Addiction Today

ARF REPRESENTS THE UK IN EUROPEAN MUTUAL-AID NETWORK OF OVER 1MILLION PEOPLE

After months of liaison, Addiction Recovery Foundation ambassador-at-large Laura Graham went to Brussels in January to meet with the Board of EMNA, the European Mutual-Help Network for Alcohol Related Problems. Their meeting concluded in success, achieving the final step of the application process required to join EMNA.

EMNA was established in Brussels in 2004 as a voluntary not-for-profit organisation with the aim of promoting mutual-aid networks for alcohol problems across Europe. Today, EMNA represents 10 European Union member states and collectively represents over 1million people and families in recovery across Europe.

ARF, the charity which publishes Addiction Today, is now associate member representing the UK: “We are delighted to be part of such a large recovery network and to help bring recovery to more people,” said Graham and ARF CEO Deirdre Boyd.

The objectives of the network are:
• To promote the importance of self-help groups and community programmes for people with alcohol-related problems in Europe
• In particular, to raise awareness of the self-help approach and community programmes in the new member states of the European Union
• To promote self-help groups and community programmes as a way to enable people with alcohol-related problems to overcome dependency, to recover, to re-integrate within their family
• To promote a diversity of effective methods within the approach and community programmes
• To give people affected by the harm of alcohol-related problems a voice
• To exchange and disseminate “best practice” on topics like:
    o Methods
    o Organisation
    o Cooperation with professional treatment system and health authorities
    o The importance of choice, individuality and  diversity
    o Evaluation and data collection
• To strengthen the role of volunteers:
    o As a valuable resource
    o As a complement to professional treatment
    o As a part of a comprehensive approach to alcohol related problems
• To promote dialogue with professionals, health officials, public authorities and the academic community
• To prepare common positions on a European level on issues relevant to those objectives.

You can read more about this synergy for the UK recovery movement in the March issue of Addiction Today journal, the most popular and influential in the UK drug- and alcohol-treatment field.

DRUG STRATEGY PROGRESS, AND MOVING FORWARD – THE HOME OFFICE VIEW

It is one year since the Drug Strategy was launched. Gus Jaspert, head of drugs and alcohol in the Home Office, recaps progress to date – and identifies some of the challenges to be faced in the year to come*.

Download Addiction Today Jan 2012-Gus Jaspert on policy progress

More forecasts for 2012.

I won’t go through the Strategy in detail as I assume you are familiar with much of it. It is not a big traditional action plan, as many previous government documents have been, but focuses around what we are aiming to achieve across the system. The Strategy has two headline ambitions: to reduce illicit and other harmful drug use, and to increase the numbers of individuals recovering from their dependence.

I will come back to that word “recovery” or “recovering” because that’s an important shift in the strategy.

Essentially it draws together work right across government. The Home Office leads, but it is a cross-government approach. There is an Inter-Ministerial Group, chaired by the Home Office minister, which includes representation from all of the key ministers across government. It is important that we try to get away from “it’s one end or another, either it’s harm reduction or it’s abstinence, either it’s criminal justice or it’s health” and focus on what is the need for each individual and how the system can respond to those individual needs. I have been in post only a few months and have been absolutely struck in my initial meetings by the polarisation of debate. We have to steer a way through that, to focus on the individual user and how we achieve the right outcomes for them.

So, what is different about this strategy to the previous strategy?  There are key changes.

First, the aim of this strategy is to reduce all drug use. Previously there was a predominant focus on problematic drug users or PDUs – quite a horrible term – which was defined as heroin and crack cocaine users. This strategy focuses, not just on dependency, but right across all drug use, and across the range of drugs as well, whether that’s heroin, crack cocaine, right down to wider issues such as the misuse of prescription drugs.

And, for the first time, it also includes dependency on alcohol. The government’s forthcoming Alcohol Strategy will look at more wider population issues around alcohol, but the Drug Strategy brings in the dependency element on alcohol.

It also covers so called “legal highs”. Personally, I hate the term ‘legal highs’, I think we’ve dug ourselves a hole by calling them “legal highs” –  maybe we should refer to them as ‘toxic highs’?

A second big focus in the strategy is the shift to recovery. This is really about raising the ambition across the system, in terms of treatment providers and individual users and, importantly, across government in terms of wider services. So what does recovery mean?  Recovery means reaching beyond just treatment or criminal justice responses, it extends into housing, employment, education: all the building blocks of recovery capital to help people achieve their route out of dependency.

LINKING DEPARTMENTS

Common to government reform is the shift of power and accountability to local areas. If we are trying to get more person centred, trying to build a system around the individual user for their own recovery, that happens best at local level. So how can we set up the right systems at the local level to support people, and a whole host of change? What we need to be doing is thinking about police and crime commissioners, Public Health England and the Health and Wellbeing Boards, in the terms of reform of the NHS and PCT commissioning. So, where are we now in terms of the main themes of the strategy?

REDUCING DEMAND

As ever with many of these things, it is too early to point at stats and say “this strategy has led directly to X” . However, while it is always said very quietly and does not get the profile, things are going well in terms of reducing the demand for drugs. Overall use is down from 11.1% in 1996 to 8.8% now in terms of the percentage of the population who those used in the last year. Drug use is falling amongst young people as well and is now at the lowest level since 1995. However, there is of course more that we can think through about our approaches to reducing demand. What are the new issues around young people, for example, high unemployment, and with budget restrictions across the board, how do we make sure our messages and approaches are right?

There is also the government’s work on troubled families, which is being led by Louise Casey in the Communities and Local Government Department. This work looks at turning around the 120,000 most troubled families in the country, and a specific programme to look at their risk factors and how we can address them. One of the things we are working at is making sure that drugs and alcohol misuse is featured as part of that work. At the moment, the mapping looks like about 30% of those 120,000 families have substance misuse as one of the issues, often going into intergenerational substance misuse.

Another aspect of reducing demand is to make sure that the drugs information we communicate in terms of the risks and awareness is up to date and as effective as possible. You might not have noticed, although hopefully our target audience did, but Frank** was relaunched in October. The statistics on Frank in terms of awareness are very strong; 86% of 11-18 year olds, Frank’s target audience, know about the service and over 80% say they trust it to give reliable information.

There is a lot of work on early intervention as well. There is the early intervention grant which is pulling together a number of streams across government to give to local authorities as one pot around early intervention support – that will become a £2billion pot.

At the same time, through Public Health England and going down to Health and Wellbeing Boards, there will also be about £2billion through the public health route. So, between the director of Children’s Services with the Early Intervention Grant and the director of Public Health, they will be the opportunity to form a very powerful bond, with the money at a local level to be able to address local needs.

RESTRICTING SUPPLY

It is important that we look at all strands so I will briefly touch on where we are with the restricting supply theme. Much of our work on the supply side is enhancing continuing work. Our focus has shifted particularly around organised criminality and targeting more “from source to street” around organised crime. The government  launched a new Organised Crime Strategy in July 2011 and is forming a National Crime Agency which is about re-targeting effort and focus at a national level.

We have also upped our international effort. In the last year, for example, we signed Memorandums of Understanding with Bolivia and Brazil, and we put in place support to Columbia on a regional counter narcotics plan.

At a more local level, we are also supporting Integrated Offender Management and the Drug Intervention Programme. This is an important area where people ask “is it all about criminal justice or all about health?” DIP is actually a good example of using the engagement with the criminal-justice system to get people quickly into health treatment and the support that they need. About 30% of treatment referrals come through a criminal-justice route in this country. It is interesting that the research shows that there is not actually a difference in outcomes between someone who is self referred and somebody who is referred in through a criminal justice system. The important thing is getting people into the treatment that’s right for them and DIP helped support about 63,000 individuals last year.

In my view, new psychoactive substances are a real challenge for us. One where we need to rethink our approach on and assess how fit for purpose our Strategy is. In the last year we have got faster and faster at reacting to “toxic highs” (as I prefer to call them). We have temporary bans that, with support and advice from the Advisory Council on the Misuse of Drugs, can be put in place rapidly and will last for 12 months. We have got faster at identifying NSPs. We have put in place a Forensic Early Warning System, sharing information across Europe and internationally on new types of drugs. About 41 were identified last year, but we are reacting, reacting... How can we get ahead of the curve to think about what is driving the demand for some of these?

Let’s focus on mephedrone as an example of this. The mephedrone phenomenon is very worrying in terms of both fast growth and the new routes, such as internet sales. We have to review our traditional approaches in how we tackle this, as well as consider what is emerging in terms of treatment needs. I went to a “Club Drug  Clinic” in London recently. Identifying early on the different approaches to treatment around some of these drugs, the differing patterns of usage, as well as users, are areas we need to think more about. In incredibly quick time, mephedrone has become the second most prevalent drug for young people and the third most for older people. Keeping abreast of that, and how we think about both our demand and recovery system or treatment systems, not just the supply systems, is something we want to do more work on. We will be responding to the ACMD on new psychoactive substances later next year and want to use that to set out our strategy on these “toxic highs”.

BUILDING RECOVERY

We should not underestimate the ambition shift on recovery. There is a lot of focus on the eight payment-by-results pilots but the important thing is not to see it as only about the  pilots –  it is actually  about a system shift, about focusing on the outcomes to  be achieved for the individuals and how the system lines up behind that. It is not just measuring numbers in treatment, it is looking at actually what was achieved; are they free from dependence?  Are they offending?  Has their health and wellbeing improved?  Adding on to that locally are questions around homelessness, housing and employment and work across government to look at bringing together, for example, a £400million grant to address homelessness as well as Supporting People. The scale of that is about £6.5billion around the Supporting People budget. So there is money in the system, and how that plays out locally is important.

Also on the recovery side, we talk about recovery champions and making sure that we at a national level champion recovery. There is an interesting UKDPC report about stigma related to employing those who have recovered from addiction. How we challenge this stigma is an area we want to be working more on in the next year.

This first year of the strategy has largely been about shifting some of the ambition, a lot of system change and laying the groundwork for that system change across government; for example: Public Health England, Health and Wellbeing Boards, Police and Crime Commissioners, National Crime Agency, as well as the shift around localism and de-ringfencing budgets.

We have already seen some of that shift of ambition around recovery deliver some results in terms of treatment, such as the National Treatment Agency for Substance Misuse reporting an 18% rise in terms of those exiting treatment free of dependency. The real challenge for next year is how does this system change deliver on the ground for the individual user?  We must bring all these strands together as we free up the money and free up the accountability

In a way, the changes can be seen as presenting two options. They can be seen as a challenge or they can be seen as an opportunity. My focus is to make sure we turn them into the right opportunity for those affected by drugs misuse.

* Gus Jaspert gave this information in a December 2011 Westminster Forum seminar.

** For more views on Frank, visit Cannabis Skunk Support.

PREVENTION MUST BE PUT INTO CONTEXT

A common definition of prevention is “educating youth to abstain” – but this is doubly erroneous, explains Peter Stoker. First, all age groups can benefit. Second, education is only part of a process which also encompasses knowledge, attitudes and behaviour. And in limiting our attention to extremes of youth and addicts, we miss a large and costly population in between.

Sitting at the King’s Fund in London in November, listening to the inspiring description of the Betty Ford Center by CEO John Schwarzlose and children’s programme director Jerry Moe, there were clear parallels with prevention principles and practice. It was a welcome change: in some 25 years covering most sectors of our profession, I have observed that the fields of treatment and prevention are too often separated by a large wall. We must do better than this. The pay-off can be a more powerful way of working together, to the ultimate benefit of the people we help.

Print-friendly version: Download Addiction Today Jan 2012-Prevention NDPA

WHAT IS PREVENTION?

Prevention has been the target of cheap shots throughout its existence. Some cynics allege that there is no technology in prevention – merely “apple pie sentiments”. This might come as a surprise to Lindsay Roberts [ref 1] who was recently awarded a Masters in Prevention Science at Oklahoma University, and to Bill Lofquist [ref 2] of Tucson, Arizona who as long ago as 1989 had a widely-regarded workbook published under the name of The Technology of Prevention.

Adding to prevention technology is Dr Barry Twigg who was awarded his doctorate [ref 3] for research focusing on the whys and wherefores of young people who choose not to use drugs: a valuable reverse of most of the research. And last August, the Independent newspaper [ref 4] published an article commending The Power of Prevention.

But simplistic prevention doesn’t cut it. To quote american humorist HL Mencken: “For every complex problem there is a simple solution – and it doesn’t work”.

Asked what prevention is, many will rely on the Oxford English Dictionary and opine that it is “obstructing” something – but obstructing is too late! Look at the Latin root: praevenire, meaning ‘to come before’, then savour Lofquist’s  definition: “We need to get beyond the notion that prevention is stopping  something happening, to a more positive approach which creates conditions which promote the well-being of people”.

