A PHONEY WAR ON DRUGS – AND THE MYTH OF ADDICTION TREATMENT PROVISION

Has pouring £300million a year into methadone helped – or quicksanded the UK into the worst drug problem in Europe? Deirdre Boyd reacts to rigorous research from the Centre for Policy Studies.

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Just as Gordon Brown attempts to address the UK’s disastrous record of debt by borrowing more, his government has been addressing its record of having the worst drug problem in Europe by pushing £300million of methadone scripts a year, be they clinically appropriate or not.

UK DRUG FACTS AT A GLANCE*

• The UK drug problem is the worst in Europe. It also has one of the highest levels of recreational drug use. There are at least 10 problem drug users per 1,000 of the adult population compared to 4.5 in Sweden or 3.2 in the Netherlands.

• The UK has one of the most liberal drug policies in Europe. Both Sweden and the Netherlands – despite popular misconceptions – have a more rigorous approach.

• The age of children’s initiation into drugs has dropped. 41% of 15 year olds and 11% of 11 year olds have taken drugs.

• Drug death rates continue to rise and are far higher than the european average. The UK has 47.5 deaths per million population aged 15-64 compared to 22 in Sweden and 9.6 in the Netherlands.

Let’s be clear. The issue is not about abstinence ‘versus’ harm reduction – it is about good practice being sacrificed for pandemic bad practice. It is about the hope for healthy lives being sacrificed.

To say otherwise – as ideologists, tick-boxers, bad practitioners, promoters of psychoactive drugs, pharmaceutical financial beneficiaries and others with vested interests do – is a deflection from this truth. Good practice must be reinstated.

Where good practice reigns, engagement, harm reduction, brief treatment leading to the goal of long-term sustainable abstinence, and aftercare all work seamlessly together with the clients’ best interests in mind. All the treatment provider and commissioning/purchasing organisations meet regularly, then start to work more collaboratively as they familiarise themselves with each other and each other’s client profiles and services. In the UK, we have started to witness such good practice in the north west, under the leadership of Mark Gilman. Others have spoken to me of wishing to recreate his recovery-oriented integrated system elsewhere around the country.

Where good practice reigns, people get well. Their families flourish. Their employers reap financial benefits, as does the taxman. They contribute to the communities in which they live, instead of draining them. If they have been abusing substances, they can cut back or cut out. If they have a “dysregulation of the mesolimbic dopamine system” – if their physiology includes an addictive disorder – they learn to replace artificial chemicals with healthier alternatives. This long-term learning to turn their lives around can come from professionals and/or mutual-aid groups, the most successful of which have been anecdotally and empirically proven to be 12-step linked.

THE STORY OF DRUG ‘TREATMENT’

• The election of the Labour government in 1997 marked a new direction for drug policy.

• Focus was switched from combating all illicit drug use to problem drug users. Cannabis was downgraded. Spending on methadone prescriptions trebled between 2003-2008, after the National Treatment Agency for Substance Misuse was created in 2001. Only 2-3% of people seeking help are given an option to access drug-free treatment/rehab.

Where bad practice reigns – well, the data in the Phoney War on Drugs research demonstrate the outcomes, some of which are listed above. Harm reduction is redefined as “treatment” and thus misused. ‘Treatment’ budgets are really drug-maintenance budgets. Recovery is redefined by vested interests not in recovery in such a way as to remove drug-free goals. Ideologists quote methadone research as ‘evidence’ that their service works – without acknowledging that the research was into successful methadone environments offering a very different service to theirs, settings where substitute prescribing is seen as short-term engagement, leading to or accompanied by psychosocial support and drug-free goals.

Where bad practice reigns, commissioners refuse to use or even visit rehabs; like the emperor’s new clothes, some title this a “masterclass” rather than absence. ‘Professionals’ including even some psychiatrists cannot differentiate between detox and rehab. Patients are prescribed a ‘care’ plan without even being diagnoses as abusing drugs, being dependent on them – or having an accompanying mental-health disorder. Depending on the research you read, 80-92% of women in rehab were sexually abused as children – how can the the effects of childhood abuse be best treated? How can they be treated without an accurate diagnosis in the first instance? People seeking to improve their lives are betrayed, left to die or numbed on drugs with their cognitive abilities deteriorating the longer they are prescribed, and their children neglected. 

Good practice starts with assessment, assessment, assessment.  It is implemented when all providers and commissioners meet constructively around a table, in practice not merely figuratively.

Bad practice is being exposed, despite Damian McBride-style efforts. Much impetus comes from the shock that 19 rehabs or more have closed, and the urge to address a system which accelerates such losses. We can create change. Just look at the film clips of Ukesad experts at www.inexcess.tv to witness how far grassroots recovery has progressed in the past year, to the highest echelons of society.

But we must do more. 

THE PHONEY WAR ON DRUGS

Despite this government spending £10billion – £1.5billion a year – on its drugs policy, the numbers emerging from government treatment programmes are the same as if there had been no treatment at all, revealed Kathy Gyngell in a recent document from the apolitical Centre for Policy Studies. The July issue of Addiction Today shares its seminal facts.

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This summer saw the release of The Phoney War on Drugs by researcher Kathy Gyngell, chair of the Centre for Policy Studies’ Prisons and Addictions forum and editor of the 400-page Addictions section of Breakthrough Britain. It is a devastating critique of the failure of the UK’s drugs policy, the waste of valuable resources and lives. 

Many experts implementing good practice will have witnessed the reality of the conclusions Gyngell arrives at, but perhaps not known the exact statistics.

Truth gives power. Not only might counter-productive policies and practices be reduced, but Gyngell offers some tried-and-tested solutions.

The UK is compared with Sweden and the Netherlands throughout The Phoney War. Both countries were chosen because they have adopted drug policies which are markedly different to those of the UK and their drug use is lower. It is noteworthy that, despite the perception that the Netherlands has a liberal drugs policy, 76% of dutch municipalities now operate local zero-tolerance drug policies. Coffee shops are now increasingly tightly regulated and  policed. A third have been closed in recent years.

Sweden and the Netherlands also have more effective prevention strategies.

THE STORY OF DRUG ‘TREATMENT'

The UK has the worst drug problem in Europe. Below is the story of the events leading up to this ...

• The election of the Labour government in 1997 marked a new direction for drug policy. It developed a ‘harm reduction’ strategy which aimed to reduce the cost of problem drug use.

• The focus was switched from combating all illicit drug use to a smaller sector: problem drug users, depersonalised as “PDUs”.

• Cannabis was reclassified downwards.

• Spending on methadone prescriptions tripled between 2003 and 2008.

• The aim of ‘treatment’ for drug offenders was no longer abstinence but ‘management’ of their addiction with the aim of reducing their reoffending. In practice, this meant prescribing methadone.

• Government targets were imposed on new quangos such as the National Treatment Agency for Substance Misuse in an attempt to increase the number of PDUs in treatment – which for most people meant getting a methadone prescription.

• Of the 200,000 or so problem drug users currently claimed to be in ‘treatment’, only 6,700 have undergone “inpatient treatment” (ie, brief detoxification, a physical first step before treatment). Only 4,300 have had residential treatment.

• A Drug Intervention Programme was introduced to direct those guilty of drugs-related offences into ‘treatment’ – again, in practice this meant prescribing methadone. There is little evidence that this has been effective.

• This disproportionate harm-reduction focus has failed. It has trapped 147,000 people in state-sponsored, taxpayer-funded drug use.

• At the same time, the numbers of recorded offences for importing, supply and possession of illicit drugs have all fallen in the past decade.

BLIGHTING THE NEXT GENERATION

“Trae-blue Lane had just turned three when she died from an overdose of methadone, the heroin substitute supplied to her mother,” reported the Sunday Telegraph in January 2009.

A Channel 4 Freedom of Information request found that between 2005-2006 police caught over 6,000 children selling drugs from class-A substances to cannabis, and caught a further 53,497 children in possession of drugs.

The deaths of infants are small windows on the UK’s worsening and chaotic drugs culture which Labour’s drug policy has, inadvertently, promoted. Consider these trends:

• the number of babies born to drug-addicted mothers has almost doubled in recent years

• * the number of children of addicts in England was estimated in 2002 at 200,000-300,000, with a further 41,000-59,000 in Scotland

• * these children, and those uncounted, are at high risk of neglect, chaotic routine, truancy, exposure to parents’ drug use and criminality, as well as the obvious risk of early drug use

• * many of these children are hidden from social services; the Home Office recommended that drug treatment agencies record drug users’ full “parental status” but the NTA fails to do this – needle exchange and frequency of injecting is monitored but not children

• one third of families seen by social workers have substance-misuse problems; in 71% of these cases substance-misuse professionals are not involved

• these children are often from second- and even third-generation substance-misusing families.

The UK remains at the top of the european schoolchildren’s cannabis league table: 29% compared with the european average of 19% – and they are using a stronger version than in the past. Schoolchildren’s cocaine use has been rising since 2001. And age of initiation has lowered.

 FROM CHILDHOOD TO ADULTHOOD

“Substance use by young people is linked with substantial levels of psychiatric and other morbidities and, according to National Statistics data, levels of mortality in this age group vie with cancer,” stated a 2008 document from the government's National Treatment Agency.

Children’s drug use impacts on their physical and mental health, education and welfare. It affects the non-drug using children around them, disrupting the classroom and school ethos, and adding to negative peer pressure. Furthermore, experimental substance use among very young people is widely recognised as a predictor of future dependence and other drug problems.

For example, Espad analysed the relationship between substance use and antisocial behaviour including depression, anomie, thoughts of self harm and suicide and running away from home. There was a strong correlation between frequency of drug use and antisocial behaviour. It also found that the percentage of high-risk users in the population corresponds to the prevalence of cannabis use in each country. In other words, the more cannabis users there are today, the more high-risk users there will be tomorrow.

So it is worrying that the UK has one of the highest rates of teenage cannabis use in Europe.

And there is no state-funded adolescent residential treatment in the UK. Middlegate Lodge, the only such centre, is closing due to lack of state funding for referrals. In lieu of treatment, children can be pushed onto substitute drugs. In contrast, Sweden’s state-funded Maria Ungdom programme sees 2,000 teenagers a year whose abstinence-based residential stays last between three days and three months, according to need. This is followed by regular outpatient clinic appointments and checks.

THE ADULT SHIFT TO HARD DRUGS

Over the past decade of Labour drug policy (see story panel near top), we have seen:

• in 1998, 3.8% of UK adults had tried cocaine but by 2007, 7.7% had – this is double the european average of 3.6%

• in 1998/99, there were 161 health emergencies caused by cocaine; this rose to 740 in 2006/7

• the european average for lifetime use of ecstasy is 3% – in the UK, it is 7.3%

• 5.6% of young european adults on average have taken ecstasy – 13% of UK young adults have done so

• heroin and opiate use are harder to establish; National Drug Treatment Monitoring System data tell us that in 2007/8, out of 202,666 problem drug users in contact with treatment services, 123,522 presented with heroin as their main drug of misuse – and 10,112 with methadone as their main drug of misuse.

THE UK’S RISING DRUG DEATHS

In 2001, when the NTA was founded, the government set a target to reduce drugs-related deaths by 20% by 2004.

Methadone prescribing doubled in general practice between 2003 and 2008. Spending on methadone tripled in the same time. 147,000 people are listed as receiving prescribing services. The NTA estimates that the median cost for prescribing methadone is £2,020 per client. This suggests the state is spending almost £300million a year on methadone treatment.

The main aim of methadone treatment is to reduce the risk of overdose from illicit drugs. But not only has the 2004 target for drug deaths not been met – the number of UK drug deaths rose.

In fact, the number of drug deaths involving methadone rose consistently between 2003-2007 to 325 in the last year. This is an increase of 35% from 2006, or 62% compared to 2003. Drug deaths in the UK are also higher than the european average. The chances of dying a drug-related death in the UK are four times higher than in the Netherlands.

THE RISING DRUG-RELATED DISEASES

The damage to the health of problem drug users is also increasing. The incidence of HIV among the 140,000 injecting drug users is higher than in the late 1990s. It is about one in 90 – or one in 20 in London. In 2002, it was about one in 400 people injecting drugs.

Despite nationwide needle-exchange units, almost half of UK injecting drug users are infected with hepatitis C. Hepatitis C transmission is greater than in the late 1990s, with a fifth of IDUs infected within three years of starting to inject.

MARKET FORCES PREVAIL

The UK is one of the easiest and cheapest places to get drugs. Prices have fallen to record lows since 2000, from £70 to £46 per gram today for heroin and from £65 to £49 for cocaine. Drug seizure quantities are down 60% on a few years ago.

