Addiction Lives: Susanne MacGregor
In this occasional series in conjunction with the SSA’s journal Addiction, we record the views and personal experiences of people who have especially contributed to the evolution of ideas in the journal’s field of interest. Professor Susanne MacGregor is an honorary Professor at the London School of Hygiene and Tropical Medicine and Emeritus Professor of Sociology and Social Policy at Middlesex University London. She previously held academic posts at the University of Edinburgh, Institute of Psychiatry, Birkbeck University of London, and Goldsmiths University of London. She is a former associate Editor of the International Journal of Drug Policy, and a Scientific Advisor to the Department of Health in England.
This interview took place on 4 April 2019. The below is an edited version of the interview, but an audio recording of the full conversation can be found here
Addiction (A): Start by telling me how you became involved in this general area of study.
Susanne MacGregor (SM): Well it was in a sense by accident. It was when I first came to London and I was appointed to a post at the MRC Social Psychiatry Research Unit at the Institute of Psychiatry and I was working as a research worker. This was a study of a place called Camberwell Reception Centre, which was a big old reception centre, which featured I think in, what was it, that famous film Blow Up[1], – the famous one with the photographer
A: Yes, oh really.
SM: Yes it was quite a famous building, an old workhouse.
A: Was it famous when you went already, or was that yet to happen?
SM: I think that was yet to happen. David Bailey that was the name of the photographer – but anyway. So it was a place where – the reception centres were places where homeless single men went to stay overnight and they would have a shower and they would be deloused and given food and they would be assessed and so on. It was a very large centre. This was the period when the old asylums were closing down and the worry was that, as they were closing down, there was an increase in the number of homeless single people on the streets of London – so a concern that people who were coming out of the old asylums were just ending up on the streets, because there was a lack of provision for them. I worked with John Wing, who was the Professor of Social Psychiatry and David Tidmarsh, who was a psychiatrist, and we did a study of the people at the centre. And basically, the findings were that yes indeed there were high proportions of people with schizophrenia and personality disorder and alcoholism and perhaps a mixture of all three. It was a definitive study in a sense: there’d been a number of other surveys, but they were not so methodologically sound. So I think one of my contributions was to design the research in such a way that it was a reliable sample and we didn’t get an overrepresentation of repeat visitors, which was a problem with some of the other surveys.
A: Because your background, you were coming to that as a?
SM: As a social scientist.
A: Yes.
SM: Yes, so I’d already got my PhD from Edinburgh, but I came down and it was just an opportunity, I just needed a job and that was the job I got, you know.
A: Was that an unusual sort of relationship to happen at that time?
SM: Well not really because in fact when I was in Edinburgh there was a connection – you know we’d had people like Erving Goffman come to visit us and Goffman of course studied in Edinburgh at one point and so Asylums, which was his famous book, was out there- that kind of interest in total institutions and social relations in institutions was part of the sorts of things that anthropologists and sociologists were looking at, at the time.
A: But working with a psychiatrist and social science, was that unusual?
SM: I think it was beginning, it had been in the air in the sixties and John Wing was – he was a person who was receptive to social science and he knew about Goffman. Wing was a very interesting man who painted and you know he wasn’t a very narrow person. So yes he was open to the social and it was a ‘social psychiatry research unit’. It’s quite interesting to think about that period – there were actually quite good links between social science and sociology and psychiatry at the time.
A: And maybe that’s not quite the same.
SM: Yes – that’s quite interesting and it might be interesting to look back at that. –
So this study was of alcohol, alcohol featured.
A: In it, but wasn’t central to it?
SM: Alcohol was a large part of the problem, but not drugs. Drugs were hardly there, 2% or something took drugs and a very small number of people were pathological gamblers. So in terms of addiction, it was the alcohol. But then they weren’t all alcoholics, – because the image of homeless, single men was of alcoholics, you know, the image was these are all meths drinkers – there were some who were meths drinkers, but there were a lot of people who were people who had schizophrenia or epilepsy – that was another issue. So it was unmet need basically that we identified.
A: And what happened to the research?
SM: It was well received but the decision had already been made to close the reception centres – this was an interesting period when responsibility was shifting from the centre to local Government.
A: So the centres were funded by?
SM: The centres were funded by I think it may have been called the Supplementary Benefits Commission.
A: Oh right through National …
SM: From the National Assistance Board, – Poor Law, National Assistance Board, SBC – they were the last remnant of the old Poor Law really. They were trying to get rid of them – I actually wrote a letter to the Guardian, about it being a mistake to devolve the responsibility to local authorities, because they would be neglected, as it turned out they were.
A: And they were closed?
SM: The reception centres were all closed and you know we now have really a lack of provision. In a way, I look at the situation now and I think – of course there was a lot wrong with them, they were old fashioned and militaristic – but people could go and get clean, could be fed. They could be assessed by doctors.
A: So they brought people in.
