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Deirdre Boyd

November 17, 2008

REHABS WORK: RESEARCH ON SUCCESS

Peter McDermott, a Board member of the National Treatment Agency for Substance Misuse, stated in The Observer national newspaper [16 November] that "Residential rehab doesn't actually work very well" alongside other negative comments. After Addiction Today complained to the NTA about the inappropriateness and inaccuracy of these, the NTA asked us to supply research showing that rehabs led to substance-free outcomes.

We are happy to disseminate this information, in which the residential rehabilitation sector has been positively evaluated in large-scale treatment outcome research across the globe. These studies show that rehab is associated with among the highest rates of abstinence, for even the worst cases.

PROJECT MATCH

The world's largest, most expensive research into the long-term results of treatment for alcohol dependency. Three methodologies were used, with 12-Step Facilitation having the better results after a 3-year followup study. Click here.

DORIS

December 2006 saw the publication of Abstinence and drug-abuse treatments: Results from the Drug Outcome Research in Scotland study. It identified the proportion of drug users contacting treatment services who were able to become and stay abstinent 33 months after starting treatment - and identified which services were most closely linked with such drug-free results.
Download DORIS-Abstinence-Final.pdf

ATOS

Hot on the heels of Doris came Patterns of sustained heroin abstinence amongst long-term, dependent heroin users: 36 months' findings Australian Treatment Outcomes Study. The results illustrate the importance of stable treatment retention.
Download atos_at_36_months_2007.pdf

NTORS

The largest UK research into outcomes of drug treatment came from the National Treatment Outcome Research Study, which published Changes in substance use, health and criminal behaviour during the five years after intake.
Download ntors_5.pdf

The NTORS authors note that "Clients in the rehabilitation units included the more chronic, long-term users with the most severe problems. Rehabilitation clients presented with the longest heroin careers, they were more likely to be regular users of stimulants (especially cocaine), and were more likely to have shared injecting equipment. There were also more heavy drinkers among the clients entering the rehabilitation programmes. Rehabilitation clients were more likely to have been actively involved in crime and they had been arrested more often than the other clients."

Note that "abstinence" in rehabs is defined as abstinent from all mood-altering substances including alcohol; in methadone-maintenance services it is defined as abstinence from illicit opiates only - about  40% of MM patients became dependent on alcohol.

THE GUIDE TO REHAB - WHAT REALLY WORKS

20 research facts everyone should know about rehab treatment for alcohol and drugs dependency... In late 1999, Dr David Best, Addiction Today editor Deirdre Boyd and the then-CEO of EATA met to initiate an easy-to-use reference document about addiction treatment which could be used by professionals and general public, and which not only covered the key issues but were based on incontrovertible research. Read more here. 

RELATED RESEARCH

The National Treatment Agency's End of Careers survey results can be read here:
Download addiction_today_107best_study.pdf

The only type of formal treatment service which was a key factor in helping drug users to stay abstinent was rehab, according to these researchers:
Download AT113Best-LifeCourse.pdf

Comments

Jon Hibbs

The NTA is, of course, well aware of this body of research. You misrepresented my specific request.

What I asked for was a reference for your claim: "there are good success rates of patients leaving rehab drug-free after four weeks."

You have failed to answer that simple question.

Jon

Deirdre Boyd

Dear Jon,

Are you asking for research on clients four weeks after leaving treatment or after four weeks' treatment? If you seriously wish to pursue specific time periods for abstinence rates, given the NTA's funding to the tune of £14million this year alone, why would you not ask your specialist research staff to provide you with the data/analysis rather than an overworked charity staffed by three?

The research listed here, kindly provided by the research experts in the field, gives the largest scale surveys of long-term abstinence outcomes of different treatments, because long-term, sustainable recovery is surely what we are all looking for and is what needs to be widely known.

But since you write that the NTA is well aware of this body of research, you leave me confused as to why the NTA has failed to support this proven successful approach - particularly in the face of the rehab closures over the past year.

Sadly many of these closures are due to the fact that, under the NTA's watch, such a tiny minority of those desperately seeking help are referred to drug-free treatment. This is unacceptable: there should be patient choice, as well as a proper regard to clinical effectiveness for drug-free recovery of one treatment over another.

Further, if the NTA is indeed fully aware of this research, why is it not directly refuting and publicly dissociating the NTA from the grossly misleading statement made by Peter McDermott, one of your board members, in The Observer last Sunday which imputed the failure of residential rehab as a treatment?

If the NTA's recent encouragement issued to commissioners to make better use of the residential sector is to be taken seriously, then surely a public disavowal of McDermott's statement is essential.

Bob Beckett

Perhaps I could help Jon get his "specific reference" to the statement "there are good success rates of patients leaving rehab drug-free after four weeks."

