A GLOSSARY FOR OUR TIMES

REWRITING THE DICTIONARY

Tickboxers could eradicate war, disease, poverty and addiction in a mere few strokes of the pen, to meet targets – by rewriting the dictionary. Deirdre Boyd offers a glossary to recent claims.

Preview from the September 2010 Addiction Today journal.

Print-friendly version:
Download Addiction Today Sept 2010 - Rewriting dictionary

In a sci-fi story, an apparatchik from earth arrives to tell the spaceship crew they would not recognise home. “We have got rid of war, disease, poverty,” he explained – we could add “addiction”.
“When did this happen?” asked the captain.
“When we rewrote the dictionary,” the apparatchik responded.

So how have today’s apparatchiks rewritten the dictionary to give a semblance of success? The words below –  from the government’s National Treatment Agency for Substance Misuse – are given a meaning perceived by people generally. This is followed by the ‘target on paper’ definition, or Top, set in the NTA context.

Problematic drug user. Someone whose drug use causes a problem for them or others.
Top definition: someone who uses heroin or crack cocaine; only these make you eligible for ‘treatment’, only these are counted in targets.

PDU.  A dehumanising word for a problematic drug user. 
Top definition: a statistic.

Legal drugs. These include addictive drugs which can destroy lives, such as benzodiazepines; kill more people in the UK than illegal drugs - click here for details.
Top definition: does not come under definition of a PDU, so does not count towards targets, so you are ineligible for treatment/funding.

Alcohol/alcoholism.  See “legal drugs”.

Treatment. The general public thinks that this means addicts and people with drug problems get help to become drug free and rebuild lives.
Top definition: someone somewhere made an appointment for you and got your name on file.

Retention/retained in treatment. Patient given consistent proactive therapy and other support to become drug free and reclaim life.
Top definition: patient is seen at one appointment, can be given a second appointment 12 weeks later (during which some died or were imprisoned), defined as hitting target of 12 weeks’ retention.

Rehab. More rigorously researched than NTA preferments, also proven to be the most successful in getting people off drugs long term. Also help people overcome methadone addiction. “Residential rehabs outstrip other sectors in every outcome group we measure,” concluded a government CSCI report.
Top definition: something to find a less-effective alternative to; over 20 closed under our regime. Click here for some details.

Balancing the treatment system. The need to balance a failed system created by the NTA where only 2-4% of patients manage to get to rehab, and a similar number to become drug free.
Top definition: aim of ARF and Recovery Group UK;  copying phrase in NTA Business Plan 2010/2011 blurs NTA role in creating such imbalance.

Dependency.  Another word for addiction, a “dysregulation of the mesolimbic dopamine system” or brain-chemical disorder, as opposed to misusing drugs through choice. Diagnosing between dependency and misuse is vital as each requires different care.
Top definition: “We don’t define dependency, just as we don’t define recovery,” stated NTA senior managers – which means targets in the NTA Annual Reports submitted to parliament are meaningless.
(2): drug users become dependent on state drugs and handouts due to lack of appropriate care.
(3): providers are dependent on NTA for referral revenue, cannot whistle-blow.

Free from dependency. The general public thinks that this means patients have been helped to quit drugs, are rebuilding their lives.
Top definition: patient stopped using main drug briefly, uses other drugs; patient is kept dependent on prescribing organisations for decades.

Recovery.  First mention I found is in a book copyrighted 1954 to Alcoholics Anonymous and means quitting alcohol/other drugs, living in such a way as to stay stopped, repairing relationships and making amends for any wrongs done.
Top definition: “We do not define recovery” (see dependency); plus UKDPC redefinition as “control over drug use” – eg, control over using exactly nine grams of cocaine every day.

Prescribing. If used, should be for brief detox and/or stabilise patients, but drugs such as methadone are more addictive and harder to withdraw from than even heroin.
Top definition: “treatment”.

Harm reduction. Aims to reduce harm from drug use, addresses fallout not the cause.
Top definition: “treatment”.

Detox/ification. Getting toxic substances out of the body, such as the ancient romans vomiting so they could continue orgies of food and drink.Should be immediately followed by treatment so people do not relapse as the ancient romans did.
Top definition: “treatment”, “rehab”, “abstinence”, “successfully leaving treatment”.

Retox. Put patients back on drugs instead of giving recovery treatment after detox.
Top definition: recommended in papers by John Strang due to number of patients dying after detox at Maudsley clinic where he works; Strang is co-heading the NTA Business Plan 2010-2011.

