November 1, 2024 • 27 mins
In this episode of the Rural Homelessness Podcast, host Matt McChlery discusses the intricate relationship between rural homelessness and addiction with guests John Heathorn and Coryn Price. They explore how addiction can both contribute to and result from homelessness, the importance of tailored support services, and the challenges faced in rural areas regarding access to addiction treatment. The conversation emphasizes the need for a holistic approach to recovery, focusing on individual needs and the importance of timely access to services.
Links
Takeaways
- The relationship between homelessness and addiction is complex and not always causal.
- Long-term homelessness can increase the likelihood of addiction issues.
- Providing stable housing can significantly reduce addiction problems.
- Support services must be tailored to individual needs for effective recovery.
- Mental health issues often accompany addiction in homeless individuals.
- Rural areas face unique challenges in accessing addiction services.
- Alcohol is more prevalent in rural homelessness compared to urban areas.
- Zero tolerance policies in shelters must balance safety and compassion.
- Recovery is a journey that may not always lead to complete abstinence.
- Timely access to services is crucial for those seeking help.
Chapters
00:00 Introduction to Rural Homelessness Podcast 01:58 Understanding the Complex Relationship Between Addiction and Homelessness 10:25 The Role of Support Services in Recovery 20:30 Managing Drug Use in Homeless Shelters 24:24 Improving Access to Addiction Services in Rural Areas
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:06):
This is the Rural Homelessness Podcast, where we discuss the important issues around ruralhomelessness, hear from those affected by it, and offer some solutions.
Brought to you by the award-winning homelessness charity, The Ferry Project.
Welcome to the Rural Homelessness Podcast.
(00:29):
Hello and welcome to this edition of the Rural Homelessness Podcast.
I am your host Matt McChlery Thank you so much for joining me on this episode today.
It really means a lot when you click over and join us for a conversation around the topicof rural homelessness.
Now before we get into today's episode, I just wanted to quickly let you know that we nowhave a mailing list and that you can sign up and it will notify you each time we publish a
(00:55):
new episode of this podcast.
If you want to join us, just click over to our website ferryproject.org.uk and go to theContact Us page where you'll find a button you can click to sign up to our mailing list.
Now, onto today's show.
I'm speaking with two guests who we have spoken to about other topics previously on theshow and that is John Heathorn, who is the Night Services and Rough Sleeper Initiative Hub
(01:23):
Manager from The Ferry Project, and also Coryn Price.
who is a dual diagnosis practitioner and a community psychiatric nurse.
Today we are discussing the topic of addiction and talking about how rural homelessnessand addiction have a complex relationship.
It's not as straightforward as we might think and the conversation sheds some light onthis often misunderstood relationship between addiction and homelessness.
(01:53):
So let's welcome John and Coryn to the show.
So let's welcome John and Coryn back to the show.
You've both been on before in previous episodes.
So hi John, welcome back.
Hi there Matt, hi Coryn.
Hi Coryn.
Hello, nice to see you both.
Yeah, welcome back to the podcast.
(02:14):
It's great to see you both again.
Now today we're going to be talking about rural homelessness and addiction.
Before we get down into the nitty-gritty of our discussion,
Let's just first of all, can you just tell us what your role is within the Ferry Projectand who you are and kind of where you fit into what goes on?
(02:38):
Yeah, so I managed across everything from the outreach work at present, which is kind ofhelping out with the hub, which is the pathway to homelessness and homelessness
prevention.
And also the night provision that we provide, which then comes for the severe weatheremergency provision we provide through the winter months to people that have not got
(03:06):
accommodation.
Great, thanks.
And Coryn?
So I'm a community psychiatric nurse and I work with the dual diagnosis street Project,which is a Project set up alongside the rough sleepers initiative, Fenland district
council and the Ferry Project
kind of co-commissioned that way.
So I work alongside John and the rest of the Project staff and try and support thosewho've got mental health issues, drug and alcohol issues and basically anybody who
(03:37):
requires support from that perspective and do some long interventions with them andlong-term work potentially if they're at the Ferry for a long time.
So Coryn, let's talk about the topic that we're looking at today which is homelessness and
addiction.
Now it seems to be a fairly obvious topic to address on the podcast because many peoplehave a perception that all homeless people have an addiction problem of some kind.
(04:02):
Is this true?
I wouldn't say that it was a complete fact, but obviously the relationship betweenhomelessness and substance abuse use is a very strong relationship.
And I think sometimes it kind of binds people together in that kind of life of uncertaintyand instability.
A lot of homeless people will clearly
move towards the subculture to make them feel part of something.
(04:25):
There's a clear association between dependents and amongst the time someone spendshomeless.
So if you look at that kind of relationship, I think we do see a lot of people who arehomeless that do present with drug and alcohol issues.
But I think that becomes more of an issue the longer time they're homeless.
Because as soon as they get that stability, for instance, with the Ferry or they get somesort of form of accommodation,
(04:49):
we do see that change and that shift.
And essentially, I wouldn't say it's a complete link, a causal link, but I do think itpresents more and becomes more prevalent because there is a subculture that develops,
which makes it look like it's worse, if that makes sense.
That's interesting what you say.
(05:09):
Have you seen this, John, with what you do, where the longer someone is homeless, thelikelihood of them having an addiction
issue is heightened.
