Understanding the child’s experience

The short- and long-term impact of parental substance misuse on children can be significant. Understanding the child’s experiences is central when working with parental substance misuse.

It is important to bear in mind that children may know a great deal about their parent’s use of substances, despite best efforts to keep things hidden. Even very young children may know that ‘something’ is going on and can be sensitive to the shifts in their parent’s presentation, such as the changing sights and smells of the house or how their parents are responding to them and each other (Houmoller et al, 2011).

It may be difficult to directly ask the child about their parent’s substance misuse. The parent might not want you to, or might believe the child knows nothing, or the child might feel worried about telling a professional. In these situations, a good starting point is to assess what a ‘typical’ day or week looks like for the child.

For example, you could talk about who they see, what happens, who looks after them or who they go to for help if they need something or are scared. These kinds of questions may help to unpick what the child’s experiences are, and how safe and stable they feel home life is.

Tips for working with children

Below are recommendations for how to approach working with children affected by parental substance misuse. These recommendations have been developed from studies where researchers talked to children about what they wanted from professionals.

• Use a non-judgmental approach: Studies show that children can experience discrimination or stigma from professionals as a result of their parent’s substance misuse (Muir et al, 2022). Children are also very likely be aware of the shame and stigma that surrounds parental substance misuse. Professionals need to approach these conversations mindful of the language they use about substance misuse and the child’s parents/carers and the assumptions they may have made about the child’s experiences.
• Provide stability and consistency: Children affected by parental substance misuse may have experienced a great deal of inconsistency in their lives and may therefore be particularly affected by things like staff turnover. Aiming to ensure a stable and consistent professional figure in a child’s life is important. To create this stable relationship, there are important things a social worker can do such as:

• • Booking visits ahead of time, making the child aware of the location and time and giving notice if things change and the visit is not possible.
  • Not over-promising; ensuring that you follow through on what you say you will do (eg making a referral).
  • Being honest about who you share information with and why, and what might happen as a result.
  • Being clear about your role in their life, how long you might be in their life for and what might happen when you are no longer their social worker.
  • Ensuring a managed ending which the child can prepare for.

• Use professionalism: Children value professionals who are non-confrontational in their approach (O’Connor et al, 2014; Houmoller et al, 2011) and who do not ‘quiz’ the child about their parent’s substance misuse (Muir et al, 2022). Children want professionals who are reliable and proactive in responding to disclosures made by them (Muir et al, 2022). Children also need to know that professionals are trustworthy and safe and that the information they share is safe. Some information children tell professionals may need to be written down or shared with other people, which requires professionals to be transparent about information sharing.
• Listen and understand: It is important that children are listened to, respected and believed. Children value flexibility in how professionals communicate and engage with them (Muir et al, 2022). Some children particularly value being able to just ‘sit’ in a safe place with a professional (eg in a teacher’s office) and not necessarily talk about anything. Children also note that the most supportive professionals tend to have a good understanding of parental substance misuse (Houmoller et al, 2011). If children have additional needs around communication, social workers need to give further consideration to ensure they are listened to and understood and ensure that their approach is appropriate to the child’s development and needs. Inform Children users can find additional information and advice can on this in these case studies from a specialist team on working with disabled children.
• Acknowledge and respect the child’s expertise: Children are experts in their own lives. Children may also have considerable strategies already in place to protect themselves and their siblings. These might include having a safe family member or friend to talk to or stay with, having a safe space in the house away from their parents, writing in journals or practising mindfulness (Muir et al, 2022). Children may also have coping strategies which are potentially harmful, for example, isolating themselves (Velleman and Templeton, 2007). When working with children, it is important to respect their expertise and potentially build on their protective strategies if it is appropriate to do.
• Support the whole family: Children report wanting practical and emotional support for them and their family. Practical support, such as financial support and help with day-to-day issues, may immediately improve a child’s life. Emotional support can be provided through one-to-one support, group work or specialist support in the local area. There are also useful websites which have resources for children affected by parental substance misuse. Children may also want support in understanding more about substance misuse. Many children report being frightened by their parent’s substance use, including worrying about them dying or being very unwell. Children do not necessarily have age-appropriate ways of finding out information about substance misuse. The signposting section in the full guide includes some resources which may be helpful to use when working with children and young people.
• Use holistic interventions: Interventions which work to help achieve best outcomes for children and families are:

• • holistic, providing support for different issues in family life;
  • integrated, with different professionals working collaboratively with the family and each other;
  • long term, as substance misuse is a relapsing and remitting issue which is unlikely to be resolved quickly and without ongoing support;
  • engaged with the whole family, with support available for the children as well as the adults in the family (McGovern et al, 2022).

What to read next

• Parental mental illness
• Increasing parental motivation and aspiration
• Parenting assessments

References

Houmoller, K, Bernays, S, Wilson, S & Rhodes, T (2011)
Juggling Harms: Coping with Parental Substance Misuse

Muir, C, Adams, E. A, Evans, V et al (2022)
‘A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances‘

McGovern, R, Newham, J, Addison, M, Hickman, M, Kaner, E (2022)
‘The effectiveness of psychosocial interventions at reducing the frequency of alcohol and drug use in parents: findings of a Cochrane Review and meta-analyses‘

O’Connor, L, Forrester, D, Holland, S & Williams, A (2014)
‘Perspectives on children’s experiences in families with parental substance misuse and child protection interventions’

Templeton, L, Velleman, R (2007)
Understanding and modifying the impact of parents substance misuse on children

The youngest children are at increased risk of harm due to growth in the numbers of parents with mental health and substance misuse issues, research has found.

Directors linked the trends in parental needs to poverty, inadequate housing and the legacy of pandemic, and said they were leaving infants at risk of neglect and physical injury.

The findings were reported in the latest phase of the Association of Directors of Children’s Services’ (ADCS) Safeguarding Pressures research series, through which it has analysed demand for, and provision of, children’s social care since 2010.

Phase 9 of the series covered 2022-24 and was based on data from 124 local authorities, extrapolated to cover all 153 councils, survey responses from 86 authorities and interviews with 34 directors of children’s services.

Growth in parental mental ill-health and substance misuse

Department for Education (DfE) data has revealed growth in the numbers of children in need assessments which identified parental mental health or substance misuse problems between 2022 and 2024. According to the DfE’s children in need census:

• Parental mental health concerns were identified 165,480 times in 2023-24, up from 158,330 in 2021-22, a rise of 4.5%. This made it the most common factor identified following an assessment, replacing domestic abuse where a parent is the victim, for which there were 160,600 cases in 2023-24, a similar number to 2021-22.
• Parental alcohol misuse concerns were identified 72,410 times in 2023-24, up 3% on 2021-22 (70,310).
• Parental drug misuse concerns were identified 70,940 times in 2023-24, up 5.8% on 2021-22 (67,010).

