Professor Julian BuchananInaugural Professorial Lecture

Thursday 21st May 2009Glyndwr University

“It’s their own fault for doing drugs”

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Personal Reflection: An unexpected journey

Shared journey Shared achievement Opportunities and support Widening access

Professor Julian BuchananInaugural Professorial Lecture

Thursday 21st May 2009Glyndwr University

“It’s their own fault for doing drugs”

Government warnings about drugs

HM Treasury (2001) £300 Million Boost For Communities Against Drugs, Press Release, 49/01 09 April 2001

‘evil of drugs’

‘fight against drugs’

‘crime it breeds’

‘blights communities’

‘destroys families and young lives’

‘get drug dealers off our kids’ backs and into prison’

‘Fuels crime’

‘Wont tolerate the menace of drugs’

‘causes misery’

‘costs lives’

UN Political Declaration

“Drugs destroy lives and communities, undermine sustainable human development and generate crime.

Drugs affect all sectors of society in all countries; in particular, drug abuse affects the freedom and development of young people, the world’s most valuable asset.

Drugs are a grave threat to the health and well-being of all mankind”.

UN Declaration http://www.un.org/ga/20special/poldecla.htm

Issue 22/97 14 October 1997 STATISTICS OF DRUG ADDICTS NOTIFIED TO THE HOME OFFICE, UNITED KINGDOM, 1996 by John Martin Corkery

Drug Use Today

Almost 11.5 million people in England and Wales between ages 16 to 59 have used illicit drugs at some point in their life.

Just under 3 million people are estimated to have used illicit drugs in the past year

Around 1.7 million have used illicit drugs in the past month

Hoare, J. & Flatley, J. (2008) Drug Misuse Declared: Findings from the 2007/08 British Crime Survey, HMSO, London, p.7

Hoare, J. & Flatley, J. (2008) Drug Misuse Declared: Findings from the 2007/08 British Crime Survey, HMSO, London, p.34

Hoare, J. & Flatley, J. (2008) Drug Misuse Declared: Findings from the 2007/08 British Crime Survey, HMSO, London,

CAFFEINE

"We have seen several well-marked cases of coffee excess.... The sufferer is tremulous, and looses his self-command; he is subject to fits of agitation and depression; he looses colour and has a haggard appearance. The appetite falls off, and symptoms of gastric catarrh may be manifested. The heart also suffers; it palpitates, or it intermits. As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery'.

Sir T.C. Allbutt and H.D. Rolleston A system of medicine 1909.

Drug A

This is a physically and psychologically addictive drug. Withdrawal of from this drug is said to be worse than any other drug. Common withdrawal symptoms include: insomnia, nightmares, depression, anxiety, panic attacks, agoraphobia, excitability, jumpiness, restlessness, poor memory and concentration, dizziness, light-headedness, weakness, “jelly legs”, tremor, muscle pain, stiffness in limbs, back, neck, jaw, head, sweating, night sweats and palpitations! These withdrawal symptoms can continue for months. Some suggest withdrawal may take one month for every year of drug taking. So someone with an 8 year habit could suffer withdrawal symptoms for 8 months.

Benzodiaze

pines

Drug B

Once hooked users find it very hard to stop. Every day they wake up they feel like they must get hold of the drug. If they don’t get hold or use this drug at some point in the day they often become irritable, preoccupied and moody. This drug is believed to kill more people than any other drug. Tobac

co

Drug C

This depressant drug can affect mood and behaviour negatively. It is physically addictive and withdrawal is particularly unpleasant – in some of the worst cases drug users suffer epileptic seizures and hallucinations when withdrawing (turkeying). This drug is strongly linked to aggression and violence. Alc

ohol

Drug D

This stimulant drug is psychologically addictive. These drug users feel that they can’t face life unless they have their fix. Most of these drug users have to take the drug at least once a day. If they can’t get hold of their drug these users become edgy, irritable and restless. Heavy users suffer palpitations, dizziness, headaches, migraine and insomnia. Caf

fein

e

Drug E

This drug is taken because of perceived health benefits but research indicates this drug can cause internal bleeding, serious stomach and intestinal problems resulting in ulcers and gastric bleeding.

Aspiri

n

Drug F

These drug users tend to have to take their drug at least every day. Although the drug can be taken in different ways – a popular way involves equipment. These drug users sadly have a habit of discarding their ‘works’ (this is a drug using term for equipment used to take a drug). This is not only unpleasant for the public and risks causing serious harm to non users – it can be life threatening to others. Every year a number of innocent people are killed.

