Archive for the ‘alcohol’ Tag

“See, I’m not an alcoholic.”

Wednesday, January 14th, 2015

I’m a bit slow off the mark with this one (and everything else, currently), but I have just become aware of the Dry January campaign. I know, for many, a solid ten days of fourteen-hours-a-day alcohol consumption, and the subsequent kidney pains and whole-body lethargy, is enough to prompt a natural reduction in drinking. The concept of New Year’s Resolutions – new year, new me – may also bring about a vague idea of slowing the ingestion of post-festive calories, with some ill-informed belief that the thought itself will result in change. “I think, therefore I am (thin).”

In substance misuse services, we would discourage these types of contemplations. Real change, we would advise, requires setting realistic and achievable targets; lasting change is made from pledging to maintainable goals. Plucking unattainable standards from the ether and imagining to reach them, with nothing more than blind optimism and a lack of self-knowledge behind you, is bound to lead to failure. So instead of a glowing complexion, reduced waistline and normal-sized liver, all you are really likely to be left with is a dissolved sense of your own ability to change and diminished self-worth. (And a sad look in your yellow-tinged eyes.)

The other opposition to the positive notion of a short period of abstinence is that this bolsters our belief that our drinking habits cannot be problematic. If we can stop, just like that, then clearly we are in control. This false sense of security is in fact a clever method of self-justification to return to dodgy patterns of alcohol use post-abstinence. We are extremely good at finding ways of doing exactly what we want, and by telling ourselves we have stopped drinking (for a few days, then just having the odd glass, until after a couple of weeks we have chanted the mantra that we have stopped drinking so many times, to so many different people, that we completely believe it ourselves), we give ourselves the perfect excuse to enable our greedy, childish true selves to feast unquestioningly for the rest of the year.

I’m sorry if this is a bit close to home. I don’t want to knock your achievements, or pretend that, for regular and heavy drinkers, a period of abstinence will not be good for your health. I like to think that, if you manage a couple of weeks completely alcohol-free, you will start to sleep properly instead of knocking yourself out with booze, and begin to see the benefits of natural sleep. Maybe you will develop a renewed sense of fun, and alter you social habits to reduce your contact with alcohol-soaked environments and associates in the future.

Or, maybe you will just sit on your flabby arse, bored shitless, waiting with a clenched jaw to flip the page on the calendar so you can get slaughtered again. Guilt-free. Safe in the knowledge that your drinking habits are aligned with those of Nigel Farage.

* WARNING – this post should not be taken as an excuse to STOP STOPPING drinking and returning to your old habits before the end of the month. Just think about what you want to return to when you do start drinking again, and how that will look in the context of your own life.

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Drug service, anyone?

Thursday, October 2nd, 2014

I have been quiet for some time, but something momentous has happened, there are things that need to be said, and again the words have started whirring..

This week, our drug services have been privatised.

I need to make a few obvious political statements, but also want to pick through what this means.

The backdrop: in this area in the late 80s and the 90s, as a result of high unemployment and entire communities lacking self-worth, heroin became rife. Intravenous amphetamine use, which had long since died out in most parts of the country, was also a firm favourite amongst the socially forgotten, given its relative cheapness compared to the city folks’ crack. Drugs services were, it has to be said, sparse and extremely poor. Methadone was virtually unobtainable, the tightly-clenched fists of a few dangling it like an ever-retreating green carrot, and healthcare was an emergency commodity.

Unsurprisingly, people died. All over the place. Bodies dumped in wheelie bins and found in skips.

Political moves meant that something had to be done. Drugs had been the Number One Priority for local Police forces for some time, but the criminal justice angle had reaped few benefits. And so the other group saddled with the problem – the healthcare providers, who until now had primarily just responded to overdoses, deep vein thromboses, septicaemia and liver failure – stepped into the void. Drugs became a health problem. Ring-fenced funding direct from Central Government arrived, and substantial NHS drug services began functioning with vigour.

The deaths ground to a halt. In the first month, burglary reportedly decreased by 80%. Methods were crude, targets were basic. But it was an intervention of unrivalled success, not only for the drug users themselves but for the communities as a whole.

