Drug and Alcohol treatment services bring benefits to individuals, families and communities and the importance of health and social initiatives to address problematic alcohol and drug use has been long recognised by the British-Irish Council as an area of shared interest across the administrations of the BIC.
At the first inaugural Summit meeting of the British-Irish Council held in December 1999 it was agreed that the issue of ‘Drugs’ would be an area of focus. Following this, the BIC discussed the issue of ‘Drug Misuse’ in depth, considering how cooperation in this area might be developed within the British-Irish Council. Initial discussion focused on the two key areas of Demand Reduction (incorporating prevention and treatment) and Supply Reduction (incorporating law enforcement) with Heads of Administration underlining the commitment of all members at the highest political level to addressing this widespread and growing problem.
As the years and work of this work sector have developed and progressed, it has been acknowledged that drug and alcohol services can: save lives with treatment being a protective factor against overdose; help people to recover and break the cycle of addiction and to turn their lives around; and reduce crime and prevent the spread of addiction.
More recently, the British-Irish Council Summits of 2015 and 2019 hosted by the Government of Ireland focused on ‘the use and misuse of alcohol’ and ‘health and social initiatives to combat substance misuse’ respectively.
The Government of Ireland is the lead administration and chairs the Misuse of Substances (Drugs & Alcohol) work sector.
The preparation of a new Work Plan has been one of the areas of key focus of the work sector in recent times. The ‘Misuse of Substances’ work sector held a virtual Ministerial meeting on 11 March 2021 hosted by the Government of Ireland where this work plan was approved.
At this Miniterial-level engagement, Ministers from the 8 administrations of the BIC discussed a number of areas of shared interest, including ‘Financial mechanisms to reduce the consumption of alcohol’. Ministers noted the efforts of Member Administrations to decrease alcohol consumption and agreed that there was value in comparing approaches and sharing learnings from the emerging evidence base.
Ministers also discussed the shared approaches across administrations on work underway to ‘Measure the effectiveness of addiction services and harm reduction strategies’. Ministers recognised the importance of effective monitoring and evaluation to ensure policy and practice is developed, based on sound evidence and that sharing this diversity of knowledge, understanding, experiences and learning across Member Administrations affords a unique resource for enhancing monitoring and evaluation.
At this meeting, Ministers also had the opportunity to listen to a presentation by Professor Dame Carol Black focused uon Part 2 of the Review of Drugs in England for the UK Government Department of Health & Social Care. Professor Dame Carol Black provided insight into lessons learned from the review study which aimed to ensure that vulnerable people with substance use get the support to recover both in the community and in prison.
At the Ministerial meeting, as well as reflecting on the work completed since the last such meeting, Ministers also considered the future challenges for Drug & Alcohol services across Member Administrations and endorsed the future focus for the work sector over the coming years, through the lens of recovery from the Covid-19 pandemic.
Areas of future focus will include:
- Considering the lessons of Covid-19 and the delivery of drug and alcohol services. Covid-19 has highlighted the underlying health inequalities for people who use drugs, including difficulties in accessing health and housing services. As Member Administrations prepare their services to recover from the pandemic, there are both opportunities and a requirement to identify long-term changes in service delivery, be it effectiveness, capacity or the financial implications.
- Reducing the risk of drug related deaths: Drug-related deaths are a significant public health concern across the BIC Member Administrations. Innovative and ambitious responses are required to adequately meet these needs. Over the last number of years, there has been a shift in the drugs implicated in overdoses and, as such, policy and harm reduction responses are required to evolve with these trends. Moving away from the heroin epidemic; prescribable drugs, alcohol and stimulants have been heavily implicated in drug related deaths over recent years. Focusing on this theme endows each Member Administration with the opportunity to improve the health outcomes for their populations that use drugs.
- Reducing alcohol related harms through the use of financial mechanisms: Evidence shows that purchasing behaviour in relation to alcohol is price sensitive – increasing the cost of alcohol reduces its consumption and decreasing the cost of alcohol increases its consumption. Price is therefore often used as a policy lever to reduce alcohol consumption and its related health and social harms. There is a general consensus that the pricing and promotions of alcohol are major policy levers. To reduce consumption, financial measures that have been taken by some administrations, include the introduction of a minimum unit price for alcohol. Such interventions can be effective in reducing alcohol consumption, alcohol-related harms (including alcohol-related deaths, hospitalisations, crimes and workplace absences) and the costs associated with those harms whilst improving quality of life. The work sector has undertaken some work previously in sharing information on this topic and this will be built upon when taking this theme forward.
- Considering joined up approaches to meeting the health and social needs of people who are homeless and use drugs and alcohol (in conjunction with the BIC Housing work sector): The links between homelessness and substance use are well documented and a number of integrated health inclusion projects and services that seek to meet the needs of some of the most vulnerable and at risk individuals in our societies are in existence across Member Administrations. Wider programmes also such as Housing First seek to incorporate health and housing components to provide sustainable solutions for vulnerable groups, including long term recovery from substance dependency. Through a focused collaboration between the BIC Housing and Misuse of Substances work sectors there will be learning to be built on, from both the substance use and homelessness responses to COVID-19 by all BIC Member Administrations.
- Engaging with the voluntary and community sectors to consider their role in the provision of drug and alcohol services, and in the development and monitoring of policy: Voluntary bodies play a key role in the delivery of drug and alcohol services. They can also have an advocacy role with Governments. Service users, because of their lived experiences, and direct knowledge of services, have unique insights which are a valuable resource to those involved in developing services and interventions. Drug treatment works by treating dependency and addiction, but if patients are to sustain their recovery, they need to be linked in with a range of appropriate support services, including family and peer support and have access to stable housing, employment, training or education opportunities. Service involvement in the development and design of services can have a positive impact on treatment and recovery outcomes because the services are relevant to service user needs. Therefore, facilitating service user involvement is a core objective of drug and alcohol policy. The Voluntary and Community Sector play a key role in enabling service users and their families to contribute to the planning, design and delivery of effective services; and in the decision making structures within local and national drug policy. Working with the voluntary and community sector supports the development of services that have a broader remit, for example, addressing the ‘causes of the causes’ across the wider determinants of health such as inequalities, deprivation, housing and employment. This requires a whole system approach and the work sector aims to bring stakeholders together to develop a shared understanding of the challenges, and integrate action to bring about sustainable services that meets the needs of the service users and strengthen the recovery process for individuals and their families.