Inaugural Professorial Lecture: Questionnaire, Powerpoint, Lecture Notes (preview and download below) by Julian Buchanan | Papers by Julian

TASK While waiting for the lecture to start the audience had paper and pens with a description of six drugs. Their task was to see if they could identify each one correctly. They have been replicated here so you can see how you get on: 1 Drug A This is a physically and psychologically addictive drug. Withdrawal from this drug is said to be worse than any other drug. Common withdrawal symptoms include: insomnia, nightmares, depression, anxiety, panic attacks, agoraphobia, excitability, jumpiness, restlessness, poor memory and concentration, dizziness, lightheadedness, weakness, “jelly legs”, tremor, muscle pain, stiffness in limbs, back, neck, jaw, head, sweating, night sweats and palpitations! These withdrawal symptoms can continue for months. Some suggest withdrawal may take one month for every year of drug taking. So someone with an 8 year habit could suffer withdrawal symptoms for 8 months. 2 Drug B Once hooked users find it very hard to stop. Every day they wake up they feel like they must get hold of the drug. If they don’t get hold or use this drug at some point in the day they often become irritable, preoccupied and moody. This drug is believed to kill more people than any other drug. 3 Drug C This depressant drug can affect mood and behaviour negatively. It is physically addictive and withdrawal is particularly unpleasant – in some of the worst cases drug users suffer epileptic seizures and hallucinations when withdrawing (turkeying). This drug is strongly linked to aggression and violence. 4 Drug D This stimulant drug is psychologically addictive. These drug users feel that they can’t face life unless they have their fix. Most of these drug users have to take the drug at least once a day. If they can’t get hold of their drug these users become edgy, irritable and restless. Heavy users suffer palpitations, dizziness, headaches, migraine and insomnia. 5 Drug E This drug is taken because of perceived health benefits but research indicates this drug can cause internal bleeding, serious stomach and intestinal problems resulting in ulcers and gastric bleeding. 6 Drug F These drug users tend to have to take their drug at least every day. Although the drug can be taken in different ways – a popular way involves equipment. These drug users sadly have a habit of discarding their ‘works’ (this is a drug using term for equipment used to take a drug). This is not only unpleasant for the public and risks causing serious harm to non users – it can be life threatening to others. Every year a number of innocent people are killed. 7 Professor Julian Buchanan Inaugural Professorial Lecture Thursday 21st May 2009 Glyndwr University “It’s their own fault for doing drugs” WHILE YOU WAIT PLEASE TEST YOUR KNOWLEDGE BY COMPLETING THE QUIZ 8 Personal Reflection: An unexpected journey Shared journey Key opportunities and support Although I’ve spoken at numerous events and places this is a rather unusual experience to give a lecture with friends, family, colleagues and member of the public altogether. Now I know what it feels like to be Peter Kay and have your mum in the audience! Good to see you mum! To arrive at this point today is an unexpected journey. I grew up in Anfield - a rough working class area of Liverpool as one of 5 children. I’d left school at 16 (having originally failed more ‘o’ levels than I passed. I started work at 17 as clerical officer with L’pool Social Services, before moving to MPS, University of Liverpool and UCLAN). But I’ve benefited from being given opportunities, from being given a chance, from being supported. It’s fitting then to make that unexpected and non traditional journey to Professor here at Glyndwr University because like my journey - this university is committed to being ‘open to all’ to giving people the opportunity, taking people from nontraditional routes to help people reach their potential. People need chances and opportunities and that will be a theme of this lecture. Glyndwr University helped me enormously by providing me with a sabbatical secondment to Oxford University to work of completing my PhD ‘Investigating the social context of problem drug use’. 9 Personal Reflection: A shared achievement Widening access Opportunities Support Appreciation Before I begin the Lecture I want to acknowledge that this achievement is one that hasn’t been achieved alone –it’s a shared achieved. There are lots of people I owe considerable thanks and appreciation to for inspiration, encouragement, opportunities and support. I’d like to thank a few people specifically: 20 years ago when seconded by MPS to do a Master degree Steve Collet a good friend now Chief of Cheshire Probation was my line manager – his interest and encouragement in my work combined with his analysis, questioning and sharp mind sparked my ambition to pursue an academic career. Prof Paul Senior SHU for constant encouragement as my PhD Supervisor and colleague in various research projects, for Prof Odette Parry for all I’ve learnt from her over the years as colleagues in SIRU (Odette pulls no punches in her critique!), to Prof Ros Carnwell for giving me the opportunity to edit a book together (such a reliable colleague to work with) – now in its second edition. To my CJ colleagues Nat, Martin, Sarah, Caroline & Jodie – great supportive colleagues and friends with a passion to do a job well. To my dad who although he died when I was 12 left a powerful legacy with his political involvement in the Trade Union movement, his passion for justice and a fairer