Treating addictions: don't focus on tomorrow at the expense of today
Dr Hugh Milroy, CEO of leading charity Veterans Aid, cites Sri Lanka’s organic farming initiative as a scheme with well-intentioned long-term objectives, but which had catastrophic consequences shortly after implementation | Credit: Alamy
From Harm to Hope is the Government’s 10-year plan to cut crime and save lives by reducing the supply/demand for drugs and delivering a high-quality treatment and recovery system. It’s one of many current initiatives focused on delivering long-term solutions to problems facing society today. CEO of Veterans Aid, Dr Hugh Milroy, reflects on the implications of ‘horizon thinking’ and questions whether the balance is right.
Veterans Aid is not a large charity. Its primary focus is on preventing homelessness, not on treating addictions, but the two are so inextricably linked that much of our funding goes towards detox and rehab.
‘John’ is a typical client. He introduced himself to our operations team thus:
“My wife left me with our young son. I’ve been on anti-depressants ever since - then I turned to alcohol.There are times when I drink 24 hours a day for a week or more and lose jobs/work. It’s getting more frequent now and my family say I need help urgently. Hope you can help.Thanks.”
‘John’s is an everyday story for us. Our last seven interventions on behalf of ex-serviceman and women with addictions cost £63,255.24.Towards that we received just £2,775 – from a much larger, wealthier military charity. This 4.4% ad hoc support is typical. We struggle, but we rarely turn people away.
My point is that while ‘horizon thinking’ describes a world in which the benefits of effective strategies have transformed society for the better, it will come too late for those who need help now. From Harm to Hope reads well and suggests that there is at last some understanding of how much damage these destructive dependencies cost in human terms. (Drug misuse presently cost taxpayers an estimated £20bn per year - around £350 for every man, woman and child in England.) But looking to the bigger picture, I wonder if we are ignoring the present at our peril?
The most widely discussed example must surely be the energy crisis. Investment, we are told, will offer long term solutions to over-reliance on oil and gas etc, but leave those struggling to heat their homes and pay their bills today, in crisis. Latest figures suggest that 40% of households will face fuel poverty
Inevitably some will fail to cope, become suicidal, turn (as ‘John’ did) to alcohol or drugs – and seek the support of charity’s like ourselves.
Recently, I’ve had conversations with people in the corporate world about impact and CSR. My question to them was ‘What did your CSR achieve during the pandemic?’ There were lots of blank looks. Some shifted the conversation to ESG (Environmental, Social & Governance) as ‘the way forward for a better society’. Few had ready answers.
Over time corporate philanthropy and investment have played a vital part in the social support mix in this country. Investing in a low-carbon economy, renewable energy, sustainable and secure food, transport etc. is commendable and I am totally in agreement with the need to have a greener world.
But what if the vital work being done in social exclusion today doesn’t align with these long-term aspirations for our sustainable future? The effects of Sri Lanka’s organic farming initiative brought only misery after domestic rice production fell 20% in the first six months. The ban on fertilisers also ruined the nation’s tea crop.
Global developments aside, my concern from a frontline charity’s perspective is more immediate.
I have a growing sense of unease that ‘jam tomorrow’ will not actually deliver the good outcome that wealth can bring to those in most urgent need. With a real financial crisis underway I am fearful that this adherence to ESG investment may actually end up harming our clients as monies that may well have been available for smaller, hands-on organisations like us – who can stop adversity in its tracks - is channelled toward these strategic issues.
These goals are important, but a balance needs to be struck between long term planning and alleviation of the clear and present social distress that is all around us.
Investment returns are best viewed in the long-term and at some point it is to be hoped that wider social good and financial interests will converge, but here at the coalface of crisis I have to ask, who will shoulder the burden of our current problems? Treatment of detox and rehabilitation is a never-ending activity for us because addiction represents a hurdle that has to be overcome before those in its grip are able to move on to any kind of sustainable existence.
In the short term, will the Government pay, or is the charity sector expected to pick up the baton? And without seamless integration of process, how will that work?
By way of example, a significant part of Veterans Aid’s 90% success rate relates to our counselling, detox and rehab work, which is a major and increasing problem in society, not just within the veteran community. Yesterday, a major local authority rang to ask us to pay for detox for a veteran who was not our client. I had to make the tough decision to refuse as I don’t have unlimited funds and have to fight hard to get contributions towards treatment of those whom we do support through this process. In the past three years we have spent over £530k on detox, rehab and counselling. Money for this from local authorities, or indeed service charities/regimental associations, is rarely forthcoming and is largely a postcode lottery.
The integrated care system advocated in From Harm to Hope represents a paradigm and it is right to take a long term, strategic approach – but I believe it must also look to the here and now. The families and neighbours of today’s addicts will become the victims of tomorrow, because they will inherit the legacy of domestic violence, disrupted education, homelessness and fear that results from association with – or abandonment by – an addict.
I believe in a better world but it would be irresponsible to think that ESG is the only option when people are crying out for help. The problems that drive people to become addicts are being caused now – by poverty, anxiety, social isolation, debt, depression, abandonment, unemployment and fear of an uncertain future. Addressing those problems must also start now – before the word pauper re-enters our lexicon and visions of Dickensian deprivation once again become normal.
Dame Carol Black’s excellent independent review of drug use, prevention, treatment and recovery is a landmark document and addresses issues beyond the remit of one veterans charity, but in exposing the scale and enormity of the problem I believe it only strengthens the case for an approach that takes in provision of funding for immediate action as well as the long view.
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