I’m not implying that things were perfect. In the years that followed, it has to be said, there was a period of relative affluence under Labour when services carried some dead wood. The overarching easiness meant that, in some corners, a lazy malaise developed. And the service users’ sense of entitlement, exploiting this new enhanced status, grew way beyond empowered independence.

Yet despite this imbalance, the interventions continued to work. The previously most excluded members of the community now had health opportunities, and with that came life choices.

Things have changed. The current Government have taken away the ring-fenced budget. They have separated financial decisions from the care providers, and moved public health money across to local councils. These councils are having their funds cut constantly. Services have been put out to tender, and decisions have been made not on quality of service provision or importance of outcome, but on finance alone. And the NHS cannot compete with private companies who pay less and offer less.

Concurrently, the Government’s smear campaign of the poor – portrayed as the cause of the financial crisis rather than the victims, a voiceless scapegoat for the mistakes of those few at the top – has made the vulnerable an easy target for funding cuts. The first service to go under council cuts in our area was rape crisis counselling. Drug services were never going to be far behind. If it’s not society’s problem when someone gets raped, it definitely isn’t when someone doesn’t have enough aspiration, self-esteem or identity to “just say no” to a drug problem. If I’m honest, I’m surprised the drug services have lasted so long.

So what does it mean to move service provision to private providers? On the plus side, in the private sector there is no room for dead wood. And there is no bureaucracy, so decisions will not take six months to make and a further six to implement.

However, no-one would want G4S running the police force. There is a reason why these services are so much cheaper to operate. Managed at arm’s length, lacking in local knowledge, paying less than an experienced, qualified professional is prepared to work for – my experience is that these organisations are inferior. And they are not healthcare providers. They are narrow, isolated ventures. So they do not have practice nurses on hand to dress wounds; they do not share a building with health visitors and school nurses to keep tabs on troubled families; they can’t run symptoms past a GP or psychiatrist to see if someone needs admitting; they have no way of providing integrated, holistic healthcare by sharing service provision with associated professionals for no extra cost.

They provide the required statistics and meet specific targets. And as anyone who has worked in healthcare knows, meeting targets is easy. Anyone can fiddle stats and ‘reinterpret criteria’ to appear splendid. Providing good care is much more complicated than that.

I worked for a similar organisation a while ago. They were never fully-staffed, because they employed inexperienced (cheap) staff who subsequently moved on as soon as they had good enough CVs to apply for other jobs. That won’t be an option for these guys – there is nowhere else for anyone to go now – but I am confident that the same attention to finance and not quality of care will rule supreme.

Recent investigations into private care homes has shown us what happens when we pay poorly and devalue care. When we treat staff like dispensable cattle, it will be those receiving the care that suffer the most. Especially when those receiving the care are once again the brunt of society and once again voiceless.

Given the bumper Afghani crop and the rate of novel psychoactives arriving, it doesn’t bode well. And whose problem will it be when drug services struggle to address the need? Not a Government organisation, that’s for sure.

The end of the Road

Thursday, October 3rd, 2013

Some interesting updates on previous articles have appeared in the news this week.

Silk Road has finally been taken offline, and the alleged administrator, the pseudonymed Dread Pirate Roberts, has been arrested. The website appears to have been a one-man operation based in San Fransisco. The suspect, Ross William Ulbricht, kept his operations so secretive that his housemates knew him only as Josh, the guy who spent all his time in his room on his computer, and the FBI had to scour years of data to find very rare glitches in his online personas in order to identify him. It was only when a package containing fake IDs were seized at the Canadian border with Ulbricht’s picture on them, that investigators linked this to online activity – Dread Pirate Roberts had asked for advice on gaining fake identities to set up more servers. Given that Silk Road had a estimated $1.2 million worth of trading each month, and the FBI have seized $3.6 million worth of Bitcoin during the operation, it is astounding that Ulbricht has evaded identification and capture for so long. I wonder whether the US authorities will now power on with their War On Drugs and hunt down his suppliers and customers..

