Risk and Responsibility

In “World at Risk” (2009), Ulrich Beck asserts that we now live in a Risk Society where the old institutions of industrial society – family, community, social class – have been undermined by the process of global modernisation and where individuals have to learn to navigate society for themselves. Beck does not suggest that we face a world of “unprecedented dangers”; rather that we live in conditions of “manufactured, self-inflicted insecurity.”

Beck’s thesis can provide a backdrop for many current ethical and moral debates. These include discussions about what should be the role of the state in public health interventions and where individuals should be left alone to make their own decisions, based on their individual assessment of risk and with a moral sense of responsibility. This ‘individualism’ conflicts markedly with Elias’ assertion in “What is Sociology?” (1970) that we are interdependent: the term individual can only be understood as referring to interdependent people in the singular, society referring to interdependent people in the plural.

How we organise our social and economic systems relies on the dynamic interweavings in which we engage. The limitations of our linguistic and conceptual abilities lead us into and trap us in dualistic debates about rights versus responsibilities that neglect human complexities and dynamism and how more powerful groups exert power over weaker groups. Thus, for example, poor people rather than globalisation are blamed for their ‘cultures of worklessness’ and the duty of individuals to “drink responsibly” is emphasised over corporations’ responsibility to promote their goods in an ethical fashion.

In 1970, Elias discussed what he saw as the fetishisation of the hydrogen bomb and argued that people projected their fears and blame onto it and the scientists who created it rather than taking responsibility for their own complicity in the reciprocal hostilities which led to its creation. Contemporary discussions about issues such as child abuse follow the same tangent; rather than considering how we have encouraged the development of a culture where sexualised imagery, whether or not involving children themselves, is displayed to them, we lament the discovery that ‘much-loved’ entertainers have been monstrous sexual predators. The individualistic culture responsibilises those monstrous individuals and the ‘victims’, i.e. those who suffer the most demonstrable harm at an individual level are deemed to be unfortunate. We convince ourselves that society has changed, that such abuse is terrible but exceptional.

As individuals and as a society, we carry on as before in our “manufactured, self-inflicted insecurity”.

Aged 16-20 in West Pilton and want to talk to a researcher?

Interviewees wanted

Alcohol Assertions – Consume with Caution

I attended a conference today. In among some very interesting and perceptive discussions about how important parents could be in supporting young people around alcohol issues and what they needed in turn to enable them to carry out this role, there were some inaccurate or misleading assertions and selective uses of statistics. There were several fairly self-congratulatory statements about the alcohol problem getting significantly better when in fact, as a population, we are drinking vastly more than we did 20-30 years ago and levels of alcohol-related harm, though they may not be at their peak, are still a huge cause for concern. I know that the statistics in relation to alcohol use will always be debated but alcohol industry retailers do not help clarify the position by maintaining their secrecy around sales figures.

Among today’s assertions, this one:

There are fewer young people drinking than ever before.

This was based on the annual schools survey in England and Wales, exclusively self-reported, which doesn’t in fact track back to “forever”. Nonetheless, the positive impression is given when in fact,  the welcome recent reductions in young people’s use have come after a period of sustained year on year increases. As well as this, even though fewer young people may be drinking now than in the recent past, the drinkers are consuming vastly greater quantities than in the past.

If we take the long view, we can see that alcohol consumption in the UK was very high at the beginning of the twentieth century and then dipped significantly mid-century. Our current, albeit improving, situation is still markedly closer to those early twentieth century figures than to the mid-century position. Now, as then and in line with other health-related issues, the harm caused to poor and socially-disadvantaged communities is disproportionate. It is inexcusable and misleading to present only positive short-term improvements and ignore the sustained and serious increases in alcohol-related harms that have crept up and overwhelmed contemporary society.

Across Europe, alcohol is the world’s number one risk factor for ill health and premature death among the 25-59 year old age group and Europe is the heaviest drinking region in the world. The UK government (2012) estimates that in a community of 100,000 people, each year:

• 2,000 people will be admitted to hospital with an alcohol-related condition;
• 1,000 people will be a victim of alcohol-related violent crime;
• Over 400 11-15 year olds will be drinking weekly;
• Over 13,000 people will binge-drink;
• Over 21,500 people will be regularly drinking above the lower-risk levels;
• Over 3,000 will be showing some signs of alcohol dependence; and
• Over 500 will be moderately or severely dependent on alcohol.