Three-quarters of respondents to the ADCS survey said issues arising from a deterioration in parental mental health had increased pressures on their services over the past two years, while two-thirds said the same about parental substance misuse.

Increased numbers of infants at risk

Directors said this was leading to increasing numbers of infants being at risk of, or experiencing, serious harm, particularly neglect or physical injury, and they linked the rising levels of parental need to family levels, poverty and inadequate housing.

Most directors reported increasing demand for children’s services from poor quality housing, homelessness and families experiencing poverty as a result of welfare reforms.

They also linked increasing parental mental health issues to the legacy of the pandemic, new parents lacking experiences of “good enough parenting” from their own childhoods and cuts to other services, such as health visiting provision.

In response to the findings, sector what works body Foundations said they underlined “the need to provide effective mental health support for parents”, including through parenting support. Its deputy chief executive, Donna Molloy, said it would shortly produce guidance for councils on “proven interventions” in relation to parenting support for families in contact with children’s social care.

Rising numbers of initial contacts but referral numbers fall

Councils reported a rise in initial contacts regarding safeguarding concerns, continuing a trend dating back to 2007-8, with the number received in 2023-24 (3,001,339) 8% up on the 2021-22 total. Two-thirds of the 2023-24 contacts came from the police, health or education.

However, the DfE’s census has shown a decrease in the number of referrals to children’s social care, which fell from 650,270 in 2021-22 to 621,880 in 2023-24, as well as in the number of children in need plans and child protection plans from 2022-24.

The ADCS found that councils accepted 22% of contacts in 2023-24 as a children’s social care referral (compared with 24% in 2021-22). Fourteen per cent were passed to early help (down from 16% in 2021-22), 30% signposted to other services or resulting in the provision of information and advice (33% in 2021-22) and 23% resulted in no further action, up from 16% in 2021-22.

“This suggests that much of this demand is being managed through an increased early help offer and by local authorities acting as a central point for offering information, advice and signposting to other services on behalf of the local partnership,” the ADCS said.

Increased use of early help

Despite the drop in the proportion of contacts referred to early help from 2022-24, the ADCS said the number of such referrals had grown by 93% from 2015-16 to 2023-24, from about 224,000 to 431,000.

Two-thirds of survey respondents said they had increased their provision of early help and targeted family support services from 2022-24. This included the establishment of family hubs, which provide a range of support services to families in a single place and for which half of local authority areas have received funding since 2022.

The ADCS said family hubs were “viewed very positively” by directors, with three-quarters of survey respondents saying they had set up such services, including some who had not received government funding.

The association added that councils had also relied heavily on funding from the Supporting Families programme, under which families with multiple needs are provided with multi-agency support, co-ordinated by a lead practitioner, and for which councils have been provided with £695m from 2022-25.

Last November, in a move strongly welcomed by ADCS, the government scrapped the payment by results element of the scheme, under which most councils received some money up front with the rest delivered based on the outcomes achieved for families.

Rollout of family help

Looking ahead, the government has allocated £250m in 2025-26 to roll out the family help model, under which councils provide multidisciplinary support to families in need by merging existing targeted early help and child in need services and bringing in staff with expertise in areas such as domestic abuse.

The model is being tested in the 10 families first for children pathfinder areas, though ADCS found that some other councils were adopting a similar approach.

In relation to looked-after children, the ADCS report charted the significant rise in the number of unaccompanied children, which grew by 30% from 2022-24, from 5,680 to 7,380, according to DfE figures.

The ADCS also highlighted the changing composition of the group, with the proportion of boys rising from 90% to 96%, and the proportion of those aged 16 or 17 increasing from 86% to 89%, from 2020-24.

Concerns over care of unaccompanied children and care leavers

Despite the government’s National Transfer Scheme – which aims to ensure unaccompanied children are more evenly spread throughout the country – the ADCS found numbers were far higher in the South East, where the vast majority of young people arrive, than in other regions.

Directors said that the “absence of national planning and support to enable an effective and sustainable asylum system was a source of real concern”. They also reported struggling to provide young people with the trauma-informed care and support they needed.

The ADCS also highlighted the number of care leavers who were former unaccompanied children, which grew by 25%, from 11,640 to 14,560, from 2022-24, and warned that councils were being under-funded to support them.

‘Shortfall in care leaver funding leaving young people at risk’

It cited a report last year by East Midlands Councils, which said that Home Office funding covered just 59% of the costs of supporting former unaccompanied care leavers, with the region’s annual shortfall in cash rising from £5.2m to £7.5m from 2020-24.

“Respondents to both the survey and interviews described how a lack of access to education, employment and appropriate therapeutic support leaves young people in limbo, exacerbating
mental health difficulties, risk of exploitation and involvement in unlawful activity, such as modern slavery,” the ADCS said.

A growing workforce but concerns over experience and agency use

The Safeguarding Pressures report also referenced the fact that the number of social workers in post in local authority children’s services reached a record high – 33,119 full-time equivalents – in September 2023, up by 4.7% on the year before.

The ADCS said that the increased numbers were largely newly qualified staff, “which can create pressures on more experienced colleagues”.

The report also noted that the number of agency staff in post also reached a record high (7,174 full-time equivalents) in September 2023, representing 17.8% of the workforce.

The association said that, while the 10 authorities with the lowest rates of agency use were all rated outstanding or good by Ofsted, seven of the 10 with the highest rates were rated inadequate with another two graded as requires improvement.

“[Directors] report that a negative judgement following inspection by Ofsted generates increased staff churn and reliance on agency social workers,” the report said.

Agency social work rules

In October 2024, the government began implementing rules on councils’ use of agency social work, which will be fully in force by October 2025. These include:

• A bar on staff with less than three years’ experience in a permanent role in local authority children’s services from taking up an agency post.
• A three-month ban on councils engaging social workers as locums within three months of them leaving a permanent role in the same region.
• Regionally agreed caps on maximum hourly pay rates for agency staff.
• Ensuring councils have direct management of staff supplied through agency project teams.

The ADCS is very supportive of the rules, but have called on the government to go further, by banning project teams outright for case-holding social work.

While the government has not committed to this, it has pledged to strengthen the agency rules by putting them into legislation and to extend them to non-social work roles in children’s services.

In 2023, Jane Dunne was named the children’s services team leader of the year for her work with the Coventry and Warwickshire family drug and alcohol court service (FDAC).