Tobacco

Reductionist Framework

Users

of

Legal

Drugs

UsersofIllegalDrugs

DIV

IDE

Now

Cla

ssifi

ed C

Re-

Cla

ssifi

ed B

Adapted from ‘Development of a rational scale to assess the harm of drugs of potential misuse’ by David Nutt, Leslie A King, William Saulsbury, Colin Blakemore, Lancet 2007; 369: pp. 1047–53

A more rational framework?

Low risk High risk

We are all drug usersWe are all drug users

Alcohol user A Alcohol user B

Cocaine user

Cannabis user A Cannabis user B

Tobacco user

LSD user

7 additional risks exacerbated by tough enforcementHas no idea of the strength of the drug - it could be so

strong it could result in risk of overdose or death.

Has no guarantee about the purity or indeed content of the drug - it could contaminated or even mixed with toxic ingredients that could cause serious harm even death.

Has to buy the drug ‘underground’ - exposing the person to the vagaries of a potentially dangerous criminal underworld.

Buying, using and sharing illegal drugs puts the person at risk of serious criminal sanctions such as a community sentence with a drug rehabilitation requirement or even imprisonment.

7 additional risks exacerbated by tough enforcement (cont.)

A person using an illegal drug risks acquiring a criminal record for a drugs offence - which could have lifelong consequences upon employment prospects, opportunities for world travel and housing.

Has to use the drug in secret. For some people this may mean using in an isolated location which could be potentially dangerous especially when intoxicated - such as a condemned building, under a railway bridge, a canal etc.

Has to hide the use of illegal drugs making it more difficult to manage and harder to seek help, support or advice if a problem arises.

Bifurcation Process

Buchanan J (2009) Understanding and misunderstanding problem drug use: working together, in R Carnwell & J Buchanan (eds) Effective Practice in Health, Social Care & Criminal Justice: A partnership approach, Open University Press, Maidenhead.

Tougher Approaches

Drugs Act 2005 enables:

• drug test suspected drug offenders on arrest, rather than on charge

• suspected to have swallowed an illegal substance remand in police custody upto 192 hours.

• If that person refuses without good cause, to consent to an intimate body search, x-ray or ultrasound scan the Act allows the court or jury to draw an adverse inference.

• Can be placed on new ASBO equivalent to get drug treatment

Tougher Approaches: welfare and work

Focus on Problem Drug Users

Drug use

PDU

expanding prison population

Scotland’s only all-female prison, 94% of the women on admission tested positive for illicit drugsHMIPS, HM Inspectorate of Prisons for Scotland. (2001). Report on HMP and YOI: Cornton Vale, Edinburgh

0

10,000

20,00030,000

40,000

50,000

60,000

70,000

80,000

90,000

1985 2007UK Prison

Prison (per 100,000 pop.) Total Prison Population Possess/Supply Drugs

Latvia 288 6,548 9.2%

Estonia 259 3,467 9.6%

Lithuania 234 7,866 4.6%

Czech Republic 182 18,901 8.0%

Spain 160 73,787 27.4%

Luxembourg 155 745 42.1%

England & Wales 151 82,240 15.5%

Bulgaria 134 10,271 5.6%

Romania 123 26,350 3.3%

Portugal 102 10,830 27.3%

Netherlands 100 16,416 18.9%

France 96 59,655 13.6%

Malta 95 387 28.1%

Belgium 93 10,002 14.3%

Italy 92 55,057 29.4%

Germany 89 73,203 14.9%

Cyprus 83 671 27.5%

Ireland 81 3,653 14.4%

Sweden 74 6,770 23.0%

Slovenia 65 1,317 10.9%

Finland 64 3,370 15.2%

Denmark 63 3,448 23.9%

Adapted from: Bewley-Taylor, D., Hallam, C., Allen, R. (2009) The Incarceration Of Drug Offenders

