Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Sarah Graham Solutions (DP167)

I am writing to you about the important matter of how we are treating young people for drug and alcohol abuse and dependency, in the UK.

Although I am an addictions expert and not a lawyer,1 I believe that the National Treatment Agency (NTA) policy of pushing “treatment in the community” to the detriment of the whole residential rehab sector highlights a lack of independence and quality of expert advice which is being given to the government.

Failure to provide a comprehensive range of medical and psychosocial treatment for young people is violating their human rights.2

Having visited many residential programmes for teenagers in the USA, I can tell you we are 20 years behind best practice: in both assessment of the illness in young people and the treatment modalities available overseas; but not being delivered here.

Rehab in the USA is not just available to the children of wealthy families—there are hundreds of teen rehabs, that cross the income spectrum.

Our young people are the mental health poor relations—compared to many other nations—despite living in a society with a very expensive National Health System (NHS). It is only families who can afford to bypass the NHS and send their children abroad for residential rehab—commonly to the USA and South Africa—who can access hospitals, that are safe places to medically detox teens with their peers. And which have the best state-of-the-art treatment tools—such as neuro-feedback brain-training—which can, visibly, help repair the damage to brain functions, caused by neuro-toxic chemicals.

Our media and society seems content to label our teens as simply “feral” and as “hoodie yobs” and when we do bother to look below the surface our NHS and social services system is using very outdated, adult-derived medical/socio-economic models of addiction to interpret this behaviour. Thus, failing to diagnose and treat thousands of young people.

A combination of inadequately trained Drs and drugs workers and over-stretched social workers are missing the many mental, physical, emotional and spiritual symptoms of this dis-ease: a disease that is becoming more common, complex and widespread and affecting younger teens; and even pre-teens. Parents are often wrongly reassured, for example, that “it’s only a bit of cannabis”; not a serious problem.3

Cannabis and alcohol misuse and dependency amongst teens are very common and not treated in many local areas- ignoring the societal costs of NHS Accident and Emergency visits, arrests, exclusions and failed educations during the crucial time young brains are still developing; and most amenable to being helped back onto a healthier path.

The vital importance of treating teens hit me very hard last year: at the Brain Enhancement Institute (BEI) facility in Florida they mapped my brain and NASA trained neuro-scientist, Dr Curtis Cripe, found that teenage binge-drinking has impaired my memory systems “radically” and much more so than my adult cocaine use. Dr Cripe told me he is very worried for the future of British youth, if we keep failing to tackle our national teen alcohol epidemic.

The current, failing, system results in severely damaged adults limping into treatment- often after costing the State hundreds of thousands of pounds—in welfare, crime, prison, social services, etc. These adults seeking help are entrenched in using drugs and drinking alcohol together or swapping between them (cross-addicting) and have irreparable cognitive, psychological and physical damage; so are much harder to treat, which is part of why some adult community and residential rehab outcomes can seem poor.

The world has changed massively in the last 10 years. Young people today have access to a much wider range of very dangerous drugs—including Class A cocaine and “legal-highs”, internet-marketed drugs often targeted at teens through social networking using brands (illegally) such as Disney and The Simpsons. We have no real evidence-based understanding of the comparative harm and costs of legal and illegal drugs mixed together in a “using episode” by adults and even less so to young people (especially, when mixed together in cocktails in a young person’s system).

The Relationship between Drug and Alcohol Abuse

Nearly all my Respond stimulant service (outline of service submitted to cocaine trade evidence) clients mixed alcohol and cocaine together (like curry and rice, one necessitates the other) but there is hardly any scientific study of this and the resultant, more liver-toxic, cocaethylene. Traditional science struggles to put real life human behaviour under a microscope.

This polydrug use culture is largely below the radar of the current- problem drug use (PDU=crack and heroin), crime-driven, treatment system. These people may not present to traditional opiate-orientated services—but “party drug” users are flocking to the new outpatient clinic at Chelsea and Westminster Hospital.4

And hundreds of parents of these “party-drug” users are on the Drugfam database and fill the room at the conference hall of the annual Bereaved By Addiction day—the saddest event in my annual diary.

