DODGY DOSSIER 3: NATIONAL TREATMENT AGENCY FIGURES
THE STATISTICS OF FAILURE IN THE NTA ANNUAL ACCOUNTS 2009/10, AND 2005 OUTCOMES RESEARCH
by Deirdre Boyd
If this country wishes to cut crime and get addicts into recovery, it is vital that our drugs policy is built on a solid foundation of fact not a quicksand of PR illusion which will bury us all. If failed so-called treatments and systems are promoted as successes, then truly successful treatments being considered by government might be discarded as unnecessary.
That would be a tragedy for Britain. In an attempt to avert this, we must correct the errors published today by Robert Verkaik, home affairs editor of the Independent newspaper, who reiterated to the nation the NTA press release that "The long battle to break the link between drug addiction and criminal behaviour is being won. Nearly a half of all addicts who participated in drug courses in 2005 have been found to be free from addiction and no longer committing crime four years after leaving treatment. For those with cannabis or cocaine habits the success rates are as high as 69 per cent and 64 per cent respectively".
Sorry but this is very far from the truth. It looks as if £848,960,000 has been spent in one year on people NOT leaving treatment satisfactorily.
Deceptively, the NTA figures were placed beside the real success stories of addicts who now lead drug-free lives thanks to Rapt rehabilitation programmes, as though they were cause and effect. The reality under the NTA regime is that only about 2% of people seeking help get rehab (and a similar number get drug free).
October is, of course, anniversary time: the NTA board meeting. This time last year, the National Treatment Agency for Substance Misuse used our hard-earned taxes to pay for positive PR in the Guardian, whose Terry Kirby wrote that it “has a seemingly perfect response” on spending resources (a Freedom of Information query from Addiction Today elicited that the NTA gave the Guardian £219,337 of our money in that 18-month period). Then Addiction Today number-crunched to put the record straight about lack of recovery-oriented treatment for addicts and thus dismal results. It was vital to identify what went wrong, as covering up the true figures denies tens of thousands – perhaps hundreds of thousands – of vulnerable people a chance to quit drugs and addiction for life.
Since then, we have changed government and health secretary Andrew Lansley abolished the NTA. But it has two years to embed its practices and its staff into the Public Health Service. Can its directors live up to the trust placed in them by the prime minister over this transition period? Judge for yourself as we numbercrunch the NTA Annual Report 2009/10 and that press release.
NTA ANNUAL REPORT 2009/10
In its Annual Report 2009/10, the NTA chooses to quote for its figures a National Audit Office report, Tackling Problem Drug Use, which states that 213,000 people were in contact with the treatment system, 168,000 of these “in effective treatment” – and that only 28,000 “left treatment satisfactorily”. The first question is what happened to the other 140,000 people? The funding per person, according to the NTA report, was £3,000 – so that is £420,000,000 spent on people not leaving treatment satisfactorily. What happened to them?
And the unexplained costs could be worse. The government-funded DTORS report estimated an average annual treatment cost not of £3,000 per patient but about £4,500 (Summary of Key Findings Research Report 23, section: Cost-effectiveness of drug treatment “With drug treatment costs of around £4,500 …”) but by Research Report 25 this figure had jumped to £6,064 (“The average cost of drug treatment over the whole DTORS sample was estimated to be £6,064…” So the NTA Annual Report 2009/10 could be indicating £848,960,000 spent on people not leaving treatment satisfactorily.
Perhaps this is why Hansard, which prints all MPs’ speeches in the House of Commons, reported a comment in July by David Burrowes: “The annual report of the National Treatment Agency for Substance Misuse, which was presented to the House… is in stark contrast with the 30th report of the Public Accounts Committee in March, which concluded that £1.2billion is spent on tackling drug misuse without the government knowing the overall effect of that approach”.
And what does “satisfactorily” mean? The previous annual report stated that “24,656 (41%) were discharged successfully, defined as those completing treatment free of their drug of dependency”. This last phrase is removed in the current version – perhaps because, last year, Addiction Today highlighted that it meant patients stopped using one drug but were using others. This is equivalent to saying that an alcoholic has completed treatment free of dependency on whiskey but is now dependent on vodka, brandy, high-strength lagers… Professionals refer to this as cross-addiction, where one drug is replaced with another and the addictive behaviours continue unchanged. The final figure came a maximum 8,980 people perhaps free from dependency: a similar number to those who managed to get into rehabs.
“Changes in definitions mean that direct comparisons to previous years are not possible,” the NTA Annual Report states. So we must leave you to judge from last year’s for the moment. And ponder this…
DODGY DOSSIER OF DISCHARGES
As the NTA prepared for its 5 October board meeting this year, it issued a congratulatory press release not about these latest annual accounts but results from five years ago. “In an international first, the NTA tracked the post-treatment journey of thousands of drug users over a four year period and has discovered that almost half of those discharged in one year subsequently demonstrated sustained recovery from addiction,” said the press release. “Nearly half of those leaving treatment neither need further treatment nor were found to be involved in drug related offending”.
