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Waythrough launches ten-year strategy

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A new ten-year programme has been launched by Waythrough. Backed by at least £10m, The way ahead has a goal of ‘saving a million lives, and enhancing a million more’, the charity states.

Paul Townsley: ‘We have the collective political will and community support to achieve generational change’
Paul Townsley: ‘We have the collective political will and community support to achieve generational change’

Waythrough, which supports more than 130,000 people across 260 services annually, will focus on breaking down the barriers that stop people from accessing the help they need, it says, with the aim of transforming how support is ‘designed, delivered and connected’ for people experiencing substance use and mental health issues.

At its centre will be a ‘commitment to tackle fragmentation across health, care and community systems’, it says – to stop people being passed between services. The strategy has been informed by the voices of people supported by the organisation, including members of its Life Experience Council who set the strategic questions that the strategy has responded to.

‘The people we serve believe we can do more to break down the barriers they experience when they need us most, and so do I,’ said CEO Paul Townsley. ‘During the 30 years I have worked in this sector across our diverse communities, I have seen the significant issues people face getting the quality, wraparound services they deserve for drug, alcohol and mental health issues.

The time for action is now – people’s lives should not be at risk because of system failures. We’re under no illusion about what’s required to achieve our goal of saving a million lives and enhancing a million more. But we believe we have the collective political will and community support to achieve generational change.

We want to develop new service models with our partners, commissioners and the people we support. To do this, Waythrough will provide sustained investment to make those connected pathways a reality by 2036.’

The way ahead is available here

More than a million people addicted to alcohol or drugs, estimates Forward

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An estimated 750,000 people in the UK are addicted to alcohol while 400,000 are addicted to illegal drugs, according to a new report from the Forward Trust and Crest Advisory. Meanwhile, around 700,000 people are currently in recovery, the document states.

Mike Trace: ‘We need all our public health services to become addiction-recovery champions’

The report is a systematic review of mostly publicly available evidence combined with insights from delivering Forward Trust’s services. While there is ‘no precise data’ on the true scale of drug and alcohol problems in the UK, the ‘picture created’ from the existing data shows that the problem is widespread and worsening, it says.

Chronic ketamine use is a rapidly growing area of harm, the document highlights, with treatment presentations 12 times higher than a decade ago. Nitazenes, meanwhile, are helping to drive the worsening drug death figures, which hit their highest ever level in 2024.

The report calls for reliable funding for treatment and recovery services to be fully maintained across the country, along with better provision of services for people struggling with alcohol and non-opiate drugs – both of which are ‘significantly under-resourced despite growing demand’. Funding should be targeted on those programmes and interventions demonstrated to have the greatest impact, it says, while more also needs to be done to tackle the stigma that deters people from seeking help in the first place.

The government should also strengthen strategies to reduce the impact of addiction on crime and anti-social behaviour, it adds: ‘The mechanisms for identifying, motivating and treating addicted people in the criminal justice system have been hollowed out over the past 15 years, but can be quickly rebuilt with the right political and institutional commitment.’

‘With change happening at the heart of government, we need a rethink and reboot when it comes to the UK’s approach to addiction,’ said Forward Trust CEO Mike Trace. ‘As our report highlights, addiction is a significant contributor to family and community disruption, as well as a driver of crime and health inequalities. Labour has yet to produce a comprehensive plan to tackle drug or alcohol addiction, and I call on the new prime minister to make this a priority. Addressing these problems is going to require the courage to think and act differently. We need to be proactive in removing the conditions that give rise to addiction. We need to be making it much easier for people to talk about addiction problems. And we need all our public health services to become addiction-recovery champions, pooling their knowledge and skills to treat the whole person in their journey towards recovery.’

Meanwhile, new risk assessments to identify people in financial difficulties are to be introduced in stages by the Gambling Commission. The first stage will see assessments carried out by the largest operators where there is high spend of ‘multiple thousands’ of pounds over a 24-hour period – ‘for most, this means £5,000 net deposit in a rolling 24-hour period’. The assessments will be based on credit agency information, with lower thresholds applying to under-25s.

‘There is evidence that some high-spending gambling customers are experiencing current financial difficulties but are not being identified or supported by gambling businesses,’ the commission states ‘Without being identified, they may continue to receive marketing and promotional offers encouraging further gambling despite being financially vulnerable.’

Addiction in the UK available here

Boredom fuelling prison demand for drugs, says chief inspector

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‘Woeful’ levels of activity and long lock-up times are causing ‘frustration, boredom and despair’ and fuelling the huge demand for drugs in the prison estate, says chief inspector of prisons Charlie Taylor in his final annual report.

Many prisoners were spending 22 hours or more locked in their cells each day

The widespread ingress of drugs remains a ‘grave threat’ to stability in prisons, the report says, with increasingly high rates of violence and self-harm. ‘Far too little’ was being done to reduce demand, he said, or to provide any meaningful incentives for prisoners to change their behaviour. Many were spending 22 hours or more locked in their cells each day.

Organised crime gangs were able to act with impunity, the document continues, with ongoing security failings such as damaged windows and broken CCTV, and drones able to deliver drugs and other contraband to order. With a ‘few exceptions’, drug recovery wings were also ‘ineffective or overrun by drugs’ and inexperienced staff were frequently ‘manipulated or simply ignored by prisoners’ it adds.

Too many people were also being released to no settled address, while around 20 per cent of prisoners were now being held on remand – with not enough done to support this vulnerable population. ‘This is a threat that needs to be taken seriously at the highest levels of government,’ the report states. ‘Only when drugs are kept out, and prisoners are involved in genuinely purposeful activity that will help them to get work and resettle successfully on release, can we expect to see prisons rehabilitate rather than just contain the men and women they hold.’

The government launched its Independent prison review last week, with a remit to look at the challenges of drugs, drones and other serious security threats. The Prison Officers’ Association, however, commented that there had been ‘dozens of so-called independent reports dating back 30 years and more’ and little done to ‘make things better’.

A lack of regular, purposeful activity had been a key factor in the ‘concerning rise in drug use and violence, as well as continued high rates of self-harm’, said Taylor. ‘At a cost of £59,000 a year for each prison place the taxpayer has the right to expect more for their money. In the best jails prisoners live in an environment with clear rules, where they are incentivised to behave. We know that if they are supported to get work on release, recover from drug addiction and maintain meaningful relationships, it is possible to reduce their likelihood of reoffending and, crucially, create fewer victims of crime.’

Report available here

Only 6 per cent of adults would rely on AI for alcohol advice

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People are still far more likely to turn to another person with concerns about their drinking than to AI, according to research by Alcohol Change UK.

‘Despite living in a world increasingly influenced by artificial intelligence’ just 6 per cent of UK adults would turn to an AI platform with questions or concerns about their alcohol use, the charity states. In a survey commissioned to mark Alcohol Awareness Week, more than 40 per cent of respondents said they would first turn to either a healthcare professional or a friend, family member or partner.

Ten per cent of respondents said they ‘would not turn anywhere’ if they had concerns about their drinking,

Ten per cent, however, said they ‘would not turn anywhere’ if they had concerns about their drinking, while 20 per cent of respondents were non-drinkers. People were also more than twice as likely to rely on traditional search engines for advice than an AI platform.

A recent report from the Alcohol Health Alliance and Alcohol Focus Scotland found that one in five alcohol products sold in the UK failed to meet the voluntary labelling guidelines, with unit information and health warnings either ‘inconsistent’ or ‘wholly absent’. Although alcohol-specific deaths registered in 2024 were 6 per cent down on the previous year’s record high of almost 10,500, the death rate remains higher than pre-pandemic levels.

The theme of this year’s Alcohol Awareness Week, which runs until 12 July, is ‘Alcohol and me’, which invites people to consider the role alcohol plays in their life – and the impact it might be having on their health, relationships and wellbeing. ‘Because alcohol is so normalised, particularly during summer, holidays and major sporting events, it can be easy to overlook the impact it is having,’ says Alcohol Change UK.

‘It’s encouraging that many of us would feel comfortable turning to a healthcare professional, friend or family member about our drinking habits,’ said Alcohol Change UK CEO Dr Richard Piper. ‘Yet, what is striking is that one in ten wouldn’t turn anywhere at all, even if they had questions or concerns about alcohol. We’re determined to change that. Millions of us find our alcohol consumption creeping up over time, but often we don’t pause to think about the impacts it’s having on our health and quality of life and the changes we could make. It’s clear that people seek information and advice in lots of different ways, but what’s important is that they have access to accurate, evidence-based information and inspirational stories that they can identify with.’

More information on Alcohol Awareness Week here

Number of daily vapers overtakes daily smokers for first time

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The proportion of UK adults who use vapes on a daily basis has increased from 4.5 per cent to 7.8 per cent since 2020, according to new data from ASH, with the proportion of daily smokers falling from 9.7 per cent to 6.6 per cent over the same period.

Hazel Cheeseman: ‘The task now is to get the balance right’

While the number of adults who used vapes ‘daily or occasionally’ overtook the number of smokers in 2024, this is the first time that daily vaping has overtaken daily smoking – representing a ‘momentous shift’, the charity states. The data comes from an ASH-commissioned YouGov survey of more than 13,000 people.

Although around 3.3m ex-smokers have now used vapes to quit, more than a million 11-17-year-olds have also tried vaping, highlighting ‘both the success of vaping as a quit aid and the urgent need to reduce youth uptake’ says ASH. The government should ‘proceed swiftly’ to regulate the promotion of vapes to children via the recently introduced Tobacco and Vapes Act, but should also make sure that regulation is proportionate and does not deter adults from using vapes as a quitting tool, it adds. Three quarters of young people report seeing vaping promotion, whether in shops or on social media platforms like TikTok and Instagram.

Around 60 per cent of vapers are ex-smokers, while 32 per cent use both tobacco and vapes, and 8 per cent have never smoked. Almost a third of ex-smokers who used vapes to stop smoking in the last five years have also reported giving up vaping, demonstrating that vaping ‘is not a permanent replacement’ for smoking for the majority of those using it to quit. A separate study by ASH, Ending smoking inequality, estimates that smoking is still pushing an estimated 417,000 UK households below the poverty line.

‘This data shows both the promise and the challenge of vaping,’ said ASH chief executive Hazel Cheeseman. ‘Millions of adults have used vapes to quit smoking, with an estimated 3.3m ex-smokers now vaping instead of smoking and many going on to stop vaping altogether. That is a major public health success which should not be undermined. At the same time, it remains unacceptable that so many children are experimenting with vapes. The fact that around 1.1m under-18s have tried vaping shows why the government must act quickly to restrict the promotion and marketing of these products to young people. The task now is to get the balance right: make vaping less visible and less appealing to children while ensuring it remains an effective and accessible quitting aid for adults who smoke.’

You’ve got to make that first step

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‘You’ve got to make that first step’: Man who was hospitalised because of alcohol shares his recovery story this Alcohol Awareness Week

This Alcohol Awareness Week (6 – 12 July), Craig is sharing his story of going from drinking 12 litres of cider a day to working as a group lead and allotment volunteer for the charity that helped him.

As the national campaign encourages open conversations about alcohol, Craig – who committed himself to recovery three years ago on 15 July – wants to make sure anyone who needs help knows it’s available at WithYou in North Lincolnshire.

Reflecting on his journey, Craig says, ‘You can have day one of being sober a hundred times but it’s getting to day two that’s the biggest thing. It doesn’t matter how many times day one happens; just keep trying as you will get there in the end.’

After losing his mum to cancer at just 12, Craig didn’t have anyone but a group of older boys who took him under their wing. He started going out and drinking regularly. By the time he was 20, he was struggling with a problem with alcohol.

‘It was just normal to me,’ he explains. ‘At worst, I was drinking eight to 12 litres of cheap white cider a day. I was drinking 24/7. I drank for years. I was married with four kids but my relationship was not great due to my drinking.’

He tried to get help but nothing stuck until at 41 he reached a crisis point. After being taken to hospital in an ambulance and spending ten days detoxing, Craig says simply, ‘I thought about everything. I chose recovery. That was three years ago on 15 July.’

With the support of WithYou in North Lincolnshire, Craig has now been sober for three years. ‘It’s the best thing I ever did,’ he reflects. ‘Now I support people in the groups. I’m a group lead and work on the allotment.’

withyou recovery allotment
‘Now I support people in the groups. I’m a group lead and work on the allotment.’

‘I love it here,’ he smiles. ‘I think it stems from my gran’s garden. I loved being outdoors, and believe it’s a connection with nature. We get a lot of people coming up here. They can just sit and chat, maybe pull up a few weeds or plant something – and watch it grow, as you grow.’

Last month, Craig won an award for volunteering with WithYou. Thinking about how far he’s come, he says, ‘I’m proud, finally. Many people think that walking through that door is the hardest thing you’ll ever do – I always say it’s not, it’s coming back. You’ve got to make that first step. It’s a hard choice, but it’s the right choice.

He looks around at the group of volunteers in the allotment. ‘You can see here that it can work. If you are experiencing challenges with alcohol, we are with you.’ Get in touch with WithYou in North Lincolnshire via the website – or by calling 01724 857 633.

You can also talk to trained recovery workers for free via WithYou’s webchat

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of WithYou

Government launches independent prison review

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An independent review to assess the long-term challenges facing prisons and recommend improvements to their effectiveness has been announced by the Ministry of Justice (MoJ).

The review will be led by former Conservative home secretary Amber Rudd and consider ‘a broad range’ of challenges including drugs, drones and other security risks, as well as issues like overcrowding, violence, self-harm and the physical condition of the prison estate. It will also look at international examples of good practice.

The review will consider ‘a broad range’ of challenges including drugs, drones and other security risks, as well as issues like overcrowding, violence and self-harm

The aim is to identify ‘practical and deliverable’ options for reform and build a ‘robust evidence base’ to support future investment and decision-making. The review is expected to report by the end of the year.

‘The prison system faces ongoing and future challenges that are not widely understood, shaped by pressures across capacity, safety and decency, security and rehabilitation, as well as the age, condition and configuration of the prison estate,’ MoJ states. ‘While recent investment and action have mitigated some pressures, the underlying risks remain structural and long-term in nature.’

Last year saw the publication of the Independent review of prison capacity by former chief inspector of prisons Dame Anne Owers – which said that overcrowding had brought the system close to collapse on three separate occasions – as well as former justice secretary David Gauke’s Independent sentencing review, which recommended a move away from short sentences to community-based punishments.

Other recent damning reports have included HM Inspectorate of Prisons warning that drugs were undermining ‘every aspect of prison life’, the National Audit Office saying that the prison service had been ‘far too slow’ in responding to the serious and ‘rapidly changing’ threat posed by prison drug markets, and a report last month from the Independent Monitoring Boards which stated that drugs were now ‘single most destabilising factor’ across the whole prison estate.

Pia Sinha: an opportunity to ‘move beyond managing crisis’

The new review would be an opportunity to ‘move beyond managing crisis andtowards building a prison system that is humane, effective and capable of reducing reoffending’, said Prison Reform Trust chief executive Pia Sinha. However, the Prison Officers Association (POA) commented that ‘there have been dozens of so-called independent reports dating back 30 years and more into prisons’ – yet after each report governments did ‘little to make things better’. There was ‘little point doing prisons in isolation as different parts of the justice system are interconnected, such as policing, probation, the court system and the infrastructure around diverting offenders away from prison,’ said POA general secretary Steve Gillan. ‘The criminal justice system is broken from end to end. Our members are tired of warm words, ministerial visits and glossy reports. They want investment.’

Earlier this week the government also repealed the 1824 Vagrancy Act as part of its national plan to end homelessness, decriminalising rough sleeping and begging in a shift towards ‘prevention, support and long-term solutions’. The move was a ‘watershed moment which marks the end of a deeply cruel policy of criminalising people because they are homeless’, said chief executive of Crisis, Matt Downie.

Independent review of the prison system: terms of reference available here

Changing the outlook

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Whether they take place in the GP’s surgery, a prison healthcare wing, a hostel, or a drug service waiting room, the first crucial interactions can build trust and hope – or reinforce feelings of stigma, frustration and defeat.

As we discussed in the first part of our Clearer Conversations series (DDN, May, page 12), early interactions around medication can make or break the ‘therapeutic partnership’ at a very early stage. Clinical expertise is just one crucial part of the skill set; the other is rooted in effective communication.

People need to feel heard, respected and involved in decisions about their own care. We heard what a vital difference the right conversations make – and what goes wrong when people are under-informed, judged and excluded from decisions about their own health.

In this article we ask for insights from the Salvation Army, an organisation used to meeting people at many stages of addiction and homelessness – the stakes could not be higher in terms of having the right conversation.

Encouraging people to talk about their experiences highlighted some interesting junctions in the road – times when communication led to a breakthrough, or missed a vital opportunity.

First taste of support

David is a current service user on a programme designed to support those addressing their substance use, one of the Salvation Army’s many services.

He spent several years moving in and out of treatment and his story shows the difference that supportive conversations have made to his progress. 

After leaving prison he had spent time in rehab, but was asked to leave after he relapsed and began using heroin again. He acknowledges that staff did give him ‘quite a few chances to sort things out before they said I had to leave’.

He got in touch with a GP and was put straight back on a script – the option of buprenorphine this time, instead of just methadone – and was then referred to Bristol Drugs Project. The Junction Project was a turning point for him in terms of peer support and staff with lived experience: ‘The staff give you advice if you’re coming off too quickly or things like that… but it’s pretty much up to you. They let you have a say.’ There was also no time limit to come off the script.

Decisions about medication were made together and rather than being pressured to achieve abstinence or provide negative samples, the focus was on support and progress. He wasn’t scared to ask for help. 

He also now sees his shared care worker every two weeks – a prescriber based in the doctor’s surgery: ‘I go in for half an hour and we sit and chat, I tell him how things are going. And he asks if I need to go up or down or whatever, or am I happy with what I’m on.’

When asked what he’d tell someone who’s never been in treatment before, he’d say: ‘Just don’t be scared to ask for help… the support workers are there to support you, you know. The support isn’t perfect, but it’s there.’ He’s appreciated being able to go into the office whenever he needs to speak to somebody.

Now, not later

Danny, a specialist support worker on the programme, with lived experience himself, agrees that those early conversations are critical.

‘People are often at their lowest point when they come to us,’ he says. ‘If people are actively using, there’s no punishment; no taking away the script. Instead they work with the person and ask ‘what can we do to support you more? What wraparound service can we give you? What other agencies do we need to get involved to help you through this?’

His client group experiences particular stigma around homelessness, which he says makes him feel quite emotional: ‘I see service users struggle so much in reaching out to GPs and doctors, and it’s just so wrong. I have conversations with GPs and their attitude is just shocking at times. It shouldn’t be an uphill battle every time our client wants to see a GP or engage with the right services.’

One of the biggest improvements he’s seen is rapid access to prescribing and same-day restarts. ‘So it’s great to be able to say, come on, let’s go and get your script sorted today. It gives them a bit of reassurance.’

But he also sees how quickly motivation can disappear when they don’t get the structure or support to address their use, or when there’s a long wait to get it. ‘The intervention is needed now, rather than later,’ he says.

He mentions a client who’s going into detox on Monday after waiting three months. He’s been seeing a clinical worker weekly to have bloods taken, plus tests and an alcohol diary to assess drinking levels – all needed by the facility to see how long the detox period needs to be. So keeping the client engaged is absolutely essential: ‘This is the first time he’s set foot into any sort of treatment at all. So it’s huge for him… his life is dependent on it because he doesn’t see any other way out of his alcohol dependency.’ 

‘Dragging people to these appointments’ can be made slightly easier when the services involved are proactive about the relationship, keeping the support worker updated about care plans. ‘I’m really fortunate because we have Horizons, a team that work at the hostels, and I’ve got a really good relationship with them,’ he says. ‘But it does feel like we have to go out of our way to get a foot in the door, to get to be known. I think services can be better about just coming in and introducing themselves.’

He’s grateful for the computer system that’s made things easier: ‘I can log on and see anyone’s treatment plan and what they’re doing, where they’re at, when their script needs renewing, and if they’ve been collecting their script on a daily basis… It’s a real holistic approach whereby everyone can see everyone’s involvement.’

Collaboration leads to change

For Craig, a service user on a similar programme in Cardiff, entering treatment while in prison felt very different from his experience in the community.

Wanting help, he disclosed his use and asked for support, only to be told he needed to provide three positive urine tests before he could access medication. ‘I said, so what’s the point of me telling you that I’ve got a fucking problem?’ he remembers. ‘You’ve just had a positive off me, isn’t that enough?’

The process took a month, during which he had to continue sourcing drugs inside prison. He remembers feeling that there were few conversations about alternatives and little discussion about different treatment options: ‘They just said methadone. They didn’t really say anything else. I don’t think there were any options.’

Yet his experience began to change once he entered community treatment – but only when he had a supportive keyworker and the conversations became more collaborative. When he wanted to slow his methadone reduction, she listened: ‘I said I was really clammy at night and asked if I could stay on the same dose for another couple of weeks. She was like, yes, all right, don’t worry.’

He’s now preparing to transition to long-acting buprenorphine and feels much more involved in his treatment. ‘Support is there if you want it,’ he says. ‘They can only offer so much and then it’s down to you to take it.’

For people seeking help, these conversations may determine whether they engage, walk away, or try again another day. For treatment providers, they are a reminder that while clinical guidance matters, the human side of treatment matters too. And very often it’s that first conversation – and the willingness to keep having it – that can make all the difference.  DDN

‘A good support worker can change the game.’

Zoe Jenkins is addiction development officer in homelessness services at The Salvation Army. She gives us her perspective.

For people accessing drug and alcohol treatment and support, there are huge disparities across the board. The process can be long-drawn-out with many hurdles to face, and sometimes people are waiting weeks, if not months, before they’re in receipt of a script. Keeping motivation up and keeping someone engaged for that time can be really hard work for everyone involved. 

Criminal justice services tend to offer a more rapid access prescribing pathway and some localities offer quicker routes for people with complex needs, but even then it can be weeks. 

I understand clinical policies need to be followed, but the timescales are a big hurdle. It’s like going to the gym for the first time and being turned away because you’ve got to wait till next month to have a gym induction or you’ve not got the right shoes – you’re probably not going to go again because your motivation has been affected or you feel really let down, so you have a McDonald’s instead.  

You may have to provide several positive urine tests, attend appointments, meet several nurses and doctors and be told to come here or go there. For someone in active addiction, timekeeping can be really difficult and constantly meeting new faces is too daunting. Unless they’ve got a support worker to encourage them and really orchestrate that, some people never get off the starting block.

