A problem forgotten

It's a problem that has been getting steadily worse over the last decade, lots of it has to do with the boom in heavy and hard drug use being seen as the 'main' substance misuse issue that our society has to deal with. 

I'm talking about alcohol and more directly about alcoholism, which doesn't seem to bother people anywhere near as much as drug use. To my thinking alcoholism, heroin addiction, even over the counter (OTC) medicine addiction are essentially one and the same in the way they affect the person in the end - addiction is alcoholism is addiction - Any one who just can't stop using a substance when the negative aspects out way the positive aspect of that use, is in big trouble - lies, deceit, denial and total emotional shutdown followed by increasing self-loathing is not far off! 

Another aspect of alcohol abuse that's causing chronic liver problems in people as young as their early twenty's is binge drinking, which has become a very popular pastime indeed. But there is a big difference between an alcoholic and a binge drinker. A friend of mine, Tom, once described this difference as -

"If a doctor tells a binge drinker that he will die within a year if he continues to drink, he will stop straight away. The alcoholic in the same situation, wouldn't be able to"

Why should alcoholics be treated any differently to addicts? Is it because treating them wouldn't bring a big crime rate dividend? 

The National Audit Office (NAO) has recently looked at what the NHS Primary Care Trusts (PCT) have been doing in the way of providing alcohol services. Primary Care Trusts are a very important part of the NHS, and they get about 80% of the total NHS budget. PCTs decide what health services a local community needs, and they are responsible for providing them. 

The NAO found that a quarter of PCTs had not carried out assessments of the problem locally, four in 10 did not have a strategy in place and a third did not know what they were spending on the problem.

Where evidence on investment was available, just £600,000 a year - or 0.1% of the budget - was spent on average.

The report said, because of the lack of co-ordination, the services were not providing value for money.

The NHS spends £2.7bn a year on alcohol abuse, treating ailments such as liver disease. Why not spend a bit more than the frankly laughable amount of £600,000 on trying to stop the problems getting this far along? There are lots of people out there that would respond to a brief intervention from their GP with some aftercare to follow up. Come on, the problems there, now do something about it.

Thank you to the BBC for the facts and figures

NTA's annual figures

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.

Wired In Recovery Support group

I've had a brilliant day of travelling around treatment providers in Cardiff giving a talk to let people know about the new support group we're setting up. The response I got was very encouraging from everywhere I went, although I got drenched while cycling around!

We had our first group last Wednesday, to which the turnout was great for a first group, a whole 4 people! It's going to be happening once a week from now on and is going to consist of a meeting in which participants will discuss their recovery and what's happening from day to day for them. There will be positive feedback encouraged as it's essentially a peer-support group, run by those in recovery, for those in recovery. After that there will be a chill out time for people to get to know each other over a cuppa and a game of pool. 

Well I didn't publish this straight away so it's a couple of days later now and we've had another group since writing this. I've been blown away by the response that I have received from people while telling them about this group. It's so encouraging to be told by people in recovery that they would like to attend this group. I've even had staff members from treatment providers I've visited asking if they can volunteer- it's been an amazing experience!!

I'm going to keep you all posted on how things go.

Heroin addicted elephant is out of rehab

The bull elephant, named Xiguang or Big Brother, has finally finished his 3 year detox program, based on a tropical Island.

He had been force-fed heroin laced bananas by his captors, who were illegal traders based in China, so they would be able to control him. When these captors were arrested in 2005, Big Brother went into 'care' but initial attempts to detox him proved too dangerous as 'even iron chains could not contain him', the Chiana daily newspaper reported.

After this first, failed attempt he was transported to Hainan to start his medicated detox. Here he was given methadone injections at a dosage of 5 times the usual human dose. After a year the frequency of these injections was gradually reduced, at a very slow rate to minimise his discomfort. He was also treated to bathing and massage treatments as part of his detox program. 

