Yoof of today!

We definitely seem to have entered the silly season in the run up to Christmas. In the past week I have received several inquiries from the press who all seem to think that I must have some kind of crystal ball or arcane knowledge about "young people". I have been asked about young people and AA/NA - “is it trendy for young people to go to 12 step meetings now that Lindsay Lohan has admitted that she is going to meetings?”

Who cares if it is “trendy” or not, they are missing the point – its about saving lives, not fashion! Is coronary care trendy? Are A & E departments trendy? I have to ask myself what kind of rarefied atmosphere do these guys live in? Have they put something in the water in Wapping?

Lindsay Lohan is living in California, I live in South Yorkshire. Young people in California do lots of things that haven't caught on over here – surfing for one – and there are huge cultural differences in the way addiction and recovery are viewed over here and there.

The end result is that young people do go to AA/NA meetings in the US – especially California, while over here in the main they don't.

Most “addicts” seem to turn up in NA at around the age of 30 and it's around 40 for AA. There are of course exceptions to this rule.

I believe that one of the causes of this is the marked reluctance on the part of treatment providers in the UK to properly diagnose alcohol and other drug use in young people.

In the main the attitude seems to be that alcohol and other drug use is symptomatic of developmental problems rather than a condition that requires proper diagnosis and treatment in it's own right. In fact there are very few services in the UK providing proper addiction treatment for “young people”. Our very politically correct practitioners prefer to treat the age rather than the disease.

Then I would say that wouldn't I? I am a grumpy old addict after all!

Booze & Drugs and Benefits!

Recently several UK newspapers printed stories about the fact that around 49,000 "alcoholics" and 48,000 "addicts" are claiming incapacity benefits because of their respective conditions.

Not suprisingly there were 2 main lines :-

1. This is an abuse of the benefits system.
2. Are people being denied treatment and condemned to a life on benefits?

My first question would be "where are the others?"

Taking the drug users first:

According to the Home Office and the National Treatment Agency there were 181,390 people in contact with drug treatment services in England alone in 2005/6.

Taking the rest of the UK into account, as well as research that has suggested that perhaps 2/3 of problematic drug users are not in contact with services it would not be unrealistic to suggest that there could be 4 to 500,000 problem drug users in total in the UK. If 48,000 are receiving disability benefits what are the rest doing? Are they committing crime? In prison? Working? Claiming Jobseekers Allowance? Does anyone know?

Similarly it has been estimated that there are up to 3,000,000 people in the UK suffering from alcohol dependency. 75% of those have been estimated to be working - driving buses, airline pilots, surgeons - all sorts of things that include many different kinds of high risk situations.

Going back to drugs for a moment (I know that area best) we have employers introducing workplace alcohol and drug policies (including drug and alcohol screening) because of, at least partially, their responsibilities under health and safety legislation - and we have major government initiatives to get people in treatment back into work (often while they are still using Methadone).

Here are 2 examples:

1. I am aware of cases where individuals on Methadone have died in Road Traffic Accidents and the Coroner has been highly critical of drug services for not notifying DVLA of the facts (thats the agency that issues driving licenses for non UK readers).
   
2. In the same month I received a phone call from a drug service asking my opinion about an offer they had received to train their clients as bus drivers. (The clients were, in many cases, still on Methadone.)

Am I the only one who finds this contradictory? Personally I would rather someone received incapacity benefit rather than drove my bus or burgled my house for that matter! At least while they received effective treatment.

National Treatment Agency for policy abuse

I have recently been sent an e mail about a forthcoming one day conference in Leicester about future arrangements for Residential (tier 4) treatment here in the UK. All official statements are now pointing to the fact that it is now policy to improve access to residential treatment.

The government’s initial "bright idea" was to give large sums of money to the NHS to open new units, this might sound like a good idea until you realize that all the existing units have empty beds. The Problem is not so much one of capacity as of commissioning arrangements. Whether one gets residential treatment here in the UK seems to depend on several factors, most of which are financial rather than based on any real assessment of clinical need.

The process takes so long and is so convoluted that there are no doubt deaths each year because of either the time it takes or because individuals are so put off that they don't even bother to try to access residential treatment.

I could go on about this - but what struck me about the flyer was that the NTA were asking me to donate a day of my time and pay £165 for the privilege of helping them to save money! As a consultant in the field who actually has many ideas as to how the system could be improved I find this attitude patronizing. Just what sort of business do they think we all run? Do they really expect hard pressed, highly skilled professionals to pay to have their brains picked?

The biggest block to progress here in the UK is the fact that all policy is ultimately driven by political considerations. The NTA and the UK government are only going down this road now because all their previous attempts at "quick fix" treatment approaches have failed dismally and they are now desperate to achieve some real outcomes rather than ending up with 10% of the UK population on methadone for the next 30 years!

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!

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!