1. Effects of substances: Social harms

2. Social harms Let’s define social harm first. We could divide this term into three areas of harm: –Harm to the individual. –Harm to the individual’s family and social network. –Harm to the individual’s community and society.

3. Which could mean... Individual social harm Loss of friends and family contacts, becoming socially excluded through loss of employment, housing, education, access to social support, being criminalised, poverty. Network social harm Impact on family, friends and the local community through crime, anti- social behaviour, domestic violence, child abuse/neglect. Societal social harm Crime rates, fear of crime, impact on economic activity, burden on health and social care services, police and criminal justice system. This resource will look mainly at the first two because these are the areas where practitioners have a greater role.

4. Definitions NICE (2010 describes alcohol-related social harm as linked to crime, impact on family members (i.e. domestic violence, mental health, poverty) and loss of working days. The British Medical Association (2013) includes deprivation and neglect, criminality, loss of family income, poor role modelling for children, unemployment, self harm and suicide. It describes the harm to communities through violence and crime, drink and drug driving, and costs of health care, crime and disorder and the impact on family and social networks. Now watch videos of Sarah Galvani, Professor of Adult Social Care, Manchester Metropolitan University, on the social harms that can affect people with problematic substance use. Note that it is not just the person who uses the substances who is affected.the social harms that can affect people with problematic substance use

5. Harms to the individual Social exclusion Problematic drug or alcohol use often leads to social exclusion for the individual. The decline to poor living conditions has traditionally been referred to as ‘skid row’: a state in which people have ‘dropped out’ of normal society (Segal 1991). Loss of job Loss of family Homeless Loss of friends Crime

6. Homelessness Homelessness usually means a range of unstable living conditions including squats, living in a series of friends’ houses, short term accommodation or on the street or even in a car. The factors leading to homelessness are often a combination of unemployment, financial problems, mental illness, physical disability (Rassool & Kilpatrick, 1998). Not having a stable address can mean not being able to register with a GP, not being able to get a job, and not having a routine which enables regular attendance at hospital or social services appointments. It can make the person vulnerable to exploitation by others, as well as to criminal justice sanctions and stigmatisation.

7. Example of social harms for the individual Watch the video ‘Leo’s Story’. He describes a host of social impacts of substance use on his life and on the life of others. Notice what Leo is most proud of about his recovery. Who is the most significant person in Leo’s life?Leo’s Story Watch the video Stuart's Story. He describes the social impacts that substance misuse has had on him. Notice how he describes how low he became. Also notice what appears to have motivated him to work on his recovery!Stuart's Story

8. Social harms to others (BMA 2013; NICE 2010) Drug and alcohol problems in families may cause harm to family members and to family life in general. It can co-exist with: –Domestic violence. –Poor role modelling to children. –Financial problems, including financial abuse. –Concern and worry about the relative with the substance problem. –A breakdown in family communication.

9. Substance misuse in families There are many potential child and adult safeguarding issues when there is someone with a drug or alcohol problem in families. (See the resource Safeguarding for further information.)Safeguarding Barnard (2007) indicates that common problems for children can be: –Distorted roles – where children have to take the responsibility in the family. –Children’s exposure to criminality – such as shoplifting and acquiring drugs. –Parental absence – both physical absence at times but neglect and an emotional absence too due to intoxication.

10. Domestic violence (Galvani, 2012) There are strong links between problematic substance use and domestic violence. This does not mean that substance use causes domestic violence, but they can occur in the same context. Domestic violence is a complex issue of which substance misuse is only a part. However, the impact on partners and children is strong. Evidence suggests that substance use increases the frequency and severity of domestic violence.

11. Involvement in the criminal justice system (CJS) (NTA 2013) There are strong links between drug use and crime for many complex reasons. These include behaviours directly and indirectly associated with drug or alcohol misuse such as acquisitive crime (to feed the habit), violence when intoxicated, drink/drug driving and dealing illegal substances. Remember what Leo said about his life in the video? What involvement with the criminal justice system did Leo have?

12. CJS responses to substance problems A number of options are available to people with problematic substance use once they enter the CJS. These include: Drug Intervention Programme (DIP) & Drug Rehabilitation Requirements (DRRs) –Treatment in prison has been traditionally poor but improvements in the last 10 years have ensured people have received both substitute prescribing and rehabilitation work while in prison as well as in the community. Arrest Referral –People arrested and suspected of drug use also now have access to assessment while in the custody suite at the police station. There are custody nurses who can assess and refer people to appropriate services.

13. ‘Through the Gate’ support Since the Patel Report (2010) identified a problem of discontinued support for people with substance problems when released from prison, ‘Through the Gate’ initiatives are working to ensure ex-offenders receive the social support they need to continue treatment and rehabilitation. Often there was no communication between prison and community services, with no referral pathways. On release, substance dependent people often had no social support, no drug and alcohol service support, no employment and unstable housing. ‘About 60 per cent of prison reform trusts tell us prisoners leaving don’t have fixed accommodation or somewhere to lay their head at night’ (Reform 2013, page 5) There are now a growing number of initiatives linking prisons with local third sector agencies providing a range of support for ex-offenders on their day of release (Ministry of Justice 2013).

14. References British Medical Association (2013) Drugs of Dependence: The role of medical professionals. London, BMA. Galvani, S (2012) Supporting people with alcohol and drug problems. Bristol. Policy Press. NICE (2010) Alcohol use disorders: preventing harmful and hazardous drinking. London, National Institute for Health and Clinical Evidence. NTA (2013) Criminal Justice. Available at: http://www.nta.nhs.uk/criminal-justice.aspxhttp://www.nta.nhs.uk/criminal-justice.aspx Rassool G H & Kilpatrick, B (1998) Working with diverse special populations. In Rassool, (Ed), Substance Use and Misuse. Oxford, Blackwell. Segal B (1991) Homelessness and Drinking: a study of a street population. New York, Haworth Press.