Some people have fantastic relation­ships with their workers at drug and alcohol support services. But many don’t even know their workers or may have only met them for a real light touch – ‘How are you? Everything ok? Cool, see you next month.’ It’s not always, but this does seem to be the majority. I suppose it depends on the person and how much they want to engage, but I also think it’s down to the relationship and how much a worker remains flexible and resilient to poor engagement.

The multiagency approach differs from service to service, and staying informed as a support worker really does depend on where you are. Some service providers will share appointment times with you, follow up with calls and emails and check in with allocated workers regularly, which works really well. Others don’t, and ultimately the service user ends up missing out on vital support. 

Some people don’t know what day of the week it is because their addiction is so encompassing, so having a support worker who keeps tabs on you and takes you to and from appointments changes the game. It helps eliminate those barriers. I’ve known of people being removed from waiting lists or taken off their OST after missing an appointment they were told about four or five weeks ago. Had their support worker known, this may not have happened. 

For some people, thinking outside of the box and offering flexible working arrangements is what’s needed, especially when someone first reaches out. 

Grateful thanks to Zoe Jenkins, colleagues and clients at The Salvation Army

This series on Clearer Conversations on OST has been made possible by a grant from Camurus, who have had no involvement in the content of these articles.

Clearer Conversations is an ongoing series and we would love to hear from you if you are willing to share your experiences of treatment – please email the editor, claire@cjwellings.com

A country mile

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Almost 60 per cent of the people in Shropshire live in rural areas. From the Welsh border in the west to the outskirts of the Black Country in the east, the majority live miles from their nearest town and its services, shops, and supermarkets.

The county is also under serious financial pressure, with recent analysis showing that government funding per head is not only less than the rural county average but forecast to drop to 29 per cent below the national average by 2028-29.  

Since 2016, WithYou has been delivering the Shropshire Recovery Partnership – staffed by people from the area who are passionate about delivering for their local communities. However, we face unique challenges deliver­ing drug and alcohol support in such a rural county, where people may not have transport or live miles from their nearest service. 

‘I grew up in a metropolitan area so it wasn’t until I moved to Shropshire that I quickly learned about the reality of rural living,’ says the partnership’s treatment and recovery manager, Sophie Morgan. ‘Whilst we have such a vast, rural and idyllic landscape surrounding us, this can bring a disconnection.

For me to feel connected to my teams and the communities we serve in, I spend a lot of my time out in our rural offices and satellites. My rural commutes bring a deep sense of appreciation for how distant support can seem – that’s why it’s so important for us to reach out far and wide.’

Know your patch

Our hub-and-spoke model allows us to have our main bases in Shrewsbury, Oswestry and Ludlow, but also operate in harder-to-reach parts of the county. But this model only works by having people who really know their patch – the rurality of the place and the financial pressure means we’ve needed to come up with innovative ways to support people. 

‘A livestock market on a Tuesday morning isn’t a clinic, but the point of being there is that nobody has to make a decision to come and see us. We’re just there…’

‘Delivering a service in such a rural county doesn’t just mean it’s a smaller version of a service in a city – it’s a different model,’ says head of service delivery Janet Burrows. ‘It needs to be relationship-led, locally embedded and patient.

We’ve learnt that you can’t parachute in. The teams that work best here are the ones who know the patch, know the partners, and stay long enough to earn trust, which is vital when building therapeutic or partnership relationships. That has implications for how we recruit, how we retain, and how we resource the service.’ 

Understanding how to engage the people who need our service means having staff who know the way relationships work in small communities, what stigma looks like in a small town, and what people will and won’t say depending on where the conversation is happening. 

‘Even if someone can get to a service, they can be really worried about the stigma they might face,’ says Sophie. ‘Walking into a building for support can be really exposing in a community where everyone knows what everyone else is doing.

We’ve removed this barrier by working with partners to hold appointments in community buildings where other services are housed. We also work in hospitals, courts, probation and prisons which helps close loops that would otherwise lose people in the journey from one service to another.’

Wellbeing hubs

Recently we’ve partnered with the Shropshire Community Wellbeing Team, with our staff attending wellbeing hubs at livestock markets across the county. A livestock market on a Tuesday morning isn’t a clinic – farmers and other regulars come over for tea and a chat and sometimes that’s all it is.

Sometimes, once they’ve worked out who we are, it turns into something else, but the point of being there is that nobody has to make a decision to come and see us. We’re just there, alongside the other services, on a day people were going to be at the market anyway.

This kind of relationship build­ing can also be seen with our peer workers – staff with their own experiences of alcohol or drugs – who are central to how the part­nership operates. Recovery worker Henry Mackley first walked through the doors of our Ludlow branch early in 2023, as a client struggling after years of alcohol use. 

‘How I ended up in that building is now a bit of a blur,’ he says. ‘I can’t remember if I referred myself or came through my GP, but once inside I found that for the first time in my life I was amongst people who didn’t judge me, and allowed me to feel heard. Knocking on that door was one of the hardest things I’d ever done.

Reaching out for help and saying to a stranger “I can’t do this on my own” wasn’t easy. But it probably saved my life.’

Service administrator Beth Petersohn and recovery worker Ellie Milner. Since 2016, WithYou has been delivering the Shropshire Recovery Partnership – staffed by people from the area who are passionate about delivering for their local communities.

Nowhere to hide

Henry has spent most of his life in Ludlow, and says that it’s a ‘tight-knit community, where everyone seems to know everyone else – or at the very least they know someone who knows you. Communities like this can be incredibly supportive, but when you’re struggling with addiction they can also feel very exposing – there are few places to hide.

‘I know the pubs, as I’ve been kicked out of most of them at one point or another,’ he continues. ‘I know the people, I know how Ludlovians whisper and how their curtains twitch. But I also know how strong the recovery community is in places like this. I live it in my work life and in my personal life. Whilst I don’t wear recovery like a badge of honour, I don’t hide anything anymore. I attend AA in Ludlow, I run SMART recovery groups at work – we’ve got each other’s phone numbers and we’ve got each other’s backs.’

This couldn’t have been done without the support of our partners and community – from GPs and pharmacies, councils and the police, to the wellbeing teams and the recovery community.

Together, we’ll keep learning and growing to make sure that anyone who needs treatment will get it, wherever in the county they happen to live.

Robin Pollard is head of policy at WithYou

A question of success

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DDN
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‘Successful outcomes’ are a key performance measure in drug and alcohol services, but the voices of those going through treatment and recovery in Blackburn with Darwen suggest that ‘success’ is an ever-changing challenge that might mean rethinking services.

Services are driven by performance measures intended to reflect the volume and quality of provision. One key metric is ‘successful completion’ of treatment, defined by a person leaving drug treatment free of drug(s) of dependence and not re-presenting to treatment again within six months.

In Blackburn with Darwen (BwD), the local authority public health team – along with Spark drug and alcohol service and Roots Community (who deliver collaborative treatment and recovery services) – recognised that in the pursuit of ‘metrics’ we can lose sight of what it can really mean to build success in the treatment and recovery journey.

To better understand people’s experiences, the public health team commissioned facilitator Dr Gavin Turnbull to work collaboratively with staff from Roots Community to explore the views, experiences and opinions of those going through treatment and recovery. ‘We conducted a series of group discussions with people at different stages and with varied experiences of treatment and recovery – some abstinent, some not – to discuss what ‘success’ meant to them,’ says Gavin.

Those involved were compensated for their time and expertise and were also invited to take part in developing findings. This follow-up process explored a further question: ‘What would a good service look like with this new understanding of success?’ The project also held a session with local practitioners to get their perspectives.

‘Six months? …it’s not long enough… somebody could be clean for six months and then on the seventh month they’d have relapsed and then not feel like approaching services again because they’re ashamed and they’re embarrassed.’

Defining success

‘It’s probably fair to say that people didn’t really recognise the formal definition of successful treatment, and responses were fairly blunt,’ says researcher Rolonde Bradshaw. ‘Many people stressed that their treatment journeys were more complex, and often at odds with this definition, and success was about more than substances.’

People’s accounts of their successes and future goals highlighted the different needs relating to drug and alcohol use that can be lost when we talk about targets and metrics. There were, however, shared themes that reflected most people’s experiences and views (see box).

‘It’s important to recognise that success is self-defined,’ says Rolonde. ‘The feeling of succeeding makes positive changes stick, but sometimes services can get caught up in assessments and performance measures and miss the important stuff.’

When discussing how services could respond to a wider understanding of success, one practitioner likened the current approach to being presented a menu where the only dish was ‘egg and chips’… no matter what an individual’s circumstances and needs were, options were sometimes limited. So what would ‘good’ services look like if we were to embrace a wider understanding of successful treatment and recovery’? Nine general themes came out of discussions (see box).

‘Success is a daily thing. It’s a daily thing. It comes in steps. Set yourself a goal. When you get to that goal, set another one.’

‘It’s important to recognise that success is self-defined,’ says Rolonde. ‘The feeling of succeeding makes positive changes stick, but sometimes services can get caught up in assessments and performance measures and miss the important stuff.’

‘I was walking around with my head down… I didn’t want to approach anybody, I didn’t want to speak to anybody. I was stood in a corner drinking cider, smoking crack. And now I can walk around the street, sit down on a bench, have a cigarette and I can greet people where at one point I wouldn’t have done that. 

So to me, I think success varies in terms of where you are, where you’re at.’

When discussing how services could respond to a wider understanding of success, one practitioner likened the current approach to being presented a menu where the only dish was ‘egg and chips’… no matter what an individual’s circumstances and needs were, options were sometimes limited.

So what would ‘good’ services look like if we were to embrace a wider understanding of successful treatment and recovery’? Nine general themes came out of discussions (see box).

Participants identified the importance of listening to per­sonal circumstances, navi­gat­ing a suitable combin­a­tion of interventions and support and reviewing progress, as well as recognising successes and updating goals. A single assessment at the start of treat­ment was rarely seen as effective in addressing changing needs.

‘Some people’s successful treatment journey could be different. One person could go through a service and pick up skills to live a productive life on their own, and not be involved in other services, whereas other people might need different referrals to carry on for a bit longer.

Everyone’s different.’

People had different ex­per­iences of services, some reporting that they were experiencing a person-centred, tailored treatment, with their worker helping them to navigate different interventions and provision. This wasn’t the case for everyone, raising questions about the variable nature of practice and services across areas.

Conversations also highlighted the importance of social connection and collective activities, both as a way of supporting treatment and recovery goals and as a wider means of building confidence and developing new social networks that are sustainable in the future.

‘Other people might not say I’m successful, I think I’m very successful. I learned from those six relapses – it doesn’t make you a failure just because you have a relapse.’

Smart Development

While services in Blackburn with Darwen were not a specific focus of this work, participants often spoke positively about the collaborative offer in the area. The study has helped to inform the development of a ‘SMART’ offer for abstinence and non-abstinence focused recovery, enhancements to outreach work, and ongoing co-design of provision between services and those with lived experience.

Insights into how metrics and performance interact with organisational culture and service user experience have also helped to inform commissioner approaches across the area.

‘If you have a lapse, if people then look at you and say, “Oh, you fucked up”, you know what I mean, “you’ve had a lapse” or whatever, that can put pressure on a person to go, “Yeah, I’ll fucking go full-blown now”.’

Discussions also raised challenging questions about stigma relating to both relapse and accessing recovery. Relapse tends to be regarded as a failure in our drug and alcohol system, and the performance measure highlights this for people who re-present to service. For participants, relapse was not seen as an unusual element of the recovery journey, though individual guilt and blame could prevent people from seeking further help. 

There was also concern about ideas of there being a ‘right way to recover’ affecting both drug and alcohol practitioners’ advice and peers’ views of one another going through recovery. ‘We know that when something works for someone, they advocate for it, but we also know that one size does not fit all,’ says Rolonde.

”That term, do you know if you want to sugarcoat it and call it a lapse or whatever?…You’re not back to square one, because basically you still managed to get that amount of sobriety time that you had, let’s just say it’s 100 days, you still managed to do that, don’t want to take that away from you, and all the knowledge you’ve picked up on the way. You’re not losing that knowledge.

‘The challenge in treatment and recovery services is creating the space to listen to the person coming through the door, guiding them through a range of options to achieve long-term, meaningful success.’

DDN Magazine July/August 2026

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DDN
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Let’s take inspiration from collaboration!

One of the biggest changes in drug and alcohol treatment over the last few decades hasn’t been a new medication or a radically new strategy. It’s been a gradual shift in recognising that the person sitting opposite us isn’t simply the recipient of treatment – they’re an equal partner in it.

As our articles throughout this month’s issue demonstrate, the conversations that matter most are the ones where people feel listened to, respected and involved in decisions about their own care. They recognise that the expert at the heart of treatment is the person themselves.

Perhaps most importantly, shared decision-making means recognising that setbacks don’t erase progress and that treatment and recovery are rarely a straight line.

Liam’s reflections on entering treatment in the 1990s (p30) are a reminder of how far we’ve travelled – being treated with suspicion and made to feel like a problem to be managed rather than a person to be supported were once commonplace.

We can’t be complacent, but let’s take inspiration from all the great collaborative work in this issue. 

Read the July/August issue as an online magazine (you can also download it as a PDF from the online magazine)

Please send your letters and comment to claire@cjwellings.com

Claire Brown Editor of DDN Magazine

Claire Brown, editor

 

Looking forward to seeing and hearing more of it at the DDN Conference this month!

Global opioid market at a ‘turning point’, says UNODC

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DDN
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The increasing availability of synthetic opioids like fentanyls, nitazenes and orphines in the wake of the Taliban’s 2022 opium ban signals a ‘turning point’ in the global opioid market, according to the UNODC’s World drug report 2026.

The move from plant-based opiates towards synthetics like fentanyls and nitazenes could lead to a ‘permanent shift’ in the market

Although other countries have increased their opium production – Myanmar’s has more than doubled to over 1,000 tons – this has not offset the declines in Afghanistan, which produced more than 6,000 tons in the year before the ban.

Traffickers had stockpiled large amounts of opium in anticipation of the ban, but stocks are believed to be finally dwindling – an assumption supported by survey data from Afghanistan showing that more men are ‘seeking treatment for problems with pharmaceutical opioids and sedatives and tranquillisers than with opiates, which had long dominated in the country,’ the report states.

The move from plant-based opiates towards synthetics could lead to a ‘permanent shift’ in the global opioid market, with consequences in terms of how the drugs are used and their harms, says UNODC. Traffickers are exploiting technologies and global instability to introduce new drugs, explore new trade rounds and expand into new markets, it continues.

More than 330m people are estimated to have used a drug in 2024, says the report – equating to 6.2 per cent of global 15-64-year-olds, and up from 5.2 per cent a decade before. Cannabis is by far the most widely used substance, at 256m users, followed by opioids (63m), amphetamines (32m), cocaine (25m) and MDMA (21m). The continuing growth in cocaine supply may soon ‘outstrip demand’, the report points out, with production quadrupling over the last decade, while new markets for methamphetamine have opened up in the Middle East, Africa and elsewhere.

‘We have seen an unprecedented surge in new drugs on the market, and, concerningly, some are more potent or dangerous than before,’ said UNODC’s executive director Monica Juma. ‘And we are already experiencing the consequences – millions of premature deaths and years of healthy life needlessly lost; drug trafficking networks distorting economies; the destruction of lives, communities, and livelihoods; and worsening insecurity and violence. The need to focus on dismantling organised criminal groups has never been greater. We must intensify deterrence efforts, strengthen intelligence sharing, and coordinate joint operations, while also investing more in prevention and treatment.’

World drug report 2026 available here

DDN Clearer Conversations on OST

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DDN
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Clearer Conversations on OST supports workers and peers to have better, clearer conversations about medication and treatment.

Through lived experience, clinical insight, and practical guidance, it aims to challenge myths, build confidence, and support informed choice.

Start with our featured conversations below, then explore the latest articles, practical resources and archive content. New material will be added regularly as the project develops.

Clearer Conversations is a growing DDN initiative. We’d like you to help shape it.

Tell us about the conversations you’re having – Share your experience – Suggest a topic – Recommend a resource.

Contact us →claire@cjwellings.com

Start with these..

Is anyone listening?

People enter treatment with a mixture of fear and hope. The first interactions are the building blocks for what happens next – so are we getting the conversations right, asks DDN.

Read it here

Girl talking into tincan telephone to illustrate feature on patient communications

Changing the dynamic

Here comes a new approach to finally giving people on OST a genuine voice in their own care, says Professor Adam Winstock.

Read it here

Changing the outlook

Whether they take place in the GP’s surgery, a prison healthcare wing, a hostel, or a drug service waiting room, the first crucial interactions can build trust and hope – or reinforce feelings of stigma, frustration and defeat.

Read it here

More conversations

Read more content created as part of the series and relevant DDN archive materials.

Join the Conversation

Have a story to share?

Know of a project making a difference?

Have a topic you’d like us to cover?

We’re always looking for lived experience voices, innovative practice and ideas that help workers have better conversations about medication and treatment.

Get in touch…

claire@cjwellings.com

The series on OST is made possible by a grant from Camurus, who have no involvement in the content of articles.

Arm in arm

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DDN
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arm in arm: Effective support for armed forces veterans struggling with substance issues means understanding the unique set of challenges they face

WithYou delivers the UK’s only dedicated drug and alcohol support programme designed specifically for the armed forces community – including veterans, serving personnel, reservists and their families.

In 2024 the programme received a prestigious gold award in the Ministry of Defence’s employer recognition scheme, and last year it supported 1,154 people across England and Scotland.

At the heart of this work is WithYou’s national armed forces community programme lead, Andy Craze, who oversees the development of specialist pathways, partnerships and trauma‑informed support across England and Scotland.

Here, Andy reflects on the unique needs of the armed forces community, the gaps in sector service provision, and how WithYou is building a national model of care that recognises the realities of military life and transition.

Can you tell us about your role as WithYou’s national armed forces community programme lead?

Absolutely. My role is to lead, design, shape, strengthen, and grow WithYou’s specialist drug and alcohol support for the armed forces community.

That includes developing consistent pathways in our services, building partnerships with military charities and statutory organisations, and ensuring our teams understand the cultural, psychological, and practical realities that veterans and serving personnel face.

I want to ensure national partners are aligned with local support, and that no one falls through the cracks when it comes to drug and alcohol support.

Why is specialist drug and alcohol support so important for the armed forces community?

Andy Craze WithYouThis is a community that experiences a unique combination of pressures – operational stress, trauma exposure, sudden transition to civilian life, loss of identity, chronic pain, and sometimes fractured relationships.

Alcohol has historically been embedded in military culture, and for some people it becomes a coping mechanism long after service ends. When you combine that with stigma around seeking support, you get a group of people who often present late, in crisis, or not at all. 

Specialist support helps break down those barriers. It says ‘we understand your world, and you don’t have to explain yourself from scratch’.

What are the biggest challenges the armed forces community faces when accessing support?

The biggest barrier is often stigma and pride – the belief that asking for help is weakness. 

Many veterans have spent years in environments where vulnerability wasn’t encouraged. For many women, we understand that they face additional barriers accessing services and have often experienced significant sexual or emotional trauma from military service.

That’s why we launched the Rebuild Project, which provides specialist trauma-focused psychological therapy for women veterans (DDN, March, page 6). 

Another challenge is navigating the system. There are many brilliant organisations out there, but the landscape can feel overwhelming. People don’t always know where to start, or they get bounced between services. Finally, transition remains a critical pressure point. Leaving the forces can mean losing structure, identity, and community overnight. That’s when some people begin to struggle.

What makes WithYou’s armed forces programme unique in the drug and alcohol sector?

Three things stand out. First, we recognise that military culture is different, and so is the way people seek help.

Veterans often avoid or delay asking for support, minimise their struggles, or feel they should ‘just get on with it’. Our programme is designed to meet people where they are, without judgement.

Second, we embed armed forces leads within all local services. These are people who understand military life, speak the language, and can build trust quickly. Third, we work in partnership rather than in isolation. We collaborate with partners and our sponsors including the Army Benevolent Fund and The Armed Forces Covenant Trust, as well as local authorities, housing providers, and other community organisations.

That network means we can respond to complex needs fast, whether that’s drug and alcohol support or referring to other partners for homelessness, mental health or social isolation.

What does effective support look like?

It’s about access, trust and coordination. 

Many veterans have had difficult experiences with services that didn’t ‘get’ them or who were passed through various services having to retell their story. Drug and alcohol challenges rarely exist alone, and can often be compounded by housing, benefits, mental health, physical health and social connection issues.

Our best work happens when we bring partners together around the individual. I’ve seen cases where, within hours, someone has been linked to a GP, secured temporary accommodation, connected with the Royal British Legion, and booked in for clinical support. 

What message would you share with veterans or serving personnel who might be hesitant to reach out?

The first step is sometimes the hardest. You’ve already done the hard things in life. Asking for support isn’t weakness — it’s strength. You don’t have to face drug and alcohol or mental health challenges alone. We’re here, we understand the culture you come from, and we’ll walk alongside you every step of the way.

Georgina Sayers is head of external communications and engagement (North) at WithYou

The first step is the hardest

Nicola Wilding, team leader and armed forces lead in WithYou’s Stoke-on-Trent service, talked about her own experiences with veterans.

What first drew you to working with veterans and the wider armed forces community? I’ve worked in this field for more than 13 years, having started as an alcohol recovery worker. 

In 2015 I met my first veteran client – listening to his story both shocked and motivated me to do the best I could to support him. I secured a four-day residential course for him and two years of aftercare support, which he loved.

Three years later another veteran who was looking for help staying sober came to us and I thought I knew the kind of support he needed, but actually I ended up connecting with him through his love of music and playing guitar. He’s now a volunteer for another drug and alcohol service up in Scotland. 

These two experiences really taught me that every veteran comes with their own unique story and their own way of dealing with their trauma.

In 2020 I met my now-husband, an army veteran, and again I was shocked and saddened hearing his story and the lack of support he received. That was when I decided to start making links with local veteran services, so I joined our local tri-services veteran support centre to offer support to anyone struggling with substances.

How do drug and alcohol issues intersect with the wider pressures veterans experience when transitioning to civilian life? Alcohol use can be a way of life for some serving personnel and veterans, and it’s vital that we take down any barriers to support and ensure people have the information they need. Education, connection and having something in common can go a long way to help someone feel at ease enough to share their vulnerabilities and fears.

What do you think the public often misunderstands about veterans’ needs? People have a lot of stereotypes about veterans. They’re seen as either ‘broken’ and ‘dangerous’ and suffering with PTSD, or ‘tough guys’ completely detached from their emotions. Women veterans are often expected to be working in support or care roles. But veterans are all unique – as every human is – and shouldn’t be stereotyped.

