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Drug treatment - success or failure?

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Mark Easton | 10:58 UK time, Friday, 3 October 2008

Drug treatment officials were busy rubbishing my journalism yesterday afternoon, telling anyone who would listen that the man from the BBC had got his figures wrong. (Listen to my report on the Today programme)

I wouldn't burden you with details of the statistical spat, except I think the episode goes to the heart of the debate over what England's half a billion pounds a year drug treatment programme is for.

The National Treatment Agency (NTA) yesterday published its annual figures showing yet another big increase in the numbers of people who were on the drug treatment programme last year - 202,000 altogether. (Trebles all round - government target achieved in style.)

Not mentioned in the press notice, discretely lodged in a table near the bottom of the data release, was the number of people who left the treatment programme drug-free last year - 7,324

What I did, and what so infuriated the people at the NTA, was to compare the two. The arithmetic was pretty simple. Just 3.6% of those in treatment were discharged free of illegal drugs.

They didn't like that - not one bit. An email was sent out from the press office steering other journalists away from doing the same sum. "Just in case anyone is tempted to follow the BBC's 3.6% figure", warned Director of Communications Jon Hibbs, "we think this is a misleading way to interpret the data: it's like measuring a school's GCSE success by counting the number of A grades as proportion of the total school population".

The NTA prefer to focus on the number in treatment and the number retained for 12 weeks - the government's measures of success. There is no target for getting people off drugs.

If pressed, they will argue that the data shows that those who left drug-free represent 11% of those who were discharged from treatment.

That looks a bit better. But do you see what they've done? They have ignored the tens of thousands of people who are in drug treatment but were not discharged.

People like Andrew Walters who I met in Sunderland this week who has spent ten years on methadone for his heroin addiction.Andrew Walters

Andrew is supposedly part of the drug treatment success story. He has appeared in the statistics for a decade but he says no-one seems interested in trying to get him clean.

"It's like everyone's give up on you", he tells me. Andrew pleaded to be allowed to get into residential rehab, but each time he was turned down. "On five separate occasions I asked them. Five times. I just got put to one side."

Methadone may have helped him untangle some of the chaos in his life, but in his view it has got him no nearer getting off drugs. He's just been parked. "They like giving methadone out", he says. "If you ask to top up your methadone they'll put it up without any questions."

But he doesn't want to be on methadone - a "vile drug" he calls it. It has rotted his teeth and ruled his daily routine. "I was just topping off with heroin", he admits.

When I first pointed out the very small proportion of users who left England's treatment programme drug free on the BBC Today programme last year, in the words of one academic in the field, it set off a small nuclear explosion in the drugs world.

The system had been patting itself on the back for getting lots of people signed up for treatment but people had not noticed what happened afterwards. The focus was on inputs not outcomes.

A debate many had thought won and lost a decade ago was reopened. Should the aim of drug treatment be to reduce harm or get people off drugs?

The harm reductionists had long ruled the roost with a philosophy of helping people who misuse drugs get their lives straight so crime and health risks were reduced. It is a worthy aim but some in the drugs field believed the system needed to be more ambitious.

In a report sent to drug teams this week, the NTA itself bemoans the way that residential services are too often used "as a last resort rather than as a concerted attempt to achieve long-term abstinence earlier in a drug-using career."
"This has led to unsatisfactory outcomes for all involved", it notes.

It was more than 'unsatisfactory'; it was very nearly fatal for Andrew who attempted suicide after being turned down for rehab. "The only reason they found me was my room in the bedsit place was above the office and they heard me hit the floor" he tells me. "They come in and I still had the needle in my body."

If you look at the figures published yesterday you see that last year 79,619 people were in treatment for the whole year. One of those was Andrew. The vast majority will be heroin addicts who are on prescriptions for methadone or another substitute. They may be in treatment for a long time to come.

It is not easy to get someone off drugs. It can take years and there may well be many false dawns on the way. But that doesn't mean we shouldn't try.

Professor David Best, an internationally renowned expert on drugs, is about to publish new research into what helped a cohort of ex-addicts get clean. "The only type of formal treatment service that was often cited as being among 'the key things that finally helped you to become abstinent' was residential rehabilitation", he reports.

Professor Best goes on to criticise the lack of ambition in the system. "The experiences of this population are at odds with the 'chronic, relapsing condition' mantra which pervades UK drug services", he writes.

The latest figures show that 147,000 of the individuals in treatment were being given prescribed medication - 74% of all those on the programme. How many accessed residential rehab? The data shows it was less than 5,000 - around 2% of the treatment population.

So I make no apology for comparing the total number of people in treatment with the number who leave the system drug free. To do otherwise would be to ignore the plight of those, like Andrew, who want to get clean but are not given the help.


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