CONSPIRACY AT WORK?
I read with some concern – as is often the
case – the letter by Elisabeth Reichert,
school head (DDN, January, page 11).
Her idea of applying the (in itself
questionable) 75 per cent success rate
cited for the ‘addiction recovery training
programmes’ she mentions to the general
population of ‘dependents’ sounds
implausible. Is she or anyone else able to
provide references for appropriately
conducted trials published in a respected
journal or is there a liberal, secular,
psychomedical conspiracy at work as, it
seems, is so often the case?
I ask this as there can be bias and
methodological problems with the
‘research’ and information (as well as the
anecdotal evidence) employed by people to
support their position. For example the
‘intention to treat’ must be considered as
in the following example:
If I were to claim that people with
substance use problems need to move
town, run ten miles prior to attending a
meeting every day and not use drugs or
alcohol for three years for them to be
‘cured’, those prepared to enter my
‘treatment’ would be self-selecting and
unlikely to be representative of most
‘dependents’, as many would not be
prepared to subject themselves to it for a
number of very good reasons.
If I were to not count the people who
dropped out (or were thrown out) of my
arduous regime for the purpose of analysis
and only considered those who had
successfully completed my miracle cure, one
year later when I wanted to look at the
success of my intervention most fair-minded
observers would say that, whatever the
percentage of (for example) abstinence in
the completers (or even those happy to be
starters), it does not represent a clear
endorsement of my intervention.
The paranoid position people and
organisations choose to adopt when faced
with the choice between ‘I am wrong’ and
‘the world is wrong and in a big conspiracy
against me’ is well illustrated in the
substance use field.
As well as being shown to work,
interventions must be ethical and
acceptable to those they affect. Any
system for people with substance use
problems needs to try to include those who
don’t simply do what you think they should.
Perhaps researchers worldwide, the
NTA, NICE and most other people
concerned with the treatment of substance
use problems are involved in a conspiracy,
but it is one I am happier to relate to than
those that come out of evidence-defying,
prejudice-embracing people and regimes
such as those in Russia, many places in
Asia and a number affiliated to certain
religious bodies that shall remain
nameless.
Niall Scott, Rochdale
NALOXONE RESPONSE
Following the flurry of letters in response to
my ‘Soapbox’ piece (DDN, December 2011,
p.24), I have written to a number of
respondents, some of whom have got back
to me, and this correspondence has been
illuminating and useful. In particular I
wanted to expand on the potential issues
relating to the unfortunate legal cases of
Evans and Townsend. These cases are
concerned with manslaughter on the
grounds of gross negligence, especially to
do with acts of omission in relation to
overdose, and have implications in terms of
the duty of care for both professionals and
concerned others.
On the one hand it seems clear to me
that there is a lack of awareness of this
case and the potential implications thereof.
On the other, following these discussions I
recognise and acknowledge that some of
the wording in the original piece could have
been more judicious and obscured the
argument. The standfirst in the soapbox
piece was not my words and I would not
have chosen them.
I have taken the gist of the letter that I
wrote to others, and have posted this as a
blog on my website so that those who want
to explore the issue further can do so
there. I would like to thank DDN for
maintaining an open and inclusive editorial
policy, and all those who have entered in to
correspondence and discussion, both
supportive and otherwise.
Kevin Flemen, KFx, www.kfx.org.uk
LETTERS
We welcome your letters...
Please email them to the editor, claire@cjwellings.com or post them
to the address on page 3. Letters may be edited for space or clarity –
please limit submissions to 350 words.
February 2012 |
drinkanddrugsnews
| 11
www.drinkanddrugsnews.com
I WAS PLEASED TO BE INVITED
, but very
sorry to go, to the leaving party of our
locality manager Teresa. She had come
into the area when the local specialist
service was in disarray, was mainly
staffed by agency staff and had a poor
reputation with people who needed
treatment and local GPs.
Over the next year or so this slowly
changed. The staff morale improved with
increasing numbers of permanent staff, the medical lead was good
and the atmosphere in the service became one of ‘how can I help
you’ rather than ‘what do you want’. Teresa was kind, effective and
supported staff. She was also able to look outwards and form good
partnership working.
There had also been many improvements in the area in the
preceding years, with commissioners and DAAT managers who
understood drug treatment and avoided the destruction of re-
tendering instead supporting services to improve. They also
‘understood’ and valued primary care drug treatment.
The area partnerships have been and continue to be,
strengthened by a monthly ‘shared care quality group’ when the
managers of all services, including me and the primary care shared
care manager, come together to discuss quality and joint working.
This meeting helps us learn and improves moving people who need
treatment to the most appropriate service.
With a joint philosophy of care in an area and people like these
on the job, it breeds respect for each other, which filters through to
users of the services. People presenting are not seen as ‘bad’, but as
individual people with complex needs who are asking for help.
During all the years I have done this job, it’s been all about
people, not policies, for me. We need guidelines and policies but
more importantly we need people with humanity, who care; we
need open-minded Teresas rather than ‘Ms Buttoned Up’. Even more
so at this time, when all the talk is about changing policies, it is easy
to forget that the more important issue in drug treatment is care
and supporting people to be who they want to be and get where
they want to get to. And we can be the facilitators, or the inhibitors,
of people’s journeys.
I thanked my lucky stars that I work where I do, when after an
hour of phone calls I still hadn’t been able to get help for a patient
who had moved to south London. Almost every conversation started
with ‘no’, or ‘we can’t do that, it’s not in our policy’. I will continue to
try, somewhat saddened by the knowledge that those staff can’t
possibly be getting job satisfaction.
I miss Teresa who was an important cog in the relatively healthy
local drug treatment system. We are fortunate because things look
good with her replacement. I’m an optimist, but I’m aware we face
changing times ahead with an emphasis on policies, with cost being
more important than quality, and where staff and the people who
need treatment are often treated poorly. Care for staff so we can
care for others.
Dr Chris Ford is a GP at Lonsdale Medical Centre, clinical director for
IDHDP and a member of the board of SMMGP, www.smmgp.org.uk
Post-its from Practice
People above policies
Cost savings must never undermine
quality of care, says Dr Chris Ford
Letters |
Post-its