p01 cover.qxd by jizhen1947


									From FDAP in association with WIRED
                                              15 November 2004


Drink and Drugs News

Falling apart
victims of alcoholism
and their families
can’t wait for help

abstinence or
harm reduction?

Your NEW fortnightly magazine | jobs | news | views
Client’s view (using drawpad) of screen in mid-session       Assessor choosing actions to place on caller’s screen

                                  Launching this month

                                  From WIRED
                         In association with FDAP and Distance Therapy Ltd

                                      VIRTUAL OUTREACH
                 A uniquely secure online tool to bring together substance misuse
                 professionals and their clients.

                 Virtual Outreach has internet-based counselling, assessment, and groupwork
                 rooms, with video and voice links, chat and whiteboard that give strict
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                 Use Virtual Outreach for:

                         "       Assessment and referral
                         "       Counselling (individual and group)
                         "       Peer support
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                 Virtual Outreach is based on the online therapy tools of
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                 addicts. It has been specially developed to relate to substance misuse.

                 To see demos and try out Distance Therapy, visit www.distancetherapy.com

                 For further information, please contact:
                 Professor David Clark
 Published by
                                       Drink and Drugs News
                                        15 November 2004

 On behalf of


                                                                 Editor’s letter

                                       Alcohol campaigning has, it seems, been a little               Neil McKeganey shares thought-provoking research
 The 21st Century approach
to tackling substance misuse           slow to get the results it needs.                              on drug users’ motivation for entering treatment. Is
                                          Tacked on to a number of major drug reports as              abstinence the driving force behind applying for
                                       a reference – ‘this could also apply to alcohol’ –             help? Send us your views.
                                       the needs of those who have drifted from using                     Our regular education series starts on page 13,
 Drink and Drugs News in               alcohol for regular relaxation and social confidence           with a journey through society’s perceptions of
 partnership with:
                                       to desperate dependency, have been neglected.                  psychoactive drugs. Prof David Clark explores
                                          The DATs who have become DAATs may be doing                 changing fashions on what’s good or bad, safe or
                                       their best, but it seems up to the persistent                  dangerous.
                                       minority to remind government that targets are not                 Those of you who followed the first part of
                                       set for shifting, and that a report on alcohol                 Natalie’s story in our last edition will be heartened
                                       services due on such and such a date means that                to see she’s turned the corner this issue (page 8)
                                       there are services looking out for a framework and             and we’ve an honest account of life as a carer. If
                                       a promise of commitment.                                       you need convincing that family support groups can
                                          Beyond legislation, there are individuals in need           play a tremendous role, turn to My Four Walls on
                                       of practical action. On page 6, Rosie Brocklehurst             page 10.
                                       reminds us of the human face of alcohol disorders,                 Finally, thanks for your great response to our
                                       beyond crime statistics and more effective policing.           first issue – and don’t forget to let us know if
                                          We’ve an invitation for debate on page 9, where             you’ve a colleague who’d like their own copy.

     European Association for
                                         Claire Brown
    the Treatment of Addiction
                                         t: 020 7463 2164                 In this issue
                                         e: claire@cjwellings.com

                                         Advertising Manager:             News Roundup
                                         Ian Ralph                        Alcohol Concern conference | Audit             My four walls
                                         t: 020 7463 3581                                                                Jane felt her four walls closing in on her
                                                                          Commission calls for drug service refocus
                                         e: ian@cjwellings.com
                                                                          | Ofcom tightens rules on alcohol ads |        before she found a support group to help
                                         Designer:                        London drug law unit gets tough     4          her cope with her family’s all-consuming
                                         Jez Tucker                                                                      drug problems.                          10
                                         e: jez@cjwellings.com
                                         Subscriptions:                   cover story                                    Internet treatment and support
         Drugs and                       e: subs@cjwellings.com                                                          Innovation and the internet is the modern
                                                                          No room at the inn
        Alcohol Today
                                                                          Rosie Brocklehurst knows all about ‘this       approach to tackling substance misuse,
                                                                          challenging time for the field...’ but asks:   says Prof David Clark.               11
                                         e: office@fdap.org.uk
                                                                          what are we doing about everyday victims
                                         Website:                         of alcoholism, who need help now? 6            Obituary
                                         www.drinkanddrugs.net                                                           A tribute to Ma Kkaya Nefertari       12
                                         Website maintained by
                                         Ash Whitney of Wired-up          How I became...
                                         Wales                            Part 2: Natalie concludes her struggle from    Education: Drugs in Society
                                                                          addiction on a happier note.          8        Good drugs or bad drugs..? Prof David
CJ Wellings Ltd, FDAP and WIRED          Published by CJ Wellings Ltd                                                    Clark traces attitudes to drugs back
do not accept responsibility for the
accuracy of statements made by           Printed on environmentally       Abstinence or harm reduction?                  through history.                     13
contributors or advertisers. The
contents of this magazine are the        friendly paper by the            Controversial new research suggests that
copyright of CJ Wellings Ltd, but do     Manson Group Ltd                 drug users seek abstinence, not harm           Letters                               7
not necessarily represent its views,
or those of FDAP, WIRED and its                                           reduction. Neil McKeganey, one of the
partner organisations.                   Cover pic by plainpicture                                                       Events                                14
                                                                          researchers, opens the debate.      9

www.drinkanddrugs.net                                                                                                        15 November 2004 | drinkanddrugsnews | 3
News | round-up

Audit Commission calls for drug                                                                                     Ofcom steers drink
services to refocus                                                                                                 ads away from youth
Refocusing on individual need is the
essential next step for drug treatment
                                                         The insight of users and carers is an
                                                    important part of shaping services, says
                                                                                                   ‘The insight     culture
                                                                                                   of users
services, according to the Audit                    the Commission. Research from those                             Ofcom has tightened its rules on alcohol advertising
Commission. Drug Misuse 2004, the                   directly involved had given useful             and carers       following recent consultation on its revised
follow-up report to Changing Habits,                information about barriers, including          is an            standards code for television advertising.
published in 2002, acknowledges                     inconvenient appointment times, off-           important             The new rules aim to reduce the appeal of
‘impressive progress’ in developing local           putting dilapidated premises and transport                      alcohol to children and young people and break the
drug treatment services and partnerships,           difficulties. Listening to this feedback       part of          link between alcohol and youth culture, by moving
but proposes a new framework to tackle              would lead to more effective use of            shaping          away from advertising styles that appeal strongly to
the 34 per cent drop-out rate.                      resources, give better value for money –       services.’       younger viewers.
     Better support and follow-on services,         and would increase users’ prospects of                               However, the media watchdog backed down
tailored to individual need, are seen as the        staying the course, it advises.                                 from controversial proposals to ban celebrities and
key to sustaining users on the road back                 While praising many local partnerships,                    music aimed at teenagers from ads for alcoholic
to recovery. Success would depend on                the Commission calls for drug partner-                          drinks. Instead, it made the advertising industry’s
consistent involvement of local authorities,        ships and mainstream services to be                             self-regulating body, the advertising standards
the health service, police, prison and              much more efficient in planning resources.                      authority, responsible for issuing guidelines on the
probation services, in delivering parts of          Only then, it says, will further government                     new rules.
an integrated package.                              funding streams be appropriate.                                      Alcohol Concern supported the new ‘tougher
                                                                                                                    clearer rules’ as preventing advertisers from being
                                                                                                                    ‘able to push the boundaries in the name of
NTA rejects claims of inflated figures                                                                              creativity’. The Institute of Alcohol Studies was less
                                                                                                                    impressed. Director Andrew McNeill told The
A question mark over accuracy of           magazine of Drugscope, Mr Hayes      target to expand treatment places   Guardian that the rules were cosmetic and likely to
drug treatment figures this week           said that the NTA stood by its       by 55 per cent within five years.   have little tangible effect: ‘We thought it would be
has been rejected by NTA chief             figures and that there had been no                                       easier to put an end to lifestyle advertising in
executive, Paul Hayes. Responding          attempt to mislead.                  Read comment from Paul Hayes        general, rather than fiddling around in this way
to an unnamed source, who had                  The accusation comes as the      in the next issue of Drink and      which is really going to be an invitation to people to
aired his views in Druglink, the           government celebrates hitting its    Drugs News.                         show their ingenuity in how they can overcome it.’

