Drug Strategy: Adjusting the Focus

A framework for the future of British drugs strategy

‘Tackling Drugs Together’, a strategy for 1995-98 came from joint action by all relevant government departments and with support from all major political parties. Specialist agencies, including NDPA, contributed to its production. Much positive progress has been made. The Drug Action Team/Drug Reference Group structure has concentrated minds. The ensuing review of prevention, intervention, treatment and rehabilitation services has pointed up areas for improvement. Above all, the commitment to more and better primary prevention (including education) has galvanised action across the field.

Three years is little enough to establish a structure, let alone deliver on it. There must be a corresponding strategy beyond 1998 and into the next millenium. This will always be a ‘long game’. This Paper suggests how an improved strategy could develop.

Drug strategy is always prey to ideology and negative agendae. A firm hand on the tiller is essential. In summary NDPA would wish to see a system which promotes total rather than just physical health; instead of reactively responding to sickness, it validates and encourages non-users, minimises the number who start, facilitates users to stop, and uses the tools – including the justice system – constructively; with firmness melded with sensitivity.

A Total Health

The World Health Organisation (and many others before them) have defined Health as having six components: physical, mental-intellectual, emotional, social, spiritual, and environmental. Far too much of drug related work to date has ignored all but the physical element. Real progress awaits this fundamental widening of vision.

B Education is not equal to Prevention

A common misunderstanding is that Education = Prevention. Section C (below) exposes the fallacy of this; education is an important part, but far from being the whole. This flaw is compounded by overviews of work in Britain, much of which has indeed been limited to education, and has in consequence been of limited efficacy. This has had much to do with the unusually pessimistic attitude towards Prevention of many British drug workers. Ample evidence of success exists in other countries, and cultural transferability has already been demonstrated to the satisfaction of all except those with the telescope to their blind eye.

The vital techniques of persuasion; vocabulary, semantics, images, psychology and ‘thinkspeak’ are well understood by those who seek to replace ‘Tackling Drugs Together’ with more acquiescent strategies. It is palpably true that those who support the strategy are sadly not so well versed. Until this disadvantage is removed the struggle will always be uneven.

C A Community Affair

We live in a symptom-focussed society, with separated response systems for such as health, social services, justice. Painful experience has shown that this ‘segmental’ attitude seriously hampers effective prevention – the correct approach must be to engage the whole of society, albeit in different ways. We must grow beyond the notion that prevention is merely ‘stopping something happening’ into promoting and enriching the wellbeing of people. Some examples of action within the community are:

• Government – Specify, resource, manage, evaluate
• Health – Cover all health elements
• Schools – Health promoting policies
• Colleges – train teachers/youth workers in prevention
• Peers – Utilise potential
• Parents – de-marginalise, train, resource, support
• Religion – spiritual lead, network
• Pharmacists – Pro-active, prevent, reduce harm
• Businesses – Employee Assistance (EAP), testing
• Media – Educate staff, avoid mixed messages
• Vol. Sector – Network and engage
• Sport – Pro-active prevention
• Drug services – Encourage plurality

D Long, wide and deep

Environmental and nurture factors around the child which may precede drug misuse start very early; even in the nursery. Factors increasing propensity for use are many and varied, and can be profound. Prevention systems must therefore be ‘long, wide and deep’.

There is a flavour permeating from some quarters that exploratory use (otherwise euphemistically named ‘experimental’ use) is of relatively little concern. This is not only untrue, it reveals a fundamental misunderstanding of the process. Community-wide primary prevention for all age groups, especially the young, needs very substantial development above the present very limited levels. Beyond this there is also scope for focussed interventions, such as ‘mentoring, with those young people identified as more ‘at risk’ than others.

Parents are a key resource in prevention, a resource largely ignored thus far. Their marginalisation and disenfranchisement must be reversed, and they need support and training to cope with the greater demands on parents in this area.

E Social Foundation

Cutting-edge prevention technology recognises that wide focus is fundamental. Whilst social factors such as deprivation, unemployment or homelessness are not necessarily causal to drug misuse, they certainly correlate. Rhetoric around ‘return to full employment’ helps no one; if life after the microchip means ‘less than full’ employment, the social strategy should own up to this and address it constructively.

Support systems in ‘deprived’ areas should not presume all residents are drug users. If anything these areas need more primary prevention resources, not less.

F Justice potential

NDPA has identified ways of improving the application of the justice system. but surrendering to the drug problem is not one of them. Research has shown that justice systems which are firm but fair and coupled with quality drug prevention produce the best results. There is certainly more scope for diversion to treatment or counselling, (such as the TASC system in America), but by no means everyone is far enough into ‘a drug career’ for this to be relevant; in earlier stages some other intervention – perhaps developed upwards from Reparative Cautioning – should be explored.

Throughout the justice system (and without denying the just application of punishment and retribution, which are matters outside the scope of this Paper) the focus should firmly be on whatever methods are needed to produce voluntary non-offending in future. The deterrent effect of the sentencing structure will only be one part of this. There is good evidence to suggest that Drug Courts can be a helpful introduction; expediting cases and hearing them before knowledgeable judges and court officials is welcomed, even by the defendants.

G No debate needed

For drug apologists still pathetically struggling, thirty years on, to justify their cause, a common ploy is to refer to “the current debate on drugs”. Just keeping the subject on the agenda is a tactical victory. The next step is to continually plead until exhaustion in the listeners yields some compromise. The truth is that outside of this minority and a strangely supportive media there is no debate. Parents and other citizens do not want their children to misuse drugs – legal or otherwise. Some groups, including NDPA, feel obliged to respond, but do so unwillingly. Many MP’s have made it clear they reject calls for a Royal Commission since this would send an erroneous signal to the public that the law might change, when there is no such intention. NDPA strongly supports this stance. Mixed messages are confusing, especially to our young people.

