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