                                                                                                                    New law unit cracks
                                                                                                                    down on London
                                                                                                                    drug networks
                                                                                                                    A pioneering law enforcement unit has been created
                                                                                                                    to tackle the supply of Class A drugs by London’s
                                                                                                                    criminal networks.
                                                                                                                         The Middle Market Drugs Project is a joint
                                                                                                                    initiative – the first of its kind in London – between
                                                                                                                    the police and customs and excise, supported by
                                                                                                                    the National Criminal Intelligence Service.
                                                                                                                         A 70-strong team will target intelligence
                                                                                                                    operations at drug wholesalers, the link between
                                                                                                                    traffickers and street dealers.
                                                                                                                         Home Office Minister, Caroline Flint, welcomed
                                                                                                                    the creation of the unit as ‘a key step in preventing
                                                                                                                    Class A drugs reaching our communities’. Breaking
                                                                                                                    down the supply chain was just half of a battle, she
                                                                                                                    said. The other part involved more than half a
                                                                                                                    billion pounds of government spending to get drug
                                                                                                                    users into treatment.
 An Afghan poppy man, one of the images from leading drug charity DrugScope’s Thin Lines, White                          The aim of the unit is to make sure that
 Lies exhibition in London, last week. Opium production accounts for between 40 and 60 percent of                   criminals do not profit from drug dealing. Early
 the Afgham economy. The set of portraits, many of them hard hitting, shows people whose lives are                  successes during the two-month trial period have
 dependent on drugs. DrugScope aims to show the importance of measures to tackle drug-related                       included hauls of cocaine worth an estimated
 harm, and is auctioning the pictures to raise funds to continue its work at www.drugscope.org.uk                   street value of £9,039,040; crack cocaine worth
 Picture by Heidi Levine/Sipa Press/Rex features                                                                    £71,250; heroin worth £176,000 and cannabis
                                                                                                                    worth £200,000.

4 | drinkanddrugsnews | 15 November 2004                                                                                                               www.drinkanddrugs.net
Conference news | Alcohol Concern

National alcohol strategy is only                                                                                                         In brief
first piece of the jigsaw                                                                                                                 Empowerment toolkit
The national alcohol strategy is a ‘key milestone,        the current state of play around supply and                ‘For the first       Boosting the involvement of users
but part of a longer process’, Clive Henn, the            demand of treatment. ‘For the first time, we will          time, we             and carers is made easier with the
Department of Health’s senior policy adviser, told        have a national picture of the state of alcohol                                 NTA’s toolkit, Extending Empower-
Alcohol Concern’s conference.                             services,’ he said. ‘Afterwards local areas will be        will have a          ment – involving service users and
     Acknowledging that the strategy ‘didn’t please       able to take data and use it for local planning.’          national             carers. Examples of practice, user
everybody’, Mr Henn warned that getting the right             Mr Henn was supportive of turning DATs into            picture of           views and sources for further advice
balance between stakeholders would not be a               DAATs, but recognised that ‘with all their                                      and information make the resource
short-term process.                                       competing demands, it’s important that they have           the state of         a useful starting point. Visit
     Melanie Johnson and Hazel Blears were                time to deliver around alcohol as well’.                   alcohol              www.nta.nhs.uk/programme/
linking up research from public health and the                In a nod towards stretched resources, Mr               services...          national/toolkit.html
Home Office, in an innovative approach, he said.          Henn advised delegates ‘not to hold up planning
The DoH’s priorities included looking at a                waiting for the budget’.                                   Afterwards           Employers get Frank
mismatch of supply and demand for services.                   Richard Phillips, acting chief executive of            local areas          Help for employers in dealing with
     The sensible drinking message needed to be           Alcohol Concern, said that we were ‘facing an              will be able         drugs and alcohol in the workplace
‘easier to understand and more relevant’,                 extraordinary set of opportunities’ and while there                             is available from the government
according to Mr Henn. DoH research indicated              were aspects of the strategy that probably                 to take data         campaign, Frank. The special edition
that while 80 per cent of people were aware of            wouldn’t see change for 10 years, ‘we mustn’t let          and use it           Action Update includes advice on
units, only 25 per cent knew what they were –             frustrations blind us’.                                    for local            pros and cons of drug testing and
and just 10 per cent checked their consumption                The watchword of the next few years would                                   advice on effective workplace
of units.                                                 be ‘mainstreaming’ – getting alcohol policy into           planning.’           policies. Download the pack at
     Early screening and interventions should be          mainstream planning, through a whole systems                                    www.drugs.gov.uk/Campaign/Resou
incorporated into medical schools’ training               approach.                                                                       rces/ActionUpdates/1098182299
modules, he suggested, and workforce issues                   Alcohol Concern intended to work with local
looked at ‘as the strategy develops’.                     authorities, the Home Office and the prison                                     Begging for drugs
     The government’s audit of alcohol services,          service ‘to cultivate allies beyond our heartland in                            New guidance to help reach drug
whose deadline was January next year, would tell          health’, he said.                                                               users who beg, complements the
                                                                                                                                          government’s begging toolkit. The
                                                                                                                                          guide offers support in developing

Culture change                                            Joint action vital to raise                                                     services that are successful in
                                                                                                                                          engaging and sustaining contact
                                                                                                                                          with drug users who beg. Available
needed to tackle                                          profile of alcohol field                                                        at www.drugs.gov.uk/Reportsand
binge drinking                                            Joint action between police,
                                                          alcohol agencies, local authorities,
                                                                                                 unions were ‘beseiged with
                                                                                                 messages like get trollied for a         Alcohol model
                                                          government and industry is the         fiver’ and without sanctions, the        The NTA reported progress on the
A cultural shift is the only way to change British        only effective way of tackling         drinks industry had no                   action plan for Models of Care for
drinking habits, according to Dr Jane Marshall,           spiralling incidents of alcohol-       compunction from the government          Alcohol (MoCA) at Alcohol Concern’s
consultant Psychiatrist at the National Addictions        related crime, according to Steven     to take their social responsibilities    conference. Annette Dale-Perera,
Centre.                                                   Green, Chief Constable of              seriously, said Mr Green.                Director of Quality, reported that a
     ‘There’s a reticence to consider a link between      Nottinghamshire Police.                     Examples of a growing               working group was underway and
alcohol and violence,’ she said. Door keepers still            ‘Police are the last line of      dialogue between criminal justice        the first stage wide-ranging
keep serving people who are worse for wear… We            defence. They only cut in when         and alcohol treatment workers,           consultation would take place
laugh at drunk people for doing crazy things.’            everyone else has failed,’ he told     were given by Peter Steele, Chief        before Christmas. Engage with the
     Alcohol had become commonplace making it             conference.                            Executive of Gloucestershire Drug        consultation as it emerges.
more difficult to spot a habit out of control.                 The police agreed with 61 per     and Alcohol Services. The alcohol
     ‘There’s so much alcohol around that people          cent of the population who             arrest referral scheme had proved        Dawn partnership
with dismal and difficult lives are using it to cope,’    believed that alcohol-related          a cost effective way of getting          A north Wales partnership has
said Dr Marshall.                                         crime was getting worse, he said.      people into treatment and ‘giving        secured two years’ funding worth
     The alcohol strategy had failed to get to the root   The licensing industry had             them a chance to look at other           £4.2m, to continue its work in drug,
of many problems, including alcohol-related violent       increased the amount of crime          parts of their life’, said Mr Steele.    alcohol and offender rehabilitation.
behaviour, she said. Between a half and a third of        hotspots, which had not been                While there were traditional        The Dawn Partnership draws on
offenders drank before an assault.                        matched by an increase in police       cultural tensions between                expertise from dier se agencies,
     People were doing an excellent job on the ground,    resources.                             criminal workers and client              and has helped over 1600 people
but had been calling for the strategy for a long time,         Nottingham had successfully       workers, the real enemy were             to bridge the gap from treatment to
she said. ‘I hope the NTA will shape up and invigorate    trialled partnership schemes           treatment targets from the drugs         mainstream further education,
alcohol treatment services in the UK.’                    between the public and private         field, he said. ‘Alcohol has to          training and employment. The
     There had been little investment in the alcohol      sector, and with trading standards     justify every pound it spends,           funding came from criminal justice
field, but Dr Marshall saw the alcohol strategy as an     to target underage drinkers, but it    unlike the drugs field… if we don’t      and health sources in north Wales
opportunity: ‘let’s take the strategy and make            was an ongoing battle against the      get the drugs targets there will be      and the European Social Fund.
something of it. Let’s shape it,’ she urged.              binge drinking culture. Student        hell to pay.’

www.drinkanddrugs.net                                                                                                                    15 November 2004 | drinkanddrugsnews | 5
Cover story | alcohol treatment

                                                        WHAT I HAVE TO SAY MAY SHOCK AND DISTRESS YOU.      Of course, the truth is, there is no endemic
                                                        THOSE WITH A DELICATE DISPOSITION MAY LIKE TO       fantasy. Rather, a tragedy is being played out: a
                                                        STOP READING NOW.                                   tragedy of lost opportunity and a tragedy of
                                                            There is a growing fantasy that millions of     political will. But the field itself is tragically failing
                                                        people in the UK are dependent on alcohol and       to come together and speak up. We are united
                                                        that this is causing a severe health crisis of      only by our muffled voices.
                                                        monumental proportions. In our hospitals for             In a weird kind of way, the politicians’ difficul-
                                                        instance, people in A&E departments are             ties, particularly financial, in providing a compre-
                                                        convinced they are seeing large numbers of          hensive alcohol strategy is easier to swallow.
                                                        people with alcohol related mental health                This tragedy I speak of plays out like a movie.
                                                        problems, diseases, alcohol injuries, and so on,    It is called ‘Demonisation Part Two’, like that old
                                                        when, in fact, they are not.                        horror movie about drugs. It is now showing on
  No room at the inn

