Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by National Drug Prevention Alliance (DP132)

1. Background

1.1 National Drug Prevention Alliance (NDPA) is a charity, operational since 1993, working across all sections of the community to advance the quality and effectiveness of drugs policy and practice. Whilst its principal focus is on Prevention (Universal, Selective and Indicated), workers within NDPA practise at various times in eg education (as Department for Education (DFE) Drug Education Advisors), intervention, drug/alcohol agency directors, counselling, enforcement, custodial sites, rehabilitation and after-care, business/industry, sports/leisure, media and politics. As such, NDPA is able to bring a wider range of outlooks to its policy considerations than is the case with those who specialise in only one field. The NDPA website is visited by more than 100 countries, and NDPA has worked in several European and other countries, as trainers and advisers. The charity is a member of several international professional groupings in this field, and holds international awards for its work.

1.2 NDPA holds no commercial or party-political interests in advancing the views in this submission.

2. Executive Summary

2.1 The UK Drug Policy is of necessity a “work in progress”, and in this Context we see the 2010 Policy as an improvement on previous editions, albeit in need of further strengthening. The recent shift to A Recovery-focused approach in the treatment field is a good example of hoe the 2010 Policy can be improved upon.

2.2 The main weaknesses in the 2010 Policy are considered to be:

the inadequate commitment of Prevention, with the aim of a Healthy Society, and

the lack of central leadership (“joining-up”) in policy delivery.

2.3 Other weaknesses are such as those identified by CRI in their submission to this review—specifically their submission section 1.3, which NDPA is please to endorse. Likewise, NDPA supports in general the positions taken by the Addiction Recovery Foundation, by Crown Prosecution Service (CPS) (Mrs Kathy Gyngell) and the International task Force for Strategic Drug Policy (Mr David Raynes) in their submissions to this review.

2.4 NDPA places on record its surprise at this review being commissioned so soon after the previous review, given what must be a crowded competition for space on Home Affairs Select Committee’s (HASC’s) agenda. The fingerprints of the Global Commission on Drug Policy (GCDP) are evident on this initiative. GCDP is no more valid a player in this policy arena than any other plaintiffs—including ourselves. We would hope that HASC will not allow the more substantial bankroll of GCDP to convey some kind of special status to what is, after all, just another pressure group.

2.5 NDPA is ready to attend HASC hearings if required, to answer such Questions as HASC may have and/or to enlarge on any aspect of this Written Evidence.

3. Specific Policy Matters

3.1 In the interests of brevity, we are mostly avoiding repetition of points which we support but which others have already made.

3.2 Some players in the drug policy field (including some in the media) have cynically or tendentiously characterised policies aimed at reducing the incidence of drug/alcohol misuse as a “War on Drugs”. If this were a true representation (which it isn’t) one would have to ask Where are the Generals? There is no evidence of a co-ordinated “attack”, instead what we have is an individualised, often self-serving array of narrowly-focused sub-policies. One can understand this sectionalism being spurred by competition for scarce funds, but this cannot be the basis for a national policy. Some examples include:

education—which gratifies teaching staff;

enforcement—which gratifies police officers;

treatment—which gratifies medical staff; and

so on.

What we need, above all, is an assertive and balanced leadership which provides project management across all the relevant fields, ensuring we all “sing from the same song sheet”. Government, together with its advisors such as HASC should provide or otherwise commission this project management, whilst practising abstinence in any direct involvement in the actual policy delivery.

3.3 As to what constitutes “Prevention”, we have produced a concise explanation which is already published in the print version of “Addiction Counselling World”—January 2012, and will appear in the online version this coming Wednesday (18 January). (A copy of the paper is attached to this submission, for ease of reference).

3.4 The clear inadequacy of attention/commitment to Prevention must be corrected as a priority in the next and future editions of the UK Drug Policy. This needs to engage cross-society and cross-discipline, for example:

Government—specify, resource, manage, evaluate.

Health—address all health elements.

Schools—Health—promoting policies (including Random Student Drug Testing (RSDT)).

Colleges—train teachers/youth workers in Prevention.

Youth Peers—utilise untapped potential.

Parents—de-marginalise, train, resource, support.

Religions—spiritual lead, network, cross boundaries.

Pharmacists—more pro-active, prevent, reduce harm.

Businesses—Employee Assistance (Employee Assistance Programmes (EAP’s)), Random Drug Testing (RDT).

Media—Educate staff, counter mixed messages.

Volunteers—network and engage better.

Sport—Pro-active Prevention.

Leisure—widen education/training.

Drug Services—encourage plurality.

