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- issue number 6: October 2015

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It’s interesting because the word ‘craving’ generates many opinions. Some people say:

  • A craving is an urge?

  • Surely it is a desire!

  • What is the difference between a craving and a trigger?

It is wonderful because it appears that if we label what a craving is, that will in some way remedy someone’s craving hence alleviate the tension that a craving generates in someone that is trying to reduce or stop their drug use. The understanding of a word, and the ability to explore similar words in order to further explain and explore ‘cravings’, is not a bad beginning in the client understanding of this ‘thing’, however once you get pass the thesaurus type understanding of ‘craving’ then what next? Remember the client and especially the worker’s understanding of ‘cravings’ is crucial to treatment because it is at the heart as to – Why someone will pick up substances/again? A client has to understand:

  • What is a craving?

  • How to recognise a craving?

  • Differentiating between blatant and hidden cravings

  • Understanding that cravings are simply present, in much the same way as oxygen is present and you breath it.... Read More

Please click here to see the video on Resonance Factor.

New Research on optimising the effectiveness of OST

Soon to be published is the research carried out by Felicia Heidebrecht (©2015) at a drug service in Hackney in collaboration with the University of East London, into the effectiveness of opiate substitute treatments (OST) namely methadone and buprenorphine.

The study was carried out over a period of 12 months with a cohort of 195 service users.

Read more 

Young People and Residential Treatment

In 1989, a joint initiative between health and social services saw the opening of a rehabilitation centre for 15-21 year olds in Hackney in East London called Lorne House. It was opened by Diana Princess of Wales, and was run by Turning Point.

The thinking behind this initiative was that young people needed specialist services catering to their specific needs, and that it may be detrimental for young people to be placed in treatment with older drug users with a longer history of using. Read More 

Smart Pills at University

In recent weeks the press has quoted Lord Ashcroft’s exposé of David Cameron including what he got up to in university:

“allegations of drug-taking, sexual promiscuity and even a lurid tale of an obscene act with a pig,”

The Independent Monday 20 September 2015.

Drug use and sexual ‘promiscuity’ may be expected in higher education establishments, although I suspect we all feel that obscene acts with animals belong to the higher enchalents of education establishments, the likes of which Mr Cameron and his peers attended. Read More 

Policy and Procedures - Baking a cake

Policy and strategy, if it is effective, is much like baking a cake, that is to say, if the ingredients are wrong then the cake usually does not bake well, being either too hard, soft, lacking flavour, lacking texture, the list goes on. Making a cake usually requires precision, and often the more complex the cake, the greater the need for precision.

Read More 

Sustainability Of The Voluntary Sector

Earlier this month the NCVO released a report reviewing the financial sustainability of the voluntary sector.

One of the aims of the report was to identify the trends that have emerged within the income of the voluntary sector since the recession. The findings are extensive, however I'd like to focus on two interesting areas in this article; 1. Small charities and 2. The support the sector at large receives from government.

Read more 

Health and Wellbeing - Negativity

"Once you have identified with some form of negativity, you do not want to let go, and on a deeply unconscious level, you do not want positive change. It would threaten your identity as a depressed, and dry, or hard-done-by person. You will then ignore, deny, or sabotage the positive in your life. This is a common phenomenon. It is also insane.” unknown

Is the relationship with negativity negative? It feels hard to let go of a relationship that you had for so long that has supported you when no other has, it has keep you safe when you have felt so scared.

Read more 

Unsung Hero - Franco Tomo

Janus would like to acknowledge the contribution of individuals in the caring sector who do great work and long lasting work, however they do not get the accolade offered to more high profiled individuals. These people go about their work in a unassuming way, the reward simply being the work.

Janus is pleased to introduce this months unsung hero. Franco Tomo has been in the drug and alcohol field for many years, and he has expanded CDSSL from a small community based project to what it is now. Janus staff have had the privelege of working with Franco over the years, and understand how he puts the service user at the forefront of his planning, and strives to make sure that he recruits staff that carry the ethos of the project. Franco has the skill to communicate with service users, his staff and volunteers and commissioners.