It will also be interesting to see whether previous Silk Road customers see a decline in the quality of their purchases now they have lost access to the Ebay-style seller rating system.. If there are any ex-customers out there, I would love for you to get in touch and let me know how you are buying your drugs now and what impact this has had on you.

Following on from last week’s blog about the normalisation of alcohol, a couple of interesting articles have been suggested to me by staff at Sheffield University. The first informed me of the alcohol industry-driven marketing concept that is Arthur’s Day. The producers of Guinness launched this national event in Ireland four years ago to ‘celebrate Arthur Guinness’, and then refused to accept any responsibility when alcohol-related ambulance call-outs increased by thirty percent. This somewhat sinister celebration, cleverly timed six months after St Patrick’s Day and on the busiest drinking night of the month (Thursday – student night, 26th – payday), has been described by some as exploitation of Irish culture for capitalist gain – and the way it has been embraced by the public suggests that alcohol marketing is even more powerful and socially influential than anyone could have predicted. (Apart from the Dr Evil-style masterminds at Guiness, obviously.)

This seems somewhat in conflict with the Irish health minister’s claim today that he wants to ‘denormalise’ tobacco use, and achieve a ‘tobacco-free state’ by 2025. Yet another example of policy-makers’ bizarre lack of parity between substances. Given that the Irish Government are encouraring Arthur’s Day as a tourist opportunity, I’m guessing from this that they would take a different approach to smoking were Marlborough produced in Galway…

The second article recommended looked at the normalisation of women’s alcohol use in the UK. It presents some scary facts about women’s health, and considers how the pressures of being a working mum are influencing alcohol intake. Again, it is pointed out that wine is sociably acceptable whilst cooking, and suggests we really need to question what has become ‘normal’ behaviour. It does make me wonder whether our kids think we drink that like all the time, been as that’s all they see of us. And with our young women drinking more than any others in the western world, maybe we need to look at ourselves and the patterns our children emulate.

And finally – I know you will all have seen this, so I will be brief – in a brave move which may mean he does himself out of a job, Chief of Police Mike Barton has stated that decriminalisation is the way forward. Drawing a clear division between drug dealers and drug users, Mike is making a bigger statement than many of us realise, given that many Police targets focus on homogenising and prosecuting anyone associated with drugs because ‘drugs are bad’. Mike draws the same comparisons that have been previously drawn here between the War On Drugs and alcohol prohibition in 1920s America – instead of stopping the trade, it routes the profits directly to criminals. It’s a relief to know that the frontline last bastion of the moral crusade, the Police, are willing to make their voices heard – instead of, as with the Police in 20s America, seeing the battle as a way of either lining their own pockets or buying their way into heaven. I think it is an honest and altruistic move by Mike, one which may well both damage his career and sit him outside his peer group, but I for one am heartened by his stance.

Alcohol – it’s not a drug, it’s a drink

Wednesday, September 25th, 2013

I have had somewhat of an epiphany recently. In light of my self-questioning around the application of morality to the laws of the land – specifically with reference to drug use – I have started to perceive alcohol differently. Anyone who knows me knows that I am a drinker. I always have been, and so has everyone around me. This is despite losing people to alcohol. And yet we all still drink drink drink like it was going out of fashion.

I still told my clients the dangers of drinking, indeed I knew them myself, and to be fair in recent years I have generally drunk within ‘safe’ limits. But that is far as I ever thought about going – after all, it was safe, so why would I question it any further?

Recently, I have pretty much stopped drinking – because after a spell of drinking very little, I realised that, when I do drink, I feel anxious the next day. Not only on the night itself, but the day after, I misjudge things, and my perception of the world and of myself is altered. This has nothing to do with ‘safety’ – but it definitely has a lot to do with health. If, as I am starting to wonder, alcohol can significantly affect mood the day after use – and bearing in mind that many people drink every night – does this not have huge implications for the mental state of the nation?

