical assistance they needed to run the place safely.

Mat Southwell, technical consultant specialising in community mobilisation for people who use drugs, agreed on the value of peers’ central role and added that it was really important to give drug users choice around a highly medicalised model or a drop-in style community centre approach. ‘If you involve people in the design of a project they’re going to have more investment,’ he said.

It was important to think about their inclusion in staffing too, as part of an ‘empathic committed service’. Drug user groups had been ‘pivotal’ to delivering NSP around the country and different parts of the world and were well placed to carry on managing many DCR environments, as they did already.

‘It’s not about saying either nurses or peer educators, but saying what’s the combination we can put together to maximise the impact of a system,’ he commented.

Summing up the session, Alex Stevens said it was really important to build the evidence base, both in the UK and globally, for whether and how SIFs work. Three clear stages of development, piloting and evaluation could be taken from the Medical Research Council’s framework and ‘all this needs to be done alongside service user involvement from the very early stages’.

We were not starting from scratch, but had research to build on, including a ‘logic model’ of how these services work from Australia and Canada. A look at costs and benefits could lead to a template that people could plug their local data into.

Joining in the summing up, the senior police representative Jason Kew added: ‘This is depoliticising it, about saving people’s lives, about keeping people safe – it’s as basic as that. People talk about going soft on drugs, but there’s nothing soft about preventing deaths. Nothing.’

DDN July/August 2020

‘Service users are central to everything’

Conversations at the moment often come back to feelings of anxiety and isolation, so we’re pleased to be able to keep sharing the ways you’re responding positively to the COVID situation. Forward Trust are among those looking for creative ways to engage their service user community (p10), while Open Road and Humankind are also redoubling their efforts to connect with service users and make sure no one is isolated (p16 and p22).

As Bill Nelles (p14) would be the first to remind us, harm reduction must stay top of the agenda so we’re pleased to see the cross-sector mobilisation to make injecting facilities a reality (p18) and to support the call for redoubled efforts on eliminating hepatitis C (p11) as World Hepatitis Day approaches on 28 July.

As one of our letter-writers points out (p20) service user involvement should be central to everything we do, so we hope you get involved with the two initiatives from the research team (p6) and PHE (p8) to bring lived experience to the heart of informing treatment.

Keep in touch  and @DDNmagazine

Read the issue as an online magazine or download the PDF

A Sure Start

The SURE Recovery app offers a new mechanism for supplying anonymised feedback on important topics relevant to the development of good quality treatment services. Each month users of the app will be invited to respond to a key question that will be developed by the recovery champion working with the app development team, which includes researchers from King’s College London and people with lived experience of addiction. Researchers from the app team will analyse the data from those who consent and share the anonymised findings with key policy makers, including Public Health England and NHS England. The sharing of anonymised data is completely optional, and people can use the app without answering any research questions.

SURE Recovery is available to download for free from Google Play and the App Store. The work to produce SURE Recovery was undertaken in collaboration with people using alcohol or other drugs, in treatment and in recovery. It was also supported by an addiction service user research group linked to a London-based peer mentoring service called the Aurora Project.

A wide range of other people were also involved in developing SURE Recovery, including addiction clinicians, Create Recovery (a small arts charity that supports people with experience of addiction issues to develop their creativity) and Mindwave Ventures (an app developer that focuses on user-centred digital design). The work was generously funded from various sources, including Action on Addiction, the Alexander Mosley Charitable Trust, the Mackie Foundation, and the NIHR Maudsley Biomedical Research Centre, King’s College London.

In developing SURE Recovery, the project team followed a co-design process to make sure that the app would meet the needs and expectations of people experiencing addiction. They conducted interviews and focus groups with people who were using substances, in treatment and in recovery, in order to better understand the process of recovery and how an app might support this. Successive versions of the app were also reviewed and tested by people with lived experience of addiction to make sure that functionality was optimised, the meaning of all text was clear, all graphics and images were appropriate, and there were no bugs or system crashes.

Not everyone has a smartphone or tablet computer, but there is evidence that people who use substances increasingly have good access to mobile technology. Mobile health apps, such as SURE Recovery, tend to be easy to download and cheap to use. They can therefore be an additional valuable resource for people who may not be in contact with services, and for people who may be thinking about, or working on, their recovery. We know that people do not generally use mobile health apps in a sustained way for months and years – instead they tend to be used as and when people feel they meet their current needs. This is how the development team expect that SURE Recovery will be used.

It seems likely that different features of the app will appeal to different populations at different points in time and with different effects. For example, the recovery tracker, with its personalised feedback, may ‘nudge’ people to reduce their substance use, change their behaviours, or encourage those who are not in treatment to enter treatment. The artwork feature may have a therapeutic effect, enhance self-esteem or appeal to those who find it difficult to express themselves in words. Meanwhile, the naloxone feature may increase engagement with take-home naloxone and improve overdose management competency, so potentially saving lives.

We encourage anyone with lived experience of addiction and an interest in recovery to download the app and give it a try. If you like it, we ask that you tell other people so they know about it too. If you think it can be improved, please let the research team know. People with experience of addiction have a right to good mobile health apps just like any other population, and the aim is to ensure that the SURE Recovery app is a resource that can help as many people as possible.

If you have an Android device, the SURE Recovery app can be downloaded from Google Play. If you have an iOS device, the SURE Recovery app can be downloaded from the App Store. People can also follow and communicate with the SURE team via Facebook, Twitter (@SURE-Recovery), Instagram (sure-recovery) and YouTube.

SURE aims and features

SURE Recovery is intended for people who are using drugs or alcohol, in recovery, or thinking about recovery. It has five main aims and six key features. The five aims are:

1. To enable people to track and monitor their own recovery journeys

2. To enable people to recognise when they might need help

3. To enable people to identify sources of support

4. To enable people to find inspiration from others in recovery

5. To generate new data that will help researchers and policy makers better understand substance use and recovery

The six key features are:

1. A recovery tracker: this allows people to monitor their own recovery using a co-designed validated outcome measure called the Substance Use Recovery Evaluator (or SURE). Once SURE is completed within the app, personalised feedback and a score are generated. Weekly, monthly and yearly scores can then be viewed in a graph, allowing app users to view and track how their scores change over time.

2. A sleep tracker: this works in a similar way to the recovery tracker. App users can complete a co-designed validated scale of sleep problems called the Substance Use Sleep Scale (or SUSS). This will then produce personalised feedback and a score that also allows app users to monitor and review their sleep problems over time.

3. A diary function: this provides a private space where people can record their thoughts and feelings.

4. Artwork: the app provides a platform for people to share their artwork with the recovery community. App users can submit their artwork for possible display in the banner on the home screen of the app.

5. A naloxone resource: this feature provides instruction on the use of naloxone in the event of overdose. There are also informational resources, including a training video and a knowledge tracker which uses the Opioid Overdose Attitudes Scale (OOAS), a validated measure of overdose management competency.

6. Reading material: app users have free access to the book The Everyday Lives of Recovering Heroin Users, based on the lived experiences of people in recovery.

• Ed Day is national drug recovery champion and clinical reader in addiction psychiatry at University of Birmingham.

• Jo Neale is professor in addictions qualitative research at King’s College.

• Alice Bowen is research assistant at King’s College.

• Paul Lennon is director of the Aurora Project

Long Hot Summer

Summer weather and lack of other entertainment mean that young people are once again turning to outdoor partying on a large scale. Drug services are going to have to get creative about harm reduction, says Kevin Flemen.

In many post-apocalyptic films there’s an unbearably naff sequence where everyone has a party. It’s like The Matrix Reloaded ‘Zion dance party’ and usually involves everyone getting into tribal drumming and showing off their tattoos. It turns out that all these scriptwriters were, in fact, absolutely on the money. While the COVID-19 pandemic is nowhere near over and social distancing is still in theory the order of the day, we’re at the Zion dance party stage of proceedings.

A few weeks ago I ran a ‘young people and drugs’ webinar and one of the things I flagged up was the likelihood as we exited lockdown of unlicensed events becoming a bigger issue. One participant highlighted that it was already happening in Bristol – that was a month ago. Since then the prediction has come to pass and there has been a massive upsurge in house parties, block parties, illegal raves and spontaneous open-air events. Some of these have made the national news, but the media attention has so far mostly been on litter and conflict with the police – the issue of drugs and safety has not yet been discussed so widely.

The upsurge in unlicensed music events should come as no surprise. Pubs are only now reopening on a restricted basis, nightclubs won’t be reopening for the foreseeable future and organised festivals have been cancelled. A cohort of people who have been furloughed, have lost work or are entering the summer unclear if they are going on to higher education are bored and craving social interaction and entertainment. And the weather’s hot. Partying outside is very clearly going to be the order of the day.

This festival harm reduction doesn’t translocate to illegal events quite as easily, especially in the current climate. Clandestine events may be organised online with the final location announced at the last minute. Organisers are understandably wary of engaging with any statutory bodies – wariness that is likely to extend to drug services. Even where workers or volunteers could gain access, their own safety needs to be ensured in terms of COVID-19, personal safety and not getting caught up in any enforcement action. There had been concern that scarcity of precursor chemicals could mean a shortage of MDMA and the re-emergence of more dangerous compounds such as PMMA. Conversely there have also been reports of extremely high-potency pills, with peak doses in excess of 350mg being reported.

Without any doubt, as we exit lockdown, the explosion in unlicensed events will be the issue to contend with and drug services need to engage with this fast, creatively and at a grassroots level, if they are to provide much-needed input.

Given that unlicensed events are going to be one of the issues over the summer months, interventions are essential. And the ‘how to’ for working with unlicensed events means revisiting earlier harm reduction and being less reliant on permitted access and high-tech onsite testing.

It’s going to need to be more grassroots, including:

• production of clear accessible literature

• use of testing sites such as WEDINOS, Pill Reports and The Loop to promote awareness of contaminated pills, high-strength and other dangerous products

• safety advice about use of nitrous oxide

• engaging with promoters via social media so that they can make events safer – water onsite, access for emergency services, trained volunteers and engaging with drug services to provide outreach if possible

• peer education – as, more often than not, drug services won’t be on site it’s essential to equip those attending events with the resources and tools to manage critical incidents. Making sure attendees know how to spot signs of MDMA overdose and manage it is critical

• using What3Words to ensure that emergency services can locate people at outdoor events with pinpoint accuracy

• general harm reduction with a view to addressing COVID-19 spread including the sharing of snorting tubes, spliffs, drinks and balloons

• legal advice cards such as Release ‘Bust Cards’ so that people detained during enforcement activity know their rights and can access legal advice and personal safety advice

The Right Questions

Now in its 30th year, the Unlinked Anonymous Monitoring Survey is a vital tool for harm reduction, says Emily Phipps.

This year the Unlinked Anonymous Monitoring Survey (UAM) of people who inject drugs celebrates its 30th anniversary in England and Wales and 18th anniversary in Northern Ireland, making it the longest running annual survey of this cohort in the world.

Coordinated by Public Health England (PHE), the survey consists of a self-completed questionnaire and biological sample that is anonymously tested for HIV, hepatitis B and hepatitis C to monitor trends in blood-borne viruses (BBVs) and behaviours that impact transmission, such as needle sharing, testing and treatment uptake. No identifiable information is collected, and the survey or test result cannot be traced back to an individual, making it easier for us to ask questions about risky behaviours that might otherwise go unanswered.

The UAM is a powerful tool for advocacy and service planning, both nationally and locally. Each centre undertaking more than thirty surveys each year is provided with a free, detailed report of their responses to help them understand what the key priorities for their clients are. Nationally, the report feeds in to key annual publications such as Shooting up and Hepatitis C in the UK. The survey data is also shared internationally with the World Health Organization and European Centre for Disease Control to support global BBV elimination initiatives.

In current times, championing the needs of people who inject drugs and ensuring continued access to services is incredibly important. There are valid concerns that reduced uptake of BBV testing and difficulties in delivering the same level of needle and syringe provision during the pandemic will lead to an increase in infections among this group. The UAM, now more than ever, is an essential tool for understanding the impact of COVID-19 on people who inject drugs, and to keep track of progress as services recover.

The UAM team would like to say a huge thank you to all of our volunteers and participants who have been undertaking the survey during the last few difficult months – the data you have collected is absolutely vital. If you would like to join the UAM survey, or have taken part previously and would like to restart, the UAM team would love to hear from you. Every survey completed is a hugely valuable source of information on this population group who are otherwise often under-represented in policy and statistics. For further information, please contact Claire Edmundson, at .

Dr Emily Phipps is consultant epidemiologist at the National Infection Service, PHE. She prepared this work with Megan Bardsley, HIV/STI surveillance and prevention scientist, and Claire Edmundson, senior scientist, at PHE

‘We have had a phenomenal number of responses to the Unlinked Anonymous MonitoringSurvey, which provides us with a wealth of information about our clients – the addition of a finger-prick test for the anonymous blood sample part gives us another opportunity to offer diagnostic testing. Through this testing done alongside the survey, we have picked up 47 cases of hepatitis C that we may not have done otherwise.’ Louise Hansford, regional Hepatitis C elimination coordinator.

Aiming High

Even in the most difficult circumstances recovery is always possible, says Jody Leach.

We are a local charity supporting those struggling with addiction across Essex and Kent. Together with our main substance misuse provisions, some of the other projects we also deliver to support vulnerable populations include our work within a specialised women’s refuge, the Essex Appropriate Adult service, our targeted housing support service and our ‘SOS Bus’ services.

Mirroring previous articles on the ‘new normal’ of delivering substance misuse provision at this time, the pandemic and its restrictions have had an unprecedented impact on all our services and how we have been able to evolve to continue supporting those most vulnerable. While it’s hard not to, rather than detail all the amazing work our teams, wider treatment system partners and the local community have undertaken to help continue supporting our service users, I feel it’s important to share the voice of some of those service users and examples of positive recovery at this uncertain time.

Coping with change

For the majority of those we support, change is not popular and can be anxiety provoking at the best of times. We have worked tirelessly to help manage the imposed uncertainty that the pandemic has created, by continuing to offer the structure and support that is normally provided as standard. We have been impressed with how our service users have accepted and adapted to the required changes – not only have they worked with us to support our teams, many have told us that elements of our new ways of working are actually preferred to practices we had been doing for some time. COVID-19’s impact is tragic, but we are indebted to our service users for their investment in what we do to share these valuable insights. The following examples highlight how the measures we have taken over the last three months have been experienced positively by those using our services.

‘I am very lucky to be working with Open Road and my worker has been nothing short of brilliant,’ she continued. ‘She has thought of me at every turn and introduced me to meetings all over the county, including many new opportunities. She is fully aware I am not a huge fan of attending meetings, so having Zoom meetings has actually aided my recovery journey and allowed me to meet others all over the county in similar situations as myself. The amount of pressure Open Road have endured in the current pandemic must have been monumental, and without any previous experience to draw on, they have been fantastic.’

Appropriate services

Our Appropriate Adult (AA) service supports many held in custody with additional substance misuse needs. We are proud to have continued delivering this crucial support throughout the lockdown – despite its challenges – thanks to the passion and commitment of our teams. Essex Police’s custody commander said of the service, ‘Of a special note is the fact that Open Road have continued to provide support to detainees – something that is almost unique in my experience in the AA world at this present time.’

Given the impact of the lockdown on the night-time economy, our usual SOS Bus services have not been needed. Instead, in collaboration with the local council, our staff used the service’s minibuses to transport local homeless residents to temporary accommodation.

Pandemic complications

Our housing support service has been extremely busy supporting service users that are being negatively impacted further by the pandemic. One was referred into the service following the death of his brother whose funeral he was unable to finance. Our worker liaised with the relevant housing association and welfare rights advisor to enable the tenancy to be transferred, and an intensive package of support was made available. Had this work not been undertaken, our service user would have remained isolated and alone during a heartbreaking situation that was made all the more difficult by social movement restrictions. The implications for his ongoing recovery are obvious, but we are happy to report that he is continuing to do well with his reduction in substitute prescribing and abstinence from illicit drug use.

One of our young service users has particularly struggled during lockdown and found it hard to get into the new routine of not seeing friends at school and being at home constantly. He is classified as high risk as he self-harms regularly and feels he can’t disclose his self-harm experiences to other professionals. He now looks forward to the increased telephone and video calls from his worker that are helping him to manage his self-harming and drug-using behaviours.

This example highlights the recovery-focused passion that our workers continue to share despite the circumstances, and how we are always trying to put the needs of our service users first. One of our workers spent time speaking with a treatment-naïve individual that just happened to be waiting in the street for a friend that was attending an appointment with our service. This person was street-homeless and had been using heroin and crack since the age of 14. Despite the strict guidelines in place to avoid transmission, the worker was able to safely organise an initial assessment, as she felt that if the person was offered a time to return the opportunity may be missed for them to follow through on their apparent desire to access treatment.

He was extremely grateful for this quick thinking and left the service with his first-ever prescription for substitute medication, and was also issued with – and accepted – naloxone. He was supported to register with a GP and referred into OCAN [Offenders with Complex & Additional Needs] provision and the DWP to access benefit assistance.

