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paradigm should have been shattered by the
‘failure’ of Project MATCH, but it still dominates
research. In psychotherapy generally, things have
decisively moved on with the American
Psychological Association’s recognition that
evidence-based relationships must take their place
alongside evidence-based treatments:
2
‘It reflects
an inexorable, evidence-based recognition that the
relationship is a common denominator that brings
diverse clinicians together.’
3
1 http://bit.ly/ZYN2pW;
2 http://bit.ly/1FSXPmW;
3 http://bit.ly/1DXlXml
Mike Ashton, editor, Drug and Alcohol Findings,
http://findings.org.uk
‘A LANDSCAPE WITH
CONFLICTING PRIORITIES’
THE NATIONAL TREATMENT AGENCY
had strong
political support during the past decade for its very
clear mission to improve the quality and quantity of
drug treatment. We actively supported local areas,
set targets, asked challenging questions and
introduced a recovery ambition.
As Public Health England, we have a much
broader interest in alcohol and drugs, in prevention,
treatment and recovery and in health inequalities.
Local government is now in the lead; we support
them through reflecting their performance back to
them, promoting the evidence and providing
bespoke support to them and providers to deliver
safe and cost-effective services. Some things
remain constant, but the landscape is now more
complex, with conflicting priorities and an un-ring-
fenced treatment funding pot.
Substantial investment expanded the sector
massively; many more people started treatment
quickly and stayed long enough to see real health
benefits. The introduction of ambitious evidenced-
based prison treatment helped close the gap
between prison and community drug treatment.
The centrality of links between effective
treatment and crime reduction was a key driver and
the emphasis on recovery introduced greater
ambition, ensuring a positive shift towards more
active and personalised treatment, often
harnessing and enhancing mutual aid and peer-led
initiatives. During this time we developed a world
class data system and accumulated evidence of
what works, so our guidance and support is now
well developed and highly regarded, with the
system delivering much improved outcomes.
Of late, the most significant development has
been the transfer of commissioning to local
authorities, with the loss of partnership
commissioning and protected funding.
Who knows what the sector might look like by
2024, but hopefully it will be responsive to new
populations of users, valued by local authorities,
health and criminal justice partners and the public.
It should certainly be more aligned with broader
services – training and employment, housing,
families, mental and sexual health – better
integrated with local initiatives, and most
importantly, seen to be delivering first class
outcomes for the whole community.
Rosanna O’Connor, director of alcohol and drugs,
Public Health England (PHE)
‘TEN YEARS AGO IT WAS
ABOUT GETTING EVERYONE
ON A SCRIPT’
I HAVE WORKED
in the drug and alcohol field for the
past ten years and have seen a dramatic change in not
only our way of working but also in the types of drugs
used. When I started, it was a case of getting everyone
on a script and keeping them there. It felt as though
the government believed that if drug users were on a
script then crime would disappear (of course it never
did). The only therapy was one-to-one key working,
which on its own proved not to work for many.
The emergence of recovery started a few years ago
and appears to have blossomed. Sadly not enough
staff were trained in it and still few are – it’s always
been a case of just running with it. Group work and
‘In Wales, service
users have grown
in confidence.’
MARTIN BLAKEBROUGH
‘Evidence-based
relationships must
take their place.’
MIKE ASHTON
‘Local government
is now in the lead.’
ROSANNA O’CONNOR
November 2014 |
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