This was not her first award since becoming manager of the then Coventry FDAC in 2016, with the team winning the public sector children’s team prize at the 2018 Children & Young People Now awards.

In 2021, the service’s success led to its expansion to cover Warwickshire.

Speaking to Community Care, Jane discussed why she believes FDACs are a better alternative to standard care proceedings, her approach to leading a multidisciplinary team and the risks to FDAC teams from constraints on public spending.

How did you become involved with the FDAC service?

Jane Dunne with the rest of her FDAC team / Photo by Jane Dunne

The service started in October 2015, and I joined in March 2016. I’d always been interested in the interaction between substance misuse and volatile relationships, and how that impacts on an individual’s mental health.

Then a secondment came up for six months to manage the Coventry FDAC service, because we only had temporary funding at that point.

I haven’t looked back. I remember thinking, “My goodness, I only had this for six months and now I’m here eight years later”.

One of the things that stood out to me was that it was a multidisciplinary team. We had a clinical lead, two substance misuse workers, a parenting officer, a children and family worker and three social workers, including a domestic abuse practitioner.

Everybody had their own expertise, but when I joined they were working in silo. I wanted to have a sense of identity as a team and to centre that around improving outcomes for children.

We did a lot of team development and broadened our knowledge and skills. We’ve all learned so much these last few years.

What makes an FDAC a better alternative to standard care proceedings?

In normal proceedings, when a case comes to the court, various assessments are ordered. But the results usually come in closer to the end of proceedings.

So if the hair and blood tests come in and they’re high in alcohol levels, then there is nowhere for the parents to go to demonstrate change because that’s their evidence. And they are expected somewhat to do everything on their own.

FDAC provides that level of scaffolding at a time when they need it. We offer an initial assessment with the experts – and we’ve got all the experts, so they don’t have to join long waiting lists.

The work is trauma-informed, it’s relationship-based. So everybody in the team tries, from the minute you meet the parent, to make them feel as comfortable as possible and build a rapport to support them.

We’re a consistent team. We see [the parent] two or three times a week. A children’s social worker might see them once a week for a parenting assessment in usual proceedings.

At the beginning of the trial, we do a peth test for alcohol consumption and an overview hair strand test of all six drugs [cocaine, cannabis, amphetamine, methamphetamine, opiates, benzodiazepines] because we know that parents are often frugal with what’s going on for them. They might say [they’ve taken] a little bit of cocaine and then when you get the hair and blood tests back it might be crack cocaine.

And then throughout the trial, we will do alcohol breath meter, oral swab and urine tests every time we see them. It helps parents reflect that they might have had a difficult week, because we don’t expect them to be progressing straight away. We want to discuss the triggers, thoughts and feelings around that and what we can put in place.

Alongside that, we’re looking at their parenting and their child’s needs, we’re running support groups and doing specific interventions. We try to understand what’s happening underneath and get to the root of the problem, to create long-lasting change.

We also build long-lasting relationships with them. A male parent who’s had his daughter in his care for four years now pops in for a cup of coffee every now and then. We talk about lifelong links for children but, if a parent has opened up to a group of professionals about their difficulties and were supported on their journey, it’s powerful to continue that relationship.

If they’re in a crisis in the future, they’ll need somebody to reach out to and some people don’t have anybody.

We are also looking at a permanent plan for the children. Reunification is what we are working towards, but where that is not possible, we look towards care with family or the possibility of reunification in the future.

FDAC has more reunification than in usual proceedings, although it takes a little more time to get there.

What happens within your service if reunification is not possible?

Even if children aren’t reunified, there is an opportunity for parents to still work on their recovery and their parenting.

If a child is put up for adoption, no matter how painful that is, if the parent can understand that they’re not in a position to care for their child, they will often say, “I consent to my child being adopted because I know I can’t meet their needs. It’s not because I don’t love them.”

And they get a lot of support with that within FDAC – it helps change the language of the negative stigma around not being there for your children. We also offer some post support, and, later on, people can still call us for advice.

For example, a young woman we worked with last year contacted me recently and said, “I’m in a new relationship, I’m pregnant, and I need to demonstrate that I’m sober”. So we were able to give her some advice.

What is your approach to managing a multidisciplinary team?

Jane Dunne during a visit to Westminster / Photo by Jane Dunne

I think it’s about shared values, and understanding our limitations and knowledge.

I was terrified of managing the substance misuse worker because of my limited knowledge. I thought I knew quite a lot about drugs and alcohol, but when I came here, I [realised], “Oh my gosh, I know nothing”. It prompted me to study more and get a diploma in substance misuse and addiction.

I’m learning as much from [workers I manage] as they’re learning from me. I wouldn’t say it’s been an easy process – but it’s about furthering your understanding. For example, I developed my learning around cognitive behavioural therapy and trained in motivational interviewing.

I wanted the whole team to take that approach, so we provided training for them. We did a course on foetal alcohol syndrome and foetal alcohol disorder together because, although you’ve got that discipline, you need to layer up your knowledge and skills base – whether you are the children and family worker, the team manager or the clinical lead.

They also know they are safe to come to me; I’ve got their backs. I think most of my team are comfortable reaching out if they’re struggling.

As a manager, if I need to do casework because we’re struggling, then I’ll do that. But I’ll also do the supervision, the advocacy in the court, the strategic stuff.

I don’t see my role as just being one thing. It’s whatever it takes to keep the service going so that families have the best experience and that people feel safe to work.

Does the limited number of FDAC teams put pressure on you?

We have 13 FDAC teams now – we recently lost Kent and Cardiff – and there is an awful lot of pressure around funding and continuing the service.

We’ve been in a very fortunate position, where Coventry could see the benefit of this model and the cost avoidance. Although it might be expensive to set up and deliver, there is an acute saving in the long run.

But local authorities are under a lot of pressure. Many of my FDAC colleagues up and down the country have really struggled, hence the closures.

The judiciary really appreciates this model. They’d like to see it in every court, so it’s not just a postcode lottery and that’s fantastic. But it’s not funded.

Currently, funding comes from different sources. Our current expanded team was setup through a Department for Education grant and is currently funded by Coventry and Warwickshire local authorities.

We are fortunate to have the domestic abuse social worker role funded by the West Midlands Police & Crime Commissioner, but overall the funding is reviewed every two years for the team.

Other teams may have health or public health funding too; it depends on how it was set up.

So what I’d like to see is core funding, so that managers can focus on the service delivery and not worry about whether our service will last another six months or two years. That’s the fragility and reality of it.

What are your goals moving forward?

