This is an audio recording of the Salvation Army Presentation in Scottish Parliament on Drug and Alcohol Rehabilitation Services which took place on Thursday 8 February 2018 17:30-19:30 in The Garden Lobby.  At the beginning of 2018 Scottish Government was to begin the process of renewing ten years of drugs and alcohol recovery policy.

Sponsored by Maurice Golden, MSP, people were invited to this event which highlighted the work of their Scotland Drug and Alcohol Strategy (SDAS) and provided an opportunity to hear from service users about the issues involved. It was also a celebration of the first year of the partnership between the Salvation Army with the University of Stirling in the form of the Salvation Army Centre for Addiction Services and Research.
The event saw academics being brought together with service users, with MSPs, University colleagues and church leaders, as well as those involved at a local level in the work of drug and alcohol addictions, for an informative and inspiring evening they had planned out.
 

 
At the moment people are being drafted from all areas of society to shape how drug and alcohol services are going to look over the next ten years.  In 2008 the policy document called ‘The Road to Recovery’ set out the vision for approaching drug problems lasting to this year, 2018.
 

 

Unpicking The Problems

In it there was an acknowledgement of a “long standing and serious drug problem”.  The statistics from 2006 showed that there were an estimated 52,000 problem drug users and that there were 40 to 60,000 children affected by the drug problem of one or more of their parents; as well as this there were 421 recorded drug related deaths that year.  Unfortunately the strategies for dealing with, and the discourses used to understand drug use, have radically failed.

We have seen a massive increase in the numbers of drug related deaths and none of the stories or policies which we have told ourselves have been sufficient to account for the numbers.  The landscape is misunderstood, misapprehended and it is changing.

In 2016 the national records of Scotland show that there were a total of 867 drug-related deaths of which 68% were Males. 327 drug-related deaths of people aged 35-44 (38% of all drug-related deaths), 213 deaths of 45-54 year olds (25%) and 199 drug-related deaths in the 25-34 age-group (23%).
Of these drug-related deaths opiates or ‘opioids’ were implicated in 765 deaths (88% of the total), including heroin and/or morphine in the case of 473 deaths (55%) and methadone in the case of 362 deaths (42%). On the surface this seems simple, however, once we dig beneath the surface we are confronted with a level of complexity which makes policy makers and industry analysts uncomfortable.
Opioids are substances that act on opioid receptors to produce morphine-like effects, and alcohol exerts it’s influence through the opioid receptors – as do a great number of intoxicating drugs, prescription, socially sanction, black market and in the diet.   For simplicity, we can look at the work of Professor Adrian Bonner who is doing critical research on the brain damage which comes about through alcohol usage.

Acute and chronic effects of ethanol intoxication and withdrawal have been associated with a number of neurotransmitters which condense with acetaldehyde, the primary metabolite of ethanol, to form tetrahydroisoquinolines (TIQs). TIQs have similar properties and function as opioids.

[Bonner A, Thomson AD & Cook CCH (2003) Alcohol, Nutrition and Recovery of Brain Function. In: Watson RR, Preedy VR (ed.). Nutrition and Alcohol: Linking Nutrient Interactions and Dietary Intake, Boca Raton, FL: CRC Press, pp. 148-174.]

Thus, what we are looking at are a series of problems which are broader and more significantly embroidered in popular culture than use of an illicit drug.  Besides opiates such as codeine and related compounds which are prescribed and bought over the counter, there are a host of other drugs which interact with the opiate system including alcohol and psychiatric medications.
In 2016 benzodiazepines (i.e. diazepam and etizolam) were implicated in, or potentially contributed to, 426 deaths (49%). These figures are higher than in any previous year.  This begs various questions including that of how many prescription pad medications which are opioids (i.e. not chemically opiates but instead act on the opiate receptors) are involved in lethal interactions ?

