Breaking the habit

Greg has a criminal record for robbery and theft, activities he took part in to finance his crack and heroin habit. He has just been arrested for stealing £300. At the police station, he is advised he can go on a treatment programme to avoid a jail sentence. He agrees to this at his first court appearance and is bailed on condition he attend. He later phones the service but they tell him there is a one-month waiting list. Unsurprisingly, given his chaotic life, Greg forgets the appointment and ends up back in court.

The story is a depressingly familiar one - last year, fewer than a third of those seen by arrest referral workers (the official who advised Greg at the police station) went on to undergo treatment. And 34% of those who sign up to treatment programmes from all points of referral do not complete the course, or do not turn up and slip back into crime. Relapses are expensive because drug users may make several further attempts before they complete the programme successfully.

The court sentenced Greg to a drug testing and treatment order of weekly drug tests and 20 hours on a treatment and rehabilitation programme - but the success rate is poor. Since July, just 34% of orders were completed.

Furthermore, the organisations supposedly there to help are too focused on the "drug problem" itself, rather than on the person behind it and the whole patchwork of complex housing, education and benefits problems they face.

Greg's fictitious scenario is detailed in an Audit Commission report, published today, that examines the work drug partnerships are undertaking to treat the hardcore 280,000 problem users in England and Wales, who create most damage for friends, family and society.

Drug Misuse 2004 - Reducing Local Impact looks at the problem through the eyes of Greg, his partner Tracey and Pat, Tracey's mum. It also looks at the other side of the problem through the eyes of local authority deputy chief executive Janet.

Tracey has been trying to cut down on drugs and alcohol since she discovered she was pregnant. A friend tells her about a scheme where midwives help women who take drugs through pregnancy. Tracey asks her GP if she can join but he hasn't heard of it and can't help.

Pat, a lone pensioner, has custody of Tracey's two other children and is struggling to bring them up. She is not aware that she can claim benefits or ask social services for help.

Janet is taking control of the local drug partnership, but doubts exist about the commitment of other agencies to meeting goals, given uncertainties about budgets, the demands of other high-profile initiatives and the fragmented regulatory framework.

Back in the "real" world, the commission says there has been impressive progress since its 2002 report, Changing Habits, recommended wider and more flexible community-based drug treatment services. Waiting times to get on to a community-based programme are down 70% since 2001, and now stand at between two and three weeks, and there has been a 20% increase in uptake.

But it says the 34% dropout rate is a "significant problem" that could be addressed if agencies at national and local level involve users and carers in planning and offer greater support to carers, since this has been shown to encourage drug users to stay in treatment.

"Carers themselves need support because caring is difficult where drug users have chaotic lives," says the report. "It makes erratic, emotional, rather than physical demands on the carer. The tendency to hide the problem because of the shame and social stigma means that large numbers of carers are unknown to social services."

It cites inefficient planning, especially in the use of short-term funding, poor joint working and the absence of any criteria for user or carer involvement.

Sharon Gernon-Booth, assistant director of the Audit Commission's criminal justice directorate, says: "We are not trying to say, 'Here are some horrible things that happen.' We are trying to say that there are all these decisions happening along a complex line and everybody from housing to education, the criminal justice system and health has a role to play.

"If, for instance, someone turns up at a GP surgery to sign up to a methadone programme, they might be scared and have very low self-esteem and if they see it as unwelcoming, or speak to a receptionist who can't offer a flexible appointment, they might go away and be lost for good."

The report is also concerned that initiatives that are successful are not being shared at a national level.

In Calderdale, Lancashire, a group of drug users were trained in interview techniques by an external agency to find out why long-term users had never been in touch with local needle exchange services.

The Calderdale Users Forum (CUF) interviewed 187 drug users and made recommendations for improvements that were implemented last year. As a consequence, the number of people using the service leapt from 180 to 500, but there has also been a cut in waiting times, more flexible opening hours and an increase in the number of users moving on to treatment programmes.

Andrew Fox, Calderdale Drug Action Team coordinator, says it was vital to include the views and experiences of drug users themselves. "Now we have trained CUF members in advocacy work so they can help other people get on to methadone programmes and they are involved in peer education. We even commission CUF to do pieces of research for us. CUF was anxious that this would be seen as giving money to drug addicts but now it is a stand-alone voluntary agency and, at its request, we have a service level agreement with it, and the project is being performance-managed."

With multiagency crime and disorder strategies being formulated now for 2005-8, there is, says the commission's report, an "excellent opportunity" for local agencies to sign up to programmes that will provide the Greg, Tracey and Pats of this world "with the support to make a recovery and good prospects for a stable lifestyle".

· Copies of Drug Misuse 2004; reducing local impact are available at www.audit-commission.gov.uk .