Evidence Based Treatment

Evidence based treatment.... how often do we hear the phrase and what does it actually mean? It is supposed to mean that treatment is based on "what works" and that "what works" has been scientifically validated by research. However.....

Here in the UK we consistently ignore evidence that does not suit the political agenda. There is a wealth of research on the effects of addiction on the brain - using various brain imaging techniques - that demonstrates that the effects that drugs have on the brain and which show that the human brain does not show signs of recovery until a considerable period of abstinence has passed. Without going into a small book this research has considerable imlications for the treatment of chemical dependency. Walk into 100 or so alcohol and/or drug agencies up and down the country and ask if any of the staff are even aware of this research and you will find not.

This week an American psychiatrist was quoted as saying that the brains of compulsive gamblers also show similar abnormal scans and it is also a known fact that Naltrexone has been researched in the US as a potential treatment for compulsive gambling.

We also know that there is a distinct correlation between the availability of "addictive" substances and behaviours and the number of people exhibiting problems. Do we take all this evidence into acount? Do we hell - it just doesn't suit the governments agenda! Lets roll out 24 hour drinking and loads of casinos. Then act suprised when the number of people with alcohol and gambling related problems goes up! It will, the all the evidence predicts that it will - but we will ignore the evidence when it doesn't suit us!

Consider the so called "assessment" of individuals with alcohol and other drug related problems. There is a wealth of evidence that shows that there is substance use, substance abuse and substance dependency. The evidence also shows that these are distinct conditions with distinct needs in terms of treatment. Do all alcohol and drug services then actually sit down and diagnose which of these groups an individual falls into? No most do not, and consequently most treatment is inapropriate not to mention ineffective. Why is this? Because dependency requires intensive skilled (and often residential) treatment and the system is generally speaking not geared up to provide this.

It is easier for services to train staff to deliver MET or SFBT (it requires a short 3 day course in many peoples eyes!) than it is to train staff for the year or so required to deliver abstinence based services.

Don't get me wrong - I have nothing against Motivational Enhancement Therapy or Solution Focussed Brief Therapy - with the right individuals at the right time there is no doubt of it's effeciveness. For the rest of the client group however is a sentence to failure and dissilusionment with treatment.

Lets carry on then, blame the clients when treastment fails and concentrate on what is usually economics rather than the real evidence!

The price of drugs......

News reports in today's press state that the price of heroin per gram is now £40 as opposed to £60 a few years back. The general drift of the articles is that Britains streets will now be "flooded with cheap heroin".

Its interesting to note that when I got clean in 1986 the average price was around £60 to £80 per gram. I guess that if you take inflation into acount then in real terms the price is even cheaper now comparatively speaking.

While I have no doubt that there is a direct relationship between availability and usuage I don't think that the picture is quite as simple as the economic model suggests.

I cast my mind back to when I started using heroin in the early 1960's:

• After a couple of initial hits which were obtained by buying from "friends" who had legal supplies I pretty quickly decided to get "registered" as they called it in those days and to get supplies from a doctor. I would not only be able to have heroin legally but I would have more - always a good idea if you are an addict!

• You might think that it was hard to find a doctor - it wasn't, there were about half a dozen in London who would more or less prescribe to anyone who walked through the door with the requisite cash (about £5) for a private prescription and who said that they had a heroin habit. It was so easy that I not only walked out the door with a prescription for heroin - I had one for cocaine as well! (The doctor asked if I used cocaine as well as heroin - I am an addict so what was I going to say? In reality I had never even used cocaine up until this point.
  

The whole scene in these days revolved around Boots the Chemist in Picadilly circus in Central London. (It was open all night and you could cash a prescription at a minute past midnight!). Pretty soon I was swoping doctors trying to get a bigger prescription and there was even a period when I was getting Methedrine on prescription as well! Yep, you read that right - heroin, cocaine and methedrine on prescription!

I can't say that my life was very manageable around this time or that I was functioning well - I wasn't - and all this was shortly to come to an end.

The end came when the Government acted on the recommendations of the 2nd Brain report which came out in 1965. You see there had been a panic - the number ok known heroin addicts in the UK had gone up to the dizzy heights of around 2,000! (A very large proportion of those actually came from Canada and the USA because of this setup!) This was enough to trigger a panic. (I bet that the "powers that be" would be more than happy with 20,000 today.)

So the law changed and all the prescribing stoped. It was decided that "psychiatrists in special drug dependency clinics" was the way to go.

Why am I telling you all this history? Because up until that point I had never seen street drugs on sale in the UK.

I can tell you however that within a couple of weeks I was buying heroin from the Chinese community in Gerrard Street.

The price? £1 a bag initially. After a police crackdown the price went up to the dizzy heights of £70 for a quater ounce. What I believe happened was that the government legislation actually created an economic climate which made it profitable to import drugs. There was plenty wrong with the so called "British System" but at least the market was dominated by dodgy doctors rather than Gangsters and in fact the gangsters couldn't compete with the "dodgy doctors" plus Boots the Chemist.

The moral? There are now between 150,000 and 300,000 heroin addicts in the UK and the "experts" who presided over this disaster are still in charge! In what other field could the scale of the problem increase 150 times over and we would still listen to these people?

Alcohol and other drugs......

I had a telephone call from a well known National newspaper today asking if I could give any details of anyone that I knew of who had died of a heroin overdose recently - the idea was to establish some kind of a link to the price of heroin coming down.

What is it in this country? More people die of overdoses involving Methadone- prescribed or otherwise - and admitedly usually used in conjunction with other drugs than heroin. However all the total drug deaths pall into insignificance when compared to alcohol and tobacco related deaths.

If one teenager takes an ecstasy tablet and dies then its all over the media for a few days, but I have yet to see the same sensational headlines about the 100 or so alcohol related deaths each day. That might well change however as thanks to the "National Alcohol Harm Reduction Strategy" and longer opening hours the numbers are rising rapidly.

It is very interesting to contrast the differences between the Alcohol and Drug Strategies however...

For Drugs: We must reduce the supply and we will lock up the suppliers for life for preying on the inocent victims.

For Alcohol: It is the consumers fault for not drinking sensibly and we will involve the suppliers in writing the strategy and do all that we can to make it easier to obtain supplies in the name of consumer choice!

Of course the Government taxes alcohol and tobacco but not drugs. Could there be a connection we wonder?

Why do the media fail to see all the inconsistencies and lack of logic in all this? Uhmm? Answers on a postcard please!

Welcome!

We now live in strange times - SAGA were recently offering cut price tickets for the latest Rolling Stones concerts and there were many of us who, in the 60's never really made plans on being around now.

The Rolling Stones are themselves now more brown corderoy than brown sugar and on the same day that the Daily Mail published pictures of old geezers like me attending a Rolling Stones concert in London on another page they carry an article on the shenanigans surrounding Pete Doherty and Kate Moss - suprise, suprise they have been using drugs - yawn!

I do have to wonder what planet the Daily Mail lives on - do they really believe that this will shock anyone from my generation? It wont.

As for Pete and Kate - wake up to the fact that your life isn't going to get any better while you carry on doing what you are doing. If you are lucky you will find recovery and live long enough to be a "grumpy old addict" too.

Thats if the so called "experts" don't enable you to kill yourselves first. What another dead Rock Legend? Wow, that would impress me - not.