My research of how the NTA misses the “party drugs” patterns and problems of the lesbian, gay, bisexual and transgender (LGBT) community (and the media ignores the outcry in the community caused by “G”, GHB/GBL, deaths) is a case study one can use to extrapolate an understanding of how other issues fall through the cracks: such as the problems in the Somali community with khat.5

Having worked in an NHS service (Respond, Reigate and Leatherhead) and seen the results of long-term methadone prescribing—lots of very poorly people, with emotionally neglected children, still trapped in their addiction mindset of lying, using on top, manipulating the system, etc—I believe that the current modality that receives the lion’s share of funding—is never going to give the taxpayer cost effectiveness for the hundreds of millions being spent annually. Many of these patients are getting free drugs-on tap, with a street value (£10 a pill of Subutex—can be chopped up and snorted for a better high) which saps their motivation to change or genuinely reduce their drug useage; and it’s very important to factor in alcohol use when analysing the “success” of “substitute” prescribing.

Having left the comfortable environs of Priory Healthcare, to work with a broader cross-section of society, I found to my dismay, that I was forced to beg friends in charities to take in my most poorly clients for rehab—without funding—who may have died waiting to access state funding for a rehab place. This is immoral and I couldn’t live with my conscience: I certainly couldn’t say, hand on heart, that I was “doing no harm” in that NHS system.

I left Respond to work at Sutton Youth Awareness Programme, as a counsellor in schools and soon discovered that one-hour’s counselling a week was often a sticky plaster on a gaping trauma wound—caused by sexual abuse, bullying (homophobic bullying is still socially acceptable in schools), abandonment, undiagnosed learning challenges etc—and with nowhere to refer a dependent young person to—young people who were begging for help—my clients were finding it impossible to stop using and getting kicked out of schools, so losing access to my support, into pupil referral units etc and sinking further into more trauma, disappointment, teenage pregnancy, gangs, prostitution… so depressing I felt compelled to leave the state system and set up my own company, Sarah Graham Solutions (finding ways to give back, such as seeing some clients for their pocket money and sitting on the ACMD, since last February).

In my opinion, the NTA is inherently not fit for purpose in preventing and treating young people’s drug usage.

Not that we will have reliable evidence for this assertion because there is no young person’s rehab service to study. And no community programme for young people is being assessed by the Payment By Results (PbR) scheme: The criteria used by the Government to measure the efficacy of its drug policies is not including young people!

A fact that even Andrew Lansley MP and Anne Milton MP were not aware of when the Amy Winehouse Foundation and I met with them, last October; that is how little the needs of young people seem to figure on the national agenda.

In those meetings, after Amy Winehouse died so tragically, aged 26, from alcohol6 , 7 between 1 August through to October, it became clear to me that the very laudable aims of the Government’s drugs strategy are being watered down—the redefinition of abstinence itself being a highly symbolic case in point—and even sabotaged by civil servants, Drs and a medical system that is fundamentally biased towards prescribing and retaining “patients”; rather than empowering “clients” to find a way to live drug-free, happy, independent, healthy lives.

I am aware that the NTA is a “dead-man walking”—with the transfer of functions of the National Treatment Agency for Substance Misuse to Public Health England but from what I have heard and seen—eg young people’s community drug treatment services are being cut hardest by local authorities—so they cannot be trusted to provide for what is a national priority.8

Especially, as these cuts has been allowed to happen, to facilitate the political agenda of localism, despite unprecedented riots by young people, and a lot of negative international media; very bad for the UK brand and tourism.

Our future, our young people, have become public enemy Number One’s—national villains and demonised as scary monsters. Much more so than the adult MPs who stole thousands, or bankers who made millions—to the detriment of the whole economy.

No-one bothered to ask, how many of these young people—whose idea of a great time is stealing trainers and TVs (high aspirations?) are addicts; or the children of addicted parents? Lots of off-licences and chemists were targeted and many of these young people were “known” to the criminal justice system.

I’d love see the results of research on skunk cannabis and violent computer games usage by the rioters (not being done, as far as I know). Many received harsh sentences in very expensive facilities that will not deal with their substance use issues (see Mark Johnson’s article below).

