Residential Rehab 01 – setting the scene

Access to residential (or even the cheaper quasi residential) rehab is at an all time low.  The stark facts are that for a variety of reasons, very few people get into rehab anymore, and yet it remains one of the most effective treatments for recovery from drug and alcohol addiction out there

Now by asserting that rehab is effective, please don’t read into that that I am saying other forms of treatment are not effective, I am advocating a mixed economy of treatment options.  Please DO read into the above that at present we do not have a proper mix of treatment options.
In 2010 the coalition government published its new drug strategy, which now promotes Recovery rather than being predominantly about Harm Reduction.  The new strategy focuses on “supporting people to live a drug free life”.  
Already less than a year old and we see some unhelpful semantics attempting to hijack the new strategy by re-defining the simple term “drug free life” to mean, “free of drugs of dependency”, or “free of illicit drugs” etc – anything except what it says on the tin
We are in danger of rebranding harm reduction and calling it recovery – not good. There seems to be a disconnect between policy and practice as very few substance misuse partnerships seem to be “re-balancing” their treatment systems to adopt a recovery focus.
There are a number of reasons for this but one of the reasons seems to be a lack of leadership from the very top of government.  To change the focus of an almost £1billion pound treatment economy needs more than the publication of a new strategy.  It needs more than a few PbR Pilots and it needs more than the current, confusing and stalled / paused NHS Reforms
My experience is that there are substance misuse partnerships out there (whether as DAATs or as part of Community Safety Partnerships) that are in limbo.  Some are taking the initiative and moving forward as best they can, and others are standing still, effectively ‘holding the fort’ until news of next steps arrives or is clarified.
The last government were characterized by an over use of targets, micro-management and medaling and this government is characterized by not wanting to be like the last government.  Therefore, rather than showing real leadership and getting behind their published strategy they are adopting a, we’ll let the market decide what works approach, predominantly through PbR.  Unfortunately there are 8 PbR pilots, some of which are already floundering (but putting on a brave face) and 140+ other DAATs wondering, “ok, we’ve had the new strategy, what next”
There is no real practical guidance, drive, or workforce development to help coax HMS Drug Strategy along.  There is no target date to achieve re-balancing by; there is no requirement to commit any % of resources to recovery.  Many partnerships are even confused about what Recovery actually is.  The coalition are hiding behind the localism and big society agenda, which is itself unclear at this stage
You may not believe me but I take no pleasure in writing in such harsh terms about a field which I love, which I am totally committed to and which has not only helped me by offering me rehabilitation when I needed it but continues to sustain me in employment.  I advised the conservatives, directly and indirectly when they were in opposition.  I gave evidence, as a civil servant, to the centre for social justice policy review (the addictions report) and I praised the breakdown and breakthrough Britain reports as some of the best evidence I had ever read. 
I guess, given the coalition that the 2010 election produced all bets were off .  Maybe this is coalition government, paralysis.
It’s a long way from the potential of the Breakthrough Britain Report, (Volume 4 Addictions, Towards Recovery) where the opening statement was…..
If we concentrate on restoring people’s lives, most of the public health and crime issues will take care of themselves.
Looking at the current treatment landscape, in the light of these excellent reports and best intentions, shows us just how far we have regressed.  These reports were based on a solid evidence base and were the result of a lot of hard work and good consultation and being so far out of step and is an indicator that at present the tail must be wagging the dog i.e. civil servants, not ministers are again driving policy
In trying not to become like the previous government the current coalition will have the same regrets as Tony Blair said he had in that he never went far enough, fast enough.  Well, the current coalition are going fast but it seems they have left the roadmap (the reports referred to above) behind
I’d urge them, to re-read the addictions reports they authored in opposition, to pick them up and drive them forward.  Any strategy is dependant upon implementation.  Implementation doesn’t arrive on its own, it needs visible and dynamic leadership, something the wait and see approach is not delivering

Huseyin Djemil
ps – later in the week I will start proper the series on how to access residential rehab, what your (and your commissioners) rights and responsibilities are; using a variety of case studies and other examples to hopefully illustrate this

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