My goal is to secure the funding for this service moving forward and improve on the offer that we give parents within proceedings and post-proceedings. Because at the end of the proceedings, when children are reunified, parents need support. It’s a time that might test your recovery and your parenting.

The best way for that is through having robust support around them, but also peer support. So that’s families and parents that have been through FDAC problem-solving together, having a community where they can support each other.

My hope would be to have that as part of the programme because many other sites do, but we’ve never had the funding. We manage a graduates’ group, but this is on frugal basis.

What has been a highlight of running this service?

The “graduates”. I think it’s such an achievement when parents come through proceedings and successfully reunite with their children.

We do a little graduation ceremony. We invite them back and they get a certificate and a card from us and the FDAC judge to say, “Well done”. We often buy or make cakes and we have a little celebration.

One parent, who I knew as a child when I was a social worker and was quite a challenging man and had a whole life of criminality, said in his graduation ceremony, “Wow, this is an achievement. I’ve always sat in court. I’ve never been invited to a court.”

For him, it was huge.

*Names have been changed

Here, they talk to you like you’re a human being and not an addict, not somebody who’s a lowlife.”

Sitting holding *Freddie, her sleeping three-month-old baby, *Megan doesn’t miss a beat when asked what it is about Jasmine Mother’s Recovery that, in her words, “saved her life” – and Freddie’s.

It’s the approach of the staff at this rehab centre that Megan credits with helping her detox and stay clean, and grow her confidence in herself and her parenting.

At Jasmine – part of Plymouth-based charity Trevi – Megan feels she’s been treated as someone worthy of support rather than “outcasted” like she’d been in the past.

A ‘lifesaving’ service

Many of the women we meet here use the word ‘lifesaving’, and it isn’t a figure of speech. If she hadn’t been “pretty much mandated” to come here in care proceedings, or have her child taken into foster care, “I’d be dead or on the streets somewhere or in hospital,” Megan says.

At points in her pregnancy, she’d been using drugs every week and was hospitalised a number of times due to suicide attempts, she explains.

Now, after two months of Jasmine’s treatment programme, and with another four weeks to go, she is hoping to return home with Freddie, subject to a successful parenting assessment.

She hopes her six-year-old daughter – who was removed after a previous relationship breakdown and period of mental ill health led to her alcohol and drug misuse – will also be returned to her care.

The only provision of its kind

Bedroom at Jasmine Mother’s Recovery. Photo: Trevi

Jasmine is the only rehab provision in the country specifically for mothers where they can stay with their children, with the goal that on leaving, as well as staying abstinent, they can keep their children.

Last year, 83% of women referred here successfully detoxed, and eight out of 10 children were able to remain with their mother after leaving.

Jasmine accepts referrals from across the UK. As some residents tell me, distance from the town where you are known to dealers – and/or from violent or co-dependent relationships – can play a part in helping someone establish a ‘clean’ life.

When Community Care visited Trevi House, as Jasmine was then called, in 2017, it was at half occupancy with no waiting list. CEO Hannah Shead, who has been here since 2011, says it is currently full but demand fluctuates due to a lack of awareness that the service exists, and the funding model meaning it is sometimes perceived as only for very extreme cases.

This is despite money spent at this point potentially saving local authorities thousands in the long run by keeping a child out of care.

For most placements, the mother and child are funded separately by adults’ and children’s services. Hannah says that, currently, funding from adults’ services is a bit easier to come by, while it is more of a challenge for cash-strapped children’s services.

Women often fight to come here or it is ordered by the court, frequently, but not always, by family drug and alcohol court (FDAC) judges.

“We’re seen as a really niche response, whereas actually I think there should be somewhere like this in every region,” she adds.

Tension between needs of parents and children

Hannah acknowledges that Jasmine sits at a point of tension: “In our world, people are often either aligned with the needs of the adult or they’re aligned with the needs of the child. And we try and work with both and that isn’t always easy.”

Women have to want to work on their recovery from addiction, not just be focused on wanting to keep their child, I learn from Vicky, a former resident back for a visit today.

Generally, a rigorous assessment and admissions process means that only women whom staff believe will benefit from the service come here.

Occasionally, Vicky says, someone would resist the treatment programme, which could disrupt the house dynamic. In severe cases, placements have to be ended, which is devastating for all involved.

An inescapable focus on child safeguarding

In the garden at Jasmine Mother’s Recovery. Photo: Community Care

The centre’s child safeguarding function is another area of potential complexity. Around 90% of the children here are under interim care orders.

While, as Megan describes, the atmosphere is warm and family-like – the communal dining area the women eat round while feeding their babies feels like the heart of the place – small reminders that their parenting is continually being observed are inescapable.

A security gate protects access to the centre, while CCTV cameras cover all the bedrooms and communal areas. Baby monitors are in constant use for mothers to monitor their child’s welfare, and for staff to observe them. Care plans and risk management plans for each family are reviewed at least once a week in Jasmine’s multi-disciplinary team meetings.

And the child’s placing social worker or local authority duty team are informed immediately of any safeguarding incidents.

*Mia has a two-year-old, one of the oldest children currently at Jasmine. She would love to take him to the park but this could only be done on a planned supervised trip.

This is the one of the few indications we hear from the women that the set-up is challenging. Another is that being around a lot of other women can be hard for some residents. Mostly though, the talk is of opportunity and being given a chance to show that they can parent.

The link between having a child removed and worsening addiction

Shona, the therapist, runs different groups with the women every day, with a focus on trauma and recovery. Women also receive one-to-one counselling.

Shona lets Trevi patron, Jenny Molloy, and me sit in on today’s group. Jenny asks the women who want to speak to tell us how they came to be here, and their experiences with social workers.

Megan is not the only one who has had a child removed previously. The experience of a removal triggering or worsening drug use and addiction is mentioned by many.

*Selena is in Jasmine with her daughter. She calls herself an alcoholic and says she’s dabbled in other drugs.

A few years ago, when her older child was born, she was in an abusive relationship. She went to a mother and baby foster placement and would secretly take her son to visit her then partner “because I was trying to build a family and I thought he loved me”.

But when she returned to living with her partner she couldn’t cope with him “not being what he needed to be for me and my son” and started drinking again. This led to her son being taken into care; he is now looked after by her family.

After my son was removed from me, my life just went so much worse. This structure was removed from my life.”

“I wasn’t getting up and bathing my son every morning,” Selena continues. “I wasn’t changing him, I had no routine to put him to bed…I used to just stand out on the street every night and drink with my children’s dads and we’d beat each other up. And then I got pregnant again with my daughter.”