It will get better

One of our recovery support service users perfectly sums up how they have experienced our response during the lockdown: ‘I miss everyone at Open Road and can see how important the service is even more now through the COVID-19 pandemic. I have always isolated myself and shut myself away, feeling like a burden or a pathetic weak person who cannot even sort themselves out. Open Road helps me to feel like I am able and can try again and not give up.’

To our fellow service providers and service users who may be reading this, things will get better. Until this new normal allows us to fully resume helping even more people struggling with addiction, we will keep trying to showcase to others that recovery continues to be a possibility for anyone that seeks support at this most unusual time.

Doubling Down

With World Hepatitis Day on 28 July, now is the time to redouble our efforts towards hepatitis C elimination, says Rachel Halford.

World Hepatitis Day this year will be unlike any other we have celebrated before. Hepatitis C continues to have a huge impact on people who inject drugs, with the latest statistics showing the rate of new infections among injecting drug users remains worryingly high. The surge of activity we have seen since last summer when NHS England signed an elimination deal with the pharmaceutical industry – not only to provide medication but also to commission case-finding initiatives – has largely come to a halt as a different virus has taken centre stage.

As with almost all other areas of healthcare, the impact of COVID-19 on services providing hepatitis C treatment has been sudden and dramatic: nurses and doctors were re-deployed overnight, clinics were cancelled, most testing ceased and new treatment starts were generally delayed. HCV Action, a network for professionals working in hepatitis C coordinated by The Hepatitis C Trust, found that around one quarter of the 22 hepatitis C treatment networks (operational delivery networks) were only able to treat patients already on their registers or no cases at all at the end of May, even as clinics began to recover.

Understandably, as many doctors and nurses have had their time diverted from clinics to wards in order to provide much needed additional capacity, some areas were under greater strain than others. Despite these difficulties, a number of services have demonstrated phenomenal creativity and determination to continue to help people. Many of The Hepatitis C Trust’s peer-to-peer support staff and volunteers have been going into temporary accommodation across the country to test people who had been living on the streets. This brilliant partnership working between NHS trusts, other charities, alcohol and drug services, and the hotels and hostels themselves has allowed many hundreds of people who had been rough sleeping to be tested and referred on to treatment – engaging a population for whom the traditional treatment model is often not accessible.

COVID-19 has laid bare the extent of health inequality in this country. In England, people living in the most deprived areas are around twice as likely to die from COVID-19 compared to those in the least deprived. Hepatitis C likewise impacts disproportionately upon the most vulnerable in our society – almost half of the people with hepatitis C who go to hospital come from the poorest fifth of the population.

Even with the persistence of laudable efforts to target those people most at risk of infection, there has been no notable reduction in new transmissions in recent years. Prevention is absolutely vital to achieving elimination and yet currently harm reduction provision does not go far enough, with 36 per cent of people who inject drugs reporting in 2018 that they did not have adequate needle and syringe equipment for their needs, heightening the risk of hepatitis C transmission through sharing injecting equipment. We must ensure people are supported to access needle and syringe exchanges adequate for their needs and so reduce the spread of blood-borne viruses such as hepatitis C.

The majority of hepatitis C cases in the UK remain undiagnosed, resulting in potentially tens of thousands of people experiencing health complications including liver damage and an increased risk of mortality. This World Hepatitis Day we must applaud services for their incredible hard work and dedication so far, and redouble our efforts to prevent new infections and expand testing and treatment until we have achieved elimination.

Find out more and download free resources at www.worldhepatitisday.org

The Heat is On – Doctor Wars (part two)

In the second part of ‘Doctor Wars’, Bill Nelles describes the tumultuous days of the 1980s.

Read part one here.

The Home Office consultants still met regularly, and included private doctors as well as NHS consultants. The NHS doctors felt the private doctors prescribed overly generously, didn’t demand reductions, left their patients ‘still addicted’, and even charged them fees. The private doctors felt the NHS doctors were too rigid and their patients poorly treated. Guidelines on the treatment of drug misuse (‘orange guidelines’) were the first national guidance issued by this group in 1984 – they pleased few. For instance, the guidelines considered that medically supervised detoxification was a ‘simple and short-term process with spontaneous remission possible’, and also stated that maintenance was not acceptable. ‘Evidence-based treatments’ didn’t really exist in addiction medicine at that time.

Ironically, the main use of the orange guidelines was as evidence in 1986 at Dr Anne Dally’s General Medical Council (GMC) hearing. She was a feisty senior private doctor on the working group and one of the signatories of the 1984 guidelines. I gave testimony supporting her at her GMC hearing, having become the drug education officer at the Terrence Higgins Trust (THT) a year earlier, but her verdict was guilty of maintenance! While she was able to still be a doctor, she was never allowed to prescribe controlled drugs again. Her practice evaporated almost overnight.

Because of its policy of avoiding methadone and arresting users for the possession of syringes alone, Scotland was one of the first parts of the UK to see the unusual and mostly lethal illnesses associated with AIDS and injecting drug use. Cheap heroin from Iran and the easy availability of Temgesic, (ironically, an early sublingual form of buprenorphine) had vastly increased the number of people injecting opioids, and police pressure had made clean needles impossible to obtain.

But two factors had yet to reveal themselves. The first was, of course, the AIDS epidemic, with the first Scottish drug user dying in Scotland in 1983. The second was the growing involvement of general practitioners in providing services to drug users and their influence on practice. Britain had not made methadone a drug needing a Home Office licence, and thanks largely to the efforts of dear Dr Tom Waller – an ACMD member who batted it back every time it was put forward – it was never adopted as policy.

These trends intersected in early 1985, when a young GP in Edinburgh published a paper in the BMJ which galvanised me, and many others, into serious action. Dr Roy Robertson, (now the Queen’s physician in Scotland and professor of addiction at Edinburgh University), had been seeing drug users for some years, and maintaining some with dihydrocodeine. He was able to obtain HIV test kits in advance of their national availability, and in late ’84 had taken blood for HIV antibody assay from around 160 patients. He knew they shared used needles, and the paper showed that 51 per cent had already been infected by HIV.

The effect of this news cannot be exaggerated. Research testing in London was showing rates of under 5 per cent positive, so we realised we had a short window to make a difference if we moved fast. By the summer of 1986, teams in London, Liverpool, Edinburgh and Amsterdam and, of course, the US were working very hard to understand what they were facing, and the UK and Holland had already implemented needle exchanges to stop sharing and prescribing to reduce injecting.

But there were still battles to be fought over clean injecting equipment. I had been seconded to the Standing Conference on Drug Addiction (SCODA) from the THT to write a booklet about AIDS for drug users, but in February ‘86 I spoke at a large National Haemophiliac Society meeting in Newcastle at which I represented SCODA and called for a serious examination of supplying clean needles.

This was picked up on Newsnight, and on Monday I found myself called to the office of the director. In fact the Friday before, after six months of abstinence from opiates, I had engaged a private doctor to look after me so that I didn’t resume injecting. He strongly objected that I had supported needle exchanges. I was also told that I ‘looked stoned’ and under no circumstances could someone work in a drugs agency even on legal methadone. That same day I returned to the THT where we concentrated on reducing the risk for drug users through advocacy with politicians, speaking engagements, and writing leaflets. By 1988, the McClelland report in Scotland and the ACMD special report chaired by Ruth Runciman gave the green light to access to clean needles, setting up 15 pilot schemes in England and Scotland. These were quickly expanded when the pilots reported favourably and both reports called for an immediate re-evaluation of methadone prescribing.

GPs had also become more independent and proactive especially if they had no specialist prescriber. West Berkshire Health Authority under Ailsa Duncan, their drugs coordinator, engaged me in 1988 to train a group of around 15 GPs to prescribe methadone. It was a five-day course with a written handbook. Apart from Ailsa, none of the doctors were aware they were being trained by a methadone patient!

I have great respect for all evidence-based treatment including non-prescribing approaches when it’s what the patient seeks. But present policies that deny people such approaches are shameful and should not be tolerated. In the last part of this series, we will look at the golden age of drug services – the first eight years of 2000. And how it all collapsed and we ended up where we are now.

‘We know that the main method of transmission [of AIDs] among drug takers is the sharing of dirty needles… It was clearly documented in a paper produced by Edinburgh professionals in February 1986. The Scottish Office commissioned a report from a committee chaired by Brian McClelland published in September 1986, which recommended decisively that the government should bite the bullet and provide clean syringes at an exchange centre, where drug injectors would be able to obtain free needles and syringes.

‘The government’s response to that call has been so inadequate as to be positively irresponsible. They sat on the McClelland report for months. Eventually, they announced 15 pilot schemes, 12 in England and three in Scotland. Of course such projects involve problems – the minister may wish to comment on them – but we must make the projects work.’

Safeguarding Sanctuary

The lockdown has forced services providing domestic abuse support to become even more resourceful and innovative, says Miranda Hawtrey.

Read the full article in DDN magazine

Working in a setting supporting those with addiction issues and complex needs is always a delicate balancing act. But when the coronavirus outbreak swept through the UK in March 2020, the team at Jane’s Place in Burnley had an extra challenge on their hands.

Jane’s Place is a somewhat unique service established in 2017 by SafeNet Domestic Abuse Support Services, who provide domestic abuse support to women, men and children. They are also the lead providers for Lancashire Refuges.

Jane’s Place is the only one of its kind in the North West – not only does it help to support women who are fleeing from all forms of domestic abuse, but it also breaks down barriers often posed by traditional refuge. A lack of appropriate accommodation and support for women and families with complex needs who need to escape from domestic abuse often results in outcomes such as women returning or staying with the perpetrator, escalating risk and coping strategies such as increased substance use, a lack of trust in services and sofa surfing, which often results in rough sleeping.

A mammoth task

The challenge of implementing safety measures and managing the extra risk posed by lockdown in this kind of specialist environment has been a mammoth task, and the team knew they had to adapt the service fast to ensure they could keep everyone involved safe and continue to support their residents.

They started by expanding and increasing their safehouse provision to provide safe spaces for those residents who were shielding, showing symptoms and needing to self-isolate. Those with serious drug and alcohol use issues and/or sex working women who found it impossible to adhere to the government guidelines had to be kept safe regardless of whether or not they were able to comply, and the team achieved this by use of separate safehouse facilities with specialist intensive floating support.

Each individual resident had an emergency COVID plan created and tailored to meet their needs. Along with various other measures, such as extra cleaning, PPE and updating residents and checking in to make sure they knew what the guidelines were, the team quickly pivoted the service to offer as much flexibility and support as possible.

This hasn’t come without its setbacks. The team have faced difficulties accessing help from outside agencies that would usually support residents, and accessing healthcare has been made much more difficult by skeleton staff in other agencies and lack of GP appointments. The residents also voiced that they were missing group work; the need for connection during their journey plays a big part in recovery.

Getting creative

Alongside the practical solutions – with staff members collecting methadone for residents daily and assisting with non-molestation orders received via court sessions over the phone with residents – the team got creative. They introduced ways for residents to connect with professionals and loved ones virtually, created online recovery groups and set up online quizzes and games to help boost morale.

With the lockdown also came a devastating rise in domestic abuse incidents, in the UK and beyond. More than ever, this highlighted the need to find other ways to reach victims who were not safe at home. The team introduced a new online chat service via their website to enable victims to safely access advice and support during periods of isolation or when they were confined at home with a perpetrator and unable to use previous routes to safety, manned by trained support workers.

What next?

So what next for Jane’s Place? No one knows how long restrictions will be in place or what the ‘new normal’ will look like, so the team are always thinking ahead and looking at new ways to engage with residents. This includes ‘walk ‘n’ talk’ sessions, encouraging communal gardening as a soothing way to pass the time and, most importantly, continuing to listen to what residents want via their ‘finding our voice’ consultations.

Case studies: Sarah and Kerry

Fleeing trauma:
Sarah, aged 34

Sarah had begun taking prescription medication and drinking alcohol at 14 years old as a way to numb the trauma of being gang raped. Both Sarah’s parents had issues with addiction and she felt unsupported in dealing with this horrific trauma. Growing up, she said she always felt ‘unloved’. During her adult life, Sarah was repeatedly subjected to sexual abuse by various males, and her drug use escalated to using heroin and crack daily.

Sarah then was in an abusive relationship and gave birth to two children. The children were subsequently removed by social care due to domestic abuse and substance abuse by both parents. Sarah became street homeless and soon got involved with another abusive male who forced her into sex work to fund substances for them both. Using heroin and crack daily, Sarah’s mental health and physical health dramatically deteriorated and she was also regularly shoplifting to fund substances. Things became too much for Sarah and she attempted to take her own life after a serious assault by her partner. She was then referred to SafeNet and accepted at Jane’s Place Recovery Refuge.

Sarah’s life dramatically changed once admitted to Jane’s Place. Her self-esteem and confidence returned as staff supported her to address health issues and receive support with her mental health. Jane’s Place referred Sarah to Inspire Wellbeing and she was allocated a key worker to help support her with substance use.

Sarah is now abstinent from all substances and back in contact with her children who live with family. She is no longer shoplifting or sex working and wants to start volunteer work after lockdown. Staff referred Sarah for specialist sexual trauma counselling and she also is supported by attending a trauma recovery group.

Sarah has said her drug use was spiralling out of control but she has dramatically changed her life with the support of staff. Sarah says the support she has received to reconnect with her children has been very important to her recovery and motivation. ‘Without Jane’s Place I would be dead,’ she says. ‘You saved my life,’

Escaping violence:
Kerry, aged 39

Upon referral, Kerry had been in a physically violent relationship for the past seven years. She had been threatened with a knife and her children had been removed for their own safety, as a result of her addiction and domestic abuse in the family home. Kerry referred herself into SafeNet’s services after trying several refuges who would not accept her as she was using alcohol and substances daily.

Kerry was drinking heavily, using crack and heroin, was on a methadone script, and was also having physical withdrawal symptoms – such as seizures – when she didn’t have alcohol. She was also a prolific shoplifter to fund her addictions, and had spent time in prison as a result.

Kerry was still having regular phone contact with the perpetrator when she arrived, who would often try to manipulate her, use controlling and coercive behaviour, give verbal abuse and threaten self-harm if she didn’t return home. SafeNet supported Kerry to stop contact and she attended domestic abuse groups at Jane’s Place. Extensive safety planning work was done as part of her support plan and as her mental health improved, Kerry was able to focus on her recovery.

While at Jane’s Place, Kerry’s anxiety reduced and she was no longer having suicidal ideation. Kerry completed RAMP (reduction and motivation programme) as part of her recovery support plan and, with the support of Jane’s Place and Inspire Wellbeing, she reduced her methadone and alcohol intake.

Kerry’s physical health greatly improved too – she gained weight, began to take pride in her appearance and was focused on getting fitter and healthier. She also began to rebuild relationships with her family and was then accepted for detox and rehab to complete her journey.

Find out more about Jane’s Place here.

I am a…

Supporting people and changing lives

People work for people – whatever your job, whatever the industry, the ultimate aim is to improve people’s lives. Nowhere is this more apparent than in the substance misuse sector and related health and social care fields.

Having the right team enables treatment services to help people change their lives for the better – and in some cases can make the difference between life and death. Healthcare workers are the vital connection between people looking for help and the services and treatment they need; their interventions can transform the lives of not just the individual in treatment, but often their families and loved ones too.

I am a...

Find out more about people's experience working in the field.

Johnny* is a homeless recovery coordinator in Lancashire. Read Johnny’s story here.

Tracey McMahon is a Delphi nurse who has developed her interest in mental health by working in a prison environment. Read Tracey’s story.

Lena Larsen is a volunteer service user representative at Change Grow Live’s community drug service in St Helens, Merseyside. Read Lena’s story.

Charlie Parker is an addiction psychiatry clinical nurse specialist, working in the liver unit. Read Charlie’s story.

Chelita De La Haye is a nurse prescriber at Delphi Medical Consultants Ltd, a community drug service in Blackpool, Lancashire. Read Chelita’s story

Stewart Bell is an isolation support worker at Phoenix Futures’ Wirral Residential service. Read Stewart’s story.

Neil Ainslie is manager of the Jericho Society, a drug project in Derby. Read Neil’s story.

Martin Holmes is service manager and registered CQC manager. Read Martin’s story.

Muriel Gutu is group clinical lead of the Social Interest Group. Read Muriel’s story.

Leanne Smullen-Bethell is head of house at Phoenix’s National Specialist Family Service. Read Leanne’s story.

Carol* is a volunteer working with a community drug service in Berkshire. Read Carol’s story here.

Iain Gray is a commissioner who is also in recovery. Read Iain’s story here.

Aisling* is a nurse/prescriber working for the HSE in Ireland. Read Aisling’s story here.

Sean Higgins is a recovery champion at the Kairos Community Trust. Read Sean’s story here.

Charlotte* is a volunteer at a community drug service in the South East. Read Charlotte’s story here.

Different strokes for different folks

People working with those experiencing problems with drugs, alcohol and other addictions do not necessarily fit into a neat category. They are likely to be based in a diverse range of settings – the inspirational youth worker; the probation officer who took the time to make a connection; or the housing support team who were able to identify problems and offer an appropriate and accessible route to help.