                           It’s a challenging time          I know this is true, because no-one with        a screen in a city centre near you. Starring
                                                        power and money to do anything about alcohol        ‘Alcohol Man’ and overworked ‘Police Man’.
                           for the field, the Alcohol   dependence and health is even talking about it.          The effect of the demonisation message in
                                                            Moreover, in a perfect example of bureau-       the popular imagination, is that everyone with an
                           Concern conference told      cratic overkill to a non-existent problem, I hear   alcohol problem gets an instant makeover as a
                                                        that the Department of Health has employed a        low-life violent yob. The government message
                           delegates. We need the       team of three alcohol advisors. Three! What do      becomes the media message. Worcester woman
                                                        they do all day?                                    sips her G&T and feels slightly better about
                           right balance between            I can back up these revelations of mass         things. Middle England adds a slice of lemon and
                                                        delusion with proof.                                perceives something is being done at last.
                           shareholders, and to plan        You can get ‘Nectar Reward’ points at
                                                        Sainsbury’s for alcohol, but you can’t get them     Demonisation silences us.
                           more resources for           for tobacco. Proof.
                                                                                                            What are we afraid of? What do we risk?
                           policing crime hotspots,     Ok. A bit feeble.
                                                                                                            Might we risk our reputations being tarnished by
                           more research, and for       How about this?                                     association? Are we afraid of being called soft-
                                                                                                            on-crime liberals with bleeding hearts? We ask
                           plugging the gaps in the     A rainy day in November, and 100 alcohol            our alcohol dependent clients to show their
                                                        professionals are gathered together in a            feelings. Why are we so afraid to show ours?
                           national alcohol harm        comfortable venue for the fourth national                Can’t we get the message to Worcester
                                                        conference to be held in five weeks on the          woman that we aren’t soft on crime, but we help
                           reduction strategy…          subject of alcohol and crime. Note the word         reduce crime in the long term? Can’t we say that
                                                        crime. Not health. Proof.                           we challenge anti-social behaviour and help
                           What about the victims            Naturally, speaker after speaker focuses on    people to become fully responsible, dignified
                                                        crime waves and policing, on arrest referral        human beings?
                           of alcoholism and their      schemes, on coercive responses to treatment,             Those sophisticated political minds amongst
                                                        on Asbos and all the pragmatic detail of            us are probably reassuring themselves that by
                           families, who need           approaches to prevention and enforcement.           remaining mute, they are playing the long game.
                                                        Impressive speakers all. Coolly clinical,           This is called the politics of considered caution.
                           help now? asks               moderate, devoid of urgency, and eminently          It’s very cool.
                                                        civilised, the words addiction and dependency            After all, there are organisational reputations
                           Rosie Brocklehurst           hardly figure. The talk is about criminals.         to consider. Of course, during periods of
                                                                                                            consultation we may speak out with moderation
                                                        What more proof do you want?                        and sense, but outside of that, we best keep
                                                                                                            quiet until spoken to.
                                                        Then someone raises a hand. “What about the              Are we frightened of losing out on funding?
                                                        children of parents and carers who misuse           On contracts? Self-interest has always played its
                                                        alcohol?” asks this person. A ripple of             part in quiet collusion. Let someone else raise
                                                        discomfort spreads around the room. Bottoms         their head above the parapet and draw the
                                                        shift uneasily in chairs. “Aren’t people with       snipers’ fire.
                                                        alcohol problems victims too?” she goes on.              But what about this thought? It is just
                                                            A man at the back of the room whispers to       possible that some parts of government might
                                                        his neighbour, “she’s brave,” he says recognising   appreciate some effective campaigning on
                                                        a social gaffe when he hears one.                   alcohol treatment, particularly around family
                                                            “Isn’t ‘brave’ the new ‘dumb’?” replies his     work. They would like the industry to do more,
                                                        companion.                                          heaven knows. So would the police. After all,
                                                                                                            there is some sympathy in the corridors of
                                                        What is going on?                                   power. But rarely is any major incursion made

6 | drinkanddrugsnews | 15 November 2004                                                                                                        www.drinkanddrugs.net
Cover story | alcohol treatment

                                                                                                            Unequal equality

                                                                                                            I read the article featuring Caroline Flint and
                                                                                                            was not surprised that alcohol featured very
                                                                                                            insignificantly in the overall big picture.
                                                                                                            (DDN, 1 Nov, page 8.)
                                                                                                                An addict is an addict and should be
                                                                                                            treated equally, whether their drug of choice
                                                                                                            is legal or not. The government thinks
                                                                                                                A recent NTA circular welcomed the
                                                                                                            government’s continuing commitment to
                                                                                                            funding – a further £219m per annum
                                                                                                            investment in treatment by 2007/8 – as ‘a
                                                                                                            result of the dedication and commitment of
                                                                                                            everyone working in the treatment field’.
                                                                                                                What of the dedication and commitment of
                                                                                                            everyone working in the alcohol treatment
                                                                                                            field? No such support is the answer.
                                                                                                                I am writing from a position in the frontline
                                                                                                            of alcoholic human suffering from which I
                                                                                                            have operated, first in day-centres then
                                                                                                            residentially, for 28 years. Few of our
                                                                                                            associated projects have survived with us.
                                                                                                            Hundreds of experienced and clever people
 ‘I try to seek comfort by periodic night-time reading of                                                   have been lost forever to the alcohol sector.
                                                                                                            At the time of writing I have 12 empty beds
 the six pages in a 95-page strategy that talks about                                                       and 65 on a waiting list who have no hope of
                                                                                                            obtaining funding.
 treatment tomorrow, maybe, and live in my own little                                                           The way this project has survived is
                                                                                                            through pure, unadulterated vocation. Senior
                                                                                                            management have subsidised running costs
 fantasy world, dreaming that perhaps a few million quid
                                                                                                            because their passion was so intense and
                                                                                                            boundless. I cannot think of another soul who
 for treatment might fall off the back of a beer lorry                                                      would have battled as we have, not only
                                                                                                            putting money in but not taking salaries out.
 owned by some of those nice alcohol industry people.’                                                      This is what the government has driven the
                                                                                                            real dedicated and committed people in the
                                                                                                            alcohol treatment field to do.
 into the public purse without a lot of noise.         tomorrow, maybe, and live in my own little               The end is drawing near for alcohol rehab
     Right now, there seems to be an unspoken          fantasy world, dreaming that perhaps a few           projects which rely on local authority funding.
 consensus that we must wait for more evidence-        million quid for treatment might fall off the back   The private/celebrity market expands all the
 based data. We must wait until hugely increased       of a beer lorry owned by some of those nice          time. The streets, police stations, A&E depts
 levels of alcohol-related harm, rising trends of      alcohol industry people.                             and hospitals are filled on weekend nights
 misuse and irresponsible behaviours, deaths,              Meanwhile, in the committee chambers and         with the ever growing culture of binge
 child abuse, broken families, and unquantifiable      conference halls, we talk about the criminal and     drinkers. Addiction to alcohol is fragmenting
 levels of individual human suffering, come            the victim as if they are always separate            and destroying families every day.
                                                                                                                What is the government doing? Burying its
 spilling out of the research databases and onto       entities, and fail to set a permanent place for
                                                                                                            head in the sand and hoping the problem will
 analysts’ graphs.                                     the end user at the policy table for fear she
                                                                                                            go away. It won’t. What will go away however,
     But many of us know quite enough already to       might slur her words. DD
                                                                                                            are the people like us who have soldiered on
 say with conviction, that we need much more                                                                in the vain hope that someone would wake up
 treatment now, not later. But we don’t say it loud    Rosie Brocklehurst works as a journalist and         and smell the coffee! Apparently the hangover
 enough. Instead, we feel it only polite to say how    communications specialist in the drugs and           has to be a great deal worse before that can
 deeply grateful we all are that there is an alcohol   alcohol related field. Her family has                happen. The problem will by then have
 policy at all.                                        experienced alcohol misuse tracked through           overwhelmed us as a society.
     Some say, silence and crumbs are better           three generations of relatives, including
                                                                                                            Teresa Weiler,
 than raised voices and an empty table. They           instances of alcohol-related child abuse,
                                                                                                            Business Manager, Chaucer Clinic
 may be right. So, I try to seek comfort by            domestic violence, liver disease, oesophageal
 periodic night-time reading of the six pages in a     cancer, heart disease and early death.
                                                                                                            Please email your letters to the editor:
 95-page strategy that talks about treatment           (rosie@brocklehurst49.freeserve.co.uk)

www.drinkanddrugs.net                                                                                                   15 November 2004 | drinkanddrugsnews | 7
How I became | an ex-addict (part 2)

