Out-of-treatment dependent drinkers and people who use opiates or crack:the perceptions of professionals working in two locations in England

Background: Following the influential Black Review, engaging out-of-treatment people who use drugs in structured provision was a particular priority in England. There is little known, however, about professionals’ perceptions of people who use opiates and/or crack, and dependent drinkers, who are not in structured treatment (OOT-PWUD). Methods: Semi-structured interviews with 34 professionals who work with OOT-PWUD (defined as those who had not been in structured treatment for the past year) in two case-study sites that have high rates of drug and alcohol use. Results: Professionals said that most OOT-PWUD they saw had previously been in structured treatment at some point in the past. Crack use was seen as an emerging problem. Professionals said the physical location and nature of services was an important barrier and that safe and non-stigmatising spaces for all users and staff were needed. Professionals stressed the importance of education to reduce societal stigma and long-term investment in treatment services and staff. Conclusion: Professionals said that most OOT-PWUD needed support with all the challenges they faced in their lives, most notably their housing needs, rather than just their substance use. Consistent long-term funding in both services and staff is critical if this is to be achieved.