PSYCHIATRISTS: PROGRESSING AT DIFFERENT SPEEDS TO UNDERSTAND RECOVERY

The Addictions Faculty of the Royal College of Psychiatrists held its annual conference in May. Laura Graham listened to psychiatrists’ advances in understanding and treating additions.

Praise is due to Dr Alison Battersby and Dr Francis Keaney who organised this year’s Royal College of Psychiatrists’ annual conference for its Addictions Faculty, to enhance practices in the profession about recovery from addiction. It kicked off with a very informative summary by Addictions Faculty chair Dr Owen Bowden-Jones of an unusually busy schedule of policies and events over the past year.

This was followed by an inspirational speech by David Burrowes MP, PPS to Oliver Letwin who is responsible for overall government policy. “The strategy covers... treatment and rehabilitation with the goal to reduce illicit drug use and, most importantly, to ensure that more people recover completely from a dependence on drugs,” he said. However, this was not as welcome as readers of Addiction Today might expect.

“It was dispiriting to hear the audience take issue with Burrowes when he mentioned getting addicts drug free, which we know is possible – arguing that addiction is a chronically relapsing condition and people must be medicated for life. It was even more of a shock to hear loud applause  across the room for that defeatist attitude. NHS psychiatrists must change practices which lead to 90% relapse rates: they must learn to be as effective as rehab professionals,” commented Deirdre Boyd, editor of Addiction Today.

Apropos of this, Professor John Strang of the Maudsley discussed with Dr David Best Practical Recovery in a workshop hosted by Battersby. Best highlighted his latest work with the National Treatment Agency for Substance Misuse, with Strang expressing his concern at the UK debate about recovery which, he said, includes a “worrying growing hostility to opiate substitution treatment” and his belief that the “assertion of people being parked on methadone” was a phrase “designed to shock”.

Strang said that “recoverymetry” should focus on improving prescribing practices, the exploration of a “possible” synergy between methadone and recovery, consider the usefulness of residential rehab and medication, and links between 12-step and medication. He said there were useful “new medications” to “support abstinence” and that rehabs have a “distorted” view of medication.

BAC O’Connor CEO Noreen Oliver, in her presentation Addiction Psychiatry and Recovery: Are We on the Same Page?, highlighted some “myths” which have led to a “divided treatment” system because people in recovery and people still active in addiction or “in treatment” have largely been kept apart, so that the latter and the professionals working with them rarely see recovery. She highlighted that this is generally the result of ‘silo’ working practices where recovery supports struggle to work together. She gave examples of how BAC O’Connor overcame this lack of integrated working in Staffordshire, including regular input from psychiatrists with her clients. With an audience of about 100 psychiatrists, she asked those who engage with their local residential rehab to raise their hand – only three people did.

Dr James Bell of SLAM presented Should recent evidence change your practice? The limits of evidence-based medicine. He highlighted the role of the pharmaceutical industry in every aspect of prescribing practice. This includes hard marketing to medical professionals with provision of incentives for using a product, their role in shaping professional and public opinion regarding medicalised treatments and, most sinister, in shaping the “evidence-base” of medicine through sponsorship of clinical trials, lobby groups and medical journals – considered by pharma’ to be the latest “arm in marketing”.

Bell highlighted research in 2005 by Firlan who undertook a meta-analysis of 41 randomised control trials. This study found that 90% were pharma-sponsored. The mean duration of the trials was only five weeks (range between 1-16 weeks) and was considered in terms of a product being more effective than a comparable product, rather than in functional outcomes.

He said that pharma-funded trials are more likely to produce positive results, but it can be regarded as poor evidence due to its quality. He added that, if addiction is considered to be a “chronic condition”, there is a dearth of longitudinal studies. Randomised control trials tend to exclude the most complex cases and are rarely studied in any follow-ups beyond a year.

Asking if evidence can help to shape policy, Bell noted that between the years 2000-2010, there had been much research but little “new” evidence on opioid treatment. He said the focus had been randomised control trials on heroin-assisted treatment, the “risks” of abstinence (mortality after detox alone) and new buprenorphine and naltroxone formations.

In a question-and-answer session, Bell highlighted that he had tried to encourage staff at SLAM to engage with Job Centre Plus staff in order to support clients back to work. However, he described codependent attitudes in his staff which manifested in them displaying hostile behaviour in accusing the Job Centre representatives of trying to get their clients “off benefits” or the “methadone pension” rather than accepting that they were trying to support people to become independent of the State.

Laura Graham is guest researcher at the Addiction Recovery Foundation.