THE NTA ANNUAL-REPORT DOSSSIER
The final annual report from the National Treatment Agency for Substance Misuse paints a colourful picture. Deirdre Boyd translates the wording to bring readers a clearer view of reality so that future decisions are not based on flawed foundations.
Download AddictionToday139 – NTA annual reports
In a Star Trek sci-fi story, an apparatchik from earth arrives to tell the spaceship crew they would not recognise home. “We have got rid of war, disease, poverty,” he explained – we could add “addiction”.
“When did this happen?” asked the captain.
“When we rewrote the dictionary,” the apparatchik responded.
Rewriting the dictionary of drug treatment and outcomes is the most significant legacy of the National Treatment Agency for Substance Misuse, founded in 2001 and to be relocated into Public Health England next April.
In 2010, this quango was declared to be due for abolition but anecdotes abound that it will move with its infrastructure almost intact; perhaps only the older senior management will leave, with gold-plated pensions. So it is vital to consider the influence on other government departments of the NTA’s language around statistics and data gathering – and the way it influences whether people desperate to stop using drugs addictively are enabled or denied that lifesaving chance.
Before looking at this year’s annual return, let’s look at the pattern over past years of the NTA’s interpretations of annual statistics.
HOW LANGUAGE LEADS TO DISCREPANCIES IN ANNUAL REPORTS
Our first critique of NTA annual reports, after years of accepting them at face value, was in 2009 when I realised that abstinence-based rehabs had been closing at an average rate of one per month for almost two years – despite addicts wanting to access them to get into recovery. Something was obviously wrong.
An accompanying NTA advertorial in The Guardian newspaper titled Why rehabilitation is important to us all – which all reasonable people will agree with – covered up the fact that only about 2% of people seeking such rehabilitation actually managed to get it under the NTA regime. This lack of referrals might also explain the rehab closures.
Point 5.2 in the 2009 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 crux in dictionary rewriting: it means that 24,656 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.
I asked NTA head office to confirm this. “15,676 who completed ‘free of dependency’ had successfully overcome addiction but may have occasionally been using other substances such as cannabis,” came the written reply, revealing ignorance of the health issues. It also ignored those on methadone who became cross-addicted to alcohol, substantiated by the government’s NTORS research to be as high as 40% of people prescribed methadone, or the thousands on both benzos and methadone.
That left only 8,980 patients who completed treatment “free of dependency (no drug use) and not using any illicit drugs at the time of exit”. Even here, a reality check is needed.
First, there are those who might wish to enhance figures because they are dependent on funding. Second, the NTA-funded Top form used to measure results is merely anecdotal self-report, without hard confirmation from, for example, hair or urine drug tests. Third, the Top form did not ask for volume of usage of addictive legal drugs including methadone.
Although the NTA denies that drug-free results come from rehabs and daycare with drug-free programmes, the number now analysed to be drug-free matched the small number of patients (2%) who managed to get into rehab.
One of the increasingly disillusioned treatment commissioners wrote to Addiction Today that “The terms ‘treatment complete’ or ‘treatment complete, drug free’ are not clinical terms/definitions – the terms essentially record entry into and exit from the NDTMS reporting framework and have no clinical value”.
The Annual Report also referred to “60,386 individuals discharged” – a deeper look revealed that 905 were “discharged” from life completely, having died. More had “moved away”, had “treatment withdrawn” or were “not known”. Read more.
After our 2009 critique, the NTA changed terminology so that we could not directly compare statistical issues year-on-year. But highlights of more recent annual reports follow…
“It looks as if £848,960,000 has been spent in one year on people NOT leaving treatment satisfactorily,” was my reaction to the NTA’s 2010 Annual Report. At this time, then-health secretary Andrew Lansley had announced the abolition of the NTA. But it still had influence.
“The annual report of the National Treatment Agency for Substance Misuse, which was presented to the House [of Commons]… 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,” Hansard reported in July 2010. Let me clarify here that only about £20-30million of all that money goes to abstinence-based treatment.
As the NTA prepared for its October 2010 board meeting, it issued a congratulatory press release not about its latest annual accounts but results from five years ago – despite admitting in the 2010 Annual Report that “changes in definitions mean that direct comparisons to previous years are not possible”.
Read more details, with comments by Professor Neil McKeganey.
“27,969 free from dependency” was a capital-letter claim featured large on the cover of the NTA 2011 Annual Report. And its spokespeople publicly defined “free of dependency” as being free of all drugs with no cross-addiction. It is a pity that they did not tell the data gatherers: “free from dependency” was NOT an outcome in the National Treatment Data Monitoring System (either dataset G or H).
“Leaving treatment drug free” was a NDTMS outcome – but (a) it is defined as quitting only illicit drugs and (b) there was no test or independent audit, merely a request that “the client is judged by the clinician”, who might have a vested interest in retaining funding dependent on outcomes.
We heard that detoxes increased, to increase “treatment completed” numbers even though detox should be regarded as pre-treatment. The NTA also headlined a “decline in people needing treatment” – who interpreted a decline in numbers presenting or accepted for treatment as a decline in need? One reason for not presenting is addicts unwilling to be parked on methadone instead of helped to quit drugs. And what about the people waiting for rehab who have been denied it? Read more.
LATEST ANNUAL REPORT AND CLAIMS
Making Recovery Real is the ironic title of NTA’s October 2012 report on events it held to spread its views on the public-health future of drug and alcohol treatment. It repeats figures in the 2011/12 Annual Report.
“Fewer people are in treatment for drug use,” NTA CEO Paul Hayes writes, as though that was an achievement: numbers fell in the past year to 197,110 from 201,815 in 2008/9.
The report shows the average waiting time is down since 2001 – but a wait for what?
“More drug users are recovering,” the report adds – but the NTA refuses to define recovery.
“Younger people are doing better,” the NTA claims – but it has also said that children are “well served” by prison and care homes instead of rehab.
The NTA also writes that there were 29,855 “successful treatment completions” compared to 11,208 in 2005-8 – but definitions have been changed, as the NTA admitted last year, so this comparison cannot accurately be made.
And what does “successful treatment completion” now mean? No, not that someone has left clean and sober with a blueprint for a life turned round, but that the patients have not returned. Rehabs must choose between helping an ex-patient or damaging its perceived outcomes on which funding depends.
MISSING FROM THE ANNUAL REPORTS
Reducing deaths was a raison d’etre for the NTA. There were 1,510 drug deaths in 2000-01 immediately before it started; they rose to 2,747 in 2010. The 2011 figure is 2,652 but is not a direct comparison because – you guessed it – ways of recording have just changed.
Taxpayer-funded state-pushed methadone was the second-greatest killer.