Reversing out of the cul-de-sac: The future of the Drugs Field

What comes first? What is the most important question? In an era of short termism, in an economy devoted to the short term, how can longer term goals be pursued? How can we even begin to think about longer term goals?

I would like to be able to ask where we in the drug treatment industry and the related policy and research fields want to be in five years. However, before one begins to talk about what kind of industry one would like to see in five years, there is a need to be reassured that we can remove the major obstacles that prevent us from thinking about the future and also from developing a longer term analysis.

So this is not intended to be an exercise in ‘blue sky thinking’; I don’t much like ‘blue sky thinking’.

Settling Accounts with our Opportunism

My belief is that what comes first, what will facilitate the necessary unblocking in our thinking is a settling of accounts, as an industry, with our opportunism.

We need, as an industry, to understand our opportunism, to celebrate our opportunism (it has, after all, led to some dramatic successes) and, ultimately, to move beyond it. That’s what comes first.

What comes first is getting much better at putting Crime and Fear in context.

The Punitive Archipeligo and the Care/Control Continuum
We, in our industry, have been a major part of the expansion of what John Muncie calls the Punitive Archipeligo. It helps here to see ‘health interventions’ not as opposed to ‘criminal justice interventions’, but to see them both as part of a single ‘care/control continuum’. On such a view, it is possible to identify key parts of our industry moving steadily away from the care end towards the control end, especially over the past five years.

A Clear Link between Drugs and Crime

In the early to mid nineties many of the drug field’s key academic advisers were arguing for a very clear link between drugs and crime. There were those who, at the time, counselled caution about making such strong claims, these people were, however, in a clear minority: Baroness Ruth Runciman was one.

Now, more than a decade later, very different arguments are emerging.

Now, there are a growing number of researchers who are not just asking questions about the drugs crime link, they are reaching conclusions.

Moronically Simplistic

We are now at a stage, based very much on the evidence rather than any supposition, where the ‘clear link’ as identified over a decade ago is being described on one view as ‘moronically simplistic’.

That’s not how we saw it back then. Although our sociology may have been flawed, we weren’t knowingly dealing in falsehoods. The measure of our opportunism wasn’t that we were prepared to tell lies.

No: our opportunism went much deeper.

We were interested in helping our political masters, at that time Labour in opposition, to find policies that would win consent.

Policies That Win Consent

As Norman Fairclough says, ‘There is no clear dividing line between finding policies that work and finding policies that win consent’.

Many years ago, I remember buying a Time Magazine Special Edition on the Theory of Relativity. On the front cover was a soft focus picture of Albert Einstein: he had a shock of grey hair and a twinkle in his eye. Next to the picture it said, "He sought to recast the classic concepts of the universe in two simple equations". And that’s just what we did.

The Classic Concepts of the Universe

Like Albert Einstein we sought to recast the classic concepts of the universe in two easy equations. They were as follows:

1. Drugs = Crime

2. Drugs Treatment = Crime Reduction + Safer Communities

These two equations went on to command massive political consent. In fact now, apparently, there is very little else needed to fill out our explanatory and descriptive paradigms. We have recast the classic concepts and we have won consent for our ‘analysis’.

The Public Gets What the Public Wants

The public may be largely ignorant of the wider achievements of the UK drug strategy; they may know little, or indeed have little interest in our various successes and failures. They may not know:

That we have halved methadone deaths over the past ten years despite doubling the numbers to whom we prescribe;

That we have treated more people, held more people in treatment and all but got rid of waiting times;

That our form of treatment, in very many cases, seems not to affect the quantities of illegal drugs that people take;

The public may not know how ineffective our coercive policies are in retaining primary offenders.

They may not know how many, or rather how few, of our clients receive effective psycho-social interventions designed to address their drug use.

For that matter they may not know what a ‘psycho-social’ intervention is. Some of us have only just learned!

Nevertheless they do consent to �the Proposition’:

Drug Treatment = Crime Reduction + Safer Communities

This is a powerful and reassuring equation for our electorate for whom crime and the fear of crime are issues of very major concern. So how best can the issues of crime and the fear of crime be put into context? Put another way, how can we reverse out of this historical and political cul-de-sac.

Reversing Out of the Historical and Political Cul-de-Sac

How can we move away from the current narrow focus that makes us think about drug use and drug users in a certain kind of way? I suggest that there are two separate bits of thinking that we need to do in order to reverse out of the cul-de-sac.

The First Bit of Thinking

This bit of thinking we really should have done years ago. It involves being clearer about the main different ways of talking about social exclusion.

