Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Against Violence and Abuse (DP013)

Against Violence and Abuse (AVA) is a national second-tier charity working to end all forms of violence against women and girls. AVA’s Stella Project was formed in 2002 and is the leading UK agency addressing the overlapping issues of domestic and sexual violence, problematic drug and alcohol use and mental health. Our written evidence covers five of the Committee’s areas of consideration, and our responses focus specifically on the experiences of women with multiple needs in relation to drug use, domestic and sexual violence and mental health.

1. The extent to which the Government’s 2010 drug strategy is a “fiscally responsible policy with strategies grounded in science, health, security and human rights” in line with the recent recommendation by the Global Commission on Drug Policy

1.1 The 2010 Drug Strategy promotes a “whole systems approach” to recovery from drug dependency, highlighting the need for a range of supports to be available “to address the needs of the whole person.”1 For women drug users specifically, drug use is often just one of multiple needs: around 40% of women accessing drug services report current experiences of domestic violence,2 and women with multiple experiences of violence are 5.5 times more likely to be diagnosed with substance use disorders and three times as likely to be diagnosed with any mental disorder.3 For these women, a whole systems approach is a commendable public health approach which acknowledges the wide range of needs that drug users may have in working towards recovery.

1.2 However, the Government’s accompanying policy of Payment by Results (PbR) in fact risks the implementation of a whole systems approach for those users with the most complex needs. Women experiencing overlapping drug dependency, domestic violence and mental health problems are often perceived by workers as difficult to support and less likely to reach recovery, risking “cherry-picking” of clients perceived as being more likely to achieve PbR outcomes. Furthermore, PbR may encourage practitioners to pursue outcomes with service users which are unattainable and potentially put clients in danger, such as promoting couples or family counselling to “improve family relationships” with survivors and perpetrators of domestic violence.

1.3 Furthermore, the Government has placed responsibility for funding its “whole systems approach” with local authorities, whilst at the same time cutting local authority budgets and freezing council tax. It remains unclear as to how effectively local authorities will be able to fund holistic services and a whole systems approach in this context. For organisations delivering PbR, requirements to deliver results prior to payment means that small, specialist voluntary-sector organisations will not have the reserves to take these contracts. For women, who make up a minority of drug treatment users, this makes it less likely that specialist services targeted at their needs will continue to be viable. Projects such as the Together Women centres in Leeds, Doncaster and Bradford and ISIS Women’s Centre in Gloucester deliver excellent outcomes using women-centred approaches that target individual needs, but as relatively small, specialist providers, they tend not to have the reserves available to make PbR a realistic option. It is more likely that under PbR, specialist women’s projects will either have to secure funding as part of a consortium with other organisations, or will merge with larger organisations. Consortiums are often problematic, diverting scant resources to the building and management of the relationship between organisations, whilst merging with a larger organisation can shift the priorities away from the project’s specialism towards the wider priorities of the larger organisation, skilled staff are often lost, and the project has less flexibility and opportunities for innovation. In the violence against women sector, the problem of mergers has been most evident in the loss of local, specialist refuges for black and minority ethnic women to national women’s organisations.

1.4 Throughout, the Drug Strategy focuses strongly on recovery, without identifying the potential human rights concern of coercive treatment. The Government has indicated that 80% of PbR funding will be tied to abstinence from drugs of dependence (which includes substitute prescriptions),4 is piloting drug recovery wings in prisons, and continues to divert offenders from prison and into treatment through Drug Intervention Programmes (DIPs). However, these approaches do not necessarily address the reasons why many women use drugs, nor the additional problems that criminalisation of women drug users creates.

1.5 Around half of all women in prison are survivors of domestic violence and a third have survived sexual violence.5 For many women, drug use is a coping mechanism for their experiences of violence and a strategy for regulating mental health symptoms,6 and coerced drug treatment (in prison or the community) can compel women to stop using these coping strategies, without then providing trauma-related treatment and support to address the underlying problems with which their substance use is associated.

1.6 Before funding drug-recovery wings in prison, a fiscally responsible public health and human rights approach would ensure that services are available to fully support women’s multiple needs before they reach the point of a custodial sentence. These services, such as those which are part of the Women’s Breakout network,7 are already in existence in some areas of the UK, but suffer from short-term and insecure funding.

1.7 A strategy grounded in human rights would also have given serious consideration to drugs and race inequality: the Drug Strategy mentions ethnicity obliquely, noting just once that services need to be responsive to the needs of different protected groups. Ethnic minority women are over-represented in the female prison population and are much more likely than white women to be detained on drug offences.

