Addiction Lives

On 18 January 2023, Virginia Berridge interviewed Viv Evans, Chief Executive of Afdam, for the Addiction Lives series. Here they talk about family drug and alcohol courts, workforce development via the Skills Consortium, and how Viv helped bring awareness to the ‘hidden harm’ of substance use to children.

Virginia Berridge: I’m going to do this interview with Viv Evans, who is the Director of Adfam, and Viv you have already filled in the questionnaire about your…

Viv Evans: I looked at that, I can’t remember what I wrote.

No, don’t worry because I’m going to probe you a bit more about some of those aspects. You mentioned, well perhaps you could start by talking about your background, because you started with the questionnaire where you worked in health promotion, but could you tell us how you came into the field?

I fell into it really, I think. I worked for the local authority and then the NHS as a Health Education Officer I was called, and this is back in the seventies and the main work I did was working in schools and youth clubs and some adult education, around health, sex education, including drug education. Then after several years there I had the children and then I got a national job working for an organisation, which sadly no longer exists, it seems to be a pattern, and I was the Deputy Director there, of an organisation called TACADE which was a national charity providing training for teachers and drug/alcohol curriculum materials for schools.

Oh yes, I remember that.

You remember TACADE?

Yeah.

The main part of my work was delivering training courses to teachers on drug and alcohol education, and it was very new at the time. We were training teachers in what is now called personal, social and health education – life skills. So, we were putting drug education and alcohol education within that context of helping young people to develop decision-making skills for example. Then I went to another organisation, which sadly no longer exists – DrugScope – and I had a post there, which was funded by the Department for Education and the Department of Health and it was a joint post with DrugScope and Alcohol Concern, again no longer with us sadly. I was the Head of Education and Prevention and after that I went to Adfam and I’ve been there for the last twenty years.

So was Adfam, when did Adfam start up?

1984.

Oh right, yeah.

So, I think I was the third or fourth chief exec and I knew of Adfam. I knew of the work that they did and obviously, because of my background in education and prevention, I was interested in the whole ‘families’ aspect of drug and alcohol use. It seems to have suited me, I’m still there.

Yeah, maybe you could explain for people who will be reading this interview, exactly what Adfam does?

Okay, Adfam is the national charity that supports and works with children, friends, and families affected by somebody else’s substance use. We work in three key areas. We provide training to a whole range of professionals around families, drugs, and alcohol – social workers, health and social care workers, people who work in the criminal justice system, treatment services, drug and alcohol treatment services. And we also run forums, professional forums, good practice sharing forums. We do a lot of advocacy, research, and what I call influencing and campaigning work. So, we are trying to essentially raise awareness of the issue, because family members are hidden in plain sight, they are very stigmatised, they don’t often speak out and so the families suffer huge impacts from living with/caring for, being affected by someone with a substance misuse disorder. A whole range of problems from mental ill health, through to domestic violence, lots of complex needs, lots of impacts and we try and advocate to raise the awareness of that, so that we can increase the support, and the number of support services. And thirdly we run services ourselves. We have some contracts with some local authorities to provide a whole family service and we also now have the national online ‘Adfam at Home’, which is a support service delivered by trained professionals online [by] zoom or on the telephone. Clients receive six sessions of emotional and practical support to help that individual cope with their situation. We have had a lot of success with that, it’s extremely popular, people don’t have to leave their homes, they can remain anonymous and that seems to be something that is attractive to people, and it’s also available at evenings and weekends. So, it’s a highly flexible, it’s an accessible service. So that is what Adfam does, those three areas of work.

And how had Adfam been set up initially?

It was set up by the mother of a heroin user.

Oh right.

And so, and we’ve stayed very much with that starting point, that philosophy, is that the word, that value of listening to, engaging with, being guided by people with lived experience. We had that tradition and we’ve kept that up both from a governance point of view with Adfam and also with all our surveys and our research and our roundtables, we always involve people with lived experience, hear their voices and try and advocate on their behalf, using their voices.

So, you said that was set up in the eighties, early eighties?

Adfam, yes, 1984.

And you became the Director in 2000 and?

[2002].

And has the work expanded? You know you’ve talked about what you’re doing currently, has the work expanded during the time you’ve been there?