In Scotland, the alarming rise from the early 1990s has now stabilised but alcohol-related harm continues to be at historically high levels with alcohol-related deaths more than doubling since the 1980s and alcohol-related hospital discharges more than quadrupling since the early 1980s. There were over 40,000 hospital discharges in 2007 and alcohol related mortality has more than doubled in the last 15 years. In addition, Scotland has one of the fastest growing rates of liver disease and cirrhosis in the world. The Scottish government (2009) estimates that alcohol misuse costs Scotland £2.25 billion every year.

A couple of today’s speakers usefully drew attention to the impact that easy availability of alcohol has on people’s behaviours. In support of this, WHO (2011) has argued that,

Of all alcohol policy measures, the evidence is strongest for the impact of alcohol prices as an incentive to reduce heavy drinking occasions and regular harmful drinking. The health gains are greatest for heavier drinkers and there are also considerable gains in the well-being of people exposed to the heavy drinking of others.

The BMA has identified minimum price per unit as the most effective of all available price-related policy options for reducing alcohol-related harm. Yet the alcohol industry has consistently tried to block statutory regulation which would impact on sales of the cheapest, most harmful products. Indeed, the Scotch Whisky Association is currently engaged in legal action to try to block the Scottish Government’s planned introduction of Minimum Unit pricing. One of the industry’s speakers today said that he “believed that it wouldn’t work”. This flies in the face of real-life evidence from Canada of the impact of the introduction of Minimum Unit Pricing there (Stockwell et al., 2012).

We need public health focussed interventions in the markets, permitted by national and international law and to my mind, required by laws of social justice, to change our drinking cultures and behaviours.

Instead of this, the overwhelming theme today was the need for more education and information campaigns. As a champion myself for many years of alcohol education and its continuing supporter, I also know that education on its own is not going to achieve very much. We should always interrogate claims that are made about interventions that are deemed to be effective, even where there do appear to be signs of positive impacts. For example, the most notorious high-level failure in drugs and alcohol education was DARE, a high profile multi-million pound programme that was delivered across the USA for decades with no significant impact. Even with Life Skills training, Gorman et al (2007, p.585) have argued that:

far from supporting the evaluators’ claims concerning the rigour of the findings and their generalisability and public health significance, the results are very fragile, of little practical significance and quite possibly analysis-dependent.

This is not to say that Life Skills training should not be promoted – indeed I would strongly argue the contrary case. We must not, however, overclaim for it. Stothard and Ashton (2000) argue that there is insufficient consistency in the findings to be confident that implementing Life Skills will cut legal or illegal drug use, only that it can do and has done, most consistently in relation to smoking.

Regarding information campaigns, the BMA (Hastings & Angus, 2009) has argued that:

while alcohol industry- sponsored marketing seems like a good idea, its public health value is questionable, and given its stakeholder marketing agenda, the effects are likely to be counterproductive. Such activity also focuses attention on individual rather than population level solutions, and can delay more effective statutory measures.

The BMA also argues that messages such as:

We promote responsible drinking and find innovative ways to challenge the national drinking culture and tackle alcohol misuse

reinforce the idea of ‘safe limits’ rather than relative risks and the impression is erroneously given that problems only arise when the product is used in specific ways , for which it is not intended.

Today’s conference facilitator called for more accurate representation of drinking behaviours in the media, arguing that we should celebrate  the fact that the numbers who do drink are (according to him) falling quite sharply. I’m sorry but I think it’s a bit premature to be thinking about cracking open the (non-alcoholic) bubbly!

BMA Board of Science 2012, Reducing the affordability of alcohol, London.

Gorman, D.M., Conde, E., & Huber Jr., J.C. (2007). The creation of “evidence-based” drug prevention: a critique of the Strengthening Families Program Plus Life Skills Training evaluation. Drug and Alcohol Review, (26), 585–593.

Hastings, G. & Angus, K. (2009). Under the influence: The damaging effect of alcohol marketing on young people British Medical Association, London.

Home Office 2012, The Government’s Alcohol Strategy, London.

Scottish Government 2009, Changing Scotland’s Relationship with Alcohol: A Framework for Action, Edinburgh.

SHAAP 2007, Price, Policy and Public Health, Edinburgh.

