Both Sides of the Coin is a project I'm working on with the LDPF with support from ADFAM and KCA. We want to explore the relationship between financial exclusion, poverty and substance use and find ways of tackling it. Our focus is not just on developing responses within the drugs field but also to support and encourage mainstream agencies to work more effectively with drugs users, their families and communities.

Inclusion and Exclusion
Financial inclusion is an increasingly important issue for the Government, with the Treasury and the Financial Inclusion Task Force leading on a range of actions to enable more people to become financially included and provide greater security for themselves and their families. Financial exclusion is not the same thing as poverty, but it is often a significant factor in poverty. Transact - the National Forum for Financial Inclusion - define it as follows:

Transact use the following definition to define financial inclusion: "A state in which all people have access to appropriate, desired financial products and services in order to manage their money effectively. It is achieved by financial literacy and financial capability on the part of the consumer, and access on the part of financial product, services and advice suppliers"

Those who are unable to access basic financial services pay more to manage their money, find it difficult to plan for the future and are more likely to become over-indebted. In the words of the Treasury Select Committee: "Too many people cannot gain access to appropriate financial products and services at present: they struggle to obtain affordable credit or helpful financial advice and face barriers in opening and operating bank accounts. Financial exclusion blights the lives of many millions of people; it increases the costs they bear for basic services; it makes them vulnerable to illegal or highcost lending; it reinforces social exclusion."
(Transact, IN BRIEF: FINANCIAL EXCLUSION)

The Problem
We know there is a strong correlation between poverty and problematic substance use. People affected by drug use - families, carers, people who use drugs or who are in drug treatment often experience financial exclusion. In the last drug strategy, Government made a commitment to tackling some related issues - for example the cost for Grandparents of looking after children affected by parental substance use. They also have prioritised issues around employment and inclusion, mainstreaming and reintegration. In our preliminary research and discussions we have found that many people who access treatment services or experience problems related to substance use also experience financial exclusion at levels that seriously impact on their quality of life - and recovery.

As part of our development of the Both Sides of the Coin project I met with a group of service users in January at the Birmingham DDN/Alliance conference. For them there was no denying the links between their economic situation and their drug use. One told the story of how on being discharged from rehab he got a grant to help him set up his new life. Unfortunately he had no bank account and no passport so he couldn’t cash the cheque anywhere but at one of those high street “Pay Day Loan” shops that seem to be springing up everywhere. This meant he lost just over 10% of his community care grant. Another woman spoke about how one of the things that had made a huge difference to her was being in her local credit union – it meant that although her income went down when she went into treatment (as it does apparently for a lot of people) she was able to manage her money better and even save a little bit. Other people have spoken to us about real difficulties they have got into with "Doorstep Credit" (take a look at Debt on Our Doortep for more about this) and loan sharks - stories that will be familiar to workers and services users across the drugs field.

Tackling Drugs Means Tackling Multiple Problems
I was recently speaking at an event where I was describing one of the impacts of the recession on drug use. People who currently feel they are managing their drug use might find that use becoming less controllable if some other areas of their life become more pressured. For example, the person who knows they have to moderate their weekend drug use because on Monday they have to be in work might find the weekends “spilling over” into the week if they lose their job. The challenge I asked the people I was talking with to consider is how we could get help and support to these people. The answer came back “Well it depends when they turn up at treatment services”. This seems fairly logical when you think about it. Job one is drug treatment, so people need to come for drug treatment before we can help – right?

Wrong! Our business is to reduce the community, individual and social harms related to drug use and help people achieve better health and a better quality of life. It’s an aim that should cut right across all our work wherever we are in the drugs field. That certainly does mean we need to continue to resource and support treatment services. Ensuring free, equitable access to high quality drug treatment is a critical part of any effective approach to drugs. But does the work begin and end there? I remember sitting in on a meeting with Mike Ashton a year or so ago when he posed the question why do we have to wait until someone hits a crisis point before we intervene?

