Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Crime Reduction Initiatives (DP100)


CRI is a health and social care charity working with individuals, families and communities across England and Wales that are affected by drugs, alcohol, crime, homelessness, domestic abuse, and antisocial behaviour. Our projects, delivered in communities and prisons, encourage and empower people to take control of their lives and motivate them to find solutions to their problems.

Executive Summary

On the whole, the 2010 drug strategy is well grounded in evidence.

Drug and alcohol misuse destroys the lives of individuals and has repercussions throughout society. It is closely linked to homelessness, mental health and social mobility; causes family and societal breakdown; and contributes to millions of crimes every year.

Central to CRI’s response to this inquiry is the firm belief that the only effective method of stopping individuals from misusing drugs and alcohol is high quality intervention and treatment. Therefore, it is essential that government retains financial and political support for education and treatment services, and that it constantly strives to integrate these services with the criminal justice, health, and education systems.

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 Government’s 2010 drug strategy is, on the whole, well thought out and effective. It builds on the country’s experience over the past decade, and has an overt focus on a recovery model, while recognising that there are many routes to recovery and that there needs to be a balanced treatment system within which evidence based treatment and harm reduction have a clear role to play. This is central to CRI’s recovery focused model, which has been proven to lead to greatly improved drug free outcomes.

1.2 CRI particularly recognises the positive effect of the following elements of current drug strategy and policy:

Criminal Justice System entry points into treatment are broad, particularly for those within the criminal justice system who have traditionally been excluded from treatment services;

the breadth of treatment available has increased;

waiting times for entry have significantly reduced, vital in allowing treatment services to exploit windows of opportunity when working with substance users;

the voice of the service user has become much more powerful;

crime and harm are being reduced; and

the emphasis upon sustained recovery builds upon the incremental improvements that have been delivered during the previous drug strategies.

Weaker points in the UK’s drug policy include:

an overemphasis on input driven rather than outcome focused targets;

the lack of discrete services for 18–25 year olds;

lack of appropriate accommodation for substance mis-users and move-on pathways; and

more broadly, there is insufficient integration with broader socio-economic conditions including housing, employment opportunities, educational under-achievement and poverty of opportunity within the UK.

The strategy is fiscally responsible, but it must be ensured that it continues to be adequately funded and that the removal of the ring-fence does not lead to a postcode lottery with better funding, and therefore better services, in some areas than others. It is vital that funding is maintained; after all, the Home Office and the NTA have estimated that drug treatment services prevent 4–5 million crimes per year. More detail on this issue is provided in later sections.

2. The criteria used by the Government to measure the efficacy of its drug policies

2.1 The criteria used to date are fit for purpose, but it is important that the sector continues to develop more efficient, reliable and accurate techniques for measuring recovery.

2.2 At CRI, we measure the impact of our projects not only in terms of reduced drug use, but also by looking at crime and antisocial behaviour, as well as improved physical and mental health, personal wellbeing, family and social relationships and community integration.

2.3 Success is demonstrated in a number of ways but established behaviour can take a long time to change and small improvements can require huge effort from the individuals concerned. People affected by substance misuse, intergenerational poverty, unemployment and lack of opportunity cannot change their lives overnight. Therefore, it is vital that we measure these factors for an extended period of time, revisiting individuals after a year, two years and even five years.

2.4 The difficulty, of course, comes in measuring these outcomes. It is far simpler to measure quantitative data. Yet if we are to gain a fuller picture of recovery—and therefore, which methods are most effective—we must look beyond things that can be easily counted.

2.5 CRI is currently carrying out longitudinal studies into sustainable recovery within its East Lancashire and Warrington services. We believe these will help us evidence not only the positive effects of our approach but also improve the operational and fiscal efficiency of its delivery.

2.6 There is scope for organisations and regions to work together to improve on the national picture. The police, job centres, social services, the NHS and treatment services should triangulate their models to give a fuller picture.

2.7 The issue of measurement is of great importance to the effectiveness of payment by results, and more effective measurement will enable more accuracy in this field.

