Key reading from Susanne MacGregor’s body of work, annotated by the author.
D. Tidmarsh and Susanne Wood, ‘Psychiatric aspects of destitution: a study of the Camberwell Reception Centre’, chapter 21 in Evaluating a Community Psychiatric Service, (eds) J. K. Wing and Anthea Hailey, Oxford University Press, 1972, pp 327-340.
The book is an account of the development of a model psychiatric service in the Camberwell area of south London. It recorded the results of ten years’ evaluative research carried out by the MRC Social Psychiatry Research Unit at the Institute of Psychiatry.
This chapter describes the numbers using the centre, the predominant type of disability or problem, demographic and social characteristics, and the slide into destitution, followed by a discussion. The conclusion was that the situation at the reception centre acts as an ever present reminder of what may be the fate of those who slip through the net of community services.
The chapter was based on ‘Report on Research at Camberwell Reception Centre’ by David Tidmarsh and Susanne Wood assisted by Valerie Mooney. The Report’s chapters covered History of Casual Wards and Reception Centres, Review of the literature on common lodging houses and homeless single persons; Aims and methods; Social background; Psychiatric illness; Other psychological and physical handicaps; The unsettled way of life; Use of reception centres; The present availability and need for further services for reception centre users; and Recommendations. There were also five appendices and a bibliography.
Other articles based on this research include: ‘Camberwell Reception Centre: a consideration of the need for health and social services of homeless single men’ Journal of Social Policy, no.5, 1976 pp389-399 1976; and ‘The social conditions of destitution’ Journal of Social Policy, 1979, no.8. pp. 207-226.
Susanne MacGregor, The Politics of Poverty, London: Longman, 1981.
This book was published in a series edited by Bernard Crick and Patrick Seyd titled Politics Today. The series aimed to meet a demand among the general public as well as students for books that deal with the main issues of modern British politics in such a way that the reader can gain a reliable account of how an issue arose, of its institutional context and then have an argument about what should be done. The book was widely reviewed. It pointed to the rediscovery of poverty but also its neglect in British politics in spite of the efforts of pressure groups. Chapters looked at the development of the welfare state and recent history including the battle of ideas and channels of influence. It identified changes in politics and perceptions which heralded an attack on the welfare state and emergence of what later became known as Thatcherism.
Other publications on the theme of poverty and the welfare state include Social Issues and Party Politics (edited Helen Jones and Susanne MacGregor), London: Routledge 288pp 1998 with chapters ‘Taxing and spending the people’s money’ pp 39-55 and ‘A New Deal for Britain?’ pp248-272. Further publications have looked at ‘problematic communities’ and ‘social exclusion’.
Anne Jamieson, Alan Glanz and Susanne MacGregor, Dealing with Drug Misuse: Crisis intervention in the city, London: Tavistock, 1984.
This book grew out of the research conducted at City Roads – an experimental unit providing for the immediate needs of young multiple drug misusers who frequently overdose and may present at hospital A&E departments. Chapters reviewed the process of planning the service, including defining the problem; the service in practice – a focus on ‘difficult clients’ and the development of multidisciplinary professional work – and barriers to policy implementation. Based on close observation, this is a unique in-depth assessment and discussion of issues still relevant today.
Susanne MacGregor (editor), Drugs and British Society: Responses to a social problem in the 1980s, London and New York: Routledge, 1989.
This edited collection adopted a social rather than medical perspective on drugs and emphasised that policy and practice should be based on reliable and detailed evidence and the informed judgements of people with a thorough understanding of the issue. ‘Drugs’ was placed in historical, social and political context. Chapters included ‘The public debate in the 1980s’ pp1-19 and ‘Choices for policy and practice’ pp170-200. Other contributors were Virginia Berridge, Richard Hartnoll, Martin Plant, Lee O’Bryan, Angela Burr, Betsy Ettorre, Stephen Tippell, Robert Power and John Strang.
