Substitution treatment in the era of "recovery": An analysis of stakeholder roles and policy windows in Britain.

Based on documentary analyses and interviews with twenty key informants in 2012, this paper analyses the shift in British drugs policy towards "recovery" from the perspectives of major stakeholders. The processes involved in reopening the debate surrounding the role of substitution treatment and its re-emergence on to the policy agenda are examined. Drawing on Kingdon's work on agenda-setting, the ways in which methadone maintenance was challenged and defended by key stakeholders in the initial phase of policy development and the negotiation of a "recovery" focus as the organizing concept for British drugs policy are explored. Study limitations are noted.

Partnerships and communities in English drug policy: the challenge of deprivation.

BACKGROUND: From the mid-1990s, UK governments developed partnerships to tackle drugs nationally and locally. Over time, increased resources focused on communities and localities in greatest need. This reflected growing awareness of the concentration of problems in deprived areas, with social and spatial segregation being a feature of post-industrial urban areas. METHODS: A review of English drug policy since the 1990s, drawing on:- analysis of documents; a review of sociological studies; an illustrative case-study of one northern town; interviews with local policy players; statistical analysis of key indicators with some of these data presented using Geographical Information System (GIS) mapping. RESULTS: In-depth sociological studies demonstrate interconnections between historical patterns, socio-economic change, cultural complexity, deprivation, limited opportunities and illicit drugs. At local level, there are links between concentrated multiple deprivation, poor health, acquisitive crime and problematic drug use. Partnership policies, encouraged by the provision of ring-fenced funds, have been effective in containing problems. Underlying issues of inequality are however neglected in political debates. The article argues that post-industrial towns and cities are characterised by an increase in problems related to poverty and drugs. Both the real shape and perceptions of what is the problem change over time. In England, the profile of the problem drug user was described in a number of sociological studies conducted from the 1980s onwards. Key features were the concentration of problems in certain social groups (such as the poorly educated or unemployed) and in certain areas (inner cities or outer estates). Responding to rising public concern, national drug strategies developed and the New Labour Government after 1997 prioritised the issue of drugs, directing increased resources to drug treatment with tight control over the use of these new monies through target setting and measurement of performance. The emphasis was on the most dangerous drugs and most disadvantaged areas. CONCLUSION: There is local variation in the pattern of problems and in implementation of national policies. In UK after 1997, New Labour policy aimed to promote a fair and cost-effective distribution of resources and improved availability and quality of treatment services and local policing. Tensions appeared between the drive to meet national targets and local perceptions of need. Ideas of localism, promoting market solutions and flexibility in provision, are now gaining ground in English social policy with the arrival of a Coalition (Conservative/Liberal Democrat) Government. These, together with an emphasis on abstinence and recovery, raise questions about the future adequacy of (a) attention to marginalised problems and stigmatised groups and (b) the distribution of resources in a context of severe fiscal restraint.