END THE COSTS OF SOCIAL BREAKDOWN
Recognising the urgency for appropriate, effective treatment of addiction and for its prevention, Iain Duncan Smith recommended approaches based on national studies. Get them now as a reference tool, a treaetment manual, an uplifting read – or to lobby your MP with, recommends Deirdre Boyd.
This article was first published in Addiction Today journal, September 2007
‚ÄúIf we concentrate on restoring people‚Äôs lives, most of the public health and crime issues will take care of themselves,‚ÄĚ rightly states the introduction to the Addictions section of Breakthrough Britain. The full policy review was published by the Social Justice Policy Group chaired by former Conservative Party leader Iain Duncan Smith MP (below, with David Cameron), and garnered many press headlines ‚ÄĒ but the Addictions section gained only a few lines.
So what is in there to help us with our work and clients?
A hefty 428 pages are devoted to this topic, chaired and authored by Kathy Gyngell. This article highlights key points which can support advocacy, treatment cases to be made to commissioners ‚ÄĒ and policy issues you might wish your local MP to champion.
I add my own recommendation. Addiction Today summarises key points of potential legislation to save readers having to search through hundreds of pages which might not be related to their specific work. Breakthrough Britain is the exception: it is both an easy read and a reference, and exploring it in full will lift morale as you find your unheard views validated.
‚ÄúA true reflection of the strengths of a society should lie in its ability to care for each other, look after the ill, disabled or those with drug and alcohol problems. Drugs of abuse have enormous power over the lives of people who are addicted who are often slaves to the brain structures responsible,‚ÄĚ Dr Kah Mirza, senior lecturer at the Institute of Psychiatry, writes.¬† ‚ÄúOur society and state have a responsibility to give a clear message: ‚ÄėI would like to help with your predicament, but I would like to bring the issue of responsibility back on to your shoulders‚Äô.‚ÄĚ
UK SPENDS LESS PER PERSON THAN MORE SUCCESSFUL COUNTRIES
The review points out that the UK is spending less per head than countries such as Sweden which are today more successfully facing the problems of drug abuse. Even so, over the past 10 years, the government has spent more on its ‚Äėwar on drugs‚Äô than on Iraq and Afghanistan combined ‚ÄĒ ‚Äúyet this spending is often wasteful, unwise and misdirected,‚ÄĚ states the report as it points to the dramatic growth of bureaucracy.
‚ÄúNational Treatment Agency staffing has gone from 30 to 150 employees in five years, matched by burgeoning local Drugs Action Team administration.
‚ÄúSpending on prescribed methadone alone has reached ¬£111million a year. Alcohol harms have gone up but spending on alcohol treatment runs at only 6% of the drugs budget.
‚ÄúIt is likely that spending on drugs and alcohol addiction treatment might have to more than double from the current ¬£400million per annum to get people into recovery and to bring us to swedish and dutch levels of success.‚ÄĚ
The review yields useful statistics, showing the UK in a worse state than neighbouring countries:
- 327,000 problem users of opiates and cocaine
- alcohol harm costs ¬£23billion each year
- polysubstance abuse has become characteristic ‚ÄĒ75% of problem users use two or more illicit drugs, over 50% use psycho-stimulants such as crack cocaine, and many have problem drinking
- the age of initiating usse has consistently fallen
- about 350,000 children have drug-addicted parents
- one million children have alcohol-addicted parents
- about half of the 80,000 prison population are problem drug users
- the most widely-used drug is cannabis ‚ÄĒ testimonies of recovering addicts suggest high and intense consumption of cannabis in their teens.
‚ÄúYoung people‚Äôs drug services and education programmes remain premised on a philosophy of harm reduction, though there is little evidence of this being a safe or effective approach to the prevention of substance abuse,‚ÄĚ the report states.
I would go further: Australian and UK research shows that ‚Äėeducation‚Äô can be counterproductive, accelerating experimentation with drugs at ever earlier ages. Education should not be about the drugs themselves but how they harm the children‚Äôs goals and dreams; it should be part of life skills teaching, not a separated issue.
The report also criticises centralised targets and a ‚Äėmedical management‚Äô approach, the combination of which has ‚Äúfurther entrenched addiction, adding to intergenerational cycles of substance dependency which are particularly damaging for children‚ÄĚ. It reiterates that ‚Äúmaintenance methadone prescribing which perpetuates addiction and dependency has been promoted under current policy while rehabilitation treatment has been marginalised and crucial family services run down‚ÄĚ.