In our last issue, Natalie faced up to 10 years of
drug-taking and turned to a local treatment agency
to help her tackle her heroin addiction. The
concluding part of her story is of immense courage
and perseverance, support from strangers who
became friends – and the unexpected revelation of
new life around the corner

         decided to enter primary treatment       written work. And there were rules to follow.      ‘As a child, my     became available in the right suburb, a

“I       and therefore give up all substances,
         including cannabis and alcohol. The
         agency’s rules also stated that I was
not to go in any wet places, so I had to stop
working in a pub. I knew I needed the agency
                                                      I still didn’t think I was going to overcome
                                                  my addiction and complete treatment.
                                                  ‘Yeah, you will’. I had all these people
                                                  believing in me and wanting the best for me,
                                                  which was something that was totally
                                                                                                     dream of what it
                                                                                                     was like to be
                                                                                                     an adult was
                                                                                                     nothing like how
                                                                                                                         week after I finished the nine-month
                                                                                                                         primary treatment programme.
                                                                                                                             I then entered the aftercare programme.
                                                                                                                         I finished the courses I had been doing at
                                                                                                                         college – I had never completed a course
if I was going to have any chance at beating      different to what I’d been used to. I began to                         before – and also began doing voluntary
my addiction. They had given me some              notice little changes in myself. I sent back       I was living and    work at the agency. Six months later, the
structure. They had guided me because I did       fifty pounds John (my ex-boyfriend) sent me        that was very       agency offered me a full-time job as a recep-
not know how to look after myself. I needed       for my birthday, even though I had no money.       sad. But now I      tionist. I could not believe it! I gradually
to be taught how to live again, to eat            I did not want something from my old life.                             built a new social network and rebuilt my
properly, be a proper mother. My son and I        And I started gaining self respect. I started      am so happy         relationship with my family. Most import-
had been arguing like brother and sister,         mixing with normal people, non-addicts.            and that dream      antly, I gradually rebuilt the relationship
because I’d been like a child during my heroin    I began to do pottery and dress making             of adulthood is     with my son. For a long time, he would not
using. I had forgotten the routine of meals       courses in college, and I helped children learn                        trust me, would not cuddle or kiss me. It
and would binge eat from three or four            to read at a local school.                         far better than I   took a long time, but now we are so close.
o’clock in the afternoon. My counsellor               I was so determined that I was going to        ever imagined.’         I’ve been off heroin and all other drugs
helped me devise a balanced diet plan.            complete treatment. I wanted to achieve                                for over four years. I shock myself when I
     My determination to beat my addiction        something. There were times when I missed                              think of the state I was in. I was 24 with no
was spurred on by the stories that I had heard    John, but I knew it was my head telling me                             future other than my addiction and I truly
from ex-users and by what the agency had to       that I miss drugs, because John was drugs as                           believed I would never achieve anything.
offer. More than anything, I had longed for       far as I was concerned. There were times                                   As a child, my dream of what it was like
happiness and the feeling of belonging            that I was scared, like doing my life story in                         to be an adult was nothing like how I was
somewhere. I’d been totally unhappy when I        group sessions. I thought I needed a                                   living and that was very sad. But now I am so
was using heroin. For the first time, I felt I    tranquilliser to get through it. I didn’t like                         happy and that dream of adulthood is far
belonged somewhere. There was something           those thoughts. Once you do it sober, you                              better than I ever imagined. I feel free and
about the agency. I just loved the people. They   feel good. Very good.                                                  very fortunate. And I have choices. Most
didn’t judge me. They treated me like a human         I began to take responsibility for the role                        people who come here are really shocked
being, supported me in whatever I wanted to       I had played in my addiction, instead of                               when they find out I’m a recovering heroin
do, and treated me as if I was a nice person.     blaming John. My counsellor was fantastic. I                           addict.
Most importantly, they believed in me.            had a lot of issues to deal with apart from                                I owe the agency my life. But I also know
     I was really scared when I first started     my addiction. Everything was brought out in                            that I accomplished a lot – I played an
primary treatment. But there were a couple        to the open, one way or another. I was                                 important role in my recovery. I’m no
of people I knew from earlier meetings and        desperate to move out of the family home                               different from anyone else, so anyone can
that made it easier. Primary treatment            because my father was still using heroin and                           do it. If a person wants to do it, they can do
required a strong commitment. You had to          he still associated with my old drug-taking                            it. Nothing is too immense to sort out, but
attend the agency one full day a week. You        friends. However, I couldn’t just move                                 you need to reach out and get the help. You
had to attend three NA/AA meetings and one        anywhere, because I had to think about my                              don’t have to do it on your own. There are
counselling session a week. You had to do         son and his schooling. An apartment finally                            people who will help you.

8 | drinkanddrugsnews | 15 November 2004                                                                                                           www.drinkanddrugs.net
Focus | treatment

or harm reduction?
New research on drug users in Scotland
revealed an overwhelming vote for abstinence
over harm reduction as their treatment goal.
Neil McKeganey, one of the researchers,
gives his views

Over the last fifteen years drug abuse              between abstinence and harm reduction,           ‘The Scottish      services that can lead them onto different
treatment services in the UK have been              when in reality the two are effectively          Drugs Forum...     forms of drug use. The research raises
influenced by one idea more than any other.         combined. But are they effectively combined                         another interesting issue which is no less
The philosophy of harm reduction, borne out         in practice? Over the last ten years in          issued a press     challenging: namely, what would our drug
of a key report from the Advisory Council on        Scotland there has been a massive expansion      statement on       treatment services look like if the voice of the
the Misuse of Drugs, has had an unparalleled        in the use of methadone prescribed to drug       the publication    drug user was given much greater
influence on the world of drug abuse treat-         users on a maintenance basis. This expansion                        prominence? I don’t know the answer to
ment not only in the UK but also world-             arose out of the harm reduction philosophy       of the Scottish    that question but I am pretty sure they
wide. But to what extent does the                   based on the findings that methadone can         findings           would look very different. You know you are
philosophy of harm reduction reflect the            enable addicts to become stabilised, to          describing the     in an odd place when your addicts are telling
views and aspirations of drug users as              commit less crime, and to reduce their illegal                      you they want fewer drugs and their doctors
opposed to those who are planning and               drug use. It can do all of these things, but     research as        are telling them they need additional drugs.
delivering drug treatment services?                 can it reduce people’s dependence?               “unhelpful and         There is little doubt that we need harm
    A surprising answer to that question has            The answer to that question is we don’t      manipulative”.     reduction and abstinence focused services.
come from recent research in Scotland where         know because we have not been counting                              The Scottish research is not about
over 1,000 drug users were asked about the          the number of people who come off                Others have        dismantling services, but it reminds us that
change in their drug use that they were             methadone. We have shown great ingenuity         rejected the       we need both types. Rather than simply
seeking to bring about on the basis of having       in getting people on methadone and we            findings on the    asserting that our harm reduction services
come forward for treatment. Almost 60 per           haven’t even bothered to find out how many                          are achieving both reduced harm and the
cent of the drug users interviewed said that        are coming off it. When one thinks that we       basis that         recovery from addiction, we had better start
the only thing they were aiming for was to          are talking here about a drug with a known       “addicts would     to find out if this is the case in reality.
become abstinent from the drugs to which            potential to create dependence (methadone)       say that           I suspect that it is not, and that we have
they had become addicted. Less than 10 per          and a population with a known capacity to                           prioritised harm reduction at the expense of
cent of those interviewed identified harm           become dependent, that is an oversight           wouldn’t they”.’   abstinence. In doing so, we may have
reduction as the sole change they were              verging on the scandalous.                                          reduced some of the harms associated with
looking for. On the basis of these results, it is       The fact that we don’t count the number of                      continued drug use at the expense of getting
abstinence not harm reduction which reflects        people coming off methadone suggests either                         people off the drugs to which they have
drug users aspirations from treatment.              that we are not expecting them to come off                          become addicted.
    These findings have touched a raw nerve         the drug in any great numbers or because we
in Scotland. The Scottish Drugs Forum, set up       are happy knowing our addicts are on metha-                         Neil McKeganey is Professor of Drug Misuse
to represent the views of drug users, issued a      done long-term. Either way, it suggests that                        Research, University of Glasgow. The author
press statement on the publication of the           we have rather pushed the idea of recovery                          refers to ‘What are drug users looking for
Scottish findings describing the research as        from dependent drug use into the long grass.                        when they contact drug treatment services:
‘unhelpful and manipulative’. Others have           In this instance, the division between                              abstinence or harm reduction?’ by Neil
rejected the findings on the basis that             abstinence and harm reduction is all too real.                      McKeganey, Zoe Morris, Joanne Neale and
‘addicts would say that wouldn’t they’.                 The drug users in the Scottish research                         Michele Robertson, in Drugs Education Prevention
    Part of the anger that these findings have      have spoken with admirable clarity. What                            and Policy Journal, vol 11, pp 423-435.
generated has to do with the claim that the         they are wanting are drug treatment services
research has set up a false dichotomy               that can help them kick their habit, not                            Do you agree? Email your views to the editor.