I think we need to begin to develop ways of supporting people to deal with their drug use before it becomes problematic, to enable people to be aware of and develop tactics to reduce the potential harms of their own use. We also need to explore further what social and economic factors can help prevent use of drugs and alcohol escalating to problematic levels. Work to ensure we invest in measures to protect vulnerable people and communities from the worst impacts of recession may be of equal value to good treatment services in the medium and long term. Within specialist treatment as well, support around issues to do with housing and employment is recognised as important – but support around money, benefits, and debt can make a real difference too.

Both Sides of The Coin
The Both Sides of The Coin project grew out of the second Goodenough Drug Strategy and a series of informal discussions between people working in the field of financial exclusion and people from the drugs field looking at how the multiple problems of financial and social exclusion, worklessness, stigma and poverty might affect people who experience problems with drugs. One of the things we have noticed since we've begun this work is the level of prejudice and exclusion even organisations working in the area of social inclusion display towards drugs users and their families. I cannot count now the number of times we have been told by organisations "Oh no, we don't work with people like that". Alongside this however we have also found that people working in substance use services often know that money and financial inclusion are big problems for their clients but don't feel they can offer any help. What we hope to initially achieve through Both Sides of the Coin is a raised awareness of how the issues of financial exclusion affect people's chances of getting their lives back on track - and how problems related to drug use affect people's ability to sort their finances out.

The Both Sides of the Coin project will report in the early summer making a series of recommendations for both the financial and the drugs sectors about how we can improve the current situation. We also hope to be able to establish a network of individuals and organisations across the field who will help develop the work in the long and medium term too. To help take the project forward, on the 23rd April in the City of London, the LDPF with ADFAM and KCA are running a conference for users, carers, policy makers, professionals, commissioners and communities to look at the impact of money and debt on people affected by drug use – users, family, carers and communities – and how we can work to improve the situation. At the conference we will be trying to scope the problem and its impact - looking at problems of debt and poverty. But the main focus will be on learning about initiatives like credit unions, debt counselling, savings clubs and community finance schemes which we might be able to adapt and use over the coming years to help people get back on their feet.

Both Sides of the Coin is - ironically perhaps - being undertaken on a shoestring and so while we have a limited number of free places sponsored by our partner organisations - KCA and ADFAM - we are having to charge a small fee (£75.00) to delegates to cover costs. If you’re interested in being part of this new initiative, you can find out more by downloading the PDF here.

A shorter version of this article appeared in this weeks Drink and Drug News

It might as well be for Mr. Kite as it's hard to see exactly who the Welfare Reform Bill's sections on drugs are meant to benefit. Certainly not drug users - for while there is potential for it to improve the lot of some, the design, implementation and administration of the initiative looks likely to be mechanistic and dehumanising. Not the wider community as the likelihood is that the main thrust of the proposals - that is benefit sanctions - can only lead to greater hardship, problematic drug use and crime for the most vulnerable communities. Nor can it, in anything but the short term thrill of seeing themselves looking "tuff" in the Daily Mail, benefit the government, as the paucity of talent and insight evident in the documentation before parliament in relation to this only demonstrates how far from intellectual rigour - or even common sense - those involved in policy making centrally have come.


Leaps and Assumptions
Lets start off by taking the single underpinning assumption of the approach - that is, that there are many numbers of people whose ability to work is only limited by their drug use, or their "propensity" (more of this later) to misuse drugs. The main piece of evidence used by government to support this is a DWP Working Paper published in July 2008 - Population estimates of problematic drug users in England who access DWP benefits. The researchers estimate that there are in the region of 267,000 drug users claiming the main benefits in England (not many really out of a total working age benefit claiming population of around 5 million). Essentially, what the researchers did was take some data from DTORS areas about how many of the in treatment population claimed benefits and then applied this to the estimated national figure of "problem drug users" (eg people using heroin and Crack). The estimate is based on a number of assumptions. Firstly that people in treatment claim benefits in pretty much the same way as people who use drugs but who are not in treatment. Secondly the authors assume that the uptake of benefits by PDUs isn't subject to any local or regional variation - so that people in rural Sussex claim benefits in much the same way as people in Knowsley or Salford regardless of local employment variations. Thirdly, the report assumes that the widely contested and ever changing prevalence estimates from the University of Glasgow that have dogged the sector for some time, are accurate. Two of the three data sources used to build this estimate are themselves estimates - the authors themselves are very honest about the limitations of the research, saying -

"This study has provided some preliminary estimates of the extent of benefit uptake by problematic drug users in England. Its findings point to the need for further research in a number of areas. In particular, the results suggest the need to test some of the assumptions included in this study through a more detailed exploration of the experience of PDUs in accessing benefits."