world – and to my mum whose instilled individually, free thinking and vision in us all and who despite the financial and practical struggle managed to bring up 5 kids as a single parent. Particular mention to my brother Nick who has often read and critiqued my articles and book chapter and always given great encouragement. Now I know at least one person has read my work! Most of all to my wife Gill (who’s kept my feet on the ground), and my sons Graham and Matthew – always supportive and understanding, they’ve put up with my disappearances in my role as father and husband as I formed a new relationship with a new partner in 1989 - the Amstrad 1512 PC - I have to confess there have been many other PCs after that one too! I think a divorce is overdue –from the PC that is! My artistic sons have been telling me for a while now to start a relationship with a Mac! Gill might have other ideas. Now for the lecture.. 10 Professor Julian Buchanan Inaugural Professorial Lecture Thursday 21st May 2009 Glyndwr University “It’s their own fault for doing drugs” ‘It’s their own fault for doing drugs’ – popular sentiment for people who get into a mess on drugs - but one that I hope to illustrate is a little misguided 11 Government warnings about drugs ‘evil of drugs’ ‘fight against drugs’ ‘crime it breeds’ ‘blights communities’ ‘destroys families and young lives’ ‘get drug dealers off our kids’ backs and into prison’ ‘Fuels crime’ ‘Wont tolerate the menace of drugs’ ‘causes misery’ ‘costs lives’ HM Treasury (2001) £300 Million Boost For Communities Against Drugs, Press Release, 49/01 09 April 2001 There is a mantra about drugs – these comments are extracted from a single Government Press Release READ SLIDE 12 UN Political Declaration “Drugs destroy lives and communities, undermine sustainable human development and generate crime. Drugs affect all sectors of society in all countries; in particular, drug abuse affects the freedom and development of young people, the world’s most valuable asset. Drugs are a grave threat to the health and well-being of all mankind”. UN Declaration http://www.un.org/ga/20special/poldecla.htm The anti-drug rhetoric begins at the top with UN whose 10-year drug strategy in 1998 was centred upon a slogan: “A drug-free world—we can do it!” Their political declaration states: READ SLIDE But is it really that simple – do these drugs really possess that all consuming and pervasive power to destroy communities and the well being of all humankind Drugs can indeed be dangerous and damaging for some – but I want to illustrate in this lecture that some of these issues are not so much to do with drugs but are connected with the way we see drugs the way we manage drug the way we see drug users the way we treat drug users. 13 Issue 22/97 14 October 1997 STATISTICS OF DRUG ADDICTS NOTIFIED TO THE HOME OFFICE, UNITED KINGDOM, 1996 by John Martin Corkery Let’s take a look a brief the growth and extent of drug use that escalated in the UK in the early 1980s. Since the 1960s anyone with a drug problem seen by a GP or Psychiatrist had to be registered or notified with the Home Office as an ‘Addict’ a terrible label but the process at least provided consistent evidence of the growing drug problem – until the notifications ceased in 1997. It’s no coincidence that the sudden rise in problem drug use coincide with the recession, mass unemployment, deindustrialisation that hit cities that were once reliant upon coal mines, ship yards, factories, and heavy industry. Many of these poor areas became awash with heroin in the mid 1980s. While the popularity and preference of particular drugs may change over time the links between discarded working class communities with few opportunities and high levels of problem drug use remain. 14 Drug Use Today Almost 11.5 million people in England and Wales between ages 16 to 59 have used illicit drugs at some point in their life. Just under 3 million people are estimated to have used illicit drugs in the past year Around 1.7 million have used illicit drugs in the past month Hoare, J. & Flatley, J. (2008) Drug Misuse Declared: Findings from the 2007/08 British Crime Survey, HMSO, London, p.7 It has been argued (see the work of Howard Parker & Fiona Measham) that drug use today has become a normalised activity – there is much debate over what this actually means but we can say that drug use is certainly not confined to a tiny minority READ SLIDE Clearly if we wage war on drugs we are waging war on 11.5million people in the UK who have used an illicit drug or at least 1.7m who used in the past month. Should these people be regarded as a threat, an enemy, should they be seen as addicts or people with a drug problem? Should 1.7m face criminal convictions as drug offenders? 15 Hoare, J. & Flatley, J. (2008) Drug Misuse Declared: Findings from the 2007/08 British Crime Survey, HMSO, London, p.34 So how widespread is drug taking? Here we can see from the most recent BCS the % of people in the different age groups who have used a drug at some time in their life, past year or past month. Over 50% of 25-29 admit to using an drug at some point in life. Around 1 in 5 people 16-24 used a drug in the past year. It would surely be misleading to suggest that 20% of our 16-24 years have a drug problem. Clearly not everyone who tries or uses illicit drugs develops a drug problem. Interestingly in 30 years time this same survey will show that over 50% of people between 55-59 have used an illegal drug compared to 17% at present. This may have implications for future drug policy as the gap between generation and their experience narrows. 