3.5 For Prevention to be most effective, it needs to be first cognisant of its own definition; to quote one of the leading experts in the field, William Lofquist:

“We need to get beyond the notion that prevention is stopping something happening, to a more positive approach which creates conditions which promote the well-being of people”

As such, it must engage the whole of society, not merely in some rigid, formulaic way but with each sector developing its practice in ways and extents that are relevant to that sector, and encourage ownership. This calls for sound project management by Government and its agents.

3.6 Effectiveness and economic justification of this approach is not well understood in this country, and even in more prevention-focused countries such the USA, there is still plenty of room for growth. In our experience, prevention can yield a 7:1 “profit” on investment (a figure echoed by CRI in their submission to this review). Moreover, as an example of what a cross-society, cross-discipline approach can achieve in health-promotion terms, one need look no further than the matter of tobacco smoking prevalence. This would make an excellent subject for study of the costs and benefits of such a practice.

3.7 Funding of the UK drug policy should recognise the Cost-Benefit as above, but we are under no illusions as to the ease of persuasion, given the present economic climate. For example, in its submission to this review, AVA (Against Violence and Abuse) Stella Project (Para 1.3) refers to Government “funding its whole systems approach” with local authorities, whilst at the same time cutting local authority budgets.

3.8 Drug Policy seems to attract an inordinate level of “radical sabotage”. Often professing to act in the interests of drug users, there has been a potent campaign since the 1980s under the euphemism of “Harm Reduction”—despite research by Glasgow University which showed that users would rather have help to give up than help to keep using. Similarly, this decade sees the promotion of “Human Rights” in relation to drug use (as this writer observed in conferences in the Vienna UN City). The two initiatives often involve the same advocates and are deployed to press for liberalisation of drug use. NDPA agree that there is a valid kernel to giving due attention to both harm reduction and human rights in the drugs field, but this is being exploited and advanced beyond all common sense, in the name of libertarianism. HASC could do the field great service if it were to introduce some reality into this fuddled dialogue.

3.9 The need for balance in a policy approach has already been stated here; sadly, the Advisory Council on Misuse of Drugs (ACMD) exhibits no such balance. Hansard has already recorded the imbalance in viewpoints and liaisons within ACMD’s membership. We would not wish to silence any point of view, but we do feel that action should be taken to correct this damaging imbalance.

3.10 In the specific case of Prevention, HASC might give consideration to encouraging the establishment of a Prevention Institute, to monitor and advise the development of this neglected sector. We emphasise that great care would be needed to ensure that such an Institution would not be annexed by any one sectional interest group—with this in mind, the Institution should be answerable to a relevant section of Government.

4. Specific Headings in HASC Terms of Reference

Turning to the specific issues listed in HASC terms of reference for this review, we offer the following brief responses to augment what we have said in more detail above. The issues are listed as they are in the HASC document:

(a)2010 Policy is essentially sound, but the Health terms are too reactive, and the application of Harm Reduction is corrupted by its tendentious and liberalising interpretation.

(b)Criteria are again too reactive. Recovery approach for treatment, and prevention/abstinence needs to govern.

(c)GCDP in no way meets the classification of “independent” or “expert”.

(d)Reduction in services is inevitable unless other measures—particularly preventive ones are introduced.

(e)Prevention yields greater net profits than other policies—but you still need them all.

(f)Public Health, especially Universal Prevention, merits greater emphasis.

(g)Abuse of legal and illegal drugs is self-evidently related; users see no boundary, but changes in approach should be gradual, accounting for a general present deep emphasis of position by alcohol services compared to illegal drugs services. There is a difference of entry attitudes and behaviours, alcohol v illegals, but recovery has many similarities.

(h)Comparative societal harms of illegals is skewed by false assumptions; harm from illegals is not confined to crime to fund acquisition of drugs; there is an alteration in the established user’s attitude which makes reluctance to commit post-onset crime weaker. It is also false to assume that societal harms are concentrated in the addiction stage; research indicates that harm from regular-to-heavy/not-yet-addicted users exceeds that from addicts—prevalence is part of this assessment.

(i)The transfer from the National Treatment Agency (NTA) to Health England is met with suspicion in some quarters, where it is seen as more cosmetic than real.

(j)Legal highs, including the abuse of pharmaceuticals (such as the practice familiarly described by young abusers as “pharming”) is already a serious and growing matter in the USA. We should learn from them at the earliest and not be slow in introducing counter-measures.

(k)Links between drugs, organised crime and terrorism are self-evident.

(l)Partner support can only be carefully approached—the insertion of GCDP is but one example of what not to do. As to “alternatives” caution is needed here too, as is ample objective research of other countries’ experience—their failures (as with Portugal) as well as their successes (as with Sweden). Precipitate changes, as with cannabis reclassification, should give us cause for circumspection.