The group work lodge, children’s play area and garden at Jasmine Mother’s Recovery. Photo: Community Care

*Caitlin’s baby, *Aimee, is eight months old. Aimee was fostered for the first few months of her life and Caitlin could only see her at a contact centre before they were able to come to Jasmine.

She says her drinking was “quite out of control” at the time and she used heroin during her pregnancy. She has completed a detox from methadone at Jasmine and Jenny tells her she looks great, glowing.

Caitlin describes how unsupported she felt when she was in a violent relationship. Her older child was taken into care soon after starting primary school.

“He was turning up late, he had holes in his socks…trivial things. But within two weeks of them getting involved, he was taken out of my care,” she says. “I just spiralled. I wasn’t getting the support I needed.

“Few years later, I got raped quite badly, and [the perpetrator got found] not guilty,” she adds. “And that’s when I realised I was actually addicted to heroin.”

Caitlin says she dislikes the terminology that is often used and the “boxes or brackets we’re put into”.

“Personally I’d rather have the stigma of being an addict, like substance misuse, rather than neglect. We made a few mistakes but it’s because of our addiction, not because we wanted to hurt our children.”

Sharing experiences with other women who have been through something similar is a key part of the therapeutic process at Jasmine. Megan tells me she used to feel there was something wrong with her.

“Obviously doing the mistakes that I did when I was pregnant and that feeling of like, ‘why am I like this? No one else is’. I was beating myself up over it. But coming here, I’ve realised that there’s other women out there with similar stories and that we are not bad people.”

We’re not bad mums.”

Everyone’s story is different and personal. But common experiences come up again and again – as well as abusive relationships and children removed, the sense that support to overcome problematic drug and alcohol use and be a good, safe parent is hard to come by.

Feeling judged and fearful of social workers

It’s uncomfortable being from Community Care in an environment where almost everyone says they have felt, at best, judged by social workers and constantly fearful of their perceived power to take their children away.

At worst, when they trusted, did what they believed was expected of them or asked for help, they felt betrayed that the ‘goalposts moved’, most often with care proceedings being initiated.

Wall hanging made by Jasmine resident. Photo: Community Care

Tammy was a resident four years ago and now works for Trevi’s Spark project, which supports multiply disadvantaged women who are experiencing abuse, and volunteers as an assertive outreach worker.

She tells me that, before coming here, she moved hundreds of miles across the country to go to a women’s refuge in an area where she knew nobody.

“I’ve done what they’d asked me to do…All through my pregnancy they said they had no plans for removing my child, that she would be going onto a child in need plan.

“Then, when she was a couple of days old, I had a social worker at the hospital saying: ‘We’re going to be taking you to court on Monday to remove your child. We’re gonna let you have contact three times a week for an hour and a half at a time.’”

Instead, the child’s guardian suggested Jasmine and the court ordered her to come here. Tammy says she felt anxious the whole time that her baby could be removed without warning.

“If I was in a [therapy] group and knowing that a social worker was going to turn up, I’d tell the nursery staff: don’t let them get anywhere near my baby, thinking that while I was in group, she was gonna do a runner with my child.

“I was being reassured that I was doing the right things and I know she couldn’t have done that. But at the time, that was how I felt.”

I was literally petrified until the day I actually walked out of that gate with my baby.”

The shared lounge at Jasmine Mother’s Recovery. Photo: Trevi

Selena says: “They tell you to be open and honest. But you go to them for support, and they use that against you. You can’t say anything. If you’re lying, you’re bad. And then if you’re honest, you’re bad too.”

Shona, the therapist, tells me that it is a “huge” betrayal of trust when someone does overcome the shame of using in pregnancy and asks for support, but then feels it is used against them.

“And there’s so much about that then affects their recovery. I don’t think there’s one woman that I’ve met here who hasn’t had that happen to them.”

‘She worked with me, not against me’

While there is fear and anger, many of the women recall good experiences with social workers too.

What characterises positive experiences with social services?

Megan says her current social worker, “seems to have my back a bit …She’s very understanding – she’s quick to give me credit and praise, which you don’t necessarily normally hear.”

“Getting to know the family, not just reading it on paper,” says Helen, a former resident who now facilitates the Freedom Programme here, supporting women to understand domestic abuse and have healthier relationships.

On paper, I look terrible. There was a lot of crap in my past….It’s about understanding people’s past,” she continues.

It’s being that person that goes that extra mile for that family, because then you will get that extra mile back.”

Helen says she sometimes feels professionals have made their mind up about women.

“You can see the hurdles they’re putting in their way. With the good ones, they’re trying to knock down hurdles and really see what’s going on: ‘What does this family really need? How can I help? What resources can I put in place for this woman? And these children. Because my ethos is: if mum’s OK, child’s OK.’”

Vicky puts it straightforwardly: “you’ve got to be kind”. “The best social worker I ever had showed me kindness I’d never seen. She worked with me, not against me. She was very transparent.”

Vicky says newer social workers seem “more open, more receptive to women – which I think is making a massive difference, but we’re not there yet.”

Staff and residents mention wanting social workers to have more training about addiction, both its links with trauma and the physical effects.

“I was told to just stop drinking”, Selena says. “That could have killed me.”

They are also keen to share understanding of domestic abuse, especially why people don’t leave abusive partners.

Women who are not in abusive relationships may face different challenges if they have a partner who is in active addiction.

Megan explains that her social worker is also trying to help her partner get into rehab: “When there’s two addicts living under the same roof, one of them’s more likely to relapse than the other and bring the other one down.”

Relocating

While some women are looking forward to going back to homes that are waiting for them, Jasmine supports others who want, need or are encouraged by professionals to relocate to Plymouth.

Returning to the town where you were in active addiction carries a risk of relapse. Caitlin is getting support to find somewhere to live in Plymouth “cos I can’t really go back to all the users and stuff where I’m from. They’re all hanging around outside rehabs waiting for you to relapse so it’s not great.”

Wall hanging made by Jasmine residents. Photo: Community Care

If families stay in Plymouth, women can continue attending the same Alcoholics Anonymous (AA), Drug Addicts Anonymous (DAA) and Narcotics Anonymous (NA) meetings they went to while at Jasmine and benefit from Trevi’s Sunflower Centre, a therapeutic service for women with complex needs, including addictions and domestic abuse.

Currently, most women are funded for 12 weeks. After that, local authorities are keen to see women’s ability to look after their children in the community.

While there’s an understanding that funding is tight, staff and many of the mothers say 12 weeks is not long enough to simultaneously detox, go through the therapeutic programme and learn parenting skills. The best results often come when women have longer.

While clearly women want to complete the programme, know whether they can keep their child and move on, I wonder if it’s also daunting to leave somewhere that offers safety, community and a rare experience of feeling supported.

