Successful Sid

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bureaucracy

Successful Sid

The English system of providing treatment to people with substance misuse problems is going through a period of challenge and change. The current system was built on the basis of fear. In the mid 1980s significant numbers of working class young men began to smoke heroin.

Those who developed a taste for this new ‘brown’ heroin quickly graduated from smoking to injecting the drug. Most of them were unemployed and some resorted to acquisitive crimes, including domestic burglary, to finance their new habits. These new heroin users created fear and this fear attracted public funding.

The Conservative government of the day began to invest in services and interventions that would reduce the harm that the behaviour of these new heroin users caused to society. The New Heroin Users were provided with Needle and Syringe Programmes (NSPs) so that they wouldn’t spread HIV and AIDs to the wider population. They were enrolled into Opioid Substitution Treatments (OST) such as Methadone Maintenance to reduce heroin driven acquisitive crime. Methadone and other opiates were prescribed in doses high enough to produce a blockade against use on top and overdose.

This was successful.

NSP and OST reduced crime, reduced HIV transmission and prevented overdose deaths. The success of this system saw investment reach a high of £1 billion and then the bubble burst and disinvestment began. The bubble burst when, in an age of economic austerity and public service reform, critics of this medical model began to point out its obvious flaws.

There is nothing in the pharmacology of methadone that means you can’t get out of bed and go to work. The person on MMT should be as economically active as his or her neighbour on insulin or blood pressure medications. But in the UK they aren’t.

In the USA a majority of people on OST and MMT are in employment. In France and Italy it is thought at least half of the people on OST and MMT are in employment. In the UK it looks like only a small percentage of people on OST and MMT are in employment. This is probably because of the culture within which OST and MMT emerged in the UK. The culture of OST and MMT in the UK is one of welfare dependency, social exclusion and marginalisation. The US had ‘Methadone, Wine and Welfare’, we have ‘Methadone, booze, benzos, benefits and daytime TV

The performance of the current system is measured against three processes; access to treatment, retention in treatment and completion of treatment. There is no measure of real world, common sense outcomes such as new Jobs, new Friends, new Homes and better lives. Local authorities now hold the treatment purse strings and they are interested in economically active citizens and public service reforms that address inter-generational complex dependencies. Asset Based approaches and Asset Based Community Development point the way to real world, common sense outcomes and away from deficit based systems of procedure and process.

Let me tell you a story about Successful Sid. He was born in 1972 and on his 30th birthday he entered treatment for heroin dependency. Within 3 days of asking for help he was on a methadone maintenance treatment programme. Sid stayed on MMT for the next 12 years. In January 2015, Sid was successfully discharged from treatment as his treatment was complete. Sid hasn’t returned to treatment so the six months are up and he is a successful completion and we can be sure he will not represent because he is dead.

Sid went to his grave at the age of 43 as a direct result of his addictions – white cider saw him off in the end. Sid did have a job once – as a paper boy, but he never worked as an adult and relied on welfare payments to support him and his partner and their 3 children. Sid is survived by his partner (still on MMT) and his 3 children who are now young adults and are themselves reliant on welfare benefits to raise Sid’s grandchildren. The current treatment system see’s Sid as a success – he got into treatment quickly (access ), he stayed 12 years (retention ) he successfully completed treatment and did not return within 6 months (successful completion ).

If Sid is a success, what does failure look like? Those who defend the current system and the status quo might say that failure looks like death from overdose.

Fair point, but Sid didn’t die from a heroin overdose.

They might also say that failure looks like increased acquisitive crime committed by people who can’t get onto OST and MMT or who leave the same prematurely.

Fair point, but Sid didn’t commit much crime before he died because you can easily drink yourself to death on benefit payments alone – as long as you don’t eat much and can stomach white cider and supermarket own brand vodka.

They might also say that we in England have a majority of our treatment population in treatment and we should be proud of this when compared to somewhere like the USA where only a minority of their treatment population are in treatment.

Fair point, but Sid died from a problem (alcohol dependency) that he developed whilst he was in treatment. He came in with a heroin problem and left with an alcohol problem that killed him.

But, Sid is a success story:

“You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing.” – Thomas Sowell

7 thoughts on “Successful Sid

  1. Ironically on Merseyside NSP’s exacerbated the problem, suddenly there was a quicker method of delivery which eager uses took full advantage of.
    Agree with most of the points though, especially OST & the culture surrounding it.

    1. Detox Nurse,

      Yes, I can. I worked for Lifeline as the first manager of Trafford Community Drug Team in 1985 and under my management (but I was a very democratic manager with a great team) this became a very efficient and compassionate methadone clinic. In November 2001 I became North East Regional Manager of the NTA where I was a strong advocate of OST and MMT. In 2005 I became North West Regional Manager and it was here that I first started to see things in a slightly different light. In January 2005 we held a meeting of, I think, 17 people to ask if there could be more to treatment than staying alive, out of prison and HIV free. The answer was yes as about ten of the people at that meeting were, what we then called “ex-users”. We then set about an action research project to look at recovery from 2005-2008. Based on this, I became the national strategic recovery lead for the NTA and then PHE. So, yes, I like to think that I did have a role in setting up the current treatment system and I hope to have a role in improving the system to be more recovery oriented.

