Select Committee on Home Affairs Memoranda


Submitted by the National Treatment Agency (NTA)


  The NTA was created on the 1st of April and I took up the post as Chief Executive on the 16th of July, with the Board members other than the Chair being appointed later that month. The appointment of a permanent Chair is imminent, in the interim we are grateful for the support and advice of Professor Joan Higgins who has been acting in a temporary capacity since April. The NTA's work since July has been focused on creating an appropriate structure, recruiting staff and establishing relationships within the treatment sector and Government. An extract from a summary of the initial Business Plan setting out the role envisaged for the NTA is attached as an Annex.


  Drugs policy and media comment is characterised by lack of clarity. The generic term `drugs' itself has probably outlined its usefulness. The media regularly combine prevalence figures based on widespread recreational cannabis use with images of heroin addiction, generating a distorted picture of reality. Policy needs to focus, as the Government's ten year drug strategy does, on harm and the drugs that cause the most harm—heroin and cocaine. However, policy also has to be situation specific and person specific. For example cannabis use itself may be largely non-problematic but located within a prison setting cannabis dealing becomes a channel for gangsterism and bullying threatening the maintenance of order in the establishment and the safety of inmates and their families. Sound policy will therefore be based on an analysis of the harms that flow from this substance used by these people in these ways in this context.


  Recreational drug use has become normalised amongst young people, that isn't to say that all young people use drugs, about half never will, but that recreational drug use is now regarded as part of a normal repertoire of behaviours. Most people use drugs because they enjoy them, and for the vast majority of users this experience remains pleasurable and under their control. Overwhelmingly this involves intermittent use of cannabis or dance drugs such as ecstasy. About half of those who experiment don't persist in the behaviour and others do so only occasionally, leaving the numbers of young people for who illegal non-dependent drug use is an integral part of their lifestyle significantly lower than most media coverage would suggest. For a minority of drug misusers their pattern of use comes to include opiates and cocaine and escalates beyond their control developing into dependency. Associated with this will be a range of other harms and risks impacting on the individual's health and welfare, the health of the wider public, and the safety of the communities within which they live.


  Improving the accessibility and effectiveness of treatment for this minority is at the core of the drug strategy. Despite much effort the evidence base to take forward a prevention strategy is at best patchy, similarly the success of attempts to restrict availability fluctuates but it is generally acknowledged that the best we can do is restrict the market, not eliminate it. Treatment on the other hand is beginning to build up a convincing evidence-base of what works best suggesting that properly administered well targeted interventions enable drug misusers to become drug free, productive members of the community. The vast majority of treatment available in the UK targets opiate misusers, about 50,000 opiate misusers access treatment each year compared to 4,000 cocaine misusers. This almost certainly reflects the availability of treatment rather than prevalence of problematic use. The identification of effective treatments for cocaine dependency and their widespread implementation is an urgent priority.

  Treatment for opiate dependency falls broadly into five categories:

  Detoxification: providing a safe process for someone to become free of physical dependency.

  Substitute prescribing: providing a controlled dose of a substitute opiate, usually methadone, to prevent craving and physical symptoms.

  Counselling: providing opportunities to understand behaviour and therefore control it.

  Residential rehabilitation: providing an opportunity to participate in an intensive programme of rehabilitation in a safe environment.

  Harm reduction: services aimed at preventing HIV, Hepatitis and other infections associated with injecting drug use.

  The growing evidence from the National Treatment Outcome Research Study and elsewhere is that each of these treatments has a role to play and can promote beneficial change in an individual's health, public health and levels of offending.


  UK drug policy is crime-driven and treatment-led. Crime driven in that the perceived link between dependent drug use and acquisitive crime underpins the Government's decision to dramatically increase expenditure on drug treatment. Treatment-led in that effective treatment is seen as the appropriate response not only to the individual and public health problems associated with drug misuse but also to drug-related crime. Drug misuse is usually characterised as `causing crime', dependant individuals being seen as out of control and driven to offend. The reality is more complex; most drug-misusing offenders were offenders before their drug misuse became problematic, what appears to happen from the research evidence therefore is not that honest men and women become criminals, but that part time amateur criminals become full time professionals. Drug misusers' pattern of offending is also more under control than the desperate drug-crazed media stereotype would suggest. Individuals retain control over their repertoire of offending continuing to engage in offences they regard as high reward and low risk and avoiding those that are dangerous or they find morally repugnant. Drug dependency can therefore be seen as amplifying the criminality of existing offenders rather than initiating criminal involvement. It follows that the success of treatment-based interventions with drug misusing offenders need to be judged by their effectiveness in reducing the number of offences committed not by the traditional Home Office methodology based on reconviction. Judged by these means Drug Treatment and Testing Orders and the Arrest Referral Schemes appear from the evidence to make a significant contribution to community safety.


  Treatment services are currently dominated by white men in their late twenties and early thirties. Women take up a quarter of treatment slots, it is unclear if this genuinely reflects lower prevalence rates or agencies continuing inability to offer services that are attractive to women. The preponderance of over twenty-fives across both male and females reflects the developing nature of drug dependency and young people's tendency to continue to derive pleasure from their drug use and support from the drug using lifestyle. Persuading younger drug users to access treatment early in their drug using careers before they slide into chaotic use and daily offending is key to the success of the drug strategy. Minority ethnic populations are also consistently under represented in treatment. There are probably a range of factors behind this. There is continuing concern that white-dominated white led services are not sufficiently responsive to the needs of the whole population. Although there is evidence that prevalence varies less from community to community than has often been supposed different patterns of use are apparent. Understanding these issues is made more difficult as many communities are wary of the potential for demonisation and scapegoating if they acknowledge their drug misuse problems.


  It follows from the above comments about the need to disentangle the range of different harms associated with different types of drug use that there is more than one answer to the question `is the drug strategy working?' Some elements of policy are working very well. I became involved in drug policy through my work in the Probation Service at the end of the 1980s in a era when drug treatment was focused on a small number of hospital based services, the Prison Service denied it had a drug problem. Local Authorities and Criminal Justice agencies accepted little or no responsibility for drug misuse, Ministers were sceptical about the effectives of treatment and there was a complete absence of strategy. Through a variety of policy initiatives implemented by successive Government's the current situation is much improved. Treatment has expanded dramatically, and is much more evenly distributed across the country. Through Drug Action Teams the key players in each area have been obliged to own their drug problems and develop local solutions. Drug misusing offenders now have access to treatment at every stage of the Criminal Justice system and the Prison Service is to be congratulated on its efforts to develop an integrated treatment system within prison. Much has been achieved, much remains to be achieved including the aspirations expressed in the NTA's Business Plan.

  Over the past fifteen years UK Drug Strategy has focused on harm; the drugs that cause the most harm and the means of use that cause most harm. If this rational pragmatic focus is retained it will provide a context within which the NTA can achieve its objectives.

October 2001

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