Stockwell, T. et al. 2012, ‘Does minimum pricing reduce alcohol consumption? The experience of a Canadian province’, Addiction, vol. 107, issue 5.

Stothard, B., & Ashton. M. (2000). Education’s Uncertain Saviour. Drug and Alcohol Findings, (3).

University of Sheffield 2012, Model based appraisal of Alcohol Minimum Pricing and Off Licensed Trade Discount Bans in Scotland using the Sheffield Alcohol Policy Model v2 – Second Update, Sheffield.

World Health Organisation 2009, Global health risks, Geneva.

World Health Organisation Europe 2011, European Alcohol Action Plan 2012-2020: Implementing regional and global alcohol strategies, Geneva.

Riots

Noone can fail to have been shocked by the events that we’ve seen in London and elsewhere this week. And it goes without saying that the actions of those involved are inexcusable. Also, that demoralised, under-resourced police officers are having to struggle to re-establish the public order and safety that all people in our communities deserve. 

David Cameron was wrong however to describe the situation as “plain and simple”; it’s anything but. I hope that when this is done we can reflect and reprioritise prevention and early intervention activities with communities and individuals who have become increasingly disengaged. Yes, wrongdoers should  certainly be punished but we need to look at how to rehabilitate young people who have done wrong. We also need to recognise that disinvestment  in youth and community services may save money in the short term but it can, at least indirectly, lead to exactly the kinds of circumstances we’ve had this week.

I lived in Lambeth for a long time and until recently I was working with the Lambeth Crime Prevention Trust in Brixton, one of the ‘hot spots’. This agency engaged many young people in meaningful leisure and community activities and provided education about being a citizen, avoiding knife crime, resisting peer pressure etc. However, it wasn’t deemed to be a priority service and consequently it lost its funding and closed down in March this year.

Closer to my current home, in Edinburgh the ‘North Edinburgh News’, a community charity based in Pilton which promoted positive views about the disadvantaged areas it covered and was able to provide a whole range of community information and to support networking  also lost its funding and closed in March this year. It would have needed £30K per year to continue.

In no way should we condone the violence and looting. However, we do need to try to understand and consider how we are running our society and what priorities we have within it. As a final point on this really sad blog,  when I saw the scenes from Clapham Junction on Tuesday night I was reminded of Polly Toynbee’s description when she undertook an experiment, flawed of course because she always had the option to go back to her ‘real’ life, of trying to live on the minimum wage in Clapham Park estate. Her overwhelming experience was of feeling excluded from an individualistic, materialistic society where we and others assess our worth based on what we own; the Arding & Hobbs store she described in the following extract subsequently became the Debenham’s store that was ransacked on Monday.  

“Well-worn and familiar tracts of the city devoted to pleasure, art, eating, clothes and shopping disappeared of my map. Why wander down the King’s Road when everything there is denied to you? Oxford Street and Regent Street vanished from my route. So did Clapham Junction and Arding and Hobbs. So did Shaftesbury Avenue, the National Theatre, the Albert Hall and the Barbican. Wherever I walked, everything I passed was out of bounds, things belonging to other people but not to me. No Starbucks sofas beckoned any more, no Borders bookshop, no restaurants, not even the most humble cafe. This is what ‘exclusion’ means, if you ever wondered at this modern wider definition of poverty. It is a large No Entry sign on every modern pleasure. No Entry to the consumer society where the rest of us live. It is a harsh apartheid. Exclusion makes the urban landscape a forbidding place where every brightly lit shop doorway designed to welcome you in to buy, buy, buy is slammed shut to one-third of the population. Shopping for the meanest food staples under rigorous cost-controls is no fun, and it becomes less so every time.”

Toynbee, Polly (2003) Hard Work: Life in Low-Pay Britain London: Bloomsbury Publishing

Decriminalising personal drug use

I am frustrated by the lack of clarity which politicians, journalists and other commentators demonstrate when talking about legal options in relation to drug use, often confusing arguments for decriminalisation of penalties with legalisation. Although people have different perspectives about the way forward, any claims of certainty about outcomes which relate to drug policy must be treated with a huge degree of scepticism. Without the possibility of having a control group to compare against, causality is impossible to measure. However, it is clear that decriminalisation of penalties for personal drug use is consistent with UN Conventions and guidance:

“Serious offences, such as trafficking in illicit drugs, must be dealt with more severely and extensively than offences such as possession of drugs for personal use. In this respect, it is clear that the use of non-custodial measures and treatment programmes for offences involving possession for personal use of drugs offer a more proportionate response and the more effective administration of justice” (Costa, A.M. 2010, p.7).