SM: People came in and people who were as we now say ‘vulnerable’, would have access to services and there were people who, you know, if they were wanting help, there was help available and there was shelter. But then, you know, quite a lot – , oh there were some really quite dramatic cases of people with – there was a man who we would now say is bi-polar, but we used to say manic depression, who hopped all the way from Camberwell Green to Camberwell Reception – because he was so high. So there were quite a lot of characters. And the other people I met at the time there were again famous names like Dr Ollendorf and Dr Hewitson who did work around the Elephant & Castle and Camberwell Green. And they were interesting because they were GPs who were looking after …
A: Which was unusual.
SM: Yeah and they saw a few people who took drugs, but a lot of people with alcohol problems as well. So that was how I came into it really, through that.
A: And so what happened next?
SM: I could have stayed on at the Institute and there was a new project on St Mungo’s in the offing, but then I saw a post advertised at Birkbeck and I applied for that and got it. That was in the Department of Politics and Sociology. So I moved on into a more conventional social science department. Although it wasn’t conventional, because it was Birkbeck.
A: No, well we’ll come back to that. But you did and you mention this in your answers to the questionnaire, you did produce a book jointly, based on the work.
SM: We did, yes.
A: Tell me about that.
SM: So we wrote a book and it was called The Spike, because the reception centres were called spikes at the time: there was a discussion about why were they called spikes and I think probably it was because there was a spike where the chitty that you handed in was put on a spike – I think journalists also used that expression, ‘to spike something’ is to put something on it – reject it – but anyway there was a lot of discussion about the origin of the term. Yes so we wrote the report and we wrote a summary of the report.
A: And who was funding it?
SM: This was funded by the Department of Health and Social Security. They funded the report and the summary. I learnt about the importance of producing a summary of a report – and that summary was then circulated to all the local authorities and health places and so on. It was quite interesting to see the way in which evidence gets into policy in that way by producing a summary. But then we also produced a book. There was a series, which Routledge were publishing at the time, International Studies in Health and Social Work, or something. So we wrote the book, which was based on the report and it was accepted. It was written, John Wing wrote the foreword and then out of the blue David Tidmarsh, who was my collaborator, said he didn’t want to publish and that his mentor had said that it would not do his career any good to be associated with this book.
A: Why not?
SM: I really don’t know. It was absolutely amazing. I think he was also doing an MD based on this, but I don’t think that that was the factor.[2] I never really understood. It may have been something to do with ideas of what counted as evidence and research and to be associated with something which was, half of it was social science.
A: Yes would have detracted.
SM: Maybe detracted from his career… I don’t know. It was just so frustrating and I just left it, I didn’t do anything about it, you know and I didn’t have any advisors or anyone at the time, to sort of, to go to, you were very much on your own. So it got lost, which was, when I look back it’s such a shame. It would have been a really good book.
A: Yeah it would have been probably a classic in the field by now.
SM: Yeah, it was really quite, yeah. And you know it had been vetted, John Wing had thought it was fine, Kathleen Jones, who was an eminent academic, she thought it was fine. So I don’t know, it was very strange.
A: And it was never rejuvenated and?
SM: Again I had the manuscript, I kept the manuscript and then in, and then you know you’re so busy and at that stage in your life, so busy, onto the next thing and so on, I think in one of the moves from offices, it somehow got lost, because of course again, you know this is pre-computer days, everything was typed or handwritten. So it was much harder to keep things.
A: What a pity.
SM: It was a pity,
A: So you went to Birkbeck, but you were also very active in research and you had this connection with the Department of Health, so what was the next thing that came out of that?
SM: So yes, I think what had happened was that for a number of years SCODA (Standing Conference on Drug Abuse) had been pressing for more attention to services for – they were called multiple drug misusers in those days, poly drug users. For a number of years they’d been saying that they wanted a special crisis intervention service for this group and Hamid Ghodse had done a very important study, looking at A&E departments. People in the A&E departments were aware that there was a problem of people who were overdosing on barbiturates, coming in, being revived, patched up, sent out again and coming back in again. They were frequently overdosing and it was a burden for A&E departments. But Hamid Ghodse did a definitive study on this, which showed that there was a problem and that helped to encourage the Department of Health to accept that there was a need to recognise that there was a need for services for this group. So they funded what was called an experimental Crisis Intervention Unit at the Angel and it eventually became named, City Roads. Those were the days – attached to this was an evaluation – and because I had done previous work on a similar group, homeless men – but this was young homeless drug users, I think that kind of qualified me to do the study. And incidentally, City Roads has just announced that it’s closing down, which is very sad, forty years it’s been going and it’s closing down due to lack of funding for residential services, even though it was a short stay, as it began, as a short stay detoxification unit. Because the important point about barbiturates is that it’s very dangerous to withdraw from barbiturates – you can die if you withdraw too quickly from barbiturates – so they needed a gradual medically supervised detoxification, as you would with alcohol and of course they were mixing drugs. So it continued in various forms, but most recently was a detoxification unit. But you know – where do people go for detoxification now?
A: Yeah.
SM: so that’s very sad.
A: And presumably that’s the change to local government and cuts in funding.
SM: I think it is and lack of money. The residential services are expensive.