2.8 CRI welcomes the shift towards payment for outcomes rather than the number of people entering services. It has been interpreted by some as being a way of reducing costs rather than driving up performance, and it must be ensured that this is not the case, but rather is genuinely linked to real outcomes as outlined above.

2.9 Our projects also demonstrate substantial savings for other public services, and this should be reflected in a payment by results framework.

3. The independence and quality of expert advice which is being given to the government

3.1 CRI supports the role of the Advisory Council for the Misuse of Drugs, specifically welcoming its approach in basing its advice upon sound scientific evidence.

3.2 Its role must be preserved and enhanced, and its independence from political pressure and influence must be ensured. The government receives advice from many sources, some of a higher quality than others, but it must ensure it listens to a wide range of organisations and stakeholders, from commissioners to service users.

4. Whether drug-related policing and expenditure is likely to decrease in line with police budgets and what impact this may have

4.1 The police are actively involved in partnerships with treatment agencies, with involvement in Drug Intervention Programme and Prolific and other Priority Offender services, as well as in creative intelligence lead work such as Operation Reduction in Brighton. We are already seeing cuts to police budgets, and CRI has concerns that this could impact on the future of partnership work between the police and treatment agencies.

4.2 This makes it all the more important that we ensure drug treatment services are properly funded. It has been estimated that issues related to drugs and alcohol cause up to 50% of crime, and DirectGov has shown that in 2007–08 more than a million crimes involved alcohol in some way. Ensuring a strong focus is retained on these services will reduce any negative impact in cuts to police budgets.

4.3 With the ring-fence removed, drug services will have to compete with 16 other public health priorities. There needs to be continuing commitment to support drug related treatment and recovery as priority public health concerns. This is the biggest threat to the sector in a generation.

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

Education and early intervention

5.1 Education and early intervention should be at the core of any cost effective drug strategy. Research from the Department for Education produced in February 2011 demonstrated that early intervention for young people is cost effective, with every £1 spent on young person’s treatment saving between £5 and £8 for the NHS and other agencies.

5.2 Despite this, we are already seeing significant disinvestment in drug related expenditure, with cuts having an impact on drug education and prevention provision for young people delivered in school settings, drug treatment for young people who are already using drugs and alcohol, and support for infrastructure organisations for professionals working in the sector.

5.3 Drug education and early intervention must go beyond the “just say no” models of previous decades. It must:

be preserved within mainstream education or the PSHE curriculum;

be evidence based, using credible, real world information;

in addition to mainstream education, be targeted at those most at risk of developing problematic substance abuse, such as those living in areas of multiple deprivation with limited opportunities, through specialist support and treatment;

include children excluded from school or in young offenders institutes, targeted appropriately; and

more widely, address poverty of aspiration and opportunity.

Integration of services

5.4 If we are to make treatment services as cost efficient as possible, we must continue pressing for more extensive integration between bodies, in order to maintain a link between, for example, criminal activity and treatment.

5.5 Opening up the market for drug treatment will also have a cost effectiveness benefit, although commissioners should be wary of organisations that take shortcuts and keep costs apparently low when tendering for contracts, where these would have a negative impact on individuals and communities.

6. The extent to which public health considerations should play a leading role in developing drugs policy

6.1 Positive impact on public health is absolutely key to drugs policy. Successful treatment for those who misuse drugs or alcohol is of vital importance not only to the substance user but to the whole of society, as it creates healthier, safer communities.

6.2 CRI welcomes the move to embed substance misuse strategies as a public health issue rather than one that can be marginalised within local government. We must ensure that a strong link is retained between drug treatment and the criminal justice system, to avoid returning to the situation of the 1980s where offenders were effectively disbarred from treatment for being “unmotivated” or “too difficult” to treat.

7. The relationship between drug and alcohol abuse

7.1 Drug and alcohol abuse are inextricably linked as public health issues; the issues are two sides of the same coin. Historically, there has been a chronic lack of integration between the two, but this is beginning to change.

7.2 CRI ensures that the two are closely linked in its treatment services, while being mindful of variations in demographics between different types of substance misuse. It may be that service users arrive at a service through different routes, but our integrated recovery services provide a full range of interventions that address a range of complex needs.