Since the overall goal of prevention is to promote wellbeing – to improve health – it behoves us to agree on a usable definition of ‘health’. Too often, this is narrowly described in terms of physical capacity or mental illness Try instead this one derived from inter alia the World Health Organisation. Health comprises: physical, mental, intellectual, social, emotional, spiritual and environmental elements.

What is prevention? The usual answer is “educating youth to abstain”. This is doubly erroneous. First, all age groups can benefit from prevention [ref 5]. Second, education is but a part of the process. A useful acronym defining prevention elements is KAB: knowledge, attitudes, behaviour [ref 6]. Importantly, behaviour should not only be about penalising negatives; it should also be about encouraging positives.

Moreover, in limiting our attention to youth abstainers at one end, and to addicts at the other end, between us we are missing a large population in the middle. Regular users of varying degrees of use [ref 7] actually cost society more than all the addicts put together.

The US Centre for Substance Abuse Prevention as long ago as 1991 concluded that the best prevention results come through “coordinated prevention efforts that offer multiple strategies, provide multiple points of access, and coordinate and expand citizen participation in community activity”.

Caution is recommended in tackling the culture round behaviour. It can and should be considered as a kind of ‘social ecology’. In a paper [ref 8] submitted to the 2003 International Drug Prevention Conference in Rome, the point was made that “dabbling” with one aspect could bring the law of  unintended consequences into play.

Of course, no consideration of drug policy and practice escapes the attention of the libertarian front. While the goal of prevention is to facilitate drug-free lifestyles for all, pro-drug adversaries cynically condemn it as part of a so-called “war on drugs”. With the benefit of hindsight we can see that the term “war on drugs is a finely conceived and executed meme. A paper by Brian Heywood [ref 9] usefully informs on memes and their deployment. In treatment as well as prevention, we need to learn from our opposition, and become adept ‘memesmiths’.

CULTURE IS THE KEY

It is not too much to say that culture drives behaviour, be it at individual or societal level.  It follows that if you want to change behaviour, you must change the culture. No small task! Put another way, if much of drug use is to escape reality, it follows that the solution is to improve reality. So, what influences the culture round decisions to use or not use drugs?  In no particular order, these are recognised as:
o Peer group influence
o Personal perceptions
o Income v cost of any action
o Health issues
o Moral structure, spiritual structure
o Family values
o The attraction of risk-taking
o Mental condition – depressed, elated, in-between
o Legislation, including laws and conventions
o Sports, leisure, the media, music, movies, TV, fashion, humour, and the like.

The media are major players in the culture game. They have transformed themselves from reporters of the culture into makers of the culture. A major US survey a few years ago found that an encouragingly high percentage of children got their information about life issues from their parents. But on asking parents where they got their information from, they answered “the TV”.

Societal factors overlay and influence culture. There is no shortage of societal factors which tend to encourage drug abuse. Here are some examples: self before society, rapid gratification, the ‘right’ to be happy, rights without responsibilities, youth supremacy, conspicuous consumption and political correctness. A drugs trainer once summed up the first four of these factors as a drug user’s rubric: “Me. Feel good. Now”. 

If someone alters the culture in which decisions are made, it is almost certain that there will be different outcomes – and not all influences are positive. The ‘values clarification’ philosophy [ref 10] founded by Carl Rogers and Professor Sidney Simon, with some input by Abraham Maslow, had a seminal damaging effect on drug abuse. Melanie Phillips, in her paper The Trouble with the Liberal Elite is that it just isn’t Liberal  [ref 11], laments the fact that today is an era in which truth has become relative. The American philosopher William James (1842-1910) went so far as to suggest that “Truth may be defined as that which it is ultimately satisfying to believe”.

Chuck Colson, in his paper The Cultivation of Conscience [ref 12], draws out today’s reality that many young felons simply do not know the difference between right and wrong. “How can you teach kids to act right when they don’t know what right looks like?”

CAN WE STRENGTHEN PREVENTION?

Prevention effectiveness is visible in the campaign to reduce tobacco smoking. KAB – knowledge, attitudes, behaviour – has produced a marked decrease in prevalence. We can learn from this. So how can we promote healthy lifestyles? Below are a few options:
o Work to the model of ‘Total Health’ – as in the World Health Organisation or similar 
o Become ‘memesmiths’.
o Fix those ‘broken windows’.
o Establish ‘prevention cities’ as in San Salvador, Argentina 
o Nurture an informal, international ‘Prevention Institute’
o Build ‘more bridges, fewer towers’ – reduce your ego quotient
o Get more funds for prevention (US State Dept told me that prevention is under 2% of their drugs budget.
 
REFERENCES:

1. Editorial: Prevention specialist Lindsay Roberts sees progress in Muskogee. www.muskogeephoenix.com  (16 October 2011)
2. Lofquist WA. Discovering the Meaning of Prevention (1983) and Technology of Prevention Workbook. AYD Publications, Arizona (1989)
3.Twigg B, Dr. The Attitudes of Young People to the Non-Use of Drugs and to Drug Education and Prevention. Doctorate Thesis. Department of Education, Brunel University. (2006)
4. www.independent.co.uk The Power of Prevention (31 August 2011)
5. Blow CF et al. Evidence-based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults. Published by Older American Substance Abuse and Mental health Technical Assistance Center. (2005)
6. Benard B. Characeristics of Effective Prevention. Published in Project Snowball training materials, Illinois Teen Institute. Available via NDPA website.  (1987)
7. Cunningham J. When is the Cost of Drinking Alcohol Too High? blogs.reuters.com  (15 February 2010)
8. Stoker P. Drug Strategies and the Cultivators of Culture. Available via NDPA website. (2003)
9. Heywood B Assaying Information in the Substance Misuse World. Presented at St Petersburg Florida conference of International Task Force. Available via NDPA website. (2004).
10. Stoker P. Moralising… demoralising. The Fight over Personal, Social and Health Education. Available via NDPA website. (2001)
11.  Phillips M. The Trouble with the Liberal Elite is that it just isn’t Liberal. See www.melaniephillips.com  (2000)
12. Colson C. The Cultivation of Conscience. Available via NDPA website. (2002)
The NDPA website is http://drug prevent.org.uk – click on Papers.

PETER STOKER C.Eng is director of the National Drug Prevention Alliance. He has worked in the drugs and alcohol field for some 25 years – as a counsellor, treatment referral and support worker, educator and (DfES) adviser in schools and communities, social work practice teacher, trainer in many settings and across many age groups. He has been an advocate to local and national political figures, and has been extensively covered in print and broadcast media. He has had several papers published, and spoken at international conferences. Before entering the drugs field, in a 30-year civil engineering career he became a chartered civil engineer, designing and managing major projects at values up to £3,000million.

PREPARE FOR THE OPPORTUNITIES AND CHALLENGES OF 2012

Leading personalities in the field of addiction treatment and recovery use their insights and inside information to predict what they consider will be the major opportunities and threats of the year to come. Prepare now.

Print-friendly version: Download Addiction Today Jan 2012-Predictions

  

 
DAVID BURROWES MP...
"2012 will be a year with great challenges and opportunities. The Drugs Strategy has meant that recovery is now on everyone’s lips and we will see this year how far recovery is transforming people’s lives.

The Alcohol Strategy will no doubt reaffirm the government’s commitment to tackle the main drug which damages lives in the UK. It is an issue of public health but will need to cut across all of government: Health, Education, Home Office, Justice, Communities and Local Government and, of course, the Treasury. I was part of the 2007 Social Justice Policy Group’s Breakthrough Britain report which identified the strong evidence linking the price of alcohol to levels of harmful alcohol consumption. Given the scale of the alcohol problem, solutions will need to be bold.

The Payment by Results pilots going live in April are the most radical and innovative reforms to drug treatment. I predict that the pilots will drive many addicts to the path of full recovery who would otherwise be parked on methadone. 2012 will demonstrate a fundamental shift to outcome-based commissioning where the outcome is living a drug-free life. How quality residential rehabs can thrive in this new PbR environment is a challenge which, as chair of the Recovery Partnership’s expert group, I am determined to meet.

This year will see a significant change in governance. It will be the last year for the National Treatment Agency as Public Health England takes the national reins and Health and Well Being Boards take local reins. Any criticism or praise for drug treatment will lie not with the NTA but with ministers and local councillors. The opportunity is that drugs misuse will be one of the biggest fishes in the new Public Health England fishbowl and well placed to receive both funds and strategic support. The challenge is the likely significant variations across the country in local areas providing additional support.

2010 was the year when the Drugs Strategy changed the tide in favour of recovery. 2011 was the year when the tanker of drug treatment began to change course. 2012 will see it negotiate some choppy waters but head firmly to the port where drug-free lives are rewarded, supported and celebrated."

Dr OWEN BOWDEN-JONES...
is chair of the Faculty of Addictions, Royal College of Psychiatrists, honorary senior lecturer at Imperial College London and consultant psychiatrist/lead clinician for Club Drug Clinic, Addictions Directorate, Central and NW London NHS Foundation Trust.
"After a period of rapid, disruptive change across healthcare in general, and substance misuse provision in particular, I predict that 2012 will see the treatment system begin to catch up and adapt. The next year will see the delivery of:
1.  Initial results from the payment by results pilots – you can read more about this at www.nta.nhs.uk/healthcare-pbr.aspx
2.  Final report of the Recovery Oriented Drug Treatment expert group – visit www.nta.nhs.uk/recovery-orientated-drug-treatment.aspx
3.  NICE Quality Standards for drug misuse, to complement the existing Quality Standards for Alcohol – details at www.nice.org.uk/guidance/qualitystandards/alcoholdependence/home.jsp
4.  Ongoing development of the ‘skills hub’ by the Skills Consortium – www.skillsconsortium.org.uk/skillshub.asp
5.  Guidance for substance-misuse commissioners from the Joint Commissioning Panel for Mental Health – updates will be at www.rcpsych.ac.uk/policy/policyandparliamentary/projects/live/commissioning.aspx
6.  Details of Public Health England transition – visit www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_122249.
These documents will begin to describe the framework in which care can be delivered and standards set.

Within this framework, recovery will rightly continue to be the focus, underlying the culture change that is now underway. Service users will increasingly collaborate with staff to improve the quality and effectiveness of treatment."

 

MARTIN BARNES...
is CEO of DrugScope, a membership organisation for the drug field in the UK.
"There are positives for the drug sector: a continuing strong political commitment to tackling drug misuse; central-government funding for drug treatment, so far relatively protected; and the outward face of the sector to government and others is increasingly coherent and collaborative. The Drug Strategy is an aspirational, balanced and sensible framework for policy and practice.

But it is hard to feel optimistic. The economy, deficit reduction and spending cuts cast a shadow: the drug sector, despite a nominal ringfence round the pooled treatment budget, is not immune. Disinvestment has started, particularly in young people’s treatment, drug education/prevention, and in services key to delivering a genuinely recovery-oriented system and the high-level ambitions and outcomes in the drug strategy.

The biggest challenge facing the sector is the new public-health service. From April 2013, responsibility for drug and alcohol treatment will transfer to local authorities, directors of public health and the new Health and Wellbeing Boards. Up to half of the likely £2billion public-health budget will represent current spending on drug and alcohol treatment. Drug and alcohol treatment will compete – at a time when local authorities are managing unprecedented spending cuts – with other needs, including tobacco control, obesity, winter deaths and so on.

The omens for how local authorities will approach investment in treatment and recovery are not encouraging, but there is time to influence the local and national agenda. The new Crime and Police commissioners, elected in November, are an unknown commodity but will have a stake in investment to tackle drug- and alcohol-related offending and antisocial behaviour. The government’s (re)new(ed) focus on ‘troubled families’ is an opportunity to emphasise the multiple relevance of treatment and recovery.
The role of Public Health England, after the National Treatment Agency, will be crucial for influencing investment. Service users, people in recovery and others will be key to champion this.

Despite the commitment to ‘localism’, there must be clear, consistent and bold leadership from government. There must be pragmatism at the centre if local disinvestment in drug treatment is to be avoided."

 

GAVIN COOPER...
is managing director of Trust The Process, alongside Tom Kirkwood who is director of development. They offer over 200 ‘recovery beds’ and services across tiers 3 and 4.
"For many it has been another tough year, with the closure of some long-standing and respected facilities. Have we learnt from this? Or are we set to continue doing the same thing with the expectation of a different result?

I am sure we’ve all heard how the National Treatment Agency is going to be disbanded and swallowed up into the NHS – and at the same time how it is going from strength to strength and going to be around for ever.

I have been told about an extra “£billions” for the system,  a fair proportion of which is ring-fenced for alcohol treatment – yet at the same time heard that it is likely to be funnelled into central coffers and used to offer family support and address consequences rather than to treat the root cause of the problem, the addict/alcoholic!

So what changes do I see?
Continuing to disburse a significant part of the budget on methadone? Or practicing client choice which includes an offering of structured daycare, detox and rehabilitation?
Continuing to commission providers with little or no experience of the assessed need? Or opening the door to service providers who have embraced true “recovery” all along?
Continuing to commission providers and pump taxpayers’ money into services with little or no experience in the true requirement but ‘happen’ to be part of the same PCT area, albeit at a higher cost and producing lesser outcomes?

