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Last night Crew won a Gold medal from amongst 100 other award winning UK charities for it's services to public health in Scotland the UK & Europe. 

At the Glaxo Smith Kline IMPACT Awards in the London Science Museum, it was a truly humbling experience to be part of an event with so many organisations who are doing such great work and to be voted by such a distinguished panel to be one of three recipients for the gold award. 

I feel this is a seal of validation on the work we do at Crew: the rigorous process involved in assessment for this award by The Kings Fund is intensive, thorough, and verging on the forensic! Ultimately though this is a vindication of all the hard work our volunteers staff and partners have put in over the years. We need to remember this when our folks are working at 3 o'clock in the morning looking after young folk who are in crisis or when another late night keeps us from our loved ones :-) 

It was recognised by the judging panel that Crew is a community project which truly mobilises the assets of the community it serves to find solutions to the thorny issues of substance use and sexual health. It utilises skills experience and capacity of partner agencies to increase it's effectiveness and it does so with integrity and in the spirit of community development. 

The cash prize of £35,000 of 'unrestricted income' (like hens teeth in this current climate)  will help the organisation to become involved in two exciting pan European projects that will make an impact on reducing harm from alcohol and other drug use.

A huge thanks to all at the Kings Fund, our assessor Roland and the good folks at Stamp Productions who's short video of Crew gave me the scary sight of seeing myself up on the giant screen of the I-max theatre (my kids voices saying dad you've got a great face for radio sprang to mind). However I nearly burst out cheering following our short film and look forward to getting it online.  

Big thanks to everyone at Crew, our supporters and partners. This is good stuff :-) 

John Arthur
Crew Director 

Photos: 1. John & former Crew Chair, Alex Cockerell can't contain their excitement. 2. John's acceptance speech on stage with Alex Cockerell (standing) & Sir Christopher Kelly, King's Fund Chairman, looks on. 3. £35,000 cheque raises a smile with Enterprise & Finance Manager Jeremy Adderley, with John & Alex for photos. 4. Crew directors old & new, John with Mike Cadger now with Project 6 & a former GSK Impact winner. 5. One of the reception areas at the London Science museum: iconic machinery, fizz & most excellent canapes round off a great night.

Crew reports on the First International Conference on Novel Psychoactive Substances (NPS):

"The Ever-Changing World of Psychoactive Drugs" held on 12-13 March 2012  in Budapest, Hungary.

Day 1

The conference kicked off with the presentation New psychoactive substances: a paradigm shift in the drugs field? by Paul Griffiths, European Monitoring Centre for Drugs and Drug Addiction. He took us back to 1988 when Ecstasy was the new phenomenon and described by some as a passing faze.  Crew grew out of the ecstasy movement in the 90’s and fast forward to 2012 we are now seeing its second coming so to speak.  George Burton from STRADA and I will be discussing trends such as this at Crew’s national event CREWSUS on Monday 26^th March.  He then spoke of the impact of globalization and IT advances on the drugs industry discussing trends with “traditional drugs” such as heroin and cocaine moving into new spheres such as precursor chemicals.  This he described as a “cat and mouse game”.  He stated the need for a re-evaluation of both the information sources we use and the ways in which we disseminate information to inform policy, practice and the general public He highlighted there were 49 new substances identified in 2011 and discussed the latest trends with some of these novel substances turning up in the ecstasy market, including cathinones and more worryingly perhaps PMMA which appears t have a higher risk profile-more info about PMMA here.  He left us with the quote “the future is here, it’s just not distributed yet”.

We then moved to The ever-changing world of psychoactive drugs: clinical and pharmacological challenges by Fabrizio Schifano, University of Hertfordshire.  He spoke of there being at least 600 available psychoactives with 179 of those being phenethylamines, 30 cathinones and hundreds of synthetic cannabinoids. He then discussed the brain chemistry of psychoactives and the potential psychopathological consequences of their use- for further details of that you will need to check out the RedNet website (where all presentations will be put online). He also spoke of newer compounds such as Camfetamine and Ethylphenidate which we have seen to appear on many online sites over the last year or so in UK.

Next up was Anticipating the future and responding to change: the role of ReDNet by Ornella Corazza, University of Hertfordshire she also spoke about advancements with IT and web technology fuelling the novel compounds market, she gave examples of vendors marketing products, instant dissemination of information and exchange of information between users in mediums such as forums.  She discussed RedNet’s methodologies to disseminate information to both young people and professionals, this included use of social media such as facebook, smart phone apps and games aimed at young people. She also discussed RedNet primary research methods which mostly seemed to be online based- monitoring user forums, online vendors and search engine analytics.

Then we had Global Drug Survey – Preliminary results from Europe. Part 1: 2012 Adam R. Winstock, Global Drug Survey

Adam had some really interesting findings to present but to the annoyance of many attending, the majority of them were embargoed until the following Thursday!  (You can hear them at CREWSUS on Monday as Adam will be presenting! Last minute tickets here). There were 7,700 UK responses with the majority of respondents being male with an average age of 28.  What he could tell us on the day were some trends that Crew have also observed at events around “mystery white powders”. This involves users consuming substances which they have no idea what’s in them. 25% said they did so when they were already intoxicated so this has obvious health risks.  He spoke of the decline of mephedrone and impact of the ban on this.  Global Drugs survey findings were that the ban had the most effect on early adopters of the drug but those who had started using later were more inclined to continue to seek it out. Adam also interested his new web based and smart phone app Drugsmeter, here more about it at CREWSUS.