The official Commentary to the 1988 UN Convention states: “It will be noted that, as with the 1961 and 1971 Conventions, paragraph 2 does not require drug consumption as such to be established as a punishable offence”. The Commentary suggests establishing a strategy regarding the range of offences relating to personal use, similar to that practised by many states, in which such offences are distinguished from those of a more serious nature by a threshold in terms, for example, of weight. However, different countries, while embracing the concept of separating out less serious from more serious offences, have established national arrangements specific to their own setting. Some countries have opted to decriminalise personal drug use, shifting to administrative rather than criminal sanctions. Others instead have opted for a policy of depenalisation, whereby they cease to apply criminal or administrative sanctions, though the laws still exist to prohibit activities. Legalisation has not been adopted by any country and would be a clear breach of UN Conventions. Thus, for example, in Portugal possession of a small quantity of drugs for personal use has been completely decriminalised, whereas in other countries the approach has been not to decriminalise but simply to treat the offence as a low priority for law enforcement. For example, in the Netherlands, Germany and the Czech Republic, possession for personal use remains unlawful, but guidelines are established for police, public prosecutors and courts to avoid imposing any punishment, including fines, if the amount is considered to be insignificant or for personal consumption. Very few EU countries (Sweden, Latvia, Cyprus) exercise the option to impose prison sentences for possession of small amounts.

Antonio Costa, former UNODC Executive Director has argued eloquently against the criminalising and incarceration of people with drug problems (Costa, A.M. 2010). According to Costa, incarceration in prison and confinement in compulsory drug treatment centres often worsens the already problematic lives of drug users and drug dependent individuals, particularly the youngest and most vulnerable. Exposure to the prison environment facilitates affiliation with older criminals and criminal gangs and organizations. It also increases stigma and helps to form a criminal identity. It often increases social exclusion, worsens health conditions and reduces social skills.

Hughes and Stevens (2010) have argued that most studies have found there are no significant increases in use as a result of decriminalisation. They have also suggested that it is difficult to make any certain judgment on the effects of decriminalisation on drug use, given the absence of adequate comparators. However, the financial and other costs associated with a focus on law enforcement and incarceration can be high and reducing the cost of arresting and punishing drug users would enable resources to be focused on maximising the other factors that protect against drug abuse, such as prevention and treatment. It has been argued that one of the biggest impacts of changes in the law has been the reduction of pressure on overburdened penal systems and prison overcrowding (Jelsma, M. 2009).  A study which considered data from the Netherlands, United States, Australia and Italy concluded that the removal of criminal penalties appeared to produce positive but slight impacts. The primary impact was reducing the burden and cost in the criminal justice system. This also reduced the intrusiveness of criminal justice responses to users (Hughes, C.A. & Stevens, A. 2010, P.  1000).

It is important to note, however, that there is little evidence that the removal of criminal penalties on its own will be likely to lead to significant increases or decreases in the overall prevalence of drug use or drug-related health harms (Hughes, C.A. & Stevens, A. 2010, P.  1000). The Portuguese experience has been arguably the most studied example of drug policy review. Portugal is the only country which has fully decriminalised personal drug use (in 2001) and it has reported outcomes which include reductions in drug use among young people and reductions in use of opiates, the most problematic type of usage. It has also noted the lack of negative outcomes, such as increased street drug use or drug tourism. However, the Portuguese legislative changes cannot be considered in isolation from the country’s corresponding investment in a range of social and health support services, intended to offer support to drug users where it is needed, while retaining the intention to deter drug use. The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use. Outcomes that have been reported include:

• small increases in reported illicit drug use amongst adults;
• reduced illicit drug use among problematic drug users and adolescents, at least since
• 2003;
• reduced burden of drug offenders on the criminal justice system;
• increased uptake of drug treatment;
• reduction in opiate-related deaths and infectious diseases;
• increases in the amounts of drugs seized by the authorities;
• reductions in the retail prices of drugs (Hughes, C.A. & Stevens, A. 2010, P.  1017).

