Lime Legal

Off the drugs, but back on the streets

Published 01 March 2024

Pumping money into drug treatment is a waste if the person you’re trying to help has no home to go to, says Tony Marshall

Drug and alcohol abuse costs the country tens of billions of pounds a year. But the government is pumping money into schemes that are having little effect because the housing needs of problem users are given too low a priority.

In cash terms the social cost is estimated at more than £33 billion – but the consequences are also measured in terms of the millions of lives shattered by drink and drug abuse. Part of the cost involves the families broken up, the revolving door of people in and out of prison, homelessness, unemployment, failing health and early death.

None of these are problems within the grasp of easy solutions – and the government, to its credit, has sought to mount an effective campaign to reduce the level of harm. It has provided state funding for treatment and rehabilitation. In the past five years alone, the Drug Interventions Programme (DIP) run by the Home Office has soaked up £7.5 billion of taxpayers’ money.

The government boasts that its drugs strategy, launched in 1998, is working. The number of dependent drug users entering treatment has risen from 85,000 in 1998, to more than 195,000 in 2016/07 – more than half the total using hard drugs in the UK. It also claims that for every £1 spent on treatment, at least £9.50 is saved in crime and health costs.

But it is now beginning to emerge that the billions spent on rehabilitation have had little impact on drug use and drug dependence. Britain still has the highest level of hard drug use in Europe. Overall use has remained stable since about 2000 and the number of drug-related deaths has not declined. Last year saw a 20 per cent rise in drug-related crime.

And alcohol abuse remains an even greater problem. Up to ten times as many people are dependent on alcohol as on drugs. There are three times as many deaths attributed directly to alcohol, with the figure doubling between 1991 and 2016 – and a massive surge in hospital admissions as a result of alcohol abuse.

For workers in the field of drug and alcohol abuse, it isn’t hard to pinpoint the cause of this failure. They say that unless more housing is made available for people wanting treatment or trying to get their life back on track after a spell in a hostel or prison, the billions currently spent on tackling drug and alcohol abuse will be largely ineffective and – as one caseworker told ROOF – ‘people will die’.

Kevin Drugan, a worker with the Streetwork project in Edinburgh, says the lack of housing constantly frustrates efforts to help people stay clean and sober. ‘In Edinburgh there’s virtually no social housing available so we depend on private letting.

‘We are trying to get people off the streets and into accommodation and B&Bs are used most. There are very few good hostel places where people can flourish and prosper. Rehab units and detox centres are limited.

‘We get people who are motivated to address their drug issues, but it’s hard to keep them motivated for weeks at a time while accommodation is found. Or if we do find somewhere, the person who is trying to cut down on their drug use is surrounded by other drug users, which makes it harder.

‘The trouble is landlords – councils, housing associations or private landlords – view abusers as bad risk clients. They assume everyone with a drug habit is the same, and they’re not. An application might say that someone has a drug problem, but it won’t say what the person is doing to address the issue. They may be granted short secure tenancy status, but if they get into any kind of difficulty they can be kicked out.’

And if that happens, they are likely to end up back on the streets and back in the cycle of addiction/prison/homelessness.

John Moore has a two-bedroom flat in a block in Edinburgh and says it was the key to helping him stay off drugs. ‘It’s given me the chance to keep myself clean. I never managed that before – except in prison. I’ve just completed a Think Again progress to work course and I’m waiting to sit an exam. I’m looking for a job in the construction trade.

‘In prison I was trained as a bricklayer but in the past when I’ve come out I’ve been homeless and just fell back into the usual drug intake, and crime, followed by prison. Being mainly on the street, I never had the opportunity to use the skill I’d learned until now. This is the first time I’ve ever had help. Having the flat is a major worry off your head – where you’re laying at the end of the day.’

Hard drug users are estimated to number around 327,000 and people with serious alcohol abuse problems are put at between three and four million. Since the 1983 Mental Health Act and the 1984 Police and Criminal Evidence Act, people with mental health problems have been diverted out of the criminal justice system and into psychiatric care, but people with substance misuse and alcohol problems fall into a huge gap in health and social services, which means their needs are only officially dealt with if they come to the attention of the police.

That is reflected by a huge gap in funding. Local authorities last year spent just £18.5 million – 1 per cent of their £1.7 billion Supporting People budget – on housing-related support for people with drug problems.

‘Drugs isn’t a small problem, it’s a big problem,’ says Grant Everitt, manager of Shelter’s street homeless project. ‘But too few housing projects are doing anything to address the issue. The general needs providers, the big agencies, leave it to the specialists – and the trouble is they aren’t big enough to cope. St Mungo’s, for instance, does a fantastic job. But, provision they have is limited. They could fill their projects 50 times over.’

Helping people find and keep accommodation is also hampered by prejudice, he says. ‘There are genuine concerns about drug users, but people’s attitudes are frequently based on prejudice. A lot of users aren’t high risk if the right support and help is available to them.

