Class and class As: How drug use and rehabilitation intersect with social class

‘I began using drugs as a teenager, and to be honest it wasn’t really apparent it had become a serious problem until I was 19 and I tried to stop – or at the very least tried to slow my drug use down.

‘But by that point it was too late. I was already addicted and starting the inevitable cycle… loss of jobs, friendships, partners, and physical and mental health problems.’

Dave* is in his 40s, and runs the Secret Drug Addict Twitter account, which he set up three years ago to support and signpost those dealing with drug addiction.

He made the account after celebrating ten years of sobriety, and those chats about his former life touring with bands such as Oasis, finding recovery, and what to do if you’re struggling – have attracted over 32,000 followers.

For Dave, addiction is an experience that bridges gaps in wealth and social status, but he’s one of a growing number of people highlighting barriers to recovery that hinder the poor and vulnerable.

Having grown up in a working class environment in Camden, London, he tells Metro.co.uk: ‘Money was a huge barrier (thankfully not as big a barrier as it has become during the last ten years due to the government gutting funding to drug services) and I certainly couldn’t have afforded private treatment when I needed help, I had to access local services.’

Drugs and socioeconomic class are two of the most complicated parts of British culture. As a nation, we are obsessed with how wealth, education, and connections affect our lives.

We also take more cocaine than our European neighbours, and the rate of deaths due to overdose is 13 times higher in Scotland than the average in Europe.

Hospital admissions (for drug-related mental and behavioural disorders and overdoses) are between five and eight times more likely in the most deprived areas compared to the least deprived areas.

Of the people in our prisons, 16% were convicted of drug offences, compared to 10% for robbery or theft respectively.

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Yet despite different research suggesting that between a third and 75% of Brits have taken drugs in our lifetime, collectively we condemn those who become addicted.

We can see the public’s feeling on drugs from a survey conducted by The UK Drug Policy Commission, where almost half of the people surveyed said that people with a history of drug dependence are ‘a burden on society’.

Almost one in four respondents also agreed with the statement that ‘most people would not become dependent on drugs if they had good parents’.

Senior policy analyst at Transform Steve Rolles tells Metro.co.uk: ‘The prevalence of use is quite similar across socioeconomic groups.

‘But the harms, in terms of drug related mortality, drug dependence, and drug-related hospital admissions are much higher for more socially deprived and excluded individuals.

‘The reasons for that are quite complicated. It’s partly to do with broader inequalities of health – poor people are generally less healthy.

‘There may often be high concentrations of certain risk behaviours, so they may be using more frequently, using a higher dosage, mixing drugs in unsafe ways, or using in less safe environments.

‘There is also an issue to do with motivation – if you’re using drugs as a form of escape, to stop feeling bad rather than just to feel good, you’re likely to run into problems.’

Because drugs do not exist in a vacuum, the existing prejudices we hold add to drug and addiction-specific prejudices, meaning stigma against those who suffer with drug-related health issues permeates from Westminster to your common-or-garden housing estate.

Take the use of the word ‘junkie’, or derogatory and inflammatory descriptors like ‘spice zombie’, and ‘crackhead’.

These pejorative terms are a way to distance ourselves from – and essentially create an underclass of – people with drug dependency, despite the fact we undoubtedly know people who take these substances, or have ourselves (and many of our leading politicians have admitted to doing so).

That stigma and othering can then lead to a reduction in opportunities.

The UKDPC states: ‘If people with drug problems are seen as “junkie scum” and “once a junkie always a junkie”, people will be reluctant to acknowledge their problems and seek treatment, employers will not want to give them jobs, landlords will be reluctant to give them tenancies and communities will resist the establishment of treatment centres.

‘As a result, drug problems will remain entrenched rather than overcome.’

Within there, too, is the fact these terms refer to those who use heroin, spice, and crack cocaine; drugs that are often singled-out and commonly associated with deprivation and poverty.

The Scottish Drugs Forum estimated that over half (54%) of all deaths related to drug poisoning in 2016 involved an opiate (mainly heroin and/or morphine).

