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October 28, 2009



The National Treatment Agency for Substance Misuse spent your hard-earned taxes and mine on paying for positive PR in the Guardian this week, sponsoring a special supplement. "Commissioning editor Terry Kirby" wrote that the NTA "has a seemingly perfect, two-part response" as to how it should spend resources on treating addicts. Kirby then trotted out figures from the NTA Annual Report released in a publicity blitz in Westminster earlier this month.

Sadly, Kirby's move move from freelance journalism to PR means that core facts have not been verified. For example, the headline Why rehabilitation is important to us all - which all reasonable people will agree with - covers up the fact that only about 2% of people desperately seeking such rehabilitation actually manage to get it under the NTA regime. So let Addiction Today number-crunch to put the record straight.

This is vital, as covering up the true figures denies tens of thousands - perhaps hundreds of thousands - of vulnerable people a chance to quit drugs and addiction for life. A complete overhaul of the NTA system of bureaucracy and paper targets is needed in order to get people on the road to recovery.

First, both the Guardian's Kirby and the NTA claim that its expensive Byzantine creation helped 24,656 people to “complete treatment free from dependency” – a closer inspection reveals that this is untrue: the true figure is at most a third of that.

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Point 5.2 in the Annual Report states that “24,656 (41%) were discharged successfully, defined as those completing treatment free of their drug of dependency”. This last phrase is the crucial one: it means that 24,656 patients stopped using one drug – but were using others.

This is equivalent to saying that an alcoholic has completed treatment free of dependency on whiskey but is now dependent on vodka, brandy, high-strength lagers... you get the picture. Professionals refer to this as cross-addiction, where one drug is replaced with another and the addictive behaviours continue unchanged.

I asked NTA head office to confirm this. “The 15,676 who completed ‘free of dependency’ had successfully overcome addiction but may have occasionally been using other substances such as cannabis,” came the written reply, revealing ignorance of the health issues.


That leaves only 8,980 patients who completed treatment “free of dependency (no drug use) and not using any illicit drugs at the time of exit”. Even here, a reality check is needed.

First, there are those who might wish to enhance figures because they are dependent on funding.

Second, the NTA-funded Top form used to measure results is merely anecdotal self-report, without hard confirmation from, for example, hair or urine drug tests.

Third, the Top form gives no option to mention addictive prescribed drugs including benzos and methadone – the NTA carefully avoids reference to the use of such drugs. As the specifically designed tool of measurement, Top thus renders it impossible for the public to learn how many of the 8,908 patients supposedly drug free are actually hooked on licit drugs, nor if they are dangerously mixing them.

Although the NTA and drug/alcohol leads at the Department of Health deny that drug-free results come from rehabs and daycare with similar approaches, this year again the number reasonably estimated to be drug-free matches the small number of patients (2%) who managed to get into rehab.

One of the increasingly disillusioned Drug/Alcohol Action Team commissioners wrote to Addiction Today that “The terms ‘treatment complete’ or ‘treatment complete, drug free’ are not clinical terms/definitions – the terms essentially record entry into and exit from the NDTMS reporting framework and have no clinical value. The NTA’s key error is to attach clinical significance to these numbers when they actually just show entry and exit from the reporting framework”.


The Annual Report also refers to “60,386 individuals discharged” – euphemisms abound here as a deeper look reveals that 905 were “discharged” from this earth completely, having died. More had “moved away”, had “treatment withdrawn” or are “not known”.

1,769 are said to have declined treatment, such as it is – this might be due to the growing phenomenon of people refusing a lifetime on methadone, or could reflect the stories of a high-volume low-care organisation which cannot cope and gets vulnerable clients to sign DIR forms which they think give treatment but are refusal forms.


The Annual Report does not reveal that drug deaths are higher than when the NTA was formed - even though this was a key reaso for its existence.

The NTA report also does not highlight the closure of about 19 rehabs/treatment centres.


Another target not met is the percentage of all addicts who should have been offered a way into treatment services. To you and me, a "problem drug user" is someone who has problems in their lives due to the use of drugs". The NTA was tasked to reach out to 50% of these. Instead, it has redefined “problem drug users” as only those who use heroin and crack cocaine. Even powder cocaine is omitted, as well as other harmful drugs. So the target is slashed and, with it, the types and number of people qualifying to be offered help.

The NTA claims that “the results... are in line with the study published in The Lancet... they are proving particularly effective”. We challenge that dodgy Lancet dossier here.


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