You may not know that your local authority is responsible for funding drug and alcohol treatment. And unless you, a friend or family member have been personally touched by addiction you might not think that these services should be a funding priority for cash-strapped councils.
We’re left to manage a host of intractable problems that we’re not qualified or able to deal with.
I work in a community drug and alcohol treatment centre and my job is to support people to overcome their addiction and support their recovery. When I arrive at work in the morning there is usually a queue of people outside wanting to get help.
They’re vulnerable people with complex needs and demand for our support is increasing. Yet we’ve seen our funding slashed by 42% since 2010. The situation is the same across the country.
I see fewer heroin users nowadays but far more people dependent on alcohol and people getting into problems with so-called party drugs such as methamphetamine and ketamine. The heroin users might be fewer in number, but they require more of our attention as they get older and sicker. They often have hepatitis C and smoke tobacco and succumb to liver and lung diseases as a consequence.
Addiction sits at the centre of a cluster of physical, psychological and social difficulties. Our service users need help and support in all these domains if they are to stand a chance of recovery. Our caseloads have got bigger because we have had to cut posts and as pressures elsewhere in the health and social care system builds, the complexity of the problems we are presented with has increased, too.
Even when there are clear mental health problems, mental health services don’t want to treat people who also use drugs or drink, so they send them to us. The same applies to the general hospitals – with access to liver treatments being rationed. I know they are also under pressure, with ever-expanding waiting lists, but as a consequence we are left to manage a host of intractable problems that we are not qualified or able to deal with.
Some of our clients lead chaotic lives and come to us in desperation with a whole host of difficulties that go far beyond addiction. They might be embroiled in the criminal justice system and need advice, they might have housing problems or be struggling with trauma; it is not uncommon for me to treat clients who used to be in care and have survived institutional abuse. We used to have psychologists in our team who could provide treatment for complex trauma related to sexual abuse but their posts were cut last year.
I have two clients who are so physically unwell that the local residential detox provider does not think they can safely manage them. The NHS-run unit we used to refer to because it had the necessary medical cover has been closed due to the cuts. If they don’t die beforehand, the only hope for my clients is that they will get a detox if they are admitted in an emergency with a physical health crisis to a general hospital.
With diminished resources we have had to prioritise treatments such as opiate substitute medications and needle exchange, which we know can keep people alive. But how are these actually helping people overcome their addiction?
Addictions services are often retendered with contracts being awarded to the cheapest bidder. I work with people who have had their service retendered and employer changed multiple times. This is a massively stressful process and I have friends who have left the sector feeling demoralised and burnt out.
We are judged on figures like the number of people leaving treatment drug-free, and treatment centres know that this can be used against them. The worst-kept secret in our sector is the gaming of this so-called “performance data”.
If a client drops out of treatment it will have a negative impact on our figures. One way to manage this is not to start the most chaotic people in treatment in the first place. People aren’t refused treatment but they are asked to jump through hoops before structured treatment is commenced.
A homeless, mentally unwell heroin user is going to find it difficult to attend a “treatment induction group”, but the consequence is that they never start on the medication that might actually help them.
Some facts are impossible to hide: drug-related deaths are increasing and new drugs and associated problems are causing problems in prisons and emergency departments. Even the shadow health secretary, Jonathan Ashworth, whose father was an alcoholic, has called for greater recognition of the damage done by excessive drinking.
Drug and alcohol use and addiction isn’t going to go away. I try to do the best I can for the people I work with. I try to close my ears to the negative and stigmatising language. Instead I keep my ears open to my clients and I try to find a connection and build a relationship that may help them in their recovery.
This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com
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Drug addiction isn"t going away so why are treatment centres being slashed?
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