I've been following with interest the debate that has followed since the release of the NTA's annual figures. Mark Easton, the BBC's home editor has reported on what he, like many others, sees as the farce that the NTA is trying to sell.
The NTA's figures concentrate on having 202,000 people in treatment last year but the people that left treatment drug-free was a bit lower - 7,324! I notice that they aren't shouting about that one! The NTA's focus is on getting people into treatment, that much is obvious, but for only a short time - 12 weeks. I say this because they have targets of 'retention in treatment' in which the box is ticked once people have lasted 12 weeks. But they don't have any targets for people leaving treatment drug-free! How can this be?
It seems to me that it's because the NTA aren't interested in getting people out the other side of treatment drug-free but rather more interested in getting people in for 12 weeks and job done! They don't care whether or not the service user achieves abstinence but rather that they are retained in treatment. The reason? So the public will think they're doing a good job and sleep safely in their beds tonight.
They do this by refusing point-blank to reduce the amount of methadone an individual will be receiving. It doesn't matter whether that person is stable, giving clear urine tests and meeting every demand they have. They will not reduce that methadone or send you to rehab, because they are scared to death that people will achieve a stable drug-free recovery and that will put them out of a job. The whole system stinks and people are starting to realise that, the charade is coming to an end. As the saying goes - you can't fool all the people all the time!
Millions upon millions are being wasted because the NTA won't admit they are wrong and change direction to focus on recovery and the things that will aid recovery, and not just keep on with their present tack of treatment for treatments sake, which, as their figures show, isn't actually helping many people to achieve drug-free lives. My fear is that when the public, as a whole, realise this there will be such a outrage at the wasted money that the drug and alcohol field's budget will be slashed and we'll be lucky to help many people at all.
5 comments:
I don't agree that they don't want to reduce methadone doses because they are "afraid" people will recover and they will lose their jobs. Are there any people who might be so cold and calculating? Probably. Is an entire industry of people who trained in the field of working with addicts (a thankless & low paying job for many)really that cruel and heartless?
The fact is that the vast majority of those tapering off methadone relapse within one year--most within 3 months. In the USA this figure tops 90%--and this in a country where abstinence based treatment is the norm, not the exception, and where there is much more access (though still not enough) to abstinence based treatment and support services. The fact is, opiate addiction is a serious, biochemical brain disorder, and full recovery from it is NOT the norm, despite the best efforts of patient and treatment team.
Abstinence based treatment is still mired in ideas from the 1930's that call addiction a "spiritual malady" and treat it with prayer, meditation, finding God, making sin lists, and confession. No other illness is treated with ideas that have not moved forward in 70 years and are based not in evidence and science, but in religion.
Although some people can indeed recover fully--even some with long term addiction issues--that is not the norm. Everyone should have that opportunity if they so desire--and by that I mean anyone wishing to taper off methadone and try for a drug free life should be given that opportunity, as long as they are fully informed of the possible risks and benefits of doing so--so in that, I agree with you. But I think it is likely that many of those who do not want to decrease their patients doses are doing so not out of greed or avarice, but from having seen what happens over and over when they do so--relapse, death, jail, loss of family, etc--and are just trying to prevent their patients from going that route when they may be doing well at the time in treatment.
This is just a ridiculous rant.
ok the NTA's targets and measurements are a nightmare and do not reflect real life. For some long term methadone treatment on a dose they are happy with is recovery regardless of who else defines it as 'drug free' this means these people are never going to 'complete treatment' but in fact they are leading full productive and more importantly 'happy' lives. Others may chose to aim for abstinance that to is fine if thats what they want even if it means relapsing on a regular basis that may be what they want- the measurements take no account of this and yet still my job depends on these boxes
Why with everyone trying to enable drug get the support they need is their this either/or approach. Neither abstinance based services nor harm reduction services have the answer for everyone. It should be about choice and access to appropriate services when the client is motivated. All these this is the way to do it/ measure it rants are a waste of time. Lets just work together and listen to each other to create better services not evangelise about our own little philosophies!
Great blog. More please
I have no quarrel with those who are content and happy to remain on methadone for the rest of their life, even though my personal view is that many of them are probably capable of becoming drug free, however if that is not their choice so be it.
I have the same view on smokers and drinkers, the difference is that they are obliged to fund their own choices.
In fact i have no quarrel with anyone who chooses to use whatever drugs they opt for, providing they are able to fund their choice with their own resources, but I do object to funding 'lifestyle choices'through taxes, especially when I read of those people with a variety of treatable conditions, who because of the decisions by NICE are having to fund their own treatment.
The views on recovery are always interesting to read as indeed are the figures of those who can and cannot recover, most of which seem to have been plucked out of thin air, or based on flawed research, or hearsay.
Addiction is addiction, it's an ugly name for an ugly intractable chronic relapsing condition, and yet millions, yes millions of people around the world one way or another manage to recover, and apart from co-occuring disorders which may have existed before addiction set in, or arose as the resullt of addiction, manage to live a drug free life.
Prof Neil McKeganey gave the facts and figures from Australian research in an issue of DDN earlier this year which showed that some 40 per cent of those who had become addicted to heroin had managed to become drug free. I would also point those who are interested in becoming drug free to the following:
http://www.holisticdetoxification.comopiod_addiction.php and
Heroin dependence in an English Town 33 year follow up. http//bjp.rcpsych.org/cgi/content/full/187/5/4/421
Insofar as the NTA ias concerned they've lost the plot, they simply do not understand the difference between treatment and recovery, or abstinence and sobriety. As such it is a miracle, which is more due to the resilience of service users, than treatment protocols which has allowed so few people to emerge from their clutches drug free. In fact they are so useless at helping those who want to become drug free, that they are now seeking to redefine recovery to included ongoing drug use.See www.edenlodgepractice.com and click on reducing drug use.
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