AUDIT BY UNIVERSITY SHOWS COMMUNITY CARE FAILING TO DELIVER RECOVERY
“Addicts in part of West Yorkshire spend years in treatment schemes with limited chance of recovery,” stated the BBC. An audit of Calderdale Substance Misuse Services by Huddersfield University proves what we knew anecdotally: the lack of services leading to full, drug-free recovery means that area will lack full recovery.
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A research team from Huddersfield University published an audit report, Recovery among tier 3 substance misuse service users in Calderdale – highlighting its depressing results. We commend Calderdale for commissioning this report and add that such outcomes are, in Addiction Today’s wide experience, the rule around the UK rather than the exception. The findings are a salutary lesson for every Drug Action Team, Primary Care Trust, Public Health England, the new police commissioners, local authorities, payment-by-results experiments and anyone else connected with funding drug services.
KEY FINDINGS: TIER 3 SERVICES
1. Most people receiving treatment continue to use heroin and crack cocaine. For every extra three years on a ‘treatment programme’ heroin use reduces by an average of only one day in 28.
2. Every extra year on a treatment programme raises the odds of recovery by only 7%. So an extra 10 years on the programme would be needed before the odds of recovery are even doubled.
3. The odds of recovery are two and a half times greater for service users who do not use crack.
Failure is set to continue, as the report’s key recommendations (a) do not mention rehab or even daycare abstinence treatment services leading to full recovery and (b) continue to refer only to heroin and crack rather than all drugs, so that Calderdale services are set to continue treating symptoms not causes, to continue cross-addiction from one drug to another, like an alcoholic switching from brandy to whiskey to cider.
There is no mention of even one link to drug-free treatment to get addicts into recovery. There is no mention of developing such services for tier-3 people to partner with.
The research aimed to “identify variables associated with recovery” – but the authors chose an abstruse definition of recovery, the only one which excludes drug-free goals. It is a definition agreed only by three people: a pharmaceutical opinion leader, his protégé who also works for the National treatment Agency, and someone from Scotland. So freedom from drugs was lost as a measurable association with recovery. If, by definition, there is no aim of drug-free recovery, how can it be achieved?
Worse, the authors state that they got this unambitious definition from the NTA. Why is it publicising something against government policy – and against public opinion despite being funded by the public purse?
The general public understand “rehab”, “recovery” and “drug free” to mean free of all drugs and restoring lives, addressing previous addictive behaviours. But the Calderdale/Huddersfield authors note that the NTA measurement tool they used – the discredited self-report Top – measures only alcohol and four illicit substances. So we are back to cross-addiction.
The report also mentions “nonresponsive or resistant” patients. This is perverse: there are no wrong patients, just the wrong treatment delivered by the wrong people at the wrong time. 10-20 minutes of “script and chat” once a month (Best 2009, Wisely 2010) is unlikely to yield success.
In addition, the report lists all (not only tier 3/community) Calderdale ‘treatment’ services – with the glaring omission of drug-free rehabs or daycare, even though they offer great starts and maintenance of drug-free recovery. How can Calderdale achieve this without offering the services? There are 149 DAAT areas but only about 50-60 rehabs offering drug/alcohol-free recovery. Will Calderdale establish one locally or refer
out of area, to deliver recovery?
According to the NTA’s own figures, less than 2% of problem drug users ‘in the system’ are lucky enough to access rehab. So Calderdale is not unique. It is not an exception to the rule but symbolic of widespread failure to recognise that, to get people off drugs, they need to be offered services which specialise in drug-free treatment.
A spokesman for NHS Calderdale told the BBC that “The report published by University of Huddersfield is still in draft form and has not been signed off by us as commissioners of the report”. This is to ignore the fact that the title of the research findings included the word “FINAL” (in caps).
“The study began in 2009 and therefore it reports on the services available at that time rather than the current services," the spokesman added. Sadly, it is unlikely that later figures will show improvement, given that the Recommendations section excludes drug-free treatment services.
Calderdale’s denial of the problem also is not promising of openness to change. It told the BBC that “Calderdale Substance Misuse Service has a good track record of successfully identifying and providing effective treatment for people who have drug and alcohol problems.” Indeed, Calderdale reports an exceptional number of “successful outcomes” to NDTMS, adding to the body of doubt about the latter’s accuracy.
You can read the (taxpayer-funded) Calderdale Segmentation Audit on Recovery Among tier 3 substance misuse services below. ARF has removed case studies to protect anonymity.
Download HUDDERSFIELD UNI TIER 3 -_FINAL_REPORT_19_01_2012 – without case histories
DEIRDRE BOYD is editor of Addiction Today and CEO of the Addiction Recovery Foundation.