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