A: Yeah. Go back to the inception
SM: Yeah so going back to City Roads. That was fascinating. That was when I got into the drugs world and met many of the key people in that world from the SCODA people, David Turner and then Martin Mitcheson was the consultant psychiatrist attached to City Roads. And I did that study with Anne Jamieson and Alan Glanz. Again that was interesting – another example of what happens when you do research that is linked with policy, because we produced a report – we had various reports, interim reports – but we produced the final report and again it’s pre-computers, so it was typed and photocopied, so it was quite a labour to produce these reports. We produced about I don’t know perhaps 20 copies, maybe 40 copies, I can’t remember and we, again naively perhaps, circulated these to members of the Management Committee and other local people, because at that point the City Roads people were wanting to get further funding. They’d had the three years funding from the Department of Health, but of course they then wanted to look for funds elsewhere. So, not surprisingly, they took the report and circulated it as part of their information – and suddenly there were missives from the Department of Health saying you can’t do this, this is copyright, this is crown copyright! We then got into a discussion of what does it really mean to say this is crown copyright, you know, and it wasn’t really about crown copyright, it was about intellectual property, you know whose intellectual property is this report, does it belong to the Department of Health, does it belong to the researchers, does it belong to City Roads? And actually crown copyright doesn’t cover any of those issues and this was before all the regulations around IPR came in – but it was an interesting example, you know – being terrified and to suddenly be told – and some people saw that as censoring it. But it was really that they just wanted to keep control of it and they didn’t want it to be discussed in …
A: Without them.
SM: Without them having gone through their procedures and so on.
A: But you did a book from it subsequently didn’t you?
SM: Yes.
A: So they must have relaxed?
SM: Oh yes, I think, I don’t think that it was that they wanted to censor it, it was about control and quite often it’s about control. But you know for agencies in the field, they haven’t got the time to wait.
A: So they need this.
SM: They needed the results. It always happens with evaluation studies, you know, evaluation studies are always caught up in this, because you are talking about the value of something.
A: Yeah.
SM: Yeah so that was that and then I carried on being linked to City Roads for a few years afterwards on the management committee and from that I got involved with the Institute for the Study of Drug Dependence and was on their council and on their finance and general purposes committee and so on. So I became involved in that work.
A: In the drugs field.
SM: Yeah.
A: And what was ISDD like at that time?
SM: Oh well of course a wonderful place. A wonderful library and there I met Philip Connell, who was the Chair of ISDD at the time and Jasper Woodcock and it was really the source for any information and research on drugs . It was the source at that time. And the library has now gone to Wellcome hasn’t it?
A: Yes. It’s been saved at long last.
SM: Yes – so that was a very interesting world to be in.
A: So yes I think you’ve commented that you’ve always done research for, one of your main focuses of work has been research for policy that you have always been concerned to produce evidence which may, or may not be used in policymaking.
SM: Yes – and being a sort of go-between I suppose. It’s been Government funded research quite often, but I’ve always been interested in linking also to what would now be called civil society groups, NGOs, the voluntary sector and being a kind of go-between and intermediary in research – as an independent voice in that complex – and that it was possible to produce evidence which could be used by …
A: By both.
SM: … a variety of people, you know core partners. So you know I wasn’t a government researcher in the sense of being employed by the Home Office, or employed within Government. It would be Government funded, but then you are meant to be independent and attached to the university.
A: And this was the period presumably when Government was, and particularly in the drugs and alcohol field, was developing those relationships to quite a great extent wasn’t it. Didn’t they have, there was a research liaison group in the Department of Health?
SM: Yes. Yes indeed – these research liaison groups were set up and I was on the Homelessness and Addictions Research Liaison Group and so you would come in as a scientific advisor and… I don’t think they exist anymore, do they?
A: Not to my knowledge, no.
SM: It was an attempt to have an exchange of knowledge and information and judgement.
A: And also as you point out a sort of a vital conduit to the field as well. So it’s interesting that those relationships don’t operate in the same way at all, do they.
SM: Then civil servants came out and went to visit, you know. I think other people have noticed this that they had the time to go and sit in, they would go and sit in meetings and sit on committees of projects that they funded. So there was a lot more connection I think.
A: Yes because there were civil servants on the Council of ASH I think and also I think on ISDD weren’t there.
SM: Yes it’s interesting isn’t it – I think that was the thing that Nicholas Deakin wrote about didn’t he, about the change in the relationship between Government and the voluntary sector.[3]
A: Really?
SM: Mm.
A: So it’s a more distant.
SM: More distant.
A: Yeah and presumably a more subservient relationship.
SM: Yes.
A: So what was going on in the drugs, well the drugs and alcohol field at the time?
SM: In a sense when I first came into it, it was almost non-existent, or hidden – the drug dependency units were just getting going – but it was a small world – but it gradually grew and changed. I’m not sure when you date it, but really from the end of the seventies into the eighties, there’s more, it’s a larger world. It spreads outside London, it spreads – although it may have been there before. There’s lots of discussion about whether it was there before and not noticed, but I think it grew – supply has something to do with this – and it changed its nature. So there’s an increase in the size, a change in the shape and then particularly the arrival of heroin, and then followed by the arrival of HIV. So a great expansion. I think that’s really been the story of my life that, you know, one gets into what’s a small field, esoteric field, and then it becomes huge over time and the increase in the numbers is amazing isn’t it.
