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The Collapse of Rehab in the UK

Tuesday, February 3rd, 2009 The Collapse of Rehab in the UK

A very interesting article in the Independent-by Nina Lakhani (01 02 09) relating to the collapse of drug rehabilitation centres in Britain.

Notably, it has been established that at least 15 of the UK’s 100 rehabilitation centres have closed within the last 15 months. Yet numbers seeking help for additions have increased.

What needs consideration is why there has been such a turn around? There have been changes to government policy. More specifically private rehabilitation centres are finding fewer and fewer health authorities willing to fund residential treatment, despite the fact that this type of treatment has been deemed far more effective according to the Addiction Recovery Foundation.

Such is the extent of the problem it has been identified that a flagship rehab centre costing £26m is preparing to close its gates after only one year of operation.

With reference to the latest Department Of Health statistics, 202,660 drug users were seen by addiction services in England in 2007-08.

The National Treatment Agency (NTA) has spent millions of pounds getting thousands more drug users into contact with addiction services since it was set up in 2001. However, last year only 3 per cent of cases were referred to a residential rehab service, while two-thirds were prescribed heroin-substitute medication by GPs and NHS doctors working in addiction services.

Furthermore it has been argued that there are few long term benefits to this medication-centered approach. Notwithstanding, in the main, rehab services use a version of the twelve step programme. The aim is for the patient to become abstinent beyond four to six weeks of intense therapy.

With the above in mind, another consideration needs to be addressed. Rehabilitation has been paid for by the drug user or by their local health authority. What has become apparent is the fact that government policy supports putting as many addicts as possible into methadone-substitute programmes because they are cheaper.

As a direct consequence, rehab clinics such as Winthrop Hall have become reliant on private clients. The hotel-style addiction clinic was opened in October 2007 by Jon Moulton, a venture capitalist and millionaire, to provide specialist treatment in luxury surroundings for high-flying City executives. But yesterday, staff confirmed that the £32,000-a-year clinic is no longer accepting new patients.

Notably, those who advocate rehab are keen to point out that research carried out by the University of Glasgow revealed that drug users who go through residential rehab are seven times more likely to be drug-free after three years than those who go to methadone clinics.

From a critical perspective, Dr David Best, from the Department of Psychiatry at the University of Birmingham, said: “Commissioners have spent bigger and bigger slices of the pie on harm reduction services at the expense of rehab, despite the evidence that rehab works. Users now have to jump through so many hoops to get there, it has become much harder, and rehab centres have closed as a result. It’s not because we don’t need these services but the system has become saturated in methadone clinics, which are a much cheaper and easier way to ‘treat’ people.” Arguably this clearly suggests that the government will cut corners in order to save money. Furthermore with reference to Deidre Boyd of Addiction Recovery Foundation, she whole heartedly rejects the governments stance on the use of methadone and states “The Methadone Programme is like doping up people in an old people’s home.”

Professor Neil McKeganey, director of the Centre for Drug Misuse in Glasgow, said: “When we stop patting ourselves on the back and look back on this period, we will see that this was a shameful dereliction of our responsibility and we failed the majority of drug users by keeping them locked into addiction. Drug services fail addicts, contrary to official figures which report overwhelming success. Our research shows that those lucky enough to get residential rehab are seven times more likely to be drug free after three years. This is an inconvenient finding for politicians and civil servants who have preferred to support cheaper services that deal with large numbers of people.”

The NTA points to research that shows substitute prescribing reduces dangerous injecting and crime rates among addicts. It also claims that overcoming dependence is the ultimate goal of all treatment it supports. Paul Hayes, the NTA’s chief executive, disputes the number of rehab closures and believes the proportion referred to rehab is closer to 8 per cent.

Finally, it has been deemed that an addict in the pursuit of recovery, must establish what has made him/her an addict in the first place.

Andy Hayden, 40, a former addict, lives and works with ex-offenders in in Weymouth, Dorset. He has been clean for five years.

“I started on alcohol, glue and gas when I was 12, but within a few years I’d progressed on to anything I could get my hands on. At my worst, my girlfriend and I spent £600 a day on crack and heroin. Eventually I ended up living on the streets, picking food up off the floor, and was in and out of hospital with abscesses and cellulitis.

“About six years ago I suddenly realised that if I didn’t do something I was going to die. I went to the local methadone clinic and was immediately prescribed 50ml ‘maintenance’ a day. This was enough, but I told them I needed more so they doubled my dose. I still had no idea what was wrong with me; we never talked about that. So I kept stealing to buy drugs because while methadone stops you feeling ill, it doesn’t give you a high. When the clinic threw me out for using extras, my addiction was even worse. Methadone is a horrible drug to come off, much harder than heroin.

“In 2003 I heard about a project that sent prolific offenders into rehab. I was so desperate by this point that I made up loads of offences, just so that I’d get in. I was eventually referred to the Providence Projects in Bournemouth and have never looked back since. I know rehab is more expensive, but you have to learn why you’re an addict before you can stop.”

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