The market has matured so dealers offer two grades of cocaine to buyers: heavily-cut £30/gram to students, pub users and those on low incomes and quality £50/gram to affluent consumers. There is a similar two-tier market for ecstasy-type drugs. And dealers have little fear of being arrested.

So how did we get into this mess?

THE HOUSE OF STRAW

In 1997, the Labour government inherited a significant drug problem. But it was one which the previous Conservative government had begun to address by, for example, piloting a community-based drugs prevention initiative and supporting 2,000 prevention projects. They had also set up a countrywide network of interagency Drug Action Teams aiming for coordinated local law enforcement, accessible treatment, education and prevention. Treatment was set to become a more central part of the drugs strategy. Abstinence had been identified as the key treatment goal.

The arrival of Labour heralded a new approach based on harm reduction. Its vision was not to a society free from drugs but from drugs harm. It translated what had begun as a public-health strategy to prevent HIV into a broader drugs policy. Policy went onto two incompatible tracks: liberality for the masses but control and coercion for the socially excluded minority.

In 2001, labour set up a Special Health Authority, the National Treatment Agency for Substance Misuse, to process as many problematic drug users into ‘treatment’ as quickly as possible. The actions of the NTA have been defined and driven by targets. Hundreds of commissioning edicts and care protocols were dictated to the 150 DATs. The NTA had the requisites of a national harm-reduction. Funding allocations became contingent on local needs assessments and treatment plans tailored to NTA demands.

Almost totally excluded from this new treatment funding was the existing network of charitable and private residential centres and programmes which provided time-intensive abstinence-based recovery and rehabilitation.

Similarly ignored, until recently, by the government and NTA were the countrywide 24/7 free fellowships (recovery groups) of Narcotics Anonymous and Alcoholics Anonymous.

Today the NTA is the pinnacle of monolithic bureaucracy. Its original staff of 30 expanded to 150. Its operating (administrative) costs stand at over £14.5million a year. On its advice, the pooled treatment budget of £655million a year is distributed to purchase ‘treatment’. Senior staff are rewarded with performance-related bonuses if they meet their targets on paper.

THE EMPEROR’S NEW CLOTHES

The number of clients in ‘treatment contact’ rose to over 200,000 by 2007/2008. 147,000 of them were prescribed opiate drug-substitutes even though some two thirds had been defined as crack cocaine addicts for whom there is no approved pharmacological treatment. According to the NTA, only 4,300 people, less than 2% of those in ‘treatment’, accessed residential rehabilitation. 6,700 had inpatient detoxification.

But the NTA could claim that it had beaten its target of getting 50% of PDUs into treatment.

The pointlessness of the bureaucracy was first exposed by BBC home affairs editor Mark Easton on the Today programme in 2007. He revealed that the numbers emerging from treatment free from addiction had barely changed from 5,759 to 5,829 despite £130million extra funding.

Not only were less than 3% of problem drug users drug-free after treatment but this had fallen from 3.5% three years previously. This is despite the fact that, between 1998-2007, the government spent more on its ‘war’ against drugs than on its combined operations in Iraq and Afghanistan.

SOLUTIONS FOR DRUGS POLICY

Both Sweden and the Netherlands have far more coherent and effective drugs policies. These are based on:

• enforcement of the drug laws

• prevention of all illicit drug use

• provision of addiction care.

All these principles have been lost sight of over the past 10 years in the UK.

While the UK spends most of its drug budget on its so-called treatment programmes, both the Netherlands and Sweden spend most of their drugs budget on [effective] prevention and enforcement. Their drugs problems are a half and a third of the size of the UK respectively.

So a successful UK drug policy would:

• focus on the illicit use of all drugs, instead of differentiating between levels of harms caused by drug use

• abandon harm reduction as the principal approach; it is only one part of the continuum of care

• develop treatment support aimed at abstinence and rehabilitation

• include a tougher, better-funded enforcement programme to reduce the supply of drugs.

FIGURES ARE WORSE FOR LEGAL DRUGS

AT note: Reports this year from the All Party Parliamentary Groups on Drug Misuse and Involuntary Tranquilliser Addiction (see Addiction Today nos 117 and 188) show that the problems are multiplied for those drugs which have been made legal and more widely available. Alcohol harms cost the country 322-25billion and 22,000 deaths a year.  Tobacco has caused 5million deaths. Legalisation is not the answer; normal market forces will prevail, worsening the problems.

MORE INFORMATION AND SOLUTIONS

The 70-page Phoney War on Drugs can be downloaded free from the Centre for Policy Studies.

KATHY GYNGELL is chair of the Prison and Addictions Forum, a working group at the Centre for Policy Studies. Its aim is to challenge the prevailing wisdom on drug policy and to advocate practical, realisable reform of this area of policy. ARF CEO Deirdre Boyd is a member of the group.

ADDICTS COMMIT CRIME TO GET TREATMENT

Heroin addicts are committing crime to get fast tracked into drug rehab because of waiting lists for treatment, a BBC programme reveals. This confirms anecdotal reports given to Addiction Today over a number of years.

BBC Wales' Week In Week Out programme, presented by the cult bank Velvet Underground's John Cale, also shows how children as young as 12 are using heroin. Cale also talks about his own heroin and cocaine use in the past.

The assembly government doubled funding over the past five years and waiting lists for help have fallen – but addicts living in the Cardiff area can still wait up to 18 months.

The programme features Jamie Harris, from the Sandpits project for under-18s in Swansea. "Young people come in more often than not around the 15 years old mark, but they are reporting that they first started using heroin younger - possibly 12 or 13,” he said.

Other addicts interviewed by the investigation team revealed that they are committing crime to get treatment more quickly.: "Basically the best way to get help is to break the law,” said Wayne Marsh, 23, who lives in a homeless hostel in Cardiff.

Mags Lyons, a project worker at the Inroads drugs project in Cardiff, said she was aware that people were breaking the law to get treatment. "Desperate times need desperate measures and quite often people might have to go out and offend," she said.

Llanelli assembly member Helen Mary Jones said: "When I have parents coming into my constituency surgery saying 'my boy wants to get off heroin but he's going to have to wait four or five months before he can see somebody', then we're not doing enough."

The assembly government said latest figures showed 85% of clients were assessed in four weeks, and 90% of those assessed started treatment in four weeks. It said £18.8million was being spent this year to community safety partnerships to tackle substance misuse in Wales, an increase of 16.6% on last year's budget, with an extra £11m allocated via local health boards.

 

COCAINE HARMS: THE FACTS

A brief over of the medical damage caused by cocaine; more to be added - please feel free to add your own research. Just click on the links below for information.

 

Cocaine damage to brain cells 1 

Cocaine damage to brain cells 2

 

Cocaine damage to the nervous system

 

Damage to babies from mothers using cocaine

Cardiovascular and kidney damage from cocaine

 

 

ANOTHER REHAB TO CLOSE

The Norfolk-based Diana Princess of Wales Treatment Centre has failed in its battle to stay open since it went into administration in July 2008.

Receivers say they will try to find new places for the 19 patients being treated there.

The centre was owned by Adapt - Alcohol and Drug Addiction Prevention and Treatment Ltd - whose centre in Somerset closed in July last year.

Ian Carr, partner at Grant Thornton LLP and administrator of Adapt, said: "We have tried to a secure a sale of the centre but this has not proved possible and the ongoing losses mean it is not possible to continue trading.

"It is a real shame that this centre, which has provided the rare service of treatment of drug and alcohol addiction for clients with a dual diagnosis, now has to close."

The administrator now intends to seek a buyer for the centre for an alternative use.
 

MORE BABIES ARE BORN DRUG-DEPENDENT

Newborns with drug-withdrawal symptoms are up by 67% in 10 years as money for specialist rehab units runs out, writes Nina Lakhani of The Independent on Sunday.

In 2007-8, 1,230 babies in England suffered from symptoms including poor sleep, agitation and difficulty feeding because of serious drug use by their mothers during pregnancy.

According to the British Association of Perinatal Medicine, one in 500 newborn babies need treatment with small doses of morphine to control these symptoms. But research by the IoS found the number of babies affected is much higher than official figures.

Last year, a total of 350 babies were born to addicted mothers in Manchester, Fife and Bradford alone. Most recovered naturally without being prescribed medication - physical withdrawals occur only if the mother uses either opiates such as heroin and methadone or sedatives such as diazepam during pregnancy.

So newborns who experience problems from exposure to cocaine, amphetamines and cannabis might be excluded from these statistics.

According to experts, the increase in withdrawing babies reflects the number of women abusing drugs and alcohol as well as a 60% increase in the number of women seen by drug services which prescribe methadone – the legal alternative to heroin.

These findings come just weeks after Edinburgh City Council took the unprecedented step of appealing for new foster carers after the number of babies born to addicted mothers doubled between 2007 and 2008.

Professor David Field, president of the British Association of Perinatal Medicine, said: "In the mid-1990s, you rarely saw these babies but now there is always one on the ward who is withdrawing, and the numbers will grow as the rates of addiction continue to grow. Most women we see tend to be on heroin or methadone or both."

Bethany Lodge, the specialist mother-and-baby rehab unit, is one of 19 centres to close in the past two years. "This further highlights the importance that we ensure that those who are habitual and dependent drug users are directed to effective drug rehabilitation schemes which bring them off drugs completely so that we can also protect unborn children," said shadow Health Secretary Andrew Lansley.

For more details, click here.

SERBIAN TORTURE UNIT FOR ADDICTS CLOSES

A happy ending to our story on brutality meted to addicts trying to recover at Crna Reka "treatment" centre for drug abusers: Reuters reports that the Serbian Orthodox Church ordered its closure  after a video showed a patient being beaten with a shovel, punched and kicked as part of supposed treatment.

The Holy Synod, the church's top body, asked Bishop Artemije, the head of the local diocese, to order an immediate shutdown of the facility and "launch proceedings against those responsible in line with church's laws and regulations".

A video posted on the website of Belgrade's Vreme weekly showed one of the centre's employees repeatedly beating a man with a shovel, kicking him and hitting him with a knuckleduster - brass knuckles - in the face inside a room decorated with icons. The victim, whose head hits religious icons on the wall during the beating, eventually falls unconscious

The statement came a day after the Serbian Health Ministry said it would investigate methods used at the rehabilitation centre near the southwestern city of Novi Pazar, and after government human rights watchdog Sasa Jankovic announced he had filed criminal charges against the centre and its lead priest Dejan Peranovic.

It is unclear whether the church acted in response to learning about the abuse, or to publicity.

STOP THIS TORTURE NOW

OUTRAGE AT SERBIAN 'TREATMENT' OF PATIENTS WITH ADDICTIVE DISORDERS

Officials in Serbia are investigating a 'rehabilitation centre' affiliated to the Orthodox Church where drug addicts have been filmed being beaten. Vreme magazine shows a man appearing to assault a patient by hitting him with a shovel and punching his face.

Defending his organisation, Archpriest Branislav Peranovic told B92 television that "whoever has a junkie in the house knows what I am talking about." He gives no evidence of knowing that addiction is a medical disorder, stemming from dysregulation of the brain's mesolimbic dopamine system, nor that he has read the well-proven effective treatments for it.

In the video posted on Vreme's website on Friday, a young man believed to be a patient at the Crna Reka rehabilitation centre is seen being beaten repeatedly with a shovel, and then punched and kicked in the head by two men in sports gear. The incident takes place in a room displaying Christian icons.

The centre said the beatings, administered by former addicts, were a necessary part of the therapy for drug addiction and were carried out with the consent of patients' parents.

A former patient said that sometimes they would be told to form a circle around a "bad one" and watch them being beaten by the priests and other staff. "They would hit him with clubs, shovels, fists, bars, belts, whatever they got their hands on," he told Vreme. Archpriest Peranovic "knows how to hit - his hands are often bloody... he practises martial arts".

Government human rights monitor Sasa Jankovic plans to file torture charges against the facility: "It is no therapy. It is a criminal act". Addiction Today strongly supports his statement. 

Complain to the serbian embassy in London here.

Complain to the serbian embassy in Washington here.

 Click on the BBC website for the video and fuller story.

RECOVERY MOVEMENT HAS ARRIVED!

As 500 people attended the UK/European Symposium on Addictive Disorders, to participate in Effective approaches to intervention, treatment and recovery, it was clear not that a grassroots recovery movement has started - but that it has arrived.

And within 36 hours of the last UKESAD presentation, the family-centric Centre for Policy Studies released a devastating critique by Kathy Gyngell of Labour's 'top down' failure to support people who need help.

Hear the voices of people in recovery and their supporters.