Well, I think it, well in terms of our organisation, it’s expanded and contracted as all charities do, depending on funding. When I started, we had several contracts in prisons, particularly in London prisons, at the visitor centres. providing support to family members, who had got a loved one who was incarcerated because of drug use. Then we lost that funding in 2010. That was Home Office funding. It’s only recently that we’ve been able to make some estimates of the number of people affected – we commissioned two YouGov surveys and identified the number of people. One in three people have been affected by someone else’s substance misuse, at some stage of their lives and one in 10 currently. Its only quite recently we’ve been able to count the numbers. I think, the need is really increasing. There’s huge unmet need around supporting family members who are suffering the impact of somebody else’s substance use. And we know that there are huge numbers of people who feel like there isn’t any help, and if there were, they feel they haven’t got the confidence to accept that help anyway, because they feel that there is a prejudice against them. So, it’s that vicious circle really, Virginia, I think of what’s going on.

So where does most of the funding come from?

Our funding?

Yes.

We’ve got Lottery funding – it’s mainly trusts and foundations, but that’s getting increasingly difficult to source. There’s no government funding. Some contracts with local authorities.

Yeah. So, tell us how things developed over the last twenty years then.

At Adfam, well, as I said when I first joined, a lot of the work was in prisons, and we had a whole Criminal Justice Division and that petered out over the years. We had some core funding from Government at one stage. Then we had funding from various pots, for example we had a very, very big contract with the [Department for Education] to deliver training for family intervention projects – the training around families, drugs, and alcohol anyway. So, we had an expansion there. Then there was a contraction. Since then, we’ve relied on trusts and foundation funding, which is, for particular projects, for our advocacy work and for some direct services. And then over the last couple of years that funding from trust and foundations is getting increasingly difficult to access and so we have shifted our focus to selling, or trying to sell, ‘Adfam at Home’ to treatment services and to local authorities. Our strategy is to become more service delivery orientated. I mean we’ve done some fantastic projects, some of that with government funding. For example, we did a lot of work with training professionals to support families where they’ve got a child with foetal alcohol syndrome. We did some really excellent work in three local authorities with funding from the government’s ‘children of alcohol-dependent parents’ fund. But all that funding has now finished. So, we’re trying to be flexible, trying to be nimble, trying to respond and find resources from other places.

And you mentioned research as well as advocacy?

We base our advocacy on the reports of our research. We’ve just finished a report on non-dependent drinking and couple conflict. That was a piece of work that was part of our alliance – the Alcohol and Families Alliance – that Eric Appleby and I set up when Eric was at Alcohol Concern, so some while ago now. We set that up and we’ve got about 50 members – different organisations, individuals, and researchers. I think I mentioned the YouGov polls that we’ve done to give us some idea of prevalence. And then we conduct our own research. We are just doing a big survey at the moment and then going to do some roundtables and we’re asking family members to tell us about the impact of the current economic climate on their lives and living with someone with a substance misuse problem and what effect that is having on them. We’re also doing a ‘state of the sector’ survey. We want to find out exactly what’s happening in local authorities – are they providing services for families, and if so, what kind of service, what kind of support do they provide, is it peer group support, one to one, or something else? We conduct our own research, write it up, and then we use that ‘product’, as I call it, to try and do some parliamentary lobbying and advocacy.

And the local authorities must be looming much larger in what you do now.

Absolutely, and you know with the new money that’s been devolved to them, we are hoping that we might be able to benefit from some of that obviously. But family support isn’t always the top of local authorities’ lists. It was mentioned in the Dame Carol Black Report (1), probably not as much as we would have liked to be honest, not with as much emphasis as we would have liked.

Well, you mentioned that through that you became a member of the Advisory Council on the Misuse of Drugs, do you want to…?

Yeah, that was before I went to Adfam actually, and I was on the prevention working group and we produced “Hidden Harm” (2), which I think was a ground-breaking report. I am proud of that.

Explain…some people reading this won’t know about Hidden Harm.

Hidden Harm. It was the report into the impact of drug use – illegal drug use, not alcohol – on children, children of problematic drug users, what their lives were like, the prevalence, what was being done about them. It was the first time that issue had really been brought to public attention. It was certainly the first piece of major research that had been done. I remember becoming interested in it, and becoming aware of it when I was doing some workshop for teachers and they were mentioning that sometimes there were children left in the playground at the end of the school day, because their parents hadn’t picked them up, because their parents weren’t in a condition to do so. That sparked my interest and then it became, it was the topic of the prevention working group then from, I think from about the year 2000/2001. It was twenty years ago, but I think a lot of the findings and recommendations of Hidden Harm around how we can support children of drug users, is still extant and important.

What sort of conclusions did it come to?

