The battle to tackle drug addiction is not lost

The debate about legalisation is a distraction.

It is impossible not to be moved by the plight of communities in Mexico and other drug-producing countries across the world. Crime and violence related to the supply of drugs are without a doubt causing extreme grief to citizens and governments. But reaching to decriminalise or legalise those drugs in the hope that it will overcome those communities’ deep-rooted problems offers them a false prospectus, and overlooks the nuanced picture of drug use and addiction which in this country at least, is in decline.

For many producer nations, drugs are one of a number of complex factors contributing to adverse conditions within their countries.  Legalisation would compound the devastating effects of drug use and the drugs trade, as former UN head of drugs and crime Antonio Maria Costa argues, especially if the structural issues that leave those states without the resources to tackle the causes and consequences of their drug problem are not addressed.

The legal framework in this country does not prevent those with drug problems from being treated humanely and effectively. Drug treatment is freely and quickly available via the NHS in England, and offers users the prospect of stability and recovery from the chaotic lives inherent in addiction. Over the last six years, 340,000 mainly heroin users have got help for their addiction, of whom around one third successfully completed their treatment, which compares favourably to the international evidence of recovery. Addicts are treated as patients in the health service, and if there are other crimes to account for, addiction treatment is offered for offenders in the community and in prison in line with NHS standards.

Drug use in this country is falling, particularly amongst young people. Heroin, crack and cannabis are being used by fewer people, and whilst there are more young people taking so-called legal highs and novel drugs, their numbers are nowhere near the levels we faced when setting up the nation’s treatment response primarily for heroin addicts more than a decade ago. At the same time, more people are recovering from drug addiction in England. There is no cause for complacency, in fact we are accelerating efforts to orientate drug treatment towards recovery, but it is worth pointing out that the trends on use, addiction and recovery are heading in the right direction.

Domestically and globally, the public discourse about drugs tends to exaggerate the power of the drug, and minimises the impact of social and economic circumstances. Compared to the 2.8million who use illegal drugs there are around 300,000 heroin or crack users in England, over half of whom are in treatment each year. Probably another 30,000 or so are in treatment for dependency on other drugs e.g. powder cocaine, cannabis and ecstasy. Those who become addicted tend to be seen by the media as the victims of hedonism, the random by-product of widespread recreational drug use. A steady trickle of millionaires’ children and celebrities fuel this myth, playing to the anxieties of middle class readers about their own children. Too often, those in the public eye think they understand drug addiction because of personal or family experiences which bear little relation to the multiple disadvantages experienced by most addicts.

In reality drug addiction is targeted. The 300,000 heroin and crack addicts are not a random sub set of England’s regular drug users. If they were, they would be as likely to live in Surrey as Salford, to have been to Westminster School as Wandsworth Prison, and their childhood would have been as likely to have been overseen by a live-in nanny as much as by Newham Borough Council.

Addiction, unlike use, is concentrated in our poorest communities, and within those communities it is the individuals with the least capital who are the most vulnerable to succumb and least able to extricate themselves. Compared to the rest of the population, heroin and crack addicts are male, working class, offenders, products of the care system, with poor educational records, little or no experience of employment, and a history of mental illness. Increasingly they are also in their forties with declining physical health. They will tend to struggle more than most to make sound personal decisions, which contributes to their other problems.

The reputation of heroin is such that few people will even try it. Of those who become addicted, the majority will recognise where they may be heading and stop. Amongst them will be people who are intelligent, resourceful and ambitious who will realise they are in “in over their heads”, pull themselves up sharp, and sort themselves out. Others will not necessarily have the innate resources to do this but will have family and friends to support them to achieve the same outcome. Key to this success will be the existence of an alternative life with the reality or realistic prospect of a job, a secure home, a stake in society and supportive relationships. The access to social, personal and economic capital not only enables individuals to overcome their immediate addiction, but to avoid relapse.

The government’s 2010 drug strategy recognises that treating addicts in isolation from efforts to address their employment, their housing status and the myriad other problems they face is unlikely to lead to long term recovery. According addiction primacy as a cause of poverty, criminality, worklessness, and child neglect denies the fact that it is as much a consequence of individual family and community breakdown as its genesis. Drug addiction exacerbates problems, and unless it is addressed will inhibit or even prevent progress in other aspects of people’s lives, but addressing it in isolation is not a silver bullet.

Drugs are not the unique barrier to normal social functioning for most addicted people. Drugs are not the unique barrier to a better, fairer and safer world in drug producing countries. The debate about legalisation is a distraction from facing and comprehensively addressing the social and economic factors that underpin drug use, addiction and the drugs trade.

Paul Hayes is the Chief Executive of the National Treatment Agency for Substance Misuse (NTA)

Opium poppy buds in an Afghan field. Photograph: Getty Images

Paul Hayes is the Chief Executive of the National Treatment Agency for Substance Misuse (NTA)

Show Hide image

The conflict in Yemen is a civil war by numbers

Amid the battles, a generation starves.