The Three Discourses of Social Exclusion: RED, SID and MUD
According to Ruth Levitas, there are three discourses of Social Exclusion. One of them owes much to traditional social democratic thinking and is described as the Redistributionist Egalitarian Discourse, RED for short. The second one is described as the Social Integrationist Discourse and emphasises the importance of paid employment as a key to tacking exclusion, SID for short. The third approach is called the Moral Underclass Discourse and emphasises the moral and cultural shortcomings of the excluded, MUD for short. So we have RED, SID and MUD. For supporters of RED, the key problem for the excluded is that they have no money, for supporters of SID, that they have no job and for supporters of MUD, that the excluded have no morals. If you use the RED discourse, the lead indicator is poverty. If you use the SID discourse, the lead indicator is labour force participation rates and if you use the MUD discourse, the lead indicator is the number of workless households in the working age population.SID and its followers
New Labour’s approach to Social Exclusion has been to mix elements of SID with quite a lot of MUD. One influential SID thinker is Geoff Mulgan — he was one of the founders of the DEMOS think tank. He also advised Tony Blair during his first administration. He thinks that work is the prime source of status: "The worst thing that can happen is to fall out of work, and lose your employability, your skills, your personal qualities, as well as friends and contacts."

There are a number of challenges to this view and these need at the very least an examination in our industry. Paid work is clearly something most of us prize for reasons too obvious to name. Nevertheless low paid, low skilled work of a casual and deregulated kind does not necessarily raise a person’s status, or lift them out of poverty, or tackle the marginal nature of their existence. In addition paid employment is not the only kind of work that has meaning and constructive value for individuals and for society. For the drug policy and treatment industry to celebrate paid employment as a total solution for marginal populations, including drug users, is not the kind of opportunism from which many of our clients would necessarily gain much benefit.

In any event, our field really should look in a more dispassionate and thorough way at changing patterns of work and what they mean for all of those who need our services.

MUD and its followers
Many people in our field have swallowed this analysis hook, line and sinker. For them, a key thinker is Theodore Dalrymple. His ‘Life at the bottom-The world view that makes the underclass’ is required reading for those who have come to the conclusion that many of our service users are inferior human beings. Dalrymple writes: "�there is now a much enlarged constituency for liberal views: the legions of helpers and carers, social workers and therapists, whose incomes and careers depend crucially on the supposed incapacity of large numbers of people to fend for themselves or behave reasonably."

Whatever position one takes, and it is interesting to note how many harm reductionists seem to have bought the world according to Dalrymple, I think it is very important to understand a bit more about key terms like Social Exclusion and the way it’s component discourses are shaped and mixed in the pursuit of political policies that have the clearest and most direct impact on poor people with drug problems.

Having done this first bit of thinking we need now to move on to the second bit.

The Second Bit of Thinking

As part our attempt to put our industries subordination to Crime and Fear in context and in order to clear the way to thinking about changes over the next five years, we need to find a way of thinking in a broader and more up-to-date context about three things:

1. Problem Drug Users:

What we have become accustomed to calling Problem Drug Using Populations

2. Our Workforce — US:

We may have a major job of work to do upon ourselves

3. The Wider Population

Stop This Puerile Marketing Language
It is with the broad mass of the population that we need to begin this second bit of thinking. And in doing this, moreover, we need to stop using the much overworked, marketing language that has become second nature to our industry. We need to stop ‘Targeting’, stop ‘Segmenting’ and above all, we need to stop ‘Niching’. It’s ill-advised, we often don’t really know what we’re talking about and most importantly it stops us from focusing on the needs of individuals. In addition, it also stops us identifying and describing more fundamental social trends. We end up just fixating on our own bad sociology.

In the drug treatment and policy industry we need to be much better at looking at what Ian Taylor called The Definitive, Contemporary, Social Transitions’ taking place in the modern world.

The Definitive, Contemporary, Social Transitions Taking Place in the Modern World

As Taylor points out very clearly, the key social fact of our times is the move away from the Welfare State to a fully- fledged market society. This latter is often referred to as a Post-Industrial Society. It is a common place that societies like the United States and the United Kingdom no longer make any claim to be inclusive societies. They are in terms of their key economic processes ‘excluding’.

In this context, income trends are particularly revealing. Figures published in the New York Times in February 2006 show that over the last 30 years in the United States the key trend has been a redistribution of income from the bottom 99% of the income earning population to the top 1%.

Over this period:

Income at the 99th percentile rose by 87%
Income at the 99.9th percentile rose by 181% and
Income at the 99.99th percentile rose 497%.

This process of income redistribution forms part of what some commentators have described as the Brazilianization of Advanced Capitalism. In societies where these trends are becoming evident, and the UK is most certainly one of these, you have a population made up of an excluded many, an at-risk most and excluding few.

 

Our Contemporary Social Structure:

A Super-Exploitative Rich,
A Squeezed Middle and
A Large Emmiserated Poor

From this ‘Brazilianization’ 1 one can see one of the clearest consequences for the United Kingdom has been the creation of a particularly insecure and unequal labour market.

