Addiction Research (1993) Vol. 1 pp 69-76 Reprints available directly from the publisher Photocopying permitted by license only

0 1993 Harwood Academic Publishers GmbH Printed in the United States

THE STRUCTURE OF SCOTLAND’S DRUG AGENCIES

JASON DITTON Research Director, Criminology Research Unit, University of Glasgow, 61

Southpark Avenue, Glasgow G12. UK.

AVRIL TAYLOR Research Fellow, Public Health Research Unit, University of Glasgow, UK.

One in a series reporting a national survey of all Scotland‘s drug agencies which was carried out in mid 1987, this paper concentrates on the location and age of the 73 agencies researched, the number and type of staff involved, the services provided, the bases of service provision, and upon gaps in provision identified by agency personnel.

Keywords: Scotland, drug agencies, illicit drugs

INTRODUCTION

This article is the first in a series reporting the results of a survey of all known Scottish drug agencies which was carried out in the summer of 1987. It may be distinguished from comparable work (Ettorre, 1987a, 1987b, 1988a, 1988b, 1988c) in that coverage was neither restricted to particular types of agency nor to particular cities. Fortunately, Scotland is small enough to permit the execution of such a national exercise within acceptable temporal and financial limits.

The full report is available from the Scottish Office (Ditton & Taylor, 1990), and an extensive digest of statistical information relating to patterns of the use of illicit drugs in Scotland for the period 1980-1984 (Ditton & Taylor, 1987) is available, on request, from the first author.

We focus here on the structure of what might loosely be called the national “network” of agencies, many of whom have opened their doors for the first time to clients since 1979. It pays particular attention to the number, location and age of these agencies, the number and type of staff involved, services provided and the bases of service provision, and to “gaps” in service provision indicated by agency personnel. Later articles will report such data on agency clients as is known to agency personnel; and the extent to which the agencies actually function as a competent referral network.

METHODS

Information was obtained from agencies using a comprehensive 16-page questionnaire adapted from Hartnoll’s “Sample Agenda for Approaching Agencies” (Hartnoll, et al., 1985). This was piloted on 5 agencies in June 1987, and administered to all known drug agencies (n=73) during July and August of that year. The most recent comprehensive register of Scottish agencies is in SHEG/SDF (1991).

“Drug agencies” were defined for the purposes of the survey as organisations having some or other responsibility for the management of persons with drug abuse problems.

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70 J. DITTON AND A . TAYLOR

The list of 73 was compiled after checking all the registers of helping agencies then available, and consulting expert opinion at national, regional and local level. Services provided by social work departments or by general practitioners were excluded.

Piloting indicated that a postal questionnaire was unlikely to succeed. Consequently one of three fieldworkers made a personal visit to each agency.

RESULTS

(i) Funding, Age and Location

Of the 73 agencies, 40 (55 %) claimed that all their income came from statutory sources, 13 (18%) claimed that their income came partly from the statutory sector, and partly from the non-statutory sector, with the final 20 (27%) claiming that all their income came from non-statutory sources. On the basis of this relationship to funding source, agencies are hereafter referred to as statutory, part statutory and non-statutory, respectively.

The growth of agency provision in Scotland has been both rapid and uneven since 1979. Before then, only 12 (16%) of the 73 were open. In 1979 two agencies opened, and the accelerating growth between 1980 and 1987 is shown in Table 1 and Figure 1. The increase in 1984 and 1985 was greatly assisted by “pump priming” finance provided by the Scottish Office.

Figure 1 Scottish Drug Agency Growth, 1980-1987

Number

80 r - Non-Statutory

” 80 81 82 83 84 85 86 87

Year

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THE STRUCTURE OF SCOTLAND’S DRUG AGENCIES 71

Table 1 Scottish Drug Agency Growth since 1979.

Year Non-Statutory Part Statutory Statutory ALL Agencies Agencies Agencies AGENCIES

new (total) new (total) new (total) New (Total)

1980 1981 1982 1983 1984 1985 1986 1987%

3 4 5 7 14 18 7 4

~~ ~~

* Note Addilional agencies may have opened in the last 6 months of 1987

The Geographical location of these 73 agencies is shown in Table 2. The location of the relevant administrative units (Health Board Areas) is plotted on Figure 2.

Figure 2 Scotland: Health Board Areas.

