The Black Review: More Opportunity than Threat

The gulf between the sharply defined world inhabited by spin doctors and newspaper columnists and the rather fuzzier one the rest of us live in can often seem impossibly wide. This was no more evident than in the recent coverage of Dame Carol Black’s review into the barriers to employment faced by those with obesity and addiction problems.

The media tell us that the welfare system is full of ‘jobless junkies, alcoholics and binge eaters’ who believe they have a right to maintain their lifestyles courtesy of the taxpayer. The solution given – accompanied by stock photos of bulging guts and drug paraphernalia – is to force people into treatment to get sober, slim or straight, so they can get a job, start paying taxes, and stop being a burden on the rest of us. Cue congratulations from the right wing press, and I suspect most voters, paralleled by outrage in the chattering classes and dire warnings about breaching medical ethics from various Royal Colleges.

Meanwhile the complex reality of people’s lives is conveniently ignored; both the Right’s caricatures of welfare claimants and the Left’s scathing portrayal of Dame Carol Black’s review gloss over the real challenges facing us in the substance misuse field. When the media roadshow moves on, those of us who support people who struggle with health and behavioural problems will continue to work in this messy reality. We can’t retreat to the false certainty of ideological positions – we actually have to take action. The Black Review gives us an opportunity to dramatically improve what we have done up until now.

Collective Voice, a new project representing the largest providers of drug and alcohol treatment in the UK, was set up for precisely this purpose: to communicate our experience from engaging with hundreds of thousands of individuals living with addiction every day and ensure their voices are heard.

We can be proud that our drug and alcohol treatment system is one of the best in the world. The success rate of alcohol treatment is high. Drug treatment is more readily available in England than it is across most of Europe and North America. Our successes have led to rapidly declining levels of drug-related crime, very low levels of HIV infection, and have contributed to the significant reduction in overall drug use over the past decade.

Despite our many successes, we also have to acknowledge where we could be doing better. Since 2010 the government has been refocusing the treatment system to enable people to leave drug and alcohol dependency behind, stabilise their lives, and become fully active contributing citizens. However, despite this shift in emphasis, relatively few graduates of treatment make it through into sustained employment. This is doubly important as a job, a home and a stake in society are crucial if an individual is to sustain their recovery. On those people’s behalf, and for their benefit, Collective Voice will be doing everything we can to help Dame Carol understand what we see as the underlying causes of the system’s collective failure and then work towards sustainable solutions.

The first fundamental barrier here is within the drug treatment system itself. Until recently the primary focus of our work was on keeping people alive, restricting the spread of blood borne viruses, and preventing crime. The system did not challenge individuals to become free of dependence and take full responsibility for their future lives. In this culture, getting people into work was not a priority. Clinical practice has been recast since 2010 to deliver services that are much more ambitious on behalf of service users, while retaining the public health and community safety benefits of previous practice. However, progress towards improving employment has been much slower.

This brings us to the second fundamental barrier, the composition of the drug and alcohol dependent population. Drug use is fairly common in society. Almost three million of us will use illegal drugs this year and apart from age there will be little to distinguish the users from the non-users. Drug addiction is much rarer, limited to about 300,000 individuals, and is concentrated in particular groups. Compared to the rest of the population people who are addicted to drugs are much more likely to be from low income groups, with poor mental health, experience of the care system as children, a history of offending, and non-existent or patchy work records. Typically most of these additional barriers to employment will have preceded addiction; they will not have been caused by it. Addiction tends to exacerbate and entrench pre-existing problems, so it is insufficient to address it in isolation. Addiction is seldom the unique barrier to employment the headline writers and spin doctors would have us believe, but part of a web of overlapping and reinforcing challenges.

The lack of ambition shown by the treatment system in the past is echoed by the Work Programme today. The many barriers to employment faced by people with serious drug and alcohol problems make them a very poor prospect for Work Programme providers who typically react by parking them in low-cost minimum intervention options so that they can concentrate their scarce resources on people much easier to place into employment and who will yield income. Even when employment can be accessed it will often require long-term, expensive support and will be of little intrinsic value.