After a dose of a much needed legal high (caffeine)- we returned to The EU early-warning system: new drugs coming our way by Ana Gallegos, European Monitoring Centre for Drugs and Drug Addiction. She started by giving a timeline of psychoactive compunds.  Starting in the 80’s with Phenethylamines, Tryptamines in the 90’s,  Piperazines in the naughties and then onto Cathinones in 2005 and synthetic cannabinoids in 2008. She re-emphasised the growth of new compounds year on year- 24 in 2009, 41 in 2010, 49 in 2011.  She explained that the majority of new compounds are in the synthetic cannabinoids or cathinone category.

Next was Best practice in drug prevention and the importance of the National Early Warning Systems by Claudia Rimondo, National Early Warning System, Italy.  The speaker focused on prevention through school interventions and through enforcement methods. Education was provided in the mediums of information websites, e-learning, video conferences within schools and an online training platform for teachers and parents.  She discussed targeting of websites: of 113, 78 were closed after law enforcement notification. But they didn’t stop at websites!  My notes say of 74 raves, 44 were shut down.  A reduction in drug using rates was observed and Claudia linked this directly to these combined methods of prevention work. many delegates present were eager to look at the evidence base for this.

The Clinical Toxicology and Patterns of Acute Toxicity Associated with Novel Psychoactive Substances by Paul Dargan, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK.  The speaker began by stating that the most common presentations are from illicit recreational drug use rather than use of novel psychoactive substances.  He discussed the ICD-10 system, bad coding for novel psychoactive substances, miscoding and misappropriation with self-reports; all these being challenges when attempting to identify an accurate picture of toxicity with these novel substances. He discussed examples of acute toxicity with some of these compounds, referring to the cluster of Ivory Wave cases in Edinburgh, where we saw a high level of these cases also present to psychiatry. 

Forums, Twitter, Facebook, YouTube, and Websites ... Marketing and promotion strategies of Legal Highs online by Paolo Deluca, Institute of Psychiatry, King’s College London.  The speaker began discussing the marketing of "legal highs" online, he stated they encourage people to start, increase consumption, discourage cutting down and avoid consumer protection legislation.  He gave examples of sales, price reductions for immediate bank transfer and next day delivery.  He then showed us a short cartoon film about cannabis which I actually saw huge potential in being adapted for a harm reduction interactive tool (amazing!).  He went on to tell us that there were a range of 22-110 products available per site with an average of 64.  Most common were synthetic powders. 7 out of 10 products were labeled not for human consumption, 1 out of 10 had active ingredients displayed on pack and 9 out of 10 had special offers.

The day concluded with On the use of heterogeneous data and policy priorities to develop new drugs legislation, with a correct involvement of the essential functions of law Pasquale Policastro, University of Szczecin, Poland.  The speaker began by stating “the law may display only tools aiming to prevent, control and punish.” Which got me rather excited that other methods rather than enforcement were going to be discussed.  Unfortunately the rest of the talk focused on control and banning with the sense that we should move quicker with banning so that these new drugs are illegal before anyone has had the chance to use them.  In my own presentation on day 2 I touched on the cycle of legal to illegal and how banning rarely has the intended effect.  I will be discussing this in more detail at CREWSUS.

To sum up, there were some interesting speakers and it was certainly worthwhile to hear of what is happening in Europe and their different approaches. However, there seemed to me (and some of my fellow delegates) to be a gap between academia and what is actually happening in the front line services.  Being a self confessed anorak I actually love the opportunity to hear about pharmacology, toxicology, studies and research papers, etc. but I was left with the feeling that some of the speakers were so detached from the youth and recreational scene that they could only provide examples from their work which focused on the problem end such as acute reactions, and drug related deaths. 

Some of the statistics that were thrown about with connections of novel psychoactive substances to suicide I felt were really flawed. They appeared to take no consideration of how many people are actually using them without issues (we know from Mixmag data (Winstock, 2010) that mephedrone became the 4^th most popular drug in the UK).  The issue of recording drug related deaths accurately is very complex, with so many factors to consider. This is especially true when you consider suicide and drug use: where drugs may well be present in the system but equally may well not have been a unique cause.

To me, it came across that there was a lack of contact with users, especially recreational users, and that info exchange was operating only one way.  There seemed to be only information available for users around prevention without consideration to harm reduction for those determined to use: I’m back on my soapbox again! If you want to hear some of my thoughts on this, check out my blog about recovery vs harm reduction http://blog.mind-altering.org/harm-reduction-vs-recovery-the-false-dichotom-90907 Crew’s National Director John Arthur will be sharing his views on this at CREWSUS, please do come & see us!

Day 2 to follow shortly :-)

Katy MacLeod- Training and Outreach Coordinator- Crew

While conducting training on new psychoactive substances throughout Scotland, I often get asked which interventions are the most effective for users of these substances.  I recently came across the paper by the fabulous Dr Adam Winstock: New recreational drugs and the primary care approach to patients who use them (Winstock and Mitcheson, 2012) which provides insightful guidance on working with users.  The paper can be downloaded for free at http://globaldrugsurvey.com/about/academic-articles 

Dr Adam Winstock is involved in some rather exciting projects connected to new psychoactive substances, namely the Global Drugs Survey published in Mixmag in March of every year and the brand new drugs meter app, more info can be found at http://globaldrugsurvey.com/ You can even catch him speaking at Crew’s national event CREWSUS in Perth later this month!

