Learning About Addiction Treatment, Part 5

I continue my series of blogs, starting here, about my journey into the addiction recovery field after I changed ‘career’ in 2000 from being a neuroscientist to working in the community. At the same time, I was still working as a Professor in the Department of Psychology, University of Wales Swansea (now Swansea University) in the UK.

In an earlier blog, I briefly described how I led the national team that evaluated all projects funded by the National Assembly of Wales’s Drug and Alcohol Treatment Fund (DATF) for two years from mid-2000. Here is what I wrote in my recently published book Our Recovery Stories: Journeys from Drug and Alcohol Addiction about the DATF evaluation and my views about the UK drug treatment system at the time.

‘The two years of working on the DATF evaluation gave Becky Hancock and I an initial understanding of what was happening in the addiction treatment field in Wales. I learnt more about the treatment field in the UK as a whole once I started visiting services in England and Scotland. I continued to read as much relevant material as I could.

One of the most important things we learnt during the initial evaluation was the need for information and education about good practice to be circulated widely. This was made all the more essential given the UK Government’s 1997 drug strategy, which focused on an integrated approach to tackling drug problems involving health, criminal justice and social service sectors. It was a tremendous challenge to equip staff in all these areas with an understanding of the nature of addiction and how best to help people overcome substance use problems, ensure best practice, and develop systems that facilitated communication between the sectors.

It didn’t take us long to discover that this challenge was not being met well. Practitioners, clients and family members told us that they were not getting enough of the right information. Leading addiction experts told us that whilst we knew a lot about how to help people overcome addiction, little of this information was actually used in practice. Practitioners told us that the overall system was not working well. As we travelled around, we met many practitioners who knew little about how to help people overcome substance use problems. The voices of recovering people were just whispers at the time. 

The problem of poor information flow was well-illustrated in the report by North Wales DATF local evaluator Anni Stonebridge about the North Wales Community Drug and Alcohol Liaison Midwife position that was supported by the DATF.

Prior to this position being developed, expert guidance regarding how to manage substance misuse in pregnancy wasn’t readily available in North Wales (and many other places). Practitioner’s personal prejudices towards substance using mothers were more likely to fill in the gaps in their knowledge than the person trying to dig for the best advice. Many pregnant women with a substance use problem who visited (or wanted to visit) services lived in fear of their baby being taken. Child removals occurred in many cases, often for no reason.

However, as revealed in Anni’s report, things changed dramatically when nurse Jill Timmins decided that she would all do she could to get a midwifery post specialising in substance use problems to be funded. The DATF provided two-year’s funding and Chris Weaver was appointed to the multi-agency post. Dramatic changes occurred for North Wales pregnant mothers who had a substance use problem. The knowledge base of different practitioner groups, and the communication between them, was greatly improved. Babies of mothers with substance use problems were not routinely taken. Proper care plans were put in place. 

It was always a great pleasure to visit Chris and Jill and hear about their work. Their passion and commitment helped fuel our passion. We could see how disseminating their story, and that of many of the other practitioners whose work was making a positive difference in their area, could help improve the practices of other people around the country and further afield. The internet was clearly a powerful tool to facilitate information flow in the field.

What was happening in the treatment field was heavily influenced by the UK government’s drug strategy, which classed the drug problem as a criminal justice issue, rather than a health/social issue.

The UK Government’s priority for drug treatment was to provide methadone, a long-lasting heroin substitute, to people who were addicted to heroin, believing that this would reduce the crime that they perceived was caused by heroin addicts. In fact, the reality of the situation was that only a small proportion of heroin users carried out large amounts of acquisitive crime to finance their addiction. And heroin was only one form of drug problem. The largest problem was in fact caused by a legal drug, alcohol. 

It was sad that the government’s focus was on reducing crime, rather than on the well-being of people affected by problematic substance use. It was ironic that I had moved away from a medical field, only to find myself working in a field where a good deal of addiction treatment was medically-based.

Counting the number of people being given methadone, rather than trying to determine how many people were overcoming their drug problem, became the priority for the UK government (and National Assembly of Wales). I started to hear more and more disturbing stories from people on methadone programmes. 

The young man who was put on methadone as part of his Drug Treatment and Testing Order (DTTO), who when funding for the position terminated, was left high and dry with no methadone. The young couple who came to see me in my university office, saying that when they asked to be put on a methadone programme to help them get off heroin, they were told by the treatment service only he could receive the drug. He had a criminal conviction and she did not! They could not offer her any help. (People used to ‘joke’ that if you wanted help for your heroin problem, go and break a window or burgle a house.)

The numbers of people on methadone programmes who complained that they got no support (other than their prescription), or at best a 20-minute interview with a drug worker every two weeks, to address their substance use and other problems in their life. 

As I have said earlier, I am not criticising the use of methadone per se. Methadone can play an important role in some people’s lives, as illustrated in Sapphire’s Story in this book. However, much of the treatment system had a paucity of ambition for the people who were turning towards it for help. It did not provide hope, choice and opportunity. 

I became convinced that we needed to improve the way we helped people overcome substance use problems. I could not see these improvements coming from a ‘top-down’ approach. Government seemed to be far too divorced from the reality of what was needed on the ground and did not understand the key issues. Some ministers and civil servants did not appear to care about the problem. They just said what they had to say to appear to have done what was expected by the system. The people who needed help were their lowest priority. A ‘bottom-up’ approach was needed.’ Our Recovery Stories: Journeys from Drug and Alcohol Addiction. Copyright © 2021 by David Clark