16 Hoare, J. & Flatley, J. (2008) Drug Misuse Declared: Findings from the 2007/08 British Crime Survey, HMSO, London, This graph again shows the difference in drug use by age –generally with the younger age brackets at the top and the older at the bottom. On the left is the percentage of that age group who have used drugs in the past year. We see 1 in 4 young people 16-24 compared to 1 in 10 30-34 yr olds But what this chart also show is a gradual decline over recent years – this is interesting because there was concern that when cannabis was downgraded to a Class C drug in 2004 many were concerned that drug use would actually increase. The opposite has occurred but as you probably know in January this year Cannabis was reclassified a Class B drug. So we know that relatively a lot of people are using drugs particularly the 16-25 years olds But what do we know of the risks posed by drugs? Hopefully you have a quick guess at the risks and harm of drugs earlier on your sheet you have. If you haven’t I’ll give you 2-3 mins now just to write down a quick guess! No worries you can keep your answers a secret they wont be collected in or marked! My students are expected to know all the answers and not to tell others! 17 Drug A This is a physically and psychologically addictive drug. Withdrawal of from this drug is said to be worse than any other drug. Common withdrawal symptoms include: insomnia, nightmares, depression, anxiety, panic attacks, agoraphobia, excitability, jumpiness, restlessness, poor memory and concentration, dizziness, light-headedness, weakness, “jelly legs”, tremor, muscle pain, stiffness in limbs, back, neck, jaw, head, sweating, night sweats and palpitations! These withdrawal symptoms can continue for months. Some suggest withdrawal may take one month for every year of drug taking. So someone with an 8 year habit could suffer withdrawal symptoms for 8 months. d o z n e B in p e z ia s e This drug is very physically and psychologically addictive and withdrawal can take months. It’s one of the hardest drugs to come off. Withdrawal symptoms are really quite unpleasant. Any guesses? BENZOS TRANX, SLEEPING TABLETS – they are depressant drugs, useful for a limited period in certain situations, but they do have some nasty side effects 18 Drug B Once hooked users find it very hard to stop. Every day they wake up they feel like they must get hold of the drug. If they don’t get hold or use this drug at some point in the day they often become irritable, preoccupied and moody. This drug is believed to kill more people than any other drug. This is a stimulant drug. Quite addictive. The key to identifying this drug is that it’s by far the biggest killer out of every drug taken. Any guesses? Yes Tobacco – which kills around 110,000 people every year in the UK, and is also linked to other problems such as poor circulation and amputations. A very dangerous drug In comparison to 110,000 people killed by tobacco - Drugscope report that the combined total of all drug related deaths in 2004 was around 1,427* http://www.drugscope.org.uk/resources/faqs/faqpages/how-many-people-diefrom-drugs.htm 19 Drug C This depressant drug can affect mood and behaviour negatively. It is physically addictive and withdrawal is particularly unpleasant – in some of the worst cases drug users suffer epileptic seizures and hallucinations when withdrawing (turkeying). This drug is strongly linked to aggression and violence. l o h o lc A It’s a depressant drug that the vast majority of people in this room use. It’s linked to 50% of murders • 45% of those arrested for assault test positive for this drug • around 15% of all road deaths are related • It’s cited in 30% of divorces • Up to 150,000 hospital admissions per year are associated with abuse of this drugs • Wander into A&E on a Friday and Saturday night and you’ll see a hospital inundated with these drug users. Any guesses? Alcohol our favourite drug is a toxic substance (one that I personally enjoy) but it damages the heart the liver, the brain and other major organs. Yet we have embraced alcohol as a cultural perception of pleasure – you’ve passed your exams –go out and celebrate – you’ve on your hen night go and have a good time, even when you pass your driving test you might receive a card with champagne bottles on suggesting a drink of this dangerous drug. The term celebrate is used to communicate getting intoxicated with alcohol. We demonise heroin and promote alcohol. It’s strange when Alcohol is toxic poisonous substance. How irresponsible would it sound if you heard people encouraging one another to go out and celebrate with an illicit drug like ecstasy, heroin or cannabis. What is it then about our culture that ‘celebrating’ by using the drug alcohol is somehow culturally approved and promoted? How many of us have some of this dangerous drug alcohol stashed away at home? Given all the dangers we now know about alcohol how would it seem those of us who have confessed to having these dangerous drugs at home be ram raided by the Police tomorrow morning about 6am? Why shouldn’t that happen? – we know that alcohol is linked to all sorts of crime and violence and damages the user and wider society. Maybe you feel that you are a responsible safe user who poses no significant problems to yourself or others. What I am suggesting here is that we need to explore this false but firm distinction between legal and illegal drugs We need to question a blanket approach that demonises illicit drugs and illicit drug users http://www.alcoholconcern.org.uk/files/20040312_160130_Statistics%20for%20Strategy%20release.pdf 20 Drug D This stimulant drug is psychologically addictive. These drug users feel that they can’t face life unless they have their fix. Most of these drug users have to take the drug at least once a day. If they can’t get hold of their drug these users become edgy, irritable and restless. Heavy users suffer palpitations, dizziness, headaches, migraine and insomnia. This drug is found in chocolate, lemonade, tea, coffee, pills such as pro-plus and energy drinks like red bull, - it’s a stimulant drug – like amphetamine, khat and cocaine. These stimulant drugs depress the appetite so are used to lose weight. T hey also depress the need for sleep so people can keep going. This is a relatively weak and harmless stimulant drug but one that does cause some problems to some people. One drug that we probably all use. Any guesses? 