So for me, know, I've had addictions and that in the past, but they've most certainly beenput to bed prior to me returning to the streets.
(05:36):
Now in in prison, heroin is commonly known as a bird killer.
by
by calling it a bird killer, it kills the time that you have to serve because it justtakes away days and days and days, you lose days.
So heroin is quite frequently used in order to just numb out the despair, the heartacheand the pain and the uncertainty.
(06:03):
And you find that on the streets.
So we find that people that are coming in and people that we're dealing with on thestreets, their addictions are probably not their heist.
And yet we see once you provide somewhere for someone that's safe and something that theycan call their home, we often see and I don't mean just often, it's quite common to see
(06:29):
that that addiction will come down tenfold within at least the first six weeks.
Absolutely.
I agree with what John just said as well.
think going back to the prison system,
we do find, we saw a big shift when the mandatory drug testing changed as part of sentenceplanning, a lot of offenders who were in custody would be subject to mandatory drug
(06:56):
testing.
And we all know that heroin use doesn't stay in the system as long as potentially cannabisuse does.
So there was a shift in the drug use and that kind of, that spilled out onto the streets.
So where you had your kind of standard alcohol users or somebody who smoked cannabis,because they'd
got into that rhythm and that, as John said, that bird killer in jail, there was a shiftin the substances which then spilled out to the streets.
(07:22):
And yeah, I agree, totally agree on the prison aspect of it as well, which we do see a lotof people who've come from custody who are potentially homeless.
And you said, John, that within the first, how many weeks was it?
Within the first six weeks.
Within the first six weeks, you see a dramatic change in that.
So,
(07:42):
That means that the person was probably going to go through withdrawal and everything elsewhilst they are with you.
How does that look like?
How do you manage that?
What support gets put in place to help someone who is probably going to go throughwithdrawal?
us, the first assessment is very short.
(08:04):
It's to assess their basic needs.
Mental health follows hand in hand with those addictions.
regardless of whether you had mental health before, because I certainly didn't have mentalhealth until I hit the streets and that trauma caused that mental health.
Here at the Ferry, what we ask, the only thing we ask is, are you willing to engage?
(08:27):
Okay, we're not going to judge on your drug or your alcohol use at point of entry, becauseat point of entry, if we did that, you'd all be too high risk and you'd all be too high
support.
We just ask that you want to change and you want to be given that opportunity to change.
So the first thing we do is we wrap that support heavily around.
(08:50):
They will be directed straight to CGL, one of our partners that we work closely with.
Karim will be immediately involved.
And then we also get our local GP surgery involved to assess their physical health.
I think with the Ferry, it's very seamless.
Like John said, that the kind of initial assessment is to understand exactly what'srequired and exactly it's not just about the addiction side of things.
(09:15):
It's psychosocial, it's about financial aspects.
I think when you ticked all those boxes that kind of feed into that sort of despair andthat kind of feeling of going nowhere and not being able to move forward, once you start
to wrap around and tick those boxes,
The kind of substance misuse sort fades into the background and becomes part of somethingelse so that they can manage that like John said with CGL, which is the local drug and
(09:39):
alcohol services.
And then the psychosocial interventions take place.
So for instance, you'll start to work on their own self and you'll start to work on whythey're using substances and what moving forward can be done to manage that not going back
to where they were before.
So I think that John said the wraparound is really important when someone comes off thestreets and it's not just to say, right, you're on drugs or you're using alcohol.
(10:02):
It's about looking at the holistic aspect of that person to make sure everything is done.
That's really interesting.
So what other things might be looked at rather than just saying, well, you're addicted tothis, you you need to stop or whatever.
How does that work?
The sort of the wraparound.
I know it's different for each individual, so it's a bit tricky.
(10:25):
It's very bespoke.
think that's what the Ferry very good at is making the bespoke work to be done.
It's very client-centered and I think because a lot of the work we do is trauma informed.
A lot of people who've come through the service have had a history of trauma.
So the trauma informed approach can be, the trauma could have just been being homeless,but there's also other things that need to be managed as well.
(10:48):
So like I said, going back to the psychosocial interventions, you're not just looking atthat person's addiction, you're looking at it as a whole package.
And that's really important to make it really client-centered and making sure that it'snot a one-size-fits-all service.
There's lots of different caveats to people's management.
What comes first?
As we said, a higher percentage of homeless people, especially if they've been homelessfor a certain length of time, usually have addiction issues.
(11:17):
So what comes first, the addiction or the homelessness?
That's likely.
ask like the chicken and the egg question.
Yeah, because people can lose their accommodation and find themselves homes throughaddiction.
You know, that be drugs, whether it be alcohol, whether it be gambling.
(11:40):
And that then puts their, you know, their houses and their homes at risk, and then theyfind themselves on to the streets.
Or you can find people go to the streets that they install participating.
in the drugs.
They may have started off on the streets on a what we call like a low-grade recreationdrugs such as cannabis, cocaine you know is is is prevalent that is something that people
(12:10):
are highly addicted to and it's very quickly becomes addictive.
So it's one of those we see variation of people that have lost you know whether that bigrelationship break down whether
you know, whether that was an addiction that lost them their accommodation, go to thestreets and then use drugs that they've never been known for using.
