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It looks like Amy Winehouse’s dad knows more about addicts’ experience of trying to access residential treatment than the head of the NTA. Mitch Winehouse gave evidence to the Home Affairs Committee in the House of Commons. This from the BBC’s website:
Talking of addicts he said: “We’re making a film about people who can’t afford it [residential treatment] and unfortunately we found there are very few facilities and very little help available for people like that.”
Mr Winehouse said he believed the problem was caused by the majority of government funding for drug treatment being spent on the criminal justice system, where a convicted addict would be offered free residential rehab.
“We’ve spoken to addicts who have told us people are desperately committing offences just so that they have a chance of receiving treatment,” he said.
“The truth is there is very little treatment available to people who walk in off the street and say ‘I need help’.”
The National Treatment Agency for Substance Misuse, which is part of the NHS, hit back at Mr Winehouse’s comments.
It said waiting lists for drug treatment in England had fallen to an average of one week, while 93% of people got the help they needed in three weeks, even when a stay in a residential rehabilitation centre was required.
Chief executive Paul Hayes said: “Drug treatment in England has never been more available to members of the public who need it. We think it is important that the public knows that, if they or a family member needs help, they can get it on the NHS.” (ENDS)
I have to say I’m growing increasingly impatient with the spin. That’s not the experience of folk who want recovery, or those on long term methadone who want to move on. At least not in most parts of the country Mr Hayes.
For the most part, they are being seen by people who don’t understand what recovery is, who don’t have the skills or experience needed to help people find recovery and if you are on methadone, don’t even think of going near abstinence, you’ll be told ‘it’s too dangerous’.
Waiting times are good. Numbers of people in treatment are impressive, and there are pockets of good practice, but there’s still too much of ‘one size fits all’.
Mark Gilman has offered to pass on any issues where limitation of access is an issue (see his blog). I fear that the folk who have found Wired In are not the ones who need help.
How has Amy’s dad got it sussed?
‘Her father said he had heard stories of people trying to steal their way into rehab after finding themselves unable to get treatment through the normal channels’
Are people really doing this? Evidence?
‘“Anecdotally, people are definitely committing offences so they can have a chance, and it’s only a chance, of receiving treatment,”’
Evidence? The statement itself simply doesn’t stand up.
‘He said that this had happened to his son-in-law – Fielder-Civil – when, as part of a sentence, the judge offered him a period in residential rehab’
This is not an example of someone committing crime to get treatment. Or is he suggesting that his son and co. gave that man a beating in order to fast-track themselves into a shot at treatment?
‘He said drug users struggling to get clean had to wait at least a year for treatment’
Simply untrue as a generality (possibly true in some cases – no particulars given)
I think it is dangerous to uncritically endorse this kind of thing, no matter how congruent it is with a progressive agenda.
And believe me, I wave no flags for the NTA!
I believe he’s going to produce some evidence in a film he’s making. In quoting what he said in the commons, I don’t think I’m endorsing all that Mitch Winehouse is alleging, but I would challenge Mr Haye’s assertion that access to all treatment modalities is equitable.
Peapod yes many are fed up with the spin from this guy and many others thankgod the dishonesty is at least being acknowledged…. and is no longer acceptable, same with the phrase evidence based research and the terrorism that goes along with it….
The tide is turning!
I like the idea that evidence comes in other shapes apart from the double blind randomised controlled trial. Like all of us in recovery!
I’m all for the evidence of experience.
The trouble with Amy’s dad (as reported) was that it was all assertion without evidence…
this “evidence based research” phrase is really starting to get on my wick!
i hope someone better qualified than me will do a blog to show the limitations of evidence based research!!! it is the terroirism of insinuated superiority in the phrase that really grates though!
I have never heard the phrase ‘evidence-based research’ before. If you think about it, it’s a bit of a tautology! Do you mean ‘evidence-based practice’ or ‘evidence-based policy’?