1.8 Of all women imprisoned for drug offences, 35% are foreign nationals.8 The Drug Strategy indicates that the Government will “take action at all levels of the distribution chain,”9 but this hard approach fails to recognise the differences between different actors in that distribution chain. Foreign national women in custody are often drug couriers, who the Global Commission on Drug Policy argues “do not usually have an extensive and violent criminal history . . . We should not treat all those arrested for trafficking as equally culpable—many are coerced into their actions, or are driven to desperate measures through their own addiction or economic situation.”10

1.9 73% of women imprisoned for drug smuggling into the UK are first time offenders, many are single mothers and come from a background of extreme deprivation.11 Custodial sentences are expensive, and given the background experiences of many of these women, the Drug Strategy’s commitment to take action at all levels of the distribution chain does not seem to be consistent with a human rights approach which requires proportionate responses.

2. The cost effectiveness of different policies to reduce drug usage

2.1 Recent research, conducted by the Revolving Doors Agency, investigated the cost effectiveness specialist, holistic women-only support services for women with multiple needs, including problematic substance use. The projects they evaluated offered community-based holistic support to adult women, support was needs-led and not tied to accommodation or substance misuse services (although access to these was available), and focused on reducing reoffending by addressing underlying issues.

2.2 Revolving Doors found that for women with multiple needs (including experiences of childhood trauma such as domestic violence, problematic substance use, involvement in prostitution, mental health problems and contact with the criminal justice system), support from specialist women-only services resulted in savings over five years of between £47,145 and £264,108 per service user.12 This included savings to the Ministry of Justice, Home Office, Communities & Local Government, Department of Health, Department for Work & Pensions and local authorities.

2.3 The same research found that without support that addressed these multiple needs, women were “likely to experience a slow build up of problems leading to a custodial sentence after approximately 4.5 years.”13

3. The comparative harm and cost of legal and illegal drugs

3.1 The way in which illegal drugs are currently classified under the Misuse of Drugs Act 1971, as well as the choices made about which drugs remain legal, is not broadly reflective of the comparative harm and cost of different drugs.

3.2 Alcohol remains legal and widely available, despite its harms to individual users, to families and communities, and the burden of cost it places on the public health system. In the UK, alcohol is the drug that causes most harm, when you take into account harms to both the individual user and harm to others.14 For women specifically, although alcohol is not a causal factor in domestic violence, alcohol use by perpetrators is associated with increased risk to the victim of serious physical injury and death.15

3.3 On the other hand, some of the harms to women who use Class A drugs, and their children, are directly related to the fact that these drugs are illegal. Over 20% of the female prison population is incarcerated on drug offences,16 and the majority of women in prison were single with dependent children at the time of their imprisonment.17 Drawing on evidence of the wide range of harms children of prisoners suffer, the New Economics Foundation has estimated that the costs to children, and the state, of mothers’ imprisonment for non-violent offences to be £17 million over 10 years.18

3.4 Research for the Stella Project in 2005 found that cannabis was the most frequently used illegal drug amongst survivors accessing domestic violence services, and men accessing perpetrator programmes also cited cannabis as the illegal drug most frequently used by their abused partners.19 Despite cannabis being much less harmful to individual users and others than other drugs, including alcohol, it is still scheduled as Class B with a maximum sentence for possession of five years imprisonment. Given what we know about women’s use of drugs to cope with trauma and the prevalence of cannabis use in particular, alongside the harms of women’s imprisonment, the current criminalisation of cannabis users seems disproportionate to its harms.

4. Whether detailed consideration ought to be given to alternative ways of tackling the drugs dilemma, as recommended by the Select Committee in 2002 (The Government’s Drugs Policy: Is It Working?, HC 318, 2001–02) and the Justice Committee’s 2010 Report on justice reinvestment (Cutting crime: the case for justice reinvestment, HC 94, 2009–10)”

4.1 The Justice Committee’s Cutting Crime report recommended that Government policy reflects the key priority of significantly reducing the prison population by 2015, “especially concentrating on women and those whose criminality is driven by mental illness and/or addictions to drugs or alcohol”20 (Cutting Crime, p 7–8).

4.2 In 2002, the Select Committee recommended that existing classifications of drugs should be reviewed, focusing specifically on cannabis.21 This recommendation was pursued, with cannabis being re-classified as Class C in 2004, but unfortunately in 2009 it was again re-classified as Class B (against the recommendations of the Advisory Council on the Misuse of Drugs22). Further to our discussion above of the problems with the classification system, it is time to re-examine proposals to the 2002 inquiry for the decriminalisation of personal possession.23 Decriminalisation of personal possession would recognise the complex reasons for women’s substance use, avoid further penalising women who are attempting to cope with responses to trauma, as well as avoiding the negative impacts of women’s criminalisation. In Portugal, decriminalisation has resulted in reductions in drug-related crime and diseases such as HIV,24 and levels of cannabis use in the past 12 months are less than half that of the UK.25

4.3 It is important to note, however, that decriminalisation of personal possession would not address the problems associated with female foreign-national drug couriers. The Government’s determination to act at all levels of the distribution chain ignores the fact that there is no evidence that prosecuting drug couriers has any impact on the availability of illegal drugs in the UK.26 Approaches to these women must recognise their vulnerabilities and the associated reasons they participate in the distribution chain. This may include a review of whether prosecution of these women is in the public interest, and cross-departmental work between the Home Office and the Department for International Development to reduce foreign women’s vulnerability to involvement in drug trafficking.