Prison (per 100,000 pop.) Total Prison Population Possess/Supply Drugs

USA 756 2,293,000 19.5% state 53% federal

Latvia 288 6,548 9.2%

Estonia 259 3,467 9.6%

Lithuania 234 7,866 4.6%

Czech Republic 182 18,901 8.0%

Spain 160 73,787 27.4%

Luxembourg 155 745 42.1%

England & Wales 151 82,240 15.5%

Bulgaria 134 10,271 5.6%

Romania 123 26,350 3.3%

Portugal 102 10,830 27.3%

Netherlands 100 16,416 18.9%

France 96 59,655 13.6%

Malta 95 387 28.1%

Belgium 93 10,002 14.3%

Italy 92 55,057 29.4%

Germany 89 73,203 14.9%

Cyprus 83 671 27.5%

Ireland 81 3,653 14.4%

Sweden 74 6,770 23.0%

Slovenia 65 1,317 10.9%

Finland 64 3,370 15.2%

Denmark 63 3,448 23.9%

Adapted from: Bewley-Taylor, D., Hallam, C., Allen, R. (2009) The Incarceration Of Drug Offenders

The disproportionately impact

“US drug policies … have a disproportionate impact on minority groups. … if white males were incarcerated at an equivalent rate as their black counterparts, there would be over 6 million people in America’s prisons and jails.”

Dave Bewley-Taylor, Chris Hallam, Rob Allen (2009), The Incarceration of Drug Offenders, Report Sixteen, The Beckley Foundation, Drug Policy Programme p.13

‘Hardening’ of cultural norms

‘Drug misuse can ruin individual lives, tear open families and blight whole communities with the menace of dealers and crime driven by drug abuse… more drug dealers – people who profit in the misery of others – behind bars… more addicts into treatment…further powers for police to drug test suspected addicts on arrest… vicious circle of drugs and crime …dealers will face harsher sentences where they prey on children …Drugs are a scourge on the world,

Caroline Flint, Home Office Minister quoted in drink and drugs news 10 January 2005 p.7

Smoking was once an approved and promoted cultural norm

Smoking is no longer an approved cultural norm

Smoking is stigmatised

People who smoke are marginalised

Some may receive ridicule, harsh treatment - even hostility

Pendulum of opinion

Focus on Problem Drug Users

Drug use

PDU

The Dominant Framework

Physical

TacklingProblem

DrugUse

Psychological

Legal

Adding a social component

ProblemDrugUse

Legal

Health

Psychological

education employment social & life skills discrimination self esteem/confidence routines/habits lack of non drug using networks reintegrating in local community

Social

Problem drug users & disadvantage

The majority of problem drug users were over 26 years old and had been taking illegal drugs for over 7 years.

52% of the known problem drug users left school before reaching 16yrs

Buchanan J & Young L (2000) The War on Drugs the War on Drug Users Drugs: education, prevention and policy, Vol. 7, No. 4

Problem drug users & disadvantage

Over half had been unemployed for the past 5 years - One in seven had never been able to secure a job

52% of the sample had no qualifications (academic or vocational)*

Only two people were currently in employment (out of 200).

*NB Each year only 6% of pupils leave school with no qualifications *NB Each year only 6% of pupils leave school with no qualifications http://www.dfes.gov.uk/performancetables/schools_01.shtmlhttp://www.dfes.gov.uk/performancetables/schools_01.shtml

Buchanan J & Young L (2000) The War on Drugs the War on Drug Users Drugs: education, prevention and policy, Vol. 7, No. 4

At–risk index of PDU

1. Contact with drugs

2. Lack of identification with the mainstream (through family, friends or peers)

3. Sense of alienation caused by unresolved bereavement or trauma

4. No suitable ally or pastime to provide emotional support and positive feedback

5. A blocked future educational, employment and relationship opportunities inhibited

Young R (2002) From War to Work Drug treatment, social inclusion and enterprise, The Foreign Policy Centre, p.45

Stigma and exclusion

‘They look down on me as scum of the earth and as someone not to be associated with’

`I feel the odd one out, I’ve nothing in common with them. I start to get paranoid’

`I used to avoid them like the plague. I used to be scared of what they might think’

`I feel nervous in case I slip up, I know they would look at me in disgust’

Buchanan, J. (2006) Understanding Problematic Drug Use: A Medical Matter or a Social Issue, British Journal of Community Justice – Volume 4, Issue 2 pp. 387–397

Mixing with Non Drug Users

‘I feel a bit beneath them, they make you feel like that’

‘I’ve got to watch what I say so I don’t land myself in it. They blame smack heads for everything.’

‘I feel labelled … like they thought I was dirt’

‘They look down on me as the scum of the earth and as someone not be associated with’

How do other people see you?