"Franco is a man who sees potential in all, from volunteers, staff and of course the service users. What's more is he acts on his beliefs. His heart and soul is for recovery, for personal development. He delivers what he says he will, he gives his trust and this is invaluable for his team and in turn for the service users" Nicki (Trust)

"Unless you work with Franco on a daily basis you don't see how hard he works, well into the late evening and over weekends, tirelessly working to keep not just a good level of service for the service users... this goes without saying... but, also jobs for all of us. I have worked at CDSSL for 10 years and I am so very grateful to have been in employment all of that time and anyone working in this environment will know that this is not easy and I would like to give recognition where due. Thank You Franco for being so good at what you do X". Deborah (CDSSL)

If you know an unsung hero please send in an acknowledgement.

Service User Writings...

As I sit here on my squeaky chair
the sun is shining bright
it bounces off the walls dancing enticing with the light
I close my eyes listening to the sounds
my peers are all arriving
I feel the energy around me and smile a Mona Lisa smile
feeling warmth and security
knowing they are here to support and hold me
with eyes still closed I listen to their chirping
giving thought to what they are trying to say
the high, the low pitches, the rhythm and the movement
I open my eyes and say me hello's
the place I sit now from the place I began
as a scared, lonely person riddled with guilt, shame and blame
living in shadows of grey with fragments of a childhood I've tried to hide
to realise I cannot change the past
acceptance, explore and to make choices
stop thinking of what you could have been
be grateful for each day
I know the work is ongoing
no more fantasy land


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READ MORE articles below

Resonance Factor - Cravings continued

After all if you have developed a profound relationship with a substance on a daily basis, at the expense of everything else, over x amount of years, then why would not someone be craving constantly, either to a lesser or greater degree. However, what is probably more interesting and relevant is the thinking process behind ‘cravings’ rather than trying to understand, from an English Language perspective, what is the meaning of the word or term ‘craving’.

Using an abstinent or ex-substance user as an example. Is it possible to crave if someone is present in their here and now? That is to say:

I am on a date with my partner. We are at the cinema. Watching a movie. Is it possible for me to crave for a substance, or more specifically is it possible for me to crave to such an extent that I make a decision to use a substance once again.

It is probably not possible to be overwhelmed by a craving if someone is totally present in their ‘here and now’. If the individual immerses him or herself in the fact that:

  • S/he is with their partner

  • S/he is fully immersed in the fact that s/he is in a cinema

  • S/he is immersed in the actual movie that s/he is watching

Even if the individual were to experience craving or a trigger, s/he should not be overwhelmed by it because the individual being rooted in the ‘here and now’, undermines the force of a craving or the stimulus of an unexpected trigger.

The only way a craving can grow in intensity is if the individual locates him or herself in past thinking, then projects their thinking forward in time, the future, to anticipate the ‘pleasure’ he or she will experience when they use, based on the pleasurable sensations they experienced through past substance use. People refer to it as euphoric recall. However, it is more than euphoric recall, it is the constant moments of pleasure the individual experienced when they used substance, and that pleasure can be measured like this:

  • Knowing that substances gives ‘me’ a fantastic high

  • The process of gathering the resources together to purchase the substance

  • The anticipation of what the sensation will be like when that substance hits me, and

  • Knowing it will begin again once I have consumed the substance

This is more than ‘euphoric recall’, this is ones whole life directed toward substance use.

Hence, using someone that is abstinent as an example, a craving is the process whereby the individual indulges PAST thoughts and memories, and then project their minds forward, to the FUTURE, anticipating the sensation of pleasure they will experience. In actual fact in is very very difficult for an individual to be overwhelmed by ‘craving’ if they are grounded in their ‘here and now’. However, if some indulges in past thinking and future anticipation he or she will be overwhelmed by their ‘craving’.

The ability to be grounded in ‘here and now’ thinking requires mental training. Unfortunately individuals who master their cravings often develop this skill themselves, as opposed to services teaching them!

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New Research on optimising the effectiveness of OST continued

The methodology was rigorously applied in pursuit of an authentic outcome that may benefit and inform both service providers and service users.

