Functional Model

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Poverty

• Strategic Inability to change national or local
  strategic direction despite the evidence
• Absolute vs. Relative
• (Global vs. Intrasocietal)
• Emotional The recovering Hippocampus

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Strategic Poverty 1

• Rising numbers of problem drug users
• Rising purity levels and better deals
• Lengthening life cycle of self-harm
• Declining age of first use
• Rising Deaths and ill-health
• Increasing fossilisation of exclusion
• Increasing convictions for non-violent drug
  offences
• Relationship between drug economy and acquisitive
  and organised crime

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Strategic Poverty 2

• 1980s saw dramatic shift in social profile
• Relationship between Drug trade and international
  oppression
• Britain the only Western nation to feature in top
  5 Heroin importers
• Newly available in communities which were
  previously free of supply
• 58 20-24 yrs use illicit drugs (highest ever)
• CONCLUSION Neither prohibition nor prevention
  forces have made any noticeable impact on uptake

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Relative vs. Absolute 1

• Poor people are everywhere yet they are
  invisible Orshansky
• Some seem destined to poverty almost from and by
  their birth
• 25 (was 40) of those who qualify as poor one
  year no longer do the following year
• Wealth of Nations Adam Smith

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Relative vs. Absolute 2

• Top ranking civil servants live longer and more
  healthily than lower ranking
• Social Gradient in Health (Marmot)
• African-Americans smaller chance of reaching old
  age than Keralans
• Subordination gt Stress gt Damage to immune system
• Limitation of capacity for social advancement

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Cornerism

• Not the place that happens to have social
  problems
• The place where many social problems intersect
  and become inseparable from each other or the
  culture
• Residents problem is the fact of being brought
  up and living there
• Single issue attempts to deal with problems
  ineffective

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SOCIAL INCLUSION EXCLUSIONSUBSTANCE USE
PROBLEMS

• School Non-Attendance
• Early Criminality
• Experience of Local Authority Care
• Unemployment as Cultural norm
• Experience of homelessness

• Heavy early use of drugs
• Personal experience of Mental Health problems
• Parents actively criminal with history of drug
  abuse
• Disruption of family unit

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Functional Model
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Treatment

• NTORS Treatment works
• Can reduce harmful behaviour (Crime / drug use)
• Can improve physical and mental health
• Ability to change predisposing life features
  doubtful
• In many treatment systems still seen as a
  function of personal psychopathology rather than
  social circumstance
• Only rarely embedded in communities
• Rarely encourage client group productivity

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Treatment Limitations 1

• OUTREACH Can be undermined by more formal and
  rigid adjunctive services
• HEALTH PROMOTION Can lack credibility if seen
  as dissonant
• - Those most at risk least likely to be affected
• NEEDLE EXCHANGE limited by function and by
  anonymity
• COUNSELLING Can be idealogically limited
• - Only indirect support for structural change
• - Terms of engagement can be rigid especially
  with active drug use
• 12 STEP limited appeal
• - Doesnt address structures of dependency

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Treatment Limitations 2

• DETOXIFICATION Seen as rigid
• - Lacks power to deal with wider issues
• RESIDENTIAL REHAB Decontextualised
• SUBSTITUTE PRESCRIBING - Doesnt promote change
  if wider issues undressed
• - Practical difficulties in adapting to change
• - Problems with generalising good practice
• - High proportion continue illicit drug use
• - Many relapse once through service
• - Poor retention rates
• - Waiting times

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PHASE 3

• Community Safety Forum
• New Deal
• Progress 2 work
• New Futures
• Benefit reform
• - All generically promoted and partitioned
• Examples of Asian projects which build their own
  enterprise initiatives to pay for services within
  local community

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SUGGESTIONS

• Focus on cause not symptom
• Holistic Approach in which work is key
• Develop new ways of helping people into work
• Give Social enterprise a central role
• Ensure the law reduces harm
• Tackle barriers to change amongst strategists
• Match new domestic policies with a new global
  approach

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