Substance misuse workers can be the vital link to ensuring that a person accesses the specialist treatment that they need. As well as providing the appropriate direct help, they are part of a network of specialist treatment workers operating in community, residential and, increasingly, online settings.

Please tell us about your career.

How I became a substance misuse nurse, by Ishbel Straker

I never thought I would become a substance misuse nurse – law was my initial career choice. But during my training to become a barrister I worked on a dementia ward to pay for my tuition fees. That was when I began to realise that I couldn’t envisage doing anything else.

Read Ishbel’s story here

Learning from lived experience

In line with the varied settings and roles, the staff supporting people come from a range of backgrounds including medicine, social care, psychology and counselling. People with lived experience are an important component of the workforce and, with the right training and work experience opportunities, bring knowledge and empathy to many roles.

Many people have been inspired to work in the field, either by their own personal experience or those of a family member, friend or colleague. Those undergoing treatment say that seeing someone who has been in the same position as them and turned their lives around was inspiring, as well as encouraging.

DDN magazine goes to people working in all areas of the sector and is also read by many of those who are on their own treatment journey. As a free magazine there are no barriers to reading it and contributing to it, and it is the forum for everyone who is involved in addiction treatment. 

We want to hear from you!

Your experience informs what we do, so we want to hear your story about working in the sector. Let us know how you came to work in your current job – what inspired you, what is your background, and what do you find rewarding and frustrating? Do you have any advice for anyone considering a similar career? Tell us as much or as little as you want to! Your contribution will be very welcome.

The latest jobs online

DDN magazine is the place for recruitment for the treatment field. We have a variety of vacancies across the country from a wide selection of treatment providers.

Please visit the jobs pageto view the latest vacancy, or contact for details of advertising for your next star!

Johnny shares his experience as a homeless recovery coordinator in Lancashire.

I have had almost ten years’ experience in this field. However, following the loss of a role that I loved, I had a cataclysmic relapse. Back in the whirlpool of cocaine and alcohol addiction, I very nearly died.

With the support of my father, I re-engaged with the local drug and alcohol service in February 2020. I then trained to be a volunteer peer mentor, delivering peer-led education to service users and co-facilitating psychosocial interventions (PSI) groups. I recently applied for and have accepted the role of homeless recovery coordinator with the same service.

Most of my recent work has been on Zoom, during the pandemic. I co-facilitate a ‘thrive’ group for six to eight service users, some of whom are just out of rehab/detox. I have done some limited learning in the office, spending time with the medical team and learning from them.

The part of my job that fires me up is the contact with people. Sharing my lived experience to show how life can be after addiction can be fantastic. I enjoy learning from colleagues, working with them in a team which includes my fellow peer mentors. The most rewarding aspect of all of it is being witness to a person’s growth and recovery.

The thing I’d most like to change would be to give greater accessibility to housing, mental health and medical services. We urgently need more funding in these areas, as there’s a crisis that’s reaching epidemic proportions.

If you’re wondering whether to become a recovery worker, I would say ‘just do it!’ You’ll make such a difference to so many lives.

—————————————————————

Tracey McMahon is a substance misuse nurse at Delphi Medical.

Read Tracey’s story here

—————————————————————

Lena Larsen is a volunteer service user representative at Change Grow Live

Read Lena’s story in DDN Magazine

—————————————————————

Charlie Parker is an addiction psychiatry clinical nurse specialist, working in the liver unit. 

How did you get into this role?

I had always been interested in mental health, then when I was training I noticed there was still a lot of stigma and prejudice in terms of drugs and alcohol. My boyfriend at the time was in recovery so I found these attitudes hard to understand. When the substance misuse job came up I leapt at the chance and haven’t looked back since!

Tell us about your day…

I run nurse-led clinics and see patients as part of their liver transplant assessment, working with them and their families to build recovery capital and reduce the risk of relapse. I work both in outpatients and on the liver ward with a multi-disciplinary team of hepatologists, transplant co-ordinators, hepatology CNSs and specialist dieticians.

Which parts of the job do you find most rewarding?

Helping people on their recovery journey and linking them in with peer support and mutual aid – people are often very anxious about this but can get so much from it. Seeing people change their lives, realise their potential and go on to help others is very rewarding.

What would you like to change?

Equity of access to liver transplant – not everyone gets this chance depending where they live. Sadly a postcode lottery does exist; some areas have fantastic services but others much less so. I would also like to see a treatment pathway for people who are abstinent but still want to access support/relapse prevention from statutory services.

What’s your advice to anyone considering a similar career?

We need skilled professionals alongside peer support and mutual aid and those with lived experience, and although the social and political landscape is challenging substance misuse services are needed now more than ever. Alcohol-related liver disease in particular is ever on the increase and we must be ready.

—————————————————————

Chelita De La Haye tells us about her role as a nurse prescriber at Delphi Medical Consultants Ltd, a community drug service in Blackpool, Lancashire. Read Chelita’s story here.

—————————————————————

—————————————————————

Martin Holmes is service manager and registered CQC manager. 

‘I am humbled that my past has become my greatest asset in helping others to freedom.’ Read Martin’s story here.

—————————————————————

Muriel Gutu is group clinical lead of the Social Interest Group

‘At Brook Drive there is no ‘them and us’, but ‘we’ – and we’ll continue working towards excellence.’ Read Muriel’s story here

—————————————————————

To anyone considering a similar career, I would say: if helping people is your passion, then go for it. A career in addiction services can be the most rewarding job of all. Knowing that you can help someone who is broken to rebuild their life is just amazing. You get to meet lots of really interesting people and have the privilege of hearing their stories and being a part of their recovery journey. What can be better than that?

Read Leanne’s story

—————————————————————

Neil Ainslie is manager of the Jericho Society, a six-month residential drug project in Derby with aftercare and resettlement.

I was a resident of Jericho house in Greenock in Scotland in 2004. I came down to volunteer in 2006 and am now the project manager. We have 11 volunteers, who are all ex-residents, and four full-time staff; between us we have achieved around 45 years abstinence. 

The moment our clients arrive they agree to be completely abstinent from all mind and mood altering chemicals. We have nine residents at any given time and we support them to go through any cold turkey with understanding, empathy, one-on-ones, group therapy, chats, hot baths, identification – or whatever they need really!

We have an insight and first hand experience into every step, from when a resident arrives to when they move out. We have truly walked a mile in their shoes and they know this from day one. We understand their mindset, which people without addiction issues usually can’t quite comprehend.

People with addiction issues generally know this and find it hard to expose their irrational, fearful, compulsive and insane thinking patterns to them, so are shocked when we openly discuss this and have a massive depth and insight which brings hope to their lives – sometimes for the first time in many years. We give them hope – ‘if they can overcome this and break the cycle of addiction, then why can’t I?’

Tell us about your day…

There’s never a dull day. My latest shift was a privilege, as always. We had staff handover as always, where we discuss every resident in depth, and then I allocated the daily tasks to the appropriate staff. One of our newer guys had a family death so I had a chat with him to make sure we can all support him as best we can. 

After that I talked to one of our longer residents about the possibility of him writing a letter to his ex-partner with the hope he may at some point reconnect with his seven-year-old son. Then a chat with another resident about him deliberately lying to us about social distancing while he was on a family visit and reminding him of the importance of honesty and trust in relationships and how this was a big part of one of his previous relapses.

Then on to another resident who is from the Asian community, about his fears around the expectations of his family members and how hard he felt it was going to be to bring the principles of recovery back to his home. I then needed to talk to an ex-resident about how to handle a situation (and the family trauma) relating to his cousin who had overdosed and was in a really bad way. 

After that was a meeting with my business manager about expanding our service, before a chat to one of my volunteers about how to conduct himself whilst answering the Jericho House phone, as he was a little dismissive to a potential service user’s brother.

What do you find most rewarding?

I love seeing people turn their lives around, reconnecting with their families and going on to be productive members of their communities. I really love to see them helping others the way they were helped!

What would you like to change?

I would like to see more financial help available for places like ours. We are a charity and rely on volunteers to make our great work possible. We generally run at a loss and are experiencing real financial difficulties.

What’s your advice to anyone considering a similar career?

If your heart’s in it, then go for it. If you are going to work with people with addiction issues then it should be taken deadly seriously as addiction is a killer. The rewards are beautiful – but for every good story there are two not so good. Good luck in whatever you do.

—————————————————————

Carol* is a volunteer working with a community drug service in Berkshire.

I volunteer two days a week on a training placement to become a recovery worker. I do a lot of my training on e-learning in the drug service. I assist the substance misuse nurse run her weekly alcohol support group and help service users read material, and I scribe for them when needed. I also assist the recovery workers with things like phoning service users and making appointments. During lockdown I have not been at the service, and have done refresher drug and alcohol training via Zoom.

I also have another voluntary role supporting an inmate with substance misuse issues at HMP Wormwood Scrubs.

What do you find most rewarding?

Helping the service users through their recovery is very rewarding – also, learning via work shadowing the clinical recovery workers and the consultant psychiatrist in the dual diagnosis clinic. 

What would you like to change?

I’d like to be able to offer more one-to-one appointments with service users, especially for those who dislike support groups. It would be good to be able to offer more ongoing support as well, especially when service users relapse.

What’s your advice to anyone considering a similar career?

It’s an extremely interesting, challenging and rewarding career.

*Not real name

—————————————————————

Iain Gray is a commissioner who is also in recovery

What would you like to change?

I would like central government to support us better and provide more secure long-term funding.

Do you have anything to say to anyone considering a similar career?

Don’t do it for the money. Always, always, always stay focused on the clients and their needs. And never give up fighting for them – they are worth it.

Aisling* is a nurse/prescriber working for the HSE in Ireland

After five years on psychiatric wards, a community position came up that was specifically working with those who are homeless. Working in substance misuse was not always my plan but it seemed to have developed that way.

Tell us about your day…

I’m out in the community visiting homeless people at hostels and B&Bs, and also run two clinics in two main towns where they also call in. I spend a lot of time filling in forms for medical cards (as healthcare is not free in Ireland) and getting the homeless linked into certain services.

I go to two housing meetings every fortnight – they are called the Homeless Action Teams, where they assign the B&B/hostel beds. We work together as professionals advocating for a homeless person.

What do you find most rewarding?

Getting the health care set up is rewarding, as is getting someone a detox/rehab bed. Doing support letters for courts and disability benefits can have worthwhile results and doing dipstick drug tests is satisfying when you can give praise for having done well that week.

What would you change?

The housing part is tough as B&Bs/hostels are always full. The council can be difficult to get this accommodation from, as the staff often pre-judge the homeless person.

What would you say to anyone considering a similar career?

Be ready for many barriers that you have to overcome for this client group.

*Not real name

—————————————————————

Sean Higgins is a recovery worker/champion at the Kairos Community Trust, a residential drug service in South London.

I had over 30 years in active addiction and was lucky to be admitted into treatment via my local drug and alcohol service. When I was one year drug-free and sober I was offered a volunteer position at the same treatment centre. After three months I was put onto the permitted hours work scheme and enrolled onto level 3 health and social care, which I have now completed, and I am just about to start the level 5.

Three years after being admitted into Kairos I now work as a full-time support worker within the same treatment centre and feel I have found a purpose in my life. Giving back what was so freely given to me is a fantastic feeling.

Tell us about your day…

I complete referrals, assessments, care plans, risk assessments and care and risk assessment reviews with clients on a regular basis – we have the capacity to accommodate 24 clients and I have a caseload of six clients, whom I see weekly for one-to-ones. I also facilitate groups and workshops, which make up part of each client’s treatment pathway.

What do you find most rewarding?

Supporting individuals to achieve their full potential.

What would you change?

I would love to see more funding available for the whole substance misuse field.

Do you have anything to say to anyone considering a similar career?

If you are considering a career in this field then I would suggest that you try it out on a voluntary basis first.

Never lose sight of your own recovery – and don’t kid yourself that working in the field is your recovery.

—————————————————————

Charlotte* is a volunteer at a community drug service in the South East.

She volunteers two days a week on a training placement to become a recovery worker and does much of her training on e-learning in the drug service. 

Tell us about your day…

I assist the substance misuse nurse to run her weekly alcohol support group and help service users read material and scribe for them when needed. I also assist the recovery workers with helping with service users – telephoning them, making appointments etc. During lockdown I have not been at the service, and have done refresher drug and alcohol training via Zoom.

I also support an inmate with substance misuse issues at HMP Wormwood Scrubs – another voluntary role.

What do you find most rewarding?

Helping the service users through their recovery is really rewarding. I’m really enjoying learning via work – shadowing the clinical recovery workers and the consultant psychiatrist in the dual diagnosis clinic.

What would you change?

It would be good to be able to offer more one-to-one appointments with service users, especially for those who dislike support groups. It would also make much more sense to offer ongoing support, especially when service users relapse.

What would you say to anyone considering a similar career?

It’s an extremely interesting, challenging and rewarding career.

*Not real name

A quarter of drinkers consuming more during lockdown

More than a quarter of people who have ever drunk alcohol think they have been drinking more during lockdown, according to research commissioned by Alcohol Change UK. Almost half said they expected to continue drinking at the same rate as the lockdown eases and pubs reopen, while 17 per cent said they anticipated drinking more.  

The figures are based on a survey of more than 2,000 people, around 1,600 of whom were current or former drinkers. Just under 20 per cent of this group said they had been drinking to cope with stress or anxiety, with parents of under-18s more likely to cite this as a reason than non-parents or parents of adult children. Although one in five drinkers had been drinking more often, the number of units consumed on an average drinking day ‘does not seem to have changed significantly’, says the charity, with 13 per cent drinking more units and 12 per cent drinking fewer. Of people who typically drank seven or more units a day, however, 38 per cent said they were now drinking more.

Just under 20 per cent of drinkers said they intended to visit a pub within two weeks of lockdown easing, but 7 per cent had stopped drinking altogether during the lockdown –equating to more than 3m people – with younger people more likely to have cut out alcohol. More than one in three people had also been taking ‘active steps’ to manage their alcohol consumption, including having alcohol-free days or looking for advice online. Traffic to the ‘get help’ section of Alcohol Change UK’s website from March to June was almost 250 per cent higher than during the same period last year, the charity says.

‘From the very start of lockdown, charities and treatment services have warned of the impact on people’s drinking,’ said chief executive Richard Piper. ‘This research shows that we were right to worry. One in five of us has drunk more often than usual over the past three months, and this research suggests that those drinking more often during lockdown are less likely than others to cut back as it eases. But the good news is that one in three of us are acknowledging that drinking is a concern and taking active steps to manage our drinking during lockdown. One in three are also planning to manage our drinking actively as the pubs reopen and lockdown eases, putting in place plans like drink-free days, keeping an eye on the amount of alcohol we buy, and getting support online or from our GPs.’

Government launches second phase of Carol Black review

The second part of Professor Dame Carol Black’s independent review into illegal drug use in England has now been launched, the government has announced. While the initial phase looked at drug supply and demand, the second will study treatment provision, recovery services and prevention.

The review will look at how drug treatment interacts with housing, employment, mental health and criminal justice services, with the overarching aim of ensuring that vulnerable people get the right support to ‘recover and turn their lives around in the community and in prison’. The final document will contain policy recommendations to government, including around funding, commissioning and how local bodies are held accountable to ‘ensure they are effective’. The review’s first phase concluded that even if more money were made available for drug treatment, there would still be ‘a lot of work to do’ to build up capacity and expertise in the sector (DDN, March, page 4).

The second phase will engage with a ‘wide range of stakeholders’ including service users and people with ‘lived experience of drug addiction’ to build a detailed picture of treatment, recovery and prevention, the government states. Professor Black will be supported by government recovery champion Dr Ed Day (DDN, June 2019, page 8) and former drug policy adviser to president Obama, Dr Keith Humphreys (DDN, June 2012, page 16).

‘In my foreword to part one I said that behind the thorough analysis of the market for illicit drugs that we had just completed lay a very tragic human story – about the effect on individuals, their families, youngsters caught up in the trade, and the economy,’ said Professor Black. ‘We showed a decade-long erosion, under previous governments, in almost every aspect of drug addiction, prevention, treatment and recovery. We now have the opportunity to correct this and build a better world. To do this many stakeholders and government departments must work together as never before.’

‘The findings of Dame Carol’s first review set out the scale of the challenge,’ added health minister Jo Churchill. ‘Now our focus must shift to ensuring the appropriate services are in place to support the treatment and recovery of drug users, as well as preventing drug use in our communities in the first place.’

More than 120 children slain in Duterte’s ‘war on drugs’

The document – which is based on interviews with families, witnesses and local authorities, as well as official documents – states that the children’s ages ranged from just 20 months up to 17. In one case a seven-year-old boy was killed simply because he had witnessed the murder of an adult. The organisations estimate that the total number of extrajudicial killings since the country began its ‘war on drugs’ under president Duterte four years ago is just under 30,000 – with just one police officer convicted – while at least seven children have been killed in the first three months of this year.

The children’s deaths documented in the report were either the result of direct targeting, mistaken identity, ‘collateral damage’ or ‘as proxies when the real targets could not be found’. Almost all of those interviewed for the report asked not to be named, and most did not even file a case for the murder of their children through fear of reprisals. ‘With parents often too afraid to testify, even anonymously, it is likely that the actual numbers of children killed are higher than the 122 documented in the report’, states OMCT.