‘Vast amounts of money for treatment is wasted because a lack of accommodation means users go through your treatment programme and then have nowehere to live and become homeless. Treatment needs to be better combined with housing provision.

‘Another problem is housing is viewed as a reward. If you lapse you lose it and for some avoiding a lapse is hard in the initial stages. The most effective projects don’t require people to stop using. They get them stabilised and using safely, reducing use. The result is fewer deaths from overdosing. It’s about saving lives. When people are forced out, some of them die.’

The breakdown of housing need of drug misusers is estimated at about 5 to 10 per cent wanting rehab, 40 per cent needing a hostel or halfway house, and 50 to 55 per cent a tenancy or individual unit provided by a local authority, housing association or private landlord. But the supply of accommodation in all these areas is inadequate.

The Home Office puts the annual cost of the 327,000 hard drug abusers at more than £13 billion, but most of that – 90 per cent – is related to crime. Alcohol abuse is estimated to cost the taxpayer £20 billion a year. The total cost of drug and alcohol abuse is more than £33 billion.

The argument for more hostel places for people undergoing treatment is compelling. What is also required is an increasing willingness on the part of council, housing association or private sector landlords to house people who are attempting to address their problems once they leave treatment or prison.

Strict rules about allocation and intentional homelessness mean recovering addicts don’t stand a chance of moving up the housing queue. Experts in the field are adamant that unless housing providers are less harsh in applying the rules, it will be impossible for more than a handful at a time to break the cycle of addiction/prison/homelessness.

Anyone who wades through the hundreds of briefing papers, national and local good practice guides and reports published by the Home Office, the National Treatment Agency, regional drug and alcohol action teams (funded by the DIP) and councils cannot fail to be struck by the importance attached to housing policy.

A 2014 DIP briefing says: ‘Housing is a foundation for successful rehabilitation of drug users and offenders. Appropriate housing provision and housing support is crucial to sustaining employment, drug treatment, family support and finances and is a major resettlement need for those leaving prison, treatment and residential rehabilitation.’

But if the rules on allocations are a problem, so are the attitudes of drug and alcohol services. The National Treatment Agency (NTA) has warned that they are often ignorant of housing options and providers. Housing was relegated so far down the list of major priorities that it dropped off entirely. ‘Some services did not regard housing as their core business,’ it said. The NTA called for a change in attitude – and a big boost in housing provision and aftercare – if the numbers of people staying clean and sober are to improve. ‘Unmet housing need is a major factor in the ability to benefit from detoxification and in sustaining abstinence,’ the NTA said. ‘There is a lack of accommodation funded through Supporting People for clients accessing aftercare services. There is also a lack of formal discharge and aftercare planning, particularly residential rehabilitation placements.’

Stuart, an alcoholic for 33 years, who lived on the streets, says: ‘You drink because you’ve got nowhere to live and that’s the only way you can sleep. If you get a stable place, you don’t need to drink – you feel comfortable and at ease.’ He now lives in a flat in Southport provided by local housing charity Green Pastures, and has stopped drinking.

Ian, a 44 year-old Southport resident, says: ‘I’ve taken drugs most of my life and been in jail. Half the reason you take drugs is because you’ve not got a stable place to live or because you’re on the street. It’s like a comfort. If you’ve got somewhere decent to stay you don’t need the drugs.’

In the United States, the federal Housing First programme funds a number of projects seeking to address problems of drug and alcohol abuse on a level that dwarfs the UK’s. But, as its name implies, housing is given a much higher priority.

UK clients complain about the massive hurdles placed in their way before they qualify for housing. The Home Office admits: ‘Drug users can face difficulty in accessing social housing where they have a history of rent arrears or antisocial behaviour’.

Frontline workers believe such clients are vulnerable, and should be given priority for housing. But most housing authorities take the opposite view, and restrict them to rundown properties in dilapidated areas. They are not given a choice.

‘Here, the authorities have a take it or leave it attitude,’ says Kevin Drugan. ‘Clients are limited to dilapidated areas away from city centres. If clients have genuine reasons for not moving to a particular area – say because they might be at greater risk or more vulnerable – they are ignored. It’s too complicated and needs police cooperation. For most it’s too much hassle. They give up.’

And as the whole government strategy on drugs comes under review, it is in this area that the Home Office acknowledges more work needs to be done. It admitted to ROOF that ‘those leaving drug treatment or custody without their housing need being met are more likely to relapse and reoffend more national direction on integrating housing and drugs issues is needed’.

Unless housing becomes a central part of the rehabilitation of drug and alcohol misusers, billions of pounds of public funding will continue to be wasted. And people such as Stuart will have to rely on the outcome of a cruel lottery which means that unless you’re lucky enough to be picked up by one of the small number of specialist housing organisations, your chances of escaping the cycle of despair are remote.