Targeting ‘high risk’ users and stigmatising families

This paper argues that the targeting of drug treatment services to substance misusers who are perceived to be at ‘high risk’ creates stigma and discourages substance misusing parents and their children from accessing support and services. The UK government drug policy focus since 2003 on increasing the numbers of users in treatment by targeting  ‘high harm causing users’ has defined harm narrowly in relation to acquisitive crime rather than in terms of the the harm caused to the health and well being of users and their families. The prioritisation and fast tracking of offenders in treatment creates a perception that services are for a profile of drug users who are typically male, opiate-users in their thirties. Qualitative interviews with 53 drug users who had dropped out of treatment for the DH funded Early Exit study suggested that women, non opiate users, younger users and those who want to distance themselves from the ‘junkie’ identity are deterred from accessing treatment services.  While the more recent 2008 Drug Strategy provision of ‘family-friendly’ treatment services is to be welcomed, we are cautious that its intention of targeting parents whose drug use may put their children at risk for ‘early intervention and support’ risks stigmatising substance misusing parents and/or making them less likely to access treatment services or disclose their substance misuse for fear of their children being removed. Qualitative interviews with midwives and antenatal staff for an ESRC funded study of pregnancy and substance misuse in its early stages, suggest that providing enhanced support and treatment in mainstream services for pregnant substance misusers when they are most motivated to succeed in treatment, is relatively successful but that too many babies are nevertheless removed once support in the community tails off. We argue that substance misusing women and their children may need specialist support services but that more community-based treatment should also be available for families via non-stigmatising mainstream services such as health and children centres.