In the third of a series on addiction, journalist Sophie Goodchild looks at dependency on illegal drugs, how to spot the signs of misuse, and how to provide appropriate support.
Cannabis, cocaine, ketamine, heroin. These are just some of the drugs subject to tight controls because they are classed by the UK Misuse of Drugs Act 1971 as especially harmful or addictive (or both). Despite penalties such as prison for supply and possession, illicit drug use is widespread, with the negative effects felt by families, communities and public services including the NHS. Addiction is often cited as having a strong correlational relationship with crime and often destroys childhoods, relationships and lives.
Around 3.2 million people (one in 11 adults) in the UK, aged 16 to 59, took an illicit drug between 2018 and 2019. Among 16- to 24-year-olds, the figure was one in five (British Crime Survey, 2020). Drug-related deaths registered in England and Wales in 2021 reached 4859, the highest levels since records began more than a quarter of a century ago (Office for National Statistics, 2022). Opiates such as heroin were primarily behind the rise.
The bill from illegal drug use to the taxpayer including NHS, prison, and police costs is nearly £22bn each year (Ministry of Justice, July 2022).
How it starts
Not everyone who uses illegal drugs is addicted. This term is only used to describe those who can’t stop or control their habit even when it may be harmful or illegal (DrugWise, 2021). The reasons behind drug use and dependency are complex and not yet fully understood. While addiction is a medical illness, it can be linked to or triggered by poor mental health, says Dr Emily Finch, vice-chair of the Royal College of Psychiatrists addictions executive. Young people who are depressed or anxious may develop problems in school that might lead them into drug use. Dealing with these underlying psychological issues ‘rather than just the drugs’ is important, says Emily.
Addiction is also associated with development in infancy. Young children need to develop a close attachment to at least one primary caregiver in the first two years of life to become healthy adults on a social and emotional level. Chartered psychologist Dr Cosmo Duff Gordon says developing a secure attachment style is a strong protective factor that makes it less likely a person will develop an addiction problem. Conversely, Cosmo says that people who develop an insecure attachment style ‘may be more at risk of substance misuse, especially if exposed to trauma or adverse life events’.
‘They’re more likely to use something outside of themselves to manage their emotional world,’ says Cosmo, who founded the Start2Stop addiction treatment service. ‘It could be food, gambling, pornography or illegal drugs.’
Cosmo highlights other factors, including dysfunctional family culture where drug-taking is normalised (for example, a parent smoking joints in the evening), neglect, abuse, influence from siblings or school friends, conflict within the family system, and underlying issues such as bullying (young people use drugs to belong) or being homeless or unemployed.
But there is no one-size-fits-all profile of a user. Experimentation with cannabis and other illicit substances is not unusual for teenagers and ‘it doesn’t make them addicts’ says Cosmo.
The toll on lives
However, both the short and long-term impact of drug dependency can have devastating consequences for users and their families.
For a child living in a home where drugs are used, dangers include accidentally ingesting an ecstasy tablet, which can trigger seizures, or hidden harms such as an intoxicated parent rolling over and suffocating their sleeping baby. Parents who are addicted are often emotionally unavailable to their children, who can grow up feeling neglected and may develop mental health issues.
Vivienne Evans, chief executive of charity Adfam, says many family members dealing with the substance misuse of a loved one ‘set aside their own needs’ and become ‘drained and exhausted’. Being manipulated and lied to is common, she adds, and those dealing with the addicted person often try to control or fix the problem themselves. Feelings of guilt – the sense the loved one’s difficulties are their fault – can also become an issue, says Vivienne.
‘Supporting a family member with a substance misuse problem can become the whole focus of one’s life, bringing about feelings of desperation and hopelessness that they aren’t able to stop their loved one’s substance use.’
Anyone who is addicted risks undermining their life chances. They may end up excluded from school, get involved in risky behaviour such as drug-driving or stealing to fund their drug habit – with consequences such as losing their home, job or ending up in prison.
Where a child or young person is in immediate danger, a CP must act urgently. The recognised pathway for working within a supervision structure is to report
the case up the chain while involving a GP and local drug services, says David Bremner. Social services may also need to be contacted.
So how do community practitioners (CPs) spot that a caregiver or young person has a drug misuse issue?
The pungent smell of cannabis on a home visit or drug paraphernalia, such as discarded silver nitrous oxide canisters or metal spoons tarnished from heating heroin, are obvious giveaways. Subtler signs are changes in mental health and inconsistent behaviour or mood swings caused by the days they are using and withdrawing. Look out for money going missing, physical issues such as bloodshot eyes, inability to sleep or sleeping in the day, paranoia and lowered academic performance. Cosmo often assesses 16- to 17-year-olds and says their parents will say ‘he was predicted 7s and 8s but only got 5s and 6s’ or may feel they have ‘lost’ their child.
Helping to change addictive behaviour
Motivating a person to change unhealthy or risky habits is known as a brief intervention. This approach has become increasingly important in tackling addiction.
