14 | drinkanddrugsnews | August 2012
www.drinkanddrugsnews.com
FOR YEARS
the treatment field has vigorously debated the balance
between reducing harm and helping recovery. I believe we are approaching the
point where we can achieve a genuine consensus that will be of benefit to
practitioners and also to patients. July’s publication of the final report on
recovery-orientated drug treatment (see news, page 5) was the culmination of
nearly two years’ work by the expert group convened in 2010 at the invitation
of the National Treatment Agency.
The interim report in July 2011 on the group’s work had already indicated
the balance we were attempting: to incorporate protection of the long-
established benefits of opioid substitution treatment (OST) while also
supporting the ambitions of the
people who use our services and of
the government’s Drug Strategy
2010 for more heroin users to
recover and break free of
dependence. The group’s final report
goes further in describing how to
meet these legitimate, deliverable
and overdue ambitions.
Our work has benefited greatly from the wealth of expertise and experience
represented on the expert group, and from the contributions of renowned
international experts, including US addiction experts Tom McLellan and Bill
White, who have written an independent commentary on our work that will be
published shortly.
Investment in drug treatment since 2001 has given more people access to
long-term, high-quality treatment, which has substantially improved their health.
England has lower rates of drug-related deaths and blood-borne virus infections
than most of our European and North American neighbours. Our report
describes how we can ally safe, evidence-based recovery-orientated practice to
the public health and wider social benefits we already accrue from treatment.
Entering and staying in treatment, coming off OST and exiting structured
treatment are all important indicators of an individual’s recovery progress, but
they do not in themselves constitute recovery. Recovery is a broader and more
complex journey that incorporates overcoming dependence, reducing risk-taking
behaviour and offending, improving health, functioning as a productive member
of society and becoming personally fulfilled. These recovery outcomes are often
mutually reinforcing.
Overcoming drug dependence is often difficult. According to the research, the
international track record and clinical experience, not everyone who comes into
treatment will succeed. We know from the same sources that it is not possible
An expert group convened by the NTA has made recommendations on
reorientating drug dependence treatment to fit the recovery agenda.
The group’s chair Professor John Strang explains
or ethical to predict which individuals will eventually overcome their dependence.
Some people have a level of personal and other resources (called ‘recovery
capital’) that enables them to stabilise and leave treatment more quickly than
others. Many others have long-term problems and complex needs, meaning their
recovery may take much longer and they require help to build their recovery
capital. But the existence of an accessible, evidence-based, drug treatment
system in every part of England gives us an excellent opportunity to improve on
the past – creating a treatment system that makes every effort to provide the
right package of support to maximise every individual’s chances of recovery.
Well-delivered OST provides a platform of stability and safety that protects
people and creates the time and space for them to move forward in their personal
recovery journeys. OST has an important and legitimate place within recovery-
orientated systems of care. The drug strategy is clear that medication-assisted
recovery can and does happen. We need to ensure OST is the best platform it can
be, but focus equally on the quality, range and purposeful management of the
broader care and support it sits within. Clear and ambitious goals, with timescales
for action, are key components of effective individualised treatment, especially
when working collaboratively with the individual in their planning.
Coming off OST or exiting treatment prematurely can harm individuals,
especially if it leads to relapse, which is also harmful to society. Clinicians and
services need to understand the risks associated with a more ambitious
approach. It requires careful planning and increased support, and inclusion of a
‘safety net’ in case of relapse.
There is no justification for poor-quality treatment anywhere in the system. It is
not acceptable to leave people on OST without actively supporting their recovery
and regularly reviewing the benefits of their treatment (as well as checking,
responding to, and stimulating their readiness for change). Nor is it acceptable to
impose time limits on their treatment that take no account of individual history,
needs and circumstances, or the benefits of continued treatment. Treatment
must be supportive and aspirational, realistic and protective.
Delivering on these ambitions will depend on the continued professionalism
and commitment of drug treatment practitioners, and the development of
systems that integrate clinical care with the wide range of services required to
deliver long-term recovery. It will also depend crucially on the quality of shared
vision and effort from those who are (or have been) dependent on drugs, their
families and communities, and on the government’s continued determination to
tackle this important challenge. Our report describes how more can be
achieved: the task is now to achieve it.
Professor John Strang is chair of the Recovery Orientated Drug Treatment
Expert Group
Treatment |
Substitute medication
Medications in recovery
‘The treatment field has vigorously debated the
balance between reducing harm and helping
recovery. I believe we are approaching the point
where we can achieve a genuine consensus...’