Drug Treatment System in the UK. Dr. Lisa Luger, LLC Consultancy CIC, London

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1 Drug Treatment System in the UK Dr. Lisa Luger, LLC Consultancy CIC, London

2 History of drug treatment in the UK (The British System) 1920 Dangerous Drugs Act 1926 Rolleston Committee Report st Brain Committee report confirms Rolleston report nd Brain Committee report restricts prescribing 1980s heroin epidemic and threat of HIV infection 1988 ACMD recommends Harm Reduction in response 1995, 1998 National Drug Treatment Strategies, DATs 2001 National Treatment Agency (NTA) 2002 to 2008 move from harm reduction to crime reduction Recovery

3 The Management Standards Consultancy(2001) A Competent Workforce to Tackle Substance Misuse. An Analysis of the Need for National Occupational Standards in the Drug and Alcohol Sector, London.

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5 Highly specialised (Non)Substance Misuse Services Substance Misuse Specialist Services Generic services with specialist input Generic services

6 Aims: to drive forward the Government Drug Strategy and oversee and improve the availability and effectiveness of drug treatment Improve quality of services and promote evidence-based practice Monitor performance of drug treatment sector through the National Treatment Monitoring System (NDTMS) Clinical guidelines on drug treatment Improve the skills of drug treatment workforce (DANOS) Advice/allocation of money from pooled treatment budget

7 DrugScope (2009) Drug treatment at the crossroads. What it s for, where it s at and how to make it even better. DrugScope. London.

8 DrugScope (2009) Drug treatment at the crossroads. What it s for, where it s at and how to make it even better. DrugScope. London.

9 DrugScope (2009) Drug treatment at the crossroads. What it s for, where it s at and how to make it even better. DrugScope. London.

10 DrugScope (2009) Drug treatment at the crossroads. What it s for, where it s at and how to make it even better. DrugScope. London.

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12 Continuous evaluation National Treatment Outcome Research Study (NTORS): For every 1 invested in drug treatment 9.50 are saved in costs to the criminal justice system and health care Changing risk behaviour amongst injecting drug users Changing attitudes of professionals Increase the number of drug users in treatment Related outcomes: Improve general health and wellbeing, relationships, social behaviour, criminal behaviour Drug free?

13 DrugScope (2009) Drug treatment at the crossroads. What it s for, where it s at and how to make it even better. DrugScope. London.

14 DrugScope (2009) Drug treatment at the crossroads. What it s for, where it s at and how to make it even better. DrugScope. London.

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18 AA founders 1935 Bill and Bob The new Abstentionism:

19 Radical... reform of treatment is needed towards holistic and abstinence-based approaches. It is about facing the fact that abstinence is the most effective method of treatment and the only appropriate one for many addictions. (politician) There are a variety of routes into drug dependency and a variety of journeys out of it. Simply parking people on methadone is not good enough (drug user) Drug treatment whether it is focused on abstinence or maintenance in and of itself Is not going to solve the underlying problems that can make drug use problematic. Poverty... is not soluble in methadone hydrochloride. Nor is a decrepit education system, or a lack of challenging and satisfying employment, or a shortage of decent housing. (professional) Well... for nearly 20 years I was a service user who was using methadone. I d been a chaotic user and a career criminal. They said I d never come off methadone, but I have and I feel recovery is now real for me for the first time. Why are treatment services allowed to tell people that they ll never be able to come off methadone? I think it is disgusting. Everyone should be offered the full range of options. For 19 years I thought I needed to take methadone every day... but, you know what? It wasn t true... I now know it was a lie. (drug user)

20 Turning up at the CAT team (drug treatment centre) once a fortnight, being handed a methadone script and going back out the door again... that is no use to anybody. Effective treatment needs to be substitute prescribing hand in hand with other things... Effective treatment is about community based programmes where people can sit down with a key worker, develop a care plan, look to where they want to go and how they are going to achieve it, and regularly reviewing that care plan substitute prescribing has a role in all this, but it is not a substitute for it. drug user Methadone keeps people alive, but what life is it? drug user Part of the reason I think we get into such confusion over this is we are using the wrong language, the wrong models, -the wrong everything for the wrong debate. We are talking about harm reduction...about treatment...about abstinence, but these are all medical ideas. Drug use is a poverty issue... It is largely an issue of deprivation... We are... trying to deal with individuals living in absolute poverty not just poverty of money, but poverty of aspiration and education. That is a huge job and it is why people relapse. When we use language like abstinence, treatment and recovery, we are using medical language for what is a social care issue. drug worker

