DATs: “TREBLE PATIENTS IN REHAB”
10% of the 128,000 people desperately seeking help for their drug problems should be offered rehab or another drug-free choice of treatment by the Drug Action Teams, stated Nick Lawrence, head of Alcohol, Drugs & Tobacco Policy at the Department of Health [30 June 2008].
This was in response to a question posed by Addiction Today highlighting that DAT commissioners currently place only 3.6% of patients into rehab, according to figures from the National Treatment Agency for Substance Misuse. This would also solve the growing crisis of empty beds alongside waiting lists of people desperate for help.
One treatment provider reported that his local DAT refused to place people in rehab until they were detoxed and/or drug-free for a month first – the very reason they needed to get into rehab! "And they are being forced to wait 28 weeks for detox," he said. They can be demotivated or even die in the interim."
"If DAT commissioners continue the way they are, I expect 50% of rehabe will be closed in a year or two," said another treatment provider.
Figures highlighted by the BBC indicate that only 3% of the 128,000 seeking help actually become abstinent from their drugs. The link between the two figures seems strong – but, oddly, there seem to be no statistics directly linking type of treatment with results. If this is true, the government should implement a new outcomes measurement tool which gives more detail than the NTA’s ‘Top’ one currently does.
The discussion arose at a meeting of CEOs of treatment providers, organised by umbrella body EATA. Providers – and Addiction Today – strongly urge that commissioners work across the full continuum of care: placing only 3.6% of people with drug problems into drug-free treatments is woefully disproportionate.
So why don’t DATs use this effective route? After all, Project Match and other research, including Dr David Best’s seminal work, prove that 12-step-based treatments have great success in leading to long-term recovery; and Professor Neil McKeganey’s research in Scotland shows that most drug users want to become drug free.
Another provider reported that her local DAT insisted her service was a "final solution" or "planned discharge" out of treatment. There was no allowance for aftercare should a patient need it, nor was there a safety net if the patient left early or was diagnosed while in care as being more appropriate for a mental-health programme.
One reason for uneven referrals is the unusually high turnover of staff."We often have to educate the commissioners," said another provider. And agreement seemed unanimous that DAT commissioners should be trained to a more adequate standard. There are, of course, some excellent commissioners of services, but these are few – it should also be noted that good commissioners get the best outcomes for their areas, as they place patients appropriately with expertise.
"DATs should be performance-managed, just as providers are. And they should be performance-managed to comply with the National Drug Strategy targets, not the NTA targets which seem to be at odds with the national strategy," was one view which drew the greatest consensus of the afternoon.
Presenting at the discussion with Lawrence were Ian Martin of the Home Office Drug Strategy Unit and Sally Richards, acting head of the Home Office Drug Intervention Programme. All had been unaware of the critical situation in which treatment centres – and patients – had been placed. Participants referred to the ways in which figures were reported to them. Some said they feared giving the facts for fear of repercussions and even less referrals.
Ian Martin stated that any treatment provider could contact him in confidence if they wished to name names – for example, the DAT which gives absolutely no patients the opportunity of benefiting from rehab.
"The most important factor in a client’s success is the treatment agency," said Lawrence. So, please, Department of Health and Home Office and providers: we must work together.