A: What users?
SM: Numbers of users and then also obviously the policy response and the service response.
A: And the personnel involved.
SM: And the personnel. And that’s the other change also – from being a small world – GPs would be the frontrunners and then some consultant psychiatrists and some social workers and some voluntary sector agencies and then you’ve got [a huge increase]… The interesting thing about City Roads was that it was bringing together nurses, social workers, probation officers as well as psychiatrists and GPs, – so you had multi professional working and collaborative working – and also an expansion of the range of addictions involved.
A: And a model for what happens later presumably.
SM: Yes. And that’s really the expansion: in the eighties it’s the arrival of HIV, expansion out of London and again more Government attention and as you know a change in policy and so on. Then in the nineties you have more awareness of the criminal justice side, linking in criminologists and probation officers and so on. Although the deputy director at City Roads came from Holloway Prison, he was a probation officer.
A: At the start?
SM: So City Roads was a fantastic place actually, it really was.
A: It was a pioneer in all sorts of ways.
SM: It was.
A: So then you said that you worked with, you were on the homelessness and addictions research liaison group, so what did being involved in that, what did that involve?
SM: Well that would involve partly looking at other projects, commenting, peer reviewing projects or commenting on applications for research and commenting on reports and so on.[4] That is where I met John Strang who was in Manchester at the time and he was establishing a service, which he then called ‘satellite clinics.’ It was about trying to respond to an increase in need, establish community-based services and he had an important project there. And then of course later on he came down to …
A: So was this a model where the Department would encourage people like John to put in research proposals, or was it, how did the research liaison work?
SM: As you know the important actor at the time was Dorothy Black – so you have specialist civil servants and there were specialist nursing officers and specialist social workers, whose names I’ve forgotten at the moment, but they were also important. So they were active in identifying responses to need. But there was along with that the notion that you should have research built in, or evaluation built in, to any new initiative and it would be quite good quality and well-funded research.
A: Yes it seems like a golden age.
SM: It does, doesn’t it!
A: Anyway how did you take your interest forward at Birkbeck, you were working at Birkbeck all this time?
SM: Yes so I was teaching and had PhD students and so on and then, I did some other research in other fields, social security and unemployment. In the eighties, the issues were unemployment and so on, so I had a number of other projects. But then the big project that came along in the eighties was the evaluation of the Central Funding Initiative.
A: Say a little bit about what that was.
SM: Which was, well that again was, so much is, when you look back, is accidental. The idea, very much under the auspices of Dorothy Black and her colleagues, the notion was to expand services outside London. Most services were concentrated in London, apart from DDUs. So the idea was to expand community-based services, a layer of community-based services and expand them outside London. So there was a Central Funding Initiative of, I forget, 2.4 million pounds,[5] or whatever it was in those days, a large sum of money, to expand services. And this money was allocated and the services were up and running and then the, what was then called I think the Social Services Committee had an enquiry, a select committee, and they said ‘oh very interesting this, we assume this is being evaluated?’ and they said ‘oh no this wasn’t actually’. So they had to rush around and fund an evaluation. So that was an example actually of where the evaluation was …
A: Was not built in.
SM: Was not built in, it was hurriedly added on, so we weren’t in at the beginning there. With the City Roads project, one of the advantages there was that we were in right at the beginning, so you could set up a realistic evaluation right from the start. So this CFI project – we had to first of all find out what was happening and it was very much trying to just describe what was going on first of all, where had the money gone to and who had got it and why – and then have some kind of evaluation of it. So yes, that was an interesting project and again I met interesting people through that.
A: Some good people working with you?
SM: And Betsy Ettorre and Ross Coomber were the researchers on that project.
A: And the results were positive, the changes or I think they were controversial at the time, weren’t they?
SM: Well I think it was, yes – because people did have different ideas about what it was for. The whole thing in evaluation is you have to identify the goals and then you evaluate in terms of the goals – and of course, there were a number of different views on what the goals of this initiative were . But I think looking back – the money – it wasn’t the sort of study which said was the money well spent and did it work? I think that notion of ‘what works’ had not arrived. But it – the CFI – certainly did develop a new layer of services and it helped to develop a new workforce really. It expanded knowledge and practice outside London. It could have been quite an interesting study to see where did these people come from – a workforce study would have been quite interesting. But it was an expansion outside London and then into the community – and then different types of professions and disciplines being involved. I suppose the other important point was that the services respond to the local need, so that you don’t have a one size fits all approach.
A: It’s not London driven.
SM: It’s not London driven, it’s responding to a lot of the needs locally and what are the bases that can be built upon, because of course what was happening is that initiatives were already developing. When you have an Initiative, money is provided and people then have to apply for the money, so the people who apply for the money are embryonic grassroots and voluntary organisations which have been working away in the field for some time and ‘oh here is a source of money’. So it helps to encourage something, it doesn’t start from scratch, it helps to encourage something that is already there.
A: And back at Birkbeck you had other developing, there were other drug researchers too weren’t there at this time?
SM: Yes, yes. Of course – the Drug Indicators project came to us. I can’t remember why but they had to move out of University College Hospital, where they had been. Something happened …
A: In the National Temperance Hospital.