“These findings are very exciting because they help us define more accurately what ‘success’ looks like for drug treatment,” trumpeted NTA CEO Paul Hayes, promoted from his career as a probation officer to this role and taking home a salary rivalling prime minister David Cameron (£135,000-£140,000 pa). NTA’s performance can also be credited to its executive director over these years, Rosanna O’Connor.
The sad reality is that only “discharged” patients were included in the study. Again, we do not know what happened to the greater number not classified this way. Nor can we refer to the 41,475 (of 54,000) discharged people in the report as “participants” as the NTA has equated lack of proof of negative results as proof of positive results – see Professor Neil McKeganey’s expert opinion on this below.
DISCHARGED OR DEAD?
Last year, when the NTA Annual Report referred to “individuals discharged”, a deeper look revealed that 905 were “discharged” from this earth completely, having died.
More had “moved away”, had “treatment withdrawn” or are “not known”. 1,769 are said to have declined ‘treatment’ – perhaps due to the growing phenomenon of people refusing a lifetime on methadone, or a reflection of stories of a high-volume low-care organisation which gets vulnerable clients to sign DIR forms which they think give treatment but are refusal forms.
Professor Neil McKeganey’s blog is copied below for clarity on this topic.
NTA TREATMENT OUTCOME RESEARCH:
HARD EVIDENCE OR POLITICAL SPIN?
by Neil McKeganey
Professor of Drug Misuse Research
University of Glasgow
The National Treatment Agency has announced a near miracle in drug treatment. Followed up over a four-year period, the NTA has claimed that “Nearly half of those leaving treatment neither need further treatment nor were found to be involved in drug related offending”. When you recall that drug addiction is a “chronic, relapsing condition”, you might wonder how any treatment could be that good? Too good perhaps to be true?
So what is the claim that addicts leaving treatment need no further treatment actually based on? Is it based on any sort of clinical or psychological assessment of the individual drug user to assess his or her level of continuing need? Have the researchers who have undertaken this work examined the living arrangements of the drug users concerned, have they looked at their contact with their children, at whether the individual drug user is in employment, at whether they are still using illegal drugs, at whether they are even using prescribed drugs? Do they know anything about the housing circumstances of the drug users involved?
The answer to all those questions, sadly, is no. The NTA has claimed near-miraculous success for drug treatment whilst knowing next to nothing about the lives of the people it is so eager to celebrate as treatment successes.
What the NTA has done is to undertake an analysis of client records to see whether drug users leaving treatment re-contact drug treatment over the next four years. If they do not, then according to the NTA, the individual must be well on the road to their sustained recovery. Here is another interpretation based on the same data: that a large proportion of individuals leaving treatment were so disappointed by their experience of treatment that they did not return. Another interpretation of the same data is that, having contacted drug treatment services with a drug problem and left those series with a drug problem, many drug users might have wondered at the point of recontacting services.
Those interpretations would not be welcomed by those providing drug ‘treatment’ or those, like the NTA, responsible for improving the quality of drug treatment. There, I am afraid, is the rub. The assessment of the success or otherwise of treatment has to be based on a good deal more than an analysis of records undertaken by the very agency with a vested interest in the quality of the treatment being provided.
So what about the claim that 'treatment' leads to a massive resolution in drug-related offending? That claim is based on the NTA looking to see whether individuals leaving treatment provided a positive drugs test to a criminal justice agency or contacted the Drug Interventions Programme over the next four years. One would not have thought it needed to be pointed out - but not being drug tested by the police and not contacting the Drug Intervention Programme is not the same thing as ceasing one's involvement in drug-related offending.
The NTA has acknowledged that it cannot categorically assert that all individuals who do not return to treatment or contact the Drug Interventions Programme are leading entirely drug-free or crime-free lives. To do that, it says, would require each of the 40,000 clients in the study to be personally contacted and interviewed.
In fact, what would be required is only to study a representative sample of treatment leavers. Despite its cautionary caveat, the NTA has done precisely what it should have refrained from doing – claimig near-miraculous success for drug treatment on the slimmest-possible evidence base.
The NTA has too much invested in a positive story of drug 'treatment' for it to be responsible for the evaluation of that treatment. What we need is for our drug treatment services to be subjected to rigorous and independent evaluation. Only then can we be assured that the claims we are reading in the press and elsewhere about the effectiveness of the treatment services provided are based on hard evidence rather than political spin.
Definition of treatment: click glossary.