Far from looking to find out more about the issue however, Government decided to go one stage further, and base policy on it. In the Green Paper "No One left Out - Reforming Welfare to reward Responsibility", drug users were singled out as a group who required special treatment within the benefit system. There were, the authors told us, some 100,000 drug users claiming benefits who were not in treatment (this estimate once again based on the estimates based on estimates based on a finger in the air in the Working Paper). These people, we were told, need to be brought into treatment, as it is obviously their drug use which stops them working. The Green Paper proposed a system to deal with this. Criminal justice agencies - who its worth remembering already share information with treatment agencies - and treatment agencies themselves, would now start to share information with Job Centre Plus. This would mean that people being discharged from prison and sentenced to DRRs would be referred via the job centre into treatment. One could be accused of thinking this was a duplication. After all weren't people coming out of prison and being sentenced to DRRs already being referred to treatment by DIP? The Green Paper however was clear that this would make a major difference - though it never quite got round to explaining why. The Green Paper also explained that Government would be providing new guidance to Job Centre Plus staff to enable them to identify problem drug users, and asked for views on the practicality of requiring everyone who claimed benefits to declare whether or not they were a problem drug user while ruling out universal drug testing.


A Propensity for Nonsense
Come the White Paper "Raising Expectations and Increasing Support: reforming Welfare for the Future" - published in December - and some of these ideas were fleshed out. By the time we reached the publication of the Welfare Reform Bill itself in early January, it became clear what intentions were. The proposed system will look something like this.

Criminal Justice Agencies will share information about people coming out of prison and being sentenced for drug related offences with Job Centre Plus. This will enable Job Centre Plus staff to identify those new and existing claimants who use drugs and require them to attend an assessment. Job Centre Plus staff will also be expected to identify at the time of claiming, people who have what is referred to throughout the proposed legislation as people with "a propensity for drug misuse". Neither the bill nor the schedules are clear about treatment agencies requirements to information share, but the NTA initial guidance for partnerships and providers (published in January) suggests that they will be involved as well, if only in terms of relaying information about compliance back to Job centre Plus staff. The people identified as PDUs or as "having a propensity to misuse drugs" will also be required to attend an assessment. The assessment will look at whether the person is or is not a problem drug user or "has a propensity to misuse drugs", whether their condition requires or may be susceptible to treatment and whether it is a factor affecting their prospects of obtaining or remaining in work.

From a brief examination of the new Schedule to the 1995 Jobseekers Act we find out that those individuals identified as a PDU or as having this "propensity to misuse drugs" who fail to take part in this assessment or who refuse -

"... can be required to undertake one or more drug tests to ascertain whether there is or has been any drug in the person's body to help determine whether they are dependant on or have a propensity to misuse, drugs" - House of Commons Research Paper 09/08, Welfare Reform Bill - Social Security Provisions referencing the proposed new Schedule 1a of the 1995 Jobseekers Act

Those who refuse to be tested (bog standard urine testing rather than the more draconian approaches originally reported!) will face benefit sanctions. Or to put it another way, no sample, no income.

Lets just detour for a minute to look at this business of "propensity".

The OED defines a propensity as "a natural inclination or tendency". The 2009 Welfare Reform Bill does not define it at all. Having a "propensity" for misusing drugs, if you think about it, could mean any number of things. It could mean that you are currently misusing drugs or that you once misused drugs and now don't. It might mean you have an environmental or familial connection to drug use. It could mean that although you might be tempted sometimes to use drugs, you don't, or it might mean that you're bang at it, 24/7 and the monkey only gets off your back when you go under low bridges. It might even mean you're a bit like Tony McNulty, now Minister of State for Employment and Welfare reform who in 2007 said he had "encountered and smoked" cannabis at university. Whichever way we define the word, its clear that the group of people who may have a "propensity to misuse drugs" (including alcohol, as the bill explains) is a pretty wide group. And this in turn makes those who could be subject to a drug assessment and being drug tested when they go to sign on a pretty wide group too. And who is going to make this judgement? well initially the Job centre Plus member of staff who registers or reviews your claim.