There has also been a sharp increase in the arrest and detention of children on drug-related charges since Duterte came to power, says the document, leading to the ‘overcrowding of detention centres where abuse, ill-treatment and even torture are rife. This increasingly brutal policy has spilled over during the recent COVID-19 related lockdown, with numerous children arrested for curfew violations, sometimes threatened with being shot and detained in dog cages or inside a coffin’.  

The report’s revelations must be a wake-up call for the international community, which has been ‘largely absent as the Philippine government has kept trampling human rights’, said OMCT secretary general Gerald Staberock. ‘Over the past four years we have hardly seen any meaningful reaction to the wanton killing of thousands of people under the pretext of the “war on drugs”, the targeting of the poorest and most marginalised citizens of the Philippines, and the persecution of human rights defenders, many of whom are in prison for their legitimate work. It is the total lack of accountability that feeds the cycle of violence, including the war on children we are witnessing.’

How could they do this to my child? Extrajudicial killings of children during the ‘war on drugs’ in the Philippines at www.omct.org – read the report here

Gambling oversight ‘complacent’ and ‘weak’, says Commons committee

The bodies overseeing gambling are failing to protect people who are vulnerable to gambling harms, says a report from the House of Commons Public Accounts Committee. The Department for Digital, Culture, Media & Sport (DCMS) and the Gambling Commission – which it oversees – have an ‘unacceptably weak understanding’ of the impact of gambling harms and lack measurable targets to reduce them, says the document, which follows a report from a separate parliamentary group calling for a complete overhaul of gambling regulation (read about that here).

The public accounts committee found the pace of change to ensure effective regulation to be ‘slow’ and the penalties imposed on companies that do too little to  address problem gambling ‘weak’. ‘Where gambling operators fail to act responsibly, consumers do not have the same rights to redress as in other sectors’ it says. As gambling increasingly moves online DCMS and the Gambling Commission have failed to adequately protect consumers, even when problems such as increased risk of gambling harm during the COVID-19 lockdown have been identified.

The committee is calling for a published league table of gambling operators’ behaviour towards customers, with ‘naming and shaming’ of poor performers and it also wants to see DCMS embark on a review of the Gambling Act within the next three months.

‘What has emerged in evidence is a picture of a torpid, toothless regulator that doesn’t seem terribly interested in either the harms it exists to reduce or the means it might use to achieve that,’ said committee chair Meg Hillier. ‘The commission needs a radical overhaul – it must be quicker at responding to problems, update company licence conditions to protect vulnerable consumers and beef up those consumers’ rights to redress when it fails. The issue of gambling harm is not high enough up the government’s agenda.’

The review of the Gambling Act was ‘long overdue’, she added, and an opportunity to see a ‘step change’ in the treatment of problem gambling. ‘The department must not keep dragging its feet – we need to see urgent moves on the badly needed overhaul of the system. Regulatory failure this comprehensive needs a quick pincer movement to expose the miscreants and strengthen those they harm.’

Gambling regulation: problem gambling and protecting vulnerable people at www.parliament.uk. Read it here

Urgent action needed to address lockdown ‘time bomb’, warns Adfam

People coping with a loved one’s drug use, drinking or gambling have been hard hit by the COVID-19 lockdown, according to a new survey from Adfam.

Families are often overlooked when it comes to discussions of problematic alcohol or drug use. However, half of the respondents to Families in lockdown said the situation had had a negative impact on their own mental health, while 28 per cent said they were experiencing more verbal abuse than usual and 13 per cent admitted to being concerned for their safety. Nearly 5 per cent said they had been experiencing more physical abuse during lockdown.

Almost half also stated that their loved one’s substance use or gambling had increased during the lockdown period, while just under a third reported that the person had either relapsed or their recovery was at risk.

Around 5m people are thought to be dealing with the negative effects of loved one’s alcohol or drug use in the UK, with 85 per cent of respondents to the survey saying the lockdown had made a ‘bad situation worse’. Many of these people will need urgent additional support as lockdown conditions ease, warns the charity.

‘At least one in ten of us are currently affected by a loved one’s drinking, drug taking or gambling problem,’ said Adfam chief executive Vivienne Evans. ‘Our survey shows that this unrecognised and hidden problem has been made worse by the lockdown. When you are already isolated, fearful or in poor mental and physical health, lockdown takes an even bigger toll. Even when restrictions ease, people will need help and support to recover. Now more than ever, we need a national conversation about how we can help people to cope with the life-long impacts of a loved one’s alcohol, drug or gambling problem.’

Meanwhile, UNODC’s latest World drug report has highlighted the increased prices and reduced purity of many drugs as a result of COVID-19 lockdown measures. The economic fallout from the pandemic is also likely to disproportionately affect the poorest and make them more vulnerable to problem drug use, it warns.

If governments react in the same way they did in the aftermath of the 2008 financial crisis, then reduced budgets for drug treatment could mean severe impact on vital areas like naloxone provision and prevention measures.

‘Vulnerable and marginalised groups, youth, women and the poor pay the price for the world drug problem,’ said UNODC executive director Ghada Waly. ‘The COVID-19 crisis and economic downturn threaten to compound drug dangers further still, when our health and social systems have been brought to the brink and our societies are struggling to cope. We need all governments to show greater solidarity and provide support, to developing countries most of all, to tackle illicit drug trafficking and offer evidence-based services for drug use disorders and related diseases.’

 Families in lockdown at adfam.org.uk

World drug report 2020 at www.unodc.org

Government announces interim housing plans for rough sleepers

The £105m is made up of £85m of new funding and £20m from ‘refocusing’ existing homelessness and rough sleeping budgets. The money will provide help with deposits and secure ‘thousands of alternative rooms already available’ – such as student accommodation – and is part of the government’s commitment to ‘end rough sleeping for good’. Partnership working between government, local authorities, charities and the hospitality sector has seen thousands of people temporarily housed in hotels during the outbreak (DDN, May, page 5).

A further £16m is being made available to help people in emergency accommodation access substance misuse support – money already announced but brought forward because of the pandemic. 

‘In recent months, I have seen a huge effort across the country to keep almost 15,000 vulnerable people off the streets,’ said housing secretary Robert Jenrick. ‘This has been vital to ensure their safety during the peak of the pandemic and has changed the lives of thousands for the better. The additional funding announced today will allow us to continue to support these individuals – giving them access to the accommodation and support they need now while we continue with plans to deliver thousands of long-term homes in the coming months. Together, this takes the funding provided by government for vulnerable rough sleepers and those at risk of becoming homeless to over half a billion this year – an unprecedented commitment as we move towards ending rough sleeping for good.’

‘I am clear that there can now be no going back to the streets as people begin to move on from the emergency accommodation that has been put in place,’ added chair of the COVID-19 rough sleeping taskforce, Dame Louise Casey. ‘The government is committed to ending rough sleeping by the the end of this parliament, and has taken unprecedented steps to protect thousands of vulnerable rough sleepers and those at risk of becoming homeless.’

‘This a great news but support in England is patchy with councils often uncertain who they should be helping,’ stated homelessness charity Crisis. ‘We need emergency legislation to ensure that every local council can provide housing support to everyone experiencing homelessness.’

Listening to people who use our services during the coronavirus pandemic

Service user involvement is about making sure people can influence decisions that will affect them. To influence, people need the opportunity to speak and be heard. The voice of people using services provides valuable feedback and we need to make sure we always acknowledge and consider it.

By Chris Barnes, National Service User Involvement Coordinator at Change Grow Live.

Coronavirus has impacted on every aspect of our lives, including the way we deliver our services. Back in March, as changes to our ways of working started happening, we quickly noticed that our approach to hearing the voices of people who use our services needed to change.

It is critical that we continue to listen to the people who use our services.

Read the full article here.

If you are getting support from us, we have heard you. We now want to know more about your experiences. Please click here to share your story and your experience through our survey.  

DDN magazine is a free publication self-funded through advertising.

This content first appeared on Change Grow Live’s website

Time to ban all gambling ads, say MPs

The All Party Parliamentary Group (APPG) for Gambling Related Harm has called for a ban on all gambling advertising as well as a complete overhaul of the UK’s system of gambling regulation. ‘The Gambling Commission is not fit for purpose,’ it states. 

The recommendations are among more than 30 set out in the APPG’s final report into online gambling-related harms, following a year-long enquiry. The group, which comprises more than 50 MPs, is also calling for a ban on all ‘VIP’ schemes and inducements – a ‘cynical tool to incentivise problem gamblers’ – and for the stake limits for online slot machine style games to be capped at £2, ‘given the potential to cause harm’. The APPG has previously called for a £2 stake limit in its interim report (DDN, November 2019, page 5). 

The group’s final report is based more than ten evidence sessions, as well as submissions from a wide range of stakeholders. Other recommendations include a new Gambling Act to reflect the realities of the digital age, as well as affordability limits to be set and imposed by the Gambling Commission. According to the commission, there almost 400,000 problem gamblers in the UK, with at least 1.8m more considered ‘at risk’. A recent report from GambleAware found that just under half of people with a gambling disorder had never accessed support (DDN, June, page 5). 

The COVID-19 pandemic has underlined the need for greater protection for people who can ‘gamble with ease from home, at any time of day and at any level, via a mobile phone’, says the APPG, which also refutes claims that it is prohibitionist or anti-gambling. ‘This is to debase what is an important discussion to protect vulnerable people and children and prevent online gambling harm,’ it says. 

‘This multi-million pound industry has destroyed people’s lives,’ said APPG chair Carolyn Harris. ‘They resist change at every turn and claim to be reforming themselves but put forward limited changes. Their primary motive is profit. During the COVID pandemic they said they would end TV and radio advertising (DDN, May, page 4) but just ended up replacing ads with ads – that none of us want to see. They have shown time and again that they will not effectively self-regulate. We cannot ignore this any longer. Urgent change is needed to stop this industry riding roughshod over people’s lives.’ 

Report from the Gambling Related Harm All Party Parliamentary Group: online gambling harm inquiry, final report at www.grh-appg.com

Bill Nelles – Doctor Wars (part one)

In the first part of his two part series ‘Doctor Wars’ Bill Nelles describes how the running battles between substance misuse clinicians in the ’70s and ’80s helped to shape today’s treatment landscape.

What to do about opiate use and users has been discussed, argued, and shouted about for more than a century now to relatively little positive change. It’s like the opening song in The Sound of Music – ‘how do you solve a problem like Maria?’ Only no one ever does solve the problem of Maria (although I think it has something to do with finding love and, of course, climbing every mountain – a familiar metaphor for any users).

The same seems true for opiate users. We dutifully sing the songs asking for help, but too often leave disappointed. There are still hundreds and even thousands of opiate-dependent users in the UK and around the world who want and deserve a safe supply of that medicine under medical oversight, and finally some are getting it. And I use the word oversight for a reason. It should mean ensuring services are providing empathic access to a safe supply with all the social support, trauma therapies and help with housing that we know are essential to settling down to a life of quality without the poisons on our streets. Having all these is what saved me for nearly 40 years. All were necessary for me and there should be widespread shame at the lack of this joined-up care today.

It wasn’t until the late ’60s that serious prohibition started in the UK – largely because young people, not elderly users and dependent doctors, were now using heroin and getting it from doctors famous for their unusual prescribing locales like coffee bars and street corners. Some changes were understandable as the system was anarchic and largely unregulated.

But the ‘classic’ NHS clinics born around 1969 all had differing attitudes with little agreement on what to do within the teams formed to run them. Thus the era of the ‘doctor wars’ broke out – psychiatry came to dominate treatment in the UK, leading to psychotherapy becoming the approach, and in London high quality Chinese heroin replaced the state gear. So people voted with their veins.

But the UK’s NHS drug dependency units were taken over by psychiatrists, not medical doctors. With some notable exceptions, their goals were abstinence through withdrawal and therapy. All these psychiatrists who held the new licences needed to prescribe heroin hardly used them, with a few notable exceptions. People were moved onto oral methadone or nothing if your particular clinician wouldn’t prescribe, or you only had access to a non-medical community drug team – tea and sympathy (of little use) if you were ‘lucky’, but confrontation if you weren’t.

The fights at the monthly meetings held at the Home Office Drugs Branch during the ’70s to mid ’80s brought together psychiatrists who hated prescribing, some of the private doctors who could still prescribe some opiates and opioids (but not heroin or cocaine), and the very few doctors who did still prescribe injectables to the few. They were often vicious and sometimes very personal – some moderating influence came from the presence and later letters and testimony of dear Bing Spear, head of the Home Office Drugs Branch the until the early ’70s. He was replaced by a warrior who did his best to shut down even oral methadone.

By 1983 even getting methadone for more than a short period became very rare in the NHS clinics and unheard of in Scotland. One of the heads of the Royal College of Psychiatrists held that ‘no one needs more than 40mg of methadone a day’ – which was a big reason so many people had such poor outcomes and used on top. Most were expected to and that’s why their methadone was kept so low. There were no objective medical tests or practices used in the UK to ensure patients had adequate doses to minimise fluctuation of methadone levels.

Prescribing anything opiate-like through the NHS to those dependent had almost completely stopped by 1983. But events were about to take an unprecedented shift, and that changed how everything would be done. I’ll explore this further in the next edition.

Read Part two here

Scottish off-sales down 5 per cent in year after MUP

Sales of alcohol from supermarkets and off-licences in Scotland fell between 4 and 5 per cent in the year after minimum unit pricing (MUP) was introduced, compared to England and Wales.  

The biggest relative net reductions were seen in the products whose price increased  most after the introduction of MUP, such as high-strength cider, with smaller reductions recorded for beer and spirits. MUP was introduced in Scotland in May 2018, following a lengthy legal battle with the drinks industry. Public Health Scotland says it will publish a three-year analysis of post-MUP sales in 2022. 

‘The methods used in this study allow us to be much more confident that the reduction we have seen in per adult off-trade sales is as a result of the introduction of MUP, rather than some other factor,’ said professor of medical statistics at the University of Glasgow’s Institute of Health and Wellbeing, Jim Lewsey. ‘Incorporating data from England and Wales into our analysis controls for any changes in sales in a neighbouring region where the legislation was not introduced. We’ve also been able to adjust for other factors, such as household income, sales of alcohol through pubs and clubs and of other drink types.’

However the reductions were partly offset by off-trade sales of wine, fortified wine and ready-to-drink beverages, which the analysis ‘found to have increased in the year post-MUP’, said public health intelligence principal at Public Health Scotland, Lucie Giles. 

‘It’s very encouraging to see further evidence that minimum unit pricing for alcohol seems to be changing our drinking habits for the better,’ added chief executive of Alcohol Focus Scotland, Alison Douglas. ‘A reduction of between 4 and 5 per cent in off-sales in the 12 months following the introduction of MUP is really significant. It is also clear that it is the high-strength, low-cost drinks, favoured by heavier drinkers, which we are drinking less of. This gives real cause for optimism that MUP is having the intended effect and that it will improve – and save – many people’s lives.’

It was important not to become complacent, however, as Scotland was still drinking enough for every adult to exceed the CMO guidelines by a third every week, she said. ‘For some of us the pressure of lockdown and social distancing may mean we are drinking more.’

Delphi Medical

Delphi Medical are a leading provider of drug and alcohol addiction treatment in the UK

Delphi Medical have an outstanding reputation as one of the leading providers of recovery-focused drug and alcohol treatment in the UK. The team offers excellent care on a pathway that supports and facilitates patients engaging in genuine recovery.

Delphi Medical provide flexible solutions to recovery by working with individuals to better understand the traumas linked to their addiction.

As part of their service delivery, Delphi Medical recognise that they have a wider role in changing cultures and social support. The service works with multiple partners and communities to make real improvements. As part of The Calico Group and Syncora, Delphi Medical are in a unique position to provide bespoke services that fit the most complex needs.

With passion and excellence, Delphi Medical make a difference to people’s lives by providing innovative and specialist addiction services that lead the way from dependence to freedom.

Find out more at www.delphimedical.co.uk

Telephone – 01524 39375 Email – 

Delphi Services

The Nursing Team are on duty 24 hours a day to support patients and monitor any changes in physical health during detox.

Delphi Pavilion Detox

The Pavilion is a residential drug and alcohol detox treatment centre on the outskirts of Lancaster, run by Delphi Medical. As part of a not-for-profit organisation, we endeavour to make detox and addiction treatment as affordable as possible.

The Pavilion team – made up of doctors, independent prescribers, therapist, nurses, support workers and volunteers – prides itself on delivering care to the highest standard with a focus on supporting patients into recovery.

The Pavilion is accessible to patients aged 18 years and over, delivering personalised and structured detoxification programmes, personally tailored to each individual.

Health, wellbeing, and personal empowerment are at the forefront of every programme, delivered in individual and group settings by trained medical and therapeutic professionals, with all services reflecting best practice, meeting CQC standards.

A combination of clinical and therapeutic services are delivered to safely support patients’ detox, whilst also addressing the contributing factors that have led to their dependence.