7.3 Our model is highly successful at getting those who commit drug-related offences to address their dependency. For example, if CRI provides a Drug Interventions Programme and treatment, clients are twice as likely to enter treatment than the national average.

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

8.1 It will always be the case that young people will experiment with drugs and alcohol and many adults will use alcohol (and some drugs) with no harm to themselves or others. A blanket approach which suggests that all drugs are equally dangerous, or that they are all a gateway to Class A drug addiction, is as counterproductive as it is disengaging—when these messages do not reflect the individual’s experience they can discredit all communications on substance misuse.

8.2 Within the current legal framework, we need an integrated system that tackles both legal and illegal drugs as interlinked issues. We must also consider “legal highs”, which CRI believes will be a major public health issue over the coming years. This issue is covered in section 10.

8.3 Over the counter medications, either prescribed by GPs or increasingly purchased online, are also a significant concern. Benzodiazepines, for example, are a feature in more than 50% of drug related deaths in Brighton compared with 18% for heroin.

9. The impact of the transfer of functions of the National Treatment Agency for Substance Misuse to Public Health England and how this will affect the provision of treatment

9.1 CRI believes the National Treatment Agency for Substance Misuse to be an effective organisation, and would hope that the transfer of functions to Public Health England will retain the best elements of this organisation.

9.2 CRI does have some concerns about the security of funding for drug treatment following the pooling of the adult Pooled Treatment Budget with other public health funding streams. There should be nationally defined firm guidance on the minimum expectations of investment in locally available drug treatment and recovery services, in order to avoid disinvestment and worsening public health and crime.

9.3 While there should be some room for local prioritisation, we must avoid a “postcode lottery” that results in very different services in different boroughs. We must retain equal access to treatment.

10. The availability of “legal highs” and the challenges associated with adapting the legal framework to deal with new substances

10.1 Legal highs will be a huge public health issue for the next decade, with new drugs appearing all the time.

10.2 The effects of these drugs are less well known than the drugs traditionally used by younger people, such as alcohol and cannabis, which means the signs of their use can be harder to spot. This could mean that it takes longer for a problem to be identified, and therefore that many individuals who need support are not being referred to treatment services. These changing patterns of drug use mean there is a vital need for more preventative and early intervention work with schools and communities.

10.3 What’s important is that we look at the issues young people have with drugs and alcohol in their wider context. Family relationships, homelessness, unemployment and mental health issues all play a part, so we must ensure services are integrated and address the complex needs of individuals.

10.4 Key to working with young people who use these legal highs is credibility and an ability to engage with them. Some young people will always experiment with drugs, and treatment around legal highs should be focused on stopping this drug use from becoming entrenched and problematic.

11. The links between drugs, organised crime and terrorism

11.1 The link between drugs, organised crime and terrorism is clear: international criminal networks are funded by the profits of the street level drug trade around the world.

11.2 Effective treatment services have the potential to have an impact on these networks, by removing some of the demand for drugs on the ground, ultimately reducing the profits of international organised crime.

12. Whether the UK is supporting its global partners effectively and what changes may occur with the introduction of the national crime agency

12.1 If we are to effectively tackle illicit drugs on a world scale, we must look far beyond the UK’s drug strategy. We must address the global issues that dictate both supply and demand in the drug trade, which are inextricably linked to questions of foreign policy (aid, trade and defence).

13. Whether detailed consideration ought to be given to alternative ways of tackling the drugs dilemma

13.1 The most effective approach to stopping people from using drugs is ensuring that accessible and high quality treatment is available, quickly. If we are to create healthier, safer communities, we must retain investment in effective treatment services and continuously strive to improve the services on offer.

13.2 The ultimate aim of services at every level, from early education and intervention to treatment for entrenched addiction that is associated with criminal behaviour and other complex issues, must be to ensure people have a stake in society. Disenfranchisement is the common thread that runs through all of the issues we tackle.

13.3 Initiatives which recognise that substance misusers are part of the community, and can make contributions, need to be championed. For example, employers should be encouraged (through tax incentives or reduction of employer NI) to provide opportunities for recovering substance misusers to access work placements and employment.

January 2012

Prepared 8th December 2012