Monday 20 June 2011

Drug Treatment Isn't Working

I've been saying it for ages and pretty well every Probation Officer has known it for ages too. Our one-size-fits-all approach to drug dependency by prescribing methadone isn't working. The utterly flawed case for this treatment method is comprehensively demolished in a recently published report by the right-wing think tank Centre for Policy Studies. The whole policy has been a disgraceful waste of time, money and effort and done nothing to reduce the problem - in fact it's almost certainly made the whole situation worse. 

During the period that the Labour government was imposing this strategy through the National Treatment Agency, they oversaw the disgraceful demise of almost all residential rehabilitation facilities, thus leaving prison as the only 'residential' drug treatment facility available. Of course this is nonsensical, both in terms of cost and the need to commit offences in order to get a prison 'rehab' bed. But sadly in prison there will invariably be little counselling and only prescribed methadone as an alternative to illegal drugs that are widely available. Despite this, many people find it a viable and preferential option and some do manage to detoxify or become 'stabalised' on a methadone script. 

In addition to ridiculing the accepted professional view that methadone prescribing works and is cost-effective, the report makes it clear that in their view the only answer is to work towards total drug abstinence. Whilst not cheap as it would involve the financing of new residential bedspaces, they make the point that if the outcomes are improved, it would be money well spent.

Whilst I agree fully with this view and have long-lamented the disappearance of residential treatment places, I think I need to sound a note of caution. This report is in danger of falling into the same trap of believing that there is only one answer to the drug problem and that it lies with total abstinence. Every person is different and their drug problem and attitude to substance misuse will differ. The solution therefore has to be tailored to that individual and it might involve the opposite option of prescribing heroin, rather than encouraging total abstinence. Understandably perhaps this gets no mention in a report advocating abstinence, but there is evidence that such a policy can work well for some people. It seems that in some instances heroin can be less addictive than methadone and ironically can be easier to withdraw from.   

This report is extremely important and timely in serving to highlight how the situation might well get worse due to impending changes being introduced by the coalition government. Whist the new government accepts that current policies are not working, their answer is to change the payment method to drug agencies rather than change the underlying policy. The report explains that 'Payment by Result' experiments will begin in October this year tailored to proxy outcomes such as housing or employment, but specifically excluding projects that wish to pursue an abstinence route. This is completely misguided and I agree entirely that such agencies ought to be included in PbR schemes with their payment linked to rewarding evidence of abstinence outcomes. That seems a sensible idea to me, rather than just rewarding the present methadone treatment industry differently.

4 comments:

  1. "But sadly in prison there will invariably be little counselling".

    I know we're making a tiny dent in the numbers of those who need it, but there are some of us working our butts off trying to provide a good rehab service inside, which isn't the most comfortable of places to work, particularly as we're regarded with almost the same suspicion as every other "visitor". One counsellor that came to work with our team stated on day two that she had changed her mind and needed a work environment with "soft furnishings"! A recent study backs up our claim that what we offer works, and in this environment that is easily measurable; if they don't re-enter the prison system chances are they're still clean. I s'pose you could argue that they leave as better criminals who don't keep getting caught but I prefer my theory! I couldn't do what I do if I weren't an eternal optimist and I guess that applies to you too.

    I hate methadone being described as drug treatment, although I have met the occasional one or two who have weaned themselves using that. Pretty much everyone else I've ever met uses on top.

    I understand your perspective on prescribing heroin, and maybe it is a viable alternative but every addict that I've ever worked with has zero self-esteem and giving them heroin is effectively telling them that we've given up on them isn't it?

    I'm grateful, at least, to have fallen over a sympathetic, informed probation officer. I occasionally tear my hair over the young 'uns who have, for instance, told one of my lifer clients that he didn't work with addicts, didn't understand how N.A. worked and, this is the blood-boiling bit, neither did he wish to! Another retoxified a successfully abstinent client "for his own protection".

    I guess we'll both plod on, trying to make a difference . . .

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  2. QuakerSal,

    Thanks ever so much for taking the trouble to comment. It's really great to hear about pockets of good practice out there. In my experience time taken to talk with clients/prisoners is invariably rewarding. Keep focussed on them, stay in touch and gently try and educate the newer probation colleagues.

    Cheers,

    Jim

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