How do you think services should treat people in the armed forces community? I recently visited WithYou in North Somerset’s armed forces community team. In that service every recovery worker has veterans on their caseload and is aware of the challenges veterans face, and they work together seamlessly to deliver the best outcome. I saw a vulnerable veteran receive coordinated support within three hours, which happened because they’ve built strong partnerships with other support services in their area. 

What kind of legacy do you hope to create for the armed forces community in Stoke? A safe space where veterans can feel supported, where there’s no shame or judgement.

If you could send one message to veterans who may be struggling silently, what would you want them to hear? The first step is the hardest and then it gets easier. Let’s share a cuppa – we can chat about the weather or put the world to rights, and everything in between. If you can’t come to us, we’ll come to you and be there to support you. If there’s something we can’t support, we’ll find a service who can, and we can see them together too.

The Emma Urquhart Cup: A Celebration of Recovery, Friendship and Community

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DDN
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Forward trust Emma Urquhart Cup 2026In this personal blog, Chantel, recovery navigator at The Forward Trust, reflects on this year’s Emma Urquhart Cup and the power of friendship, remembrance and recovery.

The Emma Urquhart Cup has become so much more than a football match. It’s a day where people come together, put differences aside, and celebrate friendship, recovery, community and remembrance. And Saturday 13 June was exactly one of those days that reminded me exactly why recovery matters

For a few hours, none of us were defined by our pasts. We weren’t ex-prisoners, people in recovery, or individuals carrying trauma and loss. We were simply friends coming together to remember someone we loved and to celebrate what recovery can look like.

The football was brilliant, but the real success of the day was seeing people laughing together, sharing memories, creating new ones and supporting one another. What stood out to me most was the atmosphere. There was a genuine sense of warmth and connection throughout the stadium.

Everywhere I looked, people were talking, reconnecting and building friendships that may never have happened if recovery hadn’t brought them together.

Read more..

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of The Forward Trust

Fruit-flavoured vapes a ‘major part’ of stop smoking support

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DDN
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Fruit-flavoured vapes are now a major part of UK stop smoking support, according to research by the Brussels-based Clearing The Air organisation. Vapes are widely incorporated into stop smoking services, the study says, with ‘flavoured vaping products commonly included within cessation support pathways’.

Flavour restrictions, are ‘one of the fiercest arguments in UK vaping policy’, with harm reduction campaigners citing them as a useful quitting aid while opponents call for them to be prohibited for their potential appeal to young people.

The researchers used FoI requests to study how services are providing vaping products to people trying to quit smoking, with all but one of 28 local authorities contacted saying they provided vapes. While none of the local authority services reported supplying disposable vapes, flavours were ‘central to the offer’. All 27 services that provided vapes offered flavours, with 15 of the 19 that provided ‘useful information on flavour popularity or frequency of supply’ saying that fruit was the most popular category. Other forms of support varied across services, the report adds, with some offering nicotine replacement therapy, some behavioural support, and others a combination of both.

Flavour restrictions, however, remain ‘one of the fiercest arguments in UK vaping policy’, the researchers point out, with harm reduction campaigners citing them as a useful quitting aid while opponents call for them to be prohibited as they can appeal to young people. Delegates at the Global Forum on Nicotine earlier this month heard that as well as outright bans on safer nicotine products in many counties, the ‘spirit of prohibition’ was also evident in policies such as bans on vape flavouring.

The Tobacco and Vapes Act, which passed into law earlier this year, contains provisions to tighten regulations around both vape flavours and packaging. According to leading anti-smoking charity ASH, however, the government’s consultation on these measures is likely to focus on how to regulate the products to ensure they don’t appeal to young people – ‘without deterring adults who smoke from switching to vaping or causing adults who vape to go back to smoking tobacco, which is much more harmful’.

While the Clearing the Air study ‘doesn’t prove fruit flavours cause higher quit rates’ it does show that ‘in real-world stop-smoking services, fruit flavours are being widely supplied to adult smokers as part of cessation support’, the researchers state.

The authors acknowledge that, as the findings are based on responses from selected local authorities, they offer a ‘snapshot’ rather than a full overview of service provision in the UK. ‘The findings should therefore be read as real-world service data rather than proof that any single flavour or product type causes higher quit rates,’ they state. ‘What they do show is still significant – many UK stop-smoking services are supplying vapes directly, often through refillable devices, and fruit flavours appear to be the leading choice.’

An assessment of the provision of vaping products by UK stop smoking services using data from freedom of information requests is published in the Cureus Journal of Medical Science and available here

Better support needed for people who want to come off substitution therapy, say researchers

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DDN
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Better support strategies are needed for people with opioid dependence who ‘aspire to live an opioid-free life’, says a new report from Imperial College London.

Researchers looked at more than 40 studies from the UK, US, Canada, Scandinavia and elsewhere, covering methadone, buprenorphine and other treatments

While substitution therapy can lead to long-term stability and improved wellbeing, drug services need to ‘urgently consider’ the way in which they support people who want to come off opioid substitutes altogether, says the report. Researchers looked at more than 40 studies from the UK, US, Canada, Scandinavia and elsewhere, covering methadone, buprenorphine and other treatments. Among the report’s recommendations are specialist training for staff to manage withdrawal during detox, and better provision of medication to alleviate withdrawal symptoms. Peer support should also be available during the detox process, it states, with people given more control over their own tapering.

Significant barriers to success were identified as both physical challenges – such as severe withdrawal symptoms during the dose taper – and psychological challenges like fear of withdrawal and relapse, and low confidence. Other factors included unstable housing and ‘negative social networks.’ Although complete detoxification is often not recommended, many people decide ‘they want to come off the substation therapies completely’ – however, a lack of recommended medicines to manage ‘notoriously challenging’ withdrawal symptoms meant that most people were treated with a ‘mixture of benzodiazepines, antidepressants, antihistamine, and anti-inflammatories’.

‘Detoxification from opioid substitutes is a difficult process to complete, but here we have found a clear roadmap to better treatment provision to support people who want to undertake it,’ said Dr Louise Paterson from Imperial College’s department of brain sciences. ‘In fact, many of these strategies are routine in alcohol detoxification pathways but less often present for opioid detoxification. Our recommendations should be urgently considered by addiction services to improve results for those who aspire to live an opioid-free life.’

‘In our experience as an addiction research team, many people with opioid dependence do want to come off opioids and their substitutes completely, at some stage,’ added lead author Amy Bagshaw. ‘But few people are managing to do this successfully every year. Having reviewed the evidence and the factors involved in successful withdrawal, we believe these steps could really help to improve the present situation. Staff at addiction services may not be aware of how to adequately support individuals through the detoxification process, or how to approach the initial conversations.’

The toolkit is designed to improve access to community services such as activity and creative groups, recovery cafes and peer support

Meanwhile, researchers at UWE Bristol have partnered with Via to develop a toolkit designed to improve access to community services such as activity and creative groups, employment, education and financial advice, recovery cafes and peer support. ‘Passive signposting’ to community assets is not effective, the researchers warn, with more assertive approaches needed instead. The toolkit is based on a ‘stages of engagement’ model, and includes conversational assessments, targeted enhancements, and a community connector role to ensure ‘warm’ handovers.

‘It was very clear from our co-production workshops that people in recovery – whatever stage they are at – do not want to be simply signposted to local assets and sent on their way,’ said senior lecturer in public health, Dr Amy Beardmore. ‘They want a friendly face (preferably someone with their own lived experience of dependency) who can tell them what to expect, build confidence and reduce fear and anxiety.’

Barriers and facilitators to detoxification from opioid substitution treatment: a mixed-methods systematic review is published in the journal Addiction at https://addictionjournal.org/

Private & International Treatment Guide

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DDN
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Exploring specialist treatment options

The DDN Residential Treatment Guide provides a comprehensive directory of residential addiction treatment providers across the UK.

Alongside residential treatment, many people also explore private, specialist and international treatment options. These may include detox services, online support, recovery coaching, family programmes, mental health support and treatment centres outside the UK.

This guide has been created to help professionals, families and individuals understand the range of options available and explore different treatment pathways.

Our aim is to provide clear, independent information that supports informed decision-making. Inclusion within this guide does not constitute an endorsement or recommendation.

Find support by need

UK Residential Treatment

Looking for a comprehensive list of UK residential treatment providers?

The DDN Residential Treatment Guide contains detailed information on residential treatment providers throughout the UK, including treatment approaches, facilities and contact information.

This section may also feature selected provider profiles, articles and specialist services.

View all of our UK listings

International Treatment

Some individuals choose to access treatment outside the UK. Reasons may include privacy, location, specialist programmes, climate, family circumstances or personal preference.

This section highlights a range of international treatment providers and explores the factors that may influence decisions about overseas treatment.

View all of our international listings

Specialist Services & Support

Not everyone requires residential treatment. Many people benefit from a range of specialist services that can support recovery, wellbeing and long-term change.

This section highlights a variety of treatment and support options, including online programmes, recovery coaching, family support, trauma-informed services, executive and workplace support, and continuing care. These services may be used alongside residential treatment, as part of ongoing recovery, or as standalone sources of support.

Featured providers and resources are selected to showcase different approaches and specialist pathways available to professionals, families and individuals seeking support.

Recovery Online by The Forward Trust is an online rehabilitation service that provides flexible, accessible support for individuals looking to overcome addiction from the comfort of their own homes.

Additional providers and resources will be added as this section develops.

Work with DDN

We welcome ideas for expert articles, features and provider spotlights exploring private, specialist and international treatment. To discuss editorial and promotional opportunities within the guide, contact ian@cjwellings.com

Vital Bonds

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DDN
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Peer mentors and volunteers are crucial to our service, says Max Griffiths.

Our peer mentors at Via are people with lived experience who have previously used our services and are looking to give back to their community, while developing their own recovery capital.

Through completing the level 2 award in peer mentoring, they can progress to become a peer mentor in our services.

For those coming into drug and alcohol services, peer mentors bring encouragement, credibility, compassion and a real understanding of what it means to navigate support and rebuild confidence. This can be a vital resource for people using our services, as well as being an amazing opportunity for peer mentors to build on their own recovery capital. 

In these two stories, our peer mentors describe their volunteering as not just a role for them, but as a way of giving something back. Through representing their service, they’re supporting others, helping people make the most of the opportunities in front of them and much more.

Their stories remind us that peer mentoring is transformative – both for the people receiving support and for those offering it. 

We know how important it is to have a volunteering culture that makes this possible, and we’re thankful to our managers and teams who are so welcoming, approachable, and generous with their time and support.

Everyone at Via is hugely appreciative of our peer mentors and volunteers and the impact they make. We couldn’t provide the life-changing services we deliver without them.

Max Griffiths is head of volunteering and participation at Via

FIONA: ‘I show there’s light at the end of the tunnel’

I’ve been a peer mentor for two and a half years. My key­worker had mentioned the peer mentor course to me, and I hoped to get off drugs and then volunteer or work in drug and alcohol services.

From the early 1990s until 2009, I was injecting heroin. I was in and out of services on methadone for several years until I was on a 2ml dose, and while doing a course I managed to come off it for good. I did the NOVA and Next Steps courses at Via (on building confidence, motivation and self-development) and then straight into the peer mentor course. 

Starting as a peer mentor was exciting and daunting at the same time. Even though you know what you’re meant to be doing, you start thinking you’re not going to live up to it or you’ll do something wrong. Then you realise you’re there to talk to people – and if they want to talk, great. If not, fine – you chat to them about the support they can get.

The kitchen is the area most people will go to, and as peer mentors we make sure it’s stocked and tidy, ready for coffee and toast. We tell people how the service has helped us and how it can help them, and we try to make them feel comfortable if it’s their first time. People can be full of anxiety, and we help them feel better. 

There’s so much support for peer mentors from staff and other peer mentors, and you can always ask your manager if you need to. Everyone is welcoming and will direct you to someone more appropriate if it’s not them. Via doesn’t feel clinical or like a hierarchy – it feels relaxed and comfortable. 

I’ve done lots of training that I didn’t know I would be able to – BBV testing and other accredited courses, such as health inequalities and access to health, and right now I’m training for my driving theory exam. Every Friday we cook in the kitchen, so I also did my food hygiene awareness certificate. 

For most people being a peer mentor is about giving back. But for me it’s more about being the person that service users will talk to, and showing them there’s light at the end of the tunnel – that there’s life after addiction. 

Some service users are very young and feel they’ve wasted their lives. I feel excited showing them that they haven’t and they’ve got so much left. I want people to know what they can achieve. It can feel like being on a hamster wheel – being stuck on it, getting your script and leaving. I was like that, but now I help engage others and show them an alternative. 

I would like to be a volunteer recovery practitioner in the future, and one day work in the drug and alcohol field.

FEY: ‘It feels good to do good’

I’ve been a peer mentor for five months now. I was using the service myself, and then moved on to attend groups at the recovery hub.

One of the Via staff at a group session mentioned to me that I would be a good peer mentor, so I did the course. 

Peer mentors do lots of different things to represent the service. As a former service user and currently abstaining, I feel able to support others. I’m relatable and people open up to me. Service users talk to me about their journey and we discuss any problems that Via can help with. I want to help them get the best out of the service, knowing what support there is. 

I feel I can give back to the service that supported me when I was in treatment. This place kept me from using, and now I can do the same for others. I help in the women’s group, and love being able to chat in a safe place. It’s really fulfilling when you meet someone at the beginning of their journey then help keep them engaged as they go from treatment into the recovery hub – it feels good to do good. 

I love peer mentoring and do it three days a week. I would like to carry on volunteering and move into other areas to experience different things such as outreach and criminal justice. My main goal is to get a job at Via.

Government to double number of intensive supervision courts in bid to cut reoffending

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The government has announced £9m funding to more than double the number of intensive supervision courts, which aim to cut reoffending by tackling the ‘root causes’ of crime.

Offenders who refuse to engage in mandatory treatment or attend hearings – or continue to use substances – will face tagging or prison time.

The intensive supervision court model sees low-level offenders attend weekly sessions and regularly appear before the same judge, in recognition that ‘factors like addiction and trauma can be the root causes’ of repeat offending, the Ministry of Justice (MoJ) states. However, people who refuse to engage in mandatory treatment or attend hearings – or continue to use substances – can then face tagging or prison time.

The model, which has ‘reduced reoffending across the world’, has already been successfully piloted in Birmingham, Bristol, Liverpool and Teeside, with a second Liverpool court to open later this year. The government has also pledged to increase probation funding by up to £700m by 2028-29, including the recruitment of at least 1,300 probation officers.

‘We know that custody alone does little to rehabilitate offenders, particularly those whose crimes are driven by addiction or mental health issues,’ said mental health minister Baroness Gillian Merron. ‘This initiative will help them turn their lives around by unpacking these issues and giving them the support they need to turn their backs on crime for good. Through this we can cut reoffending and make communities safer, while getting those often left behind back on their feet and contributing to society again.’

Meanwhile, analysis of drug diversion schemes across 13 English police forces found that people were a third less likely to reoffend than those who were prosecuted for drug possession, according to the Guardian. The study, which was led by the University of Sheffield’s Centre for Criminological Research, concluded that diversion was being used far less than it could be – even in those forces with well established schemes in place.  

The government has also announced a £35m programme to fit 13,000 cell windows across 17 high-risk prisons with steel grilles to stop drones delivering drugs, weapons and mobile phones. Drone sightings around prisons increased by nearly 800 per cent between 2019 and 2023, with the age, design and condition of many prisons making them extremely vulnerable to drug smuggling.

Drone sightings around prisons increased by nearly 800 per cent between 2019 and 2023

‘Drone smuggling fuels violence, debt and disorder in our prisons,’ said deputy prime minister David Lammy. ‘It wrecks rehabilitation and puts lives at risk. This new investment will further bolster prison defences against drones, building on our work with police to catch and prosecute the criminal gangs responsible.’

A number of damning recent reports have highlighted the impact that drugs are having on the country’s prisons. The annual report from the Independent Monitoring Boards last week stated that drugs were the ‘single most destabilising factor’ across the entire prison estate, with long standing failures to address the increasingly ‘normalised’ issues of medical emergencies and debt-driven violence and intimidation. HM Inspectorate of Prisons, meanwhile, warned that drugs were now undermining every aspect of prison life – including the  rehabilitative work that cuts reoffending – while the National Audit Office said the prison service had been too slow in responding to the ‘substantial, increasing and rapidly changing’ threat.

Two thirds of alcohol-related psychiatric admissions in Ireland are repeat cases

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Just under two thirds of alcohol-related psychiatric admissions in Ireland are repeat admissions, according to figures from the country’s Health Research Board (HRB).

There were higher per capita rates of readmission in rural counties, with men accounting for 60 per cent of readmissions overall.

There were more than 9,500 alcohol-related psychiatric inpatient admissions in the decade to 2024, according to data from HRB’s national psychiatric inpatient reporting system, with a ‘consistent pattern of repeat admission’ – at 64 per cent. Half of the repeat admissions involved alcohol dependence syndrome.

The average age of those readmitted was 48, although 6 per cent of cases involved 16-25-year-olds. There were higher per capita rates of readmission in rural counties, with men accounting for 60 per cent of readmissions overall. Almost half patients were single, with the men admitted more likely to be both single and unemployed.

Admissions declined over the course of the study period, reflecting a shift from psychiatric hospitalisations to treatment in community settings, the authors point out. ‘As treatment for alcohol-related conditions shifts to the community, this report highlights the importance of ongoing monitoring of inpatient and community settings to understand trends and patterns to inform service planning and delivery,’ said co-author Anne Doyle.

Ireland became the first country to commit to mandatory health labelling for health products, which was due to come into force this year. However its introduction has now been postponed until at least 2028, the result of pressure from the drinks industry, say health campaigners.

Last month the also HRB published its latest figures on cocaine treatment, with more than 6,500 people being treated last year – almost 25 per cent up on 2024, and the highest number ever recorded. The agency warned in 2022 that Ireland had reached a ‘tipping point’ with cocaine treatment, as the drug overtook heroin as the main problem substance for people seeking treatment for the first time.

Alcohol-related psychiatric inpatient admissions in Ireland – characteristics, trends and factors associated with first and repeat admissions, 2015-2024 available here

Dame Carol Black visits Leicester service to see impact of drug strategy funding

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Dame Carol Black visits Turning Point
Dame Carol Black (seated centre) visits the Leicester team.

The government’s independent adviser on drugs, Professor Dame Carol Black, visited Leicester on Tuesday to learn more about the innovative ways the city’s substance use service supports people who use drugs and alcohol across its diverse communities.

Dame Carol played a significant role in securing a substantial rise in funding for the sector. In 2021, her independent review on drugs led to the government announcing the 10-year strategy, ‘From Harm to Hope’, initially committing nearly £900 million in dedicated, phased funding between 2022-2025.

Dame Carol saw some of the positive impact the funding has had at Leicester Substance Use Service. Run by leading social enterprise Turning Point, and commissioned by Leicester City Council Public Health, the service offers a range of treatment options for residents who are affected by drugs or alcohol.

Among the areas that the service has shown exceptional foresight and growth in is support for families with complex needs, people with co-occurring substance use and mental health needs, and people from ethnic minority communities.

The Families with Complex Needs team focuses on families, safeguarding and improving outcomes for children affected by parental substance use. The team deliver targeted, family-focused interventions that lead to sustainable change within families, particularly those facing the highest levels of vulnerability.

In her drugs review, Dame Carol stressed that substance use cannot be addressed by treatment alone or by one agency acting in isolation; it requires coordinated action across support services.

Turning Point’s Leicester service has developed several cross-sector partnerships, including the multi award winning project with Leicester City Council Public Health Team and Leicestershire Police to train over 800 police officers on how to use the lifesaving opiate reversal medication naloxone. The antidote was administered 14 times in the first 12 months of the training – equating to 14 lives potentially saved.

For those presenting with co-occurring substance use and mental health needs, the service worked with Leicester, Leicestershire & Rutland Integrated Care Board to create a multi-disciplinary Substance Use and Mental Health (SUMH) team that is aligned to locality teams across the city and county which has led to improved access and more coordinated care for individuals with complex and high-risk presentations.

Leicester is one of the most culturally diverse cities in the UK. Recent Census data showed that 59.1% of Leicester’s residents identify from ethnic minority groups, with over 41% born outside the UK. The city hosts over 240 faith groups and speaks more than 70 languages.

In reflection of this diversity, the service created the Diverse Communities Team which now includes specialist leads for Polish, Black and Afro-Caribbean, Gujarati, and Punjabi communities. The service has also secured additional funding for the partner organisation, Spinney Hill Recovery, to enhance this provision.

One example of someone who has benefited from the increased services available at Turning Point is Ravi (not his real name), who began treatment for alcohol dependence and cannabis use in February.  The Diverse Communities Team allocated Ravi to a Gujarati speaking key worker.

‘Being able to communicate in my language has been integral to my treatment and recovery journey,’ said Ravi.

‘It has enabled me to express myself more openly, feel understood, and build a strong therapeutic relationship with my key worker who is culturally attuned to my background, values, and beliefs— key factors that have influenced my substance use.’

With specialised support and tailored harm reduction advice, Ravi has made excellent progress within a short timeframe, achieving abstinence within two months despite initially wanting to pursue a detox pathway.

Dame Carol Black, government’s independent adviser on drugs, said: ‘It was a great pleasure to visit Turning Point’s Drug and Alcohol Service in Leicester. I saw great effort being made to deliver a person-centred service which recognised the need for appropriate and timely psychological services and mental health support.

‘It was inspiring to see that many employees were individuals who had personal experience of addiction.’

Rob Howard, Director of Public Health, Leicester City Council, said: ‘It is fantastic to see Turning Point being recognised for the work they do in tackling the harm caused by alcohol and drug use in Leicester. We have commissioned Turning Point for many years, and we are incredibly proud of our ongoing partnership which continues to help reduce health inequalities, and provide vital, lifesaving interventions across our communities’

Andrea Knowles, senior operations manager Leicester Substance Use Service, said: ‘We were proud to have been selected to be visited by Dame Carol Black. I feel it reflects the exceptional service that we provide to the residents of Leicester.

‘Our dedicated team ensures that every person that comes to us is given a tailored support programme that meets their individual needs.

‘Through our diverse staff that includes clinicians, recovery workers, peer mentors, and therapists, and also our close relationships with other health services in the city, we strive to make sure that the people we support are given every opportunity to make positive changes to their lives.’

Julie Bass, Turning Point chief executive, said: ‘Dame Carol Black is a pioneering figure in health and social care. To have her visit our Leicester service was a real honour.

