Reflections on drugs, rehab and the passing of Whitney Houston

BBC Wales is reporting that alcohol and drug rehabs in Wales are facing closure because of a lack of clients. It reports that almost half of the 91 clients referred to rehab went to centres in England. http://www.bbc.co.uk/news/uk-wales-16992896

I had four reactions to this story:

Just 91 clients referred to residential rehab? Either Wales has resolved its alcohol and drug problem, in which case we should all be told how. More likely is a policy or cultural issue in Wales that does not recognise the evidence that treatment works and that head and shoulders above all treatment options is abstinence-based residential in terms of getting people off, and keeping them off alcohol and drugs

That last point “keeping them off alcohol and drugs” brings me to my second observation. Why on earth are people still being sent out of area for residential rehab? My experience over the last 25 years is that people sent out of area are ill-served since they will not have a drug-free support structure on their return and the likelihood of remaining abstinent are remote. Why do commissioners waste public funds by continuing to send people out of area?  An obvious response from some will be that here are no rehabs in their locality

That brings me to my third point, why aren’t there any rehabs? Why have commissioners failed to commission residential rehabs in their areas? Again, is it cultural or policy? If politicians are serious about tackling alcohol and drug addiction, then residential rehabs must be a corner stone of any strategy. Yes, it is often more expensive in the short term to send someone to rehab, but it is so much cheaper than keeping them on a maintenance script month after month and year after year.

My final point concerns abstinence. The word ‘recovery’ covers many approaches, including the ongoing prescribing of substitute drugs. Some use the phrase ‘abstinence’ to refer to being free from street drugs. I use the phrase to describe an individual being free from all drugs, including that most harmful one, alcohol. On this day, when the death of Whitney Houston leads the news, I am aware of reports that she had “kicked drugs” meaning cocaine and other illegal substances, but alcohol was never mentioned. Nor were prescribed drugs.

I don’t know what killed Whitney Houston, but I would suspect drugs and alcohol played a part. Like Amy Winehouse, like Michael Jackson, like so many known and not known individuals, a failure to direct them into abstinence is the ultimate neglect of individuals and the system.

Why I don’t support the decriminalisation of drugs

The outgoing president of the Royal College of Physicians, Sir Ian Gilmore, has said the laws on misuse of drugs should be reviewed and that their supply should be regulated. 

While there are many superficial benefits, I have never supported decriminalisation because there are a number of basic questions that have not been properly thought through.

For example, from what age do you decriminalise drugs?  Should it be 18, as with alcohol?  Then what about the 14, 15, 16 year olds in our towns and cities who are using?  Do you leave under 18s in the hands of “violent gangsters”?  Or do we say there is no minimum age?  There can be nobody in their right mind who would advocate drug use amongst children.

Would we place restrictions on users? For example, would we require users to forfeit their driving licences since some drugs stay in the system for 4 weeks and influence reaction time and other performance?

Would we say that users should be allowed to have custody and responsibility for children?  We know that incidents of domestic violence and child abuse increase due to alcohol use.  Are we certain that by giving respectability to drug use that there will not be similar increases in neglect?

Do we really want to write off hundreds of thousands to a life of worklessness and benefit dependency?  I wouldn’t employ someone who is drunk at work, nor would I employ someone who is under the influence of drugs.  Most employers want clear minded, focused employees.

Alcohol use is closely related to availability. Things have become so much worse since the last government liberalised alcohol availability.  It seems shear lunacy to go down the same road with drugs and expect to arrive at a different destination.

Research by Exeter University identified its illegal status as the main reason why the majority of 15 year olds don’t experiment with cannabis

I support the policy changes being introduced by the coalition government to champion abstinence. Policy for the last 25 years has often resulted in addicts being supported to stay on drugs. I welcome the government’s greater ambition to commit itself to helping people to come off, and stay off, drugs.

A spokesperson for the Home Office said: “Drugs such as heroin, cocaine and cannabis are extremely harmful and can cause misery to communities across the country.  The government does not believe that decriminalisation is the right approach. Our priorities are clear; we want to reduce drug use, crack down on drug-related crime and disorder and help addicts come off drugs for good.”

I think the government has got it just right.