Further changes and challenges that await us in 2012 are the threat of abuse of controlled drugs acquired on the internet, the need for providers to find partnerships outside our sector and the fact that we will now be in direct competition for funding from other more mainstream health services, such as children’s health, smoking, etc.

I choose to concentrate on the effects on our industry, particularly residential units, of the Care Quality Commission. Much has been said, or nervously whispered, of the negative effects of the stringent requisites of accreditation, including the closing of many smaller units. But many positive changes will come, once the dust settles.

We are being forced to professionalise as an industry, and in many right places, particularly round safeguarding, clinical governance, risk management, care planning and the respect and advocacy of our clients and staff.

Very high standard and appropriate training and qualifications in the areas we work in will help shift away from the traditional need of workers in our sector to make up for deficiencies of local services in areas such as housing, benefits, employment and education towards a more multi-agency approach to the care of our clients.

For workers ‘on the ground’, a more pervasive change is the need for more paperwork at ever-higher levels. If managed well in organisations, it will not mark the death of traditional addiction workers spending treatment time talking about feelings. Instead, I believe a new breed of worker will emerge, able – through skills in MI, Frames, Itep, etc – to turn the filling-in of a care or risk management plan into a truly inclusive, realistic, significant and inspiring therapeutic event."

 

DEIRDRE BOYD...
 is CEO of the Addiction Recovery Foundation, the charity which publishes Addiction Today, and runs the UK/European Symposia on Addictive Disorders. She is convener/spokesperson for the Concordat of rehabs.
"Many factors in the coming year have been predicted already in this article. Others come from central and local government, and from newcomers trying to exploit the recovery movement.

As an example of the first, the Department of Communities and local government ministers will use the Localism Act to reform social housing, aiming for more flexibility in the way people access social housing, and types of tenancies. There should be chances to integrate housing into local frameworks supporting recovery programmes.

Payment by Results is the great hope of this government but there is anxiety about the practice and quality of commissioning, the impact of PbR on providers’ cashflow, and the lack of nationally approved recovery outcomes. We are concerned about the lack of a drug-free goal, to sustain recovery, but ministers tell of incentivising payment using a weighting mechanism to encourage full recovery. There is a desire that at least 80% of the money in the “freedom from drugs of dependence” domain be paid on the two measures that require the cessation of dependence on drugs – including substitute prescriptions.

The Public Health Outcomes Framework will be important in keeping local areas focussed on issues round drugs and alcohol dependence. So, too, should be local areas’ Strategic Needs Assessments to include drug and alcohol users.

The Work Programme now operates across 18 contract areas where prime providers engage with about 850 subcontractors. Work Programme prime providers and subcontractors are to work closely with and support drugs PbR sites.

Amid challenges will be work on stigma around drug users – Addiction Today’s concern is the stigma round recovery, the greatest stigma being not denial but disinformation of what it is.

This brings me to the fact that 2011 was a roller coaster year for the recovery movement. We saw people claiming to represent us publicly attack others in our movement. This in turn threatened to polarise us because it was impossible to deny what we witnessed. The tactics and style of the attacks were brutal, unnecessary and unfounded and not something we could support in a recovery movement. But we learned from this, so that those who really do support recovery in the UK are now more cautious about what we support, more critical in our assessments of people and organisations who claim to be recovery advocates and claim to represent us.

It was a testing time but what happened next confirmed that we are a strong movement. Those who were on the receiving end of the attacks found support from people and organisations in a way that they had not previously experienced. We came together in our support of them. As a collective, it made us stronger and more protective. This strength will grow in 2012.

Grassroots organisations will bloom. When others in our field will be affected by the economic climate, the organisations driven by the passion of individuals will carry on regardless. Organisations excluded from mainstream funding will remain recession-proof. When bigger national services will become more competitive with each other to stay afloat, local grassroots organisations will continue to encourage other diverse recovery organisations, driven by their willingness to connect and inspire in order to grow communities of recovery across the UK. 2012 promises to be an exciting time – anything and everything is possible!"

REHABS - NOVEMBER 2011 SNAPSHOT

On 7 November 2011 with a deadline of 11 November 2011, Concordat members were emailed the question “How could/does NDTMS* artificially lower your successful completion rates?”. 

The overwhelming trend was patients waiting too long for referrals to rehab, during which their addictive disorders progressively worsened to levels necessitating the most expensive cost and care: hospital emergency admissions.

Examples from one rehab include:
1. Clients admitted so ill that they need hospital admission immediately: 2 clients were admitted and passed away in hospital 3 days later due to liver failure.
2. Clients admitted then diagnosed with Korsokoff’s so transferred to an appropriate setting (4% in 12 months)
3. Clients admitted with urgent medical appointments to attend during their stay; results of appointments were that their physical health took priority; placement cut short.

Read the report here:
Download Rehabs and NDTMS - Addendum to The State of Residential Rehabilitation in England

Related document:
Download The State of Residential Rehabilitation in England - Nov 2011

* NDTMS is the National Drug Treatment Monitoring System, and there have been ongoing concerns among providers and others about misinterpretations of data input to the system, and that this gives an inaccurate picture to government  and taxpayers of how implementation does or does not reflect drug policy aims.

THE STATE OF RESIDENTIAL TREATMENT IN ENGLAND

Patients are arriving at rehab to quit their addictions far sicker, frailer and more physically damaged (than less than five years ago), according to a report commissioned by the Addiction Recovery Foundation and completed by members of the Concordat of rehabs. Staff must spend more time addressing physical needs -- including emergency hospital admissions on arrival.

 

Read the full research paper:
Download The State of Residential Rehabilitation in England - Nov 2011

Related document:
Download Rehabs and NDTMS - Addendum to The State of Residential Rehabilitation in England

HIGHLIGHTS IN THE REHAB REPORT:

• Of the 481 beds in this report, completion rates were  68% alcohol and 62% drug (average)
• 57 clients had cost the state £4,115,749.90 before rehab (including community ‘treatment’)
• Most patients 55.5% (n= 108) had waited between 3 months and 12 years (23 people had waited longer than 6 months) to get into rehab
• Providers observed that people are arriving far sicker, frailer, more physically damaged (than less than five years ago), with less self-esteem, increased levels of DV, sex working, social services involvement, homeless, and fewer social skills – please read attached Rehabs and NDTMS for specific details and how this artificially lowers recorded completion rates
• Staff having to spend more time than ever addressing physical needs (including emergency hospital admissions on arrival)
• Majority of rehabs operating at below break-even levels since 2008/09
• 11 (out of 16) have lost staff, reduced services (including shorter programmes) and are under threat of closure (2010/11) &10 under threat of closure in 2009/10
• Statutory clients are expected to jump through hoops before securing a funded place in rehab – mode for waiting time equal at 2 & 3 months (both at 13 times frequency).

The ARF/Concordat report was collated by researcher Laura Graham. It feeds into the Recovery Partnership rehab report for the Inter-Ministerial Group on Drugs.

Many rehab CEOs said they were "too busy" fighting for survival to complete the questionnaires for the report, but hope to contribute to the next version of The State of Residential Treatment in England in early 2012.

CONCLUSION

The report shows a decline in the use of residential rehabilitation in the treatment of addiction over the past five years. There are several possible factors driving this including the commissioning and referral process which does not easily consider client choice, the culture of the drug and alcohol treatment which again focuses on the need of the service before the client’s progress and rewards for the 'retention' of clients even when the client’s circumstances are on a downward spiral.

In this climate, residential rehab provision is shrinking. This includes a reduction in provision (which in turn will affect availability) by closing, reducing bed spaces, reducing staff, and providing shorter programmes. The ability of clients to fully benefit in a reduced programme is further compromised when many are arriving at rehab requiring an unexpected detox, unaddressed health problems, and greater deficits in their recovery capital bank (requiring housing, social skills, relationship problems, social service involvement) as an increased amount of time within the time in rehab includes addressing many of these issues.

The recent practice of exploiting the good will of residential rehab providers to keep clients beyond the time they are funded for in the client’s best interests cannot be allowed to continue and requires urgent further investigation.

As shown, there are differences in waiting times for people requiring residential rehab based on their ability to pay and those requiring statutory funding. The latter are expected to jump through hoops in order to prove that they are suitable for the treatment they have identified as appropriate for them at a time when they are likely to be at their optimum motivation. This practice in itself can extend waiting times, support a decline in the individual, demotivate them, and evidence that they require a residential rehab is overlooked rather than used in support for their application when the individual struggles with compliance in a community setting. Non-compliance is regarded as a demonstration of a lack of motivation for residential rehab. This is another area which requires review.

With a few exceptions (such as awaiting release from prison), there is no logic to explain why 55.5% of the current clients in receipt of statutory funding had to wait beyond three months (with one person waiting for 12 years) of asking for rehab before arrival when there are empty rehabs across the country. During this time individuals are becoming more unwell and the collateral damage as the result of their addiction has potential to increase.

LIES, DAMN LIES AND STATISTICS:

TREATING PEOPLE AS PAWNS

Everyone involved in the treatment of addiction must know what works and what does not so that they can follow the best course of action for themselves, their patients, families, community and society. We all deserve to be given the truth. Deirdre Boyd seeks it in the latest NTA figures.

Related articles:
Dodgy dossier 1, Dodgy dossier 3

It is a deadly game which costs the country both lives and scarce resources: using statistics to hide what fails so it cannot be corrected, and hide what succeeds so it cannot be replicated. We all deserve to be given the truth in the game of life. So let’s clarify drug-treatment statistics for 2010-11.

DRUG DEATHS.  The NTA states that drug deaths in England fell to 1,625, from 1,731 two years ago and 1,697 in 2001. To put this in context, substance-misuse deaths climbed under the NTA to record highs of 1,800 in 2008 and 1,731 in 2009 – compared with 1,510 in 2000-01, immediately before the NTA started. Also, the NTA omits drug deaths in Wales: they rose from 78 deaths in 2000-01 to 152 in 2010.

We also hear anecdotes (anonymous, for fear of reprisals) of efforts not to record methadone-related deaths, which rise year on year. And Dr Chris Ford has written in a freesheet of recording, with good intentions, at least one methadone-related death as “pneumonia”- how typical is this?

Read and evaluate for yourself the breakdowns from the Office for National Statistics.  

NTA ANNUAL REPORT: “27,969 FREE FROM DEPENDENCY” CLAIM is featured large on the cover of the NTA Annual Report. And its spokespeople publicly defined “free of dependency” as being free of all drugs with no cross-addiction. It is a pity that they did not tell the data gatherers...

...“free from dependency” is NOT an outcome in the National Treatment Data Monitoring System (either dataset G or the most recent dataset H).

“Leaving treatment drug free” is a NDTMS outcome – but (a) it is defined as quitting only illicit drugs, so patients could be dependent on methadone/alcohol/benzodiazepines and (b) there is no test or independent audit, merely a request that “the client is judged by the clinician” who might have a vested interest (see NDTMS link, page 40 of Business definitions).

Again to gain context, the NTA’s 2009 Annual Report claimed that “24,656 completed treatment free of their drug of dependency” – that is free of only one drug; we analysed the figure from all drugs as a third of that, at most. We cannot directly compare, as the NTA changed its reporting terminology after our analysis, but all you need do is enter “Dodgy dossier 1” in the web-search boxin the left column of this page for a guide on how the figures can be interpreted.

In addition, we hear that detoxes increased in 2010, to build “treatment completed” numbers.

“DECLINE IN PEOPLE NEEDING TREATMENT” – who interpreted a decline in numbers presenting or accepted for treatment as a decline in need? One reason for not presenting, as Dr David Best reported, is addicts unwilling to be parked on methadone instead of being helped to quit drugs. Conversely, what about all those waiting for rehab?!

NEW CLIENTS?  Read more questions at the Straight Statistics website. 

COMMISSIONING RECOVERY:

PIECE TOGETHER A COHERENT PICTURE

"We cannot overcommunicate with commissioners” – getting addicts into rehab nowadays means many organisations, people and processes all contributing to the jigsaw that makes up a complete person in recovery. Huseyin Djemil has guided both rehabs and commissioners.

This article also gives helpful information to the NTA researchers/staff who wrote this month that they did not know how or where patients are assessed for rehab.

Print-friendly version: Download Commissioning recovery

THE REHAB (scroll down for DAAT perspective)

I was working with an abstinence-based residential rehabilitation centre for addicts recently: it had called me in because referrals to the rehab were low, as were resident numbers, and it needed help. The staff felt they were doing what they had always done, that they had remained consistent – and so something else must be the cause of their current difficulty.

If you read my last blog, you will know that I am an advocate of resi rehab and of recovery. I am in recovery today due in no small measure to my experiences in rehab over 25 years ago.

