MEMORANDUM 46
Submitted by the National Treatment
Agency (NTA)
THE NATIONAL
TREATMENT AGENCY
The NTA was created on the 1st of April and
I took up the post as Chief Executive on the 16th of July, with
the Board members other than the Chair being appointed later that
month. The appointment of a permanent Chair is imminent, in the
interim we are grateful for the support and advice of Professor
Joan Higgins who has been acting in a temporary capacity since
April. The NTA's work since July has been focused on creating
an appropriate structure, recruiting staff and establishing relationships
within the treatment sector and Government. An extract from a
summary of the initial Business Plan setting out the role envisaged
for the NTA is attached as an Annex.
DRUGS?
Drugs policy and media comment is characterised
by lack of clarity. The generic term `drugs' itself has probably
outlined its usefulness. The media regularly combine prevalence
figures based on widespread recreational cannabis use with images
of heroin addiction, generating a distorted picture of reality.
Policy needs to focus, as the Government's ten year drug strategy
does, on harm and the drugs that cause the most harm—heroin
and cocaine. However, policy also has to be situation specific
and person specific. For example cannabis use itself may be largely
non-problematic but located within a prison setting cannabis dealing
becomes a channel for gangsterism and bullying threatening the
maintenance of order in the establishment and the safety of inmates
and their families. Sound policy will therefore be based on an
analysis of the harms that flow from this substance used by these
people in these ways in this context.
NORMALISATION
Recreational drug use has become normalised
amongst young people, that isn't to say that all young people
use drugs, about half never will, but that recreational drug use
is now regarded as part of a normal repertoire of behaviours.
Most people use drugs because they enjoy them, and for the vast
majority of users this experience remains pleasurable and under
their control. Overwhelmingly this involves intermittent use of
cannabis or dance drugs such as ecstasy. About half of those who
experiment don't persist in the behaviour and others do so only
occasionally, leaving the numbers of young people for who illegal
non-dependent drug use is an integral part of their lifestyle
significantly lower than most media coverage would suggest. For
a minority of drug misusers their pattern of use comes to include
opiates and cocaine and escalates beyond their control developing
into dependency. Associated with this will be a range of other
harms and risks impacting on the individual's health and welfare,
the health of the wider public, and the safety of the communities
within which they live.
TREATMENT AND
THE DRUG
STRATEGY
Improving the accessibility and effectiveness
of treatment for this minority is at the core of the drug strategy.
Despite much effort the evidence base to take forward a prevention
strategy is at best patchy, similarly the success of attempts
to restrict availability fluctuates but it is generally acknowledged
that the best we can do is restrict the market, not eliminate
it. Treatment on the other hand is beginning to build up a convincing
evidence-base of what works best suggesting that properly administered
well targeted interventions enable drug misusers to become drug
free, productive members of the community. The vast majority of
treatment available in the UK targets opiate misusers, about 50,000
opiate misusers access treatment each year compared to 4,000 cocaine
misusers. This almost certainly reflects the availability of treatment
rather than prevalence of problematic use. The identification
of effective treatments for cocaine dependency and their widespread
implementation is an urgent priority.
Treatment for opiate dependency falls broadly
into five categories:
Detoxification: providing a safe process for
someone to become free of physical dependency.
Substitute prescribing: providing a controlled
dose of a substitute opiate, usually methadone, to prevent craving
and physical symptoms.
Counselling: providing opportunities to understand
behaviour and therefore control it.
Residential rehabilitation: providing an opportunity
to participate in an intensive programme of rehabilitation in
a safe environment.
Harm reduction: services aimed at preventing
HIV, Hepatitis and other infections associated with injecting
drug use.
The growing evidence from the National Treatment
Outcome Research Study and elsewhere is that each of these treatments
has a role to play and can promote beneficial change in an individual's
health, public health and levels of offending.
DRUGS AND
CRIME
UK drug policy is crime-driven and treatment-led.
Crime driven in that the perceived link between dependent drug
use and acquisitive crime underpins the Government's decision
to dramatically increase expenditure on drug treatment. Treatment-led
in that effective treatment is seen as the appropriate response
not only to the individual and public health problems associated
with drug misuse but also to drug-related crime. Drug misuse is
usually characterised as `causing crime', dependant individuals
being seen as out of control and driven to offend. The reality
is more complex; most drug-misusing offenders were offenders before
their drug misuse became problematic, what appears to happen from
the research evidence therefore is not that honest men and women
become criminals, but that part time amateur criminals become
full time professionals. Drug misusers' pattern of offending is
also more under control than the desperate drug-crazed media stereotype
would suggest. Individuals retain control over their repertoire
of offending continuing to engage in offences they regard as high
reward and low risk and avoiding those that are dangerous or they
find morally repugnant. Drug dependency can therefore be seen
as amplifying the criminality of existing offenders rather than
initiating criminal involvement. It follows that the success of
treatment-based interventions with drug misusing offenders need
to be judged by their effectiveness in reducing the number of
offences committed not by the traditional Home Office methodology
based on reconviction. Judged by these means Drug Treatment and
Testing Orders and the Arrest Referral Schemes appear from the
evidence to make a significant contribution to community safety.
DIVERSITY
Treatment services are currently dominated by
white men in their late twenties and early thirties. Women take
up a quarter of treatment slots, it is unclear if this genuinely
reflects lower prevalence rates or agencies continuing inability
to offer services that are attractive to women. The preponderance
of over twenty-fives across both male and females reflects the
developing nature of drug dependency and young people's tendency
to continue to derive pleasure from their drug use and support
from the drug using lifestyle. Persuading younger drug users to
access treatment early in their drug using careers before they
slide into chaotic use and daily offending is key to the success
of the drug strategy. Minority ethnic populations are also consistently
under represented in treatment. There are probably a range of
factors behind this. There is continuing concern that white-dominated
white led services are not sufficiently responsive to the needs
of the whole population. Although there is evidence that prevalence
varies less from community to community than has often been supposed
different patterns of use are apparent. Understanding these issues
is made more difficult as many communities are wary of the potential
for demonisation and scapegoating if they acknowledge their drug
misuse problems.
IS IT
WORKING?
It follows from the above comments about the
need to disentangle the range of different harms associated with
different types of drug use that there is more than one answer
to the question `is the drug strategy working?' Some elements
of policy are working very well. I became involved in drug policy
through my work in the Probation Service at the end of the 1980s
in a era when drug treatment was focused on a small number of
hospital based services, the Prison Service denied it had a drug
problem. Local Authorities and Criminal Justice agencies accepted
little or no responsibility for drug misuse, Ministers were sceptical
about the effectives of treatment and there was a complete absence
of strategy. Through a variety of policy initiatives implemented
by successive Government's the current situation is much improved.
Treatment has expanded dramatically, and is much more evenly distributed
across the country. Through Drug Action Teams the key players
in each area have been obliged to own their drug problems and
develop local solutions. Drug misusing offenders now have access
to treatment at every stage of the Criminal Justice system and
the Prison Service is to be congratulated on its efforts to develop
an integrated treatment system within prison. Much has been achieved,
much remains to be achieved including the aspirations expressed
in the NTA's Business Plan.
Over the past fifteen years UK Drug Strategy
has focused on harm; the drugs that cause the most harm and the
means of use that cause most harm. If this rational pragmatic
focus is retained it will provide a context within which the NTA
can achieve its objectives.
October 2001
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