It includes FRAMES, an interviewing technique (Miller and Sanchez, 1994):
FEEDBACK – provide the client with feedback on their risk
RESPONSIBILITY – highlight how that individual is responsible for change
ADVICE – advise reducing their drug use, or give explicit direction to change
MENU – provide a variety of options for change
EMPATHY – be warm, reflective and understanding in your approach
SELF-EFFICACY – encourage optimism about them changing their behaviour.
A non-judgmental and sympathetic approach is essential to communicate with someone who may have issues with drug addiction, says Dr David Bremner, medical director at social care organisation Turning Point. The consultant addictions psychiatrist suggests that just having a friendly chat can lead to a young person or caregiver opening up to you. ‘Nothing beats an honest conversation with someone you trust,’ he says.
If the substance misuse is not causing an immediate danger, a CP can suggest online support or that young person keeps a diary of their drug use and the triggers. ‘A young person may not want to go to rehab but may be willing to fill in a diary,’ says David.
Involving a GP is a step towards an individual getting treatment. But seeing a doctor can be daunting for young people so David suggests the CP could arrange the appointment. Self-referral into treatment services is also an option and may even be preferable given the ‘considerable pressures doctors are under and the wait to get a GP appointment’, says Nat Travis, national head of service at Turning Point.
Every area of the country is served by a drug and alcohol service. Nat advises every CP to familiarise themselves with what is available in their area and establishes a working relationship with these services.
The concept of rehab – or even treatment – can appear intimidating to families whose experience with support services has been negative. Help does not have to mean a residential stay. Addiction services provide a range of local options from one-to-one to group counselling to drop-in services.
Getting off drugs is the aim, starting with detox to remove all traces of the substance from the body. However, the drug type does dictate the approach. For opiates such as heroin, medical substitutes are available in the form of methadone or buprenorphine to reduce dependency gradually without withdrawal symptoms such as shivers and shakes, with abstinence the ultimate goal.
This treatment does not exist for drugs such as cocaine or cannabis. Instead, the evidence-based approach used by the NHS includes talking therapies such as cognitive behavioural therapy, which can help individuals to understand their addiction and change habits.
The odds of recovery
Although young people with a short history of drug addiction tend to fare better, what makes a difference is getting them into treatment to identify the root cause of the problem, says David.
Success is defined as how many people complete treatment, meaning they stop using in a problematic or dependent way. The proportion is around half for drugs such as ecstasy and between 8% and 9% for opiates such as heroin (Office for Health Improvement and Disparities, 2021). The figures don’t take into account improvements in people who do not complete and those described by Nat as ‘stable but still in treatment and who have made positive life changes’.
Getting off drugs is just one aspect of addiction support; preventing relapse is another – hence the emphasis on learning skills to cope with life’s challenges. Staying away from drugs takes hard work, but CPs have a role by continuing to encourage optimism in those who have quit their habit.
- FRANK provides an A to Z listing of every type of drug as well as advice and support talktofrank.com
- Drugwise continues the work of respected charity Drugscope, featuring its reports, factsheets and help on finding services drugwise.org.uk
- Narcotics Anonymous runs a helpline from 10am to midnight and support meetings which are free to attend ukna.org
- Charity Adfam supports families and friends affected by addictive behaviour adfam.org.uk
- The government provides details of the UK drug classification system here gov.uk/penalties-drug-possession-dealing
- The Society for the Study of Addiction promotes evidence-based understanding of addiction and is the oldest organisation of its type in the UK addiction-ssa.org
DrugWise. (2021) Addiction: what is addiction?. See: www.drugwise.org.uk/addiction/ (accessed 15 August 2022).
Miller WR, Sanchez VC. (1994) Motivating young adults for treatment and lifestyle change. In: Howard GS, Nathan PE (eds) Alcohol use and misuse by young adults University of Notre Dame Press: Notre Dame, Indiana.
Ministry of Justice. (2022) Drive to get offenders drug-free and cut crime. See: https://www.gov.uk/government/news/drive-to-get-offenders-drug-free-and-cut-crime (accessed 15 August 2022).
National Records of Scotland. (2022) Drug-related deaths in Scotland in 2021. See: https://www.nrscotland.gov.uk/files//statistics/drug-related-deaths/21/drug-related-deaths-21-report.pdf (accessed 1 September 2022).
ONS. (2020) Drug misuse in England and Wales: year ending March 2020. See: www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2020#:~:text=For%20the%20year%20ending%20March%202020%2C%204.6%25%20of%20adults%20aged,9.9%25%20(around%20622%2C000). (accessed 15 August 2022).
ONS. (2022) Deaths related to drug poisoning in England and Wales: 2021 registrations. See: www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations (accessed 15 August 2022).
Office for Health Improvement and Disparities. (2021) Adult substance misuse treatment statistics 2020 to 2021: report. See: www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2020-to-2021/adult-substance-misuse-treatment-statistics-2020-to-2021-report (accessed 15 August 2022).
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