Working with rehabs to turn them round is not unlike a rehab working with a patient to help them get their life back on track. It is tough. It is made worse because the rehab, like the patient, must arrive at their own conclusions, find and muster their own motivation and eventually take responsibility for themselves. As the facilitator of this process, you often ‘see’ things before the client does but must work with them so that they gain an understanding of the problem and the possible solutions for themselves.

Asking for help is a good first step, even if the motivation is often triggered not by a genuine desire to change, but because of impending doom such as low resident numbers, poor financial state, difficulties retaining residents and/or staff, and similar scenarios.

This particular rehab, like others I worked with, was frustrated at low resident numbers. In reality, staff were doing what they had always done, but in a world where things have been getting progressively worse for resi rehabs. And, because the promise of the new “recovery” strategy had not yet actualised, doing what they had always done is no longer good enough.

After an initial chat with the director and one of the trustees, I agreed an initial scoping exercise, to lead to a firm and comprehensive plan of action. Scoping would cover all aspects of the client journey from pre-referral to exit and aftercare.

This meant looking at how the rehab communicated its presence to the outside world: where was it listed, its website and literature, how it generated referrals, how it initiated and sustained relationships with commissioners  both locally and further afield, what ‘outside’ meetings its staff attended, open days for commissioners/ referrers etc.

I looked at what happens when referrals are received, how quickly enquiries were followed up, what data systems were in place for referrals, clients on the waiting list, commissioners ,etc (data systems need to be about retrieval not storage). I also assessed how up-to-date the referrals and admissions staffs were with the Community Care Act, and Department of Health and National Treatment Agency guidance etc.

I walked a typical client through the process of induction and went through the normal contracting process in some detail to see how effective the rehab systems were for new residents and for commissioners alike.

Finally, I also did some ‘live’ work with staff in the admissions team – which yielded some interesting results, particularly that there was a lot the rehab should be doing to ensure that people on the waiting list stood a better-than-average chance of getting help and admission.

This process took a week for the scoping exercise and
4-8 weeks for the more intensive work. It resulted in an upturn in that rehab’s fortunes. Resident numbers were up to near capacity. A few staff left and few had to be made redundant (it was a genuinely tough time). There were some minor tweaks to the programmes.
Finally, resident retention was also up.

An interesting point is that some clients had been on the waiting list for months, some were in the community, some were ‘rehab ready’ but effectively waiting for a Community Care Assessment, and some were in prison (remand and sentenced) and could be in as soon as her majesty and the assessment and funding process allowed. So much for a three-week waiting list target. So let’s look at some ‘live’ scenarios.

The first case file we looked at was a male in the community waiting for a CCA. I suggested that we ring the social work contact responsible for the CCA to ask if it had been completed yet. So that’s what we did and we got through to the social work team admin who informed us that the social worker was not in the office. We asked where he was: “out” came the response. The rehab staff member thanked her, hung up and wrote a note in the file. She was about to move onto the next file when I asked “Is that it?”. “What else can I do?” the staff member said. “He’s not there.”

KNOW THE RULES

Sometimes, staff get themselves into a rut, particularly when they are not clear about what they can and should expect from staff in statutory agencies and when they are not clear about the rules, the law, and the rights and responsibilities of the client, social workers and Drug/Alcohol Action Team staff, etc and their role in the complex process of a patient accessing rehab.

In the case of this particular staff member, I explained the relevant points of the Community Care Act, which make it clear that clients have the right to an assessment followed by a care plan – and the provision of care if eligible.

The client should also play an active part in the assessment process, which should be done with not to him or her.

Armed with the right information and the persistence which comes from having support on hand, we rang back. After escalating the matter to the social worker’s manager and being clear that we would further escalate the matter – given the unacceptable delays – we managed to get a revised date for a CCA, which the rehab would follow up, of course.

Knowing the rules gives confidence to the enquirer, persistence and a willingness to escalate issues up the line-management chain and to complain, using official channels and in creative ways – for example, get clients to ask their MP for help if need be, get to know and quote the law and the guidance – are the keys to getting results when it comes to holding statutory agencies to account when they do not do what they are supposed to do. They should not refuse to undertake timely assessments for all sorts of spurious reasons such as the budget is used up: your client still has a right to an assessment; even if they must wait for care, there is much they can address while they wait. They should not refuse to assess while the client is in prison: they can assess over the phone, or via an official or facilitated visit, they can use prison staff [the Carat team] to assess the client. They should not say your clients need is not in the right category – see FACS below. They still must assess and provide a clear care plan that is appropriate to the presenting need.

In assessing the client, social services or the joint Daat /Social Services tier 4 assessor must use Fair Access to Care Services criteria to determine eligibility/level of need. This is usually split across four levels. From top down they are: critical, substantial, moderate and low. Many councils /Daats treat only critical and substantial need so, increasingly, clients in need of resi rehab are forced to try but fail at all other community treatment options first, usually because Daats have invested most of their considerable resources in community services, the bulk of it being tier-3 prescribing services.

THE DRUG/ALCOHOL ACTION TEAM

I have worked not only with rehabs in crisis, but also with Daats wanting to review their tier-4 processes to improve detox and rehab care pathways, ensure better client/treatment outcomes, and improve budgets for tier 4-services  or make the existing budget go further.

One of my recent clients was a Daat which needed help because clients were getting stuck in a treatment roundabout. Everyone in need of tier-4, resi rehab services had to wait an age to get a referral: they were forced to try and fail at everything else on offer in the community first. They also needed a community care assessment which, due to lack of CCA staff, was taking 6-8 weeks alone. Beyond that was the job of building the ‘client case for rehab’ to take to a funding panel, getting a decision, then looking at matching the client to an appropriate rehab, which was taking another 8-12 weeks. After rehab, if the client came back, they received a generic aftercare service.

This particular Daat was spending only about £200,000 on rehab, from a total declared budget for treatment of almost £4million.

With help, the Daat improved the assessment and decision-making process, which was reduced to less than four weeks from referral, through assessment and to funding decision.

Clients no longer waste time exhausting community services first. The Daat also streamlined the budget management process, ensuring it was never wildly under- or over-spent. It even managed to target under-spend elsewhere in the treatment system to resi rehab. It aims for 10% of new treatment journeys getting to rehab.

Rehab outcomes were also improved by ensuring a more varied list of service providers, better client matching and preparation for rehab and better contracting, including price, with the rehabs being used.

Aftercare, instead of being generic, became part of the treatment-matching process. It was considered as part of the care plan before rehab, not as an afterthought if the client made it back.

Working with a Daat – and a whole treatment system, rather than one provider – was very interesting because it was clear that most of the professionals could not navigate the system either. New care pathways were required and these were publicised throughout the treatment system. User groups were told about them, as they also found it hard to advocate for people who wanted rehab and abstinence. They had not been geared up for it, did not know the rules, and were very ‘script’ oriented.

RECOMMENDATIONS

Useful guidance – there is a lot from the NTA, which is not widely publicised and thus not widely used. Some is a bit out of date, but it could improve commissioning of resi rehab and help rehabs to press the case for their clients, and improve their own practice. Guides include:

l Commissioning for recovery

l Residential treatment services: good practice in the field

l Improving the quality and provision of tier4 drug treatment interventions (2008)

l NTA models of residential rehab for drug and alcohol misusers

l NTA staff development toolkit drug alcohol residential services

l NTA voluntary sector compact - guidance.

Local substance misuse partnerships should review current care pathways, assessment and decision-making processes relating to resi rehab and/or tier4 in general, with the aim of at least 10% of all new treatment journeys getting access to resi rehab – and perhaps apportioning 10-15% of Daat resources. Following on from this...
l Any client on methadone for four or more years should get the chance to apply for detox/ rehab as a priority.
l Any one starting out on a drug-using career, where treatment gains can be quickly consolidated should be assessed for detox/rehab and, where appropriate, offered the opportunity to go to resi rehab.
l Any stimulant user in a tier-2/3 service should be given the chance to apply for a rehab assessment/ placement.
l There should be workforce development training relating to tier-4 assessment and care planning.
l There should be a transparent and realistic target for all patients wanting access to resi rehab – a ‘starter for 10’ might be no more than 6 weeks from a person asking for rehab as a treatment option to stepping through the door of a rehab if assessed as eligible.
l Serious consideration should be given to streamlining the funding of resi rehab. The Community Care Act came into force in the early 1990s, there were no Daats, no £millions spent on treatment and thus no treatment infrastructure. It made sense at that time to devolve the power to assess and treat people in need to local authority social work departments. But with a treatment infrastructure in place now, this should be reviewed and simplified.
I have achieved this on a local – county and unitary – level. It should not be beyond the current coalition to instigate this nationally.

The requirement to re-balance the treatment system in this country is real but it is not happening with the urgency required. Too much of the treatment budget is still spent on prescribing services. Local substance-misuse partnerships are fiddling round the edges as they try to build recovery, mutual aid groups and the like – sometimes only by changing names of existing practices.

I do hope that the message of the need for resi rehab and a rebalancing of the treatment system gets through.

Huseyin Djemil is director of Green Apple Consulting and blogs here.

THE LATEST DEFINITION OF ADDICTION

The American Society of Addiction Medicine has released a new definition of addiction, highlighting that it is a chronic brain disorder and not simply a behavioural problem involving too much alcohol, drugs, gambling or sex.

Four years of work with 80 experts opened the door to ASAM’s first official position that outward behaviours are manifestations of an underlying disease.

Read the full definition today:
Download ASAM definition of addiction 2011

Short Definition of Addiction.
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours.
Addiction is characterised by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of significant problems with one’s behaviours and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

CONCORDAT WATCHDOG LAUNCHES IN HOUSE OF COMMONS

To help implement the Drug Policy goal of getting more addicts into drug-free sustainable recovery -- and raise the number managing to get a referral to drug-free rehab from the current 2% to 10% of those 'in the system -- the Concordat Watchdog was launched in the House of Commons this October by Amber Rudd MP, supported by Lord Mancroft.

The 'Watchdog' will use all due diligence to establish good practice through effective communications with commissioners through a two-way process:  it will inform commissioners of expectations concerning the use of inpatient and residential rehab treatment, and of the benefits these services can offer them in relation to recovery outcomes.

In parallel, the Watchdog will provide a channel through which purchasers/ commissioners can raise their concerns about specific Concordat providers or about inpatient and residential rehab provision in general. These will equally be addressed. 

Click below to see photographs of the launch:
Download Concordat launches

 

CONCORDAT GRADUATES LAUNCH IN HOUSE OF COMMONS

With only 2% of registered drug users getting the opportunity to benefit from residential rehab, the Concordat of rehabs formed in February to raise this number to at least 10% in the next few years. But the best ‘voice’ for residential rehabilitation is that of those who have graduated from it...

In July, the Concordat Graduates formed at a meeting in London. They aim to network over 30,000 alumni or 'graduates' from Concordat rehabs, with whom they are in contact, so that more addicts can benefit from the opportunities they had to get into long-term drug-free recovery. 

In October, Sadiq Khan MP officially launched the Graduates in the House of Commons, with Mount Carmel rehab, which is in his constituency.

Photos of the Concordat Graduates launch:
Download Concordat launches

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she encounters as she travels across the country. We preview her article in the November issue of Addiction Today journal.

A close encounter places her in favour of the Rehabilitation for Addicted Prisoners’ trust.

 

Out of favour are unexplained statistics – but she does offer a prize for suggestions.

 

Read more today:
Download LLLL-Rapt-unexplained statistics

 

 

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she meets across the country. 

In favour this autumn are legacies of hope -

 

while out of favour is non-critical observation...

 

Read her thoughts today:
Download LLLL-legacies-noncritical observation

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a perspective on the people and events she encounters as she travels the country.
This article was first published in Addiction Today journal July 2011.

 

In this issue, she loves a state-of-the-art mental-health facility filled with hope as it treats people so ill they have had to be sectioned –

 

 

and is outraged by “our benzodiazepine secret” and lives ruined from childhood to grave, crushed by politicians, officials and the ‘health’ profession.

 

Read more today:
Download LLLL-mental health-benzodiazapine

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she encounters.
This article was first published in Addiction Today May 2011.

 

In this issue, she loves World of Difference philanthropy...

but is riled by the injustice of destructive ‘liberal’ condescension towards khat use despite users suffering “living deaths”.

 

Read more today:
Download LLLL-WorldofDifference-khat condescension

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she meets across the country.
This article first appeared in Addiction Today journal March 2011.

 

In favour is “hope, agency and opportunity in psychiatry”.

 

Out of favour is bereavement and its consequences for carers...

 

Read more today:
Download LLLL-hope in psychiatry-bereavement

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she encounters.
This article first appeared in Addiction Today journal January 2010.

 

She kicked off the year with a look at love – starting with building a healthy loving relationship with yourself then moving onto  relationships with others, and where to find helpful information. Incurring her wrath are financial disincentives to transforming lives.

Read her musings today:
Download LLLL-love-yourself-financial disincentives

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she meets across the country.
This article first appeared in Addiction Today journal November 2010.