‘The inspiring work that takes place in Leicester, and across all Turning Point services around the country, is a direct result of Dame Carol’s tireless work to secure more funding for the sector.

‘We look forward to continuing to build on the recommendations she set out in her independent review on drugs and hopefully invite her to visit more Turning Point services in the future.’

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Turning Point

Bournemouth charity honours two local volunteers with awards

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Bournemouth, Christchurch and Poole charity WithYou presents Peter Lee-Overy, and Debbie Millward, with volunteer awards for going above and beyond supporting people struggling with drugs and alcohol.

WithYou – a national charity supporting more than 100,000 people with problems with drugs, alcohol and mental health across England and Scotland – has recognised the outstanding volunteers for their exceptional contributions to the service.

Debbie Millward, says: ‘I have thoroughly enjoyed the last year and it was lovely to be the recipient of an award, very much unexpected and a lovely surprise.

‘I have been involved in quite a few community events, bringing awareness to the services WithYou offers, alongside helping out with carers of loved ones who are struggling with substance abuse, and with recovery check ins. I’m just happy to help out where I can.’

Peter Lee-Overy says: ‘I was really pleasantly surprised to win the Staff Impact Award. I am very grateful for everyone’s kind words and for the recognition. I thoroughly enjoyed my time supporting the Homelessness Team and I’m pleased my housing knowledge has been a useful support to the staff on the Housing Team too.’

Louise Stewart, director of volunteering at WithYou, says: ‘This award is a small way of saying thank you for something that means an enormous amount to the clients we work with. We’re incredibly lucky to have Debbie and Petey.

‘If you’ve ever thought about volunteering, I’d really encourage you to get in touch – you’d be amazed at what a few hours a week can do for someone else, and for yourself.’

Find out how you can get involved:

www.wearewithyou.org.uk/careers/volunteering

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of WithYou

Drugs the ‘single most destabilising factor’ across prison estate

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Illicit drugs are the single most destabilising factor across the entire adult prison estate, according to the annual report from the Independent Monitoring Boards (IMB). At one prison, HMP High Down in Surrey, IMB members recorded 13 drug-related medical emergencies in a single day.

Even when prisons did manage to reduce levels of drug use, IMB members ‘often observed spikes in debt-related violence and anxiety-driven self harm, as drug dealers sought to collect their debts’

As well as life-threatening medical incidents, drugs are also fuelling violence, debt, intimidation and self-isolation, the document states, with medical emergencies alone ‘placing extreme strain on healthcare and operational staff’. Even when prisons did manage to reduce levels of drug use, IMB members ‘often observed spikes in debt-related violence and anxiety-driven self‑harm, as drug dealers sought to collect their debts, destabilising regimes further’, the report says.

IMB are statutory bodies made up of unpaid volunteers appointed to monitor the treatment and welfare of prisoners. Earlier this year Inside Time magazine reported that they were to be merged with HM Inspectorate of Prisons in a bid to cut costs.

The annual report’s findings present a ‘consistent and deeply troubling picture’ across the country, it states, with prisoners living in ‘increasingly unsafe and demoralising’ conditions and failures once regarded as serious becoming normalised. Many of the gravest issues mirrored ‘those raised repeatedly in IMB annual reports over the past decade’, it says, with long-standing failures ‘compounded’ rather than resolved and the same problems persisting ‘with striking frequency’. This raised ‘unavoidable questions about effectiveness, accountability and the system’s capacity to correct its course’.

The findings also echo those of other bodies, with HM Inspectorate of Prisons warning that drugs were now undermining ‘every aspect’ of prison life and the National Audit Office saying that the prison service had been far too slow in responding to the ‘substantial, increasing and rapidly changing’ threats posed by drugs in the prison estate.

Alongside the drugs crisis, mental health needs were also far outstripping available support, the IMB report continues, with building maintenance also ‘actively making prisons less safe, less humane, and less able to function’. Cuts to education and training, meanwhile, were compounding instability, frustration and poor mental health. ‘The lived experience of custody is increasingly marked by dwindling opportunity for meaningful engagement, heightened anxiety and fading hope, calling into question whether headline assurances of improvement align with the reality on the ground,’ the report says.

The bleakness of the overall picture ‘matters because it is felt every day by people in custody’, said IMB interim national chair Jane Leech. ‘Poor conditions, limited regimes and unsafe environments damage mental and physical wellbeing, undermine rehabilitation, and erode dignity. They also affect public safety, the likelihood of reoffending, staff retention, and trust in the justice system. For both adults and children in custody, the prevailing experience is not one of progress, but of stagnation and decline. IMBs’ findings suggest that unless there is a decisive shift away from denial, short-term fixes and rhetorical reassurance, prisons and YOIs will continue to deteriorate, not through sudden collapse, but through the steady normalisation of failure.’

National annual report 2025 adult prisons, young offender institutions and immigration detention available here

Ten times more women sleeping rough than official government figures show

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There are still as many as ten times more women sleeping rough in some areas than are identified in the government’s official snapshot figures, according to the latest women’s rough sleeping census – a situation largely unchanged from last year.

Almost two thirds of the women surveyed reported sleeping in places excluded from official homelessness counts, such as buses or A&E waiting rooms, while nearly half reported walking all night to avoid being visible – and vulnerable – while sleeping rough.

Nic Adamson: ‘It’s crucial that we work together to build services that truly work for women.’

The Women’s rough sleeping census 2025: missing women studied more than 100 local authorities to gain a full picture of women’s rough sleeping, and identifying more than 160 women sleeping rough across six local authorities that had recorded no women sleeping rough at all. Now in its fourth year, the census is led by the Single Homeless Project and Solace in partnership with Change Grow Live and Crisis.

Official rough sleeping counts are still compiled on the basis of a visible, male ‘bedding down’ model, the authors point out, despite women understandably trying to avoid visible rough sleeping and the associated high risk of sexual assault, violence or exploitation. More than 1,400 women were consulted for the survey – via face-to-face interviews and anonymised surveys – alongside information from ‘local insights’ meetings between homelessness, healthcare and domestic abuse services, among others.

Nearly 40 per cent of the women surveyed were receiving no support from housing officials or homelessness organisations, while 45 per cent reported being in some form of homelessness accommodation immediately prior to sleeping rough – demonstrating that services ‘often fail to meet women’s needs’, the document states. The census began in a single London borough before being rolled out across the capital in 2022 and beyond London the following year, after findings ‘showed overwhelmingly’ that women’s homelessness was being under counted.

The report calls on the government to update the definition of rough sleeping to better reflect women’s experiences and include ‘hidden, transient and less visible’ forms, as well as make sure that temporary and supported accommodation are safe and accessible for women. It also wants to the see the census funded to be rolled out to every local authority, along with clear guidance, so that accurate and inclusive data can be collected to shape policy, funding and service provision.

The government pledged to halve rough sleeping as part of its National plan to end homelessness late last year. However, the census authors state that that this needs to work for women, and calls on the government to make sure that toolkits for prevention, outreach, temporary accommodation and complex needs are gender-informed and tackle the ‘barriers faced by women most likely to be missed’.

‘Whilst homelessness and rough sleeping are dangerous and devastating for everyone, women’s rough sleeping is compounded by two key factors: near-universal experiences of violence and abuse, and inequitable policies and data systems that fail to capture, or address, women’s experiences – leading to a lack of adequate services,’ the census states.

‘Year-on-year, the Women’s rough sleeping census has identified concerning disparities between government figures, and the true number of women sleeping rough, unidentified and invisible to decision makers,’ said Change Grow Live deputy chief executive Nic Adamson. ‘Women who are experiencing homelessness are among the most vulnerable in our society – but our findings show that too often, they are falling through the cracks. Now is the time for government to listen to women’s experiences and to deliver the investment and focus required for support which recognises women’s unique needs. Now, more than ever, it is crucial that we work together to build services that truly work for women.’

Women’s rough sleeping census 2025: missing women is available here

Changing the dynamic

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Here comes a new approach to finally giving people on OST a genuine voice in their own care, says Professor Adam Winstock.

Let me start with a simple question. How many people in your service are getting the most out of their OST? You may not know. You might have a guess. But the fact that a service can’t easily answer that question is, in itself, a problem.

You can look at doses – what percentage are on methadone above 60mg, say. But that misses the point. The evidence is clear that the best outcomes come from personalised dosing. The right dose for one person is not the right dose for another. It’s not a magic number. In practice, this means that for many people being in treatment is not the same as doing well in treatment.

I’ve been prescribing opioid substitution treatment for more than 25 years. I’ve seen thousands of people cycle in and out, never quite getting stable, never quite getting the dose right, eventually concluding that treatment doesn’t work for them. The biggest single modifiable reason – not the only one, but the biggest – is that they were never on enough. People on adequate doses use less heroin, stay in treatment longer, and when they’re ready to reduce, they do it from a position of stability rather than desperation. NICE says it. The Orange guidelines say it. The evidence has said it for 40 years.

And yet here we are in 2026, with average methadone doses in England still sitting well below therapeutic thresholds, over half of people on OST classified as moderately or highly unstable by any structured measure, and no brief tool – until now – that a person could complete themselves in five minutes to make their own instability visible. With escalating deaths related to potent synthetic opioids and the need for services to adapt to the arrival of depot buprenorphine, the importance of learning how to make the most of the tools we have in treating opioid dependence is more important than ever.

That’s the gap SODA was built to fill. So what does SODA actually do? The Stability of Opioid Dose Assessor (SODA) is a seven-item questionnaire that takes about five minutes to complete. It asks about withdrawal between doses, craving, and on-top use. The score runs from zero to 20 – zero meaning treatment is doing its job, 20 meaning it really isn’t. Scores fall into four bands from stable to high instability, and the person gets immediate automated feedback in plain English.

It replaces informal, variable clinical assessment with a structured, real-time, patient-mediated process – usable by any staff member in any setting, without training, without system integration, and without adding time to existing appointments

SODA starts by asking what the person wants from treatment – whether that’s to stop using, manage active use, or reduce and eventually detox, SODA follows the patient. That’s the foundation for trust and shared decision-making.

No jargon. No medical degree needed. It can be self-administered or completed with a keyworker, nurse, peer or prescriber. No retrospective outcome monitoring. Just a structured, plain-English way for someone to articulate something they already know – that their dose isn’t covering them – in a format that makes it easier to do something about it. People can also create an anonymous account and track themselves over time, seeing how their decisions influence their treatment outcomes.

We piloted it across three community OST services in England and Wales with just over a thousand people. The results were sobering but unsurprising – 67 per cent fell into moderate or high instability bands despite being actively engaged in treatment. Being in treatment, it turns out, does not mean treatment is working.

Acceptability was high – 87 per cent rated SODA as accurate, 88 per cent found it helpful, and 72 per cent said they would definitely discuss their treatment with their prescriber after completing it. In the highest instability band, that rose to 92.6 per cent. So SODA doesn’t just measure the problem, it activates the conversation.

The majority of people in OST have far more contact with their keyworker than with their prescriber. The keyworker is the relationship. But without a structured tool, their knowledge stays informal – a hunch, a concern raised in supervision, a note in the file that might not reach the prescriber before the next review. With high staff turnover and variation in confidence around medication conversations, we’re left with informal descriptors: ‘it’s not holding her’, ‘still using on top’. 

SODA changes that dynamic. It gives non-prescribing staff a shared language and a concrete number to work with. The patient’s own score speaks for them. It turns the conversation about dose from a negotiation into a clinical discussion, and it shifts the locus of agency back towards the person in treatment where it belongs.

SODA v2 has been adapted to take into account medication adherence and will include adjustments to better accommodate long-acting injectable buprenorphine, an audio option to bypass health literacy barriers, and improved data architecture to enable population-level benchmarking for services and commissioners. Prison integration pathways are also in development – because the weeks after release from custody represent one of the highest-risk periods for opioid-related death, and continuity of care assessment matters enormously at that transition.

It’s worth being clear about what SODA is not. It’s not a medical device, it doesn’t tell people they are underdosed. It does not direct a prescription. All clinical decisions remain the responsibility of the prescriber – what SODA does is enable people to understand their treatment, their options, and how their own choices can influence their outcomes.

SODA isn’t about parking people on OST, it’s about allowing OST to fulfil its dual role as both harm reduction and a recovery tool. For people who want to come off, we’ve developed a ‘readiness to reduce’ companion – a structured assessment that starts from the position that reducing from a place of instability usually leads to escalating use and abandoned attempts. Getting stable before reducing isn’t about keeping people on treatment longer than they want to be. It’s about giving them the best possible chance when they do decide to come off.

People on OST are not passive recipients of a prescription. They know how they feel. They know when their dose is covering them, and when it isn’t. What they haven’t always had is a simple, dignified, structured way of making that knowledge count in the room where decisions get made.

SODA is that tool. It won’t replace clinical judgement, and it won’t tell a prescriber what to do. But it will make sure that what the person already knows isn’t lost in the gap between how they feel walking in and what gets discussed before they walk out.

That gap has cost lives. It’s time to close it.

SODA v1 is available at mydose.digital. The pilot evaluation has been submitted to Drug and Alcohol Review. For service partnership enquiries: adam@stayingsafer.com

Professor Adam Winstock is a consultant addiction psychiatrist, founder of the Global Drug Survey, and clinical lead for SODA

Your voice matters!

DDN is currently running a series on Clearer Conversations on OST – see part one in DDN, May 2026, page 12-14. We would love to have your involvement – please get in touch if you can offer your thoughts or experiences.

The series is made possible by an educational grant from Camurus, who have no involvement in the content of articles.

Via celebrates new Trustee appointments during Volunteers’ Week

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Via is marking this year’s Volunteers’ Week by welcoming five newest Trustees to the Board and celebrating the contribution of all Board members who have joined the organisation over the past year. 

Jennifer Aikman, Heather Cook, Claire Denton, Dr Heather Noble and Dr Charles Young are the latest appointments to join Via’s Board of Trustees, bringing additional expertise from across healthcare, clinical governance, legal, digital health, and human resources. 

Anna Whitton, CEO at Via, said: ‘Volunteers’ Week is the perfect opportunity to recognise the enthusiasm and expertise our Trustees bring to Via. We are delighted to welcome our newest Board members and to celebrate the dedication of our whole Board. Their collective experience and insight are helping us to continue to grow our impact as well as supporting our organisational ambitions for the future.’

Find out more and join the campaign at viaorg.uk

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of VIA

NPS still being detected in Europe at a rate of one a week

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New psychoactive substances (NPS) are still being detected in Europe at a rate of ‘around one a week’, according to EUDA’s European drug report 2026: trends and developments.

Levels of cocaine use remain high across the continent, with around 4.3m people having used it in the last year. Cocaine is now the second most common substance among first time entrants to drug treatment.

Fifty were reported for the first time last year, bringing the number being monitored in Europe to 1,050. ‘Among these are potent new synthetic opioids,’ the agency warns. People who use drugs are facing more and more health risks, as markets rapidly evolve and become ever more complex, says the report – which is based on data from nearly 30 countries. Ketamine is becoming more embedded in the European drug landscape, with health services ‘beginning to feel the impact’. The number of people entering treatment for ketamine has quadrupled in the space of five years, with treatment availability remaining uneven. There have been ‘strong increases’ in both ketamine and cocaine detections in European wastewater analysis, according to recent analysis.

Levels of cocaine use remain high across the continent, with around 4.3m people having used it in the last year. Cocaine is now the second most common substance among first time entrants to drug treatment, with crack cocaine a significant problem in many cities, particularly among marginalised groups. This is potentially being driven by high levels of cocaine availability and the ease of local conversion from powder cocaine, says EUDA. ‘Crack cocaine use is placing increasing strain on harm reduction and treatment providers as they respond to the needs of a group experiencing serious health and social problems,’ it states.

Opioids, usually in combination with other substances, remain Europe’s leading cause of drug-related deaths, with at least 7,600 fatal overdoses in the EU in 2024. Almost 100 new synthetic opioids have been detected since 2009, with China’s blanket ban on nitazenes in July 2025 possibly redirecting the market towards other substances. Nine new orphines have been identified in the last two years, linked to nearly 20 deaths. Fentanyl, meanwhile, was linked to more than 100 deaths in Bulgaria alone between 2024 and 2025.

The heroin market is also proving resilient, EUDA states, with ‘tactical supply management’ of Afghanistan’s large opium stockpiles providing a ‘buffer’ to the sharp decline in cultivation and production after the Taliban’s 2022 opium ban. Production is also shifting elsewhere, it points out, with 9,000 hectares of opium poppy cultivation in Pakistan – rivalling Afghanistan’s output – and cultivation in Myanmar reaching a ten-year peak. EUDA estimates that there are around 522,000 people who inject drugs in the EU, rising to 530,000 with the inclusion of Norway.

The continent’s heroin market is proving resilient, with ‘tactical supply management’ of Afghanistan’s large opium stockpiles providing a ‘buffer’ to the sharp decline in cultivation and production after the Taliban’s 2022 opium ban.

The continent’s drug markets are also continuing to have an impact on security, with drug-related intimidation and violence remaining a concern – including ‘the exploitation and recruitment of vulnerable young people by criminal groups to traffic drugs and perpetuate violence’. Traffickers are also quick to adapt to enforcement efforts, with more drugs now entering Europe via smaller ports following intensified policing at Rotterdam, Antwerp and elsewhere.

Timely identification of new substances and emerging trends is vital, the report stresses. ‘The increasing overlap between the illicit drug and new psychoactive substance markets, including fake and diverted medicines, contributes to the potential for sudden shifts in the substance types available at retail level. This can increase people’s exposure to unpredictable health risks from unknowingly using highly potent substances that appear on the market.’

‘Drug markets are evolving at speed, with the variety of substances on Europe’s streets becoming ever more unpredictable,’ said EUDA executive director Dr Lorraine Nolan. ‘This raises the risk: people may be taking high-potency drugs, often without knowing it. A balanced approach is essential, tackling both supply and demand. As well as being grounded in science, it must also be focused on human rights and public health.’

The report revealed the ‘human cost of drug use, with the latest annual figures showing at least 7,600 overdose deaths’, said European commissioner for internal affairs and migration, Magnus Brunner. ‘We must pull out all the stops to prevent dangerous new products from flooding the market and use the full force of the law to strip illegal traffickers of their business model.’

European drug report 2026: trends and developments available here

One in five alcohol products fail to meet labelling guidelines

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DDN
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One in five alcohol products sold in the UK fail to meet the voluntary labelling guidelines set out by industry regulator the Portman Group, claims a report by the Alcohol Health Alliance and Alcohol Focus Scotland.

The Alcohol Health Alliance and Alcohol Focus Scotland are calling on the government to introduce mandatory labelling that includes both units per serving and per container alongside nutritional and ingredient information, and health and pregnancy warnings

The study – which is the largest in the UK to date – looked at more than 530 products and found that information on units and ingredients as well as health and pregnancy warnings were either inconsistent or ‘wholly absent’. When health information was displayed, it was often in the form of ‘very small text or pictograms’, it adds – some measuring as little as 2.5mm in diameter.

While industry-approved messaging such as ‘drink responsibly’ appeared on almost 90 per cent of the products studied, one in four failed to include information on units per serving, while 8 per cent also failed to include the minimum requirement of units per container. Just under 7 per cent included a health warning, while only 1.3 per cent included specific warnings about cancer or liver disease.

Separate analysis by the Portman Group itself, however, claims that compliance with its voluntary health labelling guidelines is at ‘near universal’ levels, with a study of 500 top-brand products finding that 99 per cent carried a pregnancy warning ‘logo or message’, 96 per cent carried unit information, and 89 per cent displayed the chief medical officer’s low-risk drinking guidelines.

The Alcohol Health Alliance and Alcohol Focus Scotland are calling on the government to introduce mandatory labelling that includes both units per serving and per container alongside nutritional and ingredient information, and health and pregnancy warnings – including cancer warnings. Mandatory health warnings on the risks of liver disease, alcohol-related cancers and drinking while pregnant formed part of Ireland’s Public Health (Alcohol) Act eight years ago, but their introduction has now been delayed until 2028 – the result of ongoing lobbying from the drinks industry, say campaigners.

‘Consumers are being kept in the dark about the potential health harms of alcohol products,’ said Alcohol Focus Scotland chief executive Carolyn Lochhead. ‘It is ludicrous that a pint of milk is required to carry more information than most alcohol products. With more than 50 people a week dying of preventable alcohol-related causes in Scotland, this situation cannot continue. Consumers have the right to know what they are drinking so that they can make genuinely informed choices about their health. Self-regulation has clearly failed. It’s time for the governments to act and introduce mandatory health warning labels on alcohol products.’

‘Alcohol is a type 1 carcinogen – in the same category as tobacco and asbestos – yet most alcohol products carry little or no meaningful health information communicating those risks,’ added Alcohol Health Alliance chair Professor Sir Ian Gilmore. ‘Public awareness of alcohol harms remains low, particularly around alcohol and cancer, despite alcohol being attributable to an estimated one in 25 cancer cases in the UK. Consumers would not accept this level of missing health information on other food and drink products, and alcohol should not be treated differently. Consumers have a right to know what is in their drink, how much alcohol it contains, and the health risks associated with drinking it. Mandatory alcohol labelling would help ensure everyone can make informed decisions about their health.’

A clear way forward: the case for better alcohol labelling available here

Informing customers through responsible alcohol labelling: 2026 UK market review available here

Public health impact of tobacco harm reduction will be like the ‘introduction of vaccination’

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DDN
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Safer nicotine alternatives like vapes will ‘inevitably and soon’ replace combustible cigarettes worldwide, former president of the Australian Drug Law Reform Foundation Dr Alex Wodak told the Global Forum on Nicotine (GFN) in Warsaw. When they do the public health impact will be ‘akin to the introduction of vaccination’, he said.

Around a billion people worldwide still smoke, ‘fuelling millions of preventable deaths’

Tobacco harm reduction products such as vapes, nicotine pouches, heated tobacco products and snus were ‘vastly less harmful’ than cigarettes, as well as being effective smoking cessation aids. However, people worldwide were finding their access to them blocked, hampered or under threat, delegates heard.

Just as there had been ‘vehement and protracted opposition to every new harm reduction intervention for drugs’, this was now the case with nicotine, Wodak said. Almost 50 countries now banned the sale of vapes, while the EU continued to prohibit snus. Tobacco harm reduction was ‘an existential threat to organisations committed to a tobacco control “endgame”,’ he said – which would become ‘obsolete‘ once safer nicotine products replaced cigarettes.

