ADDICTION TODAY EVIDENCE LEADS TO MORE REHAB TREATMENT/FUNDS

... and more cocaine-powder users to be treated

The Home Affairs Committee 96-page Report on the Cocaine Trade has been released - and among its recommendations to government are two which have been influenced by evidence from the Addiction Recovery Foundation, charitable publisher of Addiction Today. "This is a step in helping the country move towards a more balanced treatment system," commented Deirdre Boyd, CEO of the Foundation. "As it is, only 2-4% of people seeking help manage to get a referral to rehab/drug-free treatment."

Both recommendations first appear in the Summary on page 5 of the report:

• "We are concerned by reports that residential rehabilitation is not readily available, and recommend that the government increase funding for this treatment."
• "We warn that restricting the definition of a ‘problem drug user’ to opiate and/or crack users only may reduce treatment for cocaine powder users, and recommend that the government revise its definition to include powder users."

They are reframed more specifically in the Recommendations section:

• "The government has invested an additional £11.8 million investment in treatment in 2009/10, a quarter of which is earmarked for residential treatment. We recommend that the proportion dedicated to residential treatment be increased."
• “We are worried that this [PDU definition] will adversely affect the funding, commissioning and availability of good treatment services for powder cocaine users, which are vital given the increase in users. We therefore recommend that the government revise the basis on which PSA 25, Indicator 1 is measured, to include powder cocaine users.”

TRENDS

Chapter 7, on Treatment, gives more detail on these, along with some of ARF's evidence. We look at this below, as well as some errors in the report. We recommend professionals to read the report for its valuable insights into trends, overviews, statistics and suggestions on much more than cocaine trafficking.

The report confirms, for example, that there has been a large increase in cocaine powder users, and that they have diversified from the ‘rich and famous’ to a far wider cross-section of society. The committee says greater attention must thus be focused on targeting demand, in particular to challenge the socially acceptable image of cocaine powder and its misguided reputation as a ‘safe’, non-addictive party drug.

The number of adults reporting cocaine use in the past year quintupled from 1996 to 2008/09, as did the number of young people, bucking the overall trend of a fall in illicit drug use in the UK. The number of people in treatment for primary cocaine powder addiction has also risen, from 10,770 in 2006/07 to 12,592 in 2007/08

DEFINITION OF PROBLEM DRUG USERS

Chapter 7 of the report states that...

The Addiction Recovery Foundation was critical of the Government’s narrow definition of Problem Drug Users (PDUs) as “those who use opiates (heroin, morphine or codeine) and/or crack cocaine”, arguing that: ‘Discrimination results from the definition of “problem drug users” solely as heroin and crack cocaine users; so only the latter can be used for targets, statistics and funding’.

The National Treatment Agency’s performance is assessed by the Government’s Public Service Agreement (PSA) 25, Indicator 1. PSA 25 is to “reduce the harm caused by alcohol and drugs” and Indicator 1 is “the number of drug users recorded as being in effective treatment”. A HM Treasury document explains that the indicator measures the per cent change in the number of drug users using crack and/or opiates in treatment in a financial year. This means that the government’s target for the NTA for getting drug users into treatment only measures those using opiates and/or crack cocaine, thereby excluding cocaine powder users.

Some treatment service providers surveyed by the Addiction Recovery Foundation considered that this definition meant that services were unable to obtain funding to treat cocaine powder users. For instance, Action on Addiction wrote: “It is our experience that the commissioning system seems to prioritise crack and opiate users over cocaine users.”

Treatment provider The Providence Projects agreed: “Our experience in line with the NTA definition is that one needs to be heroin/crack dependent to have any chance of getting treatment, although it seems as though this group are also being denied residential treatment.”

ACCESS TO RESIDENTIAL REHABILITATION

The report continues with two key statements...

"We were perturbed by reports that access to residential rehabilitation was not as readily available as to community programmes. Despite the insistence of the National Treatment Agency that community programmes offer appropriate treatment for the majority of cocaine users, doctors, treatment providers and ex-users expressed the view that addicts in a chaotic environment could benefit from periods of stable, residential treatment. The government has invested an additional £11.8 million investment in treatment in 2009/10, a quarter of which is earmarked for residential treatment. We recommend that the proportion dedicated to residential treatment be increased.

Whilst it was clear from the figures provided by the National Treatment Agency that powder cocaine users were accessing treatment, we were unhappy to learn that the government’s target for getting drug users into treatment only counted opiate and/or crack users, according to its narrow definition of problem drug users. We are worried that this will adversely affect the funding, commissioning and availability of good treatment services for powder cocaine users, which are vital given the increase in users. We therefore recommend that the government revise the basis on which PSA 25, Indicator 1 is measured, to include powder cocaine users."

