Renewing the Right to Rehab

In response to calls by Amy Winehouse’s family for greater access to drug and alcohol rehabilitation, the NHS in England has tried to claim that 94% of patients are waiting less than 3 weeks for rehab. This sounds as though 94% of 207,000 patients currently being treated by the NHS are waiting a maximum of three weeks, and then entering into rehab. Is this the case? An emphatic “no” seems to be the answer.

Only 2% of addicts entered into the NHS ‘system’ get anywhere near a rehab centre – and often only when at death’s door.

This is how the NHS both in Scotland and England are treating drug and alcohol addicts. Addicts who want to take the best route into recovery – which is residential rehabilitation – are being told by GPs and social workers up and down the country, “no chance.”

Levels of referrals to rehab in Scotland are “abysmal” to quote Castle Craig’s chairman Peter McCann.  In some areas it is still possible to be referred into rehab but in most areas this proven treatment is rarely offered.

As a result of this, addicts are being ‘parked’ on substitute drugs such as methadone with their lives left in limbo, or just left to deteriorate, or even subjected to the dangerous practice of multiple home detoxes. Meanwhile rehab centres are closing, or sitting half empty.

This is the picture at grass root level across the country. Yet addicts in England and Scotland may have a right to be in rehab – and may be able to force their case on legal grounds, especially in Scotland, where the case should be quite clear cut because both the auditor general and successive Scottish governments have confirmed the ‘right to rehab’.

We first heard it in September 2006 when the Scottish government created the ‘National Quality Standards for Substance Misuse Services’. In the introduction to these standards it was recognised that people who misuse alcohol or drugs often have a range of needs, and to meet these needs there is a wide range of services across Scotland which can provide treatment and support.

That range of services was recognised as covering both residential rehabilitation as well as less structured interventions, such as out patient treatment in the community. These new standards are based on the same set of principles as the ‘National Care Standards’, which are based on the concept of citizens’ rights. In short: services must be accessible and suitable for everyone who needs them; the opinion and experience of service users is important; and that you as a citizen have rights. The standards also talk about the client’s right to make informed choices and to be informed about the range of choices.

In 2008 a strategy document called “The Road to Recovery – a new approach to tackling Scotland’s drug problem” was published. It was produced by the Scottish Government and it states that “we would expect the following treatments to be available in each part of Scotland”. The document then lists detoxification, relapse prevention programmes as well as “residential rehabilitation – lasting from between three months and one year”.

In March 2009 the Auditor General for Scotland produced a study on drug and alcohol services in Scotland, and the following extract is particularly relevant: “it is important that a range of services is available to meet the needs of people who misuse drugs and alcohol as it is unlikely that a single service or type of treatment will suit everyone…Service users should be actively involved in these decisions.”  

Wanted: A New Policy for Addiction Treatment

It is time to renew the UK’s ineffective addiction treatment policy. Addiction is a disease and addicts have a right to rehab treatment — at least the option of this. Wherever possible a clamour needs to go up when local health commissioners are found to be dispensing with the option of rehabilitation, or when GPs tell their patients, “no chance – don’t even request it.”

Welcome support has been heard in the House of Commons from the Prime Minister who was recently told parliament, “drugs policy has been a failure over recent years,” and that we need to focus on “getting people clean.” Such frank language is uncommon enough from a politician, least of all on the subject of drug and alcohol addiction.  The pendulum may be swinging back. Let us hope that the coalition government will hold its nerve.  

Already the NHS agency in charge of drugs policy – the National Treatment Agency – has been told to close its doors by April 2013. No longer can the NTA’s chief executive – Paul Hayes – dismiss his critics as “a few academics, politicians and ideologues stoked up by the media.”

Yet although the NTA is on its way out its staff will move elsewhere in the field. The systems may change for the better but the practices that the NTA have encouraged and entrenched will not die easily. For example, a group of anti-rehab doctors called Substance Misuse Management in General Practice (SSMGP) have entitled their next conference ‘Recovery – How to make the system work for you’.

Groups like this believe that ‘recovery’ shouldn’t necessarily mean ‘abstinent recovery’, but instead everybody should define it for themselves. Their message to patients is that, “you could just replace one drug for another” regardless of the 2% success rates that substitute prescription treatments such as methadone and subutex produce – not to mention their side effects.

A Coalition of Rehab Centres

In opposition to such practices a coalition of rehab centres was set up under the name “Recovery Concordat”. Their sister organisation, “The Graduates”, is also a welcome new initiative in the field, as it promotes the voice of former drug and alcohol addicts who have been through rehab.

They will have their work cut out, trying to influence policy and practice for the better – and will have an important role to play as whistle blowers throughout the UK – advocating on behalf of the terribly sick and vulnerable people whose lives are blighted by addiction.

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