DATs: "TREBLE PATIENTS IN REHAB"

10% of the 128,000 people desperately seeking help for their drug problems should be offered rehab or another drug-free choice of treatment by the Drug Action Teams, stated Nick Lawrence, head of Alcohol, Drugs & Tobacco Policy at the Department of Health [30 June 2008]. 

This was in response to a question posed by Addiction Today highlighting that DAT commissioners currently place only 3.6% of patients into rehab, according to figures from the National Treatment Agency for Substance Misuse. This would also solve the growing crisis of empty beds alongside waiting lists of people desperate for help.

One treatment provider reported that his local DAT refused to place people in rehab until they were detoxed and/or drug-free for a month first - the very reason they needed to get into rehab! "And they are being forced to wait 28 weeks for detox," he said. They can be demotivated or even die in the interim."

"If DAT commissioners continue the way they are, I expect 50% of rehabe will be closed in a year or two," said another treatment provider.

Figures highlighted by the BBC indicate that only 3% of the 128,000 seeking help actually become abstinent from their drugs. The link between the two figures seems strong - but, oddly, there seem to be no statistics directly linking type of treatment with results. If this is true, the government should implement a new outcomes measurement tool which gives more detail than the NTA's 'Top' one currently does.

The discussion arose at a meeting of CEOs of treatment providers, organised by umbrella body EATA. Providers - and Addiction Today - strongly urge that commissioners work across the full continuum of care: placing only 3.6% of people with drug problems into drug-free treatments is woefully disproportionate.

So why don't DATs use this effective route?  After all, Project Match and other research, including Dr David Best's seminal work, prove that 12-step-based treatments have great success in leading to long-term recovery; and Professor Neil McKeganey's research in Scotland shows that most drug users want to become drug free.

Another provider reported that her local DAT insisted her service was a "final solution" or "planned discharge" out of treatment. There was no allowance for aftercare should a patient need it, nor was there a safety net if the patient left early or was diagnosed while in care as being more appropriate for a mental-health programme.

One reason for uneven referrals is the unusually high turnover of staff."We often have to educate the commissioners," said another provider. And agreement seemed unanimous that DAT commissioners should be trained to a more adequate standard.  There are, of course, some excellent commissioners of services, but these are few - it should also be noted that good commissioners get the best outcomes for their areas, as they place patients appropriately with expertise.

"DATs should be performance-managed, just as providers are.  And they should be performance-managed to comply with the National Drug Strategy targets, not the NTA targets which seem to be at odds with the national strategy," was one view which drew the greatest consensus of the afternoon.

Presenting at the discussion with Lawrence were Ian Martin of the Home Office Drug Strategy Unit and Sally Richards, acting head of the Home Office Drug Intervention Programme.  All had been unaware of the critical situation in which treatment centres - and patients - had been placed. Participants referred to the ways in which figures were reported to them. Some said they feared giving the facts for fear of repercussions and even less referrals.

Ian Martin stated that any treatment provider could contact him in confidence if they wished to name names - for example, the DAT which gives absolutely no patients the opportunity of benefiting from rehab.

"The most important factor in a client's success is the treatment agency," said Lawrence. So, please, Department of Health and Home Office and providers: we must work together.

Comments

[zenith]

This quote:

"Figures highlighted by the BBC indicate that only 3% of the 128,000 seeking help actually become abstinent from their drugs."

Implies that only 3% stop using "their drugs". i.e., heroin or another opiate of abuse, while on methadone treatment. That is the very problem with this study--most people who read it assume that it means that only 3% stopped abusing drugs--but this is NOT the case!

The study considered anyone who was still on methadone after 3 years' time to be a treatment failure, even if they were free of all other drugs and were living a responsible, productive life--the goal of methadone treatment. So it is untrue that 97% were still abusing drugs. The study results have been published in a way that is intentionally misleading and confusing, to cloud the issue.

In addition, the fact that methadone patients in the UK are consistently underdosed, against all known studies that show that patients who receive higher doses do much better in treatment. These underdosed patients go into withdrawal every evening and are much more vulnerable to relapsing into drug use in order to find relief. Correction of this issue, and concurrent treatment for those with poly-drug addictions (not just opiates)would go a long way towards correcting the methadone problem.

[Peter O'Loughlin]

Given that the vast majority of those the NTA describe as 'in treatment' have entered via the criminal justice system, it is not unreasonable to conclude that their drug use has passed from 'recreational use', to what the NTA refer to as 'problematic use'; a eupemism for dependency, which in turn is probably more acccurately described as addiction.

That being the case it would be interesting to know the criteria which Nick Laurence has used for his figure of 10%.

Notwithstanding the ostensible reasons why so few are in rehab, this writer suggests that the true reason is that the treatment strategy over the past decade has been focused on what is erroneously described as Harm Reduction, which in this instance is largely confined to the use of substitute drugs suuch as methadone maintainence and social learning theories of teaching people to use drugs 'more safely'. These misguided policies which have been influenced by those who have vested interests in the increased use of addictive drugs, was 'sold' to Tony Blair' on the false premise that it would reduce crime, get people back into work etc. That it has failed to do either is self evident as summarised in this writers article, The Disastrous Outome Of The UK Drug and Treatment Strategy.
(http://www.medicalnewstoday.com/articles/92807.php)

The so called new strategy published earlier this year is more spin than substance which also appears to have been influenced by those who wish to see drugs legalised, as such it is unlikely to be effective. A further article by this writer and published by Medical News Today on February 28 last explains the reasons why.

There are a number of reason why past strategies have failed and why proposed stategies are likely to fail, not the least of which is they are focused on treating the addiction, rather than the addict. There is the also the highly significant fact that they ignore the universal evidence which clearly shows how those who have developed dependency as specified in DSM-1V and ICD-10 are unable to control their use.

The strategies also ignore the scientiific evidence which has emerged over the past 15 years which establishes beyond doubt that the continuing administration and ingestion of addictive drugs for the addicted, increases the severity of the addiction, to the point that the various interacting systems of the brain are so badly affected, that the users ability of choice and free will is eroded. (Psychiatric News July 6 2007).

In view of those facts the failure to focus on on drug free recovery not only indicates an aversion to reality, but qualifiies for Eistein's definition of insanity, as indeed does the current ideological definition of recovery offered up by the NTA and the wholly self appointed United Kingdom on Drug Policy Commisssion, with the meaningless and undefined use of the 'sustained control' phrase. If those in treatment, were physically and capable of achieving that, it is highly unlikely they would be 'in treatment'.

[susi Harris]

Can anyone tell me how much it would cost to start referring up to 10% or our patieints to rehab, say in a CDT like ours treating around 1000 patients?

[susi Harris]

can anyone tell me what it would cost to send an extra 100 patients a year to rehab (vs community-based substitutiion therapy?)