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This NTA document looks to answer the question of how powder cocaine addicts are doing through treatment. If we look at the paper with our recovery glasses on, how does it shape up?
The authors acknowledge that there is a growing problem in England with powder cocaine; particularly with young adults. A small but significant percentage (10%) of those coming into treatment generally identify powder cocaine as their main problem. Access to community treatment is very fast and the aim is abstinence. The document states clearly that full recovery is the goal and actually defines recovery capital. This is the language of recovery and is good news.
For those going through treatment, other substance use was reduced too and there were measurable improvements in health and quality of life. The social background of those treated was broader than those with heroin problems.
In 2008-9, over 8000 people entered treatment for cocaine addiction and over 8000 people left treatment. Of those that left, 63% had “beaten their dependency”!
That’s stunning, until you realise that the follow up time was six months and the abstinence measurement was the 28 days prior to this. Cocaine addiction does not behave like a virus, resolving quickly. It behaves like a chronic condition. To make sense of outcomes we need to have one year, two year and five year follow up intervals. For the same cohort.
And to protect and support the individuals leaving treatment, was there assertive referral to mutual aid? We don’t know. Mutual aid is not mentioned in the paper at all. This is despite the prominence of the practice in the Orange Book and NICE guidelines and the fact that unlike this paper, mutual aid groups do recognise the chronicity of addiction and have much to offer both during and after treatment.
The authors are very confident that residential treatment has almost no part to play for powder cocaine users, but of course this is based on the false premise that they are all cured six months down the line. The cocaine addicts I see in my service have years of misery to report, have often lost jobs, marriages, mental health and sometimes freedom and need much more intense support and aftercare than is indicated here.
We don’t actually know how much support the folk in this study need for the follow up is not long enough to assess their needs. I can hear the creak and whirr of a revolving door in the background. This paper does not serve addicts well; being told you have beaten your dependency is sweet music.
We already know much about how addiction behaves. To package it as a short term problem, cured at six months by treatment is unhelpful. Not to mention mutual aid is curious. If I were cynical, I’d be concluding that either the authors are not knowledgeable of how cocaine addiction behaves, or they want to put a positive spin on things. Neither is admirable.
Recovery score? Marks out of ten: three.
Recovery Score! I like this concept perhaps even a job or the UKRF to access and score documents such as these with a clear recovery based criteria for the scoring!
3 is a little generous in my opinion so if the UKRF do decide to offer such a benchmarking service make sure Im not on it!
Hmmm – mutual aid goes missing again. Curiouser and curiouser as Alice remarked.
A sin of omission of comission I wonder?
I’m suspicious of data being handled by the NTA. Good science should involve a totally independent organisation collecting and analysing data – there is too much vested interest involved at all levels in this study and too much money concerned to those involved (NTA, DAATs). And we have had too much PR from the NTA, which leads many people to question the veracity of all that they have to say.
I would love to see an independent commission set up to look at this and other NTA studies (some of which have been very iffy) with independent scientists brought in to look at the study at all levels (including interviews with people who have given up cocaine).
I’ve heard horror studies from services over time about outcome measuring, including if we don’t see the client we count them as having given up drugs. We are under pressure to perform (i.e. we lose money if we don’t get positive outcomes, and this means our jobs are potentially at risk). Can we really trust all data in these sorts of situations? I’m sure there is a huge story here for an investigative journalist.
It is such a sad situation.
Peapod, you are a very generous individual – three out of ten!
I’ve looked at this paper and it seems to me that the numbers don’t add up – and I don’t think 12 pages is much of a report, really.
5,511 people at the start of the “study” and only 3,075 left at the end; the pie charts suggest 51% of 3,965 people are abstinent for a 28 day period prior to a 6-month review – this is hardly scientific.
The use of the TOP is questionable, too – people usually don’t complete these forms themselves, so the treatment provider may have a vested interest in “ticking boxes” should a service user refuse to answer questions they find offensive.
A 6-month review doesn’t signify sustained recovery, and like others, I’m not impressed that the issue of follow-up care and mutual aid has been largely ignored. Of course, no paid individual would be keen for their masters to know that people join self-help groups or fellowships finding the existing services so lacking in long-term care and peer-group support.
I think the NTA needs to produce figures like this to maintain its’ stranglehold on services – without “results” it would lose its’ rationale for existence.
David is absolutely right about the horror stories; and thank you for this, Peapod – good stuff.
Andrea
Very interesting, I don’t believe a word, or a figure. The figures are massaged to keep people in a job and to look good to their bosses, their bosses bosses and ultimately the government. Any statistician could massage the base figures (which you don’t see here) in a fail or success report depending on how you wanted to see the result.
