DRUG TREATMENT STATISTICS: ONLY 1.2% OF ADDICTS GET REHAB

The National Treatment Agency for Substance Misuse today issued a statement on drug treatment statistics claiming that Addiction Today, published by the Addiction Recovery Foundation charity, was inaccurate in one sentence of its four-page cover story. The sad fact is that the NTA prefers to expend its resources on semantics in order to avoid addressing issues of becoming drug free.

At issue is that few people get truly drug free, no matter how much they need it, because only 1.2% of problem drug users in contact with the drug-treatment system under the NTA enter rehab. In 2008/9, it was 4,711 out of 202,000 users, or 2.3%. In 2009/10 numbers fell to 3,914 out of 320,000 users.

The figure could be lower. For, last week, Jon Hibbs of the NTA gave us a list of “rehabs” which appears instead to be a medley of organisations which do not fit neatly into other categories: first- and second-stage units, quasiresidential, detox and other setups which we would not define as rehabs.

A related serious concern is that the  NTA intends to pay for the author of its failed TOP measurement tool to measure rehab outcomes – using this list?

The NTA calls for and approves plans from local areas and purchasers of treatment and boasted recently about £570million funding. Where are the drug-free outcomes under its regime?...

• Gloucestershire has a treatment budget of £6million; there are 1,000 clients on maintenance prescriptions and 6 (yes, six) in abstinence programmes
• A procurement manager in St Helens writes that “Tier 4 interventions [rehab] will not be provided... it is not envisaged that this will be a subsequent requirement”
• Another area handed over its total commissioning to a single organisation which has been fined £1million for not referring addicts to rehab in over a year
• Camden has 1,200 clients on maintenance prescriptions; it has £300,000 to spend before the end of its budget year this month but “no one to refer to rehab”
• Nottingham has ended its contracts with 12-step-based organisations.

“There is no evidence rehab works,” claim NTA senior managers, despite empirical research – and despite their own research by Dr David Best who interviewed people in true long-term abstinent recovery and found that the only effective treatment episode was rehab.

When Hibbs asked us to clarify the “drug free” statement last Friday, we were happy to help and proffered an olive branch. We explained that calling addicts “drug free” when they are still using psychoactive drugs means that cross-addiction (swapping one drug for another) is rife, resources are spent on symptoms rather than causes, and thus destructive addictive behaviours continue apace.

Illicit or licit, psychoactive drugs incur harms which continue throughout families and generations. For example, in a catch 22, methadone is supposed to replace heroin but is more addictive and harder to withdraw from, and is the second-greatest drug killer in the country – so some prescribers now want to issue pure heroin legally to replace this substitute. In this Alice in Wonderland world of NTA redefinitions,  people can then be called “drug free” while still on heroin. Incidentally, the heroin trials were many times more expensive than rehab which, unaccountably, was not offered nor even considered as a control.

“Any individual on a methadone prescription is by definition still in treatment, and cannot be discharged or claimed as ‘drug free’,” the NTA website states. We are confused: the categories "retained in treatment" seem to overlap  with successful discharge from treatment "drug free" (ie, free only of illicit drugs).  These and similar sentences also contradict its reverie of “medically assisted recovery”. How can can this exist when the person is “still in treatment” (sometimes for decades), dependent rather than having moved on?

“An individual who has overcome a drug dependency but shows signs of addiction to other substances (including alcohol or cannabis), or is at risk of relapse, should not be discharged but referred on to an appropriate service,” the NTA website states. It begs the question of whether this "appropriate service" is logged by NDTMS.  The 1.2% annual rehab access figure suggests that these "appropriate" other services cannot be rehab, as do the above examples refusing to commission rehab leading to recovery.

As for next year... well, the last sentence of the NTA website states it has no plans to improve the NDTMS dataset.

Key in “dodgy dossier” 1 or 2 or 3 in the search box to the left for more analyses of NTA figures. 

Comments

[Kathy Gyngell]

The NTA statement underlines its irreconcilable demand to have it both ways.

(1) The category "drug free" in official national statistics is defined as no longer requiring structured treatment and not using any illicit drug. In other words, users could be using prescribed (licit) methadone.

(2) Yet two sentences later, the NTA says "It therefore follows that any client recorded on the National Drug Treatment Monitoring System as having 'completed treatment drug free' is judged by their clinician as having overcome the dependency for which they entered treatment and is not dependent on any other drug. As such clients have left structured treatment they cannot be on methadone or any other substitute prescription".

