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.