A related publication was ‘Could Britain inherit the American nightmare?’ in British Journal of Addiction 1990, 85: 863-872 which compared British and American perspectives, noting the condition of African American people and the emerging concept of the underclass, and concluded that understanding of the social problem of drugs could not be divorced from judgements about wider socio-cultural conditions and appropriate policies. It concluded that a third way was possible between the legalisation and War on Drugs approaches, that of a new public health.
Susanne MacGregor and Ben Pimlott, (editors) Tackling the Inner Cities: the 1980s reviewed and prospects for the 1990s, Oxford: Oxford University Press; 1990.
On the night of her election victory in 1987, Mrs Thatcher declared that tackling the inner cities would be a major goal of her third term. This edited collection reviewed the government record over the decade of the 1980s and concluded that the effects of government policies – including in education, housing and local government – had been largely negative. The chapters provided evidence of increasing tension and social polarisation. Contributors included John Benyon, Franco Bianchini, John Gibson, Hilary Land, David Mallen, Doreen Massey, Nick Raynsford, Robert Reiner, John Solomos and Peter Townsend. Other chapters were ‘Action and Inaction in the Cities’ by Susanne MacGregor and Ben Pimlott pp 1-21; and Susanne MacGregor ‘’The inner city battlefield: politics, ideology and social relations’ pp 64-92.
Other research and publications in the field of urban issues include ‘Reconstructing the divided city: problems of pluralism and governance’ in Managing Divided Cities Fulbright Papers edited by Seamus Dunn , Ryburn, Keele University Press 1994 pp 228-243; ‘’Social policy and the city’ in The Handbook of Urban Studies edited by Ronan Paddison, Sage 2001 pp 351-366; The Other City: People and politics in New York and London (edited with Arthur Lipow) Humanities Press 1995; and Transforming Cities: contested governance and new spatial divisions (edited with N Jewson) London: Routledge 244pp 1997 (reprinted BSA 2018) with chapters from among others David Harvey, Bob Jessop, John Lea, and Janet Foster.
Susanne MacGregor, Betsy Ettorre, Ross Coomber, Adam Crosier and Harriet LodgeHarriet L, Drugs Services in England and the Impact of the Central Funding Initiative, ISDD research monograph series, London: ISDD, 1991.
This monograph summarised the main findings from the research on the Central Funding Initiative. The CFI was the government’s main response to the ACMD 1982 Report on Treatment and Rehabilitation. The key finding was that the CFI radically changed the landscape of drugs services in England. The £17.5 million pump priming programme was crucial in adding a layer of community services to the previous pattern of hospital and residential provision. Seven out of ten then existing services were established after 1984. One third of 323 dedicated drugs projects were developed with CFI grants. Almost half of agencies were in the statutory sector and the remainder in the non-statutory and private sectors. There were 1656 full time and 490 part time workers. The research found variation between regions and local areas in the extent and type of services available. This diversity did not however indicate choice at local level. The existence of the new network of community agencies influenced the speed and nature of the response to the link between injecting drug use and HIV/AIDS.
Other publications on the CFI include ‘Paradigms and practice in drugs services in England’ in The International Journal on Drug Policy Vol 3 No 1 Spring 1992 pp 16-27 and ‘Promoting new services: the central funding initiative and other mechanisms’ in Heroin Addiction and Drug Policy: the British System (ed) John Strang and Michael Gossop, Oxford University Press 1994 pp 259-269.
Susanne MacGregor, Lynne E Smith and Peter Flory, The Drugs Treatment System in England: report on a mapping exercise for the Department of Health Task Force to Review Services for Drug Misusers, Social Policy Research Centre, Middlesex University, 1994.
Information was collected for the Polkinghorne Review on the formal definition of each service, the actual service interventions, the mission of the unit, staffing and client group. Types of services identified were: residential rehabilitation; DDUs and clinics; in patient treatment and detoxification in public hospitals or private clinics; community based treatment centres; community drug teams; drugs counselling and advice centres; needle exchanges; GPs; and self help groups. Regional differences were noted. 454 dedicated drugs services were identified. Four out of ten were funded solely by health authority funds with the others deriving funds from more than one source. Half were in the statutory and half in the voluntary sector. Staff profiles were reviewed. Interventions ranged over assessment, counselling and therapy, detoxification, prescribing, methadone maintenance, residential rehabilitation and 12 step recovery programmes. Prescribing might be for 6-8 weeks for detoxification, for up to six months for a gradual withdrawal, and from 18 months to five years or more for maintenance regimes. The estimate of the size of the current client population accessing drug treatment was 80,000.
