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.
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In a Star Trek sci-fi story, an apparatchik from earth arrives to tell the spaceship crew they would not recognise home. âWe have got rid of war, disease, poverty,â he explained â we could add âaddictionâ.
âWhen did this happen?â asked the captain.
âWhen we rewrote the dictionary,â 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 NTAâs language around statistics and data gathering â and the way it influences whether people desperate to stop using drugs addictively are enabled or denied that lifesaving chance.
Before looking at this yearâs annual return, letâs look at the pattern over past years of the NTAâs 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 â 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 â which all reasonable people will agree with â 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 â24,656 (41%) were discharged successfully, defined as those completing treatment free of their drug of dependencyâ. This last phrase is crux in dictionary rewriting: it means that 24,656 patients stopped using one drug â 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. â15,676 who completed âfree of dependencyâ had successfully overcome addiction but may have occasionally been using other substances such as cannabis,â 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 governmentâs 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 âfree of dependency (no drug use) and not using any illicit drugs at the time of exitâ. 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 âThe terms âtreatment completeâ or âtreatment complete, drug freeâ are not clinical terms/definitions â the terms essentially record entry into and exit from the NDTMS reporting framework and have no clinical valueâ.
The Annual Report also referred to â60,386 individuals dischargedâ â a deeper look revealed that 905 were âdischargedâ from life completely, having died. More had âmoved awayâ, had âtreatment withdrawnâ or were ânot knownâ. 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…
âIt looks as if ÂŁ848,960,000 has been spent in one year on people NOT leaving treatment satisfactorily,â was my reaction to the NTAâs 2010 Annual Report. At this time, then-health secretary Andrew Lansley had announced the abolition of the NTA. But it still had influence.
âThe 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 ÂŁ1.2billion is spent on tackling drug misuse without the government knowing the overall effect of that approach,â Hansard reported in July 2010. Let me clarify here that only about ÂŁ20-30million 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 â despite admitting in the 2010 Annual Report that âchanges in definitions mean that direct comparisons to previous years are not possibleâ.
Read more details, with comments by Professor Neil McKeganey.
â27,969 free from dependencyâ was a capital-letter claim featured large on the cover of the NTA 2011 Annual Report. And its spokespeople publicly defined âfree of dependencyâ as being free of all drugs with no cross-addiction. It is a pity that they did not tell the data gatherers: âfree from dependencyâ was NOT an outcome in the National Treatment Data Monitoring System (either dataset G or H).
âLeaving treatment drug freeâ was a NDTMS outcome â but (a) it is defined as quitting only illicit drugs and (b) there was no test or independent audit, merely a request that âthe client is judged by the clinicianâ, who might have a vested interest in retaining funding dependent on outcomes.
We heard that detoxes increased, to increase âtreatment completedâ numbers even though detox should be regarded as pre-treatment. The NTA also headlined a âdecline in people needing treatmentâ â 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 NTAâs 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.
âFewer people are in treatment for drug use,â 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 â but a wait for what?
âMore drug users are recovering,â the report adds â but the NTA refuses to define recovery.
âYounger people are doing better,â the NTA claims â but it has also said that children are âwell servedâ by prison and care homes instead of rehab.
The NTA also writes that there were 29,855 âsuccessful treatment completionsâ compared to 11,208 in 2005-8 â but definitions have been changed, as the NTA admitted last year, so this comparison cannot accurately be made.
And what does âsuccessful treatment completionâ 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 dâetre 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.