www.drinkanddrugs.net                                                                                                              15 November 2004 | drinkanddrugsnews | 9
Support | family addiction

                                                                                                                Media watch
My four walls                                                                                                   Units of alcohol could be displayed on
                                                                                                                bottles and cans, in an attempt to curb
Coping with a family member’s addiction can be a strange and                                                    Britain’s binge-drinking culture. The
                                                                                                                proposals are expected in the public
stressful business. Jane had entered a spiral of guilt and despair
                                                                                                                health white paper and would aim to
when she came across her local family support group.                                                            educate young drinkers about health
                                                                                                                risks of drinking more than the
She shares her experience of finding new strength to cope with                                                  recommended amount of units.
her own role as carer.                                                                                          Drinking a pint of lager costs 3 out of
                                                                                                                your 14 units if you’re a woman, 3 out
                                                                                                                of your 21 units if you’re a man.
                                                                                                                                 The Times, 7 November

             y story has a beginning but as yet no     health issues involved with substance abuse, it was      The Home Office has granted a licence
             end, my life of living with substance     a case of go home and cope, but no-one to tell me        to the Duchess of Northumberland to
             abuse. Will the reader judge me any       how. Walls at every turn, but not my four walls.         grow cannabis, opium poppies, magic
more than I judge myself, will the stigma                  Then a bus journey that changed my life.             mushrooms, tobacco and coca plants
disappear with the telling, the answer is no.          A friendly face, a helping hand, a caring look from      in her public garden. Visitors will be
Could my story of care help anybody else? I can        old friends. An invitation to visit a group of carers.   escorted by marshals to ensure the
only hope.                                             The first time someone had been non-judgmental.          garden is used for educational
    Who can say where my story should begin –          The realisation I was not alone; I now have new          observation.
was it ten, twelve or fifteen years ago? I am not                                                                       The Independent, 10 November
sure. What I do know, is that it has felt like a
lifetime. The lies began quite small and only to        ‘I try to get help from the GP the dependency
                                                                                      ,                         The proposed model of enforced
myself, my way to cope with the strangers that                                                                  rehabilitation will do little to change
have taken over the bodies and minds of some of         agencies, mental health crisis teams and                decades of following the wrong policy
my family. As their behaviour went from bad to                                                                  model, according to Emmanuel Reinart
worse the lies grew, I began to not only lie to         hospitals – to no avail. There is no recognition        of The Senlis Council Drug Policy
myself but to other family members and friends,                                                                 Advisory Forum. Innovative policies
keeping the problems and my shame within my             of the mental health issues involved with               that have proved successful are
four walls. Mothers Day, birthdays and Christmas                                                                cutting crime, reducing overdoses,
– seeing to their cards and gifts so that no one
                                                        substance abuse, it was a case of go home               reintegrating drug users into society
would think badly of them. Pretence and lies, on                                                                and reducing the spread of HIV and
                                                        and cope, but no-one to tell me how. Walls at
and on, part of my life in my four walls.                                                                       Hepatitis C.
    Finance problems, verbal abuse, emotional           every turn, but not my four walls.’                               Letter to The Daily Telegraph,
blackmail, stress and depression are now new                                                                                                   3 November
members of my family. My four walls are
beginning to bulge, then when I thought things                                                                  Launched this week, the Spikey could
could get no worse, drug-induced psychosis,            members in my family that I welcome with open            soon become a regular feature at the
paranoia and violence came to stay. Cracks appear      arms. CASA, the support group, have helped me in         bar if pubs and clubs take to the new
in my four walls.                                      so many ways, but mainly by giving me the                anti-tamper device. Placed in the neck
    My family unit spirals out of control, but still   strength to make changes in my life that have not        of a bottle, the device stops anyone
the never-ending pretence and lies. Emergency          been easy, and at times very hard. But in making         from adding drugs to a drink. Spikeys
services became regular visitors; the justice          changes in my life, it has in turn given encourage-      will cost 2.5p each and be supplied to
system became involved with the family unit. I         ment to the abusers to make changes in their lives.      the trade in boxes of 5,000.
began to question myself constantly: was this all      It takes time to regain trust and respect, like the      London Evening Standard, 11 November
my fault, what had I done wrong, had I made            rebuilding of my new four walls – but at least the
things too easy for them, was I a bad mother and       foundation is there to build on.                         The Scottish smoking ban is not such
wife, had I condoned the abuse with the lies?              My story will continue now with truth, hope          good news for intercity train operators
My four walls began to crumble.                        and strength – but how many hidden carers of             GNER, who are mid-way through a
    The lies had now led to my self-induced            substance abusers are in our communities, living         £30m rolling stock refurbishment that
isolation and lack of self respect. My way to cope     their story in their four walls in desperation.          includes enhanced smoking compart-
went out the window. My life began to revolve          Who will hear their screams for help?                    ments with floor to ceiling partitions
around my own prescribed medication, my                                                                         and extractor fans. The company will
thoughts and my constant silent screams... how         Jane attends CASA (Carers Against Substance              now enforce a complete ban on
do I end this never-ending spiral? Where do I go,      Abuse), who provide advice and support to                smoking, A light up, stub out
who can I talk to, who will listen? Help! my four      families and partners of users in Gateshead.             arrangement, as the train crossed the
walls are now rubble around my feet.                                                                            border from England to Scotland, was
    I try to get help from the GP, the dependency      A list of similar groups can be found at                 deemed too difficult to police.
agencies, mental health crisis teams and hospitals     www.nta.nhs.uk/programme/national/                                  The Guardian, 11 November
– to no avail. There is no recognition of the mental   being_heard.pdf

10 | drinkanddrugsnews | 15 November 2004                                                                                            www.drinkanddrugs.net
Innovation | Internet support

Internet treatment
and support
Despite increased Government spending, still only a
minority of people with a drug and alcohol problem
access treatment services. Waiting times to access
treatment are still too long. As demand outstrips
resources that can be given to treatment facilities in the
community, Professor David Clark argues that there is
an urgent need to be innovative in developing ways of
tackling substance misuse.

        he internet provides a platform for         and/or wary about the potential of the internet         ‘The internet-          Treatment must involve enhancing the self-
        enhancing access to information and         for providing effective treatment and support.          based approach          esteem of clients.
        support, for extending treatment options,       There is an urgent need to develop an holist-                           "   Enhancing motivation. People with a
and for providing opportunities for prevention of   ic substance misuse service delivered on the            must emphasise          substance misuse problem must also
substance misuse problems. Over 50 per cent of      internet, of which treatment interventions are a        the capacity for        personally want to change. Treatment must
households in the UK have access to the inter-      part. Such a service needs to be developed in           self help...            involve enhancing motivation.
net, and many other people are able to access       collaboration with practitioners, clients and                               "   Goal definition. Recovery is movement
the internet in work and educational establish-     commissioners, as well as IT experts.                   Treatment               towards a goal – the client must define that
ments. However, while there has been a marked           This service will need to be integrated into        offered on the          goal and keep it in sight. The client and
consumer use of the internet in health fields,      the cycle of drug (and or) alcohol-using careers.       internet will           therapist must work on goals, which may
particularly in the USA, this trend is not appar-   It must offer interventions for people in the                                   involve small steps (e.g. to reduce drinking
ent in the substance misuse field in the UK.        early stages of drug use, people in transition          ultimately              an amount) or large steps (abstinence).
    The internet offers a number of advantages.     between recreational and problematic use, and           provide a variety   "   Avoiding relapse. Staying off substances
A 24 x 7 x 365 service can be provided, with        long-term problem users. It must help people            of ways of              involves the use of distinct psychological
people being able to take what they want, when      before they develop a substance misuse                                          skills. Some people work out these skills
they want and as often as they want. Use of         problem, and for those who have a problem it            helping people          spontaneously, whilst others need to be
web-based information can facilitate self care      must go beyond helping them stop – it must              find their own          trained and helped in the implementation
and help people become more involved in             help them stay stopped.                                 particular route        of the skills.
treatment decisions. The internet can also be           The internet-based approach must                                        "   Using support networks. People who have
used to facilitate peer support.                    emphasise the capacity for self help. Research          to recovery.’           had a substance misuse problem must
    It provides access to people who might not      tells us that many people with a substance                                      establish a new network of people who
attend normal services because of distance or       misuse problem get better without going near a                                  support their new-found status. Support
concerns about stigma. Anonymity can be main-       professional or treatment agency. Treatment                                     from others is a tool to recovery, as evid-
tained. Access can be provided to multi-media       offered on the internet will ultimately provide a                               enced by AA and Narcotics Anonymous (NA).
and interactive material, which can facilitate      variety of ways of helping people find their own                            "   Change must feel good to be held. People
treatment and support. Finally, it must be em-      particular route to recovery.                                                   must not feel that they are missing the life
phasised that using the internet is a preferred         An holistic substance misuse service on the                                 they had when misusing substances. The
way of communicating for many young people.         internet should not be limited to any particular                                essence of treatment therefore resides partly
    At the same time, there are potential           philosophy or treatment regimen. Rather, it                                     in finding rewarding substitutes for the
problems of using the internet. Firstly, not all    should involve a wide variety of approaches.                                    substance misuse. There is an added bonus
information provided on the web is high             An essential characteristic of the service is that it                           when the person engages in activities which
quality, evidence-based or accurate. Secondly, a    should involve key principles that are known to                                 enhance self-esteem, such as learning new
variety of ethical issues need to be addressed,     help people reduce the harm caused by drugs                                     skills and gaining meaningful employment.
including potential concerns about client           and alcohol and, where appropriate, facilitate
‘safety’ (security and confidentiality).            the path to abstinence. These principles include:                           In a forthcoming article, we will consider some
    Thirdly, the internet provides access to only   " Feeling that it can be done. People with a                                of the elements of an internet-based treat-
certain types of client – although this is also a       substance misuse problem who are to get                                 ment service and look at a new communi-
problem with real-world services. Fourthly,             better must believe they have it within                                 cation tool for linking together professionals
practitioners and commissioners are still unsure        their power to change their behaviour.                                  and their clients online.