Since finishing his program he has been relocated to a new home in the mainland city of Kunming, the capital city of his home province, Yunnan.  

I read this story in the Cardiff Metro newspaper on 5/09/08 and at first it seemed very sad, upseting me greatly. An elephant that couldn't have fully realised what was going on, was put through the hell of living with addiction and withdrawal. On thinking about it further though, it then occured to me that during his detox this elephant had received better treatment than most of the people I know who struggle with substance misuse problems - A holistic detox program which included substitute prescribing in a reduction plan, with massage and hot baths to boot, and to top it off, an aftercare program which included re-housing!

If only the treatment services for human beings were so caring and thorough in the delivery of their service. 

The 'Recovery Movement'

I decided to get involved with the “Recovery Movement’ as I feel the substance misuse field really needs rejuvenating. There is a lot about the field that is good but I’m afraid there is more that is both negative and non-productive. If we all speak up about this, that is addicts, recovered addicts, and all those working in the field, and say what we think about treatment services, the good, the bad and the ugly, then just maybe the policy makers will start listening and actually develop a new, recovery based treatment service that will help more people into sustained recovery from their addictions.

Those with addiction problems should be shown all the treatment/recovery options when they present asking for help, including – abstinence based, maintenance based, counselling, CBT etc, with an explanation of what all of the options entail.

The concept of a ‘Recovery Movement’ is very simple – the joining together of like-minded, ambitious people who are willing to do what they can to adapt the treatment system so it will help more people into sustained recovery. My aim is to highlight the areas, both good and bad, that need looking at with a view to improving them, so that we can maximise the good that this field does for those with substance misuse issues and also remove some of the barriers that are in the way for those seeking to change their behaviour.

There are lots of people and services around the UK that are pushing the recovery agenda on their own, cut off from others who are trying to do the same. By bringing all of these people together, we will make a stronger, louder voice, a voice that will reach Westminster with so much energy, it will demand a response!

Well, they're my thought's on the 'Recovery Movement', to see what the Prof has to say please visit 'The Prof speaks out'.

The black or white approach to treatment

I read with interest the story highlighted on today's Daily Dose - 'Tackling substance abuse in families'. Bruce Thomson starts by saying-

"Debate regarding the most appropriate ways to help people to get off drugs has resulted in what often seem to be polarised positions in favour of either methadone prescribing or abstinence-based interventions."

This has long been the case in the substance misuse field - why it is so I'm not sure, as it is a pointless debate with both sides losing out. In my opinion the "extras" that usually come with abstinence based programs, i.e. counselling, fellowship groups, reflection/meditation groups, one to one/group therapy etc, are what make the difference. 

Why aren't all of these "extra" interventions offered with methadone maintenance or reduction prescribing? I don't see any reasons why they couldn't fit together, in fact, I've worked in a project myself that offered this kind of methadone prescribing service, which was then reduced leading to abstinence as the final goal - with good success rates I'd like to add. To my knowledge this project is the only one of it's kind. It could work just as well with methadone maintenance for those wanting that.

I'd like to see the whole range of interventions being offered to prospective clients with a kind of self-selection (with professional guidance) of the particular services they'd like to have in their recovery program, kind of like choosing what subjects to take for your GCSE's! This way service users aren't being forced into doing something that they don't need just to get the services that will help them. Of course for this to happen there would need to be co-operation between different services throughout treatment, all governed by a new kind of direct access free service, doing the initial assessment, referrals and overseeing/supporting the clients throughout the whole process including the aftercare.

That would be my 'perfect world' answer to substance misuse! No black or white but black AND white - I think I'd call it 'The zebra intervention'!

My experience of methadone reduction

When I went to my first appointment at the CAU (Community Addiction Unit) in Cardiff and asked for help in stopping using heroin and crack cocaine, I was told that they could give me methadone for the heroin addiction and there wasn't anything they could do for the crack habit. So I went on to methadone, starting at 20ml/day.