      Best regards

      Mark Gilman

  2. There are Sids up and down the UK in every town and city from Aberdeen to Dover. When the ONS released their drug related death figures in Sept 2014 you would have thought what Mark had raised would have stirred a national conversation but it didn’t. In around 2008 the BBC ran a story highlighting the pitiful numbers that left the treatment system drug free, this story then heralded the new system of output= drug free outcomes. This was the correct approach but via commissioning teams this new framework for recovery was implemented as a One size fits all approach to everyone in treatment regardless of individual circumstances and physical ability. What commissioners say to providers is, you have to get 20-30 or 40 people out of treatment every month drug free. Ill thought out targets can sometimes engender a set of circumstances that create unintended consequences, especially when financial tariffs are attached.
    We all know that drug free exits will only be successful if you are linked to a positive social network and have a decent place to live and are in employment or education. I have yet to meet ANYONE in long term recovery who is unemployed, unemployment will surely reverse the wheels of any success.
    The drug related deaths reported last year were the highest for a number of years and this years figures will probably be higher, I wonder how history will view this period in our sector.

  3. I’d like to introduce you to Rehab Robbie.

    Like Sid, Robbie is a success story as well. He’s currently been discharged from drug treatment and is living in a half way house provided by one of the third sector drug treatment providers.

    Robbie had a bit of a slip last week, when he left the half way house and went home to visit his ex-partner. But it wasn’t a full blown relapse, so they’ve pulled some of his privileges and because he owned it, they’ll let him stay.

    Robbie is still a success though.

    Of course, it wasn’t his first slip in the 12 months that he’s been in the half way house. He was found out about six months in. But the place was chaotic then. They got rid of the real troublemakers, and gave Robbie a second chance then as well.

    Robbie was such a strong candidate for success, see? It didn’t make sense to chuck him out over a single slip like that.

    Mind you, they were saying exactly the same thing about Robbie eighteen months ago, when he got discharged from another rehab in the same group. Robbie had learned such a lot during the time that he’d been in the programme. Yes, he’d had a few minor slips, but who doesn’t? That’s the nature of addiction, right?

    He’s not what you’d call popular with the other residents, mind. They see him as a bit of a know-it-all. He’s always bitching about the place, and always going on about the quality of the therapy that they have on offer. He seems to have spent a lot of time in those confrontational rehabs, because he’s forever pulling other people up about what they’re doing wrong.

    Then he’ll go on a home visit and come back with his eyes pinned, scratching his nose.

    But Robbie is a success, right?

    In fact, this is Robbie’s eighteenth stretch in rehab in the last twenty two years. He comes out, he settles in the area where the rehab is, and because he’s never used the local treatment system in that area, the next time he screws up, he’s never been sent to rehab from that DAT area, so they’ll be perfectly happy to fund his next couple of stabs.

    But just like Sid, Robbie was discharged from treatment drug free six months ago, and hasn’t presented for treatment during that period, so Robbie is yet another success.

    Robbie kind of likes rehab. He spent his childhood in a minor public school, and his early adulthood in the army. A short prison sentence was a bit of a shock for him – he could get comfortable in there really quickly. He’d better straighten his act out, right?

    Here we are, 20 years later. If you talked to him, he talks that slick recovery shit – been in the rooms so long, people just assume he’s an old timer and give him the respect that most old timers get. And Robbie thinks that’s right. He’s not like these other sad bastards who just show up to meetings. Keep coming back? Losers.

    Nah, Robbie is working a programme. OK, from time to time, whenever he gets too stressed, or when a cute, gullible female newcomer shows up, he might put that programme down for a little bit, but he always picks it up again.

    But Robbie was discharged, drug free from treatment nine months ago. He hasn’t represented in that time.

    Robbie, like Sid, is a success.

  4. I don’t normally get involved in ‘opinions’… I also don’t want to get into the blame culture or get personal. But has a practitioner grafting to promote recovery and working with an ever shrinking resource I found myself feeling ‘ouch’ when I read some of the above ( we are doing our best). I hope I haven’t taken it personal or out of context. Mark what you refer to is very similar/same to recent talk David Best is echoing at the moment (jobs, homes friends)! I believe the model is working in Blackpool and is planned to be delivered in other areas?? Is this the new wave – fingers crossed as it sounds aspiring. However, its been working for many years you will know they are thousands of recovering addicts (thank fuck for mutual aid groups) and it’s a sad statistic but there will be casualties in the war against addiction in any proposed model either medical or not is my experience .

  5. So… Given what I have read the system is bleak with outcomes that are hard to reach and given the financial penalties humans will devise ways of keeping the wolves from the door – regardless (which is nothing new and history shows that) (Martin Smith). Albeit, there is some hopes (jobs, homes, friends) in no particular order? This is all well and good but very external similarly, to the interventions we use CBT (cruel bastard therapy) but its measurable and a quick fix. I was wondering how we move this forward (Mark Gilman) it’s my belief that together ‘we’ may make a change = solution. Oh should we add a ‘r’ to John Royal’s post ‘evolution’ or was it typo should say revolution…

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