ANALYSIS OF FAILURE: NATIONALISATION OF ADDICTION

The 2008-2018 drug strategy.

by Kathy Gyngell.

Who could fail to disagree with the sentiments behind the government’s revised drug strategy, Drugs: Protecting Families and Communities, 2008 -2018 Strategy (Home Office, 27 February 2008)? Strengthening communities, working together, “a clear commitment to meet the needs of all our diverse communities” and “preventing harm to children, young people and families affected by drug misuse” are hardly controversial.

But does this report avoid controversy because, like its predecessors, it lacks direction, critical reflection, and a fundamental understanding of the complex problem at hand?

The new strategy is even more all-encompassing, woolly and vague. Instead of challenging the incompatibility of addicts’ wants – of their aspirations for normalcy along with continuing drug dependency, be it on licit or illicit drugs – the government continues to ask us to suspend disbelief and to muddy the waters of policy by asserting that it has met, is meeting and managing this incompatible demand.

Unsurprisingly then, the strategy document fails to look critically at the treatment system of its own creation, overburdened by bureaucracy but undermanned in terms of real skill and knowledge in relation to treatment.

RECOVERY AND/OR HARM REDUCTION?

An effective drugs strategy should be grounded on the need to move people from a culture of addiction into a culture of recovery. Helping people to get better is what the public expects and is crucial to a healthy civil society. Allied to this must be an understanding of the behavioural change involved in getting better. Yet this plays little part in current government policy. Its preferred but unachievable aim remains to reduce the harms of drugs use, mainly in terms of crime.

This approach is a misconceived ‘early retirement’ strategy to reduce crime by pasturing addicts out on prescribed substitute drugs. The necessity of abstinence, which in other european countries is recognised as the key step on the road to recovery, is absent from UK treatment policy. The revised strategy pays lip service to it – possibly in response to recent criticism of poor policy outcomes – but mentions it is only as an optional add on, not as a fundamental.

“Harm minimisation” is instead central. Again, who could disagree with this? We all want to reduce drug-related harm – social, psychological and medical – to the lowest possible level. But the harm-reduction techniques espoused to achieve this goal seem to rely almost entirely on replacing one substance (say heroin) with another (methadone).

This failure was exposed by Mark Easton, the BBC’s Home Affairs editor. “The real business of this strategy is about spending something like £4billion of public money over the next decade on drug treatment. But this strategy was written after the Treasury last year agreed its funding for all of this, based on the same targets as the old strategy. So whatever the press release says, this new plan will be very similar to that old one, based primarily on measuring how many people are signed up for treatment, and the problem with that is it doesn't tell you whether treatment is actually doing any good,” he wrote in February.

“Last October on the Today programme, we revealed figures which showed that of the 180,000-odd people who were signed up for treatment, 20,000 never actually had treatment, 80,000 didn't complete their treatment, and just 5,000, less than 3%, left the government programme free of illegal drugs. Since that report, one academic in the drugs world said it was ‘like a rocket fired into the english drug treatment structure, an emperor's new clothes moment’.”

This failure cannot be excused by the nihilistic argument that drug addiction is a ‘chronically relapsing condition’ – nihilistic because it ignores the international evidence that recovery is possible, common and more likely without rather than with government intervention.

GOVERNMENT BUREAUCRACY COSTS LIVES.

For the past 10 years, the government has mirrored the incompatible aspirations of the addicts themselves. It has promoted the prescription of methadone as the panacea that can reduce the harms of drug use despite the reality that it is maintaining – euphemistically described as managing – drug users’ dependency, indefinitely delaying their day of reckoning.

Though dressed in the language of the need to engage families in treatment, though espousing the need to ‘safeguard’ communities, nothing in the strategy suggests a fundamental review of what constitutes treatment.

The policy of moving addicts (described as ‘service users’), from one dependency to another, in which ‘treatment managers’, ‘substance abuse’ workers and policy advisers, as well as addicts, are caught up, remains intact. Those ‘drugs workers’ who are employed by and who have ‘grown up’ under the aegis of the National Treatment Agency for Substance Misuse, know little else.