www.drinkanddrugs.net                                                                                                                      15 November 2004 | drinkanddrugsnews | 11
Obituary | Ma Kkaya Nefertari

 New research                               Ma Kkaya Nefertari
 ‘Changes in route of drug
 administration among
                                                                                                                 We were deeply saddened to hear the
 continuing drug users:
 Outcomes 1 year after                                                                                           news of the death of Ma Kkaya
 intake to treatment’                                                                                            Nefertari, Chief Officer of the Federation
                                                                                                                 of Black and Asian Drug and Alcohol
 Michael Gossop, Duncan
 Stewart, John Marsden,                                                                                          Workers. Simon Shepherd, Chief
 Tara Kidd and John                                                                                                                  ,
                                                                                                                 Executive of FDAP said 'Ma Kkaya's
 Strang (National Addiction                                                                                      untimely death is a real blow to this
 Centre, London) in
                                                                                                                 field. It is incredible to think that only a
 Addictive Behaviors 29:
 1085 – 1094, 2004.                                                                                              fortnight earlier she was speaking at our
                                                                                                                 annual conference.
 A total of 641 long-term (mean:                                                                                 My thoughts are with her family at this
 8.4 years) heroin users recruited
 from 54 UK treatment centres                                                                                    time.' The Federation has asked us to
 were asked their main route of
 administration at intake into the
                                                                                                                 print the following tribute
 study. Injecting (61%) and
 ‘chasing the dragon’ (37%) were
 the main routes. One year later,
 29% had not used heroin in the                                                                                      She was a highly successful professional who provided
 90 days before the follow-up                                                                                    consultancy and training for the Home Office, Metropolitan
 interview. There was no                                                                                         Police, and a number of public and private sector initiatives.
 difference in the probability of                                                                                Ma Kkaya served as an LEA School Governor and was a certified
 abstinence between injectors                                                                                    NVQ Assessor, ITS Neuro-Linguistic Practitioner and was just
 and chasers.                                                                                                    finishing her MBA.
                                            Colleagues, members, friends and partners of the Federation              Even as chief executive, she made the time to mentor and
 Of the 443 clients who were
                                            of Black and Asian Drug and Alcohol Workers are in shock             motivate particularly women and young people. She instilled
 using heroin at intake and follow-
                                            and disbelief. Ma Kkaya Nefertari passed away on Sunday              within them the desire to put their troubled and desperate
 up, 14% had switched from
 injecting to chasing and 5% had            24th October.                                                        past behind them and transform themselves and their
 made the reverse transition.                   Ma Kkaya, our dearest sister, mentor, guide and friend –         situation to release their true selves from within. For this is
 The greatest reductions in heroin          chief officer of the Federation – suffered a brain haemorrhage       exactly what she had to do for herself and with her own past –
 intake between intake and follow-          early Saturday morning. She was rushed to hospital and kept on       a fact which she never paraded, but never hid. And for this
 up occurred in users who had               life support for much of the weekend, as specialists struggled to    transparency, courage and honesty she was much loved and
 switched from injecting to                 save her. Eventually and reluctantly her family agreed to let her    respected within the community and even by professionals
 chasing. Those who were                    go. The life support machine was switched off on Sunday              within government offices. Ma Kkaya demonstrated through
 injecting heroin at follow-up were         evening at about 7.15pm. All of us at the Federation take this       words and action that it is possible to use adversity and painful
 more likely than heroin chasers
                                            opportunity to express our sincerest and deepest condolences         memories of the past as stepping stones on the healing
 to be regular users of non-
 prescribed methadone, non-
                                            to Ma Kkaya’s family and her partner for their loss.                 journey to realising one’s own greatness.
 prescribed benzodiazepines and                 Under her visionary guidance and leadership, both she and            Ma Kkaya Nefertari, the only black woman chief officer of a
 crack cocaine.                             the Federation grew in stature and impact over the past four         national organisation in the field of substance misuse may
                                            years. It is now a growing national membership organisation          have left us physically, but her greatness and unique legacy
 Changes in route represent an              with governance structures and presence within East and West         lives on – Gwaan Sista Ma Kkaya – nuff love and respect!
 important aspect of drug-taking            Midlands, the North West and London. Beginning as a
 behaviour. The authors                     volunteer in In-Volve a national drug treatment agency based         “I am a woman of Afrikan ancestry, a daughter, a mother, a
 emphasise the need to study the            in Newham, Ma Kkaya became one of the first development              grandmother, a sister, an aunt, a partner, a colleague, a mentor
 subgroup of heroin users who
                                            officers for the Federation, then its first director of operations   – a performer, a leader. By virtue of my gender and culture, I am
 switch from injecting to chasing
                                            and finally its chief officer.                                       assigned a number of roles. It is through my knowledge and
 to help understand the signifi-
 cance of this apparently                       Ma Kkaya impressed many by her extremely business-like,          experience of these perspectives that I engage you in an open
 constructive change and the                strategic and pragmatic approach to the chaotic and                  dialogue, which will focus on the context within which the roles
 implications for long-term                 problematic field of race and drugs. However what inspired and       and responsibilities of women from other communities are
 outcomes. Also, interventions are          touched people most, was her motivation and dedication to her        often defined. Whilst also looking at the paradigm within
 required to help heroin users              community, especially those living on the front line of drug use     which other women operate as key drivers actively informing
 make the transition from chasing           and violence. She symbolised the insistent voice and striking        the growth, healing, progress and advancement of our ‘selves’,
 to injecting: this may represent a         presence of diverse communities and women around the                 families, communities and wider societies.”
 useful intermediate treatment              decision-making table, when policies and services of drug
 goal for drug injectors who
                                            treatment and related criminal justice agencies were reviewed,       Ma Kkaya Nefertari
 cannot achieve abstinence.
                                            discussed and developed.                                             ‘Through the Eyes of a Woman’

12 | drinkanddrugsnews | 15 November 2004                                                                                                                      www.drinkanddrugs.net
Education | professor David Clark

Drugs in society
How can we make a rational decision about whether
drugs are good or bad, when we’re all drug takers?
Professor David Clark takes the definition of a
psychoactive drug right back through history, and
reveals how politics, economics and the media all play
their part in shaping people’s attitudes. Society will
only make progress when it learns to address
substance issues openly and realistically, he suggests.