(12:33):
From a dual diagnosis perspective, I think a lot of the time I get faced with the factthat people with mental health issues and substance misuse issues, that they can't,
they're subject to a lot of rejection due to the fact that like you just said, what comesfirst.
A lot of people will use drugs or alcohol to manage that disparity, to manage that
the uncertainty of their lifestyle, the disconnection from their families.
(12:56):
But then the addiction might have been there before.
There's never a kind of a clear pathway for any certain person.
A lot of people may use the gateway drugs as youngsters.
It's about peer pressure and then they start to form other peer group circles where theyuse different drugs.
And then due to the fact they're in addiction, they may lose their property, they may losetheir jobs.
Their mental health might change due to the drugs.
(13:20):
It changes for everybody.
don't think there's a set standard for whether or not it's what comes first.
And I think the kind of code, the co-occurring issues we have at the moment with people onthe streets that come through the Ferry, they could have been the vast majority of the
professionals.
could have been in very, very good jobs, come from big, come from families where there wasa real safe structure.
(13:42):
And then all of a sudden that's gone.
And they realize actually, do you know what?
I can manage my lifestyle easier if I'm with a group of people that use drugs and takethat pain away.
So yeah, there's no set standard for what comes first.
It's how we deal with it is the main priority.
Very good.
Do you think addiction issues are more prevalent in rural areas compared to urban areas oris the pattern similar?
(14:09):
I think, rurally it's more hidden.
think we've talked to, we've discussed this before and I think it's a more of a hiddenharm.
don't, it's not as in your face.
I don't think services are as accessible as they are in urban areas.
So you tend to miss a cohort of service users that potentially might be hidden away.
Urban areas do tend to have more accessible services that are easily located, easilyaccessed by trains, buses, whatever, walkable.
(14:39):
Sorry, does that change the maybe the type of drug people have access to or is it fairlywidespread?
Whatever drug is causing
big issues sort of on the streets of London or Cambridge say is also doing a similar thingin rural areas such as Whistbeach or is there a difference in that?
(15:00):
I suppose it's what's accessible and I think, rurally, think there's more, I think alcoholis more prevalent in rural areas because you've got a demographic that includes street
drinkers and people who live in small collective areas.
Research, don't suppose there's that much research on the different kind of drugs that areused, but I know urban is more heroin and crack cocaine.
(15:22):
But then that's starting to spill out now into more rural areas because obviously there'sthe shifts, the shifts in patterns of what drugs are actually highlight of the month, I
suppose.
I don't know if you see any differences, John, in terms of that.
Yeah, we see the pattern shifts and this all comes across from county lines.
(15:42):
But from a drug dealer's perspective, the best customer to have would be crack cocaine.
So if you can start bringing the heroin in quite cheap, heroin and crack cocaine go handin hand.
It's very unusual to find someone that only does one or two, but it will start off withsmoking crack cocaine.
(16:07):
And people don't realize because they're smoking it how addictive it is.
So cocaine has been known as a sex drugs and rock and roll recreational party drug thatmany people back in the day have participated with.
You see it in lots of 80s movies, don't you?
kind of thing.
Yeah.
And he stood out there.
(16:29):
then all of a sudden, someone discovered that they could wash it up into a rock and it'dbe smoked.
And that was one of the worst things that happened.
More addictive than any other drug.
and there is no substitute for it.
You cannot be medicated for crack cocaine.
You cannot be given Subutex.
You cannot be given methadone.
(16:52):
It's one of those that are very difficult to stop once you've started.
It's kind of on trend as well, isn't it?
I think it's what's available and you do get, like John said, when county lines have beenstopped, the drugs trend changes.
in the 80s, early 90s, we had a real kind of prevalence of amphetamine use.
(17:13):
And that went hand in hand with injecting of amphetamines and the lack of understandingabout bloodborne viruses.
Then that changes into the heroin users because the amphetamine dries up.
And it's very on trend as to what's kind of prevalent.
But I think in terms of alcohol use, that probably was the most common among those who'vebeen homeless for like over 10 years.
(17:34):
I think some like
70 or 70 had used it within the last couple of weeks.
Whereas if you look at it in terms of heroin, it was much less.
But then I do think when you start to develop a small culture of people who arepotentially drinking, you will get other people coming, influencers coming in, say for
instance, drug dealers and saying, maybe try this or then one person tries it and itbecomes a pattern.
(17:59):
And we do see that a lot, especially with the kind of the benefit circles almost.
people becoming quite dependent on each other as well as the drug.
What about this drug called Spice?
I've heard a bit about this and affecting sort of homeless people in certain areas.
Have we seen much of that in our particular rural context or not really?
(18:21):
It started to come through at one stage and along with this monkey dust.
But I think we've been quite lucky to avoid that.
We've not seen it in other towns and cities have seen it.
I think it was quite prevalent in the prison system, in the prison estates sort of early2010, 2015, because it became harder for drugs to come into prisons.
(18:46):
A lot of the prisons were up their security.
There was a lot more input into management of drugs in prisons.
And also it was non-detectable as well.
So it was an easy drug to use without actually impacting on the sentence planning.
I haven't seen it as much in the community, but I know it's more prevalent in cities.
