The Guardian newspaper at the weekend produced an article entitled “David Cameron shifts drug addicts treatment to live-in schemes” which stated that the Prime Minister has requested a revised drug policy to be in place by the end of the year.
They report that in PM Direct debate this week David Cameron stated…
“The last government became too target obsessed. It was all about how many addicts are in touch with treatment agencies, and this, in too many cases, really meant the addict was talking to someone and maybe getting some methadone, which is a government authorised form of opium, rather than heroin. It did not really address the problem – that [the addict] had a drug habit.
“I would like to … try to provide – difficult though it will be given the shortage of money we have been left – more residential treatment programmes. In the end, the way you get drug addicts clean is by getting them off drugs altogether, challenging their addiction rather than just replacing one opiate with another.”
I thoroughly agree with Mr Cameron that the last government was totally target obsessed, something that I have blogged about in the past, but I cannot agree with the idea that we need to promote residential rehabilitation over substitute prescribing. We also aren’t very good about moving people through the treatment system and pursuing abstinence. However, it is not quite as straightforward as Mr Cameron would like it to seem.
Dealing with addicts is a tricky business at times. They are often very opinionated about the type of treatment they would like to have, they can be difficult to engage and they are often very resilient. As individuals they can be extremely challenging, which in a weird way is one of the joys of working with them.
There are several difficulties with promoting residential rehabilitation as the primary form of treatment.
1) The cost. A stay in residential rehabilitation will cost approximately £8000 – £12000 for a 6 month stay, and that is a conservative costing. In 2008 the National Treatment Outcome Research Study estimated that methadone would cost on average £55 per person per week. A cost of £2,860 per person per year. Whilst we may not always like it, substitute prescribing is far cheaper than residential treatment.
2) The readiness of the client. When I used to send people to residential rehab I had to do loads of preparation work with them. We had to consider whether they were suitable for inpatient treatment and what might be the right resource for them. We expected them to be stable in treatment and engaging in group work in the community. In reality, not every client is ready to go to rehab. They need to find the point when they are prepared, physically and emotionally, to enter ongoing long term treatment. For some people this will never happen.
3) Maintenance treatment reduces crime. People who are maintained on methadone need to engage in less (ideally no) criminal activity to fund their habit. This benefits the wider community.
4) Maintenance treatment improves healthcare in patients. If individuals no longer have to engage in unsafe injecting practices they are less likely to be hospitalised with major illnesses and injuries caused by illicit drugs use. This could be anything from overdose to DVT’s to falling off a bridge whilst under the influence etc.
These are just a few issues related to the maintenance in the community vs. residential rehabilitation debate. However, I feel I should add a caveat to this. My comments here might lead some people to think that I would rather see people opiate dependent than becoming drug-free. This is categorically untrue. One of the biggest pleasures I had was seeing people progress through rehab and become drug free. Those people undoubtedly had the best chance of achieving lifelong, sustainable change and being able to be a fully functioning member of society. However, I also had to recognise that some people just were not in the place to be able to make those changes. They hadn’t reached the stage in their lives where they were able to consider a life without drugs.
To quote David Cameron again when he said
“It was all about how many addicts are in touch with treatment agencies, and this, in too many cases, really meant the addict was talking to someone and maybe getting some methadone, which is a government authorised form of opium, rather than heroin. It did not really address the problem – that [the addict] had a drug habit.”
If the government want to invest in making positive changes to drug treatment then they should be providing the funding for services to be able to train their drug and alcohol workers to make them highly professional and specialised workers. It is almost impossible to underestimate what a difference a really fantastic worker can make to the client. That therapeutic relationship can really lead to change, whether it be motivational work in order to help people progress onto more intensive treatment, or whether they are discussing harm minimisation practices. A good drug worker is part of the journey, they are not just “someone to talk to”; they are treatment in and of themselves.
Anyway, I don’t know what I am ranting about this. They are going to reduce investment in drug treatment in 2012 so there will probably be no changes anyway!