Other publications from this study include ‘The English Drug Treatment System: Experimentation or Pragmatism?’ in Drug Treatment Systems in an International Perspective: drugs, demons and delinquents edited by H Klingemann and G Hunt, Sage ,1998, pp 69-80 and ‘Drug treatment systems and policy frameworks: a comparative social policy perspective’ in European Addiction Research (1999) Volume 5: 118-125.
Publications relevant to this phase of drugs policy include ‘Tackling Drugs Together: Ten Years On’ in Drugs: education, prevention and policy (2006) 13/5: 393-398 and ‘”Tackling Drugs Together”’ and the establishment of the principle that “treatment works”’ in Drugs: education, prevention and policy 2006 13/5: 399-408.
Karen Duke and Susanne MacGregor, Tackling Drugs Locally, London: Stationery Office 1997.
This was an interim assessment of the development of 105 Drug Action Teams in England. DATS were expected to assess their local drug problems and the effectiveness of their current responses. They were expected to work towards improving the coherence of the policies of the various single agencies represented on the DAT and pursue the national objectives of the 1995 White Paper Tackling Drugs Together. They set up Drug Reference Groups to act as a forum to exchange ideas, share good practice and involve local communities. The research found that DAT and DRG structures had been established in all areas; the most influential agencies were health and the police, with local authorities and the probation service also playing key roles; six of ten were involved in joint commissioning and half had pooled resources; DATS had improved relations between police/criminal justice agencies and health and other services; drugs had been lifted up as an issue on local agendas; context was influential especially: the extent of deprivation locally; whether metropolitan or non-metropolitan area; the size and shape of the drugs problem; and the nature of previous partnership alliances. The majority of respondents wanted to see DATs continue.
Other research on developments locally include S MacGregor ‘Reluctant partners: trends in approaches to urban drug-taking in contemporary Britain’ in Journal of Drug Issues (1998) volume 28 (1) 191-204 (guest editor Robert Power)); S MacGregor, L Smith and K Duke, Activating Local Networks: a comparison of two community development approaches to drug prevention, London: Home Office-Drugs Prevention Initiative 1996 132pp; M Shiner, B Thom and S MacGregor Exploring community responses to drugs, Joseph Rowntree Foundation 2004 62pp; and S MacGregor and A Thickett ‘Partnerships and communities in English drug policy: the challenge of deprivation’ International Journal of Drug Policy 2011 Vol22, Issue 6, pp478-490.
Susanne MacGregor ‘Welfare, Neo-Liberalism and New Paternalism: Three Ways for Social Policy in Late Capitalist Societies’ in Capital and Class, Special Issue: Global Capitalism: Riding the Storm? Spring 1999, Volume 67, pp 91-118.
This article gives an overview of three tendencies in advanced capitalist societies with regard to social policy. The article characterises the phases of welfare state, neo-liberal and new paternalist and shows how each is a response or reaction to what went before.
This continued earlier interests in social security changes over time. Other publications on related themes include ‘Modernization or insecurity? Labour market deregulation and state retrenchment: the British case’ in Employment and Citizenship in Britain and France edited by J Edwards and J P Revauger, Ashgate (with T Cutler, P James and B Waine) pp 75-93 2000; and ‘Neoliberalism and the welfare state’ in Neoliberalism: a critical reader edited by D Johnston and A Saad Filho, Pluto Press 2005 pp142-148
Susanne MacGregor (editor), Responding to Drug Misuse: Research and Policy Priorities in Health and Social Care, Routledge, 2011.