So for instance, if you've got prisons that are in, in local prisons that kick out intothe local community in the cities, you do see it more there.
(19:13):
So kind of our neighbor in cities like Peterborough, you will see it more, but it doesn'tfilter down as much to, to Wisbech beach because it's not, we haven't got the local jails
and we haven't got the connections for things like that.
It's not an easy drug to sell.
Hmm.
That's interesting.
Now.
I was reading a book, recently about, a hotel, know, during COVID when everyone wasbrought in off the streets because of COVID and housed in hotels.
(19:41):
And part of the story of this particular hotel that they were telling was this whole thingabout the hoteliers hadn't really had any experience with people with addictions before
and drugs and things.
And they would start to find sort of drug paraphernalia and all that kind of stuff inpeople's rooms and things that just how they.
dealt with it or didn't deal with it or maybe should have done it in a different way.
(20:06):
What does Ferry do?
What's the standpoint on drug use within the homeless hostel at Ferry when it comes tothat sort of thing?
Is it something that you just go, well, they're homeless.
They're trying to quit.
So, you know, we give them a pass or how does it work?
(20:28):
What does it look like?
We have zero tolerance for drugs and alcohol on site.
We are sympathetic to those that are still using and just ask that if that happens, ithappens off site in a controlled way.
We do come across a lot of drug paraphernalia and that can be anything from what we wouldconsider roles of tin foil in rooms which would suggest some kind of smoking of heroin or
(20:58):
crack cocaine.
to grinders.
Now depending on the level of risk to others, including staff, would be determining theconversation or the action taken.
Hence if we went into a room and there was uncapped needles that had clearly been set upand had blood in them and heroin in them and they were putting staff at risk because we
(21:28):
all know
The consequences of being pricked by one of those needles, the uncertainty of what you mayhave contracted for the next six months will turn your life upside down and inside out.
So it always depends on what we find and where that conversation is to be had first.
what is the success rate of helping people to overcome their addiction issues at FerryProject?
(21:55):
Again, the total
number of people that have abstained from drug and alcohol use is probably something thatwe don't keep because their partners who specialize in drug and alcohol would keep those.
What I can tell you is we, although we may not get someone to abstain from drugs andalcohol, it's about getting them to the best version of themselves where they are
(22:23):
functioning and when I say functioning I mean
being able to take the responsibilities of your bills, your payments, your house andgetting your priorities straight.
And then the addiction behind that at the level that's safe for them.
So it's all about harm minimization and making that person, we can't, it's not for us totell someone that they should never drink again or they should never do this again.
(22:50):
However, if it poses a risk to themselves or others within our hostel.
that's the only time that they'll put their tenancy at risk.
I think also as well when you look at abstinence, I think that's not a kind of finitething.
I think we look at recovery as well.
It's about somebody's recovery journey.
If somebody's going through a homeless period and they're in addiction, the change, likeJohn said, making somebody a better version of themselves, the change that they go through
(23:18):
and the recovery journey they go through is in itself the next step towards managing theiraddiction.
So I think it's not necessarily about abstaining, it's more about management and riskmanagement and minimizing the harm to themselves and others and understanding why they're
in addiction and getting more of an understanding of where this comes from.
(23:43):
And I think that's the main priority here for me is looking back into somebody's life andfiguring out where things changed and where things went wrong.
But I think a lot of the...
For instance, with the drug and alcohol services, they'll use the recovery agenda as well,rather than people saying, right, you need to be off drugs or off alcohol.
If somebody's in alcohol addiction and they shift to controlled drinking, that in itselfis almost as good as abstinence in terms of management of their health.
(24:13):
So yeah, think abstinence for me is not the main agenda.
It's more about their recovery and what they've done along the way to manage that andunderstand themselves and their trauma history.
Thank you.
What can be done to help improve access to services that help people overcome addiction inrural areas?
(24:33):
I think it is about consistency, about continually providing something to people and nothaving to have things taken away, for instance, through funding streams and things like
that, and not having that constant battle to kind of maintain a service.
That clearly works very well.
So for me,
The main priority is continuing that care and making it a beacon of hope for people sothat people will always know that something's there to offer support.
(25:03):
And that's the priority for me and for access to services.
Maintaining something that works and keeping it there.
the shorter the accessibility, the better because we're always watching.
So although we are surrounded by people that there is no doubt in my mind,
They need some help from someone somewhere.
(25:26):
Are they ready for it?
That's what we're waiting for.
That's what we're looking for.
And when they are, we need to access them services as quick as possible whilst they're inthat engagement mode.
Because you leave it too long, you'll just lose them.
You'll just lose them because they'll just think that they've been messed around or it wasa waste of time.
They've asked for the help.
(25:47):
It's not happening.
So resources would obviously help that.
to make these accessible quicker than they are now.
I think also as well, like quite rightly John said, you're feeding into that pathology ofa life long time of rejection at some point.
If somebody can't access something immediately and things don't go well, you're almostfeeding into what they believe in about themselves, that they're not worthy or they don't
(26:16):
deserve that help.
I think like John said, that kind of really quick
accessibility and not losing somebody while they're in that phase of recovery is really,important.
No, really good points.
Thank you.
Thank you.
