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Effective Interventions Unit: Advocacy for Drug Users: A Guide

Chapter 2: Could advocacy be useful for drug users?

There is a growing recognition of the benefits of advocacy to marginalized groups, including drug users (see 'Mind the Gaps' SACDM,SACAM 2003). Drug users often experience a range of problems and need to deal with a range of agencies. At different stages of their recovery process, individuals may benefit from different types of advocacy. For example, a drug user who is not in touch with services may rely on family and friends for advocacy. Once they have begun receiving treatment, clients may rely on staff from the treatment and care services to advocate on their behalf. When they are ready to move on, recovering drug users could benefit from the help of an independent advocacy agency.

What are the problems drug users face?

Evidence shows that people who have drug misuse problems will, in many cases, have a range of other difficulties in their lives. These difficulties include problems with housing, family relationships, employment, offending behaviour and debt. This means that a wide range of interventions and support will need to be deployed to address those problems (Integrated Care for Drug Users EIU 2002).

Service users commonly feel that support is offered to them at the beginning of the recovery process and that, very often, when they are ready to move on to services such as employability or housing, support is no longer there. Consequently, service users are often unaware of the options open to them, the specific services they can access and how to go about accessing these services. In addition, drug users often suffer from a wide range of barriers and low self-esteem. They find it difficult to express their views and are often not skilled at getting people to listen to them.

Advocacy and drug users

The evidence from the EIU advocacy survey, consultation seminar and focus groups suggest that service users and providers consider advocacy to be an important component of effective treatment and care provision.

Reasons given by service users and providers for the usefulness of advocacy included:

• Drug users often need to use a wide range of specialist and generic services. Advocacy can help them find out what services are available and how to access them.

• By being knowledgeable about specific subjects, an advocate can add weight and credibility to a client's case.

• Advocacy can help people understand their rights and the range of choices they have.

In addition, service users and providers identified a number of activities that they associated with advocacy but which would not fall within the remit of an independent advocate. These activities might include a range of support, such as

• helping clients to sort out and understand the large amounts of information they receive which can be confusing.

• helping service users who find reading and writing difficult to complete forms and read a range of information sources.

• helping clients who may not represent themselves very effectively to make themselves heard by telling them what to expect from a meeting, and how to conduct themselves when speaking to other people.

• helping clients to be realistic about what to expect from services and what is expected from them when they use services.

• helping service users to deal with the negative attitudes towards them from a range of professionals.

When planning advocacy service for drug users, it will be important to define the scope of advocacy and to make the core remit of the provider(s) explicit. It will also be crucial for the advocates to know where clients can get the other support that they might need.

A recent mapping exercise of independent advocacy agencies in Scotland (ASA 2004) identifies substance misusers and other marginalized groups, including the homeless and people leaving prisons, as "hidden" groups for whom there is the largest gap in independent advocacy provision. The ' Mind the Gaps' report(SACDM, SACAM 2003) identifies advocacy, alongside early intervention, broadly based intervention and person-centred intervention, as a key feature of service provision for people with co-occurring substance misuse and mental health problems. The report recommends that advocacy services should become integral to the care plans for this client group.

Where and when is advocacy most needed?

The majority of the service users who participated in our focus groups had personal experience of having someone speaking on their behalf or representing them. 'Personal treatment' was identified as the area where most participants needed advocacy. This included accessing GP services and negotiating changes in treatment interventions. Some felt that without somebody advocating on their behalf, their chances of registering with a GP or receiving access to a range of treatment and care services would have been reduced. Other service users received advocacy which included support with benefit appeals, court attendances and housing.

The majority of the service providers who responded to the EIU survey reported that many of their clients needed advocacy support when dealing with agencies including housing, social work, training & employment, children and family teams, GPs and the police. More specifically, the issues with which clients needed advocacy included benefit, finance and debt, physical and mental health, training and employability, substitute prescribing, and childcare.

The limits of advocacy

It is important to recognise the limits of advocacy and be clear about what it cannot achieve. The purpose of advocacy is not:

• to create a substitute for making services more accessible or to bypass user involvement in the planning and delivery of services

• to avoid the need to provide person-centred services

• about making complaints (although advocacy may involve supporting people who want to make a complaint and helping them to do so effectively).

Advocacy is often provided to those most in need of safeguarding, who are often least likely to have their needs and rights recognised, but who are also least likely to provide specific instructions or have specific ideas about what they want or need. Consequently there is always the danger of the advocate taking over the process rather than empowering the client to deal with issues themselves. Therefore standards must be in place to ensure that best practice is carried out. For information about standards see Principles and standards in Independent Advocacy organisations and groups (Advocacy 2000, January 2002).

Advocacy and befriending services

It is important to stress that advocacy is not the same as providing befriending services. The Befriending Network Scotland says the role of a befriender is primarily about social contact and about forming a reliable, trusting relationship, and therefore not about doing practical jobs like driving, shopping or DIY. Befriending offers supportive reliable relationships through volunteer befrienders to people who would otherwise be socially isolated. For more information see www.befriending.co.uk

What Service User Focus Group participants said about advocacy:

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