HIGHLIGHTS OF DAY 2 - click for video:

"It’s been a fantastic day at UKESAD. We didn’t know what to expect but were rewarded again with a range of presentations and interviews that have brought insight and views from around the world. We started the day with Christopher Kennedy Lawford who was testament that addiction reaches all levels of society and does not discriminate. We have heard the views of Dr Robert Johnson, Prof Roger Weiss and Dr Louis Baxter. In a slight departure form our normal content we heard Dr Jack Kuo on Video Game addiction," writes George Williams.
"In the afternoon we were treated to The Outside Edge Theatre Company and managed to catch up with Phil Fox their creative force and board member David Charkman. The surprise of the day was managing to grab a few words with Jimmy Page - one of the finest guitarists in the world and patron of the Outside Edge Theatre Company."

 

Some of the speakers 15 May (l-r): Shadow minister for justice David Burrowes MP, UKESAD organiser Deirdre Boyd and actor/author/advocate Christopher Kennedy Lawford. 

HIGHLIGHTS OF DAY 1 - click for video:

"Inexcess’s first day at UKESAD has been an inspiration. We met people bringing a diverse view of the world of addiction, treatment and recovery. Dr Brian Iddon MP brought a political perspective to the debate, while we have been enlightened by academics and medical practitioners including Dr Robin Lawrence and Professor David Rosenbloom from Boston University," George Wiliams reports. "After lunch, we found ourselves in the company of Nick Barton and Kirby Gregory from Action on Addiction. Ed Mitchell shared his recovery in an interview of humour, honesty and experience."

 

  

Speakers on their way to the All-Party Parliamentary Drugs Misuse Group, 13 May (l-r): Professor Larry Ashley of the University of Nevada, Professor Roger Weiss of Dept of Psychiatry-Harvard, Professor David Rosenbloom of Casa and JoinTogether.com, Patrick Kennedy Lawford, ASAM president Dr Louis Baxter, Jaime Delgado of Behavioral Health of the Palm Beaches, Association of Intervention Specialists board member Jane Eigner Mintz, IC&RC president Jeff Wilbee, Addiction Recovery Foundation CEO Deirdre Boyd, HRDI CEO Dr Andrea Barthwell, Tammi VerHelst of IITAP, Patrick Carnes, interventionist John Southworth and Freedom Consultancy director Johan Sorensen.

Comments from Professor David Clark and the WiredIn online recovery community

REGISTER FOR UKESAD 2010

We look forward to seeing friends old and new, to the 'buzz'  of like minds, and exchanging international expertise via networking and our 60 national and international speakers in about 40 presentations. Delegates booking before December 2009 can benefit from significant 'early bird' discounts.
Telephone 020-7233 5333.

THE PHONEY WAR ON DRUGS

FAILURE OF GOVERNMENT DRUG POLICY IS EXPOSED 

The government has repeatedly declared that it is fighting a "war on drugs". But Kathy Gyngell shows that this has been a facade, in The Phoney War on Drugs, published today by the Centre for Policy Studies.

Indeed, the UK now has one of the most liberal drug policies in Europe. Both Sweden and the Netherlands, despite popular misconceptions, have a more rigorous approach – and far fewer problems with drugs.

 The UK faces a widening and a deepening crisis. Over the past 10 years, Class A consumption and "problem drug use" have risen dramatically, drug use has spread to rural areas and the age of children’s initiation into drugs has dropped. 41% of 15 year olds, and 11% of 11 year olds, have taken drugs.

Drug death rates continue to rise and are far higher than the European average. The UK has 47.5 deaths per million population (aged 15 to 64) compared to 22.0 in Sweden and 9.6 in the Netherlands. There are over 10 problem drug ssers (PDUs) per 1,000 of the adult population, compared to 4.5 in Sweden or 3.2 in the Netherlands.

Click here for the full 82-page Phoney War on Drugs pdf from the Centre for Policy Studies. For highlights, read on...

Gyngell's report shows how the Labour government has taken a new direction for drug policy. Its new “harm-reduction” strategy aimed to reduce the cost of problem drug use. The focus was switched from combating all illicit drug use to the problems of PDUs. Cannabis was declassified. Spending on methadone 'treatment' increased threefold between 2003 and 2008. Treatment for drug offenders was redefined as being no longer abstinence but management of their addiction with the aim of reducing their reoffending. In practice, this meant prescribing methadone.

"This harm-reduction approach, at the expense of others, has failed. It has entrapped 147,000 people in state sponsored (mainly methadone) addiction," Gyngell writes. "The numbers emerging from government treatment programmes are at the same level as if there had been no treatment programme at all."

WEAK ENFORCEMENT AND PREVENTION

The UK drugs market is estimated to be worth £5billion a year. In comparison, the government is spending only £380 million a year – or 28% of the total drugs budget – attempting to control the supply of drugs (over £800 million is spent on treatment programmes and reducing drug-related crime). Only five boats now patrol the UK’s 7,750 mile coastline.

The numbers of recorded offences for importing, supply and possession of illicit drugs have all fallen over the last 10 years. At the same time, seizures of drugs have fallen and drug prices have dropped to record low. The quantity of heroin, cocaine and cannabis that has been seized coming into the UK has fallen by 68%, 16% and 34% respectively (the recent announcement by SOCA of record cocaine seizures should be treated with great caution).

AN ALTERNATIVE

Both Sweden and the Netherlands have far more coherent and effective drugs policies. These are based on the enforcement of the drug laws (unlike in the UK, most of the drugs budget in both countries is spent on prevention and enforcement); the prevention of all illicit drug use; and the provision of addiction care.  Gyngell demonstrates t hat these principles have been lost sight of over the last 10 years in the UK. A successful UK drug policy would in contrast:

• focus on the illicit use of all drugs, not the harms caused by drug use;

• abandon the harm reduction approach;

• develop treatment support aimed at abstinence and rehabilitation;

• include a far tougher, better-funded enforcement programme to reduce the supply of drugs.

NOTES:

1. The full report can be downloaded here.

2. Kathy Gyngell chaired and authored the Addictions Reports of the Social Justice Policy Review for the Conservative Party, published in Breakdown Britain in December 2006 and Breakthrough Britain in July 2007. She is chair of the Prisons and Addictions Policy Forum at the CPS. She was also the co-author with Ray Lewis of From Latchkey to Leadership: Channelling the Talents of Inner City Youth.

INVOLUNTARY TRANQUILLISER ADDICTION

An All-Party Parliamentary Group recently drew the nation’s attention to the damage caused by prescription and over-the-counter drugs – harms to a greater volume of people than from all illicit drugs. Michael Behan reports a worsening situation.

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The March 2009 edition of Addiction Today contained an article from the All Party Parliamentary Drug Misuse Group – APPDMG – summarising its recent report on the group’s inquiry into physical dependence and addiction to legal drugs. The All Party Parliamentary Group on Involuntary Tranquilliser Addiction – APPGITA – originally assisted in this inquiry. After reading a draft copy of the inquiry’s report we disassociated ourselves and decided to produce an alternative report on involuntary tranquilliser addiction, and to make alternative recommendations.

We had provided expert witnesses to the inquiry on the tranquilliser problem: Professor Heather Ashton of Newcastle University, Una Corbett of the withdrawal charity Battle Against Tranquillisers and Pam Armstrong of  the Council for Information on Tranquillisers and Antidepressants. However, the authors  discounted that oral and written evidence put to the enquiry in reporting their own conclusions and ideas on tranquillisers. Those ideas correspond closely to existing Department of Health misconceptions on the subject.

It is DoH misconceptions which have led to the present situation: described by a witness to the enquiry, Milly Kieve, as a “public health emergency”.

BACKGROUND

By “involuntary tranquilliser addicts” we mean patients introduced to tranquillisers by their doctors without appropriate warning of the dangers involved. Guidelines for tranquilliser use recommend  prescribing for short periods only, two-four weeks. But doctors are prescribing tranquillisers to patients for months, years – and to some patients for 30-40 years.

Tranquillisers are highly addictive and toxic drugs. They consist of benzodiazepines such as Valium (diazepam), Ativan (lorazepam), temazepam and Mogadon (nitrazepam) and the “Zed” drugs such as zopiclone. Tranquillisers cannot cure any illness but they can alleviate symptoms of anxiety for a short time.

In chronic use, tranquillisers produce physical  and psychological side effects which can be intense  and bizarre. 200  side effects are listed and addicts often experience 20-30 at one time.

Tranquilliser addiction is a physical addiction which alters the chemistry of the brain, which is slow to recover after chronic use. So tranquilliser withdrawal is complex and can be traumatic and painful. To be safe and successful, withdrawal from a therapeutic dose can take from six months to two years.

Good-practice withdrawal involves  slow tapering of  dosage. A withdrawal protocol has been designed and published by Ashton. This has been used successfully worldwide and is available in 10 languages at www.benzo.org.uk. When addicts have reduced to a zero dose, they might experience a  post-withdrawal syndrome lasting months or years and  which could be permanent.

Benzodiazepine tranquillisers were introduced into the UK in the 1960s by Roche Products with exaggerated and proven-to-be-untrue  claims for their indications and safety. Benzodiazepines were issued with “licences of right” by the Department of Health licensing agency with no assessment of safety or efficacy. A population of involuntary addicts was created  which has existed continuously ever since – and is currently estimated at over 1million people.

Throughout this time, the DoH has refused to provide withdrawal services to involuntary tranquilliser addicts, with the current  exceptions of one worker in Oldham and one prescribed medication nurse in Belfast.

The APPGITA was set up to raise awareness of this problem, and in particular to lobby for specialised withdrawal services to be provided by the DoH.

HARMFUL EFFECTS OF INVOLUNTARY TRANQUILLISER ADDICTION  

1: Deaths. From 1990-1996, during which time the Home Office collected this statistic, benzodiazepine tranquillisers were responsible for more deaths – 1,810 – than all class A drugs added together, which totalled 1,660. Ashton has extrapolated those figures to cover the 45 years of tranquilliser prescribing, and added tranquilliser-related road traffic accident deaths, to produce a total of 17,000 tranquilliser deaths in the UK.

2: Benzo-babies. Babies born to mothers who have ingested tranquillisers during pregnancy can be born addicted and with damage such as floppy infant syndrome, neurological hyper-excitability and poor feeding.

3: Accidents. Tranquilliser impairment causes accidents in the home, such as falls and fractures in the elderly, at work and on the road.  

4: Tranquillisers are routinely overused in care homes and homes for the elderly.

5: Social Cost. The social cost of involuntary tranquilliser addiction remains uncalculated but must be enormous. Like all drug addictions, involuntary tranquilliser addiction leads to the loss of employment, homes and marriages.

I believe that the APPDMG report ignores or under-reports all aspects of the tranquilliser problem. As mentioned, its recommendations resemble existing DoH policy on tranquillisers.

The only explanation offered for the tranquilliser problem is that, in the 1960s,  “benzodiazepines were very favourably received by most patients” (p7).This is akin to the “blame the patient” explanation used by the DoH under this and previous administrations.

We believe that the tranquilliser problem does not come from the minds of patients but from within the DoH, where the pharmaceutical lobby dominates control of policy.

THREE WAVES OF DISASTER

The DoH failure to tackle the tranquilliser scandal  paved the way for a second drug disaster, the SSRI – selective serotonin re-uptake inhibitor – antidepressants. The third psychoactive disaster is also on the way.

As with tranquillisers, the drug manufacturers  were able to obtain a product licence for SSRIs as safe and efficacious – but  SSRIs have been found to be toxic with low efficacy and cause a

withdrawal reaction which can be severe. An estimated 7.5million people in the UK are long-term users of  SSRIs . 

Meanwhile, pro-drug campaigners are at work in and around government to introduce a third wave of psychoactive drugs. The new products include so-called “cognitive enhancers”, “safe recreational drugs” and “psychedelic treatments for mental illness”.

These plans can be seen on the website of Foresight, a government think-tank, in its Drugs Futures 2025 literature and  on the website of The Beckley Foundation. Many of the new products will contain the ingredients of drugs that are currently illegal.

The pharmaceutical companies can convert those ingredients into supposedly safe products, obtain product licences and then manufacture drugs designed to take control of the huge illegal market. The outcome could be that increasingly large segments of the population will be drugged – using drugs endorsed by the DoH. Sound familiar?

We believe that the DoH should break free from the pharmaceutical lobby and start work against all prescribed-drug addiction.

Furthermore, we believe that the DoH policy on tranquillisers is  immoral because thousands of patients are introduced to  addictive drugs by the NHS and reduced to the misery of drug  dependence and addiction. Addicts are then been stigmatized as drug abusers and denied NHS treatment for their addiction. We have prepared a list of alternative  recommendations  which reflects the evidence of witnesses to the inquiry and   are designed to seriously tackle involuntary tranquilliser addiction.

RECOMMENDATIONS

• There should be... a national network of NHS-funded specialised tranquilliser withdrawal clinics with regional residential clinics for difficult cases... NHS-funded local support groups... a NHS-funded 24-hour national tranquilliser helpline... and training courses for specialised tranquilliser withdrawal counsellors.

