Health Committee - The Government's Alcohol StrategyWritten evidence from DrugScope (GAS 48)

DrugScope is the national membership organisation for the drugs field, with over 400 members. Many work with people affected by alcohol problems. In March 2009 we incorporated the London Drug and Alcohol Network (LDAN), which supports drug and alcohol services in London. Recently we announced plans to merge with eATA, a representative organisation with a particular focus on drug and alcohol residential rehabilitation services.

We are concerned that the Committee’s inquiry should give careful consideration to the inter-relationship between drug and alcohol issues, which are relevant to a number of the issues in the terms of reference. We would draw attention to eight key areas where the relationship between drug and alcohol policy is important.

1.Trends and approaches. In 2009, the Annual Report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) concluded that “in Europe today, poly-drug patterns are the norm, and the combined use of different substances is responsible for, or complicates, most of the problems we face”, this includes the combined use of alcohol and drugs. This is an under discussed issue for the current debate about the night time economy. Recent figures from the National Treatment Agency suggest that the numbers of people presenting to specialist services with heroin dependency fell by around 10,000 in the two years to 2010–11. However, there is unmet need among people with other kinds of substance misuse problems, including poly-drug use and alcohol dependency.

2.Education and prevention. Investment in drug and alcohol education has fallen sharply, less than half of schools deliver drug education more than once a year and this number is declining.1 Evidence-based education and information resources for young people should be a priority for both drug and alcohol policy.

3.Specialist services for young people. Nine out of 10 of the 22,000 young people in contact with young people’s specialist substance misuse services in 2010–11 had alcohol and/or cannabis problems. The UK Drug Policy Commission report “Charting new waters” (April 2012) identified funding for young people’s treatment and prevention as the most vulnerable area for local disinvestment. Fifty one% of Drug Action Teams had observed a significant decline in funding for young people’s substance misuse prevention services, and 41% had observed a significant decline in funding for young people’s substance misuse treatment services.

4.Localism and the transition to public health. Funding for drug and alcohol treatment has been largely managed through different structures and processes: a national “pooled treatment budget” for drug treatment—supported by significant local investment—with alcohol services funded primarily through local sources, including Primary Care Trusts. Following the transition to public health in April 2013 the majority of drug and alcohol funding will be combined into a new ring-fenced public health budget to be allocated locally by Directors of Public Health, guided by Health and Wellbeing Boards, and the Joint Strategic Needs Assessment and joint Health and Wellbeing Strategies they produce. There are positive opportunities for a rebalancing of treatment provision (including more investment in alcohol services). However, there are risks in this pooling and rebalancing—in particular, it is important that investment of local spending is in evidence-based approaches and that “population wide measures” are not at the expense of an adequate level and quality of provision for individuals and families experiencing acute and entrenched drug and/or alcohol problems. The role of Clinical Commissioning Groups also needs to be clarified.

There is a broader concern among our membership that the absorption of drug and alcohol funding into the public health budget could lead to disinvestment, given that this will be only one of 17 potential responsibilities for Health and Wellbeing Boards.

5.Payment by results. On 2 April the Department of Health launched eight Drug and Alcohol Recovery Payment by Results pilots (and we are aware that other localities are experimenting with their own “payment by results” approaches). Services will be paid depending on their success in achieving outcomes across three “domains”: “free of drugs of dependence”, “reduced offending” and “improved health and well-being”. It will be important to evaluate how effectively these outcomes and tariffs incentivise services to work with people with alcohol problems. We also understand that a separate payment by results scheme for alcohol treatment has been under development within the NHS. It would be helpful to have clarification of the relationship between these two programmes. People affected by alcohol problems will also be impacted by other schemes with a PbR component—including, the Work Programme, the Troubled Families initiative and PbR in prisons and criminal justice.

6.Recovery and social re-integration. The 2010 Drug Strategy stresses that the barriers to recovery for people with serious alcohol and drug problems (and their families) are similar. These include access to housing, employment and meaningful activity, family support and relationships and addressing issues of stigma and discrimination, which affect families as well as service users. There is concern that the removal of the ring fence from Supporting People has resulted in disinvestment in housing support for people in recovery from substance misuse problems, and that this group may be particularly vulnerable to “parking” within the Work Programme, as they are not viewed as likely to secure employment.

7.Co-morbidity and dual diagnosis. A 2002 research study concluded that 75% of users of drug services and 85% of users of alcohol services were experiencing mental health problems. It is important to continue to build on work to address the issue of “dual diagnosis”, as well as to develop effective care pathways and interventions for people experiencing less severe mental health problems linked to their drug and/or alcohol use (for example, by improving access to psychological therapies for this group). DrugScope has published a paper exploring these issues in partnership with the Centre for Mental Health and UK Drug Policy Commission.2 We recently published a “positive practice guide for working with people who use drugs and alcohol”, in partnership with the Improving Access to Psychological Therapies programme (IAPT) and the National Treatment Agency.3

We note that alcohol problems are common amongst people experiencing multiple need, including contact with the criminal justice system, homelessness and mental health problems. DrugScope is a partner in the Making Every Adult Matter coalition with Clinks, Homeless Link and Mind. In 2011, MEAM published “Turning the tide—a vision paper for multiple needs and exclusions”, which sets out proposals to ensure that in every local area people experiencing multiple needs are supported by effective and coordinated services and empowered to tackle their problems, reach their full potential and contribute to their community.

8.Prisons and the criminal justice system. A 2010 report from HM Inspectorate of Prisons was entitled “Alcohol services in prisons: an unmet need”—and noted that most alcohol misusers in prison reported concurrent use of illicit drugs. The Patel Report on Prison Drug Treatment noted that around 7% of prisoners had a severe alcohol dependency, while again emphasising that poly-drug use is common among prisoners—combining alcohol, opiates, stimulants and benzodiazepines—and access to effective treatment has been limited for this group. The Bradley Report (2009) concluded that “improved services for prisoners who have a dual diagnosis of mental health and drug/alcohol problems should be urgently developed”. It is important to address these issues as new planning and commissioning structures for prison treatment are developed.

We have supported the use of community sentences (such as Drug Rehabilitation Requirements) as an alternative to prison that challenges offenders to tackle their dependency and engage in treatment. We will watch the development of alcohol abstinence requirements with interest, but our view is that community sentences for people with alcohol problems should normally have a strong therapeutic component, providing access to appropriate interventions, treatment (where appropriate) and other support.

We recognise that these issues are comparatively marginal in the Alcohol Strategy itself, and are primarily dealt with in the 2010 Drug Strategy, which is explicitly concerned with tackling both drugs and alcohol dependency. We have welcomed the Government’s commitment to bringing these two agendas closer together, and believe the Alcohol Strategy document needs to be considered in this wider context. It would be helpful for the Government to clarify the relationship between these two strategies, as there is a concern about the “read across” between the two—the Alcohol Strategy, for example, has comparatively little of substance to say on alcohol dependency, treatment and recovery.

We would welcome opportunities to provide further evidence to the Health Select Committee on the issues identified in this letter, or, more generally, on the relationship between drug and alcohol policy.

May 2012

1 See United Kingdom, UK Focal Point (2011), Department for Education (2011) and PSHE Education: a mapping study of the prevalent models of delivery and their effectiveness.

2 Centre for Mental Health, Drugscope and UK Drug Policy Commission (2012), “Dual diagnosis: a challenge for the reformed NHS and Public Health England” at www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/DSDualDiagnosisDiscussionPaper.pdf

3 www.iapt.nhs.uk/silo/files/iaptdrugandalcoholpositivepracticeguide.pdf

Prepared 21st July 2012