Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by RehabGrads (DP141)

Summary

This submission, from the RehabGrads, provides evidence that it is possible to recover from addiction and alcoholism and to live a life free from all mood altering substances illicit and prescribed, including alcohol.

This submission draws attention to the fact that the term “recovery”, within the field of addiction, has been hijacked by the harm reduction movement to enable the culture of substitute prescribing to become embedded in our substance misuse treatment system. This submission describes what the term “recovery” means, its history and proof that recovery from addiction is possible and accessible through residential rehabilitation.

Accompanied by a “Addiction Treatment Truths” factsheet, this submission draws attention to the danger of presenting harm reduction as a solution to addiction as opposed to a tool to be used on the path to abstinent recovery.

Recommendations discussed include:

Promoting abstinent recovery within the substance misuse treatment system.

Residential rehabilitation should be a readily accessible option for any addict or alcoholic who seeks its.

That immediate action needs to be taken to address the rate of closures within the residential rehabilitation marketplace.

1. In response the closure of 32 residential rehabilitation facilities across the UK in the preceding 24 months, the RehabGrads were formed on 14 July 2010 at a meeting of the Concordat—a collective of 46 residential rehabilitation centres across the United Kingdom.

2. As the graduates of residential rehabilitation programmes, now leading a life free from all mood altering chemicals, including alcohol, our purpose is to demonstrate that recovery from addiction is possible and that it can be achieved through attending residential rehabilitation.

3. In five short months we have organised ourselves nationally, regionally and locally as a nationwide volunteer network able to advocate for recovery and for residential rehabilitation. We seek to break down the stigma surrounding addiction and alcoholism.

4. The RehabGrads are now represented on The Recovery Group (RGUK), The Recovery Partnership and lastly the Residential Rehabilitation Expert Group. RGUK is a group of the leading minds in addiction treatment in the UK. Represented at this group amongst others are DrugScope, Addaction, The Concordat (a collective of 40 residential rehabilitation centres), Turning Point and BAC O’Connor. We debate current policy, its implementation and ongoing strategies to bring current drugs treatment policy into being. The Recovery Partnership and the Residential Rehabilitation Expert Group, both chaired by David Burrowes MP, are informal policy advisory groups which feedback deliberations directly to Oliver Letwin and the Inter Ministerial Advisory group for substance misuse treatment. Whilst we collectively have a significant voice drug treatment policy implementation is still led by the NTA and its policy is still centred around and focused on harm reduction. This is unacceptable.

5. It is important to understand the word “recovery” in respect to addiction and alcoholism.

6. The term recovery was first used by Alcoholics Anonymous in 1934 to describe entering into a life of total abstinence from alcohol, in essence to “recover” from alcoholism. Further adopted by Narcotics Anonymous and Cocaine Anonymous the term, within the realms of addiction, is used to describe leading a life free from ALL mood altering substances—illicit, legal or prescribed—including alcohol.

7. The “treatment” system in the United Kingdom is STILL centred around harm reduction ie substitute prescribing. It continues to be so despite the 2010 Drugs Strategy being focused in abstinence and recovery. Our members have all experienced this treatment system from periods ranging from one to 10 years, told that the best we could hope for was to “stabilise” our chaotic using through substitute prescribing. Once given the opportunity of recovery via residential rehabilitation we have become productive members of society. We have collected hundreds of “life stories” describing life before rehabilitation, during rehabilitation and after rehabilitation.

8. Consistent in all these stories is the problem one faces when entering into the treatment system. Substance misuse workers have been educated that prescribing substitutes is THE solution. It is virtually impossible to be referred and then funded into residential rehabilitation despite the success of such facilities.

9. Susbstitute prescribing as a solution leaves the addict in a desperate state—tied to the demeaning daily ‘pick up’ from the chemist, more often than not then needing to pick up the street drugs still needed to satisfy the untreated addict mind and left, in the worst case scenario completely unable to work or to function. Giving methadone, an opiate, to a heroin addict is akin to giving an alcoholic a daily drink to stop the shakes … its DOES NOT SOLVE THE PROBLEM. We know because we have been there.

In short the current treatment system in the UK is keeping addicts and alcoholics locked in addiction. Referrals to residential rehab were down by more than a third last year again. This is nothing short of criminal.

10. As the RehabGrads with a volunteer membership of thousands we are the demonstration of what happens when offered a chance of genuine recovery. Many of us accessed residential rehabilitation through family funding having been systematically denied the opportunity by treatment service providers and treatment commissioners. We are campaigning to ensure that the state delivers on its promise to grant addicts and alcoholics in desperate need of residential rehabilitation the opportunity to access it. The average addict or alcoholic never meets anyone in recovery as treatment services, steeped in harm reduction, do not enable service users the opportunity to attend abstinence groups or meetings. This keeps the service users ‘sick’, the service workers gainfully employed achieving nothing and society is left with an every growing number of people entering treatment and never coming back.

11. The only source of “facts” about the success of the treatment system come from NDTMS (see attached “Addiction Treatment Truths” factsheet). In 2010 NO ONE was recorded as leaving treatment abstinent from anything other than illicit opiates and crack cocaine, 75% of the 200,000 in treatment were on prescription (mainly methadone) of whom 49% had been so for more than five years and only 2% had been referred to residential rehabilitation.