• There should be medical research sponsored by the DoH into the mechanisms of damage from long-term use tranquilliser damage, which are so far unknown.

• Statistics should be compiled by the DoH to measure, for example, the number of addicts, the duration of addiction, the number of ex-addicts and the proportion of addicts permanently damaged, and the correlation between tranquilliser addiction and the uptake of Disability Benefit.

• Rehabilitation and back-to-work schemes should be available to those whose lives have been ruined by tranquilliser addiction.

• A review of all tranquilliser product licences should be conducted.

• A no-fault drug compensation scheme funded by a levy on the pharmaceutical industry should be created.

 MICHAEL BEHAN  is parliamentary researcher to Jim Dobbin MP, chair of the All-Party Parliamentary Group on Involuntary Tranquilliser Addiction.

 

OPEN LETTER FROM MIDDLEGATE LODGE

UNIQUE REHAB FOR CHILDREN FACES CLOSURE

"By way of introduction, I am chairman of Middlegate,

a unique Ofsted-registered, residential rehabilitation unit treating young people aged 11-18 years of age which has been caring and treating young people since 1995. Middlegate's aim is to rehabilitate and treat young people with substance-misuse and behavioural-related problems in a family residential setting.

I have read Kathy Gyngell's article, No reason to be sanguine about teenage drug use, and also note the comment by Mike Trace of the urgent need for residential treatment for young under-18 addicts.

Middlegate has only five beds available to treat young people. It was forced over three years ago, because of funding issues, to lay off 10 programme workers and to close a four-bed unit.

In October last year, I attended the Community Care Live 08 conference for children and young people services and went to a workshop lead by Penelope Gibbs of the Prison Reform Trust, Why we should lock up fewer children.

 My colleagues and I believe that too many young people lose their freedom unnecessarily. Our team of trained specialists work with the young people to develop their life skills, nurture them back into meaningful education, address their emotional and psychological issues, improve their general health, carry out family mediation and outreach involvement and gently help them over their dependence on drugs, alcohol and related substances.

Middlegate gets referrals from various sources: Drug Action Teams, Primary Care Trusts, Youth Offending Teams. We have had young people referred to us who have been in secure accommodation or indeed have been on Tag Orders. Normally, an assessment is done on site at our own cost or an assessment is done at the secure unit or young person’s home etc.

I regret to say that, unless a solution can be found to the current funding crisis, Middlegate will be joining the 18 adult residential units who because of lack of referrals have been forced to close. The experience of our dedicated caring and experienced staff will be lost.

Middlegate had a meeting with Tom Aldridge, head of Young People's services in the National Treatment Agency for Substance Misuse last week. He mentioned that there are reforms in the criminal youth justice system in August. Although unable to assist in any way regarding unblocking the flow of referrals, he did say it was worth seeing if Middlegate could be of value to rehabilitate young people with drug, alcohol and substance misuse issues who have entered the criminal-justice system.

We are obviously concerned by the lack of foresight of the NTA. We believe very strongly that it would be better to treat young people before they are forced into the criminal justice system but it appears that current NTA and government policy has more of a punitive outlook.

I would welcome the opportunity to discuss this matter further and extend an invitation to referrers to visit Middlegate

.

Kind Regards,

Chris Robertson

Chairman

Middlegate

-Caring for Young People

Drug, Alcohol and Substance Misuse Residential Treatment.

EFT: TAPPING INTO NEW SOLUTIONS

After an initial period of scepticism – “I have a background in science and am suspicious of new ‘fads’ unless they have good evidence base” – Masha Bennett trained in EFT and has become a convert. She explains how it can help clients.

This article first featured in Addiction Today, January 2009
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Meet Masha at UKESAD.

Complementary and holistic therapies are not new in supporting treatment of substance dependency – auricular acupuncture is used by many services for alleviating cravings, as well as general relaxation and stress management. Other complementary approaches encountered in addiction treatment are aromatherapy, nutritional therapy, massage, yoga, meditation and sometimes homeopathy (Peters, 2005).

EFT – Emotional Freedom Technique – is a therapeutic approach and self-help tool developed in the 1990s in the US by Gary Craig, from the previous work of Dr Roger Callahan on Thought Field Therapy. It is a simple procedure which can be learnt in a short time for self-help purposes. At its most basic, EFT combines stimulation of acupressure points with affirmations.

When I first trained, I was employed as a drug worker then as a drug-treatment manager at HM Prison Styal. I began to gain confidence in the effectiveness of the technique, having witnessed some startling results with anxiety and anger management, pain relief, and reduction in cravings for a variety of substances. So I gradually started to teach it to prisoners and some staff.

One of the ‘listeners’ who came to my introductory workshop – listeners are prisoners trained by Samaritans who “listen” to other prisoners in distress – soon told me that the two women whom she had taught the basic EFT procedure have since stopped self-harming.

Another prisoner noted how much the technique helped to relieve intense negative emotions from the break-up of her relationship.

I saw many prisoners use EFT for relief from anger, anxiety, pains and aches associated with substance withdrawal. When I gained more experience, I was able to help the women gain relief from some of their difficult past memories.

It appears that the effects of EFT are comparable to those of EMDR, Eye Movement and Desensitisation Reprocessing, another unusual therapeutic approach, recently recommended by the National Institute for Clinical Excellence for post-traumatic stress disorder.

Why  try another technique?

There is extensive anecdotal evidence for EFT giving relief from a wide variety of physical and emotional conditions.

Numerous case studies where EFT is claimed to have been used successfully include: addictive cravings, anxiety, back pain, depression, obsessive-compulsive disorder, phobias and PTSD. Beginnings of scientific research show promising results with EFT and related ‘meridian therapies’ (Johnson et al 2001, Feinstein 2005 , Sutherland 2000, Wells 2003). 

“My clients have found EFT useful and helpful, and left with a tool they can rely on to lower their emotional arousal, and face fears,” notes NHS counsellor Peter Woods.

 “EFT is accessible, safe, enjoyable and easy to learn, regardless of the issue being worked with or the age or cultural/educational background of the client,” adds Phil Reed, who works with adolescents at risk of exclusion in inner city schools in London. “EFT is inclusive, in that it is a neutral tool, which respects and acts as a powerful catalyst for other effective self-development strategies, attitudes and belief systems.”

Nikki, who has worked as an occupational therapist in mental-health services for over 10 years, states that “I have found EFT to be far more effective and to provide results far quicker than any other form of therapy I have used or seen used in mental health”.

Many practitioners have also found EFT invaluable as a self-care and stress management tool. “I’ve used EFT successfully with my own physical symptoms – notably dizziness, aches and pains, cramp in my foot, and tiredness,” explains Veronica Williams, a complementary practitioner and teacher. “It helped me through a very difficult time at work. I was amazed how my mood could shift from negative back to positive so quickly.”

Many workers appreciate the ease and accessibility of EFT, with even beginners often reporting good results in managing anxiety, everyday upsets, physical aches, tensions, and cravings for a wide range of substances.

PSYCHOLOGICAL APPROACHES

In addition to the routine of tapping acupressure points, EFT uses some conventional psychological approaches, such as identifying and acknowledging the problem or issues, developing self-acceptance and self-esteem and reframing negative thinking patterns. Experienced practitioners often use humour and ‘paradoxical’ interventions akin to Frank Farelly’s Provocative Therapy.

Identification of triggers for substance use and high-risk situations allows us to apply EFT to specific circumstances relevant to the particular client, and to reduce the intensity and likelihood of automatic reaction to these stimuli. Behavioural experiments are an important part of testing the results, with the client trying new behaviours previously too frightening or difficult for them to attempt – such as saying “no” when under pressure, visiting an area linked to a traumatic past experience, taking a test or visiting a dentist.

EFT practitioners need skills for helping the client to identify difficult emotions and other triggers. They use the 1-10 Sud – Subjective Unit of Distress – scale to evaluate the intensity of the negative emotion, thought or physical sensation. As with other therapeutic interventions, reflective listening, Socratic questioning, motivational and and rapport-building skills are all important for an EFT therapist, to achieve robust treatment outcomes with clients.

How does it work?

There is no clear scientific explanation of how the EFT procedure works. Sceptics  acknowledge that EFT appears to be effective, but point out that as the procedure involves some psychological techniques akin to cognitive behavioural therapy (for example, reframing the problem), it might be that those approaches produce the results.  But in a recent survey of about 60 professional and lay users of EFT, experienced CBT therapists who introduced ‘tapping’ into their work stated that the addition of EFT significantly enhanced the effectiveness of their therapeutic interventions.

John Bullough, who has extensive experience of work with addictions, notes: “My clinical practice as a counsellor/psychotherapist has historically been based on integration of approaches such as cognitive behavioural therapy, rational emotive behavioural therapy, person centred counselling, NLP and hypnotherapy. But I noticed significantly improved success rates since integrating EFT into the mix in 2005”.

Provisional results of the survey show that at least two thirds of the practitioners experienced in both CBT and EFT found the latter more effective of the two, or at least as effective as CBT (Bennett 2008). Similarly, most person-centred counsellors and hypnotherapists taking part in the survey rated EFT as more effective than their second therapeutic approach. 

The common explanation of how EFT works, adopted by many holistic practitioners, relies on the belief in our body’s ‘energy system’ originating in traditional chinese medicine. It is thought that the energy – known across various cultures as chi, prana, life force, etc – runs through meridians or channels through our body. When we are not well, cannot cope with everyday problems, over-react to situations or self-sabotage, it is said that the energy is out of balance in our body. EFT is said to restore the balance in the meridian system in relation to a specific problem or issue.

Argentinean Dr Andrade conducted EFT trials with thousands of anxiety patients. He proposed a neurological explanation of how EFT and related techniques could work.

The tapping, or other types of pressure, on acupressure points stimulates mechanoreceptors in our skin. These points have been shown to have a high concentration of mechanoreceptors and free nerve endings. The signal generated when tapping eventually reaches specific locations in the brain, such as the amygdala, hippocampus, and other structures where the emotional problem is thought to “reside”, and the signal seemingly disrupts established patterns.

Enhanced secretion of serotonin, one of the ‘feel-good’ hormones, also correlates with tapping specific points, a well researched aspect of acupuncture (Feinstein 2005).

Russian psychotherapist Oksana Korsunova suggests another explanation of the efficacy of EFT. She proposes that tapping on the points combined with the mental focus on the issue helps to balance the activity of sympathetic and parasympathetic nervous systems, with the former involved with the ‘fight or flight’ response, and the latter linked with rest, calm and relaxation.

Self-help

One of the most valuable features of EFT is that, after just a brief introduction, clients can use the technique on their own for relief from cravings, anxiety, pains, aches and other withdrawal symptoms. In my experience, people recovering from substance addiction, chronic anxiety and other conditions, who learn EFT for self-help, often become so enthusiastic about it that they eagerly teach the technique to friends and family.

As it is proactive, EFT might be especially useful for ‘activist’ clients, or those suffering with ADHD who find it difficult to be still long enough to practise conventional relaxation methods. EFT is often used in self-help groups and can be easily combined with both 12-step and CBT-based therapeutic group work.

EFT can be an empowering tool for people who used to feel helpless and powerless to deal with their issues, as they now have a technique literally at their fingertips  to help relieve some symptoms. “I teach EFT to every client,” enthuses psychotherapist and hypnotherapist Helen Ryle. “Most enjoy using it very much... It is also useful to give to clients as homework; they feel they are contributing to their own therapy rather than having it done to them.” 

Masha Bennett was a drug worker and prison drug treatment manager and now manages the Well Being Centre in Stockport. She is trained in neurolinguistic psychotherapy, is an advanced practitioner and international trainer in Emotional Freedom Techniques, and has developed the skills- based training for drug & alcohol professionals, EFT for Addictions. Bennett also runs a therapy and training practice – see www.practicalhappiness.co.uk.

MEET MASHA AT UKESAD

Bennett will share her techniques on a very practical level with delegates at the UK/European Symposium on Addictive Disorders in London, 14-16 May 2009. Don’t miss the opportunity to take away some new skills – details at www.ukesad.org

REFERENCES

1. Bennett, M. (2008) Use of EFT Survey, in preparation for publication.

2. Bennett M, 2007: Emotional Freedom Technique (EFT) in Aslan M & Smith M: The Thrive approach to mental wellness. Clifford Press / crazy diamond, pp43-44.

3. Craig G. The EFT Manual.

4. Feinstein D, 2005: An overview of research in energy psychology. 

5. Johnson C, Shala M, Sejdijaj X, Odell R & Dabishevci K, 2001: Thought Field Therapy – soothing the bad moments of Kosovo. in Journal of Clinical Psychology, 57, 1237-1240.

