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This paper explores the competing influences which inform public health policy and describes the role that research evidence plays within the policy-making process. In particular it draws on a recent English alcohol policy case study to assess the role of evidence in informing policy and practice. Semi-structured interviews with key national, regional and local policy informants were transcribed and analysed thematically. A strong theme identified was that of the role of evidence. Findings are discussed in the context of competing views on what constitutes appropriate evidence for policy making.

Regional Alcohol Managers (RAMs) were employed in the nine English health regions over 2008–2011. Their mission was to impact on the ‘hard target’ of Alcohol-Related Hospital Admissions (AHRAs) through the ‘soft methods’ of persuasion and influence: working with local partners on evidence-based interventions. Drawing on a qualitative evaluation, this article shows how a central government policy imperative (ARHAs) led to ‘government at a distance’ responses, including the introduction of RAMs. The processes involved in shaping and delivering this function bore the hallmarks of a complex, interactive policy network model, involving individuals whose bearings and roles were flexible and sometimes ambiguous. While there were overlaps and blurring of boundaries, there were three levels of policy network: central government, regional and local. As the ‘network in the middle’, the RAMs were pulled in both directions by conflicting agendas but were also able to have an impact on central and local policy.

This chapter gives an overview of the development of UK drugs policy since the MDA 1971. After noting changes in the social context, three phases are identified: the turn to harm reduction; the drugs-crime agenda; and the move to recovery. Continuities and changes are noted in the perception of the ‘problem’ (HIV/AIDS, acquisitive crime and welfare dependence) and solutions proposed (expansion of treatment, partnership, localism and recovery). Current issues are highlighted including the effects of stop and search, imprisonment and the impact of austerity budgets.

This chapter introduces the themes of the book. Over a 40 year period, ‘drugs’ have become a more familiar aspect of British life and increased in importance as a social issue. There have been changes in patterns of drug taking. While heroin use has receded, use of novel psychoactive substances has increased. The drugs problem cannot be said to have gone away even if reported drug crimes are going down. What we see is a more complex pattern of use. This chapter introduces the key concepts and theoretical perspectives which will inform the analysis of the drugs policy process.

This chapter draws together the arguments of previous chapters, showing how ideas, interests and institutions interconnect and the ways in which evidence and reasoning can contribute. It looks at the current international situation regarding the debate on drugs policy. It considers key issues for British discussion on drugs today, such as drug-related deaths and NPS. The chapter discusses the potential for progressive reform in Britain and reviews proposals to place public health and wellbeing at centre. This chapter concludes that to make progress we will need to improve the way issues are debated and, in devising policies, we will need to recognise the links between drugs, culture and other social needs.

This overview report summarizes the outcome of Phase One of the Drugs Misuse Research Initiative, which was funded through the Policy Research Programme at the Department of Health. The views expressed are those of the author and are not necessarily those of the Department of Health. The brief summaries of key messages and findings from each project are drawn from their final reports and executive summaries, and from commentaries on and discussions of these reports. The selection of what are “key” findings and lessons for research, policy, and practice are those of myself, as author of the overview report, but derive directly from the substantial reports produced by project teams. I hope I have done justice to their work, while recognizing that the interpretation and contextualization are my own, as is responsibility for any errors. The authors of the executive summaries which follow the overview report are the project teams themselves.

(2004). Editorial: The department of health (policy research programme) drug misuse research initiative. Drugs: Education, Prevention and Policy: Vol. 11, No. 4, pp. 277-280.

Drug use among older people is a neglected topic. Not all older drug users are a social problem; they have varying needs and live in different situations within and between countries. Most policies focus on the young but numbers of older problem drug users are rising. There are high levels of unmet need and co-morbidity. Mainstream services will have to adapt to the changed profile of this population. A variety of proposals have been suggested by researchers and practitioners. There is a need to expand harm reduction services, provide services in the community and involve primary care physicians, encourage services to be more sensitive to the needs of this group, recruit and train staff appropriately, initiate innovations, link generic and specialist practitioners and coordinate health services with social care and housing provision. Key dilemmas are how to organise and finance services and whether these should be specialist or mainstream.

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK\ud Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and\ud a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts.

Summary The article offers a critical review of the debate on policy towards illegal drugs in the United States and demonstrates how discussion of the ‘drugs’ issue there is linked to perceptions of the condition of African-American people and to the contentious concept of the ‘underclass’. Alternatives to the Reagan-Bush policies include the extension of treatment options, possibly compulsorily, and pro-legalization arguments. The links between these perspectives and wider social philosophies and programmes are indicated. Ripples of the legalization debate are now felt in Britain and Europe. The paper concludes that understanding of the social problem of ‘drugs’ cannot be divorced from judgements about wider socio-cultural conditions and appropriate policies. US definitions of the problem and views of policy are not as yet the only options for Britain. A ‘third way’ is possible between neo-conservative and free-market approaches, that of a ‘new public health’.

International Drug Control: Consensus Fractured, David R. Bewley-Taylor, Cambridge, Cambridge University Press, 2012, 344pp, (pbk) £21.99 ($36.99), 9781107014978 (hdbk) £60 ($99), ISBN 978110764128...

Drink and the city: Alcohol and alcohol problems in urban UK since the 1950s, by J. E. McGregor, Nottingham, Nottingham University Press, 2012, 272 pp., ISBN 978-1-908062-85-7Jane McGregor's aim in...

SUMMARYThis article casts some light on a neglected area of the health and social services in Britain, namely provision for homeless, single men. It is shown that the services available are grossly inadequate to meet their needs. The paper uses results from a study of Camberwell reception centre which demonstrate that the absolute number of men having either a physical or mental illness who use the centre in any one year is much higher than had previously been calculated. The reception centre is unable to meet their needs which are principally for low-rent accommodation for single people and appropriate health care and social support.

This article discusses the particular characteristics of men with schizophrenia or personality disorder and it compares these two categories with one another and with the destitute population as a whole. On a number of variables, no significant differences are discerned, the category as a whole sharing a background of considerable material and social deprivation. However, with reference to place of birth, loss of mother, and father's occupation, significant differences do appear. The two categories also show distinctly different patterns in the process of becoming destitute and they use existing agencies differently. Finally, the type of service most suitable for these men is discussed together with other issues raised by the question, ‘How can we improve the lot of the homeless single person?’

Drug use is a common social activity, the motivations, methods and consequences of which are shaped by a variety of historical, cultural and political forces. Similarly, official responses to drug taking are influenced by those same forces, whether or not they are socially visible. It is beyond the scope of this chapter to analyse in detail how these social forces have operated over time or their level of impact on the development of treatment and rehabilitation policies. We simply describe current treatment and rehabilitation policies and ask if they represent a rational response appropriate to the realities of the 1980s and to the new wave of concern with heroin misuse in Britain.