Yes, it's been a very interesting discussion about addictions and homelessness and how itkind of interrelates and works and what you guys do to help those trying to recover from
(26:47):
that.
So thank you.
Thank you, John and Karen for joining us today.
on this episode of the Rural Homelessness podcast.
Thank you very much.
Thank you very much.
And thank you as well for listening to this episode.
And don't forget that the Rural Homelessness podcast comes out twice a month on the 1stand the 15th.
So I'll be back really soon discussing another important topic around the issue of ruralhomelessness.
(27:11):
And I look forward to having the pleasure of your company again really soon.
Thank you and goodbye.
Thank you for listening to the Rural Homelessness Podcast brought to you by The FerryProject.
Visit our website on www.ferryproject.org.uk.
This is the Rural Homelessness Podcast, where we discuss the important issues around ruralhomelessness, hear from those affected by it, and offer some solutions.
Brought to you by the award-winning homelessness charity, The Ferry Project.
Welcome to the Rural Homelessness Podcast.
(00:29):
Hello and welcome to this edition of the Rural Homelessness Podcast.
I am your host Matt McChlery Thank you so much for joining me on this episode today.
It really means a lot when you click over and join us for a conversation around the topicof rural homelessness.
Now before we get into today's episode, I just wanted to quickly let you know that we nowhave a mailing list and that you can sign up and it will notify you each time we publish a
(00:55):
new episode of this podcast.
If you want to join us, just click over to our website ferryproject.org.uk and go to theContact Us page where you'll find a button you can click to sign up to our mailing list.
Now, onto today's show.
I'm speaking with two guests who we have spoken to about other topics previously on theshow and that is John Heathorn, who is the Night Services and Rough Sleeper Initiative Hub
(01:23):
Manager from The Ferry Project, and also Coryn Price.
who is a dual diagnosis practitioner and a community psychiatric nurse.
Today we are discussing the topic of addiction and talking about how rural homelessnessand addiction have a complex relationship.
It's not as straightforward as we might think and the conversation sheds some light onthis often misunderstood relationship between addiction and homelessness.
(01:53):
So let's welcome John and Coryn to the show.
So let's welcome John and Coryn back to the show.
You've both been on before in previous episodes.
So hi John, welcome back.
Hi there Matt, hi Coryn.
Hi Coryn.
Hello, nice to see you both.
Yeah, welcome back to the podcast.
(02:14):
It's great to see you both again.
Now today we're going to be talking about rural homelessness and addiction.
Before we get down into the nitty-gritty of our discussion,
Let's just first of all, can you just tell us what your role is within the Ferry Projectand who you are and kind of where you fit into what goes on?
(02:38):
Yeah, so I managed across everything from the outreach work at present, which is kind ofhelping out with the hub, which is the pathway to homelessness and homelessness
prevention.
And also the night provision that we provide, which then comes for the severe weatheremergency provision we provide through the winter months to people that have not got
(03:06):
accommodation.
Great, thanks.
And Coryn?
So I'm a community psychiatric nurse and I work with the dual diagnosis street Project,which is a Project set up alongside the rough sleepers initiative, Fenland district
council and the Ferry Project
kind of co-commissioned that way.
So I work alongside John and the rest of the Project staff and try and support thosewho've got mental health issues, drug and alcohol issues and basically anybody who
(03:37):
requires support from that perspective and do some long interventions with them andlong-term work potentially if they're at the Ferry for a long time.
So Coryn, let's talk about the topic that we're looking at today which is homelessness and
addiction.
Now it seems to be a fairly obvious topic to address on the podcast because many peoplehave a perception that all homeless people have an addiction problem of some kind.
(04:02):
Is this true?
I wouldn't say that it was a complete fact, but obviously the relationship betweenhomelessness and substance abuse use is a very strong relationship.
And I think sometimes it kind of binds people together in that kind of life of uncertaintyand instability.
A lot of homeless people will clearly
move towards the subculture to make them feel part of something.
(04:25):
There's a clear association between dependents and amongst the time someone spendshomeless.
So if you look at that kind of relationship, I think we do see a lot of people who arehomeless that do present with drug and alcohol issues.
But I think that becomes more of an issue the longer time they're homeless.
Because as soon as they get that stability, for instance, with the Ferry or they get somesort of form of accommodation,
(04:49):
we do see that change and that shift.
And essentially, I wouldn't say it's a complete link, a causal link, but I do think itpresents more and becomes more prevalent because there is a subculture that develops,
which makes it look like it's worse, if that makes sense.
That's interesting what you say.
(05:09):
Have you seen this, John, with what you do, where the longer someone is homeless, thelikelihood of them having an addiction
issue is heightened.
So for me, know, I've had addictions and that in the past, but they've most certainly beenput to bed prior to me returning to the streets.
(05:36):
Now in in prison, heroin is commonly known as a bird killer.
by
by calling it a bird killer, it kills the time that you have to serve because it justtakes away days and days and days, you lose days.
So heroin is quite frequently used in order to just numb out the despair, the heartacheand the pain and the uncertainty.
(06:03):
And you find that on the streets.
So we find that people that are coming in and people that we're dealing with on thestreets, their addictions are probably not their heist.
And yet we see once you provide somewhere for someone that's safe and something that theycan call their home, we often see and I don't mean just often, it's quite common to see
(06:29):
that that addiction will come down tenfold within at least the first six weeks.
