Glasgow School of Social Work Research Seminar

Substance Misuse and Social Work – the essential contribution

‘It’s everyone’s job’ - now

Joy Barlow MBE, Head of STRADA 29 April 2010

Summary of Presentation

• Recovery• How we got to where we are now?• Scale of the problem• Drugs and what’s so special about

alcohol• What does this mean for Social Work• Policy shifts• Benefits of the social work approach• What social workers should know• So what needs to happen?

The drugs strategy sets out a significant programme of

reform to tackle Scotland’s drug problem. Central to the

strategy is the concept of recovery – a process through

which individuals are enabled to move on from their

problem drug use towards a drug- free life and become

an active and contributing member of society.

Scottish Government’s Definition of Recovery

“ a process through which an individual is enabled to

move on from their problem drug use, towards a drug-

free life as an active and contributing member of

society........, it incorporates the principle that recovery

is most effective when service users’ needs and

aspirations are placed at the centre of their care and

treatment.” (The Road to Recovery, page 23)

• 1926 – Rolleston Report – Departmental Committee on Morphine and Heroin Addiction Report: Codified existing practices Humane regard for ‘addicts in their care’ “the

condition must be regarded as a manifestation of disease and not as a mere force of vicious indulgence.”

• 1961 – Interdepartmental Committee. Drug Addiction (The first Brain Report): Reviewed Rolleston – “stabilised addicts”

How we got to where we are now? Drug Policy

• 1965 – The second Brain Report:Did not recommend the dismantling of

the British prescription systemDid licence doctors – prescriptions of

maintenanceSetting up of treatment centres –

‘addicts’ sick not criminalNotification of addicts

• Misuse of Drugs Act 1971

More Recent Activity

• Advent of HIV/AIDS – harm reduction “HIV/AIDS is a greater threat to public health than drug misuse” ACMD Report, AIDS & Drugs Part1

• Seminal reports

• Recognition of the affect of problem drug and alcohol use on children and families

• AMCCs 1989

• Tackling Drugs Together 1999

• Action Plan on Alcohol Problems 2001 – update 2005 & 2007

• Framework for Action

Alcohol Policy

Alcohol Policy History

Not such a well defined set of policies and strategies“to scrutinise the character of his patient, his pursuits, his modes of living, his very passions and private affairs.” (Thomas Trotter 1804)

• Inebriate (Scotland) Act 1898 – a burden on the rates!

• Temperance Movement

• 1947 - AA came to Scotland

• 1962/3 establishment of units for ‘the treatment of alcoholism’

• Advisory Committee on Alcoholism (1978) – treatment at primary care level

• Attempts to engage GPs; social workers; general medical wards

• Crofton Committee 1985 – blueprint for prevention of alcohol problems

• SCA 1989

Nicholson Committee 2003:

More liberal opening hours

Crack down on happy hour promotions

National proof of age scheme“could end binge drinking culture” Cathy Jamieson

• Licensing Law Reform 2005

Scale of the Problem

Drugs• Estimated 52,000 people problem drug users

– almost 1 in 5 of Scottish population between 15 & 54. Comparison difficult but seems to be higher than Ireland, Finland or Denmark

• Most common illegal drugs used Cannabis (1 in 3 at some point in life) Cocaine (4% of adults in Scotland in 2006) Ecstasy ( 3% of adults in Scotland in 2006)

Scale of the Problem

Drugs• Poly-drug use – around 2 in 5 current drug

users report 2 or more illegal drugs together• Alcohol and other drugs – 4 in 5• Hepatitis C – 85% with hep c in Scotland –

sharing needles, syringe or other paraphernalia

• Estimated 40-60,000 children affected by drug problem of one or more parent (4% - 6% of all children under 16)

• 421 drug-related deaths in Scotland – 2006• Services still largely opiate focussed

Trends

• Crack cocaine

• Cocaine/alcohol mix

• Cannabis

• Methamphetamine

• Amphetamine ‘type’ drugs e.g. mephedrone (‘legal high’)

Scale of the Problem

Alcohol• Enough alcohol sold in Scotland in 2007 to

enable every man and woman over age of 16 to exceed sensible drinking limits every week of the year. Manifestation of ‘binge drinking’

• Significant number of children regularly drinking alcohol. In 2006 over ⅓ of 15 year old boys and girls drunk in previous week – 650 children treated for alcohol related problems – five week period in A & E departments

Scale of the Problem

Alcohol• More than half of alcohol sold is now

consumed at home• Impact of alcohol in areas of:

Crime Road accidents Domestic abuse cases (67% in 2003) Deaths – more than doubled in last 15 years Child care – 65,000 Scottish children are estimated

to be living with parent whose drinking is problematic

Cost – to NHS Scotland estimated to be around £400 million per year

Title here

Women’s alcohol consumption

• More women drink alcohol• Women’s drinking has become

more visible• More women drink at levels defined

as harmful • Research indicates women are

physiologically more vulnerable• BUT women drink less and less

harmfully than men

We may have a problem!

