Select Committee on Home Affairs Appendices to the Minutes of Evidence




1.1  Alternatives to prison. Turning Point's STEP Project in Wakefield

  The STEP project was the first pilot in Britain, targeting drug-related offending. It is run along similar lines to American models and has been operating since 1998. The scheme is now the main DTTO (Drug Treatment and Testing Order) provider in West Yorkshire, but has maintained this unique drug court feature.

  The main objective of the STEP project is to deliver an effective drug court service linked to a specifically designed treatment programme. The principal aims of the project are to reduce offending, reduce drug dependence and be cost effective. Phases of treatment include detoxification/stabilisation and rehabilitation. Like DTTO's the STEP Project works with clients who are sentenced in a Magistrates Court (High tariff option) and willing to comply with both the treatment programme and the Probation Order.

  Through the arrest referral process, STEP also provides access to other community programmes and treatment facilities. For example, rehabilitation includes mentoring support, literacy and numeracy, education and vocational training.

  Key features of the STEP project are the use of specially trained magistrates and the use of the same court and panel for a client's monthly review.


    —  the views of service users and magistrates indicates that both parties benefit from the consistency of the panel in the drug court, from the initial sentence to subsequent review. This means far more accountability for the offender as well as the opportunity for positive feedback from the magistrates. Consistency lends itself to building relationships and respect. In other settings, client may see many different people in the course of a DTTO;

    —  in Wakefield, reviews are held in the Family court and clients often speak more freely because the atmosphere is less intimidating than a Crown Court; and

    —  magistrates are specially trained and also receive ongoing training.

  This type of work gives them an insight into the complexities around offending and drug use.

1.2  A Young People's Drug Service—the SHED Project

  Over the last five years, there has been an increased emphasis on the need for separate services for young people.

  Advisory documents:

    —  Assessing Young People's Drug Taking: Guidance for services 1999.

    —  Assessing Local Need: Drug Interventions for Vulnerable Young People 1999.

    —  Policy Guidelines for Working with Young Drug Users 1999.

    —  HAS Substance of Young Need 1996 (newly replaced by 2001 document).

  The above documents identify the need for separate policies, assessment and interventions specifically aimed at young people.

  SHED Young People's Drug and Alcohol Project has based its service provision on such guidance resulting in a service which includes:

  Drop-in services providing low threshold access to advice support, counselling and guidance. Immediate access is essential as young people will often base their views of a service on initial contact.

  Ongoing support to young people, long and short term. This includes a variety of interventions including brief solution focused therapy, play therapy, cognitive behavioural therapy and key-working approaches. Many of our clients will not have undertaken long-term work, or are not sufficiently motivated to attend ongoing programmes of care. This is often due to them being at the start of their drug using career where the attraction to continue is greater. It may also be due to the level of chaos in their lives—this may include family breakdown, school issues or sexual exploitation. SHED staff appreciate that some young people will only attend the service for one session and so will impart as much advice and information as possible without overwhelming the client.

  Education work: among all age groups from primary age, secondary age and colleges. SHED feels it is important for all young people to receive age appropriate drugs education along the key stages. Drugs education is done on a primary, secondary and tertiary basis with issues such as incorrect injecting practices, inquiries about the physical effects of substances on the body, the effects of mixing substances and a lack of understanding re: legal implications, being common with individuals accessing the service for one-to-one work.

  Outreach work with young people including specific groups who are considered socially excluded.

  SHED aims to provide education and interventions to young people wherever they are in their drug using careers. This includes providing basic information to the first time cannabis user on the physical, social and legal effects, to harm minimisation advice around safer use to the long-term chaotic heroin user.

  SHED's philosophy is that of harm minimisation. We appreciate that the safest use of drugs is not to use at all but this is unrealistic to many young people and fails to advise and support those young people who will experiment and continue to use drugs on whatever level.

  Our experience is that intervention is most successful if undertaken at early in the individual's drug-taking career. Working with an individual who has already got a criminal record, an infection such as hepatitis or HIV, or who has become isolated from family, friends and support mechanisms, is never as successful as undertaking preventative work to stop such problems occurring.

  Young People's drug services should incorporate all aspects of treatment including support to those who are not able to stop using. Services should also provide variety of interventions as not all young people will respond to one type. Particularly vulnerable groups also need to be catered for.

  To this aim, SHED undertakes work, or is in the process of developing work with:

    —  young people who are being sexually exploited;

    —  young people in Local Authority Care—acquiring a worker to be seconded to Looked After Children's Service;

    —  care leavers—Worker to be recruited to work with young people leaving care;

    —  socially excluded young people;

    —  young injectors including the development of young people's needle exchange;

    —  prescribing for young people;

    —  children of drug misusing parents—from 2002 SHED will be developing a therapeutic support group for this client group; and

    —  young people in the criminal justice system—YOT worker to be seconded from SHED to that team.