Those who are assessed as being PDUs or as having a "propensity for drug misuse" will be referred to the new programme. Curiously detail here is sparser, with what people will actually get at the end of the ordeal of testing and assessment, described simply as

"a personalised programme of support until they are ready to move onto the mainstream Flexible New Deal or Pathways to Work programme".

We do know that individuals brought into the programme will have their JSA converted into what's called a "Treatment Allowance" which will have different conditions mandating compliance with the individual treatment regime - or "personalised support programme". Those on Treatment Allowance will not be required to fulfil the job-seeking conditions of JSA. It is not clear whether a move to the Treatment Allowance off JSA will represent a break in claim and require the individual to make a new claim under new conditions when treatment finishes.

A joint NTA Job Centre Plus letter that went out to partnerships on the 5th January describes the Treatment Allowance as

"an appropriate ‘safety net’ of support, to which other claimants would be entitled, for drug users in treatment"

Which itself implies that drug users - and presumably "those with a propensity for drug misuse" are by fact of being in treatment, unable to comply with the requirements of the JSA, namely seeking work. This rather turns on its head the idea that work and inclusion are critical parts of the treatment process, rather describing treatment as an essential precursor to employment support. It is clear from even a preliminary reading of the documentation that the issue of maintenance has been barely - if at all - understood by those who have drafted these proposals. The White Paper explained that

"While the ultimate goal must be abstinence, we understand that many problem drug users need additional help such as substitute medication to become drug free. The approach that we adopt will support that"

But support it how? Take the case of Barry. Barry spent large parts of his twenties involved in pretty heavy opiate use, but got into treatment in 2001. At the point he got stable on his script, Barry got a job as a labourer for a house-building company. He has done pretty well - being in work more or less constantly since 2003. He's still on his script and though its sometimes a problem picking it up because of his working hours, he manages pretty well. In two weeks time though Barry reckons he's going to get laid off. The job he's working on is finishing and it doesn't look like there's much more work in house-building at the moment. When Barry goes to sign on, he won't declare his drug use, because he doesn't have to. Barry will simply sign on and start looking for work or retraining, and he'll carry on with his script cos that's what he does.

Under the new regime, Barry would be required to declare he was a drug user. He'd then be referred for an assessment, presumably mandated to stay on his script with maybe some additional requirements about attending drug specific services (though stable as he is that might be a waste of time - and money). Is Barry going to be moved onto the Treatment Allowance? Maybe - after all he hasn't reached the "ultimate goal". On the other hand Barry has been stable and working for 5 or 6 years now - so shouldn't he be trying to get back into work.? It seems that at the heart of this piece of legislation is a real confusion about the nature and effectiveness of drug treatment and the experience and ability of those who benefit from it.


Compulsion, Coercion and Sanctions
The proposals for tackling drug use and dependency in the ways suggested, have met with widespread criticism. Last week Addaction challenged the whole premise of a sanctions based approach to increasing opportunity for people affected by drug use. DrugScope too have been critical. The Scottish Government have refused to engage with the proposal, with Scottish ministers pointing out that taking benefits from drug users will simply lead them to engage in more criminal activity. This is a view that was borne out in discussions with drug users at last weeks DDN/Alliance conference in Birmingham and has been expressed by pretty much every drug charity and non statutory body since the proposals were first made.

But increased crime is only one part of the problem with a sanctions based approach. Unemployment and worklessness are not just the responsibility of the individual jobseeker. They are complex phenomena, that involve multiple factors - some structural and accordingly not controlled by the individual. A number of things impact on the ability of anyone to get a job. Firstly there is the state of the local, regional and national labour market. Secondly, the marketability of a type of individual and their skills, and finally the situation and motivation of the individual. Of all of these factors, a sanctions based approach is purely targeted at the motivation of the individual to get work, with some knock on impact, if the right programme is mandated, of improving their skills so that they become more marketable.

