For at least my first decade as Chief Executive of the Addiction Recovery Foundation, campaigning for recovery treatment for addicts and alcoholics, the evidence I presented to government ministers, their ‘health’ expert advisers and even large ‘treatment’ chains as to what worked was met with accusations. I was being “ideological” and representing a “different philosophy” – and worse.
My perceived defect was that I advocated abstinence-based treatment, based not just on my own and countless millions of others’ experience, but also on world-class empirical research published in 1996 with Project Match (an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment).
In my second decade of campaigning for best-practice treatment for recovery from addiction, rigorous research confirmed and consolidated proof for the effectiveness and efficacy of abstinence-based therapy linked to and/or based on the 12-step programme that I and others had advocated. But all efforts to communicate this evidence to the Department of Health’s National Treatment Agency fell on stony ground.
It is true, with the advent of the Conservative-led Coalition Government, the efficacy of abstinence-based rehabilitation was finally acknowledged in the Government’s new drugs strategy.
Well nominally this was the case. But the old approach – the default medical management of ‘clients’ with substitute opiate prescription – was written in too. In the small print. For as has become disappointingly clear over the last four years, while politicians now pay lip-service to rehabilitation, the funding and practice of treatment has not changed.
Rather than investing in the abstinence-based residential rehabs that result in 60 per cent of their clients achieving sobriety and the chance of a new life, funding has continued to pour into the services and providers developed under the Labour government, whose skill, if it can be called that, is to ‘manage’ rather than transform addicts’ lives.
As a result, at least 18 more rehabs have closed under the current Government, on top of the 24 rehabs that gave up the ghost in face of inadequate government-financed referrals in the 24 months up to the last general election. Yet Iain Duncan Smith had promised in the lead-up to the election that rehab capacity would increase tenfold. Instead it has halved. Why is this?
Answer: it is not about best clinical practice but about money, numbers, proxy targets and endless performance management.
Earmarked government expenditure for addressing drug problems has been running at over £1 billion a year for several years. Yet only about £20-30 million of this huge budget is spent funding addicts to recover at the rehabs that have managed through their own enterprise to survive closure. Even so this allocation is not evenly spread but according to how treatment providers work the system. Those businesses and charities who know how to operate in the public sector secure more funding, regardless of the quality of their provision.
Unsurprisingly, given the Department of Health’s historic antipathy to abstinence and its stubborn adherence to counter-productive ‘methadone’ treatment, some treatment providers who stand to gain financially are working with civil servants to redefine rehabs as not necessarily being abstinent!
The Department of Health’s default is still substitution treatment – swapping an illicit drug for a state-provided drug: for example, prescribing methadone for heroin addicts, then prescribing heroin in the very expensive diamorphine form if the methadone does not work. Government ministers who acknowledge that this approach has proved an expensive failure – in welfare terms too – seem to be powerless over these civil servants and their network of advisers. Top civil servants, for their part, have told me that ministers were not specific in their directives, something sadly borne out when I discussed fine-tuning the wording of government guidance with them.
Big Pharma and those others who profit from government largesse always seem to win: witness the unnecessary spending of £1 billion from the public purse on unused flu jabs a few winters ago.
Now we read of the Prime Minister’s public support for pharma “investment” and employment. It might seem promising that the Government now includes alcohol as well as other drugs when it discusses treatment – but is it a fluke that the timing coincides with the launch by pharmaceutical companies of new drugs which are, basically, equivalent to methadone for alcoholics?
The general public might be forgiven for thinking that the strength ranking of research on how to treat addiction indicates strength of accuracy and efficacy. But ranking may simply reflect the number of research trials, which of course multinational ‘pharmas’ have endless resources to fund. The small rehab or intervention therapists can never hope to compete and can only offer the evidence of their experience. The Government is on record as saying this does not count – despite testimony after testimony of successful rehabilitation.
Although there is discussion of this changing, little has happened. Trials with negative results still need not be publicised; only the three best trial results are usually enough to secure official UK or US medical approval. Impartiality and transparency – and users of these products – are sacrificed for commercial gain.
Now we see Big Tobacco and Big Pharma turning to marijuana products. What a gift of a marketing tool that so many pro-legalisers pave the way for them. There will be a high cost to pay. For, financially and personally, it will borne by a society that is still denied the most cost-effective and clinically-effective solutions to the addiction it will drive.
Worse we have a Minister for Drugs in Norman Baker who is seriously considering making cannabis available for pain relief, despite no scientific evidence for it and negligible evidence even for the licensed medicine Sativex. Science, not ideology, should guide his responsibility to the public he is supposed to serve.
His stance belies the fact that legalising drugs demonstrably increases demand and harms – as evidenced by alcohol, tobacco and emerging research on benzodiazepines and prescribed drugs as well as by so called medical marijuana in the United States.
This is a far cry from the hopes we had when the Coalition took power. There is little to choose between its lip-service and Labour’s original policy, something the Centre for Social Justice’s latest report reminds us of.