The problem is not the drug

Kit Harbottle is the southern regional lead for criminal
justice for the Audit Commission. She has a long-standing interest
in community safety and health issues and has established strong
links with police, drug and health agencies in the South West.
Before joining the commission in 1990, she worked for the
Metropolitan Police, the Ministry of Defence and as a
lecturer.

Tackling drug misuse will be a key theme in local authorities and
their partners’ plans for reducing crime and disorder for 2005-8,
which are to be published this month. This is not just because the
Police Reform Act 2002 requires it: 84 per cent of the current
(2002-5) plans in England and Wales already include this priority.
The Audit Commission found, in research for the national report on
drug misuse, that senior managers in the health service and local
government as well as the police see this as one of the most
important issues for their area.(1)

One chief executive summed up the impact as: “Crime…fear of
crime…risks to children…family breakdown. Serious health risks
to users themselves. The draining effect on community capacity and
social capital.”

So are these local agencies getting better at tackling it? Do the
people most affected see a difference? And are the government and
regulators a help or a hindrance?

The Audit Commission answers this by tracing two interlinked
journeys in its report: the drug user’s journey from a point of
desperation to a stable life. This is a fictional story about Greg
who spends £300 a week on heroin and crack. It follows him,
his pregnant girlfriend Tracey and her mother – at breaking point
coping with the children Tracey has abandoned – from arrest for
theft through to at least a hope of living happily ever
after.

Then there is the journey for the people who commission and deliver
the services that intervene to help drug users. The second story is
of Janet, a local authority chief executive, who has the challenge
of chairing a partnership squabbling about whether drug misuse is a
health or a police problem. It shows her leading them to have some
confidence about the real benefits for the community.

This optimism reflects the Audit Commission’s view that there has
been considerable progress since its 2002 report on adult drug
treatment.(2) This includes:

• Making a reality of joint commissioning of treatment.
• Expanding community treatment, particularly through primary
  care.
• Re-designing services to reduce waiting lists.
• Access to treatment from the criminal justice system.

But this progress varies too much across the country, and easier
access to treatment is not in itself enough. Too many of those who
start treatment – one in three – drop out too early for avoidable
reasons, so fail to benefit from the investment.

Drug users take a big step as they seek help, over barriers that
include fear of exposure, stigma and peer pressure. This may be
triggered by a personal crisis, encouragement by someone they
value, or opportunity presented after arrest for a drug-related
crime. The Audit Commission found that, although public information
about drug services has improved, it is not sufficiently available
in places to which users and carers turn in a crisis. Insights from
relevant research, for example into drug use by ethnic
minorities,(3) are not used as well as they could be in
understanding local needs.

Users are more likely to stay on the recovery journey if care is
well planned by staff who empathise with them, and if it offers a
package of support to help solve the range of problems they face.
Users said the attitude of staff is a crucial factor.

The overall package of care available can make a difference to
whether the user continues treatment. Support and follow-on
services are vital to sustain users on their journey, and to give
them a worthwhile destination. Carers are entitled to help in their
own right, but also because they can help users complete the
journey to recovery. All too often they receive no recognition. The
problems for users’ children, highlighted in the report Hidden Harm
still remain.(4)

A finding in all areas of the Audit Commission’s work is that, for
services to achieve the outcomes they want and to use resources
effectively, they have to listen to users – and to those who could
benefit from services but do not – to understand how to meet their
needs.

The Audit Commission helped the National Treatment Agency (NTA) to
prepare a web-based resource, Extending Empowerment, to provide a
practical starting point for anyone looking to boost the
involvement of users and carers. As well as examples of good
practice in England, the website includes information on user views
and sources for further advice and information.

In some areas, councils, the NHS and criminal justice agencies work
smoothly together, with trust built by experience. But, in others,
partners have still to agree on how to develop services, so the
help for users is often fragmented. The woman in residential
treatment who told the researcher, “I leave here on Monday with my
six-year-old son, I have nowhere to go, different departments and
different councils don’t work together” may not be typical – but
there is undoubtedly much scope for improvement.

The wider challenge is to obtain coherent planning of resources.
Few areas have reviewed all that they spend on tackling drugs, and
few partnerships are planning for success – making sure that
services will be in place next year for users they are encouraging
to start treatment this year. Short-term funding and inconsistent
national targets are a problem, but are too often used as an excuse
– if tackling drug misuse is as important as local decision-makers
say it is, investment should pay in greater health, safety and
prosperity for local people.

National and regional action can help (or hinder) local agencies on
their partnership journey. The Audit Commission believes strategic
regulation to be the way forward. For drugs, the performance
management framework introduced this year could help this, but
needs development, including more robust and outcome-focused
performance indicators, greater clarity of role between the NTA and
government office staff at regional level, and smoother
collaboration between the inspectorates involved – including the
commission itself.

If intervention is to deliver results, agencies need to work
together coherently and tailor services to individual drug users.
The report includes a set of key questions to help managers,
commissioners and staff do this. The 2005 strategies offer them the
opportunity to shape effective paths to recovery, treating the
person, not the drug problem and making good use of the increased
resources available to make communities safer for everyone.
CC

Abstract
The Audit Commission report Drug Misuse 2004 draws on
the experience of drug users who come into contact with
organisations that provide them with help. It finds that agencies
focus too much on tackling the person’s drug problem alone. They
need to tailor services to meet other needs such as housing,
education and employment. Improving this will provide better
outcomes for users and, in turn, will help make communities safer
for everyone.

References
(1) Audit Commission, Drug Misuse 2004 – Reducing the
Local Impact, Audit Commission, 2004
(2) Audit Commission, Changing Habits: The Commissioning and
Management of Community Drug Treatment Services for Adults, Audit
Commission, 2002
(3) University of Central Lancashire, Drug Misuse Needs Assessment
Project: Community Engagement – the Process, UCL 2002
(4) Advisory Council on the Misuse of Drugs, Hidden Harm, ACMD,
2003

Further Information

• Extending Empowerment is at www.nta-nhs.uk
• Go to www.audit-commission. gov.uk for more on the report,
  including questions to help providers tailor services

Contact the author
Email at k-harbottle@audit-commission.gov.uk