In delivering drug services many of us are aware of the drug using characteristics presented by services users eg. on-going on top heroin use with methadone prescriptions, and crack use often accompanying heroin use. So how do these aspects impact outcomes?

Heidebrecht found that on-going on top use was most prevalent with those on lower doses of methadone or bup, whereas those on an optimum dose were more likely to reach their treatment goals. However, she does not attribute this outcome to medication alone. She concludes that an additional 2 components are essential to achieving goals: the user’s motivation; and the delivery of robust psycho social interventions.

Of the 195 participants, 78.5% were also crack users. The research shows clearly that the outcomes for this group are poorer than for those who do not use crack along with heroin. The probability of a good outcome for daily crack users was only 19% whereas for those using heroin only, the probability rises to 45%, more than double.

Does this information hold any surprises for drug workers? Unlikely. Many are fully aware of the drug using profile of those coming into services. However, how many services give proper attention to the on-going crack use once the service user is ‘stable on a ‘script’ and possibly achieving occasional or no heroin use. In addition, how many service users are honest about their crack use at the point of entry and therefore are not asked about their crack use as they become engaged in treatment. This research found that many service users do not reveal their crack use or minimise it when they engage with the service and therefore this may not come to light unless they are specifically asked about it.

The recommendations of the research aimed at both providers and service users are therefore very clear. The medical intervention forms one part of the treatment package and is most effective when it is at an optimum level. The medical intervention alone will rarely achieve the desired outcome and will be most effective if delivered together with psycho social interventions individually tailored towards the service user. Crack use has a significant impact on treatment outcomes and must be explored and addressed in tandem with OST.

We welcome this research as the first definitive piece of work focussing on the needs of the largest group of service users accessing treatment and remaining in long term treatment and look forward to the publication of the full paper later this year.

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Policy and Procedures - Baking a cake continued

Policy and strategy, if it is effective, is much like baking a cake, that is to say, if the ingredients are wrong then the cake usually does not bake well, being either too hard, soft, lacking flavour, lacking texture, the list goes on. Making a cake usually requires precision, and often the more complex the cake, the greater the need for precision.

The striking thing about the substance misuse field, is the diversity and variety of interventions. Diversity of course, suggests that there are many opportunities to learn and deliver new and interesting things. However, diversity and variety of approaches and interventions needs to be tempered by an exploration and understanding of what we are working with. Policy and Strategy appears to suggest that evidence is essential in identifying best practice. The Government manifesto is clear in that it focuses on its desire to:

… “become smarter with crime prevention” and “deal with the drivers of crime such as drugs and alcohol”. Further pledges include rooting out drug and alcohol dependency.

Yet if interventions are extremely varied then where is the synchronicity with regards to service delivery:

  • How can members of the same team be massively divergent in their view of the client?

  • How can the different, yet complementary services, such as street agencies, detoxes, day programmes, rehabilitation units, job brokerage agencies etc, have differing and at times very different views to treatment as their sister services?

  • How can we as ‘thee’ professional state the client is ‘the expert’?

  • The list goes on with regard to in congruencies that exist within the field of substance use.

Policy makers may never attain the results they want if they continue to have conversations with familiar experts; continue to not look in detail at what is being delivered; continue to underestimate the training needs for professionals working with this client group, and finally to be clear about the strategic imperative or absolute outcome service providers are aspiring to. These things need to be considered and implemented if all the ingredients of treatment and aftercare provision are to come together to achieve that absolute outcome.

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Sustainability Of The Voluntary Sector continued

Government grants are at an all-time low. Grants from central and local government fell by a massive 49.3% (£2bn) between 2007/08 and 2013/14. Furthermore, income from government contracts has also fallen (£1.7bn) since its 2009/10 peak. “Despite positive developments like the Social Value Act review and government contract transparency clause pilots, there remain significant barriers for charities seeking to engage with public service contracting”.

