RESPONSE TO PAUL HAYES (20.7.2009)
Dear editor,
One has to admire the ingenious manner in which Paul Hayes of the National Treatment Agency for Substance Misuse has responded to Addiction Today and others' demands for a change in current protocols for drug treatment to become focused on drug-free recovery. Disregarding the fact that the percentage of those emerging from NTA-specified treatment drug-free is considerably less than that which occurs spontaneously without any treatment, Mr Hayes indulges in rhetoric about how treatment has improved.
HOME OFFICE CRITICISMS
In 2003 the Home Office Strategy Unit issued a paper1 on the then-current system; in summary 1 it highlighted the following:
· “The current system has had a limited impact on reducing the massive crime, health and social harms caused by ‘high harm causing users’ (HHCUs)”... Since there is no universal definition or criteria for a ‘HHCU’, this writer is assuming that convoluted term is a euphemism for addiction.
The summary goes on to state:
· “The current system) has failed extensively to grip HCCUs when they encounter the criminal justice system, or are being treated in the community”
· “The treatment regime has not coped with the formidable difficulty of treating chaotic and constantly relapsing ‘problem drug users’, and has not borne down holistically on the harms they cause”
· “The greater attack, ministerial focus and additional resources of recent years have brought and will continue to bring improvements; but the changes do not address the fundamental flaws of the historic system, and will not have a transformational impact, particularly on crime harms”.
FACTS BELIE CLAIMS
Mr Hayes insists that “Drug Treatment in England has vastly improved”. Regrettably, and not withstanding a huge increase in budget between the fiscal years 2004-5 and 2006-7, the facts indicate that this is not the case2.
First, the numbers emerging from treatment drug free during 2006-7 was just 3%, compared with 3.5% in 2005-62.
In what appears to be an emerging corporate evasiveness, the same source quotes the NTA response as “the reporting on treatment expenditures was factually incorrect and that 2,200 more people had completed treatment in 2006 than in 2004-5”. That attempt to avoid the realisation of the fulfilling of the predictions made by the Strategy Unit in 2003 is rooted in the simplistic box-ticking mentality of numbers in numbers out, rather than the more realistic assessment of just how successfully and effective treatment has been in terms of patients becoming free of drug, state-funded welfare dependency and criminal activity.
The DoH response in the same article endorses the NTA ploy: “In the last few years there has been a massive expansion in the numbers entering drug treatment”. That attempt to claim success out of failure serves only to confirm what the Strategy Unit predicted, in the summary quoted above.
Whatever improvements Mr Hayes contends have occurred, have not had a ‘transformation impact’, nor are they likely to whilst the fundamental aspects of current treatment protocols continue to fail to meet the challenge of what the Strategy Unit referred to as the formidable problems and chaos caused by addiction through the absence of an holistic approach, wherein the addicted, rather than the addiction to any specific substance, is addressed, together with the common co-occurring disorders associated with addiction.
POLITICAL EXPEDIENCY
The one thing that Mr Hayes has almost got right is his view on the length of time such a process might take. As he has pointed out in other publicised comments, recovery is a process, not an event. It follows that, because of the intractable nature and complexity of addiction, recovery as defined by the panel of the Betty Ford Institute does not fit into a box of treatment limited by such arbitrary measures of time. So the phrase “successfully completing treatment” used by the NTA to describe those who complete 12 weeks in treatment, but continue to use the addictive substances for which they are in treatment, is meaningless. It is another box-ticking exercise that serves political expediency rather than the needs of the addicted to recover and create healthy lifestyles.
Political expediency, ideological views and social learning theories have all failed to reduce the total harms caused by addiction in the UK.
It is now time for the NTA and the DoH to accept the fact that abstinence is the inevitable outcome of addiction. Whether that occurs as the result of abstinence-focused treatment, insanity or death is how the success of treatment protocols and interventions should be measured.
Rather than continuing to avoid that reality, we need to devote our resources to it because, according to the UKDPC, the benefits of the current strategy are limited; users relapse and many go untreated3.
REFERENCES
1. Drugs Project: Phase 2 Report: Diagnosis and Recommendations. December 2003.
2. ‘Join Together’ News summary, November 2007 citing a report published in the Daily Telegraph dated 31 October 2007
3. http://newsvote.bbc.co.uk/mpapps/pagetools//printnews,bbc.co.uk
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