I told them that I was injecting a lot of heroin ( 1-2 grams/day), so would that amount of methadone be enough for me? I was then advised to 'top up with heroin' until the methadone had gone up to a high enough dose to hold me on it's own, and then to gradually reduce my heroin use. The problem was I couldn't control the amount of heroin I used, that depended solely on the amount of money I had, and nothing else! So I ended up on 120ml/day of methadone and I was still using the same amount, if not more, of heroin. I'd gone in with 2 addictions and come out with 3, in a right daze - basically I was up the creek without a paddle!

When push came to shove and I ended up in hospital, with an unconnected injury, for 8 months, I decided to look into rehab options. I met with my CAU key worker, explained that I wanted to get off the methadone as I wasn't using heroin anymore, and go to a rehab, I was told in no uncertain terms that she thought I wasn't ready for rehab and the local authority wouldn't be funding it.

As it happens that was probably for the best as I found a rehab myself, funded by housing benefit in Cardiff, that had a place for me. So I left hospital and went straight into LivingStones Rehab. I wanted to discuss reducing my methadone, so at this point I went to see my key worker again, really chuffed to be able to give my first negative urine sample(negative for heroin), She said that's great but I'd like to increase your methadone dose, just in case. I couldn't believe it, why raise it? I'd stopped taking heroin, was in a stable environment, with support and they wanted to raise my dose? After a lengthy discussion, she agreed to not increasing it but would have none of it when it came to talk of reducing it.

So I decided to write my own reduction plan, as I was on weekly pickup it was possible for me to measure it myself and discard the remainder. I decided on 10% drops every week, until I was completely off it. I let my key worker know my plan, accepted the flack she gave me and got on with it.

Every time I went in for an appointment after that I ended up being chastised for reducing myself,it was going smoothly but she still wouldn't agree to reducing as I wanted and would only drop it to the level I was on that day, so by the next week I was having to measure it and throw away the excess again. No matter what I said or how I explained it, the CAU would not reduce it for me, worse than that they put every barrier possible in front of me. This went on for months, in fact it wasn't until I was on 8ml/day that they realised I was serious about coming off methadone for good and actually started to reduce it for me when I asked.

At a time when I was taking huge steps forward the CAU were trying to drag me back at every opportunity, that was how it felt to me. I'd go as far to say they made it a lot harder than it could of been, it was only because I was so certain that I was making the right decision did I continue it alone. I didn't want to have to argue my point and defend my position at every appointment, I wanted supporting in what I was doing. It was my decision to reduce and it was a decision I didn't make lightly. But I was forced to fight a pitched battle all the way through my reduction.

It took me just over 5 months to get off 120ml/day of methadone, the sweating went on a lot longer but has also improved vastly! But there is one thing I'd like to know - Why was there so much opposition from the CAU to me coming off methadone? I have my own ideas about that but if there's anyone else out there who can help me understand this, then please let me know!

I'd like to add that I know the way the CAU acted was obviously in accordance with the directives passed down to them, and weren't local decisions. So the real question is - Why is it this way?

Wired In volunteers kick ass!

Earlier today I had a meeting with Rachel, a researcher from a TV production company based in London. The company she works for is looking to make a hard hitting, 2-part documentary about cocaine and heroin, which is planned to cover the whole process involved with drugs, that's everything from the farmers who grow the crops, to the street level user and the drug policy's that effect everyone, across the world.

They are looking for a city in the UK to film the heroin part of the program, and it looks like that city could be Cardiff! Rachel wanted to meet up with our volunteers to find out their feelings and thoughts on the issues facing drug users, how the drug policy's in place affect them and also to see if they wanted to be part of the cast!

Three of our volunteers were there, Chris Hobbs, Patrick McClellan and Brian White. It was a great meeting, everyone got stuck in debating the different issues that drug users are facing, from how people get into it, right through to how people get into recovery and what the treatment services can offer to them. We got on so well that three hours later we were still chatting! 

