A new conversation about drugs

Politicians do not have a reputation for taking an objective approach to drug use. We only have to take a look at the recent decision around the classification of Mephadrone to see how far from common sense our politicians can drift. While there was a media storm for a legislative solution, this was not based on evidence to suggest that making Mephadrone illegal would reduce harm. Quite the reverse.

Politicians’ desire to echo what they suppose to be popular opinion of drugs and drug users - as dirty, criminal and dangerous - does not easily lend itself to developing a rational and humane approach to this most pervasive of social problems. Yet humanity and rationality is exactly what is needed. We know that simple solutions – whether they be “legalise everything” or “flog ’em and hang ’em” – are unlikely to get much traction: this is a problem that even at a conservative estimate directly or indirectly affects over six million people across the UK from a wide variety of backgrounds who experience a wide range of problems as a result of their drug and alcohol use.

The Labour government has put significant extra funding into drugs treatment. They have made the case for this by pointing out that drug users without access to treatment are far more dangerous to society than drug users with treatment. As a result, we have seen record numbers of drug users enter treatment, starting out on the road to their own recovery. The quality and quantity of drug treatment has improved out of all recognition. Waiting times, which prior to 1998 in some parts of the country had been over a year, are now down to below four weeks pretty much everywhere.

Simply providing treatment is not enough. To say that we need to ‘tackle the causes of drug use’ may feel like a set piece of historical irony given the political context we are in, but clichéd as it may be, it is the truth. Treatment helps people stabilise and deal with the direct health consequences of their drug or alcohol use. But it is the other interventions – the ones that help people get housing and employment, rebuild their family relationships and express achievable aspirations – that make the real difference.

In the drug and alcohol field we call these things “recovery capital”. They provide the social investment that helps people rebuild their lives. Often they represent the very deficits that made a drug or alcohol problem so very easy to develop in the first place. Reintegration into mainstream society is a critical part of recovering from problematic substance use. It requires society to be welcoming and open to people who are recovering and those who have yet to take those steps.

The downside of the Government’s approach to drug treatment has been that it has reinforced the stigma attached to drugs and drug users. In order to secure political capital and justify investment, the Government has stressed that treatment is about protecting us (“the community”) from them (“the dirty smackheads”). What has been missing is an emphasis on our shared responsibilities to take care of those who are vulnerable or sick. Nor have we heard enough about the fact that the majority of people who have problems with drugs can and do get over them and lead usually normal and constructive lives.

It can be argued that stigma is an unavoidable by-product of using illegal drugs; that it is socially necessary and even productive. Stigma does however have unfortunate consequences for people who have problems with drugs, including on people’s ability to achieve recovery and to integrate in mainstream society. People who had or have problems with substance use can have difficulties finding work, accommodation, and accessing a wide range of public services. Recent work by The UK Drug Policy Commission has revealed that most employers would refuse to employ even an abstinent recovered drug user, let alone one who is still in treatment.

Solutions to complex social problems are often more effectively deployed in partnership with the people who need the services. Involving people in the development of their own services at a strategic, local and personal level works. It reduces waste and duplication, enhances efficiency and provides the service user – and the taxpayer – with better outcomes. For those who experience problems with drugs, personalisation – the principle of involving people directly in the planning and delivery of their own care – is under developed. However new projects – including that supported by the RSA in West Sussex – are proving that just like everyone else who uses public services, drug users benefit from services that directly fit their needs.

Personalisation requires that we first and foremost acknowledge the rights of people affected by substance use to services and support and to aspire and achieve and be a part of mainstream society. This means agreeing that people affected by problematic drug and/or alcohol use have the same rights as every one else to access education, healthcare, support with employment. The continued stigmatisation of drug use and drug users makes this difficult to achieve and tackling this needs to be a critical part of improving our response.

Whoever governs Britain over the next five years will need to deal with the issue of problematic substance use. Continued recession, public sector funding cuts and the increasing availability of new intoxicating substances means the problem is unlikely to go away. It may get worse. The core underlying factors of the 1980s’ heroin epidemic - poverty, unemployment and cheap available substances - mean we could be looking at a problem that will have an increasing impact on the wider community. If this does happen it will be tempting for government to further marginalise and stigmatise drug users and their families. Tempting, but ultimately self-defeating.

Government needs to address drugs not simply as a matter of public protection, crime reduction or public health, but as a multi-dimensional complex social problem affecting some of its most vulnerable citizens. We need a new conversation about drugs. And a government brave enough to start it.