Around a billion people worldwide still smoke, ‘fuelling millions of preventable deaths’ according to the World Health Organization (WHO). The organisation, however, remains opposed to e-cigarettes, with its director of health determinants, Etienne Krug, last year stating that they were fuelling ‘a new wave of nicotine addiction’. An independent review commissioned by Public Health England, however, concluded that they were around 95 per cent less harmful than smoking.

The UK’s Tobacco and Vapes Act, which passed into law earlier this year, contains measures to phase out the legal sale of tobacco to anyone born after January 2009 as well as tighten the regulations around vape flavouring and packaging. Although more than a million people in the UK quit smoking last year, the cost of smoking to society in England alone is almost £45bn a year, according to new analysis from ASH – a figure that includes healthcare, social care and lost productivity.

While outright bans on safer nicotine products were common, the ‘spirit of prohibition’ was also evident in policies such as bans on vape flavours, caps on nicotine content and tax measures that made them unaffordable for the populations most in need of them, GFN delegates heard.

‘Prohibition fails by every measure,’ said GFN director Jessica Harding. ‘It damages public health and costs lives by encouraging people to keep smoking. And rather than eradicating safer nicotine products as intended, it fosters illicit markets that operate without consumer protections or age restrictions. The biggest victims of prohibition are the vulnerable populations that smoke at the highest rates, disproportionately people who are on low incomes and marginalised. It is their right to health that is under attack.’

 Global Forum on Nicotine 2026, including live streaming of sessions, here

ASH ready reckoner available here

Out in the cold

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DDN
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On the rare occasions when chemsex is covered in the mainstream media, mental health issues don’t tend to figure.

A recent report, however, offers a very different perspective.

A report by London Friend and LGBT HERO has revealed that mental health issues like trauma, loneliness and isolation are the biggest chemsex-related concerns for LGBTQ+ people in London (DDN, May, page 5). With nearly three-quarters of the 334 survey respondents citing the mental health impacts of chemsex, the findings paint a ‘stark picture of unmet need’, the organisations say.

A supplementary report heard from service users at Antidote – the specialist LGBTQ+ drug and alcohol support service operated by London Friend – as well as healthcare professionals supporting people with chemsex issues. The results challenge some common assumptions, the organisations say, with survey respondents ‘consistently’ linking their drug use to coping with poor mental health. This meant that chemsex was ‘often rooted not just in risk-taking behaviour, but in unmet emotional and psychological needs’, the report states.  

So were the findings a surprise? ‘Not really,’ London Friend chief executive Monty Moncrieff tells DDN. ‘Very often when chemsex starts to cause difficulties for people we find there’s underlying mental health issues – around half of our clients already have a mental health diagnosis, but far more experience issues around their identity, shame and stigma around chems use, and very frequently loneliness. Chemsex helps people connect in the moment, but if any of these issues are underlying already they can be exacerbated by chems use and the comedowns.’ 

Higher risks

ONS analysis of mortality statistics from 2021 to 2024 by sexual orientation found that lesbian, gay and bisexual people had a 2.8 times higher risk of death related to drug poisoning than the heterosexual population. Overall rates of substance use tend to be higher in the LGBTQ+ community – whether because of the more central role of the bar and club scene, or self-medication to cope with mental health issues – but some chemsex drugs carry a high risk of potential harm, such as the danger of overdosing on even small amounts of GHB/GBL.

The most common chemsex substances alongside GHB/GBL tend to be mephedrone and methamphetamine, with the latter associated with more and more cases of psychosis, Moncrieff says. ‘We see it manifesting in feelings of paranoia, often thinking people are spying on them or listening in through devices and the like, and we also hear about some very significant challenges in services like emergency departments.’ 

The report details the significant barriers to accessing help, with people citing issues like waiting lists, costs and limited numbers of sessions. Lack of awareness was also a major barrier, however, with 40 per cent of LGBTQ+ Londoners never having tried to access support – and half unaware that chemsex-specific services even existed. That statistic was also ‘sadly not’ a surprise, says Moncrieff. ‘We know it can often be difficult for people to recognise when chems are becoming a problem for them, which was echoed in our discussions with healthcare professionals.

But it’s also difficult for services like ours to advertise ourselves too much because we wouldn’t be able to cope with the increased demand. There’s no tariff payment activated for everyone we support, like there would be in sexual health for example.’ Instead the money tends to go to local services that LGBTQ+ clients can be reluctant to access, he says. ‘We need to do more work to make sure what’s there already can meet the needs of LGBTQ+ people, and those engaged in chemsex, appropriately.’

Monty Moncrieff has been working in the LGBTQ+ sector since 1996, campaigning for equality and delivering support services, including ten years as a helpline volunteer.

He established Antidote in 2002, joined London Friend in 2011, and was appointed chief executive the following year. In June 2018 he was awarded an MBE in the Queen’s Birthday Honours List.

Shame and stigma

Staff in both drug treatment and sexual health services are increasingly encountering complex chemsex-related needs but lack the capacity to respond properly, the report warns. Perhaps inevitably, shame and stigma were also identified as major barriers to accessing support, with many respondents stating that mainstream drug and alcohol services ‘didn’t understand LGBTQ+ lives’, leaving them feeling unable to engage.

One interesting finding was that drug workers themselves wanted more training, with more than 40 per cent saying they’d like more education around methamphet­amine and GHB/GBL, while almost half wanted more mephedrone training. Some respondents had positive experiences of the support they did access, however, with more than half rating it excellent or very good, while about a third rated it fair, and 16 per cent poor. ‘There were fairly mixed results in what kind of interventions were helpful or not – one-to-one keywork and counselling scored most highly – but this just emphasises the importance of offering a range of intervention types to meet differing needs,’ says Moncrieff. ‘But the need for support to be LGBTQ+ specific was really strongly indicated, so we do know people want more targeted interventions.’ 

The document also calls for mental health support to be properly integrated into chemsex pathways, via embedded therapists and support groups, and better links generally between services. How optimistic is he this will happen over the next few years? ‘It should be happening already, and not just for chems users,’ he states. ‘We know how much mental health support other people who use drugs often require, so it always feels astonishing to me that we haven’t got this right yet. We still hear of services routinely not accepting clients unless they’ve addressed their drug use first – this was something the clients in our focus group were particularly vocal about.’

While it can be difficult for people to engage in very structured mental health interventions if they’re still using drugs, mental health support can be ‘integrated in so many ways’, he says. ‘We’ve had to adapt our services to bring it in and be more holistic, as well as bringing in interventions that help people look at their sexual behaviour and health. Psychoeducational workshops are a good way of doing this, but these need to be rooted in the experiences of LGBTQ+ people and delivered in ways that are safe for them to disclose what’s been going on for them. This just can’t be achieved through most existing mixed groups – people need to know they’re safe to talk about chems use and sex and won’t be judged. The respondents were so clear about needing LGBTQ+ specific services to do this, so we just can’t keep expecting them to fit into mixed groups in treatment services.’ 

Strategic approach

Alongside things like mandatory LGBTQ+ awareness training for frontline staff, including on chemsex culture, the report says that visibility around the support that is available needs to be improved. How is this best achieved – through targeted campaigns via apps and venues, wider awareness campaigns, or a mix of both? ‘I think we need to maximise all opportunities really,’ he says. ‘Professionals asking about chems use in sexual health appointments is really helpful, as it gives people permission to open up and talk frankly and honestly. We’re also trying to piggy-back onto existing sexual health outreach – often funded by HIV prevention programmes – to help outreach workers feel more confident to ask about chems, offer harm reduction, and strengthen referrals pathways into support services.

Crucially, if awareness is raised then how to sustain and expand services to meet the increased demand has to be properly thought through, he stresses. ‘Referring hundreds of people to somewhere they’re potentially going to be waiting months to be seen isn’t an effective intervention either – improving chemsex support needs a strategic and long-term approach.’  

RECOMMENDATIONS

The report’s recommendations are based on survey findings and are intended to shape future service development, investment, and commissioning across London.

  • Expand access to LGBTQ+-specific care
  • Integrate mental health support into chemsex pathways
  • Commission a structured LGBTQ+ peer mentor programme
  • Increase community-led and peer-led interventions
  • Reduce practical barriers and improve accessibility
  • Strengthen harm reduction communications
  • Improve visibility and public information
  • Tackle stigma and shame
  • Strengthen research and ongoing monitoring

More work to do

When DDN spoke to him more than a decade ago (April 2015, page 12) he was already highlighting the fact that people didn’t feel comfortable talking to mainstream services about their issues around chemsex – has there been much progress over the last decade? ‘I think there has, and I think more people working in services have had to improve their knowledge because chems are increasingly coming through the door,’ he says. ‘But it really varies. In our survey of healthcare professionals there was a wide range of scores when we asked people to rate their knowledge and confidence – some rated themselves at eight or nine, even some tens, but we had just as many rating themselves at one, two, three or four out of 10, so it feels like there’s still a lot of work to do. 

‘Sadly though, I think one of the reasons more professionals are having to work with chemsex is that the health and social issues people are experiencing related to their chems use are so much more complex,’ he continues. ‘So they’re having to use services to access more specialist and clinical help that’s beyond the psychosocial support we can offer at Antidote. Just like we did when we first started seeing chemsex and these newer drugs emerge, professionals are having to learn and adapt. Because the people are right there in their services.’

LGBTQ+ services for drugs and chemsex in London and Examining the drug, alcohol and chemsex experiences of LGBTQ+ people and the healthcare staff supporting them are available at londonfriend.org.uk/chemsexreport2026

For some, it may be linked to confidence, connection, or coping. For others, it can become a source of harm, isolation, or escalating risk. This complexity is precisely why compassionate, non-judgemental support is so vital.

The risks associated with chemsex are well documented – increased likelihood of sexually transmitted infections, challenges around consent, sleep deprivation, dependency, and the psychological strain that can follow extended sessions.

But focusing solely on risk misses the point. People who engage in chemsex often describe unmet emotional needs, experiences of stigma, or difficulty accessing mainstream services that understand the cultural and relational context of their lives.

Effective support begins with recognising chemsex as a health and wellbeing issue, not a moral one. It requires practitioners who understand both substance use and sexual health, who can speak openly about shame, trauma, pleasure, and identity without pathologising the person in front of them.

It also requires services that are flexible enough to meet people where they are – whether they want to reduce harm, take a break, stop entirely, or simply talk to someone who understands.

This is why structured, evidence-based pathways matter. At Forward Trust, we now have clear clinical and psychosocial pathways specifically designed for people engaged in chemsex. These pathways bring together specialist substance use clinicians, sexual health expertise, and psychosocial practitioners who understand the broader emotional and social factors that shape chemsex experiences. They provide safe spaces for honest conversations, comprehensive assessments that consider both physical and psychological wellbeing, and tailored plans that respect each person’s goals.

Our approach includes harm-reduction guidance, support around consent and boundaries, relapse-prevention strategies, and links to sexual health services. It also includes psychosocial interventions that explore loneliness, identity, trauma, and relationship patterns – factors that often sit beneath the surface but profoundly influence behaviour. Crucially, our pathways are designed to be accessible and stigma-free, ensuring that people feel able to reach out without fear of judgement.

Supporting people who engage in chemsex isn’t about telling them how to live. It’s about recognising that behind every behaviour is a person with a story, and that meaningful change – whatever form it takes – happens when people feel heard, respected, and supported. Forward Trust’s dedicated pathways reflect this belief, and they ensure that no one has to navigate chemsex-related challenges alone.

Darren Lacey is inclusion coordinator at The Forward Trust

DDN Magazine June 2026

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DDN
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Championing many forms of inclusion

ddn magazine june 2026As the country celebrates Pride in all its glory, we’re championing many forms of inclusion in this month’s issue. 

As a new report by London Friend reveals (p14), mental health issues like trauma, loneliness and isolation are major challenges for LGBTQ+ drug and alcohol support services – issues that confront us in many contexts.

We’re always looking for inspiration to break through these barriers and the SODA questionnaire takes each person to the heart of their own treatment (p6) – ‘the foundation for trust and shared decision-making’. We want to hear about more initiatives like this, so please think about contributing to our ‘Clearer Conversations’ articles.

In every context, treatment should be a partnership – doing things ‘with’ and not ‘to’. So we’re delighted to hear bright ideas on co-designing services with veterans, people facing multiple disadvantage, and those experiencing homelessness. It’s not the easiest approach, but as experiences in Surrey show (p8), participating in system change can be profoundly motivational for all involved. 

And let’s celebrate Volunteers’ Week with all the truly amazing peers and volunteers (p10, p12). You rock!

Read the June issue as an online magazine (you can also download it as a PDF from the online magazine)

Please send your letters and comment to claire@cjwellings.com

Claire Brown Editor of DDN Magazine

Claire Brown, editor

Debug the System

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DDN
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Persistence and flexibility are key when supporting people facing multiple disadvantage, says Melanie Pellicci.

People experiencing substance use, homelessness, poor mental health and contact with the criminal justice system are too often passed between services that treat each issue in isolation. They are told they’re ‘too complex’ for one service, but not meeting the threshold for another. Support arrives late, and often when crisis has already escalated.

After more than a decade of working alongside people facing multiple disadvantage in Essex, Phoenix Futures and Essex County Council have learned that recovery rarely happens through rigid referral pathways, short-term interventions or appointment-led systems. It happens through trust, persistence and services designed around real lives.

Futures Together was commissioned in 2016 following national research into severe and multiple disadvantage, building on years of frontline experience supporting people whose lives do not fit neatly within traditional service boundaries. The service works with people affected by substance use, homelessness, mental ill health, offending and deep social exclusion, often all at once.

Systemic exclusion

Over the years, one lesson has remained consistent – people facing multiple disadvantage are often excluded by the very systems designed to help them. Fixed appointments, strict engagement expecta­tions and time-limited inter­ventions frequently fail people living with trauma, unstable housing, poor health and financial insecurity. Missed appointments, relapse and disengagement are often viewed as non-compliance, but in reality they’re often signs that someone is struggling to survive. That’s why Futures Together was intentionally built differently.

Support is not withdrawn because someone relapses, misses appointments or struggles to engage. Through assertive outreach and community-based support, staff meet people where they are, physically and emotionally, removing barriers that prevent people from accessing help.

Persistent presence

This approach requires persistence. If someone disengages, staff continue reaching out. If someone relapses, support continues. If someone faces a setback, they’re not pushed back to the start of the process. As James, who had been trying to access mental health care for many years before finding support through our service, shared: ‘I was in a mess… I’d worked all my life and had my own house, and it was a shock to lose so much so quickly. I got to the point where I didn’t care anymore. But they never gave up. If they couldn’t get me, they kept trying, and if that didn’t work, they came to the door.’

Low caseloads allow staff to provide intensive support that addresses both immediate needs and long-term stability, from housing, benefits and healthcare access to recovery planning and wellbeing support. Just as importantly, staff often act as advocates, helping people navigate systems that can feel confusing, inflexible or punitive. As Susan explained after finding the service after trying for many years to navigate the complexities of the healthcare system: ‘Mental health isn’t something that just goes away. But I feel better knowing I’ve got someone in my corner. Someone who listens and pushes to get answers.’

Building bridges

This learning has also shaped wider partnerships. A recent pilot between Essex County Council, Phoenix Futures, Tesco and Open Road offers early intervention for people affected by substance use who come into contact with store security due to shoplifting. Rather than defaulting straight to criminal justice responses, people are offered access to specialist support that addresses the underlying causes of offending behaviour. It’s a practical example of what can happen when organisations respond to vulnerability with intervention instead of punishment.

The same principles are also embedded within Phoenix Futures’ enhanced support and access team (ESAT), which works with people from Gypsy, Roma and Traveller communities who often face significant health inequalities and barriers to mainstream services.

Traditional models that rely heavily on assessments, referrals and formal appointments can reinforce exclusion, particularly where trust has been damaged by previous discrimination or poor experiences of services. ESAT instead delivers outreach in environments where people feel comfortable, building relationships over time and offering practical support with everything from identification and housing to healthcare access.

As one person from the Gypsy, Roma and Traveller community who had been struggling with their drinking prior to accessing our support explained: ‘I’ve been really happy with the support. I wouldn’t have known how to do any of this without her help. She’s helped me get my birth certificate, benefits, ID, my first bank account and is supporting me with housing. She’s convinced me to see a GP – I hate needles – and is taking me to alcohol support classes. She’s even going to teach me how to cook, and I’m going to teach her to cook coddle.’

Melanie Pellicci head of operations, Essex, at Phoenix Futures
Melanie Pellicci is head of operations, Essex, at Phoenix Futures

The evidence is clear – relational, flexible and persistent support works for people facing multiple disadvantage. The bigger challenge is whether systems are willing to adapt. As public services face growing pressure, there’s a danger of becoming more risk-averse, more fragmented and more focused on quick outcomes. But people facing the most complex challenges rarely fit into neat systems or short funding cycles. If we want better outcomes, services must be designed around people’s realities and not organisational convenience.

For the people who have spent years being turned away, that shift could make all the difference.

Tobacco harm reduction guide for drug services launched

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DDN
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A new guide setting out practical ways for drug services to help their clients reduce or quit smoking has been published by the Global State of Tobacco Harm Reduction (GSTHR).  

According to NDTMS figures almost half of people in drug and alcohol treatment are smokers, compared to 12 per cent of men and 9 per cent of women in the general population.

Supporting tobacco harm reduction ‘does not have to cost services anything, aside from time,’ GSTHR says. The guide, Integrating tobacco harm reduction into drug treatment and harm reduction services, is accompanied by a briefing paper detailing the scale and impact of tobacco-related harm in this population, Smoking among people facing problems with drug use.  

According to NDTMS figures almost half of people in drug and alcohol treatment are smokers, compared to just 12 per cent of men and 9 per cent of women in the general population. Recent analysis of mortality figures for 100,000 people showed that 63 per cent of those using heroin died before the age of 70, compared to just 16 per cent of the general population. Of these, 24 per cent died as a result of tobacco smoking – just 4 per cent lower than the 28 per cent who died as a result of illegal drugs.

‘Globally, drug services help hundreds of thousands of people avoid illness and death every year,’ says David MacKintosh, a director of K·A·C, which runs GSTHR. ‘The evidence shows that smoking rates among people who use drugs are much higher than national averages. We hope that these resources will help services and funders to reduce smoking, including by making use of the potential of tobacco harm reduction. This will play an important role in helping people live longer and healthier lives.’

‘Unless there is a collective effort from treatment services over half the people who use services will die from smoking-related causes,’ added Waythrough CEO Paul Townsley. ‘There are simple steps we can all do to help reduce the impact and burden of this.’

Meanwhile, a ‘polluter pays’ levy scheme on the tobacco industry could raise almost £5bn over five years at the same time as reducing smoking deaths, says a report from the Sheffield Addictions Research Group and the University of Bath. ‘By passing the Tobacco and Vapes Act, the UK government has protected a generation from the harmful effects of smoking,’ said Dr Rob Branston of the University of Bath’s Tobacco Control Research Group. ‘Our research shows there is an opportunity for further leadership by tackling the vast profits of an industry that kills more than half of its long-term users. This proposed policy would bring about multiple wins: it raises a large amount of money for the government, delivers health benefits, and helps the poorest the most.’

Integrating tobacco harm reduction into drug treatment and harm reduction services available here

Smoking among people facing problems with drug use available here  

Reducing tobacco supplier profits and pricing power: Modelling the impact of a tobacco price cap and tax increase on socioeconomic inequalities in England is published in the journal Social Science and Medicine and available here

Broadway Lodge, the miracle mansion

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DDN
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Broadway Lodge’s ‘Miracle Mansion’ podcast shares personal stories of addiction, treatment and recovery, alongside conversations exploring wider issues around substance use and wellbeing.

The name originated from former clients who affectionately referred to Broadway Lodge as the ‘Miracle Mansion’ because of the transformative experiences and life-saving recovery they experienced there.

 

Listen and watch all episodes at broadwaylodge.org.uk/stories/

 

Opioid dependency increases dementia risk by almost 60 per cent

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DDN
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People with an opioid dependency have a 56 per cent higher risk of developing dementia than the general population, according to a study by Oxford Population Health and the University of Oxford’s Department of Psychiatry.

The participants with a diagnosis of opioid use disorder were found to be 56 per more likely to develop dementia than those without in the nine years of follow-up

Researchers analysed more than 220,000 health records from the US Million Veteran Program (MVP), a database of over a million US military personnel. Comparing the data to other large studies, they used genetic analysis to ‘disentangle’ opioid use from other potential causes of dementia. Almost 9,000 MVP participants had a diagnosis of opioid use disorder (OUD), and in the nine years of follow-up were found to be 56 per more likely to develop dementia than those without an OUD diagnosis.

Drawing conclusions from previous emerging evidence has been complicated by the challenges of distinguishing the effects of opioid addiction from other factors that could contribute to the development of dementia, such as problem alcohol use, psychiatric disorders or chronic pain, the researchers point out. Although the mechanisms linking opioids to dementia ‘remain unclear’, long-term use may contribute to hardening and narrowing of the arteries and hypotension which can reduce the flow of oxygen to the brain. Dementia may also have gone undiagnosed in people whose drug use may have ‘obscured the symptoms of cognitive decline’, they say.

‘While the short-term effects of opioids are well known, our findings show that opioid use disorder may also have important long-term consequences for brain health, including a higher risk of dementia,’ said lead author Dr Anya Topiwala. ‘Using large-scale data and genetic methods, we found evidence suggesting this link may be causal, pointing to the direct impact of opioid exposure rather than underlying genetic risk. This work underscores the need for medicine safety, preventive strategies, and further investigation into the neurological consequences of chronic opioid exposure.’

Meanwhile, a new report from ASH and the Mental Health and Smoking Partnership warns that 1.5m people in the UK with depression and anxiety are being left without support to quit smoking. Smoking rates among people with mental health conditions are significantly higher, but while there are ‘promising examples’ of local innovation these are being hampered by lack of a national strategy or national targets. An open letter to public health minister Sharon Hodgson to accompany the report is signed by more than 140 campaigners and health professionals.

Opioid use disorder and dementia risk: evidence from observational and genetic analyses in diverse ancestry cohorts is published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association and is available here

Falling through the cracks: Closing the gap in stop smoking support for people with common mental health conditions available here 

The Anti-Stigma Network: Three Years of Challenging Stigma

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DDN
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anti-stigma networkThe Anti-Stigma Network recently marked three years since their launch.

What started as a conversation about the harm caused by stigma has grown into a national network working to challenge discrimination around drug and alcohol use and promote dignity, compassion and fairness across systems, services and communities.

Over the past three years, we’ve been continually inspired by the people who make up this network. Whether you’ve attended a webinar, shared a post, contributed a blog, used one of our resources, or simply followed and supported the work. Thank you.