I’m guessing that the point you want to make is that ‘research’ should not always be held as the ‘best’ sort of evidence, superior to everything else (including personal experience). I would certainly agree with that. I see research as a particular type of evidence rather than as indicative of a particular quality standard of evidence (- there is, as we all know, plenty of poor research knocking around).
A man I respect greatly pointed out to me this week that back in the dark ages the evidence base for witchcraft was overwhelming. Great scholars produced tomes proving the existence of witchcraft and justify the burning at the stake or drowning in the ducking pond of proven witches….lol
I am also reminded that basing your whole modus operandi on historical data is like driving a car blindfold with a guy directing you who is looking out of the rear windscreen.
However, we live in a world where the spend for treament is large and comes down through the NHS. So its not surprising to see evidence bases as important. Its what clinicians have been weaned on from their days as young trainees. Plus the litigation culture of our society has made the NHS super conservative and risk averse.
If the Recovery movement wants to make a swift and decisive impact it must generate an evidence base which will withstand scrutiny.
You know, nobody ever did a randomised controlled trial on parachutes. We don’t actually know that they work better than no parachutes because nobody has done the scientific work. Of course we have anecdote and common sense, but I’m afraid these are not scientific.
Can I propose that we ban parachutes until we have evidence of their efficacy?
A consequence of criminallity can often lead to more positive treatment options and that is a fact no matter who says it, and i’m sorry to say that truth be known this fast track method to recovery can be viewed as the only option left when things are getting desparate, speaking from personal experience their, things need to change in the mainstreem and i wonder how cheap is the cheap option of methadone maintainance, i personally cost the tax payer a fortune with my behaviour whilst on prescribed meds, you see i’ve found the stable addict a rareity and chaos in addiction a more natural process.
The whole business of RCT’s versus other forms of evidence has become an important issue in my world and it’s something George De Leon and Eric Broekaert have been writing about recently. This is a link to a recording of Michael Gossop speaking at the EWODOR symposium some years ago in Oslo. It’s a while since I listened to it but I remember it as a pretty crushing indictment of RCT-world:
http://www.ihwte.org.uk/radiotc/ch3/s14/p3s14-0014.mp3
From the same conference, here’s a link to George De Leon talking about RCTs and therapeutic communities:
http://www.tc-of.org.uk/radiotc/ch3/s14/p3s14-0005.mp3
Actually the whole conference was really interesting on that “what is evidence” question. Most of it was recorded there is a full list of speakers here:
http://www.tc-of.org.uk/wiki/index.php?title=P3S14#p3s14-0014
The truth is that some interventions (like TCs) are extremely complex with a large number of variables which MAY have an impact upon an individual’s recovery trajectory. Frankly it would not be possible to conduct RCTs on such complex interventions. The model does not lend itself to that kind of application. It works best with simple interventions (if we take a group of drug users and give some of them methadone and others nothing what is the result? Does one group do better than the others?)
What the research community needs to begin to ask itself is whether it is OK to continue to discredit other sorts of evidence (we have 40 years of evidence showing that people who complete TC programmes, overwhelmingly remain addiction-free – not admissable for some researchers because there is no control) when the sort of evidence we approve of (RCT – the gold standard) is not applicable to the sort of interventions we are wanting to examine.
Interesting comments, Rowdy. I think approaches vary between different disciplines. I don’t see many drug/alcohol researchers from a social policy or criminology background, for example, who are too hung up on RCTs as the ‘gold standard’. It’s more the medical and health care bods. On the whole question of ‘evidence’, I’ve found Ray Pawson’s work really helpful and clear. His most recent book is well worth a read if you haven’t come across it already. I think his approach to ‘realist synthesis’ could be a really productive tool in our field, especially in the evaluation of complex interventions like TCs.
Hello!
Given all the media furore about Prof David Nutt, it seems that Anne Marie isn’t alone when she says “this “evidence based research” phrase is really starting to get on my wick!” So presumably she is a fan of the Alan Johnson school of policy making which abandons any evidence base because of populist, media driven, vote winning policies.
