WHAT CAN WE EXPECT IN 2008?

by Paul Hayes, chief executive of the National Treatment Agency for Substance Misuse, which oversees implementation of the government drugs strategy across England and Wales.

CHALLENGING TREATMENT.

The consensus that ‘treatment works’ is being overtly challenged in the media for the first time in many years. This is in part a reflection of a shift in thinking in some political and academic circles to support an increasingly abstinence-focused system. The NTA believes the evidence supports a treatment system which balances the immediate benefits to individuals and communities of maintenance and harm reduction, with the long- term benefits of recovery from dependency and treatment completion.

Those of us involved in the shaping, commissioning and delivery of treatment, including service users and carers, need to be involved in this public debate.

The body of evidence that treatment works and delivers value for service users and communities is powerful. We must convince the public that money spent on drug treatment is money well spent.

LAUNCHING OUTCOMES.     

Underpinning this debate will be a dramatic improvement in our ability to understand and report individuals’ progress in treatment, through the Treatment Outcomes Profile which was launched last year. With this, commissioners, providers, policy-makers and the public will be able to gauge the impact of treatment on their outcomes. This will be particularly influential in shaping the effectiveness and quality of treatment in the future.             

GREAT EXPECTATIONS AND VALUE FOR MONEY.

The unprecedented annual increases in resources experienced since 2001 have probably come to an end.  A number of partnerships and providers will need to meet increasing expectations with the same – or fewer – resources.

The NTA development of Unit Costs for treatment allied to the Treatment Outcome Profile will need to underpin the delivery of high-quality cost-effective treatment in the future.

PRISONS.   

The provision of treatment in prison has too often lagged behind treatment in the community.  In 2008, there must be a significant improvement in the quality and availability of treatment across the prison estate.   

COMPETENT STAFF.

Delivering effective treatment, which meets the needs of service users and has the confidence of the public, demands skilled, trained and competent staff and managers.

The NTA will continue to work with providers and commissioners to ensure that the expectations placed on staff do not exceed their competence to deliver.

Read more predictions by Karen Biggs of the £14million-turnover Phoenix Futures and by DrugScope CEO Martin Barnes.

All three articles first appeared in Addiction Today journal, issue 110.

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Has Paul Hayes succeeded? Click here for situation as at September 2008.

Comments

[Peter O'Loughlin]

if we want to convince the public that money spent on treatment is worthwhile, we need to demonstrate that the treatment is effective. To prove in simple terms, that people are not just 'in treatment' but in recovery, that they have taken those vital steps back into reintergration, first by letting go of the use of Drugs of Destruction.

For far too long our treatment policy has been dictated, by 'harm reduction', a misleading term, because there is no way that the harms caused by drugs of destruction can be reduced.

One cannot reduce the harms already caused by past use, but one can prevent further harm by freedom from use.

We need to accept that addiction is an irreversible condition, and that the ongoing use of Drugs of Addiction will only increase the severity of it.

We need to accept that those who have sucumbed to addiction, have lost the ability to control their use, and that attempts to cut down or modify use, are doomed to failure. Money spent in attempts to prove otherwise, cannot be claimed as money spent on treatment, but money wasted testing out a social learning hypothesis, or conducting a social engineering experimment.

Even worse, is that when it is apparent as it is now that it has failed, those who insisted that it would work, blame the user with phrases like 'treatment resistant'. They might even have the gall to insist that we need to increase the amount of money spent on such non effective methods, thereby proving Einstein's definition of insanity, continuing to do the same thing, whilst expecting a different result.

Any 'harm reduction' method that advocates the ongoing use of addictive drugs of destruction, shoud be re-named immediately, as harm facilitation, because that's what it is.

For the past decade we have allowed ourselves to be persuaded otherwise, small wonder that the public have lost their faith, trust and patience. They want results for their money.

People having spent a year or more experimenting with different ways of modifying use and in the process, ignoring all the evidence that it can't work, cannot be regarded as having been in treatment, but that is what the public has been told.

The object of all treatment has to be, to initially ease the suffering, and then to move, insofar as possible towards full recovery. Let us accept what our own experience and science tells us; recovery is not possible without abstinence.

[Kenneth Eckersley]

PAUL HAYES IS ABSOLUTELY RIGHT.

We must convince the public that money spent on drug treatment is money well spent.

But as Peter O'Loughlin also just as rightly notes, The effectiveness of rehabilitation must satisfy both the recovering addict and the taxpayers who pay for most of the treatment.

For both these groups, harm reduction and prescription drug habit management are increasingly unacceptable, and a return to treatment values based on abstinence goals is more and more seen as the only humane and worthwhile goal.

Residential rehabilitation delivering relaxed abstinence for life is today available at 150 public access centres plus prison units in 43 countries and has been for 42 years.

However, huge vested interest PR, lobbying and propaganda have for half a century sought to side-line, marginalise, scorn, ridicule and lie about such effective treatments in order to compensate for the inadequacies of the psycho-pharms' own outdated "therapies".

As a result, if the NTA is going to succeed in its basic purposes, Paul and his hard-working team are going to have to remove the blindfolds and earplugs imposed on them by those vested interests and start taking a look at non psychiatric, non medical and non pharmaceutical approaches to abstinence based on training, education and self application.

CEPTA - Council for Effective Prevention & Treatment of Addiction.