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In part 2 of her Review of Drugs, Dame Carol Black says our drug treatment and broader support services need rebuilding.

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Concerns over quantity, quality & morale of workforce

This is the latest in a series of blog posts I’m writing covering the detail of Dame Carol Black’s second part of her independent Review of Drugs which sets out a way forward on drug treatment and recovery for the government and which was published last month (8 July 2021). There is consensus across the field that the Review is the most important drugs report of the century so far. This week’s post looks at Dame Carol’s recommendations on how to rebuild our drug and broader support services which have deteriorated in the years of austerity. You can read the full series of posts summarising both Part 1 and Part 2 of the Review of Drugs here.


As usual, Dame Carol does not mince her words when expounding a problem:

“The drug treatment and recovery workforce has deteriorated significantly in quantity, quality and morale in recent years, due to excessive caseloads, decreased training and lack of clinical supervision. A recent workforce survey showed that drug workers had caseloads of between 50 and 80, sometimes rising as high as 100 people. Good practice suggests a caseload of 40 or less, depending on complexity of need. Such high caseloads reduce the quality of care provided and the effectiveness of treatment. Focus should be on providing high-quality personalised care, rather than paperwork.”

Dame Carol goes on to highlight a number of key issues including:

  • The lack of training placements
  • A big fall in the number of drug specialist psychiatrists
  • A shortage of workers with CBT skills
  • The disappearance of drug & alcohol social work teams

She goes on to talk about the lack of training and support for both drug workers and the peer supporters whose voluntary work now makes up 10% of the workforce. Dame Carol again points the finger at the over-frequent re-tendering cycle which exacerbates recruitment difficulties and means that professionally trained staff such as psychiatrists, psychologists, and nurses are tending to work in mental health services instead.

Again, Dame Carol is blunt when saying that the only way to restore the workforce is via “sustained focus and financial investment”. She also recommends consideration of creating a professional body, a Centre for Addictions, to develop specialist training for the workforce and provide accreditation.

Pretty Drug Things LSD
LSD © Pretty Drug Things

Treatment recommendations

Dame Carol recommends that a full range of drug prevention and treatment services (both harm-reduction and recovery) should be available locally. Her review found that “in many local areas psychosocial interventions are limited and their delivery is substandard, frequently amounting to little more than a chat with a drug worker.” She says that non-opioid users in particular are poorly served and that outreach and harm-reduction services have been cut back. She also highlights the fall in the number of inpatient detox and residential rehab services over recent years. Dame Carol also advocates a strong focus on early intervention and the treatment needs of offenders.

The Review also highlights the importance of a Recovery-Orientated System of Care (ROSC) and says that services should include people with lived experience of drug dependence working as recovery champions and recovery coaches. She cites the importance of networks of peer-based recovery support and communities of recovery and mutual aid groups. Dame Carol says she was impressed by the passion and commitment of people in these roles but puts down a clear marker that:

“Peer supporters should not be left to do the work of professionals without appropriate training, pay or support. This is exploitative and underlines the need for a comprehensive workforce strategy.”

Dame Carol also recognises the consolidation of the drug treatment market into a small number of large providers, lamenting the fact that smaller providers have been forced out resulting in the closure of many grassroots organisations and local charities. She says (and many will agree) that this has adversely affected women and people from minority groups, including black, Asian and minority ethnic (BAME) communities, because local organisations (including lived experience recovery organisations) are better at understanding and responding to their needs.


In next week’s post, I turn attention to Dame Carol’s conclusions and recommendations about drug treatment for people in contact with the criminal justice system.

Thanks to Pretty Drug Things for the images in this post. Pretty Drug Things  explores different visual aesthetics and marketing techniques used in either promoting or demonising different psychoactive substances in our society.

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