21 Drug E This drug is taken because of perceived health benefits but research indicates this drug can cause internal bleeding, serious stomach and intestinal problems resulting in ulcers and gastric bleeding. Any guesses on the mild painkilling drug – A very useful drug but again all substances carry risks You can die of a salt overdose You can die from excessive drinking of water! 22 Drug F These drug users tend to have to take their drug at least every day. Although the drug can be taken in different ways – a popular way involves equipment. These drug users sadly have a habit of discarding their ‘works’ (this is a drug using term for equipment used to take a drug). This is not only unpleasant for the public and risks causing serious harm to non users – it can be life threatening to others. Every year a number of innocent people are killed. I’m not sure anyone will identify this drug – unless it’s one my students. These users can chew the drug, that can place it on their body and absorb it. But this drug is often smoked - sometimes in pipes mostly often these drug users use spongy filters to inhale their drug and when they have finished their smoke they often drop them on the floor. This is unpleasant for non users – when abroad lying on the beach in the hot sunshine you pick up a hand full of sand let it run through your fingers and then discover a handful of cigarette buts. More seriously this drug has proved fatal for others and has resulted in house fires. The Bradford FC fire disaster in which killed 56 people was thought to have been caused by a tobacco user. The King Cross fire disaster which killed 31 people was believed to have been caused by a tobacco user discarding a match. So did anyone get them all correct? What do you notice about these dangerous drugs? 23 Bifurcation Process Buchanan J (2009) Understanding and misunderstanding problem drug use: working together, in R Carnwell & J Buchanan (eds) Effective Practice in Health, Social Care & Criminal Justice: A partnership approach, Open University Press, Maidenhead. I began with the horrors claimed about illegal ‘drugs’ We hardly ever hear people refer to alcohol, tobacco or caffeine as drugs –but make no mistake they are drugs with some quite serious risks too. This graphic illustrates the way we are encouraged to view drugs. There appears no rational basis for this distinction. This division is based upon cultural norms, politics and historical developments rather than any rational assessment. Illegal drugs under the MDA illegal drugs are referred to ironically as ‘controlled’ drugs – but by being illegal they are actually under very little control In the use in the 1920s/30s prohibition of alcohol offered a great example of how a drug pushed underground breeds sub cultures of deceit, crime, violence, money laundering, basically tough enforcement and prohibition creates crime and provides a lucrative opportunity for gangsters 24 What do we see here? Culturally we use language like celebrating, having a laugh, having fun, relaxing, out enjoying themselves, having a good time? The consequences and risks of legal drug use are often overlooked and perceived altogether differently to illicit drug abuse. This collage could easily be images of illicit drug abuse 25 Adapted from ‘Development of a rational scale to assess the harm of drugs of potential misuse’ by David Nutt, Leslie A King, William Saulsbury, Colin Blakemore, Lancet 2007; 369: pp. 1047–53 No w Cl as sif ied C Let’s take a closer look at scientific evidence published in the medical Journal The Lancet to understand the dangers of legal and illegal drugs Basically this research involved a group of drug specialists from various disciplines to rate the risks posed by all drugs using a matrix of harms posed. The results here are the overall mean scores produced in a league table of potential harm –the drugs perceived most harmful on the left –led by heroin and cocaine. The colour coding indicates the classification under the MDA 1971 red maroon colour being the most serious drugs that carry possible life imprisonment for supply. In contrast the turquoise are legal substances. Rational thinking would assume that if the MDA was a good reflection of harm all the A drugs (reddish colour) would be on the far left, followed by the Class B (pale pink) Class C purple and the legal drugs (turquoise ) on the far right. But look where Alcohol is 5th most dangerous and tobacco 9th and see we have some class A drugs way down the list. This experts view is a lot more helpful than an over simplified division between legal and illegal drugs – it illustrates the dangers of legal drugs. Re -C las sif ied B 26 A more rational framework? We are all drug users Low risk High risk However – I think this framework I think offers a more rational approach to drugs. We are all drug users. We take drugs for pleasure albeit caffeine, alcohol or whatever. We should avoid any oversimplified dichotomous framework that presents legal as safe and illegal as dangerous. Also while drugs do have generalized properties, risks and effects, we cannot create a hierarchy or league table that puts a drug at a particular place on the continuum because the impact of a drug varies from person to person. For one person alcohol is high risk, to another it’s low risk, same could be said of cannabis. What is important is that we see ourselves together on a continuum and recognize that ALL drug use carry risk legal and illegal. It seems clear from the evidence that some legal drugs can be much more dangerous than some illegal drugs. 