Ten thousand dead – a conservative estimate at best. Three million internally displaced. Twenty million in need of aid. Two hundred thousand besieged for over a year. Thirty-four ballistic missiles fired into Saudi Arabia. More than 140 mourners killed in a double-tap strike on a funeral. These are just some of the numerical subscripts of the war in Yemen.

The British government would probably prefer to draw attention to the money being spent on aid in Yemen – £37m extra, according to figures released by the Department for International Development in September – rather than the £3.3bn worth of arms that the UK licensed for sale to Saudi Arabia in the first year of the kingdom’s bombing campaign against one of the poorest nations in the Middle East.

Yet, on the ground, the numbers are meaningless. What they do not show is how the conflict is tearing Yemeni society apart. Nor do they account for the deaths from disease and starvation caused by the hindering of food imports and medical supplies – siege tactics used by both sides – and for the appropriation of aid for financial gain.

Since the war began in March 2015 I have travelled more than 2,500 miles across Yemen, criss-crossing the front lines in and out of territories controlled by Houthi rebels, or by their opponents, the Saudi-backed resistance forces, or through vast stretches of land held by al-Qaeda. On those journeys, what struck me most was the deepening resentment expressed by so many people towards their fellow Yemenis.

The object of that loathing can change in the space of a few hundred metres. The soundtrack to this hatred emanates from smartphones resting on rusting oil drums, protruding from the breast pockets of military fatigues, or lying on chairs under makeshift awnings where flags denote the beginning of the dead ground of no-man’s-land. The rabble-rousing propaganda songs preach to the watchful gunmen about a feeble and irreligious enemy backed by foreign powers. Down the road, an almost identical scene awaits, only the flag is different and the song, though echoing the same sentiment, chants of an opponent altogether different from the one decried barely out of earshot in the dust behind you.

“We hate them. They hate us. We kill each other. Who wins?” mused a fellow passenger on one of my trips as he pressed green leaves of the mildly narcotic khat plant into his mouth.

Mohammed was a friend of a friend who helped to smuggle me – dressed in the all-black, face-covering garb of a Yemeni woman – across front lines into the besieged enclave of Taiz. “We lose everything,” he said. “They win. They always win.” He gesticulated as he spoke of these invisible yet omnipresent powers: Yemen’s political elite and the foreign states entangled in his country’s conflict.

This promotion of hatred, creating what are likely to be irreversible divisions, is necessary for the war’s belligerents in order to incite tens of thousands to fight. It is essential to perpetuate the cycle of revenge unleashed by the territorial advances in 2014 and 2015 by Houthi rebels and the forces of their patron, the former president Ali Abdullah Saleh. This demand for retribution is matched by those who are now seeking vengeance for the lives lost in a UK-supported, Saudi-led aerial bombing campaign.

More than 25 years after the two states of North and South Yemen united, the gulf between them has never been wider. The political south, now controlled by forces aligned with the Saudi-led coalition, is logistically as well as politically severed from the north-western territories under the command of the Houthi rebels and Saleh loyalists. Caught in the middle is the city of Taiz, which is steadily being reduced to rubble after a year-long siege imposed by the Houthi-Saleh forces.

Revenge nourishes the violence, but it cannot feed those who are dying from malnutrition. Blowing in the sandy wind on roadsides up and down the country are tattered tents that hundreds of thousands of displaced families now call home. Others have fled from the cities and towns affected by the conflict to remote but safer village areas. There, food and medical care are scarce.

The acute child malnutrition reported in urban hospitals remains largely hidden in these isolated villages, far from tarmac roads, beyond the reach of international aid agencies. On my road trips across Yemen, a journey that would normally take 45 minutes on asphalt could take five hours on tracks across scrubland and rock, climbing mountainsides and descending into valleys where bridges stand useless, snapped in half by air strikes.

Among the other statistics are the missing millions needed by the state – the country’s largest employer. Workers haven’t been paid in months, amid fears of an economic collapse. This is apparently a deliberate tactic of fiscal strangulation by the Saudi-backed Yemeni government-in-exile. The recent relocation of the central bank from the Houthi-controlled capital, Sana’a, to the southern city of Aden is so far proving symbolic, given that the institution remains devoid of funds. The workforce on both sides of the conflict has taken to the streets to protest against salaries being overdue.

Following the deaths of more than 140 people in Saudi-led air strikes on a funeral hall on 8 October, Saleh and the Houthi leader, Abdulmalik al-Houthi, called for yet more revenge. Within hours, ballistic missiles were fired from within Houthi territory, reaching up to 350 miles into Saudi Arabia.

Meanwhile, in the Red Sea, Houthi missile attacks on US warships resulted in retaliation, sucking the US further into the mire. Hours later, Iran announced its intention to deploy naval vessels in the area.

Vengeance continues to drive the violence in Yemen, which is being drawn ever closer to proxy conflicts being fought elsewhere in the Middle East. Yet the impact on Yemeni society and the consequences for the population’s health for generations to come are unlikely to appear to the outside world, not even as annotated numbers in the brief glimpses we get of this war. 

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood