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Professor McKeganey attacks
harm reduction on three principle
grounds; cost, failure to stem the
spread of hepatitis C, and the
presence of methadone in drug
deaths.
Oddly, he also seems to blame
harm reduction for the take up of drug
use at an increasingly younger age,
increases in cocaine use, and the
growth of parental drug use – perhaps
harm reduction has allowed drug
users to live long enough to become
parents in the first place.
The increase in cost is a result of
the general increase in drug use
which has its roots in the wider
availability of drugs and an increase
in the social conditions that create
the market. A recovery approach has
to be holistic and client-centred and is
not a cheap option. However, if
Professor McKeganey's argument is
for an increase in public expenditure
on drug and alcohol treatment
services, then it is to be applauded.
Hepatitis C is a more robust virus
than HIV and it will only be through
increasing harm reduction measures
that we have any hope of stemming
its spread.
We do not have to fall in line with
the false dichotomy of recovery
versus harm reduction. Interpretation
of research evidence is not always
straightforward but it is our
responsibility to both funders and
service users to make the best use of
it we can. Being drug-free might
obviate the need for harm reduction;
wanting to be drug-free does not.
The successful interlinking of
recovery and harm reduction
approaches will occur if we address
the needs of the individual by helping
service users articulate and achieve
their own goals without pushing our
own opinions and values. For anyone
who has experienced problems with
drugs or alcohol phrases like ‘what
you should do is...’ are all too familiar
and are rarely helpful.
Giles Wheatley, by email
DIFFERENT SIZE FEET
I can’t believe some people. For years
they bang on about abstinence being
the only way forward, and how harm
reduction is a load of rubbish. They
now say ‘is it harm reduction or is it
abstinence – it’s both’. That makes
me cringe.
Is it all about funding and targets?
One word springs to mind –
Hippocratic. For me it’s a personal
journey and what works for one might
not work for others. We all have
different size feet.
Des Whittall, by email
MISLEADING REPORT
Your report of the NTA’s recent
roundtable to discuss recovery (
DDN
,
7 February, p12) gave a useful
summary of the seminar, but
unfortunately was misleading in one
respect.
In my capacity as chair of the
gathering, I summarised the
proposition put forward by some
participants as ‘the system is too big’
and needed to shrink. That view was
proposed by Kathy Gyngell of the
Centre for Policy Studies, and I put it
to the meeting for debate with the
rider, if so, what is the right size for
the treatment system to be?
My view is that any proposal to
downsize has to take account of the
scale of addiction, with those in
treatment in the community accounting
for only half of the estimated 300,000
heroin and crack users in England.This
means that those still outside the
system will continue to be at risk of
bloodborne viruses and drug-related
deaths, they will be denied access to
recovery, and their offending will
continue to be a blight on the lives of
their communities.
In these circumstances, I don’t
think it is sensible to say there are
too many in treatment. If the system
does retrench, for example through
pressures on public spending, then
our challenge is to find and deliver
ever-smarter ways of building recovery
rather than introduce rationing of
services.
Paul Hayes, chief executive, NTA
ABANDON TIME-
WASTER PILOTS
I notice that some adverse comments
on Payment by Results are coming
from those organisations supporting
the NTA’s team of ‘pilots’. A briefing
from UKDPC, and another from
DrugScope, contain subtle knocking of
both abstinence and PbR, and also
omit mention of the most important
factors needed to successfully
combine a lifelong abstinence result
with PbR. Fully justifiable upfront
payments are of course the
reimbursement of a service user’s
bed and board and general living-in
costs. These are around 30 per cent
of an abstinence provider’s total
costs, and result in the addict being
kept away from drugs and crime for
the whole four to nine months he is in
residence – a worthwhile result. But
interim steps in his progress such as
withdrawal, detox, re-education and
improved employability merit no
advance payments until those steps
are fully proved over time.
Any rehabilitation provider with
extended experience of delivering
lasting abstinence knows what seems
to elude the NTA with its lack of
experience in the full recovery field.
Namely that, when an addict enters a
successful abstinence provider’s
premises, he goes immediately into
the withdrawal suite and stops using
there and then, and any humane
provider’s non-drug withdrawal
technology works to alleviate any cold-
turkey effects. As a result the user
stops drug-taking from day one.
This means that the imposition of
a result based on a 12-month drug-
free period from the date of
programme completion is a totally
unnecessary delayed payment burden
for any charitably based provider. If
NTA-favoured providers cannot deliver
this result now, instead of pushing
them into entering expensive pilots
which demand results they know their
rehab systems cannot provide, let’s
abandon this time and money-wasting
needless exercise and start working
with those providers who already
regularly deliver abstinence and who
will work on a PbR basis immediately.
Elisabeth Reichert, school head
INNOVATIVE TOOL
It was great to see your article
Star
quality
highlighting further development
of outcomes tools that enable service
users to make positive changes and
measure these changes (
DDN
, 17
January, page 11).
Open Road has been using a
version of the Outcome Star across
our services in Essex since 2007.
The benefits for staff, service users
and the organisation are fantastic.
Feedback from service users is
overwhelmingly positive – noting its
simplicity and visual appeal. We are
currently producing an independent
evaluation report on the outcomes
achieved by service users as well as
the benefits and impact of using such
an innovative tool, we plan to publish
the report in June 2011.
Joni Thompson, treatment manager,
Open Road
THE REAL KEY
PLANNERS
Because the government has set
‘lasting abstinence’ as the goal of
recovery, a ‘key player’ must now be a
provider who can consistently succeed
in delivering 60 to 80 per cent of his
clients in that abstinent condition.
But how many larger organisations
have such an essential success level,
because to my knowledge, most of
these providers are, as Lord Mancroft
states: ‘getting telephone number
amounts of money for not making
people very much better – just holding
onto them and maintaining them on
drugs’ (
DDN
, 7 February, page 12).
As the bulk of such treatments
are based on methadone or 12-step,
and it is known that their abstinence
rates run from 3 to 25 per cent, it is
clear that the providers with which
the NTA are working are in no way
qualified to regularly deliver ‘lasting
abstinence’ or to depend on being
paid on their results. Hence all the
diversionary fuss.
Better results are obtained by AA,
NA and CA, and in fact, the rehabs
which can and do regularly deliver
lasting abstinence are usually smaller,
have longer duration programmes
than most and, as the chairman of
the APPG observed ‘…know what
works, and we need to bring those
people who haven’t been in the
mainstream into the mainstream’.
As the NTA doesn’t know or have
contact with them, it would be more
effective to widely advertise for those
providers of lasting abstinent
recovery to come forward and meet
ministers with a view to delivering
training intended to convert 25 per
cent success rate rehabs into at
least 60 per cent. Internationally
there are organisations which do this
all the time.
Kenneth Eckersley, CEO Addiction
Recovery Training Services (ARTS)
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