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72 J. DITTON AND A . TAYLOR

Table 2 Scottish Health Board Areas: Populations and Drug Agencies

Health Board Key General Number of Drug Population per Population Agencies Drug Agency

Greater Glasgow Highland Lothian Argyll and Clyde Ayrshire and Arran

Tayside Fife Forth Valley Lanarkshire Dumfries and Galloway

Grampian Borders Western Isles Shetland Orkney

SCOTLAND

GG H

Lo AC AA

T F

FV La

DG

G B

WI S 0

1,000,000 195,000 744,500 447.900 375,700

395,000 342,800 272,000 563,000 146,100

500,000 101,200 31,000 23,000 20,000

5,127,000

32 3

12 5 4

4 3 2 4 1

3

13

3 1,250 64,333 64,542 89,580 93,925

98,750 114,267 136,000 140,750 146,100

166,667

70,232

Although statutory funding of drug agencies is now mainly on a general per capita basis, the actual distribution of agencies is markedly skewed. Greater Glasgow and Lothian have 35% of the population and 60% of the agencies known in mid 1987. It is possible that this reflects a reaction to the lagged impact of a series of local “epidemics”, particularly of heroin use, beginning in Glasgow in 1981 and Edinburgh (Lothian) in 1982, before affecting Dundee (Tayside) and Aberdeen (Grampian) in the middle 1980s.

At a general level, insofar as the increase in the location of these drug agencies may be held to reflect an increase in and change of drug use itself, the apparent pattern appears to resemble two key dimensions of the principle of “macrodiffusion” (local “epidemics”, particularly of heroin use, begin in the largest city of any country, and spread progressively thereafter to cities and towns of declining size) as elaborated by American observers (eg. Hunt & Chambers, 1976, pp. 27-55).

(ii) StafJing

Agencies were asked how many full time (working for over 30 paid hours a week), how many part time (less than 30 paid hours per week) and how many unpaid workers they had at time of interview. The results are given in Table 3.

Table 3 Staff Working in Scottish Drug Agencies

Non-Statutory Part Statutory Statutory ALL Agencies Agencies Agencies AGENCIES

Full Time

Part Time

Unpaid

25 35 288 348

5 13 69 87

215 159 93 467

Total ~ ____~ ~ ~

245 207 450 902

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THE STRUCTURE OF SCOTLAND’S DRUG AGENCIES 73

As expected, full time workers dominate in the statutory agencies, with unpaid workers being in a clear majority in agencies in both the part statutory and non-statutory sectors. An average statutory agency has 7 full time, 2 part time and 2 unpaid workers; an average part statutory agency has 3 full time, 1 part time and 12 unpaid workers; and an average non-statutory agency has 1 full time and 11 unpaid workers.

(iii) Services

Overall, only about a quarter (19,26%) of agencies had a current client load exclusively of drug users,with a further 17 (23%) indicating that drug users constitute most of their clients (see under “drug priority” in Table 4). The non statutory agencies specialise to a greater extent in assisting drug users (with 14 or 70% specialising in drug users), with only 5 (13%) of the statutory agencies being drug user specific.

Table 4 Service Structure in Scottish Drug Agencies

Non-Statutory Part Statutory Statutory ALL Agencies Agencies Agencies AGENCIES (n =20) (n =13) (n =40) (N=73)

Drug Priority All Most Some

Service Priority Counselling Assisting Information Support Services

Service Basis Once Off Ongoing Residential none

Service Gaps (*)

Staff Medical General Auxiliary

10 4 6

5 12 2 1

10 10 6 5

4 2 7

5 11 24

19 12 5 4

5 26 6 3

21 18 19 17

19 17 37

32 18 1 1 12

12 43 12 6

37 33 33 29

(*) Agencies were asked to nominate as many as they wished

On average all agencies indicated that they offered 5 major services to clients. When asked to pick the one each regarded as its primary task, counselling was nominated by 32 (44 %) of all agencies, and was nominated more frequently than any other service in each sector (see under “service priority” in Table 4). Assisting drug users (including crisis intervention, detoxification) is more the province of the more medically oriented statutory agencies; offering information a minority concern across the board; and the provision of support services (parent and family groups, leisure activities and prison visits) more frequently mentioned in the part statutory and non statutory sectors.