‘They see me as a drug addict, a smackhead and they think I’ll rob them’

‘Some people don’t want to talk cos of being on gear they just think ‘smackhead’. They don’t realise just how hard it is to get off’

`I feel nervous in case I slip up, I know they would look at me in disgust’

`I never really mixed with people who have never taken drugs’

Internalising prejudice

‘Discrimination has led many problem drug users to internalize and blame themselves for their position. This loss of confidence and self-esteem is a serious debilitating factor. They feel themselves to be labelled, discarded and isolated from mainstream society.’

Buchanan J & Young L (2000) The War on Drugs the War on Drug UsersDrugs: education, prevention and policy, Vol. 7, No. 4

PDU & social exclusion links

73% drug users Average age 28yrs 47% didn’t complete educ. 59% no qualifications 0% had A level + 51% unemployed 11% unable to work

Survey of 1884 males in 2000 who had recently been sent to prison. (Liriano & Ramsay 2003 HORS 267)

Average age 32yrs 54% excluded from school 20% been in care 64% had been in prison age first time use 16yrs age drug problem 21yrs

Jones S, Drainey S, Walker L & Rooney J (2004) Collecting the Evidence: Clients views on drug services, Addaction N=550

73% drug users 60% unemployed prior to custody 54% didn’t complete educ 32% been in care

Survey of 529 male prisoners in 2000 (Bullock T 2003 HORS 267)

Arrestees who used crack and heroin

50% said they had left school before they were 16

58% said they had been temporarily excluded

36% permanently excluded from school

only 1 in 10 were in employment (compared with almost half of other arrestees);

29% had been in local authority care at some time

almost a quarter had slept rough in the past month

Reducing Drug Use, Reducing Re-offending March 2008 The UK Drug Policy Commission (UKDPC) pp20-21

The Barrier of Exclusion

‘it is evident that the anti-drug campaigns over the past 20 years have added to the isolation and marginalization of the discarded working-class youth …. In addition to having to overcome their addiction, one of the biggest hurdles they have to face is breaking through the barrier of social exclusion.

JULIAN BUCHANAN & LEE YOUNGThe War on Drugs -a war on drug users?Drugs: education, prevention and policy, Vol. 7, No. 4, 2000

Coping Without Drugs

‘When considering treatment and rehabilitation it must be recognised that many problem drug users have had such limited options in life, that they lack personal resources (confidence, social skills and life skills) and have limited positive life experiences to lean upon or return to. This client group need social integration not social reintegration, they need habilitation not re-habilitation – it seems that many have never really been able to get started in life in the first place. This makes living without drugs a very tough option indeed.’

Buchanan, J. (2004)‘Missing links? Problem drug use and social exclusion’

Probation Journal, Special Issue: Rethinking Drugs & Crime, Vol 51(4): 421–431

The struggle for reintegration

Adapted from Buchanan J (2004) Tackling Problem Drug Use: A New Conceptual Framework, pp117-138, in Social Work in Mental in Health, Vol. 2 No 2/3, Haworth press Free article download from http://epubs.newi.ac.uk/siru/1/

Barriers to Integration

‘Many socially excluded dependent drug users in the UK struggle to break out of a drug centred existence, - even when they become physically drug free and display an abundance of psychological insight and self-motivation. These drug users face a more difficult challenge of overcoming the many layers of discrimination and social exclusion’ (Buchanan 2004 p124).

Buchanan J (2004) Tackling Problem Drug Use: A New Conceptual Framework, pp117-138, in Social Work in Mental in Health, Vol. 2 No 2/3, Haworth Press

Summary ‘It’s their own fault for doing drugs’

1. We all take drugs and the legal ones are not particularly safe.

2. Making a drug illegal significantly increases the dangers posed by the drug.

3. The division between legal drugs and illegal is not rational

4. Criminalisation and tough enforcement upon selected drugs has created considerable additional problems.

5. The majority of the people who develop drug problems had significant difficulties before they began taking drugs and few legitimate options.

6. The war on drugs and the associated discrimination and exclusion can be a bigger hurdle than the drugs.

7. A move away from a drug centred lifestyle and reintegration with mainstream society poses an enormous challenge.

8. Approaches to drugs have been dominated by the physiological and psychological aspects of problem drug use - these people need major personal, social and practical support

Thank you for your time

If you want more information please email me:

Email now:

julian.buchanan@vuw.ac.nz

…time for a drink in the Foyer?