In favour is deconstruction of happiness.

Out of favour is pharmapimping: ‘health practitioners’ giving unsafe drugs to children sold as prostitutes to make them appear healthier and older...

 

Read her thoughts today:
Download LLLL-happiness-pharmapimping

LAURA LOVES, LAURA LOATHES...

Laura Graham gives a personal perspective on the news, trends, people and events she encounters as she travels across the country.
This article was first published in Addiction Today journal September 2010, and is now brought online.

In favour is www.williamwhitepapers.com. 

Out of favour: overprescribing to children, especially with drugs which could lead to use of cocaine.

Read it today:
Download LLLL-WilliamWhitePapers-drugging children

LAURA LOVES, LAURA LOATHES...

The July/August 2010 Addiction Today journal debuted a regular column from Laura Graham who gives a personal perspective on the news, trends, people and events she encounters as she travels across the country.
She now shares her thoughts online.

In favour: jentacular. 

Out of favour: enforced sterilisation.

Read it today:
Download LLLL-jentacular-sterilisation

 

WATCHDOG LAUNCHED FOR LOCAL COMMISSIONING

REHABS PREPARE TO NAME AND SHAME LOCAL HEALTH AND COUNCIL CHIEFS
- IF REASONABLE, PROFESSIONAL DISCUSSIONS FAIL
- IF PROCUREMENT REGULATIONS IGNORED

http://theconcordat.net/2011/09/concordat-watchdog-process/

The Concordat watchdog is officially launching on 14 September in the House of Commons. The event is being hosted by Amber Rudd MP (pictured). Deirdre Boyd and the Rt Hon Lord Mancroft will speak at the event.

The government’s drive to get addicts off drugs to reduce related crime, benefit dependency and the burden on the NHS, is at risk of being strangled at birth by poor commissioning, according to the Concordat expert group of over 40 UK drug-free rehab providers. It is launching the watchdog to help compliance where decisions of local drug and alcohol commissioners* do not use public funds in line with government policy and regulations.

The ‘Concordat’ of residential rehab providers decided to take the dramatic step of launching the watchdog as evidence mounts that commissioners around the country are going against government policy and underinvesting in abstinence-based recovery, the goal of government. This is evidenced by only 2% of addicts 'in the treatment system' being referred to rehabs where they can become free of all drugs and address causes of use in the first place.

JOINT STRENGTHS WITH THE NTA

Serious recognition of the need for best-practice commissioning is demonstrated in the agreement between the Concordat Watchdog and the National Treatment Agency on Substance Misuse to work complementarily together on specific commissioning issues/areas.

NTA programme manager Jez Stannard has written that he is keen to talk about “how we can work together to make best use of the intelligence that is gathered as part of the Concordat Watchdog". There will be a "NTA development that complements the Concordat Watchdog function: a ‘Rehab Watch’ on the NTA website, to provide a specific function for people to report any difficulties that they have experienced in accessing rehab".

The Concordat Watchdog has already achieved successes, for example by getting tender documents altered to comply with EU regulations so that they give fair opportunities to providers who wish to bid for contracts, rather than being skewed to preferential organisations with unfair competitive advantage. It has on call commissioning and legal experts and is seeking a clear-cut case to sue an individual local commissioner, to set an example. But in all cases, it will negotiate first.

Link to more Concordat Watchdog details.

IMPLEMENTATION OF THE STRATEGY DEPENDS ON COMMISSIONING

The coalition government set out a clear policy in its Drug Strategy last year to reform the drug treatment system to reduce bureaucracy and prioritise abstinence based recovery to help people overcome substance dependency, rather than continuing to support the maintenance of addiction via treatments such as prescribing methadone. However, implementation of the strategy depends on the commissioning decisions of NHS and Local Authority budget holders around the country, and there are signs that many of them are going against the agreed policy.

“Prime Minister David Cameron said this summer that: ‘Drugs policy has been a failure over recent years... We have spent too much time on heroin replacement and methadone rather than on trying to get people clean and clear up all the things in their lives that perhaps cause them to take drugs in the first place’. The concordat Watchdog’s ambition is to help support exactly that aim,” explained Concordat convener Deirdre Boyd, who is also CEO of the Addiction Recovery Foundation charity.

Wendy Dawson, chief executive of the award-winning charity Ley Community, and Concordat member and Watchdog adviser said: “The drug and alcohol recovery strategy is vital to the health and welfare of the nation, but it is at risk of being strangled at birth because some central and local civil servants are ignoring government policy. The watchdog will seek to ensure local people and taxpayers are not let down, and commissioning of proper recovery is not stifled by a deadly cocktail of inertia, fear and short-sightedness.”

She added: “The government has recognised that abstinence-based recovery is the best way to save individuals and communities from the cycle of addiction. We have come together to launch this watchdog because no-one - neither government nor national bodies - are doing anything to ensure this vital lifesaving, efficient and crime-preventing strategy is implemented on the ground.”

NOTES

The Home Office set out what it called a ‘major change’ in approach in its Drug Strategy Reducing demand, restricting supply, building recovery: supporting people to live a drug free life, published last December. 

*Budgets for all drug and alcohol treatment has been given to local PCTs who are assessing and commissioning treatment in partnership with local authority partners.

Link to more Concordat Watchdog details.

ESTABLISHMENT OF A ‘WATCHDOG’ FUNCTION FOR DRUG AND ALCOHOL TREATMENT COMMISSIONING

The coalition government has articulated a clear policy for the reform of the drug- and alcohol-treatment sector to make it less bureaucratic, and more focused on producing outcomes in terms of individuals’ recovery from addiction. There are real concerns about the extent to which this policy will be reflected in commissioning decisions of local budget holders. Primary Care Trusts and Local Authorities, through local commissioning partnerships, are now charged with reviewing the expenditure of over £1billion of public money, and ensuring that they remove waste, and introduce more opportunities for real recovery, into their local treatment systems.

In the absence of any government scrutiny mechanism, or disciplinary/whistleblower infrastructure, the Concordat proposes to establish an informal mechanism for assessing commissioners’ progress in this task, and for challenging examples of poor practice.

This will be a two-level approach in that the Concordat will first use all due diligence to establish good practice through effective communications with Commissioners, through a two-way process whereby we communicate to Commissioners what our expectations are around the use of Inpatient and Residential treatment and the benefits in terms of outcomes that its use offers them. At the same time, it will provide a channel through which purchasers can address their concerns about specific Concordat providers or Inpatient and Residential provision in general. Public feedback/whistle blowing and legal challenges will be used only where this first stage fails.

LAUNCH IN HOUSE OF COMMONS
14 SEPTEMBER 2011

Amber Rudd MP is kindly hosting the Concordat Watchdog launch.
The Rt Hon Lord Mancroft and Deirdre Boyd will reveal details.

GRASSROOTS RECOVERY:POCKETS OF GROWTH IN BARREN GROUND

The oft-quoted recovery researcher, writer and advocate William White interviewed Laura Graham about UK grassroots recovery support and advocacy.Our definitive guide offers a wealth of resources.

WW: Recovery advocacy movements can be difficult to track at a global level. They often involve multiple grassroots organisations and activities unfolding simultaneously across expansive geographical regions. This is what is unfolding in the UK. I asked Laura Graham to help connect the dots to see what larger picture is emerging there. In her role with the Addiction Recovery Foundation, Laura has tracked the recent boom in recovery support and advocacy activities in the UK and offers insightful glimpses into these projects and the larger movement. Please join me in this sweeping review.

26-page interview at William White Papers and at Faces and Voices of Recovery.

WW: How would you describe the rise and current state of interest in recovery in the UK?

LG: “Recovery” has become fashionable over the last few years in the UK. However, there is a lot of confusion about recovery means. For many years, we had a drugs policy that had harm reduction at its core. The focus concentrated on reducing crime, reducing blood-borne viruses, and getting as many people into ‘treatment’ as possible. A disgraceful term used to describe the people targeted in this system is pdu, abbreviated from problematic drug user, with an emphasis on heroin and crack cocaine users.

A few years ago, concerns started to be raised about the large numbers of people going into treatment but the tiny proportion leaving drug treatment. It was found that our treatment system developed into a culture of a methadone-script-and-not-much-else service where abstinence-based treatment has become marginalised. Some people have been stuck in this system for years.

There is very little mainstream treatment for people requiring help with drugs other than heroin or crack. Little help exists for alcohol or cannabis dependency and there is terrible denial about our prescription-drug addiction problem.We have a situation where drugs workers, commissioners and others in the field don’t know what residential rehab is, they’ve never been encouraged to visit one or trained how to refer a client to one, never met anybody in recovery nor been to a fellowship or other mutual-aid meeting. It is stunning that only 2% of people seeking help with drug problems have funded access to rehab.

In December 2010, our government published a new drug strategy which attempts to put recovery at its core. Our politicians get it, the public gets it – our civil servants and commissioners don’t, and at times it seems they are determined to undermine it! This sadly means that recovery advocates must work harder to be heard. Our civil servants are supported by a few who have vested interests in retaining the status quo and are putting great effort into rebranding the old system rather than changing it in line with the new strategy. Drug treatment is big business in the UK and for years has been dominated by a few big organisations and others who, it seems, are in no hurry to change the way they work in order to help people get “better than well”.

Despite this, there are some great advocates and advocacy work and they are happy to stand up to this challenge and educate those who need it. I remain optimistic and I can even see some humour in the current debate. You really do have to laugh when you hear people say things like “there are some great drugs to support abstinence” or that people who are abstinent have “hijacked” the very recovery agenda they created.  

WW:  There is a long history of recovery mutual aid in the UK, but recovery advocacy—the mobilisation of people in recovery to create advocacy and peer recovery support organizations distinct from these mutual aid societies—seems a relatively recent development.  How did such a movement develop in the UK?

LG:  I think that in recent years the growth of these groups and recovery advocacy has largely arisen in response to our treatment system which has supported the myth that people don’t recover. The system has grown on the mantra that addiction is a chronically relapsing condition but where are the longitudinal studies to support this? When people in recovery keep hearing that people can’t recover and it is not their experience, or that of their peers, they have to speak up; and the more who do, the more others will. It’s an incredibly powerful message and I believe the system will change as the result. Th e myths and those who use them can’t last.

Many of our really great recovery support organisations have come from people in recovery developing an idea based on what would have helped them but was missing or underdeveloped or poorly designed. Spaces to meet people and socialise is a biggy, advice hubs is another, and support without much else is another. Largely, none of these organisations relied on funding or waited for an evidence base; it’s happened with innovation, determination, skill, hard work and a deep belief that it’s right thing to do.

WW: What are the key organisations that are providing leadership of this movement in England, Scotland and Wales?

LG: I am not sure that we have key leaders representing countries of the UK but we do we have pockets of recovery communities across the UK and it’s relatively easy to identify the leaders or the driving forces within them.

Jacquie Johnston-Lynch at Self Help Addiction Recovery Programme, an abstinence-based structured day facility in Liverpool, and Carl Edwards at the Parkview Project in Liverpool are examples of that. Carl and Jacquie have been at the core of creating an environment for a recovery community to develop up in Liverpool. It was Jacquie and her team at Sharp who instigated the UK’s fi rst national recovery walk in 2009 although, technically, Fraser Ross and the Highlands Faces and Voices of Recovery were the first recovery walk, startring at a ridiculously early time of the morning.

Norman Preddy, Karen Ozzatti and their team at the West Glamorgan Advisory Council on Drugs and Alcohol Abuse in Wales are a similar example. Norman’s recently retired but WGCADA has been in operation for 31 years and does everything from general advice, needle exchange, 12-step treatment, post-treatment aftercare, family support, tenancy support, employer relations, criminal justice involvement, a service user network with its own facilities (the Sun Lounge) and The Pad for young people.

Since 1997, the Domino project has run parallel to all their other services. Development of Motivation In New Outlooks is led by a musician Keith Morgan, and provides activities such as relaxation techniques, assertiveness training, computer classes, sport, gardening, cookery and music. Music is loved here and they have a band called the Box of Frogs where people can learn to play any instrument they choose, they write songs, they produce CDs... People stay involved with Domino for years because it’s such good fun.

ARF, the Addiction Recovery Foundation, have had a major influence on changing the current system. If it wasn’t for people like Deirdre Boyd, none of the current debate would be happening. It hasn’t been easy for her and she has had to take some really tough attacks from detractors but she has never shifted from her advocacy work and is held in huge esteem for it. We’re very lucky to have her although she will probably tell me off for saying it! For many years she was out in the wilderness as a recovery advocate but she carried on. It helps that she has a brain the size of a planet and is utterly charming.

I think we are just starting to assess this moment in our history and where we’re at and where we’re heading. Some early analysis is already being debated and it is interesting to see key moments have included ARF and the importance of UKESAD symposia and Addiction Today, both part of ARF. None of the work of ARF was designed with the sole intention of developing a movement but it has happened organically, a movement has grown up around it as people have gravitated towards it.

