Frontline: Substance misuse officer

“For the last seven years I’ve held the title of senior substance misuse officer, working for a council containing a mix of rural and urban areas. I’ve been in the field for 20 years, starting out in voluntary work and working my way into a full-time job in social work.Addiction services grew up on an ad hoc basis. When I first came into the field, my patch – I was working in the centre of a major city – had 14 addiction services, funded from various sources, and they all did things differently. Then, in 2000, the addiction teams were aligned with the social work area teams, so that addiction workers became part of the core services of social work.

We get referrals from GPs, other people in social work, criminal justice agencies, child and family teams and employment agencies; there are self-referrals, too. Our service is aimed at adults of any age, any race. It’s across social class as well. It’s not only people from poor areas; we get a lot of people who are working, people who are in quite high-flying jobs.

Each drug service falls under an Alcohol and Drug Partnership, which monitors service delivery and identifies local needs. Within that, there are certain targets, like the National Waiting Times Framework, which decrees that people presenting to a service must be seen for an assessment within 14 days of the referral. This data ends up in league tables, with different services reporting their waiting times. For example, the social work addiction team and the health addiction team will report their figures, and it becomes quite competitive – that can get in the way of what you’re trying to do with the person.

The fact that the government is looking for a lot of statistical information has made the job harder, because you’re spending more time on that than actually seeing people. I think the intention was to measure quality of service, and I think that intention was right. But in reality, social workers and substance misuse workers are spending a lot of time in front of their computers. There are frequent inspections, and people get so involved in preparation for these that they lose sight of what they’re actually there for – this job shouldn’t be about ticking boxes.

Funding has been okay for addiction services over the last few years, with lots of money floating about. Now, with the recession and councils cutting back on budgets, all the additional services that are funded by the council are getting knocked out. Cuts are going to be in resources, rather than staff – we’ve been told we have to cut £50,000 off our annual residential rehabilitation budget. The biggest impact for us is going to be where we send people; potentially, service users are going to be sent for shorter stays to the cheaper, less effective services.

The ‘personalisation’ agenda is huge where I work just now – it’s certainly the buzz word. Previously, if somebody wanted to go to rehab, we would fund that and manage the budget involved in it. But then direct payments came along, meaning that the council gives the individual money to buy their own care. There was a fear that – in the field I work in – giving people a load of cash was a bit dicey. There’s a line between what people want and what they need. But there is definitely a case for some degree of personalisation, and I think it’s important that people are treated with respect and involved in what’s happening to them.

The drug problem is difficult because there’s no real answer to it. Success depends on whether people are motivated to make changes in their lives. But we certainly need more residential places within the locality that people are living. Going to a residential rehabilitation centre 50 miles from your home, out in the country with nice surroundings, and then coming back to the city is a waste of time, because then you’re back in amongst all your problems again. A lot of these kinds of services right now are pretty ropey. They produce fantastic programmes and brochures, but the actual delivery is pretty poor.

We’re reviewing our service just now and, in looking at follow-ups, we find the vast majority of former clients are not any better off and are still floating about in the system somewhere. I think we need to get away from talking about addiction all the time; a lot of the services focus on a lot of talking about drugs and alcohol, but that can actually be a trigger for a lot of people to go and drink or score.

The services that operate locally and provide alternative activities, like outdoor stuff and taking people for days out, are introducing service users to normal life and are far more successful. We should be taking funding out of the services that we know from experience don’t work, and pouring it into the ones that get better results.”