Detox is the first step into abstinence from drugs or alcohol, and can be a daunting decision for patients. The Pavilion provides a safe and effective in-patient detox from both drugs and alcohol, through medically assisted withdrawal.

Single and multiple detoxification services are available for the following substances:

• Illicit drugs (opiate and non-opiate based)
• Alcohol
• Psychoactive substances
• Over the counter medication
• Prescription medication

Find out more at www.delphipavilion.co.uk

Telephone – 01524 39375 Email –

Kenward Trust rises to the challenge 

Kenward Trust rises to the challenge 

COVID-19 has proven to be an incredibly challenging time for the addiction rehabilitation sector, with community services having to limit face-to-face meetings where possible and lockdown forcing residential units to rethink their admissions process or close altogether. However, Kenward Trust, a residential alcohol and drug rehabilitation centre based in Yalding, Kent, are proud to say they are still open and taking admissions.

The Trust, situated in 15 acres of stunning Kent countryside has a variety of services to provide support to those affected by addiction, homelessness and crime. The core service of Kenward Trust is their residential rehabilitation programme which provides support to those affected by alcohol and drug addiction from for to 24 weeks. They also have Kenward Lodge based on their site in Yalding, which provides supported accommodation to those who are struggling to access drug and alcohol treatment due to not having accommodation, whether this be because they are street homeless or living in unsuitable housing. 

Increased demand

‘We are currently facing a significant increase in demand for our residential services during lockdown, so have managed to repurpose some of our accommodation to allow two isolation areas for new arrivals to the project,’ said Penny Williams, CEO of Kenward Trust. ‘We have ensured that during isolation, any residents can still partake of the programme through remote connection, so they are benefitting from all the time they have with us. I am incredibly proud of our team for keeping COVID-19 off our site and for ensuring that we can safely help those who really need it and that this is being recognised by our referrers.’

Kenward Trust are currently recruiting for a Residential Resettlement Manager (closing date 19.6.20) Click here to find out more

The Trust has Move On accommodation across Kent and East Sussex, which are quickly filling up due to the increase in demand. Residents live independently in the Move On accommodation but have support from a dedicated Kenward staff team member to help them reintegrate back into the community whilst sustaining their recovery. The typical length of stay is up to two years while they find longer term accommodation and employment or volunteering opportunities.

Kenward Trust CEO, Penny Williams

‘Due to this increase in demand we are looking at finding more Move On accommodation within the Maidstone area, so it is closer to our Yalding base,’ explained Penny Williams. ‘We are currently getting in contact with the council and surrounding housing associations to see how we can start this process, however if anyone could provide support with this please do get in touch. We are passionate about helping as many vulnerable members of society that we can, so any support would be greatly appreciated.’

Statutory funding

While demand for the Trust’s services is increasing, the statutory funding for residential rehabilitation is continuing to decline. Additionally, as a charity which relies on donations and grants to help fund the services, we are in a challenging time with lockdown. Therefore, to help provide support to those who either cannot afford the residential treatment privately or cannot take the four to 24 weeks needed off work, the Trust is launching a Day Treatment Service. This service can be run remotely during lockdown with confidential counselling via Zoom, but will also feature Evening and Weekend groups when lockdown is over.

To find out more about the services Kenward Trust provides, or to find out how you can support their life changing work visit kenwardtrust.org.uk or give them a ring on 01622 814187.

Would you like to learn how to save a life?

Peer distribution of naloxone is the best way to get the opioid overdose reversal drug where it’s needed.

by Nye Jones, We Are With You

Andy struts through Redcar town centre, his bright blue naloxone hoody protecting him from the fierce north sea breeze. He bellows hello to a woman across the street and fist bumps a guy he knows from his childhood. Then he sees a man he recognises from picking up his methadone script and it’s all systems go. Andy asks if he’s heard of naloxone. He hasn’t. He asks if he’d like to learn how to save a life. He would. The two sit together on a bench outside Sports Direct. In just eight minutes Andy expertly takes him through how to respond if someone has taken an opiate overdose. With a slap on the back, he hands the man a naloxone pack to keep and waves him on his way.

It seems like he’s been doing this for years, but just three months before the programme started Andy knew very little about naloxone — “I’d never seen a pack before, I never had a clue.” Drug related deaths are at record levels in the UK, with the north east recording the highest rate of deaths in England. Now, Andy is part of a team of peers proactively taking naloxone out into the community in the coastal area of Redcar and Cleveland.

Read the full article on the We Are With You Blog.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by We Are With You, and first appeared on

https://medium.com/we-are-with-you

‘Resilient’ organised crime groups adapting to pandemic conditions

‘Active and resilient’ organised crime groups have been successfully adapting their drug trafficking routes, transportation models and concealment methods during the COVID-19 pandemic, according to a report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. While the pandemic has led to local shortages, higher prices and reduced purity of some drugs, crime groups are continuing to thrive and make ‘huge profits’, it says.

Disruption of the drug supply chain has been seen ‘mostly at the distribution level’, the document states, as lockdown and social distancing measures have made street deals more difficult. While dealers and customers are increasingly turning to encrypted communication apps, social media platforms and the dark web to buy and sell substances, the ‘continued commercial transportation of goods across Europe’ has enabled the ongoing movement of bulk quantities of drugs between countries.

Trafficking via maritime shipping remains at pre-pandemic levels, say the agencies, although there has been ‘marked disruption’ in smuggling via passenger planes, echoing the findings of a recent UNODC report (DDN, June, page 4). Violent incidents related to drug trafficking have also continued during the pandemic, the document says.

‘The economic effect of the crisis is likely to make some in our communities more vulnerable to both drug problems and drug market involvement,’ said EMCDDA Director Alexis Goosdeel. ‘Furthermore, the growth of online dealing and encrypted communication will place greater strains on law enforcement. In the post-pandemic period we are likely to see greater volatility, competition and violence associated with the drug trade. By anticipating these developments now, we will be better prepared to respond quickly and effectively to the new challenges we are likely to face.’

EU drug markets: impact of COVID-19 at www.emcdda.europa.eu – read it here

The Benzo Trap

Improving our understanding of benzodiazepines would save many lives, says Kevin Flemen.

Non-medical use of benzodiazepines creates big challenges for treatment services. There need to be significant changes in how we respond if we are to reduce dependency and fatalities related to this family of drugs.

The extent of non-prescribed benzo use is poorly understood. The Crime Survey for England and Wales (CSEW) reports a drop in use, but anecdotal information from drug services, including young people’s services, suggests the opposite is true.

The CSEW data is highly suspect in relation to benzos, and this may be because it misses key using populations. Questions to identify benzo use need to be carefully framed too – would young people taking ‘Xans’ automatically know that this is alprazolam, a benzodiazepine? If not, standard screening questions such as ‘have you used benzodiazepines in the past six months?’ are liable to under-count actual use.

Further, not all our benzo-type drugs will show up on urine screens, possibly because the stronger ones produce effect at very low doses – producing lower levels of metabolites below the detection threshold. And some of the drugs, such as etizolam, are thienodiazepines not benzodiazepines, so won’t produce metabolites that show up on a standard screen.

Young people

Young people’s benzo use appears to have increased. Some of this is recreational, influenced by popular culture, including a new generation of rappers whose image and lyrics have popularised Xanax. For others, use may be self-medicating for trauma, anxiety or other negative mental health conditions.

The trap here is the slow access that too many young people encounter when seeking help from child and adolescent mental health services (CAMHS). Long waiting lists or failure to meet the threshold to access services mean young people may be waiting months for access to CAMHS, if they can access the service at all.

In the meantime, some will find benzos and start to self-medicate. When and if the young person does access mental health services there is a good chance – in classic ‘dual diagnosis ping pong’ – that they will be told they have a primary presenting drug problem and therefore should be referred to a drug service. In turn, when they present to the drug service they may well find a paucity of treatment options to assist with their benzo dependency.

The benzo backlash

The increase in the use of Xanax may have started among young people, but the wider pattern of non-prescribed benzo use has been an ongoing issue and has morphed over time. Initial benzo dependency was largely driven by massive over-prescribing and long-term prescribing, something that has been addressed but remains an issue.

The path to hell is, however, paved with good intentions. The ongoing guidance to GPs to carefully consider the need for benzo prescribing and review existing patients has certainly reduced the extent of benzos being prescribed in the UK. But without measures to address the underlying reasons why people feel they need tranquillisers, people ended up seeking these drugs first from online pharmacies, then via the NPS market off the dark web and, ultimately, off the streets. This has allowed people to build up tolerance to novel benzos at far higher doses than they would have obtained on the NHS. These same patients, when presenting to GPs for treatment, may encounter the same reluctance to prescribe benzos that pushed them to the street market in the first place.

Prescribing trap

The NICE BNF guidance on benzos for the treatment of anxiety allows for doses up to 30mg a day. For someone who has a significant street-acquired strong benzo habit, the BNF upper limit may be well below that person’s current dose. The dose equivalence for someone using four 2mg alprazolam a day (8mg x 20) would be 160mg diazepam – more than five times the BNF upper limit for treating anxiety.

Where services do have a benzo-prescribing pathway it typically requires a person to reduce themselves off their own illicit benzos to a level where drug services or GPs could take over prescribing. This approach effectively directs a person to continue purchasing off the illicit market, with all the risks that this entails. It is the equivalent of having an arbitrary maximum dose of 30ml methadone and saying to heroin users they should reduce themselves off street heroin until they get to this level.

This situation also assumes that the person has continued access to illicit benzos that they can taper off. If a person has been purchasing off a dark web site which is then shut down, they could be left without any access to drugs, withdrawing off a high dose with no access to legal substitutes. This brings with it huge risks, including psychosis and life-threatening convulsions.

Ashton Manual

Many professionals and people seeking help online will find the Ashton Manual, a guide to benzo reduction and withdrawal by Professor C Heather Ashton. A helpful resource for many, the manual and related resources create two key challenges. First, for some people, reading the manual could reinforce fear and anxiety of withdrawal symptoms. There is a risk that people will anticipate and expect symptoms and could therefore experience a wider range of symptoms and with greater severity.

Second, the withdrawal schedules suggested by Ashton typically reflect people reducing off NHS-prescribed dose ranges. Where people have built up dependency on stronger novel benzos, and built up high tolerance on street drugs, following the sort of slow tapers proposed by Ashton could take one to two years or longer to complete. While on the one hand very slow tapers as described by Ashton minimise risks of unpleasant or dangerous symptoms, they can prove prohibitively and unnecessarily slow for people who have been using at high doses. Minute dose reductions can lead to people fixating on each reduction, and losing motivation over a protracted reduction programme.

Unknown tablets

Efforts to accurately substitute prescribe for illicitly acquired benzo habits are further confounded by our uncertainty as to the specific drug and specific dose that the person is actually taking.

A significant amount of the tablets sold as Xanax could contain one or more other compounds. Alprazolam may or may not be present – weaker or stronger benzos could be present, and these could be shorter or longer acting than alprazolam. Dose may be higher or lower than the claimed strength, and there may be other psychoactive compounds present such as quetiapine.

While drug testing websites such as WEDINOS are invaluable in highlighting trends in pill composition they are less helpful when considering tapers and withdrawal protocols – even if pills held by the client are submitted for analysis. The analysis doesn’t show the amount of each psychoactive compound in a pill, and without testing several pills from a batch, no certainty can be derived from testing a single pill.

This uncertainty about drug, dose and strength makes it impossible to accurately assess:

• what level of substitute prescribing is required
• how fast or slow a taper should be applied – some novel benzos have a very long duration of effect (100-200 hours) and so slower tapers may be required.

In lieu of accurate and rapid pill testing, the only practical way of substitute prescribing and tapering is to prescribe symptomatically, increasing dose and slowing withdrawal where there are clinical indicators of unmanageable withdrawal symptoms combined with careful assessment of the patient’s self-reported symptoms.

Escaping the trap

Services need to urgently develop new pathways and treatment protocols for people using benzodiazepines outside of clinical and prescribed settings. These need to include:

• screening tools to assess for patterns and nature of
  benzo use
• research into the extent of non-prescribed benzo use
  in the UK
• protocols to test clients’ pills for content and potency
• appropriate levels of substitute prescribing with tapers
• rapid access for children experiencing anxiety to CAMHS to reduce self-medicating with benzos
• staff training and training for GPs about addressing the use of prescribed benzos without driving people towards illicit markets.

www.kfx.org.uk workshops have moved online during the current lockdown.

Email for joining instructions.

Commissioning Quality

The new national substance misuse commissioner forum will play a vital role in responding to future challenges, say Chris Lee and Prof Jim McManus.

Even through these unprecedented times, councils are absolutely committed to ensuring that people seeking help with substance misuse get the right treatment and support, as part of their public health and other wider responsibilities. This includes helping vulnerable people being given another chance to find work, rebuild relationships, improve their physical and mental health and find safe and secure accommodation.

But more must be done. Only a fifth of dependent drinkers are currently accessing treatment, while the success rates of drug services vary five-fold from place to place. What’s more, new threats are emerging all the time – one only needs to look at the drug-related death statistics to see that. We must not be complacent. Councils know more needs to be done in close collaboration with local partners to ensure everyone gets the support they need wherever possible.

Covid-19

The COVID-19 emergency comes after a lengthy period of financial and policy upheaval for the drug and alcohol sector. For example, those of us in local government have long argued that reductions to councils’ public health grant – used to fund drug and alcohol prevention and treatment services – is a false economy that will only compound acute pressures for criminal justice, NHS and social care services further down the line.

The Local Government Association (LGA) and the Association of Directors of Public Health (ADPH) have jointly agreed to support the establishment of a national forum for substance misuse commissioners in England. While there are strong regional support networks across England, coordinated by Public Health England regional teams, the purpose of this new forum is to provide a strategic national space in which to bring together those with commissioning responsibility in local government, and enable a representative commissioner voice.

With many people currently finding new ways to work, this development will be a timely opportunity adding structure and support around the alcohol and drug agenda in England. It will provide a dedicated space to address the issues and concerns of those commissioning substance misuse related services and the opportunity to share ideas and experience or even just support colleagues.

‘The new national network comes at an important time,’ said director of public health at Hertfordshire County Council, Prof Jim McManus. ‘Bringing commissioners together to learn and share good practice is core to the improvement ethos of local government known as sector-led improvement, and will seek to bring some structured support to an area which has been neglected in recent years. Part of this will be ensuring we develop the best possible services and best commissioning practices. This is just one plank of ensuring we have a response to drug and alcohol issues and the need of our populations. But it is an important plank.’

With physical meetings unlikely to happen for the foreseeable future, the intention is to initially develop an online forum to bring people together and use Knowledge Hub as a central platform – it’s hoped we can physically bring people together at a future date!

Key objectives

• To support the development of good practice and effective commissioning approaches
• To enable commissioners to share information, intelligence, challenges, ideas, and to support problem-solving
• To represent commissioner views on relevant current and emerging policy and strategy
• To influence legislation and policy at a local, regional and national level
• To enable national representation of substance misuse commissioners in relation to other sector organisations.

While planning is at an early stage, we would welcome expressions of interest to join this emerging forum. If you have any ideas to support this development or wish to register interest in joining, please contact:

DDN June 2020

‘We need to be proactive and responsive’

INNOVATIVE DEVELOPMENTS and impressive collaboration have characterised our sector’s response to the crisis (page 8).

But what we also need to keep up with are the changes in the drugs market and regional trends that could tip the drug-related deaths crisis into further catastrophe. One of the trends identified by Release’s new drug monitoring network is increased use of benzodiazepines, so our cover story looks at how we can respond to this by developing urgent new pathways and treatment protocols. It’s essential that we remain proactive and responsive at the same time as making so many other adjustments to routine.

Commissioners have been thinking along the same lines and there’s an invitation to join a new national forum on page 11. As we’re all particularly concerned about diminishing resources and the threat of services being decommissioned, it’s the right time to create a space for clear strategy and a representative commissioner voice.

Collective Voice are working hard for the treatment sector and invite your involvement in rising to important challenges (p14). When we emerge from this crisis let’s not forget the many gains we’ve discovered from working more closely together.

Keep in touch  and @DDNmagazine

Read the issue as an online magazine or download the PDF

Gender imbalance

The lockdown may be having a disproportionate effect on female service users, warns Gordon Hay.

The coronavirus pandemic and the subsequent lockdown impacts on all society, and is likely to be impacting more on groups such as those in contact with drug or alcohol services. Research studies are being launched to explore how COVID-19 and lockdown impact on people who use drugs, and there is a wider discussion about how levels of alcohol use within the general population have changed over the last few months (DDN, May, page 5) and issues such as the relationship between domestic abuse and alcohol use during the current crisis. While new research studies are being set up, existing monitoring and surveillance systems can quickly be augmented to highlight emerging issues facing those in contact with drug or alcohol services.

The Public Health Institute at Liverpool John Moores University has, since 2013, hosted the Integrated Monitoring System (IMS) which records activity at a range of primarily low-threshold drug and alcohol services across Merseyside and Cheshire. Just as the UK entered lockdown, six additional questions were added to the monitoring system to enable services and commissioners to identify additional issues facing their clients.