This book brought together research findings from the Department of Health’s Drug Misuse Research Initiative which was linked to the government’s ten year drugs strategy Tackling Drugs to Build a Better Britain. The chapters place the findings in the context of policy, practice and service development. Contributors reflect on current debates for drug strategies. Topics discussed include recent trends in drugs policy and how these link to crime; responses of dedicated drug treatment services; service users’ perceptions and suggestions for improvement; and the impact of drug misuse on children, families and communities. Contributors include Karen Duke, John Macleod, Duncan Raistrick, Gillian Tober, Christine Godfrey, Tim Weaver, Nicola Metrebian, Michael Donmall, Tim Miller, Polly Radcliffe, Alex Stevens, Joanne Neale, Christos Kouimtsidas, Colin Drummond, Michael Crawford, Sue Patterson, Kostas Agath, Vikki Charles, Martin Frisher, Ilana Crome, Jim Orford, Alex Copello, Daniel Clay, Judy Corlyon, Brynna Kroll, and Andy Taylor. Chapters discuss patterns of drug taking and use of services, care coordination, waiting for treatment, early exit from treatment, barriers to effective treatment of injecting drug users, prescribing injectable opiates, CBT, service user involvement, comorbidity, services for BME families, parental drug misuse and services for their children.
Other publications from the DMRI include ‘Messages and Findings from the Department of Health Drugs Misuse Research Initiative: Final Overview Report’ Drugs: education, prevention and policy Volume 12 Supplement 1 December 2005 ISSN 0968-7637 pp1-55
Susanne MacGregor, ‘Barriers to the influence of evidence on policy: are politicians the problem?’, Drugs: Education, Prevention and Policy, June 2013, 20:3, pp 225-233.
The question of the extent to which policy is influenced by evidence is a central one for most researchers in the addictions and social policy fields. Researchers feel frustrated that their findings are not immediately acted upon. This article took up this question and focused on how politicians in the UK have viewed the drugs problem and the relative influence on them of values and evidence. The context is seen to be one where over-arching narratives play a dominant role and in this the mass media are important. Many politicians see drugs as a toxic issue, best avoided. Where drugs have appeared on the political agenda, the issue has been used as a weapon in a political game.
A related issue is how far research can influence policy ‘below the radar’ working with intermediaries like civil servants. This was discussed in ‘The Impact of Research on Policy in the Drugs Field’ Methodological Innovations Online 2011; 6 (1): 41-57. Other publications have looked at the evidence-policy connection, including International and Interdisciplinary Insights into Evidence and Policy edited L Hantrais, A T Lenihan and S MacGregor, Routledge, 2016 Academy of Social Sciences, Contemporary Issues in Social Science Series 138pp.
Betsy Thom, Susanne MacGregor, Christine Godfrey, Rachel Herring, Charlie Lloyd, Jordan Tchilingirian and Paul Toner, ‘The Alcohol Improvement Programme: evaluation of an initiative to address alcohol-related health harm in England’, Alcohol and Alcoholism, 2013 48:5, pp 585-591.
This article described the main findings from the EVALUATION OF THE ALCOHOL IMPROVEMENT PROGRAMME, Report to the Department of Health (Policy Research Programme) 2012 200+pp. The Department of Health’s Alcohol Improvement Programme (AIP) ran from 2008 – 2011. It aimed to address alcohol-related harm at regional and local level and to reduce what had been identified as a worrying increase in the rate of alcohol-related hospital admissions. The AIP was a multi-component programme, consisting of: the Central Policy Team at the DH; Regional Alcohol Managers/Offices in each region; an Alcohol Learning Centre; an Alcohol National Support Team; the North West Public Health Observatory; 20 Early Implementer PCTs; and seven High Impact Changes (HICs).
The AIP was a complex intervention operating in different local environments, with their particular complexes of health and social needs, prior policies and funding structures. The evaluation raised questions about the utliity of ARHAs as a measure of impact. Alcohol misuse has a large economic cost, then estimated at over £20 billion annually. Total direct expenditure on the AIP programme was £7.7 million in 2008/9, £9.8 million in 2009/10 and £4.9 million in 2010/11.