WW: How do you see the rising recovery advocacy movement influencing the design and delivery of addiction treatment in the UK?

LG: Earlier this year, ARF were approached by various residential rehabs in the UK concerned about the lack of funded places available to people in need of rehab. After many discussions, the Concordat was formed, convened by ARF. Concordat is made up of 50-60, of the UK’s residential rehab providers, mostly independent and small charities run by people in recovery and some of the larger charities like the Salvation Army and RAPt, to campaign for greater access for people needing rehab.

As I said earlier, currently only 2% of people seeking treatment get referred to rehab and Concordat is hoping to improve access for many more. It is shocking that people seeking treatment are placed on a waiting list when rehabs can provide a place immediately! It is also shocking that people who need help are bumped around inappropriate services for years before they can secure a place in rehab. It’s only since Concordat was formed that these issues are being discussed but some of the evidence now being gathered is horrific – we know of people virtually dying on the doorstep at the rehab or turning up with broken bones and they have been engaged with other treatment services for years! People have to try and exhaust every other avenue first – it’s cruel and inhumane.

Concordat has already achieved a great deal. This has included raising awareness about the lack of access to rehab, educating policy makers and politicians about what residential rehab can do, challenging much of the misinformation, ignorance and mythology about rehabs and gathering data for research. I love working with Concordat who have real passion for what they do in helping people to get well and the dignity with which they conduct their campaign and support each other. The individuals of Concordat speak as one voice with a shared aim and put principles over personalities.

WW: Is anything being done to support and mobilise those who have completed rehab?

LG: Yes, an off shoot of the Concordat is the mighty Graduates! The clue is in the title: they are a network of thousands of people who have graduated from residential rehab and who want to be involved in the Concordat campaign in supporting greater access to rehab. They have also said that they as “graduates” of treatment they don’t feel represented by other groups which have a tendency to focus on “service users”.

Additionally, the recent debates about what recovery is have caused confusion to the point where those who have graduated from treatment are joining “recovery groups” but are having to explain that they are in “abstinent recovery” rather than on substitute drugs and all the other shades of recovery debated by vested interests.

So, now the Graduates have a representative body and they are huge… about 20,000 people from across the UK so far and growing as the word gets round, and this is before any official launch! Already, the Graduates are meeting their local MPs, working locally to raise awareness, challenging perceptions and, as they are drawn from such a diverse population, they bring skills, experience and resources to the party... an army of rehabilitation revolutionaries!

WW: I would like to talk about what you see as innovative approaches to recovery support in the UK.

LG: Perhaps we could start with Riot, or Recovery Is Out There, which is led by the young and handsome James McDermott. James set up Riot, an abstinence-based organisation when he was about six months into his recovery with support from Noreen Oliver OBE, founder of BAC O’Connor, a peer-run residential rehab in Burton. Riot provides recovery champions to local community-based treatment services and criminal justice services. It also works with the local police to go into schools to give talks. I used to work for the National Offender Management Service developing the offender drug strategy and would have Riot join me at conferences to help educate prison staff, police and probation staff . It is so successful that it now has funding for four paid ‘recovery champions’. Alongside ARF, Riot are also members of the UK Recovery Group, a lobby group which campaigns for an improved treatment system in the UK.

WW: If you were to pick an organisation that links music and recovery, what would be the first that comes to mind?

LG: I’ve mentioned Domino’s Box of Frogs. There is also Jim Smith and his Two Different Roads whereby he travels to rehabs across the UK and across the world with his guitar and tells his addiction and recovery story through music, encouraging others to do the same. He’s about to finish touring the US, visiting music projects under a Winston Churchill Fellowship and exchanging expertise internationally.

On a larger scale, we have John Sinclair, former keyboard player with Ozzy Osbourne, now in recovery, who offers Motivation Through Music at this recording studio in the scottish Highlands. He is also part of a project called Rock School where he and a group of musicians travel across the country to engage marginalised young people and adults in a musical performance.

WW: Are there other organisations that integrate the arts into recovery support process?

LG: The Outside Edge Theatre Company, based in London, is an 11-year old "chemically independent" theatre company led by founder and artistic director Phil Fox. The company welcomes anyone affected by substance misuse to be involved in writing, performing and directing plays. They run support groups on Tuesday nights including an informal group of people in early recovery with little or no experience of drama but with an emphasis on having fun, and another group for people further down the road of recovery to develop performance projects. They have just started a women-only group on Thursday evenings. Outside Edge also go into rehabs to stage psychodrama plays to rehearse real-life scenarios and options to prevent relapse.

WW: You have referenced recovery cafés.

LG: Recently, there have been café evenings and day events across the UK providing a local space
for people in recovery to socialise in a safe and welcoming environment. There are the Serenity Cafes in Edinburgh and Newcastle, and the Recovery Link Up Cafes blooming across London. These are great for developing local recovery networks. We are now getting designed-for-purpose recovery cafes, too. The Brink, a recovery social enterprise, is about to open in central Liverpool. It will offer hot and cold food and non-alcoholic drinks seven days and nights per week and intends to promote health and wellbeing initiatives through cultural events. There are plans for bike clubs, baking clubs, yoga clubs… and more.

Later in the year, the O’Connor Gateway Charitable Trust cafe will open, managed and staffed by people who complete the BAC O’Connor abstinence based programme in paid and voluntary work placements. The café will provide a “Victorian style tea-room” with home made food, a shop, an internet café, a gym, complementary therapies and, in the evenings, a drug and alcohol-free lounge with a pool table and wide screen TV’s for major sporting events. There will a space for a broad range of peer-led mutual aid groups including family groups.

WW: Are there other recovery-focused social outlets emerging?

LG: Godspeed (meaning successful journey) is one example. Since November 2009, Godspeed has operated as a monthly nightclub in London’s King Cross led by recovering DJs Tony Gordon (aka Fat Tony), Mark Pavey and Boy George. The venue is an up-market nightclub which, on Godspeed night, has its bar removed and replaced with mocktails (Safe Sex on the Beach, Virgin Mary etc) and no drugs. It attracts people in recovery but also in residential rehab which is a tremendous development. People can go there with their sponsors, recovery groups or on their own.

WW: What other projects come to mind?

LG: The Freedom from Addiction Project: founder and coordinator Gary Topley set up this peer-run and peer-led project in Derbyshire last year for people with alcohol problems. His group meets every Tuesday evening in a space provided in a GP surgery and off ers non-judgemental peer support to promote wellbeing and recovery in a safe environment. The group work through issues relating to alcohol, or plan activities including social events. Last year, the group was offered some wasteland by the Local Authority and they have now established a sizeable allotment where they grow fresh vegetables. The wasteland has been rejuvenated into an oasis of calm, so good for the local community. The group also have training with a local gym and enjoy going out as a group of friends to comedy clubs, a film or the theatre. They would like to do more but are unfunded.

WW: A project we discussed is Recovery Cymru.

LG: Recovery Cymru is a mutual-aid support community in Cardiff for people in or seeking recovery. It was founded by Sarah Davies in March 2010, achieving charity status in January 2011, from the origins of a weekly support group established two years before. RC members have a shared passion about developing and strengthening recovery communities and support and empower people to initiate and continue recovery journeys, exploring skills and interests and improving their quality of life.

RC has a music project, For-Matt, where people learn to play instruments and make music. It has activity groups such as crafts, and “activity Saturdays”. Volunteering in local community events included the “Great Taff Tidy” to clean up the river Taff . RC is at the heart of organising the first welsh Recovery Walk in September. It includes family members, volunteers and professionals; three student doctors will undertake work placements, to understand recovery from addiction. It is supported by the Welsh Assembly government and has full funding for two years.

WW: I’ve recently become interested in projects that integrate athletic competition into recovery support activities. Are there any such projects in the UK?

LG: Sadly, we lost David Bruce earlier this year but his legacy of Glasgow-based Carlton Athletic Recovery Group will hopefully run for years. David established Carg in 1985 as a football team and support group for people in recovery. Based on his own experience of addiction, he was clear that participation at Carg required abstinence and a willingness to change. He wanted Carg to be ambassadors of what addicts can achieve. Carg concentrates on fitness through including running, fitness training and football. David published a book about this in 2005 called Alive and Kicking. Carg members have got involved with adventures including mountain climbing, following the Inca Trail in Peru, marathons,
winning football matches and tournaments, all off their own steam (again, Carg is unfunded), and their own hard work in getting to fitness levels enough to be able to participate.

In Bournemouth, treatment charity Streetscene developed links with Boscombe Celtic football club which was started by a member of staff at Streetscene. People in early recovery there can take part in local Football Association games. Streetscene also have a fishing club.

WW: You made a special plea about the need to include offenders in recovery.

LG: Our prisons are hives of peer support activity. Listener schemes, PADs and RAPt are amazing.

CONCORDAT WELCOMES EATA FOLOWING ITS LEAD

The Concordat of providers of full recovery welcomes eATA following its leadership: the latter will set up a working group to meet in autumn “to advise its interim chief executive on issues affecting residential rehab providers”.

The Concordat has been invited as an observer and is willing to offer its unparalleled expertise in abstinence and full recovery; included in those offering a helping hand are Concordat members who had resigned as eATA trustees this year.

“While EATA has not had a reputation for supporting rehabs, even when more than 20 closed in as many months, we are cautiously optimistic that its interim CEO is willing to consider collaborating on common issues that we might identify,” said a Concordat spokesperson. “We must rebalance our treatment system so that more than 2% of patients manage to get referrals to rehab.”

WHO IS RIGHT? MITCH WINEHOUSE OR PAUL HAYES?

Still grieving for his daughter Amy, Mitch Winehouse is today meeting politicians and the media to urge that waiting times for rehab be cut – and Keith Vaz MP has called for a formal review of waiting times.

 

“But these services (treatment and recovery) are widely available... more than nine out of 10 patients wait less than three weeks for treatment,” claimed an e-blast today publicising a letter by Paul Hayes, CEO of the National Treatment Agency for Substance Misuse, earning a salary similar to the Prime Minister’s.
Who is right?

 Answer: Mitch Winehouse. Read on to learn why...

On 30 July, health secretary Andrew Lansley accused NHS managers of risking lives by making patients wait longer for treatment in a “cynical” bid to save money. Hayes and the NTA do not seem to be an exception (click on Facts for details):

Fact 1. Only 2% of problem drug users in the ‘treatment’ system manage to get rehab; for too many, the waiting list means until death...
Fact 2. ...or not until you have a stroke, break bones, vomit blood – while in taxpayer-funded (non-rehab) ‘treatment’
Fact 3a, Fact 3b. One of Hayes and the NTA’s core tasks was to reduce death from drugs – but they are far higher now than when the NTA was established, with methadone the second-greatest drug killer
Fact 4. The lack of training to get addicts off drugs long term is exemplified by Dr Richard Watson’s letter in The Times blaming rehabs for deaths such as Amy Winehouse’s – when research shows the deaths he referred to were at the NHS Maudsley run by John Strang, a fact Watson admitted on the PM programme (BBC Radio 4, 26 July 2011)
Facts galore. The Centre for Policy Studies analysed a £3.6billion cost to taxpayers of NTA ‘treatment’ keeping addicts dependent on drugs instead of helping them to quit
 
WILL THIS CRISIS GET BETTER?

Not if the eight payment-by-results drug-treatment pilots get their unilateral way. They are supposed to be templates for good prctice in treating addiction across the country. But, as we predicted, they have spurned both government and the general public, drafting Outcome Measures which exclude drug-free/abstinence targets. More details will be at www.addictiontoday.org by 2 August.

SO FEW ADDICTS ARE REFERRED TO REHAB THAT THEY COULD CLOSE PERMANENTLY

Because only 2% of people ‘in treatment’ are referred to rehab, the centres themselves – most founded and run by people in recovery – could close, with irrecoverable loss of the highest recovery skills in the country.

In a real rehab revolution, these marginalised recoverers are working together as The Concordat, to increase access to rehabs for those who need it, and to relieve addicts’ families from their distress. Graduates from Concordat rehabs are also banding together to campaign for access to rehabs which saved their lives. 

Support the Concordat and Mitch Winehouse’s aim to increase access to lifesaving rehab. Contact Deirdre@addictiontoday.org 

PAYMENT by RESULTS PILOTS: RESISTING REFORM

"Drugs Recovery PbR is to be tested out through eight pilot areas to run for one year from 11 October 2011. Problems are inherent from the start," stated a report by the Centre for Policy Studies's Kathy Gyngell.

The PbR plans are intended to be a template for the country in implementing the drug strategy and reducing the annual £3.6billion cost of taxpayers of keeping addicts dependent on drugs instead of helping them to quit. Government's stated goal is to help individuals recover from their addiction; and to contribute to society instead of being a cost to society - contrarily, rehabs and their experts in getting addicts drug-free have been excluded from these templates. 