This cycle of demonisation and ostracisation hampers recovery. Vulnerable people without a financial safety net or the means to access private rehabilitation have little recourse without government-funded intervention.

Nuno Albuquerque, an Addictions Counseller with UKAT, tells Metro.co.uk: ‘Councils are not spending the money on alcohol and drug treatment services, especially residential, so there is a lack of funding.

‘And that’s what makes a difference when we are talking about classes, because people from lower classes, they will rely on that to get help.

‘If that funding is not there, they will not get the help that they need to save their lives.’

He estimates that private residential treatment can cost a patient between £1,000 and £5,000. If you’ve been excluded from society, as mentioned above, finding that kind of money seems almost impossible.

Stigma also affects how we use moralising in policy, and suggests that it’s not harm reduction at the forefront of our minds, but sweeping away the problem.

The War on Drugs in the US has been credited with inspiring similar policies here in the UK, whereby punitive measures like stop and search and long prison sentences are used to (in theory) deter people from drug use and reduce demand.

It’s been 50 years since the Misuse of Drugs Act – the framework for how we deal with drug use in Britain – was introduced.

Steve says: ‘We’ve poured more and more resources into punitive enforcement, criminalising users, and using police and military to stop drugs being available and to reduce use – but the exact opposite has happened

‘Use has gone up, harms have gone up. Drugs are more available than they’ve ever been; they’re cheaper, more potent, and more dangerous. And loads more people are dying.

‘It’s transparently been an atrocious atrocious failure on any metric you choose.’

In regards to stop and search specifically, it was found that people from black and minority ethnic groups were over-represented in arrests and warnings for cannabis – once again proving that existing biases affect who is criminalised.

When the Scottish Drugs Forum announced a proposed scheme to widen heroin-assisted treatment (where people can be given heroin in a safe injecting environment) earlier this year, it caused controversy.

When the Daily Record posted a story on the scheme to social media, comments included: ‘Most of these users never worked a day in their lives. Something is far wrong.’

Another wrote: ‘What is this world coming to just feeding there [sic] habits what about a cure for cancer instead of feeding the junkies habits.’

Even though a similar project has been hugely successful in Switzerland (seeing a 64% reduction in drug deaths, an 84% reduction in HIV cases, and a 98% reduction in home thefts) our need to place fault on those with substance abuse disorders has trumped harm reduction.

In Portugal in 2001, drugs were essentially decriminalised, whereby those found in possession of drugs would have them confiscated or receive fines rather than receive a custodial sentence or criminal record. People can also be referred to treatment if social workers deem their drug use to be ‘high risk’.

Drug-related HIV infections have reduced by 95%, and Portugal’s drug-induced mortality rate is five times lower than the EU average.

A focus towards a health-centred approach like this could end the vicious cycle for those with drug dependency, making them less afraid to seek help, and integrating people who may otherwise be excluded back into society.

Targeting inequality – and the most vulnerable in society – can have overarching positive effects, including on drug dependency.

The review of drugs by Dame Carol Black was released last month, making similar recommendations to treat drug-related health problems as just that, focusing on holistic ways to reduce harm.

‘You have to deal with the broader problems that people are facing, or they will just relapse into the same sort of unsafe, high risk behaviour.

‘So you have to deal with their mental health problems, housing problems, you, give counselling to deal with issues around unresolved bereavement or trauma, fix issues around employment.’

UN agencies such as the WHO and UNICEF support decriminalisation similar to that in Portugal, as does the Royal College of Physicians, the Royal Society for Public Health, and the BMJ.

Until a different approach is put forward here in the UK, though, poverty and deprivation will still create a cycle of drug dependency without reprieve.

As Steve puts it: ‘If you’ve got a job and a house, and a strong social network, you’re much less likely to die from drugs or become dependent on drugs. And if you do have problems, you generally find it much easier to sort them out.

‘So the idea that you give someone a criminal record [for drug-related issues] (making it harder to get housing and harder to get a job, and undermining relationships) is clearly a stupid thing to be doing.’

This article is a part of High Alert, a campaign from Metro.co.uk and drug checking organisation The Loop. To find out more about their 2021 harm reduction campaign and how to reduce the risks of drug use, click here.

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