27 7 additional risks exacerbated by tough enforcement Has no idea of the strength of the drug - it could be so strong it could result in risk of overdose or death. Has no guarantee about the purity or indeed content of the drug - it could contaminated or even mixed with toxic ingredients that could cause serious harm even death. Has to buy the drug ‘underground’ - exposing the person to the vagaries of a potentially dangerous criminal underworld. Buying, using and sharing illegal drugs puts the person at risk of serious criminal sanctions such as a community sentence with a drug rehabilitation requirement or even imprisonment. But all illegal drugs are in some ways always inherently more dangerous than legal drugs because making drugs illegal actually significantly increases the harm they pose. Let me explain. READ SLIDE [Continue next slide] 28 7 additional risks exacerbated by tough enforcement (cont.) A person using an illegal drug risks acquiring a criminal record for a drugs offence - which could have lifelong consequences upon employment prospects, opportunities for world travel and housing. Has to use the drug in secret. For some people this may mean using in an isolated location which could be potentially dangerous especially when intoxicated such as a condemned building, under a railway bridge, a canal etc. Has to hide the use of illegal drugs making it more difficult to manage and harder to seek help, support or advice if a problem arises. READ SLIDE So the criminalisation of a drug may create more risks than posed by the drug. Perhaps we need a change in thinking Perhaps we need to decriminalise possession of drugs 29 Tougher Approaches Drugs Act 2005 enables: • drug test suspected drug offenders on arrest, rather than on charge • suspected to have swallowed an illegal substance remand in police custody upto 192 hours. • If that person refuses without good cause, to consent to an intimate body search, x-ray or ultrasound scan the Act allows the court or jury to draw an adverse inference. • Can be placed on new ASBO equivalent to get drug treatment But instead of a more inclusive approach we are seeing a tougher approach to illicit drugs READ SLIDE A criminal record for a drugs offence could seriously damage a young persons future - in terms of insurance, housing, employment, welfare and ability to travel abroad. This doesn’t illustrate the dangers of drugs it’s socially constructed harm that illustrates the impact of tough criminalisation and enforcement. Our tough enforcement on drugs is leading to an ever increasing rise in the prison population. 30 Tougher Approaches: welfare and work There are plans to involve the Jobcentre to identify illicit drug users and get them into treatment – failure to admit a drug problem or take treatment might result in a loss of benefits Drug testing by employers is growing – in recent months there has been a sharp increase in redundancies. A drug like cannabis can stay in the bloodstream for many weeks. These approaches wont just catch people who have problems with drugs they’ll catch all users – people who just experiment, people who use recreationally or for medical reasons. 31 Focus on Problem Drug Users Drug use PDU The vast majority of people who have taken or take illicit drugs are not problem drug users – just like the vast majority of drinkers don’t end up with drink problems. A small proportion do develop drug problems - it’s those I want to concentrate upon. 32 expanding prison population p 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 1996 2007 US Prison 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 1985 2007 UK Prison Scotland’s only all-female prison, 94% of the women on admission tested positive for illicit drugs HMIPS, HM Inspectorate of Prisons for Scotland. (2001). Report on HMP and YOI: Cornton Vale, Edinburgh The tough war on drugs promoted by the USA & UK has led to significant increases in the prison population. It costs around £33,000 every year to keep someone in prison – we now have around 83,000 people in prison that adds up to £2.7 billion per year Our prison are becoming silos to house illicit drug users 33 Prison (per 100,000 pop.) Latvia Estonia Lithuania Czech Republic Spain Luxembourg England & Wales Bulgaria Romania Portugal Netherlands France Malta Belgium Italy Germany Cyprus Ireland Sweden Slovenia Finland Denmark 288 259 234 182 160 155 151 134 123 102 100 96 95 93 92 89 83 81 74 65 64 63 Total Prison Population 6,548 3,467 7,866 18,901 73,787 745 82,240 10,271 26,350 10,830 16,416 59,655 387 10,002 55,057 73,203 671 3,653 6,770 1,317 3,370 3,448 Possess/Supply Drugs 9.2% 9.6% 4.6% 8.0% 27.4% 42.1% 15.5% 5.6% 3.3% 27.3% 18.9% 13.6% 28.1% 14.3% 29.4% 14.9% 27.5% 14.4% 23.0% 10.9% 15.2% 23.9% Adapted from: Bewley-Taylor, D., Hallam, C., Allen, R. (2009) The Incarceration Of Drug Offenders We lock up more than most EU countries and those with more than us tend to be from the Eastern block with a history of greater use of prison. The key figure is not the overall total in prison but the column that indicates the prison population per 100,000 population. This gives an idea of the proportion of people locked up. The column on the far right indicates 15% of offenders are in UK prisons for specified drug offences (Possession or supply) the figure for drug related will be much bigger. As an advanced democratic country we should be concerned by excessive use of imprisonment. So let’s have a look at outside Europe at the USA who have for decades championed the war on drugs. 