5. Recommendations

5.1 The Government must ensure that the funding strategy for its whole systems approach does not discriminate against women with multiple needs: specialist, holistic, local women’s services should be sustained and expanded.

5.2 The Government should ensure that women drug users with past or current experiences of domestic and sexual violence have access to treatment that addresses their responses to trauma. This is particularly important where women are compelled to access drug treatment by the criminal justice system.

5.3 The Government should reconsider decriminalising personal possession of illicit substances.

5.4 The Government should review whether its commitment to act at all levels of the distribution chain is proportionate to the harm posed by female drug couriers.

January 2012

1 HM Government, 2010. Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting people to live a drug free life. London: Home Office, p 20.

2 McKeganey, N P, Neale, J & Robertson, M, 2005. “Physical and Sexual Abuse Among Drug Users Contacting Drug Treatment Services in Scotland.” Drugs: Education Prevention and Policy, Vol 12, No 3, June 2005, 223–232; Bury, C, Powis, B, Ofori-Wilson, F, Downer, L & Griffiths, P, 1999. An examination of the needs of women crack users with the attention to the role of domestic violence and housing. London: Lambeth, Southwark & Lewisham Health Authority in collaboration with the National Addiction Centre and the Brixton Drug Project.

3 Rees, S, Silove, D, Chey, T, Ivancic, L, Steel, Z et al 2011. “Lifetime Prevalence of Gender-Based Violence in Women and the Relationship With Mental Disorders and Psychosocial Function.” Journal of American Medical Association, Vol 306, No 5, pp 513–521.

4 Gus Jaspert, 19 December 2011, Letter to the Recovery Partnership. Available:
www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/Recovery_Partnership_letter.pdf

5 See: HM Government, 2010. Call to end violence against women and girls: Action plan. London: Home Office.

6 See: Hien, D, Cohen, L & Campbell, A, 2005. “Is traumatic stress a vulnerability factor for women with substance use disorders?” Clinical Psychology Review, I. 25, 813–823; and Kaysen, D, Dillworth, T M, Simpson, T, Waldrop, A, Larimer, M E, & Resick, P, 2007. “Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking.” Addictive Behaviours, I. 32, 1272–1283.

7 Women’s Breakout is the representative body for a national network of women-centred services offering effective gender specific community alternatives to custody. See: www.womensbreakout.org.uk.

8 Smee, S & Moosa, Z, 2010. Realising Rights: increasing ethnic minority women’s access to justice. London: Fawcett Society.

9 HM Government, 2010, op cit, p 15.

10 Global Commission on Drug Policy, 2011. War on Drugs. Rio de Janeiro: Global Commission on Drug Policy, p 6.

11 Smee & Moosa, 2010, op cit, p 20.

12 Page, A, 2011. Counting the cost: the financial impact of supporting women with multiple needs in the criminal justice system. London: Revolving Doors Agency, pp 23–25.

13 Ibid, p 23.

14 Nutt, D, King, L A & Phillips, L D, 2010. “Drug harms in the UK: a multicriteria decision analysis.” The Lancet, Vol. 376, I. 9752, pp 558–1565.

15 Galvani, S, 2004. “Responsible disinhibition: alcohol, men and violence to women.” Addiction Research & Theory, Vol 12, No 4, pp 357–371.

16 Ministry of Justice, 2010. Population in custody, monthly tables, August 2010 England & Wales. London: Ministry of Justice Statistics Bulletin.

17 Hamlyn, B & Lewis, D, 2000. Home Office Research Study 208: Women prisoners: a survey of their work and training experiences in custody and on release. London: Home Office.

18 Lawlor, E, Nicholls, J & Sanfilippo, L, 2008. Unlocking value: How we all benefit from alternatives to prison for women offenders. London: new economics foundation.

19 Humphreys, C, Regan, L & Thiara, R, 2005. Domestic violence and substance use: overlapping issues in separate services? London: Stella Project, p 33.

20 House of Commons Justice Committee, 2009. Cutting Crime: the case for justice reinvestment: first report of the session 2009–10. London: House of Commons, p 8.

21 Home Affairs Select Committee, 2002. The Government’s Drug Policy: Is It Working? London: House of Commons, para 88.

22 Advisory Council on the Misuse of Drugs, 2008. Cannabis: Classification & Public Health. London: Home Office.

23 Home Affairs Select Committee, 2002, op cit, para 67.

24 Domosławski, Artur, 2011. Drug Policy in Portugal: The benefits of decriminalising drug use. Warsaw: Open Society Foundations.

25 European Monitoring Centre for Drugs and Drug Addiction, 2011. Table GPS-2. Last 12 months prevalence of drug use by age and country. Lisbon: EMCDDA. Available: www.emcdda.europa.eu/stats11/gpstab2a.

26 Smee & Moosa, 2010, op cit, p 19.

Prepared 8th December 2012