The reference Jon requires is a pilot that took place at the Nottingham Clinic between April 1990 and October 1993. The pilot was funded by the Department of Health via The Nottingham Health Authority which funded the cost of eight inpatient beds. The treatment programme consisted of a 28-day intensive, abstinence based structured treatment programme. After the trial period, the Audit Commission commented that it was the most effective and best value for money it had ever inspected. The criteria for a successful outcome was set by a panel consisting of clinicians and York University Health and Economics.

Patients were measured for levels of drinking, offending, GP visits, arrests and hospitalisations two years pre- and post-treatment. The results were truly astonishing and were audited by the Nottingham Health Authority.

Not surprisingly, they caused less than a ripple among the psychiatric community who felt perhaps threatened by the results. They were quickly swept under the carpet by DoH officials during 1994/5. The pilot was sold to Priory as part of the provider-purchaser split going on at the time. The results are available provided that Priory and the PCT have no objections for their release. They are, regrettably, too complex to rehearse in such a short response such as this.

Bob Beckett

Steve Spiegel

What does Jon Hibbs actually mean when he states that rehab doesn't 'work'?

Besides the thousands of people who do actually remain abstinent there are many people who go through rehab, some complete treatment some don't, who chose not to remain abstinent but it has still 'worked' for them. Their expectation might have been to get off opiates or free themselves of the curse of methadone maintenance but not remain totally abstinent from other chemicals. Their lives have improved, the lives of their families and loved ones have improved and the whole community has benefited. No court appearances, no visits to A & E , no drain on society etc.... Has that treatment episode worked or not?

If someone goes through rehab and as a direct result of the intensive therapy they receive are able to gain awareness into self that they never had before and as a direct result of this started to help others would this be seen as it working? Or does 'working' simply mean staying off drugs and alcohol. And is someone on methadone actually off drugs? Of course not. Many thousand members of AA, NA, and CA started their journey by going through rehab. What is this man talking about and where does he get his information and evidence from?

If people gain employment or access college course and better themselves, has it worked?

Our (The Providence Projects) DTTO figures for the 3 years that we held the contract for Dorset (before the NTA insisted we were too 'intensive' and people needed more choices) clearly showed that our outcomes of success were over 60%. These were figures that probation put together, not us. We had examiners from Probation come to evaluate our service to see why we were so successful when compared to the national average at the time, most whom were on scripts and not on abstinent based programmes. Even if every single one of those people that were successful with us while in treatment eventually went back on drugs the fact that they had been drug and crime free for a period of over 6 months was cost effective in itself.

Actually many of them did remain 'crime free', many drug and alcohol free and some now work in the field of addiction helping others while others have gained other types of employment and become upstanding members of society and haven't re-offended.

Many of our current staff (10) actually came though our project while 5 other staff members went through other rehabs. They now have degrees or are in the process of getting them and are experts in their field. Are they a success? I would also like to point out that we retain our staff all of whom have been with us for years. What does that tell you about people in recovery? Once clean they generally committed, hard working people whose self esteem grows by them ‘giving something back’. I myself used heroin virtually everyday for over 20 years. I also used cocaine (powder and freebase) and alcohol even longer as well as all the uppers, downers, inners and outers. In the late 70’s and early 1980’s I had methadone scripts, Neuro Electric Therapy, Sleep Treatment in France and over 9 in-patient detox’s. It wasn’t until I went to rehab (Clouds House) and then on to secondary (Thurston, sadly now closed) that I became abstinent and have stayed that way ever since. I opened The Providence Projects in 1996 with a local GP and our model has now been successfully copied by LEAP (Scottish NHS run and funded) and many other centres throughout the country. How’s that for rehab working. I owe them my life!!!

We recently had a family member write to us and thank us for giving her the sister back that she and her family once knew. She stated in her letter that, as a direct result of her sister getting well, the lives of 45 people that she knew had improved. She also told us how her parents would shudder whenever the phone rang at night. They lived in fear that one of those phone calls would be the one that informed them that their child would never be coming home again. Let’s multiply that story by the hundreds that successfully go through our centre and through other rehabs.

I also like to ask this nagging question. If Jon Hibbs had a loved one on drugs who wanted help would he put them on a maintenance programme or send them to rehab? I believe I know the answer to that. And, I’m sure the same goes for most DAAT and NTA workers. Where would they send their loved ones?

Hundreds of our clients lives have improved and we believe that a seed gets sown in every person that walks through our doors. They see others get clean and sober, they see families reunited, they see people become good parents, they see people get gainful employment so, maybe, just maybe they can do the same. Maybe next time will be their time.

Or should we just say that every opiate addict should be on methadone? They have to turn up everyday to collect it and have it administered. It doessn't matter if they are using crack or other substances. They have to tick a box to say they attended. Look.... 100% success...

From our first group of eight people in September 1996, SC is 12 years clean and sober. She is married, has twins and lives lovely house in Bournemouth which her and her husband who is also in recovery and went through another local rehab, own.