34 Prison (per 100,000 pop.) USA Latvia Estonia Lithuania Czech Republic Spain Luxembourg England & Wales Bulgaria Romania Portugal Netherlands France Malta Belgium Italy Germany Cyprus Ireland Sweden Slovenia Finland Denmark 151 134 123 102 100 96 95 93 92 89 83 81 74 65 64 63 756 288 259 234 182 160 155 Total Prison Population 2,293,000 6,548 3,467 7,866 18,901 73,787 745 82,240 10,271 26,350 10,830 16,416 59,655 387 10,002 55,057 73,203 671 3,653 6,770 1,317 3,370 3,448 Possess/Supply Drugs 19.5% state 53% federal 9.2% 9.6% 4.6% 8.0% 27.4% 42.1% 15.5% 5.6% 3.3% 27.3% 18.9% 13.6% 28.1% 14.3% 29.4% 14.9% 27.5% 14.4% 23.0% 10.9% 15.2% 23.9% Adapted from: Bewley-Taylor, D., Hallam, C., Allen, R. (2009) The Incarceration Of Drug Offenders We can see here that not only does the USA incarcerate 2.3 million people it locks up a staggering proportion of people 756 per 100,000 of the population. More than any other country in the world. 35 ‘Hardening’ of cultural norms ‘Drug misuse can ruin individual lives, tear open families and blight whole communities with the menace of dealers and crime driven by drug abuse… more drug dealers – people who profit in the misery of others – behind bars… more addicts into treatment…further powers for police to drug test suspected addicts on arrest… vicious circle of drugs and crime …dealers will face harsher sentences where they prey on children …Drugs are a scourge on the world, Caroline Flint, Home Office Minister quoted in drink and drugs news 10 January 2005 p.7 Yet despite the failure of the war on drugs we continue to press ahead following the US model and continuing the rhetoric against illicit drugs. The language by the Home Office minister is about fighting an enemy Sadly the fight against drugs often results in an attack on drug users. This stigmatisation of illicit drugs and illicit users reflects cultural norms more than it reflects rationale or reason. 36 Cultural norms shift over time – opium was once widely available in the UK from the corner shops and used as a tonic for a wide range of ailments. Opium had some eminent regular users including the Lakeland Poets! Opium hasn’t changed our attitudes have. Do this people look like heroin users? 37 Opium is now illegal and seen very differently. I was asked to speak at a conference in Glasgow on stigma –and drug use last year – so I did a quick search on the way drug users where portrayed in the local press. It was very revealing illustrating the prejudice and distain towards drug users – addict appears to be the preferred word READ SLIDE some These are dreadful tale of abuse and harm to often vulnerable people but where all these crimes and events motivated and instigated because of drug addiction – I doubt it. Drugs and drug users are an easy scapegoat I suspect these are very damaged and sometimes very bad people who also take drugs – perhaps drugs help hide their difficult unpleasant or nasty reality. Change the word ‘addict’ for Hoodie, Schizophrenic, homeless youth, Immigrant, Muslim, Asian and it rightly feels very uncomfortable and objectionable. 38 Smoking was once an approved and promoted cultural norm READ SLIDE 39 This drug taking was promoted as glamorous, cool, sophisticated, sexy, sociable - tobacco use was once everywhere you looked 40 Pendulum of opinion Smoking is no longer an approved cultural norm Smoking is stigmatised People who smoke are marginalised Some may receive ridicule, harsh treatment - even hostility We swing in our attitudes from promotion to demonisation 41 These recent images reflect the shift towards stigmatising tobacco use. the tide is turning on tobacco users This overt pro-active stigmatisation of particular drugs has often resulted in the stigmatisation of drug users. 42 Focus on Problem Drug Users Drug use PDU Having set the context for drug use lets look closer at those small proportion of people who develop drug problems – often referred to as the problem drug user. Drug policy and law is developed with pdu in mind but captures all. As well as the considerable difficulties of dealing with a drug problem an almost bigger hurdle for many is coping with war on drug user and stigmatisation these are the people So how do we make sense of addiction – of pdu –drug dependency? 43 The Dominant Conceptual Framework Physical To understand & tackle problem drug use Legal Psychological We frame it as a legal problem using full force of the law to punish people for possession and supply We concentrate on the physical use by an abstentionist approach that is enforced by regular and random drug tests –and ever increasing drug testing technology We concentrate on the psychological – the craving for drugs, the thinking patterns, using Millar & Rollnicks motivation for change, and Prochaska and Di Clemetntes stage of addiction. 