 ‘The sufferer is tremulous and loses his self            caused by excessive use of amphetamine.                     would like to believe that these laws have developed
command; he is subject to fits of agitation and               Society has clung to the notion that some psycho-       objectively, in an attempt to reduce the heath and
depression. He loses colour and has a haggard             active drugs we use are ‘good’, whereas others are ‘bad’.   social problems caused by drugs. However, a closer
appearance… As with other such agents, a renewed          Heroin is a ‘bad drug’ and heroin users are often classed   look reveals a more complicated picture – ideological,
dose of the poison gives temporary relief, but at the     as deviant or abnormal. Tea and coffee are ‘good’ drugs     political and economic interests play a major role.
cost of future misery.’                                   – although most people do not consider them as drugs.           People in society today have a set of attitudes
From a medical textbook published in 1909. (See end       Alcohol is a ‘good’ drug, even though we are becoming       towards drugs and drug taking, that are often shaped
of article to discover the drug.)                         increasingly aware of the risks that can be associated      by the popular media. As Gossop points out, ‘the term
    People have been taking psychoactive drugs to         with its misuse. Tobacco is rapidly shifting from being a   “drug taker” is used as a condemnation, as a way of
change their state of consciousness for thousands of      ‘good’ drug to a ‘bad’ drug.                                identifying someone who is involved in a strange and
years. Man has discovered psychoactive drugs serendipi-       Librium and valium, which can be obtained on            deviant way of behaviour. There is a continuing
tously, has cultivated them deliberately, and has been    prescription to alleviate anxiety states, are considered    reluctance to face up to the fact that drugs and drug
producing them in laboratories, even in suburban homes.   ‘good’ drugs. This situation is complicated though,         takers are part of everyday life’.
    Many people consider that only a minority take        because these same drugs become ‘bad’ drugs if used             We live in an inconsistent society. On the one
psychoactive drugs. However, in his excellent book        by people who also take heroin or amphetamine.              hand, we tell our young people not to take drugs and
Living with Drugs, Michael Gossop points out that         Librium and valium are also known to be addictive.          keep away from people selling drugs. On the other
drug taking is ‘almost a universal phenomenon, and            The ‘good/bad’ drug distinction sometimes               hand, doctors and others are constantly encouraging
in the statistical sense of the term it is the person     becomes synonymous with ‘safe/dangerous’. Society           us to take drugs produced by the pharmaceutical
who does not take drugs who is abnormal’.                 would have us believe that good drugs are all safe, or      industry – some of which are addictive – for a variety
    While some people might react strongly to the         at least relatively safe, whereas bad drugs produce bad     of conditions. Moreover, while we tell young people
idea that they are a ‘drug taker’, drugs come in          effects and are not safe. However, as Michael Gossop        that certain illegal drugs are dangerous for their
various forms other than illegal substances such as       points out, it is here that society has problems, because   health, we ignore to a large extent the bad effects
heroin and cocaine: nicotine in cigarettes, alcohol,      ‘scientific questions about the actual effects of a         that alcohol has on health.
and various prescription drugs used for problems          particular drug become entangled with issues of                 Psychoactive drugs have always been part of life –
such as sleeplessness, depression and anxiety.            personal morality and subjective beliefs’.                  and they will always be present. Substance misuse is
Even tea and coffee contain a drug – caffeine.                It is important to note that the ‘good/bad’ and         not going to go away. Society needs to recognise the
    So what is a psychoactive drug? The World Health      ‘safe/dangerous’ classifications have varied across         problems caused by substance misuse and deal with
Organisation defines a drug as ‘any chemical entity or    time, and from culture to culture. Some drugs which         them in a realistic and open way. We also need to
mixture of entities, other than those required for the    are illegal today were commonly used in the past            recognise that many problems caused by drugs are
maintenance of normal health (food), the administra-      legally, often for medicinal purposes. Some drugs           intimately related to other factors, such as social
tion of which alters biological function and possibly     deemed illegal in Western society are used for              deprivation and social exclusion. Society needs to
structure’. A psychoactive drug is a drug that affects    religious purposes in other cultures.                       address these problems.
the brain to produce alterations in mood, thinking,           It also needs to be emphasised that the
perception and behaviour.                                 ‘safe/dangerous’ distinction does not hold up to               The drug is coffee!
    The positive effects of psychoactive drugs are the    scrutiny. Many more people die, either directly or
pleasurable mood states they induce and their ability     indirectly, as a result of using tobacco, alcohol and       Michael Gossop’s book Living with Drugs is essential
to reduce negative mood states such as anxiety.           prescription drugs than all illegal drugs combined.         reading for people interested in learning more about
However, psychoactive drugs may also produce                  Throughout history, societies have developed laws       psychoactive drugs. It can be obtained from Amazon
negative effects, such as the paranoia and delusions      to regulate or control the use of certain drugs. One        books for £17.99.

www.drinkanddrugs.net                                                                                                                    15 November 2004 | drinkanddrugsnews | 13
Events | up and coming

17 November
Drug-related deaths: exploring issues
                                            EDACT, Lisburn, NI.
                                            Contact Davis Turkington.
                                                                                       the understanding of the role of
                                                                                       housing and housing related support
                                                                                                                                   OVERSEAS EVENTS
& finding solutions                         t: 028 9043 4248,                          services in the pre-treatment, through
                                                                                                                                   25-27 November
One-day conference on reducing drug-        e: dturkington@ehssb.n-i.nhs.uk.           care and aftercare of drug users.
                                                                                                                                   7th international symposium on
related deaths. Themes include:                                                        Contact National Housing Federation.
                                                                                                                                   substance abuse treatment
setting up confidential inquiry panels,     26 November                                t: 020 7067 1069
                                                                                                                                   ‘21st century drug free treatment?
working with injecting drug users to        Binge drinking: problems and               w: www.housing.org
                                                                                                                                   Between evidence and belief’. Looking
reduce risk of death, ambulance             responses
                                                                                                                                   at whether treatment is more or less
protocol/ policy for responding to over-    Topics cover binge drinking and school     21-22 February
                                                                                                                                   effective than in the early 1970s, and
doses, needs of BME communities             students, adults, economics, medical       National drug treatment conference
                                                                                                                                   if not, what we should do. Centre for
and deaths in custody. Greater              effects, Manchester City Centre Safe       Organised by Exchange Conference in
                                                                                                                                   Alcohol and Drug Research. Denmark.
Manchester Ambulance Service NHS            Project, reducing trouble in bars, a       association with The Alliance. A two
                                                                                                                                   e: sat@crf.dk.
Trust, Manchester.                          Canadian approach and harm                 day annual event. Keynote plenary
Contact Salman Desai.                       minimisation. Addictions Forum,            sessions, parallel workshops,
                                                                                                                                   7-11 February
t: 01204 492419,                            Bristol. Contact Addictions Forum at       discussion, paper presentations and
                                                                                                                                   Through and after Care for drug-using
e: info@gmas.nhs.uk.                        University of the West of England.         fringe meetings offering delegates an
                                            t: 0117 328 8800.                          opportunity to look in depth at a range
                                                                                                                                   The first in a series of six training
18-19 November                                                                         of issues. Essential for drug workers,
                                                                                                                                   academies which will take place in
SSA annual symposium                        3 December                                 drug activists, criminal justice workers,
                                                                                                                                   various European locations from
‘Examining legitimacy, competence and       Dual diagnosis: mental health & drug       prison healthcare staff, clinicians,
                                                                                                                                   February 2005 to November 2006.
effectiveness in primary and                addiction & alcoholism                     researchers, policy makers, service
                                                                                                                                   Looking at good practice in Europe and
secondary care’. Society lecture will be    A detailed look at how the gap between     providers and commissioners.
                                                                                                                                   assisting participants to develop plans
by Professor Griffith Edwards. Society      mental health problems and alcoholism      Contact Monique.
                                                                                                                                   for models of intervention. Future
for Study of Addiction, York.               and drug addiction can be addressed,       t: 020 7928 9152
                                                                                                                                   academies will cover peer support and
Contact Christine Weatherill.               particularly issues arising from           e: moniquetomlinson@wdi.co.uk
                                                                                                                                   peer education, harm reduction,
t: 0113 295 1330                            differences between health service and     w: www.exchangesupplies.org
                                                                                                                                   working with cocaine, crack cocaine
e: training@lau.org.uk.                     voluntary organisations. London.
                                                                                                                                   and stimulant users, research
                                            w: www.conferencesandtraining.com          10 March
                                                                                                                                   methodologies, working with women,
24 November                                 Reduced rate for FDAP members              Meeting drug treatment needs –
                                                                                                                                   juveniles, staff support and
Tackling alcohol-related crime – an                                                    innovative strategies
                                                                                                                                   supervision. Brussels. Contact Vikky
after-dark problem                          7-8 December                               Looking at innovative strategies to
                                                                                                                                   Bullock, Cranstoun Drug Services
One-day conference to discuss how           NTA national conference                    reduce drug addition, improve treatment
                                                                                                                                   e: vbullock@cranstoun.org.uk.
different agencies can work together        The NTA’s second major conference          and accessibility including effective
to tackle alcohol-related violence and      will acknowledge significant               cross-sector provision, including working
                                                                                                                                   7-9 July
anti-social behaviour in the night-time     improvements in drug treatment in          with employment, housing and
                                                                                                                                   8th European conference on drugs
economy. Capita, London.                    England, identify challenges we still      education services. Invited speakers
                                                                                                                                   and infections in prison
Contact Jasmin Matharu.                     face, and set out the vision for the       include Caroline Flint, MP; Lord Victor
                                                                                                                                   This year's event is ‘Unlocking
t: 0207 808 5292,                           remaining three years of the current       Adebowale and Paul Hayes. London.
                                                                                                                                   potential – making prisons safe for
e: jasmin.matharu@capita.co.uk.             drugs strategy. NTA, London.               t: 020 7324 4373
                                                                                                                                   everyone’. The conference will cover
w: www.capita-ld.co.uk                      w: www.nta.nhs.uk                          e: amanda.smith@neilstewart
                                                                                                                                   throughcare and after care, multi-
                                                                                                                                   agency working in practice, and harm
24 November                                                                            w: www.neilstewartassociates.com
HIV and AIDS treatment                      2005                                                                                   Contact Salma Master.
One-day event with presenters from both                                                20-24 March
                                                                                                                                   e: smaster@cranstoun.org.uk
the HIV and drug and alcohol sectors.       28 January                                 16th International Conference on
Keynote presentation by Dr Mike Youle,      Release drugs university IV                Reduction of Drug Related Harm
Director of HIV Clinical Research at the    ‘Drugs – the politics, philosophy and      Organised by Department of Health,
Royal Free Centre for HIV Medicine.         economics’ – the fourth Release            Social Services and Public Safety for
Other speakers include Annette Dale-        Drugs University will examine the          Northern Ireland, in association with
Perera (NTA), Kathryn Leafe (Cranstoun)     theme of drugs, the law and human          International Harm Reduction
and Dr Peter Miller (National Addiction     rights. Speakers include: Professor        Association. Belfast.
Centre). EATA, London.                      Craig Reinarman, University of             w: www.ihra.net
t: 020 7922 8753,                           California; Shami Chakrabarti, Director,
e: office@eata.org.uk.                      Liberty UK; Dr Peter Cohen, University     19-21 May
                                            of Amsterdam. Release, London.             UK/European Symposium on
24 November                                 w: www.release.org.uk                      Addictive Disorders
Alcohol, drugs & social inclusion                                                      Speakers will include Prof Carlo              Please email details of your
Annual seminar exploring barriers faced     3 February                                 DiClemente, author or world-renowned                     events to:
by some groups in accessing services.       Dealing with drugs: A housing agenda       research on the impact of treatment
Conference includes workshops and a         Event for people with a strategic          for alcoholism.                                   office@fdap.org.uk
task group will be drawn together to        responsibility for housing and drug        Contact Deirdre Boyd.
take forward issues identified.             treatment. The aim will be to increase     e: deirdre@addictiontoday.co.uk.