In these conditions of insecurity and inequality Crime and its attendant Fears have become one of the major dislocating factors across what we now call Civil Society.

Our Workforce — US!

Our workforce is particularly interesting in this context. Our workforce is very vulnerable in this shifting, changing, insecure, unequal market place devoted towards short-term, year-on-year political goals. For instance, what if it became apparent that our Coercive Policies weren’t having the required crime reduction impact with those categories of offender that were meant to be their key target and objective. We may find that our disproportionate focus, our opportunistic focus upon the growth of a crime- reduction based industry has led us up a cul-de-sac from which there is no easy return.

In this climate, we don’t just need to equip our workforce with an NVQ level 3, we need to train them in a range of ways to respond to broader emergent trends that already have been identified by researchers like Howard Parker. Once again, our strategic thinking about working with broader populations than those who are targeted currently and our strategic thinking about how we should prepare our workforce for such changes has fallen well behind what our practitioners are experiencing and learning about every day.

Reversing out of our historical and political cul-de-sac isn’t about going back; there is no going back. It is about looking more closely at drug trends across the whole population. It is about dispensing with the morally denigrating labels that have become attached to a large section of our client group. In this context it is worth reminding ourselves what from our very own experience as professionals we know only too well, and that is that there is an increasingly large economically at-risk middle class in this country.

This very large group is prone to the same kinds of pressures and stresses that all economically and socially ‘squeezed’ populations feel. Binge drinking, problematic recreational drug use, multi-drug use, all of these affect much

broader sections of the population than those who are at the most economically deprived margins.

Woe betide our industry if one of our cardinal errors is seen to be one of asking too little of ourselves. If our opportunism has led us to believe that a narrow focus on a government-defined group of target drug users is sufficient to guarantee our futures. Do we really believe this? Is this really the best our industry leaders can come up with?

Will Hutton has written extensively about workforce issues, particularly in respect of what he describes as the ‘knowledge economy’. He says that 41% of the UK Labour Force is now employed in Knowledge-Based occupations. In defining the knowledge economy, Hutton states that "While some definitions focus narrowly on technology and science, my own extends the conception from high-tech manufacturing to creative industries like advertising and web design, from investment banking to the world of psychoanalysis, and also included education and health care.

Looking at contemporary Britain , Hutton argues that we remain "in a halfway house between a fully fledged knowledge economy and a low-skill, low value-added, low-innovation economy." Are we part of Hutton’s knowledge economy?

In order that we think more constructively about the next five years of our industry we must become clearer about the plainly political uses to which our industry has been put; uses with which we have actively collaborated–we must, in short, acknowledge our opportunism. This involves acknowledging that the link between drugs and crime isn’t what we thought it was or what we claimed. That there is a link is indisputable, but the link needs now to be more soberly examined. Our industry needs to move on.

One of the key benefits of the industrial age was mass employment. In the post industrial era we can no longer take quality mass employment for granted. Part of becoming clearer about our future involves recognising that the labour market in our society is very insecure and very unequal. Those in the middle are both ‘squeezed’ and at risk — of unemployment, of loss of status, of debt and of disillusion. Far more of us are at risk of substance abuse problems in this modern risk society than our industry currently wishes to acknowledge.

How short-sighted to imagine that the only major areas of problem drug use are those that can linked to certain kinds of property crime. Soon the public may require clearer evidence of the drugs = crime equation. Evidence, for instance, that is as soundly based and as extensive as the links between violent crime and alcohol: 65% of murders, 75% of stabbings, 25% of drownings, 40% of deaths in fire. Now there’s a drug for you!

In five years time we will, as an industry, be much clearer about which side of Hutton’s divide we fall. Will we be part of the knowledge economy, or will we be "low skill, low value-added, and low on innovation.� The answers to those questions are already pressing. As we discuss and debate what should be in the new drug strategy, we need to spend time looking beyond April 2008. Our futures and the welfare of many of future service users may depend on the kind of debates we initiate now, and the kind of decisions we take tomorrow.

Ian Wardle, Lifeline Chief Executive

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July 13th 2007

1 Wikipedia "Brazilianization" is characterized by the "increasing withdrawal of the White American overclass into its world of private neighborhoods, private schools, private police, private health care, and even private roads, walled off from the spreading squalor beyond. Like a Latin American oligarchy , the rich and well-connected members of the overclass can flourish in a decadent America with Third World levels of inequality and crime.

Reading :

John Muncie: Youth & Crime, 2004

Norman Fairclough: New Labour, New Language? , 2000,

Ruth Levitas: The Inclusive Society? Social Exclusion and New Labour, 2005

Ian Taylor: Crime in Context: A Critical Criminology of Market Societies, 1999

Howard Parker: Drug Strategy loses its way, Drink and Drugs News, May 7th 2000

Will Hutton: The Writing on the Wall China and the West in the 21st Century, 2006