44 Adding a social component Psychological education employment social & life skills discrimination self esteem/confidence routines/habits lack of non drug using networks reintegrating in local community Physical Problem Drug Use Social Legal Those three component promote a view that pathologises problem drug use as a difficulty that lies with the individual –when as we shall explore pdu appears to be much more to do with social disadvantages, alienation and wider structural factors. So this framework is more helpful. It may be that the often overlooked social factors are actually the most important component. Factors such as: READ SLIDE 45 Problem drug users & disadvantage The majority of problem drug users were over 26 years old and had been taking illegal drugs for over 7 years. 52% of the known problem drug users left school before reaching 16yrs Buchanan J & Young L (2000) The War on Drugs the War on Drug Users Drugs: education, prevention and policy, Vol. 7, No. 4 After years of working face to face with pdu on M’side I was involved in a number of research projects in the mid –late 1990s The backgrounds of these PDU began to reveal that these people had major problems BEFORE they started taking drugs. READ SLIDE 46 Problem drug users & disadvantage Over half had been unemployed for the past 5 years One in seven had never been able to secure a job 52% of the sample had no qualifications (academic or vocational)* *NB Each year only 6% of pupils leave school with no qualifications http://www.dfes.gov.uk/performancetables/schools_01.shtml qualifications Only two people were currently in employment (out of 200). Buchanan J & Young L (2000) The War on Drugs the War on Drug Users Drugs: education, prevention and policy, Vol. 7, No. 4 READ SLIDE 47 At–risk index of PDU 1. 2. Contact with drugs Lack of identification with the mainstream (through family, friends or peers) Sense of alienation caused by unresolved bereavement or trauma No suitable ally or pastime to provide emotional support and positive feedback A blocked future educational, employment and relationship opportunities inhibited 3. 4. 5. Young R (2002) From War to Work Drug treatment, social inclusion and enterprise, The Foreign Policy Centre, p.45 Later research published by the The Foreign Policy Centre found those who tend to develop drug problems (not those that use drugs) are people who: READ SLIDE This reinforces the notion that the social disadvantage and exclusion are key factors that precipitate and perpetuate ongoing pdu 48 Stigma and exclusion ‘They look down on me as scum of the earth and as someone not to be associated with’ `I feel the odd one out, I’ve nothing in common with them. I start to get paranoid’ `I used to avoid them like the plague. I used to be scared of what they might think’ `I feel nervous in case I slip up, I know they would look at me in disgust’ In our research we talked to pdu and asked them how they felt being with people who didn’t use drugs Many problem drug users felt rejected and stigmatized by the non-drugusing population: Here are separate comments from different people we interviewed: READ SLIDE 49 Mixing with Non Drug Users ‘I feel a bit beneath them, they make you feel like that’ ‘I’ve got to watch what I say so I don’t land myself in it. They blame smack heads for everything.’ ‘I feel labelled … like they thought I was dirt’ `I never really mixed with people who have never taken drugs’ READ SLIDE 50 How do other people see you? ‘They see me as a drug addict, a smackhead and they think I’ll rob them’ ‘Some people don’t want to talk cos of being on gear they just think ‘smackhead’. They don’t realise just how hard it is to get off’ `I feel nervous in case I slip up, I know they would look at me in disgust’ ‘They look down on me as the scum of the earth and as someone not be associated with’ READ SLIDE 51 Internalising stigma ‘Discrimination has led many problem drug users to internalize and blame themselves for their position. This loss of confidence and self-esteem is a serious debilitating factor. They feel themselves to be labelled, discarded and isolated from mainstream society.’ Buchanan J & Young L (2000) The War on Drugs the War on Drug Users Drugs: education, prevention and policy, Vol. 7, No. 4 READ SLIDE 52 PDU & social exclusion links 73% drug users Average age 28yrs 47% didn’t complete educ. 59% no qualifications 0% had A level + 51% unemployed 11% unable to work Survey of 1884 males in 2000 who had recently been sent to prison. (Liriano & Ramsay 2003 HORS 267) Average age 32yrs 54% excluded from school 20% been in care 64% had been in prison age first time use 16yrs age drug problem 21yrs Jones S, Drainey S, Walker L & Rooney J (2004) Collecting the Evidence: Clients views on drug services, Addaction N=550 73% drug users 60% unemployed prior to custody 54% didn’t complete educ 32% been in care Survey of 529 male prisoners in 2000 (Bullock T 2003 HORS 267) The disadvantage and difficult start that people had in life before they drifted into drugs and crime is mirrored in a number of other subsequent studies. SUMMARISE 53 Arrestees who used crack and heroin 50% said they had left school before they were 16 58% said they had been temporarily excluded from school 36% permanently excluded from school only 1 in 10 were in employment (compared with almost half of other arrestees); 29% had been in local authority care at some time almost a quarter had slept rough in the past month Reducing Drug Use, Reducing Re-offending March 2008 The UK Drug Policy Commission (UKDPC) pp20-21 A more recent study last year again confirms the point: Problem drug-using offenders are a group with particularly complex and intractable problems, which means they will be more challenging to treat, rehabilitate and reintegrate into society. Prison, the courts and the CJS more generally does little to address these deep seated underlying needs –if anything