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I read with interest DDN‘s recent article about veterans in treatment (DDN, December, page 6). Firstly, I was wondering where you found the statistical data to back up the quote that ‘military veterans do not tend to do well in traditional treatment settings.’
I work for Veterans Aid, a UK charity that assists ex-service personnel in crisis. I’m responsible for coordinating all of the drug, alcohol and/or gambling treatment services for veterans who present to the charity. For the past six years we’ve supported around 40 veterans per year into treatment and, as far as I’m aware, this is the only service in the country tasked with specifically doing this. I don’t know of any other service that holds data relating to ex-servicemen and women in treatment (average age, verified service, length of service, time spent since leaving HM armed forces, substances used, treatment completion, etc).
Rather than sending all of our clients to one veteran-specific treatment centre, our approach is to match the most approppriate programme with clients who’re suitably motivated. This ethos appears to be absolutely the right way forward, as our statistics tell us that veterans actually do even better than civvies in treatment in terms of completion.
While I understand the writer Jacquie Johnston-Lynch wanting to promote her service, I think it’s crucial that we challenge the media perception of veterans as ‘damaged goods’, and the claim that they’re more likely to fail in treatment does the community no favours whatsoever. Indeed, such claims could dissuade people from coming forward to access help, or for care managers across the country to rethink their help offered.
Veterans Aid has seen a great number of people complete treatment and go on to rebuild their lives. It’s really important that veterans are given as much support and encouragement to access treatment as possible.
Phil Rogers, Veterans Aid, London
Given your recent conference report, Community chest (DDN, November, page 9) and the subsequent letter from Laurie Andrews (DDN, December, page 18), it may be appropriate to clarify here precisely the point I was making at the RiTC conference. My point was not whether we call addiction a ‘disease’ or a ‘disorder’ or an ‘anti-social behaviour’. I’m not terribly concerned about that. What does worry me is the promotion by some of the idea that this is a problem which is intrinsically incurable.
It isn’t. Hundreds upon hundreds of addicts every year get out from under their addiction. Some will do so by completing a programme in a therapeutic community. Some will attend mutual aid meetings. Some will simply stop. All will be hampered by a stigma that says, ‘I won’t employ this ex-alcoholic because sooner or later he will start drinking again and give me major problems.’ Or, ‘I don’t want this ex-heroin addict living next to me because she’ll start using again and be a danger to my children.’
How do I know this as an employer or a neighbour? Well, all the treatment professionals tell me that this is incurable. And this is the root of the stigma. Try applying as an ex-addict for a job as a policeman, or a nursery nurse, or a teacher. Can’t be done. The stigma is all-pervasive and debilitating. And it’s based on a belief that addicts never change and will always go back to their bad old ways.
Now it’s always convenient to blame the media for this stigma but in truth, significant numbers within the treatment and fellowship camps are promoting the same message. ‘This is incurable,’ they say. ‘The best we can do is to manage it with medication.’ Or, ‘This is incurable. The best we can do is to manage it with regular attendance at meetings.’ Both messages encourage a view of addiction that supports a belief within the general population that recovery is a chimera.
I’m not attacking any particular type of intervention here. Nor am I arguing that addiction isn’t a serious problem, often with serious physiological complications. But I am saying that it behoves us as treatment providers or supporters or recovery advocates, to celebrate recovery wherever we find it. To hunt it down where we can’t find it. And to abandon forever the defeatist mantra of the ‘incurable disease’ (or ‘disorder’ or ‘anti-social behaviour’).
Rowdy Yates, president, European Federation of Therapeutic Communities; senior research fellow, Scottish Addiction Studies, University of Stirling.
Nice little earner
Of course addiction isn’t a disease (Laurie Andrews, DDN letters, page 18), and is only generally speaking an illness, malady or sickness. Furthermore, it is because its true nature has not been widely identified and admitted that progress in curing addiction has been slow.
It is vital to recognise the absurdly obvious – that if an individual never uses a particular addictive substance, he or she will never become addicted to that substance. They cannot, because it is the addictive substance itself that generates the addiction. Not ‘blame the user’, ‘abuse’ or ‘misuse’, but straightforward ‘usage’ on two or more occasions.
Twenty-five to 30 per cent of users are more susceptible to intense addiction than others, but in all cases it is the actual fact of ‘usage’ which initiates and holds in place the addictive condition the drug generates.
In addition to illicit drugs such as cannabis, cocaine and heroin etc, ‘hypnotic and addictive reinforced demand substances’ (which include the benzodiazepines, the ‘Z’ drugs, chloral drugs and derivatives, plus clomethiazole, and some of the anxiolytics and barbiturates) can have the same physical and psychological effects. And because they are dangerous, all of these are ‘prescription-only’ drugs, and thus a matter of physician specification rather than patient selection.
Bearing in mind that for all the officially reported UK addicts on illicit substances, there are many more addicted to prescription drugs, paid for by the taxpayer. All of which makes prescription drug production and distribution a nice little earner.
Elisabeth Reichert, school head, East Sussex
I recently read in the national press that there has been a huge increase in the prescribing of gabapentin and pregabalin medication, both associated with addiction or its treatment.
It seems to me that this could be a hidden menace awaiting the attention of medical and addiction professionals. I addressed this within my own service but was met with some reluctance to pursue it, as it was viewed as non-addictive and the drugs were being prescribed by doctors who must be aware of the implications. I did some ringing around and it seems that these medications are regularly prescribed within the prison service and may be seen as less problematic when compared to other medical requests within HMP.
I fear that failure to address this relatively new addiction will mask individuals’ recovery from more obvious drug and alcohol problems. Services should work together to elicit change from those promoting this medication.
Ken Crawford, by email
Annemarie Ward is absolutely right to highlight the reducing support of local authorities for addiction rehabilitation and recovery (DDN, December, page 18). But in these ‘cash-strapped-days’, can we really blame them?
If psychiatric professor John Strang’s four-year time-wasting ‘piloting’ of payment by results (PbR) had produced a viable system for providing 12 months free of addictive substance usage and thus an effective basis for delivering the coalition’s 2010 drug strategy, local authorities would be rushing to implement that brilliant strategy. But Strang has merely proved that OST, methadone and buprenorphine can still only deliver a less than 3 per cent abstinence result, and that residential 12 steps still delivers only a 20 to 30 per cent abstinence result over a four-year period.
So, in respect of the requirements of the coalition’s drug strategy, local authorities are being asked to invest in recovery programmes that have a far greater likelihood of failure than success. Would you?
In addition to spreading the false idea that addiction is incurable, the infamous PbR ‘pilots’ have been used to hide the fact that there exist alternative approaches to addiction recovery other than continuing OST addiction to prescription medication.
In fact those alternatives (based on training in self-help resurrection of personal responsibility and resumption of control of one’s life) have not only been excluded from the ‘pilots’, but have also been regularly attacked by lobbying and black propaganda because certain vested interests know that training in self-help addiction recovery is the sure way to lasting abstinence for a clear majority of substance addicts.
Kenneth Eckersley, CEO Addiction Recovery Training Services (ARTS)