Personally, I am all for a good analogy – but Peapod your irrational parachute argument just doesn’t work here. How do you think factors such as size of parachute, material, and the required height before opening were arrived at? Faith, or science? Which parachute would you choose. The one made by a person of faith or one that reflected scientific research? Science isn’t WHOLLY dependent on double blind trials you know. To suggest it is is to create a straw man, all the more easy to knock down.
Like Tom’s argument re witchcraft – “A man I respect greatly pointed out to me this week that back in the dark ages the evidence base for witchcraft was overwhelming. Great scholars produced tomes proving the existence of witchcraft and justify the burning at the stake or drowning in the ducking pond of proven witches….lol”
We don’t frankly know what happened in the Dark Ages and there was certainly a lack of material to support his points about “great scholars producing tomes.” Maybe in the Middle Ages, but not the dark ages. Ironically, in a site which has a fair few fantasists who believe in a mythical character called God, and his fabled abilities to help people with addiction, it seems ironic to cite Witchcraft as a LOL subject. After all I think it’s probably the Christian Scholars of the Vatican who wrote the Malleus Malleficarum and drove the burning and dunking of witches. So belief in witches is laughable, eh Tom? How about belief in Devils? Or Gods?
I couldn’t agree more, Molly. We will be throwing the baby out with the bathwater if we go down the road of being ‘anti-evidence’ and valorizing ‘experience’ over and above everything else (- or, even worse, only listening to evidence when we agree with it). It’s a dangerous direction to take, as anyone’s opinion can be seen to have equal weight. What we need, in my view, is a serious grown-up approach to evidence, rather than some of the more shrill contributions here.
If either of you are referring to my comment I think you need to step back from your high horses. I made a light hearted comment about evidence base and you start quoting historical innaccuracies and making fun of those with religious/spiritual beliefs. I’m not suggesting we do away with an evidence base but quite the contrary that we need to create one for Recovery Outcomes. That requires researchers, clinicians, therapists and social workers to come together and work in unison for the benefit of service users.
Rule 62 applies to both of you.
Ray, Molly. No, I don’t think that is what people are saying here. I think what is being expressed here is a growing discontent within the field that the only “evidence base” that seems to count is that purveyed by the medical profession who have once more attained control over addiction treatment despite its interest/relevance to other disciplines and all that they have to offer.
It’s simply stating a fact to say that research in the medical profession is dominated by the RCT doctrine (NICE, Cochrane et al) and that other forms of evidence, however well founded and however persuasive, are often dismissed out of hand (take the off-the-cuff remark by a NICE representative recently that therapeutic communities are an “evidence-free zone” – actually he wasn’t talking about just addiction TCs, he was dismissing all TCs including the Henderson and Cassell!!).
In an earlier post, Ray remarked that he hadn’t found too many sociologists and criminologists who are hung up on RCTs and that’s right. But that’s just the research community. I’ve been working in and around the addictions field for nearly 40 years now and I’m absolutely clear that the past 10 years has seen dramatic changes in the field’s concept of what constitutes an evidence base for treatment.
It’s increasingly become hugely more medically orientated (people like Zinberg and Robbins would probably not get funded for their work today), much narrower in focus and with a very biological or disease model understanding of what addiction is (take, for instance the huge rebirth of interest in genetic transference research). None of this can be good for effective treatment and those of us who have consistently argued that addiction is much broader than the public health imperative and more complex than a mere biological phenomenon would be rightly castigated if we fell silent now.
Tom –
Sorry; I forgot that I was back in the Wired In website and I should stick with things like:
“good post Tom. That analogy about how people in the past were dumb and did things from a faith basis rather than an evidence base was spot on.”
Great post.
MZ
I guess any form of humour is lost on you Molly.
I can remember being that angry. T’was a burden I am glad I found relief from!
Rowdy –
I’d love to be able to agree that “what is being expressed here is a growing discontent within the field that the only “evidence base” that seems to count is that purveyed by the medical profession.”
The OP here highlighted the wisdom of Mitch Winehouse, and was challenged as to how wise it was to take this as being evidence based;
Anne Marie followed by expressing frustration with “evidence based research.” Not I stress scientific, or double blind – merely “evidence base.” Others suggested the value of the obvious or the observable over the evidential.
