Young people’s drug and alcohol treatment at the crossroads

This DrugScope document was published last week following a similar look at adult treatment last year. It’s worth a look. It calls for us to have better ways of knowing what the trends are in young people’s drug use; to bridge the gap between services for young people and adults; to map out what services we already have and to increase access. So far so good.

The authors make the point that young people use different drugs from older people and they have different needs. The treatment system is not geared to these needs.

For instance young people often have mental health problems; criminal justice issues; social exclusion or educational needs.

Hang on a minute, that’s a perfect description of most of the adults I work with too.

Okay, what else? Well the document says that most young people do not need substitute prescribing or residential treatment. I’m with you on the first one, but we don’t actually know what who “needs” residential treatment.

The authors imply that it’s really only those with heroin or cocaine dependence who need this. The substance has got little to do with it guys; it’s the effect the addiction has on the person that matters. Have there been any studies looking at whether young people who go to residential treatment do better or worse than those who don’t go?

The paper seems to infer that we don’t need to worry about the drug use as much as sorting out the other social needs. It’s as if the problem will then melt away. This might be true for those using drugs in a non-harmful way, but for those who are dependent this is not likely to be the case.

If a young client is dependent on drugs and you educate them and put them in a nice flat, you’ll have a clever addict using in a nice house. You need to look at the alcohol and drug use too.

The document accepts that we don’t know how many young people are dependent. Furthermore the document is not at all clear about what it thinks dependence is. DrugScope equate it with ‘serious problems’ which is clearly not specific and there is a real blurriness around this here for me.

It sounds like they are still thinking about physical or psychological dependence instead of looking at broad markers like the DSM IV or ICD 10. There is a feeling that “medicalised” diagnosis of dependence is of little relevance to young people.

My worry here is that we will not recognise dependence if we don’t have a way of identifying it. While the document points to research suggesting 15% of young people might be alcohol dependent, it then goes on to say that “a very small number” might benefit from residential services like detoxification.

We are told that targets need to be different for young people’s treatment services compared to adult services. I would go further and say that targets need to be different for all services with recovery outcomes as evidence of efficacy.

How did the report come to be? Well it wasn’t for lack of consulting: four events with stakeholders were held in 2009 in York, Gateshead, Birmingham and London. In addition 43 DrugScope members who deliver treatment to young People were consulted.

Young service users also give their views and of course these are amongst the most interesting parts of the paper. However, I do wonder if they involved young people in sustained recovery from addiction. There’s not much sign of that to be honest.

The acid test of this paper for me was always going to be; does it recognise that addiction can cause chaos in this group? Some young people can’t use alcohol or drugs safely. For those folk who are dependent, does it recognise the concept of recovery, does it understand the principles and will it do everything it can to promote that goal for young people? For these principles apply regardless of age.

My litmus paper has been applied and I’m afraid it’s blue. Acid test failed. The word recovery is mentioned in this paper only three times. All in the same paragraph on page 30. That’s out of 65 pages. From a recovery perspective, it’s worse than the Cross Government Drugs Research Strategy and that was dire. Does it recognise the protective effect of recovery communities? Mutual aid is not mentioned once, despite the fact that there are specific groups for young people in recovery. Despite the positive things that are in here, my recovery mark for the document is two out of ten, and that’s generous.

I work in a service that does treat people under 25 whose lives have been ravaged by alcohol and other drugs. They have the right to recovery. If those who advocate for them don’t recognise this right, then they need to look again at their own thinking.

While there are things to commend this document, it falls so far short of what might have been possible and once more shows that the “experts” are in danger of being very out of step with the growing desire for full recovery and the hope, aspiration and energy of the emerging recovery movement.

Addicted young people need and deserve this too.