Absolutely.
I agree with what John just said as well.
think going back to the prison system,
we do find, we saw a big shift when the mandatory drug testing changed as part of sentenceplanning, a lot of offenders who were in custody would be subject to mandatory drug
(06:56):
testing.
And we all know that heroin use doesn't stay in the system as long as potentially cannabisuse does.
So there was a shift in the drug use and that kind of, that spilled out onto the streets.
So where you had your kind of standard alcohol users or somebody who smoked cannabis,because they'd
got into that rhythm and that, as John said, that bird killer in jail, there was a shiftin the substances which then spilled out to the streets.
(07:22):
And yeah, I agree, totally agree on the prison aspect of it as well, which we do see a lotof people who've come from custody who are potentially homeless.
And you said, John, that within the first, how many weeks was it?
Within the first six weeks.
Within the first six weeks, you see a dramatic change in that.
So,
(07:42):
That means that the person was probably going to go through withdrawal and everything elsewhilst they are with you.
How does that look like?
How do you manage that?
What support gets put in place to help someone who is probably going to go throughwithdrawal?
us, the first assessment is very short.
(08:04):
It's to assess their basic needs.
Mental health follows hand in hand with those addictions.
regardless of whether you had mental health before, because I certainly didn't have mentalhealth until I hit the streets and that trauma caused that mental health.
Here at the Ferry, what we ask, the only thing we ask is, are you willing to engage?
(08:27):
Okay, we're not going to judge on your drug or your alcohol use at point of entry, becauseat point of entry, if we did that, you'd all be too high risk and you'd all be too high
support.
We just ask that you want to change and you want to be given that opportunity to change.
So the first thing we do is we wrap that support heavily around.
(08:50):
They will be directed straight to CGL, one of our partners that we work closely with.
Karim will be immediately involved.
And then we also get our local GP surgery involved to assess their physical health.
I think with the Ferry, it's very seamless.
Like John said, that the kind of initial assessment is to understand exactly what'srequired and exactly it's not just about the addiction side of things.
(09:15):
It's psychosocial, it's about financial aspects.
I think when you ticked all those boxes that kind of feed into that sort of despair andthat kind of feeling of going nowhere and not being able to move forward, once you start
to wrap around and tick those boxes,
The kind of substance misuse sort fades into the background and becomes part of somethingelse so that they can manage that like John said with CGL, which is the local drug and
(09:39):
alcohol services.
And then the psychosocial interventions take place.
So for instance, you'll start to work on their own self and you'll start to work on whythey're using substances and what moving forward can be done to manage that not going back
to where they were before.
So I think that John said the wraparound is really important when someone comes off thestreets and it's not just to say, right, you're on drugs or you're using alcohol.
(10:02):
It's about looking at the holistic aspect of that person to make sure everything is done.
That's really interesting.
So what other things might be looked at rather than just saying, well, you're addicted tothis, you you need to stop or whatever.
How does that work?
The sort of the wraparound.
I know it's different for each individual, so it's a bit tricky.
(10:25):
It's very bespoke.
think that's what the Ferry very good at is making the bespoke work to be done.
It's very client-centered and I think because a lot of the work we do is trauma informed.
A lot of people who've come through the service have had a history of trauma.
So the trauma informed approach can be, the trauma could have just been being homeless,but there's also other things that need to be managed as well.
(10:48):
So like I said, going back to the psychosocial interventions, you're not just looking atthat person's addiction, you're looking at it as a whole package.
And that's really important to make it really client-centered and making sure that it'snot a one-size-fits-all service.
There's lots of different caveats to people's management.
What comes first?
As we said, a higher percentage of homeless people, especially if they've been homelessfor a certain length of time, usually have addiction issues.
(11:17):
So what comes first, the addiction or the homelessness?
That's likely.
ask like the chicken and the egg question.
Yeah, because people can lose their accommodation and find themselves homes throughaddiction.
You know, that be drugs, whether it be alcohol, whether it be gambling.
(11:40):
And that then puts their, you know, their houses and their homes at risk, and then theyfind themselves on to the streets.
Or you can find people go to the streets that they install participating.
in the drugs.
They may have started off on the streets on a what we call like a low-grade recreationdrugs such as cannabis, cocaine you know is is is prevalent that is something that people
(12:10):
are highly addicted to and it's very quickly becomes addictive.
So it's one of those we see variation of people that have lost you know whether that bigrelationship break down whether
you know, whether that was an addiction that lost them their accommodation, go to thestreets and then use drugs that they've never been known for using.
(12:33):
From a dual diagnosis perspective, I think a lot of the time I get faced with the factthat people with mental health issues and substance misuse issues, that they can't,
they're subject to a lot of rejection due to the fact that like you just said, what comesfirst.
A lot of people will use drugs or alcohol to manage that disparity, to manage that
the uncertainty of their lifestyle, the disconnection from their families.
(12:56):
But then the addiction might have been there before.
There's never a kind of a clear pathway for any certain person.
A lot of people may use the gateway drugs as youngsters.
It's about peer pressure and then they start to form other peer group circles where theyuse different drugs.
And then due to the fact they're in addiction, they may lose their property, they may losetheir jobs.