• Alcohol Statistics Scotland 2007

• In 2004 46% of 15 year old girls reported drinking in the week prior to the survey (compared to 40% of 15 year old boys)

Other relevant issues

• Tolerant and accepting social attitudes towards alcohol

• Need for real understanding of the impact – research and evidence-based practice requirements

• Patterns of use of alcohol and impact are changing

• Alcohol – an extraordinary commodity

(Aberlour Child Trust Think Tank Report ‘A Matter of Substance? Alcohol or Drugs.’)

Differences between impact of alcohol rather than other drugs

• Legality• Perspectives (of others)

• Attitudes of society• Attitudes and approach

of services• Costs and availability• Coverage of media• Less visibility of

children

• Types of drink• Alcohol and links to

domestic violence• More varied social-

economical status• Alcohol a greater

cost

Summary

• Continuing, long standing, seemingly intractable drug problem

• Much greater recognition of the problems caused by alcohol

• Health impacts as well as economic impacts

• Increase in women’s drinking

Need for a change in relationships

What does this mean for social work

• Children and Families• Young People• Mental ill Health• Older People• Young Offenders• Learning Difficulties• Physical Disabilities• Domestic Violence

Children and Families

• Impact of ‘Hidden Harm’• Before Hidden Harm, Getting Our

Priorities Right• What do we know of the ‘lived’

experience of children?• Parents’ responses• Influence of Getting it Right for Every

Child• Background of ‘It’s everyone’s job to

make sure I’m alright’

Limits of Drug Policy (Peter Reuter)

• Little evidence that it influences the number of drug users, or the share of drug users who are dependent (prevalence)

• Little evidence that tougher enforcement, more prevention or increased treatment – substantially reduced number of users or dependent users in a nation

• Cultural and social factors appear much more important

• Yet the public wants impact on prevalence

Policy Shifts

“harm reduction is often made an unnecessarily

controversial issue, as if there were a

contradiction between treatment and

prevention on the one hand, and reducing the

adverse health and social consequences of

drug use on the other. This is a false

dichotomy. They are complementary.” (UNODC 2008)

The Old Debate?

Summary

• Policy shift

• Impact on service delivery

• Complex relationships with alcohol and other substances

• Impact of alcohol

ALCOHOL

DRUGS

Benefits of the social work approach

• Relationships

• ‘emphasis on the individual within a particular environment and context’ (Galvani. S)

• Values and ethics of the profession

What social workers should know (Galvani & Forrester 2008)

• Knowledge

• Competence

• STRADA’s findings and experience

The Road to Recovery – do we have a map?

What About... ‘Recovery of’ ?

• Essence of the self• Relationships – family and community• Children• Youth• A moral compass• Health and well being• Economic viability

Thoughts on Recovery

• On-going support – emphasis on physical/social ‘ecology’ of recovery

• Self help• Role of all professionals • Partnership model of relationship –

consumer-led services• Supports within natural community – get rid

of concept of ‘after care’ – continuing care• Emphasis on advocacy/activist approach

(White W. et al. Chestnut Health Systems USA)

Thoughts on Recovery

• ‘addictive disorders’ – chronic disease• What we might need to do to change

engagement with service user

Low threshold (early identification); emphasis on outreach

Motivation – how can we impact on pre-contemplation stage of change

Comprehensive, strengths based assessment Building of ‘recovery capital’

(White W. et al. Chestnut Health Systems USA)

Recovery Model Pitfalls

• Out of the box thinking – conceptual resistance, fiscal/regulatory barriers

• Whole person: integrated care in a siloed world

• Resources/caseload management• Escape from

accountability/exploitation• Ethical/boundary issues – misuse of

the recovery model

Journey with the Service User

• Facilitating the ability to speak – asking the right questions

• Choices and the stages of recovery

• Creating ‘informed consumers’

• Choice and limited resource alternatives

What can social work do?

• Professional excellence – frontline evidence based interventions

• Direct observation and feedback – developing good practice

• Tools and interventions

• Time and space to reflect on practice

• Action-based research and evaluation

Observations and Conclusions

• It’s about people

• It’s about management

So what needs to happen?

• Cultural change

• Workforce development

• Engagement with families and users of services

• ‘Circle of care’

Summary

Psychoactive necessity?

• Why do we use substances?

• Relationships between substances; environment; culture; religion

• How do we cope with the problems?

• Can we change the relationships?

BIG Questions

• Whose job is it anyway?

• Ethical considerations and dilemmas

• New wine – old wineskins

“ It is not for kings, O Lemuel, it is not for kings to drink wine; nor for princes strong drink; lest they drink and forget the law, and pervert the judgement of any of the afflicted.

Give strong drink unto him that is ready to perish, and wine unto those that be of heavy heart. Let him drink, and forget his poverty, and remember his misery no more”

(Proverbs 31, 4-7)

STRADA contact details are:

Email: strada@gla.ac.uk

Phone: 0141 330 2335/2400

Web-site: www.projectstrada.org

Expanding Knowledge, Changing Practice