The review stated that “Government policy has for some time been to move away from grants and towards contracts as a funding modality. Many of these contracts are large scale, awarded on a lowest cost/price basis, and require upfront financial investment and/or the ability to manage significant financial risk over the contract duration. These and other aspects of contracting are proving especially challenging for the small – and medium-sized charities that constitute the bulk of the voluntary sector”.

Smaller charities’ income has been the worst affected by government spending reductions and as such these smaller charities in particular are not benefiting from the general trends in economic recovery we have seen since the recession. “They are experiencing a ‘capacity crunch’ that limits their ability to adapt, or to even engage with funder programmes designed to improve their sustainability”.

Despite the hardships and reduced support from government, charities have demonstrated a significant amount of innovation and entrepreneurship during the economic downturn and recovery.

“Charities have sought to diversify their income away from government sources towards income from individuals, which includes donations, fundraising, fees for services, and legacies”.

“Income from individuals has grown £2.3bn in the last five years and donations have recently recovered to pre-recession levels, this has become a significant proportion of total sector income.

However the significant growth has been driven by fees charged by charities for services, relying on this as a major source of future income growth may be unsustainable or undermine organisations’ charitable aims in some parts of the sector”.

For example, a small charity working with beneficiaries who may be financially disadvantaged and coming from low-income environments faces a clear and obvious dilemma when considering charging for services. If they do charge for the service, many beneficiaries in need may shy away, if they don't charge, the charity may not have the financial resources to provide the service at all. It seems that by continually cutting funding, government seems to be passing even more responsibility (including the moral dilemma) to the small, often grass roots organisations who exist purely to help those in need. It's no wonder that some in the sector are left feeling emotionally deflated.

View the full report here

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Health and Wellbeing - Negativity continued

It has comforted you when you have felt that the world has been against you. It has braved the cold when you needed to be kept warm.

Why is it hard to say goodbye? Why is it hard let go?

The question can be asked would you be able to live without the negative part of self, as it can play an important part to remind you what is positive.

What happens when Circumstances and experiences shine a light on that negative part of you? Are you creating a choice to be kept in the darkness as you feel it better for you, or are you opening your self up for change as you know you need to?

Telling signs of the subconscious mind reminds you, negative has reached it sell by date and has long expired, but is easier to work with familiarization than co creation of the unknown. IT is easier to live without living rather to fully live and be alive.

Are you Dismissing choices, projecting, blaming, deflecting from uncomfortable emotions, do you want to change, are you feeling lost without it and remaining the same?

Is there a patten here that cleverly repeats itself? Are you recognising the insanity and remaining insane, living life or remaining in pain? The choice is yours, it's up to you, keep doing what you're doing or change what you do.

Question: do you have a relationship with negativity or does negativity have a relationship with you?

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Young People and Residential Treatment continued
The workers came from a variety of backgrounds, but all had an active interest in working with young people. The programme not only looked at psychological issues, but also engaged residents in activities, that were age appropriate for 15-21 year olds. In an interview with Turning Point, Rosanna O Connor, Programme Director, said that in 9 years the service had helped over 500 young people become drug free. She cited the reason the project closed was withdrawal of funding in-keeping with on-going cuts to health and social care provisions for young people.

Residential treatment is designed to provide the service user with a place of safety, in a drug free environment where they have a forum to address their drug use. This is achieved through counselling and group work and usually in a therapeutic setting, where the residents live as a community. Programmes times average from 6 weeks to 6 months. In order to secure funding for these programmes, a community care assessment is completed and considerations may include the service user’s history in treatment, previous funding granted, currently health issues, safeguarding issues and homelessness. This criteria is not always easily adapted to young people, aside from the question of the suitability for placement in an adult treatment centre for young people.

The specific issues facing young people today may differ significantly from 1989 when Lorne House began. We often hear of the social pressures on young people not only in their communities and in their homes, but also in schools, colleges and university. Drug use includes the use of high grade ‘skunk’, synthetic cannabis and other legal highs, and of course alcohol and ecstasy. Sexual coercion, and exploitation through social media, as well as involvement in gangs driven by poverty and environment are sadly commonplace issues facing many young people. Options for young people to escape their environment and pursue alternatives without experiencing isolation are hard to come by leaving many despondent about their future.