6. NPS, 2008. EFT and Anxiety. Anxious Times in the Quarterly Magazine of the National Phobics Society, Issue 67, pp6-7.

7. Peters, Prof D (editor-in-chief) 2005: New Medicine. Dorling Kindersley, 428-431.

8. Sutherland C, 2000: Neuro-Somatic treatment for depression: A preliminary report on a group treatment program. Lifeworks Group Pty, Research Division.

9. Wells S, Polglase K, Andrews HB, Carrington P & Baker AH, 2003:  Evaluation of a Meridian Based Intervention, Emotional Freedom Techniques (EFT), for Reducing Specific Phobias of Small Animals in Journal of Clinical Psychology, vol 59(9), 943-966.

EAAT 2009

The 5^th European Association of Addiction Therapy Conference

5-7 October 2009

Cankarjev Dom Cultural and Congress Centre,
Ljubljana, Slovenia

Chairman:  Dr Andrej Kastelic

·         The EAAT Conference has been developed to create a series of dynamic conferences with a broad spectrum of non-substance dependant and substance-dependant subject material.

·         EAAT provides a focus for understanding the scientific medical and social bases of addiction and a discussion forum to further develop relevant therapies throughout

Europe

. EAAT also provides a central platform through which information can be disseminated across country and cultural boundaries.

·         The EAAT will approach the problem of addiction from many different angles, and foster the evaluation and development of research strategies and treatment programmes.

·         EAAT aims to improve our understanding of prevention and treatment of addictive behaviours, with much emphasis on psychopharmacological treatment.

·         Over the three days the audience will hear from international contributors on key topics in addiction including Alcohol, Smoking, Cocaine, Non-Substance Related Addiction, Health Professionals & Addiction, Pain Management and Addiction and Drug Testing.

·         The poster exhibition regularly attracts more than 40 authors and provides them with the opportunity to present their research to an international audience.

·         Social activities including a drinks reception and Speakers' Dinner giving conference delegates the opportunity to meet and discuss issues with key individuals in the field.

 

FREE AT LAST: MOMENTS OF CLARITY

As a member of the Kennedy clan, Christopher Kennedy Lawford had it all – including a full-blown addiction to alcohol and drugs. Here he talks about how he finally managed to stop, and stay stopped for the past 23 years.

 

 

This article was published in Addiction Today, March/April 2009.
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Don't miss the opportunity to attend the London presentation by Christopher Kennedy Lawford by registering here.

“I looked out my window onto Boston’s Commonwealth Avenue, described by Winston Churchill as one of the most beautiful avenues in the whole world, and all I could see was desolation and despair.”

Christopher Kennedy Lawford – nephew of John, Robert and Edward Kennedy and thus as close as it comes to american royalty – is recalling in painful detail the exact moment when his years of drinking and drugging finally became just too much for him to bear.

“It was 17 February 1986. I’d known I had a problem since I was 21, and I’d been trying for nine years to get sober and never been able to manage it. Nothing worked for me. I’d just been bouncing along the bottom for all those years, until that day in Boston.”

More than 20 years on, Lawford still finds it hard to explain exactly what happened to him on that fateful day in 1986.

“At first, the only answer that I felt would heal the pain in my gut was to put a gun in my mouth. But I didn’t have a gun, so instead I simply surrendered, and on such a profound level too. I can’t really explain it, and I believe that when you can’t explain something then there has to be some other force at work there. Call it spiritual, call it God, all I know is that something came into me that day and changed me so much that I was able to get sober, and then stay sober for what’s now more than 23 years. Which truly is a miracle.”

Now 53 years old, Christopher Kennedy Lawford was born into a remarkable family, one whose very name still conjures up memories of both a magical and tragic time in american history. As the son of legendary Rat Pack actor Peter Lawford and JFK’s sister Patricia, it presumably was a rather strange childhood?

“For me, it didn’t actually seem that strange,” he says, talking to me from Los Angeles where he was promoting his book, Moments Of Clarity, which hit the New York Times bestseller the same month it was launched.

“I guess you always adjust to whatever situation you find yourself in, so I never really thought about my circumstances being that unique.

“I mean, I understood that lots of people seemed to be paying lots of attention to certain members of my family, and that always filled me with pride. I had a great deal of respect for my uncles (the late John and Robert and the now very ill Senator Ted Kennedy) and the work they did and the courage they showed, and I was also very engaged by my own father’s life. He always seemed very exciting and charismatic to me when I was growing up. So it’s fair to say that I always appreciated what I was born into.”

Unfortunately, along with the courage and the high-profile, the young Christopher also inherited the addictive gene from his parents, both of whom had their own well-documented battles with drink and drugs.

Photo: Christopher Kennedy Lawford with Anthony Hopkins on the set of The Fastest Indian.

FAMILY INHERITANCE

“I had the genetics,” he sighs. “So when I first picked up drink and drugs at 12 years old, I never really looked back. And at first it answered a lot of questions for me, as it does for a lot of people. Then, of course, by the time it stops answering those questions it’s all a bit too late.

“But you have to remember that this was also a very different time in America, a totally different ethos. This was the era of sex and drugs and rock and roll and when cocaine wasn’t even meant to be addictive! All very different to America today.”

Does he also think that he was perhaps running away from your childhood?

“I think all addicts are running away from something. We just use different-coloured sneakers and I was the Imelda Marcos of sneakers! Every colour in the closet! I would literally take anything back then that would get me out of the moment. So when I first discovered drink and drugs, they took me out of my life – which is exactly what I wanted them to do.

“You have to remember that, by my teens, I had witnessed two of my uncles being assassinated and my parents get divorced. So I was this traumatised kid who just didn’t want to be here. And drink and drugs were therefore the perfect solution.”

LIFE-CHANGING MOMENTS

So began almost 20 years of using alcohol and narcotics before the big clean-up, a period relived in full colour in Lawford’s first book, the bestselling Symptoms Of  Withdrawal. It was while promoting this book that he stumbled across the idea for its current follow-up, the equally compelling Moments Of Clarity.

“After the first book, I had no real interest in doing another one about recovery. Then while I was touring the country talking about the first book, it just amazed me that there seemed such a need out there for a message of hope and transformation. And on such a scale, too. I learned that it is estimated that, in the US, about 26million people suffer from some sort of substance-abuse disorder. That’s one in 10 of the population.

“So expand that out to the families and loved ones and friends affected by it, and you’ve probably got four or five times that original figure. That’s an awful lot of people and an awful lot of suffering.

“And as I went around the country these people kept asking me what had happened to me on 17 February 17 1986, and they seemed desperate to know if what had happened to me could happen to them or to the people they loved. So I started to think that a book about those moments that had allowed people to move from addiction to recovery would be a useful thing to do.”

Hence his publishing the stories of 45 people who have made just such a journey, ranging from Hollywood A-list stars to total unknowns. “A moment of clarity is what Carl Jung called a psychic change or what Bill Wilson, the founder of Alcoholics Anonymous, called a change of heart or a spiritual epiphany – basically a moment that allows someone to change the spiritual trajectory of his or her life.

“Some of the people who talk about their moments in the book are famous, like Martin Sheen or Alec Baldwin or Jamie Lee Curtis, and some of them are regular folk. Because these moments of clarity happen to all human beings, famous and non-famous – and, in fact, addicts and non-addicts alike. It’s just that we addicts have to pay close attention to them, because our very lives depend on them.”

MAINTAINING RECOVERY

So do these life-changing moments always have to be followed thereafter by a lifetime’s adherence to a traditional 12-step regime?

“None of the people in Moments Of Clarity say whether or not they are in a 12-step group because, as you know, all of these groups are by their very nature anonymous. So even if I did happen to be a member of one of those groups, I would not talk about it.

“What I will say about the 12-step movement – without, you understand, claiming any association with it – is that I agree with the head of the American Psychiatrists’ society who said back in the 1950s that it was the most significant social invention since Christ. I am a huge supporter of the 12-step movement and the various fellowships, but I also believe that you can get sober in lots of different ways. Whatever is working for you is what you ought to be doing.”

ADDICTION IS AN ILLNESS

And is all this drinking and all this drugging a moral issue or really a genuine illness?

“It is an illness. We now know from scientific tests that the alcoholic and addictive brain is different from others, backing up the anecdotal evidence from many years before that. There are, basically, about 10% of people in the world who simply cannot leave half a glass of wine on the table and they are fundamentally, physiologically, different from those who can.

“Any idea that the alcoholic or addict is just weak-willed is simply not true.

“The problem is that the only way someone can really understand that is for them to walk in the shoes of the addict. Otherwise, there is no way someone can understand what is unleashed within me when I put any drugs or alcohol inside my system.”

Finally, nearly a quarter of a century on from his last drink, does Christopher Kennedy Lawford never ever dream about the next one?

“People often say to me that it must be so hard to have stayed sober for so long, and the amazing thing is that it hasn’t been hard at all. That is the real miracle of the whole story for me.

“Before I had that moment of clarity in 1986, I used to have to lock myself in my own house for weeks on end so as not to drink or use drugs. Locked up in my own house! And now it just simply isn’t an issue for me.

“Sure, there are occasions, sometimes on a daily basis, when I think I would quite like a vacation from my life. And drink and drugs gave me that for a very long time. So now that I no longer do that, I have to find other things for relief, things like exercise and meditation.

“But no, I am under no illusions whatsoever about what would happen if I had that drink or that drug ever again.”

HEALING HEPATITIS C

Lawford’s story is all the more remarkable in that he has successfully recovered from hepatitis C, and has written a book, with Dr Diana Sylvestre, to raise awareness and give hope to others. It will be launched in May, the same month as the 6th UK/European Symposium on Addictive Disorders in London where he is a keynote speaker.

“Even though about 200million people worldwide are affected by hepatitis C, it is still hard to get straightforward answers. We hope to change that here,” he says.

DON’T  MISS THE OPPORTUNITY TO CATCH UP WITH CKL IN PERSON

The actor, advocate and author is a keynote speaker at this year’s UK/European Symposium on Addictive Disorders held in London from 14-16 May 2009. Booking forms are available online at www.ukesad.org or by calling Melissa Gordon and Suzanne Gooch on 020-7233 5333.

Christopher Kennedy Lawford holds a Bachelor of Arts from Tufts University, a Juris Doctor from Boston College Law School and a Masters Certification in Clinical Psychology from Harvard Medical School. He has worked extensively in Hollywood as an actor, lawyer, executive, and producer, and his book, Symptoms of Withdrawal, was a New York Times bestseller. His latest book, Moments of Clarity, was released in January 2009. His book on Healing Hepatitis C will be launched in May, the week of UKESAD 2009.

Lawford is a public advocacy consultant with Caron Treatment Centers. In his role, he raises awareness about addiction and long-term recovery by sharing his experience, strength and hope with clinicians, educators, families and professionals. He lives in California.

He was talking in this interview to fellow recovering writer BARRY McILHENEY, an award-winning journalist and recovering addict. He has edited magazines in the UK and around the world, and is currently writing a book about his experiences.

US BANKERS SEEK TREATMENT

Reuters reports that people in finance are seeking treatment for addiction as the global economic crisis sinks its teeth into a high-stakes industry where confidence is the name of the game and nobody wants to admit to a weakness. This phenomenon occurred in the UK during the 1980s financial crisis.

"We see more people coming in naming either a job loss or huge financial reversals or big investments with Bernie Madoff. They're being admitted with depression or increases in substance abuse, or both," said Sigurd Ackerman, medical director at Silver Hill Hospital rehabilitation facility in New Canaan. There is a high concentration of financial professionals in the town, 40 miles from New York.

"You're supposed to be on top of everything," said one financial services executive who began alcohol rehab in August.

Robert Curry, founder of Turning Point for Leaders, said the financial crisis was a factor in more drink and drug use. "We've got more than 50 homes in foreclosure in this town and that's unheard of.  Domestic violence incidents have spiked, and that is closely tied to substance abuse." Curry is a former financial executive who started working with substance abusers two decades ago.

Despite the recession, demand is growing. Clients include bankers, businessmen and doctors and are overwhelmingly male.

ADRENALIN JUNKIES

Harris Stratyner, a psychologist with Caron Treatment Centers, a leading non-profit addiction treatment foundation with offices in Manhattan, said stars of the financial world were by nature more prone to risky and extreme behaviour.

"There's an adrenalin rush that's connected to economics," he said. "Why are so many people attracted to that world? Many already are adrenalin junkies, and are looking for the high highs and the low lows."

Stratyner said economic anxiety can push people over the edge, but also allows addicts to rationalise their behaviour, blaming stress or claiming they can't afford treatment.