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22 Individual journey out of drug use holistic approach to treatment oriented on individual need Looking at the underlying issues of the drug problem to cope with a bigger problem Housing Education Unemployment Relationships Domestic violence Abuse, rape Prison The list is endless...

23 Drug Strategy 2010: This Government will work with, and offer every opportunity to those people who face up to the problems caused by their dependence on drugs or alcohol, and who wish to take steps to address them. The investment made in the drug treatment system over the last decade has built capacity and enabled people to access treatment for a sufficient period of time to bring about substantial health gains. We now need to make the same progress in treating those with more severe alcohol dependence and to become much more ambitious for individuals to leave treatment free of their drug or alcohol dependence so they can recover fully. We will create a recovery system that focuses not only on getting people into treatment and meeting process-driven targets, but getting them into full recovery and off drugs and alcohol for good. It is only through this permanent change that individuals will cease offending, stop harming themselves and their communities and successfully contribute to society. It is an individual, person-centred journey, as opposed to an end state, and one that will mean different things to different people. We must...put the individual at the heart of any recovery system and commission a range of services at the local level to provide tailored packages of care and support. This means that local services must take account of the diverse needs of their community when commissioning services. HM Government (2010) Drug Strategy Reducing Demand, Restricting Supply, Building Recovery: Supporting people to live a drug free life. HM Government. London.

24 Possible barriers to recovery: Lack of collaboration between Government departments(social services, health, education, employment) Professionals lack of understanding of complexity of drug problems and treatment Access to services (i.e. Housing, employment, education) conditional to being drug free Criminal record Recovery is just tokenism/ too strict or unrealistic outcome measures Pressure on drug users to get drug free Money: most drastic public spending cuts in a generation. Payment by results

25 Payment by Result -Outcome related payment -Payment by central or local government to providers is dependent on achieving specified results -In the NHS: payment per case, no. of patient through put to fixed prices -What are the issues for drug treatment /recovery? Focus on outcomes of drug treatment is important with particular emphasis on recovery and social integration - Issues and challenges

26 Payment by Result for Recovery (PbR) Getting the outcomes right Multiple needs require collaboration between services Ensuring compliance with clinical standards Market approach leads to competition Organisations may game the system Bureaucracy degree of messiness Customer choice Workforce development Concern that HR work does not fit into recovery and reintegration Gradualist approach with piloting and evaluation

27 Recommendations Radical rethinking of how services are provided and what works Collaboration with other providers all singing from the same hymn sheet Putting client into the centre Holistic treatment is costly but cost effective Long-term view of commissioning effective treatment rather than shortterm populist activities Workforce development is more important than ever...

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29 Further Reading: HM Government (2010) Drug Strategy Reducing Demand, Restricting Supply, Building Recovery. Supporting People to Live a Drug Free Life. HM Government. NTA (2010) Drug Treatment and Recovery in National Treatment Agency. London. Drugscope (2009) Drug treatment at the crossroads. Drugscope. London. UKDPC (2008) No one written off. A response to the Department of Work and Pension s Welfare Green Paper. Oct UK Drug Policy Commission. UKDPC (2011) By their fruits... Applying payment by results to drugs recovery. UK Drug Policy Commission. February Luger, L (2011) Lifestyle Factors Substance Use and Misuse: A UK Perspective. Chapter 12 In: Porter, E. and Coles, L. (2011) Policy and Strategy for Improving Health and Wellbeing. Transforming Public Health Practice. Learning Matters Ltd. Robert, M (2011) By their fruits... Applying payment by results to drugs recovery. UKDPC.

30 Contact details: Dr. Lisa Luger LLC Consultancy CIC T: M:

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