Their mental health might change due to the drugs.
(13:20):
It changes for everybody.
don't think there's a set standard for whether or not it's what comes first.
And I think the kind of code, the co-occurring issues we have at the moment with people onthe streets that come through the Ferry, they could have been the vast majority of the
professionals.
could have been in very, very good jobs, come from big, come from families where there wasa real safe structure.
(13:42):
And then all of a sudden that's gone.
And they realize actually, do you know what?
I can manage my lifestyle easier if I'm with a group of people that use drugs and takethat pain away.
So yeah, there's no set standard for what comes first.
It's how we deal with it is the main priority.
Very good.
Do you think addiction issues are more prevalent in rural areas compared to urban areas oris the pattern similar?
(14:09):
I think, rurally it's more hidden.
think we've talked to, we've discussed this before and I think it's a more of a hiddenharm.
don't, it's not as in your face.
I don't think services are as accessible as they are in urban areas.
So you tend to miss a cohort of service users that potentially might be hidden away.
Urban areas do tend to have more accessible services that are easily located, easilyaccessed by trains, buses, whatever, walkable.
(14:39):
Sorry, does that change the maybe the type of drug people have access to or is it fairlywidespread?
Whatever drug is causing
big issues sort of on the streets of London or Cambridge say is also doing a similar thingin rural areas such as Whistbeach or is there a difference in that?
(15:00):
I suppose it's what's accessible and I think, rurally, think there's more, I think alcoholis more prevalent in rural areas because you've got a demographic that includes street
drinkers and people who live in small collective areas.
Research, don't suppose there's that much research on the different kind of drugs that areused, but I know urban is more heroin and crack cocaine.
(15:22):
But then that's starting to spill out now into more rural areas because obviously there'sthe shifts, the shifts in patterns of what drugs are actually highlight of the month, I
suppose.
I don't know if you see any differences, John, in terms of that.
Yeah, we see the pattern shifts and this all comes across from county lines.
(15:42):
But from a drug dealer's perspective, the best customer to have would be crack cocaine.
So if you can start bringing the heroin in quite cheap, heroin and crack cocaine go handin hand.
It's very unusual to find someone that only does one or two, but it will start off withsmoking crack cocaine.
(16:07):
And people don't realize because they're smoking it how addictive it is.
So cocaine has been known as a sex drugs and rock and roll recreational party drug thatmany people back in the day have participated with.
You see it in lots of 80s movies, don't you?
kind of thing.
Yeah.
And he stood out there.
(16:29):
then all of a sudden, someone discovered that they could wash it up into a rock and it'dbe smoked.
And that was one of the worst things that happened.
More addictive than any other drug.
and there is no substitute for it.
You cannot be medicated for crack cocaine.
You cannot be given Subutex.
You cannot be given methadone.
(16:52):
It's one of those that are very difficult to stop once you've started.
It's kind of on trend as well, isn't it?
I think it's what's available and you do get, like John said, when county lines have beenstopped, the drugs trend changes.
in the 80s, early 90s, we had a real kind of prevalence of amphetamine use.
(17:13):
And that went hand in hand with injecting of amphetamines and the lack of understandingabout bloodborne viruses.
Then that changes into the heroin users because the amphetamine dries up.
And it's very on trend as to what's kind of prevalent.
But I think in terms of alcohol use, that probably was the most common among those who'vebeen homeless for like over 10 years.
(17:34):
I think some like
70 or 70 had used it within the last couple of weeks.
Whereas if you look at it in terms of heroin, it was much less.
But then I do think when you start to develop a small culture of people who arepotentially drinking, you will get other people coming, influencers coming in, say for
instance, drug dealers and saying, maybe try this or then one person tries it and itbecomes a pattern.
(17:59):
And we do see that a lot, especially with the kind of the benefit circles almost.
people becoming quite dependent on each other as well as the drug.
What about this drug called Spice?
I've heard a bit about this and affecting sort of homeless people in certain areas.
Have we seen much of that in our particular rural context or not really?
(18:21):
It started to come through at one stage and along with this monkey dust.
But I think we've been quite lucky to avoid that.
We've not seen it in other towns and cities have seen it.
I think it was quite prevalent in the prison system, in the prison estates sort of early2010, 2015, because it became harder for drugs to come into prisons.
(18:46):
A lot of the prisons were up their security.
There was a lot more input into management of drugs in prisons.
And also it was non-detectable as well.
So it was an easy drug to use without actually impacting on the sentence planning.
I haven't seen it as much in the community, but I know it's more prevalent in cities.
So for instance, if you've got prisons that are in, in local prisons that kick out intothe local community in the cities, you do see it more there.
(19:13):
So kind of our neighbor in cities like Peterborough, you will see it more, but it doesn'tfilter down as much to, to Wisbech beach because it's not, we haven't got the local jails
and we haven't got the connections for things like that.
It's not an easy drug to sell.
Hmm.
That's interesting.
Now.
I was reading a book, recently about, a hotel, know, during COVID when everyone wasbrought in off the streets because of COVID and housed in hotels.
(19:41):
And part of the story of this particular hotel that they were telling was this whole thingabout the hoteliers hadn't really had any experience with people with addictions before
and drugs and things.