From my work with the, recently liquidated, young people’s holistic treatment charity In-volve (over 20 years experience gone to the wall) on the streets and in the parks at night—for a year—I know that cannabis dealing is part and parcel of the postcode wars—enforced, oh-so-casually, with the use of deadly force. These kids don’t give a f***. They are so traumatised by their environments, lack of a father, baby-mothers being children themselves, growing up on welfare, in an institutionally racist world, without hope of a way out except for the gangsta life—get rich or die tryin’—that nothing can touch them. Not in “the community” anyway.

The NTA is so out of touch they don’t realise these gang member young ’uns can’t attend a “community treatment service” if it’s a few roads into the wrong ’hood. They risk being shanked (knifed) for straying into another gang’s territory.

I feel very worried that things are set to get worse, in 2012—the year of the Olympics—rather than better. That with no ring-fencing of the treatment budget, money will be spent locally on the more popular, PR-friendly illnesses such as cancer; even though, ironically, many cancers are preventable and lifestyle related. It’s interesting that the Teenage Cancer Trust is very media-friendly and very well-resourced.

Addicts and the children of addicts are at the bottom of the pile, when it comes to “good causes”. The general public haven’t got beyond seeing addiction as a moral failing or self-inflicted problem.

The Extent to which Public Health Considerations should Play a Leading Role in Developing Drugs Policy

Neglecting to apply this logic to obesity (another hidden addiction issue—refined sugar is a very addictive substance for some—especially when combined with fat and refined flour; and the food industry use the science of brain chemistry and pleasure release to entrap us and sell more product).9

We have a big public education job ahead. There are examples of good practice.10

But there is still so much shame attached to addiction in the UK that many families are scared to speak up—or even seek help for a loved one. Challenging the status quo is off the agenda. Which is why I applaud and support Mitch Winehouse, Amy’s family and the Amy Winehouse Foundation for daring to speak up for those families who are affected by this illness.

And is precisely why I am taking the time to write to your inquiry.

I am sending you a proposal for a fiscally responsible project with strategies grounded in science, health, security and human rights’: a plan for a world-class teen rehab; written by John Taylor, from the band Duran Duran, and I.11

Aside from treating the most desperate, vulnerable young people—this facility will be a national centre for research, education and training. It will flag up emerging problems: the availability of “legal highs” and the challenges associated with adapting the legal framework to deal with new substances. It will also pioneer new treatment protocols.

By working holistically with families and younger siblings too—to break the chains of addiction and stop this illness being passed to the next generations. It will create citizens and families who really contribute and pass on their knowledge to their schools and whole communities. Very good value for money.

There are many respected people who support this project—including Camila Batmanghelidjh,12 Mark Johnson,13 Jerry Moe14 and Elizabeth Burton Phillips—who lost one of her twin boys to a heroin overdose and now runs Drugfam.15

I am sure that with John Taylor’s help and extensive contacts book we can raise much of the capital to build Kate’s House.

We are calling it Kate’s House (working title) because we are very much hoping that Action on Addiction16 will ask their new patron—Kate, Duchess of Cambridge to help us work together on this important, legacy project.

A successful businessman—whose father died of alcoholism and who is himself an addict in recovery has kindly volunteered to give us a £5 million plot of land in Essex to build on. Not a bad start.

But, and it’s a big but, we do need the British Government to commit to funding at least five of the beds—an ask of less than £2 million a year. Nothing in the grand scheme of things. Certainly, a lot less than a new royal yacht; which I support—as an investment in a valuable part of our national brand.

In these fiscally tight times, it will take a lot of lobbying to get ministers to commit to #teenrehab (see Twitter.)

I would be very happy to attend as a witness in person before your committee—to be questioned about this evidence. John Taylor is coming to the end of his very successful world tour with Duran Duran (see their YouTube 5 million+hit Girl Panic17). His diary “is pretty gnarly” but he is open to attending with me, for what is such an important, timely, drugs policy inquiry.

