The Independent Drug Commission for Brighton is missing the opportunity to help turn the City from being the “drug death capital” to the “recovery capital” of the UK

The preliminary conclusions of the Independent Drug Commission for Brighton and Hove raise some interesting issues, worthy of debate, but overall the report is an opportunity missed.  This post is basically my personal response to the Commission’s consultation.

The Commission addressed four issues:

• Are the current strategies to prevent drug related deaths sufficient to achieve a significant reduction in the coming years?
• Are the policing, prosecution and sentencing strategies currently pursued, effective in reducing drug related harm?
• Are we doing enough to protect young people and to enable them to make informed decisions around drug use and involvement in drug markets?
• To what extent does the treatment system meet the treatment and recovery needs of the citizens of Brighton & Hove?

Unfortunately, the report is presented in a vacuum, giving no acknowledgement of the most radical change in national drug strategy for a generation which has called for a treatment revolution and the championing of abstinence. The words “abstinence”, “abstain”, even “drug free” do not appear in the report once. By ignoring the national context, the report is immediately undermined, and is, at best, of academic interest.

My disappointment with the preliminary conclusions focuses on the first and fourth points above and can be summarised by two points: it lacks ambition, and the presentation of the issues does not create the right platform for a proper debate on how to enhance progress in drug treatment.

Just 12% of those entering treatment services in Brighton “left the treatment system in a planned way, having overcome their dependency”. This compares to a national figure of 15%. The report is correct to say that “For the system to remain sustainable, the number of successful exits from the treatment system must keep pace with the number of new clients registered. If too many clients are retained in the system for too long, the system will become log-jammed. The Health and Well Being Board needs to find ways to increase the numbers successfully treated each year and support their recovery in order to prevent relapses and a return to dependence, both on drugs and on the treatment system”.

Sadly, this conclusion is not supported by a formal recommendation. It is almost an afterthought, appearing on page 22 of the 23 page report. It illustrates a lack of ambition. This issue should be upfront and should set the tone for the rest of the report, creating the climate where the more sensationalist issues, such as consumption rooms, could have been dealt with in the context of recovery and abstinence.

A bold ambition, of say 30% or 40% leaving treatment drug free, would have been a defining contribution to the debate and the development of services in Brighton. Such an approach would be right for clients, it would help them achieve their aspirations, and would better prepare them to cope with the fundamental changes we are experiencing in welfare reform. A failure to address the addiction of a sizeable cohort will result in them finding themselves further outside the structures of society with all the predictable consequences for them, their families and society at large.

The presentation of the report attracted predictable, yet avoidable, headlines. The media led on consumption rooms. How different it could have been had the report recommended a treatment revolution locally, with the ambition that Brighton will replace the unwanted headline of “drug death capital” to the “recovery capital” of the UK.

That would have created a climate where more controversial steps could have been introduced as part of a process aimed at getting people into recovery and abstinence.

I hope that the Commission will look again at its report, delay the final report if necessary so that it can strengthen its recommendations and thereby becoming a defining point in the evolution of drug policy locally and the start of a real treatment revolution.

The ambition of abstinence is key to tackling drug addiction

This is the text of an article I wrote that first appeared in the Brighton Argus on 21st June 2011 and in Drink and Drug News in July 2011:

In the last week I bumped into two former clients of Brighton Housing Trust’s Recovery Project. The project offers an abstinence based programme which provides a route to life without use of illegal drugs or prescribed substitutes.

Rob (not his real name) is just finishing his final exams at Sussex University. He looked well although stressed and tired due to lack of sleep. The next day I saw Rachel (again not her real name) who spoke about how much she was loving her new job – she had recently been promoted to become a manager within her organisation. I remember her 15 years ago when many would have written her off as another “hopeless junkie”.

One had left the Project four years ago, the other more than a decade ago. They have remained abstinent and have turned their aspirations into reality. Both are happy. Both are an inspiration to me and others, showing that recovery from addiction is possible.

In the same week I read the comments of two leaders in the City with whom I often agree, Caroline Lucas MP, and the head of Brighton police, Chief Superintendent Graham Bartlett, who have called for the decriminalisation of drugs and a harm-minimisation, health-based response. They said that “the war on drugs” has failed, that a new approach is needed that looks at the problem from a health perspective, with more prescribing to reduce crime and social dysfunction.

Like them I am deeply concerned about the high death rate of addicts in Brighton and Hove. However, I was frankly depressed by their proposals since (apart from the call for formal decriminalisation of private use) they are simply advocating a view which has dominated government policy since at least 1997. It is a policy that has failed. This policy has seen ever-increasing numbers maintained in drug use, with spiralling costs to addicted individuals and the wider community that cannot be sustained in ethical or economic terms.

The coalition government has signalled a fundamental change in approach, although this has yet to be translated on the ground. It says it wants to change the way drug addiction is tackled, with more people with problems diverted away from prison and into treatment as part of what it calls a “rehabilitation revolution”. Its strategy involves “championing abstinence” and the Department of Health said its aim is to get users “off drugs for good”.  I support all of this.

The Department says the current annual cost of maintaining treatment for 320,000 problem drug users is made up of £1.7bn in benefits, £1.2bn for looking after their children and £730m for prescribing the heroin substitute methadone.

A key issue is one of ambition or rather what can now be seen, in hindsight, as a poverty of ambition. Do we think that it is acceptable to tolerate the £3.6bn now spent on treating users with drug substitutes like methadone and keeping them on benefits each year, not to mention the wasted potential of 320,000 (a conservative estimate) addicts who are maintained in their drug use. Is it acceptable that addicts who wish to be abstinent have for many years now been all too often either denied the detoxification facilities they need or have been actively encouraged to use heroin substitutes?

It is a simple matter of logic that things cannot improve if much of what we do is to maintain people in their addiction. Clients in the Recovery Project testify that, before entering our abstinence programme and when on maintenance scripts, they ‘topped up’ with street drugs. There is also an active market in prescribed drugs which are sold on by addicts supposedly ‘in recovery’. Those addicted in this way may not use or commit crime at the same rate, but they are certainly still stuck in the drug using culture and often acting illegally and destructively.

It is surely ethical that addicted people should be helped to achieve genuine abstinence since it is only when abstinence is achieved that healthy relationships, safe parenting, genuinely secure housing, education, training and employment become viable options.

I fully support the call made by the think tank, the Centre for Policy Studies (CPS), for “a real transfer of power from large distant organisations to small innovative providers” for

rehabilitation.  I agree that small units such as the Recovery Project have a better chance of getting addicts off drugs completely, not least because they tend to involve abstinent users in the planning and delivery of services.

Kathy Gyngell, from the CPS, said prescribing methadone to addicts delays their recovery. “The state is subsidising people to be any number of years on methadone, which has turned out not to be a cheap option and will only subsidise the tiniest proportion – 2% – to go into a rehabilitation unit that would actually free them from dependency and allow them to live their life.”

The CPS states “There is one simple measure of success: that of six months abstinence from drugs.” As the CEO of an organisation which offers both harm minimisation services and genuinely abstinence-based treatment, I am ambitious on behalf of our clients. I maintain that 6 months abstinence is readily achievable and would go a step further. Treatment providers should be judged on whether the client is genuinely abstinent – from all mood-altering drugs – six months after finishing treatment.

 Recovery from addiction is possible. Those of us involved in policy making, commissioning services and delivering treatment for addicts have an ethical duty to offer safe care to using addicts, but to ensure that treatment leads, in each and every case, to abstinence. Too many lives depend on it.