H The public and the media

Engaging with the community at several levels and in several ways is the lifeblood of democracy, if a little anaemic at times.

With the drugs issue, the task is hampered by accidental or calculated misinformation, the use of out of date materials and by the personal agendae of those delivering the information – be they media personnel, drugs professionals, or others in the community. A whole vocabulary of ‘weasel words’ has been developed by a well-financed international pro-drug lobby, to confuse and seduce our policy makers and the public at large.

For ‘realism’ read ‘surrender’; for ‘informed choices’ read ‘laissez-faire’, for ‘normalisation’ read ‘decriminalisation’, for ‘prohibition’ read ‘the current laws almost all of us support’; for ‘harm reduction’ read ‘legalisation’, and so on.

NDPA finds the metaphor ‘War on Drugs’ inexact and unhelpful, but rumours of its death are greatly exaggerated. Some pro-drug campaigners suggest this is a ‘Civil War’, with the public as innocent victims – if this be so, then these campaigners are to the drug barons as collaborators are to an invasion force.

Government could do the whole process a great service, and increase the chances of its strategy succeeding, by tackling this issue assertively. The fact is that over at least the last ten years far too much succour has been given to those who seek to undermine the governments’, strategies; despite people of the calibre of Anna Bradley – ISDD Director, making it clear that “there is no research base for Harm Reduction”. The received wisdom of Harm Reduction has been widely applied whilst Prevention of any merit has either been undercut or excluded altogether. Ironically, in the face of increasing use over this period the protagonists of Harm Reduction audaciously claim that this is evidence that Prevention is failing! Government attempted to put Harm Reduction in proper perspective when producing ‘Tackling Drugs Together’, but old ideology dies hard. A good start would be to correct the definition of ‘Prevention’: to prevent should mean to be pre-event; anything during or after the event is damage limitation (harm reduction) or repair (treatment/rehab.)

(NDPA wishes to make it plain that the above relates to the ‘abuse’ of Harm Reduction as a ‘Trojan Horse’ for legalisation or decriminalisation, in the guise of a broad policy for non-users and users alike. In the quite separate and more traditional application of Harm Reduction (or damage limitation) to mitigate the effects on actual users, NDPA is supportive.)

J More support needed

The structure for ‘Quality Assurance and Quality Control’ in delivering the national strategy needs strengthening. At present there is a system (CDCU/DAT/DRG) for communicating up and down. but the level of ‘specifying’ and ‘compliance control’ is less than desirable.

In essence, the government should be able to verify that its strategy is reflected in local policy and action; and if not, why not. The obvious control mechanism would be funding, which should be prospectively and retrospectively tied to compliance (as well as to effectiveness). Funding of all aspects (prevention, intervention and treatment/rehab.) is well below where it should be. Moreover, within this funding structure prevention is very much the ‘Cinderella’ service. If compliance is given its due importance, it follows that it must be underpinned with appropriate ‘good practice’ training mechanisms.

Training should not be confined to the professions directly concerned with drugs services but should cover others of secondary and tertiary relevance; it must also cover the Voluntary Sector. In the case of any future regulating/accreditation systems for this field, it is essential that this is done by an independent body able to take a detached and balanced view of the whole process. Those working in intervention and treatment may well come under the purview of the Dept. of Health but for those at the Primary Prevention end a body such as America’s CSAP (Center for Substance Abuse Prevention) would be more appropriate.

Whilst sound arguments exist for having lengthier funding for proven schemes, there is also sound argument for seed-funding new initiatives, in order to judge their effectiveness. Evaluation budgets tend to ignore or under-resource newer, smaller initiatives; the reverse should be the case if value for money is to be achieved.

K Drug Information

Research, surveys and observation will continue to be vital to the success of prevention. There is a regrettable degree of xenophobia (towards overseas research and practice) in the drugs field which may have more to do with ‘ownership/control’ fixations, or excluding that which does not fit certain agendas; these factors often seem to hold more sway than the technical merits of the material. NDPA strongly recommend increased interchange with other countries on all aspects of drug-related work, particularly primary prevention, where there is so much that we can learn.

An almost unheralded reduction, in the USA of 60% over twelve years in the use of all drugs at all ages led Neil Dixon, BBC Social Affairs Editor to describe it as “America’s best kept secret”. The misuse of drugs is a global problem and we should be more willing to share international successes as well as failures.

It is fashionable to decry painful facts about drugs and their misuse; these should, it is argued, be excluded on the grounds that all “shock-horror” input is counter productive. A grain of common sense would not come amiss here; certainly hyperbole should be avoided, but rational facts set into context about the personal and social harm which can ensue should not be shirked. Leaving them out gives a falsely rosy picture of drug misuse. Prescribed drugs packaging contains information on all the possible harm – even though it is unlikely to affect more than a few people using the medicine.

L And in conclusion…

Current vogue in youth education speaks of ‘Informed Choices’. ‘Choice’ implies there are two or more valid options for selection. In the case of illegal drug use there is no option. In what other area of illegal behaviour – theft, violence. etc. do we permit choice? Moreover, the educationist vogue is to say this is ‘your choice’ – implying that the many other people consequentially impacted by that choice feature little if at all in the process. This is another area of training our young for life which needs rapid rectification.

Though the prevalence of drug use, especially by young people seems to be worsening, there is no need for fatalism. Others have succeeded, and if we improve our ways of tackling this together -not hoping for that mythical ‘silver bullet’ but instead co-operating in a pluralist approach, there is a bright future ahead. In this era of unemployment the word “redundancy” has become tainted, but there is one redundancy we can all welcome…

…we don’t need drugs!

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