Using people’s complex needs to write them off is both short-sighted and morally dubious. Although complexity may be typical it is not universal. Many thousands of individuals, particularly those who overcome alcohol dependency, have lengthy work histories and valuable employment skills equipping them for a speedy successful return to employment. Some individuals will transcend the most difficult barriers to turn their lives around. More fundamentally no individual, no matter how far they are from the labour market, should be denied the opportunity to reach out for the dignity and satisfaction of earning their own living. This applies not just to those recovering from addiction but also to other excluded groups like former offenders, the homeless, and people with mental health problems.

The Black review presents us with an opportunity to build political momentum to overcome the policy inertia which has undermined efforts to improve the employability of all excluded groups under successive governments over many decades. It is an opportunity the treatment sector needs to seize.


5 Responses to The Black Review: More Opportunity than Threat

  1. angela scully 18/08/2015 at 3:21 pm #

    I totally agree with your reasoning about addiction and being accepted back into the work force. Unfortunately, no one seems to want to offer the extra support needed to give a stable addict, employment. I must add, that many addicts have lots of skills to offer employers if the stigma could be removed.

  2. cees goos 19/08/2015 at 2:01 pm #

    great piece; congratulations – also on the new job and the new voice!
    there are fortunately good examples around too of small scale opportunities for work supported/initiated by ngo’s or private initiatives – showing that trust and enthusiasm can do little miracles..let us build on these

  3. Chris Ford 22/08/2015 at 11:44 am #

    Far from being “more opportunity than threat” the Black Review is yet another attack on some of the most vulnerable members of our society and on our welfare state itself.

    The welfare state was set up to promote and protect the social well-being of all people. It is based on the principles of equality of opportunity, a fairer distribution of wealth and public responsibility for those unable to fend for themselves. It is funded by a progressive tax system to ensure there is an adequate safety net to protect the vulnerable in our society and rightly includes direct payments to those with little or no income

    Along with the current government you seem to have dismissed the thing we should all be proud of – a nation where the haves provide for the have not’s. Instead it appears you hell-bent on punishing those who most need our help at the same time as destroying what was once the best welfare system in the world.

    Even some of your “Collective Voice” disagrees with you. To quote Simon Antrobus, Chief Executive of Addaction “Many people in similar situations – people with complex needs and chaotic lives – struggle to engage with treatment services.” …. “but we are not convinced that a threat to take away benefits if they don’t agree to help will work.”

    The excellent report “Solutions from the Frontline” shows 88% of services reported that welfare changes had a negative effect on their clients’ overall well-being, and 86% on their mental health. In the same report, only 2% of services believed that welfare reforms have had a positive impact on people’s ability to engage with the job market, with 55% reporting a negative impact.

    I could take issue with a lot more of your blog but perhaps it is sufficient to say that in the health service our primary aim has always been to treat people who use drugs as human beings and just as we do with everyone else ensure that they are kept as healthy as possible.

  4. Tony Lee 30/11/2015 at 4:25 pm #

    Hi. Good blog, congrats on your new posting and the new “collective voice” org, although I await to see how representative it is for both service users and those in recovery in or out of treatment. Your point that the treatment system doesn’t go far enough in seeing clients supported through to employment is one I’ve been raising for 5 yrs, there are some excellent work supported schemes out there the problem I’ve faced is getting the treatment service itself to take this onboard, despite repeatedly showing examples of how to achieve this. Until we can get all treatment services to work with local community’s in developing pathways to address these issue addicts will always struggle back into mainstream society. Also in my area, Fleetwood, Lancs, it would help if the local treatment service would help develop BRIC. Again they don’t seem to want to work with the local community.

  5. Deborah 19/03/2016 at 10:28 am #

    Maybe collective voice should approach Chris ford to write for you as her comment is spot on and very in tune with the current situation.
    We all seem to get caught up in speaking on behalf of people with complex needs get out in communities and ask or develop a pathway for people to feedback with their experiences,
    we are working to a one size fits all with the treatment sector, personalised treatment is no longer available, workers are all generic and we expect the community we work with to be the same, some people can not focus on work they are focusing on staying alive today , who looks out for them, you appear to look down on treatment prior to 2010 however it worked harm reduction and retention kept people alive and stable drug workers who were ambitious for clients not pushy , people are dying because of policy drug deaths are increasing because of lack of effective funding which results in poor treatment. Black review needs to understand the roots of the problem

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