And they would start to find sort of drug paraphernalia and all that kind of stuff inpeople's rooms and things that just how they.
dealt with it or didn't deal with it or maybe should have done it in a different way.
(20:06):
What does Ferry do?
What's the standpoint on drug use within the homeless hostel at Ferry when it comes tothat sort of thing?
Is it something that you just go, well, they're homeless.
They're trying to quit.
So, you know, we give them a pass or how does it work?
(20:28):
What does it look like?
We have zero tolerance for drugs and alcohol on site.
We are sympathetic to those that are still using and just ask that if that happens, ithappens off site in a controlled way.
We do come across a lot of drug paraphernalia and that can be anything from what we wouldconsider roles of tin foil in rooms which would suggest some kind of smoking of heroin or
(20:58):
crack cocaine.
to grinders.
Now depending on the level of risk to others, including staff, would be determining theconversation or the action taken.
Hence if we went into a room and there was uncapped needles that had clearly been set upand had blood in them and heroin in them and they were putting staff at risk because we
(21:28):
all know
The consequences of being pricked by one of those needles, the uncertainty of what you mayhave contracted for the next six months will turn your life upside down and inside out.
So it always depends on what we find and where that conversation is to be had first.
what is the success rate of helping people to overcome their addiction issues at FerryProject?
(21:55):
Again, the total
number of people that have abstained from drug and alcohol use is probably something thatwe don't keep because their partners who specialize in drug and alcohol would keep those.
What I can tell you is we, although we may not get someone to abstain from drugs andalcohol, it's about getting them to the best version of themselves where they are
(22:23):
functioning and when I say functioning I mean
being able to take the responsibilities of your bills, your payments, your house andgetting your priorities straight.
And then the addiction behind that at the level that's safe for them.
So it's all about harm minimization and making that person, we can't, it's not for us totell someone that they should never drink again or they should never do this again.
(22:50):
However, if it poses a risk to themselves or others within our hostel.
that's the only time that they'll put their tenancy at risk.
I think also as well when you look at abstinence, I think that's not a kind of finitething.
I think we look at recovery as well.
It's about somebody's recovery journey.
If somebody's going through a homeless period and they're in addiction, the change, likeJohn said, making somebody a better version of themselves, the change that they go through
(23:18):
and the recovery journey they go through is in itself the next step towards managing theiraddiction.
So I think it's not necessarily about abstaining, it's more about management and riskmanagement and minimizing the harm to themselves and others and understanding why they're
in addiction and getting more of an understanding of where this comes from.
(23:43):
And I think that's the main priority here for me is looking back into somebody's life andfiguring out where things changed and where things went wrong.
But I think a lot of the...
For instance, with the drug and alcohol services, they'll use the recovery agenda as well,rather than people saying, right, you need to be off drugs or off alcohol.
If somebody's in alcohol addiction and they shift to controlled drinking, that in itselfis almost as good as abstinence in terms of management of their health.
(24:13):
So yeah, think abstinence for me is not the main agenda.
It's more about their recovery and what they've done along the way to manage that andunderstand themselves and their trauma history.
Thank you.
What can be done to help improve access to services that help people overcome addiction inrural areas?
(24:33):
I think it is about consistency, about continually providing something to people and nothaving to have things taken away, for instance, through funding streams and things like
that, and not having that constant battle to kind of maintain a service.
That clearly works very well.
So for me,
The main priority is continuing that care and making it a beacon of hope for people sothat people will always know that something's there to offer support.
(25:03):
And that's the priority for me and for access to services.
Maintaining something that works and keeping it there.
the shorter the accessibility, the better because we're always watching.
So although we are surrounded by people that there is no doubt in my mind,
They need some help from someone somewhere.
(25:26):
Are they ready for it?
That's what we're waiting for.
That's what we're looking for.
And when they are, we need to access them services as quick as possible whilst they're inthat engagement mode.
Because you leave it too long, you'll just lose them.
You'll just lose them because they'll just think that they've been messed around or it wasa waste of time.
They've asked for the help.
(25:47):
It's not happening.
So resources would obviously help that.
to make these accessible quicker than they are now.
I think also as well, like quite rightly John said, you're feeding into that pathology ofa life long time of rejection at some point.
If somebody can't access something immediately and things don't go well, you're almostfeeding into what they believe in about themselves, that they're not worthy or they don't
(26:16):
deserve that help.
I think like John said, that kind of really quick
accessibility and not losing somebody while they're in that phase of recovery is really,important.
No, really good points.
Thank you.
Thank you.
Yes, it's been a very interesting discussion about addictions and homelessness and how itkind of interrelates and works and what you guys do to help those trying to recover from
(26:47):
that.
So thank you.
Thank you, John and Karen for joining us today.
on this episode of the Rural Homelessness podcast.
Thank you very much.
Thank you very much.
And thank you as well for listening to this episode.
And don't forget that the Rural Homelessness podcast comes out twice a month on the 1stand the 15th.
So I'll be back really soon discussing another important topic around the issue of ruralhomelessness.
(27:11):
And I look forward to having the pleasure of your company again really soon.
Thank you and goodbye.
Thank you for listening to the Rural Homelessness Podcast brought to you by The FerryProject.
Visit our website on www.ferryproject.org.uk.
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