Instead, what I am seeing, I am afraid, is a very selective, targeted and specific denigration of one model by another and a fair degree of censorship and control underpinning this.
The very same charges are routinely wheeled out against scientists but I am seeing the same denigration regularly and routinely on this site and others.
So Pat O’Hare gets a good going over, has his academic credentials questioned, the amount that he’s published criticised, and his entitlement to use the term “professor” questioned.
Mike Ashton, who has done a huge amount to put a massive range of evidence, RCT trials and other in to the public domain, gets slammed. If information is power, few people have done more than Mike to empower: by making research available free, and accessible he does far more than many University Lecturers who publish only in journals and don’t make their research available to the masses.
You, Rowdy, have slammed people who are critical for posting anonymously, but it’s fine for people who post things you agree with under a pseuodonym?
It’s impossible to know how much comment is censored in Wired In; by promoting some blogs as “features” others are demoted and easily hidden from site. Comments are erased and there’s no trace of them unless they were captured by Google’s cache. Despite an earlier request there’s still no “comment deleted” marker to show where this has happened.
The same thing is happening at Addiction Today. In their Blog Entry on the NTA “Dodgy Dossier” Deirdre Boyde launches in to a diatribe against the NTA and draws on a number of sources to bolster her argument; one of these is laughably “Tony Wilk” of New Ways Clinic – purveyor of hocum “bioreduction therapy.” It’s the logical endpoint of this “out with the scientists” mindset – all quacks, fraudsters, bigots, evangelists and zealots end up with the same value, status and credibility. Unfortunately as the AT responses to articles are controlled by AT, they have not posted my comments on their article. It’s the same sort of censorship.
So an illusion of consensus is built and maintained, and any chance of real debate is stifled.
And very few people here challenge the more irrational edges of this discussion.
MZ
Tom –
You’d guess wrong. Please don’t patronise me with your “I was that angry once” schtick and quoting AA lore at me. In a situation where there’s a witchhunt on for scientists, I found your analogy weak. Sorry you didn’t like being pulled on it.
MZ
What’s behind the anger? To paraphrase Eleanor Roosevelt, you can only be patronised if you give permission.
And to quote (I think) Douglas Adams, “I need aphorisms now like I need a hole in the head.”
I am fairly depressed that a whole collection of people are denigrating “evidence” except when it serves their arguments. We’ve got to a twisted position where Mitch Winehouse = good evidence and Mike Ashton = bad.
And that doesn’t make you angry?
MZ
For the record, I am from a scientific background and respect scientific research in all its rich diversity. I don’t consider Mr Winehouse’s comments to be evidence, but I have trouble with the NTA’s line that access to all treatment modalities is equitable. That’s what got me motivated to post.
I don’t see a witch hunt on scientists here. Some of the posters (including me) have published research along established scientifc lines! Mike Ashton is hugely well regarded here and in fact is quoted in several other blogs.
Mike Ashton’s interpretation of research has helped my own understanding greatly. I don’t agree with every conclusion he reaches, but I respect his integrity. Lack of respect for each other does worry me though and I have stated that clearly in other places.
Quite serious allegations about Wired In and AT Molly. As someone who has had a few blog threads edited now, I have to say that in my opinion the interventions have been entirely appropriate.
Sarcasm, intolerance, mockery, cherry picking, disrespect, organised ‘attacks’ etc are not attractive and are so against the ethos of the site (stated clearly) that they have to be tackled and dealt with. Some of the most harmful comment has been in response to the blogs of incredibly vulnerable folk very early on the recovery journey.
The response to such harmful posts and to other responses attracting complaint has been made in a fair and even handed way. From memory, I believe it was stated here that for technical reasons there was no way to indicate that a comment had been removed. That may have changed.
Those who have respect for others’ views, value the variety of recovery experience of others (including those with faith and spiritual orientations) and can agree to disagree will have no problem being active and valued members of Wired In.