References

No separate references are offered at this time, but these can be submitted if HASC require it, ad-hoc. In the meantime, there is an extensive listing in the paper by us, published in the Addiction Today bulleting for January 2012, and many of these references support this Written Evidence.

Attachment to HASC Review

In augmentation of Paragraph 3.3 of this review, we propose that the paper solicited from us by the Addiction Research Foundation, and scheduled for publication online next Wednesday, 18 January, gives an adequate definition of what constitutes “effective and comprehensive Prevention”.

As this paper is not yet available, we have attached here below. Once it is available, a reference to it in this review will suffice and the attachment can be removed.

Addiction Today—for Deirdre Boyd—Submitted 14 Nov 2011

Paper by Peter Stoker, CEng, Director, National Drug Prevention Alliance

To come before

Prevention, the Cinderella of drug services, deserves to come to the ball.

Listening to the inspiring description of the Betty Ford Center (BFC) by John Schwarzlose and Jerry Moe (at the King’s Fund on 2 November) there were clear parallels with prevention principles and practice. A welcome change, for in some 25 years covering most sectors of our profession, I have observed that the fields of treatment and prevention (both of which I hold in high regard) are more often than not separated by a large wall, over which insults are hurled—with divorce as the inevitable result. We must be able to do better than this, and the pay-off can be a more powerful way of working together.

What is it?

Prevention has been the target of cheap shots throughout its existence. Some cynics even allege that there is no technology in prevention—just “apple pie sentiments”. This might come as a surprise to Lindsay Roberts1 who has just been awarded a Masters in Prevention Science at Oklahoma University, likewise to Bill Lofquist2 Tucson, Arizona who as long ago as 1989 had a widely-regarded workbook published under the name of “The Technology of Prevention”. Adding to the weight of prevention technology, Dr Barry Twigg was awarded his Doctorate3 for research focusing on the whys and wherefores of young people who choose not to use drugs—a valuable reverse of most of the research, which concentrates on users. And to cap it all, this August the Independent4—known more for pro-drug apologia than anything—published an article commending “The Power of Prevention”.

Fact is, simplistic prevention doesn’t cut it. To quote American humorist H L Mencken: “For every complex problem there is a simple solution—and it doesn’t work”.

Asked what prevention is, many will rely on the OED and opine it is “obstructing” something—but obstructing is too late! Look at the Latin root—praevenire, meaning “to come before”—then savour Bill Lofquist’s definition: “We need to get beyond the notion that prevention is stopping something happening, to a more positive approach which creates conditions which promote the well-being of people.”

Since the overall goal of prevention is to promote well-being ie to improve health, it behoves us to agree on a usable definition of “Health”. Too often this is narrowly described in terms of physical capacity or mental illness … try instead this one derived from (int al) the World Health Organisation. Health comprises: Physical—Mental—Intellectual—Social—Emotional—Spiritual—and Environmental elements.

What is Prevention? The usual answer is “Educating youth to abstain”. This is doubly erroneous—all age groups can benefit from prevention5 and education is but a part of the process. A useful acronym defining prevention elements is KAB (Knowledge, Attitudes, Behaviour).6 Importantly, behaviour should not just be about penalising negatives, it should also be about encouraging positives.

Moreover, in limiting one’s attention to (at one end) youth abstainers, and at the other end, to addicts, between us we are missing a large population in the middle. Regular users (of varying degrees of use)7 actually cost society more than all the addicts put together.

America’s CSAP (Centre for Substance Abuse Prevention) as long ago as 1991 concluded that the best prevention results come through “… co-ordinated prevention efforts that offer multiple strategies, provide multiple points of access, and coordinate and expand citizen participation in community activity.”

Caution is recommended in tackling the culture around behaviour—it can and should be considered as a kind of “social ecology”. In a paper8 submitted to the 2003 International Drug Prevention Conference in Rome, the point is made that “dabbling” with one aspect may bring the “law of unintended consequences” into play.

Of course, no consideration of drug policy and practice escapes the attention of the libertarian front, and whilst the goal of prevention is to facilitate drug-free lifestyles for all, our pro-drug adversaries cynically condemn it as part of a so-called “war on drugs”. With the benefit of hindsight we can see that the term “war on drugs” is a finely conceived and executed meme—a paper by Brian Heywood9 usefully informs on memes and their deployment. In treatment as well as prevention, we need to learn from our opposition, and become adept “memesmiths”.

Culture is the key

It is not too much to say that Culture drives Behaviour—be it at individual or societal level. It follows that if you want to change behaviour, you have to change the culture. No small task! Put another way, if much of drug use is to escape reality, it follows that the solution is to improve reality. Discuss!