I have been working alongside many talented, committed individuals—including Middlegate’s wonderful former staff—giving our time for free, for a number of years now—to realise the goal of a new teen rehab in the UK. And with Mitch Winehouse’s help—in Amy’s memory—we have achieved meetings with ministers at a high level in the Home Office and Department of Health. But what looked at first like hopeful signs of progress, towards the later part of 2011, under the coalition, is now seriously wilting on the vine.

Dr Deborah Judge’s project in Taunton was turned down for lottery funding and her team had a meeting with David Burrowes MP—where it was clear that the Government are not going to allocate new money to this.

The Amy Winehouse Foundation realised what we were up against and have chosen to put their energies into more easily achievable goals—such as putting Recovery Champions into schools; which is very valuable work.

To be very honest, over Christmas I felt very depressed about all this. I’ve worked very hard to get positive about 2012. But if things don’t improve soon here in Great Britain, I will have to seriously consider the work offers from the brilliant rehabs and treatment companies in the USA—such as The Newport Academy, in Orange County.18

If I’m to be able to do the highest standard work, I feel so called to do, I will pack up and leave my home and beautiful dog (@MarnieTheBeagle) to do this.

I am very grateful for my recovery. And know how lucky I was to be able to afford eight months in the Priory; which saved my life.19

I could have done with rehab as a teenager, after my mum left my 11 year old brother and me, I went into a suicidal melt-down and stopped going to school. And if a loving place of safety—like Kate’s House—had been available to me then, maybe I wouldn’t have lost my virginity to an unemployed paedophile—who groomed me in the community and gave me free alcohol and drugs?

I am so passionate about this because I really know what these most vulnerable kids—who think they are so grown-up—are going through. I have walked through the pain of facing abuse, trauma and abandonment and know what is needed to make that experience—that words cannot describe—as safe as it can be.

Whilst California has its many attractions, I would so much rather stay grounded here and help our great British youth have the treatment they deserve. To pass on what has been given to me—One Day at a Time; for over 10 years now.

To misquote from that great spiritual masterpiece that is Star Wars, “Please, help us Home Affairs Select Committee—you’re our only hope.”

Your report can shine a light into the dark corners and could really help us change things to improve public health and reduce demand for substances that damage health and ruin families.

I hope you have found this document and the links useful? Please email or call me, if anything is not clear?

May the force be with you.

And with our innocent, addicted, children too.

Memorandum

1. The Problem

We have no residential rehab facility for teenagers in the UK.

Middlegate was our only facility and it closed on 19 February 2010.

Please watch this short video on YouTube to explain the background of how Middlegate came to close:
http://youtube/yDc4vH7lfak

The situation for adults in the UK is less than satisfactory—here’s an article—Rehab Needs A Fix—from The Independent; that explains the wider context.
www.independent.co.uk/life-style/health-and-families/features/rehab-needs-a-fix-2330673.html

Mark Johnson wrote an important article in The Guardian last month about trying to find a place to take in a 16 year old heroin user (who had been physically addicted to heroin since 12) for detox.20

The NTA’s response to his article—in comments section—highlights the challenges that the clinicians like myself, who understand how to work with people to get them abstinent (a desired objective of the new drugs’ strategy), are facing.

The NTA are clearly not respecting young people’s human right to humane, age-appropriate, treatment. This is their statement to the BBC- shortly after Mr Mitch Winehouse and I visited Mr Vaz and Mr James Brokenshire at the Home Office on 1 August, last year:

“Young people with drugs problems are definitely not being short-changed”.

It says that while there are no longer any rehab centres that focus solely on substance addiction, there are facilities that can help: “There are plenty of residential places for children in need—care homes or secure estate,” said an NTA spokesman.

“There’s no problem sending a child with a substance misuse problem into one of these home where they can get treatment for their problem alongside other problems.”

(Source: Kicking The Habit: How Important Are Teen Rehab Centres?21)

So, it’s OK to remove a child from a loving home—who has a mephedrone addiction (or any of the many emerging “legal highs”), or a history of dangerous binge-drinking, or failing in school because of cannabis smoking—and put them in a state care home, or lock them in a secure detention centre? Doesn’t this trample all over their human rights?

