What does treatment 'treat'?

If you stopped somebody on the street and asked them the purpose of treating people with drug problems, would they answer:

a. To help people get better
b. To break the link between drugs and crime

Chances are that (a) would win hands down which explains why some awkward questions were being asked in the media when it was revealed by the BBC’s Mark Easton last week (BBC 30th October) that very few people actually left treatment ‘drug free’ despite the huge cash investment. The National Treatment Agency was quick to point out correctly that the BBC had screwed the figures up by not comparing like with like across recent statistics. But even allowing for that adjustment, the impression given to the general public is that drug treatment has been a costly failure. Is that fair? No it isn’t. Those working in the field, users and families know that the treatment journey can be long and arduous with many slips on the way and that outcomes of success will differ from total abstinence to a regular methadone script. This was borne out by the Radio 5 Live session following the BBC revelation where several people who had been through treatment phoned their story in and of course, no two people had the same story to tell – but the end result for all those people was a life back on track however that was achieved.

The problem maybe that the successes of individual treatment are buried under the workings of a treatment system and a set of success criteria that do not play to the public perception of what treatment is about i.e. health improvement and not crime reduction - and which also unravel at the slightest challenge.

Back in the 1990s, the National Treatment Outcome Research Study (NTORS) determined that simply engaging in treatment without coercion reduced criminal activity. Latching onto this, the government decided to up the ante, concluding that if more people were forced through the treatment system, government could make a big impact on crime. Ever since – and certainly since the updated strategy published in 2002, the emphasis has been to push more and more people into treatment. But then you hit a snag. Can the system actually bear the load? Do you have enough treatment places to cope with demand even though you have significantly ramped up the investment? If the answer is ‘no’ then to prevent blockage, the imperative is for people to come out the other side of treatment as quickly as possible. And you can do that by taking the evidence that people do best if they are in treatment for at least twelve weeks and making that one of the exit benchmarks for treatment success against which agencies desperately tick the boxes to keep the funds flowing. You have to keep people for at least twelve weeks (which might account for some agencies who might be otherwise failing doling out extra drugs over and above therapeutic need as the BBC highlighted the week before). But then you might be encouraging them out of treatment so you can tick the ‘drug free’ box .

But what does ‘drug free’ really mean? It can’t mean much because a study from the north west of England showed that most of those who leave treatment ‘drug free’ in one year, are back in treatment the next. And what about those crime figures? It is commonly accepted that the crime drug users are most likely to commit to fund their habit is acquisitive crime and in particular, shoplifting – and that a large percentage of shoplifting is committed by drug users. So when the government announced in the House of Lords during last week’s debate on the government drug strategy consultation (Hansard 29th October) that drug-related crime had fallen by 20%, you would assume that figures for shoplifting are included in the calculation. You’d be wrong. According to the Home Office research department, the government doesn’t routinely collect data on shoplifting. There was one general survey of commercial crime in 1994 and another in 2002, but that’s it. That wouldn’t matter so much if shoplifting figures were going down. Yet according to data also published last week from the British Retail Consortium, consumer theft has been rising right through the life of the drug strategy. So what does that do to the government’s assertion that drug-related crime is falling as a result of the drug strategy? Hard to say when key data is missing – a calculation further complicated by the fact that rates of acquisitive crime were already falling before the strategy kicked in.

So where does that leave us?

Lots of people are being helped by the treatment system, but it feels like this is just a fortunate by-product of the prime directive to cut crime using a set of criteria that doesn’t stand up to much scrutiny making the whole treatment system look suspect.

We need to re-engineer the system so that it is geared more to helping people than reducing crime (which it may not be doing anyway). And this is not necessarily the hard political sell that ministers might think it is. But it won’t come cheap. If the imperative became sustainable effectiveness rather than bums on waiting room seats - so quality rather than quantity - then you are looking at a substantial investment in training for staff dealing with people in the treatment system - followed by another big investment to address all the housing, employment and education issues.

The chief executive of the National Treatment Agency once theatrically tore up a ten pound note in front of a conference hall full of drug workers saying that if you challenge the crime-focus of the treatment system, that’s what you are doing to your wages. On the basis of the headline data about treatment success, voters could be forgiven for thinking that’s exactly what’s happening to a large chunk of the current treatment spend.