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74 J. DITTON AND A. TAYLOR

Only very rarely did agencies offer services to clients exclusively on one particular basis. Two claimed to see all their clients on a once-off basis; 12 all their clients on an ongoing non-residential basis; and 6 all their clients on residential basis. Accordingly, service basis (under that heading in Table 4) has been classified in the way that agencies claimed to see 50% or more of their clients. It can be seen that ongoing non-residential is the predominant mode of service delivery in each sector and overall.

Finally, agencies were asked to suggest what additional services or facilities they would find helpful. As the data under “service gaps” in Table 4 shows, resources for staff (which included premises, staff, information materials and training) were nominated with slightly more frequency than any other category. Additional medical resources (particularly for crisis intervention and residential detoxification facilities), and general resources (especially for transport and follow up services) were demanded nearly as frequently; with demand for auxiliary services (particularly for short-term accommodation) not far behind. Overall, greater provision of short-term client accommodation on dedicated premises offering crisis intervention would go a long way to filling service gaps indicated by agency personnel. It is heartening to be able to report that, at least in two of Scotland’s major health board areas, significant moves are currently in progress with a view to providing this sort of facility.

DISCUSSION

Services for drug users in Scotland differ from those offered in the rest of the United Kingdom, and a description of Scottish provision has been provided by the Advisory Council on the Misuse of Drugs (ACMD, 1988, pp.95-99). One key difference is believed to be a greater dependence on community -based rather than hospital-based service provision. Another is of rapid recent development of services specifically in areas of widespread drug use.

An additional feature of Scottish drug user service provision (perhaps derived from the two features cited above) is that the structure of provision is more generic than specific or specialised. While there are, of course, a small number of agencies that only offer services to the users of illicit drugs, function with only one type of worker and only offer one type of service, and whilst it is still true that wholly statutorily funded agencies, for example, tend to have more full time workers than is the case for those with no statutory funding, the overwhelming impression is of a broad range of services being on offer across the board. To this extent, at least, is it legitimate to refer to the “structure” of Scotland’s drug agencies.

ACKNOWLEDGEMENTS

We are indebted to the Scottish Home and Health Department who funded data gathering; to Tom Watkinson, Roy Campbell, Alasdair McKee, Bob Archer and Mark Kilgallon who assisted with fieldwork and/or data processing; and to many agency personnel who gave freely and willingly of their time to assist us.

RcIferences Advisory Council on the Misuse of Drugs (ACMD) (1988) AIDS and Drug Misuse Part I(London, HMSO). Ditton, 3. & Taylor, A. (1987)Scotlund Drugs Resource Book, 1980-84, (Glasgow, PressGang).

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THE STRUCTURE OF SCOTLAND’S DRUG AGENCIES 75

Ditton, J. & Taylor, A. (1990) Scotland’s Drug Misuse Agencies: The 1987 Survey (Edinburgh, Scottish Office). Ettorre, B., (1987a) Drug Problems and the Voluntary Sector of Care in the UK: identifying key issues, British

Journal of Addiction, Vol. 82, pp.469-476. Ettorre, B., (1987h) A Study of Voluntary Drug Agencies: their roles in the treatment and rehabilitation field,

British Journal of Addiction, Vol. 82, pp. 681-689. Ettorre, B., (1988a) London’s Voluntary Drug Agencies: I Funding and Organizational Management, International

Journal of Addictions, Vol. 23, pp.1041-1056. Ettorre, B., (1988b) London’s Voluntary Drug Agencies: I1 Staffing in London’s Voluntary Drug Agencies,

International Journal of Addictions, Vol. 23, pp. 1157-1170. Ettorre, B., (1988~) London’s Voluntary Drug Agencies: 111 A “Snapshot” View of London’s Voluntary Drug

Agencies: Residential and Non-residential Clients, International Journal ofAddictions, Vol. 23, pp.1255-1269. Hartnoll, R., Daviaud, E., Lewis, R., & Mitcheson, M. (1985) Drug Problems: Assessing LocalNeeds (London,

Drug Indicators Project). Hunt, L.G. & Chambers, C.D. (1976) The Heroin Epidemics (New York, Spectrum). Scottish Health Education Group/Scottish Drug Forum (SHEG/SDF) (1991) Drug Problems: A Register of Helping

Agencies (Edinburgh, SHEG).

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