Megan laughs that she’d almost like to live here and is a bit nervous about leaving.

“Obviously just the whole thought of relapsing. Because it’s always in my head, as an addict, it’s always there. But because of the groups and things [here], it’s taught me the techniques I need to prevent that. And it really does, because it’s consistent, it’s every single day.

“Every time I think about using or going back to that, it’s flip and then switch and I do it subconsciously now, so it just goes away. And it installs a fear in you as well that if I do it again, I’m going to lose absolutely everything and I will not have an opportunity to come back here again.”

Megan knows that when she leaves she will have the number of a family support worker from Jasmine and be able to have FaceTime calls.

Does she think she’ll be one of the people who comes back to visit? “Definitely,” she says.

I’ll bring him back when he’s older and be like, look, this is our journey. This is where mum brought you. This place, everyone here, is the reason why we’re together.

Starting life again

Before we leave, Helen has arranged for us to speak on the phone to Hayley, who left Jasmine two weeks ago with her son. We can’t see her face, but the positivity, strength and life in her voice are palpable. Hayley remembers that she didn’t want help at first.

Wall decoration at Jasmine Mother’s Recovery. Photo: Community Care

“I had to reach my low – I couldn’t get any lower – for me to pick myself up,” she says.

Hayley was here for 16 weeks and adds: “It was only the last few weeks of me being here that I feel normal. Like for the past few weeks, I wake up every single morning full of life. I don’t feel ill, I don’t feel groggy. I’m able to see to my son without feeling like shit. I feel amazing.”

She credits Jasmine with helping her to be a mum and also find her own identity, even down to what food and music she likes.

“I literally get to start my life again and figure out what it is I like. I get to do it all from fresh. Clean.

“I never used to see a future. Now you’re asking me about my future and I do. A happy life, a clean life with my boys… I can see it. And I’m jumping in with both hands.”

by Rosie R

Some of the children we work with have started out life on a very rocky path and their journeys can be shocking and very unsettling to hear.

This poem recounts a very turbulent trajectory of events that could have resulted in a different outcome to that described if not for a social work intervention.  The outcome was, fortunately, favourable for the young person, though the impact of such turbulence has had a lasting effect.

Do you have a experience or opinion to share or write about? Read our guidelines page and contact our community journalist at anastasia.koutsounia@markallengroup.com.

Social workers should be a core part of community alcohol treatment services, according to proposed government treatment guidelines issued last week for consultation.

They should be members of multidisciplinary teams in every area responsible for assessment, treatment and recovery planning, alongside doctors, nurses and psychologists, say the guidelines on treating harmful drinking and alcohol dependence.

The UK-wide guidelines, drawn up by experts, including those with lived experience, are designed to constitute good practice in delivering alcohol treatment services in community, custodial, residential and inpatient settings.

They are based on “a recovery-oriented system of care” designed to help a person achieve abstinence, while developing a meaningful life, delivered by trained practitioners and experts by experience.

Key skills needed by alcohol practitioners

Though community alcohol services are generally integrated with drugs provision, teams should be inclusive of people with a primary alcohol need, including by having named keyworkers and sufficient specialist staff with relevant knowledge and skills.

These should include the ability to build a trusting relationship with the person, knowledge of harmful drinking and alcohol dependence, assessment skills, motivational skills, cultural competence, a trauma-informed approach and care co-ordination.

These should be underpinned by appropriate caseloads, regular and good-quality supervision and effective training, say the guidelines.

Recovery and harm reduction

Community teams should provide a range of evidence-based services including pharmacological interventions, for example, to support medically assisted withdrawal, and harm reduction provision for those unwilling to consider abstinence.

Alongside these, they should provide recovery support, for example, help with accessing employment, training, education or social activities, and psychosocial interventions that include practical help with basic needs such as accommodation and income.

Outside of specialist services, social care services should be able to identify people with alcohol use disorders using a validated screening tool such as the alcohol use disorders identification test (AUDIT).

They should also be able to offer people “brief interventions” to people whose drinking increases risks to, or is already harming, their health, but who are not dependent on alcohol. These are designed to motivate people to reduce their drinking, with staff delivering these trained in motivational approaches.

Goal of services based on ‘best scientific and medical expertise’

Launching the proposed guidelines last week, minister for public health Neil O’Brien said it was “vital that treatment for those with alcohol dependence is informed by the best scientific and medical expertise, as well as the views of those with lived experience”.

He added: “This consultation will help us develop guidance to ensure alcohol treatment services are of consistently high quality, providing stronger pathways to recovery for those in need of treatment for alcohol dependence.”

Wulf Livingston, a qualified social worker who is professor in alcohol studies at Glyndwr University in Wales, said any focus on alcohol services was welcome as they were “too often neglected”, and there was “much to applaud in the document”.

“Its extra emphasis on recovery while not dismissing harm reduction is helpful,” he added. “It utilises some well-established evidence-based interventions.”

Guidelines ‘too focused on fixing individuals’

However, he said it was too focused on “fixing individuals” and on treatment, rather than on the social determinants of alcohol use and interventions to tackle these.

“The core problem from a social work perspective is that it assumes alcohol is the problem, rather than the means or solution by which individuals seek to cope with a whole myriad of other problems,” he added.

Children whose parents are referred to family drug and alcohol courts (FDACs) are more likely to be reunified with their families than those involved in standard care proceedings, research has found.

Parents involved in FDACs are also more likely to have stopped using drugs or alcohol by the end of their cases than those in standard proceedings.

But study limitations mean these positive effects cannot be attributed entirely to FDACs, so further research is needed to evaluate whether the courts cause improved outcomes, said evidence body Foundations (formerly What Works for Children’s Social Care).

It commissioned National Centre for Social Research (NatCen) to carry out the study, as part of the Department for Education’s (DfE) Supporting Families: Investing in Practice programme, which is designed to identify effective interventions for keeping families together.

Promising evidence for FDACs

The research was designed to build on promising existing evidence about the impact of FDACs, an alternative to standard care proceedings in substance misuse cases, geared towards keeping children with their families, where possible.

Under the model, multidisciplinary teams work with parents to help them tackle their alcohol or drug misuse, including through key worker support, individual or group therapy and referral to other services.

At the same time, specially trained judges undertake fortnightly sessions with parents – in the absence of lawyers – to oversee progress and foster positive working relationships between families, the judiciary and FDAC practitioners.

Since first being piloted in London from 2008-12, the number of FDAC teams has grown to 15, covering 36 local authority areas in England and Wales.

