‘The main route to addiction is pain’

I started by asking Sarah about her work in Bristol as well as her role as Chair of the British Psychological Society's Division of Clinical Psychology Faculty of Addictions. Sarah quickly pointed out 'I've recently changed jobs and now work as Professional Lead in Psychology for Inclusion, part of the Midlands Partnership University NHS Foundation Trust, based in Staffordshire but covering services across England.'

The focus of Sarah's new job draws hugely on her experience. 'We work with marginalised people in prisons and in the community – basically with people who struggle to access what we might consider to be mainstream services, on issues like gambling, drug and alcohol addiction, and sexual health. We run community drug and alcohol services, providing community hubs as well as specialised outreach workers focused on specific populations such as people who are homeless.'

'We need to look for common humanity'

Both Bristol and Sarah's present base in Staffordshire area present very specific socio-economic conditions. 'They are both diverse in everything from wealth to health outcomes. Certain lower socio-economic groups are hugely over-represented in the areas of problematic drug and alcohol use. More generally, older age groups are not only drinking more but find it harder to see this as problematic, even though that behaviour may cause increasing physical and psychological damage with age.'

I asked Sarah about other key issues in the addiction area. She emphasised one regularly in our interview. 'A very important phenomenon for professionals working with younger people is innovation in drug design. It is almost impossible to keep up with new variations of drugs as they come onto the market. For instance, we still don't know enough about how to effectively treat dependence on "Spice" (also known as mamba), the sort of laboratory-designed drug that originated in the early 2000s.'

Sarah's previous roles in this area were hands-on. How does the leadership role differ? 'I'll still do delivery but much less as, primarily, I oversee the quality of psychological practice, looking at what is effective and what is evidence-based. It is a real opportunity to have influence over how we apply our discipline. I've been trying to travel and meet people a lot in this first period: relationships are the bedrock of everything we do. It's particularly helpful to visit prison services as technology is unreliable in many prisons so it's difficult to hold virtual meetings.'

In researching this interview I found some fascinating slides by Sarah on the issue of compassion. 'We've come to understand that shame and guilt are hugely associated with trauma which, in turn, is linked to addiction. The antidote to this is compassion. Self-compassion is also important for practitioners working in such a challenging areas. If we treat ourselves with compassion we can offer more to others and avoid empathy fatigue. Again, this is particularly crucial in prison environments which can be extremely challenging. We need to look for common humanity and to do this we need to notice our own biases and prejudices. We need a greater emphasis on what we are as psychologists, what we bring to our relationships with people.'

'Compassion is key'

I wondered if there was a personal reason for Sarah's interest in these areas. 'Not really. I was always interested in the "darker" side of people, by which I mean I read mystery books and watched mystery series on TV, asking myself "Why do people do what they do?" Books like The Jigsaw Man by forensic psychologist Paul Britton fascinated me. So, I studied psychology at A-level but then took two years out working in HMP Exeter as an administrator. CARAT services were introduced then – the first nationally funded drug services in prisons – and when I went on to do my undergraduate degree, I worked with the CARAT team part time.'

What fascinated you about this addiction work? 'The people: both the professional team and the service users. I felt at home. Not just that, I felt I was doing something with practical value and that's important to me. I had been less interested in certain elements of my psychology degree – biological topics for instance – because I couldn't see how to apply them. Increasingly I've seen psychology as a means to an end, which is to work with people in distress. So, when I graduated, I got a job with Exeter Drugs Project. I'd been advised by my undergraduate tutors not to put all my eggs in one basket in pursuing training as a clinical psychologist, so, I put that on one side for a while working my way up to team leader within the community drug and alcohol team. But at that time, I didn't want to become a manager. I still prefer concentrating on leadership and quality rather than direct people management.'

Sarah then worked as an assistant psychologist at the AccEPT clinic at the University of Exeter ('Where I learnt about mindfulness, IAPT and other useful areas') before applying for clinical training in Bath. It struck me that Sarah could easily have followed a forensic route but she pointed out that 'at that time forensic psychology was largely focused on risk assessment and management which didn't interest me much. It's changed a lot since then.'

Sarah's husband was in the military when she did her clinical training in Bath. 'We moved to Wiltshire but I got a job at St Michael's Hospital in Bristol when I qualified working in a maternity/neonatal unit. I'd always had an interest in women's, particularly reproductive, health. That suggests common threads in my different interests: one is the experience of trauma and adversity; the other is the interaction of mind and body. I worked there for a couple of years and then went part-time while taking on another job at HMP Bristol. In the end I worked full-time in the prison mental health team. Looking back, the situation in prisons then is quite a contrast with what we see now. Nowadays there are less staff, less safety, and less control while there is much more self-harm and much more substance use.'

Sarah says 'I wanted a less challenging job after my maternity leave and that's where I started working in the Bristol Specialist Drug and Alcohol Service: part of this was a role with the Drugs and Alcohol Health Integration Team (HIT) which was supported by Bristol Health Partners. There are a number of HITs in Bristol focused on different issues: stroke, self-harm, drug, and alcohol use. The HITs have autonomy in how they use their resources and their leadership teams comprise academics, clinicians and those who have lived experience of an issue. The services that HITs offer certainly improved networking between professions and institutions but also ensured some research happened which otherwise might have been unfunded. For me that mattered if the research informed practice, reduced harm, and saved lives.'

Integrated teams were key to her experiences in both Bristol and her new role. 'Addictions correlate highly with health problems whether this is the direct effect of alcohol or drug misuse, homelessness, or financial problems due to gambling addiction so more integrated teams of different professionals can provide more effective services. At one stage psychology was seen as peripheral to the area but integrated teams are changing that and offering better treatment. The main route to addiction is pain. Most people who use substances have a history of adversity and complex trauma, areas where psychology can contribute and where, as I've stressed, compassion is key.'
'Addiction services are on their knees'

I asked Sarah to sum up the present situation and the future. 'There is a crisis in UK drug/alcohol deaths.' When I looked, reported statistics seemed to confirm Sarah's point. Liver disease is the fifth most common cause of death in the UK and is on the increase; 50 per cent of those under 16 report heavy episodic drinking; estimates of the economic costs of drug and alcohol misuse top £30 billion. 

Sarah commented: 'Given the miserable present social and political situation internationally you can see why some people find substance use as a way to cope. We have seen significant meaningful investment in recent years in response to Dame Carol Black's Review of Drugs but this must be sustained in order for addiction services to truly serve their purpose and support people to achieve meaningful recovery.'

Sarah's role in the Faculty of Addictions highlights the particular challenge this situation poses to psychology and psychologists. 'Addiction services are on their knees but I'm feeling hopeful that the new government will work to improve the social and political contexts within which addiction can thrive. To do this we need more professional roles to be reintroduced to services. We must also ensure that psychologists and others understand that this is an attractive, enriching, interesting area to work in. You can make a real difference through your work. And as I've found, meeting the people involved will enrich your thinking, your career, and your life. So, the faculty has a big job ahead.'