You cannot recover if you are dead.

Substance use is a topic that often divides opinion. While many will not condone such behaviour, they will be compassionate and empathetic as to the reasons behind it, while others will instinctively see drugs as ‘bad’ and therefore view people that use them, in the same light. What is a matter of fact though is substance use has been part of our society for a long time. There is a human instinct to often see, and view the world, in a different light to normal or to experience a different level of consciousness. This can ultimately be achieved from most drugs, from alcohol to heroin and what people’s expectations and needs are, can often determine the behaviour they go on to undertake.

People from all walks of life enter through the doors of treatment services, seeking support, from those within highly respected professions, to people who are experiencing homelessness and significant mental health issues, and everyone else in between. There has yet to be a case where the person seeking support outlined that one day, they woke up wanting to be reliant and dependent upon a substance. It just doesn’t happen. And yet, there are still shouts of why can’t people just stop using? It’s not that simple and the complexities of dependency means that for people to have the best chance possible in overcoming such health issues, multiple factors need to be considered from social, biological and environmental perspectives to current brain function.

Drug use can change the way a person’s brain develops and operates in terms of their neurotransmitter functions, resulting in once natural pleasures, no longer hitting the spot, or at least, not in comparison to the use of certain substances. Image source: Pixabay.com

Substance use, and more so dependency, can often be a reaction to something. A coping mechanism. What we tend to hear too often is a story of trauma, abuse and neglect at a young age. Stories of families going through the vicious cycle from one generation to the next. Many who seek support for their substance use are trying to end this cycle. Trying to end the social marginalisation and isolation that often comes with such behaviour. Some with success, others not so much. But for the latter, many will return, to try again. Something they should be commended for. One image will forever stick in my mind from my early days as a young person’s worker. A 16-year old, accessing support from our service, lying in the back of an ambulance following an overdose, was greeted by her then partner, asking if she had a ‘few quid for a can’. It brought home to me, early on in my career, that despite people accessing support, there was often a greater battle to be fought on their own, in their everyday lives. This young woman was trying her to break cycles of generational substance use, but her efforts were often undermined by those closest to her.

A report by Public Health Wales in relation to Adverse Childhood Experiences (ACEs) in 2016, found that people who experience four or more ACEs, such as parents getting divorced, at least one parent being incarcerated, mental health issues in the family, history of drug use in the family, experience of any form of abuse, and so on, are sixteen times more likely to go on to use heroin or crack cocaine within their lifetime, compared to someone who has experienced none. Often, many are fighting an uphill battle from the start. From services point of view, this correlation is as clear as day, confirmed by the fact many are now taking a more trauma informed approach in their delivery.

Services are forever trying to realign, innovate and develop, to break down barriers in accessing support and provide best-practice provisions. In the last two years, given the pandemic, Barod has significantly increased its digital, online services, from a Wales-wide Live Webchat Service open 7-days a week, to a national click and deliver service for Naloxone, a lifesaving medication that temporarily reverses the effects of an opioid overdose. Dyfed Drug and Alcohol Service (DDAS), a consortium service led by Barod, have recently launched ‘Spike on a Bike’, a unique provision delivering harm reduction interventions throughout Dyfed, a service not seen elsewhere throughout Europe.

What is always at the forefront of service design and delivery is that we are dealing with, and supporting, people. Every person that walks through our door and every person that uses substances, is a person. They are someone’s daughter, someone’s son, someone’s somebody. They deserve to be treated with dignity and respect and without judgement, just like the next person. These are fundamental messages that need to be conveyed and repeated, none more so than when the annual drug-related-death figures are announced every August. This year saw an increase of nearly 44% of drug poisoning fatalities in Wales. This shows that more needs to be done and more can be done, to support those affected by substance use and to reduce and end preventable fatal overdoses and early mortality. As we say in this game, you cannot recover if you are dead.

This article was first published in August edition of the Welsh Pharmacy Review. Rob Barker is the Campaigns and Communications Lead for Barod. Rob holds an MSc degree in Addictive Behaviours from the University of Liverpool and has worked in the substance use field, in South Wales, for over a decade. Rob has previously undertaken a Churchill Fellowship, researching the policies and processes of setting up a drug consumption room in Wales. Twitter @RobBarkerW.