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OF SCIENCE
October 2015 |
drinkanddrugsnews
| 11
if you’re a clinician the people you’re going to
see are those who didn’t recover
spontaneously. But spontaneous recovery is
based on a range of external conditions, so we
need to make sure the right external
conditions are in place.’
This was very different from addiction
being a chronic relapsing disorder, he argued,
‘so when we require treatment of someone
who’s been arrested for drug possession, for
example, we’re making a mistake that can
start a cycle of unjustified and ineffective
punishment. Involuntary treatment should
not be a first resort, as it is in too many cases.
If one definition of addiction is to continue to
use in the face of adverse circumstances – for
example, very intense enforced treatment –
then your diagnosis is made. In the US a very
large percentage of people with drug
problems are under criminal supervision.’
However, the outcomes of treatment were
‘multi-dimensional’, he said. ‘One way to think
about treatment is to think about the other
problems that people have – treatment should
be measured by overall outcomes, not just
drug outcomes. The goal should be achieving
the best available outcomes for people with
substance problems, and the people around
them, by whatever means.’
‘Do we need treatment as a first response?
Yes,’ countered Gabriele Fischer of the
University of Vienna. ‘It reduces deaths,
reduces use, reduces HIV and HCV risk and
saves money. Some say, “why spend the
money when people relapse?”Well, relapse
isn’t limited to drug treatment – it also
applies to the treatment of chronic conditions
like diabetes, asthma, hypertension. And when
people talk about dependence on methadone,
remember that people are also dependent on
drugs for diabetes, asthma, hypertension.
What’s unique in our population is the
percentage of people who are ending up in
the criminal justice system.’
In terms of whether those polices would
change, Mark Kleiman told the conference
that, ‘I’m sure cannabis will be fully legalised
in the US in ten years. But I’m only moderately
happy about that. If you were going to pick a
country to legalise cannabis in you wouldn’t
choose one where the courts had ruled that
any legal activity can be advertised and
promoted without limits. I think we will lurch
from prohibition – which admittedly doesn’t
work – to the most extreme version of
legalisation, and you only have to look to
alcohol to see the model for what we’ll have.’
When it came to whether academics
should even try to influence policy, views
varied, said Linda Bauld of the University of
Sterling. ‘It’s very context-specific, and we
have to show that there’s a positive impact on
society or the economy.’ A great deal had been
written about the gaps between research and
policy, she said, and addictions research often
responded to policy ambiguity by ‘trying to
improve the supply of evidence – but that
tends to ignore the importance of other
factors. It’s very often a long game.’
Alcohol policy was a case in point, she said,
where research findings came up against the
power of the drinks industry, government
indifference, media hostility, low levels of
public awareness and other factors. ‘So
research alone isn’t enough, but being an
advocate for the evidence certainly helps.’
Research into new psychoactive
substances (NPS), however, had helped to
both inform policy and practice and challenge
myths, said Felix Carvalho of the University of
Porto. ‘Those myths included that NPS are
safer than street drugs, contain fewer
contaminants and are associated with lower
health risks – general addiction pathways are
the same.’ However, researchers tended to
publish their findings in scientific journals, he
said. ‘And politicians don’t read those. So we
do need the mass media.’
Things had changed dramatically for people
with addiction issues in the US over the last
few years, said former White House ‘drug czar’
Keith Humphreys, now at Stanford University’s
School of Medicine (
DDN
, June 2012, page 16).
The 2010 Affordable Care Act – or ‘ObamaCare’
– had defined mental health and substance
use as an ‘essential healthcare benefit’, as well
as allowing parents to keep their children on
their private insurance plans until the age of
26 – and ‘almost all substance use problems
have an onset early in life,’ he said. ‘So access
to, and insurance coverage for, substance
treatment has never been better in the US.’
This meant the law was driving the
integration of previously ghettoised
specialities into the mainstream, ‘where they
belong’, he said. ‘But is science supposed to
define policy by itself? Science is very good at
identifying emerging problems, and it can
also suggest new polices and determine
whether existing policies are working. But it
can’t tell us what we care about.’ Ultimately,
politicians had to make value judgements, he
said. ‘You can’t fund everything. Just because
we’re experts in science doesn’t make us
experts in government.’
The main routes through which findings
eventually translated into policy were media
coverage, professional and grass-roots
organisations, scientists engaging the
bureaucracy – both formally and informally –
and scientists in policy-making roles
themselves, he said.
‘US healthcare policy around substance
use has changed dramatically. Scientists did
not cause that to happen – they shouldn’t
expect to, and no one should expect them to.
But when you have political will combined
with good research and evidence – that’s
when you can really make a difference.’
‘Science is very good at
identifying emerging problems,
and it can also suggest new
polices and determine whether
existing policies are working.
But it can’t tell us what we care
about... You can’t fund every-
thing. Just because we’re
experts in science doesn’t make
us experts in government.’
KEITH HUMPHREYS