There are addiction sites where intolerance, undermining and dogged negativity flourish. Wired In is not one of them.
OK – one last time and then I’ll stop. I’m sorry Peapod, I really value your blogs and regularly read them. I know I already ended up in a contratemps on another of your threads and I had no intention of doing it again. So this is my last post here:
I am not denigrating evidence – I make my living out of it!
I’m not attacking Mike Ashton. I’ve been a friend of Mike’s for more than 30 years. Actually I didn’t even know he was a member of Wired In
I’m not denigrating the NTA. I have no real interest in the NTA which is an English institution and has no powers here in Scotland.
I’m not going to repeat my argument because I’ve just reread it and I think it’s perfectly clear. If you are really interested in my views you could just read my post again.
I am fascinated that I keep getting pulled up by people who insist on remaining anonymous but I suppose that’s life!
Don’t apologise Rowdy, I value your posts and am flattered you take time to read my wanderings. Truth is I welcome all posts within the spirit of recovery.
There’s a bit of me (no doubt related to that addicted bit) that is like a stick of Blackpool Rock. It has the word “MORE” running through it. It’s the grandiose bit that loves to see the comments stacking up on my blog.
I’m not sure it’s a healthy bit…
Several comments. I’m not sure why you are apologising Rowdy, I for one value your postings.
Can as I say as a long-standing scientist, I see no witch hunt of scientists. As for criticism of Mike Ashton, I know that people here have huge regard Mike – and some of us are his friends.
As for deleting comments, I put a comment on the vast majority saying it has been moderated out. I know I have slipped up and forgotten a couple (and therefore may missed a few more) but I don’t pretend to be perfect. Just trying to help people in my spare time.
Personally Molly, I do feel you are getting heated and close to being offensive which is against the principles of this site. I apologise if I am wrong here. At times you give the impression of being more destructive than constructive.
Let’s not forget we are here to help people improve their lives – inevitably that will involve criticism of the system as the system has many problems. The important thing is to suggest how the system can be improved – those thoughts can be criticised as well, but I find it sad that some people get heated when doing this.
For the very large part though, the atmosphere on this site is very good, which is SO important given some of the vulnerable people who are using this place as a form of support.
I am sorry to have to come back on this, but I have just edited an upsetting blog from someone who has just lost their son. This sort of thing really puts things into perspective for me – and should do for others.
I spend a good deal of time reading personal and sometimes upsetting blogs and comments from people who are genuinely struggling in life (and for very good reason). I also spend time behind the scenes interacting with some of these people emailing back and forth. It is not easy. And it has been tiring doing this pretty much myself over the past year.
Understandably, I therefore get disappointed, and sometimes frustrated and upset by a small number of people who get heated and sometimes aggressive on the site. Generally, the comments are destructive rather than constructive.
I am also reminded of part of a comment above:
“Sarcasm, intolerance, mockery, cherry picking, disrespect, organised ‘attacks’ etc are not attractive and are so against the ethos of the site (stated clearly) that they have to be tackled and dealt with. Some of the most harmful comment has been in response to the blogs of incredibly vulnerable folk very early on the recovery journey.
The response to such harmful posts and to other responses attracting complaint has been made in a fair and even handed way.”
Let us get on with trying to help people get better, deal with their problems, and improve their lives.
This comment has been deleted by a moderator.
Pretty offensive Molly and disappointingly uncongisant of the concerns raised against this style and content. Be kinder to yourself.
It seems to me that Molly only addressed what other posters had written, whereas some posters responses to her made disparaging presumptions about her sense of humour; divined anger problems, etc.
I take the point about vulnerable folk posting, but surely every poster should be responsible for the content of their posts.
As far as I could see, Molly met passion with passion, and as regards thread comment deletes, and AT, offered at least as much detail and info as the majority of posters did in this thread.
We’ll have to agree to disagree Peter. I also found the comment offensive and I have had other people complain about other postings from Molly. I really don’t think they fit with the ethos of the site. I don’t want to start a site scrap here, so I am terminating the thread.
