As readers of previous
posts will know, I’m not the greatest fan of the work of the Centre for
Social Justice on substance misuse. This
isn’t anything to do with my own politics, or theirs. I don’t think the claims are actually
political in the sense of left or right.
Rather, they are (apparently) more like managerialism: ‘what works’ to
deal with ‘addiction’?
The most recent claim of the CSJ was that there’s not enough
residential rehabilitation in this country.
I say recent, but it’s an ongoing claim, but with a
new quick and dirty bit of analysis behind it.
The CSJ looked at the estimated number of
opiate and/or crack users in each region of the country, and then divided
this by the number of residential rehabs
listed by Public Health England (PHE).
Today’s post is just a short response to this analysis,
highlighting a few points that make this not just inaccurate but unhelpful.
Setting aside one issue that frustrated me – whether we
should be calling all (or any?) users of crack and opiates ‘addicts’ – there’s
a clear and straightforward issue with the analysis.
I’m assuming that fundamentally what we’re concerned with is
whether people are able to access a particular mode of treatment, which the CSJ
says is “the most effective means of helping someone fully recover from
addiction”. Location is not the same as
access. This is particularly the case
for a type of treatment where people generally stay for 3-6 months, and part of
the very point of it (as opposed to the community-based treatment the CSJ
continually run down) is that it’s not in the service user’s own local
area.
It is, at best unintentionally misleading to claim that
these stats suggest rehab is the preserve of the ‘wealthy’. That might be true, and there would be ways
of assessing that, but this analysis certainly doesn’t offer that evidence.
And this brings me to the more fundamental point: the CSJ
are still claiming that res rehab is “the most effective means of helping someone
fully recover from addiction”, when there is no evidence to suggest this.
Again, I’m not saying this isn’t the case. I’m concerned that despite the illusion NDTMS gives of there being plenty
of quality and quantity of data related to treatment, we don’t actually have
quite the information we’d want to identify if someone can be said to have ‘fully
recover[ed] from addiction’. The NTA admitted as
much in 2012. And this is quite apart
from working out what it would mean to ‘fully recover’. (It seems from the CSJ ‘2015
manifesto’ that cocaine users should never drink again, otherwise they
shouldn’t be classed as ‘successfully completing’ treatment – see p.22.)
The statement about the effectiveness of res rehab is
particularly difficult to sustain when Iain Duncan Smith’s own Department for
Work and Pensions has
just recently published research showing that if res rehab is more
effective than standard community-based treatment that only applies to a small
cohort of the most ‘complex’ clients, and even then it’s not clear it’s ‘cost
effective’. There’s a great summary of
this work at findings.org.uk
(It might seem harsh to be discussing cost effectiveness,
but at some level all policy decisions have to come down to this, particularly
if we’re talking about funding one form of treatment in place of another.)
Why does this matter?
Well, if CSJ staff really want to make a difference, they should be
looking at producing evidence and arguments that make the debate about
substance misuse treatment clearer, not muddier. We do need an open debate about how well
currently-commissioned work, and what the aims of those services should be, but
outlandish statements about the number of res rehabs in the North East doesn’t
help that. Perhaps those staff could
benefit from some reflection on why they’re so attached to res rehab. That or reply to my tweets
asking how they can substantiate their bold claims – because if there’s
something they know and I don’t, it would be helpful to pass it on. Then maybe we could work together to make a
difference.
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