SM: Yes was it that it closed down or something?
A: I don’t know.
SM: There’s this accidental – , it’s always part of the story of life – but something happened and they had to find a new home and of course I knew Martin Mitcheson and you know I said ‘oh yes bring them to Birkbeck, that would be great’. So the Drug Indicators project came to our department [where I was Head] and of course that was a very important project. I mean the very name, Drug Indicators Project – Richard Hartnoll developing a kind of practical epidemiology. He’d previously worked there with Martin Mitcheson on that other study[6], – but here they were trying to find out how many drug users are there – which was a question the civil servants are always interested in, – how big is the problem and is it growing?. Yes so we had Richard Hartnoll and then Robert Power was appointed and Tim Rhodes. They were just new to the field at the time and where are they now! (Laughs)
A: Just down the corridor, or one of them!
SM: And of course Richard went on to expand from the Drug Indicators Project – he moves to Lisbon, sets up the whole idea of, develops the idea of epidemiological research and really the concept of indicators is embedded in European drug policy now.
A: Yeah and the origins of the EMCDDA really.
SM: Yeah.
A: So a lot of things going on there.
SM: It’s quite interesting.
A: So how long were you, you were at Birkbeck ?
SM: I was there for twenty years at Birkbeck altogether, yes and then I moved to Goldsmiths for a little while and they had a funding crisis, so after Goldsmiths I moved to Middlesex.
A: Did you do drug and alcohol work at Goldsmiths?
SM: Yes that was a period when we had another project, which was a study of City Challenge and I was looking at quite a lot of urban policy and urban development studies. But it was also the period of the move to um, the, I’m trying to remember the name of it now, but it was again a shift of funding and yes was it the 1988 Act[7], which changed the funding basis for projects? So residential drug and alcohol services were affected and it was a shift to local authorities again really. That’s right – the shift was from Social Security to local authorities and so we did a number of studies looking at what was happening there. I think it was the Community Care Act – it was tied up with the move to community care – so we had a number of projects on what was happening in the drug and alcohol field. Some of them funded by the Department of Health, some funded by Alcohol Concern and SCODA. Again, they were very much descriptive studies really – just to say what is happening in a changing world, to try and provide information on what is going on – and Aileen O’Gorman worked on one of those projects and she’s now a leading researcher.
A: Yes in Scotland. And so in fact you weren’t at Goldsmiths for that long, because of the …
SM: No because they had a funding crisis.
A: This is the beginning of the funding crisis.
SM: Yes it is.
A: So you moved to Middlesex.
SM: Which was a very large famous Sociology department full of deviants. (Laughs.) And criminologists – and that really was very interesting actually because I was then working more closely with criminologists – Jock Young who had written a famous book called The Drug Takers was there – and they had done a lot of other research – Roger Matthews and John Lea had done work in this field. So that was rather interesting to come at the issue from another angle. During those years, I was involved in a number of studies, some funded by the Home Office, what was then the Central Drug Prevention Unit – we did some studies of community drug prevention – and by Joseph Rowntree. But perhaps the most interesting project at that time was again a benchmarking study in a sense for the Polkinghorne Review.
A: And that was the review of drug treatment?
SM: Yes. So again it was a ‘what is going on study’, so a description really of what were the services and what was happening in the field – and that then provided the basis on which NTORS was built, when it then evaluated what was happening to clients of drug services.
A: So the context of all that was the, it was the ministerial questioning of treatment.
SM: That’s right. It was Mawhinney who questioned the value of methadone in particular – it’s a constant battle isn’t it in the field – and that was very interesting where, in a sense an alliance of civil servants, psychiatrists, representatives of drugs services, somehow managed to kick the issue into the long grass – and by having a task force review by the time it reported the minister had moved on or lost interest . And it was also an interesting period because on that taskforce, Esther Rantzen for example was appointed, so it was the beginning of that period saying ‘we want other voices here’. This field of experts should no longer be the decision makers, let’s have some celebrities and other people on – but she got fed up I think – she resigned before it completed. But I think that was the beginning of that period of questioning.
A: And we’ll bring somebody in to ask difficult questions.
SM: Yes, this is too cosy a world – and I remember we had to present our findings to them and they were all looking terribly bored, you know they did not want to hear these boring descriptions of who was where and how many and you know.
A: So bore them into submission.
SM: Yes. So that was very interesting to see the way that worked.
A: So this is something quite interesting in the drugs field in particular isn’t it that the in-house people seem to take control of the policy process and mould it
SM: Yes they were certainly able to at that point. They were able to at that point, whether it is still the case – but certainly and also picking up on what we said before – the civil servants working with other people – John Strang was a sort of insider as well, you know. So this kind of collaboration between people within the civil service and other groups – who worked together – who were experts really.
A: So having done that research, how did your research develop in the 1990s?
SM: I’m trying to remember.
A: Community based provision.
SM: Yes what did I do next?
A: Drug action teams?