The paper explores interventions in primary care settings with Winstock and Mitcheson suggesting “a guiding communication style based on motivational interviewing”. This is certainly an approach we would advocate at Crew.  As the paper describes “A good starting point is to assume that the patient might be ambivalent about change.”  In Crew’s experience this is often the case.  The very term “legal highs” which many users still apply, could arguably suggest use of these kind of substances is ‘safer’ than illicit substances to users.  Teamed with a greater level of social acceptance for psychostimulants generally, it’s easy to see why a user may be ambivalent about change.

The key elements of motivational interviewing are its person centred and non judgemental approach which elicits motivation for change by providing feedback and rolls with any resistance encountered.  As the paper explains “The key to motivational interviewing is to ascertain the patient’s concerns and respond accordingly; hold back from advocating change until a clearer picture is obtained”. The starting point for this is assessment, where it is crucial to establish the service users perception of the issues and most importantly what they wish to do about it.  Depending on what setting you are working, one might expect if they have come forward to talk to you about it at all they may have at the very least a tiny seed of motivation for change.  Of course it is possible the substance issue is not the key issue why that person has been referred and motivation for change may not be as immediately apparent.  In these cases the recommended approach by Winstock and Mitcheson would be very effective: 

(Winstock and Mitcheson, 2012).

In my own experience, the majority of clients would be willing to discuss substance use when it is introduced in this way.  Where a client is completely resistant to talking about substance use as a problem, it may be that it is more appropriate to revisit at a later date rather than pursue at that time.  Having introduced the topic and communicated to the client that any further discussions will move at their own pace, backing off is often very powerful and will make them far more likely to come to you when they do feel ready to discuss their use.  The paper suggests ending any such interaction by seeking permission to review it again in the future.  By doing this, you are making clear you are respecting the clients wishes not to discuss at this time but at the same time communicating that you are aware there may be a problem worthy of addressing.

Brief Interventions

MI techniques fit very well within brief interventions, something which the NHS has been applying to alcohol for a long time.  Much of the NHS resources for alcohol brief interventions are transferable and adaptable to new psychoactive substances.  There are many available at the Health Scotland website here. There’s also lots of good information available via SAMHSA in their Treatment Improvement Protocols collection, the brief intervention protocol is available here.

The paper goes on to highlight some useful techniques found in brief interventions including providing information and advice, feedback on risk, offering choices (menu of options) and signposting or referring.  Where we have established problems related to drug use with a client, the paper suggests service users are more likely to be receptive to “expert information”.  This could be described by specialist information given by the staff member gleaned from their knowledge and experience. It goes on to give an example: “When people use stimulants over a weekend and don’t get any sleep, it can lead to a reduction in the chemicals in your brain that help keep our mood stable and feeling happy”.  Again this fits with Crew’s experience, through our client work we find the majority are very receptive to specialist information and often ask more detailed questions once rapport has been built.  It is vital that the rapport is kept intact at this stage and it doesn't fall into the “expert trap”, which is to be avoided within MI.  The paper makes an excellent yet simple suggestion for this by suggesting “eliciting the patient’s response to that information (“How does that fit with your experience?”)” This simple open question communicates value and is likely to open up the interaction to change talk.  

Another useful tool is the decisional balance.  This is basically looking at reasons for and against change.  This is done by exploring the costs of change against the benefits of change and then the costs of staying the same against the benefits of staying the same.  You can talk this through with a client or you may find it useful to use a worksheet within the session so that you can compare the costs and benefits.

The paper also outlines some useful ways of broaching the subject of change: 

“We’ve spoken about some of the concerns you have and how your drug use might be related to this̶, where do we go from here?” A direct question might be: “Would you like to do something about your drug use?”

If change is indeed established as a goal in accordance with the brief intervention structure, we must be clear of an exit strategy for the intervention, can we follow up with the client directly ourselves or is it more appropriate to signpost or refer on? 

(If you are coming to CREWSUS, George Burton from STRADA will be joining me for the Legal HIghs & Emerging Trends plenary. STRADA also offer courses on MI & brief interventions. In Edinburgh, try NHS training.)

Harm Reduction

Where the client is more ambivalent to change, harm reduction advice (as the paper also identifies) is often an effective alternative.  One of the key issues with new psychoactive substances is the lack of specialist knowledge, much of the knowledge base being taken from anecdotal reports.  In these cases, we must refer to general safety tips and advice from other related substances.  The paper describes this as ‘common sense advice”.  Typical practical harm reduction advice for those determined to use may be around:

• Administration route- are there ways they can use more safely? E.g use rolled up card rather than money as tooter (snorting equipment) and don't share with anyone else

• Test dosing- taking a very small amount and waiting an adequate amount of time before re-dosing.  (some of the new psychoactives have delayed onsets so people should ideally be waiting 2 hours before re-dosing)

• Limit the amount they take in a drug using session

Other sensible advice as described in the paper is “reviewing the progression of any health concerns with a period of cessation, and total avoidance of the drug for people in high risk groups, such as those with pre-existing mental health issues.”  Encouraging users to research the substance they are going to take is something we certainly do at Crew but as the paper correctly highlights, there are issues with user reports from Internet forums.  They can be unreliable and are only one part of the picture.

