1. Workforce development in the new...... Annette Dale- Perera Strategic Director of Addiction and Offender Care

2. Wider range of service users

3. POLICY RECOVERY Voluntary self control over substance use plus health and wellbeing plus re- integration Push for abstinence – planned discharges substance free Training & employment Housing Friends/relationships PUBLIC HEALTH Reduce Blood borne viruses Reduce drug and alcohol related deaths Reduce health inequalities Increase life expectancy Increase health & wellbeing Smoking cessation Prevention

4. Evidence WHAT RECOVERY OUTCOMES White( 2012) 407 studies: around 50% with substance dependency achieve remission: 20% do so through abstinence. Cannot tell until someone is in stable remission until after 5 years Different people have different recovery capital/ potential Some substances are more difficult to achieve remission from

5. Evidence RECOVERY OUTCOMES Heroin is sticky First 6 mths to a yr in treatment – most potential for change (NTA) Drug outcomes improving in England since mid 1990’s 75-65% heroin users stopped using 3-5 yrs (NTORS etc). 30 yr follow-up study: Grella and Lovinger (2011) Of survivers 40% in stable remission but normally after 5-8yrs in opioid substitution, 25% did not reduce use at all.

6. Evidence HEALTH OUTCOMES Substance dependence causes significant collateral health damage, directly or through associated lifestyle – smoking, diet, hygiene etc 33 yr follow-up study: 50% heroin users dead (Hser 2007) Alcohol - mental health, cognitive damage, liver disease & and `system damage’ – cancers Injecting drugs – infections, vein damage & DVT, heroin overdose risk & death Smoking tobacco, cannabis, crack lung & heart disease Teeth !!!

7. Evidence EMPLOYMENT OUTCOMES International evidence suggests this is the most difficult to achieve Those employed on starting treatment likely be employed at follow -up and visa versa UK worst rate of unemployment in drug users compared to EU & USA BUT Education, training & voluntary work helps recovery & happiness CRIME OUTCOMES Substance - driven crime outcomes good if people achieve remission

8. Evidence SOCIAL OUTCOMES Having supportive friendship/family networks is paramount NICE: Mutual Aid, Family Therapy and Behaviour Couples Therapy Wellbeing research: friendship group of more than 3 = happiness

9. Some great guidance and tools Drug Matrix: Evidence for effective treatment: FINDINGS....

10. Overcoming dependence takes time Manager competence clear pathways - staff and service users know Track progress of clients particularly heroin users eg using `MAR’ data Review clients every 3 months If treatment not working – optimise Data/reviews to track clients progress and key workers caseload & complexity

11. Workforce competency improvements Health screening, assessment, treatment better harm reduction & health treatment when using better treatment for health issues when in treatment Evidence-based behaviour change interventions Empowering service users rebuild lives Helping (re) establish constructive relationships Education, training and meaningful activities Longer term health & wellbeing strategies

12. Competency required to treat Drug families

13. Reality check EXTENSIVE APPROACH needed ie longer term support but can we afford to do this PbR EXPECTATIONS................failing More health improvement & treatment More competence in behaviour change techniques –with fidelity & supervision Re-commissioning risks: TUPE, Disruption Smaller financial envelop risks of `Dumbing down’ loss of `expensive workers’

14. EG Well-being amongst staff and clients `Five Ways to Wellbeing’ framework. Staff & service users have 5 ways plans Teams have 5 ways activities & funding