So where does the responsibility lay to support young people out of the trap they may find themselves in? Who can they go to? The truth is that many feel helpless and that there is nowhere to turn. Perhaps we should ask instead, who are the stakeholders and where is the likely impact?

As the media frequently informs us, the impact is felt most acutely by families where the loss of a teenager through knife crime is sadly far too common in our communities. But the impact is far reaching also to services such as criminal justice, health services particularly A&E, social services for children and families and young people, youth offending team, schools and colleges as well as young peoples drug and alcohol services.

It is time for all stakeholders to come together to develop and provide residential services for young people that meets the need for a ‘place of safety’ away from their usual environment, where young people are supported to explore the issues they face, to examine their drug use and how it relates to their health, their criminality, their self perception and their hopes and aspirations. Such an investment in the generation of young people who are tomorrow’s parents and decision-makers might turn the tide from hopelessness to possibilities, from violence to communication, and from exploitation to acceptance for our children and young people.

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Smart Pills at University continued

Alcohol has always been the most popular drug of choice in colleges and universities with cannabis following closely behind, and ecstasy has seen a resurgence in use in recent years. But increasingly common nowadays is the use of stimulants, or ‘smart’ drugs that students use to help them stay awake and alert for longer.

Guardian February 2015

The stimulants used are all prescription drugs such as Modafinil, used for sleep disorders:

“It’s not that it makes you more intelligent,” says Phoebe, a history student. “It’s just that it helps you work. You can study for longer. You don’t get distracted. You’re actually happy to go to the library and you don’t even want to stop for lunch. And then it’s like 7pm, and you’re still, ‘Actually, you know what? I could do another hour.’”

And, this is where Modafinil, and the other smart drugs that have become increasingly common in universities across Britain – Ritalin (methylphenidate), Adderall (mixed amphetamine salts), Dexedrine (dextroamphetamine), all of which are attention deficit hyperactivity disorder (ADHD) medications – start to look like a symptom rather than a cause.

(Dexamphetamine is the second most privately prescribed drug in Britain).

Because this year’s final students are the first to graduate into a brave new world of massive debt. They’re the first cohort to come through who will experience the full force of the impact of the coalition’s decision to introduce tuition fees: they’ll owe an average of £44,000 a head by the time they leave university.

And in this scenario, if you were offered a small white pill that held the promise of enhanced productivity, greater focus, more hours in the library, and, ultimately, the potential of a better degree, well… it’s not hard to see the attraction.

“I didn’t know anything about it in my first year,” says Phoebe. “It’s all coming from the international students. It was the American students that we discovered it from. They’re all medicated and they’ve got prescriptions and they sell them on.”

Phoebe has taken such drugs intermittently and lists the plus points: “You take it on an empty stomach first thing in the morning and then you work really hard all day and it kills your appetite and then if you go to the gym, you do a really good workout. So you lose weight, nail your exams, and go hard at the gym all at once.”

And in Britain, informal surveys, such as one carried out by student website the Tab, have suggested the highest levels of usage are in the more academic universities – Oxford came top of its poll – and students of subjects with the highest workloads tended to show the highest usage. Rivlin, the editor of the Tab, was studying at Cambridge in 2010 when he first heard about modafinil and started using it. “It was my third year and it suddenly appeared and people were like, ‘It’s amazing. It allows you to concentrate.’ And, you know, there’s a lot of pressure to perform and it was very useful for mechanical academic work when you’re just trying to do a lot of notes or something.

In these times of high student expectations followed by increased competitiveness in job market, is it any wonder that students among others are reaching for a small pill that enhances cognitive performance? However, as those of us working in the drugs field know, the consequences of long term stimulant use can be far reaching both psychologically and physically and at some point, those using these drugs may access our services for support, opening the door to a new cohort of clients with specific needs.

Were David Cameron at Oxbridge today, he may well be struggling with much more than historical allegation and embarrassment,

Reference to interviews by Jasmine Andersson and Shakeel Hashim. Guardian February 2015

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