Well, that children are only going to be helped and supported if the parents get into treatment. That was really one of the main conclusions and that we need to remember that the impact of substance misuse is not confined to the user. It has a huge impact on children, on safeguarding, socially, on a whole range of different services as well, and one of the key recommendations was that services should work together to support these children. It wasn’t just the remit of drug and alcohol treatment, or social services, or early years, health, or schools. And I don’t know whether this happens everywhere, but at local authority level, at a key strategy level, all those organisations, and professionals should be working together to deal with this issue. It’s everybody’s responsibility.

Yeah, yeah. Because there was a big debate at one stage wasn’t there about whether children should be taken into care, or not.

Yeah, yeah. And one of the points that we made in that report was that just because someone is using drugs, that doesn’t mean to say that their parenting is compromised. It may be, it may well be, but it’s not an automatic conclusion to be made and that social services needed to be wary of that. And we know that so many women are reluctant to go for help, because they are worried that their children will be taken away from them. So, all those balances have to be put in place by professionals, I think when they are dealing with this issue.

Yes. And did the report make a big impact when it…?

I think it did. People still talk about it and the term ‘hidden harm’ has become part of the vocabulary and means ‘children affected by substance misuse’. But it was one of the members of the committee [who] came up with the title when we were trying to think of a title, and it stuck and become coterminous with children affected.

And did it lead to a good impact in practical terms?

Well, I think it led to a much, much greater awareness. I think the children affected by substance misuse were recognised, have been recognised, and you see that running through, I mean not at the moment there isn’t any funding, there aren’t any funding streams from government specifically for these families and children, although there is support for broader areas of concern that could include substance misuse. But, a lot of the emphasis from government policy and initiatives after Hidden Harm tended to focus, not on adult family members, but on children and I think that is to some extent still the case. I think a lot of local authorities did appoint Hidden Harm leads, and did identify that they needed a coordinator, a lead person in the authority, to bring all this work together and that happened. I’m not sure if it still does, I don’t know. But I think certainly initially it had an impact in terms of the way local authorities were responding to it and the way government responded to it and I would like to think it still does.

Because you said you were Chair of the group which then…

I was Chair of the Implementation Group. Laurence Gruer was the Chair of the Prevention Group and then I was asked if I would Chair this Implementation Group and we tried to get, it’s somewhere, probably behind me on that shelf, examples of practice from local authorities and treatment services around how they were dealing with this and so many of them were. But you know that’s nearly 20 years ago now. And I need to, I think perhaps that is something I could do, ask the question, what’s happened to Hidden Harm?

Twenty years on…

It will be a good piece of work, a good piece of research.

Get somebody to fund that.

If only!

Yeah. And you said you were also chairing the committee, was this at the same time, which led to the pilot of the family drug and alcohol courts?

Yes, I chaired the advisory group for the family drug and alcohol court and that was funded by the Ministry of Justice, [Department of Health] and [Department for Education] and the pilot was in three London boroughs.

When was this?

Oh, probably about 2006/7/8 around that time. And that then took off. I mean there was [a] very, very positive evaluation that was commissioned, and now part of some local authorities’ provision is the family court.

Could you explain how that operates?

Well, it’s essentially, it’s the partnership between the court, the family court, and drug and alcohol services, and social services. And what it does, and this is, you know my key take home from it, was it actually was – the judge was supportive and would put in a whole package of support around, usually the mother, who was in court, because she was at risk of losing her children and rather than that happening, a package of support was put in. And the court took a very supportive and understanding non-judgemental role and so it was very much about really, really good support partnership working, enabling, ensuring that the court was a place where you didn’t have to be frightened and worried that the children were going to be taken away from you, but you would be actually given a whole wraparound service and that’s what happened. It was quite expensive because it involves a lot of people.

And that was three local authorities, the pilot?

Yeah, yeah in London.

In London, but there was funding for that at the time?

There was funding from government for that. It was a pilot, yeah.

And so, did that expand more generally?

Well as I say yeah, I mean I know there are, there was a family drug and alcohol court central hub and central organisation and then after the pilot, the job of that team, the central team, was to encourage local authorities to take up the family drug and alcohol court themselves, with support from the central team. I’m not sure how many local authorities are offering it now.

So that was local authority based?

Yeah the idea was that the pilot was funded by government and local authority input and some funding and then it needed to become a service that could be paid for by the local authority and be the responsibility of a local authority. That was the idea.

So, they have, some of them have taken that on, have they?