As services were not mandated to ask the additional questions, the numbers are relatively small but large enough to highlight the impact of gender. Two months from lockdown, emerging findings from 1,435 contacts with services involving 468 clients suggest that female clients are impacted more than males. Overall, very few clients (about 1 per cent) report concerns about having symptoms of coronavirus. Interestingly, only a similarly small amount reported problems accessing medicines, healthcare or harm-reduction supplies – however this finding is unlikely to be representative of all people who use drugs or have problems with alcohol, as the monitoring is being undertaken in healthcare, particularly harm-reduction, settings.

More clients report difficulties in social distancing and accessing basic needs such as food. While social distancing was reported as an issue for 22 per cent of female clients, only about 10 per cent of male clients reported difficulties. For accessing basic needs, 6 per cent of female clients as opposed to 2 per cent of male clients reported issues.

Behavioural change

Changes in the clients’ alcohol, drug or tobacco use were explored. Although it cannot be assumed that any changes are increases or decreases, 15 per cent of female clients reported a change compared to 6 per cent of male clients. While all of these differences are seen to be statistically significant, the starkest gender difference occurred when considering mental health, with 23 per cent of female clients reporting that their mental health had been affected by the current environment, compared to 10 per cent of male clients.

Research typically shows that women who use drugs face additional challenges, for example the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) suggests that women are particularly likely to experience stigma and social disadvantage and to have less social support. They may be likely to come from families with substance use problems and have a substance-using partner, have faced Adverse Childhood Experiences (ACEs) and may have co-occurring mental disorders.

Information monitoring

The emerging information from this monitoring system is not a replacement for more detailed research, as we can only highlight that there are differences and would only be able to speculate on why these differences are occurring, and research is needed to examine why females are experiencing lockdown differently to males. Those working in drug and alcohol services, and commissioners of these and similar services, should be alert to any additional difficulties faced by female clients and seek to explore them in more detail during contacts with female clients.

In the Picture

The parliamentary group discussion moved to Zoom for its first meeting since the crisis hit services, as DDN reports.

The issue around deprivation and inequality is going to come out really strongly.’ Speaking at the Drugs, Alcohol and Justice Cross-Party Parliamentary Group’s first Zoom meeting, Karen Tyrell, executive director of Humankind, was the first of the treatment providers to give an update on the situation since COVID-19 had turned ways of working upside down.

With two-thirds of clients falling into the ‘vulnerable’ category, the organisation was pleased with the way many had switched readily to online support. Staff and commissioning teams had risen to the challenge, but one of the main worries was the drop-off in people coming into treatment – Humankind had seen a third fewer people entering services, and exits were also down as the organisation was trying to keep people in treatment during this unpredictable time.

Laura Bunt, deputy chief executive at We Are With you echoed that the move to remote working overnight had been ‘astonishing’, but that many people who weren’t accessing support were deterred by fear of putting pressure on the NHS as well as contracting COVID. There had been impressive collaboration within the sector, and some innovative developments including trialling a ‘click and collect’ model for needles and other essential harm reduction equipment. But there was also an increase in mental health issues from the boredom, loneliness and a situation that ‘has been really tough for everybody’.

‘We’ve had to put our thinking caps on,’ said WDP’s chair Yasmin Batliwala. Collaboration and communication – between staff, service users, commissioners and other services – had been key to carrying on, including more training through webinars. ‘We’re speaking more to each other than we ever did,’ she said. The crisis had shown that there were opportunities to do more online in the longer term.

Beyond the immediate crisis all the organisations were deeply worried about funding, redirection of resources and the threat of services being decommissioned.

The vital need for sector funding was underlined by Niamh Eastwood, executive director of Release, which had set up a monitoring network to hear about changes in the drugs market.

‘We’ve already had a public health crisis with drug-related deaths,’ she said. ‘If fentanyl arrives it will be a catastrophe.’ The network had been identifying regional issues, such as fluctuations in heroin purity in the north and north east of England and reports of ‘really poor’ quality ketamine.

There was increased use of Xanax, especially among young people, increased use of psychedelics, and a reduction in MDMA use (‘not a drug for physical distancing’).

Diversion was not happening, as ‘people are holding onto their meds’ (mainly methadone) during the crisis. The move to longer-term prescribing had been helpful in making people ‘feel more in control of their treatment’.

A reduction in opportunities for shoplifting and begging had led to increased use of benzodiazepines to replace other drugs. Meanwhile patterns of policing ‘were not proportionate in lockdown’, she said, with an increase in stop and search for low level offences.

Dr Richard Piper, chief executive of Alcohol Change UK, gave a snapshot of the effect on drinking culture. A national survey on lockdown drinking had tested the hypothesis that people would be drinking more, but findings contradicted this. While 21 per cent of people were drinking a greater volume of alcohol (‘binge drinkers’ continuing to binge), many (35 per cent) were found to be drinking less (DDN, May, page 5).

‘Some have decided to protect their immunity, take care of themselves and only drink when out,’ he said, adding that the disruption had enabled people to break drinking routines. There were five times as many people coming to Alcohol Change UK’s website looking for information and five times as many searches around alcohol and health on Google, suggesting that people were receptive to the opportunity to make healthier choices.

Participating in the group discussion, most felt that there were lessons for working smarter after the crisis, particularly around more intelligent prescribing options, tech solutions and web-based support.

But there was also a note of caution about moving to a world of teleconferences and losing face to face contact.

‘The recovery community has responded very strongly with some great web-based support,’ commented Dr Ed Day. ‘But it is no replacement for real face-to-face contact and some people must be falling through the cracks.’

Staying Alert

The sector has risen admirably to the challenges of COVID-19. But it needs to remain vigilant when it comes to what happens next, says Peter Keeling.

If the current emergency has demonstrated anything, it’s the importance of having a robust healthcare system. Drug and alcohol treatment and recovery services form an absolutely essential part of this, but like so many others our sector is facing incredible challenges because of COVID-19.

The fact that services from community treatment to residential rehab have been able to find solutions is testament to both the sector’s innovative strength and the dedication of its key workers. And it’s these qualities that are keeping people safe. But now we need to ask ourselves about the next steps for drug and alcohol treatment, and what lies ahead for the people who rely on our support.

Over the past few months, Collective Voice has been working hard to bring together people and organisations from across the sector, so we can identify key challenges and find solutions that work for everybody. We’ve seen unprecedented levels of collaboration across third sector providers, NHS trusts and commissioners, who have all brought their expertise to bear on what is possible when it comes to provision of OST, face-to-face interventions, supported housing, and many other areas of our work.

It’s far too early to assess the longer-term impacts of changes to these core aspects of treatment and recovery. But even at this early stage it’s clear that many in our field are asking themselves the hard questions of ‘what do we keep?’ and ‘what do we lose?’ The sector has always been a champion of innovation and flexibility when it comes to designing services around people’s needs, and this flexibility has been crucial in recent months. It has allowed us to keep people supplied with life-saving OST medication and food, helped us create safe spaces for women and children fleeing abuse and violence and, almost overnight, allowed the sector to shift to digital ways of working so frontline staff can maintain crucial relationships with their clients and support them in their recovery.

The crisis has also highlighted our sector’s ability to collaborate; not just at national policy level, but also at local levels. Because it’s at these levels that drug and alcohol services have established themselves as key partners in cross-sector initiatives that support some of the most vulnerable people in society. The London Homeless Hotels Drug and Alcohol Support Service (HDAS), brought together to provide treatment for people living in hotels under the government’s rough sleeping initiative, is a perfect example of the kind of innovative, collaborative response the sector is capable of. Similarly in Dorset, Avon and Wiltshire Mental Health Partnership NHS Trust is working with drug and alcohol partners and the local public health team so that council delivery drivers can provide vulnerable service users with OST medications. Across the country, there are many other examples of such collaboration.

These local and national relationships have helped the sector support itself during an extremely turbulent period where quick decisions have had to be made to keep people safe. Areas that already had strong relationships across sectors tell us they’ve been well placed to respond quickly, and councils which already had good relationships with the voluntary sector have stated how critical these relationships have been when mobilising the local response.

The sector has proven itself entirely capable of meeting the immediate challenges of COVID-19, but what comes next? Because as we look to how services will operate in the ‘new normal’, there are a number of issues that are already causing concern.

1. Increased alcohol consumption

The effects of social isolation during the COVID-19 lockdown appear to be having a noticeable effect on the country’s alcohol consumption. Recent research from Alcohol Change UK, while highlighting some positive indications of a segment of the population who are actually drinking less during lockdown, nonetheless showed that around one in five drinkers are drinking more frequently (DDN, May, page 5). The longer-terms effect of such a substantial portion of the population negatively changing their relationship with alcohol could create a potential new cohort of people seeking treatment as they begin to recognise their consumption has changed for the worse. If there is an increase how will it be paid for? None of us have a crystal ball but it seems fair to say there may well be questions over the level of public spending the country can afford and we know that people with drug or alcohol problems are a frequently discriminated-against group.

2. Rough sleeping exit strategy

The move to swiftly house people in hotels and other temporary accommodation during the COVID-19 emergency has, in many ways, been a success story. It has taken enormous energy across different systems from local authority workers to homelessness, mental health and drug and alcohol workers, but as the COVID-19 emergency enters its second phase, the contracts with hotels to accommodate people previously sleeping rough will end. This leaves our sector, and the many other connected parts of the system, with a significant challenge to continue providing support. But it is also an important (possibly never-before-seen) opportunity for services to create pathways into long-term meaningful support for people who have historically sometimes been difficult to engage (see news, page 4). Ensuring continued accommodation obviously needs to be at the heart of the planning for this group, but it will be a wasted effort for many people if the building blocks of wider support are not also put in place – especially access to drug and alcohol treatment.

3. Local government funding

We welcome the £3.2bn commitment by the Ministry of Housing, Communities and Local Government to support people in the most vulnerable of circumstances during this unprecedented crisis. Local authorities have already distributed some of this funding to fortify services that support people experiencing multiple disadvantage, particularly around rough sleeping, and it is testament to the strength of collaboration between local government and treatment providers that our service users have been kept as safe as possible. But since the funding lacks protection, we are concerned that some public health services – including drug and alcohol treatment – will not benefit from its distribution. This funding is needed by a sector that has been forced to take on unexpected emergency costs around PPE procurement, and payment of locum and bank staff to cover staff sickness.

4. Unforeseen consequences of service adaptation

Services have mobilised quickly and effectively to adapt, while both managing risk and maintaining effective support. But there will soon be a need for the sector to properly assess the consequences of these changes and their effects on service users’ treatment and recovery. The remote (and particularly digital) delivery of assessment, key working and more structured interventions has undoubtedly made services more accessible for some people, and the forced changes to OST provision are likely to provide benefits going forward. But there will still be people in desperate need of treatment for whom online services will not be appropriate, and it is vital that these changes are seen as a welcome addition to the range of available services, not as a replacement. At a time when investment in drug and alcohol services may become challenging, and where digital services could be seen to be a cost-saving exercise, the sector must be vigilant as to the effects of service adaptation and ensure an appropriate balance is found.

Finally… We want to pay tribute to the thousands of workers across the country providing essential treatment and support to people with drug and alcohol problems. COVID-19 has shone a light on the extreme vulnerability of many of our citizens, from rough sleeping to domestic violence, and we will continue to push for our sector, and its many unsung heroes, to receive the same level of recognition. But we can only do this with your help and expertise, which is why we’ve launched some new ways to communicate with the field, including a weekly bulletin and an open source Slack community (all details at www.collectivevoice.org.uk). We want to hear from you about how we can best support the sector, so please do get in touch:

June Letters and Comment

Letters may be edited for space or clarity.

Serious stress

I was pleased to read Victoria Hancock’s article about secondary traumatic stress (DDN, May, page 14), especially her call for this to be taken more seriously by senior management. I must confess that although it’s an issue that’s concerned me for a long time, I wasn’t even aware that it had an official name.

I’ve worked in this sector and associated fields like homelessness and mental health Ð for close to two decades, and some of the stories I’ve heard from clients have been truly horrific. Hearing about this kind of trauma and abuse, and witnessing its often still-raw effects on clients, is something that can be extremely difficult to switch off from or forget Ð and I’m not sure what it would say about me if I was easily able to do that.

In my experience it’s not something that necessarily gets any easier, either. I remember asking a colleague how they coped with it early on in my career and being light-heartedly assured that I’d soon ‘toughen up’ Ð the implication being that if I didn’t then I’d probably be better off in some other line of work. Obviously things have moved on since then, but this is still an under-discussed issue and it’s good to see it getting some attention.

Name and address supplied

Best buddies

I read with interest the article about Lancashire’s Recovery communities working together during COVID-19 (DDN, May, page 8) and thought you may be interested in our ‘sobriety buddy’ initiative.

For members of any detox community meetings are a cornerstone of recovery, but this is just not an option for anyone leaving a detox facility right now. So at our Birchwood residential detox centre community in Birkenhead we’ve created a new initiative – each member can have their own personal ‘sobriety buddy’ (see news, page 5). The idea is to provide support for people while they undertake a detox programme, so that support can continue when they return home too.

We realised extra support is needed under current conditions, and so we set about finding volunteers to help service users in this difficult time and be that person on the other end of the telephone with some good sobriety time under their belt.

Research shows that coping with stress and isolation can make a relapse more likely, especially in the early stages of sobriety. When our coping skills are tried, we often revert back to behaviours that are not necessarily serving us.

We offer people this service before they arrive for their detox. During their first telephone consultation with our office we ask if they would like a sobriety buddy to support them. Their buddy will then text first to introduce themselves, and they can move onto talking daily if that support is wanted. There is no better way to learn than from someone who has been there and is happy to share their experience; we are able to guide people on how to deal with difficult life events without resorting to past behaviours and it’s been getting great results.

It’s already been such a success we are going to continue running this after lockdown as the support people have received has made all the difference.

Jo Moore, manager at Birchwood (a Kaleidoscope Project facility), Birkenhead

In solidarity

When I was at school I always thought that I’d make something of my life, do something exciting and follow my dream of helping others. However, it turned out I’d end up on a different path.

I joined the ambulance service the day after my 18th birthday and worked for them for over ten years as a paramedic. Six years ago I developed a brain problem and ended up needing multiple surgeries over the following two years and during this time I was prescribed Oramorph. It turned out that I’d become addicted to it and I never thought I’d end up becoming one of the people I previously cared for. I then began injecting the Oramorph when taking it orally wasn’t working quickly enough. When my prescription was abruptly cut off I went into withdrawals and ended up swapping to injecting heroin and crack cocaine.

After getting myself clean I decided to start a blog to help those who are in my previous shoes and the family and friends of those with an addiction. The blog can be found here at: www.drink-n-drugs.com or on Facebook and Twitter ‘Drink ‘n’ Drugs’. I hope it helps others as writing it helps me!

Dave Richens, by email

In memory of Kevin Knott

Kevin was a great guy who was very popular and loved by all – such an inspirational, funny, caring and genuine individual, fantastic at his job and able to instil confidence in anyone he met. He was a proper character who loved a laugh and was a true legend. It was such a pleasure to have known him over the years and his legacy and treasured memories will last forever.

Gerard Smyth and all his colleagues in Bradford

Zooming in

Technology is helping to make sure that recovery workers and clients stay connected. While it can never take the place of face-to-face working we should retain the best parts of the ‘Zoom boom’, says Charlotte Hadaway

Before lockdown, technology enabled me to do simple things like keep an online diary so everyone knew where I was and who I was seeing, or write up my notes on the hoof using Wi-Fi and phone tethering. When lockdown hit, all this changed. We had to adapt quickly to be able to offer a safe and secure service, and I have to say Together/EDP have been brilliant at supporting us during the changes. We have daily virtual meetings with managers and team members, we’re kept really well informed of developments and what we need to do to keep everyone safe, and we’ve been encouraged to use virtual groups utilising Microsoft Teams, WhatsApp, Zoom and other technologies. I think it’s fair to say that we’ve adapted well and changed the way we work – we continuously share the experience, reflect on what’s working, and keep each other going.

When we started setting up Zoom meetings we didn’t know how tech savvy people were, but I was really surprised that clients jumped at the chance of joining an online group. They really wanted to see each other and know how they were getting on in their recovery. It’s never quite the same as being in the same room, but it’s a great alternative. I don’t think you can beat human contact because you see people’s expressions, you see their movements, you can look into people’s eyes and you can see behaviours better up close. You can still see that on Zoom, but it’s not as powerful as face-to-face.

We are very clear about our meeting rules with Zoom, especially around respecting each other and confidentiality. I find that when people do share their feelings, others still connect well with them – they are very respectful, they are listening to that person and that person feels held by everybody in the virtual group. The online meetings have kept clients in contact with each other. It’s often just talking about the little things that makes people feel they’re part of something. Just knowing they’re being heard is really important.

What will happen beyond lockdown is hard to tell, but I would like to offer an evening virtual meeting going forward. It will be easier for some clients who experience high anxiety or who are trying to work full-time and manage their recovery. I know that just getting to an appointment can be quite stressful for some people, so these digital solutions are a great way for people to have more choice in treatment. I’ve also learnt that it is important to be patient while clients are setting up Zoom accounts, as tech can be daunting for those not used to it.