  It is hoped that SHED will soon be an all encompassing service where young people are not lost in a system of waiting lists an cross referrals.

  The most important aspect of working with young people includes the need for separate policies around working with young people, taking into account local child protection procedures. SHED works within South Yorkshire Child Protection Policies and Procedures and has a close working relationship with the Area Child Protection Committee whilst maintaining its own confidentiality and child protection procedures.

  As seen above, SHED works with young people from a variety of backgrounds. As young people often have a variety of issues which impact upon their use of substances, to be successful in any intervention, it is important that all these needs are looked at, not simply focusing on a single issue. It is also essential to understand that those interventions which work for adult substance users cannot always be directly applied to young people. Young people often have more complex issues, are less likely to engage with services, require services to be more flexible, and need workers with skills and a desire to work with this challenging client group.

1.3  Druglink's Stimulant Service based in Hammersmith and Fulham

  Druglink's Stimulant Service provides a semi-structured flexible day programme for stimulant drug users (75 per cent of whom are Crack Cocaine users). It provides a menu of services—key-working, structured groups, unstructured groups, complementary therapies, practical interventions and an activities group—from which clients select, in conjunction with a worker, the elements that are most suitable for them (although there is an expectation of each client selecting a minimum of three options. This Care Plan is reviewed on a monthly basis, as well as being Outcome monitored, using the Christo Inventory. The service operates on an holistic basis seeking to address a range of social factors including housing, education, training and employment physical and mental health.

  The service is designed to work with crises, ie relapse, normal hour long structured appointments are flexible in order to accommodate individual need. The priority is to maintain contact with service users, missed appointments will be followed up by 'phone calls so as to minimise drop-out rates; often clients engagement will be patchy for one to two months, but where contact is maintained they are far more likely to engage fully in the medium term. Where possible family members/partners are included in order to enhance support networks.

  Stimulant users have generally been neglected by services in the past, therefore it is important to promote services in more innovative ways. Long-term outreach is an integral part of such a strategy, especially as the client group has a tendency towards paranoia/anxiety; therefore using existing service users as conduits into the using environment helps to build trust and confidence. There are obvious links with the Criminal Justice system, which need to be exploited particularly Arrest Referral Schemes and Court based Outreach. The other significant access issue relates to opening hours, the service operates a structured group and appointments between 6 pm and 8 pm on Mondays and an unstructured group and appointments 7 pm to 9 pm on Wednesdays.

Key issues

    —  flexible services that work with the individual rather than trying to fit him/her into a structured programme;

    —  working with chaos and relapse—providing space and support when it is required by the client;

    —  strong links with generalist services—Mental Health, Housing, ETE, Dyslexia;

    —  diverse staff teams reflecting the community;

    —  sophisticated Outreach model involving the Criminal Justice Services;

    —  involving family members;

    —  the service should be distinct but not detached from other drug services;

    —  strong partnerships, including the Police, Regeneration and Health Living projects;

    —  complementary service to support younger drug users;

    —  skills in working with mental health problems; and

    —  a service needs to be local to encourage attendance but not right in the middle of a using area.

1.4  Effective community resettlement

North Tyneside Resettlement Project (NTRP)

  Resettlement services are few and as far as Turning Point is aware, this is the only one in the country whose clients include those outside the criminal justice system. The project provides a resettlement service for people returning to North Tyneside who have had a history of drug use and acts as a bridge in the transition from custody or rehabilitation to community resettlement.

  Clients are referred:

    —  from the criminal justice system;

    —  from rehabilitation services round the country; and

    —  from detox services in local hospitals.

  An independent evaluation by the University of Northumbria and Newcastle has shown positive results for this pilot (Minding the Gap: an evaluation of a re-settlement scheme for drug users in North Tyneside by Peter Francis and Jamie Thompson, November 2001). Paul Hayes has commended the service and the model, so it is anticipated that this service and similar ones in the future will be more closely linked to targets and outcomes within the criminal justice agenda. This type of service is one that should also be applied to people in a variety of situations.

  The responsibility for ex-offenders and other people leaving rehabilitation who require drugs services, often falls between the relevant agencies. As a consequence of the lack of support during this crucial transition stage and the non-specialist support of what is available, the crucial links are not made. There are problems with take up of referrals, missed appointments and resettlement into the community that results in the loss of treatment gains made in relation to substance use.

  The NTRP is a project that from its early beginnings has sought to address the gap in service provision to offer a joined up and seamless approach to resettlement support. The NTRP developed in late 2000 from the work of a Community CARAT worker. Funded in 1999, for 18 months, the aim of the Community CARAT worker was to work with re-settling alcohol/substance misusing offenders to reduce re-offending.