Establishing Goals

Another approach I have found effective with this users group is solution focused therapy: there is a good article exploring its elements and uses here. The idea of focusing on solutions rather than problems is, again, very motivational.  Techniques such as the miracle question and scaling questions are great at establishing goals both short and long term.  In my experience, where someone is in the grips of problematic use, they can find it hard to establish aspirations and their self-efficacy may be non-existent.  They are often not accustomed to being asked about their aspirations so this can be the start of a really powerful interaction.  

The key for me is linking some of the more aspirational and long term goals into smaller and achievable goals.  Again scaling questions can be used within this, for example “If 10 is where you want to be and 2 is where you are now, what things could you do to get you to move towards 3”.  SMART goals are often effective here, so goals that are specific, measurable, achievable, realistic and time-based.  If goal setting is applied correctly, it can be incredibly motivational.  Where goals have not been achieved, it’s always worth reviewing them using the SMART framework as often it could be a case of simply moving too fast.

Though working with users of new psychoactives or legal highs can seem daunting for workers, the tools and techniques above can provide a framework for working effectively with a user of any substances.

Our drug counseling team will be providing some useful insights into other effective techniques in their workshop at the National event CREWSUS.  Be sure to book your place now before you miss out! I'm also doing open workshop training in Aberdeen with the Incite team, April 24 & 25, please take a look.

Katy MacLeod,
Crew Training & Outreach Coordinator 

Want to book a ticket for CREWSUS online? Check here.

By Katy MacLeod -Crew Training and Outreach Coordinator

I opened up my email the other week with my DS daily snippet courtesy of Drugscope landing in my mailbox.  I flicked through the top stories and for the first time (well at least in a few days) I got really fired up about something.   I came across this: 

“A team including one of the researchers responsible for the original finding have queried the interpretation of the highly influential report from a national Scottish study that most drug users starting treatment wanted to become abstinent. On the basis of in-depth interviews, they caution that it is just not that simple.”

What is the role of harm reduction when drug users say they want abstinence?
Neale J., Nettleton S., Pickering L.
International Journal of Drug Policy: 2011, 22, p. 189–193.  Located here 

The original report it discusses What are drug users looking for when they contact drug services: abstinence or harm reduction? (McKeagney et al), recruited participants from a total of 33 drug treatment agencies located in rural, urban and inner-city areas across Scotland. “ The research identified widespread support for abstinence as a goal of treatment with 56.6% of drug users questioned identifying ‘abstinence’ as the only change they hoped to achieve on the basis of attending the drug treatment agency. By contrast relatively small proportions of drug users questioned identified harm reduction changes in terms of their aspiration from treatment, 7.1% cited ‘reduced drug use’, and 7.4% cited ‘stabilisation’ only. Less than 1% of respondents identified ‘safer drug use’ or ‘another goal’, whilst just over 4% reported having ‘no goals’.”  Full report found here 

Having recently attended the Mckeagney/Peele debate, I observed a bit of a backlash on harm reduction with some claiming that it interfered with recovery. Neil Mckeagney even suggested that the majority of drug services are focused on reducing harm and as a result are not focusing enough on recovery.  As Stanton Peele clarified, Neil (and many others attending) actually mean abstinence when they say recovery. (For more info on the debate view our blog entry.)

Having mostly worked in abstinence-based services previously, I found this claim in stark contrast to the reality of working in drug services.  If anything I feel it is the other way about; we promote abstinence and often add harm reduction as an afterthought.  This is certainly true in my experience when you consider psychostimulant use.  In Scotland we are pretty good at harm reduction for injecting use.  There is good access to needle exchange in many areas and there is a lot more invested in education for workers with regards to injecting use.  I don’t think the same can be said about psychostimulant use.  Don’t get me wrong, there are some wonderful services out there that are doing this, e.g Incite in Aberdeen, NHS Harm reduction teams, etc.  However I don’t think it is prioritised across the general drugs field.  This may have something to do with the dominance of opiates when looking at problem drug use in Scotland.  I would argue that our problematic psychostimulant users of today could be our problematic opiate users of tomorrow if not given the right support and advice when they need it.

In delivering training across Scotland for Crew, there is often a harm reduction section of the training.  Often I am faced with pretty limited discussion from workshop participants around practical harm reduction tips.  Responses generally slide toward tips for stopping or at least reducing use. This is overlooking a significant percentage of psychostimulant users who do not wish to stop, or, are not ready to yet.  Because people are much more likely to be using psychostimulants recreationally, harm reduction is really crucial for this user group.  Recreational use doesn’t mean use isn’t problematic. People may well be taking risks.  With much more social acceptance of psychostimulant drug use, the risks and harms often get overlooked.

Of course this doesn’t mean that we can only approach people with ways of cutting down.  This is part of harm reduction for sure, but looking at some of Miller and Rollnick’s suggestions within Motivational Interviewing, presenting people with a menu of options is more likely to get them to do something. In this menu of options there could be techniques to cut down their use, control their use or at the very least, use with the minimum impact to health possible.