Opponents of the legal change had expressed concerns that decriminalisation would lead to mass expansion of the drug market in Portugal. This did not happen and, in contrast with market expansions in neighbouring Spain, the numbers of problematic drug users and the burden on the criminal justice system in Portugal have reduced. It is not possible to state that any of these changes were the direct result of the decriminalisation policy. However, it is clear from the Portuguese experience that decriminalisation does not necessarily lead to increases in the most harmful forms of drug use. While small increases in drug use were reported by Portuguese adults, this was arguably less important than the major reductions in opiate-related deaths and infections, as well as reductions in young people’s drug use.  Other countries, such as Sweden and Switzerland, though adopting different legislative approaches, have also claimed successful outcomes from their drug policies but, as with Portugal, these countries’ substantial investments in health and social care services must be considered as at least as important as the legal framework.

Costa, A.M., 2010. Drug control, crime prevention and criminal justice: A Human Rights perspective: Note by the Executive Director UNODC, Vienna: Commission on Narcotic Drugs, 53rd session.

Hughes, C.A. & Stevens, A., 2010. What can we learn from the Portuguese decriminalization of illicit drugs? British Journal of Criminology, 50, Pp. 999-1022.

Jelsma, M., 2009. Legislative Innovation in Drug Policy:Latin American Initiative on Drugs and Democracy, Amsterdam: Transnational Institute.

Recovering communities

I was really excited and honoured recently to chair a side event on Recovery at this year’s Commission on Narcotic Drugs in Vienna. I’ve been learning a lot in the past few months through my involvement as a volunteer with Wired In. I’ve had opportunities to listen to the experiences and challenges of people who are recovering not only from addiction problems but from many difficult life experiences. They want and are planning to manage their recovery, not passive recipients of drug treatment, rather, mapping out positive life futures. Drug treatment and other social services and stronger communities can support this, they can’t deliver it. It seems fundamental but it is revolutionary and it’s about hope not hopelessness. It requires a systemic rethink, based on listening to and trusting communities and learning from people in recovery.

The Wired In website – www.wiredin.co.uk – supports an increasingly empowered community of people in recovery, supporting each other, exchanging ideas, challenging the traditional way drug and alcohol treatment services have been provided, emphasising that people with drug and alcohol problems are the experts who are best placed to map out and manage their recovery. Many people in recovery are talking about how drugs and alcohol had always been the focus of their lives and how that’s changing so that their focus is becoming not just about what treatment they get; rather, it’s about how they become integrated into their communities, how their communities change to support that and how they contribute as full members of their communities. And this movement is growing within communities and across countries.

When we think about the problems that people have with drugs and alcohol, we know that problematic drug and alcohol use almost always comes with a whole lot of accompaniments – family breakdowns, abuse, violence, housing difficulties, involvement with criminals and the criminal justice system, financial problems and poverty, social exclusion. We all need support in recovering from that. We all need to recover from the challenges we experience as we go through life. I was in Glasgow last week. I always visit this city with somewhat mixed emotions; I haven’t been there very often recently. I grew up there and have very fond memories of visits to the Kelvin Hall at Christmas and to the Citizens Theatre where I remember a memorable Hamlet set in a mental hospital. However, I also remember when I was very young being frightened of a very drunk man slavering up against our car window. I also remember the sectarianism, which sadly continues to this day – bombs to Celtic supporters! – so that it wouldn’t be unusual for me, even at the age of 48, to be asked which school I went to. (St. Patrick’s it was – no hiding one’s religion and cultural background with that one.)  I can appreciate Glasgow’s incredible architecture and history and the great wit and culture of its people. However, we’re never just professionals or academics or just private individuals, nor are we ever only addicts; as individuals, we’re part of communities and as individuals and as communities we need to and can recover together from all the difficulties we encounter. I guess Glasgow makes me reflect and reframe; thus my ambivalence towards the place.

