CAN THESE LEOPARDS CHANGE THEIR SPOTS?
RESPONSE TO THE NTA BUSINESS PLAN 2010/2011
Deirdre Boyd, CEO of the Addiction Recovery Foundation
Kathy Gyngell, chair of the Centre for Policy Studies' Addictions working group
With the threat of abolition hanging over its head, the National Treatment Agency has cleverly extended its longevity by promising to mend its ways. It will, it announced on Friday, use the final two years of its now-extended life to change the policy it has promulgated over the past nine years.
‚ÄúWe‚Äôve got to get rid of the centralised bureaucracy that wastes money and undermines morale,‚ÄĚ prime minister David Cameron stated in July. But the NTA would seem to have got the last laugh, with over ¬£42.8million of taxpayer‚Äės money now allocated to it for two more years to change the disastrous system it created and has so steadfastly defended even in face of the indefensible.
The NTA will, it promises, help people get off the methadone dependency, tier 2/3 organisation dependency and state dependency which it created via its performance-managed targets. Its new Business Plan 2010/11, in a truly Orwellian "four legs bad, two legs good" style, now seemingly advocates the very abstinence approach its spokespeople have repeatedly declared to be unviable.
It will even consult rehabs, the NTA graciously announced ‚Äď those very rehabs it has ignored for almost a decade and of whose success in getting addicts into drug-free and rewarding recovery Paul Hayes (yes, still the NTA‚Äôs CEO) has publicly belittled, scorned or downright denied. Could it be less than two years ago that the NTA‚Äôs ‚Äėfirst point-of-contact‚Äô told BBC Home Affairs editor Mark Easton that ‚Äúrehab doesn‚Äôt work‚ÄĚ? (see Comment 5th from bottom here for more derogatory comments from NTA senior managers).
But maybe this was not such a hard promise for the NTA top brass to make, as they look forward to their ‚Äėbrobdingnagian‚Äô pension pots in two years‚Äô time. After all, there are fewer rehabs to consult… For under the NTA regime, only 2-4% of addicts seeking help to quit drugs were actually referred to them. The result? Financial hardship, redundancies, the closure of over 20 specialist rehabs, more wing and bed closures and a loss of the real expertise required to rehabilitate addicts. And with their own personal futures well secured, would success of change be in their interest?
There isn‚Äôt any evidence for abstinence or for rehab, they have repeated declared. This is despite two national treatment outcomes surveys – Ntors and Doris - which indicate strongly to the contrary. It is also in face of experience. As Sir Ian Gilmore said yesterday, the "absence of evidence" about school milk for under fives is only that; it does not mean that it is not a good thing and has not helped children‚Äôs health. All experience suggests it certainly has, he insisted. Similarly with rehab: a joint report in 2008 by the Commission for Social Care Inspectorate with the NTA itself that ‚Äúresidential rehabs outstrip other sectors in every outcome group we measure".
The NTA seems to have bamboozled the Department of Health and a too readily believing government. For who have they tasked to change their policy and now shift people into ‚Äėrecovery‚Äô? Brazenly, it has appointed as one of the duo the addiction psychiatrist most closely associated with the failed medico-clinical treatment approach of the past 20 years years, one of the the proponents and instigators of the last government's failed treating-drugs-with-drugs approach so loved by the NTA, key lobbyist for counterintuitive, expensive and ethically questionable prescribing programmes: John Strang of the National Addiction Centre.
In his capacity as a director of the UKDPC – recipient of millions of charitable funds to, among other briefs, redefine for the nation the notion of (addiction) recovery - Strang chose to use this remit to ensure that any new official definition of recovery excluded full abstinence, ignoring all expert advice to the contrary.
Nor did he stop there. His UKDPC's plan was to use this new definition of ‚Äúrecovery‚ÄĚ to replace real total drug-free outcomes as the measure for the NTA‚Äôs Treatment Outomes Profile forms, meaning that their targets could be easily be hit. Very convenient. For, in one Orwellian sleight of hand, the NTA could claim a recovery outcome when no such thing had been achieved. A reduction in injection frequency would suffice. This would be the basis of NTA‚Äôs (aspirationless) claims of treatment success. In face of the derision this deserved, the NTA has gone on record saying it does not define recovery at all now ‚Äď despite the fact that ‚Äúrecovery‚ÄĚ is the raison d‚Äôetre of its Janus-faced Business Plan 2010/2011. That all the goals and actions therein are meaningless can thus be taken as read.
For example, there is apparently no plan to replace the discredited and bureaucratically heavy Top form. It will be forced on ever more people. The NTA states, too, that it has looked at the ASAM patient placement criteria. Yet instead of contacting the creators of this highly-researched method, it plans to reinvent the wheel and spend taxpayer money developing a version for its own purposes. It also plans to spend more taxpayer money on a mutual aid directory. Yet this is already provided free by Addiction Today. Under Championing abstinence-focussed treatment in the business plan… well, for further help interpreting the Business Plan‚Äôs double speak, read our glossary.
It is, however, commendable that Dr David Best, who has wriiten so cogently and expertly on abstinence-based recovery in the pages of Addiction Today and other professional journals, has been appointed as the other half of the recovery duo. We wish him the very best of luck in counterbalancing his former mentors, and getting them on the true road to recovery with a Damascene conversion. They should heed him, for he is the only person giving this exercise any credibility.
As David Cameron said in June,‚ÄúThere is a problem in our national health service, in that we spend too much time treating the symptoms rather than necessarily dealing with the causes… All addictions need proper attention, and proper treatment and therapy, to rid people of their addictions‚ÄĚ.
We really would love to believe, as he and many in government must wish to believe, that we will witness the NTA's respecting the trust that has been placed in it and seeking the rehab expertise that actually helps people to get off life-destroying drugs and rebuild their lives and their families‚Äô lives. But the serious worry is that this initiative for change get will be lost in adherence to disinformation and blowback, and submerged in intransigent ideology about the non-recoverability from addiction. Of even more concern, will its lack of understanding continue to marginalise the expertise necessary to help the 330,000 or so addicts desperate for the sobriety which is the basis for them to get back, or get for the first time, their self esteem and their lives?
We will be happy to be proved wrong. But we are not holding our breath.