But it’s not desirable for this “treatment agency” to fund a specialist medical centre to deal with, what is now evidence-based to be, a brain-centred illness; often with a genetic component that is triggered by trauma.22

I’d like to remind you all of where this addiction can take young, vulnerable people; and how powerful it is.

Let’s not forget the national shock about the stories of the young Ipswich prostitutes. This is my Sky interview, as addictions expert for Frank,23 about prostitution and addiction to heroin and crack.
www.youtube.com/watch?v=DfR-U5q_H1c&list=UUvQ15DugBUuM6KWca42MOUg&index=27&feature=plcp

As a Priory Healthcare-trained therapist- who has been privileged to work with some of the best Drs and psychiatrists- I can tell you, that any interventions delivered in a care home or detention centre are not by qualified experts and the environment is itself not conducive for healing. There are other young people using or drinking around the person trying to get off drugs and often poor boundaries; and the environment itself is adding to the trauma, which is what triggers and fuels addiction in the first place.

Middlegate shut just as a national media campaign was gaining momentum:
www.thesun.co.uk/sol/homepage/features/2840250/Battle-to-keep-open-unit-rehabilitating-addict-children.html

A burgeoning social media network community of friends, family and former patients—who were amongst the hundreds of young people who had benefitted from Middlegate’s24 outstanding educational and therapeutic support.
www.facebook.com/group.php?gid=322866671101

2. Solutions

John Taylor and I have had access to some of the best facilities and addiction professionals in the field. They have helped us shape this proposal for a world-class UK-based facility, to be pioneered and perfected here and then rolled out across the world (starting with the Commonwealth nations).

Kate’s House—A Rehab for Teens

Mission Statement

Kate’s House will be a safe haven for teenagers who are addicted to drugs and alcohol and need specialist, holistic treatment—away from the people, places and things that have triggered and enabled their illness; which have made treatment in the community not a viable option.

Kate’s House offers sober scholarships to those most desperate young people.

Kate’s House will be equipped to medically manage detox and rehabilitate up to ten teenagers together in a warm, homely, household. The skilled, multi-disciplinary team will foster a healthy family-like environment: working with the young people to restore their hope and health and trust in adults, their fellows, and themselves- so they can begin to enjoy living clean of substances and harming behaviours.

Kate’s House will provide a pioneering, world-class, therapeutic and educational environment which is dynamic and innovative- that both acknowledges the differences that gender, culture, sexuality and socio-economic backgrounds make, whilst also helping the students understand how the patterns of addiction and alcoholism have impacted their lives;

All students of Kate’s House will be treated with equal respect and dignity.

The seven days a week/365 days a year schedule incorporates evidence-based treatment approaches such as the 12 Step programme, Family Week, Cognitive Behaviour Therapy (CBT), experiential therapies such as Music and Equine therapy, outward bound team-building, and body work such as yoga, acupuncture and reflexology.

Family Week at Kate’s House is a key component of our holistic approach that ensures the students and their family/responsible adults learn together about the addictive illness and what is needed to overcome it.

Younger siblings and children of addicts will be invited to take part in the regular Kate’s House children’s programme, to break the cycle and prevent the trauma leading to yet more addicted children.

Full Assessment—physical, mental and emotional—will provide a template for individualised Care Plans and pick up any particular challenges such as cognitive impairment and/or learning difficulties. Within a structured, boundaried setting the students will be given the therapeutic support and sense of security to face and heal past traumas and rebuild self-esteem to enable healthier relationships.

Our Fast Track scholarship referral system means we can respond quickly to constantly changing fashions in teenage poly-drug use. We will be uniquely placed to acquire and share new street-level knowledge and related research, new treatment protocols and accredited training with the in-house team and wider UK/international community of addiction professionals. Information sharing can be established with need-to-know organisations such as Government departments and ACMD (Advisory Council on the Misuse of Drugs).

Kate’s House is founded on the “actualising principle” that all the young people who come to us have enormous potential. Our facilities will include an in-house music studio, guest speakers from the creative fields will talk on the subject of living and working sober, The students will be encouraged to find and develop their talent through expressing their creative selves in the telling of their Life Story. The journeys through treatment will be documented by the students themselves and they will graduate with a story that expresses the past and a dream for the future.

