The current issue of "Drug and Alcohol Findings" (1) highlights the sudden reversal in 2013 of some indicators of the good progress that we have made in substance misuse treatment in recent years.
This is a quote from their conclusions which needs to be widely disseminated when considering what evidence based drugs policy should look like:
"Within the reporting year 2007/08 the BBC exposed the tiny proportion of patients who within a single year left treatment drug-free, intensifying a national policy emphasis on successful completion. Since then commissioners and services have been under reputational pressure to produce more successful completions, and in recent years, under financial pressure too. If exits are indeed being promoted to meet national or local needs and ambitions rather than those of the patient, this would make the increased successful completion rate partly a marker of a worse rather than a better treatment system."
This is a warning which we must heed now. I believe that the "recovery = abstinence" agenda that has gained traction over the last few years may be contributing to these emerging problems. The insistence on increasing the number of "successful completions", has shifted the focus from the quality of professional person centered care a person receives, to an outcome measure which either overtly or covertly pushes people to get off a substitute script and leave services - perhaps before they are ready.
Recovery is so much more than being off a script - indeed, the script itself is not the important thing for most people. They want a decent home, not to have to commit crime to feed their addiction, good family and social relationships, work and/or education, health and a hope for the future. All this is possible on a script - and takes time. There is good evidence that being on treatment is protective and helpful in several ways - we already know that - why are we going backwards?
Treatment needs to be individual and to be characterised by competent compassion. It must not be driven by external pressures on contracts and targets. Otherwise we will see more of these poor outcomes for people and increasing deaths because they cant get the treatment they need.
There is more discussion on this at www.competentcompassion.org.uk, and I have discussed the background in more detail in a previous eLetter to the BMJ (2)
Are we as professionals willing to stand up and be counted for the sake of our patients on this? That is what professionalism should be all about.
Dr Joss Bray MRCPsych FRCGP
2. BMJ 2014;349:g7493
Competing interests: I am the founder of www.competentcompassion.org.uk - which promotes a simple concept that should underpin all that we do as professionals.