Sanctions do not expand shrinking labour markets, they do not make economically struggling regions and towns more successful and they do not make employers more likely to employ people with less experience or who are for other reasons less desirable as employees. The sanctions regime proposed by this legislation will do nothing to tackle the root causes of worklessness in some of our most vulnerable communities - which are also those where the social harms of problematic substance use are felt most keenly.

The 2004 DWP Research Report on the Evaluation of the Community Sentences Sanctions Pilot (where benefits were cut if people did not comply with community sentences) in 2001 found that sanctioning offenders benefits led to an increase of only 1.8% in compliance with sentences. Offenders reported that sanctions had little or no effect on their behaviour - with some reporting increased hardship and increased criminal behaviour as a result of being sanctioned.

Benefit sanctions themselves have been shown to have a significant effect however when applied to people who experience multiple disadvantage. They make their lives worse. In a 2004 Social Exclusion Unit (SEU) Report from the Office of the Deputy Prime Minster the efficacy of applying benefit sanctions to people with multiple disadvantages was examined. The report argued that sanctions can lead to increasing marginalisation, possibly pushing some into criminality and having a detrimental effect on health. It was clear that

"There is evidence that compulsion – in the guise of benefit sanctions – are not effective at engaging clients with a number of disadvantages ... the use of sanctions on people with multiple disadvantages results in increased social exclusion and participation in the informal economy... some are pushed into criminality. The side effects of compulsion and sanctions push those who are already marginalised further from the reach of employment organisations. (Social Exclusion Unit Report 2004: 76).

Value for Money
The use of sanctions and compulsion with people who experience problems with drug use has a chequered history. While undoubtedly a useful tool in working with some groups, when applied across systems they have rarely yielded results. When we aver with such bombast that people coerced into treatment experience broadly similar outcomes to people who enter voluntarily, maybe we should be asking ourselves why we feel its necessary to coerce people into treatment at all in that case? As Judith Rumgay said in her presentation at the 2005 National Drug Treatment Conference

"... all this expansion of coerced treatment, with its accompanying costs, has taken place with little thought as to whether we are making good enough use of the existing mainstream treatment opportunities. An attraction of the coercive approach arose from early American evaluations that found an association between coercion and time spent in treatment. Time spent in treatment is itself associated with successful outcome. It was all too easy to conclude that ‘coercion works’. Wrong – it is engagement with treatment that works. The very high drop out and breach rates of DTTOs and all the effective practice pathfinder programmes demonstrate the damaging naïveté of privileging coercion over engagement,"

Progress to Work has against the odds been a surprisingly successful programme - as far as we know. The final evaluation report of this costly initiative has not been published - nor does it look as though it is likely to be. However anecdotal reports suggest that the practice of working intensively with people affected by drug use, to help the retrain and get back into the labour market can be effective. However no one associated with progress to Work - either at a local or national level has talked about sanctions, no one has said, "this was good, but it would have been better if we'd been able to force more people in".

The most widespread coercive scheme we've employed in drug treatment in the UK has been the Tough Choices element of the DIP programme. In this, various channels compel the drug user into assessment and treatment and in principle keep them there with prison as the ultimate sanction. 3 years on from its inception, we are now looking at a prison system swelled to beyond its limits with breaches and a DIP portal to treatment characterised by repeated admissions and assessments and referrals. For something which when applied widely makes so little difference to engagement , coercion is an expensive business. Commissioners and stakeholders are already beginning to ask serious questions about the value for money of DIP schemes and their usefulness above and beyond the expansion of the treatment system. To take the DIP approach of coercion and testing and to apply it wholesale to the issue of worklessness and benefit dependency is likely to be expensive. Investment in treatment and support for people affected by drug use is falling per head of the anticipated community of beneficiaries at the moment. Is this really the right time to see resources and worker time drain away from much needed services towards a scheme the need for which is unproven and the approach to which risky and marginalising?

Job Creation ... In Administration
The fact is that we know and have known for some time that getting and keeping a job makes a real difference to people affected by problems related to drugs and alcohol. Working, making a contribution and earning money are really positive reasons for someone to maintain their own recovery and stick with what at times can be a difficult process - whether they are maintained or abstinent.