  It was originally set up by SRB 5 funding which was part of a consortium (the Probation Service had secured the funding and Turning Point, Women's Aid and Barnado's provided the service). It is envisaged that the service is going to continue to be funded by DA/AT pooled budgets.

  There are now three full-time resettlement workers and one fill-time community service volunteer. In the future, staff are hoping to link the project with Turning Point's mentoring scheme, and with local colleges and employment services, who have identified learning and skills priorities to help find employment for socially excluded groups.



2.1  Is cannabis a stepping-stone drug?

  This section contains further information on the "Stepping-stone" theory—the notion that cannabis use "causes" further harmful drug use and the Gateway theory based on the user's behaviour and environment, not on any qualities or effects of the drug itself.

  There appears to be no definite hierarchy of drug use. There is no reason to think that drug use will increase as a result of the reclassification of cannabis.

  The "Stepping-stone" theory—the notion that cannabis use "causes" further harmful drug use has been dismissed by scientific inquiry and should be conclusively rejected (DrugScope).

  Whilst it is likely that many problem heroin and crack/cocaine users would report past and present cannabis use, recent research undertaken by Howard Parker indicates that early tobacco smoking and alcohol use is far more predictive of later hard drug use.


  Illegal leisure: The normalisation of adolescent recreational drug use—Parker, Aldridge and Measham 1998. This study confirms the link between heavier drinking and the use of tobacco, illicit drugs and other risk-taking behaviour. There is evidence from our interviews with young people of a blurring of the legal and illicit in their "pick and mix" psycho-active culture with the alcohol and tobacco acting as possible gateway drugs through to the illicit range, in a literal sense, in that they usually precede experimentation with illicit drugs, but more particularly because of the relationship between heavy and frequent drinking and drug use.

  Also of relevance to alcohol's possible gateway role is its physiological effect as a depressant or disinhibitor, affecting or excusing young people's judgement, leading to alcohol being considered to be a cause of unplanned drug use for some respondents when they were intoxicated with alcohol. P81.

  Alcohol also particularly dangerous drug because, not only is it legal, but it is also socially acceptable behaviour to consume large quantities.

  (Earliest) risk taking behaviour is around smoking and drinking and cannabis comes later with some young people. Parker would support the gateway hypothesis.

  The gateway hypothesis—drug use follows a developmental sequence where those using illicit drugs will invariably have used alcohol or tobacco but not all those using illicit drugs will move onto using more harmful illicit drugs such as heroin or cocaine. It is not dictating or predicting what will happen to people using trying cannabis, it is an analytical tool for understanding individual drug use.

  The gateway theory is based on the user's behaviour and environment and not on any qualities or effects of the drug itself (DrugScope).

2.2  The need for closer integration of a drugs strategy with neighbourhood renewal initiatives

  Background: Robin Burgess, Policy lead in Home Office Drug Strategy Directorate has said: "For the first time an identifiable and large scale drug specific source of funding exists (Communities against Drugs 2001 budget £220 million over three years) to enable communities to resist drug use. CAD funding allied to other regeneration spending such as the NRF, offers real hope for some of the poorest communities. The CAD funding supports this new willingness to join up the strategies". Druglink November-December 2001.

  However, Turning Point's observations are that:

    —  if there is a new willingness to join up strategies, it is not demonstrated by a clear "drugs focus" in neighbourhood renewal initiatives;

    —  in our own research—Stuart Wilks-Heeg—Turning Point and Urban Regeneration October 2001, Turning Point was surprised that although the New Commitment to Neighbourhood Renewal to have the goals of lower worklessness and crime, better health, skills, housing and physical employment and to narrow the gap of these measures between the poorest areas and the rest of the country, it makes very limited reference to substance misuse, although commitments 31-33 do address the issue of tackling drug dependency in deprived areas;

    —  Turning Point's experience of Single Regeneration Budget and other regeneration funding is that it is extremely complex, time-consuming and bureaucratic. This was borne out in another article in the same issue of Druglink by Kate Davis, a DAAT team Co-ordinator for North Notts who comments that: drugs schemes compete with more politically friendly bids (school clubs, football pitches) and that despite increased evidence of drug use among young people, there is reluctance to fund drug projects through regeneration schemes and the intensity of paperwork, bureaucracy and the need to match funding by at least 50 per cent deters many substance misuse projects from applying; and

    —  within the general youth population, those who are the most likely to try heroin are: "serious drug users distinctively and away from the norm . . . on sensation seeking. There is little doubt that if we add poor school performance, and attendance, light parental supervision and growing up at the wrong end of town, we are offering the basic identikit of the most likely heroin user." Howard Parker: New Heroin outbreaks amongst young people in England and Wales, p 44, 1998.

December 2001

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