SM: Oh yes I’d forgotten about that. Yes that’s right that was the other one, the Drug Action Teams. That was also fascinating – the Drug Action Teams had been set up – the beginnings of the partnership approach – and this was coming to the end of the period of the Conservative Government and there would be a new Government. I don’t know that they knew that it would be Labour, but it would be a new Government – so the Cabinet Office were interested in looking and producing a report which said what were the 105 drug action teams in England doing and how had it worked. …
A: And the drug action teams were locally based?
SM: They were locally based. The new policy. This was the period where partnership policies were coming in – following Roger Howard’s report[8] and others, which had talked about the need for partnership, the drug action teams were set up and they had representatives from a number of different funding agencies and responsible bodies, at local level. So this structure and this design actually was established under John Major, but it did then continue under New Labour, with a few tweaks. But our report – I think the fear was that it might all be thrown up in the air and something, you know, another reorganisation would come in. So I think that the report helped – it wasn’t the only thing – there were a number of efforts to try to maintain that system – and so I did that work – with Karen Duke and a number of other people.
A: And then she did her …
SM: And then she did her PhD on prison drugs policy, yeah.
A: And all this time you were also Head of the School of Sociology and Social Policy. Was it difficult to keep the sort of …
SM: It was very difficult. This was the most difficult part of my life. It was really exhausting. I mean I didn’t have a holiday. I worked Christmas Days, New Year’s Days, weekends, it really, really was hard, because what I was trying to do was to carry on with research as well as teaching and administration and it was a period when actually it was impossible to do all three. And what’s happened since is these roles have become separated. But I was – I could have just become a manager and I didn’t want to be just a manager, I wanted to carry on with the research and also I have always liked teaching. I didn’t do a lot of teaching, but I had PhD students and Master’s students. But it was really doing several jobs at once and it was very, very hard.
A: But you also, you were developing this group of drug and alcohol researchers though. Betsy Thom.
SM: Yes Betsy Thom was there and Karen Duke and Aileen O’Gorman did her PhD there. Yes there were some good people – and in fact there was good work going on there before, it just needed organising.
A: And it expanded from being criminology only?
SM: Yes – and also it was the period when the polytechnics became universities, so we were setting up good practice, good practice in postgraduate work and you know getting ESRC recognition, having research training, ethics committees, you know setting up actually the whole structures. They weren’t there, so one had to build them up from scratch. So yes and I think, you know, in a way that was probably an achievement, but it was exhausting.
A: Exhausting yes. And you then left, well you became the Coordinator for the Department of Health.
SM: Yes this was a part time position.
A: So was that after you left Middlesex?
SM: No the first, phase one I did at Middlesex and then for phase two I came to the London School of Hygiene to your Centre Again, that was part time but I then had other things, did other things as well to make up the difference.
A: So what was that research initiative, what did that consist of?
SM: Well this was interesting wasn’t it. Yes this was the Department of Health’s Drug Misuse Research Initiative, which was a very large programme of work, with quite a large amount of money that the Department had allocated, I think on the basis – because Labour had identified, this was under New Labour, Labour had identified drugs as a high priority issue. So the Department of Health Policy Research Programme identified drugs as a priority and put a relatively large sum of money for drug misuse research – and I think phase one was something like £2.4 million and phase two was something like £1.2 million, which was quite a large amount of money. Altogether there were about 24 projects under this, on a number of different topics, which again were identified by the experts in the civil service, the specialist civil servants, as initially, comorbidity, waiting lists, I think young people – you know a number of areas – and then people would bid for funds and so on, and there were a number of projects. This was very good work and it was interesting to see it, to see the whole process through from beginning to end, from the identification of a policy priority, to working out the call and the specifications and then allocating peer reviewers. And I was just an advisor in a sense, but I would be in on those decisions. So it was interesting to see the process from beginning to end. And also the Department, interesting to see the Department of Health’s approach, which is, I think still is, but certainly at that point, was very much an emphasis on excellent research, peer reviewed research, wants the research to be published in scientific journals, still doesn’t publish its own findings. It’s very much the idea that the research will be published in scientific journals, which is different from the Home Office or some other …
A: That publishes reports.
SM: So it’s very much a medical model really. But there was also an emphasis on knowledge translation. So while that was a model, there was also the idea of getting the findings somehow into policy and practice.
A: So was that your role?
SM: It was in a way – but what then happened was that while this was underway, unbeknown to anyone at the Department of Health, or at least many people in the Department of Health, the National Treatment Agency was established and certainly the civil servants that I was working with, who were quite senior, didn’t know anything about it, until they saw it on the 9 o’clock news.
A: Really? So where did that come from then?
SM: It came absolutely from Tony Blair and from the top. So the National Treatment Agency took over and we then had to link our dissemination activities into the NTA, although we did have some separate dissemination activities. We did produce some bulletins and briefings and you know that was this thought coming in, the idea of having short summaries and so on. But we also then linked those into the NTA, which had a much bigger budget and was a larger enterprise altogether. But in a way it was quite useful. So a lot of those findings did get into practice through the NTA. So one had to liaise with the NTA as well.
A: So that was an interesting change.
SM: So it was fascinating and then of course the other thing that happened at that time was that the Home Office grew rapidly and had its research unit with a lot of money and a lot of researchers and it eclipsed the research going on in the Department of Health.
