Flaws in our approach to drug and alcohol services

Part of The Big Life’s group work is to campaign for the commissioning of effective support services in the North West, including substance addiction support. Executive Director Simon Kweeday speaks candidly about the changes needed to the national approach to drug and alcohol services to truly help the people most impacted.  

Each year, more people die from drug use than from knife crime and road traffic incidents combined.

In England, more under-65’s lives are lost because of alcohol-related deaths than they are to deaths from many types of cancers.

Last February, the government announced that local authorities across England will benefit from an extra £421 million in government funding through to 2025. The funding is explicitly to improve drug and alcohol addiction treatment and recovery. This news followed the recommendations made by the government’s drug strategy, published in December 2021, that it significantly increases the capacity of treatment and recovery services as part of the whole-system approach to tackling supply and demand.[1]

The strategy also stated that drug use is behind half of all homicides, burglaries, robberies, and “other acquisitive crimes.” Dame Carol Black’s independent review of drug use outlined that the best way to tackle this issue is by boosting the capacity of the treatment and recovery system.

Millions of people are impacted by drug and alcohol abuse, be it personally or through a loved one’s addiction. In England, drug and alcohol treatment services are commissioned through the Public Health Grant on a regional basis. Funding is allocated via the assessment of local needs, and the plans proposed, or implemented by local services.

A quick online search for localised support options looks promising. Looking for “drug and alcohol services in Liverpool” brought up a range of results from a variety of providers: community projects, private treatment programmes, NHS links, and prison-led outreach. Our own drug and alcohol community services – including Community Voice – also appear.

As a provider, we actively work in partnership with other local services to help people to turn their lives around. We also know that addiction and recovery are not something to be treated in silo. Addiction and substance abuse are rarely a standalone problem. They are often symptomatic, consequential, or indicative of other issues.

How can you treat a deeply complex, individualised problem like addiction with a one-sized, systematic solution?

The need for a whole-person approach is at the core of Dame Carol Black’s recommendations. Too often mental health challenges and drug or alcohol addiction are seen as separate problems. Instead, they should be viewed holistically and, wherever possible, treated concurrently. “If someone had breast cancer and rheumatoid arthritis,” describes Dame Carol, “there would be an outcry if they were told ‘we can’t treat your cancer until we have cured your rheumatoid.’ The same consideration should be given to addiction.”

The physical effects of addiction are usually what gets treated first. Addiction can cause serious physical health complications that call for urgent medical intervention. Yet, as much as help may start there, it all too often ends there too. Our emergency health services – repeatedly underfunded, understaffed, under-resourced – are rarely positioned to go beyond the primary presenting issue.

So, who is?

For too long, drug and alcohol treatments and services have been limited in terms of ongoing, in-depth support. In turn, the support available remains too disjointed in approach. Those seeking help usually need to access multiple providers to address the various issues they are having.

Whilst this will be unavoidable in some instances, the expectation on someone struggling with addiction to attend multiple appointments with different services is categorically unreasonable, and even more so when you consider the lengthy, demand-induced wait times for a lot of the providers. Again, this is why people with addiction are usually first seen by emergency services – the issues in their lives have often escalated to the point of a drastic intervention being needed. Police called to make an arrest, or paramedics arriving to take someone to hospital.

Beyond the practical and financial constraints that influence the approach to drug and alcohol services, there is also a social stigma attached to those with addiction that has an impact.

Research has repeatedly shown that feelings of judgment prevent people who need treatment from seeking help. This stigma also affects organisations and people who provide support.

“We need to remember how people with addictions are seen by society,” says Fay Selvan, CEO of The Big Life group. “Society habitually blames the individual. It’s their fault. We do it with addiction, obesity, with smoking… but blaming people for their problems abdicates us from taking responsibility or needing to help them. It stops us looking at what we collectively need to improve or change.”

Those in need of ongoing, in-depth help with their addiction are often viewed less than sympathetically. They can be termed as difficult, oppositional, and problematic. Some of them are absolutely these things. Substance misuse has dramatic effects on someone’s neurology. Long-term alcohol abuse, for example, is a direct proponent for Alcohol-Related Brain Damage and induced dementia.

But, again, addiction can be symptomatic of an already impacted neuropathy. Professor Stephen Weatherhead, a Clinical Psychologist specialising in brain injury and Director of NeuroTriage, explains that trauma is a common denominator for those he assesses, particularly early-life trauma: “Developmental trauma means adults are pressed into the expectations of ‘adult life’ without the cognitive tools to support and function in that life.”

Viewed scientifically, it makes complete sense that people who have trauma are more likely to face struggles with addiction. Drugs and/or alcohol have long been a source of comfort and a means of coping for people who are, due to developmental trauma, ill-equipped to face life’s biggest challenges. It also follows that their addiction and other issues will directly affect their ability to make and sustain positive changes.

Only when we look at someone’s whole life and work to understand them as a person, can we truly begin to understand their addiction.

Our Big Lifelines project is a specific, trauma-informed means of trying to empower the people we work with to tell their life stories, focusing on the moments in their lives that matter most to them.

These stories are not about services, diagnoses, or blame. They are a chance to hear first-hand about the traumas, challenges, successes, and relationships that make people who they are. They enable you to see a person and not a problem. Those who have taken part in the project have all experienced addiction; some are in recovery, others have relapsed. Some remain in active addiction. What is apparent is the impact that early intervention or access to the right kind of support could have had. For them and the people around them.

The recent Frontline Workers Conference – which welcomed people working in drug and alcohol engagement services across Liverpool – highlighted through questions and discussion that the pressure on frontline staff working within drug and alcohol services mostly comes from the limitations and restrictions the current systems place on their ability to help, not from those seeking their assistance.

For any service provider to have a chance at truly tackling addiction and substance abuse, our treatment and recovery systems must evolve. Our attitudes must evolve. Public services are commonly focused on single issues with staff trained accordingly. Services focus on their offer, not what someone needs or wants. How can you treat a deeply complex, individualised problem like addiction with a one-sized, systematic solution?

Through working together, service partners add more value to someone’s recovery. We are seeing this via The Achieve Partnership in Greater Manchester. The Achieve Drug and Alcohol Recovery Service has provided holistic support to adults and young people experiencing substance misuse issues in Bolton, Salford, and Trafford since 2018 and Bury since 2019. The Achieve Partnership comprises of organisations within the region that have expertise directly and indirectly related to substance misuse and recovery. This includes clinical expertise, outreach, training, housing, and grant funding for community groups.

Following an independent evaluation, Achieve service users were broadly very positive about the support/treatment they received, experiencing a joined-up offer. Service users reported positive impacts from the holistic service (although there were variations due to the support available in different areas). Some service users who were in recovery became volunteers with Achieve or set up their support services, contributing to the range of support services available in local communities. Sustaining partner knowledge, engagement, and understanding of services and developments will be key to maintaining this progress.

The Big Life group is built on a whole-person approach. Every person is multifaceted and more than the problems they present with. All our services work in ‘The Big Life Way’ – helping people across all areas of their lives. We continue to strive to do this in every community we work in: developing partnerships with other providers, decision-makers, and services. We need to bring about widespread, tangible, connective change.

This September, The Big Life group and Community Voice hosted The Frontline Workers Conference, bringing together staff who support the people affected by drug and alcohol addictions. Speakers included Dame Carol Black and Director of Public Health for Liverpool, Matt Ashton. 

Community Voice is a user-led service run by people who have been affected by drug or alcohol use. It works to get their voices heard in the commissioning and everyday running of substance addiction services in Liverpool.