So, what influences the culture around decisions? In no particular order:

Peer Group Influence; Personal perceptions; Income v Cost of any action; Health Issues; Moral Structure; Spiritual structure; Family values; The attraction of risk-taking; Mental condition, (depressed, elated, in-between); Legislation, including Laws and Conventions; Sports; Leisure; and the Media, music, movies, TV, fashion, humour etc.

Of course the media are major players in the culture game. They have transformed themselves from reporters of the culture into makers of the culture. A major survey in America a few years ago found that an encouragingly high percentage of children got their information about life issues from their parents. But on asking parents where they got their information from, they answered “the TV”.

Societal factors overlay and influence culture. There is no shortage of societal factors which tend to encourage drug abuse. Here are some examples:

Self before society; Rapid gratification; The “Right” to be Happy; Rights but no responsibilities; Youth supremacy; Conspicuous consumption; and Political Correctness. A drugs trainer once summed up the first four of these factors as a drug user’s rubric: “ME. FEEL GOOD. NOW.”

If someone alters the culture within which decisions are made, it is virtually certain that there will be different outcomes—and not all influences are positive. The “Values Clarification” philosophy10 founded by Carl Rogers and Professor Sidney Simon (with some input by Abraham Maslow) had a seminal effect, albeit a damaging one, on drug abuse. Melanie Phillips, in her paper “The Trouble with the Liberal Elite is that it just isn’t Liberal” 11 laments the fact that today is an era in which truth has become relative. The American philosopher William James (1842–1910) went so far as to suggest that: “Truth may be defined as that which it is ultimately satisfying to believe”. Chuck Colson, in his paper “The Cultivation of Conscience” 12 draws out the reality today, that many young felons simply do not know the difference between right and wrong. “How can you teach kids to act right when they don’t know what right looks like?”

Does it work? Can we strengthen it?

Prevention effectiveness is visible in the campaign to reduce tobacco smoking, where “KAB” has produced a marked decrease in prevalence. We can learn from this lesson.

How can we promote healthy lifestyles? Here are a few options:

Work to the model of “Total Health” (as W.H.O. or similar). Become “memesmiths”. Fix those “Broken Windows”. Establish “Prevention Cities” (as in San Salvador, Argentina). Nurture an informal, international “Prevention Institute”. Build “more bridges, fewer towers” (ie reduce your Ego Quotient). And get more funds for Prevention (US State Dept told me that prevention is under 2% of their drugs budget!

References

1 Editorial: “Prevention specialist Lindsay Roberts sees progress in Muskogee”.
www.muskogeephoenix.com (16 October 2011).

2 Lofquist W A “Discovering the Meaning of Prevention” (1983) and “Technology of Prevention Workbook”. AYD Publications, Arizona (1989).

3 Twigg B, Dr “The Attitudes of Young People to the Non-Use of Drugs and to Drug Education and Prevention”. Doctorate Thesis. Department of Education, Brunel University. (2006).

4 www.independent.co.uk “The Power of Prevention” (31 August 2011).

5 Blow C F et al “Evidence-based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults”. Published by Older American Substance Abuse and Mental health Technical Assistance Center. (2005).

6 Benard B “Characeristics of Effective Prevention”. Published in Project Snowball training materials, Illinois Teen Institute. Available via NDPA website. (1987).

7 Cunningham J “When is the Cost of Drinking Alcohol Too High?” blogs.reuters.com (15 February 2010).

8 Stoker P “Drug Strategies and the Cultivators of Culture”. Available via NDPA website. (2003)

9 Heywood B “Assaying Information in the Substance Misuse World”. Presented at St Petersburg Florida conference of International Task Force. Available via NDPA website. (2004).

10 Stoker P “Moralising … demoralising. The Fight over Personal, Social and Health Education” Available via NDPA website. (2001).

11 Phillips M “The Trouble with the Liberal Elite is that it just isn’t Liberal” See www.melaniephillips.com (2000).

12 Colson C “The Cultivation of Conscience” Available via NDPA website. (2002).

Note: For references “Available via NDPA Website” visit http://drugprevent.org.uk (“Papers”).

Bio: Peter Stoker has worked in the drugs and alcohol field for some 25 years—as a counsellor, treatment referral and support worker, educator and Department for Education and Skills (DfES) advisor in schools and communities, social work practice teacher, trainer in many settings and across many age groups. He has been an advocate to local and national political figures, and has been extensively covered in print and broadcast media. He has had several papers published, and spoken at many international conferences. Prior to entering the drugs field, in a 30 year civil engineering career he rose to the level of Chartered Civil Engineer, designing and managing major projects at current values up to £3,000 million.

January 2012

Prepared 8th December 2012