Following on from this, there seems to me to be a huge and continuing gap between how we frame the context within which drug and alcohol addictions and other social problems occur and the policy responses to it. The UK Employment Minister, Chris Grayling, was on the Today programme on Radio 4 this morning talking about the government’s plans to introduce a payment by results scheme for services delivered for people with drug and alcohol problems. Regardless of whether the government’s motivation is essentially ideological and about cost-cutting, it’s undoubtedly correct that there needs to be more emphasis on delivery of outcomes from treatment. However, recovery communities need to be trusted and supported to grow and they need to be engaged fully in a process to define what successful outcomes look like and to plan how people can be supported to achieve them. Within a new framework, clinicians need to be less arrogant and politicians less ideological and simplistic to recognise that addiction is a chronic long term health condition and that treatment can only ever contribute to delivering recovery, it can’t deliver it – individuals supported within and working as part of communities do that. Just as the law on its own can’t prevent drug problems – for example, drug use patterns in San Francisco and Amsterdam, with strikingly different legal arrangements, are remarkably similar, indicating perhaps the irrelevance of drug laws to people’s behaviours – neither can treatment on its own. And moreover, just as a treatment service which opts to work with complex drug or alcohol users rather than “cherry picking” more likely “successes”, should not be automatically deemed as failing, coming off drugs and alcohol on its own should not be deemed to be a success. Nor indeed should being employed. You can be employed and still be poor, unfulfilled, unloved and unappreciated, lonely and isolated.

I believe that there’s a very positive debate currently going on in the general public about how we re-build our communities and develop community solutions across all areas of our lives, rather than simply pathologising and blaming individuals for problems such as drug and alcohol misuse (or indeed unemployment) and penalising them. Wired In is one example of a network that is demonstrating the high aspirations of people in recovery, celebrating achievements and showing the way forward. But our politicians still have a long way to go to appreciate and embrace the full meaning of recovery, rather than just using the word as a rhetorical tool.

LGBT Pride and Prejudice

I greatly respect and usually agree with Evan Harris and I know that he has actively championed measures to make LGBT (lesbian, gay, bisexual and transgender) people less unequal.  However, I’m afraid that he (
http://www.guardian.co.uk/science/political-science/2011/jan/25/political-science-evan-harris-advisory-committees
)  and other “liberal” commentators are wrong when they take issue with the appointment of Hans-Christian Raabe to the Advisory Council on the Misuse of Drugs (ACMD) on the basis of his not being clinically qualified (which I find odd, as a practising GP he must bring useful perspectives), but don’t consider that his and his colleagues’ odious and highly unscientific views about LGBT people are relevant.

Evan and others are colluding with a position where it is acceptable to hold and express repellent views about the LGBT minority which they would find unacceptable, were they to be expressed about other groups, such as women (even at Sky, ask Andy Gray) or black people (ask any non-Daily Mail reader).

Previously, when discussing drug classification, the ACMD considered at length its role in giving out public signals, especially to young people, about harms of different drugs and usually concluded that it was important to take this into consideration. Well, with this appointment and many of the arguments being voiced about it LGBT young people and others are being sent a clear signal. Imagine, if you can, an argument being made that it didn’t matter whether a fellow committee member had linked black people with paedophiles, it’s the committee member’s professional experience that counts, anything else is irrelevant. It simply wouldn’t happen if suggested links with paedophilia had informed prejudiced public discourses about black people, as they have done for many years in relation to gay men.

Of course, Melanie Phillips has waded in to express her concern about the ‘demonised’ Christian community, echoing previously voiced concerns by Dr. Raabe himself (
http://www.dailymail.co.uk/debate/article-1349951/Gayness-mandatory-schools-Gay-victims-prejudice-new-McCarthyites.html
).  This woman has the uncanny ability to articulate the polar opposite of what I usually believe, despite her alleged concern about many of the same issues which worry me, issues that affect young people and communities, including drugs and alcohol, violence, bullying, anti-social behaviour, community engagement and responsibility.

Many of my family and friends would consider themselves to be Christians but they would hold no truck with the homophobic bigots who have colonised Christian public discourse. Melanie, however, trades on being extreme and controversial; it sells papers. But promotion of such views also damages people’s lives and leads to bullying and in still too many cases, depression, self harm and suicide.  However, though unacceptable, in a way it’s easier to deal with than the acceptance and normalisation by usually unprejudiced people of the bigoted positions of others.

I was in a seminar last week where someone was sounding off about what she perceived as the unacceptability of discussion of religion in social situations nowadays. Without any irony, she suggested that religion had become “The love that dare not speak its name”. I wish Oscar Wilde were here to respond to such rubbish. Every day LGBT people and women are treated to bigoted argumentations based on asserted religious beliefs about how we should conduct our lives and what rights we should or shouldn’t have.