Yeah. I don’t know how many, but there are family drug and alcohol courts across the country, but I’m not sure exactly where.

Yeah. And then you talk about chairing another initiative, the…?

The Skills Consortium.

The Skills Consortium.

Well that was set up by the [National Treatment Agency for Substance Misuse (NTA)] and that was a group of us who wanted to promote the workforce – it was professionalising the workforce, simple as that and that is what that did.

In the drug and alcohol field?

Yeah, sorry, in the drug and alcohol field.

Because I think DrugScope had also done some work in that area hadn’t they?

Oh they, well DrugScope did QuADS – Quality Standards in Alcohol and Drugs Services. So, it was not dissimilar, you know, it was trying to disseminate all that good practice, bring people together to recognise good practice and professionalise the workforce, recognise that working with people with drug and alcohol dependencies is a profession and needs to be properly qualified and accredited and accepted.

And has that actually happened as a result?

I think so yes. I mean perhaps not enough. I mean Dame Carol Black’s report talks about the need to upskill the workforce, so there’s obviously still work to be done. But you know that, the same as, well the family drug and alcohol court, that money lasted and the funding for the Skills Consortium, you know it’s all short term and you get so far and then the funding runs out and you have to move on and things stop, or not. Unless they can get funding from somewhere else, but it’s always that short-termism that sometimes defeats innovation in our sector, well probably in every sector, but certainly in our sector.

Yeah, has there been a change since a lot of this moved into local government, under the public health changes?

I don’t know, Virginia, I don’t know. I’m not close enough to it, to that, I’m not close enough to that work, to know.

No, no. And then you mention you are involved in an international association?

Yeah, International Society of Substance Use Professionals. That’s a bit like the Skills Consortium, only an international one. It’s funded by the US State Department, and it hosts a website with a knowledge share. It provides a lot of webinars promoting research and good practice, sharing good practice on a global level. So that’s what that does.

Do you find that, is that useful to, has it brought…?

Yeah, I’ve found it very interesting. I find the, when I used to go to Washington to the meetings, and that all stopped with COVID obviously, the, some of the attitudes and the approaches that some of the American’s take, I find interesting. I met colleagues in America, who think ‘harm reduction’ means legalisation, for example. I’ve learned a lot about different approaches to substance misuse, I guess.

I remember, it struck me at another meeting that the French drug workers were all very kind of psychoanalytically…

Yes, they are.

They still are?

I think so, yes, they are. There’s far more of a, yeah, you’re absolutely right, yeah. But then (laughs) yeah, they are, you’re right.

Yeah, but I guess it’s always helpful to look across the countries?

Yeah, it is, it is, you know different approaches to all this and yeah it is, it’s fascinating and I learn a lot.

One of the questions we asked in the questionnaire was, what’s it been like working in the area, what have been the key facilitators and challenges?

Well, I think what I’ve just raised is one of them. There has been sometimes a polarisation of approach if you like. I mean you’ll remember the time when we had that sort of polarisation between abstinence and harm reduction, when there was an attack on methadone treatment. I think at one stage, and this thankfully doesn’t exist any longer, I don’t think, I’m very pleased to say, there was a real diversity, a real division in the sector between this harm reduction and recovery, which meant abstinence. You know there was a lot of friction at one stage about ten, eight/ten years ago and quite a lot of division in the sector around it.

People ‘parked on methadone’?

Yeah, that’s right people ‘parked on methadone’. And it became quite nasty at one stage, and I think it became a bit personalised. But I’m happy to say that I think there’s a lot of consensus now in the sector, a lot more understanding, partnership working and there’s obviously competition because it’s a market to provide services, but beyond that there’s much more consensus around approaches to dealing with people with a substance use disorder and supporting recovery. There’s a lot more emphasis which is to be welcomed on people with lived experience and I want the families work to be up there on that level of awareness.

Okay and we also asked you, who has influenced you, and in what way, during your career?

Oh, um well Roger Howard and Eric Appleby, because I learned about management and leadership from them. I think…

Roger was…?

Roger was my boss and Eric my boss, at DrugScope and Alcohol Concern. I think people like, when I was on ACMD, people like Joy Barlow.