Randomised controlled trial model rejected

This study was originally designed to be a randomised controlled trial (RCT), which would have involved families being randomly assigned to an intervention group receiving an FDAC and a control group who did not, with the two groups having similar characteristics overall.

However, while this would have helped identify whether FDACs caused improved outcomes, an RCT was rejected on the grounds of legal obstacles, such as families in the control group appealing the outcome of the case or the assignment process.

Instead, researchers chose a model – known as a quasi-experimental design (QED) – in which families referred to FDACs in 13 areas were compared with families involved in standard care proceedings, where parental substance misuse was the key issue, in nine local authorities.

All but one of the latter councils were covered by FDAC sites and researchers sought to ensure that families in the two groups had broadly similar characteristics, in the data they analysed.

Better outcomes from FDACs

On the two key outcomes analysed, the study found that:

• Over half of children with a primary carer in FDAC care proceedings (52%) were reunified with this carer at the end of proceedings; the figure for children in the comparison group was one in eight (12.5%).
• A third of FDAC parents had stopped misusing drugs or alcohol by the end of the case (33.6%) compared with 8.1% of parents in the comparison group.

Interviews with 40 practitioners and parents involved with FDACs also highlighted three key perceived benefits with them compared with standard care proceedings:

• They were a more supportive process for parents, allowing them to demonstrate their ability to meet their child’s needs, rather than feeling punitive.
• They led to better outcomes including reductions in substance use, higher rates of reunification, increased insight and parenting skills and lower rates of contested cases.
• They achieved long-term cost savings despite the upfront investment required to provide intensive support and supervision to parents.

Study caveats

However, the study report warned that the positive results needed to be treated with caution because there was a high risk that the differences in outcomes were being driven by differences between the FDAC families and those in the comparison group.

Researchers lacked data on key characteristics that may have influenced outcomes – such as parents’ mental health diagnoses, the severity of their substance use and their motivations to stop misuse.

And, in their final analysis, the study team had to exclude a number of families in order to match the FDAC and control group samples as far as possible, which the report said “limited the generalisability of [the findings]”.

Foundations chief executive Jo Casebourne said this meant “unable to draw firm conclusions about the impact of FDAC based on this study” and that a “more robust comparison” was required, involving either a randomised controlled trial or a quasi-experimental design with better data.

Findings ‘a testament to practitioners’ hard work’

Despite the caveats, the research was welcomed by the Association of Directors of Children’s Services (ADCS) and the Centre for Justice Innovation, which provides national leadership and support for FDACs.

Its director, Phil Bowen, said the findings were “a testament to the hard work and diligence of the judges and professionals” within FDACs across England and Wales.

“These positive findings build on a strong evidence base, reinforcing the message that if we expand the number of FDACs across the country, we will improve the life chances of hundreds of children and parents across our country.”

ADCS president John Pearce said FDACs were an example of the value of problem-solving approaches in helping keep children with their families, where this was in their best interests.

However, he said that “the piecemeal nature of new funding has meant the benefits have been limited to a small number of local authorities”.

“ADCS would welcome a shift in approach so that all local authorities were resourced to explore new ways of working and where there is evidence of what works, all were resourced to implement such models,” Pearce added.

Assessing parental substance misuse

It is important to define substance misuse. This helps identify how the issue is presenting within the family.

In the guide, substance misuse is defined as, “the use of alcohol or drugs in a way that results in social, psychological, physiological and legal problems for the person who is using substances and those around them”.

If completing an assessment where there are concerns about parental substance misuse, practitioners should consider:

1. Stability and consistency: How consistent and reliable are the parents/carers at meeting the child’s needs? How stable is the household composition? Establish who looks after the child, and if there are routines in place to support the child to attend school/activities on a regular basis.
2. Household safety: Is the household environment safe and free from hazards? When and where are drugs prepared, used and disposed of? Is alcohol kept in a safe location? Are children present when substances are used/consumed? Assess if the parents have safety plans or strategies in place.
3. Support from another parent or carer: Does the child have a parent or carer residing at home who does not misuse substances? Does the non-using parent know about the substance misuse? What is the quality of their relationship with the parent who is misusing? Assess if the non-using parent/carer provides safe and consistent care for the child if the parent who is misusing is unable to.
4. Pattern and severity of substance misuse: Parents may be unwilling to disclose this information. However, it is vital to assess what the child may be seeing and experiencing. Evaluate what, when and how substances are being misused. How does this affect the parent,  and for how long, and what do periods of withdrawal or recovery look like?
5. Engagement with substance misuse treatment services: Is the parent receiving substance misuse treatment? With consent, talk to the support service to obtain further information. Assess the parent’s motivation for seeking treatment. Is disguised compliance occurring? If there is no treatment in place, encourage a parent/carer to speak to their GP or signpost to appropriate services.
6. Historical professional involvement: Have there been previous referrals to children’s social care and have there been previous interventions or assessments completed? Consider the longevity of family issues, what actions were taken, what worked and what didn’t.
7. Domestic violence and abuse: Parental substance misuse is associated with increased levels of violence – a 2021 study of around 300 children living with parental substance misuse found that over 40% had also witnessed domestic violence. If you are aware or are concerned that domestic abuse is also taking place, assess whether the child and non-abusive parent feel safe. Is the victim or perpetrator misusing substances? Is substance misuse being used to control or coerce the victim? Remember, the physical safety of the non-abusive parent and child is always the priority.
8. Support available outside of the home: Does the child have a good support network outside of the home and access to community resources (eg school, extra-curricular activities)? Assess if the child has extended family or friends to support them and the quality of these relationships.
9. Deprivation and poverty: Do the parents/carers have financial and practical resources to meet the child’s needs? Assess the financial situation and the family’s access to local community resources and safety. While socioeconomic advantage can reduce or prevent children being stigmatised as a result of parental substance misuse, remember that all children can experience stigmatisation regardless of their parent’s socioeconomic position. Stigma can affect friendships, wellbeing and feelings about professional support.

If you have a Community Care Inform Children licence, log in to access the full guide and read more detailed information on assessments, the impact of parental substance misuse on children and how to work with and support children and families affected.

Story updated 14 December 2021

The government’s drugs strategy appears to have “completely overlooked” the role of social work in supporting individuals and familied affected by substance use.

That was the warning from Sarah Galvani, professor of social research and substance use at Manchester Metropolitan University, following the publication of the strategy this week.

Despite the strategy taking a “whole systems approach” to reducing drugs use and promoting recovery, it makes no specific references to the role of social care.

By contrast, there are significant sections, backed by investment, on the role of housing and employment support, in promoting recovery, alongside a strong focus on expanding specialist drugs services, in prisons and the community.