Rachel seemed to have a passion for the truth and I got a really good feeling about what her company wanted to do. But if there's one thing that stood out for me, it's how proud I felt of the guys there. They've come such a long way in a short time, and for them to be there, meeting with a production company researcher, who wants to put them on prime time! Well I'm filling up just thinking about it. Next stop Hollywood lads!

Everyone of the guy's there was an ex-heroin user. It just shows that addiction can be overcome and it is possible to have a fulfilling, active life after drug addiction. I'm not just talking about a lucky few people who manage to cling on to recovery by the skin of their teeth, I'm saying that EVERYONE who has a drug addiction has the potential within themselves to conquer it and live a free life again. That inner potential just needs to be realised and gently nurtured in a supportive atmosphere.

 

Chronic???

I thought I'd post a blog on the topic covered in an earlier blog by David Clark - 'The nature of addiction:chronic or not?'

In my opinion, addiction can seem like a chronic problem to overcome, especially when you're in the middle of it. There is not only the physical addiction to overcome, with all it can bring along - withdrawals, poor health etc: there is also the mental addiction, and the consequences of this can be far more reaching - lack of confidence, poor self-esteem etc, which can last a lifetime, whether or not that person stops using/drinking or not.

For those addicted to mind altering substances (and by that I mean alcoholics and drug users), understanding mental addiction can be a lot harder than understanding physical addiction. Physical addiction stops from between 1-5 days (depending on which drug or whether it's alcohol) after the last dose has been taken, those days characterised by physical withdrawals. Mental addiction doesn't stop there, it's far more complicated than that, it goes on and on whether or not you're actually physically using. Add to that equation the fact that not many addicts have even heard of something called 'mental addiction', let alone know how to combat and overcome it and you have a set of circumstances that are very, very hard to recover from.

I myself, in the earlier years of my addiction, couldn't understand why after a period of physical abstinence (not using) I would at some point, go back to using drugs addictively. My family figured that as I'd gone back to it, of my own free will, it must have been because I didn't really want to stop. I must admit, with what I understood about addiction at the time, that was the only conclusion I could come up with as well! But the fact was, I didn't want to be an addict.

It was years later that I realised, through contact with an inspirational man who ran the rehab I went to - LivingStones, that whenever I had managed, by a huge act of will, to stop using for any length of time (sometimes a week, sometimes a year), I was still mentally addicted, that was why I'd eventually go back to using. I needed to break my mental addiction to secure any kind of meaningful recovery. 

Breaking my mental addiction was a long process and involved such things as support from those who understand addiction and recovery, a change of the setting I was in, building up a new set of friends, belief that I could achieve my goals ( from myself and those supporting me), having structure in my day and getting involved in voluntary work that boosted my confidence.

So personally, I don't think of the word 'chronic' in a negative sense. To me it portrays the long-term nature of recover from serious substance use problems. Recovery is not something that comes over night - it takes a lot of hard work over a period of time and that is why it is so important to have long-term help and support available. At the moment many treatment services think that putting people, for instance, on a methadone script, is classed as successful treatment - but it's not as simple as this, as I have said above - people need help dealing with all of the other issues in their lives (i.e. the reasons they began using and the problems that have occurred as a result of their using). I think if workers understand the chronic and long term nature of addiction, then the ways that they try to address the problems will be far more effective and longer lasting.

The most important thing is, that if addiction is labelled as a chronic disease then people MUST be made aware that RECOVERY IS POSSIBLE. Calling addiction a chronic disorder and not telling and showing people that addiction can be overcome would be very detrimental to the addict.

All in all I'd say yes, addiction is chronic and yes, it can be overcome.

The Wired In 'Way Forward'

Wired In's strategy was launched today on Daily Dose and I for one think it's bang on! Drug and alcohol services out there should be offering a service based on 'recovery' not simply treatment for treatment's sake.