14 | drinkanddrugsnews | 15 November 2004                                                                                                              www.drinkanddrugs.net
Classified | education and learning

                        For more information:

www.drinkanddrugs.net                              15 November 2004 | drinkanddrugsnews | 15
Classified | education and learning

         Drink and Drugs News
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           by over 10,000 substance
           misuse practitioners

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16 | drinkanddrugsnews | 15 November 2004   www.drinkanddrugs.net
Classified | recruitment

                                                                                                            Leader of Therapeutic Services –
                                                                                                            Familes Plus
                                                                                                            Up to £26,000 + benefits
                                                                                                            Salisbury, WIltshire

                                                                                                            You don't have to be addicted to alcohol and drugs
                                                                                                            to suffer from alcohol and drug addiction.
                                                                                                            Since 1983, the charity Clouds has directly and indirectly helped
    RAPt, the charity that provide 12-Step drug and alcohol rehabilitation and CARAT                        thousands of people from all walks of life to recover from the
    services in prisons and the community, are currently looking for new team member in the                 effects of alcohol and drug addiction. Families Plus was
                                                                                                            established by Clouds specifically to respond to the needs of
    following position and location:                                                                        anyone personally affected by someone else's addiction and this
                                                                                                            division is now acknowledged as a field leader in the delivery of
    12-Step Addiction Counsellor at HMP Norwich
                                                                                                            professional services to these beneficiaries.

    Full Salary Range £18,397 - £24,229 (including regional & therapy allowance)                            To build on the substantial progress made since 1998, we are
    We are looking for a full time counsellor to join our team at HMP Norwich. To be successful,            seeking to recruit a dynamic Leader of Therapeutic Services.
    you would need to have a thorough knowledge of, and commitment to 12-Step. Counselling                  You will be (or soon become) an authoritative professional
    qualifications and experience are essential, with experience of working with addicts desirable.         champion for the needs of families affected by addiction. By
                                                                                                            designing and overseeing the delivery of high quality services
    Some level of training will be provided for staff with limited experience of working with this client
                                                                                                            that respond effectively to the needs of beneficiaries, you will
    group. You will also need to be efficient, enthusiastic and determined, with the ability to work in     lead and supervise the Families Plus practitioners and clinically
    a challenging, sometimes pressurized environment.                                                       supervise family counsellors across Clouds. You will work with
                                                                                                            the Clouds' professional education department to deliver short
    The successful candidate will usually be placed on a point in the middle of                             courses to treatment professionals on working with Families.
    the advertised salary range, depending on relevant experience and
    qualifications.                                                                                         Ideally you will have a Diploma in Family Therapy as well as an
                                                                                                            accredited addictions counselling qualification and a strong
                                                                                                            educational background. A qualification in supervision or
    If you are interested in the above position and would like to receive an                                previous leadership/management experience would be a distinct
    application pack, please send a SAE for 42p to Sophie Civardi, Riverside                                advantage. Don't be put off if you do not fit the ideal just yet but
    House, 27-29 Vauxhall Grove, London, SW8 1SY, stating clearly which post                                you might soon be able to with our help.
    you are interested in.
                                                                                                            Reporting to the Head of Families Plus, you will be responsible
    Closing date for completed applications: Midday, Monday 30th November 2004                              for the management and professional development of
                                                                                                            practitioners to ensure delivery of services to a high standard,
                                                                                                            You will advocate on behalf of beneficiaries, help promote the
    RAPt strongly encourages applications from Black and Minority Ethnic individuals                        work of Families Plus and contribute to fundraising activities.
    and from those in recovery from addiction.
                                                                                                            For a confidential discussion, please contact
    Registered Charity no. 1001701                           www.rapt.org.uk                                Emma White, Human Resources Manager,
                                                                                                            on 01747 832013. Alternatively, you can email
                                                                                                            Emma White on emma.white@clouds.org.uk

www.drinkanddrugs.net                                                                                                                     15 November 2004 | drinkanddrugsnews | 17
Classified | recruitment

                                            D r i n k a n d D r u g s N ew s

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                                                See all the latest vacancies

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                                            until the office copy finds its way to you,
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                                                 The Providence Projects

                                                Counsellor - 15K - Bournemouth

                                                The Providence Projects are leaders in the field of
                                                Quasi-Residential Day-care treatment. We offer
                                                detoxification together with a full therapeutic
                                                abstinence based programme incorporating the
                                                best in primary and secondary care.

                                                For details contact
                                                The Providence Projects
                                                Henley Court,
                                                32 Christchurch Road,
                                                Bournemouth BH1 3PD,

                                                tel: 01202 555000,
                                                fax: 01202 555100,
                                                e-mail: info@providenceproject.org,
                                                web site: www.providenceproject.org

18 | drinkanddrugsnews | 15 November 2004                                                www.drinkanddrugs.net
Classified | recruitment

                                                                        (Hillingdon Action Group for
                                                                          Addiction Management)

                                               Old Bank House,
                                               64 High Street, Uxbridge,
                                               Middlesex, UB8 1JP

                                                        Consultant Counselling Supervisor Required

                                               We currently have a vacancy for an experienced consultant supervisor to
                                               provide client work supervision for our senior counselling staff. The time
                                               commitment will be around 4.5 hours per month

                                               Please contact Kate Henderson, Director
                                               on 01895 207788 for further details and
                                               an application pack.

                                                              Residential Training courses 2005
                                                         “ Working with families & Substance Misuse”
                                               Monday 24-Friday 28 January
                                               Monday 18-Friday 22 July
                                               Monday 31 October-Friday 4 November
                                               "    Increase insight into family dynamics
                           Please mention      "    Develop therapeutic relationships with families
                                               "    Improve techniques and interventions
                        Drink and Drugs News          01722 340 325            admin.familiesplus@clouds.org.uk
                    when replying to adverts           Clouds Families Plus 11B York Road, Salisbury, Wilts SP2 7AP
                                                   Registered Charity no 296637   Company Ltd by Guarantee No 2116410
                                                       Clouds and the Clouds Logo are registered trademarks of Clouds

www.drinkanddrugs.net                                                                        15 November 2004 | drinkanddrugsnews | 19

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