The Origins of Conflict in Dependent Drug Treatment: Lessons for Partnership Working (2014)

Introduction Partnership working has become an inescapable feature of contemporary social policy (Heenan & Birrell, 2006) but 'nowhere is it more apparent than in the treatment of drug misuse' (Heath, 2010:185). Problematic drug users rarely present with issues relating only to addiction; multiple and complex needs, including mental health, housing and employment, are the norm rather than the exception (Mclellen et al, 1986; Drake & Wallach, 1989; Hartwell, 2004). If the diversity of these needs is to be addressed it is perhaps inevitable that drug users will require support from a range of disciplines and agencies. Therefore, over the last 20 years policy-makers in the UK and abroad have consistently recommended that public sector agencies collaborate in order to address drug users' needs. However, as the 2010 UK Drug Strategy (HM Government, 2010:5) acknowledges 'although there has been some progress in tackling drug dependence, an integrated approach to support people to overcome their drug and alcohol dependence has not been the priority'. The aim of this paper is to explore some of the possible origins of the difficulties associated with partnership working in the drug treatment field. In particular, this paper shows how the reframing of UK drug policy and guidance developed since the 1998 Drug Strategy has not only failed to adequately acknowledge the problems associated with partnership working but may have contributed towards them. Background Recognition of the multi-faceted nature of problematic drug use and calls for collaboration are nothing new. In an attempt to shift attention away from the narrow medical model of treatment towards a more multi-disciplinary approach the Advisory Council for the Misuse of Drugs (ACMD) in 1982 suggested that: 'individuals with whom the treatment/rehabilitation system is concerned may have various problems arising from the misuse of drugs ... These are not solely physical or psychological problems, but also social and environmental problems, being concurrently psychologically dependent on some drugs and physiologically dependent on others, and at the same time having financial or legal problems or difficulties over housing. The response to the needs of drug misuse therefore requires a fully-multidisciplinary approach.' (ACMD, 1982:34). Similar recommendations continued to be made into the 1990s. In 1993, both the Department of Health (DH) and Home Office identified the need for more effective joint-working (Drake & Wallach, 1989; Reed Report, 1993). In 1995, Tackling Drugs Together (HM Government, 1995) reinforced the partnership approach to local drug strategy and commissioning through the creation of Drug Action Teams (DATs), comprising representatives from agencies such as health, probation, police and local authorities. Similarly, numerous subsequent policy and guidance documents--the 1998, 2002, 2008, and 2010 Drug Strategies (HM Government, 1998 2002; 2008; 2010), Models of Care for the Treatment of Adult Drug Misusers (NTA, 2002), and Drug Misuse and Dependence: UK guidelines on clinical management (DH, 2007)--have consistently recommended that health, social care and criminal justice agencies work collaboratively to address the complex needs of problematic drug users. Despite the consistency of these recommendations and recognition that failure to attend to needs in relation to mental health, accommodation, employment, training, and education is likely to undermine progress in other areas, partnership working has yet to be effectively implemented. Research examining the working relationships between drug treatment and mental health services has highlighted major concerns relating to the willingness of agencies to treat individuals with co-existing drug and mental health problems simultaneously (Baldacchino, 2007). The wide range of systems, institutions and agencies involved, that often have very different goals, values, responsibilities, organisational structures and resources, have been suggested as reasons for this reluctance (Hawkings & Gilburt, 2004:30). …