CPS CRITIQUE OF PbR PLANS

The eight PbR pilots are: Bracknell Forest, Enfield, Kent, Lincolnshire, Oxfordshire, Stockport, Wakefield and Wigan. It is up to local commissioners/Drug Action Teams to decide how much of their significant budgets will be given over to PbR, and whether it will be applied equitably and proportionately across approaches. 

Bracknell is not applying “Payment by Results to their Primary Care Prescribing, the Needle Exchange Scheme or the Supervised Consumption Scheme”. Instead, these will be paid "by activity" without visible evaluation. This begs two questions: what budgets will be left to be assigned to psychosocial or recovery interventions; and what chance will the area pilot have to work when a substantial proportion of clients will be retained on methadone prescribing because there are no incentives to get them off?

Enfield similarly is restricting the scope of PbR to its mentoring scheme, service user programme, and residential treatment components of delivery. 

Wigan proposes to restrict PbR ‘eligibility’ to clients in ‘structured tier three drug treatment services only’ plus dependent alcohol users. Its aim for them appears to relate more to resettlement services – housing, education etc – than providing innovative recovery treatment.

Kent proposes to run “an integrated recovery system” through all the existing treatment tiers, but plans to divest the responsibility of how to do this to a ‘prime provider’ who is likely to be a major drug charity or NH provider. 

The resistance to innovation is also demonstrated by the statement from Wakefield that they have been using an outcomes-focused system for the past two years that “can be quickly adapted to our proposed PbR model”.

Oxford, too, looks to be reluctant to engage in any fundamental change or new and innovative commissioning since it has decided that all its current structured drug and alcohol interventions will simply be re-commissioned under a “Recovery Framework.” It plans also to continue to commission needle exchanges (currently in approximately 40% of pharmacies across the county) on a payment by activity basis. Having said that, it recently opened up communications with a range of providers.

The strength of negativity towards rehab driven abstinence-based recovery is also shown by the example of NE Lincolnshire’s DAAT strategy manager. At a National Treatment Agency round-table discussion of the new strategy, he announced that he had no rehab within 50 miles and “in any case ‘service users’ show no wish to go”. This is despite surveys showing the opposite.

None of the pilots involve change of commissioning personnel – leaving the old guard in charge of 'reform'.  

BENZO REPORTS 2011: CONFLICT OF INTERESTS

Related story on National Addiction Centre and National Treatment Agency reports on Addiction to Medicine. Professor John Strang was lead author of the NAC report.

 

Parliamentary question by Eric Ollerenshaw: To ask the Secretary of State for Health what interests were declared by each author of the recently published National Addiction Centre report on addiction to prescribed medicine. [64022]

Anne Milton: “All academic research is bound by strict codes of conduct such as the Research Councils UK policy and code of conduct on the governance of good research conduct and the UK Research Integrity Office code of conduct for research (Hansard 5 July 2011, col 1186W).

“The National Addictions Centre is part of Kings College London and as such is bound by the college's commitment to maintaining the highest possible standards of integrity and probity in the conduct of academic research. This includes a specific requirement for all possible conflicts of interest to be declared within any tender for externally commissioned work. The authors of the report published by the National Addiction Centre declared no conflicts of interest in their tender for the work commissioned by the Department.”

HOWEVER...

Before reading further, please note:
Genus Pharmaceuticals manufactures Lorazepam, one of the most addictive benzodiazepines, and the same product which brutalised the lives of the Beat the Benzos and APPGITA campaigners.
(Of interest on other issues of overprescribing is that Auralis manufactures diamorphine - ie, heroin, such as used in the Riott trials - and Martindale Pharma is the leading UK supplier of methadone).

“John Strang has received research grant support and/or payment in the form of honoraria, consultancy payments and travel expenses from several pharmaceutical companies that develop new medicines for use in the addiction treatment field (i.e.Genus Pharmaceuticals formerly Britannia, Auralis Pharmaceuticals, Reckitt Benckiser, Schering- Plough, Napp Pharmaceuticals, Martindale/Cardinal and Catalent, Titan and Lanacher Pharmaceuticals)”  (Drug Policy & The Public Good, page 1144).

“John Strang has provided consultancy advice to Britannia/Genus, Auralis, and Martindale Pharmaceuticals; JS and JS’s institution have received support and funding from the Department of Health (England) and National Treatment Agency (England)”  (Supervised injectable heroin or injectable methadone... page 1894).

ADDICTION TO OTC AND PRESCRIBED MEDICINES: UP A PRIMROSE PATH*

Two reports on addiction to prescription and over-the-counter medicines have been created to help government develop policy and services – but they are fatally flawed, omitting critical drugs, ignoring treatment providers they were tasked to contact and hiding possibly 1.5million desperate benzo addicts.

* Defined in the dictionary as “a course of action that seems easy and appropriate but can actually end in calamity”.

 

Print-friendly version:
Download AddictionToday131-Benzo reports
Related notes on conflict of interests
                                                                      A personal story 

On 11 May, health minister Anne Milton informed parliament that two reports on addiction to prescription and over-the-counter medicines had being published. Recognising a lack of information on this subject, the Department of Health had commissioned two reports in 2009/10:

• the National Addiction Centre under Professor John Strang was asked to conduct a literature review of evidence on the scale of the problem and how to respond to dependence on medicines
• the National Treatment Agency for Substance Misuse – senior consultant reporting to delivery director Colin  Bradbury is NAC/NTA’s John Marsden – was asked to contact primary care trusts and treatment providers to investigate prescribing patterns and the help that is currently offered to people who develop problems.

 “These two reports will play a role in informing the future development of policy and services,” Milton explained. “I will lead work to involve relevant organisations and interested individuals to discuss future action in the light of the information contained in the reports.”

The NTA report, Addiction to medicine: an investigation into the configuration and commissioning of treatment services to support those who develop problems with prescription-only or over-the-counter medicine, and the NAC report, The changing use of prescribed benzodiazapines and z-drugs and over-the-counter codeine-containing products in England, can be accessed at www.nta.nhs.uk.

Note that the NAC report title limits drugs covered, excluding prescribed methadone which is more addictive than heroin; it also ignores addictive Clonazepam which is 20 times stronger than diazepam and causes long-term harms.

CONCORDAT COMMENT...

Addiction Today asked Concordat members – treatment providers every one, leading patients to full recovery and totalling 50-60 rehab centres – if the NTA had contacted them as tasked by the DoH above. The unanimous answer was “no”. The 50-60 rehabs were not consulted.

 

BENZO-ADDICT CHAMPION JOHN PERROTT’S COMMENTS...
(Scroll down for Professor Heather Ashton's comments)

  These reports are completely misleading, providing massaged statistics and non-specific terms and spinning myths that there is no  significant problem with addiction to prescribed medicine, especially benzodiazepines.

Scale of problem. A misleading statistic in the NTA report is that “of 32,510 people in drug treatment who reported problems with prescription or over-the-counter medicines only 3,735 were not also using illegal drugs”. This implies that the scale of the problem, which the report states elsewhere cannot be quantified, is only a few thousand people who are not also on opiates. The reality is that the 1.5million prescribed-benzodiazepine addicts estimated by Professor Heather Ashton in 2001 are not in the NTA’s ‘treatment’ regime but remain hidden and under ‘treatment’ by their GPs. To untrained eyes, it might appear that the reports did not look outside the NTA population for figures.

Indeed, elsewhere the reports state that they are unable to assess the scale of the problem even though that was a prime objective. A bit of investigation could have led them to quantify the number of patients addicted to prescribed benzos on a redacted DoH document dated 2009.

Hiding lack of help. The reports state that patients have no difficulty finding local help. In reality, there is little help available and the few charity helplines are inundated. GPs have nowhere to obtain expert help for their patients. The report repeatedly refers to drug treatment centres but does not specify which centres they are referring to, making their inclusion meaningless.

Also, an objective of the report was to conduct an audit of specialist help.  Some of these have still not been contacted, such as The Bristol and District Tranquilliser Project.

Confusing drugs and figures. The reports have mixed up opiates, benzodiazepines and codeine products in the same statistics and presentations. This has resulted in pages of charts confusing iatrogenic and illicit drug problems and disguising failure to quantify the number of patients addicted to prescribed benzodiazepines or to provide an appropriate action plan.

Ignoring withdrawal guidelines. The reports recommend an 8-10 week withdrawal schedule. This disregards current British National Formularly guidelines stating that withdrawal can take up to a year. It is also not consistent with the NHS Clinical Knowledge Summaries provided for doctors’ guidance and based on Ashton’s work. Gaba receptors require time to regain their affinity for Gaba and abrupt withdrawals do not allow this process to take place, leading to acute and protracted withdrawal symptoms.

The reports also state that “there is ‘no optimum rate for tapering or duration”. How can they therefore recommend 8-10 week withdrawal schedules if they are also saying they do not know what an optimum rate or duration is?

The reports further recommend a cut-off point of a maximum of six months for benzo withdrawal. This is not consistent with the recommended rate of withdrawal in the NHS CKS which is 10% of the total dose every two weeks or so and must be flexible and under the patient’s control

Long-term use is not appropriate. The reports state that long-term use is appropriate for recurrent anxiety. This is again contradictory to the BNF guidelines advising that use should be restricted to 2-4 weeks, and to scientific evidence that not only are benzos ineffective as anxiolytics after a few months but they also cause anxiety and other withdrawal symptoms as tolerance occurs.

Withdrawal symptoms. The reports state that withdrawal symptoms do not occur for 2-3 days in short-acting benzos, when in reality they occur after only a few hours: for example, lorazepam has a half life of 8-20 hours. So people on short acting benzodiazepines need regular doses to avoid inter-dose withdrawal symptoms. This is a basic error and further demonstrates lack of knowledge of the subject.

The reports state that there are no problems linked with withdrawal from zolpidem or zalepon. Z drugs work on benzodiazepine receptor sites and thus have the same inherent withdrawal problems, as reported by the few charities offering withdrawal support.

Long-term damage. The reports assert that there is no evidence of anatomical or functional damage after long-term use. But the little research that has been carried out has either been ignored or not followed up; even the MHRA concedes that more research is required.

The DoH did promise to address Professor Malcolm Lader’s 1980 studies showing that seven out of 14 patients on benzos had brain damage. The reports failed to mention it.

Clonazepam should be included. The reason given for excluding Clonazepam is that it is indicated for epilepsy and assumed not to be prescribed for anxiety or insomnia. This is despite the fact that it is widely misprescribed for other indications including insomnia and muscle spasms and is 20 times stronger than diazepam and has caused addiction and long-term damage. There were 589,200 prescriptions for Clonazepam in 2009/10 (Hansard PQ, 31600 21/12/2010).

More work is needed. The NTA and NAC do not know the scale of the problem even though this need was known as far back as Panorama in 2001 – it is estimated that 1.5 million patients are currently addicted to benzos. They need to carry out more research on prevalence, GPRD prescribing data and pharmacy prescribing even though these were the review’s objectives.

The reports state they were unable to consult service users as it “would have necessitated ethical research” . I could not phrase it better.

Serious harm, long-term damage, great suffering and suicides are reported by tranquilliser support charities. Many more will be inevitable if these recommendations are followed.

PROFESSOR HEATHER ASHTON'S COMMENTS...

Unfortunately, neither the NAC nor NTA reports produces a national picture of what is happening in the community, nor do they fully address addiction to pain killers and tranquillisers.  Also, both reports are extraordinarily complacent about the services available to support people who develop problems.

Prescriptions.  The Executive Summary of the NAC report states “Literature on the prevalence of benzodiazepine use and misuse in the UK is limited.”  The same is true of Z-drugs.  So it is impossible to conclude from this review of prescription data how many people are taking benzodiazepines or Z-drugs and how many are dependent on them.

The report (p17) used the Prescription Cost Analysis system, in which 10 prescription items could represent repeat prescriptions for one patient or single prescriptions for 10 different patients. It does not record the indication for the prescriptions nor how many patients become dependent. So this review does not inform, as claimed in its title, “to inform consideration of the extent of dependence and harm”.

The NTA also needs to separate iatrogenic (people who sought medical advise and ended up being maintained by their prescribers) and abuse populations. It appears to have surveyed the wrong population, and a very mixed population at that, including innocent prescribed users on benzos only, and drug abusers on multiple drugs. This is emphasised by its comment that half of benzo or z-drug users were on methadone or buprenorphine – ie, were opiate abusers.

Earlier estimates indicate that there could be over a million people in the first population but these get “lost” in the plethora of prescribing data. The two populations are composed of quite different groups of individuals who require separate considerations and treatments.

Long-term effects. The risk of fatal overdose with benzos is increased not only with heroin but also with other drugs that depress respiration including barbiturates, alcohol, other opioids and other drugs that depress respiration.