Joseph Califano, former US secretary of health who founded the National Center on Addiction and Substance Abuse in 1992, said anxiety clearly raised the risk of substance abuse in all socio-economic groups. "There's still tremendous stigma and shame – but this is not a moral failing, it's a disease."

"The cost is more than I'd like," said one businessman in rehab. “But it's less expensive than losing your job ... less expensive than losing a client or losing your family, or losing your home or getting in trouble with the law."

 

BRITISH TEENAGERS ARE BINGE-DRINKING 'CHAMPIONS' OF EUROPE

A European survey of 35 countries reveals 'chronic' drinking problems in 15-16 year-olds, which leads to rifts with parents, unplanned pregnancies and injuries. British teenagers are among the worst binge drinkers in Europe, with girls more likely to get drunk than boys.

The survey found more than half of UK teenagers were binge-drinking in the past month, defined as five or more drinks on any occasion

One in three admitted getting drunk in the past month, the third-highest rate after Denmark and the Isle of Man. Only in Iceland, Norway and Sweden are girls more likely to binge drink .

Binge drinking was first highlighted as more prevalent in girls during research carried out in 2003. "The UK retains its unenviable position in relation to binge-drinking, intoxication and alcohol-related problems among teenagers," confirmed head researcher Professor Martin Plant, from the University of the West of England.

"I hope that the government will prioritise policies that are effective to reduce heavy drinking and alcohol-related disorder and health problems amongst young people... Many people whose alcohol consumption is generally moderate also experience some adverse effects from their drinking."

The survey, which included 1,004 boys and 1,175 girls from the UK, found 18% of teenagers said their drinking had caused problems with their parents, compared with just 3% where drugs were involved.

More teenagers in the UK than almost anywhere else expected "positive consequences" from drinking. Instead, drinking caused one in four to have an accident, while 11% said they "regretted sex" while drunk and 11% cent had unprotected sex.

Shadow health secretary Andrew Lansley said: "Labour are neglecting a forgotten generation of teenagers. The government needs to take action now, before it's too late".

BINGE DRINKING AND MISCARRIAGES

Binge drinking by pregnant women led to 4% more miscarriages in England last year: 9,086, compared with 8,763 in 2004.

Health Minister Dawn Primarolo said: "Women who are pregnant or trying to conceive should steer clear of alcohol. 'These figures show the damaging effect too much alcohol can have on an unborn child".

MISUSE & ADDICTIONS MONTH

WHERE TO FIND HELP

Treatment agency 'open days' May 2009

Join in a series of 'open days' or half days throughout May, when addiction-treatment providers, referrers and commissioeinrs can visit each other and learn from service users. They will welcome the general public, raising awareness of the services available across the UK for people needing help to recover from alcohol, drug and other addictions/depencencies.

Let the world know about your work, chat with your Daat, and meet organisations with which you work or wish to forge partnerships.

Participate in Misuse & Addictions Week: where to get help in May 2009. You can simply reschedule a planned open day to this week, or create a focused event to help meet your strategic/business plan and targets.

This is the second year of this new initiative from the substance-misuse treatment field, which was supported from the start by the Home Office.

Organised via the multi-approach Unity group of treatment agencies (cofounded by the Addiction Recovery Foundation), it alsos also working for support from the National Treatment Agency, as some of the most successful events last year were those involving Drug/Alcohol Action Teams.

UNITED NATIONS INTERNATIONAL DAY AGAINST DRUG ABUSE.

The UN Office on Drugs & Crime launches campaigns to raise awareness of drugs and crime problems – and on 26 June every year, it marks the International Day against Drug Abuse and Illicit Trafficking.  Misuse & Addictions Month: where to get help raises awareness of this ensuing event.   

To use UNODC materials to start a discussion on drugs, how children can stand up to peer pressure and more  - simply click here.

LOCAL AND NATIONAL PUBLICITY.

To gain immediate publicity, all you need do is give brief details on this linked page. Within 24 hours, you will be featured on the website. You can add more details later.

When you register your event, you will also receive by email the contact details of media in your local area. In an excel format, this will save your organisation days of labour, and can be used to garner publicity for your service.

UNITY MEMBERS AND PARTICIPANTS.

Over 40 organisations participated in Misuse & Addictions Week 2007 and 2008, and their early commitment and enthusiasm are to be lauded. These include the following.

Action on Addiction, London and Wiltshire

Addaction-Thrift House, East Sussex

The Addiction Recovery Foundation, London

Adfam, London

ANA Portsmouth, with its local Dat, the Safer Portsmouth Partnership and First Step family and carers group

ARA-Addiction Recovery Agency, Bristol

Avon & Wiltshire Partnership

Bedfordshire Drug Action Team

Bristol Drugs Project

Bristol Specialist Drug & Alcohol Service

Broadway Lodge, Somerset

CAAD Project, Bristol

Doncaster Drug Strategy Unit

Drug & Alcohol Service Haringey (NHS)

EATA

Ellesmere Port Drug & Alcohol Service

Haringey Drug/Alcohol Action Team

Haga-Haringey Advisory Group on Alcohol

Intuition Foundation, Bromley, Kent

Lampton Court, Devon

Lynwode Manor and Linwood Group

Minor Tranquilliser Project, Camden

MKDAT, Milton Keynes

Nelson Trust, Gloucestershire

New Beginnings, Doncaster

Norcas, Suffolk

Open Road Visions, Essex

Phoenix Futures: Brighton Family Service, and the residential services in Wirral, Hampshire, Sheffield and London

St James Priory Project, Bristol

Rehabilitation for Addicted Prisoners trust – Island day programme, Tower Hamlets

The Recovery Network.

TTP Counselling, Luton

VIA Group, Somerset

Western Counselling, Weston-super-Mare.

7-8 May 2009

WORKING WITH DRUG & ALCOHOL USERS IN PRIMARY CARE:

14th National Conference

Family Medicine: from cradle to grave

7&8 May 2009, ACC, Liverpool

 

Don’t miss the opportunity to promote your products and services to 600 GP’s Shared Care Works, Nurses and other Primary Care Staff, Specialists and researchers at the 14^th National Conference: Working with Drug & Alcohol Users in Primary Care

 

To view the full delegate list please click on the following link: exhibition information flyer (the list is on page 4 onwards). 

UNITY GROUP: WORKING TOGETHER

MISUSE & ADDICTIONS WEEK: WHERE TO FIND HELP

PREVIOUS PARTICIPANTS - 2008

Addiction Recovery Foundation

Addiction Today journal staff will be partnering with The Recovery Network to hold a London-based event during the Misuse & Addictions Awareness Week.

*******

The Recovery Network

The Recovery Network will be partnering with the Addiction Recovery Foundation and Addiction Today to promote this event to the  media, and help those who need treatment for alcohol and drug addiction/dependency to learn where they can find help.

*******

Abbey Gisburne - the Dependency Centre

Abbey Gisburne Park Hospital
Bisburne BB7 4HX

Tel:          01200-415467      

Event to be decided. Contact Susan Giles.

*******

Action on Addiction

1 Regent Terrace
Rita Road
London SW8 1AW

Action on Addiction is delighted to support Addiction & Treatment Week and encourages more organisations to join up.

*******

Addaction

Maya Project
Peckam Hill Street
London SW15

Tel: 020-7635 54930

Professional Open Morning on Thursday 26 June 2008, 11am - 1pm.
Opportunity to gain awareness of the work of the project, meet staff team, tour of project and meet current and ex-residents sharing their experiences of this programme. Refreshments provided.

*******

Adfam

Adfam will be holding an open event at one of its prison support services - highlighting existing work with families and the benefits of carer involvement.

*******

Addictions Services Northumberland

On June 27th Addictions Services Northumberland plans to open their harm reduction service/needle exchange and 2 other offices in Blyth and Ashington where they provide an integrated package of care for Class A users. Although this will be an opportunity to strengthen links with agencies working in the same area, we seek to establish positive links with the business sector and the local strategic partnership.

Contact me: Jerry Hayes, development worker for Northumberland DAAT. jhayes@blythvalley.gov.uk 

*******

ANA Treatment Centres Open Day

Date: to be confirmed, between 23-30 June 2008,  10.30 - 14.30

Title:  "Treatment In The Real World"

Background:   Last year, ANA, in partnership with Havant Housing Association and others, held an Open Day, as above.  ANA showcased new facilities and programme enhancements and our successful partnership with Havant Housing Association.

The event comprises inputs from clients past and present, staff and our local Drug Action Team, The Safer Portsmouth Partnership and members of our Family and Carers Group, First Step.  A page on our web site will also be dedicated to the event, in support of the Home Office / Unity Misuse & Addictions week. 

ANA has a diverse staff team and a diverse client base with people from many different backgrounds and walks of life.  The lunch time will reflect this with diverse foods from around the world, celebrating difference and community.

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ARA (Addiction Recovery Agency)

… is a residential 2nd-stage abstinence-based programme featuring mixed-gender treatment and single-gender accommodation, group therapy, 1:1 counselling, workshops, life skills, attendance at 12-step meetings, and learning & development work.

3rd-stage move-on accommodation is also available, with extensive relapse-prevention, aftercare and resettlement support.

info@addictionrecovery.org.uk This email address is being protected from spam bots, you need Javascript enabled to view it or tel          0117-930 0282       .

We plan to again partner Broadway Lodge during Misuse & Addictions Week – details under Broadway Lodge below.

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The Awareness Centre

41 Abbeville Road
Clapham
London SW4 9JX

Tel:          020-8673 4545      

On Wednesday 25 June from 2pm, we will be holding a half-day Open Day on our premises. Our day will include information about our programme structure and the treatment we offer from the counsellors on our addiction-recovery programme. We are inviting previous clients who have attended our programme to offer you their first-hand experience of our treatment services.

There will be light refreshments and the opportunity to view our premises in the afternoon. For more information on the location of our centre and the addiction-recovery programme, click on our website. Please RSVP via email to recovery@theawarenesscentre.com

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AWP – Avon and Wiltshire Partnership

… is one of the largest mental-health trusts in the country, servicing people both within its area and further afield. We have eight directorates and our services are managed in five strategic business units or care groups, supported by a research and development unit, to help develop best practice and expertise. Every year, our 4,200 staff care for about 23,000 service users. We work in people’s homes, GP surgeries, community mental-health units and other community settings as well as hospital and community-based inpatient units. Most of our £160million annual funding comes from Primary Care Trusts, responsible for commissioning local health services and funded by the Department of Health.

We hope to again partner Broadway Lodge during Misuse & Addictions Week – details under Broadway Lodge below.

*******

THE DEADLY COST OF NOT RAISING DRINK PRICES

It's clear: if alcohol is more expensive, lives are saved and crime falls. So why the resistance? Magnus Linklater investigates a sobering issue in The Times.

Can you be “lukewarm” about a proposal that would save lives and cut crime? Can you indulge in a philosophical discussion about governments and how far they should interfere with our lives, when people are dying of diseases that could be prevented?

Gordon Brown says that he is “lukewarm” on proposals to introduce a minimum pricing strategy to curb alcohol, but he knows, because Sir Liam Donaldson, his chief medical officer, has told him, that the statistics show overwhelmingly that putting up prices would cut the number of alcohol-related deaths - and dramatically at that.

All the research shows that there is a straight correlation between the price of alcohol and its use.

When Sheffield University carried out its definitive review last year of the effect of increasing the price per unit of alcohol on sales and consumption, it came up with a striking model and some equally striking conclusions. A minimum price of 40p per unit, it estimated, would reduce hospital admissions by 40,000; it would cut crime by 3,800 cases a year; it would save the government more than £1billion in social costs; above all, it would reduce the number of deaths by anything up to half.

If this was just some urbane discussion on The Moral Maze, we might indeed balance the philosophical with the practical. But this is now a matter of life and, increasingly, death. We cannot stand back and allow the market to dictate events, not least because the market is slewed in favour of those who disrupt society rather than those who hold it together.

I suspect that the real reason for the objections to minimum pricing comes from the drinks industry rather than from conscience. And that is a lousy reason for letting the mayhem continue.

MINISTER LOOKS AT WEANING PATIENTS OFF METHADONE

Minister John Curran wants evidence on whether patients manage to stave off addiction, reports Stephen O’Brien in The Times newspaper.

In Ireland, drug detox programmes for heroin addicts are to be overhauled in an attempt to reduce the death toll among former drug users and bring down the numbers who stay on methadone for years.

John Curran, Ireland’s minister for drugs strategy and community affairs, has asked the Health Service Executive and the National Advisory Committee on Drugs to review all methadone-maintenance programmes and report on how effectively they wean patients off the heroin substitute.

Of the 400 drug-related deaths each year, up to 60 occur among the 8,600 registered methadone users, prompting fears that they are not being steered off the laboratory drug and that many are combining it with illegal substances.

