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!

The next magic bullet.....

There were several interesting news stories this week:

On Thursday The Guardian run a story reporting that the total social and economic cost of class A drug use is around £15.4 billion a year. The research was commissioned by the Home Office and also reported that 90% of this cost was accounted for by drug related crime.

The Guardian followed this up on Friday with another story which reported that the UK has 327,426 "problem drug users" and that the country spent £5.9 billion a year on illegal drugs.

These figures again came from the Home Office.

What is going on here - there are supposedly 181,000 people in "structured drug treatment" in England and Wales (NTA figures).

This represents around 55% of the Home Offices "total number of problematic drug users" (if the numbers in treatment in Scotland and Northern Ireland were taken into account the figure would be even higher!)

Sorry - but I don't believe a word of it! All the research that I have ever seen suggests that the percentage ""in treatment" at any one time is not likely to be more than 25 to 33 % of the total. If the governments research is right then they aren't commisssioning very effective treatment are they ? I mean if a minimum of 55% of all problematic drug users in the UK are in treatment and its still costing £15.4 billion?

Last year we were being told that each £ spent on drug treatment produced savings of £9.50. On this basis we need to be spending say an extra £1.5 billion a year - on top of the roughly half billion already spent. That would represent a 400% increase!

Spend £2 billion a year and the total cost in theory comes down to zero. Yeah well, thats not going to happen anyway - and it wouldn't work if they did spend the money because there will always be "treatment resistant" individuals.

Interesting to compare the Governments expenditure on drug treatment to the cost nevertheless. Interesting to see that we spend 10 times as much on illegal drugs as we do on treatment!

My final news story of the week was widely reported - the suggestion that we ought to consider prescribing heroin instead of methadone. A senior policeman suggested that this would reduce drug related crime - and guess what, he is right! He is after all a policeman, and it his job to reduce crime.

I suspect that this would be even more successful than he thinks - for one thing the bottom would fall out of the drugs market as the dealers could not compete on price and quality against the NHS!

My job however has always been about treating individuals rather than finding solutions to social problems such as crime and from the treatment point of view I would predict the following:

1. The numbers seeking treatment would greatly increase - many users do not seek treatment because they don't want methadone, it doesn't do what they want it to do. Many users who receive methadone on prescription use on top - for the euphoria that heroin provides and methadone does not!
2. Not many people would ever complete treatment "drug free" - although perhaps a few more would than now as the withdrawals are reconned to be less severe!

Either way don't for a moment believe that the Governments aim is to provide quality treatment for the individual - it isn't and hasn't been for a long while now.

It is to save money, to increase its popularity by reducing crime and to reduce the spread of blood borne viruses associated with drug use into the general community.

They really don't care if individual addicts sit in a corner and dribble while life passes them by if that is what it takes to achieve those goals (which are legitimate goals by the way - but not the only ones!)

To this end I suspect that prescribing heroin will be the next "magic bullet" which is going to achieve these goals!

We have now gone full circle and are rapidly coming back to the point where we were in 1966 - in 40 years there are now around 200 times as many heroin addicts as there were last time that prescribing heroin was official policy.

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!