ERRORS IN THE REPORT

Addiction Today accepts that not everyone could or should be given a copy of all the evidence in advance – but is acutely conscious that the Addiction Recovery Foundation could have corrected some misinformation given to the Committee, if we had been made aware of it.

For example, in Par 177, NTA CEO Paul Hayes told the committee that it costs, on average, between £1,500 and £3,000 to "treat" one individual with cocaine addiction, although if residential rehabilitation were required as part of the treatment it would be “much more expensive”. He knows, but did not state, that a one-off four-week course of treatment in a rehab could cost the equivalent of a year on methadone. The first gets people drug free, the second does not. And many of those on the heroin substitute continue to use methadone for quarter of a century or more, making it 25-30 times more costly per person than rehab.

In addition, if community 'treatment' really does get someone off all drugs, it is unlikely that they were addicted in the first place. Conversely, the 'worst-cases' - given up on by others - are sent to rehab. 

Dr Brener of the Priory explained that the average cost of a 28 day residential rehabilitation at The Priory costs around £15–17,000. But Hayes did not offer information that there are far cheaper options, even though they are listed on the NTA’s BedVacs resource.

Paragraph 183 contains a rare opinion. John Mann MP wrote that “whilst residential stays have a health benefit, their ongoing effectiveness in dealing with substance abuse is highly questionable. Medical opinion in most countries puts the success rates of rehabilitation in eliminating substance abuse as low as 2% of clients”.  We have not seen any research to substantiate this “opinion” from the politician.

Paragraphs 185 is also misleading. “The National Treatment Agency told us that in 2008/09, 63% of the 8,479 who left community–based treatment that year for cocaine dependency, did so after having overcome their addiction.  In the same year a small number of people were treated in residential services for cocaine misuse—they had similar outcomes to those in community treatment: 62% left residential rehab free from dependence on cocaine.” Click here or here to read how the outcomes were very different.

NTA VERSUS DEMAND FOR REHAB

The report continues to say that...

There seemed to be a distinction between treatment in the community, to which there is quick access, and the availability of residential rehabilitation. Although the NTA told us that there was “no evidence of unmet clinically appropriate demand for rehab”, John Jolly warned that “access to residential treatment provision has actually been getting more and more difficult, certainly over the last four or five years…we find it difficult to access residential treatment within what we would define as the relevant time window”.

Addiction Today has heard many stories agreeing with John Jolly.

Hayes agreed that “waits for rehab can be longer” but added that they could be “misunderstood by the individual”. He later clarified what this meant: “For the minority of clients who need rehab, they will probably consider their wait to have begun when they first considered rehab as an option, and not when it was agreed with their clinician or keyworker... and began the process of applying for a rehabilitation place [which is the point from which the NTA would measure the waiting time].”

This spotlights how targets are twisted. First, because people consider the wait from asking or presenting for treatment until they get treatment as waiting time, rather than the later NTA date. Second, the very first point of contact is the point from which the NTA measures “retention in treatment”. Kafka would have a field day.

READ THE REPORT

Committee website: www.parliament.uk/homeaffairs.com 

Copies of all select committee reports are available from the Parliamentary Bookshop (12 Bridge St, Westminster, 020 7219 3890) or the Stationery Office (0845 7023474).

Comments

[Steve Rolles]

Whilst Transform did not think as much of the report as the ARF (our response is here: http://dlvr.it/531G ) I think both of the recommendtions you flag up were among the better ones.

One concern we had, however, was that the report covered far to much ground in not enough detail - so the treatment section for example - felt like a rather cursory breeze through the debate, and entirely lacked the sort of detail and rigor we would all have liked to see (as your corrections highlight).

[Concerned Commissioner]

Good news.

Regarding the PDU recommendation, government have built up such a coercive regime around PDUs and - by adopting a narrow definition e.g. crack/heroin only - have tended to target predominantly lower socio-economic groups. If they widen the definition to include powder cocaine, it will be interesting to see if they get away with continuation of this coercive approach, given as I suspect powder cocaine users may be more likely to have the resources to challenge some aspects of this regime (DIP in particular).

[Bobby]

It really doesn't matter what criteria is used to define a drug addict. The fact remains someone who is addicted to cocaine is just as addicted as someone who is addicted to crack. The need for residential treatment is there and the funding for it must meet this need. It is in everyone's best interest to fund these programs. With drug addiction there also comes elevated crime among other problems. An addict in treatment is less dangerous than an addict out of treatment.

[mani]

good