The National Treatment Agency has become the pinnacle of a monolithic treatment bureaucracy. Its commissioning edicts and care protocols must now be implemented by the 150 local area bureaucracies (Drugs Action Teams or DATs). Yet when the DATs were first formed in the mid-1990s, it was in recognition that no single agency could deal with the drug problem in its area on its own. Since the formation of the NTA in 2001, they have, however, become part of the state. Commissioners and coordinators have grown in prominence and use public funds without much accountability or transparency. The names of DAT ‘chairs’ are not even published, only those of their coordinators and commissioners.

Today, rehabilitation is the treatment of last, not first, resort and only then when the addict, rather than the system, is seen to have irredeemably failed – by which time the destructive impact of his or her dependency is likely to have had far-reaching and negative consequences.

Today ‘fast-tracking’ into prescribing treatment via the criminal-justice system is the norm. The 150 Drugs Action Teams, idealistically established on a joint services partnership basis to commission treatment, have become little more than expensive quangos.

The current treatment requirement is a demand for limited cooperation. It is not a challenge to or support for recovery. Voluntary access through the health system and through social services, where such problems can and should be picked up, has remained underdeveloped.

TRAPPED IN ADDICTION/DEPENDENCY.

In engaging in a policy of mass prescription, in believing that incompatible wants can be met, in making doctors and counsellors act to meet political goals rather than patients’ needs, the government has taken upon itself an extraordinarily interventionist, ethically questionable and contradictory role. It is guilty of worse than over-promising and underdelivering.

It is guilty of effectively legalising drug use by the back door at the tax payer’s expense; and of trapping addicts in the condition they need to escape from.

It is also responsible for a burgeoning addiction industry funded to the tune of £7billion over 10 years, replete with vested interests in its continuation. Few involved in the complex commissioning funding framework can afford to be totally honest about the problem even when they understand it. Through this treatment hegemony the government has institutionalised the pretence that addicts can have it both ways. They cannot. Neither can the government.

KATHY GYNGELL is chair of the Centre for Public Policy's Prisons and Addiction unit. The views expressed are her own.

Comments

[J Mark Whiteley]

In response to Kathy Gyngell's article "Analysis of Failure" I feel compelled to state that as far as I'm aware Queen Victoria is long dead. As an academic who happens to have struggled with addiction for over 2o years I feel obliged to challenge such a naive and condescending appraisal of addicts and the systems in place to help them. Has prohibition and enforcement been a resounding success or expensive failure? No-one intheir right minds can honestly state that forcing addicts into clean living is going to work. The bottom line is that whilst the global market is flooded with drugs any moves to force current or potential drug users to say no will fail. I have spent several years researching at the street level and users, like it or not, are well versed in being punished and treated like social outcasts. The language you chose to describe them - or us I should say - is faulty to say the least. Of course no-one in their right mind would argue that drug use is desirable in an ideal world but it is not an ideal world.
What gets right up my nose is the fact that comments on drug use are generally based on an information rich but knowledge poor foundation. Drug use in its current guise is a function of a greedy, stress ridden society. There are no simple answers to the issue but a return to notions of enforced abstinence will be counterproductive. Do any of you honestly believe that stopping people's benefits or other such methods will stop drug use and heal the social wounds? I think not. In many ways all you will do is challenge the individuals skills of cunning and guile. The bottom line is and always has been control of supply. The only rational outcome will be a decriminalisation of all drugs. In that way control of supply can be taken out of the hands of gangsters and intelligence agencies. Until this has happened the debate regarding harm reduction (the only workable approach available to us) and enforcement will continue to roll on. Kathy Gyngell is entitled to her opinion, as are users. It just so happens that she is wrong. If the treatment system does become increasingly punitive and benefits or medication are stopped or used as sticks the situation will not improve. If it does I would gladly eat my words.
Harm reduction as an approach to current drug use issues has a proven track record. And, as a great deal of research now tells us, the average drug users is not a social problem. In my experience, those who can be regarded as the most chaotic drug users would exprience chronic social problems with or without drug use. This is the issue we should be targetting -- why are there so many people who feel they have no vested interest in mainstream society? We need to find solutions to the problems of education and underachievment we now face. Bating addicts around the head with threats of even more social sanctions will achieve nothing.