I get really frustrated about the suggestion that harm reduction is somehow separate from recovery or prevents someone from achieving abstinence.  At Crew we support people to reduce, stabilise or stop.  We always promote abstinence as a choice but we also tell people about safer ways to use if they are determined to use.  Is this not what being person centred is all about?  Working within that person's goals?  With some major advancements in the drugs field, it seems crazy to me that Crew often gets viewed as slightly “edgy” or radical.  Our stance is really very simple:  we neither condemn nor condone substance use.  We see substance use as a public health issue not a moral issue.  This doesn’t mean we are pro drugs! 

Of course we would love to see people leading a happy fulfilling life without the use of mind-altering substances but we also recognise that people can and do use substances safely, look at alcohol! We probably all know people who use safely and then those who use to excess.  We recognise that people engaging with harm reduction may have made that first vital step on the road to recovery.  Many people are calling for a review of drugs policy and as we have mentioned before, the war on drugs could be described as flogging a dead horse.  Crew supports an open and frank discussion with regards to drug policy.  We come from a neutral place as we recognise that legal and illegal drugs have both positive and negative aspects to use.  Our learned colleagues at Transform have described many models for regulation in their book Blueprint for Regulation which don’t involve opening the flood gates and legalising everything.

 The report: what is the role of harm reduction when drug users say they want abstinence? helps us to clarify.  When people are talking about abstinence, we find they often mean different things.  Many of the people surveyed actually didn’t mean complete abstinence.  They wanted to abstain from their problem drug but perhaps continue using other substances on a recreational basis.  Surely this is evidence that there is a need for harm reduction to sit within recovery.  We need to recognise that recovery is personal and will not mean abstinence for every individual.  At Crew we define recovery as “stopping problematic use”.  For many of our clients this does involve complete abstinence but for others they may return to recreational drinking for example.

Taken from the Road to Recovery:

“ For too long, debate in Scotland has centred on whether the primary aim of treatment for people who use drugs should be harm reduction or abstinence. We fundamentally disagree with the terms of this debate. We do agree with the United Nations Office on Drugs and Crime, which said in a recent report that "harm reduction is often made an unnecessarily controversial issue, as if there were a contradiction between treatment and prevention on the one hand, and reducing the adverse health and social consequences of drug use on the other. This is a false dichotomy. They are complementary.”

At Crew we fully support this statement. Much time can be lost getting caught up in the debate and as a result we can lose focus of what’s important- facilitating and sustaining recovery. Being one of the pioneers of harm reduction in psychostimulants, Crew sees no separation between our harm reduction work and our recovery work.  Crew’s National Director John Arthur is at the forefront of the Recovery Agenda with his work through the Scottish Drugs Recovery Consortium.

At Crew we apply a stepped care approach. Its key elements are that it is easily accessible, person centred, is proportionate to wherever someone may be in their substance use and crucially doesn’t wait until people become problematic users before engaging with them.  Crew are showcasing our stepped care approach at our National event in March.  Over the last 2 years Crew have been focusing on the recovery support part of our approach.  This involves ongoing support to build recovery capital following drug counselling.  Support is provided in groups and one to one sessions. Crew facilitates SMART recovery and wellbeing groups in collaboration with other agencies such as Simpson House and with people in recovery.  We also offer waiting list support for our drug counselling.  For more information on our recovery services, visit our website http://www.crew2000.org.uk/services/support-services/recovery-work.html

Looking back at the Abstinence or Harm Reduction report (McKeagney et al, 2004), one thing we do agree with is that recovery is a process and that “harm reduction may form an essential element of transitional support” within that process. Turning to the role of harm reduction report (Neale, 2011) we also firmly agree with the statement  “If researchers do not probe for cannabis, alcohol or tobacco, interviewees will probably not think to mention them”.  At Crew we find this extends to anyone working with users of drugs and it is something we hear time and again from front line workers.  If we continue to only have an opiate focus when looking at problem drug use, we are missing a whole sphere of drug use.  With the emergence of trends such as new psychoactive substances and Scotland being named the cocaine capital of the world (World Drug report, 2010), it is crucial we give more focus to psychostimulants. .  If you or your team need to get up to date with the latest trends in substance use, check out our training courses at http://www.mindaltering.co.uk/training Equally if we only focus our services at the problem end of drug use, we will never break the cycle. Surely then, the key to success with preventative spend is more emphasis on effective early interventions.

Harm reduction is one thing that can be done with all drug users regardless of their goals.  Giving users safety advice doesn’t interfere with recovery; very often it is harm reduction that engages someone in seeking further treatment.   We firmly acknowledge that a drug free life should be promoted as an option but also see the damage of not acknowledging that complete abstinence isn’t always a user’s preferred option.  When offering harm reduction support in a recovery orientated service, we feel it can only be a good thing.  Ultimately it saves lives.

Crew’s National Director John Arthur will continue to explore this debate in his presentation Harm reduction vs recovery- the false dichotomy at our National event, full details and to book visit http://crewsus2012.eventbrite.com/ 

As a bloke who is increasingly energised by the successes of others in the 3rd Sector, I found myself at a Tods Murray 3rd Sector Forum to hear Mel Young talk about the Homeless World Cup for some more inspirational tips to take our story at Crew forward.

You see I once heard a chat about the relevance of sport in business success. There was a delightful analogy that compared the effectiveness of a business to a football team. If one asked any employee what their team's goal was or what their own role is and where their business was going, as a football team it would translate that most players weren't quite sure of the rules, a handful didn't know who was on the their side and some couldn't be sure which goal to shoot for.