And to get back to the ACMD, ideally, it should be a committee with the best representation of scientists, researchers and professionals for it to give good advice about drugs, with a public health focus. Dr Raabe has co-authored a vile paper that asserted:  

“Any attempts to legalise gay marriage should be aware of the link between homosexuality and paedophilia. While the majority of homosexuals are not involved in paedophilia, it is of grave concern that there is a disproportionately greater number of homosexuals among paedophiles and an overlap between the gay movement and the movement to  make paedophilia acceptable.”
http://www.catholiceducation.org/articles/homosexuality/ho0095.html

Being a member of the Advisory Council on the Misuse of Drugs is an important public office. It should not be acceptable to hold such an office and to express and publish offensive statements against LGBT people or any other minority group.

New Police Reform and Social Responsibility Bill

Like many others, I’m very worried about the proposals to remove the  requirement  in the Police Reform and Social Responsibility Bill for the ACMD members to include a doctor, a dentist, a vet, a pharmacist, a drugs industry expert and a scientist from another branch of chemistry.

The Coalition government may be taking a more honest position than that of the last Government, though that does not make it less mistaken or more damaging for any hopes that we might move towards sensible, evidence-based drug policy.

When I resigned from the ACMD over the Mephedrone debacle, it was because I felt that rather than giving balanced, research-based advice, the committee had bowed to inappropriate media and political pressure to make recommendations which were incomplete in themselves and based on inadequate research evidence or consideration of important issues, such as how the drug was being used and what the likely consequences of a ban would be. So my problems were with the Government in putting undue pressure on the ACMD and also with the ACMD itself for neglecting its statutory and moral responsibilities by bowing to that pressure.

Fast forward to the current situation: I think that there are at least two important issues here:
 
1. The ‘scientific’ advice – I think for the ACMD to function at all, this needs to be absolutely the best and the statutory positions are required for that. From what I can see, I think the ACMD members have been naive and mistaken in ceding this position.

2. In addition to this, I believe that the ACMD needs also to be advised by experts who know about education, prevention and harm reduction practice and research, about how people behave and how to influence that - therefore, educationalists, social scientists and practitioners with substantial experience are also required.
 
Rather than removing the no. 1 requirement, the ACMD would have been strengthened by adding new statutory requirements re no. 2.

As it is, the public perception now is that the scientific credibility of ACMD members is of no importance to political decision makers, and the latter are now not even trying to hide that fact. Moreover, there are even suggestions being circulated on the internet that the change  has been prompted not just because politicians want to avoid science-based deliberations on drug policy but also because scientists worth their salt might not wish to tarnish their reputations by joining the ACMD.

Resilience in young people: Feeling Good!

The Foyer Federation has just published my report based on focus groups and interviews with their young residents. This was a great and really enjoyable project. These really interesting young people who have had disruptions that I never had to negotiate at such an early age told me about how they could become and remain resilient, not just to survive but to overcome their problems and disadvantages and to do well and to contribute to society.  Good communication was vitally important for them to be able to assess their situations and to put realistic plans in place to manage them. This included countering the stigma and prejudice which they felt from other people. Despite their disadvantages, all of the young people I met described what made them feel good about themselves and hopeful about the future and gave suggestions about how the Foyers could support that. The lessons are transferrable to other settings. For me, it was really striking that after feeling safe and secure, the most important thing in helping them to do well was the informal communication they experienced with other people, “How are you?”, “Did you do what you were  telling me about last week?”, “Your hair looks nice today”, “Can I help?”.  Not difficult really. The report is available here:
http://www.foyer.net/pdf/Feeling_Good.pdf

The need for New Politics on Drugs

“Whatever the options on the table, whatever the decision to be made, the same questions must be asked: will it put more power in people’s hands? And will it equip Britain for long-term success?”

(David Cameron and Nick Clegg, UK Prime Minister and Deputy Prime Minister, 3^rd August 2010)

Apart from drug policy, everything seems to be up for discussion and possible revision by the UK’s new Coalition government. This includes a range of services for young people such as Connexions, bizarrely criticised by the Government for focusing too much on those with greatest needs, the “N.E.E.T.s”, young people who are not in employment, education or training at the expense of the needs of more ‘mainstream’ teenagers (BBC News, 4^th August 2010). It is difficult to see how maintaining the embedded approach by politicians to drug policy, ignoring the reality that it is failing a generation of young people, can be useful. In a rational world the argument proposed by Sebastian Saville in this week’s ‘Observer’ that we need to “move from dogma to science in the way we manage drug use” would hardly be regarded as radical, despite there being a range of opinions about what policy should eventually look like and how necessary changes might be introduced.