An interesting finding was that the ability to frame arguments in the language of money and cost savings was a critical factor within the politics of local negotiations and commissioning. The AIP played a major role in bringing health to the foreground following a period when criminal justice perspectives on alcohol-related harms had dominated the policy and public discourse. While there was no clear short-term impact on the rise in the rate of alcohol-related hospital admissions, the AIP set up a strategic response and a delivery infrastructure as a first step in working towards that goal. Unfortunately, with a change in government this was dismantled.
Other publications from the AIP include ‘Perceptions on the role of evidence: an English alcohol policy case study’ Evidence & Policy 2014 vol 10, no 1: 93-112 and ‘Soft methods, hard targets: regional alcohol managers as a policy network,’ Journal of Substance Use, 2014 19 (4), pp.319-326.
Susanne MacGregor, ‘Public health approaches to substance use: a critique’, in T Kolind, B Thom, and G Hunt (eds.), The SAGE Handbook of Drug & Alcohol Studies: Social Science Approaches, Thousand Oaks, CA: SAGE, 2016, pp. 628-643.
The handbook covers the shifting terrain of drug and alcohol studies from history and theory to emerging approaches to public policy. This chapter shows that there are a number of differing understandings of ‘a public health approach’ which vary across drugs, tobacco, alcohol and other substances as well as across time and place. The chapter addresses key concepts and key characteristics of public health, theories of social determinants, the new public health, total consumption theory and total population policies, the paradigm of drinking patterns or cultures, harm reduction, and tobacco control. While there are shared goals, core concepts and characteristics, there are also competing priorities within public health. Underlying issues refer to the role of the state, respect for science and the authority of professionals.
Related publications have looked at European drug policy and the place of harm reduction within this and considered the value of a European Union Drugs Strategy.
Susanne MacGregor, ‘Universalism and Health: the battle of ideas’, in Towards Universal Health Care in Emerging Economies: opportunities and challenges, Ilcheong Yi (ed), UNRISD Social Policy in Development Context series, Palgrave Macmillan, 2017, pp 61-8.8
This collection explores factors influencing the move towards universal health care in eight emerging economies. It presents the findings from a programme of studies conceived in partnership with the World Social Forum on Health and Social Security and the Public Health Movement in Brazil. The chapter reviews the rise of universal health care as an affordable dream, the idea of a universal right to health, arguments for and against universalism in health care, ideas of social investment, the influence of context and conditions, drivers of change, working with health systems variation, state capacity and new challenges.
Susanne MacGregor, The Politics of Drugs: Perceptions, Power and Policies, Palgrave Macmillan, 2017.
This book explores the complexities of drugs policy in Britain, focusing on developments since the Misuse of Drugs Act 1971. It covers debates at national level and local experiences, set in international and European context. Institutions and networks are examined to illustrate their roles as vehicles for ideas and interests within the policy process. The roles of key actors – including politicians, media and advocacy organisations – are analysed as well as the influence of evidence in shaping policy.
It summarises reflections from years of research and involvement in the drugs field as well as research conducted specifically for this book. Other publications over time have looked at drugs policy, including chapters in books edited by Nicholas Dorn, Nigel South, Renaud Colson, Henri Bergeron, P Anderson, G Bühringer, J Colom and N Singleton. Also on this theme is a chapter Susanne MacGregor ‘Pragmatism or principle? Continuity and change in the British approach to treatment and control’ in The Control of Drugs and Drug Users: Reason or Reaction edited by R Coomber, Harwood Academic Publishers (1998) pp 131-154.
Susanne MacGregor (2019), Money matters: Resource allocation, alcohol and other drugs and neo‐liberal austerity in the UK—Commentary on Ritter and van de Ven. Drug Alcohol Rev., 38: 125-126. doi:10.1111/dar.12901.
This article is a commentary on an innovative article by leading Australian researchers but also provided the opportunity to highlight the dramatic and deleterious changes happening in the English drug and alcohol treatment system currently as a result of restructuring, managerialism and austerity.