Despite the difficulties of its timing - right at the start of what looks to be the hardest recession in generations - The Welfare Reform Bill itself has some interesting proposals that are about making real efforts to help people who are currently excluded from opportunities for employment get work. There's an emphasis on introducing flexibility and personalisation to the benefits regime so that people can find the approach to work that helps them. There is also greater support for employers prepared to give disadvantaged people an opportunity - and greater expectations that employers will make more efforts to support people in work. Above all there was an increased focus on ability rather than disability - and a step towards valuing people for what they can achieve.

Its unclear though how many of these opportunities will be open to people who have experienced problems because of drug or alcohol misuse. Its likely that the approach that has been taken - to single out drug users and those with "a propensity to misuse drugs" and coerce them into complying with treatment - will put at risk any gains around inclusion that might be made. The sheer sprawling expense of the system that is proposed is extraordinary.
The reporting system - like the DIP one - is evidently to be as cumbersome and involved as the central fetish for information management demands - with £9 million already ringfenced for the establishment of 62 new roles in Job Centres. It looks like they'll have lots to do

"Jobcentre Plus will be seeking evidence from affected clients that they have indeed attended that appointment... Jobcentre Plus may ask the treatment provider in question to independently verify attendance of specific clients ... Where service users are engaged both in treatment and working towards employment, Jobcentre Plus may retain responsibilities for the case management of their clients in relation to seeking and gaining employment, acquiring skills and accessing training... Drug treatment services retain responsibility for their clients’ treatment and care planning in line with existing clinical guidelines. Services will need to agree arrangements for the co-ordination of care in these cases, clarifying key worker roles, information exchange for the purpose of case reviews, treatment completion and loss of contact by either service. The identity and role of key-working care co-ordinators will need to be specified. "

A mass of new reporting lines and monitoring is likely to simply overburden the existing treatment system. More importantly, as those who have spent any time mapping a service users journey lately will note, a proliferation of new assessments and case management responsibilities risks losing the individual in the system. Reading through the initial guidance, for all the talk of individualised support, you sometimes struggle to remember that this is about people at all -

"The NTA is in discussion with Jobcentre Plus regarding the possible matching of anonymised client attributors in order to monitor the robustness of referral pathways between Jobcentre Plus and drug treatment providers. This information may also support requirements within the Memorandum of Understanding for Jobcentre Plus to report progress of the effectiveness of local pathways to the Department for Health (DH) and NTA. If, and when, anonymised matching is agreed to be possible and desirable, further communications will be issued. ..."

We don't have long to wait until we see how some of the changes bed in. Whereas the Bill and its associated documentation suggests that all the approaches will be piloted in advance of implementation and that the programme will start properly in 2013, the NTA guidance tells us that some of the changes will happen much more quickly than we originally believed.

"... from 1 April 2009 benefit claimants in receipt of Jobseeker’s Allowance (JSA) and individuals in receipt of Employment Support Allowance (ESA) who disclose, respectively, at their 13-week interview and via their Personal Capability Assessment that opiate and/or crack cocaine use is a barrier to work will be mandated to attend an initial appointment with a local drug treatment provider..."

The sheer numbers who will soon be entering the jobseekers programmes will make reform and change even harder to manage in the benefit system. In addition the recession may be the trigger for some people to move from non problematic to problematic substance use - affording your coke habit with a salary is one thing, keeping your head above water on benefits is quite another. Employers, who have mostly been unwilling to take drug users onto the workforce knowingly, may be even less reluctant to do so when there will be so many other people in the market - some with considerable experience. It seems that this is a bad time to try to bring about the changes Government wants to see, and worse of course, the wrong approach to achieve them. For as the group of people experiencing problems with substance use grows, and the labour market contracts we run the risk of creating a permanently sidelined population, who with their Treatment Allowance and their separate status, are excluded even from the mainstream job seeking population.

At a time when there is a widespread recognition that treating disadvantaged people as individuals with different needs and expectations is important; where mainstreaming the public service experience of people affected by substance use is the priority, this approach makes no sense. Defining a problem based on estimates and over exaggerating its importance to meet political goals, then carving out a separate system for a group of people defined simply in terms of their drug use (or propensity to misuse drugs), and establishing a series of involved and complex administrative procedures in order to manage it also seems pointless and wasteful. Still, I guess it'll keep a lot of people in work - if only in administrating the system.








8708