Today, I was expecting to hear Mel Young tell me how to make a Social Enterprise success out of football and wasn't quite ready for the actual message I would take home.

Now Mel, despite global pretentions (co-founder of the Big Issue, now Chairman & co-founder of a global organisation helping 50,000 homeless annually, hosting events in 80 countries with attendances of up to 100,000) isn't an intense, polished salseman. Instead he has a kind of shaggy relaxed look, bit like a comfy sofa, and settles us into a chat about the possibilities of an idea born over a beer in a pub in Cape Town.

Firstly, it goes without saying that having an idea (countless many of us do) and acting on it (nearly as many again don't) hardly makes for an inspriational story. On paper this idea, set in motion as Mel did with the conviction of a lunatic who believes that football is a truely international language that will unify & educate individuals, governments & the world of the plight of our 500 million homeless, probably wouldn't have convinced me. Goodness knows such insurmountable numbers would happily bury the best intentions of much better people!

No, I took my inspiration when Mel talked about passion.

It was the "expression of passion for his cause" that got Mel noticed at a networking dinner nine years ago, the topic: "the Olympics is a waste of Money." In the process of defending his ridiculous idea during dinner debate, probably so left-field it raised hoots of laughter from the table, the hostess noticed that this guy had something of a conviction in his simple odd concept. She took the podium to wrap up the dinner, but rather than speak herself, she threw this mop-haired Hibs fan on the spot about his bonkers plans to get homeless people competing in football around the world and asked him to share them.

The next bit of the story I have to preface with this fact: this man, at that moment in 2003, nearly did have his idea launched: the first competition would be played anyway just months later in Austria. So what happened next takes nothing away from the special drive to implement such a concept. However I'd forgive any hard working fundraiser for feeling just a mite indignant, for who was in the room that night? Phil Knight, chairman & co-founder of Nike. Phil clearly felt Mel's passion, he passed him his card.

OK, while this salt smarts in our collective funding battle wounds, here's where I remind you that despite the luxurious coincidence of the presence of philanthropic corporate royalty, the real reason why the Homeless World Cup enjoys massive support from Nike is down to Mel's expression of passion for his cause. Indeed, there's so much at stake if one isn't passionate about one's job, organisation or ideas, for at worst opportunity like this is fleeting, but at best you create it in a moment without realising.

What has all this to do with recovery? Well, I can't help think that culturing passion is the key to the Homeless World Cup's success, and not just for its very existence. You see, of the individuals engaged in the program, HWC reports that nearly 80% make positive change through this process of finding community, wearing colours and exhibiting passion to play for their city and maybe their country. It translates roughly as 8 out of 10 individuals inspired to kick drugs, get jobs, find a home. To find self worth.

In working for the frontline team at Crew, and in promoting their many successes, I'm pleased my own passion for our cause is flourishing and I owe it to them to express it: wouldn't want to miss an opportunity! Thanks Mel.

Jeremy Adderley
Enterprise & Finance Manager, Crew 

Recognised as one of the world’s leading social entrepreneurs by the Schwab Foundation for Social Entrepreneurship, Mel Young is certainly one to watch to boost you passion. His talk including inspring personal stories, social enterprise challenges and keys to success to empowering people or governments to make change should be streamable on the Tods Murray website soon.

For people who might feel vulnerable at this time of the year (trying to stabilise, reduce or stop their substance use)

Relapsing into past behaviours can be a danger at this time of year especially when you are feeling vulnerable. However, there are things you can do to help yourself avoid problems. Here are Crew’s FIVE main tips on keeping yourself safe...

Number 1: Look after yourself

Take care of yourself by improving your general health and wellbeing i.e. eating regularly and using relaxation techniques can help you remain calm and gain perspective (often our perceptions are skewed into thinking everyone else is having a great time! When in fact other people are often stressed to the max).

TIP: Use a relaxation technique before you go to bed to help build a better sleep pattern.

Relaxing the body: Controlling Breathing

·        Place one hand on your stomach

·        Breath in through your nose to the silent count of four, allowing your stomach to swell

·        Breath out gently through the mouth to the count of six, allowing the stomach to return to normal

·        Count to two and inhale again

·        Try to get a rhythm going, counting to four on the in-breaths and to six as you exhale.  You are aiming to take about 8 – 12 breaths per minute.

At first this will feel uncomfortable and as though you are not getting enough air.  However, with practice, this slower rate of breathing will feel comfortable.  Practice will also make you aware of what is your normal breathing rate – this will vary slightly for different people. When you feel anxious and start breathing faster you will be able to bring your breathing back under control.

If you take prescribed medication, make sure you have enough to tide you over the festive period. 
TIP: If you find yourself caught short/you run out, call NHS 24 on 08454 24 24 24 where they will be able to talk to you about your concerns.  Also, be aware that there is an out-of-hours pharmacy available at Boots in Shandwick Place, open Christmas Eve, Christmas day and Boxing Day. Click here to find out times

Number 2: Understand your past behaviour/triggers

Be aware of the situations that are triggers to use for you and avoid them or seek support from friends’ family or professionals.

TIP: A really useful tool to help manage this has the rather unfortunate acronym of D.E.A.D.S.  

D...DELAY – delay acting on the feeling/craving – even just for a few minutes and see if your feelings have changed?

E....ESCAPE – if you find yourself in a situation where you feel vulnerable/ feel the urge to use – how can you escape?

