NTA TREATMENT OUTCOME RESEARCH:

HARD EVIDENCE OR POLITICAL SPIN?

by Neil McKeganey
Professor of Drug Misuse Research
University of Glasgow

Related article

The National Treatment Agency has announced a near miracle in drug treatment. Followed up over a four-year period, the NTA has claimed that “Nearly half of those leaving treatment neither need further treatment nor were found to be involved in drug related offending”. When you recall that drug addiction is a “chronic, relapsing condition”, you might wonder how any treatment could be that good? Too good perhaps to be true?

So what is the claim that addicts leaving treatment need no further treatment actually based on? Is it based on any sort of clinical or psychological assessment of the individual drug user to assess his or her level of continuing need? Have the researchers who have undertaken this work examined the living arrangements of the drug users concerned, have they looked at their contact with their children, at whether the individual drug user is in employment, at whether they are still using illegal drugs, at whether they are even using prescribed drugs? Do they know anything about the housing circumstances of the drug users involved?

The answer to all those questions, sadly, is no.  The NTA has claimed near-miraculous success for drug treatment whilst knowing next to nothing about the lives of the people it is so eager to celebrate as treatment successes.

What the NTA has done is to undertake an analysis of client records to see whether drug users leaving treatment re-contact drug treatment over the next four years. If they  do not, then according to the NTA,  the individual must be well on the road to their sustained recovery. Here is another interpretation based on the same data: that a large proportion of individuals leaving treatment were so disappointed by their experience of treatment that they did not return. Another interpretation of the same data is that, having contacted drug treatment services with a drug problem and left those series with a drug problem, many drug users might have wondered at the point of recontacting services.

Those interpretations would not be welcomed by those providing drug ‘treatment’ or those, like the NTA, responsible for improving the quality of drug treatment. There, I am afraid, is the rub. The assessment of the success or otherwise of treatment has to be based on a good deal more than an analysis of records undertaken by the very agency with a vested interest in the quality of the treatment being provided.

So what about the claim that 'treatment' leads to a massive resolution in drug-related offending? That claim is based on the NTA looking to see whether individuals leaving treatment provided a positive drugs test to a criminal justice agency or contacted the Drug Interventions Programme over the next four years. One would not have thought it needed to be pointed out - but not being drug tested by the police and not contacting the Drug Intervention Programme is not the same thing as ceasing one's involvement in drug-related offending. 

The NTA has acknowledged that it cannot categorically assert that all individuals who do not return to treatment or contact the Drug Interventions Programme are leading entirely drug-free or crime-free lives. To do that, it says, would require each of the 40,000 clients in the study to be personally contacted and interviewed.

In fact, what would be required is only to study a representative sample of treatment leavers. Despite its cautionary caveat, the NTA has done precisely what it should have  refrained from doing - claimig near-miraculous success for drug treatment on the slimmest-possible evidence base.

The NTA has too much invested in a positive story of drug 'treatment' for it to be responsible for the evaluation of that treatment. What we need is for our drug treatment services to be subjected to rigorous and independent evaluation. Only then can we be assured that the claims we are reading in the press and elsewhere about the effectiveness of the treatment services provided are based on hard evidence rather that political spin. 

Definition of treatment: click glossary.

Comments

[John Jolly CEO Blenheim CDP]

There is overwhelming evidence that properly funded and evidence-based drug and alcohol treatment delivers benefits for individuals, families and carers, neighbourhoods, communities and society at large. This applies to the whole range of services, from programmes providing injecting drug users with clean needles to abstinence-based residential programmes.

It is important that we as a drug and alcohol misuse sector move to demonstrate our contribution and value the remaining diversity of treatment provision. Let’s all ensure that we do everything in our power to maintain a balanced treatment system designed to meet local needs, rather than going further down the road of developing standardised and limited substance misuse services. The threat comes not from the NTA but from funding cuts and local authority procurement processes that are often little more than a mind numbing complex reverse auc2tion process where the lowest price bid for drug services wins.

I support the publication of outcome data by the NTA indeed I would argue we need to see more data, however to often where outcomes are published the focus has tended to be solely on abstinence or reductions in drug use. This is a great shame as hidden in the data, if you can extract it, is the amazing impact drug and alcohol services are helping service users achieve in turning round their lives to the benefit of them, their families and communities. For this reason Blenheim CDP commissioned and published independent reviews of our organisations TOP outcomes for 2008 and 2009. The report is available on the Blenheim CDP website www.blenheimcdp.org.uk

[Kenneth Eckersley]

Neil McNeganey is right.

There have to be some questionable reasons as to why the business of reporting addiction rehabilitation results has become so complicated and long-winded.

The only logical, economical, efficient and humane definition for "recovered from addiction" is "a lasting return to the natural state of relaxed abstinence into which 99% of the UK population is born".

So giving results is very simple:
a) How many addicts for heroin went into a particular "treatment" this year?
b) How many dropped out of that treatment before reaching abstinence?
c) How many former addicts left that treatment free of addiction to heroin or any other substitute addictive substance, and,
d) How many are still free of addiction a year later.

The same analysis is then applied to users of alcohol, cannabis, cocaine, crack, crystal meth and speed, etc., etc.

According to the NAO maintaining and supporting a prescription methadone user costs the taxpayers £49,000 a year and continues for some 40 years or so.

With well over 300,000 on opiates/opioids including methadone - do the maths for yourself - and you find where the government can start saving the billions they need to find - right now.

Kenneth Eckersley,
C.E.O. Addiction Recovery Training Services
A not-for-profit community support group.

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[Ed]

John, these statistics are part of the problem constituted by judging a project's success or failure by how the results of simplistic "research" like like this looks on paper. Any project worker in any project will tell you about the many reasons there can be for an individual not re-engaging with drug services.