Then I saw a news report last week about the proposed ‘drunk tanks’. The idea was that people who were incapable of being responsible for their own welfare because of excessive alcohol consumption would be put into a unit overnight and then charged for the care they received – both to protect people and to reclaim some of the money in revenue spent on policing costs. It seemed like quite a good idea for me. But the man representing the alcohol industry gave me an insight into how much they care about the damage done by alcohol consumption and what they want to do to tackle it – which was, in summary, fuck all. The well-groomed young man in expensive glasses had a seemingly endless list about why no national mandates should be passed – why this was about local services making local decisions. Which, as anyone who works in the public sector knows, means doing nothing. Because everyone is too busy, are all praying to keep their heads above water and their jobs, and are not about to stump up the cash and time to commission and implement something so huge without imperative direction from the very top.

And as I sat there, watching this nicely-spoken young gent, something happened. Before my eyes, he morphed into every heroin and crack dealer I had ever met. His shirt was ironed, his face was clean – but his justifications for the continued sale of his product, his reasonings for why the deaths and the violence and the illnesses were not his fault, made him seem to me no different from the many dealers I have challenged about their choice of product and its impacts. The truth was – he didn’t give a shit about the number of young women getting sexually assaulted. He wasn’t the least bit interested in how much use of his product cost the taxpayer each weekend in policing and health interventions. And he certainly wasn’t willing to do anything about it.

Now, fear not – I am not about to go all evangelical about alcohol use and start praying to a higher power for strength to repel the demon drink. I am still going to have a drink when I feel like it and, likely as not, will drink too much on occasions. I suppose I am just realising, for myself, another layer to my indoctrination on the matter of legal and illegal drugs. Alcohol is not ‘bad’ – just like any other drug – and of course alcohol companies are only interested in taking your money, as per the capitalist mantra, or just like any other drug dealer. But where is the logic that most drugs should be illegal while just one remains legal – and what impact does this have on perceived safety and social acceptability?

My brother recently came back to the UK, and commented after a night out, “God, I’d forgotten how the English drink”. Recent reports indicate that, in fact, much like the truth-dodging representative for the licensing industry, we as a nation also forget how we drink. A report published by Alcohol Concern found that, in 2007-8, for Brits to drink within advised limits, alcohol consumption (excluding that brought into the country duty-free and home-brewed) would need to reduce by a third. The report found that if the alcohol bought in shops was divided between every adult, we would all be consuming twenty-six units a week.

However, an even scarier report published this year in the European Journal of Public Health , found that half the alcohol consumed in England was unaccounted for. (Again, this does not include imported of home-brewed alcohol, so the actual consumption is even higher.) The report exposed the discrepancy between self-reports of alcohol consumption, and alcohol sales. So at least three quarters of the population are estimated to drink above recommended limits – and no-one is admitting to it.

Now the alcohol industry clearly know this. If this wasn’t happening, they wouldn’t be eating caviar on their yachts. And yet, despite the serious health problems associated with drinking at these levels, they continue to push the drug. They continue to fight legislation to minimise the harm it causes. And they continue to put their hands up in objection when anyone suggests maybe they could be partly responsible for this problem and, as such, should maybe put their hands in their ever-deepening pockets and contribute towards reducing some of the damage done by their product. No less ruthless that the dealers who keep selling heroin they know contains congealants, or market their stash of PMA as ecstacy.

It also makes me wonder how much sway the alcohol firms have in the Tories’ drug policies. They bring in billions in revenue – and I am sure they are none-to-happy at the idea of someone muscling in on their market share by selling cannabis or other alternative products. Yet again, I am left questioning how much of our legislation is about the welfare of the population, and how much is about rich people scratching each other’s backs..

Baby wants a double vodka

Saturday, July 20th, 2013

Pregnant women who use methadone are likely to under-report their alcohol and drug use, a piece of research published this month has found. The admittedly small sample of fifty-six opioid-dependent women, prescribed methadone as a substitute for heroin, were found to continue taking illicit drugs and alcohol during their pregnancy, as discovered by testing mothers’ and babies’ urine, and meconium (first stools). The study showed that 91% of women taking part in the study had used illicit drugs – 73% had continued taking opiates, and 70% had used benzodiazepines (which are thought to be linked to birth defects). 47% of the babies had also been exposed to alcohol use at levels of at least 2 units a day or 5 units at once, despite only 5% of the women disclosing this level of alcohol use. The most common combination (drug workers won’t be surprised to hear) was heroin, cannabis and alcohol.

