UK Drug Treatment - Lessons from History for the Future

On 7th November 2019, Public Health England released their adult substance misuse treatment statistics report. During the reporting year, a total of 268,251 adults were in contact with drug and alcohol treatment services, between April 2018 and March 2019. To put this in to context, that figure equates to more than the total population of the city where I live, Wolverhampton (est. 258,440 in September 2017).

For each person that touched the treatment system that year, regardless of how they came to be in touch with services (i.e. via criminal justice, self-referral, primary care etc.), they had encountered a problematic relationship with either drugs and alcohol, or both. One fifth of new entrants to treatment (19% or 24,565) reported housing problems, with differentials depending upon the substance(s) that they were using. More than half of people in treatment were over 40 years old (54%), with 53% of people stating that they had a mental health need. The report details further detailed data on various subjects, such as links to areas of deprivation, safeguarding and parenting, injecting, deaths, employability etc.

Furthermore the report offers a 14 year period of treatment data, starting from 2005 to 2006, where a total of 966,040 different people have been in contact with drug and alcohol treatment services. By 31 March 2019:

·         141,667 (15%) were still engaged in treatment

·         383,954 (40%) had left and not completed their treatment and not returned

·         440,419 (45%) had completed their treatment and not returned

So what does this tell us?

Treatment engagement is definitely a positive protective factor for those encountering difficulties with drugs and/or alcohol. A substantial proportion of people have left treatment successfully and not returned (45%). But as someone who is accounted for within the history of NDTMS (National Drug Treatment Monitoring System) it was post treatment where much of the hard work began – building trusting relationships, securing & maintaining good quality housing, seeking a fulfilling career, managing finances, taking care of my physical and mental wellbeing and overall, becoming a productive member of society.

Upon further reflection, there were cultural and systemic barriers that I encountered during my time in treatment, and after. During treatment, my mental health suffered greatly, with the staple intervention offered being prescribed antidepressants. Mental health affects us all at some point in our life, for some it is something that we learn to live with (either through medication or other means). It is worrying that the battle that I faced in receiving meaningful interventions for both my mental health and addiction issues are still a sticking ground for people today.  

It is good that treatment services are asked to provide information on wider determinants for those that are accessing their services, such as employability and housing, but this is often self-reported. I would often feel it necessary to provide falsified information to services, as it would make me feel a bit better about my situation and I did not want to feel as if I was somehow letting down the person asking me.

In my opinion, there is far greater emphasis on ensuring that treatment initially, engages individuals suffering from addiction, treats them, ensures that they can exit successfully and importantly do not return. I would suggest that concentrating efforts mainly on this premise is not making the scale of difference to people’s lives that they require and deserve, especially as, since 2005, 40% of those left the treatment system and did not return.

From my time leading a peer led and run support charity in Wolverhampton called SUIT (2007 to 2019), the most important measurement of success when supporting people facing problems with drugs and/or alcohol was whether people felt comfortable in honestly discussing and addressing deeply personal problems, so that effective solutions could be devised together. We also designed a bespoke data system that allowed intricate analysis on performance, outcomes and cost (the average intervention cost was £34.07).   

I would ensure that the individual would decide what their immediate, medium term and long term goals would be, and spend a countless number of hours listening to, and providing advocacy, in order to reach (and record) the desired outcome. 

This approach received much attention, both from within the sector and outside, but most importantly from the communities that we would serve. It was awarded the ‘Queens Award for Voluntary Service’, cited in various ‘Good Practice’ guidance papers and twice marked as ‘European Best Practice’.

Now, I would offer the following recommendations to ensure that the treatment services achieve consistent levels of excellence, so that more and more people leave their services, achieve their potential and activate their productivity within society:

• Diversify, and re-weight the accepted outcomes from treatment services (i.e. not predominantly focussed on ensuring successful completions)

• Re-invest funding in to the drug and alcohol treatment sector (the core Public Health grant has reduced by 25% since 2014/15)

• Workforce development, with a particular focus on – trauma informed approaches, emotional intelligence and partnership working

• Specialist efforts in working with older people who are accessing treatment  

• Treatment flexibility and an improved levels of risk tolerance

• Develop a diverse and inclusive workforce

• Efficient pathways with organisations and services providing post treatment support with social integration

• Adopt a partnership based approach, in areas that are particularly pertinent (e.g. housing, tackling indebtedness, mental health, welfare, health etc.)

• Ensure that Lived Experience is able to influence, shape, design, implement, deliver, monitor and evaluate service provision.  

• Embrace digital technology and integrate tools within treatment delivery modalities

Broader recommendations include:

• At a policy level, shift from a criminal justice approach to a health based approach

• Adopt decriminalisation at the earliest possible point

• Ensure widespread availability of naloxone across all local authorities areas, to tackle the shocking levels of drug related deaths (particularly in the most deprived regions)

• Address the gap between health and poverty

• Examine and address housing inequality, particularly within the private rented sector

• Create multiple, integrated pathways for employment, including self-employment and social entrepreneurship

• Ensure social impact measurements across the spectrum of service delivery

• Examine the impact of school expulsions, care system involvement, social disadvantage and implement effective solutions 

• Ease access to medical cannabis, for a variety of health issues (including conducting research in to smoking cessation, alcoholism and tackling opiate addiction)  

• Integrate data systems in order to provide macro (system) level analysis