This movement has always been collaborative, shaped by lived and living experience, partnership and a shared belief that change is possible.

Together, we’ve:

  • Built a network of 1,600 members and 31 organisations, representing more than 10,000 staff
  • Delivered webinars, training and resources reaching thousands across sectors
  • Increased confidence to address stigma from 47.5% to 74% through training
  • Published more than 60 blogs reaching over 40,000 readers
  • Developed partnerships across health, justice, local government and academia
  • Created free practical tools, including our Language Guide, to support real-world change

While we’re proud of how far the network has come, we also know the work is far from over. Stigma still shapes how people are treated, supported and understood every day across healthcare, housing, criminal justice, employment and communities.

Find out more and join the campaign at antistigmanetwork.org.uk

DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of The Anti-Stigma Network

‘Dedicated funding’ needed for Combating Drugs Partnerships

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DDN
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The government should provide dedicated funding for the operation of Combating Drugs Partnerships (CDPs), says a new report by independent research agency Verian for the Home Office. Lack of dedicated funding is the most challenging barrier facing CDPs, it states, with partners instead expected to fund their activities through existing budgets.

While local authorities received ring-fenced funding for drug treatment, funding for
police force areas did not ‘earmark resources for drug-related enforcement activity’ the report states.

CDPs, which are overseen by the Joint Combating Drugs Unit (JCDU), were established to coordinate the delivery of the ten-year drug strategy. Verian partnered with NatCen and CECAN to evaluate their application of the ‘whole-system approach’ to tackling drugs, looking at how multi-agency working was being implemented at strategic and operational level, the key challenges and other issues – via interviews with stakeholders and service users, surveys, workshops and an evidence review.

There are more than 100 CDPs across England, typically made up of local authorities, criminal justice, treatment organisations and other partners like the NHS, Jobcentre plus, and housing services. However they ‘varied significantly’ in their structures, priorities, leadership and partnerships, the report says.

The lack of dedicated funding could lead to difficulties in properly engaging partners like the NHS and PCCs, the document states, while other challenges included data sharing between organisations, leading to evidence gaps and lack of strategic alignment. While stakeholders overall were ‘enthusiastic about CDPs and believed that the joined-up approach had a positive impact’ on meeting local needs and delivering the drug strategy, other challenges identified by the research included difficulties in finding ways to address ‘less visible harms’ – such as drug use in communities that experienced additional stigma and discrimination, and the impact of drugs on families. Lack of capacity in wider parts of the system – such as mental health and housing – were also a challenge for CDPs, it says.

It was important to note that while local authorities received ring-fenced funding from OHID to improve treatment in addition to money from the public health grant, the funding for police force areas was ‘embedded within broader allocations and does not specify or earmark resources for drug-related enforcement activity’ the report states. Having ‘strong pre-existing relationships and structures’ was the most important factor in mitigating these challenges, the report states.

The report’s other recommendations include customisable templates for data sharing agreements, forums for sharing best practice, and regular collection and monitoring of data to improve accountability and identify areas for improvement. The CDPs themselves, meanwhile, should try to improve awareness of their activities in the community, reflect on their leadership structures and the formalisation of partnerships, and clarify membership and representation to make sure they involved lived experience representatives as well as mental health, health and housing services. They should also identify areas for further collaboration, including co-location of services, it said.

However, more than two-thirds of CDPs reported improved collaboration in identifying people at risk, with just over 60 per cent stating that new treatment opportunities had been enabled through joint working. Almost all of the CDP representatives who responded to the survey believed that the creation of CDPs ‘had led to improvements in partnership working’.

 Process evaluation of Combating Drugs Partnerships available here

Irish treatment rates for cocaine hit record levels

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More than 6,500 people were treated for cocaine issues in Ireland last year according to the latest figures from the Health Research Board (HRB) – 24 per cent up on 2024, and the highest number ever recorded.

Ireland has seen a 336 per cent increase in treatment cases for cocaine as the main problem drug since 2017 – a 282 per cent rise for powder cocaine and more than 900 per cent for crack.

There were almost 15,500 treatment episodes for problem drug use last year, with cocaine remaining the most common drug treated – treatment demand for powder cocaine increased by 21 per cent and crack cocaine by 31 per cent. HRB has previously warned that Ireland had reached its ‘tipping point’ for problem cocaine use, with the drug overtaking heroin as the main problem substance for people seeking treatment for the first time in 2022.

Ireland has seen a 336 per cent increase in treatment cases for cocaine as the main problem drug since 2017 – a 282 per cent rise for powder cocaine and more than 900 per cent for crack. A recent study found that cocaine was now linked to almost 60 per cent of all cases of drug-related intimidation in the country, a ‘pervasive’ form of criminal activity affecting individuals, families and communities that is rarely reported to the authorities for fear of retaliation.

The number of women seeking treatment for cocaine has increased nearly seven-fold over the last decade, the HRB report continues, from 284 in 2017 to more than 1,900. Treatment demand for ketamine has also increased 12-fold over the same period, to 334 cases. Opioids remained the second most commonly reported main problem drug in 2025, although treatment for NPS increased by 50 per cent to 256 cases.

‘Many findings from our 2025 report are similar to 2024 – or example, we see continued rise in demand for cocaine treatment,’ said senior researcher at HRB Dr Anne Marie Carew. ‘However, at the same time, we are seeing early signals of emerging drug trends, particularly for new psychoactive substances and ketamine. While numbers are still small, these trends are important and will be closely monitored. Identifying emerging trends like this really demonstrates the sensitivity of the data we collect in the HRB and its importance for policy makers and service planners to understand and effectively treat the changing face of problem drug use in Irish society.’

Meanwhile, smoking‑attributable hospital admissions in Scotland have fallen by 36 per cent since 2008, according to Public Health Scotland (PHS) – to just over 1,100 per 100,000 population. The rate of smoking-attributable deaths also fell by nearly 40 per cent over the same period, to 236 per 100,000 population. However, those living in the most deprived areas had a 4.7 times higher death rate and 4.4 times higher admissions rate than those in the least deprived, the report states.

National drug treatment reporting system – 2025 drug treatment demand available here

Smoking attributable hospital admissions and deaths: Scotland 2024 available here

Government consults on new mental health strategy

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The government has launched a call for evidence to shape its forthcoming ‘once-in-a-generation’ mental health strategy. The strategy will signal a fundamental shift from crisis intervention to prevention, DHSC states.

Levels of support largely remain a postcode lottery, with many people only getting help when they reach crisis point.

Demand for mental health services has been increasing exponentially, especially among younger people, with many facing long waiting times to access support. The government wants to hear from frontline workers, clinicians and others on how care can be transformed, it says, with NHS spending on mental health projected to top £16bn this year. However, the current system remains ‘reactive, fragmented and inconsistent’, it says, with levels of support largely a postcode lottery and many people only getting help when they reach crisis point. The strategy will set a new direction for the system so that it ‘responds earlier and more proportionately’, the government says.

The strategy will ‘look beyond’ clinical settings to consider the role of the voluntary sector, schools, workplaces and local government in promoting positive mental health, DHSC adds, ‘moving from a system that first and foremost seeks to diagnose patients, to one that asks what support people need to live better’.

According to NDTMS figures, around three quarters of people starting drug and alcohol treatment also have a mental health treatment need. A new co-occurring mental health and substance use delivery framework was published by DHSC and NHS England last year to try to address deficiencies in provision and stop people falling through the gaps in services.

‘This government believes that mental health should be treated with the same seriousness as physical health, yet too many people across the country are struggling to get the support they need, when they need it,’ said mental health minister Baroness Merron. ‘Alongside record investment in mental health services and more mental health workers than ever in the NHS, this strategy will give mental health the attention it deserves and set us on a new direction – one that focuses on earlier help, faster access and a whole-system approach. We want to hear from everyone with a stake in getting this right, including frontline clinicians, service providers, and people with lived experience of mental health conditions, so that we can build a system that truly works for everyone.’

According to NDTMS figures, around three quarters of people starting drug and alcohol treatment also have a mental health treatment need

‘What matters now is delivery,’ stated chief executive of Rethink Mental Illness UK, Mark Winstanley. ‘We need rapid improvements in access to timely, appropriate treatment, urgent action to ensure inpatient settings are safe and therapeutic, and support that is properly joined up across health, housing and community services.’

Any new strategy would ‘only come to fruition if there is a targeted plan for the workforcein terms of recruitment and retention’, added British Psychological Society president, Dr Roman Raczka – ‘this must take into consideration workloads, supervision and career progression if we are to stand a realistic chance of retaining existing staff as well as attracting new members of the workforce. Only then will be able to reduce mental health waiting lists, and get people the support they need and deserve, and before they reach crisis point.’

Open call for evidence: informing the mental health strategy for England available here until 10 July

Better data needed on drug use in ethnic groups, says ACMD

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‘Timely and useful’ data on drug use in ethnic groups should be gathered to feed into the next drug strategy, says a new report from the ACMD. Cultural competence and diversity also needs to be enhanced in drug services across the country, says Drug use in ethnic minority groups: a review and recommendations.

According to last year’s Adult Psychiatry Morbidity Survey (APMS), ‘all drug’ use in the previous year was highest for white respondents, at 26 per cent

There is currently an ‘inconsistent and fragmented’ picture of the prevalence of drug use across minority groups says the report, which forms part of a series of ACMD documents on drug use in vulnerable populations. Structural barriers – including ‘stigma, mistrust, cultural insensitivity, and negligible service visibility’ – have all been found to limit engagement with treatment, adds a covering letter from the ACMD to policing minister Sarah Jones.

More research is needed to understand the differences in harms, engagement and treatment outcomes in different groups and the factors that influence them, it continues. Workforce planning, meanwhile, should define the competencies necessary to develop culturally sensitive services that are able to properly understand the issues of stigma and shame that deter many people from accessing support. Ethnic groups should also be represented in services ‘across all levels’, it states, from frontline workers to board and trustee level.

According to last year’s Adult Psychiatry Morbidity Survey (APMS), ‘all drug’ use in the previous year was highest for white respondents, at 26 per cent, followed by ‘mixed/multiple/other ethnicities’ (22 per cent), Black/Black British (12 per cent) and Asian/Asian British (2 per cent). Drug dependence, meanwhile, was highest in the mixed/multiple/other ethnicities group at 22 per cent, followed by white (15 per cent) and Black/Black British (6 per cent).

Adopting the report’s recommendations would help to develop a clearer, more robust evidence base, ensure better targeting of policies and funding, improve service uptake and engagement, and reduce levels of stigma and inequalities, said ACMD chair Professor David Wood.

Drug use in ethnic minority groups: a review and recommendations available here

Access Denied: Why is treatment still so hard to reach for people experiencing homelessness?

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DDN
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For people experiencing homelessness, accessing substance use treatment is rarely straightforward.

Fragmented systems, strict criteria and the limitations of borough-based boundaries often leave people excluded before they have even had a chance to engage. At Phoenix Futures, our Regional Homeless Engagement with Substance Use Treatment (RhEST) service works to remove these barriers.

RhEST is the only pan-London substance use service, operating across 32 local authorities, each with its own structures and commissioning arrangements. Meanwhile, the people we support frequently move across boroughs, often out of necessity rather than choice. Traditional services, tied to specific geographical areas, can struggle to maintain contact when someone’s life does not remain within one set of boundaries. Our role is to bridge those gaps and ensure that access to treatment does not depend on having a stable postcode.

Our team focuses on building trusted relationships with people facing multiple disadvantage. Many have complex physical, mental and social needs. Consistency is vital, yet difficult to achieve within a system not designed for mobility. By working across boroughs, RhEST can stay alongside people no matter where they move, advocating for them when their circumstances do not neatly fit the criteria expected by commissioned services.

By Chris Annison, Phoenix Futures Head of Services – London

Read more

DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Phoenix Futures

Cocaine driving drug-related intimidation in Ireland

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Cocaine is linked with just under 60 per cent of all cases of drug-related intimidation in Ireland, according to the country’s first ever national report on the issue.

Drug-related intimidation (DRI) is a ‘pervasive and under-reported form of criminal activity that affects individuals, families and communities’, the report states. However, fear of reprisals, living in proximity to the intimidators, stigma, and limited awareness of available support mean that it is often not reported to the authorities.

Cocaine is associated with 59 per cent of all cases of drug-related intimidation (DRI) in Ireland

There were 1,027 cases of DRI among people engaged with drug and/or family support services in Ireland last year, the document says. All age groups – ranging from the under-18s to the over-50s – were affected, although the majority of cases were in the 20-44 age group. Two thirds of the cases related to threats to individuals, and a quarter related to threats to family, while debts associated with DRI could be more than €10,000 or as little as €100. Around two thirds of cases were related to personal drug use and 28 per cent related to another person’s drug use, while a third of people reported suffering intimidation for more than a year.

‘A consistent pattern of harms is evident, ranging from verbal threats and property damage to physical violence, coercion into drug distribution, and sexual exploitation,’ says the report. ‘Those impacted by DRI include people who use drugs as well as their family members, partners, and their wider community, reflecting the broader social reach of intimidation linked to drug debt and criminal activity.’

DRI was reported across the country, with Dublin accounting for more than 40 per cent of cases. The data was collected using the Irish Health Research Board’s (HRB) National Drug Treatment Reporting System (NDTRS) on behalf of the DRIVE (Drug Related Intimidation and Violence Engagement) project. The report calls for enhanced prevention and community level interventions, as well as more support for those affected.

A 2022 report from HRB warned that Ireland had reached a ‘tipping point’ regarding problem cocaine use, with the drug overtaking heroin as the main problem drug for people seeking treatment for the first time. The number of people entering treatment for cocaine tripled between 2015 and 2021, with women accounting for one in four cases reporting cocaine as their main problem drug – compared to one in five pre-2020. A report from the Insight Crime think tank earlier this month stated that the market for cocaine in Europe was ‘now the biggest in the world and still growing’, with record seizures across the continent.

‘This first data report from the DRIVE project confirms the lived experiences of people affected by drug-related intimidation in Ireland,’ said Dr Suzi Lyons of the national DRIVE oversight committee. ‘It shows that drug-related intimidation affects everyone, both old and young, families, friends and the wider community. Ireland is leading the way in systematically capturing the evidence as it is embedded in the Health Research Board’s national system, which will inform the integrated, coordinated, community-based response to the harms of DRI.’

Sheila Gilheany: ‘Ireland has the second highest level of binge drinking across the OECD’

‘Drug-related intimidation is very insidious and frightening,’ added drugs minister Murnane O’Connor. ‘We want people who are affected by this to know that they are not alone. As this report demonstrates, this is an issue affecting every community and people from all walks of life. Local drug and alcohol task forces can put you in touch with a range of confidential services and supports in your local community and Gardaí are on hand to offer advice without the need to make formal complaints.’

Meanwhile, although new figures show a 2 per cent decrease in per capita alcohol consumption in Ireland ‘some important realities are hidden in the data’ says Alcohol Action Ireland (AAI), with those who do drink ‘drinking more, and in a more hazardous manner – which is a perfect storm for alcohol harms’.

‘While we welcome the reduction in consumption per capita, we get a very different picture when we look at the per drinker data which is more relevant for harms analysis,’ said AAI CEO Dr Sheila Gilheany. ‘This data equates to every drinker aged 15 and over in Ireland drinking on average 257 cans of beer, 11 bottles of spirits, 41 bottles of wine and 32 cans of cider a year. Hazardous drinking is normalised in Ireland. In fact, Ireland has the second highest level of binge drinking across the OECD, with HRB reporting that binge drinking among low- to moderate-risk drinkers accounts for most alcohol-related harm.’

Drug-related intimidation in Ireland: the first data report from the national DRIVE project available here

WithYou in Scotland named finalist for Scottish Charity of the Year

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DDN
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WithYou in Scotland has been named as a finalist for the SCVO’s Scottish Charity of the Year for its dedicated work supporting people facing challenges with drugs and alcohol.

Last year, staff in 13 community-based services across the country helped 14,000 people. Referrals rose 21 per cent year-on-year, and teams held more than 63,000 appointments, up 17 per cent. WithYou’s online webchat, available 364 days a year, connected with a record 1,987 people seeking support, up 28% year-on-year.

The human impact of that work was summed up by one father in Dundee, whose words were later cited in the opening address at the National Drugs Mission Conference in Edinburgh in March as an example of what Scotland’s drug and alcohol sector delivers.

He said: ‘Without WithYou and others, I wouldn’t be sitting here. I would be dead. Every single person in here saved my life. My kids wouldn’t have a dad if it wasn’t for the support I received.’

Louise Stewart, Scotland Director at WithYou
Louise Stewart, Scotland Director at WithYou

Louise Stewart, Scotland Director at WithYou, said the award nomination recognised work that changed lives across Scotland.

‘Over the last two decades, my colleagues have helped tens of thousands of people take steps towards a healthier life,’ Louise explained. ‘I’m incredibly proud of them and so pleased their vital work has been recognised in this way.

‘People facing challenges with drugs and alcohol must be able to access the right support, free from stigma and discrimination, when and where they need it, driven by their goals.’

Ronnie Hart, an advanced practitioner at WithYou’s North East Glasgow Recovery Hub, is one of many WithYou staff who brings his own experience of recovery to his work.

He said: ‘At WithYou, I feel valued. They support me, my recovery, my physical health, and my mental health. There hasn’t been a day since I started where I’ve not wanted to go to my work.’

Almost everyone in Scotland has been touched by drug and alcohol harm. Figures published in September offered a moment of cautious optimism, with drug deaths in 2024 at their lowest level since 2017 and alcohol deaths at a five-year low.

During that period, the charity launched WithYou Anywhere in Highland — the UK’s first fully virtual drug and alcohol service — bringing recovery support to people in Scotland’s most remote communities. 

They also helped shape policy, playing a key role in developing Scotland’s Charter of Rights for People Affected by Substance Use and the Standards for Young People Accessing Treatment or Support for Alcohol or Drugs. And as synthetic opioids entered Scotland’s drug supply, they expanded drug-checking and naloxone provision to keep people safe.

Winners will be announced on 11 June 2026 in a celebratory awards ceremony hosted by broadcaster Sally Magnusson at the Radisson Blu in Glasgow.

Anna Fowlie, Chief Executive, SCVO said: ‘Across Scotland and beyond, voluntary organisations are making an extraordinary difference, and the breadth and depth of their impact never fails to inspire. Our 2026 finalists epitomise this.’

Find out more scvo.scot/scottish-charity-awards

DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of WithYou Scotland

New drug and alcohol service directory for Scotland

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DDN
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Scottish Drugs Forum (SDF) has relaunched the national directory for drug and alcohol services – making it easy to find the right support, at the right time.

The refreshed directory brings together information on drug and alcohol services, alongside injecting equipment provision, in one simple, mobile-friendly platform.

Free and publicly accessible, it helps people seeking support – as well as their friends and family – to find services in their local area.

It is also a vital tool for professionals working across Scotland, including those in the NHS and across drug, alcohol and wider social care services, helping them connect people with appropriate specialist support.

The directory, which is maintained by SDF on behalf of Scottish Government, is available at: drugandalcoholservices.scot

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DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of SDF

Introduce opt-out stop smoking support across NHS, say doctors

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DDN
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Opt-out smoking cessation services should be introduced across ‘every NHS setting’ says a new report from the Royal College of Physicians (RCP). This would include emergency departments, outpatient services, primary care and neighbourhood health services.

Opt-out smoking cessation support should be introduced across the NHS says the RCP, including emergency departments, outpatient services, primary care and community health services

While smoking remains the UK’s ‘biggest avoidable cause of death and disability’ its impact is far from equal, says Smoking, health and social justice. One in five residents of Blackpool – one of the most deprived towns in the country – are smokers, compared to just 4 per cent of people in Woking.

When barriers to accessing services are removed, however, the ‘greatest number of successful quit attempts come from the least advantaged communities’, the report states. If opt-out quit services were introduced across the health service, ‘everyone who smokes and has contact with the NHS’ would be automatically referred to support unless they chose otherwise. Research by ASH last year highlighted that a number of acute hospitals and mental health trusts were now beginning to decommission their stop-smoking services as a result of budget uncertainty, risking the reversal of ‘hard-won progress’.

The elimination of smoking in the UK would see a potential ‘smoke-free dividend’ for the country’s economy of just under £11bn, says the RCP report, ‘lifting many families out of poverty and creating an estimated 135,000 jobs’. Lower employment levels among smokers as a result of smoking-related ill health account for just under £9bn in lost productivity a year, it continues, with premature deaths – particularly among experienced workers over 45 – resulting in a further £1.35bn in 2024 alone.

People experiencing homelessness or entering prison are more than six times more likely to smoke than the general population, the report states

People experiencing homelessness or entering prison are more than six times more likely to smoke than the general population, the report adds, with the actual rate in the former group likely to ‘significantly higher than official figures suggest’. In addition to opt-out support services, the RCP is calling for a rebalancing of national tobacco polity towards ‘high prevalence and underserved groups’, as well as investment in improved data collection to target action towards ‘hidden populations’. A report from the University of York published late last year stressed that urgent action was needed to address the ‘unseen epidemic’ of tobacco-related deaths among people with mental health issues. People with conditions like depression, bipolar disorder or schizophrenia are around three times more likely to smoke than the general population, it said, shortening life expectancy ‘by up to 20 years’.

The tobacco and vapes bill, which aims to create a ‘smokefree generation’ by phasing out the legal sale of tobacco to anyone born after January 2009, finally passed into law at the end of last month.

‘The health effects of tobacco place an enormous and entirely preventable strain on the NHS,’ said RCP president Professor Mumtaz Patel. ‘The government has taken an important step forward with the Tobacco and Vapes Act, which will help create the first smokeo-free generation and deliver long term gains for public health. But we must also act now to help the millions of people already addicted to tobacco who desperately need support. Too many are still being missed.’

‘Put simply, smoking reinforces persistent cycles of disadvantage and inequality,’ added the college’s special adviser on tobacco, Professor Sanjay Agrawal. ‘Addressing it is a matter of public and economic urgency. Opt-out smoking cessation pathways reduce inequality by removing the barriers that prevent people from accessing treatment, particularly in more deprived areas where smoking rates are highest and awareness of support is lowest. NHS inpatient data already show that when support is offered as standard, the greatest quit success is seen among the least advantaged groups, delivering both health and economic returns. Opt-out reaches the people our current system consistently fails.’

Smoking, health and social justice available here

Alcohol-specific deaths down by 6 per cent

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There were 9,809 deaths from alcohol-specific causes registered in the UK in 2024, according to new figures from ONS – 6.3 per cent down on 2023’s record high of 10,473.  