Now this is clearly a highly-contentious area to discuss. On one side of the debate, there are people who acknowledge that women become pregnant for a variety of reasons, not necessarily through choice, and that the lifestyle that comes with heroin addiction may not be the most happy or meaningful existence, or borne from the most stable of upbringings. Once pregnant, drug users typically face extreme feelings of guilt – feelings which they have historically used drugs and alcohol to manage. And then the judgements and processes they are subjected to during pregnancy – safeguarding procedures and meetings, constant monitoring, reports written weekly about them and their parenting capacity, every bad decision they have ever made dragged up and pored over – make pregnancy not a joyful but a very stressful experience.

And then, on the other side of the debate, there are the tabloid readers – and there is so much meat on this bone for them to chew. First of all, of course, all drug users should die. They sacrificed their right to be on this planet the first time they smoked a spliff. Then – it gets worse – they are mothers. Should a woman not cease to exist in her own right the instant she conceives? She is, after all, a vessel. She should be pure and demure and fit all the glowing, maternal images we associate with motherhood. So the lifetime of misery, abuse, ill-treatment and self-deprecation should end the second that sperm hits that egg.

Now, don’t get me wrong, I find it very hard not to judge drug-using mothers-to-be. The unborn child is helpless and dependent on her to meet its every need, and it is heart-wrenching to think that it is disadvantaged before it has even left her womb. I do read the riot-act to these women, making it very clear that they are putting their baby’s welfare at risk, and increasing the chance that, once born, their baby will suffer painful and distressing withdrawal symptoms. What a sad and sorry start to life.

However, one thing is for sure – guilt does not perpetuate healthy behaviour. The fact these women are under-reporting their substance use is a sure sign that they already know all of this. You can bet your bottom dollar that they are beating themselves up more than anyone else ever could. And it is the discrepancy between what is expected of them and what they believe themselves to be capable of that makes burying one’s head in the sand the most realistic option.

I would imagine that most women who have had children would find this research both sickening and saddening. Whilst the idea of doing anything that may put their babies at risk may repulse them, I bet most of them have also felt judged, squeezed by other people’s expectations, desperate not to stand outside the prescriptive maternal mould that is dictated to them. Surely there is no worse judgement than being a bad mother. And not breast-feeding…?!

In the late stages of her pregnancy, I took a good friend of mine out for a drink. She was a single mum with two other kids at home, and she was desperate, for one last time before her baby was born, to just be herself for a night. She hadn’t drunk at all throughout her pregnancy, but on this occasion, I bought her a bottle of Corona, and she savoured it as we sat talking for an hour. We were in Wetherspoon’s – not an establishment known for its distinguished clientele with high moral values – but you should have seen the looks she got that evening. People gathered to bitch and point; judgements were formed, comments were made. At the time, she was drinking within the acceptable limits in pregnancy (guidance has since changed to ‘no alcohol during pregnancy’, although I believe this was mainly due to the fact that people struggle to quantify a unit), and she certainly wasn’t putting her late-stage pregnancy at any risk by her action. But as she sat there, gorgeous and bulbous, trying to enjoy her one night of being a person before months of being a multi-tasking milk machine, she was deemed by the other drinkers gathered that evening as the scourge of the earth.

So I suppose, in conclusion, I just want to say – this piece of research is sad. It is sad for the babies, it is sad for the mothers, it is sad for society. But maybe, maybe, if we saw pregnant women as people first and mothers second, the gap between expectation and reality might not be so great, and the image of the happy, stable, glowing mum-to-be might change into something more achievable for all pregnant women.