During the presentation at the parliament I spoke with the manager of an Edinburgh hostel who was saying that they were seeing more overdoses or unstable reactions to prescription drugs than blackmarket substances which got me thinking about what is being left out of the clinical discourse…

Besides these issues, since 2008 such a number of ‘legal highs’ have become available and used in the UK that toxicologists cannot keep up with the novel compounds.  The effect of prohibition has been to create a whole industry of busy beaver chemists creating drugs which get people intoxicated that attract people because they cannot get arrested and penalised for consuming such things.
New approaches are no doubt needed in the coming ten years, everybody knows this.  The previous strategy was to “tackle problem drug use based firmly on the concept of recovery.  Recovery is a process through which an individual is enabled to move-on from their problem drug use towards a drug-free life and become an active and contributing member of society.” [Road to Recovery document above]
The aspirational statements we find in policy statements are tricky precisely because they sound so ideal.  Pitching ‘recovery’ as a state is very euphemistic and I wonder what sins it is hiding – I am curious about the sins which get eaten by the sin eaters; the poor, the dispossessed, the traumatised, the stressed, the ill, the vulnerable.  I am also suspect of the notion of ‘moving on’ individuals from their problem drug use towards a ‘drug free life’ to become ‘active and contributing members of society’….
What if the only thing holding people together is consuming drugs because they are financially destitute and in fuel, rent and food poverty; what if the only thing keeping the pain inside from splitting them right open is the anaesthesis of the bottle etc and the black humour you get with it; what if they are and always have been active and contributing members of society, but society is not geared up to recognise or acknowledge extreme outgroups ?

There are significant issues which we have to deal with in society in terms of how groups of people are dehumanized, marginalised and ostracized in interpersonal and structural ways before we can help change their living circumstances.  Susan Fiske at Princeton has a useful model for understanding dehumanization:

 

From what I have investigated, there seems to be little acknowledgement of the sociology of drug use in that many people turn to forms of intoxication because their lives are so miserable. Trauma and the pain of existence in poverty can be made bearable through means of blocking out and anaesthetising.  How are we to acknowledge and factor into this series of recurring problems the notion that some of the most vulnerable people in society are being criminalised ?
Scotland’s figures imply a drug-death rate higher than those reported for all the EU countries and a drug-death rate per head of population that is roughly two and a half times that of the UK as a whole.  As Edinburgh and various places become saturated by displacement tourism and gentrification via student town-and-gown companies, the hidden populations are ruled out of cultural production.  My own sense, as a long term resident of Edinburgh, is that this plays a significant role in the loss of social habitat which creates an anomic society.
This is all beside the fact that drug use is pathologised in popular discourse.  It is clear to us, if we look, that cultures celebrate various forms of intoxication, and equally clear in this is the different status afforded to each drug.  Alcohol is openly sanctioned, where cultures of celebrating the first of the beaujolais or a seasoned rioja wine is fetishized in different ways to the social interchange of less prestigious intoxicants.  Caffeination seems like it is positively deified these days – a norm to which if you dont belong, people look at you a bit funny.
Various stereotypes are appended to various social interchanges and intoxicants.  What is good for the goose is spoken as bad for the gander (i.e. gender based prejudices).  Status drugs like cocaine and whiskey recieve glamourous images from the wealth which accompany their use.  This results in a complex and knotted sociological landscape which requires analysis if we are to understand what ‘problem drug use’ is meaning in real terms.
 

Reportage and Action Research

I have become involved in the public consultation lending my lived experience of recovery to the process which is holistically exploring the issues involved in drug and alcohol use and recovery.  As a part of the Drugs Research Network which is based at Stirling University, over the coming years I will be contributing the knowledge I have accumulated to the collective for scrutiny whilst gaining the opportunity to learn and talk through the issues which are left out of the discourse.
Two significant issues which I am concerned with are the propagation of prejudice (structural and interpersonal) and the role which clinical nutrition and natural molecules play in ‘recovering’ from problem drug use.  Working alongside and interfacing with multiple recovery communities and individuals my hope is to collect together a range of perspectives – which dont necessarily have to be in agreement – into an open access public archive to support studies in this area.  For me this is manifest as a mode of participatory action research which holds the aim of addressing some of the social injustices which are realities for many people.
This project involves engaging with the likes of The Salvation Army and their Scotland Drug and Alcohol Strategy, taking in the thinking that is going on, and being honest enough to be critical with myself and others.
 

 
This critical honesty is the hardest part of it all precisely because it is an easier life to fawn to what stereotypes the world (or yourself) would like you to occupy – be it embodying the helpful co-worker who curbs their tongue because it is genuinely more pleasant to be constructive or be it the rebel inside who want to speak out and indulge in forms of ‘comfort radicalism’.
 

 

Only in a space of honesty will a created taboo such a drug taking be approachable and the possibility of reducing the number of deaths and lives of alienation be achievable.  I would like to hear from anyone who has something to contribute to the archive (anonymously or otherwise), so please get in touch.

 

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by Alex Dunedin