Queen’s Speech

My Lords, I welcome much of what is in the Queen’s Speech and I will be supporting it. I want to take us in a rather different direction from the two or three previous speakers and say something about drugs and alcohol public health policy. I shall be speaking as a trustee of the charity Action on Addiction. It is a relatively new charity, formed in April 2007 by the merger of three well established addiction charities: Clouds, the Chemical Dependency Centre and Action on Addiction, from which the new charity has taken its name. Addiction is one of the biggest preventable killers in the UK. It breaks up families, it damages communities and it destroys lives. In some way, it touches all of us. Action on Addiction takes action to try to disarm addiction. It does so through a uniquely comprehensive approach that encompasses a range of responses from prevention through to recovery. We cover research, treatment and rehabilitation. We also increasingly provide support for families and children, workforce development and education and campaigns against addiction. Like many others, we have been closely involved with the Government’s first drugs strategy, which came to an end last March. While we might argue about its merits and effectiveness, we finally have an alcohol harm reduction strategy. Had I had the opportunity to speak on Tuesday in the home affairs debate, I would have congratulated the Government on some of the steps that they announced then, which they hope will reduce the level of crime, particularly arising from alcohol misuse. A significant amount of money has been invested over the past 10 years in drug treatment; I believe that it is moving to close on £1 billion. As a result, more people have had access to some form of treatment and, if somewhat late in the day, we are seeing a growing recognition of the need to provide proper support to families and carers, including children. The current strategy brings the needs of families to the fore. I am not sure that the culture of the commissioning and treatment system is yet ready to respond appropriately. In some areas, there have been clear improvements in commissioning and service provision. In respect of the latter, I acknowledge the contribution of the European Association for the Treatment of Addiction in introducing an internationally recognised accreditation scheme. We now need to learn the lessons of the past 10 years and act accordingly. Therefore, I shall focus on the four areas that we believe are key to an effective second stage of the strategy: treatment, research, family support and workforce development. The predominant mode of treatment for heroin users remains a methadone prescription. There is no argument about the fact that methadone maintenance is a legitimate, evidence-based and necessary intervention if we want to help to stabilise chaotic drug users’ lives and reduce crime. However, we must wise up to the fact that this predominantly pharmacological approach has all too often been deployed as a response to the demand to achieve targets of numbers of people in treatment rather than to secure sustainable long-term benefits and to be the platform from which individuals can make progress to a life free of drug dependence. Maintenance works when it is provided as part of a meaningful package of support, but I am disheartened to learn that it is common for people on methadone to be seen for as little as one and a half hours a month and to receive evidence-based psychological interventions for less than four hours a year. There appear to be no reductions in alcohol or crack use, and problem drinking is said to exist in 40 per cent of methadone clients. It appears that to all intents and purposes the goal of a drug-free existence—not for its own sake but because it is something that is known to bring a wide range of benefits to the individual, his/her family and society—has fallen off the radar. This makes little sense when we consider that major outcome studies, including the UK’s own national treatment outcome research study, which was the very thing that gave rise to a treatment strategy, indicate that abstinence is a viable treatment goal achievable by large numbers. It also fails to take into account the fact that, according to one leading researcher, most clients would prefer not to have methadone, and certainly not for life. The neglect of the abstinence option has resulted in significant damage to the sector providing services working to that model. Action on Addiction is in that field. These are primarily voluntary sector-based organisations and many are residential units. Yet the NTORS stated clearly enough: "““The clients in the residential programmes presented with some of the most severe problems and complex needs and these clients made some of the greatest treatment gains””." While full cost recovery is seldom an issue for prescribing services, it most certainly is a problem for those providing abstinence-based programmes. Should it really be easier to stay on drugs than to get off them, as presently seems to be the case? Why is it perceived in many quarters that abstinence-based programmes have not been given the same support as chemically delivered programmes have? Maybe that is a misunderstanding—if it is, I will be pleased to hear that from the Government—but there is a general perception that little sympathy has been given in recent years in this direction. I do not want to exacerbate the divide that has grown up between different treatment modalities—quite the contrary. I want a treatment system that encourages and facilitates people to move out of their drug-dependent lifestyle, to experience maximum well-being