Methadone does have a role to play, but it should open not close doors, including the path towards psychosocial interventions and drug-free lifestyles.
In contrast to its highly interventionist approach to drugs policy, the government approach to the ‚Äėalcohol problem‚Äô is remarkably laissez faire. Liberalising alcohol licensing laws, it had given no formal signal that it views alcohol as a potentially dangerous commodity. ‚ÄúThe alcohol strategy exists on paper only. Many health areas across the country have no alcohol treatment provision at all,‚ÄĚ the report summarises.
Neither the NHS nor the statutory social work services have been using Alcoholics or Narcotics Anonymous as effectively as the US or even Iran, if at all, even though they are free and perhaps all that is available in certain circumstances.
There is no point in advocating the need for more residential rehabilitation without understanding how radical a reform is needed. ‚ÄúIt is about facing the fact that abstinence is the most effective method of treatment, and the only appropriate one for many addictions,‚ÄĚ states the review. It proposes:
- an integrated addiction policy to replace the separate drugs and alcohol ones, led by a ‚ÄėNational Addiction Trust‚Äô responsible to a Cabinet Office ‚ÄėSecond Chance‚Äô unit and in charge of a ‚ÄėTreatment Trust Fund‚Äô
- devolved responsibility to local ‚ÄėAddiction Action Centres‚Äô for identifying local need, working alongside one-stop (treatment) shops to ensure clients‚Äô progress to supported abstinence treatment and an improved response to clinical and public health needs ‚ÄĒ I recall recommending this in Addiction Today about 14 years ago!
- expansion of third-sector proven provision of holistic, value-added, abstinence-based treatment, both day and residential, prioritising much-needed family residential centres and adolescent residential development
- a new method of reward-driven funding via
personal abstinence-treatment vouchers from the Treatment Trust Fund, to incentivise both system and client change
- further development of dedicated drugs courts, raising their treatment threshold and provision requirements
- replicating successful prison treatment programmes run by Rapt and Phoenix Futures among others, aiming for a dedicated wing in every prison in the UK
- reclassifying cannabis back to class B as part of a national action plan to discourage cannabis use
- formal assessment of adolescent needs ‚ÄĒ for substance abuse, associated mental health, family and social issues
- a general adolescent ‚Äėservices‚Äô review
- developing residential treatment for adolescents which could be an informal setting for juvenile drugs courts
- introduction of juvenile treatment orders for drugs offences, to be expunged after five years of clean record
- a tender for research using well-designed systematic experimental school drug tests
- trialling of effective addiction education in schools, with well-designed research.
MORE ALCOHOL AND DRUG REHAB IS NEEDED
The review notes that 90% of the rehab sector is supplied by charities. And, despite the commissioning of a formidable array of drug services, access to residential rehab is at an all-time low. In 2003/4, there were only 4,601 residential admissions out of a treatment population of 180,000 patients. The dedicated pooled budget was not used to secure or protect rehab treatment. This threatens closure of some.
This omission ignores not only research about what constitutes the most effective treatment but also the NTA‚Äôs recent Service User Survey which found that most users aspire to abstinence, seeing it as the goal of treatment ‚ÄĒ a finding backed by surveys in Scotland.
The omission also ignores data in the oft-quoted NOTRS research on the results of drug treatment, which reveal that it is not treatment generally which counts but specific treatment ‚ÄĒ at five-year followup, by far the best outcome measures are ascribed to NTORS participants who attended residential treatment.
The Addictions section ends with a review of gambling by Dr Mark Griffiths, professor of gambling studies at Nottingham Trent University.
KATHY GYNGELL is a research fellow at the Centre for Policy Studies where she published From Latchkey to Leadership, Channelling Talents of Inner City Youth with Ray Lewis. She graduated from Cambridge with a 1st class degree in social anthropology, then from Oxford with a MPhil on sociology. She was a current-affairs television producer.
Contributing to the report was PROFESSOR CHRIS COOK, former trustee of the charity which publishes Addiction Today.
Readers can download the Addictions section from the Centre for Social Justice.
For simplicity and easier reading of what will be a reference tool, I instead recommend posting a cheque for ¬£30 for the full report to The Centre for Social Justice, 9 Westminster Palace Gardens, Artillery Row, London SW1P 1RL (tel: ¬† ¬† ¬†¬† ¬† 020-7340 9650¬† ¬†¬† ¬† ).