Patient placement criteria. Created by the American Society of Addiction Medicine to give the most fitting type(s) of care to people with drug problems, in the most clinically- and cost-effective ways – click here.
Top definition: “[UK] criteria are based on failure,” NTA CEO Paul Hayes said this year; not the ASAM criteria, something to be created.

Top. Targets on paper; an unverified page of boxes to tick to show ‘treatment’ results, which omits legal addictive drugs and other outcomes which quality rehabs offer, including treating worse cases.
Top definition: Treatment Outcomes Profile, used by the NTA as official data for UK statistics.

Drug deaths. Something the NTA was set up to reduce, have instead increased under its regime.
Top definition: "drug deaths have reduced" - click here for facts.

Ideologists. Top definition: people who question us.

Comments

[Annemarie Ward]

I laughed hard reading this, Thankyou! But I would cry if if wasnt so obviously insane. I am grateful today that that many others are speaking out about the insanity and inherent dishonesty within the systems we, our families and communities are currently stuck with. The most effective ways to deal with poverty, declining economic opportunity, and community rebuilding originate from within the community. And the most efficient way of administering these solutions is by and through the community. But one of the unfortunate parts of this approach is that community programs often lack breadth, their ability to reach many, because they lack that one important resource that frequently determines whether a program will last or perish !!!!! Money.

And that is where we need great politico-economic innovation: combining the fantastic depth and effectiveness of community programs with the more-encompassing breadth and monetary resources of a regional or even a national program.

Governments must cease to be a bureaucratic parasite that takes large percentages of our income and then swallows it up to be wasted, misappropriated, and disappear into ineffective committees and useless Quangos. Instead, government must be a tool that like-minded individuals can use to confront—and defeat—a problem bigger than themselves.

[Steve Rolles]

For the sake of completion - The UKDPC consesus statement on recovery that you selectively quote is available in full here:

http://www.ukdpc.org.uk/resources/recovery.pdf

An IHRA statement on 'what is harm reduction' is available here:

http://www.ukdpc.org.uk/resources/recovery.pdf

[Deirdre Boyd]

Steve, you refer to a "consensus" so it is appropriate to put right the public record.

My dream is to reach a true consensus which is so spot on that it invokes minimum genuine disagreement and much praise(!). However, below are contemporaneous notes I took at the UKDPC meeting on redefining recovery. These were sent to all participants within a few days, and no one disagreed with their accuracy.

Neil McKeganey and I thought the definition polarised the field rather than uniting it.
Another argued with the retention of "control" - indeed, I noted only three people happy with this word.
Quotes from others present were:
"The definition is flawed"
"Clearly the statement is not strong enough. It is misunderstood by all sorts of people all over the place."
"There is a gap between intention and perception."
"We need to state this is just a statement by the UKDPC, it is not a consensus"
"Only a partial consensus is possible."
"People will disagree with this. They are polarised and prejudiced" [DB comment : not if the definition truly were a consensus]
"So what if people disagree? I am prepared to stand by this statement. People can disagree with it."
"This definition will not lead to different practice" [but opposite views also]

[Steve Rolles]

Deidre; I refered to the consensus statement as that was what the UKDPC have called it. Im not commenting on it either way as such, I just felt that it was worth linking the complete statement whcih contains more than just “control over drug use”.

Re the harm reduction reference - it should have been:

http://www.ihra.net/files/2010/06/01/Briefing_What_is_HR_English.pdf

(rather than repeating the UKDPC link. apologies.)

I hope you will take the time to read it (its only two sides).

[Barry Haslam]

As an ex addict of benzodiazeine drugs, legally prescribed and now disabled as a result.
The UK needs fresh directives, for both legal and illegal drugs of addiction. Treat the addict as a human being and with compassion. Give them a chance to change their lifestyle and to join society.
Government MUST listen, and learn.
Big Pharma, have a lot to answer for.

[Russell Newcombe]

Abstentionist morality, and its legal implementation in the international drug prohibition kills more people than drugs do. The examples are endless. Anyone keeping up with the news on Mexico? Closer to home, two young lads died because they did not know that alcohol and methadone are two of the most toxic drugs they could take mixed together. Alcohol is legal and promoted, methadone is prescribed to heroin addicts as treatment. The sad thing is that these poor young guys were too ignorant about drugs to know that methadone is a green slimy liquid, while mephedrone (meow, the drug they were trying to buy) is a white powder. Mephedrone also appears to have no serious interactions with alcohol, and is linked to very few deaths (unlike alcohol and methadone, which are among the top five most deadly drugs). Protect our children.

www.yorkshirepost.co.uk/news/Warning-issued-to-region-39awash.6702263.jp