It’s fair to say that most agree there is a new place for virtual groups post lockdown. Of course, nothing beats face-to-face group work. The interaction between clients can mean everything, especially in early recovery. A hug, a conversation over a cup of tea, a chat in the break – it’s bonding, friendship and fellowship all rolled into one. But to meet online is the next best thing, and I’m looking forward to keeping the best bits as we move forward and offer more choice and variety to our clients.

Grow a little kindness

Samantha Smith shares the Roots project’s successful campaign for Mental Health Awareness Week.

After weeks working from home in lockdown, while the Roots staff are busy supporting the community, my mind started to turn to what we would have been doing if life was still ‘normal’. For the past four years we have put on our annual Walk and Talk (adding cycling in 2019) to mark Mental Health Awareness Week. We would go for a leisurely walk around the Luton area, with service users and local partners, to discuss the important topic of mental health in a more relaxed and open way.

The team of staff and volunteers got to work planting 50 lettuce seeds to grow and nurture into something that we could give out to the community. By 18 May, the team had grown the lettuces, made care labels and were ready to start randomly placing the lettuces across Luton. They went to bus stops, parks and green spaces, doorsteps and various residential streets. All carried the message: #lettucebekind – perhaps the roots to kindness can start with yourself. Be kind to this lettuce and it will repay your kindness.

The campaign was a huge success and had many tweets and messages from excited community members who had found one of the lettuces. The campaign also got a mention on the BBC East Twitter live update and the team was invited to talk about the campaign on BBC Three Counties Radio.

We will be following up with other campaigns over the coming months. It was a huge effort by the whole team and helped to get the message of kindness out there as a gentle reminder that in these days of supposed disconnection we have never been more connected.

Follow the campaign on twitter

SIG launches newly designed website

User-friendly site gives clear signposts to all the services on offer.

Previously, the main SIG website consisted of details about the charity and overall strategic information. Alongside this, there were individual websites for the subsidiaries, Penrose Options and Equinox Care, where visitors could find information on the individual charities and the services they offer. 

There is now one single SIG website incorporating the Equinox Care, Penrose Options and SIG investments information. This provides a seamless integration of the group brand as a whole and includes information on the services offered. 

The new site provides visitors with an easier way to learn about SIG’s services, including who they are, how they work, service user stories, staff blogs and careers pages. It also features integrated social media buttons for Facebook, Twitter, Instagram and LinkedIn to foster improved communication with stakeholders and visitors.

www.socialinterestgroup.org.uk

DDN magazine is a free publication self-funded through advertising.

This content also appeared on The Social Interest Group’s site.

Don’t squander chance to end rough sleeping, urge parliamentarians

The government needs to establish a £100m housing support fund to avoid losing a ‘golden opportunity’ to put an end to rough sleeping, says a report from the Housing, Communities and Local Government Committee. 

The government needs to work quickly to put in place a housing-based exit strategy and the funding to support it, the committee urges. This should be in the form of a dedicated funding stream to allow local authorities to make sure people are securely housed, as well as provide for additional support services for rough sleepers. The government recently denied press reports that it was about to stop funding the scheme to provide emergency accommodation for rough sleepers in hotels.

‘We must praise the efforts of all those who have done so much to help take people of the streets during the current health emergency, but what happens next is crucial,’ said committee chair Clive Betts. ‘It is simply not good enough for anyone to leave temporary accommodation and end up back on the streets. This isn’t just about protecting vulnerable people from COVID-19. It is not safe to live on the streets in any circumstances, and it is not acceptable to allow it to return once the health crisis abates.
 
‘In our report we have called on the government to grasp the golden opportunity that has presented itself,’ he continued. ‘For the first time in over a decade rough sleepers have been comprehensively taken off the streets and given accommodation. This must become the new norm.’

Protecting rough sleepers and renters: interim report available here.

Early Day Motion salutes vital role of treatment services

It also calls for MPs to ensure treatment providers are involved in post-pandemic public health plans.

The statement reads:

That this House acknowledges the vital role being performed by drug and alcohol treatment services throughout the country during the COVID-19 outbreak; recognises that key workers on the frontline of critical service provision are among the unsung heroes who rarely receive the recognition they deserve; commends the dedication with which they have maintained crucial support for a most vulnerable section of our society; expresses its gratitude for the flexibility shown in adapting to meet the needs of service users in these most difficult current circumstances; recognises that the work has been achieved after a decade of depleted resources as a result of austerity and funding cuts; notes that a surge in mental health issues can be anticipated in the wake of such crises; recommends that to help people stay safe, protect the NHS and save lives, future funding for this often-overlooked sector should be safeguarded; and calls on the Government to ensure drug and alcohol treatment providers are involved in shaping plans for post-pandemic public health provision.

Statement, with signatories, here: https://edm.parliament.uk/early-day-motion/56995/treatment-services-during-the-covid19-outbreak

Half of people with gambling disorders have not accessed support

Just under half of people with a gambling disorder have not accessed treatment or support, according to a study by GambleAware. Of those scoring above eight on the Problem Gambling Severity Index (PGSI) – considered ‘high risk’ – 46 per cent had not accessed support. 

The research, which included a YouGov survey, found that up to 61 per cent of the population had gambled in the last 12 months. Overall, 17 per cent of gamblers experiencing harm at any level had accessed support over the last year, with barriers to seeking treatment including stigma, reluctance to admit having a problem and lack of awareness of available services. Perceived stigma or shame was cited as a reason for not accessing support by 27 per cent of problem gamblers. 

In particular, women and people from BAME communities and lower socio-economic backgrounds may ‘not be having their treatment and support needs adequately met’, says GambleAware. Just under a fifth of gamblers from lower socio-economic backgrounds were ‘likely to report that nothing would motivate them to seek support’, researchers said, while women were three times more likely than men to cite practical barriers like time, cost or location as reasons for not accessing treatment. Around 7 per cent of respondents said other people had also been affected by their gambling. 

GambleAware is calling for services tailored to the needs of groups less likely to access services, as well as campaigns to increase awareness and reduce stigma.  

‘This research has shown that there is a clear need to further strengthen and improve the existing treatment and support on offer, to develop routes into treatment and to reduce barriers to accessing help,’ said GambleAware chief executive Marc Etches. 

‘Services have to be flexible to meet the needs of individuals and easy to access. Meeting the needs highlighted in this report will require partnerships between the statutory and voluntary sectors, both those services specific to gambling treatment and other health and support provisions. Working with those with lived experiences is essential in designing and promoting access to services, as well as helping to prevent relapse. It is important to engage community institutions including faith groups, to help make more people aware of the options available to them and ensure no one feels excluded from services.’

Treatment needs and gap analysis in Great Britain: synthesis of findings from a programme of studies available here.

Be kind to yourself

Kindness is all around us lately. But how do we be kind to ourselves?

As a cognitive behavioural therapist I see kindness in the people I work with and support every day

by Beth Marr, cognitive behavioural therapist

Kindness is everywhere at present. We hear stories about acts of kindness on the news, be it frontline staff putting their lives on the line to protect sufferers, or people delivering food and goods to neighbours in need. We see it in the pictures of rainbows on windows, a warm and comforting image depicting hope through the scrawl of a child’s crayon. We can even wear it courtesy of the numerous t-shirts available bearing slogans such as ‘Be kind’ and ‘Keep talking’.

As a cognitive behavioural therapist, much of my working day is spent in the company of people’s hopes and fears. I get to know who they feel they are, who they would like to be, but something that is very often missing is kindness.

I hear of loved ones, I hear of the people who have become their second heartbeat in a way, helping them to breathe through life’s darkest moments, but when we come to look at their own self-image, the words on my notepad take a decidedly harsher tone. ‘Useless’, ‘embarrassment’, ‘ugly’, ‘inadequate’. These words pepper the pages with a sense of resignation – as much a part of the individual’s identity as the blood that flows through their veins.

Read the full article on the We Are With You Blog.

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by We Are With You, and first appeared on

https://medium.com/we-are-with-you

DDN Conference 2022 Information

Please see below for information for delegates and exhibitors 

———–

The venue

The New Bingley Hall, Hockley Circus, B18 5PP –  is a large space approximately 10 minutes in a taxi from Birmingham stations and has ample free parking. We have held events there in the past and it is a large flexible space that allows plenty of room for both presentations and the exhibition area. The venue is all on the ground floor with disabled access.

From 7pm on the night of the 22 June some of the speakers, delegates, exhibitors, and the DDN team are meeting for an informal catch up and ‘harm reduction cafe’ in the Shakespeare Inn, B3 1JJ If you are in town the night before the conference we hope you will join us.

The DDN Team are staying in the IBIS Styles on Lionel Street. Unfortunately we have been unable to secure a reduced rate or block booking. Please book your hotel independently on booking.com or similar sites. 

Travel Updates

The venue is on the outskirts of Birmingham with ample free parking and well connected to the main road network meaning most delegates travel by road. If the proposed rail disruption means you are looking to make alternative arrangements please check out the DDN social channels and the hashtag #ddnconf to arrange carsharing.

Delegate Names

If you have booked as part of the CLERO or made an individual credit card booking we already have your details. If you have made a booking directly with DDN as part of an exhibition package or group booking please use this form to add the names of people attending. 

Conference Timings

Delegate registration will be from 9am and the main conference sessions will run from 10-3pm with additional breakout meetings and sessions running until 5pm. There will be tea coffee and refreshments on arrival with further refreshments throughout the day including a full cooked lunch!

The programme

We are running presentations from the main stage throughout the day (with breaks for lunch and refreshments). We are committed to focussing on projects that are led by people with lived experience and support people to engage with wider services. A full programme will be available shortly.

Exhibitor information

Exhibitors will have access to set up stands from 8am on the morning of the conference. There will be limited availability to drop stands and materials off at the venue between 2-4pm the afternoon before (22 June) but you will not be able to set your stand up until the morning of the event. If you would like access to drop stuff off on 22 June please email to be added to the list.

Exhibition stands can be dismantled after the lunch break (approximately 3pm) although you are welcome to leave your stand up until the end of the day.

Exhibition Stand details

You have an exhibition stand which will be a tabletop and chairs. If you need power for your stand, require more space or have specific requirements please email to request them. 

As those of you who have attended before will know this is a vibrant area at the heart of the event and interactive stands and giveaways are incredibly popular. 

Delegate bag inserts and information for couriers

If you are sending inserts for delegate bags or would like to courier stands etc in advance this is being coordinated by our partners at Changes UK. The deadline for bag inserts is Friday 17 June at 5pm (please send 500) and deliveries for stands must be received by 5pm Tuesday 21 June at the latest. If you are couriering materials in advance please email to be added to the list. 

Please mark all deliveries clearly as DDN Conference 2022 and send them to:

Attention Stacey Smith, Changes UK, Recovery Central, 9 Allcock St, Birmingham B9 4DY. Contact number for couriers is 0121 796 1000.

If you are arranging couriers to pick up stands etc after the event please let know in advance. Stands must be picked up from the venue on the day of the conference unless you make prior arrangement.

Delegate names

If you have not already done so please add names of people attending as part of your group using THIS FORM

I hope this helps you prepare for what should be a fantastic, interactive, energetic and inspiring event.

If you have any questions or would just like to discuss the event or DDN magazine please don’t hesitate to contact 07711 950 300

Government denies imminent end to rough sleeper funding

The Ministry of Housing, Communities and Local Government (MHCLG) has denied claims that it will no longer be funding the scheme to provide emergency accommodation for rough sleepers in hotels (DDN, May, page 5). A story in the Manchester Evening News on 14 May stated that civil servants had told Greater Manchester Combined Authority officials that the scheme was ‘no longer being funded by central government’, that March’s original COVID guidance to local authorities had ‘been scrapped’, and that a leaked report said that MHCLG had now ‘drawn a line’ under the programme.

More than 90 per cent of rough sleepers known to councils at the beginning of the COVID-19 crisis – around 5,400 people – had now been ‘made offers of safe accommodation’, the ministry added, stating that it would ‘work with partners to ensure rough sleepers can move into long-term, safe accommodation once the immediate crisis is over’.

The government came in for significant criticism from homelessness organisations at the start of the outbreak for failing to provide them with adequate guidance or explain how people sleeping rough or in hostels were expected to self isolate. It later instructed all local authorities to find emergency accommodation for rough sleepers by the end of March.

 Details of No going back campaign at www.mungos.org – read it here

Tsunami of Need

Phoenix Chief Exec Karen Biggs blogs about the impact of COVID-19 on the people who rely on drug and alcohol treatment services.

The COVID-19 pandemic has brought many people in society to a crisis point. People who were already struggling to access the health and social care they desperately need. When society opens its doors again it will reveal a tsunami of need which we should be ready to meet.

Many people use drugs and alcohol to try to numb pain and smother deeply traumatic experiences. Many more of us would too, if faced with similar circumstances. People who use drugs have always been invisible; labelled as ‘hard to reach’ or ‘too complex’.

They are not; the reality is that decision-makers and funders haven’t spent the time and money required to reach out, understand and help. There are many reasons for that – poverty, entrenched stigma across society and the sense of some people are more deserving than others. What is clear now that is that we don’t need to argue anymore about whether or not that is true. It is fact, proven, accepted and understood – no matter how hard it is to stomach.

‘Funding reductions are exacerbating gaps in treatment provision. As funding pressures have increased some services have disappeared altogether (such as outreach service targeting newer users), whilst others have been rationed (such as inpatient detoxification for people with complex and multiple problems heroin assisted treatment and residential rehabilitation.)’
Professor Dame Carol Black

So, what happens when people who are already struggling to stay alive lose the fragile links to the support they have? Lose the opportunity to be with others with the same shared experiences of life? When people lose their sense of belonging? The answer: negative thoughts, relapse, self-harm, overdose, suicide and death.

Read the article at

www.phoenix-futures.org.uk

———–

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Phoenix Futures, and first appeared on their site. Read this and more article like it on

www.phoenix-futures.org.uk

Why COVID-19 will change social care for good

COVID-19 and its impacts will be widespread and felt for years to come. Nowhere more so than in social care, says Julie Bass, chief executive of Turning Point

For too long it has been the neglected sibling of the NHS. But the care sector is now receiving the acknowledgment it deserves as are the thousands of skilled staff who have dedicated their lives to looking after some of the most vulnerable people in society.

From claps for our carers to government recognition that funding for adult social care is a top priority, something is finally changing.

It would have seemed unimaginable a year ago that neighbours would come together at 8pm every Thursday night to join a chorus of thanks and appreciation for everyone working hard throughout the NHS and in social care. The cheering and saucepan banging is wonderful recognition for those going out on the frontline every day to treat those in great need and to support the rest of us to keep safe.

Giving credit to hard working doctors, nurses and all NHS staff in the direct path of this virus is, of course, extremely important. Alongside this, valuing the role of care staff and other public sector key workers marks a significant change.

Read the full article at www.turning-point.co.uk

——–

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content first appeared in the Turning Point blog

WDP and Hermes deliver essential items to Capital Card users during COVID-19 pandemic

Leading drug and alcohol charity WDP has partnered with Hermes, one of the UK’s largest parcel delivery companies, to provide its most vulnerable Capital Card users access to essential items during the coronavirus pandemic through a home delivery service.

This innovative partnership means that service users who are currently unable to leave their place of residence, whether because of self-isolating or mobility issues, can place orders for essential items that they would usually ‘buy’ in their local WDP service’s pop-up shops, such as toiletries and non-perishable items. Hermes will then deliver these orders to the service user’s door within one week, as part of the Capital Card ‘Shop on Wheels’ initiative. While WDP services remain fully operational, social distancing guidelines dictate that the pop-up shops cannot currently open on-site.

Hermes is generously providing delivery options in 11 different WDP service locations across Greater London and Cheshire West and Chester, meaning ten packages per week per location can be delivered to service user homes.

Yasmin Batliwala, Chair of WDP, said: ‘We are excited to be partnering with Hermes to support our service users during these difficult times. Our Capital Card team are doing everything they can to find new and innovative ways to support our service users, and this news is yet another example of their hard work and dedication and exemplifies everything that WDP is about. We welcome Hermes into the Spend Partner family and thank them wholeheartedly for enabling us to provide safe and secure access to essential everyday items for our most vulnerable service users without them needing to leave their homes.’

Sasha Law, head of internal comms and engagement at Hermes, said: ‘We’re proud to be able to support the Shop on Wheels initiative, which is a great cause, and we’re pleased to be able to use our network to support some of the most vulnerable in society. Hopefully this support will help make a positive impact and enable WDP to continue their valuable work.’

Read the full article and find out more about the Capital Card on www.wdp.org.uk/news

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by WDP, and first appeared on www.wdp.org.uk

New helpline for prisoners released during pandemic

A new free-phone helpline has opened for men and women in the North East who are being released from prison during the coronavirus crisis.

‘Changes community based services have had to make alongside the Ministry of Justice initiative to release some people from prison early have prompted us to launch this additional support for drug and alcohol recovery clients leaving North East prisons,’ said Amy Levy, of Humankind, which is based in Bowburn, Co. Durham. ‘We hope to provide information and guided signposting to services and support which is already available across each local authority area in the North East.