12,354 people were in treatment in 08-09. 8,491 were new, and 8,479 of those 12,354 left treatment. It does not say how long these 8479 people were in treatment before they got out. 5341 (the 63%) of these people who left this undisclosed timescale of treatment had beaten their dependency.
“Using TOP data, this bulletin looks at a study that tracked the progress of people accessing services for powder cocaine over a period of six months.” This does not state that the people tracked are those people starting treatment, though it can be read this way as “Treatment Outcomes Profile (TOP), provides a more detailed examination of an individual’s progress from the start of their treatment to its conclusion.” It only says people “accessing services”.
So from the 8479 who left treatment in 08-09 the DAT partnerships only had data sufficient for 5511 cocaine users to use in the manipulation of figures – what is this criteria?. What happened to the other 35% ? So 51% completed successfully = 2022.
I’m getting lost now as I seem to have lost 3087 people. It states 12,354 were in treatment in 08-09 but adding the total up in table1 (Age of cocaine users in treatment) it only adds up to 9267.
What the results tell us: mmmm ?And I just love this statement “ Most powder cocaine users start treatment with a specialist drug treatment service, based in the community, within a week of being referred (on average, it takes just over five days).”
I agree with David, lets have an independent organisation to do the math.
Cliffy,
p.s. what is the UKRF (I’m collecting acronyms I read about and only have UKBA in my list) Too many TLA and FLA’s in this subject lol.
Hi Cliffy,
Go to Member Directory on left side and click then put in UKRF in search and you will get to their profile page. You can read about it by going through blogs.
I wonder if MPs know how much the data is massaged by the NTA and system and if they did know whether they would care? It’s a disgrace, and we’re talking about people’s lives ultimately.
Well, a few days after this paper came out, the Home Affairs Committee report on the Cocaine Trade bemoans lack of residential treatment provision for cocaine addiction and recommends extra funding for this.
You will remember that the NTA report said that residential treatment had almost no part to play.
You couln’t make this stuff up.
Incidentally; thanks for all the comments. Michaela for the Alice in Wonderland reference. Very apt.
To those who thought I’d been too generous with my awards from the PeaPod jury; it’s just my nature…
For the comments on potential conflict of interest; points well made. I don’t think the NTA is a big supporter of residential treatment. Addiction Today has had a word or two to say about that!
And to Andrea and Cliffy for your observation that the figures don’t quite add up to give the shining conclusions; many thanks.
Cliffy; is there a term for folk who collect acronyms?
Mutual aid is missing because that is where most Cocaine users are going for Support.I speak from personal experience There was one CA meetinhg in Liverpool 5 years ago there is now one every night of the week across the North west.
As somone who has always been a graetfull member of the CA fellowship can tell people hand on heart the meetngs are overflowing every night of the week.So where are all the Cocaine users gone having beeten there addiction I wonder.
Ollie M
I have a few comments about this report. I don’t think it has been ‘made up’. However it seems to be a crude analysis of NDTMS/TOPS figures. I’m not sure how mauch it tells us about the effectiveness of treatment, though as powdered cocaine use could include people who are not dependent and who would have stopped using anyway. Also the way these figures are compiled can mean that someone who leaves treatment can end up going down as a successful treamtent completion without them necessarily having stopped using, unless all of these people were contacted 6 months after leaving which is improbable.
I am sure the figures are correct, but as I said, manipulated / massaged for government reading, not mine and not yours.
All i know is that I left my local substance misuse service over 6 months ago and I am still waiting for my follow up call / letter etc.
I have however had lots of different government people ringing, writing etc, to tell me I should be working ! And they have this scheme and that scheme and a scheme within the scheme that was outsourced by the scheme running the scheme last year but under a different scheme title than before.
I have met people in the scheme who can’t answer my questions about where exactly do I stand within the scheme of things, but they do know another person who works in another scheme and they can help me, but guess what …. and we talk about the vicous circle of addiction ?
Good to read the additional comments. My own feeling is that the science and understanding of cocaine addiction behaves really could be so much better here.
Cliffy; it sounds like you are really entangled in a network of schemes. We really need integration (and aftercare!)
Oh, and forgot to say that I saw the mainstream press pick this story up and repeat it as a “success” for treatment, which however you look at it is not exactly a critical appraisal of the data.
PeaPod, Yes, there is an entanglement of schemes and departement and services (some of them even scheming and plotting) out there but compared to the entanglement that went on in my head for so long, I’m looking forward to understanding more, though I’m certain I could not disentangle it from PM (Prime Minister) to GP