“I have a grave concern that people seem to be on methadone for an extended period of time,” said Curran. “I would like to see the hard evidence to show progression. I want to see an active methadone-reduction programme.”

GOOD vs BAD PRACTICE IN METHADONE MANAGEMENT

Curran said the HSE is developing an “overdose prevention strategy” to address the risk to methadone clients. Since becoming minister, he has met many former addicts who were on methadone maintenance for years.

While methadone helps heroin addicts stabilise their chaotic lifestyles, Curran believes this period of stabilisation must eventually be used to reduce the dosage to help former addicts progress to a drugs-free lifestyle.

Methadone, also known as physeptone, helps block withdrawal symptoms for someone coming off opiates. Properly supervised and managed methadone patients can reduce or stop their use of substances such as heroin.

Jack Wall, the Labour drugs spokesman, has challenged Curran about the death toll among those registered on state-run methadone programmes. Wall said he was concerned that some patients were getting supplies of the drug from a number of sources.

“If that is the case, instead of curing themselves, addicts are creating more problems for themselves and can become addicted to using methadone,” he said.

DRUG DEATHS

Curran confirmed that, out of 400 drug-related deaths in 2005, 60 people died while on methadone maintenance and the use of drugs with alcohol and other substances was a factor in many of the deaths.

The national drugs-related death index published by the Health Research Board last year showed 2,442 young people had died as a result of problem drug use between 1998 and 2005. Causes of death included overdoses, illnesses linked to hepatitis C and HIV infection, and trips and falls linked to incapacitation from drug use.

“When a person enters drug treatment they should have a realistic prospective of becoming drug-free,” said Curran. “We need to be much more proactive in exploring ways towards helping people to exit successfully from opiate substitution treatment, and this is something that I intend to pursue.”

He said drug users’ relatives also needed help in accepting and coping with the problem that had arisen within their family, and support to help their relative re-engage with society.

The minister said the national drugs strategy for 2009-2016, now nearing completion, would set demanding but achievable targets to tackle the problem of substance abuse in Ireland.

In Vienna last week, Curran signed a new UN political declaration on drugs that commits Ireland to closer co-operation in the international battle against the illicit drugs trade.

FAMILIES TORN APART BY TEENAGE CANNABIS USE

 

It is the end of a taboo: articulate, middle-class parents are speaking out about the nightmare of seeing their children spiral into drug abuse and, all too often, mental illness.

Many blame themselves for staying silent, assuming that modern strains of cannabis were little different from the pot that baby boomers smoked at college. The reality is very different, reports Tracy McVeigh in The Observer newspaper.

 

Click here to read the full story today

 

.

FACTS vs PROPAGANDA

Members of the United Nations Office on Drugs & Crime are to sign a declaration to extend a "war on drugs" – a policy that some critics argue is ineffective and contributes to the spread of HIV.
But the views expressed by these critical pro-drug lobbyists (click here for details) are a distortion of the truth, writes Peter O'Loughlin.

Notwithstanding research carried out by the National Treatment Agency for Substance Misuse -- which clearly established that most people who developed dependence wish to become drug free -- in the UK, the focus for the past 10 years has been on ‘harm reduction’, rather than seeking to engage users into abstinence-focused recovery.

That this policy is disastrous and misguided is evidenced in the escalation in drug-related deaths which are at their highest for five years, 325 of which are attributed to methadone, the flagship of current harm reduction policy, together with a devastating rise in blood-borne disease among injecting drug users.

The statistics provided by the Health Protection Agency for England and Wales are as follows:

• The level of HIV infection among injecting drug users (IDUs) in England and Wales is higher now than at the start of the decade
• In London, where the prevalence of HIV in IDUs is higher than elsewhere in England and Wales, 1 in 20 IDUs is infected
• In the remainder of England and Wales, HIV among IDUs has increased from about 1 in 400 in 2002 to about 1 in 150 in 2006
• The prevalence of Hepatitis C among IDUs has increased from 33% in 2000 to 42% in 2006
• About 1 in 5 IDUs has Hepatitis B, which extrapolates as an increase approaching 200% since 1997.

The escalating increase in blood-borne disease occurred despite the plethora of needle-exchange facilities throughout England and Wales, and the growth of supervised drug-consumption rooms.

It is unavoidably obvious from the foregoing that, here in the UK at least, it is not the lack of harm-reduction measures which contributes to avoidable deaths and the epidemic of blood-borne disease being wreaked on our society. It is the use of dangerous, illegal drugs. That is why the UNODC wishes to end their use worldwide.

It is not so-called prohibition which has failed, but the encouragement, tacit permission and even not-so-tacit encouraging of continued use, inherent in too much of the harm-reduction ideology instead of good practice, which has failed users and society so abysmally. After all, only about 2% of drug users seeking help to quit via the NTA are offered therapy-led treatment – the very same abstinence-focused treatment recommended for recovery from Hepatitis C.

The main beneficiaries of pro-drug and legalisation campaigns will be the pharmaceutical industry, and perhaps the tobacco industry which could use its production and distribution routes for cannabis. Such a move would inflict further incalculable harm on society, since it would result in an explosion of use and addiction, at least equal to that seen in the late 1800s when most of the drugs which are controlled today were, in fact, legal.

The growth of drug use during that period was the direct result of concerted efforts by leading members of the medical profession in promoting drug use. Many of these were influenced by Sigmund Freud, who was so unethical in his dealings that he accepted commissions from two competing pharmaceutical companies (both still in business today), to write papers extolling the benefits of life-destroying cocaine as the “elixir of life” and as a cure for alcohol and morphine addiction. The rest, as they say, is history.

Is it a coincidence that many of the bodies pressing for an end to what they term “prohibition” receive ‘research grants’ from the pharmaceutical industry?

WILL GOVERNMENT SET DRUG-FREE TARGETS FOR TREATMENT?

DECISION MUST BE MADE IN MARCH 2009

In January, Drug Action Teams around the country submitted draft treatment plans for 2009/10 to the government’s National Treatment Agency for Substance Misuse – NTA approval is needed before they can receive funding to treat problematic drug users. The NTA feedback was due in February – but has it set targets for addicts to become drug free in the year to come? 

Has the NTA set any targets – even, say, a low 10% – for patients with addictive disorders to even access effective residential or daycare services promoting abstinence from all their drugs?

A life-threatening low of only 2% of such patients were referred to abstinence treatment last year. This is despite the government’s drug strategy stating that “the goal of all treatment is for drug users to achieve abstinence from their drug – or drugs – of dependency” (p28, Protecting Families and Communities).

NTA senior managers told Addiction Today that they were blameless: the low referral rates were “the fault of Local Authorities and Primary Care Trusts” as “they hold the budgets, not us”. But at this moment of each year, the allocation is within the power of the NTA and its masters at the Department of Health and the Home Office.

Last year, Nick Lawrence, head of the DH’s Alcohol, Drugs & Tobacco Policy, stated that 10% of the people desperately seeking help for their drug problems should be offered rehab or another drug-free choice of treatment by the Drug Action Teams. So there is no excuse for not setting targets this month.

NTA’S ROLE IN BUDGET DECISIONS

The Drug Action Teams are due to submit final treatment plans (ie, after NTA input) for 2009/10 by 20 March.  These are then signed off by the NTA and budgets released to fund those plans. For transparency, the local area needs assessment reports should be open to scrutiny – so far, the taxpayer-funded NTA has not allowed this.

The plans are based on a DAT ‘needs assessment’ of their geographic area. But historically these assessments never stray far from NTA priorities – which are set out in NTA guidance to the DATs on how to calculate and present their needs assessment. Catch 22.

So if the NTA said that it wanted to see a re-balancing of treatment to ensure more access to recovery-based services or set a target, DATs would in the main strive to meet the target. After all, performance against targets dictates DAT funding.

NTA CEO Paul Hayes and colleagues talk about the need to improve the effectiveness of treatment – while simultaneously refusing to do the one thing which could deliver that aim.

At the stroke of a pen or tap of keyboard, the DoH and NTA could set a target which would begin a renaissance of recovery from drug problems throughout the country, stop the decline in residential treatment and fund innovative community-based treatments which lead to many more people leaving treatment drug- and alcohol-free. This accelerates our national drug policy goal, and is the ultimate in ‘harm reduction’.

It would rebalance the system currently weighted in favour of what the NTA now labels 'treatments' but were previously defined as ‘adjuncts’ or supports.  It would redress the new phenomenon of addicts no longer seeking recovery help from statutory services as they know 98% will not be given a patient choice of becoming drug free, many forced instead onto clinically-ineffective regimes.

In these difficult financial times, targets relating to becoming drug-free (and treatments making that possible) could yield a clearer statement of what value is derived from our treatment system.

SAFEGUARD CHILDREN

This would also act as a safeguarding measure to some of the millions of children living with the consequences of addiction via their parents/carers.

It might also reduce domestic abuse:  thousands of women and men either suffer or perpetrate violence because of addiction issues or become addicted as a coping mechanism to deal with the violence suffered at the hands of others.

Helping addicts to become drug free is a stated government objective, with which no responsible person would disagree. Setting a target of 10% of all new treatments journeys (a clear government National Drug Treatment Monitoring System measure) to access effective recovery/abstinence-oriented treatment will help to achieve government targets – and is the least that citizens deserve.

RECRUITMENT: SUBSTANCE MISUSE PRACTITIONER

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Rugby House-ARP provides a range of community and residential services in London for people with alcohol and drug related problems. The Organisation is underpinned by a strong learning culture and actively encourages personal and professional development of its staff.   We value difference and divergence and would like to hear from you if you have the same values as us. We are currently looking to appoint the following:

LONG YARD – CRISIS CENTRE
(based in Central London)

SUBSTANCE MISUSE PRACTITIONER

6 Months Fixed Term (with possible extension to 9 months)

Long Yard, is a unique 13-bedded scheme which provides supervised alcohol withdrawal to clients who have a dependant relationship with this substance. Our treatment package is underpinned by a socially determined philosophy. It is combination of a psycho-educational group programme, Motivational Interviewing, primary medical care and health promotion.

§  You will be imaginative, professional, committed to this client group and able to deliver the highest quality service to your residents.

§  You will have at least one-year’s experience of working in the substance misuse field in a professional capacity. You will have counselling and group work experience and an excellent understanding of the recovery process.

§  The successful applicant will have the knowledge, skills and motivation to support residents as they withdraw from alcohol and begin to make choices for their future.

§  A calm professional approach is essential.  You will be expected to work as part of a team, be self-motivated and dynamic.

§  Excellent communication skills and the ability to present the clinical information accurately to different audiences with varied backgrounds and interests are essential. (Clients, colleagues, external professionals, families etc.).

Long Yard is registered as a care home. Knowledge of the CSCI Regulations and principles of duty of care are essential.

 

NJC scale point 26 – 31 (£25,194 - £29,197) including L.W    

This is a full time post at 35 hours per week.

   

Closing date for all applications is
Wednesday, 25^th March 2009.

Further information and application packs can be downloaded from the www.rugbyhouse.org.uk or please email: jobs@rharp.org.uk

All advertised posts are subject to Criminal Records Bureau enhanced disclosure.

Rugby

House-ARP is an equal opportunities employer and welcomes application from all qualified candidates.

www.rugbyhouse.org.uk

RECRUITMENT: SENIOR SUBSTANCE MISUSE PRACTITIONER

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Herbert Street

Senior Substance Misuse Practitioner
(No overnights)

Based in North London

Herbert Street is an intimate 9 bed residential project that is managed by a trained clinical supervisor, counsellor and systemic family therapist. Leading a team of skilled practitioners you will support them to deliver a comprehensive service to clients who wish to maintain abstinence and establish an improved lifestyle in the community. You will use your experience in this field to enhance programme delivery and promote our culture of clinical excellence. Responsive in an informed and creative manner, you will be a highly motivated individual who is able to communicate effectively with clients, colleagues and stakeholders.

In addition we offer:

·         External Clinical Supervision;

·         Internal clinical and line management supervision; and

·         A Comprehensive in-house training programme that is geared towards Continued Professional Development. 

You will have:

·                A Diploma in counselling or other relevant qualification

·                Experience of one to one counselling/keyworking and group facilitation

·                Significant experience of working within the substance misuse field

·                Experience of staff supervision.

·                Demonstrative experience of service and programme development, monitoring and evaluation.

·                A firm commitment to effective team working

·                The ability to respond promptly, appropriately and confidently under pressure

_______________________________________________________________

NJC Scale Point 31 – 34 (£29,197 – 31,527) per annum

This is a full time post @ 35 hrs per week.

Closing date for all applications is
Wednesday, 25^th March 2009.

Further information and an application pack can be downloaded from www.rugbyhouse.org.uk or please email: jobs@rharp.org.uk

All advertised posts are subject to Criminal Records Bureau enhanced disclosure.