12. Research carried out by the Concordat in 2011 demonstrated that the average cost to society of an addict in the year leading up to entering residential rehabilitation is £85,000—this is based on GP visits, criminal justice and police expenditure, NHS funded detox, prescriptions. An episode in residential rehabilitation, for six months, costs on average £14,000. Drug users who go to residential rehab are seven times more likely to be drug-free after three years than those who go to methadone clinics. (Drugs Outcomes Research Study in Scotland—The Centre for Drug Misuse Research, University of Glasgow).

13. A recent survey (soon to be published) of services users in Birmingham shows that 10% of those service users would like the opportunity to go to residential rehabilitation. A second survey (soon to be published) of service users in the Wirral shows that 50% of service users do not want to be on prescribed substitute medication but are unable to access a pathway to achieve it.

14. Despite the 2010 Drug Strategy having “recovery” and abstinence as key elements of the strategy, referrals into residential rehabilitation are down by over a third from five years ago. In the same period of time the national treatment budget had doubled.

15. In light of all these points and in further reference to the attached “Addiction Treatment Truths” factsheet it cannot be claimed harm reduction “treatment” works as a solution to addiction. It can be seen as vital part of the treatment system IF it is seen as a stepping stone on the journey into recovery—a life free from all mood altering chemicals, illicit or prescribed

Conclusion

16. It is clear that the current “treatment” system neither provides nor promotes adequate pathways into abstinent recovery, despite the 2010 Drugs Strategy having recovery at its core.

17. Service users are being denied the opportunity to recover, being kept locked in a co-dependant relationship with treatment service providers and the situation is getting worse and worse.

18. Residential Rehabilitation DOES provide an exceptional pathway into abstinent recovery, however it is an extremely underused resource and the industry faces significant challenges in 2012 and beyond. Unless direct action is taken within Government then more residential rehabilitation centres WILL close and the huge depth of experienced addiction therapists will be lost.

19. The cost to society as a whole cannot be underestimated, both financially and socially if the 2010 Drugs Strategy is not implemented as it was intended to be.

20. Significant work needs to be done with treatment service providers to educate service workers, and service users, about true abstinent recovery and when it is right to refer to residential rehabilitation.

21. The RehabGrads are working extremely hard to demonstrate that abstinent recovery works, that it is achievable and that making proper use of residential rehabilitation facilities is vital to creating a vibrant, healthy and socially beneficial recovery community in the United Kingdom. To achieve this we have forged working relationships with the big treatment providers, like Addaction, and are proposing to offer a nationwide network of Recovery Champions to treatment providers and service users, to guide service users on their journey into abstinent recovery. We are developing a nationwide addiction prevention “Schools” project with the Amy Winehouse Foundation, to carry our message and experience to parents and schoolchildren alike to break down the stigma around addiction.

22. Recovery from drugs and alcohol abuse is possible, we are the active and real life demonstration of that fact and we will work tirelessly to achieve our goals.

January 2012

Addiction Treatment Truths

(2010 figures, National Treatment Agency)

204,473 “in contact” with treatment services (100%);

75% on prescription (mainly methadone);

49% on scripts alone with NO other intervention or support;

19% of those on scripts have been for more than five years;

Methadone consumption not supervised after three weeks;

5% inpatient detoxification * see note;

2% (or less) residential rehab (of unknown length and at an all time low)* see note;

0% leave treatment abstinent and sober (no records taken) NDTMS treatment discharge figures refer only to “freedom” from illicit opiate or crack use, not from opiate substitutes, alcohol, cannabis or other illicit drugs;

£730 million spent annually on this “treatment” system;

£3,800 for each addict “in treatment”;

£300 per addict per annum methadone dispensing costs;

£1.4–£1.7 billion spent on benefits of those in treatment (without child care costs) see Breaking the Habit CPS 2011 http://www.cps.org.uk/cps_catalog2/Breaking_the_Habit.html

average cost to society of an addict or alcoholic in active addiction, in the year leading up to admission into residential rehabilitation £85,000—including costs for hospital detox, police and criminal justice, GP visits, prescriptions. Does not include benefits. (Research carried out the The Concordat 2011);

average weekly abstinence based rehab costs £550 per week—less if housing and other benefits used to contribute to cost;

approximately 3,200 beds in England and Wales;

rehab referrals down by over a third from five years ago (it was nearly 6,000 then);

on average 1 in 3 of those people referred to residential rehab go on to receive state funding and successful admission into rehab; and

drug users who go to residential rehab are seven times more likely to be drug-free after three years than those who go to methadone clinics. (Drugs Outcomes Research Study in Scotland—The Centre for Drug Misuse Research, University of Glasgow).

* These figures from the most recent NDTMS report (Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2010– 31 March 2011) taken from table 3.2.2 may be inflated as they do not tally with another table 3.2.1 on the same Page (12) that reports only 3,845 Inpatient detoxification “pathways” last year which would be less than 2%. This requires further investigation—possibly a parliamentary question. Similarly there is a discrepancy between two tables regarding the residential rehab figs which would make RR figs 1.2%.

Prepared 8th December 2012