A: Oh really because the Home Office always had researchers on drugs.
SM: It did, but in this period of New Labour it was the rise and fall of social research really.
A: It expanded.
SM: It was a bonanza time for social research, not just in drugs, but everywhere, because to begin with they were going to be ‘evidence based policy’ and everything was going to be evidence based – ‘what works’ was the mantra. So there was you know loads and loads …
A: Is this late nineties?
SM: Yeah – more the beginning of the century, you know that first and second period. Then they became disillusioned and the money dried up and the researchers must have lost their jobs. The emphasis under New Labour was very much on the crime and justice focused research – and I think you know a number of topics like comorbidity – which have always had to struggle for recognition – are still not recognised – even though there were some very good studies carried out on comorbidity within the drug misuse research initiative.
A: So was the impact of that initiative sort of, how did it pan out, given that you’ve got these different blocks emergent in the field?
SM: Well I think it didn’t have a huge impact as a programme – but individual projects had.
A: Did.
SM: But again, they were very much taken over by events – the classic one was the waiting list studies. The civil servants had identified waiting lists as a problem and so there were a number of projects on waiting lists and one was how to use waiting lists effectively. So – how could you have brief interventions or various interventions with people, while they were waiting, – so there were a number of such studies. Then from the top came the waiting list initiative and waiting lists disappeared overnight, because there was new money to abolish waiting lists. So there were these projects on waiting lists, which were irrelevant – and they had to adapt – and it was really quite funny to see you know the impact of political decisions on research projects – all well-meant, but you know things coming out of left field as they say.
A: Oh dear.
SM: I think the programme – there were people who said that with that amount of money it would have been better spent on one big project – and of course there were people who wanted all that money to go on looking at say heroin assisted treatment, or a big randomised controlled trial of heroin versus methadone, or something like that. But that was not, it was just not feasible, it was not the sort of thing that could be funded in the context. There were too many questions and too many interests, which had to be satisfied – and also in terms of developing the field – I think these programmes have a role in developing research and researchers and research teams. So actually one could see a number of people who did their research and developed their skills through this money being available, whereas if it had all been in one centre, on one project, it would have been much more limited. So I think it did help. It did help to develop collaborative research, which involved both health and social research, medical and social.
A: Yes and you were busy in other areas too at this time, on the Research Assessment Exercise?
SM: Oh yes that’s right. Yes that was another – that was probably again one of the most demanding things I’ve ever done, to chair that panel.
A: You were the social policy?
SM: Social Policy and Administration and Social Work.
A: That was in 2001.
SM: In 2001.
A: Research Assessment Exercise.
SM: So a huge amount of work. And that took place – we had a grand meeting, to finalise our results in September of that year and just as we were in the midst of it, 9/11 happened. So one of my jobs as Chair was to try to keep people focused on the matter in hand, when what they wanted to do was leave the room and watch the television.
A: Yeah.
SM: So it was a very dramatic time.
A: Yes.
SM: That was very interesting, because one saw a whole breadth of research, social policy, social work, criminology, sociology, a whole range.
A: It covered that whole area.
SM: Yes and getting a feel for what’s going on.
A: For the whole field, yeah. And then you moved, you left Middlesex?
SM: Yes I think altogether I was exhausted by then, what with chairing the research assessment exercise and all the other work: so then, on phase two of the DMRI, I concentrated on that. Although once I was here, I did some other projects, for example I worked on an evaluation of the alcohol improvement project with Betsy Thom.
A: And Betsy Thom took on the drugs and alcohol brief at Middlesex.
SM: Yes. I had had a Social Policy Research Centre within which there was drugs and alcohol and then when I left it divided really – and Betsy concentrated on drugs and alcohol and then some other people worked on social policy, with a particular interest in migration, which was their particular work.
A: Oh right. And you carried on as an advisor to the Department of Health?
SM: I think I stopped in about 2010.
A: Right okay. But you also had a, while you came here to the Centre, that you had a Leverhulme Fellowship.
SM: That’s right yes. So the Leverhulme Fellowship was to try and reflect on all this and so yes I managed to produce the book ‘The Politics of Drugs,’ which came out in 2017.
A: Yes. So what changes have you seen during your time both in this field but in the wider university field?
SM: Well in terms of, yes the field, the topic has grown. Although I suppose alcohol hasn’t grown has it – it’s a shifting world – but drugs is now established as an area of social science research now. But it is still fragmented in a way – between criminology, social work, psychiatry – almost by definition, because it’s a topic area and different disciplines approach it. Research has grown – there was that vast expansion of research funds under New Labour but in the last few years it’s been, it’s a more difficult field I think. I think people have had to come to terms with the drying up of social research funds.
A: And European funds too presumably.
SM: And that. Yes, well European money has been very important and perhaps filled a gap in the last few years and if that disappears that will be a major problem.
A: Difficult to see, yeah. And who over this period has been, who’s influenced you, what’s been the greatest influences on you?
SM: It’s hard to say. I mean there’s people you meet and there’s the people whose work you read and the people you work with as colleagues. I think they’ve all been influential. I wouldn’t want to single out any one.
A: You mention here the role of ISSDP as an academic organisation.