The rate of alcohol-specific deaths was at its lowest level since 2020, at 14.8 per 100,000 people. Scotland and Northern Ireland continue to have the highest rates, at 20.9 and 21.4 deaths per 100,000 respectively, with alcohol-specific deaths in Northern Ireland increasing by 80 per cent in the space of a decade.

As in previous years, the North East had the highest rate of any English region, while the death rate for men remained double that for women.

The year-on-year decrease is the first since 2018, with registered alcohol-specific deaths rising by more than 38 per cent between 2019 and 2023.

The year-on-year decrease is the first since 2018, with registered alcohol-specific deaths rising by more than 38 per cent between 2019 and 2023. Alcohol-specific fatalities only include those where the death was a direct consequence of alcohol use, such as alcoholic liver disease, and do not include all of the deaths that could be attributed to alcohol. Delays in registration mean that while 85 per cent of the deaths occurred in 2024, just under 13 per cent occurred in 2023 and 1.5 per cent in 2022 or earlier.

While the 6.3 per cent reduction was welcome, deaths remained ‘far too high and are still significantly above pre-pandemic levels’, said Alcohol Health Alliance chair Professor Sir Ian Gilmore. ‘This small decline does not indicate meaningful progress. It is a continuation of a public health crisis that has been allowed to worsen over recent years. We know that the sharp rise in deaths since the pandemic has been driven by increasing levels of heavy drinking, widening health inequalities, and a lack of meaningful government action to reduce alcohol harm.’

Richard Piper: The drop ‘must not lull any of us, including the government, into a false sense of security about alcohol harm in the UK’

Although it was encouraging to see a decline, ‘the fact that around 189 people still die every week is a stark and tragic reminder of the scale of the problem,’ added Turning Point chief operating officer Clare Taylor. ‘Alcohol-related deaths are avoidable, and timely access to information, support and treatment is one of the strongest protections against harm. Although more people are entering treatment, too many still miss out on support until it is too late, and stigma continues to prevent people from seeking help. Tackling alcohol harm must be a national priority. This includes strengthening training for healthcare professionals across primary care, emergency departments and hospitals, and improving coordination with specialist community alcohol and drug services.’

The drop ‘must not lull any of us, including the government, into a false sense of security about alcohol harm in the UK’, stated Alcohol Change UK CEO Dr Richard Piper. ‘While a reduction from the pandemic-era spike in harmful drinking was expected over time, deaths are still much higher than pre-pandemic levels and not falling fast enough. And these figures exclude the tens of thousands more deaths where alcohol plays a role, or the millions of us whose lives are affected by the wider toll alcohol has on our health, wellbeing and quality of life.’ While the government had ambitious national plans to tackle issues like smoking, it was ‘falling short on meaningful policies to prevent alcohol harm’, he said.

The latest statistics represented a ‘step in the right direction, but we must meet it with caution, not celebration’, agreed WithYou CEO Simon Phillips, with more than 75 per cent of people with alcohol dependency still not accessing treatment. ‘The underlying challenges are pervasive and deeply concerning. Despite investment in recent years, services continue to be under pressure after years of chronic underfunding. Further, policy failures have prevented alcohol treatment from progressing. The last UK government alcohol strategy was published more than ten years ago, but alcohol-related deaths have been rising since 2001.’

Alcohol-specific deaths in the UK: registered in 2024 is available here

Is anyone listening?

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Girl talking into tincan telephone to illustrate feature on patient communications
People enter treatment with a mixture of fear and hope. The first interactions are the building blocks for what happens next – so are we getting the conversations right, asks DDN.

When someone plucks up the courage to come into a treatment service, they can feel at their most vulnerable. At this crucial point, the quality of communication – what’s explained, how it’s said, what’s asked – can shape that vital next stage, and even the entire course of their treatment.

Conversations with people who’ve accessed opioid substitution therapy (OST) give a mixed picture. Some of the experiences we’re about to share are recent, some as long ago as two decades, but what we wanted to know was – did you have options? Were they explained clearly? Did you have time to ask questions? Were you involved in discussions about review and titration? And how did all of this affect you?

Two distinct scenarios began to form – while some described compassionate, collaborative care, others recalled feeling excluded from decisions, under-informed, or judged. So how much of this was down to the quality of the conversation?

For some, the first contact with treatment services was daunting but ultimately positive. Reagan, who accessed treatment at a clinic in Wales, recalls feeling frightened but supported. ‘The worker was good and helpful,’ she says. ‘I was always involved in decisions with my treatment.’

At the clinic she felt comfortable to ask questions and ‘always had them answered’, and if they didn’t know the answer ‘they would find someone who did’. Later on, hospital staff and midwives were a different story – ‘I was treated so bad in hospital, I was even asked to find my own veins even though I never injected,’ she says. ‘They just assumed that I had, but I was on methadone.’

Julian, who first sought help in the mid-1990s, was fortunate to experience a positive and person-centred approach through his GP. Rather than defaulting to methadone, the doctor took time to assess his situation and discuss alternatives.

‘I was given more than one option of medication… the information was very clear and detailed and I was made aware of what to expect during my treatment,’ he says. Regular reviews and clear communication left him feeling supported and involved: ‘One of the most crucial aspects was that I was made to feel that I was no longer alone in my attempts to become drug-free, and that I had an enormous amount of support and encouragement.’

tincan divider1

However, not everyone was offered that level of engagement.

Several contributors describe being given only one treatment option, typically methadone, with little discussion of possible alternatives. Louise, who entered treatment in 2004, says simply ‘no’ when asked if she was offered more than one option. 

Before arriving at rehab she had a methadone script, which she ‘either sold, or used on its own or with heroin’. Her reception in treatment was not a two-way conversation back then – ‘the more heroin you said you took, the more methadone they gave you, so it was ripe for abuse.’ Was she reviewed and titrated? ‘Not really,’ she says. The chemist offered little by way of further encouragement. While the methadone ‘definitely took the edge of and stopped the rattle’, the chemist ‘used to say it was worse that heroin in some respects and always said it was best to get off it,’ she says. ‘It was very sugary then, and rotted teeth,’ she adds. 

Fifteen years later Cathy from Liverpool was among many others who were still missing out on a partnership approach to treatment: ‘I was only given one option of treatment and that was methadone,’ she says. ‘The information I was given was only brief and I was told I would be put on a low dose.’ However, she was reviewed frequently – the start of something more positive – and she found the medication really started to help, so she was only using heroin ‘once every few months’.

While she felt that she was treated ‘fairly well’ she stumbled with the lack of consistency: ‘changing key workers made it very uncomfortable to open up… I’d just got used to the keyworkers, then was told I was being moved to another service.’ She finally detoxed at home during COVID and is now heroin and methadone free, but remains grateful to the drug and alcohol services, as ‘without methadone I probably wouldn’t be alive today’

Lack of clarity – the missing conversations that should take place – is a common part of the experience. Fraser Parry hears of many such situations in his role as drugs advocacy and support advisor at Release, and says it’s ‘not at all uncommon’ for people to feel excluded from decisions about their treatment. ‘Often people do not have different medications properly explained to them,’ he says. ‘For example, they may not understand that if they choose buprenorphine they could move away from daily supervision more quickly; or that opiates detected in a UDS [urine drug screen] doesn’t mean that a methadone script will be stopped or reduced.’

First impressions are important, and he sees the consequences of many lost opportunities to engage. When practitioners don’t ask the right questions during those first interactions, the cues are missed. ‘One individual I spoke with had – after taking a long time to build up the courage – booked in for his first medical appointment with the intention of asking to be put on methadone,’ he says. ‘At the appointment, without being given the opportunity to even discuss his preference he was given a script for buprenorphine and sent on his way.

Unsurprisingly, he never picked up his first dose, and his trust in the treatment service was hugely affected. This could have been easily avoided had the clinician just asked a couple of simple questions.’

tin phone divider2

Lorraine received OST under two different health boards in Scotland and had contrasting experiences in each.

When she first went for treatment ‘the doctor was nicer, he used to speak to you like a human being. I had a nicer worker too.’

The doctor explained to Lorraine that if he started her on methadone she could be on it a long time, and may find it hard to come off. ‘He sat me down and explained a lot,’ she says. ‘It was nice that he approached it like that. He wanted me to have all the information first so I could make the right choice for me.

‘He’d ask me if I wanted to go up a dose, if I was comfy on it, if I wanted to come down. It helped stabilise my life – I was shoplifting, in and out of jail all the time. So it removed a lot of the chaos and I felt like I was pretty in control of my treatment with that doctor and that worker.’

Moving to a different area, Lorraine had a completely different experience – a drugs worker who ‘kept knocking me back – for rehab, for anything basically’. It felt ‘really harsh’, like they ‘wanted to tell you what to do instead of listening to you. Really speaking down to you all the time… You’re struggling with drugs and they’re giving you it tight all the time, accusing you of giving them a dirty sample, stuff like that.’

She resorted to taking the Medication Assisted Treatment (MAT) standards and ‘slapping them down’ in front of him, asking for a detox. ‘His attitude changed as soon as he saw them,’ she says. ‘He said oh yeah, I was going to get you a detox anyway. I’d been fighting with him about it for a year and just him seeing that I knew what I was talking about changed my treatment straightaway.’

Lorraine’s two experiences demonstrate the dramatic difference in potential outcomes. ‘If you get a worker who will talk you through everything you need to know, the difference is night and day,’ she says. ‘It’s more like you’re a person who can work with them to sort things, than you’re a problem they need to solve. That kind of support can mean you turn your life around within a few years rather than being stuck in one kind of treat­ment for most of your life.’  DDN

 

 

 

 

My first experience wasn’t great. I attended my partner’s appointment with him to see his keyworker, to get his methadone script. I was full of shame and guilt and hadn’t admitted to anyone – except my partner – that I was using heroin and had a habit.

Up until this point I’d been sharing his supervised script that he was collecting daily. He was drinking it in the chemist and saving some in his mouth to pass to me waiting outside. As our heroin consumption increased, the script was no longer holding us both, and at this appointment he was going to ask for it to be increased.

What actually happened at the appointment was that he told his keyworker I was pregnant – another thing along with the heroin addiction that I was in complete denial about. I was 22 years old, had been taking heroin and crack for the last four years and told no one. I had a five-year-old little boy and was five months pregnant.

The reason I didn’t seek support before is that I was CONVINCED they would take my child from me. The guilt and shame I felt and how harshly I judged myself – and knew how others would judge – stopped me from reaching out to get any harm reduction or treatment support.

At that appointment they did what I knew they would do. They told me they would need to contact social services and that I would need a specialised midwife to take on my care for my unborn child and my OST prescribing. It reinforced my belief that I was a terrible person and mother.

I was put on a methadone script and increased quite quickly to 60ml – a pretty high dose as I’d been taking unprescribed methadone – using on top of that, and was pregnant. My dose was given to me daily and supervised, and they would monitor me to see if I needed more. 

Methadone was the only option offered to me. My treatment provider didn’t explain to me the correlation between how much methadone I was being prescribed and my heroin use, and I didn’t know that it was a substitute that would help me get off using heroin. No one explained how it would stop some withdrawals physically, but my brain would still crave heroin and work against the medication. I didn’t know that I would still feel agitated and that my thoughts and emotions would still be pretty much unbearable.

I had a pregnancy bump and was queuing up to take my methadone in front of everyone else that I had been hiding my drug use from. It was humiliating and I felt like the worst mother in the world and a murderer – I really thought I was killing my unborn child, yet I felt I had no choice but to use. I could now no longer function without the methadone in the morning and was taking heroin all through the day too. My habit massively increased, partly because my ‘secret’ was out and partly due to the shame and guilt I was carrying.

My care then got passed on to the substance misuse midwives. They was amazing – discreet, compassionate, and gave me all the information about harm to my baby: the facts, not just that I was killing my baby, but the harms that using was doing and how I could minimise the risk. They helped me reduce the amount of heroin I was using, and then eventually stop and stick to my script. 

They treated me like a mum that was trying her very best to drastically reduce the harm I was causing my baby and put me on a reduction plan with realistic goals. Once I engaged and kept all my appointments with them, they offered me a detox bed, specifically for drug-dependent expectant mothers on a maternity ward, which I could stay on until our baby was born. I managed to stay substance-free until after the birth and although I did use again, my baby was born without withdrawals. I had done what I needed to do for her, which was a miracle to me.

I think the treatment plan saved me, I really do. It reduced the harm to my unborn child and it also helped me to keep my children.

Emma is now enjoying life in active recovery

Grateful thanks for input to this article: Emma, Julian, Louise, Red Rose Recovery, Lorraine, SDF, George Charlton, Reagan, Cathy, Fraser and Release

Clearer Conversations is an ongoing series and we would love to hear from you if you are willing to share your experiences of treatment – please email the editor, claire@cjwellings.com

This series on Clearer Conversations in OST has been made possible by an educational grant from Camurus, who have had no involvement in the content of these articles.

Broadway Lodge Survey: Insights on Stigma & Addiction

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DDN
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Broadway Lodge are conducting research to understand current thoughts around stigma and addiction specifically from people who have lived experience of addiction.

Survey on stigma and addiction
Breaking the Stigma: Your Insights on Addiction

If you have experienced addiction personally, please consider completing our short, multiple-choice, anonymous survey which should take no longer than 5 minutes to complete by clicking on the link.

Responses will remain anonymous and will help us raise awareness and drive meaningful conversations about reducing stigma in society. Your time and input is valued so thank you in advance.

This survey will be live until Sunday 24th May

They would like to see what trends (if any) appear in relation to what people feel they have experienced, what can cause it and what they think could be done to try to reduce stigma in society.

The findings will be used to drive conversation in the sector.

Complete the survey Breaking the Stigma: Your Insights on Addiction

 

Drugs ‘too readily available’ in HMP Leeds

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DDN
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Illicit drugs remain easily available in HMP Leeds, according to a new report from HM Inspectorate of Prisons – with some men even being paid to get recalled so they could bring drugs back inside.

More than a fifth of prisoners tested positive in mandatory drug testing – higher than the previous rate

Too many prisoners were also developing a substance misuse problem while actually in the prison, says the review, which is a follow-up on concerns raised last year.  More than a fifth of prisoners tested positive in mandatory drug testing – higher than the previous rate – with positive results in around two thirds of suspicion drug tests.

HMP Leeds is a large category B establishment holding more than 1,000 men, with a high turnover of remand and recalled prisoners, high levels of overcrowding and around 600 new arrivals every month. The inspectorate’s 2025 review also found the highest number of self-inflicted deaths of any adult male prison. While the prison now had a new governor and had since made progress on issues such as early days support, there had been three more self-inflicted deaths since last summer, the report states.

A prison service spokesperson told the BBC that the prison was ‘still operating under immense pressure – that is why we are already taking urgent action to tackle the spread of drugs by investing over £40m in new prison security nationally and reduce self-harm by strengthening support for prisoners who may be at risk’.

Last year a report from HM Inspectorate of Prisons stated that drugs were now ‘undermining every aspect of prison life’ in England and Wales, and called on the government to take the threat ‘far more seriously’.

Analysis published last month by OHID and the Ministry of Justice found that giving prisoners OST on their last day in custody was associated with a 54 per cent reduction in the risk of a drug-related death in the four weeks following release, with around 75 per cent of prisoners serving short sentences estimated to have substance misuse issues. According to Dame Carol Black’s Independent review of drugs, ‘people with serious drug addiction’ now occupy one in three prison places overall.

HM Inspectorate of Prisons report on HMP Leeds available here

Streets ahead

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DDN
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As pioneering street publication The Big Issue celebrates its 35th birthday, Carl Stanley invited co-founder Lord Bird to discuss its achievements and what the future holds.

Streets ahead interview in ddn magazine with John Bird founder of the Big Issue

Congratulations on an amazing achievement, as The Big Issue reaches its 35-year anniversary. It was built on the back of your passion to give homeless people not only a voice but the much-needed support required to get out of homelessness and start a new life – what were your initial hopes for the magazine, and what were the difficulties in trying to establish it on the streets back in 1991?

My aim was to bring the homeless person out of a system of begging and relying on the goodness of the public into a position of trading – selling a product that they were proud of, and wanted to sell.

When they started selling The Big Issue, their self-worth went up and they were more likely to interact with the public, which we can still see today is a great motivator for the vendor. I suppose my hopes were to give people with no option apart from illegal activity a chance to become an honest person, and feed their addictions without having to sell their bodies or rob people.

Looking back on those 35 years there are so many achievements and milestones. But what are your own personal favourite moments in the history of The Big Issue, and why?

My favourite moment was when I saw a Big Issue vendor I was about to de-badge for bad behaviour. Just before I approached him a police officer came up and gave him a coffee and a sandwich.

I followed the officer and asked him why he’d done it and told him who I was – he shook my hand and said that in the last two weeks the vendor had completely transformed himself from an anti-social pain in the arse into almost a model citizen. The policeman thanked me for starting The Big Issue – helping bad people become good people was wonderful to see.

The Big Issue continues to grow and adapt a changing society. One example is teaming up with the likes of Lenovo and giffgaff for projects where vendors are not only given smartphones but also IT training.

How does The Big Issue see its mission to fight homelessness in such a technically enhanced world?

Our current challenge is the reinvention of The Big Issue as a model. Back in 1991, for every two papers sold, one was taken. We didn’t mind that as we were still selling thousands of copies a week.

Now for every 20 sold, only one is taken. This is most likely a combination of people not wanting to read a paper or thinking it’s better for the vendor. We’re currently being killed by kindness and we must adapt. I’m personally very excited for the future, as challenge is a catalyst for change. 

There’s no doubt in my mind that we’ll never stop working and supporting our vendors on the street, as they are the real heroes. I suppose the triumphs are the fact that hundreds of thousands of vendors have sold the magazine and we’ve produced millions of pounds of sales that has directly gone to them.

Coming into 2026, there have been so many societal changes that in turn have led to an unprecedented rise in homelessness across the country, something which you made quite clear earlier this year with your statement that ‘poverty is destroying us’, and highlighting child poverty as one of your main concerns.

With the recent amendment to the children’s wellbeing and schools bill you tabled failing to gain government backing, where do you feel that leaves the situation regarding poverty and homelessness right now in the UK?

 

I believe the reason we have record high numbers of homeless people is because they were failed years before they became homeless. Apart from a few exceptions, I haven’t met a homeless person where their only problem is that they’re homeless. They’re normally battling drug and drink addictions, they come from incredibly horrific backgrounds. The only thing people in poverty inherit is poverty itself. 

We must tackle the root causes of poverty – we must support the children of poverty as they will pay the highest prices for our failure as a country. We have an ideology in government that’s based on keeping the poorest amongst us as comfortable as possible – not creating a route out. For many years I’ve been badgering on about a ministry of poverty prevention. I’ve now changed my ask – I’m calling for a commissioner of poverty prevention and cure that will report directly to the prime minister and create a space to talk and discuss what the future of prevention looks like.

What do you feel are the first changes that should be made to tackle this head on? More affordable homes, government funding and a change in policy, or is it much deeper than simply funding, as you’ve stated previously with what you term PECC – ‘prevention, emergency, coping and cure’?

With ‘emergency’ and ‘coping’ usually receiving the majority of government funding, do you find ‘prevention’ is still somewhat overlooked?

I find the cause of prevention to be completely overlooked in the name of making the homeless and poorest comfortable. Recently the government released its newest figures on homelessness, and we have the highest number of homeless people since 2010 – which was when the recording of the numbers started. 

They announced a £50m boost to homelessness – what they failed to mention to the public was that £35m went mostly on homeless shelters and prep for winter, and only £15m on prevention.

We’re in a constant cycle, because no one in government stops and looks around and asks the very simple question of what can we do to stop these people being homeless, and not just comfortable? We have to shift our funding away from emergency and firefighting and more into prevention and cure. I believe very strongly that if we do this we can finally change the narrative and create a path out of poverty.

If I could ask about the services that have been crucial in supporting homeless people out of poverty – housing, mental health, drug and family support, all of which The Big Issue has had the strongest of links to.

It seems to be the disconnection between services, and long waiting lists, that are still mentioned as the biggest problems. How do you feel they’re holding up right now?

We naturally need more affordable and social housing, and support for the drug rehabilitation centres. The problem lies in when the coping doesn’t then lead to cure, and we don’t spare a thought for prevention.

I’m sorry if I sound like a scratched record, but the fact of the matter is that we spend billions and billions on everything a homeless person would need or want – apart from a job, or education, or mental health. This is what will lift you out of the sticky stuff and onto a path of recovery from poverty.

Lastly, after coming so far with The Big Issue over the last 35 years and everything you’ve put into it, what would be some of your personal hopes and dreams when it comes to the future of the magazine, and why?

I feel very proud of the fact that over the last 35 years we’ve never stopped supporting the vendor on the street, regardless of what’s happened around the world.

We’ve always done our best to be there for them. When in 2020 we were told that all vendors had to be off the street, we were there to make sure they were housed and looked after. We gave them some money to make sure they had something when the government stopped housing them. 

As the world changes, so do we. This year is a year of transformation, a time to change to make sure we’re relevant and as supportive to the vendors as ever. At this moment we aren’t sure how things will change, but we will never turn our backs on anyone who wants to sell the paper. And we’ll never stop supporting our vendors.

Carl Stanley is a freelance writer

Cold Sober

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DDN
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ddn article on the cultural importance of pubsThere are more challenges involved in stopping drinking than simply no longer consuming the substance itself, says bar operator Jason Rothwell. For men in particular, it can often mean losing a sense of identity and belonging.

For the best part of nine years, I’ve stood behind the bar of my own venue watching people come together. I’ve seen friendships built, relationships formed, problems shared, and – at times – quiet struggles hidden in plain sight. On the surface, it looks like people are just having a drink. But if you stand there long enough, you begin to realise something deeper is happening. The pub isn’t just a place – it’s a structure, a rhythm. For many, particularly men, it’s part of who they are.

And that’s where my research begins. My PhD, The stigma of sobriety: auto-ethnographic reflections on alcohol, masculinity, and the hospitality-health divide in modern British culture, is rooted in a simple but underexplored question – what happens when alcohol is removed from environments where identity, belonging, and connection have long been built around it?

Cultural DNA

For many northern men, alcohol isn’t just something you do – it’s something you’re surrounded by from the very beginning. Birthdays, weddings, funerals, catching up with friends – it all revolves around the pub. Over time, this becomes normal, part of the cultural DNA. So when alcohol is removed – whether by choice, necessity, or medical advice – it’s not just the drink that disappears. It can feel like everything connected to it disappears too.

