Drink and Drugs News DDN 1804 - Page 10

Letters and Comment DDN welcomes your letters Please email the editor, claire@cjwellings.com, or post them to DDN, cJ wellings ltd, romney House, school road, Ashford, Kent tN27 0lt. letters may be edited for space or clarity. ‘...it’s best to turn a blind eye to the “recreational” and focus instead on the genuinely problematic.’ unwanted interventiOns I very much enjoyed Mike Ashton’s look at the chequered history of alcohol brief interventions (DDN, March, page 22). My gut feeling has always been that they’re at best useless, and at worst potentially counter-productive and – while I realise the jury is still out – it’s nice to get even a tiny bit of academic back-up for that. And surely, they’re also at odds with much of the current direction of thought around drug use, as espoused by more and more police and crime commissioners – that it’s best to turn a blind eye to the ‘recreational’ and focus instead on the genuinely problematic. James Burton, by email HObsOn’s cHOice ‘Find out who your local commissioner is, and let’s bring some new thinking in,’ advises Paul Musgrave in your conference reports (DDN, March, page 12). Well I’ve known who my commissioner is for quite a while. The problem is he doesn’t know who I am, nor does he seem to have the slightest interest in finding out, let alone 10 | drinkanddrugsnews | April 2018 listening to anything I might have to say. I realise my experience may not be all that representative, but somehow I doubt it. ‘It’s all about choice,’ he says earlier in the article. Fine, but whose choice exactly? Name and address supplied Privileged POsitiOn Commissioning for change (DDN, February, page 10) was a good article. What is apparent in the current commissioning environment is the generalising of commissioning across local authorities, leading to poor analysis of need, poor engagement and, consequently, poor decision making. Money is being wasted on ideas rather than need, because no one connects the pieces anymore. Partnership work, so fundamental to complex health and wellbeing cases, is best driven by a common understanding of shared responsibility and shared outcomes. That’s always been difficult, made increasingly so now by fractured thinking at the very top, which has fragmented commissioning across three different structures – NHS, CCG and local authority/public health – that see themselves in competition, even if they’re unwilling to admit that publicly. The one thing I would take issue with in the article is what seems to be a focus on the effect – the use of a substance which needs to be resolved. What needs to be resolved is the causation – the background, be it peer pressure, abuse or mental health, which leads many to self- medicate, to misuse substances. How do we as people face this? By seeing each person we label pejoratively as an addict or worse, as a human being like us, someone who is a mother, sister, aunt, brother.… How do we, as commissioners, resolve this? We can’t. Only those who experience the effect can do that. Commissioners need to be able to provide the tools to assist that process. If any commissioner/authority is brave/far-sighted enough to try, distributed networks, together with ‘time banking’ offer some solutions for individuals to break away. As humans we all like to live in networks of like- minded people – it’s easy and we’re lazy. Those who are locked in a cycle of substance misuse need to be offered the opportunity to break from their homogeneous networks to ones that are more varied. ‘Time banking’, as envisaged by American civil rights lawyer Edgar Cahn, offers part of the solution: providing a reason to integrate, an inspiration to change. But this has to be a bold move, energising thousands, not the few, establishing communities that thrive and don’t pay lip service to people’s aspirations, because of local attitudes. Treatment is an adjunctive, a means by which we help people focus on their aspirations and their innate skills to move to where they need to be. As providers/commissioners we should be privileged to work with people who have survived so much and who currently are so let down by our system. Clive Hallam, via www.drinkanddrugsnews.com Out Of cOmmissiOn I have been out of commissioning now for over three years. I was involved from the mid 1980s across drugs and alcohol, through the biggest wave of class A and immunological challenges. For all the flaws of the NTA a great deal was achieved. That achievement to my mind was to a great extent driven by a sometimes unholy NHS, local authority and criminal justice alliance, but with a limited presence of user and recovery perspectives. Mental health and housing were never really properly integrated. So some, but not enough, foundations. What happened afterwards led to the building of even more impressive new structures amid the shifts of resource to CCG and local authority and public health. That should have meant the critical underpinning of the foundations with housing and mental health. That should have seen the structure develop new understandings between treatment and recovery. It’s not just about the money – what we have is a house built on poor foundations. The loss of the criminal justice/ recovery analysis into large