Angie is also 12 years clean and has just moved back to Newcastle which she left many years ago. She had her own nursery in Bournemouth and is now opening one in Newcastle.

Two other people of that group are still clean and sober as are so many of our ex-clients who come from all walks of life.

We now treat eighteen people in primary, eighteen people in secondary and up to twenty people in aftercare at a time. Tell them and their loved ones, and their neighbours and the people they have helped that Rehab doesn’t work. What do you think their answer would be??

Steve Spiegel
Accredited Drug & Alcohol Counsellor
CEO & Founder of The Providence Projects
Recovered Drug Addict and Alcoholic

Peter O'Loughlin

A question for Jon Hibb:

If you were as you claim aware of all of the evidence proving the efficacy of rehab treatment, why on earth do you claim it does not 'work very well'

hdjemil

I do feel some sympathy for Jon Hibbs.

He was drafted in to try and solve the NTA's poor media form of late, as the minutes from their July HR Committee at the Bristol Marriott Hotel reveal (see below - details cut and pasted from the NTA website).

"6. Any other business
6.1 Communications Team
The Committee was informed that the Communications Manager was currently on sick leave, and was expected to return around the Easter period.
6.2 The NTA had appointed consultants DHA Communications to assist the organisation with improving the communications / media performance.
However, the consultants decided not to continue with this contract on Monday 10 March 2008.
6.3 The NTA’s Chair, Audit & Risk Committee Chair and Chief Executive had discussions on possible solutions, one of these being the secondment of a media expert (from Department of Health). The Board would be kept updated on any further developments.
Action: Chair"

What would be interesting to know is why the consultants drafted in to help decided not to continue with the contract!!

Judging by how things have gone since Jon's arrival from the DoH there is still a way to go for the NTA. Perhaps he should stick to PR and Spin and leave research arguments well alone!!


Jon Hibbs

This debate seems to have taken an odd turn, since I never said rehab doesn't work. The NTA's position is that rehab works for certain people in certain circumstances, but the evidence is not conclusive enough for NICE to recommend it in all cases. Meanwhile, we encourage DATs to expand residential rehabilitation capacity, which is why today we announced that £54 million of capital spending will be divided between new 42 residential and supported housing projects, providing an extra 500 beds that will enable some 2,000 more people to be treated each year.

Deirdre Boyd

Re Jon's comments above...
1) See a critique of the NTA claim of £54million at
http://www.addictiontoday.org/addictiontoday/2008/11/q-when-is-54million-not-54million.html
2) In recent correspondence with Addiction Today, quotes from Jon, NTA head of research Oswin Baker and delivery manager Colin Bradbury include:
"There is not enough evidence supporting rehab"
"The evidence for the effectiveness of avowedly abstinence-based approaches to drug treatment is - to put it mildly - scant"
"Literature on residential rehabilitation was of low quality and the evidence on the effectivness of specific aspects of programme delivery was sparse"
"I am not convinced the evidence you adduce actually supports the conclusions you draw from it" [great to learn that in his few months in this specialist field Jon has more confidence in his judgment than my 17 years of experience and erudition or that of the researchers over the decades]
"There is inadequate evidence concerning the effectiveness of residential rehabilitation programmes".
Also, when a BBC reporter called NTA head office, his first point of contact told him that "rehab doesn't work"

Finally, in your and Baker's reponses to me, you quotes research on detox, as though you did not understand the difference between it and residential (or day care or sessional) rehab and abstinence-based psychosocial support.
I am glad to hear elsewhere that the NTA accepts (sporadically) that certain groups of people will benefit more from certain types of treatment. So please refer patients to rehab and daycare as clinically appropriate - that should be at least 5 times the number of patients currently being referred there.


Deirdre Boyd

In December 2008, the NTA advertised for a new Communications Director; interviews week starting 12 January 2009.

On 13 January 2009, the NTA advertised for a new chair and four board members, including chair of an Audit Committee.

Ann SToker

Jon Hibbs says '£54 million of capital spending be divided between new 42 residential and supported housing projects, providing an extra 500 beds that will enable some 2,000 more people to be treated each year. Would it not have been more cost effective to
allocate some of that money to existing rehabs that have been
closed ?
Ann Stoker

san diego sober living

I was looking for the topic like this,the residential rehabilitation sector has been positively evaluated in large-scale treatment outcome research across the globe.You have a very informative blog.

cletsey

Hugh Morgan

I have taken great pleasure in reading your magazine in fact i would like a few more copies to pass around the various drop ins i visit at the moment i have just passed a nvq in advice and guidance and work on a volantary basis i seem to be steered towards drug and alcahol clients as i spent a lot of my life living the misery of addiction so i find i can have a good understanding of where they are on their journey keep up the good work Hugh

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