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Drugs and alcohol are getting a lot of airtime these days - David Cameron recently launched his new Alcohol Strategy and Sir Richard Branson leads the charge against the so-called War on Drugs. There is more debate on these issues than there has been for years.
At issue are the imposition of a minimum price on alcohol and the relaxation of laws regarding the consumption of marijuana and other "soft" drugs. But positions are as entrenched as ever - amongst newspapers, drug companies as well as politicians - and even a small reform will involve a stupendous political brawl.
But there is one issue that all parties seem to agree on: addicts should be offered treatment; they should be dealt with by the health service rather than the legal system. If you look at this fascinating debate on the War on Drugs (Branson versus the American establishment) there is just one issue where there seems to be consensus: rehab is good.
This should be good news for Britain's 60 rehab units, the residential clinics that offer alcoholics and drug addicts the therapy needed to overcome addictions. Considering how many addicts there are in Britain (the BBC estimates there are two million) and how few spaces there are in these rehab clinics, each one should be packed to the rafters. Even getting on the waiting list should be hard.
But the opposite is happening - residential rehab units are being closed down: over the last two years 31 drug and alcohol rehab units have been closed down in the UK. The tragedy is that setting up a rehab unit is complex and time consuming and there is a shortage of experienced addiction therapists in the UK. Replacing them could take a generation.
I work for a drug and alcohol rehab centre in Scotland. With over 110 beds it is one of the biggest in the UK and for many years we relied on referrals from the NHS. But the number of NHS referrals has declined from an average of 250 a year to just 50 -- despite the fact that over 60% of those who complete residential rehab treatment manage to remain abstinent.
The British Government spends an estimated £800 million a year on what it calls "addiction treatment" but less than 2% of this is used to fund people to go into residential rehab. Most of the budget is spent on "revolving door" treatments such as home detoxes, community interventions and replacement drugs such as methadone.
Methadone is popular among policy makers: it is credited with cutting crime and HIV infection rates and, with a simple prescription, vast numbers of drug addicts can be offered "addiction treatment". If used under medical supervision, methadone can be useful in stablising intravenous drug users and bringing them down off their illegal highs.
But methadone is highly addictive. Also, it is supposed to be prescribed as part of a comprehensive treatment programme that includes the kind of individual therapy needed to beat the addiction. But it's impossible to offer this type of treatment to the estimated 200,000 heroin addicts who get methadone every day in the UK. As a result their addiction is simply perpetuated.
The real scandal, as far as those in the rehab sector are concerned, is that very few addicts are offered the chance of going into residential rehab. Community and "substitute treatment" certainly have a place but surely rehab should be allocaed a more reasonable share of the budget. Surely those addicted to methadone should be given the opportunity of going into an abstinence-based treatment programme?
Before they got into power, it was reported in the Guardian that the "The Tories want an overhaul of the system, with many more people going into residential rehabilitation and making a serious effort to become drug-free, and fewer being given methadone."
Dominic Ruffy of RehabGrads, a lobby group for the rehab sector, told me the Coalition Government is struggling to change the culture in the NHS: "the challenge is to educate the drug workers, and treatment commissioners, about abstinent recovery and the role that and rehab centres can play. For the last 14 years they have been focused on harm reduction and substitute prescribing."
Let's hope that these reforms come into effect before more rehab centres have to close down
Follow Rupert Wolfe-Murray on Twitter: www.twitter.com/wolfemurray
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It is worth remembering that many people are not in a position to 'up-sticks' to rehab for an extended period - interventions have to be acceptable to people.
What's your experience?
One of the big problems with any comparative analysis of community and residential treatment is of course the potential and in some cases tendency for residential treatment providers to cherry pick their service users. Many will only take people who have already completed detoxification - meaning that much of the work for which they take credit has already been undertaken by the person themselves before they enter rehab. Others will specify that people have to demonstrate their "motivation to change". This is of course all well and good, but it would be wrong for organisations to claim their interventions are so much better than those provided by community services who are not able to select their client group, but whose client group selects them - often in desparate circumstances . Hope this is helpful.
Are you referring to the "Outcomes for Dutch patients at Castle Craig Hospital" study? I cannot see another reference on there that quotes a 60% abstinence figure, but sorry if I have just missed it.
If it is this study, it is based on 156 Dutch patients, 39 of whom were unavailable for follow-up, and only 72% of the remaining participants responded - so 84 participants? That doesnt exactly justify the broad statement in your article, which implies that the stat is for all rehabs.
My own experience is that 60% seems optimistic, which is not a slight on any specific rehab programme or service - just a general observation based on the unfortunate realities of drug use for many people.
People with serious addiction issues frankly need locking up in secure, caring facilities for a good few months with the best treatment. Perhapsfamily members can nominate someone for treatment? Addiction is a serious and its time we stopped thinking that herion addiction for example can be resolved by giving the likes of Boots a very profitable contract to dispense methodone.
I know herion addicts, there on it when they've robbed someone and they pop up to Boots when they are skint or can't tick.
Anyway, most addicts (yes, even serious addicts) can actually function relatively normally on a day-to-day basis. If not enough addicts are ending up in the rehabiliation centres, it's simply because there is not enough awareness among both patients and NHS staff that such facilities exist. It sounds ludicrous, I know. Why wouldn't NHS staff be aware of services they offer? Well, it happens. I would have been stuck in hospital for three months last year had a nurse not approached the most senior neurologist in a complex serving the entire North West of England and informed him of an anti-biotic outpatient service (OPAT) offered in the area. I got out of there six weeks early thanks to that random nurse. The NHS is so huge and complex that even its most senior staff are oblivious to the many services they offer.
There is a wealth of very good evidence for the efficacy of community treatment - including substitute prescribing.
Therapists tell me that the main problem with treatment is denial. Addicts can spend 25 years denying they have a problem, and even in treatment denial is a big issue. They have to open up if they are to treat their problems which underlie their addicitons.
Tell me more about Boots. I would like to know more about the mechanics of how methadone is dispensed. I thought that users were obliged to drink it in front of a Pharamacist and this took place behind a screen or door? Sounds like a contractual arrangement of some sort. Pls enlighten us if you can.
I lived in an area where there was an alcohol rehab unit that also worked closely with a housing association. Four guys came out of rehab into a newly furnished flat. Supervision was weak. After around three months they wrecked the flat selling everything they could (toilets, fixtures, etc), moved to the street, earned their right to re-register for rehab and were back in within the year.
We need rehabilitation. That does not mean present systems are effective.
We need addiction treatment. That does not mean present systems are effective.
The old dilemma still exists. Addict is part of a social problem. Remove addict from social context and treat. Addict becomes ''well.'' Place addict back in social context. Addiction recurs.
Your model of diagnosis and treatment is based upon the individual rather than the social context.
It is hopelessly inadequate. We need a sociological model of treatment based upon the social context and sociology, not an individual model of treatment based upon isolating individuals within psychological models.
Addicts for the most part become that way through mental health issues and so by treating those at an earlier stage can prevent addiction and indeed cure it.
However addiction especially booze is a choice and most MH issues are not but addicts get taken out of their environment and treated whilst other people who cause way less crime are either given a pill or ignored totally.
2 billion on addicts and how much on care in the community(not including drugs)?
Of course, if we treated the problems we face sociologically we would find ourselves hitting dead ends pretty soon. After all decent housing and improved life opportunities would alleviate a lot of problems. Treating the individual helps us stay away - collectively - from the social causes of these problems.