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.