Rugby House-ARP is an equal opportunities employer and welcomes application from all qualified candidates.

www.rugbyhouse.org.uk

RECRUITMENT: OLDER PEOPLE SPECIALIST ALCOHOL PRACTITIONER

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Rugby House - ARP

Older People Specialist Alcohol Practitioner

Based in Hammersmith & Fulham

2 Year Fixed Term Contract

This is an exciting opportunity for an experienced, self motivated alcohol specialist to develop a new alcohol service for older people in Hammersmith & Fulham. Working as a part of multidisciplinary team you will deliver brief interventions using the Motivational Interviewing Techniques and support other professionals working with the older people. You will be expected to make a life saving difference in modifying the clients’ attitudes and patterns of drinking using Screening and Brief Intervention (SBI), enabling the targeted client group to make significant health gains.

You will have:

·        At least 3 year’s experience of delivering specialist alcohol interventions in a wide range of settings;

·        Experience of using accredited alcohol screening tools and undertaking brief interventions;

·        A relevant professional qualification such as social work, counselling or nursing;

·        Experience of case management and shared care models of clinical care;

·        Experience of supporting non-specialist agencies and delivering joint care plans; and

·        Experience of setting up a new service and working in a wide range of settings, including health centres and hospitals.

This is a full time post at 35 hours per week.

Salary: NJC Point 31 - 34 (£29,197- £31,527) including LW

Closing date for all applications is

 Wednesday, 25^th March 2009.

Further information and an application pack can be downloaded from www.rugbyhouse.org.uk or please email: jobs@rharp.org.uk

All advertised posts are subject to Criminal Records Bureau enhanced disclosure.

Rugby

House-ARP is an equal opportunities employer and welcomes application from all qualified candidates.

www.rugbyhouse.org.uk

USE STRUCTURED INTERVENTIONS...

... TO SPEED CLIENTS INTO CARE

Structured family and workplace interventions are a powerful catalyst for change, raising a troubled person’s ‘rock bottom’ to the here and now without the dangers of a progressively-worsening addictive life. Deirdre Boyd studied cutting-edge guidelines from Bobby Bonds and Szabi Ishtai-Zee

  This article first appeared in Addiction Today, March 2006 and is still cutting edge - we were inspired by Cassandra Jardine's article in the Daily Telegraph newspaper to reproduce it online.

Print-friendly version: Download AT99-Structured Interventions

If we cannot help someone with alcohol or drug problems until they want help, what will it take to get them to that point? This question changes most seemingly-hopeless scenarios: we do not have to wait for personal tragedy such as divorce, job loss, financial ruin, prison, cirrhosis or death – indeed, we can avoid the worst of these.

Modern intervention techniques have had four decades to be refined and expanded since they were first developed by Vernon Johnson and the staff of St Mary’s Hospital in the 1960s.

William Bennett, author and former White House drug czar, said that “Success is often a function of time in treatment. And time in treatment is often a function of coercion – being forced into treatment by a loved one, an employer or, as is often the case, the legal system”. The more we understand about the nature of addiction/dependency, the faster we can get people into treatment, and the better we can all do our jobs.

EARLY WARNING SIGNS

The following signs are not a formal diagnosis but their existence can signal the need to reduce the risk of substance-abuse problems. Have you (or the family member, employer or colleague who contacted you for help) noticed any of the following in someone close?

·         missed days at work                  

·         frequent sick days

·         traffic tickets, traffic accidents  

·         penalty points on driver’s licence

·         more family arguments                            

·         taking things out on your children

·         inefficiency ratings at work       

·         blackouts

·         using alcohol or drugs to get through the day, or to sleep.

COMMITMENT

Structured intervention requires a commitment to a great deal of work, and is not be undertaken lightly. Hours – even days – of preparation are needed with all the participants in the “intervention event”. These can include colleagues, managers, friends and family who had previously tried unsuccessfully to get the user to change. As well as this group of concerned and caring people, structured intervention requires at the minimum:

·         specific dates, times and places of the user’s behaviour, accompanied by observations, feelings and message of care

·         that anger, hurt and pain be set aside so that the concern is evident

·         a suggested treatment plan for the user; cost, availability, timeliness and other factors – right down to how household bills will be paid while in treatment – go into this researched plan which covers the entire treatment range from inpatient to outpatient to self-help groups... there is something for everyone

·         consideration of the consequences if things do not change; threats are common but specific and honest consequences must be discussed and pre-planned.

The earlier an intervention takes place, the more likely the relationships can use consequences – such as loss of job or withdrawal of financial support – as leverage. Later, it can be hard to find consequences. The main job of the interventionist is to teach and trail all the parties involved.

STRATEGIES

Each intervention is “situationally based” depending on the user’s circumstances but we can build a systems approach for our foundations. We can use our existing skills to switch from a facilitative strategy, to a re-educational strategy, persuasive strategy or power-coercive strategy as the situation dictates.

Our approach matters: using strategies of behavioural knowledge of change on identified areas of resistance causes a reversal in the user’s ability to maintain the harmful status quo. We will see a paradigm shift in relationships and the environment in which they exist. In many cases, the need for change is clear. How to go about that change needs to be understood and accepted. We can start with a force field analysis (click on the pdf above to view).

List all the forces for change in one column, and all the forces against change in another column. Assign a score to each force, from a weak 1 to a strong 5. Draw a diagram showing the forces for and against change, with the strength of each force as a number beside it.

An interventionist utilising the help of both family and employer might draw up a force-field analysis like that below. If you then had to implement the plan, the analysis would suggest the following changes:

·         by training staff (increase cost by 1) you reduce risk of recovery sabotage for this and future employees (reduce by 2)

·         it would be useful to show the mother that change is necessary for long-term gain (in favour, +2)

·         family members financially dependent on Jack need support in exploring the short- and medium-term effect of treatment.

Already we can see that changes swing the balance from an ambivalent 11:10 to a likely 13:7. And we can identify a re-educational strategy for the workforce, probably the whole set of strategies to get the mother on side.

PREPARATION, PREPARATION, PREPARATION

The cornerstone to any intervention is assessment. Collecting and analysing information about the exact nature of the situation is vital. Here, we can use the Intervention Readiness Scale, a 25-item questionnaire rating severity from 1 to 5 of such things as the current crisis, worklife, co-workers, family life and important relationships, stressors, previous attempts to change, scope of the problem and who else is affected, general knowledge about addiction/dependency, obstacles to recovery and the impact of the addiction.

The scale will help us identify people and resources who could facilitate the intervention, and to determine their role.

To gather the information for both the Intervention Readiness Scale and the force-field analysis, it is important to contact, either face to face or by telephone, everyone concerned. Involve as many family members as possible, and to learn from them who else is influential in the user’s life and could also help. If there is a particularly negative influencer, the best course of action might not be to omit them from the intervention as they could sabotage recovery later down the line, but to use a re-educational or other strategy to convert them into a positive force.

The Intervention Readiness Scale first looks at history of use: demographics, drug/alcohol history, prior treatments and the like.

The second section looks at leverage points: what losses does the addict fear which in turn could be used as motivation to seek help. What positive factors or people exist in the addict’s life? Ask open, leading questions as an interview and rate from O for not applicable to 1 for mild/unlikely, 2 for little, 3 for moderate, 4 for often and 5 for severe/often. Then ask the following...

1  What is the pending crisis which brought this situation to a head? How severe is it? Does it concern legal, family, work, health, financial or other factors? How often has this crisis occurred in the past? How was it dealt with?

2   What is going on at work? What is the potential motivation for an intervention?

3   Have there been any past negative job consequences due to addiction? How many actions have taken place?

4   Is there any formal or informal threat/job jeopardy? Is the user concerned about losing his/her job?

5  What is the user’s relationship with co-workers?

6   Are those co-workers a positive or negative force?

7    What resources exist at the job? What quality are they and how accessible? Is the client willing to use them?

8   How long has the person been working in their current position?

9   How stimulating/important is the job to their life?

10  What is going on with the family? Who are the important relationships? What is important about the relationship? List these in priority. How many important relationships are there?

11  What strains have been placed on the important relationships? List.

12  What past attempts have been made to correct the strains on the relationships? How many attempts?

13  Who and what are the more difficult or negative relationships in the addict’s life? What makes them difficult?

14  What is the difference between the two (difficult vs important) relationships?

15  What previous attempts have been made to change the difficult relationships, by either party? How many?

16  What is going on with the family? What are the family members doing to help perpetuate the problem or to positively manage the situation? Who are the principal caregivers in the addict’s life?

17  When is the caregiving successful?

18  What is it not successful?

19  Describe how you (the person being interviewed) control the problem.

20  Describe how you try to manage the situation.

21  Describe how you contribute to the way the situation is now.

22  Scope of the problem: who and what are affected besides the addict? Identify all the principal players and situations adversely affecting any positive progression of change in the addict’s world. What do they know about addiction (personal philosophy)?

23  What obstacles besides the addict’s behaviours/use of drugs or alcohol prevent the situation from changing?

24  What personal impact does the dependency have on the interviewee’s life (loss of sleep, worry for the addict or self, monetary, fear)? List these.

25  What changes have been made to alleviate the suffering caused by the addicted person’s behaviour?

The scores are totalled under two headings: motivational factors and influence factors. Priorities are then ascertained, so you can decide where to focus your efforts. The development of the intervention strategy begins with the interventionist’s interpretation of the principal leverage and dynamics found in this scale. Often, the family/institution will not recognise their repetitive reaction to similar situations: enablers tend to overlook, rationalise and justify behaviours which trigger automatic, counterproductive responses. These often inhibit change and the development of healthy relationships. Discovering these triggers becomes an important factor in facilitating the plan.

AND MORE PREPARATION...

As well as individual meetings, the interventionist should facilitate at least one group meeting of all potential participants. If some people cannot attend, invite them to write a letter to the addict which can be read aloud. As a general rule, do not lie to the addict about a facilitation taking place – but the decision about whether to reveal this must be made on a case-by-case basis.

The final step before the intervention is a rehearsal. By this stage, you will have shortlisted appropriate treatment facilities and alerted them of a pending arrival, packed the suitcase, and agreed with all participants what the ground rules are about physically restraining the addict.

You will also have rehearsed what will happen if the addict refuses treatment – there are always others in that room who need help themselves. And remember: 85% of addicts accept help the day of the intervention.

THE AUTHORS

BOBBY BONDS MHS has, since 1983, been responsible for designing and implementing the US railroad company Amtrak’s substance-abuse programmes. His Operation RedBlock is the railroad industry’s model programme for drug and alcohol interventions and prevention: in the 18 years since this started, Bonds trained over 15,000 volunteers to deal with workplace interventions. He also regularly leads  coordinated efforts with agencies to implement integrated peer-based models for families dealing with a drug or alcohol problem. Bonds earned a Master Degree in Human Service and was recognised by the US government on a national level for his innovative work.

Dr SZABI ISHTAI-ZEE PhD is professor and director of Human Services at Lincoln University. He is on the faculty of  the Educational Leadership & Change programme at Fielding Graduate University.

DEIRDRE BOYD is editor of Addiction Today and CEO of the Addiction Recovery Foundation, which she joined in 1993 after training in BACP-accredited integrative psychotherapy and facilitating women’s groups at the Drug & Alcohol Foundation. In 2006, she gained a certificate in proactive structured interventions.

"DRUG-RELATED DEATHS": DEFINITION

Further to the debate on what does or does not count as a "drug-related death", Peter O'Loughlin gives the authoritative definition, as below.

In 2000, the advisory Council on the Misuse of Drugs (ACMD) published a report, Reducing Drug Related Deaths (1) that fed into the 10-year strategy. In addition to several recommendations about the prevention of drug misuse deaths, the ACMD recommended that a better system for the surveillance of drug misuse deaths was needed.

In response to this recommendation, a technical working group was set up consisting of experts across government, the devolved administrations, coroners, toxicologists and drug agencies. The working group reviewed the system for collecting data on drug related deaths and proposed an indicator for the surveillance of deaths related to drug misuse.

“The definition of the indicator is, deaths where the underlying cause is poisoning, drug abuse or dependence and any of the substances controlled under the Misuse of Drug Act (1971) are involved”.

The definition was accepted by the DoH (2) and still stands today.

In view of the foregoing, I reject the subsequent NTA claim that my questions posted on this site are rhetorical - the NTA has both a duty and obligation to respond to them.

REFERENCES:

1.  Advisory Committee on the Misuse of Drugs (2000) Reducing Drug Related Deaths. The Stationery Office:  London.

2. Department of Health (2001) The Government Response to the Advisory Council on the Misuse of Drugs Report into Drug Related Deaths, The Stationery Office London