Cannabis vending machines, coming soon to a pub near you

Sunday, June 23rd, 2013

Correct me if I’m wrong, but I’m starting to think that cannabis is actually going to get decriminalised. Over the last six months, I have noticed a significant swing in the reporting of all debates around drugs, from the moral to the practicable. Particularly where cannabis is concerned, the reporting has changed from “if” to “when”. There have been changes to the social presentation of cannabis, as well as the moral and political discussions around drug use per se, and even discussions in the professional and academic arenas have started to reflect that this not only should but also might actually happen.

Yes, we know that the Tories are digging their heels in when it comes to making changes. But gigantic intra-party rifts (and an overall lack of charisma) pretty much guarantee that they won’t be getting in next time. The Lim Dems have voiced their more liberal approach to these matters, and whilst Labour have remained diplomatically quiet on the matter, the bunch of Guardian readers will not have been able to avoid the swing in public and press opinions. Plus by the time the Tories have deconstructed the NHS, the next Government will inherit a bunch of uni drop-outs instead of proper drug workers (because untrained, inexperienced workers are ever so cheap, you know), progress at tackling the issue will be reversed, and the drug problem the Tories so confidently state is currently under control (ahem) will be rearing its ugly head yet again, forcing a new course of action. And really, if the Tories actually thought about it, regulating and taxing cannabis would be an excellent capitalist move and revenue generator.

But when I take a step back and stop wrangling with the current political debate, I am in total awe of the social shift we are witnessing. If cannabis does become decriminalised and therefore a marketable product and commodity, and it becomes widely accepted that it does not cause the same level of physical and social harm as alcohol, the social laws that have existed throughout our lives so far will change.

Let’s take as an example the British institution – the public house. We can pretend that the Government has appeased the alcohol companies by giving them licenses to sell cannabis, hence reversing the demise of the good old boozer. People crowded into smoking areas outside pubs will now be passing round spliffs – a much more social activity than smoking cigarettes, and one which tends to spark discussions and create a sense of community. When these people go back into the pub they will probably feel a bit stoned (especially if they’ve already had a drink) and won’t feel like drinking as much. With less alcohol being consumed, and a more general state of relaxation taking prevalence, these punters will be feeling way too chilled out for the usual fight or sexual assault.

So there you have it – my solution to the main target for alcohol services over the last three years – if you want to reduce alcohol-related hospital admissions and A&E presentations, legalise pot. Seriously, with policies like that, I should totally work in public health.

However, what genuinely entertains me about this huge social shift is the looks on our future generations’ faces when we tell them what life was like under prohibition.

Futuristic young person (scanning screen implanted on palm): “So drugs used to be illegal?”
Old me (hopefully donning a jet pack): “They did. You could go for prison for having them in your possession.”
FYP: “What?! Seriously?! So did everyone go to prison then? Did you go to prison?”
OM: “No – we used to hide our drugs in air-tight containers called Tupperware and drive out into the countryside to take them without anyone knowing.”
FYP: “Plastic and petrol? That’s not very ecofriendly! You’d get arrested for that now.”
OM: “And the Police used to drive out into the countryside to to try and catch us.”
FYP: “That is totally wasteful of public money.”
OM: “Well think how much it cost to convict the people they caught and keep them in prison – then have to maintain them on state benefits when they were released because no-one wanted to employ a convicted drug user.”
FYP: “So if drugs were illegal, that means they weren’t taxable – so who paid for drug treatment?”
OM: “Most of the money for drug treatment came out of criminal justice and health budgets.”
FYP: “So money was taken away from catching rapists and treating cancer?! That is crazy!”
OM: “You lot don’t know you’re born. I bet you’ve never even been to a criminal’s house. You’d arrive at the dealer’s, completely shitting yourself, fearing unreportable violence, or, even worse, a Police raid, until the minute you left the dingy, fortified shit-hole, with a bag of godknowswhat, no doubt weighing less than you’d paid for.”
FYP: “Why would I have anything to do with criminals? You lot were bonkers, it’s only weed, as if I’d risk getting arrested for something so boring.”
OM: *shameful lowering of eyes at own stupidity* then *nostalgic state into space at memories of the old days when we thought drugs were cool*.

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