In an earlier blog I spoke of my experiences of community based drug services in my local area, and how once I was on Methadone my key worker thought her job was done, she couldn't even remember my name without looking on her folder. For people to succeed in obtaining lasting recovery, they need a strong relationship with their worker/s which is led by the client themselves. Without this it becomes very hard to make any meaningful, lasting changes to their lives. 

I'd like to stress I'm not saying all the doctors, CPN's or key-workers I've ever been with, have been of no help to me, because that simply wouldn't be true, my current GP is excellent and I know there are many other excellent workers out there.But, we need more of them and if your in a 'caring job' and aren't enjoying it or you've lost your enthusiasm, then get out, do something else, something that will fulfill you.

The current 'containment' strategy in operation, at prescribing services up and down the country isn't working. Yes substitute prescribing has it's place, but it's not the magical answer to everything.

Vancouver mayoral candidates unite to keep 'shooting gallery' open

In a news conference in downtown Vancouver, four different candidates from two different party's plus a former mayor, came together to deliver a united message to the federal government: stop being ideological, look at the facts, and allow Vancouver's supervised-injection site to stay open.

Non-Partisan Association (NPA) Councillor, Peter Ladner said he realizes that it bothers some policy-makers that people who use the site often have to commit crimes and always have to buy illegal drugs on the street in order to be there, but they have to realize the site has community support and is a humanitarian response to a terrible health crisis.

As covered in an earlier blog, the supervised injecting site was recently reviewed by an expert advisory committee commissioned by Health Minister, Tony Clement to decide whether or not the site was having favourable results in the community it serves. Their findings showed the site was doing just that, providing health benefits without increasing harm.

A member of that panel, Dr Thomas Kerr, a researcher with the Centre for Excellence on HIV/AIDS, commented, "Now it's time for the federal government to honour the findings and stop asking if this program should remain open."

The site's current exemption from federal drug laws expires June 30, but Federal Health Minister Tony Clement hasn't yet said whether he will extend the pass and allow the site to remain open.

Why is it that after fighting to get this place open in the first place, and it being proven to benefit the local community, that it's future still isn't guaranteed? Far from looking to close it, the Canadian Government should be heralding this project as the success it is, and promoting it across Canada and the World as a whole. I for one would welcome this kind of provision in the UK. When our Government is looking for 'new' strategy's why don't they look at what's working in other Countries and follow their example?

It's time for a whole new approach to 'recovery' in the UK.

Alan Carr's "Easy way to stop smoking"

I started to read this book last night and was absolutely stunned by the claims it made. Apparently 90% of the people who go through Allen Carr's EASYWAY clinics, kick the smoking habit for good. As anybody in the addiction field will know these statistics are the thing of dreams for any of the services offering help with addiction, world wide.

I've only just scratched the surface of this book, but it set my mind thinking, what, fundamentally, is the difference to being addicted to nicotine or any other substance? If these claims are true, they must obviously work on a psychological level, changing the way we think, which then leads on to a change in the physical state, changing the way we feel and act.

I don't know how substantiated these claims are or whether or not the same principles this method uses could be applied to other addictive drugs.

Has anybody else read this book or gone to Allen Carr's clinics? If so, did it work for you?

I'll keep you posted as I go along

Your Country needs YOU!!

I'm still tamping about that insulting advertising campaign I wrote about yesterday, so today I decided a call to action was needed.

One voice can make a difference if we're bold enough to speak loudly, from the right platform. The internet gives us all that platform, if we want it. I for one have had quite enough of the largely ineffectual drug and alcohol services in this Country. Yes, there are some that are very good and make a great deal of difference to alot of people. But these services are few and far between and from what I've experienced, they tend to be self sustaining, choosing not to receive money from the government.

If you are putting up with a service that isn't up to scratch it's time to complain. We all deserve to receive the best treatment and this simply isn't happening in large areas of Britain. By speaking out it will help to identify areas in need and get the ball rolling in improving health services for everyone. Let's put the GREAT back into Britain.