Which is correct - the first or the second? If it is the second, will the NTA confirm that no one discharged under the category drug free remains on prescribed methadone or any other subsitute?
Will it agree that, to be absolutely clear, it must add to "not using any illicit drug" "no longer using licit or prescribed ones - e.g. methadone or any other substitute via any drug services, GP or other national health outlet"

[Matthew]

I don't understand this article. The discharge definition "treatment completed drug free" means completing treatment no longer using drugs or being on an opiate substitute. Any agency that reports that someone has completed treatment drug free when they are still on a methadone script, is therefore not telling the truth.
I don't see any ambiguity in the NTA definitions.

Of course, none of this measures rates of relapse. Until this is measured effectively, the treatment completed measure is effectively meaningless.

[Steve Rolles]

Does either the NTA or Addiction Recovery Foundation definition of 'drug free' include abstinence from tobacco/nicotine use?

[Laurence McM]

I had a headache trying to make sense of the NTA's final paragraphs as they contradict previous NTA statements about people on cannabis and other drugs being counted as drug free. And I cannot reconcile these paragraphs to real-life practice.

Perhaps the answer to this and Matthew's comment lies how the information is submitted. Are the clinicians drug workers? Are they prescribers? Are they using the NTA TOP form? If they are using TOP, there is no tick-box for methadone, or indeed the newer drugs flooding into clubs, or benzodiazepines. If the ‘clinician’ does not fill in TOP because the client is not off drugs, the NTA contacts the DAT to threaten stoppage of funding because TOP and NDTMS are not filled in on time. But if the clinician fills in TOP, the client is still on drugs not mentioned on the form.
It is a catch 22.
And why should someone used to prescribing or giving out drugs interpret “free of illicit drugs” as “free of licit drugs”?

[(name and address supplied to Addiction Today)]

Here’s another clear sign that Tier 4 out-of-area rehabs are being discriminated against. My bet is one of the national’s will do the Tier 3 work and automatically pick up all the Tier 4 placements funding.
The retender for addiction services in Coventry and Warwickshire states that the inpatient service must be within a 50-mile radius of Coventry! Nowhere else in the DAT area, no matter how appropriate or how good the practice or the outcomes or history. (ESPO ref 3032/11; Warks CC ref 2974: 04 Lot 2 Spec under section 3.13, page 24)
WHAT ABOUT PATIENT CHOICE !!!!!!!!!!!

[Matthew]

Lawrence McM,
There's no question that NTA guidance over the years has been contradictory and their directives and expectations have changed. But on this issue I'm not sure that the NTA is the culprit.
If someone is still on a methadone prescription or is still using any drug they should not be recorded as leaving treatment drug free. There is another discharge category "treatment completed, occasional use (not crack or heroin)" which could be applied to someone leaving a service using some of the other drugs you mention.
So, if someone leaves treatment and are recorded as being drug free, and are actually still on an opiate substitute or using drugs, the agency reporting that is either dishonest or wrong.

[Yusuf Al-M]

Khat is licit. Does that mean addicts using it are drug free, even though its harms include psychological problems, impotence, gastrointestinal tract problems and oral cancer? ‘Inverted racists’ ignore pleas from the Somali community to ban/treat addiction to it. Some say that its use will not spread outside Somalis and Ethiopians – but I have seen Polish addicts in London being ‘treated’ for addiction to khat.
Tristan McConnell and Narayan Mahon traveled to Somaliland on a grant from the Pulitzer Center for Crisis Reporting – read their story here:
http://somalilandpress.com/somalilands-addict-economy-khat-drains-struggling-economy-7319
And if khat is not addictive, why are rumours rife that it is being given to disaffected young muslims in England to recruit them for Al Quaeda?

[NTA spokesman]

There is no ambiguity intended in the NTA statement. The NDTMS records clients in structured treatment, which includes methadone prescribing. The act of being discharged from structured treatment ends access to legal methadone. If a client is discharged "drug free", they are also free of dependence on the drug for which they entered treatment and are not using any other illicit drugs. There is no need to specify they are not using methadone in the statistical definition, because anyone being prescribed methadone is still classified as in treatment. However, to avoid any further misunderstanding, the NTA is making it absolutely clear that users cannot be discharged "drug free" if they are using prescribed (licit) methadone or any other prescribed medication to treat dependency on drugs.

[addiction centre]

All too true, sad statistics but great article.