A....AVOID – try avoiding situations where you could feel vulnerable or try avoid being around people or in places that could trigger cravings/urges for you.

D....DISTRACT – what could you do to distract yourself – make a cup of tea or coffee (caffeine free might be bestJ)? Go out of the room/ place where you are having cravings?

S.....SUBSTITUTE – what activity could you do instead? Go for a walk? Go to the gym?

Coping with cravings:
It is important to realise that urges and cravings are to be expected when you are going through the process of changing your drug use.  Feeling these cravings can also be a response to people, situations and moods connected to your old drug habits and environments.  It can also be a sign that you are in a high-risk situation and should be careful.

TIP: You may have a fear of being completely overwhelmed by the craving/urge and think that the only way to relieve the craving is by using drugs.  This is not the case.  Using Hippy techniques has been proven to work, try this: Imagine an ocean wave and how it moves.  It starts as a small wave and slowly but steadily grows and grows until it reaches its peak, then slowly reverses the process until it disappears.  This too is the process of urges and cravings; you should try to ride the craving as a surfer rides the wave and see that craving off dude!.

Number 3: Replace the habit

“Self love my Liege is not as vile a sin as self loathing” W. Shakespeare

Try new exercise or social activities. This can distract you from cravings and may also lead to something you enjoy and want to make a permanent part of your life.

Think of the money you might save and what positive thing you could put it to, go on spoil yourself or someone you love. If you’re skint ask yourself if you really need the debt.  

Number 4: Set achievable, small goals to lead you toward a bigger goal

This can be about getting through the next hour and most people can get by without doing something for an hour. Then do it again and in no time 24 hours will have passed! Taking things one day at a time is not merely a cliché it really works, especially when your world seems like shite.  Think about who you can call...who’d like to hear from you?  Sometimes thinking of someone else to help takes your thoughts away from your own worrying.

TIP: Remember what you want to achieve and think about how much you have worked towards it already.   Make sure that achieving the goal is something you can do and doesn’t depend on others to make it happen.

Number 5: Use the support available

Find and make use of as much support from family and friends. Research shows that you’re more likely to succeed with the support of others.

Talk to someone if the craving is bad:
If you need help immediately over Christmas and New Year, click here to access a list of some local services you may find helpful. 

And remember... Crew is here to support you!
Crew Shop will be open on times below over the Christmas period and resume normal open hours from Wednesday 4th January 2012. Crew Support Services will also be available for telephone support between Christmas and New Year, click here to access our opening times.

Finally if all else fails and you do lapse or relapse evidence has shown that the sooner you get back to support the more likely for a sustained recovery. Most people who are attempting to reduce, stabilize or stop their substance use will experience lapses however it is not inevitable and if you use some of the tips above you might just avoid it altogether.

If you have found other things help please drop us a line and we will share it with others for future publications and information provision.

Have a great festive season,

From everyone at Crew X

World AIDS Day is celebrated today! This day is an opportunity for people to unite in the fight against HIV/AIDS, to remember those who have died of the disease and to celebrate accomplishments, such as increased access to treatment and prevention services. 

After 30 years of the global fight against HIV/AIDS, this year the focus is on achieving 3 targets: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.

Here is Crew’s guide on how to do more than just wear the ribbon this year...

GET EDUCATED!

• Find out the facts about HIV and AIDs
• Learn about what our friends at the BRITISH RED CROSS have been doing to raise awareness!

GET SORTED!

• Free Hep B, Hep C & HIV testing at Crew
• Come to the Crew drop in shop on Cockburn Street for Free condoms and advice on how to stay safe

GET INVOLVED!

• Find out what you can do to get involved with The British Red Cross
• See what you can do to raise awareness & money this World Aids Day

Elaina Garcia

Beginning this week, every Wednesday Crew will operate a drop-in surgery for blood-borne virus (BBV) testing between 10am & 12pm from our Cockburn Street shop.

It couldn't be easier: the free and confidential dry blood test service takes minutes to sample & has the potential to alleviate anxiety or get people into treatment earlier, preventing unecessary heart-ache and spread of BBVs. So please contribute however appropriate: spreading the word, telling your friends & colleagues, or referring your clients.

I'm keen to tell you how it goes and I'll add some detail soon about the process for those interested. Anyone seeking more information now please contact me by telephone on 0131 220 3404, email  lisa@crew2000.org.uk or, like thousands do every year, pop into the shop for a chat.

Shop opening times: Mon-Tue, Fri-Sat 1-5pm, Thurs 3-7pm & now Wed 10am-5pm.

Lisa Waiting
Senior Project Worker 

On Wednesday November 2, Crew attended a conference held by DrugScope attended by over 100 DrugScope members and stakeholders.  The keynote speaker, Lord Henley, Minister of State for Crime Prevention and Anti-Social Behaviour Reduction at the Home Office, gave his first address to the substance use sector, in which he outlined plans for the ongoing implementation of the 2010 drug strategy.  Lord Henley acknowledged “one size does not fit all, there should be a range of interventions, you as workers know what works best”.

After his Speech Crew’s question was the first one put to him from the conference: “Why are most of the nations resources pitched at the chronic end of substance use and at the criminal justice sector, surely a more balanced strategy with public health messages and early intervention strategies incorporating a whole population approach would be significantly more effective at preventing harm, reducing stigma and promoting recovery to those with dependency and addiction issues.”