She added, ‘There’s considerable evidence that confirms the first few weeks following release as being a critical period during which men and women face a range of increased risks.’

The helpline will point callers to community drug and alcohol service provision, local pharmacy information, local authority housing support and support hubs for vulnerable people, Job Centre Plus and a wide range of community support projects. Links to Probation will also be key for those men and women released on any form of licence, including those released under the early release scheme.

Humankind provides the non-clinical drug and alcohol recovery service element of the new Reconnected to Health service led by Spectrum Community Health CIC.

The Reconnected to Health partnership, which also includes Tees, Esk & Wear Valleys NHS Foundation Trust (TEWV) provides integrated healthcare to men and women resident across the region’s seven prison establishments – Durham, Frankland, Holme House, Low Newton, Northumberland, Kirklevington Grange and Deerbolt. The service is commissioned by NHS England. 

All drug and alcohol recovery clients leaving prison in the North East will get details of the helpline in their release packs. Information about local services, including links and telephone numbers, will be held on a dedicated page on the Humankind website.

Weathering the storm

While COVID-19 is wreaking havoc on the vulnerable, the economy and society as a whole, it is also generating – by necessity – some new and innovative ways of working. DDN reports.

With the UK’s lockdown now in its second month, everyone has had to adjust to the ‘new normal’. However, in much the same way that COVID-19 can be far more damaging to people with weakened immune systems or pre-existing conditions, so it has the potential to cause disproportionate damage to sectors already depleted by year after year of shrinking budgets. Whether the inevitable recession that comes in its wake will lead to greater austerity, or whether renewed respect for health services and – perhaps – a different attitude to society’s most vulnerable might see the drug and alcohol sector get off relatively lightly (DDN, April, page 7) is yet to be seen.

In the meantime treatment services, like everyone else, are having to get by as best they can. Substance misuse staff have been designated as key workers eligible for COVID-19 testing if they display symptoms and for school-based care for their children, which means the sector is able to function better than most. Arrangements have also been made to try to ensure people can get their substitute medication, and organisations have also been able to move elements of their support online.

Guidance

The government published its guidance for treatment services and commissioners on 15 April (see news, page 4) which – alongside instructions to minimise face-to-face contact, scale back hep C testing and defer detoxes – recommends increasing provision of harm reduction measures including naloxone, and encourages services to increase stock held by NSPs and allow people to take more equipment. The guidance also advocates new ways of working, such as by phone or video call, something most organisations were already doing.

‘I do think that the drug and alcohol sector were getting on with it ourselves because of the very nature of what we do,’ director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill, tells DDN. ‘But I think what the guidance did was offer reassurance. One example was that staff were recognised as key workers. That alone really helped me and the management teams realise we’d be able to manage staffing levels and safeguarding better.’

‘We were heartened to read the guidance, especially as WDP had already implemented the overwhelming majority of it,’ agrees WDP chair Yasmin Batliwala. ‘The guidance is sensible and comprehensive but will of course need to be updated to suit the ever-changing situation, particularly as lockdown restrictions are eased and we begin the return towards normal service operation – albeit with stringent protection measures in place.’

WDP has moved support to online resources, videoconferencing facilities and phone appointments where it’s considered safe for the service user, although it also continues to safely operate in-person appointments. ‘Our IT department has also rolled out a large amount of equipment and support in a short space of time, for example a desktop phone system used on tablets to allow staff to make and receive calls using the usual service number,’ she says.

It’s possible that one of the long-term impacts of all of this might be a shift towards more online support and counselling generally, although clearly there are areas where this will be far from ideal. ‘We’ve been adapting the model and the programme where we can to offer virtual support and virtual counselling,’ says Crompton-Hill. ‘Some staff in our residentials aren’t used to working digitally so I’m really proud of how quickly that culture’s been adapted, and we’re starting to think about how we can enhance services going forward. Given that when we come out of the actual crisis we may be left with a reduction in funding, can we do more in the style that we’ve had to adapt to? But there are lots of mutual aid groups operating virtually at the moment and what’s key to mutual aid is actually going out there and socialising with people in similar situations – having that connectedness and those one-to-one chats. So although people have done their very, very best, those sort of things will be really impacted, so it’s just trying to get the balance right. I think we’ve just got to hope as a sector – and fight a bit – to try to get back to where we were in terms of our offer and delivery.’

Unprecedented

The unprecedented operating environment has meant that organisations have needed to come up with other alternative ways of working. While the lockdown has inevitably forced the partners who provide the rewards for WDP’s Capital Card scheme (DDN, February 2019, page 6) to close, the organisation is securing a free-of-charge arrangement with a national delivery company to deliver essentials like clothing and hygiene products from Capital Card shops – normally located in services – direct to service users’ doors. While keen to return to normal operating models, WDP will ‘certainly be able to boost our offer with a lot more home participation for service users in the future,’ says Batliwala. ‘This should really help the momentum of recovery journeys between in-service appointments.

Support

Although it’s been a period of rapid change, the local authorities commissioning WDP’s services have been ‘extremely supportive, which has been a big help’, she adds. ‘It’s been a real two-way process – there’s been a real sense of really wanting to help us with PPE, for example, which has been really welcome,’ agrees Crompton-Hill.

‘We’re proud of the way all WDP staff have risen to the challenge with both dedication and innovation,’ says Batliwala. ‘To say thank you to them doesn’t seem nearly enough. The fact that we’ve managed to still provide both an in-person and remote service in all areas has been a huge success. We’ve maintained very regular communication, guidance and encouragement to staff throughout, and have done whatever we can to boost morale in small ways such as pizza lunch deliveries and ‘fresh fruit Mondays’. We have also vastly expanded our online support for staff, including workouts, weekly wellbeing webinars and tips for effective home-working and coping with lockdown in general.’

Long-term impact

What no one knows, of course, is what the long-term financial impact of all this is going to be on the sector. ‘A lot of the work we’re doing at the moment is looking at the “what if?” and factoring in the financial implications of that as a business,’ says Crompton-Hill. ‘I think what we need to try to do as a sector is use what we’ve learnt over the last month to see if we can step up to what those financial challenges might be, for example can we do more digitally so we can see more people? We don’t want to have to do that because a lot of our services run on being able to come together, but we may have to.

‘One of the things I’m proud of is the staff and their resilience, and their ability within a very short time frame to adapt their everyday practice,’ she continues. ‘We’ve been specifically helping with homelessness. We looked at all the beds we had available and with every service that had a bed it was, “can we help?” Everyone mucking in together has been a real theme over the last month.’

Another thing that the crisis has reinforced is the vital importance of effective communication. ‘Really open and transparent communication has been key,’ she states. ‘I’ve had that from the local authorities we work with, and we’ve done that with all of our clients in treatment, all of our staff, partners – it’s really helped us through this. I’ve never had as much communication coming through, and I’ve never sent as much out. But I think that helps people feel fully informed, and it’s been a real key thing for me. You’ve not felt alone in the process.’

Scots widen availability of naloxone

The Scottish Government has widened the availability of naloxone as part of a package of support for people affected by drug use during the COVID-19 pandemic.

Under current UK regulations, only drug treatment services are allowed to supply take-home naloxone kits. However, Scotland’s lord advocate has confirmed that it would ‘not be in the public interest’ to prosecute anyone working for a service registered with the Scottish Government – for example, a homelessness organisation – who supplies naloxone for use in an emergency during the crisis. Non drug treatment services will need to register with the Scottish Government to become a naloxone provider.  

‘While this public health crisis is ongoing, we must not lose sight of the fact there continues to be a significant number of highly vulnerable individuals who are at great risk of harm as a result of alcohol and drug use, who continue to need a wide range of help and support,’ said public health minister Joe FitzPatrick.

‘Buvidal is an alternative to methadone or buprenorphine tablets which is administered by a seven or 28-day injectable dose, rather than daily administration. By making this available to people in prisons, we will support continuity of care, while reducing the need for daily contact and reducing pressure on our frontline prison officers and NHS staff.

‘I welcome the lord advocate’s statement of prosecution policy in respect of the distribution of naloxone during the period of disruption caused by COVID-19,’ he added. ‘This will help to ensure that we can continue to support those affected by drug use and keep them safe.’

A new normal

Within days of lockdown being announced, Lancashire’s recovery communities had transformed their way of life on a grand scale, as Chris Lee explains.

We are all living with significant changes as a result of the threat posed by COVID-19. For some this is just another factor in busy lives, for others it’s a real threat to a safe and functioning lifestyle. The pressures of isolation, worries about money, housing, food, keeping children occupied and all of us safe will be creating untold pressures and risks for some.

The UK recovery movement might have drifted from the popular narrative, however in parts of the country, thriving, diverse recovery communities are adapting to the ‘new normal’. We wanted to highlight how two organisations, Red Rose Recovery/Lancashire User Forum (LUF) and The Well Communities are adapting to support those in recovery and beyond.

Lancashire has had a sustainable and thriving recovery scene for well over a decade. This had led to well-developed peer support structures, training, employment, group work, activities, volunteering and more. All of this is delivered very much as an asset-based community development approach – local people with lived experience supporting other local people with lived experience.

The Old Normal

In the current circumstances, some ‘normal’ work is still ongoing, albeit under the guidance of physical distancing, use of appropriate protective equipment and essential journeys:

• In the early days of lockdown donations of food and toiletries from high street retailers were delivered to the elderly, homeless and vulnerable, along with packs from Lancashire Fire and Rescue Service.
• Volunteers have been supporting the delivery of more than 600 meals a day to feed individuals who are vulnerable, isolated, quarantined or shielded in local communities; information about digital support is distributed through the food parcels.
• Local treatment providers have been supported to deliver naloxone and safe storage boxes
• Support has been given to individuals in recovery housing.

However, with no face-to-face mutual aid running and normal peer support ‘suspended’, a dramatic shift to digital provision has been implemented locally to do all we can to ensure no one is left behind. Both Red Rose Recovery and The Well Communities have rapidly embraced digital tools and shifted support online within days of the UK lockdown coming into force. This emphasises the flexibility of community organisations and the principle of building delivery around those who use them.

This isn’t perfect, but sharing the learning has been key to the success of recovery communities locally. One simple issue has been to try to buy mobile phones and credit for those with no resource and therefore at risk of isolation, or to actively support people to download software and give tutorials to support access.

The New Normal

Employed workers and volunteers in the recovery communities are desperate to help those in need in any way they can. It took a while to get them to recognise the severity of the situation, the risks involved and to adapt to new ways of working. However, now as always, they have proved how they adapt quickly and develop new skills to enable work to continue safely.

The ‘new normal’ is being supported with daily team Zoom meetings (other platforms are available), and regular outreach is now via telephone and social media platforms and tools – WhatsApp and Facebook. This aims to replicate as far as possible the principles of pre-COVID delivery but with the added bonus that group work is now open to all without geographical restrictions.

Since the lockdown began:

• more than 15 online support groups are running each week with regular participation
• live exercise classes (weekly) achieve around 100 views per session and active participation
• recovery shares (weekly) are viewed by up to 500 people
• live topic broadcast (with field experts) are viewed by up to 700 people

Both organisations have also inadvertently created ‘flagship’ broadcasts. Red Rose Recovery and the Lancashire User Forum developed the ‘LUF Lounge’ on Saturday evenings at 5pm – hosted on Zoom and broadcast to Facebook as a live stream. The Well have been using Facebook to live stream for broadcasts on Monday and Friday each week at 12 noon. Both events have drawn in both local and national figures to update, educate, support and entertain our recovery communities.

Both organisations have been collaborating to share experience of the technology, to support each other’s approaches in reaching out and provide meaningful content for the local recovery communities – and beyond. Digital delivery has meant reaching recovery communities in Wales, Australia and New York!

New partnerships are appearing as a result of the new digital world, for example working with local housing providers to support delivery of food parcels in the physical world and support them to access the online offer.

The Lessons

What are we learning as a result of all this?

• Isolation and mental health have been key issues raised, especially from those in supported housing as they are almost confined to their bedrooms (although we know that not all are keeping to lockdown rules and meeting up with friends etc).
• People are struggling when they are unable to see their children and other family members; this is also undermining some people’s mental health.
• There is a perceived increase in relapse; local treatment provision has seen an increase in referrals.
• Another key concern is that those who have experienced crime, assault or dispute are desperate for personal contact, something no digital transformation can ever overcome.
• Facebook and Twitter followers are rapidly increasing alongside significant increases in requests for support.
• The beauty of digital is that the analytics are available to help inform reach. We can see an unprecedented surge in views with a global reach from the broadcast events so far.

The future

This has yet again highlighted the inherent value of community organisations and community participation. It has shone a light on the need to address digital inclusion and ensure people have access to the right tools to enable participation, alongside other existing social, economic and health inequalities.

Plans are currently being developed to build on these early developments and to bring along other groups who wish to join in, to build digital inclusion, develop the new digital skills and embrace what technology has to offer. This will include technical, social and policy development needs.

The future is clearly unknown. When will lockdown measures begin to ease, how will that happen and what restrictions will remain? All are questions that society as a whole will be grappling with. What is certain is that the digital shift in delivery for recovery communities locally is here to stay. Yes, the physical world is important and digital cannot replace much of ‘normal’ recovery activity. However the ability to reach out beyond borders (of whatever sort), to share stories, experiences, music and thought in times of crisis is aided by digital platforms. The increased connectivity is making a difference, for example people who suffer with anxiety or those living in rural communities. We can’t just go back to ‘normal’.

FIND OUT MORE

Chris Lee is public health specialist at Lancashire County Council

Peter Yarwood, strategic engagement lead, Red Rose Recovery,

David Higham, CEO, The Well Communities,

LUF Lounge: www.facebook.com/groups/279396408828996

The Well Communities: www.facebook.com/groups/thewellcommunities/

DDN May 2020

‘We’re learning about new versions of outreach’

WE’VE HAD TO CHANGE OUR PLAN for this issue several times this month as your news and survival tips have been coming in.

Tweeting their invitation to the LUF Lounge on a Saturday night, Red Rose Recovery offer ‘community and connection with a whole heap of compassion’ and this spirit is playing out through the Lancashire recovery communities, with their ‘dramatic shift to digital provision’ (page 8). Particularly exciting are the partnerships that are forming from this ‘new digital world’.

Last month we raised the issue of delayed scripts through a ‘plea from the pharmacy queue’ and there’s been a lot of hard work going on to improve the situation. The clinical and prescribing team at Humankind are among those working round the clock to ensure no one is ever without medication (page 13).

Carry on the great work and new ideas – and share them with us! Community means more than ever right now.

Keep in touch  and @DDNmagazine

Read the issue as an online magazine or download the PDF

Staying on track

What does COVID-19 mean for hepatitis C elimination plans in London? Dee Cunniffe gives an update.

Two months ago, on 2 March, senior leaders from across the NHS, addictions sector and public health in London came together at City Hall to kick start work on a new routemap to eliminate hepatitis C in the capital. The World Hepatitis Alliance hailed the partnership as ‘an example of best practice that could be replicated in cities across the world’ and support for this initiative from every connected sector in London has been impressive.

However, just days after our ‘kick start’ event, the enormity of the impact of COVID-19 started to unfold. That seems like a lifetime ago now, and since then the NHS has completely reconfigured to create capacity for coronavirus patients, and all outreach and addictions support services have had to adapt to supporting people remotely.

So, where does that leave our plans for eliminating hepatitis C? While people who had started treatment are being supported to complete it and become hepatitis C free, outreach testing and treatment initiations have paused in most places, and some hepatologists have been redeployed to COVID wards.

We know this is not forever and Matt Hancock has already started talking about the restoration of other NHS services. This will require substantial service reconfiguration in many places and will take several weeks, maybe months for some areas.

Creativity and fresh thinking will be required to ensure that healthcare challenges, such as finding the undiagnosed people who are living with hepatitis C, are not worsened in the long term due to this crisis. For example, we will need to think more creatively about how we raise awareness and provide information and support online, and whether self-testing could be used, as it has for HIV.

The steering group for the routemap brings together senior representatives from Public Health England, local government, NHS England, addictions service providers, homeless services, CCGs and The Hepatitis C Trust. While many of these people and their organisations are completely focused on combatting COVID-19 at the moment, they are all also deeply committed to the goal of eliminating hepatitis C. No one wants progress made in addressing hepatitis C to be another victim of COVID-19.

There is one thing that has been constant in my experience of working in the hepatitis C field for the last ten years: progress has always been built on the passion and dedication of an army of incredible people, from people with experience of living with hepatitis C to nurses, consultants, addictions support workers, and many more. I know that we will all rise to the new challenges and, as a ‘new normal’ develops, ensure we continue to make progress to our goal of eliminating hepatitis C.

Key Areas for Action

Five Key Areas for Action

The routemap to eliminating hepatitis C in London has five key areas for action – raising awareness, engaging with people who are under-served by traditional health systems, working with GPs to find the undiagnosed, making pathways as quick and easy as possible, and aligning hepatitis C and HIV Fast Track Cities Initiatives.

1...111213...42Page 12 of 42

What school of psychology is most associated with research on learning?

When learning takes place as a result of imitating a model it is referred to as?

What part of the brain is most associated with the positive aspects of reinforcement?