Official ONS statistics show 4,359 people died as a result of drug related causes in England and Wales in 2018. That’s both the highest number of deaths and the highest annual increase since the Office for National Statistics began keeping records in 1993.
When new drug related deaths statistics are released, media coverage inevitably focuses on what drugs are to blame. Is it rising cocaine use among millennials or prescription drugs? An influx of fentanyl or cheaper, stronger heroin?
These are important questions that need to be asked as they shape drug education and harm reduction efforts. But to help reduce harmful drug use we need also need to look beyond what drugs people are taking. Without understanding the underlying reasons why many people use drugs we can never make sure treatment, and society as a whole, is properly geared towards people’s needs.
“When you consider well over half of people in drug treatment have a mental health issue this should be the cornerstone of drug policy.”
As addiction expert Gabor Mate says: “It is impossible to understand addiction without asking what relief the person finds, or hopes to find, in the drug or the addictive behaviour.”
I’m a team leader at Addaction’s drug and alcohol treatment service in North Somerset. Whenever someone accesses our service we ask them to fill in a questionnaire about their childhood. This may seem slightly odd but traumatic upbringings, known as adverse childhood experiences in the sector, are a major reason people develop a problem with drugs as an adult. An adverse childhood experience could be physical or sexual abuse. It could be domestic violence or having a caregiver who has a drug or alcohol problem, or parental abandonment. Sometimes it’s emotional neglect or a parent going to prison or having mental health issues.
People who experience childhood trauma are twice as likely to have a mental health condition, according to a recent study by The British Medical Journal. Drugs like heroin offer brief but exceptionally powerful relief from mental health problems. They regulate and numb deep seated emotions that have never properly been dealt with. It’s therefore no surprise that 61% of the people who access our service in North Somerset identify as having experienced four or more adverse childhood experiences compared to just 12% of the population as a whole.
Most mental health services don’t support people who admit to having a drug issue as it’s judged the mind altering power of drugs prevent people from making progress. But the source of people’s psychological pain must be addressed to help lessen the grip drugs have on them. I see the power of this approach everyday. The unbelievable resilience of people who’ve had painful pasts never ceases to amaze me.
The crux of the work is helping them see they aren’t different, that, like all of us, they’re a product of their environment. As my colleague Lorraine Bustard, a counsellor for people who’ve experienced childhood trauma, wrote, “What holds people back is the feeling they’re to blame for what’s happened to them. That’s why getting to that moment where they say “this really wasn’t my fault” is so powerful. Letting go of that kind of guilt is a huge weight off someone’s shoulders.”
Putting trauma work at the front and centre of drug treatment makes a big difference. Yet we also need to treat people with empathy and respect outside of treatment. Criminalising people who use drugs focuses action on the drug use rather than the underlying cause. Branding someone a criminal often confirms people’s feelings of shame. Ironically, this can lead them to spiral into further drug use.
We also need to do more to prevent people from feeling the need to use drugs in the first place. This may sound simplistic but a big part of this should be focused on making children’s lives better. Official figures show over 4 million children are currently living in relative poverty in the UK, with this number expected to increase in the coming years. Poverty itself is not an adverse childhood experience, many people who grow up in low-income households have happy, loving childhoods. But not having enough money for food, or enough room in the house isn’t conducive to the calm, loving environment children need. That stress and angst can trickle down to children. In a recent report the UN Special Rapporteur on Health Dr Darius Puras said said tackling inequality and poverty should be the cornerstone of combating mental illness. When you consider well over half of people in drug treatment have a mental health issue this should be the cornerstone of drug policy too.
Witnessing a child in a traumatic situation would make anyone feel rage and empathy on their behalf. Yet we don’t realise that that scared child continues to live inside many people. Joining these dots can help people now and for generations to come.
Adrian Riley is team leader for Addaction north Somerset. Speak to a trained addiction advisor at addaction.org.uk.