Lord Henlely’s Response was later described as ‘less than scintillating’ and we’re still not sure he actually answered the question.  He stated that “high quality treatment is the most effective” in combination with reducing demand and providing info and advice through mediums such as the government website talk to FRANK. We’re overjoyed at the mention of such a high quality service and wish only that they could include harm reduction techniques for those determined to use. He also discussed the need to enforce criminal sanctions- a point that seemed starkly juxtaposed against Dominic Harrison’s reminder of the imminent 30^th anniversary of the “War on Drugs” speech by Ronald Reagan (40^th anniversary for Nixon's speech; 50^th anniversary year of the 1961 UN Single Convention on Narcotic Drugs, the convention "which cemented global drug control into an international legal framework that has remained largely unchanged to this day." Whichever way you look at it, a long time flogging a dead horse). 

Crew were most interested by the speakers Professor John Ashton and Dominic Harrison, both Directors of Public Health.  Prof John Ashton spoke about from dependency to assesst mobilisation and discussed harm reduction over the past 20 years, having been involved with the establishment of the first needle exchange in the UK, based in Liverpool.  He outlined the 3 key principles:

·      make contact;
·      maintain contact;
·      discuss change when user is ready.

An approach which Crew fully supports and applies in our day to day work.  It was good to hear of harm reduction as part of recovery again as too often it is split off as something different or something that interferes with a recovery focus.  He also discussed having a whole population approach and highlighted the fact we often haven’t built counselling skills with front line workers. (Workforce development is a key part of Crew’s current work and details of our training packages can be found on our here).

Dominic Harrison explored what is wrong with the national drugs strategy and gave some interesting statistics, 10 adults in every 1000 has a drug problem in UK. He then presented a pertinent quote taken from Gil Kerlikowske, Director of National Drug Control Policy “ we cannot treat or arrest our way out of the problem”.  This highlights the need for a range of options including harm reduction and from Crew’s perspective, the need for more effective early intervention work, we should not wait till users become problematic. An approach highlighted by the Stepped Care Model which underpins Crew’s work.

Following a panel session of people in recovery and organisations working on the frontline with recovery Crew posed the question:  “do the panel think that too much time is wasted in arguing over whether harm reduction or recovery should be the way forward and that surely they were not mutually exclusive? After all, services such as Crew have been doing this as part of an integrated model for years”.  To which there was general agreement around the conference.

Joy Barlow, Head of Strategy at STRADA also gave an inspiring speech on developing a workforce able to respond to the recovery agenda.  There was further focus on the nature of recovery by the panel discussion with input from our colleagues at UK recovery federation, SMART recovery and the Recovery Academy to name a few (find out more about Crew’s recovery services here).  Tim Hollis, Chair of ACPO Drugs Committee gains first prize for making us laugh the most, discussing policing in an age of austerity.

The workshop on detecting and monitoring new psychoactive substances- by Dr. John Ramsey gave some useful insights to current trends and both the techniques and barriers to gathering intelligence on these.  There has been some interesting work done with waste water analysis which could be taken forward at events such as music festivals, something Crew would be in support of when combined with other useful tools such as amnesty bins.  This works well at events such as Glastonbury and we would like to see it replicated in Scotland. 41 new compounds were discovered in 2010, there are just above 20  reported for this year to date.  He highlighted some findings in British Crime Survey where 4.4% users report mephedrone use (same percentage as reporting cocaine use) post ban.  The new UK process to manage legal highs was discussed with legislation such as the Temporary Class Drug Order, for drugs of concern which will then fall under a temporary ban for 1 year.  The focus will be on supply rather than possession of these substances but Crew are keen to see how the legislation will be applied, especially if a substance is found not to be harmful.  Some jokes were made at the conference about the situation where we might have the first government approved legal high!  

Although there were the obvious concerns of funding cuts, actual and looming, there was nevertheless an underpinning of belief in recovery and commitment to providing appropriate services for those in need with a balance of abstinence and harm reduction approaches.

Remember you or your team can be brought up to date on legal highs by booking training with us and staying in touch with our websites. Visit the Crew Enterprise site for more details on courses.

A full release on conference can be found here.

Thank you drug scope!

Katy MacLeod
Training and Outreach Coordinator Crew

Jeremy Adderley
Enterprise Development Manager 

Crew stalwart and emerging trends in substance use specialist Katy MacLeod talked to Newsdrive on Radio Scotland on Wednesday about Ketamine and the increase in use reported by Druglink who published DrugScope’s 2011 Street Drug Trends Survey this month.

Regardless of new trends, it's interesting to see that the big issue of why people take substances at all is given a fresh forum when a "new" drug hits the headlines. BBC's Bill Whiteford seeks understanding as to why an "anaesthetic" like Ketamine might be used, which must seem completely bizarre when disassociated from the community that uses it while assuming the drug will always be consumed to the logical extreme of its effect.

You need only glance in the door of your local pub to understand why a "disinfectant" like alcohol is used and that the notion of getting "off your face" is certainly not isolated to the unusual or illegal drug.

Have a listen and give us your thoughts.

Need help or training on Ketamine & other substances? See Crew's courses or contact us.

katy_macleod_radio_scotland_interview.aiff

(download)

Click here to download:

katy_macleod_radio_scotland_interview.aiff (40.17 MB)

Jeremy Adderley
Crew Enterprise