Yes. Tell the listener who Joy…

Joy Barlow who initially in Scotland set up a residential care home for drug-using women and their children. Joy was on [the Advisory Council on the Misuse of Drugs] with me. I’m trying to think who else. Those are the people who spring to mind immediately. Annette del Pereira, with whom, I worked at DrugScope, who now is running a big agency in Qatar, I learned a huge amount from her about treatment, because when I went to DrugScope I knew nothing about treatment, but I learned a lot from Annette. Paul Hayes at the NTA, [who] I’ve always had a huge amount of respect for, and the way he led the NTA. Rosanna O’Connor who was at the NTA and, well it’s not the NTA now, but it was the NTA and various civil servants that I’ve worked with and other partners in the sector.

Yeah, and you said that Roger in particular and Eric, taught you how to lead an organisation, what were the key lessons in doing that?

(Laughs) Oh I think, maybe I’ve, you know you can learn as much, they’ll laugh when I tell them I’ve said this, but you can learn about how to do it by looking at how not to do it, can’t you? So there is always that element. But no, um, I think they were both always very, clear about people’s roles and responsibilities, would listen and there was never a culture of punishment or blame. You know everyone was, and this is what I try to inculcate at Adfam, everyone has a role to play, everyone knows what their targets are, what their work plan is, and they’re left to get on with it. If they have any problems they speak to their line manager, or if necessary to me, but I believe in people having autonomy, employees, people with, who have got initiative, who have got really good ideas, who want to take those forward, they don’t want me breathing down their neck every day, asking how they’re getting on and what they’re doing. They need to be able to get on with it, within a supportive framework and structure of an organisation. I think that’s what I learned and also the importance of having someone at the head of your organisation, who actually knows what they’re talking about in terms of the issues.

Yes.

I’ve always thought that was really important and organisations that don’t have that I think suffer, because you know you get invited to the top tables if you know what you’re talking about in terms of your organisation and who it’s for, its beneficiaries and the issues it involves.

Yeah, I guess people who are parachuted in as a kind of career move, tend not to do so well, don’t they?

Yeah, and may be brilliant at running organisations, but I think you need that combination of the professional technical expertise, if that’s the word, and the ability to lead and to manage and to know the difference between leadership and management.

Yeah. So how do you see things at the present, what are some of the issues at the moment and what do you think is likely…?

For Adfam, or generally?

Well, Adfam and generally.

Well, I think generally there is a big opportunity with the Carol Black report and the new strategy and the money that’s been devolved, I think that’s great, that’s not been around for a long time and that I hope will play out and will be helpful to people with drug and alcohol problems and their families and the whole sector. From an Adfam perspective it is increasingly difficult to get the money in. Trusts and foundations have got more and more demands on their, probably reducing coffers, so that’s difficult. So we know that there is a huge need for our services, but getting the money to meet the needs of our beneficiaries is difficult and that upsets and frustrates me, because I know there’s a huge need, a huge unmet need and you know I’m there to try and, I went into the charity sector, I went to Adfam, I went to DrugScope, because I want to help people and give them some support. I want to do something for somebody else and I can’t do as much as I’d like to because of constraints on the money. That is fundamentally it, Virginia, I think.

Yeah, and you mentioned at the start of the interview that many of the organisations that you’ve been involved with no longer exist, which, I guess…

That’s right, absolutely and that’s the same across, well certainly our sector, well certainly the family sector and others. A lot has gone to the wall I’m afraid.

Yeah, and I suppose COVID…

…didn’t help.

No, didn’t help. A lot of funding is going in the COVID-related field.

It is, yeah. Yeah, that’s right, absolutely.

So, what have I not asked you about that you think…?

I think you’ve asked me about everything! (Laughs) It’s interesting. Yeah, you have. You’ve asked me about the past and the future, and the present challenges I’ve mentioned. I still like it and the people. I am well over retirement age and people say to me, ‘what are you doing still working?’ and I say, ‘because I like it’. I like all the people I work with and the people that work with me at Adfam and all the colleagues and partners I’ve come across. I like the work, I like being able to, as I just said, feel I’m doing something for somebody and there are people who need Adfam. They don’t necessarily need me, but I get, I still get a huge amount of satisfaction from my job, a huge amount, despite the difficulties, despite the challenges, I still believe that we’re trying to make, at Adfam, make a change for people, make people’s lives better. And while I can, touch wood, I want to be there to do that.

Continue to do that, yeah.

Continue to do that.

Yes. Oh right, well I think, so you think we’ve covered most things?

I think so, yeah, I think that was comprehensive, yeah, I can’t think of anything else I’d like to, I can’t think of anything else to add, so yes, well done.

Editor’s note: This transcript of the interview with Viv Evans has been edited slightly from the original interview.

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