Addiction Today

UNIT COSTS FOR SUBSTANCE MISUSE

"Transparent pricing" for drug treatment

The National Treatment Agency for Substance Misuse is working with the Department of Health, Home Office and HM Treasury to understand the costs of substance-misuse treatment in England . The aim is to allow the purchase of the most effective interventions at a transparent price.

Expansion and improvement of drug treatment is expected to be driven by better use of existing resources or growth in local investment, not by increases in central government investment through the Pooled Treatment Budget.

A successful pilot was carried out in the South East, and the project expanded nationwide in 2006/7. Work has begun on the 2007/8 exercise after consultation with the field. The main changes to this year's exercise are:

* Rather than looking at theoretical capacity for a service, the NTA will use actual NDTMS performance data

* Alignment of Tier 3 and 4 modalities with NDTMS modalities

* Use of most recent information – ie, using 07/08 rather than 06/07 data

* Simplification of some of the categories, particularly for direct non-pay costs and overheads

* A bespoke, web-based tool for data collection rather than individual (excel) spreadsheets.

Work is ongoing to sample primary care based projects across the country as well as some Tier 2 agencies. Consensus is that this model is not readily applicable to Tier 4 residential services (due to the different nature of their income streams), so a parallel exercise will be conducted for this sector.

PROPOSED TIMETABLE

Nov 2007-January 2008 

Web-based tool being built

Feb-March 2008              

Testing of web-based tool and draft guidance with regional working groups

April 2008                         

Final guidance for 07/08 exercise published on the web

April-May 2008                

Providers refer to guidance, and regional Memoranda of Understandings where agreed, to prepare date for entry in June 2008

June 2008            

Web-based tool available for provider data submission

August 2008

NTDMS performance data uploaded to tool

End August 2008

Final unit cost reports available to partnerships and commissioners

GUIDANCE

This has been modified to reduce bureaucracy and incorporate learning from the first exercise. The final documents will be released by April 2008. If you have any queries about the unit costs exercise before the guidance is made available and the data collection phase begins in June 2008, forward your comments to beverley.oliver@nta-nhs.org.uk.

The NTA lead is treatment-delivery manager Colin Bradbury on 020 7261 8835.

The latest version of the unit costs FAQ can be found here  FAQ Version 4 (September 2007).

THE SCIENCE OF ADDICTION

by Carlton Erickson

Published by WW Norton at £19.95. 292 pages.

ISBN 978-0-393-70463-1.

I MUST CONFESS TO KNOWING Professor Carlton Erickson: I first heard him speak in the US and was so impressed that I invited him to be a key presenter at the inaugural UK/European Symposium on Addictive Disorders in 2004 – due to demand, he returned in 2006.

Even personalities who had worked in this field for decades told me afterwards that his lecture was the first time they could understand the difference between addiction/ dependency and abuse/misuse. So I was looking forward to receiving this book, and was not disappointed. I can unreservedly recommend this book to anyone, professional or general public, who has any interest in addiction.

Scientists tend to blame treatment professionals for not taking time to read the latest scientific literature or to attend educational science lectures. Treatment professionals tell the scientists that they are boring and use confusing jargon. Government sometimes tries to get the two sides together. Erickson is one of the few people in this world who not only has the ability but also the interest and love to be a scientific spokesperson who feels comfortable helping counsellors, treatment and other health professionals as well as lawyers and administrators to become excited about addiction science.

"Given the likelihood that there will never be enough studies in addiction science to be totally convincing, the science that best matches the 'voices of the afflicted' is most useful," he writes. "Listening to people who live the problem is a great way to come up with hypotheses to test." He can be confident only when evidence-based and practice-based findings consolidate each other.

10 chapters cover terminology and characterisation of "addiction", the basics of brain science, anatomy and neurobiology of chemical dependence, genetics, stimulants and depressants, alcohol, other drugs, treatment, the power and limitations of addiction research, and evidence-based research for the future. There are appendices, references and a glossary.

The subject matter demands concentration from readers, but the information is written in an easy-to-read style. The thoroughness with which Erickson covers his topics can be illustrated in, for example, the chapter on treatment.

This covers the philosophy of "dependence disease treatment", placebo (expectancy) effects,
12-step programmes, interactional and behaviour-therapy, methadone, buprenorphine, harm reduction, moderation management, faith-based treatment, vouchers, detoxification, anti-craving drugs, anti-smoking therapies and drugs, new developments such as vaccines, the need for painkillers, comorbid mental disorders and "chronic care".

Deirdre Boyd is editor of Addiction Today

by Carlton Erickson

Published by WW Norton at £19.95. 292 pages.

ISBN 978-0-393-70463-1.

I MUST CONFESS TO KNOWING Professor Carlton Erickson: I first heard him speak in the US and was so impressed that I invited him to be a key presenter at the inaugural UK/European Symposium on Addictive Disorders in 2004 – due to demand, he returned in 2006.

Even personalities who had worked in this field for decades told me afterwards that his lecture was the first time they could understand the difference between addiction/ dependency and abuse/misuse. So I was looking forward to receiving this book, and was not disappointed. I can unreservedly recommend this book to anyone, professional or general public, who has any interest in addiction.

Scientists tend to blame treatment professionals for not taking time to read the latest scientific literature or to attend educational science lectures. Treatment professionals tell the scientists that they are boring and use confusing jargon. Government sometimes tries to get the two sides together. Erickson is one of the few people in this world who not only has the ability but also the interest and love to be a scientific spokesperson who feels comfortable helping counsellors, treatment and other health professionals as well as lawyers and administrators to become excited about addiction science.

"Given the likelihood that there will never be enough studies in addiction science to be totally convincing, the science that best matches the 'voices of the afflicted' is most useful," he writes. "Listening to people who live the problem is a great way to come up with hypotheses to test." He can be confident only when evidence-based and practice-based findings consolidate each other.

10 chapters cover terminology and characterisation of "addiction", the basics of brain science, anatomy and neurobiology of chemical dependence, genetics, stimulants and depressants, alcohol, other drugs, treatment, the power and limitations of addiction research, and evidence-based research for the future. There are appendices, references and a glossary.

The subject matter demands concentration from readers, but the information is written in an easy-to-read style. The thoroughness with which Erickson covers his topics can be illustrated in, for example, the chapter on treatment.

This covers the philosophy of "dependence disease treatment", placebo (expectancy) effects,
12-step programmes, interactional and behaviour-therapy, methadone, buprenorphine, harm reduction, moderation management, faith-based treatment, vouchers, detoxification, anti-craving drugs, anti-smoking therapies and drugs, new developments such as vaccines, the need for painkillers, comorbid mental disorders and "chronic care".

Deirdre Boyd is editor of Addiction Today