these people become more damaged – even hardened and set into a fixed lifestyle built around drugs 54 Buchanan, J. (2006) Understanding Problematic Drug Use: A Medical Matter or a Social Issue, British Journal of Community Justice – Volume 4, Issue 2 pp. 387–397 For these people a drug centred lifestyle offers a daily routine, a purpose, a focus and a structure. This provides skills, stress, excitement, pressures and rewards that replace the monotony and frustration of not fitting in and struggling to connect. READ SLIDE But this is a tough, lonely, brutalising 24/7 treadmill – and for these people prison is sometimes welcomed as a relief – not a punishment If we are going to get people drug free we are going to have to fill the void in their life. 55 The Barrier of Exclusion ‘the anti-drug campaigns over the past 20 years have added to the isolation and marginalization of the discarded workingclass youth …. In addition to having to overcome their addiction, one of the biggest hurdles they have to face is breaking through the barrier of social exclusion. JULIAN BUCHANAN & LEE YOUNG The War on Drugs -a war on drug users? Drugs: education, prevention and policy, Vol. 7, No. 4, 2000 When progress is made and pdu’s do become drug free they find it extremely difficult to overcome the barriers of exclusion which are reinforced and encouraged by the fear, demonisation and hostility directed towards illicit drugs. READ SLIDE 56 The struggle for reintegration Adapted from Buchanan J (2004) Tackling Problem Drug Use: A New Conceptual Framework, pp117-138, in Social Work in Mental in Health, Vol. 2 No 2/3, Haworth press Free article download from http://epubs.newi.ac.uk/siru/1/ This is a cut down version of a model I devised and submitted for my PhD. It’s an adaptation of Prochaska & Di Clemente’s ‘cycle of change’ It shows the stages that pdu go through and move between different phases. Most will be familiar with the the four bottom phases GO THROUGH But what this model does is illustrate three more crucial stage which are often overlooked. GO THROUGH These are the stages that are the most difficult and where opportunities, support and encouragements are needed. However –the wall of exclusion – a product of the war on drugs - a war on drug users – serves to isolate, shun and disqualify drug users. How can a recovered drug user re-qualify – how can a recovering drug user complete their recovery unless they can achieve some integration with mainstream society? I have come to believe that the wall of exclusion is the biggest cause of drug relapse – it’s so hard to break through that many pdu spiral around in circles stuck in a ghetto with fellow drug acquaintances stranded from mainstream social networks and social capital. 57 Coping Without Drugs ‘When considering treatment and rehabilitation it must be recognised that many problem drug users have had such limited options in life, that they lack personal resources (confidence, social skills and life skills) and have limited positive life experiences to lean upon or return to. This client group need social integration not social reintegration, they need habilitation not re-habilitation – it seems that many have never really been able to get started in life in the first place. This makes living without drugs a very tough option indeed.’ Buchanan, J. (2004) ‘Missing links? Problem drug use and social exclusion’ Probation Journal, Special Issue: Rethinking Drugs & Crime, Vol 51(4): 421–431 Developing an alternative lifestyle is not easy when drugs are all some people have ever known 58 Summary ‘It’s their own fault for doing drugs’ 1. 2. 3. 4. We all ‘doing drugs’ and the legal ones are not particularly safe. The division between legal drugs and illegal is misleading Making some drugs illegal has significantly increased the dangers posed. Criminalisation and tough enforcement upon selected drugs has created considerable additional problems –not least giving people a criminal record. The majority of the people who develop drug problems had significant difficulties before they began taking drugs and few legitimate options. A move away from a drug centred lifestyle and reintegration with mainstream society poses an enormous challenge. The war on drugs and the associated discrimination and exclusion can be a bigger hurdle than the struggle to deal with a drug problem. Approaches to drugs have been dominated by the legal, physiological and psychological aspects of problem drug use – the social dimension is key. These people need major personal, social and practical support. 5. 6. 7. 8. READ SLIDE So is it ‘their own fault for doing drugs’ I think it’s an awful lot more complicated than that. While people who develop drug problems must accept their share of the responsibility it is clear many are also victims of damaged backgrounds and a drug strategy and policy that if anything exacerbates their problem and fails to understand or engage effectively. Time for change on the war on drugs …..? Let me end with some good news.. 59 Just a few days ago the US drug Czar in the new administration has announced the US intend to banish the idea of a war on drugs arguing that it is wrong to wage war on your own people. The Drug Czar announced that in future drugs will be seen as a health problem needing treatment rather than a CJ problem needing punishment or prison. After years of US War on Drugs … the tide appears to be turning – so just maybe the UK might follow? 60 Thank you for coming, for your time and attention. If you want more information please email me: j.buchanan@glyndwr.ac.uk …time to enjoy ‘a drink’ in the Foyer? Thanks for listening 61