Following others, Sir Ian Gilmore, former President of the Royal College of Physicians, has this week made a useful contribution to the discussion, arguing that our current approach with its focus on criminalising people rather than dealing with drugs as a health issue has led to both increased crime and health problems. However, the Coalition’s knee-jerk response, saying they don’t agree, has once more highlighted politicians’ fears and insecurities about exploring new options in drug control policy. The media are negligent in their coverage also; for example, the BBC this morning reported uncritically that “anti-drugs” campaigners criticised Sir Ian’s comments. Who are these “anti-drugs” people? What does “anti-drugs” mean? Is Sir Ian Gilmore “pro-drugs” then? In my own experience, earlier this year I was asked in a BBC interview whether I felt “vindicated” in resigning from the Advisory Council on the Misuse of Drugs because two young men in Scunthorpe who had died, reportedly with a connection to the use of Mephedrone which was then legal, had not in fact taken the drug. I thought it was an inappropriate question. How could one feel vindicated when two lives have been cut short and when two families and many friends are mourning? Whether legal (alcohol) or illegal drugs had caused this tragedy, two young people were failed and are tragically no longer with us.

I have to say that I find the hypocrisy of the UK Liberal Democrats on the drugs issue to be particularly astonishing. For example, consider the current Deputy Prime Minister’s comments in 2007:

 “The present debate on classification of drugs is nonsense, with politicians second guessing science and evidence…If you’re interested in reducing harm, you need to revisit the spectrum of drugs, both legal and illegal and categorise them according to the evidence.” 

(Nick Clegg, 2007)

Of course politicians can always find ways to explain their revisionism: For example:

“I did lots of things before I came into politics which I shouldn’t have done. We all did”.

(David Cameron, 2005)

Lucky for David Cameron that he was born into privilege. For his youthful experimentation, he was neither arrested, nor excluded from school, nor dragged into the circle of harms, including but not limited to addiction, that are made both more likely and more extreme for the most socially disadvantaged people in our communities. Where illegal drug use is concerned, as well as the majority of UK property crimes being related to people’s needs to ‘feed’ a drug habit, we have countless horrific examples such as the murders of three sex workers in Bradford this year and five in Ipswich in 2006 which were directly connected to their need to work the streets to raise the cash for heroin and crack.

But it seems to me that support to intervene early with evidence-based initiatives to prevent and reduce problematic drug use remains a low political priority. I have previously criticised the consensus reached by Labour, Conservatives and Liberal Democrats to abandon the last Government’s commitment to make drugs education compulsory in schools.  It’s not all that it is needed but it could be a vital component which would help improve the quality and range of drugs education provision in schools.  Young people themselves consistently ask for more and better drugs education, even where they have already begun experimenting with drugs. Although a new survey by the charity YouthNet found worrying levels of drug use among young people, for example, with one in four reporting cocaine use, they also found that young people are crying out for more reliable and readily available information about drugs.

More than anything, our political leaders need to be brave and properly open up the drugs policy discussion to all options. This will require finding more useful language: let’s dump “pro” and “anti” drugs, “prohibitionist” and “legaliser”. Everyone knows that establishing appropriate regulation of drug use has to be a part of any drug strategy. Criminal justice measures should be used to contribute to preventing and reducing health and social harms but the focus should be on drug use as primarily a public health issue. Transform’s ‘Blueprint’ report, www.tdpf.org.uk/Transform_Drugs_Blueprint.pdf, explores the potential for introducing a new, improved regulatory framework. I don’t agree with all the conclusions drawn but nor do I disagree with everything. Of course it includes assumptions, positions based on political beliefs and some inconsistencies and gaps, such as what to do with those, particularly young people who might choose not to go along with their suggested new regulatory framework. However, it is exceptionally useful in highlighting some new options that the new Coalition Government could at least put on the table. As Professor Gilmore put it this week,

“There are really strong arguments to look again.”

(Professor Ian Gilmore, August 2010)