I see this not just as a researcher, but as someone embedded in the environment I’m studying. I run a venue. I’ve lived in these spaces. And increasingly, I’ve observed them from the outside as well – spending sustained periods sober, standing in the same room but experiencing it very differently. As a researcher, I believe it’s important to understand a subject from all angles, and those periods of sobriety have provided a valuable grounding – allowing me to experience first-hand the social dynamics, tensions, and subtle disconnections that can emerge when you step outside the norm.

There’s a moment in most evenings where the atmosphere shifts. Early on, everything feels balanced. Conversation flows, people are aligned. But as the drinks build, something changes – the pace, the humour, the energy. If you’re sober, you feel it at once. You’re not excluded, just out of step with the rhythm of the room.

That feeling – of being present, but not quite aligned – is one of the biggest challenges facing people who are trying to reduce or stop drinking. Alongside this, there’s often a dual pressure at play. On the one hand, there can be subtle – or at times more direct – social pressure to join in. What might be dismissed as light-hearted encouragement can become a form of ‘sober shaming’, where not drinking is treated as something that needs to be explained or corrected.

But beyond that external pressure, there’s a deeper internal challenge. The feeling of missing out is not just about others – it’s tied to something more ingrained. For many men, drinking is embedded within the cultural DNA of social life, built up over years of shared experiences and expectations.

Expectation

So in many cases, it’s not just about saying no to a drink. It’s about navigating both external expectations and the internal sense of stepping outside something that’s long felt like a shared norm. What this highlights is a gap in how we approach alcohol reduction. Policy often focuses on consumption, availability and price, but far less attention is given to the lived social experience of change – particularly in environments where alcohol has shaped identity and belonging.

If that dimension isn’t better understood, there’s a risk that well-intended interventions overlook one of the most significant barriers to change – not stopping drinking itself, but what it means to remain in the space without it. This is where the concept of the pub as a ‘third place’ becomes critical. These are spaces beyond home and work where people connect, form identity, and build relationships. For many men, particularly in the North, the pub has been the primary third place.

It’s where advice is given without formality. Where problems are aired without pressure. Where you don’t have to explain yourself – you just belong. So when we talk about reducing alcohol consumption, we also need to ask: what replaces that? Because what I’m increasingly seeing is that when the pub declines, or when individuals step away from alcohol, the social structure doesn’t always evolve alongside it. Instead, drinking often shifts into the home – out of sight, behind closed doors, without the same level of interaction or informal regulation.

And this is where the conversation becomes more serious. Behind those closed doors, drinking can become more isolated, less visible, and less moderated. The informal support systems that exist in pubs – conversation, familiarity, simple human presence – are removed. What can follow is a quiet escalation of mental health challenges – isolation, low mood, anxiety, and a lack of connection that is not always recognised. So if we’re not careful, in trying to reduce harm in one setting, we risk displacing it into another – one that’s far less visible and far less understood.

I also recognise that my position in this conversation isn’t neutral. I make a living from selling alcohol. That alone can attract suspicion from some health groups. But this research isn’t about promoting the pub, and it isn’t about defending alcohol. Alcohol is not going away. The question is not whether people will drink – it’s where, how, and in what context that drinking takes place.

Connection

Currently, around 75 per cent of alcohol consumption happens behind closed doors. That’s the reality we’re working within. So the question becomes: is that where we want drinking to be concentrated – in private, unregulated environments, often in isolation? Or should we be exploring ways to bring people back into shared, social settings – where connection exists, behaviour is visible, and informal support structures still play a role?

This is why I believe we need to think differently about the role of the pub. Rather than viewing it purely as part of the problem, there’s a strong case for seeing it as part of the solution – a partner in health. A managed, social environment where behaviour is visible, connection is present, and people are not alone.

Because the alternative, in many cases, isn’t no drinking at all. It is drinking in isolation, without the social frameworks that have historically helped regulate it. This is particularly important when viewed through the lens of masculinity.

For many men, alcohol isn’t just a behaviour, but a cultural norm embedded within key life events and everyday interaction. Over time, this becomes less a choice and more an assumed structure. Removing alcohol from this context creates a form of social displacement. The question shifts from ‘how do I stop drinking?’ to ‘who am I in this space without it?’ From what I’ve observed, this internal struggle – the loss of alignment with environment, peers, and identity – is one of the biggest barriers to change. In many cases, it’s more significant than the physical act of stopping drinking. And yet, it remains largely overlooked.

So if we’re serious about addressing alcohol-related harm, we need to look beyond the substance itself and towards the environments, identities, and social structures that surround it. Because when you take alcohol out of the pub – or take the pub out of the community – you’re not just removing a product. You are, in many ways, removing part of the cultural DNA.

jason Rothwell
Jason Rothwell is a hospitality operator and PhD researcher at Lancaster University Law School

If we fail to understand what the pub represents – not just as a place to drink, but as a place to belong – we risk driving behaviour into more isolated and less visible spaces. Increasingly, that means drinking behind closed doors, where alcohol is cheaper, less regulated, and consumed without the social frameworks that once surrounded it.

That shift is not neutral. It carries consequences – not only for individual health, but for wider public health outcomes and long-term fiscal sustainability.

DDN May 2026

By
DDN
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Can we create spaces to move forward?

DDN Magazine may 2026We all want to feel like we belong and for young people peer influence can be intense. This month’s cover story shows how supported accommodation – such as hostels and shared housing – can multiply risks, but also provide many opportunities. The challenge is where and how to intervene, and that’s not about trying to dismantle peer networks (unrealistic!) but about reshaping the places in which they operate – something we do have influence over. Can we create spaces where young people are not just supported to cope, but to move forward?

It’s all about catching the moment, and quality of interaction is never more important than when entering treatment – at whatever age. This issue we begin our ‘Clearer Conversations’ series and with your help we’ll look at experiences of entering services: Were there choices? Were they explained? Was it a positive, listening – and ongoing – therapeutic relationship? 

What can we do better? We’re setting the scene and want your input to examine how we can have better, warmer, and more productive interactions around treatment. We hope to build a resource to learn from, so please get in touch!

Read the May issue as an online magazine (you can also download it as a PDF from the online magazine)

Please send your letters and comment to claire@cjwellings.com

Claire Brown Editor of DDN Magazine

Claire Brown, editor

Time for a rethink

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DDN
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Surrey Changing futures mental health article: Time for a rethink

Last month’s article explored the benefits of the Bridge the GAP model for supporting people experiencing multiple disadvantage (MD) in Surrey (DDN, April, page 12). For individuals experiencing MD, conventional mental health and substance use treatment pathways can be overly structured, overwhelming and difficult to navigate.   

When we talk about substance use and mental health treatment it can often be assumed that treatment starts from the first ‘clinical’ intervention – formal, time-limited activities delivered within a clinical governance framework. But for people experiencing MD these pathways assume a level of compliance that’s not always possible – and it’s often the voluntary sector that serves as the community safety net to catch them when they fall out of formal treatment. 

Surrey’s Bridge the Gap Model was coproduced by a community of residents with lived experience of MD, and is delivered by an alliance of 12 of Surrey’s VCSE organisations taking a holistic, person-centred and trauma-informed approach. It’s through the relational model, delivered alongside VCSEs and offering intensive support over a longer period of time, that trust is built and clients begin to develop the emotional regulation needed for them to stabilise, achieve agency and prepare for the more structured offer of substance use treatment. 

The trauma-informed care delivered by a skilled outreach worker is not a precursor to formal treatment – it is treatment. Bridge the Gap conducts highly skilled interventions that are not formally recognised as such by partner agencies because they’re provided through the voluntary sector. The model follows a psychosocial approach tailored to each individual’s goals and readiness, understanding challenges as complex and interconnected. It avoids a ‘too much too soon’ approach often associated with structured treatment offers to clients with a history of complex trauma, and works to avoid re-traumatisation and to overcome service weariness. 

The voluntary sector excels at this work precisely because it’s not bound by time pressures, risk-averse policies and diagnostic frameworks. Bridge the Gap supports a high number of people with neurodivergence who struggle with existing services, large numbers of people with co-occurring substance use and mental health challenges, and increasing numbers who are rough sleeping.

Individuals often present with multiple labels – one person had seven, including ASD, ADHD, EUPD and PTSD. Labels can mean people get passed from service to service, but Bridge the Gap works with the person rather than their labels. Learning has also been fundamental to the programme, with more than 1,000 hours of direct training.

Surrey published its first MD joint strategic needs assessment in 2024 – the research identified that there is ‘a place for both relational and medical support models to effectively work in tandem to ensure equitable access, experiences, and outcomes for all’. 

Funding must follow the evidence. ‘While statutory and clinical services play a vital role, we know that for people with the most complex needs, engagement is not always straightforward,’ says Sue Murphy, CEO of Bridge the Gap provider Catalyst Support. ‘System thresholds, appointment-based models, and fragmented pathways can all create barriers for individuals whose lives are already unstable or who have experienced previous trauma. As a result, support often comes at the point of crisis.’

This is not a separate or alternative pathway, but part of a wider system response. ‘Effective support for people experiencing MD depends on how well different parts of the system work together so that people can move between services without losing continuity or being required to repeatedly retell their story,’ she continues. ‘If we are to improve outcomes for people experiencing MD, the focus needs to remain on system integration ensuring that support is timely, joined-up, and coherent.’  

System leaders must look beyond just statutory commitments and build and invest greater capacity in the wider system. By funding VCSE organisations appropriately, a wider workforce can be developed alongside improved service pathways designed to support vulnerable populations. It’s time it was recognised that the interventions provided by the charitable sector are often an essential first stage of substance use and mental health treatment – not a discretionary bolt-on. 

Helen Munro is marketing and communications lead at Changing Futures Surrey.

M’s STORY

M was a long-term substance user who was feeling victimised and harassed by their live-in landlord. While feeling they had no option other than to move out, they didn’t meet the threshold for domestic abuse housing support as they were fleeing a landlord rather than a partner. 

They started sofa surfing and spending most days at a homelessness charity. A Bridge the Gap outreach worker supported them in organising their administrative paperwork and eventually helped them into safe, secure accommodation as well as accessing funding and charity support to purchase basic furniture. 

M said that ‘having the help and support when I was highly stressed has been incredibly helpful.’

Record cocaine seizures across Europe

By
DDN
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The market for cocaine in Europe is ‘now the biggest in the world and still growing’, says a new report from the Insight Crime think tank. Last year saw France record a 49 per cent increase in seizures alongside a 25 per cent rise in Belgium, while Portugal is also becoming a ‘key hub’ for cocaine trafficking to Europe.

Rates of coca cultivation and cocaine production are continuing to rise, with production in Colombia increasing by more than 50 per cent in 2023 alone.

Belgium remains the main European destination for cocaine imported via maritime traffic, however, with the port of Antwerp the primary entry point. Brussels is facing rising rates of drug-related violence as a result, the report continues, with an ‘unprecedented surge in the frequency and intensity of shootings’.

As the Belgian authorities have increased security measures traffickers have increasingly been looking at other entry points, with Spain seizing large amounts of cocaine from semi-submersible submarines and speedboats. The UK Border Force, meanwhile, seized almost 15 tonnes of cocaine worth more than £1bn in a single three-month period last year – ‘equivalent to the weight of a London double decker bus’.

The findings reflect the data from the latest European wastewater analysis by EUDA and SCORE, which saw a 22 per cent increase in cocaine residue detected between 2024 and 2025. Separate wastewater analysis by the Home Office analysis showed an estimated £9.8bn cocaine consumption in England alone in the year to July 2025.

The UK Border Force seized almost 15 tonnes of cocaine worth more than £1bn in a single three-month period last year

Rates of coca cultivation and cocaine production are continuing to rise, with production in Colombia increasing by more than 50 per cent in 2023 alone. Prices, however, are ‘not falling as increased supply would suggest’, the document states. ‘The cocaine industry seems immune to normal market pressures.’

As the traditional markets of Western Europe and the US become saturated, traffickers are also looking to develop new markets ‘where prices are higher and risks are lower’ the report continues, with South Korea seeing 300 per cent increase in seizures last year and Australia registering a 40 per cent increase. ‘Complementary to this, we are seeing the growing involvement of European mafias in the cocaine business, not just to Europe but worldwide,’ Insight Crime states.

Traffickers are also evolving their transportation methods in response to improvements in port security and container scanning with ‘growing discoveries of semi-submersible vessels or narco-subs’, the report says. Gangs are increasingly mixing their cocaine with different chemicals or organic matter for transportation, or converting it into liquids to bypass the growing scanner capacity at ports. ‘By moving liquid cocaine to evade modern scanners and using alternative transportation like sailing vessels, criminal organizations are making the global cocaine trade more innovative and geographically diverse than ever.’

Meanwhile, the tobacco and vapes bill has now come into law, ‘delivering a historic step towards a smoke-free UK’. The bill passed its final stages in the House of Commons last week. The legislation ‘marks a turning point for the nation’s health’, said health secretary Wes Streeting. ‘By ending the cycle of tobacco addiction for future generations, we are taking one of the boldest steps in decades to prevent illness before it even begins.’

‘This is a truly watershed moment in public health. It is no longer a question of if smoking will end but rather a question of when,’ added ASH chief executive Hazel Cheeseman. ‘Smoking has prematurely taken millions of lives in the UK over the last 50 years. Ridding our society of the pain and suffering it causes is a gift to future generations.’

 InSight Crime 2025 cocaine seizure round-up available here

State of the Family Support Sector 2026

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DDN
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Family Support
The purpose of this survey is to look at the current state of play of drug and alcohol family support.

Adfam has launched its State of the Family Support 2026 survey. Conducted every three years, this survey gathers vital insights into the current landscape of drug and alcohol family support, including service delivery, sustainability, funding, and partnerships.

The findings will help identify changes across the sector, highlight emerging trends, and explore the opportunities and challenges facing organisations, and what this means for families.

The survey is for anyone working at an organisation that supports families affected by substance use and takes 10-15 minutes to complete and can be done anonymously.

Open until Monday 1st June 2026.

Take part via this link: https://www.surveymonkey.com/r/99XMMTL

DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Adfam

Suspected Scottish drug deaths up by more than 30 per cent

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DDN
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There were 330 suspected drug deaths in Scotland between December 2025 and February this year, according to the latest Public Health Scotland (PHS) figures – 31 per cent up on the previous quarter, and 16 per cent higher than the corresponding period last year.

Scottish Ambulance Service naloxone administration incidents fell by 10 per cent compared to the previous quarter

Scottish Ambulance Service naloxone administration incidents, however, were 10 per cent down on the previous quarter, says the Rapid action drug alerts and response (RADAR) quarterly ​report. Drug-related attendances at emergency departments were also 6 per cent lower than the previous quarter, while drug-related hospital admissions overall were down by 21 per cent.

‘Drug-related harms remained at a high level in the most recent quarter,’ the document states. ‘While some harm indicators have decreased, they remain higher or similar to the same period in 2024 and there has been a marked increase in suspected drug deaths compared with both the previous quarter and the same period in the previous year.’ Contamination of the drug supply continues to be ‘common and widespread’, it continues, with nitazene-type opioids detected in post mortems at high levels. Earlier this year PHS warned that anyone using street drugs should assume they were contaminated with other substances.

Cocaine was the most commonly reported main drug in treatment assessments, while the benzodiazepine market ‘continued to shift’, with increasing reports of new substances and changing tablet types. The agency regularly received reports of fake medicines, the report adds, most commonly referring to benzos, gabapentin and pregabalin – these were ‘often seen in legitimate-looking packaging (including boxes and blister packs) but when tested contamination is common’.

‘The emergence and establishment of a highly toxic drug supply, in addition to widespread polysubstance use, has increased the risk of overdose and the likelihood of death, despite the estimated number of people with opioid dependence remaining stable,’ the document states. ‘A coordinated multi-agency approach that prevents drug harms and enables access to treatment, care and recovery support remains critical.’

Widening pathways of low-threshold access to care via proactive outreach alongside ‘enabling meaningful engagement in settings other than drug treatment services’ were necessary early interventions in a period of heightened risk, it says. ‘Scotland continues to be impacted by a period of rapid drug market change during which there remains a very high likelihood of sudden, localised spikes of severe harms.’

The Scottish Government published its new ten-year drug and alcohol plan last month.

Rapid action drug alerts and response (RADAR) quarterly ​report available here

Longer opening hours ‘significantly’ increase alcohol-related ambulance call outs

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DDN
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Extended late-night opening hours for bars and pubs can significantly increase alcohol-related ambulance call outs as well as levels of reported crime, says a report from the University of Glasgow in partnership with the universities of Stirling and Sheffield.

There were also ‘no meaningful economic benefits’ from longer opening hours, it adds, meaning they were ‘unlikely to revitalise the night time economy’.

There were ‘no meaningful economic benefits’ from longer opening hours, says the report, meaning they were ‘unlikely to revitalise the night time economy’

The study, which is the first of its kind in the UK, looked at the impact of extended opening in bars and pubs across Glasgow and Aberdeen. Longer and more widespread licensing extensions in Aberdeen led to an 11 per cent increase in ambulance call outs along with an 8 per cent increase in reported crime, while in Glasgow – where far fewer venues had extended opening, and those that did had more regulated extensions – there was no comparable increase in either call outs or crime. Almost 40 Aberdeen venues were granted late-night extensions of up to three hours, while Glasgow saw just ten venues granted a one-hour extension. These were nightclubs that had ‘already implemented specific safety measures’ the researchers point out.

Scotland saw more than 31,000 alcohol-specific hospital admissions in 2022-23, with alcohol estimated to be involved in more than 15 per cent of all ambulance call outs. Last year a Public Health Scotland report projected that the number of Scots living with chronic liver disease would increase by more than 50 per cent by 2044 – an additional 23,100 people.

Meanwhile, a new report from the Health Foundation think tank states that average healthy life expectancy in the UK – defined as the number of years someone can expect to live in good health – fell by two years in the decade to 2022-24, to just over 60 for both men and women. The vast majority of areas saw a decline over the decade, with a 20-year gap opening up between the most and least deprived areas.

The vast majority of areas saw a decline over the decade, with a 20-year gap opening up between the most and least deprived

‘Of 21 high-income countries, the UK is one of only five that saw healthy life expectancy fall between 2011 and 2021, and had the second steepest decline,’ the document states. ‘As a result, the UK has fallen from 14th to 20th out of these countries – only the United States now has a lower healthy life expectancy.’ The economic and human costs were ‘huge’, said Alcohol Focus Scotland, with high levels of alcohol-related illness and death forming ‘part of the picture’.

The findings reinforced the ‘growing evidence’ about declining health in the UK, the report continues, with successive governments failing to take the long-term action needed to address it. Cross-government action was needed on the wider factors that shape people’s health, it adds, with a ‘shift to prevention and a new strategy to address economic and health inequalities.’

Impact of later trading hours for bars and clubs on alcohol-related ambulance call-outs and crimes in Scotland is published in the journal BMJ Public Health and available here

 Healthy life expectancy trends in the UK: a watershed moment available here

What We Learned About England’s State-Funded Residential Rehab

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DDN
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A New Picture from FOI Analysis

By James Armstrong, Director of Marketing & Innovation

Over the last decade, England’s residential rehab sector has been quietly shrinking. Rehab placements have fallen by almost 50 per cent, and the number of available services has declined by a similar proportion. At the same time, service quality and regulatory expectations have never been higher. Yet despite this increased scrutiny, very little is known about the true size, shape, or functioning of England’s state-funded rehab system today.

James Armstrong, Director of Marketing & Innovation (left)
James Armstrong, director of marketing and innovation (left)

To help fill that gap, Phoenix Futures submitted Freedom of Information (FOI) requests to every local authority in England, asking for details of budgets and expenditure on residential rehab over the past three years. What we received back offers one of the clearest pictures in years of how rehab is funded in England, who controls the money, and what it means for the future.

Read the full report 

 

 

DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of Phoenix Futures

‘If someone asks for help, we help’: Cornwall service supports 4,100 a year

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DDN
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Around 4,100 adults are supported each year by drug and alcohol charity WithYou in Cornwall, the charity reveals, reflecting both the scale of need and the importance of accessible, person-centred services.

Of those accessing support, 37 per cent are struggling with opiates, 33 per cent with alcohol, and 30 per cent with a range of other substances. The figures highlight the complexity of need across the county, with many people requiring tailored and flexible support.

At the heart of the service is a simple principle – that help should be easy to access.

‘There’s no referral criteria,’ says Will Whittaker, team leader for outreach. ‘If someone comes in or rings up and says ‘I want help’, we’ll help them. I’m really proud to work at a place that does that.’

That open access approach underpins a wide range of support, including one-to-one sessions with key workers, peer support groups, medication, needle exchange services, and the distribution of naloxone. The service also provides support for families and friends, recognising the wider impact of substance use.

Alongside clinical and harm reduction interventions, WithYou supports people with the practical aspects of rebuilding their lives – from accessing housing and managing debt to developing life skills such as cooking and budgeting. The service also offers pathways into employment and runs a residential rehabilitation programme.

‘We work in a person-centred way, we’re not looking at a one-size-fits-all,’ explains key worker Amy Chiswell.

That flexibility extends to more specialist provision for groups with particular needs. The Armed Forces Community programme supports around 600 veterans and their families, recognising the specific experiences of military life and using those strengths to support recovery.

The Women’s Team works with more than 100 of the most disadvantaged women in the area, providing holistic support that goes beyond substance use to address wider challenges, often in partnership with other services.

For staff, the impact of the work is clear.

‘I get something out of it as well, that’s the beautiful thing about it,’ says community engagement co-ordinator Billy Horton. ‘We build people’s confidence, their self-esteem, their self-worth. Seeing that happen, you feel it too.’

Amy agrees that the human element is central to the service. ‘If you’ve got empathy then you’re already showing someone something that they might never have encountered before,’ she says.

WithYou has recently launched a film featuring the voices of clients and staff, aiming to raise awareness of the service and the work taking place across Cornwall. The film captures the commitment of the team, as well as the experiences of people accessing support.

‘Everyone is here because they want to be, because they care and have a real passion for the work,’ says Amy. ‘You can feel that when you walk into the office.’

community engagement co-ordinator Connor Harmsworth
Community Engagement Co-ordinator Connor Harmsworth

For community engagement co-ordinator Connor Harmsworth, that sense of purpose is what sets the service apart.

‘You’ll never work anywhere else like WithYou,’ he says.

As demand continues to grow, services like WithYou remain a vital part of the local response – offering accessible, flexible support to people at different stages of their journey, and helping to ensure that when someone asks for help, there is someone there to listen.

DDN magazine is a free publication self-funded through advertising.

ddn magazine partnersWe are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created on behalf of WithYou

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