WILL GOVERNMENT SET DRUG-FREE TARGETS FOR TREATMENT?

DECISION MUST BE MADE IN MARCH 2009

In January, Drug Action Teams around the country submitted draft treatment plans for 2009/10 to the government’s National Treatment Agency for Substance Misuse – NTA approval is needed before they can receive funding to treat problematic drug users. The NTA feedback was due in February – but has it set targets for addicts to become drug free in the year to come? 

Has the NTA set any targets – even, say, a low 10% – for patients with addictive disorders to even access effective residential or daycare services promoting abstinence from all their drugs?

A life-threatening low of only 2% of such patients were referred to abstinence treatment last year. This is despite the government’s drug strategy stating that “the goal of all treatment is for drug users to achieve abstinence from their drug – or drugs – of dependency” (p28, Protecting Families and Communities).

NTA senior managers told Addiction Today that they were blameless: the low referral rates were “the fault of Local Authorities and Primary Care Trusts” as “they hold the budgets, not us”. But at this moment of each year, the allocation is within the power of the NTA and its masters at the Department of Health and the Home Office.

Last year, Nick Lawrence, head of the DH’s Alcohol, Drugs & Tobacco Policy, stated that 10% of the people desperately seeking help for their drug problems should be offered rehab or another drug-free choice of treatment by the Drug Action Teams. So there is no excuse for not setting targets this month.

NTA’S ROLE IN BUDGET DECISIONS

The Drug Action Teams are due to submit final treatment plans (ie, after NTA input) for 2009/10 by 20 March.  These are then signed off by the NTA and budgets released to fund those plans. For transparency, the local area needs assessment reports should be open to scrutiny – so far, the taxpayer-funded NTA has not allowed this.

The plans are based on a DAT ‘needs assessment’ of their geographic area. But historically these assessments never stray far from NTA priorities – which are set out in NTA guidance to the DATs on how to calculate and present their needs assessment. Catch 22.

So if the NTA said that it wanted to see a re-balancing of treatment to ensure more access to recovery-based services or set a target, DATs would in the main strive to meet the target. After all, performance against targets dictates DAT funding.

NTA CEO Paul Hayes and colleagues talk about the need to improve the effectiveness of treatment – while simultaneously refusing to do the one thing which could deliver that aim.

At the stroke of a pen or tap of keyboard, the DoH and NTA could set a target which would begin a renaissance of recovery from drug problems throughout the country, stop the decline in residential treatment and fund innovative community-based treatments which lead to many more people leaving treatment drug- and alcohol-free. This accelerates our national drug policy goal, and is the ultimate in ‘harm reduction’.

It would rebalance the system currently weighted in favour of what the NTA now labels 'treatments' but were previously defined as ‘adjuncts’ or supports.  It would redress the new phenomenon of addicts no longer seeking recovery help from statutory services as they know 98% will not be given a patient choice of becoming drug free, many forced instead onto clinically-ineffective regimes.

In these difficult financial times, targets relating to becoming drug-free (and treatments making that possible) could yield a clearer statement of what value is derived from our treatment system.

SAFEGUARD CHILDREN

This would also act as a safeguarding measure to some of the millions of children living with the consequences of addiction via their parents/carers.

It might also reduce domestic abuse:  thousands of women and men either suffer or perpetrate violence because of addiction issues or become addicted as a coping mechanism to deal with the violence suffered at the hands of others.

Helping addicts to become drug free is a stated government objective, with which no responsible person would disagree. Setting a target of 10% of all new treatments journeys (a clear government National Drug Treatment Monitoring System measure) to access effective recovery/abstinence-oriented treatment will help to achieve government targets – and is the least that citizens deserve.

Comments

[Peter O'Loughlin]

Given the that quite early last year the government announced an extra 54 million pounds to increase the availability of abstinence based services during this year, the NTA subsequently issued a media notice dated 29 September, which stated the following:

"The investment is being allocated regionally, both to upgrade existing provision and to provide an additional 500 beds in residential rehabilitation, inpatient and other settings across the country"

The notice went on to say:

"This will allow Tier 4 treatment provision for more than 2,000 people with problematic drug use in a year".

In view of those statements and the fact that almost 18 months has elapsed since they were made, is the NTA willing and able to inform us of the following.

How many of the 2000 beds have been made available?

How many of the beds which have been made available are dedicated to 'abstinence based treatment'?

How much of the 54 million pounds has been invested on its intended purpose of 'abstinence based services', including non residential abstinence based non residential facilities?

In view of the fact that the 'mission statement' of the Inward House project includes, but is not dedicated to 'abstinence based' treatment, whereas the investment of taxpayers money, was specifically for the latter, will the NTA inform us why it was considered necesssary for their director of Regional Management, to visit the Inward House premises in Lancaster, to mark the launch of what is supposed to be abstinence based treatment, rather than one of the many residential facilities which is dedicated to abstinence based treatment, but which through lack of funding has been obliged to close?

I do hope the NTA will not choose to regard the foregoing questions as rhetorical, and that it will not become necessary to press for anything other than unambiguous factual answers.

[Frugal Dougal]

I thnink it says something about governmental priorities when you can go into public toilets and there's a sharpsbox in case you inject heroin, but should you be found to have smoked a cigarette you'll get the whole weight of the law on you.

[mick]

Any policies that are target driven will always be open to manipulation. Would the figures for recovery be even worse than they already are, if the true statistics were not influenced by targets?
The current treatment stratagy that the NTA is implementing only enables addiction and alcoholism to flourish; a greater focus has to be put on abstinence.