and to fulfil their potential at the earliest opportunity. We need intensive and extensive treatment and rehabilitation and in that regard I draw your Lordships’ attention to Action on Addiction’s Working Recovery project in Boscombe, Bournemouth, which operates under the compelling slogan, "““A working recovery is a recovery working””." That pioneering project helps to build on the gains made in treatment, supporting people to develop life skills and to enter employment and training. Working Recovery, which has depended almost entirely on charitable grants, is celebrating its 10th anniversary. The pride that participants feel when they come off benefits as well as drugs is indeed a moving sight to behold. People can, I believe, achieve much more than we are inclined to think. We should incentivise progress to the exit from dependence, rather than continue with policies and practices that encourage inertia. Treatment is not only important to one generation. Well over a million children are growing up in households where parental alcohol and drug problems dominate their family life. Seeing that parents have the best chance of recovery is an investment in their children’s lives, too. On research, if we are to improve our treatment system to achieve the goals to which I have alluded, we need to learn more about what helps people to progress. Momentum is, happily, growing within what has become known as the recovery movement. There are large numbers of people in drug-free recovery across this country. We need to understand the factors that helped them to initiate and sustain recovery, then ensure that our treatment system takes full account of what we learn to make it possible for more to have that experience. That is one direction that research should take. One aspect of the recovery movement that I applaud is the drive to establish local recovering communities, which have the potential to effect a significant cultural and social change on communities blighted by drug misuse. The more we can increase our understanding of how that can be made to work, so much the better for the whole of the country. On families and children, there are literally millions more people personally affected by someone else’s substance misuse than there are actual substance misusers. The wide and varied range of symptoms relating to the psychological and physical distress that they suffer—anxiety, depression, aches and pains, disturbances—is multiplied by the number of people suffering from them and the treatment received. We should recognise and address that as a major public health issue. Any other condition placing that level of demand on our health service would certainly be viewed in that light. Action on Addiction’s Families Plus—also celebrating its 10th anniversary—has shown that, with the right kind of economic support, these symptoms can be dramatically improved. If such interventions were widely available, significant savings would be made to the health and social costs associated with the distress caused. Furthermore, Families Plus argues that supporting family members and families in their own right, rather than simply in relation to the treatment of the substance misuse, could well have a significant beneficial impact both on the family members and on the misuser. That is another area that we need to investigate much more thoroughly than we have done so far. The Moving Parents and Children Together programme, devised by Families Plus, is timely indeed. With alcohol and drug misuse becoming ever more socially entrenched, we are beginning to see several generations afflicted with this problem. The children who grow up in these families are isolated, vulnerable and disadvantaged. They often do not have a voice. Many end up effectively taking care of their parents, losing their childhood in the process. They are at significant risk of developing a host of problems. M-PACT offers these children and their families an opportunity to make collective change, with the help and support of other families in similar situations. Action on Addiction aims for this programme to become available across the country, so that fewer children go to bed at night feeling that drugs or alcohol are more important to their parents than they are. I hope that, while my noble friend the Minister may not be able to respond on this point, in the context of some of the problems that we currently see in dealing with children he will ensure that the department reviews this again, to see whether we can start to see more work done around the programme that I have been describing. Finally, as I am running out of time, I will mention workforce development. As so many other contributors have said, particularly when speaking on the health service, it is vital to have people in the field who are not just keen to be there but want to make change. They should be handed all possible support and training, to ensure that their work produces the result that we need. Again, I believe that Action on Addiction has contributed significantly here, by establishing a Centre for Addiction Treatment Studies, where students are trained to degree level on courses that equip them to become addictions counsellors and to work in a variety of settings and modes. The centre has formed a productive partnership with the University of Bath, which awards the foundation and honours degrees. The aim of the centre is to raise professional standards across the UK. I would like to see workforce development promoted much higher up the agenda in the drugs and alcohol field. How else are we to see that the significant sums of taxpayers’ money mentioned as being committed to treatment are being well spent?