SM: Oh yes of course. I think that indeed, I think that has been, for me has been – I found that to be a very useful home in that it is focusing on policy, which is, within all this, my interest. So yes it’s been going about ten years now, so over the last ten years or so that’s been a very …
A: A home for social researchers.
SM: Yes.
A: So where do you see the field going and where would you like it to go?
SM: Ah. Well I don’t know – I worry a bit about the overly academic approach to research in the universities. As you know, all the developments in universities to prove performance in certain ways, publishing in journals, certain kind of journal article counting more than a book or a chapter or a conference paper. So a certain kind of research counting more than supervising PhD students or writing book reviews. All the collegiate activities which I think are really important in universities are being squeezed out by these metrics, the emphasis on metrics and certain kinds of metrics. Then I think the emphasis on – you know I’ve never liked jargon – I certainly dislike an overly specialised language developing within the disciplines. And I’m of an age now, where I interpret things I hear and I think oh yes I know what that means and it’s just a new term for an old idea. And with that you’ve then got the separation of universities from the real world – and the kind of research I’ve always enjoyed has been where you’ve been out in the real world, doing realistic evaluations which have some benefit and use. I think that looks like a missing area for me.
A: Is that harder to do now, because you talked about the role of civil servants and how you worked with these civil servants, who really knew their field, but does that system operate in the same way?
SM: Well of course into that gap have come other researchers. For a time I worked with the Social Research Association, I was the Secretary of the Social Research Association for a number of years and on the committee there – and there you have people who don’t just work in universities, you know – they work in the free standing research institutes, your NatCen and so on. So they have filled that gap and they do a lot of – and actually I think Government will go to them for research now rather than to universities. So you have a new world of very, very good research being carried out. Now I think universities need to re-establish, (some do), to re-establish the links between the ‘real world’ and themselves. Of course, the difficulty for universities is that they have the students and if you want research done quickly – fast and quick and producing a result in time for something – the research centres, the dedicated research centres are people who can do it.
A: They haven’t got anything else.
SM: That’s what they can do and they do it better. So they have taken that particular kind of work and that’s good – but then you know you do need the link with reflection and the knowledge of the field and so on, so I think that division is a worry. So that’s one. What were we talking about – the changes?
A: The changes and what you would like to happen.
SM: That’s something I regret. And then the other thing I regret is the methodological turn to quantitative – and obviously it’s terribly important, but the arrival of computers and the ability to play with numbers means that people play with numbers and sometimes forget why they are doing it. So that the big projects, having a large population and many variables, swamp the smaller, more detailed qualitative studies.
A: And also I suppose economics, health economics and things like that.
SM: That’s right, complex interventions, RCTs and so on, the glamorous end of it – and does it tell us very much?.
A: Yeah.
SM: One of the things that I enjoyed in working on the drug misuse research initiative and then coming here has been what I’ve learnt about other methodologies. You know I have great respect for them and I’ve learnt a lot about different approaches and they all have their place. But the danger is that some of the more qualitative ethnographic work finds it hard to maintain a position.
A: Two things that struck me looking at your career is your work in knowledge translation, as you said in the middle between the people on the outside and the people on the inside, which are the civil servants, which I think is very important. But also your role as an enabler and supporter of other people’s careers. The names that have been mentioned during this interview- it’s quite a cast of people who are there.
SM: Yes. I think my one area where I feel most proud has been PhD students. I think that my PhD students – and then also research officers who’ve been in my teams – seeing their development is probably the most gratifying aspect of my career I would say and they outshine me in many ways. (Laughs.)
A: I’m sure not. So is there anything else that you think I should have asked you, as they always say? Anything else?
SM: I think the other thing is – I came into this through, again accidentally, through psychiatry and now at the end of this period, I do think that the issue of mental ill health has got rather forgotten – and I think the issues of trauma and psychological suffering, which are behind a lot of drug and alcohol use, do need to be recovered and remembered and I don’t think we’ll solve or respond adequately to the problems of drugs and alcohol, unless we reassert that issue of mental health.
A: Which seems to be a coming issue more generally now doesn’t it.
SM: I think so, I think so definitely. But whether we are responding to it adequately is another matter.
A: Yeah. Well thank you very much Susanne.
Susanne MacGregor was in conversation with Virginia Berridge.
This interview is licensed under CC BY-NC-ND.
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The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.
[1] Blowup is a 1966 film directed by Michelangelo Antonioni.
[2] Later comment from SM: “Although now on reflection perhaps that was the reason – the fear that he would not get the MD if there was a prior publication?”
[3] Nicholas Deakin In Search of Civil Society Palgrave 2001
[4] Later comment from SM: “By the way we were not paid for this of course – all part of our public service!”
[5] Later comment from SM: “Actually £17.4 million plus more came later through AIDS money and specific grants.”
[6] R Hartnoll, M Mitcheson and A Battersby et al Evaluation of Heroin Maintenance in Controlled Trial Arch Gen Psychiatry 1980; 37 (8) 877-884
[7] 1990 Community Care Act
[8] R Howard, P Beadel and J Maitland (1994) Across the Divide: building community partnerships to tackle drug misuse. London: Department of Health