The report states that “complete recovery to levels of non-user does occur a few years after stopping”.  It would be more accurate to use “can” instead of “does” since the possibility of irreversible damage is still not resolved.  Only one paper on recovery from cognitive decline 3.5 years after stopping alprazolam is quoted (p72, Killic et al 1999) but there are patients who complain of apparently irreversible tinnitus, muscle spasms, chronic pain and other symptoms lasting many years, apparently related to long-term benzodiazepine use.

The possibility of long-term damage is discussed in the 2011 Supplement to the Ashton Manual 2002 available on www.benzo.org.uk, and also the related question of “recurrences” years after successful benzodiazepine withdrawal.

Withdrawal strategies. The report rightly states the lack of good research evidence on managing benzodiazepine withdrawal. It does not mention substitution with diazepam in patients on short-acting benzods or psychological help, both of which are recommended in the British National Formulary and many literature sources.

Withdrawal symptoms are described in the report but the incidence of these is said to be “only in about 20-30% of patients (Lader 1998)”.  This is a wild estimate which does not specify whether it refers to anxiolytics, hypnotics or benzos prescribed for other reasons, type of patient, dose or other factors and does not take into account that there is a large population of long-term prescribed benzo users in which the incidence of withdrawal symptoms has never been studied.  There is no mention of the observed fact that long-term benzo use can itself cause anxiety (eg, Ashton BJ, Addiction (1987) 82, 665 and Ashton Psychiatric Annals (1995) 25, 158).

The report’s finale that “more research is needed” are empty words for desperate people on long-term prescribed benzo and z-drugs. They will be disillusioned, with their hopes dashed.

IATROGENESIS AND OUR BENZODIAZEPINE SECRET

In June, Addiction Today was contacted by a 50-year old man, Josh, who kindly gave me permission to tell his story in the hope that it will help effect change and help others in a similar situation.

Read related article: NAC and NTA reports.

As an eight year old, Josh was considered to be a “problem child” and his GP prescribed him Librium. Over a short period of time, he became tolerant to the drug so the dose was increased.

As the result, Josh lost out on schooling, his drug-induced lack of energy prevented his engagement in childhood activities such as playing, participating in sport and having friends as, in his own words, other children regarded him as a “freak” due to his zombie-like state from the prescribed drugs.

At the age of 11 years, Josh was placed on Ativan when his behaviour was considered “out of control”. He explains that, as the result of being permanently medicated, he “had to fight harder than most 8-11 year olds in order to function on a daily basis”. After four years of benzo addiction, he “had no idea nor did I feel good about my life”.
In 1998, at Josh’s own request, he stopped taking Ativan and was prescribed Valium.

In April this year, Josh moved to London which meant he had to find a new GP. Josh had remained stable on 12mg of Valium, having steadily reduced his 40mg dose on his on volition over the years. On his first appointment, his GP told him to “reduce or find another practice”. Josh finds it hard to accept that, after 42 years of addiction, when he is starting to get his life on track, a GP with little knowledge of his patient has the power to pull the rug from under his feet without any suggestion of rehab, support groups… nothing. Just “do it or else”.

Understandably, Josh says he is “terrified as the GP has a power over me as a dependent user of a legally prescribed drug” which he has been addicted to for all but the first eight years of his life. The prestigious mental-health charity Mind contacted Josh’s GP to gently request that he review his decision but the GP dismissed Mind as “too laid back” and “very generous” in its attitude to reduction.

There were two reports published recently – one by the National Addiction Centre, one by the National Treatment Agency for Substance Misuse –  which led health minister Anne Milton to believe provided a “national picture of what is happening in the community and how we can address addiction to painkillers and tranquillisers. Most areas of the country have services in place to support people who develop problems”.

However, an analysis of said reports by Heather Ashton, professor of clinical psychopharmacology at the University of Newcastle upon Tyne, found differently.

The reports are careless, looking only within the NTA population for the numbers of people addicted to benzos as the result of prescribing practices like Josh’s, which earlier estimates suggest actually tipped the million-patient point.

As Ashton highlights, services devoted to illegal drug users are currently inappropriate to this population and as such there is very little support or understanding about benzo addiction.

Ashton’s report highlights that withdrawal from benzos can be severe. “There has been a number of suicides, particularly if the withdrawal has not been competently managed…” Ashton points out that “there is a pressing need for… dedicated benzodiazepine withdrawal clinics” because this “iatrogenically dependent population” relies on advice mainly from volunteer projects such as the Bristol and District Tranquilliser Project and Council for Information on Tranquilisers and Antidressants.

We know Josh’s example is common because GPs are happy to prescribe but are not experienced in benzodiazepine withdrawal and there are no specific referral centres to help.

The “official reports” are disappointing. Until the truth about this is out, GPs will continue to prescribe carelessly and millions of people like Josh will continue to suffer as the result of this denial and ignorance.
There are people who will not allow this to continue. They are extraordinarily persistent.

Barry Haslam is one and is working on a documentary Face the Facts, due to be aired on BBC4 radio on 3 August looking at this very subject. He offers facts at www.benzo.org.uk.

Jim Dobbin MP and Mick Behan of the All Party Parliamentary Group on Involuntary Tranquilliser Addiction are other stalwarts and offer information at www.appgita.com website.

Spread the word… people need to know what is going on!

LAURA GRAHAM is an independent consultant undertaking research, and policy and strategy development on substance misuse, mental health and offender management.



BLUE-SKY THINKING

Half a year after the Drug Strategy was launched, stating that “supporting people to live a drug-free is at the heart of our recovery ambition”, what highlights and pitfalls have arisen? David Burrowes MP gives a personal and political overview.

This is, to our knowledge, the first article on drug policy written by a MP since the 2010 general election.

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This article and conferences at which I spoke this summer – the UK/European Symposium on Addictive Disorders and the Royal Society of Psychiatrists – are timely for two reasons.

First, we have had time both to assess the proposals of the new Drugs Strategy and begin to take forward and test its positive and person-centred vision for tackling drug abuse and the devastating effect it has on so many people in this country. This is a moment to consider what role we can all play in sharing and refining this new, necessary and exciting direction.

Second, they are timely because they give me the opportunity to say thank you. I am glad to be able to publicly recognise the excellent work that is being done by so many Addiction Today readers in the sphere of addiction recovery. We all know too well that those who champion recovery and help others attain it have often been undervalued and marginalised – it is your involvement which has led to so many breaking free of addiction.

Despite this, I am conscious that many rehabs are struggling with a lack of referrals and the % of addicts becoming abstinent is too small.

It was witnessing (as a lawyer) damaged lives, the living dead heroin addict with no more aspiration than living off a methadone script and whatever else he could top it up with, the lost opportunities of being good parents and the harm to their children, which motivated me to try and improve the situation locally and nationally.

My first and last client over 11 years was Mark who hoped to weightlift for England; sadly, the only thing he was left lifting was the hatch on his prison cell. His only graduation was in drugs.

I remember people like Mark when discussing drugs and alcohol policy because amid all the statistics and targets we are talking about individuals who are part of families and communities. Drugs and alcohol policy could be so much more ambitious for these people who are often parked on a script or given up on entirely.

THE DRUG STRATEGY’S VISION

The drugs strategy published in December 2010 sets out the cross-government vision for drugs policy and drugs services, avoiding the old territorial mindset, and advocating for local commissioning to help people regain their lives and a healthy place in their communities and families. So let me explain a little further.

The strategy covers prevention, enforcement, treatment and rehabilitation with the goal to reduce illicit drug use and, most importantly, to ensure that more people recover completely from a dependence on drugs. For far too long, the way in which the country had tried to deal with this huge problem just had not worked. The government inherited a dreadful legacy of a failed drug policy. And it is remarkable that, despite significant failures in the past, too many are still wedded to the same status quo. Too many are not embracing opportunities for recovery. Too many in the drugs policy world have never visited a rehab.

The centrally imposed target regime of the last administration saw a lack of real and local accountability, breeding a culture of detachment and distance between a local community, service users trying to tackle their dependence and the service providers trying to support them. There were process targets which considered how many people receive some form of treatment rather than the outcomes. With little sign of recovery in parts of the country, helplessness, cynicism and what has been described as a “culture of discouragement” took hold of many professionals and volunteers, and left service users with a sense of little possibility of real change.

And so the new Drugs Strategy lays out clearly how we can as a country Reduce Demand, Restrict Supply and Build Recovery, as its title emphasises, taking a united approach to breaking up criminal structures, providing clearer information and education and putting individuals at the heart of a system designed to help them return to a life marked by wellbeing and freedom.

It is this renewed focus on the needs of the person struggling with an addiction, an emphasis on a recovery that means the end of dependence but also the enjoyment of a good and stable life, that is most relevant.

Real recovery – a recovery that is not only marked by an absence of substance misuse but also defined by the visible presence of good health, an improved quality of life and sense of wellbeing, and meaningful community involvement and social interaction – is evidence based and achievable. The Centre for Substance Abuse Treatment has said that, even as things stand, 58% of people who have struggled with lifetimes of substance dependence can recover.

As service cultures are challenged and changed, there is scope to see a much higher percentage of people freeing themselves from addictions and restoring their relationships with families and friends. Drug and alcohol dependence does not exist in a vacuum, divorced from other circumstances of a person’s life. Likewise, recovery is not simply a matter of getting people free from injecting heroin or smoking crack, but about the quality of life and relationships a person has, and about active community engagement.

Recovery is not recovery unless it deals with the whole person – their hopes, fears, strengths, weaknesses, ambitions, self esteem and attitude to others. We need a renewed focus on growing each person’s “recovery capital” which is crucial to beginning and sustaining a recovery over months, then years. Such a recovery capital is external – money and property – and the limitations and strains that this places on trying to recover. It is also human: health, skills, education, aspirations and hopes. These make it easier to face the challenges they will come across on the recovery road. And it is cultural: beliefs and values which affect their standards of behaviour.

Any sustained whole-person recovery must drive our attention to the families of those who are addicted and to take account of the quality and character of the relationships involved. This is especially important because a third of the adult treatment population have parental responsibility for a child, and their ability to handle parenthood affects their ability to sustain recovery.

Furthermore, the desire to take an active and positive part in the life of a child can be a powerful motivational factor for recovery. I recall again my client Mark who was in the darkness of addiction and crime until he became a father. He suddenly woke up to a sense of responsibility beyond himself and beyond his addiction.

And Mark was a second- perhaps third-generation addict. If we are to tackle the hurt and damage passed down from generation to generation, we must look at the entire family – grandparent, parent and child – and the assistance and encouragement they might need when relating to an addict in their family.

But as we look forward with optimism and aspiration to what can be achieved – to the powerful possibility of thousands of lives transformed – it is important to remember that these are complex problems because people are complex. No one addict is exactly the same as another. This means that the way in which we build individual recovery strategies, and elements in those strategies, will and should differ person to person.

For some this will mean residential rehab, for others it will not. It is not that methadone has no place in treatment – it does – but as a stabilising base from which to continue a journey to complete recovery. It is a step along the path, but not the finishing line against which we judge success; and it must be accompanied with consistent and complementary psychosocial support.

WE ARE IN THIS TOGETHER

In practice, recovery means individuals or organisations or local government cannot work alone. “We’re in this together” has real meaning in the field of drug and alcohol treatment.

As financial resources are pooled and commissioning becomes a local affair, there is an opportunity to link services and share information and experience. It is here that you will play the most important role.
Government can set the tone and the vision, and provide the resources, but it up to those with special expertise to provide advice and the benefits of their perspective to help identify challenges in their area and specific needs of the people that they support and care for.

Of course existing plans are not perfect. But there has been progress. The NTA is being closed down and Public Health England is being launched with a focus on recovery.

We are reorienting and rebalancing local commissioning towards recovery, supporting significant expansion of abstinence-based treatment.

We are committed to integrating and expanding alcohol treatment and to an inspired, equipped treatment sector achieving full recovery where possible.

We are progressing with a payment-by-results model for outcomes of becoming drug free, reducing offending, getting into employment and improved health and wellbeing.

The government is committed to real recovery. We must do all we can to ensure that institutions and groups supporting people through recovery succeed in this difficult time. The drug strategy will keep our efforts in the right direction.

We will continue to assess what works well and what does not as we progress. The ongoing payment-by-results pilots will be scrutinised carefully – it is important that readers know that we are very open to making whatever alterations and changes prove necessary to ensuring we achieve the recovery outcomes we are aiming for.

PERSONAL PERSPECTIVE

From my point of view, make no mistake about the scale of ambition for recovery to transform individuals, families and communities. I look forward to a time when full recovery is the norm and not the exception; where we see more people living in restored relationships, enjoying the personal freedom, the community engagement, the recovery which we celebrate.

Government can only do so much and  we need recovery champions at every level, willing to take what can work and ensure it is refined and applied to make sure it does work on the ground. This is the next step, I look forward to working with you on this most important of journeys.

DAVID BURROWES MP is PPS to Oliver Letwin, Cabinet minister with responsibility for policy. He was involved in writing the 400-page Addictions section of Breakthrough Britain which initiated current drugs policy.