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drinkanddrugsnews
| 23 March 2009
Hanging on the telephone
I wanted to say a few words that for
some time have played on my mind.
Recently my users’ group had
advocacy training and I must say this
was superb – it was done by the very
capable Mr Bill Nelles. All of us who did
the training felt as if our eyes had been
opened to what we could do to help
others. Many who are in the grip of
addiction and could have benefited
from our wonderful training are not
being reached – all of us who did the
training did part one and part two,
which are both recognised training
certificates.
The point I would like to make is
this – even after we gained our
certificates, many drug organisations
that work with addicted people are very
unwilling to let us loose on their
clients. I myself have over 30 years of
addiction experience, many of those
years spent in extreme hardship, and
would have given my right arm for an
advocate. I nearly did give my right arm
trying to get the help I needed in harm
minimisation all those years ago.
I could get alongside most drug
users who came to me with a problem
even without that training, so what is
this training all about? All that money
spent on training ‘good to go’ people
who want to help people who are still
immersed in addiction.
For crying out loud, what is going
on here? Why do we sit here, trained
and willing to get alongside people
who I am sure need an advocate, and
no one ever calls?
Bri Edwards, Cumbria
Back to school
The Independent
reports that 15 per
cent of residential rehabilitation clinics
have closed their doors during 2008
and that many more will likely go the
same way this year. While some of this
is due to bank policies, it is clear that
government spending on methadone
and Subutex prescribing instead of on
12-step and other residential
rehabilitation is a major cause.
The majority of 12-step systems
deliver results in long duration
abstinence terms seven times better
than methadone, but as methadone
only has a 3 per cent success rate over
a three-year period, this means that 12-
step is still only succeeding in 21 per
cent of cases.
As a result, for many health
authorities, civil servants and MPs this
means that residential rehabilitation is
merely six weeks of expensive bed and
board for 79 per cent of those who are
referred. And because such substitute
pharmaceutical drugs have been
advertised, promoted, lobbied and sold
to government as ‘the answer’ for over
half a century, it looks like good value to
any chancellor to spread costs over
eight years, especially as at least half
those costs could thus be left to be paid
by the next government – which might
well be the opposition. Although the
psycho-pharm fraternity has for over half
a century been trying to convince
government that drug addiction is
basically incurable, one has only to talk
to a few senior MPs to discover that a
majority do actually know it can be
cured, ‘if only we could afford it’. Well,
‘Even after we gained our certificates,
many drug organisations that work
with addicted people are very unwilling
to let us loose on their clients.’
The conference began with Stefan Janikiewicz, clinical director of drug and
alcohol services at Cheshire and Wirral Partnership Trust discussing how
much of drug treatment was art and howmuch was science. Acknowledging
the role of science and that ‘evidence-based medicine is now accepted as the
norm’ he went on to warn against treating all medical studies as being
completely without bias’.
‘I would like to see more companies publish negative data – you could
print it in a magazine called
Clangers
,’ he said, adding that ‘almost every
drug trial shows the drug is only slightly better than the placebo’. There were
also external factors that impact on trials, he stated. ‘If buprenorphine cost
the same as methadone, the studies and general practice would probably be
different.’ The art came with treating the patient as a person: ‘Qualifications
don't mean a thing – if you don't have a good bedside manner, forget it.’
Virginal Berridge, professor of history at the London School of Hygiene
and Tropical Medicine, looked at historical changes in drug treatment and
the relative position of healthcare professionals, the state and the patient. In
the late 19th century, when treatment first started becoming
institutionalised, British physicians looked to new American state funded
treatments for drunkenness and their efforts to take 'inebriates' out of the
criminal justice system and into public health by recognising the condition
as a disease. The 1902 Licensing Act allowed magistrates to send inebriates
to reformatories – there was already a worry about the hereditary nature of
addiction, she said.
The meeting of the Rolleston Committee in 1924 – the departmental
meeting on cocaine and morphine named after its chair Sir Humphrey
Rolleston – saw a conflict between those wanting to pursue the American
policy of prohibition and the many doctors who still followed the ‘disease
model’ and wanted to treat their patients on an individual basis. The doctors
won the day, with the report from the committee allowing autonomy on
how they treated their patients, and with the option to use prescriptions as
part of this.
After World War II, a shift occurred with addiction being seen as an
infectious disease, one that could infect society. More state intervention
occurred with the rise of specialist treatment services such as psychiatry,
and the 1970s saw the start of methadone prescribing. HIV and Aids in the
1980s saw a move towards harm reduction services and there was also a
swing back towards seeing addiction as part of the criminal justice system.
The recent rise of patient power was stressed by Dr Chris Ford, speaking
from the floor, who highlighted the ‘quiet revolution’ – more than 30 per
cent of GPs treat patients with drug and alcohol problems, as opposed to
less than 1 per cent 25 years ago. This, she said, was because GPs treat the
person not the problem.
Dr Phil Barker, honourary professor at the University of Dundee, told
delegates that addiction was not a disease, just what some people choose to
do with their lives.
‘Despite all my years at university, when someone sits down in front of me
I know sweet FA about their lives,’ he said. ‘People are storytellers – their life is
just their story and you have to listen to them. You have to talk to the person
and if you don’t have enough time to sit and talk, you need to make time.’
It’s all about you
Treatment must be person centred was
the message that came out of the three
different presentations that opened the
National Drug Treatment Conference this
week.
DDN
reports