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Dramas in the Drugs World? by Kathy Gyngell
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Written on 17-Jun-2008 by
policystudies‘Methadone has been used far too liberally, and is actually now part of the problem….
‘In due course, I think we will look back (and see) this has been a shameful episode in drug abuse treatment, in which we simply provided an addictive drug to tens of thousands, and possibly hundreds of thousands of drug addicts, instead of helping them become drug free.’
Professor Neil McKegany, Today, BBC Radio 4 June 11th 08
Last week was a high octane drugs news week. The Centre for Policy Studies published Huseyin Djemil’s positive pamphlet demanding a new political will for an intelligence led, pre emptive policy for getting drugs out of prisons.[1] The comprehensive coverage given by the Observer and Channel Four News to Huesyin’s critique provoked a ferocious yet entirely inadequate rebuttal from the Ministry of Justice, who refused to engage in further debate.
Later in the week Price Waterhouse published their Review of Prison Based Drugs Treatment Funding for the DoH. Going beyond their original remit of funding and straying into ‘treatment’ choices, they have produced a report which is nothing short of a counsel of despair. It includes the staggeringly naïve and ethically questionable suggestion of retoxifying prisoners before release.
Midweek a BBC Today programme report by Mark Easton turned an otherwise unnoticed National Treatment Agency Conference into the subject of public debate – which once more highlighted the poor recovery outcomes of the government’s ambitious but misguided drugs treatment policy.
The catalyst, almost unbelievably, was an argument about the definition of one word – ‘recovery’. Strange to the reader it may seem but some in the drugs policy establishment want the term to include a notion of indefinite ‘medicated’ recovery. To others, the ‘medicated recovery’ model not only misleads those entering treatment about what is on offer, but fear it ‘may well act as barrier to the more liberating (but riskier) recovery that is not reliant on the prescription pad’.[2]
Underlying the sound and fury though is a serious challenge to current treatment orthodoxies. The poor track record of ‘medicated recovery’, the concept on which the government’s current treatment drive is premised into which billions of investment has been sunk, has presented the addictions establishment with a number of questions to digest and address:
· Is the reality of ‘stable drug dependent recovery’ too close to a less pleasant truth of a growing cultural ‘hinterland of methadone, wine and welfare’?
· Does ‘treatment’ as currently provided (other than the minority rehab services) in fact lower the likelihood of achieving lasting abstinent recovery?
· Where is the evidence of the rates of new entrants to maintenance prescribing services to achieve the ‘stable recovery’ that would justify current treatment approaches and goals?
· How robust is the evidence that there are good treatment outcomes in terms of public health or public safety?
What is not clear is how the notion of recovery defined by the United Kingdom Drugs Policy Commission’s working party in terms of ‘sustained control over substance use’ can help with this process.[3] In the hope of establishing a consensus about recovery (and of providing a route through what they perceive to be a polarised and simplistic debate) they appear to have arrived at a definition which not only equates those who have ceased their drug use with those who are continuing to use drugs but, as such, runs counter to the NA /12 step understanding of recovery. Such an equation of course conveniently side steps the issue of why so few leave treatment drugs free.
In the light of Mark Easton’s recent bombshell on these numbers the NTA has, effectively, been presented with a choice. They are at a crossroads and must choose which path to follow. Maintenance and abstinence are not happy bedfellows. The NTA must either get much better at getting people off drugs (looking to the abstinence models that work); or they must continue to persuade the public that people can be considered recovered even in the face of their continuing drug dependence. They have to decide whether to take the advice of Dawn Primarolo, the Minister for State for Public Health, or not. Last week she asked them ‘to review how they communicate these messages’ in face of 'media stories feeding public perception that investment has been wasted’. [4]
The latter course would be as unacceptable as it is naïve. It suggests that it doesn’t matter whether addicts become drug free or not when of course it matters, to them and to the society they want to be part of again.
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written on 17-Jun-2008
sidneygreenstreet says:
The solution is blindingly obvious. All addicts to be given free drugs. These will be recycled drugs seized from dealers and Afghanistan. They must take them in a secure environment, a walled sink estate or camp, a drugs for free zone. The area will have armed guards with a shoot to kill policy for attempts to escape. Anyone guilty of selling or taking class A drugs sentenced to the life in the walled camp. Addicts can also apply to enter the drugs for free zone. The addicts life expectancy will be short as they will almost certainly overdose on the abundance of free drugs or related health problems. Sick addicts will not receive medical treatment as it will merely be a waste of money, time and effort. This will keep the population in the camp at a manageable number. Only those addicts who have stopped taking drugs will be considered for parole or release. Gang shootings will drop dramatically and as most crimes are drug related this will be a major blow to organised crime. Parents of addicts will benefit the most as the addict usually destroy their own family before destroying themselves.The streets will be safer, cleaner and the money saved can be used to make major tax cuts.
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written on 18-Jun-2008
peteroloughlin [http://www.edenlodgepractice.com] says:
The definition of recovery as suggested by the official sounding, but wholly self appointed UKDPC is a classic in rhetoric and an oxymoron.
First there is no universal defination of what a 'problematic substance user' is, however from what I've read of people who fit that description, together with the equally nebulous 'entrenched pattern of drug use' favoured by the NTA, one can only conclude it is a euphemism for addiction, which in turn is inaccurately referred to as dependency.
Characteristics of the latter as defined in DSM-1V and ICD-10 make it absolutely clear that those who are unfortunate enough to have developed addiction, include, but are not limited to:
Loss of control, indicated by frequent and failed attempts to cut down on either or both frequency and quantity of use, together with quantities and duration of use often greater than intended.
Considerable time is spent by the user either 'recovering', or attempting to recover from the effects, using the substance(s), or trying to obtain them.
Users reduces, or abandons important work, social, or leisure activities because of use.
Users continue to use the substance(s) despite knowing it has or is causing ongoing physical or psychological problems.
Such characteristics strongly suggest that the UKDPC's suggestion of addicts are able to maintain control over substance use flies in the face of universal evidence to the contrary. How strange then that the UKDPC are always insisting on 'evidenced based policies'.
The equally ludicrous suggestion that active addicts can or will contribute to society, fulfilling their civic and other responsiblities, fails to recognise that such unfortunates, may not only be unwilling to do so, but mentally and physically incapable of engaging in such pursuits.
The UKDPC's defintion of Recovery with its statement of 'ongoing controlled use' is not only a contradiction in terms, but more seriously it is advocating the use of addictive, psycho active drugs. In doing so it also ignores the scientific evidence which has emerged over the past 15 years, which clearly shows that such substances affect many areas of the brain, and that with ongoing use, interacting systems of the brain are affected and ithe severity of the addiction is increased resulting in the gradually eroding the users ability to exercise their free will. As such the UKDPS's advocacy for continued use cannot be classified as Harm Reduction, nor can it possibly be taken seriously as recovery, in fact the opposite in both instanctes, is the likely outcome.
The bulk of universal evidence suggests that addiction is an irreversible condition to which science has yet to find an answer. The inevetiable outcome of addiction is abstinence, it is only a question of whether that is achieved by choice, death or insanity. However abstinence like continued and ongoing use does not constitute recovery. The former is an essential stepping stone to recovery which will take as long as it takes.The latter, through loss of control, is precluded
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