By empowering a positive peer culture—residents will learn and practise leadership skills and accountability to the group and wider community. As active participants in the daily running of Kate’s House the young people will learn about budgeting, a good work ethic, healthy eating, exercise and being active; relaxing naturally and balancing their work/fun schedule.

Graduates of the Kate’s House programme will exit residential treatment with a clear focus and solid structure- to help them through the difficult first years of recovery, to reach their highest potential and walk their life path with integrity and purpose.

Alumni will be expected to check-in regularly as part of their after-care plan and submit to further treatment such random drug testing, 12 Step meetings, and attending the annual House reunions Kate’s Recovery Champions will be responsible for carrying the torch of recovery, sharing their privileged knowledge in schools and youth clubs across the UK—to illuminate the path for other young people who need help.

Fundraising

Our talks with the UK government—to fund the medical facilities at Kate’s House and to simplify the state referral system, so that local areas can more easily pay for some of our beds—have ground to a halt.

We are being told that no new money will be made available to fund this project.

So in order to open this facility and guarantee standards of holistic care, and to ensure our door is always open to give fast-track access to help, Kate’s House will have to be funded by charitable giving and benefactors.

To this end, we have approached Action on Addiction, to ask if their new patron—Kate, Duchess of Cambridge, will put her name to the project and help us to raise funds.

Raising £2.5–5 million is going to take some considerable time.

Meanwhile our most desperate young addicts have no choice but to keep selling themselves on the streets and doing whatever crime they have to, to feed their addictions.

Imagine if it was your child or grandchild… would you help us? What would you do?

February 2012

1 Internationally recognised as an expert: I was awarded the Pillar of the Community, 2010, award by Sierra Tuscon- ranked #2 psychiatric hospital and treatment provider in the USA.

2 Article 25 of the U.N. Universal Declaration of Human Rights (1948) reads:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Likewise, Article 12 of the UN International Covenant on Economic, Social, and Cultural Rights (1966) reads:
1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.
We ratified this on 20 May 1976.

3 See my article Skunk Cannabis: a therapist’s opinion
www.drugfam.co.uk/download/i/mark_dl/u/.../therapist_view.pdf

4 www.thisislondon.co.uk/health/article-24025800-ket-meph-crystal-and-gbl-the-party-drugs-blighting-the-lives-of-londons-clubbers.do

5 See Death By Diversity—in the respected journal, Addiction Today
(www.addictiontoday.org/addictiontoday/2009/08/death-by-diversity.html)

6 See My Daughter Amy clip http://youtu.be/ILeND5DO3UM

7 www.channel4.com/news/rehab-plea-from-amy-winehouse-family

8 www.drugscope.org.uk/ourwork/pressoffice/pressreleases/Young+Peoples+Cuts

9 www.youtube.com/watch?v=dBnniua6-oM&feature=youtu.be

10 Such as this project I assisted the Wellcome Trust with
www.wellcome.ac.uk/Education-resources/Teaching-and-education/Big-Picture/All-issues/Addiction/index.htm

11 John Taylor is in recovery, for 18 years, and is the parent of teens who have had access to best practice treatment, in California. His career success globally with Duran Duran and his long term recovery has given him a unique insight into addiction and popular culture. He lives in both LA and Wiltshire.

12 www.kidsco.org.uk

13 www.uservoice.org/

14 www.bettyfordcenter.org/family-and-children/children/index.php

15 www.drugfam.co.uk/

16 www.actiononaddiction.org.uk/home.aspx

17 www.youtube.com/watch?v=sSMbOuNBV0s

18 www.newport-academy.com/

19 www.independent.co.uk/life-style/health-and-families/health-news/from-groucho-club-to-rehab-one-womans-battle-to-beat-cocaine-addiction-468765.html

20 www.guardian.co.uk/society/2012/jan/17/treat-drug-addicted-children-as-adults

21 www.bbc.co.uk/news/uk-14384213

22 latest research www.bbc.co.uk/news/health-16854593

23 www.talktofrank.com

24 www.middlegate.co.uk/brochure.php

Prepared 8th December 2012