‘Completely overlooked’

Galvani, whose research focuses on substance use and social work, said: “Social work and social care services appear to have been completely overlooked in terms of their role in supporting individuals and their families where there is substance use.

“The focus appears to be primarily on the specialist workforce with little understanding that social care services, be they social work or social care, work with people using substances who never reach services or who drop out or whose lives and families are negatively impacted by their use.”

She welcomed the whole systems approach – taken from Dame Carol Black’s review of drugs services that provides the basis for the strategy – but Galvani said the absence of focus on social care betrayed a lack of understanding of its role within government.

“Substance use can become an adult and child safeguarding issue as we know and social workers work daily with people using substances who are experiencing problems,” she added.

“The wider social work and social care workforce need training in substance use in order to feed in to the specialist services appropriately and to ‘hold’ those who do not want to receive specialist support. It’s not simply a case of referring on.”

Lack of clarity on social work posts

It is also not clear how far specialist social workers are included in the government’s plan to “rebuild” the “depleted” drug and alcohol workforce, as part of the strategy.

It includes plans to increase the number of medical, mental health and other professionals by 800 and drug, alcohol and criminal justice staff by 950 over the next three years.

However, while the strategy references doctors, nurses, psychiatrists, psychologists and registered health professionals generally by name as being among the first of these groups, it does not mention social workers.

This was despite the fact that Black recommended the creation of 52 new social worker posts over the next three years, and 78 over the next five.

‘Significant deterioration’ in workforce

In the second report of her review, published in July, Black said there had been a “significant deterioration” in the quantity, quality and morale of the drugs workforce due to service cuts in recent years, leading to high caseloads.

She added: “The only effective treatments for people dependent on non-opioid drugs are psychosocial interventions including cognitive behavioural therapy, yet people with professional skills in these areas are in very short supply. Dedicated social work teams for drugs and alcohol are also disappearing.”

The government accepted Black’s recommendation to rebuild the “depleted” drugs workforce.

“We need to rebuild the sector’s health professional workforce (including psychiatrists, doctors, nurses and psychologists) and improve the level of skill and training among drug workers and peer recovery workers, so that they are all well equipped to deliver the psychosocial and health interventions that drug users in treatment require to succeed,” the strategy says.

It adds that staff would have lower caseloads and the skills to deliver “evidence-based psychological interventions” that would improve recovery rates, particularly for users of non-opiate drugs, such as cocaine, and recently initiated heroin users.

The government’s figures appear to fall short overall of Black’s recommended expansion in the number of professionals over the next three years (800, as opposed to 1,113).

It said it would develop a strategy with Health Education England to expand the workforce and “define and improve the training and skills of all sections of the drug treatment workforce, including registered health professionals, drug and alcohol workers, and peer supporters”. This will include consideration of the role that can be played by social workers, though it is not clear how far this will include extra roles as recommended by Black.

Need for ‘serious effort’ to recruit social workers

In response, the British Association of Social Workers (BASW) criticised the lack of detail on expanding social worker numbers in the strategy.

A spokesperson said: “Professor Dame Carol Black’s independent review into misuse of illegal drugs recommended an increase to the number of professionally qualified drug treatment staff, including social workers, but the Prime Minister’s new drugs strategy fails to mention how they intend to implement this.

“The strategy also falsely places an emphasis on alcohol and drug use as criminal activity and a ‘war that can be won’ instead of recognising wider issues of addressing economic and social injustices that play a direct link to such activity.

“Social workers are on the front line of health and social care, with substance abuse impacting the lives of many people who receive social work services. Any proposals to tackle drug misuse will not be enough if there is not a serious effort and strategy to recruit more social workers in drug services.”

‘Safeguarding professionals key’

Provider Turning Point backed the workforce plans and stressed the importance of social workers’ roles.

“We are really supportive of the proposals in the strategy around the expansion and professionalisation of the substance misuse workforce,” said national director of operations Clare Taylor. “Increased numbers of specialists, along with the introduction of new professional standards will help improve the quality of services.

“There is an important role for professionals with a robust safeguarding qualification, such as social workers, in drug and alcohol services. There is clearly work to do on the detail – and hopefully there will be the opportunity for provider organisations to work with government on this.”

Funding boost

A Department of Health and Social Care spokesperson said: “We’re investing a record £780 million to improve access to treatment and increasing the capacity of services as part of our bold 10-year drug strategy.

“This will allow us to develop a world-leading treatment system, including expanding the workforce by over 1,500 staff to ensure people have more support and help to overcome their addiction.”

As part of this, the government said it would continue this year’s £80m boost to local authority-commissioned drugs services over each of the next three years, which is on top of the existing £670m-a-year public health grant, designed for the same purpose.

The strategy says councils should focus this on reducing drug-related deaths, bringing more offenders into treatment, and expanding inpatient detox services and provision for those with complex needs.

The government will also provide an extra £293m from 2022-25 for councils to invest in drug and alcohol services. This will go first to the 50 areas with the highest needs, based on drug-related deaths, and levels of use and crime, before being rolled out to the rest of the country.

The government said it would set grant conditions to ensure this money was spent on evidence-based treatments, potentially with a clawback mechanism if money was not used as intended by councils.

It said it would expect the funding to cover interventions such as needle and syringe programmes, medicines to reduce harm and support detoxification and psychosocial programmes “to support people to understand their addiction, make changes and develop coping strategies”.

‘Ignored and marginalised for too long’

Treatment provider Change Grow Live strongly welcomed the strategy, including its plans for the workforce.

“The success of this strategy depends in large part on the people who deliver treatment and recovery services, from psychiatrists to caseworkers and volunteers, so we welcome new funding to attract people to jobs in the sector, to support better training for them, and to keep caseloads manageable,” said chief executive Mark Moody.

He added: “We also back the ambition to see the full range of evidence-based harm reduction and treatment services available for all those that need them in every community, starting with the most deprived areas, which are disproportionately affected by drug use.”

However, Moody said, “people who use drugs have been ignored and marginalised for too long by policymakers”, meaning the strategy was “just the start”.

Deaths at highest level since records began

The strategy comes with drug-related deaths in England and Wales reaching their highest level since records began, in 1993, last year.

Turning Point said this made the strategy – which it also strongly welcomed – “timely”.

Chief executive Julie Bass said: “The introduction of new professional standards for the workforce will help improve the quality of services and we are glad to see that the strategy acknowledges the value added by people who’ve experienced drug problems themselves working alongside clinicians to support others in their recovery.

“This is a significant additional investment in the sector and we are encouraged by the fact that funding will be ring-fenced, with local accountability strengthened and a clear focus on reducing drug-related deaths.”