Sober N Clean

The head of the National Treatment Agency dismisses 'ideologues' who claim his organisation's addiction programmes aren't working. 'The evidence in favour is overwhelming'.

After seven years at the helm of the National Treatment Agency for Substance Misuse (NTA), Paul Hayes is adamant that the addiction programmes he has overseen during his tenure are working. Not everyone is so convinced. On Radio 4 last week, Hayes was forced to defend his record against criticism that the current strategy of "treatment management" - using, for example, methadone for heroin addicts rather than "curing" their addiction - was failing and wrong-headed.

Hayes dismisses his critics as a few academics, politicians and "ideologues" stoked up by the media. He says any notion that investment in treatment programmes - central government funding has risen from £60m in 2001 to £400m in 2008-09 - has been a failure is wrong. The idea that treatment based on harm reduction could be replaced in future by an "abstentionist" approach, where success is measured primarily by the number of addicts "cured", is misguided, he insists. "We need to keep maintenance prescribing as an integral part of the drug treatment system because it stabilises people, reduces crime, reduces deaths."

The number of problem users in contact with treatment services has more than doubled in the last 10 years, from 85,000 to 195,000. Hayes says this is a clear indication that the system is working, but is far from the whole picture. Treatment centres, he insists, are also about taking the opportunity to ensure they help "as many people as they can to overcome their addiction, leave treatment and get on with their lives. But that's always been the objective of policy, so to a large extent a false division has been created. Rather more has been made of this very sharp split than it actually warrants."

There is an element of electioneering and political expediency to the current debate, Hayes suggests. "There was a political consensus for some time that drug treatment was a good thing and that, therefore, the more we had of it the better. There was consensus that the maintenance-led prescribing regime, which has got all the evidence behind it, is right. The National Institute for Clinical Excellence says it's the right approach, the World Health Organisation says it's the right approach - but always with an expectation that those people who could leave treatment free of their drug dependency should be encouraged to do so."

So if this is the case, why is there a debate now? Is it that the evidence doesn't stack up? Hayes says the evidence is clear and robust. "There are 130% more people in treatment than when we started [in 2001], rather than half the people dropping out because treatment isn't of good quality."

Chaotic lifestyles

But it isn't just about treatment numbers, he says. The impact on crime and a reduction in the social fallout from the chaotic lifestyles of problem drug users is also important to understand, he insists. "Long-term crime is falling, and when we match the criminal histories of people going through the treatment system, we show a reduction in arrests and charges. A York University study showed that for every £1 invested in treatment, the community gets £9.50-worth of benefit back - most of which is crimes that haven't happened."

Hayes suggests criticisms began to gain traction a year-and-a-half ago when the Conservative party's Social Justice Policy Group, headed by Iain Duncan Smith, published its Breakdown Britain report. A lengthy document examining the causes of social breakdown and poverty, the report concluded that an "explosion of addiction" was a major factor in fostering wider social exclusion. The possibility that policy might change direction under a future Conservative government was also mooted when it asked if current policy was "treating the symptoms rather than the causes", and concluded that treatment was being pushed in "the wrong direction, preferring maintenance to recovery".

Hayes insists that, despite the signs of a sea change indicated by Breakdown Britain, "the political reality" is very different. "If you actually scrape away the rhetoric of Breakdown Britain, you find people saying, 'Yes, methadone does work. We're not actually anti-methadone, but it's been given too much of a role in the past.'" He cautions against reading too much into the report. "What you promise in opposition and what you are forced to deliver in government are very different. You have to face the reality of the evidence and the resources you have available."

But how can Hayes be so sure that drastic changes in policy direction are not on the horizon if a Conservative administration does make it to Downing Street? If past performance in government is anything to go by, he says, then pragmatism dictates what is done. He points out that the "shift in policy away from an abstinence-driven policy towards a harm reduction policy took place when Margaret Thatcher was prime minister".

It also comes down, he says, to the fact that "very few people will deny there's a correlation" between drug dependency and crime. He argues that this, along with the "many complex problems" such as mental health difficulties that tend to come with people who are drug-dependent, tends to steer politicians down a more pragmatic path when in power.

So does Hayes concede anything to his critics? He admits that if the funding dries up things could get difficult - but says there is enough "for the moment". He also accepts that as the cash has been "pumped in" and local treatment services have expanded, quality of provision and cost-effectiveness has not always kept up. "You can't do that overnight," he says, adding that improving the quality of services - and therefore outcomes - will be a focus for the NTA for the next three years. Addressing critics who might say progress isn't coming quickly enough, he responds: "There is inevitably a time lag between the investment and the investment bearing fruit."

As for the future, Hayes sounds confident. "The evidence in favour of current approaches to treatment are overwhelming," he says. "The evidence and the cost-effectiveness will stand the test of examination and will stand up to whatever political spin is put on it. It may well be recast, relabelled, repackaged, but the evidence is the strength."
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source: The Guardian U.K